Antenatal Care Practices Research Articles

A Survey to Assess Knowledge of Antenatal Care among Rural Women of Gujrat, Pakistan

Introduction:Antenatal care is the daily health management of healthy pregnant women with few symptoms, orderly diagnosis of diseases or difficulties connected to obstetrics, and contributing to lifestyle, pregnancy, antenatal care, and safe delivery of child.
 Objective:To assess the knowledgeof antenatal Care among Pregnant women of Rural Population
 Material and Methods:The study was conducted at rural areas of Gujrat city for the periodof 6 months, fromJanuary 2021 to June 2021. The data was collected through Questionnaire which was piloted tested and validated by Cronbach. A sample of 100 was taken following inclusion criteria of pregnant women to assess knowledge from rural under developed areas of Gujrat, Pakistan.
 Results:A total of 100 participants were included in which common agegroups were 26-32 having 37%. The Profession and literacy status was evaluated and found 73% Housewives and 59% Illiterate. Results also shows the Responses about their knowledge clearly showing that 59% pregnant women do not visit and unaware of number of visits in Maternity Clinics. 40 % of the women were unaware about Blood Pressure maintenance in Antenatal care.52% women did not know about blood and urine tests performed during pregnancy. Pregnant women who was unaware of vaccination during antenatal care was 54% and 59% do not acknowledge about using of Multi vitamins during this period of pregnancy.
 Conclusion:In conclusion rural population had little of Antenatal care, maternal issues, nutritional supplements, investigation tests, and vaccinations practices. The primary reason for this was lack of awareness about proper health care services in rural areas. The secondary reason was family/husband restraints and impediments for not seeking antenatal care.

OVERVIEW OF PREGNANT WOMAN BEHAVIOUR AGAINST ANTENATAL CARE COMPLIANCE IN KEBON KALAPA VILLAGE, CISARUA SUB-DISTRICT, SUMEDANG REGENCY, WEST JAVA IN 2019

Antenatal services, according to standards, are services provided to pregnant women, given four times during pregnancy. According to RISKESDAS Data, the province's antenatal care proportion in Indonesia was 2013 at 95.2% and 2018 at 96.1% over the past five years. This study was designed to describe pregnant women against antenatal mediation in Kebon Kalapa Village, Cisarua District, Sumedang, West Java, 2019. This research is a descriptive-analytic study. Sampling using purposive sampling technique and obtained a total sample of 22 respondents. The results showed significant differences between pregnant women's knowledge, attitudes, and practices about the regulation of antenatal care in Kebon Kalapa Village, Cisarua District, Sumedang, West Java, in 2019. The research studies showed that there was a significant difference between knowledge, attitudes and antenatal care practices in Kebon Kalapa Village, Cisarua District, Sumedang, West Java, 2019 with an overview of good knowledge is nine people (40.9%) and sufficient knowledge of 4 people (18.2%). An overview of a good attitude is 21 people (95.5%), and an overview of good practice is 17 people (77.3%). The overview of antenatal care is 18 people (81.8%). Most pregnant women in Kebon Kalapa Village, Cisarua District, Sumedang Regency, West Java In 2019 have good knowledge, and most pregnant women in Kebon Kalapa Village, Cisarua District, Sumedang District, West Java, 2019 have a positive attitude. Most pregnant women in Kebon Kalapa Village Cisarua Sumedang Regency, West Java 2019 have positive practice, and most pregnant women in Kebon Kalapa Village, Cisarua Sub-District, Sumedang District, West Java, 2019 are obedient to antenatal care.

