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Anesthesia and Analgesia Jul 2021Liver and biliary disease complicates pregnancy in varying degrees of severity to the mother and fetus, and anesthesiologists may be asked to assist in caring for these... (Review)
Review
Liver and biliary disease complicates pregnancy in varying degrees of severity to the mother and fetus, and anesthesiologists may be asked to assist in caring for these patients before, during, and after birth of the fetus. Therefore, it is important to be familiar with how different liver diseases impact the pregnancy state. In addition, knowing symptoms, signs, and laboratory markers in the context of a pregnant patient will lead to faster diagnosis and treatment of such patients. This review article discusses changes in physiology of parturients, patients with liver disease, and parturients with liver disease. Next, general treatment of parturients with acute and chronic liver dysfunction is presented. The article progresses to specific liver diseases with treatments as they relate to pregnancy. And finally, important aspects to consider when anesthetizing parturients with liver disease are discussed.
Topics: Anesthesia, Obstetrical; Bile Duct Diseases; Female; Humans; Liver Diseases; Pregnancy; Pregnancy Complications; Prenatal Care
PubMed: 33687174
DOI: 10.1213/ANE.0000000000005433 -
BMC Pregnancy and Childbirth Mar 2023In Canada, nearly nine pregnancies end in stillbirth daily. Most of these families will go on to have subsequent pregnancies, but research into how best to care for...
BACKGROUND
In Canada, nearly nine pregnancies end in stillbirth daily. Most of these families will go on to have subsequent pregnancies, but research into how best to care for these parents is lacking. This study explores the lived experiences and the most important aspects of person-centred care for Canadian families experiencing a pregnancy after a stillbirth.
METHODS
This qualitative descriptive design used secondary data collected from an online, international survey for bereaved parents who reported having experienced a pregnancy subsequent to a stillbirth. Only parents who identified as Canadian were included in this study. Three open text questions were asked about parents' experiences in their subsequent pregnancy. An inductive thematic analysis approach was used with open coding and a constant comparative method.
RESULTS
Families' responses fell into six main themes that identified what they would have preferred for high quality, excellent care. These included: (1) recognizing anxiety throughout the subsequent pregnancy, (2) wanting one's voices and concerns to be heard and taken seriously, (3) needing additional and specific clinical care for reassurance, (4) desiring kindness and empathy from caregivers and others, (5) seeking support from others who had also experienced pregnancy after stillbirth; and (6) addressing mixed emotions including guilt, continuity of care and carer, positive thoughts versus more realistic ones, and poignant feelings of self-blame.
CONCLUSIONS
Participants' responses identified that pregnancy after stillbirth is an extremely stressful time requiring patient-oriented care and support, both physically and psychologically. Families were able to articulate specific areas that would have improved the experience of their subsequent pregnancy. Parents asked for high-quality clinical and psychosocial prenatal care that was specific to them having experienced a prior stillbirth. They also requested connections to others experiencing this similar scenario. Further research is needed to delineate what supports and resources would be needed to ensure this care would be available to all families experiencing pregnancy after stillbirth across Canada and their caregivers.
Topics: Pregnancy; Female; Humans; Stillbirth; Canada; Parents; Prenatal Care; Emotions; Qualitative Research
PubMed: 36973661
DOI: 10.1186/s12884-023-05533-5 -
Revista Brasileira de Enfermagem Dec 2019to understand the satisfaction of pregnant women with diabetes who took insulin during pregnancy and prenatal care performed through outpatient and inpatient follow-up.
OBJECTIVE
to understand the satisfaction of pregnant women with diabetes who took insulin during pregnancy and prenatal care performed through outpatient and inpatient follow-up.
METHOD
a qualitative approach with analysis of 30 pregnant women who underwent prenatal care and participated in a clinical trial study carried out by the research group of the Perinatal Diabetes Research Center of the Hospital das Clínicas, of the Faculdade de Medicina de Botucatu. The data were collected through interviews and analyzed from content analysis.
