Antenatal Unit Research Articles

Prevalence of Hepatitis B Viral Infection in Pregnant Women at the Suhum Municipality, Ghana

Background. Global prevalence of chronic hepatitis B virus (HBV) infection was estimated between 257 and 291 million since 2020, posing a great public health challenge. In Africa, an estimated 60 million cases of HBV were reported in the same year. Pregnant women might be susceptible to HBV infection dependent on their level of awareness and knowledge about the causes, transmission, and prevention of HBV. The aim of the study was to assess the awareness and prevalence of HBV infection and prolonged bleeding risk among pregnant women at the Suhum Municipality of Ghana. Methods. The study was a cross-sectional design involving pregnant women who were sampled following their visit to the antenatal unit at the Suhum Government Hospital. Sociodemographics including history of HBV screening and vaccinations were obtained from consented individuals using pretested questionnaires. Also, venous blood samples were obtained for platelet count, whereas bleeding time assay was performed to assess functional platelet disorders. Results. Hepatitis B prevalence was 4.4%, with 14.1% prevalence of mild thrombocytopenia and 1.5% prevalence of prolonged bleeding time. Pregnant women who had tertiary education and previous screening were about 8 times (AOR=7.78, 95% CI: 1.50-40.50) and 14 times (AOR=13.66, 95% CI: 1.72-108.75) more likely to have knowledge of hepatitis B than those without tertiary education and previous screening, respectively. Conclusion. The prevalence of HBV was 4.4%. Education status and previous screening were associated with demonstration of knowledge about HBV; therefore, intensification of education and screening are recommended.

The Impact of Educational Sessions on Anxiety Levels among Women Undergoing Caesarean Section: A Quasi-Experimental Study.

Although the Caesarean section (CS) is considered a harmless surgery, it has various complications. Women scheduled for elective CSs often have high levels of anxiety due to a lack of knowledge. The aim of this quantitative quasi-experimental study was to determine the relationship between preoperative educational sessions and anxiety levels among women undergoing CSs. The study was conducted at the antenatal unit in the King Faisal Medical Complex (KFMC) in Taif, Saudi Arabia, using a structured interview questionnaire, the State-Trait Anxiety Inventory (STAI), and satisfaction interviews. A total of 50 pregnant women participated in this study, who were divided into two groups: 25 participants in the intervention group and 25 in the control group. Most participants (92%) in the intervention group had low anxiety levels following educational sessions, and 96% of the participants were very satisfied with the preoperative information they had been given. Women in the control group (again, 92%) had high anxiety levels, and there was a significant difference in the anxiety levels of the intervention and control groups (p ≤ 0.5) after the educational sessions. Providing proper preoperative education about CSs can reduce preoperative anxiety, improve patient outcomes, and enhance patients' involvement in their care and decision-making.

Magnitude of Thrombocytopenia and Associated Factors among Pregnant Women Attending the Antenatal Care Service Unit of Wachemo University Nigist Ellen Mohammed Comprehensive Specialized Hospital Hosanna, Southern Ethiopia.

Thrombocytopenia is the second most common hematological disorder in pregnancy after anemia worldwide and affects 7-8% of all pregnancies. Pregnant women with thrombocytopenia have complications of excessive bleeding during or after childbirth, exudation at the cesarean section, and neonatal thrombocytopenia. Therefore, the main aim of this study was to assess the magnitude of thrombocytopenia and its associated factors among pregnant women attending the Antenatal Care Service Unit of Wachemo University Nigist Ellen Mohammed Comprehensive Specialized Hospital Hosanna, Southern Ethiopia. A cross-sectional study was conducted from June 1 to August 30, 2022, involving 209 consecutive pregnant women who came to the hospital during the study period for antenatal care follow-up. Sociodemographic, reproductive, and other clinical data were collected using a structured questionnaire. A four-milliliter venous blood specimen was collected for complete blood analysis and peripheral blood smear. The data were analyzed by using SPSS version 25. Descriptive statistical analysis and bivariate and multivariate logistic regression analyses were performed. A P value ≤0.05 was considered to indicate statistical significance. The overall magnitude of thrombocytopenia among pregnant women was 14.8% (95% CI: 10, 19.6). The prevalence of mild, moderate, and severe thrombocytopenia was 77.4%, 16.1%, and 6.5%, respectively. Multivariate logistic regression revealed that rural residence (AOR = 2.6 and 95% CI = 1.02, 7.12), cigarette smoking (AOR = 8.4 and 95% CI = 1.86, 38), anemia (AOR = 8.3 and 95% CI = 2.7, 25.6), and alcohol consumption (AOR = 8.2 and 95% CI = 2.17-31) were significantly independent factors associated with the development of thrombocytopenia. The magnitude of thrombocytopenia in this study was 14.8%. Rural residence, cigarette smoking, alcohol consumption, and anemia were significantly associated with thrombocytopenia. Therefore, the platelet count should be routinely determined during antenatal care visits for proper diagnosis and to minimize bleeding during and/or after childbirth.