FAKTOR-FAKTOR YANG MEMPENGARUHI KELULUSAN UJI PRAKTIK ANTENATAL CARE PADA MAHASISWA TINGKAT I SEMESTER II AKADEMI KEBIDANAN

FAKTOR-FAKTOR YANG MEMPENGARUHI KELULUSAN UJI PRAKTIK ANTENATAL CARE PADA MAHASISWA TINGKAT I SEMESTER II AKADEMI KEBIDANAN

Timing and factors associated with early antenatal visits among pregnant women in west Gojjam, northwest Ethiopia

Background Early and appropriate antenatal care practices have the potential to save the lives of mothers and their children, and enable mothers to receive the full range of antenatal care services. However, in developing countries, including Ethiopia, a number of pregnant women do not attend antenatal care in the recommended time period. Therefore, this article assessed the timing and factors associated with early antenatal care visits in west Gojjam, northwest Ethiopia. Methods An institution-based cross-sectional study was conducted among pregnant women attending antenatal care services in west Gojjam. Data on participants' sociodemographic, obostetric and reproductive health information were collected from 820 participants using a structured interviewer-administered pretested questionnaire. Bivariate and multivariate logistic regression analyses were used to identify variables associated with early antenatal care visits. Variables with P<0.05 were considered significant. A visit was considered ‘early’ if a pregnant woman attended their first antenatal care session within the first 12 weeks of gestation. Results Almost a third (31.5%) of mothers started antenatal care early. The mean gestational age at the first visit was 17 weeks (standard deviation±7.7), with a range of 3–36 weeks. In multivariate analysis, it was found that being nulliparous (adjusted odds ratio: 2.3; P=0.013), travel time to the health facility being less than 30 minutes (adjusted odds ratio: 6.1; P<0.001) and living in an urban area (adjusted odds ratio: 2.4; P=0.001) were significantly associated with attending antenatal care early. Conclusions Early first antenatal care attendance was low in the study area. It is important to decentralise the provision of antenatal care services at health posts through an outreach service, by strengthening the mobilisation, screening and early referral system through health extension workers and the women development army. This will allow more women to receive antenatal care from skilled providers.

Barriers to eHealth adoption in routine antenatal care practices: Perspectives of expectant mothers in Uganda - A qualitative study using the unified theory of acceptance and use of technology model.

Current empirical evidence suggests that successful adoption of eHealth systems improves maternal health outcomes, yet there are still existing gaps in adopting such systems in Uganda. Service delivery in maternal health is operating in a spectrum of inadequacy, hence eHealth adoption cannot ensue. This study set out to explore the challenges that impede eHealth adoption in women's routine antenatal care practices in Uganda. A qualitative approach using semi-structured interviews was employed to document challenges. These challenges were classified based on a unified theory of acceptance and use of technology constructs. One hundred and fifteen expectant mothers, aged between 18 and 49 years, who spoke either English or Luganda were included in the study that took place between January to May 2019. Thematic analysis using template analysis was adopted to analyse qualitative responses. Challenges were categorised based on five principal unified theories of acceptance and use of technology constructs namely: performance expectancy, effort expectancy, social influence, facilitating conditions and behavioural intention. Facilitating conditions had more influence on technology acceptance and adoption than the other four constructs. Specifically, the lack of training prior to using the system, technical support, computers and smart phones had a downhill effect on adoption. Subsequently, the cost of data services, internet intermittency, and the lack of systems that bridge the gap between mothers and health providers further hindered technology uptake. In conclusion, strategies such as co-development, training end-users, garnering support at the national and hospital levels should be advocated to improve user acceptance of technology.

ICT Uptake as a Determinant of Antenatal Care Utilization in Uganda

Few studies have investigated information and communication technologies (ICTs) as determinants of ANC utilization, yet ICTs in health can improve patient outcome, tackle health systems challenges, and improve client-to-provider relationship. A cross-sectional design using both quantitative and qualitative data collection approaches was used to ascertain whether ICT uptake can determine ANC utilization. Women aged 18-50 years who were pregnant had given birth two years preceding the survey and who had at least a primary school education participated in this study. Data was analyzed using Pearson's Chi-square and descriptive discriminant analysis. Results from this study suggest an association between ICT uptake and ANC utilization (χ2 = 19.3, ρ <0.001) and a statistically significant relationship between the discriminant function and the grouping variable at p=.012 (Wilks's ᴧ = .822; χ2 = 28.62 (14df), p<0.05, valid n = 164). Control measures and interventions should be geared towards integrating ICTs in women's routine antenatal care practices.

