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MCN. the American Journal of Maternal...The purpose of this study was to examine the impact of the first year of COVID-19 pandemic on maternal and neonatal outcomes at a large military treatment facility in...
PURPOSE
The purpose of this study was to examine the impact of the first year of COVID-19 pandemic on maternal and neonatal outcomes at a large military treatment facility in Southern California.
STUDY DESIGN AND METHODS
A retrospective review of maternal and neonatal medical records was conducted between January 1, 2019, and December 31, 2020. Outcomes measured included stillbirth rate, neonatal intensive care unit admission, neonatal death, cesarean birth, and postpartum hemorrhage.
RESULTS
A total of 4,425 records were analyzed. Rates of stillbirth between the years did not vary. The neonatal death rate decreased more than 50% in 2020 (p = .149). Cesarean births rose by 2.7% in 2020 (p = .046). Rates of postpartum hemorrhage did not vary between years.
CLINICAL IMPLICATIONS
The impact of COVID-19 on maternal and neonatal outcomes at a military treatment facility in the first year of the COVID-19 pandemic provides guidance for optimizing perinatal health care. Vertical transmission of COVID-19 is low and routine testing of asymptomatic neonates of positive mothers may not be necessary. COVID-19 infections should not be an indication for cesarean birth and are not associated with neonatal deaths or NICU admission.
Topics: Humans; COVID-19; Female; Retrospective Studies; Pregnancy; Hospitals, Military; Infant, Newborn; Adult; California; Stillbirth; Cesarean Section; Pregnancy Outcome; SARS-CoV-2; Pandemics; Intensive Care Units, Neonatal; Postpartum Hemorrhage
PubMed: 38926920
DOI: 10.1097/NMC.0000000000001023 -
Nursing Open Jun 2024To establish a comprehensive understanding of the roles of midwives and the challenges they encounter in the prevention, diagnosis and management of postpartum... (Review)
Review
AIMS
To establish a comprehensive understanding of the roles of midwives and the challenges they encounter in the prevention, diagnosis and management of postpartum haemorrhage (PPH) following normal vaginal delivery.
DESIGN
We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews (PRISMA-ScR) recommendations.
METHODS
We considered studies related to the roles of midwives and the challenges they encounter in the prevention, diagnosis and management of PPH during vaginal delivery. We excluded guidelines, consensuses, abstracts of meetings and non-English language studies. Databases, including the Cochrane Library, PubMed, Web of Science, Ovid, Medline, Embase, JBI EBP and BIOSIS Previews, were searched on January 1, 2023, with no time limitations.
RESULTS
We included 28 publications. Midwives play important roles in the prevention, diagnosis and management of postpartum haemorrhage during vaginal delivery. In the prevention of PPH, midwives' roles include identifying and managing high-risk factors, managing labour and implementing skin-to-skin contact. In the diagnosis of PPH, midwives' roles include early recognition and blood loss estimation. In the management of PPH, midwives are involved in mobilizing other professional team members, emergency management, investigating causes, enhancing uterine contractions, the repair of perineal tears, arranging transfers and preparation for surgical intervention. However, midwives face substantial challenges, including insufficient knowledge and skills, poor teamwork skills, insufficient resources and the need to deal with their negative emotions. Midwives must improve their knowledge, skills and teamwork abilities. Health care system managers and the government should give full support to midwives. Future research should focus on developing clinical practice guidelines for midwives for preventing, diagnosing and managing postpartum haemorrhage.
Topics: Humans; Postpartum Hemorrhage; Female; Delivery, Obstetric; Pregnancy; Midwifery; Nurse Midwives
PubMed: 38923309
DOI: 10.1002/nop2.2221 -
Annali Dell'Istituto Superiore Di Sanita 2024Maternal antenatal depression affects 21-28% of expectants globally and negatively impacts both maternal and child health in the short and long term. (Comparative Study)
Comparative Study
BACKGROUND
Maternal antenatal depression affects 21-28% of expectants globally and negatively impacts both maternal and child health in the short and long term.
