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Ciencia & Saude Coletiva 2019Puerperium is a period of significant morbimortality for women, and Primary Health Care (PHC) is important in developing actions to meet women's health needs. This study... (Review)
Review
Puerperium is a period of significant morbimortality for women, and Primary Health Care (PHC) is important in developing actions to meet women's health needs. This study aimed to systematize the knowledge produced on postpartum care programs actions within PHC at both national and international levels. This is an integrative review of the literature in databases LILACS (Latin American and Caribbean Health Sciences Literature), BDENF (Nursing Database), SciELO (Scientific Electronic Library Online) and PubMed (US National Library of Medicine). Search was performed in the period April-May 2017. Forty-three papers met the selection criteria. Results indicate that PHC has the physical structure to provide puerperae with care, but has a shortage of human and material resources; there is low postpartum consultation coverage and home visits; there is a good evaluation of the incentive for breastfeeding, but focused on the child; international screening of Postpartum Depression through the Edinburgh Postnatal Depression Scale and care shortage for this condition in Brazil. Postpartum care still focuses on care for the newborn and is mostly restricted to the immediate and late puerperium.
Topics: Brazil; Child Health Services; Female; House Calls; Humans; Infant, Newborn; Maternal Health Services; Postnatal Care; Postpartum Period; Primary Health Care
PubMed: 31664395
DOI: 10.1590/1413-812320182411.28112017 -
American Family Physician Oct 2019The postpartum period, defined as the 12 weeks after delivery, is an important time for a new mother and her family and can be considered a fourth trimester. Outpatient...
The postpartum period, defined as the 12 weeks after delivery, is an important time for a new mother and her family and can be considered a fourth trimester. Outpatient postpartum care should be initiated within three weeks after delivery in person or by phone, and may require multiple contacts with the patient to fully address needs and concerns. A full assessment is recommended within 12 weeks. Care should initially focus on acute needs and risks for morbidity and mortality and then transition to care for chronic conditions and health maintenance. Complications of pregnancy, such as hypertensive disorders and gestational diabetes mellitus, affect a woman's long-term health and require specific attention. Women diagnosed with gestational diabetes should receive a 75-g two-hour fasting oral glucose tolerance test between four and 12 weeks postpartum. Patients with hypertensive disorders of pregnancy should have a blood pressure check performed within seven days of delivery. All women should have a biopsychosocial assessment (e.g., depression, intimate partner violence) screening in the postpartum period, and preventive counseling should be offered to women at high risk. Additional patient concerns may include urinary incontinence, constipation, breastfeeding, sexuality, and contraception. Treating these issues during the postpartum period is important to the new mother's immediate and long-term health.
Topics: Breast Feeding; Curriculum; Education, Medical, Continuing; Female; Humans; Mothers; Postnatal Care; Postpartum Period; Practice Guidelines as Topic
PubMed: 31613576
DOI: No ID Found -
Journal of Advanced Nursing Oct 2019To determine if an electronic nursing intervention during the first 6 months postpartum was effective in improving mood and decreasing stress. (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
To determine if an electronic nursing intervention during the first 6 months postpartum was effective in improving mood and decreasing stress.
BACKGROUND
Unmet needs postpartum can have a negative impact on mood and parenting stress. Technology-assisted nursing care may provide needed support and reduce risk.
DESIGN
Randomized controlled trial (RCT) with three conditions.
METHODS
Enrollment began on 11 May 2017. Participants were randomized into one of three groups after completion of the baseline survey. Intervention I participants received standardized electronic messages four times/week for 6 months postpartum. Intervention II participants additionally received the option for nurse contact. Depression and parenting stress as measured using the Edinburgh Postnatal Depression Scale (EPDS) and Parenting Stress Index-Short form (PSI-SF) was obtained at 3 weeks, 3 months and 6 months postpartum and results compared with a usual care group. Patient satisfaction and nursing factors were measured.
RESULTS
Significantly higher satisfaction scores were found in both intervention groups as compared with control, but there were no significant changes in EPDS or PSI-SF.
CONCLUSION
The interventions were perceived as helpful and not burdensome. Better nurse-sensitive outcome measures are needed to adequately assess effectiveness.
IMPACT
Postpartum women report unmet needs for support and education. The interventions were perceived as being helpful but did not significantly reduce depressive symptoms or parenting stress. Nurses can use this research to inform development of innovative approaches to support postpartum women.
TRIAL REGISTRATION NUMBER
ClinicalTrials.gov NCT02843022.