Prevalence of Antenatal Care Practice among Marginalized Community of Nepal

Background: The government of Nepal aims to improve the health of mothers and newborns by providing quality safe motherhood services. Increasing access and utilization of antenatal care (ANC) services are the first steps towards improving maternal and neonatal health outcomes, particularly those of the marginalized communities.Objective: The aim of this study is to assess the prevalence and factors associated with the antenatal care visits among the marginalized community of Nepal.Methods: A mixed-method study was conducted among 202 reproductive aged females of marginalized community in Nepal having childbirth during the last 2 years. Pre-tested semi-structured questionnaires and key informant interview guidelines were used for the collection of data. Bivariate and multiple regression analysis were carried out to find out the factors associated with the antenatal care visits. For qualitative data, thematic analysis was done. Results: More than half (56.9%) of the participants had completed four or more antenatal care visits. Mothers with primary level of education were 2.7 times more likely to complete four or more ANC visits (AOR: 2.7, CI: 1.09-7.07). Age at marriage (AOR: 2.3, CI: 1.08-5.22), women who took decisions alone for their health (AOR: 2.9, CI: 1.22-6.96),exposure to FCHV (AOR:2.5, CI: 1.1-5.9), knowledge about safe delivery incentive program (AOR: 3.6, CI: 1.46-9.0) and perception of “good quality” ANC service(AOR:7.5, CI: 3.3-17.1)were significantly associated with the number of ANC visits. Conclusion: The overall utilization of antenatal health services was low. So, there is a need of different community based maternal health programs especially targeting the marginalized females.

Knowledge, attitude and practices among pregnant women about antenatal care, danger sign during pregnancy and adopting family planning method

Introduction: The knowledge, attitude and practices (KAP) for antenatal check-up during pregnancy is a key indicator of health care facility in a community. The study was conducted in a district hospital in North Delhi of India about antenatal care among pregnant female. Materials and Methods: Total 54 pregnant females were studied about KAP during antenatal care check-up in a tertiary care hospital.The study was cross sectional in design. They were asked questions while attending the outpatient clinic in the hospital. Result: It was found that practices and positive attitude about antenatal care among pregnant females was adequate. Score for positive attitude was 93% and score for antenatal care practices was 62%. Both are more than 50%. But knowledge among them is not adequate; the score for knowledge about antenatal care was 17%, which was less than 50%. Hence periodic health education sessions have to be conducted by the doctors and health staffs. Ten pregnant females(18.5%) had faced danger signs during their previous pregnancy, these danger signs were dizziness and fainting, persistent vomiting, less movement of baby inside uterus, bleeding per vagina (for abortion), persistent vomiting, leaking per vagina and pain abdomen. Four pregnant women (7.4 %) had mentioned bleeding per vagina in their previous pregnancy. Out of 54 pregnant women nine pregnant female told that they were using condom and six not using any contraceptive methods after marriage. Conclusion: The study detected knowledge score of 17%, practice score of 62% and attitude score of 93% in pregnant female attending antenatal check-up clinic. Keywords: Antenatal care, Family planning, Danger signs, Knowledge, Attitude, Practices.

The development of an alternative growth chart for estimated fetal weight in the absence of ultrasound: Application in Indonesia.