Feasibility and Acceptability of Antenatal Hepatitis C Screening: A Pilot Study.

Hepatitis C virus (HCV) is not currently included in the United Kingdom routine antenatal screening program, but the latest guidelines from the Centers for Disease Control and Prevention, American Association for the Study of Liver Diseases, and Infectious Diseases Society of America recommend HCV screening for all pregnant women during each pregnancy. The aim of this study was to collect qualitative data on the feasibility and acceptability of antenatal HCV screening in pregnant women at the time of routine antenatal screening at 12 weeks, to estimate patient knowledge about HCV and identify the prevalence of HCV infection in antenatal women. This was a pilot study targeting a single hospital-based antenatal clinic in Birmingham, initially conducted for eight weeks with a further extension of the study period to enhance recruitment to meet the feasibility target of 500 patients. Data collected included demographic and epidemiological details. Pregnant women attending the antenatal unit were given information regarding HCV and antenatal screening for HCV prior to their initial antenatal visit. During the antenatal visit, research nurses provided further information about the study and HCV infection. Consent was obtained for taking part in the study and testing for HCV using blood samples taken at the same time as other routine antenatal screening blood tests. All women who agreed to participate in the study were asked to complete an acceptability and knowledge questionnaire. All women had HCV antibody testing as the primary screening assay. The test result was communicated in writing to the women and their general practitioner. Confirmatory positive antibody tests were followed up with quantitative HCV PCR and genotype analysis. The outcomes of testing were no evidence of HCV infection and evidence of past HCV infection or current HCV infection. Five hundred and forty-nine women were approached in the antenatal clinic; 30 women refused consent while 29 women were excluded from the study (blood tests not performed after consenting, age less than 18 years, and consent form lost). Four hundred and ninety women were included in the study. The median age of the study population was 29 years (range, 18-46). Knowledge about blood-borne viruses was limited; 75% of women had some understanding about antenatal hepatitis B (HBV) and human immunodeficiency virus (HIV) testing. Previous awareness about hepatitis C was reported by 55%. Ninety-one percent of women found the information they were given about hepatitis C helpful. Ninety-six percent of the women included in this study found the counselling they received about HCV useful and felt that the delivery of this information was carried out in an acceptable manner. Once given information about HCV, 99% felt that universal screening for HCV should be implemented. HCV antibody was negative in 489 women. One patient with a positive HCV antibody (prevalence: 0.2%) had a negative HCV PCR. Routine antenatal screening for HCV is not currently recommended in the UK. Our study suggests that antenatal HCV screening would be both feasible and acceptable to most pregnant women attending antenatal clinics. Though the awareness of HCV was low, with appropriate counselling and communication, 99% of pregnant women were in favor of antenatal screening for HCV. Antenatal screening would identify HCV-positive mothers and allow follow-up of their infants so that any infected mothers and infants could be offered effective curative therapy and prevent the progression of liver disease. The inclusion of HCV antenatal screening would complete the blood-borne virus profile and enhance the WHO target to eliminate HCV in the UK.

