Clinical guidance VVOG: Antenatal care for twin pregnancies.

To assess the frequency of additional care, and parents' perceptions of quality, respectful care, in pregnancies subsequent to stillbirth. Multi-language web-based survey. International. A total of 2716 parents, from 40 high- and middle-income countries. Data were obtained from a broader survey of parents' experiences following stillbirth. Data were analysed using descriptive statistics and stratified by geographic region. Subgroup analyses explored variation in additional care by gestational age at index stillbirth. Frequency of additional care, and perceptions of quality, respectful care. The majority (66%) of parents conceived their subsequent pregnancy within 1 year of stillbirth. Additional antenatal care visits and ultrasound scans were provided for 67% and 70% of all parents, respectively, although there was wide variation across geographic regions. Care addressing psychosocial needs was less frequently provided, such as additional visits to a bereavement counsellor (10%) and access to named care provider's phone number (27%). Compared with parents whose stillbirth occurred at ≤ 29 weeks of gestation, parents whose stillbirth occurred at ≥ 30 weeks of gestation were more likely to receive various forms of additional care, particularly the option for early delivery after 37 weeks. Around half (47-63%) of all parents felt that elements of quality, respectful care were consistently applied, such as spending enough time with parents and involving parents in decision-making. Greater attention is required to providing thoughtful, empathic and collaborative care in all pregnancies following stillbirth. Specific education and training for health professionals is needed. More support for providing quality care in pregnancies after stillbirth is needed. Study rationale and design More than two million babies are stillborn every year. Most parents will conceive again soon after having a stillborn baby. These parents are more likely to have another stillborn baby in the next pregnancy than parents who have not had a stillborn baby before. The next pregnancy after stillbirth is often an extremely anxious time for parents, as they worry about whether their baby will survive. In this study we asked 2716 parents from 40 countries about the care they received during their first pregnancy after stillbirth. Parents were recruited mainly through the International Stillbirth Alliance and completed on online survey that was available in six languages. Findings Parents often had extra antenatal visits and extra ultrasound scans in the next pregnancy, but they rarely had extra emotional support. Also, many parents felt their care providers did not always listen to them and spend enough time with them, involve them in decisions, and take their concerns seriously. Parents were more likely to receive various forms of extra care in the next pregnancy if their baby had died later in pregnancy compared to earlier in pregnancy. Limitations In this study we only have information from parents who were able and willing to complete an online survey. Most of the parents were involved in charity and support groups and most parents lived in developed countries. We do not know how well the findings relate to other parents. Finally, our study does not include parents who may have tried for another pregnancy but were not able to conceive. Potential impact This study can help to improve care through the development of best practice guidelines for pregnancies following stillbirth. The results suggest that parents need better emotional support in these pregnancies, and more opportunities to participate actively in decisions about care. Extra support should be available no matter how far along in pregnancy the previous stillborn baby died.

Background: Men’s influences are gradually being recognised in pregnancy and delivery care. The study aims to determine the knowledge and attitude of male commercial motorcyclists on pregnancy care and delivery of women.
 Materials and Methods: This cross-sectional study was conducted among married male commercial motorcyclists, operating in Ibadan North Local Government Area selected using a cluster sampling technique. Data was collected using a pre-tested, structured interviewer-administered questionnaire, and analysed using SPSS version 16. Each section was evaluated using rating of a three-point Likert scale with each item scored based on responses ranging from disagree to agree. Results were presented in tables and charts.
 Results: Four hundred and fifty three male commercial motorcyclists were interviewed. The mean age was 34.2±7.3years, 301 (66.4%) had secondary education, while 390 (86.1%) were in a monogamous marriage. Thirty 30(6.6%) respondents did not know when their wives registered for ANC while majority, 444(98.1%) did not know the duration of their wives’ labour. Few respondents 46 (10.2%) recognized vaginal bleeding as a common danger signs in pregnancy while 277 (61.1%) agree that women should have at least four ANC visits before delivery. Many of the respondents 315 (69.6%) had good knowledge, and 304 (67.1%) had positive attitude towards antenatal and delivery care.
 Conclusion: Educational efforts on maternal health care should also focus on the men to improve their knowledge, attitude and involvement in antenatal and pregnancy.