RESULTS
from the category Satisfaction, the following subcategories emerged: facilities and difficulties faced in prenatal care performed through outpatient or inpatient follow-up, demonstrating that the pregnant women were satisfied with the prenatal care offered regardless of the type of follow-up.
CONCLUSION
there was satisfaction in both care, but in outpatient care some structural, technical and administrative difficulties were identified, requiring reassessment, in order to guarantee service agility.
Topics: Adolescent; Adult; Caregivers; Diabetes Mellitus; Female; Humans; Patient Satisfaction; Perception; Pregnancy; Prenatal Care; Qualitative Research
PubMed: 31851268
DOI: 10.1590/0034-7167-2018-0978 -
International Journal of Community... Jan 2022The health care behavior of Thai pregnant women should enhance. Pregnant women are facing anxiety from a variety of issues. Current evidence suggests that a text message... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The health care behavior of Thai pregnant women should enhance. Pregnant women are facing anxiety from a variety of issues. Current evidence suggests that a text message can support health care services and reduce anxiety. This study aimed to examine receiving text messages on health care behavior and state anxiety among Thai pregnant women.
METHODS
This study was a single-blind randomized controlled trial. A sample of 66 primigravidas was randomly assigned using a random number table, 33 per group. All participants received a recommendation for healthy behavior during pregnancy. The intervention group added 56 text messages between 13 and 40 gestational weeks, from two government hospitals in Thailand, from March 2018 to May 2019. The data collection tool comprised of demographic characteristics questionnaire, Pregnancy Outcomes Record, The Health Care Behavior during Pregnancy Questionnaire (HCBPQ) (Thai version) which developed by the researcher, and State-Trait Anxiety Inventory (STAI-S). Data were analyzed via SPSS version 18 using descriptive statistics, independent t-test, Fisher's exact test, and chi-square. The significance level was considered P<0.05.
RESULTS
The results showed that the intervention group adopted appropriate mean health care behaviors significantly only in physical activity domain (15.40±3.19) compared to the control group (13.58±1.89), (P=0.01) and revealed a significantly lower total mean score of state-anxiety than the control group (35.23±8.50 vs. 40.79±9.28, P=0.02). Other health care behavior domains between the two groups were not statistically significant (P>0.05).
CONCLUSION
Text messages could increase physical activity in Thai pregnant women and reduce the total score of anxiety during pregnancy. Thus, the text message strategy is appropriate to use during the antenatal period.
TRIAL REGISTRATION NUMBER
TCTR20180814005.
Topics: Anxiety; Delivery of Health Care; Female; Health Behavior; Humans; Pregnancy; Pregnancy Outcome; Pregnant Women; Prenatal Care; Single-Blind Method; Text Messaging; Thailand
PubMed: 35005038
DOI: 10.30476/IJCBNM.2021.89364.1604 -
Indian Pediatrics Oct 2023Fetal Neurology continues to grow as a distinct subspecialty informed by evolving precision diagnosis with advancements in prenatal neuroimaging, genetic and infectious...
Fetal Neurology continues to grow as a distinct subspecialty informed by evolving precision diagnosis with advancements in prenatal neuroimaging, genetic and infectious testing. While there are inherent limitations and challenges in prenatal diagnostic testing and prognostic counseling, the interdisciplinary approach allows comprehensive guidance for perinatal and postnatal management of neurological disorders detected early in development. The current practice of fetal neurology is heterogenous and variable across centers. In low- and middle-income countries (LMICs), fetal neurology practice is under the umbrella of neonatal and perinatal medicine. Since infrastructure and capacity for prenatal diagnostic and prognostic counseling may be variable, the practice approach may have to be modified regionally based on resources, education, and setting. There is a need for collaborative development of educational opportunities, training, guidelines, and research exploring short- and long-term outcome of prenatally identified neurological conditions. Interdisciplinary collaborations and global professional networks are crucial to advance this unique subspecialty.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Counseling; Neurology; Prenatal Care; Perinatal Care
PubMed: 37818807
DOI: No ID Found -
BMC Public Health Apr 2023Pregnant women with criminal legal involvement and opioid use disorder (CL-OUD) living in non-urban regions may be at risk for complex biomedical, psychological, and... (Comparative Study)
Comparative Study Observational Study
OBJECTIVE
Pregnant women with criminal legal involvement and opioid use disorder (CL-OUD) living in non-urban regions may be at risk for complex biomedical, psychological, and social barriers to prenatal care and healthy pregnancy. Yet, limited research has explored prenatal care utilization patterns among this subpopulation. This study describes the biopsychosocial factors of pregnant women with a history of criminal legal involvement and opioid use disorder (CL-OUD) associated with timely prenatal care initiation and adequate prenatal care utilization (APNCU).