Study of Anemia during Pregnancy in Multigravida Women

Anemia is a prevailing health issue faced by many women during their pregnancy. World Health Organisation has proposed the level of hemoglobin in women during pregnancy to classify anemia. The present work was done on 204 women subjects of Darbhanga district who were pregnant, to study the pattern of anemia specially in multigravida women. Data was collected from different antenatal units. In the present study, we deduced that maximum number of women were anemic, also anemia had a higher prevalence in women with higher parity.

Molecular detection and association of HIV and HSV-2 IgM co-infection among asymptomatic pregnant women in Port Harcourt, Nigeria

HSV-2 is a common human pathogen that can cause primary and recurrent infection of the mucous membrane. Genital infection with HSV-2 facilitates the acquisition of HIV, both mutually reinforcing infection. Infection with herpes simplex virus type 2 is a significant public health problem being the leading cause of genital ulcerative disease. This study aimed at Molecular investigation and association of HIV and HSV-2 IgM co-infection among asymptomatic pregnant women in Port Harcourt, Nigeria. This is a cross-sectional study conducted at the antenatal unit of the University of Port Harcourt Teaching Hospital (UPTH), River State. A total of 168 consenting pregnant women were selected. The study involved collecting socio-demographic data and laboratory determination of HSV-2 immunoglobulin M (IgM) and HIV seroprevalence using enzyme linked immunosorbent assay (DIAPRO Diagnostic Bioprobes, Milan, Italy) and ALERE determine/STAT PAK respectively. Data analysis was done using graph pad statistical package. Chi square analysis was used to determine the correlation of the infection with socio-demographic factors. The seroprevalence for HSV-2 IgM was 29.8% (50/168) of the respondents while there was no co-infection between IgM and HIV. All HIV respondents were married. Majority are trader having tertiary educational qualification and are in a monogamous relationship. With regard to IgM seropositivity age, marital status, religion and gestation period were significantly associated with IgM while educational level, occupation, type of family and parity were not significantly associated with HSV-2 IgM. There is a significant correlation between HIV seropositivity with parity and history of sexually transmitted disease while there is no significant difference between HIV prevalence with age, marital status education level occupation type of family, religion history of abortion and the prevalence of HSV-2 was high among women of childbearing age in Port Harcourt, Nigeria. Effort should be made to increase the awareness of HSV-2 and HIV infection among the childbearing populace and serological testing of pregnant women should be included as a routine test.

Erythrocyte Indices in Asymptomatic Malaria Infected Pregnant Women

Background: Red blood cell changes are one of the most common complications in malaria and they play a very crucial role in malaria pathogenesis. Malaria infections are one of the common causes of maternal anaemia especially during pregnancy. The aim of this study was to determine red cell indices of pregnant women with asymptomatic malaria.
 Place and Duration of Study: Department of Haematology and Antenatal Unit both of Enugu State University of Science and Technology Teaching Hospital, between June and September 2022.
 Methodology: The study population consisted of 90 pregnant women (65 pregnant women positive to malaria parasite without symptoms and 25 pregnant women negative to malaria parasite) and 26 control non-pregnant women. For the whole study population, red cell indices which include hemoglobin (HGB), packed cell volume (PCV), red blood cell count (RBC), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width standard deviation (RDW-SD), red cell distribution width coefficient of variation (RDW-CV) were measured by automated haematology analyzer.
 Results: In the asymptomatic malaria group (AMG), 21 (32.3%) had mild anaemia (HGB level 9.0-10.0 g/dl), 11 (16.9%) had moderate anaemia (HGB level 7.0-8.0 g/dl) and 2 (3.1%) had severe anaemia (HGB level <7.0 g/dl). Also in AMG group, the RDW-SD was 54.22 +/- 11.45 fl, whereas in control group it was 48.75 +/- 10.24 fl (p=0.002). Again in the AMG group the MCHC of those that had two pluses was 318.03 +/- 16.31 g/l, whereas in those that had one plus, it was 309 +/- 20.17 g/l. The comparison between the first, second and third trimester showed significant decrease in HGB (7.63 +/- 1.36 vs 11.64 +/- 0.72 g/dl) and PCV (26.98 +/- 5.14 vs 36.20 +/- 2.19 %) in third trimester compared to first trimester (p= <0.001, <0.001). whereas RDW-CV (18.96 +/- 5.04 vs 15.00 +/- 2.64 %) and RDW-SD (59.04 +/- 15.19 vs 49.16+/- 7.00 fl) (p= 0.002, 0.003) significantly increased in third trimester compared to first trimester
 Conclusion: This study found anaemia in asymptomatic malaria infected pregnant women, significant decrease in haemoglobin and packed cell volume at third trimester, higher MCHC in those with two pluses of malaria and significant increase in red cell distribution width at third trimester.