A fetal growth chart is a vital tool for assessing fetal risk during pregnancy. Since fetal weight cannot be directly measured, its reliable estimation at different stages of pregnancy has become an essential issue in obstetrics and gynecology and one of the critical elements in developing a fetal growth chart for estimated fetal weight. In Indonesia, however, a reliable model and data for fetal weight estimation remain challenging, and this causes the absence of a standard fetal growth chart in antenatal care practices. This study has reviewed and evaluated the efficacy of the prediction models used to develop the most prominent growth charts for estimated fetal weight. The study also has discussed the potential challenges when such surveillance tools are utilized in low resource settings. The study, then, has proposed an alternative model based only on maternal fundal height to estimate fetal weight. Finally, the study has developed an alternative growth chart and assessed its capability in detecting abnormal patterns of fetal growth during pregnancy. Prospective data from twenty selected primary health centers in South Kalimantan, Indonesia, were used for the proposed model validation, the comparison task, and the alternative growth chart development using both descriptive and inferential statistics. Results show that limited access to individual fetal biometric characteristics and low-quality data on personal maternal and neonatal characteristics make the existing fetal growth charts less applicable in the local setting. The proposed model based only on maternal fundal height has a comparable ability in predicting fetal weight with less error than the existing models. The results have shown that the developed chart based on the proposed model can effectively detect signs of abnormality, between 20 and 41 weeks, among low birth weight babies in the absence of ultrasound. Consequently, the developed chart would improve the quality of fetal risk assessment during pregnancy and reduce the risk of adverse neonatal outcomes.

Prevalence and determinants of hypertensive disorders of pregnancy in Ethiopia: A systematic review and meta-analysis.

IntroductionHypertensive disorder of pregnancy is the second commonest causes of maternal death globally. Different public health studies were conducted on hypertensive disorder of pregnancy which presented inconsistent result. Therefore, this systematic review and meta-analysis was commenced to summarize the findings conducted in several parts of the country and to generate the nationwide representative data on the prevalence and risk factors of hypertensive disorder of pregnancy in Ethiopia.Methods and materialsElectronic databases such as PubMed, Scopus, Google Scholar, Hinari, and African Journals Online were searched for studies published in English up to March, 2020. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument and Newcastle-Ottawa Scale were used for data extraction and quality assessment of the included studies. The meta- regression analysis was computed at 95% CI to present the pooled prevalence and risk factors of hypertensive disorder of pregnancy.ResultsThirty four studies were included in this systematic review and meta-analysis. The pooled prevalence of hypertensive disorder of pregnancy and preeclampsia in Ethiopia were 6.82% (95% CI (5.90, 7.74)) and 4.74% (95% CI (3.99, 5.49)) respectively. Maternal age ≥35 years (Adjusted Odds Ratio (AOR): 2.91 (95% CI: 1.60, 5.26)), twin pregnancy (AOR: 3.04 (95% CI: 1.89, 4.87)), previous history of preeclampsia (AOR: 5.36 (95% CI: 3.37, 8.53)), family history of hypertension (AOR: 4.01 (95% CI: 2.65, 6.07)), family history of diabetes mellitus (AOR: 3.07 (95% CI: 1.66, 7.70)), body mass index ≥25 (AOR: 3.92 (95% CI: 1.82, 8.42)), alcohol consumption (AOR: 1.77 (95% CI: 1.11, 2.83)), urinary tract infection (AOR: 4.57 (95% CI: 3.47, 6.02)), lack of nutritional counseling during antenatal period (AOR: 4.87 (95% CI: 3.36, 7.06)), lack of fruits (AOR: 3.49 (95% CI: 2.29, 5.30)), and vegetables consumption (AOR: 2.94 (95% CI: 2.01, 4.31)) were the risk factors of hypertensive disorder of pregnancy in Ethiopia.ConclusionsThe pooled prevalence of hypertensive disorder of pregnancy is relatively higher compared with the previous reports. Maternal age ≥35 years, twin pregnancy, previous history of preeclampsia, family history of hypertension, family history of diabetes mellitus, body mass index ≥25, alcohol consumption, urinary tract infection, lack of fruits and vegetables during pregnancy were risk factors of hypertensive disorder of pregnancy. The governments and stakeholders should work to strengthen the antenatal care practice to include the possible risk factors of hypertensive disorders of pregnancy.