OBJECTIVE
To compare the psychometric properties and clinical utility of the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ-9) in pregnant individuals.
METHODS
In this cross-sectional study, 953 third-trimester pregnant Italian individuals completed both the EPDS and the PHQ-9.
RESULTS
Both scales demonstrated good internal consistency (EPDS ω=0.83, PHQ-9 ω=0.80) and a moderate correlation between their scores (r=0.59). Concordance at recommended cut-off points (≥14 for both) was moderate (k=0.55). Factor analyses indicated a bifactor solution for the EPDS (dimensions: "depression" and "anxiety") and for the PHQ-9 (dimensions: "depression", "pregnancy symptoms", "somatic"). Benchmarks for clinical change were also established.
CONCLUSIONS
The EPDS and PHQ-9 capture distinct aspects of perinatal depressive symptomatology. Clinically, these findings recommend using both scales in obstetric and gynaecologic settings to minimize false positives and negatives.
Topics: Humans; Female; Pregnancy; Adult; Cross-Sectional Studies; Pregnancy Complications; Psychometrics; Depression; Patient Health Questionnaire; Psychiatric Status Rating Scales; Depression, Postpartum; Italy; Young Adult; Surveys and Questionnaires; Reproducibility of Results; Mass Screening
PubMed: 38920259
DOI: 10.4415/ANN_24_01_08 -
Nature Jun 2024
Topics: Female; Humans; Pregnancy; Global Health; Postpartum Hemorrhage; World Health Organization
PubMed: 38918521
DOI: 10.1038/d41586-024-02089-y -
Journal of Obstetrics and Gynaecology :... Dec 2024The aim is to investigate the risk of short-term maternal morbidity caused by the selective clinical use of episiotomy (rate < 0.02), and to compare the risk of severe...
BACKGROUND
The aim is to investigate the risk of short-term maternal morbidity caused by the selective clinical use of episiotomy (rate < 0.02), and to compare the risk of severe perineal tears with the statewide risk.
METHODS
In this retrospective cohort study, we investigated the effect of selective episiotomy on the risk of severe perineal tears and blood loss in singleton term deliveries, using propensity scores with inverse probability weighting.
RESULTS
This study included 10992 women who delivered vaginally between 2008-2018. Episiotomy was performed in 171 patients (1.55%), three of whom (1.75%) experienced severe perineal tears compared to 156 (1.44%) in the control cohort. The adjusted odds ratio of severe perineal tears was 2.06 (95% confidence interval [CI]: 0.51, 8.19 with 0.3 value). Multivariate linear regression showed that episiotomy increased blood loss by 96.3 ml (95% CI: 6.4, 186.2 with 0.03 value). Episiotomy was performed in 23% (95% CI: 0.228, 0.23) of vaginal deliveries in the state of Hessen, with a risk of severe perineal tears of 0.0143 (95% CI: 0.0139, 0.0147) compared to 0.0145 (95% CI: 0.0123, 0.0168) in our entire cohort.
CONCLUSIONS
Selective use of episiotomy does not increase the risk of higher-grade perineal tears. However, it may be associated with maternal morbidity in terms of increased blood loss.
Topics: Humans; Female; Episiotomy; Retrospective Studies; Pregnancy; Adult; Perineum; Obstetric Labor Complications; Delivery, Obstetric; Risk Factors; Lacerations; Propensity Score; Postpartum Hemorrhage; Young Adult
PubMed: 38917046
DOI: 10.1080/01443615.2024.2369664 -
The Journal of Maternal-fetal &... Dec 2024The current study aims to evaluate the correlation between oxytocin augmentation and postpartum hemorrhage. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The current study aims to evaluate the correlation between oxytocin augmentation and postpartum hemorrhage.
METHOD
PubMed, Web of Science, and Scopus has been searched for studies assessing the correlation between oxytocin augmentation and postpartum hemorrhage up to January 24, 2024. The search strategy included relevant keywords related to PPH and oxytocin augmentation. The risk of bias assessment was conducted by two reviewers using the Newcastle-Ottawa Scale (NOS). To pool the effects sized of included studies odds ratios (OR) of interest outcome with their 95% confidence interval (CI) were used.