Association between Socioeconomic Status and the Utilization of Maternal Health Services in Nigeria.

Maternal health is the mother's state of well-being before, during, and after conception. Studies have suggested that the increasing maternal mortality rate is preventable provided maternal health services are accessible during pregnancy. This study explored the association between socioeconomic status and the utilization of maternal health services in the Federal Medical Centre (FMC), Abeokuta, Ogun State. This study is a cross-sectional survey. One hundred and eighty-eight pregnant women from the antenatal unit of a tertiary hospital in Southwestern Nigeria were selected using a convenience sampling technique. Data were collected via a pretested, self-designed questionnaire. The descriptive statistics were used to analyze the resulting data, and the hypotheses were tested using the Pearson product-moment correlation at 0.05 level of significance. From the study, 72 (38.30%) and 58 (30.90%) agreed that their income and occupation influence their maternal health services utilization. Significant relationship (p < 0.05) existed between maternal health service utilization and age and between socioeconomic factors (occupation and income level) and utilization of maternal health services of pregnant women. Overall, this study revealed that the level of utilization of maternal health services among expectant women attending FMC is moderate. As this study has shown that socioeconomic factors influence the utilization of maternal health services, we recommend that interventions by health workers targeted at improving the utilization of maternal health services should consider these factors when designing such interventions. It is hoped that this will contribute to reducing maternal mortality and morbidity in this state.

Analysis of thyroid stimulating hormone (thyrotrophin) level as a gold standard marker for assessing frequency of subclinical hypothyroidism in the first fifteen weeks of gestation.

Objective: To find out the frequency of subclinical hypothyroidism in the first trimester of pregnancy. Study Design: Cross-Sectional study. Setting: Bacha Khan Medical Complex Swabi. Period: May 2019 to October 2019. Material &amp; Methods: Total ninety (90) subjects visiting antenatal unit were taken for the study by using non-probability sampling technique. The sample size was calculated by Andrew Fisher’s formula. After the informed consent 5ml of blood was collected in EDTA tube from the enrolled patient. The blood was centrifuged and their serum was preserved in cuvets for forthcoming TSH analysis. The cut-off value for TSH was 4.0 mIU/L as per new American guidelines 2017. Results: The cases were described according to their thyroid function tests. There were eleven (11) cases in which TSH value was more than 4.0 mIU/L. To rule out hypothyroid state we also do Ft4 for these cases whose results were normal. This interpretation identifies subclinical hypothyroid state in these cases. We did not perform ft4 for cases whose TSH was in normal range. The p-value &lt; 0.5 was considered significant. Pearson correlation values were given in the Table-III. Conclusion: it has been concluded from the results that pregnant women are associated with subclinical hypothyroidism (TSH &gt; 4.0 mIU/L and Free T4 within normal range) which requires proper assessment during pregnancy to avoid from any further risk.

The influence of pica practice on nutritional status, stress and anxiety of pregnant women