Management of prepregnancy, pregnancy, and postpartum obesity from the FIGO Pregnancy and Non‐Communicable Diseases Committee: A FIGO (International Federation of Gynecology and Obstetrics) guideline

Management of prepregnancy, pregnancy, and postpartum obesity from the FIGO Pregnancy and Non‐Communicable Diseases Committee: A FIGO (International Federation of Gynecology and Obstetrics) guideline

Society for Maternal-Fetal Medicine Special Statement: Updated checklists for management of monochorionic twin pregnancy

Approximately 20% of twin pregnancies are monochorionic. The management of monochorionic twin pregnancy involves several additional interventions beyond the routine management of singletons or dichorionic twins. In 2015, the Society for Maternal-Fetal Medicine posted checklists for monochorionic/diamniotic twins and monochorionic/monoamniotic twins. The Society presents updated versions of these 2 checklists reflecting recent changes in practice recommendations. Suggestions for implementing the use of the checklists into antenatal care practices are also included.

Malaria preventive practices and delivery outcomes: A cross-sectional study of parturient women in a tertiary hospital in Eastern Uganda.

Uganda ranks third in the number of deaths attributable to malaria and has some of the highest recorded malaria transmission rates in the general population. Malaria in Pregnancy is associated with detrimental effects for the mother and unborn baby and these effects seem to have long term effects and consequences on the life of the baby. Despite the preventive measures put in place by the World Health Organization in antenatal care, the burden of malaria in pregnancy is still high. We determined the use of malaria preventive strategies during pregnancy and the presence of plasmodium infection, anemia, and low birth weight babies at delivery among parturient women at Mbale regional referral hospital in eastern Uganda. A cross-sectional study was conducted among 210 women delivering at MRRH between July 2017 and January 2018. Information on demographics, antenatal care, and prevention practices was collected using an interviewer-administered questionnaire. Maternal venous blood and cord blood samples were screened for Plasmodium infection by both microscopy of Giemsa-stained blood films and Plasmodium falciparum rapid diagnostic test (pf. HPR2 mRDT). Polymerase Chain Reaction (PCR) was done on cord blood. The presence of anemia was determined by the use of an automated hemoglobin analyzer. Data were analyzed using descriptive and analytical statistics. Of the 210 women, 3 (1.4%) and 19(9.1%) tested positive for malaria by using Giemsa stained blood smear microscopy and malaria rapid diagnosticMRDT tests respectively. PCR detected 4(%) of Plasmodium in cord blood. Twenty-nine percent of the women had anaemia and 11 (5.2%) had low birth weight babies. Only 23.3% of the women received at least three doses of IPTp-SP and 57.9% reported sleeping under an Insecticide Treated Net the night before the survey. The women who reported sleeping under a mosquito net the previous night (OR 0.67, 95% CI: 0.24-1.86) and those who reported taking fansidar as a directly observed therapy (OR 0.31, 95% CI: 0.04-2.39) appeared to have few chances of getting plasmodium infection though the findings were not statistically significant. The effective use of malaria preventive strategies (IPT-SP and Insecticide Treated Nets) was generally low. Most of the women took less than three doses of SP and there was no strict adherence to the recommended directly observed therapy. The prevalence of Plasmodium infection during pregnancy was low though maternal anaemia and low birth weight were relatively high.