Special considerations regarding antenatal care and pregnancy complications in dichorionic twin pregnancies

Maternal mortality in developing countries remains a major public health concern and lack of men's support for their spouse during pregnancy contributes to this adverse outcome. This study examined the level and determinants of men's involvement in pregnancy care in Modakeke, Southwest Nigeria. A community-based cross-sectional, mixed-methods study involving quantitative and qualitative data. A multistage sampling strategy was used to select the study participants. The study involved 414 male respondents interviewed using a structured interviewer-administered questionnaire. The interview was complemented with one focus group discussion facilitated using an unstructured interview guide. Quantitative data were analyzed using descriptive and inferential analytical techniques while qualitative data were explored using thematic content analysis. Findings revealed a 55% level of involvement in pregnancy care among the participants. However, involvement rates were higher among those who were younger, married, from monogamous family, with secondary or tertiary education, low-income earners, and holding positive perception about nontraditional gender roles. Multivariate logistic regression estimates indicated significantly lower odds of involvement among unmarried men than the married but increased odds among those who had secondary or higher education relative to the uneducated, and among those whose partners received antenatal care from multiple providers compared to from health facilities only. Furthermore, significantly reduced odds of involvement were associated with holding nonpositive perceptions towards accompanying spouse to antenatal care clinic and being involved in general pregnancy care as opposed to holding positive perception. Perceived challenges undermining male involvement as highlighted during focus group discussion include time constraints due to job demands, prohibitive sociocultural norms, rebuke and unconducive health facility environment. The level of involvement in pregnancy care is suboptimal among the study participants with considerable sociodemographic, socioeconomic and sociocultural dimensions. Enhancing men's involvement in pregnancy care requires community-based awareness-raising interventions that emphasize crosscutting benefits of male partner's participation in pregnancy-related care and address known sociocultural barriers impeding active involvement.

Pregnancy in adolescents causes psychological impacts such as shame, fear, depression and even the desire to commit suicide. This condition has an impact on the treatment of pregnancy. The aim of this review literature is to determine unwanted pregnancy versus pregnancy in adolescents. The used method is narrative review using a systematic review of Preferred Reporting Items for Sytematic Review (PRISMA). The data base that used in this literature is Google Scholar and Pubmed. Literature search based on qualitative study design criteria, national and international articles, year published the last 10 years (2010-2020) in Indonesian and English by using Indonesian keywords namely unwanted pregnancy, adolescents, school children and pregnancy care. While English keywords are Adolescent Pregnancy OR Adolescence pregnancies OR Adolescenct pregnancy OR Adolescenct pregnancies OR Teen pregnancy OR Teen pregnancies OR Unwanted Pregnancy OR Unwanted Pregnancies OR Unintended Pregnant OR Unintented Pregnancy OR Unplanned Pregnancy OR Pregnancy Care OR Pregnancies Care OR Antenatal Care. Research articles rated critical appraisal cheklis from JBI. From the 6 articles reviewed, it was found that there were 10 impacts of unwanted pregnancy (KTD) on pregnancy care in adolescemts, including: adolescents are not doing Antenatal Care (ANC) during pregnancy, teenagers tend to make efforts to abort the womb, do not consume healthy foods with balance nutrition, do not consume blood-increasing tablets, do not do physical activity and exercise, sleep rest is lacking, adolescents tend to ignore personal hygiene, teenagers do not stimulate in the fetus, defensive and depression. Further research can be carried out regarding the needs of adolescents with unwanted physical and psychological support and care during pregnancy.