RESULTS
Eight studies were included in this meta-analysis. The pooled analysis of the included studies showed a statistically significant association between oxytocin augmentation and increased odds of PPH (pooled odds ratio [OR] = 1.27, 95% confidence interval [CI]: 1.05-1.53; I2 = 84.94%; = 0.01). Publication bias was assessed using funnel plots, which appeared relatively asymmetrical, indicating significant publication bias. Galbraith plot and trim and fill plot were used for publication bias. Sensitivity analyses were performed by leave one out method.
CONCLUSION
This meta-analysis suggests that using oxytocin for labor augmentation is linked to a significant increase in the risk of PPH. It highlights the need for careful monitoring and consideration when using oxytocin, especially in low and middle-income countries where guidelines and supervision are crucial.
Topics: Humans; Oxytocin; Female; Postpartum Hemorrhage; Pregnancy; Oxytocics
PubMed: 38910114
DOI: 10.1080/14767058.2024.2369210 -
BMJ Open Jun 2024To identify determinants of puerperal sepsis among postpartum women attending East Shoa Zone public hospitals, Central Ethiopia, 2023.
OBJECTIVE
To identify determinants of puerperal sepsis among postpartum women attending East Shoa Zone public hospitals, Central Ethiopia, 2023.
DESIGN AND SETTING
An institutional-based, unmatched case-control study was conducted from 19 June 2023 to 4 September 2023, in East Shoa Zone public hospitals.
PARTICIPANTS
495 postpartum women (100 cases and 395 controls) were selected using systematic sampling techniques. Data were collected through face-to-face interviews and from medical charts using a pretested, structured questionnaire. The AOR with its corresponding 95% CI was used to identify determinant variables. Findings were presented in texts and tables.
OUTCOME MEASURES
The medical charts of participants were reviewed to identify those who had developed puerperal sepsis.
RESULTS
Anaemia (AOR 6.05; 95% CI 2.57 to 14.26), undernourishment (AOR 4.43; 95% CI 1.96 to 10.01), gestational diabetes mellitus (AOR 3.26; 95% CI 1.22 to 8.74), postpartum haemorrhage (AOR 3.17; 95% CI 1.28 to 7.87), obstructed labour (AOR 2.76; 95% CI 1.17 to 6.52), multiparity (AOR 2.54; 95% CI 1.17 to 5.50), placenta previa (AOR 2.27; 95% CI 1.11 to 4.67) and vaginal examination ≥5 times (AOR 2.19; 95% CI 1.05 to 4.54) were the independent determinants of puerperal sepsis in this study.
CONCLUSION
This study found that gestational diabetes mellitus, anaemia, undernourishment, placenta previa, obstructed labour, postpartum haemorrhage and five or more per-vaginal examinations during labour were the determinants of puerperal sepsis. Therefore, it is recommended that obstetric care providers strictly adhere to guidelines on the number of vaginal exams that should be performed throughout labour and that they perform these exams using the appropriate infection-prevention techniques. In addition, they should provide comprehensive health education on nutrition during pregnancy and postnatal periods and the importance of iron supplements.
Topics: Humans; Female; Ethiopia; Case-Control Studies; Adult; Hospitals, Public; Sepsis; Pregnancy; Puerperal Infection; Risk Factors; Young Adult; Postpartum Period; Postpartum Hemorrhage; Anemia; Adolescent; Diabetes, Gestational
PubMed: 38908838
DOI: 10.1136/bmjopen-2023-083230 -
Journal of the American Heart... Jul 2024Although peripartum cardiomyopathy (PPCM) is a fatal disease affecting young patients and fetuses, little is known about its recent prognosis and risk factors. This...