Pica is a minor disorder in pregnancy associated with strong craving for food or non -food substances of little or no nutritional value. ObjectiveThe study assesses the characteristics of pica practice among pregnant women and evaluates its influence on the nutritional status, anxiety and stress of pregnant women. MethodsA cross-sectional study was conducted among pregnant women attending the antenatal unit of a tertiary care hospital in Chennai, India. Pregnant women took a survey for presence of pica practice. Women with pica practice were assessed for dietary information, haemoglobin, pre-pregnant body mass index and stool analysis. Women's anxiety and stress were assessed using Beck anxiety inventory scale and Lipp Stress Inventory Scale. ResultsOut of 739 pregnant women screened, 220 (29.7%) women were found to practice pica. Of the 220 women, 42.2% ingested food substances, 41% ingested non-food substance and 16.8% consumed both. The most common substances craved for were: unripe mango (42.2%), pagophagia (23.8%), ash (41%) and geophagia (19%). Amongst the women with pica, 67.3% women had anaemia, 36% were underweight and 9.5% were overweight. About 40% women had low anxiety, 43% had moderate anxiety and 17% had severe anxiety. Distribution of women based on phases of stress found 15.4% in alert phase, 65% in resistance phase, 1.4% in near exhaustion phase, and 18.2% in exhaustions phase. ConclusionThe study identified that pica practice is not limited to ingestion of edible substances alone. Women practicing pica during pregnancy had anaemia, increased levels of stress and anxiety.

Factors associated with poor sleep quality and excessive daytime sleepiness in late pregnancy: A pilot study in an antenatal unit

Objectives: To assess factors associated with poor sleep quality and excessive daytime sleepiness (EDS) in late pregnancy.Methods: A cross sectional study was carried out on 109 pregnant women in their third trimester admitted to Teaching Hospital Peradeniya using validated Sinhala translations of both Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Consecutive sampling was used from February to April 2021.Results: Application of PSQI demonstrated that 59.6% had a poor overall sleep quality (PSQI score&gt;5). Subcomponent analysis showed poor sleep duration (&lt; 06 hours per day) in 27.5%, sleep latency of over 30 minutes in 29.4%, poor sleep efficiency among 33.9% and day-time dysfunction in 30.3%. Poor overall sleep quality was associated with presence of foetal movements (OR=11.8, 95% CI=1.5-93.5) and backache (OR=3.8, 95% CI=1.2-12.3). Poor sleep duration was associated with the presence of one or more pregnancy related complications (OR=3.4, 95% CI=1.4-8.5) and advanced maternal age over 35 years (OR=3.7, 95% CI=1.4-9.7). Increased sleep latency over 30 minutes was seen in mothers over 34 weeks of gestation (OR=9.1, 95% CI=2.9-28.6) and over 10kg of weight gain (OR=5.3, 95% CI=1.2-24.4). Application of ESS demonstrated 26.6% had EDS, which was associated with maternal employment (OR=2.8, 95% CI=1.1-7.1) and higher educational status (OR=4.7, 95% CI=1.5-15.1). EDS did not result in poor sleep quality, however, mothers experiencing insomnia had a higher PSQI score (Mean ± SD 7.2±3.7 vs 6.2±3.4 hours, p=0.044).Conclusion: Majority of pregnant women in third trimester had poor overall sleep quality. EDS was seen among one fourth. Modifiable risk factors were associated with poor sleep quality and EDS.

Awareness and Practice of Birth Preparedness and Complications Readiness among Pregnant Women in the COVID-19 era in Fako Division, Cameroon

Background: Birth Preparedness and Complication Readiness is a strategy to enhance the timely use of skilled maternal and neonatal care, especially during childbirth, based on the theory that preparing for childbirth and readiness for complications reduces delays in obtaining this care and reducing possible pregnancy risk. Sustainable Development Goal 3 has as one of its targets to reduce the global maternal mortality ratio to less than 70 per 100,000 births, with no country having a maternal mortality rate of more than twice the global average.&#x0D; Following the intensity of the problem, it is necessary to investigate ways to curb marternal mortality which is an essential component which should begin with awareness, and practice of birth preparedness readiness and complications and inturn vital in the management and development of intervention measures.&#x0D; Objective: of this study was to investigate the awareness and practice of birth preparedness and complication readiness among pregnant women in Fako Division.&#x0D; Methods: This was a community -based cross sectional study carried out in the Fako division of the South West Region, Cameroon. 163 pregnant women of ≥28 weeks gestational ages seen at the antenatal consultation units were selected using convenient sampling method. Data collected was analysed with SPSS version 25.0 and Microsoft excel 2010.&#x0D; Results: Of the 163 pregnant women included in this study, 129 (79.1%) were aware of birth preparedness and complication readiness. 136 (83.4%) had knowledge in recognising danger signs in pregnancy and Vaginal bleeding was the most frequent mentioned danger sign (72.4%). 80(49.1%) had excellent knowledge on danger signs, 59(36.2%) had good knowledge while 24(14.7%) had poor knowledge on key danger sign in pregnancy. The practice of birth preparedness and complication readiness, 47.9% had optimal practice, 37.4% had standard practice while 14.7% had poor practice.&#x0D; Conclusion: The findings of this study revealed that the awareness of birth preparedness and complication readiness was high. Few pregnant women lacked adequate preparations as required by the BPCR plan. The findings also indicated that the knowledge on danger signs in pregnancy among pregnant women in the BHD are high. Women’s knowledge of danger signs during pregnancy positively influenced their decisions regarding when to seek medical care and when to take appropriate action.