METHODS
Analyses were conducted on a subsample of medical record data from an observational comparative effectiveness study of medication treatment models for pregnant women with diagnosed opioid use disorder (OUD) who received prenatal care in Northern New England between 2015 and 2022. The subsample included women aged ≥ 16 years with documented criminal legal involvement. Analyses included χ, Fisher exact tests, and multiple logistic regression to assess differences in timely prenatal care and APNCU associated with biopsychosocial factors selected by backwards stepwise regression.
RESULTS
Among 317 women with CL-OUD, 203 (64.0%) received timely prenatal care and 174 (54.9%) received adequate care. Timely prenatal care was associated with having two or three prior pregnancies (aOR 2.37, 95% CI 1.07-5.20), receiving buprenorphine at care initiation (aOR 1.85, 95% CI 1.01-3.41), having stable housing (aOR 2.49, 95% CI 1.41-4.41), and being mandated to court diversion (aOR 4.06, 95% CI 1.54-10.7) or community supervision (aOR 2.05, 95% CI 1.16-3.63). APNCU was associated with having a pregnancy-related medical condition (aOR 2.17, 95% CI 1.27-3.71), receiving MOUD throughout the entire prenatal care period (aOR 3.40, 95% CI 1.45-7.94), having a higher number of psychiatric diagnoses (aOR 1.35, 95% CI 1.07-1.70), attending a rurally-located prenatal care practice (aOR 2.14, 95% CI 1.22-3.76), having stable housing (aOR 1.94, 95% CI 1.06-3.54), and being mandated to court diversion (aOR 3.11, 95% CI 1.19-8.15).
CONCLUSION
While not causal, results suggest that timely and adequate prenatal care among women with CL-OUD may be supported by OUD treatment, comorbid indications for care, stable access to social resources, and maintained residence in the community (i.e., community-based alternatives to incarceration).
Topics: Female; Humans; Pregnancy; Analgesics, Opioid; Criminals; Opiate Substitution Treatment; Opioid-Related Disorders; Pregnant Women; Prenatal Care
PubMed: 37085842
DOI: 10.1186/s12889-023-15627-6 -
BMC Pregnancy and Childbirth Jan 2022Given that maternal mortality is a major global health concern, multiple measures including antenatal care visits have been promoted by the global community. However,...
INTRODUCTION
Given that maternal mortality is a major global health concern, multiple measures including antenatal care visits have been promoted by the global community. However, most pregnant women in Ghana and other sub-Saharan African countries do not attain the recommended timelines, in addition to a slower progress towards meeting the required minimum of eight visits stipulated by the World Health Organization. Therefore, this study explored the trends in antenatal care visits and the associated factors in Ghana from 2006 to 2018 using the Multiple Indicator Cluster Surveys.
METHODS
The study used women datasets (N = 7795) aged 15 to 49 years from three waves (2006, 2011, and 2017-2018) of the Ghana Multiple Indicator Cluster Surveys (GMICS). STATA version 14 was used for data analyses. Univariable analyses, bivariable analyses with chi-square test of independence, and multivariable analyses with robust multinomial logistic regression models were fitted.
RESULTS
The study found a consistent increase in the proportion of women having adequate and optimal antenatal attendance from 2006 to 2018 across the women's sociodemographic segments. For instance, the proportion of mothers achieving adequate antenatal care (4 to 7 antenatal care visits) increased from 49.3% in 2006 to 49.98% in 2011 to 58.61% in 2017-2018. In the multivariable model, women with upward attainment of formal education, health insurance coverage, increasing household wealth, and residing in the Upper East Region were consistently associated with a higher likelihood of adequate and/or optimal antenatal care attendance from 2006 to 2018.