Pregnancy care consists of prenatal (before birth) and postpartum (after birth) healthcare for expectant mothers. Antenatal / prenatal care can be defined as the care provided by trained health-care professionals to pregnant women and adolescent girls in order to make sure the best health conditions for both mother and baby throughout the pregnancy. The components of ANC include: risk identification, prevention and management of pregnancy-related or concurrent diseases, and health education and health promotion. 1 According to Indian government guidelines, every pregnant should make use of 3 or more antenatal care visits along with 90 or more IFA tablets and 2 or more TT injections. According to joint WHO and MOD meeting report, birth defects account for 7% of all neonatal mortality and 3.3 million under five deaths. The prevalence of birth defects in India is 6-7% which translates to around 1.7 million birth defects annually. Objectives: The main objective of the study was to find out the knowledge level of the subjects on pregnancy care, to educate the community subjects on pregnancy care and to Evaluate Pregnancy Information leaflet on pregnancy care Methodology: A questionnaire-based interview was executed on 100 study subjects in Mangalore region. Study duration was 6 months. Ethical approval was obtained from Ethics Committee of Srinivas Institute of Medical Science and Research Center. The study population included in the study were adults above 18 years of age, who can understand English/Malayalam and belonging to the family with one or more pregnancy either in past, present or to be in future. Data was analyzed with the help of excel 17 and SPSS 20. Result and Discussion: In our study, survey was carried out on 100 subjects of Mangalore region All the study subjects were female. Out of 100 subjects 58 participants were in between 31 years to 50 Years of age while 19 participants were in 18-30 Years age group. The subjects in the present study do not have adequate knowledge regarding antenatal care, folic acid supplementation, TT injection and dietary change, irrespective to their educational level. The study found that 75% of the subjects were not aware of the antenatal care and about 100% were unknown regarding the necessity of antenatal check- up. ANC visit should be an essential part of the antenatal care but our study found that about 13% of the study subjects were not going for check- up. On pharmacist intervention and proper counselling, in our follow up interview we found that unawareness has reduced to 17%, while 84% realized the need for check-up. Conclusion: In our study we found that the respondents do not have adequate knowledge regarding antenatal care, folic acid supplementation, TT injection and dietary change. The age, literacy of the mother significantly influences antenatal care and ANC service utilization. To improve effective utilization of ANC services we need to raise awareness through counselling, improve the quality of ANC service, along with effective monitoring and evaluation. Pharmacist plays a major role in increasing awareness among mothers in pregnancy and further emphasizing the importance of ANC. Keywords: Antenatal care, Knowledge, Awareness.

BackgroundAntenatal care (ANC) is a key strategy to improve maternal and infant health. However, survey data from sub-Saharan Africa indicate that women often only initiate ANC after the first trimester and do not achieve the recommended number of ANC visits. Drawing on qualitative data, this article comparatively explores the factors that influence ANC attendance across four sub-Saharan African sites in three countries (Ghana, Kenya and Malawi) with varying levels of ANC attendance.MethodsData were collected as part of a programme of qualitative research investigating the social and cultural context of malaria in pregnancy. A range of methods was employed interviews, focus groups with diverse respondents and observations in local communities and health facilities.ResultsAcross the sites, women attended ANC at least once. However, their descriptions of ANC were often vague. General ideas about pregnancy care – checking the foetus’ position or monitoring its progress – motivated women to attend ANC; as did, especially in Kenya, obtaining the ANC card to avoid reprimands from health workers. Women’s timing of ANC initiation was influenced by reproductive concerns and pregnancy uncertainties, particularly during the first trimester, and how ANC services responded to this uncertainty; age, parity and the associated implications for pregnancy disclosure; interactions with healthcare workers, particularly messages about timing of ANC; and the cost of ANC, including charges levied for ANC procedures – in spite of policies of free ANC – combined with ideas about the compulsory nature of follow-up appointments.ConclusionIn these socially and culturally diverse sites, the findings suggest that ‘supply’ side factors have an important influence on ANC attendance: the design of ANC and particularly how ANC deals with the needs and concerns of women during the first trimester has implications for timing of initiation.