Antenatal care attendance and maternal knowledge on child feeding predict haemoglobin level of pre-school children in Wa Municipality of Ghana

Purpose The purpose of this paper is to identify locally relevant factors that predict low haemoglobin (Hb < 11.0g/dl) level of pre-school children (6–23 months) in an impoverished area of Ghana. Design/methodology/approach This study used a cross-sectional analysis of 278 mother–child pairs selected from households using random sampling techniques. Child feeding knowledge, antenatal care (ANC) practices and socio-demographic characteristics were assessed. Hb levels were laboratory determined. This paper modelled the predictors of low Hb in multiple linear regressions. Findings More than half (53.0%) of the children were female and aged more than one year (60.4%). Mean Hb was 8.5 ± 1.5 g/dl, and the prevalence of anaemia was 95.0%. High child feeding knowledge was independently associated with increased Hb of children after adjusting for the effects of other factors (β = 0.61, p < 0.005), and mothers who made at least four ANC visits during pregnancy had children with high Hb (β = 0.42, p = 0.04). This paper found some evidence of an inverse association between high household wealth and child Hb levels (β= −0.75, p = 0.06). Originality/value This study reports a high prevalence of low haemoglobin levels and anaemia in pre-school children in an impoverished area in Ghana. Maternal education on appropriate child feeding and encouragement of antenatal care attendance during pregnancy are key factors to increasing child haemoglobin levels in this setting. Though the current study bridges the knowledge gap between health service education and practice, a large population-based study is required to confirm the finding.

Protocol for a cluster randomised trial in Madhya Pradesh, India: community health promotion and medical provision and impact on neonates (CHAMPION2); and support to rural India’s public education system and impact on numeracy and literacy scores (STRIPES2)

BackgroundRural areas of India exhibit high neonatal mortality, and low literacy and numeracy. We assess the effect of a complex package of health interventions on neonatal survival and the effect of out-of-school-hours teaching on children’s literacy and numeracy in rural Madhya Pradesh.Methods/designThis is a cluster-randomised controlled trial with villages (clusters) receiving either a health (CHAMPION2) or education (STRIPES2) intervention. Building on the design of the earlier CHAMPION/STRIPES trial, villages receiving the health intervention are controls for the education intervention and vice versa.The clusters are 196 villages in Satna district, Madhya Pradesh, India: each is at least 5 km from a Community Health Centre, has a population below 2500, and has at least 15 children eligible for the education intervention. The participants in CHAMPION2 are resident married women younger than 50 years of age who had not undergone a family planning operation, provided they are enumerated pre-randomisation or marry a man enumerated pre-randomisation. The participants in STRIPES2 are resident children born 16 June 2010 to 15 June 2013, not in school before the 2018–2019 school year and intending to enrol in first grade in 2018–2019 or 2019–2020.DiscussionIn CHAMPION2, the NICE Foundation will deliver a 3.5-year programme comprising Accredited Social Health Activists or village health workers and midwives promoting health knowledge and providing antenatal, postnatal, and neonatal healthcare; community mobilisation; referrals to appropriate government health facilities; and a health education campaign. In STRIPES2, the Pratham Education Foundation will deliver a programme of village-based, before/after school support focusing on literacy and numeracy. As controls, the CHAMPION2 control villages will receive the usual health services (plus the STRIPES2 intervention). STRIPES2 control villages will receive the usual education services (plus the CHAMPION2 intervention). The primary outcome in CHAMPION2 is neonatal mortality. Secondary outcomes include antenatal, delivery, immediate neonatal and postnatal care practices, maternal mortality, stillbirths, early neonatal deaths, perinatal deaths, health knowledge, hospital admissions, maternal blood transfusions, and cost effectiveness. The primary outcome in STRIPES2 is a composite literacy and numeracy test score. Secondary outcomes include separate literacy and numeracy scores, reported school enrolment and attendance, parents’ engagement with children’s learning, and cost effectiveness. Independent research and implementation teams will conduct the trial. Trial Steering and Data Monitoring Committees, with independent members, will supervise the trial.Trial registrationClinical Trial Registry of India: CTRI/2019/05/019296. Registered on 23 May 2019. http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=31198&EncHid=&modid=&compid=%27,%2731198det%27

Antenatal and Postnatal Care Practices among Indigenous People in Bangladesh: A Case Study in Dinajpur