BACKGROUND
Although peripartum cardiomyopathy (PPCM) is a fatal disease affecting young patients and fetuses, little is known about its recent prognosis and risk factors. This study investigated temporal trends in clinical characteristics and outcomes for PPCM in a nationwide multicenter registry.
METHODS AND RESULTS
The study population comprised 340 patients (mean age, 33 years) who were diagnosed with PPCM between January 2000 and September 2022 in 26 tertiary hospitals in South Korea. PPCM was defined as heart failure with left ventricular ejection fraction ≤45% and no previously known cardiac disease. The main study outcomes included time to the first occurrence of all-cause death, heart transplantation, and cardiovascular hospitalization. The diagnosis of PPCM cases increased notably during the study period (<0.001). However, clinical outcomes showed no significant improvement (all-cause death for 10 years: 0.9% [2000-2010] versus 2.3% [2011-2022], =0.450; all-cause death and heart transplantation for 10 years: 3.6% [2000-2010] versus 3.0% [2011-2022] =0.520; all-cause death, heart transplantation, and cardiovascular hospitalization for 10 years: 11.7% [2000-2010] versus 19.8% [2011-2022], =0.240). High body mass index (hazard ratio [HR], 1.106 [95% CI, 1.024-1.196]; =0.011), the presence of gestational diabetes (HR, 5.346 [95% CI, 1.778-16.07]; =0.002), and increased baseline left ventricular end-diastolic dimension (HR, 1.078 [95% CI, 1.002-1.159]; =0.044) were significant risk factors for poor prognosis.
CONCLUSIONS
While the incidence of PPCM has increased over the past 20 years, the prognosis has not improved significantly. Timely management and close follow-up are necessary for high-risk patients with PPCM with high body mass index, gestational diabetes, or large left ventricular end-diastolic dimension.
Topics: Humans; Female; Registries; Adult; Pregnancy; Republic of Korea; Cardiomyopathies; Peripartum Period; Pregnancy Complications, Cardiovascular; Risk Factors; Time Factors; Heart Transplantation; Prognosis; Ventricular Function, Left; Stroke Volume; Cause of Death; Hospitalization; Puerperal Disorders; Retrospective Studies; Heart Failure; Incidence
PubMed: 38904229
DOI: 10.1161/JAHA.123.034055 -
Radiographics : a Review Publication of... Jul 2024
Topics: Female; Humans; Pregnancy; Magnetic Resonance Imaging; Placenta Previa; Postpartum Hemorrhage; Ultrasonography, Prenatal
PubMed: 38900680
DOI: 10.1148/rg.240127 -
Ciencia & Saude Coletiva Jun 2024This study investigated access to health care among female prisoners in the state of Ceará, Brazil, and screened for common mental disorders. We conducted an analytical...
This study investigated access to health care among female prisoners in the state of Ceará, Brazil, and screened for common mental disorders. We conducted an analytical cross-sectional study in the only female prison in the state. Ninety detainees participated in the study. All participants were either pregnant or postpartum women or had one or more of the following health problems: hypertension, diabetes mellitus, tuberculosis, syphilis, hepatitis B, HIV/AIDS. The data were collected using a structured questionnaire. The findings reveal that access to health care was limited, violating the fundamental rights of the prisoners. Screening for diseases on admission to prison was limited, especially among non-pregnant women. Differences in health care were found between health conditions, with priority being given to pregnant and postpartum women. Most of the inmates (68.24%) were found to be at risk for common mental disorders (SRQ score > 7). A positive correlation was found between age and mental health problems (p = 0.0002). Despite legislation guaranteeing access to health care in prisons, the prison system is unprepared to meet the health needs of female prisoners with comorbidities and pregnant and puerperal women.
Topics: Humans; Brazil; Female; Prisoners; Cross-Sectional Studies; Health Services Accessibility; Adult; Mental Disorders; Pregnancy; Young Adult; Surveys and Questionnaires; Prisons; Middle Aged; Postpartum Period; Mass Screening; Adolescent; Pregnancy Complications; Age Factors
PubMed: 38896675
DOI: 10.1590/1413-81232024296.09172023