Antenatal Counseling Research Articles

The Influence of the Partner's Involvement in Antenatal Genetic Group Counseling on Pregnant individuals' Scores on Tests of Vital Knowledge Relating to Pregnancy.

Physicians and other medical providers counsel patients to provide them with most important information and available medical service options. How to provide the most effective antenatal counseling is an important focus among experts. Our study focuses on the influence of the partner's involvement during antenatal genetic group counseling (AGGC). This study aimed to compare the ratio of pregnant individuals who have knowledge score improvement after AGGC, with a focus on pregnant individuals who attend counseling with/without their partner and to identify other possible factors that could influence the knowledge improvement. A prospective cohort study was conducted. Pregnant individuals were assessed for their knowledge by using a self-questionnaire prior to and immediately after AGGC. A total of 553 pregnant women were enrolled; 310 and 243 participants attended the AGGC without and with their partner, respectively. The ratio of the participants who increased their overall knowledge score was significantly higher after the AGGC for those who were with partner compared with those without. The medians (Q1-Q3) of the overall knowledge scores before and after the AGGC were 32 (29-36) and 36 (31-39) in the AGGC with their partner, respectively, and 33 (30-36) and 35 (32-39) in the AGGC without their partner, respectively. Knowledge of trisomy-21 screening of all participants got the lowest score and less improvement when compared with other topics. Partner's involvement in the AGGC was associated with a higher ratio of the participants who increased their overall knowledge score when comparing the scores prior to and immediately after the AGGC.

Integrated antenatal care services with breastfeeding counseling practices to improve pregnant women's knowledge, skills and readiness for exclusive breastfeeding

Background: Stunting is the most common form of child malnutrition in millions of children in Indonesia, around 37% and one of the highest proportions of stunting is found in West Nusa Tenggara. Breastfeeding counseling during antenatal care (ANC) can encourage early breastfeeding. Still, counseling is not generally done even though the stage I and stage IV of normal labor, coverage exceeds the target and only one-fifth of the midwives provide complete and correct ANC services for the ten-step component service. The study aims to evaluate model of integrated antenatal care services with breastfeeding counseling practices to increase pregnant women's knowledge, skills and readiness to breastfeed Methods: Pregnant women from Kuripan Primary health care were selected randomly. This study compared two study groups, namely the intervention and control group of third-trimester pregnant women who were given integrated ANC and breastfeeding counseling compared to conventional ANC. Both groups were assessed for the knowledge, skills, and readiness of exclusive breastfeeding mothers before and after counseling. Chi-square test were used to compare readiness, knowledge, and breastfeeding practice before and after intervention in the study group. Results: The provision of integrated ANC and breastfeeding counseling in this study show a difference between knowledge before and after treatment with a p-value = 0.002 (p<0.05). There was a difference between the practice of breastfeeding before and after the treatment with p-value = 0.003 (p<0.05) and in the integrated antenatal care breastfeeding counseling treatment group it showed that there was a difference in readiness for exclusive breastfeeding before (p = 0.005) (p<0.05) and after being given treatment with p-value = 0.001 (p<0.05). Conclusions: Integrated antenatal care and breastfeeding counseling have shown differences in increased knowledge, exclusive breastfeeding practices and readiness for breastfeeding.

Correlates of post-partum intra-uterine copper-T devices (PPIUCD) acceptance and retention: an observational study from North India

BackgroundPostpartum intrauterine contraceptives device (PPIUCD) offers an effective means of providing contraceptive services to women in countries with high rates of unmet needs for family planning services. However, scientific literature estimating the long-term retention rates is scarce. We estimate the factors affecting acceptance and retention of PPIUCD and explore the risk factors against PPIUCD Discontinuation at six months”.Material and method: This prospective observational study was conducted between 2018 and 20 at a tertiary care institute in North India. PPIUCD was inserted following a detailed counseling session and consent. The women were followed up for six months. Bivariate analysis was done to depict the association between socio-demographic characteristics and acceptance. Logistic regression, cox regression, and Kaplan Meier analysis were applied to explore factors affecting acceptance and retention of PPIUCD.ResultsOf the 300 women counseled for PPIUCD, 60% accepted them. The majority of these women were between 25 and 30 years (40.6%), primigravida (61.7%), educated (86.1%), and from urban areas (61.7%). Retention rates at six months were about 65.6%, while 13.9% and 5.6% were either removed or expelled. Women declined PPIUCD due to refusal by spouses, partial knowledge, inclination towards other methods, non-willingness, religious beliefs, and fear of pain and heavy bleeding. Adjusted logistic regression depicted that higher education, housewife status, lower-middle and richest SES, Hinduism, and counseling in early pregnancy promoted acceptance of PPIUCD. The most common reasons for removal were AUB, infection, and family pressure (23.1%). Adjusted hazard ratio depicted religion other than Hinduism, counseling in late stages of pregnancy, and normal vaginal delivery were significant predictors for early removal or expulsion. While education, higher socio-economic status favoured retention.ConclusionPPIUCD is a safe, highly effective, low-cost, long-acting, and feasible method of contraception. Skill enhancement of healthcare personnel for insertion techniques, adequate antenatal counseling, and advocacy of PPIUCD can help increase the acceptance of PPIUCD.