CONCLUSION
Women who are less likely to achieve optimal antenatal care visits should be targeted by policies towards reducing maternal mortalities and other birth complications. Poverty-reduction policies, promoting maternal and girl-child education, improving general livelihood in rural settings, expanding health insurance coverage and infrastructural access, harnessing community-level structures, and innovative measures such as telehealth and telemedicine are required to increase antenatal care utilization.
Topics: Adolescent; Adult; Female; Ghana; Humans; Middle Aged; Patient Acceptance of Health Care; Pregnancy; Prenatal Care; Social Determinants of Health; Sociodemographic Factors; Young Adult
PubMed: 35062909
DOI: 10.1186/s12884-022-04404-9 -
Acta Obstetricia Et Gynecologica... Apr 2023Patient-reported measures (PRMs) are becoming popular as they might influence clinical decisions, help to deliver patient-centered care, and improve health care quality.... (Review)
Review
INTRODUCTION
Patient-reported measures (PRMs) are becoming popular as they might influence clinical decisions, help to deliver patient-centered care, and improve health care quality. However, the limited knowledge and consensus about the acceptability of implementing PRMs in maternity care hinder their widespread use in clinical practice, and evidence-based recommendations are lacking. This systematic review aims to synthesize available evidence on the acceptability of implementing PRMs in routine maternity care.
MATERIAL AND METHODS
Literature on the implementation of PRMs in maternity care was electronically searched in six databases (PsycARTICLES, PubMed, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and CINAHL), screened and selected for the topic of "acceptability". Theoretical Framework of Acceptability was used as the basic framework guiding data analysis and synthesis. Evidence was thematically analyzed and synthesized. Mixed Method Appraisal Tool and GRADE-CERQual approach were used to assess the quality of studies and evaluate the confidence in the review findings.
RESULTS
Overall, 4971 articles were screened. From 24 studies, we identified five themes regarding the acceptability of implementing PRMs in routine maternity care: (1) user's action and behavior, (2) stakeholders' attitudes, (3) perceived benefits, (4) perceived challenges and risks, and (5) stakeholders' preferences and suggestions on implementation. While pregnant and postpartum women, health professionals and other stakeholders involved in maternity care were generally positive about the implementation of PRMs in routine care and recognized the potential benefits (eg health improvement, women empowerment, care and services improvement and healthcare system advancement), they pointed out possible challenges and risks in answering PRMs questions, responding to answers, and setting up integrated information systems as well as suggested solutions in the aspects of PRMs data collection, follow-up care, and system-level management. The confidence in the review findings was moderate due to methodological limitations of included studies.
CONCLUSIONS
Available empirical evidence suggested that the use of PRMs in routine maternity care is acceptable among stakeholders involved in maternity care and the potential benefits of its integration in routine clinical practice to healthcare improvement has been recognized. However, possible challenges in data collection, follow-up care arrangement and system-level integration should be appropriately addressed.
Topics: Pregnancy; Humans; Female; Maternal Health Services; Prenatal Care; Delivery of Health Care; Patient Reported Outcome Measures
PubMed: 36647292
DOI: 10.1111/aogs.14506 -
American Journal of Perinatology Jun 2020As New York City became an international epicenter of the novel coronavirus disease 2019 (COVID-19) pandemic, telehealth was rapidly integrated into prenatal care at...