Background: In the process pregnancy-postpartum, the role of the husband is very important and necessary. It is highly expected for the husbands to accompany their wives, so that their wives can have healthy pregnancy which is later able to give birth a healthy baby and the mothers can survive. Objectives: The purpose of this study is to find out the effect of husband’s knowledge regarding Antenatal Care (ANC) and Early High-Risk Detection, husband behavior in the pregnancy-postpartum care with reproductive health problems experienced by wife and to determine which variable that has the greatest effect among the three variables. Metohdes: This research is an analytical observation, carried out in the working area of Tinggede Health Center which includes 3 villages namely Sunju, Tinggede and South Tinggede the research target is all husbands who have pregnant wife (second pregnancy) and have children under two years old with a total of 180 husbands. The survey was carried out on 180 husbands. Data collection is carried out through interviews, observations and FGDs. Data analysis technique with Chi Square value test (p <0.05). Results: The results showed that the level of husband’s knowledge about Antenatal Care and early detection of high risk was low, 58.88% and 56.66%, respectively. Husband behavior in pregnancy care was also categorized as less healthy/bad, i.e., 55.55%, and the prevalence of wife’s respondents who experienced reproductive health problems was 57.7%. Husband’s knowledge about ANC, early detection of high-risk pregnancy, and husband behavior in pregnancy care had a significant relationship to reproductive health problems (p<0.05). The highest frequency of husband’s participation in the pregnancy-postpartum care is making referrals to the healthcare facilities by 79%, Husband behavior in pregnancy care has the greatest effect on maternal reproductive health problems with a P value = 0.001. Conclusion: It can be concluded that the husband’sknowledgeregardingANCandearlydetectionofpregnancyandpostpartum periodhasaneffectonmaternalreproductivehealthinSigiRegency, CentralSulawesi. It’s expected that the development of models for improving husband’s Information, AdvocacyandCommunication(IAC)of reproductive health could be a preventive effort in improving women’s reproductive health.

Background : Adolescence is particularly a transition period of human development which has profound influence on a person’s future. In Bangladesh adolescents usually gather their knowledge about reproductive health from their family and surroundings and therefore their knowledge remains incorrect and insufficient. Government increases the provision of schooling for girls but there is no provision of sex education.
 Objective : To assess the knowledge of adolescent girls about pregnancy and antenatal care.
 Methods : A cross sectional study was done during the period of January ’15 to June ’15 among 143 students of class 1X and X of 2 rural private schools of Rupganj and Narayanganj. Simple random sampling method was applied for enrolling the study population and data was collected by interview method using pretested questionnaire. Finally, data was analyzed by SPSS version 17.
 Result : Most of the respondents had average knowledge about pregnancy and antenatal care. Nearly three-forth (61.5%) of the respondents had incorrect knowledge about pregnancy period and majority (76.3%) do not know about the correct mother’s organ for developing baby during pregnancy. Maximum respondents (95%) had good knowledge about extra care of a pregnant mother. Although 74.8% mentioned about TT vaccination of a pregnant mother but majority (65%) did not know detail about the vaccines’ dose and schedule. Statistically significant difference found in knowledge on pregnancy and antenatal care among married and unmarried girls. (P=<0.05)
 Conclusion : Knowledge of adolescent girls about pregnancy and ANC was average in our rural area.
 Northern International Medical College Journal Vol. 11 No. 1 July 2019, Page 423-426