Maternal request for cesarean delivery; a solid indication or a window for complications; a teaching hospital experience

Background: Cesarean Section on Maternal Request (CSMR) is a growing phenomenon whose literature needs to be appraised, and it is exemplified by a steady increase in the world neck and neck by high percentage of births by CS. It is even more luckless that giving birth by elective CS based on the pregnant woman’s choice has become the first place among the justifications, notwithstanding its direct and long-term complications. Methods: This retrospective study reviewed data of all CS deliveries during the year 2022 at our hospital using electronic medical records in the hospital information system. Retrieved data include baseline demographic characteristics, mode of delivery, indications, and the type of CS, aiming to clarify the reason for CS to challenge the percentage of CS based on the yearning of the pregnant woman without a medical reason; to identify, analyze and try to solve the ethical problem raised up by the pregnant woman’s request for CS. Results: The results revealed two significant facts; a sturdy noteworthy increase in the percentage of pregnant women delivering by CS compared to vaginal delivery at 54% versus 45.6%, and a sharp increase in the CS deliveries on maternal requests at 22.78%. The main reason for this shifting practice is the previous one CS followed by a decision that was taken on personal and family convictions. These harvested results revealed a significant increase in the percentage of pregnant women not receiving proper antenatal counseling about the appropriate method of delivery, with improper justification to jump over nature. Conclusion: Cesarean section should be signposted when on earth there is any indication or menace of detriment to the maternal and fetal binomial. If in earlier times "labor death" was a fact of life, nowadays it is astonishing and disgraceful the death of a mother due to pregnancy-delivery-postpartum. The proclamation that vaginal delivery is better because it is "natural" cannot and should not be taken to the last consequences under the risk of bad luck. The best form of birth is the safe one. To provide every pregnant woman with the right to choose her child's mode of delivery is to arbitrate for her sovereignty, yielding her respect and pride, nonetheless, it should be minimalistic and not absolute under this banner. Minimizing the rate of primary CS carries the secret key to ideal obstetrical care.

Effectiveness of Antenatal Counselling in Increasing the Acceptability and Insertion of Postplacental IUCD in Postpartum

Aim: To evaluate effectiveness of antenatal counselling in increasing the acceptability and insertion of Post Placental Intrauterine Contraceptive Device in postpartum women Study design: Prospective study. Place and duration of study: Department of Obstetrics & Gynaecology, Hayatabad Medical Complex, Peshawar from 1st April 2022 to 30th September 2022. Methodology: Fifty pregnant women were enrolled. The age of the pregnant women was taken within 18-43 years. The couples were counselled for the uptake of PPIUCD through gynaecological professional assistance. The counselling was done at 28 weeks followed by at 36 weeks. The misconceptions and myths were eradicated through the use of one-to-one interview as well as focus group discussions. The fears of the patients and their spouse were addressed through detailed discussion. Results: The mean age was 24.8±4.06 years. There were 70% of the pregnant women who agreed to get PPIUCD inserted, however only 42% actually underwent the procedure. Majority of the cases were within the age group of 18-28 years. The reasons recorded for not getting PPIUCD insertion previously presented data where 23% of the pregnant women had no awareness provided about PPIUCD before while 13% preferred other contraceptive methods. Conclusion: The outcomes of the antenatal counselling are higher uptake of post placental intrauterine contraceptive device with a rate of 42% increase in post-partum women. There is an evident reduction in misconceptions and myths about post-placental intrauterine contraceptive device through antenatal counselling. Key words: Antenatal counselling, Outcome, Intrauterine contraceptive device, Post-partum

Skin-to-skin contact in mothers with suspected, probable, or confirmed COVID-19.