Antenatal (ANC) and postnatal care (PNC) contact have long been considered a critical component of the continuum of care for a pregnant mother along with the newborn child. The study aims to determine the influential factors related to the practice of antenatal and postnatal care amongst indigenous mothers of newborns and identifier associated with the ANC and PNC contacts for women in indigenous communities. This study was carried out purposefully selected six upazilas of Dinajpur district where most of the indigenous people live and respondents were 223 married women having at least one under-five children. Results found that the respondents had very poor knowledge about their maternal status and literacy. During the pregnancy period, 39.5% and 6.7% mothers had one and two-time miscarriage respectively. Only 43.9% indigenous pregnant mothers appointed to the health center during pregnancy, 27.8% appointed within three months, 13% went at the last stages of pregnancy and 10.3% felt no need to go there. In 69.1% cases delivery occurred at home by inexpert birth attendance. About 10.3% of deliveries, the placenta was removed manually during delivery. About 33% mothers and their husbands (34%) were found illiterate. The likelihood of mothers who received either antenatal care or postnatal care depended on husband’s education level. It was significantly lower for illiterate (OR=0. 247, 95% CI = 0.063-0.969) husband’s compared to a secondary and above level of educated husbands. Distant health service center (More than 2 km from home) was the lower chances (OR=0. 384, 95% CI = 0.152-0.970) for mothers being access to health care service centers compared to low distant centers (≤ 2 km from home). Also, the age of the mother (30+) was another factor that influenced the mothers for taking the service from hospitals or health centers during pregnancy. This study concludes that about one-third of the respondents of the community has access to health care services, which can be one of the most important factors in their poor health. Counseling and proper education can influence people to take antenatal care and visits to the health center to take postnatal care service further.

Achieving Optimal Gestational Weight Gain, Birth Weight, and Perinatal Outcomes Among Pregnant Women at Risk of Hypertension: Protocol for a Pilot Randomized Controlled Trial.

BackgroundHypertensive disorders, including preeclampsia, complicate 10% of all pregnancies, causing maternal and fetal morbidity and mortality. In Bangladesh, 24% of all maternal deaths are directly attributed to hypertensive disorders. Conventional antenatal care practices often delay or miss detecting hypertensive disorders in pregnancy, which may allow some women to become vulnerable to the adverse consequences of the hypertensive disorders. Regular self-monitoring of blood pressure and weight gain may improve maternal and fetal outcomes among pregnant women at risk of developing hypertensive disorders during pregnancy through early diagnosis, prompt referral, and timely clinical management; however, to undertake a randomized controlled trial of an intervention to reduce adverse consequences of hypertensive disorders in pregnancy, its feasibility must first be determined.ObjectiveThe objectives of this study are to evaluate the accuracy of a wearable blood pressure monitoring device (Health Gauge) in order to test the design and methods of a future definitive randomized controlled trial, and to examine the feasibility, acceptability, and fidelity of an intervention focusing on regular monitoring of weight gain and self-monitoring of blood pressure for pregnant women at risk of developing hypertensive disorders and their associated complications.MethodsThe study is located in Matlab, Bangladesh will be conducted in two phases. First, a wearable blood pressure device (Health Gauge) will be validated in accordance with the European Society of Hypertension International Protocol (revision 2010). Second, a prospective, two-arm, parallel, and nonblinded randomized controlled external pilot trial will be conducted. In the pilot trial, 70 eligible participants will be individually randomized to the intervention arm, in which pregnant women will self-monitor their blood pressure daily using a wearable device (Health Gauge) and be evaluated monthly by trained health workers for weight gain from 20 weeks of gestation until delivery, or the control arm, in which pregnant women will be assessed for weight gain every two months from 20 weeks of gestation until delivery (1:1 intervention to control allocation ratio using a permuted block randomization method with concealment). All women will receive standard antenatal care.ResultsA validation study of the wearable blood pressure device has successfully been conducted among the general adult population in Matlab, Bangladesh. As of September 2019, the pilot trial has completed enrollment of women who are pregnant (N=70; intervention: n=35; control: n=35) and follow-up of the participants is ongoing. Data analysis is expected to be completed by June 2020, and results are expected to be submitted for publication in August 2020.ConclusionsThe findings of this study will help us to design a comprehensive, full-scale randomized controlled trial to test the efficacy of regular self-monitoring of blood pressure and weight gain during pregnancy, a simple and inexpensive intervention to help to achieve optimal maternal and fetal outcomes in pregnant women at risk of developing hypertensive disorders and their associated complications during pregnancy.Trial RegistrationClinicalTrials.gov NCT03858595; https://clinicaltrials.gov/ct2/show/NCT03858595International Registered Report Identifier (IRRID)DERR1-10.2196/16676