Background Maternal morbidity presents a growing challenge to the American healthcare system and increasing numbers of patients are requiring higher levels of care in pregnancy. Identifying patients at high risk for critical care interventions, including intensive care unit admission, during delivery hospitalizations may facilitate appropriate multidisciplinary planning and lead to improved maternal safety. Baseline risk factors for critical care in pregnancy have not been well-described previously. Objective This study assesses baseline factors associated with critical care interventions that were present at admission for delivery. Study design This is a secondary analysis of a multicenter observational registry of pregnancy after prior uterine surgery and primary cesarean delivery. All women with known gestational age were included. The primary outcome measure was a composite of critical care interventions that included postpartum intensive care unit admission, mechanical ventilation, central intravenous access, and arterial line placement. Risk for this critical care outcome measure was compared by selected baseline and obstetric characteristics known at the time of hospital admission, including maternal age, pre-pregnancy BMI, race, maternal co-morbidities, parity, and plurality. We evaluated these potential predictors and fit a multivariable logistic regression model to ascertain the most significant risk factors for critical care during a delivery hospitalization. Results 73,096 of 73,257 women in the parent trial met inclusion criteria, of whom 505 underwent a critical care intervention (0.7%). In the adjusted model, heart disease [aOR = 10.05, CI = 6.97 − 14.49], renal disease [aOR = 2.78, CI = 1.49 − 5.18], and connective tissue disease [aOR = 3.27, CI = 1.52 − 6.99], as well as hypertensive disorders of pregnancy [aOR = 2.04, CI = 1.31 − 3.17] were associated with the greatest odds of critical care intervention [p < .01] (Table 2). Other predictors associated with increased risk included maternal age, African American race, smoking, diabetes, asthma, anemia, nulliparity, and twin pregnancy. Conclusion In this cohort, women with cardiac disease, renal disease, connective tissue disease and preeclampsia spectrum disorders were at increased risk for critical care interventions. Obstetric providers should assess patient risk routinely, ensure appropriate maternal level of care, and create multidisciplinary plans to improve maternal safety and reduce risk.

The clinical practice guidelines on pregnancy care have been developed to provide reliable and standardised guidance for health professionals providing antenatal care in Australia. They were originally released as the Clinical Practice Guidelines: Antenatal Care in two separate editions (modules 1 and 2) in 2012 and 2014. These modules have now been combined and updated to form a single set of consolidated guidelines that were publicly released in February 2018 as the Clinical Practice Guidelines: Pregnancy Care. Eleven topics have been updated and new guidance on substance use in pregnancy has been added. Main recommendations: The updated guidelines include the following key changes to practice: recommend routine testing for hepatitis C at the first antenatal visit; recommend against routine testing for vitamin D status in the absence of a specific indication; recommend discussing weight change, diet and physical activity with all pregnant women; and recommend offering pregnant women the opportunity to be weighed at every antenatal visit and encouraging women to self-monitor weight gain. Changes in management as a result of the guidelines: The guidelines will enable pregnant women diagnosed with hepatitis C to be identified and thus avoid invasive procedures that increase the risk of mother-to-baby transmission. Women can be treated postpartum, reducing the risk of liver disease and removing the risk of perinatal infection for subsequent pregnancies. Routine testing of all pregnant women for vitamin D status and subsequent vitamin D supplementation is not supported by evidence and should cease as the benefits and harms of vitamin D supplementation remain unclear. The recommendation for health professionals to provide advice to pregnant women about weight, diet and physical activity, and the opportunity to be weighed will help women to make changes leading to better health outcomes for themselves and their babies.

BackgroundMyanmar has a high maternal mortality rate. Evidence about pregnancy and antenatal care experiences of women in more remote areas, where Covid and conflict have increased poverty and restricted travel,...