The World Health Organization recommends skin-to-skin contact (SSC) in newborns of mothers with COVID-19, applying infection prevention and control measures, and after a process of antenatal counseling on the possible risks and benefits. In this study, the reasons given for and against postnatal SSC in mothers with COVID-19 were reviewed. Between November and December 2020, we conducted a scoping review. Twenty-six relevant studies were identified. The results were extracted and presented narratively. The reasons described for avoiding SSC have include contradictory recommendations, risk of virus transmission, impossibility of universal antepartum maternal screening for COVID-19, work overload, and ethical considerations. The reasons given for the maintenance of SSC include maternal and infant benefits of SSC, previous experiences in viral outbreaks, protection of newborns against infections, decreased contact with professionals, caregivers and surfaces, and preservation of natural processes. The recommendation to allow SSC is based primarily on the acceptance that horizontal perinatal transmission is unlikely if correct hygiene precautions are taken and that the benefits of SSC outweigh the potential risks of neonatal COVID-19 infection. Knowing the reasons that have motivated the current recommendations on SSC is essential to be able to carry out an effective prenatal parental education that allows a shared decision to be made.

The effects of maternal smoking on fetal cranial development. Findings from routine midtrimester sonographic anomaly screening

The aim of this study was to assess the effect of continued smoking before and during pregnancy on mid-trimester fetal head development. A total of 250 pregnant women enrolled in the study. All participants were confirmed to be smokers or non-smokers by verifying breath carbon monoxide readings. Biparietal diameter (BPD), head circumference (HC), lateral ventricle (LV), and cisterna magna (CM) were evaluated by ultrasound between 20–22 weeks of pregnancy. Gender and gestational age-adjusted BPD z- scores were not statistically different between smokers and non-smokers (−0.75 ± 1.6 vs −0.51 ± 1, p = .3). HC measurements and z- scores were significantly lower in the smoking group than in the non-smoking groups (183.38 ± 14.56 vs. 189.28 ± 12.53, p = .003, 0.18 ± 1.39 multiple of median (MoM) vs. 0.56 ± 0.92, respectively, p = .023). At linear regression analysis, maternal smoking was the only independent factor associated with fetal HC z score (p = .041). In conclusion, continued smoking during pregnancy reduces fetal HC and has no effect on BPD, LV, or CM measurements at mid-gestation. IMPACT STATEMENT What is already known on this subject? Smoking during pregnancy is one of the most common environmental factors affecting fetal and neonatal growth and well-being. Despite the well-known effects of smoking on somatic growth, current studies have shown that it selectively affects some parts of the fetal brain, even in appropriately growing fetuses. What do the results of this study add? Continued smoking during pregnancy reduces fetal HC and has no effect on BPD, LV or CM measurements at mid-gestation. Since smoking is well known for its early and late childhood behavioral and neurological consequences, smaller mid-trimester fetal HC measurements should bring maternal smoking to mind as one of the potentially reversible causes. What are the implications of these findings for clinical practice and/or further research? The harmful effects of smoking start before the third trimester and antenatal counseling should be started early in the gestation. Every effort should be made to quit smoking before or early in pregnancy.

Study protocol for a randomised controlled trial of a virtual antenatal intervention for improved diet and iron intake in Kapilvastu district, Nepal: VALID

IntroductionDespite evidence that iron and folic acid (IFA) supplements can improve anaemia in pregnant women, uptake in Nepal is suboptimal. We hypothesised that providing virtual counselling twice in mid-pregnancy, would...