Topics: Adult; Depression, Postpartum; Female; Humans; Inventions; Mothers; Postnatal Care; Pregnancy
PubMed: 31222789
DOI: 10.1111/jan.14114 -
Reproductive Health Jan 2021For most parents, getting pregnant means having a child. Generally, the couple outlines plans and has expectations regarding the baby. When these plans are interrupted...
The perinatal bereavement project: development and evaluation of supportive guidelines for families experiencing stillbirth and neonatal death in Southeast Brazil-a quasi-experimental before-and-after study.
BACKGROUND
For most parents, getting pregnant means having a child. Generally, the couple outlines plans and has expectations regarding the baby. When these plans are interrupted because of a perinatal loss, it turns out to be a traumatic experience for the family. Validating the grief of these losses has been a challenge to Brazilian society, which is evident considering the childbirth care offered to bereaved families in maternity wards. Positively assessed care that brings physical and emotional memories about the baby has a positive impact on the bereavement process that family undergoes. Therefore, this study aims to assess the effects supportive guidelines have on mental health. They were designed to assist grieving parents and their families while undergoing perinatal loss in public maternities in Ribeirão Preto, São Paulo state, Brazil.
METHOD
A mixed-methods (qualitative/quantitative), quasi-experimental (before/after) study. The intervention is the implementation of bereavement supportive guidelines for women who experienced a stillbirth or a neonatal death. A total of forty women will be included. Twenty participants will be assessed before and twenty will be assessed after the implementation of the guidelines. A semi-structured questionnaire and three scales will be used to assess the effects of the guidelines. Health care professionals and managers of all childbirth facilities will be invited to participate in focus group. Data will be analyzed using statistical tests, as well as thematic analysis approach.
DISCUSSION
The Perinatal Bereavement guidelines are a local adaptation of the Canadian and British corresponding guidelines. These guidelines have been developed based on the families' needs of baby memories during the bereavement process and include the following aspects: (1) Organization of care into periods, considering their respective needs along the process; (2) Creation of the Bereavement Professional figure in maternity wards; (3) Adequacy of the institutional environment; (4) Communication of the guidance; (5) Creation of baby memories. We expect that the current project generates additional evidence for improving the mental health of women and families that experience a perinatal loss. Trial registration RBR-3cpthr For many couples, getting pregnant does not only mean carrying a baby, but also having a child. Most of the time, the couple has already made many plans and has expectations towards the child. When these plans are interrupted because of a perinatal loss, it turns out to be a traumatic experience for the family. In Brazilian culture, validating this traumatic grief is very difficult, especially when it happens too soon. The barriers can be noticed not only by the way society deals with the parents' grief, but also when we see the care the grieving families receive from the health care establishment. Creating physical and emotional memories might bring the parents satisfaction regarding the care they receive when a baby dies. These memories can be built when there is good communication throughout the care received; shared decisions; the chance to see and hold the baby, as well as collect memories; privacy and continuous care during the whole process, including when there is a new pregnancy, childbirth and postnatal period. With this in mind, among the most important factors are the training of health staff and other professionals, the preparation of the maternity ward to support bereaved families and the continuous support to the professionals involved in the bereavement. This article proposes guidelines to support the families who are experiencing stillbirth and neonatal death. It may be followed by childbirth professionals (nurses, midwives, obstetricians and employees of a maternity ward), managers, researchers, policymakers or those interested in developing specific protocols for their maternity wards.
Topics: Bereavement; Brazil; Child; Female; Grief; Humans; Infant, Newborn; Parents; Perinatal Care; Perinatal Death; Postnatal Care; Practice Guidelines as Topic; Pregnancy; Professional-Patient Relations; Social Support; Stillbirth
PubMed: 33407643
DOI: 10.1186/s12978-020-01040-4 -
Best Practice & Research. Clinical... Jul 2020Thyroid hormone (TH) is indispensable for normal embryonic and fetal development. Throughout gestation TH is provided by the mother via the placenta, later in pregnancy... (Review)
Review
Thyroid hormone (TH) is indispensable for normal embryonic and fetal development. Throughout gestation TH is provided by the mother via the placenta, later in pregnancy the fetal thyroid gland makes an increasing contribution. Maternal thyroid dysfunction, resulting in lower or higher than normal (maternal) TH levels and transfer to the embryo/fetus, can disturb normal early development. (Maternal) thyroid dysfunction is mostly caused by autoimmune hypo- or hyperthyroidism, i.e. Hashimoto and Graves disease. Autoimmune hyperthyroidism is caused by stimulating TSH receptor antibodies (TSHR Ab), patients with autoimmune hypothyroidism may have blocking TSHR Ab. Maternal TSHR Ab cross the placenta from mid gestation and may cause fetal and transient neonatal hyper- or hypothyroidism. Anti-thyroid drugs taken for autoimmune hyperthyroidism cross the placenta throughout gestation, and may cause fetal and transient neonatal hypothyroidism. This review focusses on the consequences of maternal hypo- and hyperthyroidism for fetus and neonate, and provides a practical approach to clinical management of neonates born to mothers with thyroid dysfunction.