‘Putting salt on the wound’: a qualitative study of the impact of FGM-safeguarding in healthcare settings on people with a British Somali heritage living in Bristol, UK

ObjectivesThis research documents the experiences of people with Somali heritage with female genital mutilation (FGM)-safeguarding services in healthcare and whether such services are considered appropriate by the people who encounter...

Fetal Diagnosis and Therapy during the COVID-19 Pandemic: Guidance on Behalf of the International Fetal Medicine and Surgery Society

The COVID-19 pandemic has stressed patients and healthcare givers alike and challenged our practice of antenatal care, including fetal diagnosis and therapy. This document aims to review relevant recent information to allow us to optimize prenatal care delivery. We discuss potential modifications to obstetric management and fetal procedures in SARS-CoV2-negative and SARS-CoV2-positive patients with fetal anomalies or disorders. Most fetal therapies are time sensitive and cannot be delayed. If personnel and resources are available, we should continue to offer procedures of proven benefit, acknowledging any fetal and maternal risks, including those to health care workers. There is, to date, minimal, unconfirmed evidence of spontaneous vertical transmission, though it may theoretically be increased with some procedures. Knowing a mother’s preoperative SARS-CoV-2 status would enable us to avoid or defer certain procedures while she is contagious and to protect health care workers appropriately. Some fetal conditions may alternatively be managed neonatally. Counseling regarding fetal interventions which have a possibility of additional intra- or postoperative morbidity must be performed in the context of local resource availability. Procedures of unproven benefit should not be offered. We encourage participation in registries and trials that may help us to understand the impact of COVID-19 on pregnant women, their fetuses, and neonates.

PMU48 EFFECT OF MOBILE HEALTH INTERVENTIONS ON MATERNAL AND CHILD HEALTH: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS

Recently, attempts have been made to use mobile phone text messaging, phone calls, and application to achieve positive outcomes in maternal and child health outcomes. Existing evidence on its use to improve the outcomes in mother and child are sparse. This study synthesizes and critically reviews the existing level of evidence on the use of mobile-based services for maternal and perinatal healthcare utilization and its impact. This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. A systematic search was performed in MEDLINE. Two independent researchers undertook study selection and data extraction. Results were reported narratively. The systematic review only included studies that were randomized controlled trials. A total of 551 references were identified, of which nine studies were included in this review. The maternal education using text messages was found to be effective in decreasing both maternal and perinatal morbidity and mortality. Further, maternal education reported to increase, facility delivery, vaccine uptake, care-seeking for newborn illness and postnatal-care appointments. In particular, management of gestation diabetes using mobile health intervention was associated with positive outcomes in terms of decreased complications in both pregnant women and fetuses. Postnatal care appointments were reported higher with the use of mobile health interventions as compared to their control groups the group using mobile health interventions on comparing to controls. Mobile phone utilization was also reported to improve the coverage of recommended antenatal care practices, including syphilis and HIV testing. The call center was an efficient approach for the measurement of post-discharge childbirth outcomes. Mobile phone call/SMS/Application utilization was found to increase the healthcare facility uptake and reporting. Its usage was associated with favorable outcomes in both mother and child. Mobile health interventions could be successfully used for improving outcomes in different healthcare programs.