Why Do Pregnant Mothers Prefer to Give Birth at Home After they Attended Antenatal Care Visits in Southern Ethiopia? A Phenomenological Study Design

Background: Common causes of maternal deaths are direct obstetric complications that can be managed by healthcare providers in health facilities. Women giving birth at home have a higher contribution to maternal mortality and morbidity as well as a poor fetal outcome. Sub-Saharan Africa accounts for an estimated 66% of all maternal deaths. This study aimed to explore why pregnant mothers prefer to deliver at home after antenatal care follow-up in South Ethiopia. Methods: Phenomenological study design was used to explore the factors that push women to home delivery despite antenatal care being provided. A purposive technique was used to recruit the twenty pregnant mothers for the focused group discussion and ten healthcare providers for an in-depth interview. The data saturation approach determined the sample size. A focused group discussion was commenced with women who had ANC follow-ups during pregnancy gave birth at home and came for immunization services in health facilities. The in-depth interview was done with physicians, midwives, health officers, and traditional birth attendants. Data were translated into English by a bilingual translator and analyzed thematically using Open Code software. The result was presented in a table and text. Results: The study includes a total of 20 women for FGDs, seven health professionals, and three traditional birth attendants from selected health facilities. The age of most FGD participants was 25-35 years. The ideas of the participants were grouped into five themes and subthemes. Fear of health professionals’ disrespect and abuse, a family decision on the place of delivery, lack of transport and money, traditional birth attendants’ acceptability by the community, and sociocultural influences were commonly raised as barriers to institutional delivery. Conclusion: Most of the barriers are related to behavioural issues, and effort should be made to change the behaviour of the community in general. Improving the quality of the antenatal care service and adequate counseling may be an appropriate intervention to increase health facilities' delivery.

P741 Do gastroenterology services need published standards for provision of antenatal care in patients with Inflammatory Bowel Disease? A local evaluation of UK practice

Abstract Background Inflammatory bowel disease (IBD) is common with 0.5-1% of the UK living with the disease. Poor disease control can result in adverse pregnancy outcomes including low birth weight and preterm labour. It is essential that pregnant patients with IBD receive care from physicians experienced in management of antenatal IBD. Furthermore patients must be equipped with the knowledge to make decisions on their care and the care of their new-born. Audit standards by Selinger et al 20201 for the British Society of Gastroenterology (endorsed by the British Maternal and Fetal Medicine Society) have been published for UK practice but local service standards are unknown. Methods Pregnant patients with Crohn’s disease (CD) and Ulcerative Colitis (UC) between 2017-2020 were identified with ICD-10 and OPSC-4 codes for a hospital with 650 inpatient beds and a catchment area of 450,000 with around 4,600 births per annum. The service was assessed against a 90% compliance standard for documentation of: a decision on biological therapy during pregnancy; discussion on mode of delivery (MoD); antenatal live vaccine counselling; and breast-feeding advice. Results 48 eligible patients were identified. Mean birth weight and delivery date were in line with the national average with no preterm births. 41 of 48 patients (85%) were in remission at the time of conception. 9 of 25 CD pregnancies were on biologics at conception and 7 of 9 (78%) discontinued this by 24-weeks gestation; one continued vedolizumab to 30-weeks and received antenatal vaccine counselling; one continued ustekinumab to 34-weeks. 4 out of 23 UC pregnancies were on biologics at conception; all ceased biologics by 24-weeks and vaccine counselling was not indicated. Only one published standard was achieved, with decision on biologics in pregnancy discussed in 100% (13/13). 3 standards were not met; MoD discussion (23%, 11/48); antenatal vaccine counselling (50%, 1/2); and breast-feeding advice (4%, 2/48). Conclusion Our service did not meet new standards for antenatal IBD care, demonstrating a need for improvement. We recommend that all IBD teams understand the expected service standards, perform a baseline service evaluation and develop clear patient pathways and departmental guidelines to identify pregnant patients with IBD. Clear patient information and close collaboration between obstetricians and gastroenterologists is essential to optimise the outcome for mother and baby. 1) Selinger C et al Standards for the provision of antenatal care for patients with inflammatory bowel disease: guidance endorsed by the British Society of Gastroenterology and the British Maternal and Fetal Medicine Society. Frontline Gastroenterology 2021;12:182-187 BMJ 2020

Improving Initial Steps during Neonatal Resuscitation: A Quality Improvement Study