Sonological Evaluation of Ectopic Pregnancy-an Analysis of 50 Cases

Introduction: Ectopic pregnancy is the implantation of a fertilized egg in a location outside of the uterine cavity, including the fallopian tubes, cervix, ovary, cornual region of the uterus, and the abdominal cavity. Objective: To evaluate the sonological findings of ectopic pregnancy. Materials and Methods: A descriptive study was carried out at ultrasound unit in Lab-Aid diagnostic, Comfort Medical Services and Green View Diagnostic Complex in Sylhet city between January 2012 to January 2014. We included all cases with confirmed diagnosis of ectopic pregnancy, all antenatal mothers who are present in antenatal unit in a selected Hospital and excluded mothers with other associated medical condition. Results: Common clinical pattern were shock, marked pallor ness, abdominal pain, amenorrhea and irregular vaginal bleeding 52%, 66%,62%,54% and 38% respectively. Risk factor of ectopic pregnant in this study, 40% had history of infertility, 06% had Non tuberculous PID, 70% had no risk factor, 04% had tuberculous PID, 14% had previous abdominal pelvic surgery, 18% had previous ectopic and 10% had endometriosis. Conclusion: Common clinical pattern were shock, marked pallor ness, abdominal pain, amenorrhea and irregular vaginal bleeding. History of infertility, Non tuberculous PID, no risk factor, tuberculous PID, previous abdominal pelvic surgery, previous ectopic and endometriosis were risk factor of ectopic pregnant in this study. Medicine Today 2022 Vol.34(1): 75-78

Effect of Lifestyle Modification Guidelines on Mild Preeclampsia

Background: Preeclampsia has an adverse effect on both mother and fetus, and may be life-threating condition. Lifestyle modification can improve the clinical presentation of preeclampsia. Methods: Aim of the current study was to examine the effect of lifestyle modification guidelines on improving mild preeclampsia. A Quasi-experimental design was adopted on a purposive sample of 80 pregnant women with mild preeclampsia at the antenatal outpatient unit in Port Said Maternity Hospital, they were assigned into two groups; the study group received lifestyle modification guidelines alongside the routine care and pharmacological management, while the control group received the routine care and pharmacological management. Two tools were used for data collection, Interviewing Questionnaire Sheet and Follow Up Assessment Sheet. Results: The findings showed that lifestyle modifications guidelines lowering the mean of systolic and diastolic blood pressure, gestational weight gain, and proteinuria. Also, reducing risk of delivery before 34 weeks of gestation by 10.0%, delivery from 34 to 36 weeks of gestation by 30.0%, altered liver function by 22.5%, altered kidney function by 15.0%, and cardiac symptoms by 17.5%. Conclusion: Lifestyle modification guidelines alongside with routine care and pharmacological treatment are effective method in modifying mild preeclampsia and its complications

Exploring midwives' experiences of implementing the Labour Hopscotch Framework: A midwifery innovation.