As New York City became an international epicenter of the novel coronavirus disease 2019 (COVID-19) pandemic, telehealth was rapidly integrated into prenatal care at Columbia University Irving Medical Center, an academic hospital system in Manhattan. Goals of implementation were to consolidate in-person prenatal screening, surveillance, and examinations into fewer in-person visits while maintaining patient access to ongoing antenatal care and subspecialty consultations via telehealth virtual visits. The rationale for this change was to minimize patient travel and thus risk for COVID-19 exposure. Because a large portion of obstetric patients had underlying medical or fetal conditions placing them at increased risk for adverse outcomes, prenatal care telehealth regimens were tailored for increased surveillance and/or counseling. Based on the incorporation of telehealth into prenatal care for high-risk patients, specific recommendations are made for the following conditions, clinical scenarios, and services: (1) hypertensive disorders of pregnancy including preeclampsia, gestational hypertension, and chronic hypertension; (2) pregestational and gestational diabetes mellitus; (3) maternal cardiovascular disease; (4) maternal neurologic conditions; (5) history of preterm birth and poor obstetrical history including prior stillbirth; (6) fetal conditions such as intrauterine growth restriction, congenital anomalies, and multiple gestations including monochorionic placentation; (7) genetic counseling; (8) mental health services; (9) obstetric anesthesia consultations; and (10) postpartum care. While telehealth virtual visits do not fully replace in-person encounters during prenatal care, they do offer a means of reducing potential patient and provider exposure to COVID-19 while providing consolidated in-person testing and services. KEY POINTS: · Telehealth for prenatal care is feasible.. · Telehealth may reduce coronavirus exposure during prenatal care.. · Telehealth should be tailored for high risk prenatal patients..
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Female; Genetic Counseling; Health Services Accessibility; Humans; Infection Control; New York City; Pandemics; Pneumonia, Viral; Pregnancy; Pregnancy Complications; Pregnancy, High-Risk; Prenatal Care; Prenatal Diagnosis; Remote Consultation; SARS-CoV-2; Telemedicine
PubMed: 32396948
DOI: 10.1055/s-0040-1712121 -
Revista de Saude Publica 2019To evaluate the factors associated with HIV and syphilis testing during pregnancy in Brazil.
OBJECTIVE
To evaluate the factors associated with HIV and syphilis testing during pregnancy in Brazil.
METHODS
This was an ecological study covering all Brazilian municipalities evaluated by the second cycle of the National Program for Access and Quality Improvement in Primary Care, 2013-2014. The dependent variables were based on prenatal care access: prenatal care appointments, and HIV and syphilis tests during prenatal care. The independent variables were compared with demographic and social characteristics. Bivariate analysis was performed assessing the three outcomes with the independent variables. Variables with significant associations in this bivariate analysis were fit in a Poisson multiple regression analysis with robust variance to obtain adjusted estimates.
RESULT
Poisson regression analysis showed a statistically significant association with the variables "less than eight years of study" [prevalence ratio (PR) = 1.31; 95%CI 1.19-1.45; p < 0.001] and "participants of the cash transfer program" (PR = 0.80; 95%CI 0.72-0.88; p < 0.001) for the outcome of "having less than six prenatal care appointments" and individual variables. A statistically significant association was found for "participants of the cash transfer program" (PR = 1.43; 95%CI 1.19-1.72; p < 0.001) regarding the outcome from the comparison between HIV testing absence during prenatal care and demographic and social characteristics. The absence of syphilis testing during prenatal care, and demographic and social characteristics presented a statistically significant association for the education level variable "less than eight years of study" (PR =1.75; 95%CI 1.56-1.96; p < 0.001) and "participants of the cash transfer program" (PR = 1.21, 95%CI 1.07-1.36; p < 0.001).
CONCLUSIONS
The individual factors were associated with prenatal care appointments and HIV and syphilis tests in Brazilian pregnant women. They show missed opportunities for diagnosing HIV and syphilis infection during prenatal care and indicate weaknesses in the quality of maternal health care services to eliminate mother-to-child transmission.
Topics: Age Distribution; Brazil; Cross-Sectional Studies; Female; HIV Infections; Humans; Infectious Disease Transmission, Vertical; Poisson Distribution; Pregnancy; Pregnancy Complications, Infectious; Prenatal Care; Prevalence; Primary Health Care; Quality of Health Care; Regression Analysis; Socioeconomic Factors; Syphilis, Congenital
PubMed: 31553379
DOI: 10.11606/s1518-8787.2019053001205