Background Neonatal resuscitation guided by the Neonatal Resuscitation Program (NRP) algorithm is a frequently performed event. However, strict adherence to the algorithm is often lacking. This quality improvement study was conducted when we identified poor compliance with the NRP algorithm in the ‘initial steps’ as a problem in our hospital. Methods The study was carried out over 48 weeks with an aim to improve the early steps of the NRP algorithm in the delivery room from the existing baseline score (maximum score of 22) of 5 (22%) to at least 13 (60%). Objective scoring, which included 11 domains (maximum score of 2 for each) from antenatal counselling, team briefing, equipment check and initial steps, and the time taken to begin positive pressure ventilation (PPV) were taken as process measures. Improvement of score to >90%, PPV requirement, beginning of PPV within 60 s and the use of various checklists were studied as outcome measures, along with the balancing outcome of neonatal intensive care unit admission temperature. Statistical process control charts were used for data analysis with standard rules for upper and lower control limits. Results A total of 480 resuscitations were scored. All domains of scoring improved from the baseline to the sustenance phase. The control limit improved from a baseline score of 5.1–21 during the sustenance phase, while the time to start PPV improved from 93.7 to 61.7 seconds. There was a significant improvement in the use of checklists for antenatal counselling, team briefing, and equipment checks. The need for PPV remained the same, and it could be started in only 36.4% of households within 60 seconds. Conclusion Proper implementation of the initial steps of the NRP algorithm improved along with the time of initiation of PPV after the study, though no major change was documented in the need for PPV administration.

The Efficacy of the Prevention of Mother-to-Child Transmission (PMTCT) Program in Mitigating Pediatric HIV/AIDS Incidence in the Mansa District, Zambia

This qualitative study was set out to intricately explore the landscape of the Prevention of Mother-to-Child Transmission (PMTCT) program in the Mansa district in order to shed light on its multifaceted nature. Key informants, pivotal to the program, offered invaluable insights into its fundamental components, recent progress, encountered challenges, and proposed improvements. The study emphasized the paramount importance of early detection and timely intervention in preventing HIV transmission from mother to child. The study highlighted key areas of focus within the PMTCT program, as elucidated by informants, emphasizing the central role of antenatal care, HIV testing and counseling, provision of antiretroviral therapy (ART), and vigilant postnatal follow-up. Together, these elements constituted a comprehensive strategy for safeguarding maternal and child well-being, with a strong emphasis on early identification and effective intervention. Recent developments in the program portrayed an evolving landscape, including enhancements such as improved access to rapid testing, the integration of maternal and child health services, expanded community outreach efforts, and initiatives aimed at enhancing community awareness. These innovations underscored the program’s adaptability and unwavering commitment to extending its reach. However, the challenges that impeded the reduction of mother-to-child HIV transmission were deeply rooted and multifaceted, encompassing issues such as stigma, inadequacies in healthcare infrastructure, medication adherence challenges, geographic barriers, personnel shortages, and logistical complexities. In response to these challenges, key informants put forth practical recommendations to strengthen the PMTCT program. These recommendations included broader community awareness and education efforts, the fortification of peer support networks, increased allocation of resources for transportation, and continuous training and sensitization programs for healthcare providers. These measures were deemed vital for enhancing program effectiveness and improving the health outcomes of mothers and infants in the Mansa district.

STUDI KASUS: PENANGANAN PUTING LECET PADA IBU MENYUSUI

Exclusive breastfeeding is recognized as the single most effective preventive intervention to reduce child mortality in the world. Unfortunately, the success of this exclusive breastfeeding has still a lot of obstacles in daily practice. Breast pain due to nipple crack is one of the most common reasons for premature weaning of breastfeeding. This case study describes the management of midwifery care for Mrs. A, a 29-years-old primipara, who experienced nipple crack on the 19th day of postpartum. She was confused because her baby refused to be given milk formula while she had difficulty giving breastmilk because her nipple soreness. Expressed Breastmilk (EBM) was suggested to be applied topically on the nipple to heal the crack. Meanwhile correction of position and attachment as well as breast care were suggested to prevent repeated nipple trauma. The midwifery care provided in this case made Mrs. A was able to breastfeed her baby comfortably and the sores on her nipple had completely healed within 8 days. Single intervention is not enough to treat nipple crack for breastfeeding mothers. It is necessary to provide combination of continuous midwifery interventions so that the results are more effective. Interventions to prevent nipple trauma in breastfeeding mothers which include correct breastfeeding positions and techniques, breast care and EBM for topical use should be given as standard information provided by health workers in antenatal and postnatal counseling to ensure continuity of breastfeeding and the success of exclusive breastfeeding.

Quality Initiative to Reduce Failed Trial of Labor after Cesarean Using Calculated VBAC Success Likelihood.