Topics: Female; Humans; Infant Care; Infant, Newborn; Infant, Newborn, Diseases; Postnatal Care; Pregnancy; Pregnancy Complications; Prenatal Care; Prenatal Exposure Delayed Effects; Thyroid Diseases
PubMed: 32651060
DOI: 10.1016/j.beem.2020.101437 -
Medicine Nov 2019Despite breastfeeding is significant benefits for maternal and infant, the discontinuation of breastfeeding is high. Some of studies showed that the effect of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Despite breastfeeding is significant benefits for maternal and infant, the discontinuation of breastfeeding is high. Some of studies showed that the effect of intervention in improving the rate of exclusively breastfeeding is unclear. The aim of this study is to investigate the effectiveness of individualized intervention compared with routine care in improving rates of exclusive breast feeding.
METHODS
Women were divided into two groups. We provided individual antenatal breastfeeding education and postnatal lactation support to intervention group. Control group received routine care. Significance was set at P < .05.
RESULTS
We recruited 352 women of whom 176 were randomized to intervention group, 176 to control group. In total, 293 (83.2%) completed 4 months of follow-up. At discharge from hospital, 43.2% of women randomized to intervention group were exclusively breastfeeding compared with 30.0% of women in control group (relative risk 1.78; 95% confidence interval [CI] 1.12-2.82). At 4 months, 70.9% of women in the intervention group were exclusively breastfeeding compared with 46.2% of the women in the control group (2.84; 1.76-4.60). At discharge from hospital, 95.1% of women in the intervention group were breastfeeding on demand compared with 68.1% of women receiving routine care (9.00; 4.09-19.74). At 4 months, 94.6% of women in intervention group were breastfeeding on demand compared with 75.9% of women in the control group (5.57; 2.48-12.49).
CONCLUSION
The regular ongoing individualized antenatal education and postnatal support can effective increase the rates of exclusive breastfeeding from delivery to postpartum 4 months and change the breastfeeding behavior.
Topics: Adult; Breast Feeding; Female; Health Promotion; Humans; Postnatal Care; Prenatal Education; Single-Blind Method
PubMed: 31764775
DOI: 10.1097/MD.0000000000017822 -
JAMA Nov 2023Pregnancy hypertension results in adverse cardiac remodeling and higher incidence of hypertension and cardiovascular diseases in later life. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Pregnancy hypertension results in adverse cardiac remodeling and higher incidence of hypertension and cardiovascular diseases in later life.
OBJECTIVE
To evaluate whether an intervention designed to achieve better blood pressure control in the postnatal period is associated with lower blood pressure than usual outpatient care during the first 9 months postpartum.
DESIGN, SETTING, AND PARTICIPANTS
Randomized, open-label, blinded, end point trial set in a single hospital in the UK. Eligible participants were aged 18 years or older, following pregnancy complicated by preeclampsia or gestational hypertension, requiring antihypertensive medication postnatally when discharged. The first enrollment occurred on February 21, 2020, and the last follow-up, November 2, 2021. The follow-up period was approximately 9 months.
INTERVENTIONS
Participants were randomly assigned 1:1 to self-monitoring along with physician-optimized antihypertensive titration or usual postnatal care.
MAIN OUTCOMES AND MEASURES
The primary outcome was 24-hour mean diastolic blood pressure at 9 months postpartum, adjusted for baseline postnatal blood pressure.
RESULTS
Two hundred twenty participants were randomly assigned to either the intervention group (n = 112) or the control group (n = 108). The mean (SD) age of participants was 32.6 (5.0) years, 40% had gestational hypertension, and 60% had preeclampsia. Two hundred participants (91%) were included in the primary analysis. The 24-hour mean (SD) diastolic blood pressure, measured at 249 (16) days postpartum, was 5.8 mm Hg lower in the intervention group (71.2 [5.6] mm Hg) than in the control group (76.6 [5.7] mm Hg). The between-group difference was -5.80 mm Hg (95% CI, -7.40 to -4.20; P < .001). Similarly, the 24-hour mean (SD) systolic blood pressure was 6.5 mm Hg lower in the intervention group (114.0 [7.7] mm Hg) than in the control group (120.3 [9.1] mm Hg). The between-group difference was -6.51 mm Hg (95% CI, -8.80 to -4.22; P < .001).