&lt;p&gt;&lt;strong&gt;&lt;em&gt;Background: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;One in four mothers experience u&lt;/em&gt;&lt;em&gt;nwanted pregnancy. It causes great risks for mothers and children, such as malnutrition, neglected, violence and even death. During pregnancy, a woman is expected to take the initiative and change her behavior by taking adequate care. Antenatal care is a part of maternal and child health services that are vital in early detection and monitoring of fetal well-being as an efforts to improve the health of mothers and babies during pregnancy, childbirth and postpartum. The mother's intention towards her pregnancy, whether desired or not, is related to the mother's behavior during pregnancy. Unintended pregnancy can obstruct the achievement of adequate antenatal care.&lt;/em&gt;&lt;em&gt;.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Objectives: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;This study aims to determine the relationship between unintended pregnancy and antenatal care behavior&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Methods: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;This study used a cross-sectional design with the secondary data from 2017 Indonesian Demographic Health Survey. The dependent variable in this study was antenatal care behavior which is a composite of the first antenatal visit, frequency of antenatal visit and iron consumption. There were 14.223 women of childbearing age 15-49 years which eligible for this study’s criteria. The collected data was analyzed with chi square and logistic regression models of risk factors test&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Results:&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; Mothers with unintended pregnancies have a bigger opportunity to do unhealthy antenatal care behavior (OR = 2.338: 95% CI 1.707- 3.203) compared to intended pregnancies. The effect of unintended pregnancy on antenatal care behavior varies according to maternal age (OR- 1.267: 95% CI 1.034-1.553), parity (OR= 0.579: 95% CI 0.430-0.780) and residency (OR= 1.490: 95% CI 1.226- 1.811).&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Conclusions: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;There is a relationship between unintended pregnancy and antenatal care behavior. Mothers with unintended pregnancies is 2.338 times more likely to have unhealthy antenatal behavior care. We also found that this effect differs according to the maternal age, parity and residency.&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;

To analyze maternal and neonatal morbidity and mortality in twin pregnancies, associated with the quality of prenatal and labor care, through the level of adherence to recommended protocols. This was a retrospective cohort study carried outbetween 2019 and 2022 involving twin pregnancies. Thesocioeconomic and demographic characteristics of the pregnant women were assessed, as well as maternal and perinatal outcomes. The association between variables was measured by the odds ratio (OR) obtained from the logistic regression. The sample was constituted by 118 twin pregnancies, being 72 monochorionic (MC) and 46 dichorionic (DC). The majority of mothers (44.9 %) were between 16 and 25 years old. The majority of pregnant women developed some disorder during pregnancy (69.5 %). The most common neonatal complication was respiratory distress, which mainly affected the 2nd twins in both MC and DC twin pregnancies (65.8 and 52.2 %, respectively). Regarding the outcome "complications after delivery of the 1st twin", somepredictors showed statistical significance such as "professionals responsible for prenatal care" (OR=3.37) and"breastfeeding in the first hour of life" (OR=1.07). With regard to the outcome "death of the 2nd twin", only variables related to prenatal care showed statistical significance such as "mode of delivery" (OR=0.25), "calcium supplementation" (OR=5.81), and "unit of prenatal care visits" (OR=9.96). MC twin pregnancies had more adverse perinatal outcomes than DC twin pregnancies. In addition, adherence to prenatal care and labor protocols for twin pregnancies was associated with the outcomes studied, such as complications after delivery and death.

Background: Antenatal care is pivotal for maternal and child health, with husband involvement enhancing its efficacy. This study conducted in Mangalore, India, aimed to evaluate husbands’ knowledge and engagement in antenatal care, aligning with Sustainable Development Goals (SDGs) for human health and well-being. Objectives: The study aimed to assess husbands’ understanding of and involvement in supporting their wives during pregnancy. Methodology: A cross-sectional study surveyed 150 husbands using a semi-structured questionnaire, collecting data on personal details, antenatal care knowledge, and involvement in their wives’ pregnancy care. Descriptive statistics and Chi-Square tests were employed for analysis. Results: The majority of husbands exhibited sufficient knowledge of antenatal care, particularly regarding identifying danger signs. However, levels of active involvement varied due to socio-cultural factors and work commitments. While many accompanied their wives to appointments and participated in decision-making, some faced barriers such as work obligations. Conclusion: Enhancing husband involvement is essential for achieving SDG targets in maternal health. Tailored interventions addressing socio-cultural barriers can empower husbands to play a more active role in supporting maternal well-being. By fostering inclusive healthcare practices, we can improve health outcomes for mothers, infants, and communities at large.