Vaginal birth after cesarean can reduce morbidity associated with multiple cesarean deliveries. Failed vaginal birth after cesarean is associated with increased maternal and neonatal morbidity. The Maternal-Fetal Medicine Units Vaginal Birth After Cesarean calculator is a validated tool to predict the likelihood of successful trial of labor after cesarean. Predicted likelihood < 60% has been associated with increased maternal and neonatal morbidity. We sought to determine if formal incorporation of calculated vaginal birth after cesarean likelihood into patient-centered counseling would reduce failed vaginal birth after cesarean. This is a quality improvement intervention at a single tertiary-care academic medical center, in which standardized patient counseling was implemented, facilitated by an electronic medical record template featuring patient-specific likelihood of vaginal birth after cesarean success. Term singleton pregnancies with history of one to two cesareans were included; those with contraindication to labor were excluded. Historical controls (January 2016-December 2018, n = 693) were compared with a postimplementation cohort (January 2019-April 2020, n = 328). Primary outcome was failed vaginal birth after cesarean. Fewer patients in the postintervention cohort had a history of an arrest disorder (PRE: 48%, 330/693 vs. POST: 40%, 130/326, p = 0.03); demographics were otherwise similar, including the proportion of patients with <60% likelihood of success (PRE: 39%, 267/693, vs. POST: 38%, 125/326). Following implementation, induction of labor in patients with a <60% likelihood of successful vaginal birth after cesarean decreased from 17% (45/267) to 5% (6/125, p < 0.01). The proportion of failed vaginal birth after cesarean decreased from 33% (107/329) to 22% (32/143, p = 0.04). Overall vaginal birth after cesarean rate did not change (PRE: 32%, 222/693, vs. POST: 34%, 111/326, p = 0.52). An intervention targeting provider counseling that included a validated vaginal birth after cesarean success likelihood was associated with decreased risk of failed trial of labor after cesarean without affecting overall vaginal birth after cesarean rate. · Labored cesarean increases maternal morbidity.. · Application of the Maternal-Fetal Medicine Units (MFMU) calculator to antenatal counseling decreased labored cesarean.. · Application of the MFMU calculator to antenatal counseling did not decrease overall vaginal birth after cesarean rate..

Impact of placenta accreta spectrum (PAS) pathology on neonatal respiratory outcomes in cesarean hysterectomies

Objective Placenta accreta spectrum (PAS) is a continuum of disorders characterized by the pathologically adherent placenta to the uterine myometrium. Delivery by cesarean hysterectomy at 34–36 weeks is recommended to mitigate the risks of maternal morbidity. Iatrogenic preterm delivery, has potential neonatal implications; late preterm infants are at risk for significant respiratory morbidity. Neonatal outcomes in PAS neonates are not well described in the literature, we aimed to investigate these outcomes. Methods A case-control study was performed with 107 cases of pathology-confirmed PAS patients with singleton, non-anomalous, viable pregnancies, compared to 76 cases of placenta previa with prior cesarean section who underwent repeat cesarean section. All patients were delivered through our institution’s Placenta Accreta Program from 2005 to 2020. Rates of neonatal respiratory morbidity and related outcomes were analyzed. Results Maternal characteristics and antenatal complications were similar between groups, as were gestational age, steroid exposure, and emergent delivery. PAS was associated with increased use of general anesthesia (20 vs. 54%, p = .001), larger estimated blood loss (1875 vs. 6077 ml, p = .008), and longer post-operative stays (4.8 vs. 7.3 days, p = .01). PAS was also associated with neonatal increased rates of high flow nasal cannula (HFNC) (41 vs. 58%, p = .02), intubation (17 vs. 37%, p = .008), and duration of respiratory support (0 vs. 2 days, p = .03). There were no differences in rates of continuous positive airway pressure (CPAP)/positive pressure ventilation (PPV) (21 vs. 22%, p = .85), anemia, hyperbilirubinemia, or NICU length of stay. Multivariate analysis adjusting for general anesthesia demonstrated this variable confounded the impact of PAS pathology in respiratory outcomes the risk of the respiratory composite (adjusted odds ratio (aOR) 0.57, 95% CI [0.11, 2.82]), use of HFNC (aOR 0.33, 95% CI [0.08–1.48]), and intubation (aOR 1.29, 95% CI [0.25–6.75]), were no longer significant. Conclusions Based on these results, we conclude that PAS neonates have higher rates of respiratory morbidity and that general anesthesia is a significant contributor to these respiratory outcomes. This is important for the antenatal counseling of cases of PAS, especially if general anesthesia is anticipated or requested. Furthermore, it supports efforts to limit general anesthesia exposure of neonates when necessary.