CONCLUSIONS AND RELEVANCE
In this single-center trial, self-monitoring and physician-guided titration of antihypertensive medications was associated with lower blood pressure during the first 9 months postpartum than usual postnatal outpatient care in the UK.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT04273854.
Topics: Female; Humans; Antihypertensive Agents; Blood Pressure; Cardiovascular Diseases; Hypertension; Hypertension, Pregnancy-Induced; Pre-Eclampsia; Self-Management; Adult; Postnatal Care
PubMed: 37950919
DOI: 10.1001/jama.2023.21523 -
Global Health, Science and Practice Aug 2019Universal access to voluntary postabortion family planning is a critical and compelling component of postabortion care. Such access should be joined with postpartum...
Universal access to voluntary postabortion family planning is a critical and compelling component of postabortion care. Such access should be joined with postpartum family planning services in national programs, health information systems, and training programs. The same providers and facilities deliver both services, and integration could yield cost efficiencies and increased coverage for women receiving postabortion care.
Topics: Abortion, Induced; Aftercare; Contraception; Contraceptive Agents; Family Planning Services; Female; Health Services Accessibility; Humans; Long-Acting Reversible Contraception; Postnatal Care; Pregnancy; Program Evaluation
PubMed: 31455617
DOI: 10.9745/GHSP-D-19-00128 -
Computational and Mathematical Methods... 2022The effect of skin-to-skin contact (SSC) on postpartum depression and physical rehabilitation of cesarean section women was explored. 280 parturients undergoing cesarean... (Randomized Controlled Trial)
Randomized Controlled Trial
The effect of skin-to-skin contact (SSC) on postpartum depression and physical rehabilitation of cesarean section women was explored. 280 parturients undergoing cesarean section were selected and were rolled into two groups randomly. The parturients in the control group (Con group, 140 cases) received routine care, and those in the experimental group (Exp group, 140 cases) received SSC on the basis of routine care. The postpartum depression and physical recovery of parturients in two groups were compared. It was found that, in the Exp group, the number of pregnant women with no or with very mild depression was much more 85% vs. 55%), the number of women with adequate lactation was more (53 cases vs. 27 cases), the first lactation time (FLT) was dramatically shorter (41.25 ± 4.81 h vs. 58.43 ± 5.43 h), the breastfeeding success rate (BFSR) and breastfeeding rate (BFR) were obvious higher, the days for uterine involution was much shorter (6.96 ± 1.13 days vs. 9.47 ± 1.75 days), the descent of uterine fundus 24 hours after delivery (24 h-DUF) was obviously larger (3.17 ± 0.26 mm vs. 1.56 ± 0.43 mm), the duration of lochia (DOL) was remarkably shorter (33.21 ± 5.32 days vs. 25.32 ± 3.54 days), and the (VAS) score was lower (4.88 ± 0.32 points vs. 3.41 ± 0.53 points), showing statistical differences for all above indicators ( < 0.05). It suggested that SSC could effectively relieve the postpartum depression of uterine parturients, promote the lactation, increase the BFR, facilitate uterine involution, and alleviate chronic uterine inflammation and postpartum pain, showing high clinical application and promotion value.
Topics: Adult; Breast Feeding; Cesarean Section; China; Computational Biology; Depression, Postpartum; Female; Humans; Infant Care; Infant, Newborn; Male; Mother-Child Relations; Obstetrics and Gynecology Department, Hospital; Postnatal Care; Postoperative Complications; Pregnancy; Young Adult
PubMed: 35103074
DOI: 10.1155/2022/9927805 -
Australian Journal of General Practice Mar 2022The postnatal period is a rapidly changing and challenging time for new parents. General practitioners are well placed to provide support, advice, clinical care and...
BACKGROUND
The postnatal period is a rapidly changing and challenging time for new parents. General practitioners are well placed to provide support, advice, clinical care and intervention for common psychosocial and physical concerns in this critical period.
OBJECTIVE
The aim of this article is to outline a consistent approach to the content and structure of the postnatal visit in the general practice setting, along with key management strategies for common postnatal conditions and comorbidities.
DISCUSSION
Common physical and mental health postpartum concerns, follow-up management of antenatal comorbidities and contraceptive choices are outlined, along with management of early parenting issues.
Topics: Family Practice; Female; General Practice; General Practitioners; Humans; Parenting; Postnatal Care; Pregnancy
PubMed: 35224571
DOI: 10.31128/AJGP-02-21-5835