A Prospective Study of Maternal and Perinatal Outcomes in Eclampsia in a Tertiary Care Centre

Background: The term eclampsia is derived from a Greek word, meaning like a flash of lightening. The onset of convulsions in a woman with pre-eclampsia that cannot be attributed to other causes is termed eclampsia. It is a major cause of maternal and fetal mortality and morbidity in our country. The management of eclampsia is still challenging to the obstetrician, requiring the greatest skill, judgement, and patience. Methods and Materials: Our study is an observational and prospective study of 58 cases admitted with eclampsia in Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram. The study was extended from January 2020 to December 2021. The inclusion criteria were all the cases of eclampsia (antepartum and postpartum), primigravida and multigravida, duration of gestation&gt;20 weeks. Patients with convulsion during pregnancy or in puerperal period attributed to epilepsy or other causes were excluded from the study. Results: In our study majority of cases (58.6 %) belong to the younger age group /= 37 weeks). 55.2% had antepartum eclampsia, 36.2% postpartum and 8.6% had intrapartum eclampsia. Most common complication observed was need of blood or blood products transfusion (35 %), Hemolysis, Elevated Liver Enzymes Low Platelets (HELLP) syndrome (21%), prolonged Intensive Care Unit (ICU) admission (19%) followed by abruption, Disseminated Intravascular Coagulation (DIC), Acute Kidney Injury (AKI), Posterior Reversible Encephalopathy Syndrome (PRES), hypertensive retinopathy, pulmonary edema. Majority of patients (57%) underwent cesarean section, most common indication being poor bishop’s score with deteriorating maternal condition (54.5%). Out of 58 cases, 84.4% were live births and 15.6% were still born. 63.2% of all live births were small for gestational age, 44.8% had Neonatal Intensive Care Unit (NICU), and 8% had early neonatal death. Conclusion: Early pregnancy registration, good antenatal care and counselling about warning symptoms, early identification of pre-eclampsia and its complications, and timely intervention can reduce the incidence of eclampsia. Early identification of high-risk cases at primary healthcare facilities including severe pre-eclampsia, impending eclampsia and eclampsia and immediate referral to tertiary care centre equipped with multidisciplinary team, ICU and NICU facilities, might reduce fetal morbidities like prematurity, neonatal intensive care unit admission etc. and maternal morbidities like prolonged hospitalisation, AKI, DIC , pulmonary edema, multi organ dysfunction syndrome etc. and mortality.

Antenatal prediction models for outcomes of extremely and very preterm infants based on machine learning.

Predicting individual risks for adverse outcomes in preterm infants is necessary for perinatal management and antenatal counseling for their parents. To evaluate whether a machine learning approach can improve the prediction of severe infant outcomes beyond the performance of conventional logistic models, and to identify maternal and fetal factors that largely contribute to these outcomes. A population-based retrospective study was performed using clinical data of 31,157 infants born at < 32weeks of gestation and weighing ≤ 1500g, registered in the Neonatal Research Network of Japan between 2006 and 2015. We developed a conventional logistic model and 6 types of machine learning models based on 12 maternal and fetal factors. Discriminative ability was evaluated using the area under the receiver operating characteristic curves (AUROCs), and the importance of each factor in terms of its contribution to outcomes was evaluated using the SHAP (SHapley Additive exPlanations) value. The AUROCs of the most discriminative machine learning models were better than those of the conventional models for all outcomes. The AUROCs for in-hospital death and short-term adverse outcomes in the gradient boosting decision tree were significantly higher than those in the conventional model (p = 0.015 and p = 0.002, respectively). The SHAP value analyses showed that gestational age, birth weight, and antenatal corticosteroid treatment were the three most important factors associated with severe infant outcomes. Machine learning models improve the prediction of severe infant outcomes. Moreover, the machine learning approach provides insight into the potential risk factors for severe infant outcomes.

Antenatal Counselling for Anticipated Preterm Birth

Antenatal Counselling for Anticipated Preterm Birth

Knowledge of obstetric fistula and its associated factors among women of reproductive age in Northwestern Ethiopia: a community-based cross-sectional study

BackgroundObstetric fistula has been a major maternal health challenges in low and middle-income countries, especially in Ethiopia, due to high child marriage and poor access to healthcare. Obstetric fistula is common among teenage mothers that results in a vast social, economic and cultural sequel. In Ethiopia, there is a paucity of research evidence on women’s knowledge about obstetric fistula. Therefore, this study aimed to assess women’s knowledge about obstetric fistula and its associated factors at Banja District, Northwestern Ethiopia.MethodsA community-based cross-sectional study design was conducted from 1st -21th July 2021. Systematic sampling method was used to recruit 784 women in the reproductive age from six rural and one urban sub-districts. Two days of training was given to research assistants regarding the objective of the study, inclusion and exclusion criteria, checking completeness and ways of protecting confidentiality. Data were collected using face-to-face interview method. Collected data were entered into EpiData and exported into SPSS version 24 for cleaning and analysis. Descriptive statistics, binary and multivariable logistic regression analysis were performed to identify associated factors. Adjusted odds ratio (AOR) at 95% CI with p < 0.05 was used to declare significant association with women’s knowledge of obstetric fistula.ResultsA total of 773 women gave a complete response with response rate of 98.6% (773/784). One-third (36.4%; 95%CI: 32.9-39.7%) had good knowledge about obstetric fistula. Women who had completed primary education (AOR:3.47, 95%CI:2.01–5.98), secondary and above (AOR:3.30, 95%CI:1.88–5.80), being a student (AOR: 6.78, 95%CI:3.88–11.86), get counseling about obstetric fistula (AOR:6.22, 95%CI: 3.78–10.24), participated in pregnant women’s discussion forum (AOR:3.36, 95%CI: 1.99–5.66), had antenatal care follow-up (AOR: 2.40, 95% CI: 1.39–4.13), being an urban resident (AOR: 3.19, 95% CI: 1.33–7.66), and having access to Television/Radio (AOR:1.68, 95%CI:1.10–2.60) were significantly associated with women’s good knowledge about obstetric fistula.ConclusionWomen’s knowledge about obstetric fistula is unacceptably low. Therefore, concerned stakeholders should enhance awareness creation programs, strengthen antenatal care, counselling and women’s discussion forum that could substantially optimize women’s knowledge about obstetric fistula and its risk factors of obstetric fistula.

KNOWLEDGE REGARDING BREASTFEEDING - A CROSS-SECTIONAL SURVEY AMONG POSTPARTUM MOTHERS IN A NORTH INDIAN STATE

Objective: To assess the level of knowledge regarding breastfeeding among postpartum mothers who attended immunization clinics in four maternity hospitals in Allahabad, Uttar Pradesh. Design: Descriptive cross-sectional survey design. Setting: Four maternity hospitals in Allahabad, Uttar Pradesh, India. Participants: 400 postpartum mothers (up to 6 months) Methods: The data was collected after obtaining University ethical clearance and administrative permissions from the four maternity hospitals in Allahabad, Uttar Pradesh, India. 400 postpartum mothers who attended the immunization clinics (up to 6 months) were approached through convenience sampling technique. The participants were explained about the purpose of the study. Based on the inclusion and exclusion criteria, the participants were selected. Informed consent was taken from the participants. The demographic data and breastfeeding related knowledge questionnaire was collected from the participants. Results: Only [46(11.5%)] postpartum mothers had good breastfeeding knowledge, [255(63.7%)] had average knowledge and [99(24.8%)] mothers had poor breastfeeding knowledge. The mean knowledge score was 4.94±1.92 (maximum score = 12 with mean score % = 41.16). Conclusions: Mothers knowledge is a key factor for improving breastfeeding rates. The majority of the mothers attending immunization clinics were having insufficient knowledge regarding breastfeeding. This underlines the need for the involvement of health care professionals in educating mothers about breastfeeding. Implications for Practice: While developing countries strive to increase institutional births, there is a growing demand for a healthy atmosphere for breastfeeding in health care facilities. Improving the knowledge of expecting mothers in the antenatal period itself can bring in a lot of change in practice of breastfeeding as breastfeeding knowledge is an important factor for improving breastfeeding outcomes. Antenatal counseling regarding breastfeeding, arrangement of child birth classes to couples, provision of guidance and support, are some of the steps which can enhance confidence in mothers and can lead to successful establishment of breastfeeding.