INTRODUCTIONMidwives are ideally placed to promote physiological birth and improve women’s birth experiences. Freedom of movement in labor is highly recommended as it reduces a need for obstetric interventions in labor and prevents and corrects labor complications, such as poor progress and malposition of the fetus. The Labour Hopscotch Framework (LHF) provides women and midwives with a visual depiction of the steps they can undertake to remain active and, in this way, support physiological birth processes. The objective of this study was to explore midwives’ experiences of supporting women during labor with the Labour Hopscotch Framework and identify any improvements necessary to the Labour Hopscotch Framework.METHODSA two phased mixed-method sequential explanatory design study consisting of a survey (women, n=809 and partners, n=759) and focus group (n=8 midwives) was completed to evaluate the LHF following its implementation. This article presents the findings reporting midwives’ perceptions of using the Labour Hopscotch Framework with women and their birthing partners. The setting was a large urban teaching maternity hospital in Dublin, Ireland, where eight midwives practiced in the following areas: labor suite, antenatal unit, and community midwifery.RESULTSThe Labour Hopscotch Framework was described as beneficial in promoting physiological birth, using a creative, attractive visual depiction to guide women in, and before, labor. The Labour Hopscotch Framework was deemed helpful in increasing midwifery students and newly qualified midwives’ confidence to provide women with tangible, supportive assistance during labor and increased partners’ involvement in the labor process.CONCLUSIONSLabour Hopscotch Framework should be more widely promoted to all women attending the hospital for maternity care and a clear explanation of each step given and demonstrated to increase women’s understanding of the steps within. Labour Hopscotch training should be included in midwifery education programs.

Effects of lipid based Multiple Micronutrients Supplement on the birth outcome of underweight pre-eclamptic women: A randomized clinical trial.

ABSTRACTBackground and Objective:Maternal under nutrition and low birth weight babies are among the common tragedies of developing countries like Pakistan. Preeclampsia and its significant association with fetal growth restriction due to spiral arteries remodeling and trophoblastic invasion decreases nutritional supply to growing fetus added by maternal under nutrition. This study was designed to see the effects of lipid based nutritional supplements for pregnant and lactating women LNS-PLW on maternal and fetal outcome of pre-eclampsia.Methods:Sixty underweight pre-eclamptic women were randomly assigned into two study Groups from April 2018 to December 2019 at the antenatal units of the tertiary Health care facilities of Lady Reading Hospital, Hayatabad Medical Complex Peshawar and Civil Hospital Matta Swat, KPK Pakistan in a randomized clinical trial. Participants were on routine drugs for pre-eclampsia and Iron and Folic Acid (60mg, 400 μg) daily, while participant of Group-2 (n=30) received one sachet of Lipid based nutritional supplement for pregnant and lactating women LNS-PLW in addition daily till delivery. The birth weight, gestational age, head-circumference, and birth length of babies were measured.Results:The significant improvement found in the birth weight (p-value 0.003), gestational age (p-value 0.006), head circumference (P-value of 0.0006) and birth length (P-value of 0.0017) of babies of Group-2 women. We observed that addition of Lipid based nutritional supplement for pregnant and lactating women LNS-LPW improved the birth outcome in underweight women of pre-eclampsia.Conclusion:The Prenatal supplementation of Lipid based nutritional supplement for pregnant and lactating women LNS-PLW can improve birth weight, gestational age, length and head circumference of babies of underweight preeclamptic women.

Effect of Nutritional Program on Anemic Status and Pregnancy outcome among Pregnant Women Suffering from Iron Deficiency Anemia

Background: Iron deficiency anemia (IDA) is the most common nutritional disorder during pregnancy. The aim of this study: was to determine the effect of nutritional program on anemic status and pregnancy outcome among pregnant women suffering from iron deficiency anemia. Subjects and Method: The study was carried out at antenatal inpatient units and outpatient clinics in obstetrics and gynecological department at Tanta University and El-Menshawy Hospitals and four governmental antenatal clinics in Tanta city. Convenient sample of 60 pregnant women were included in the study and fulfilling the inclusive criteria. Five tools were used: Tool (I):A structured interview schedule included four parts: (a) Socio-demographic data, (b) Reproductive history, menstrual history, antenatal booking and attendance of antenatal care classes regarding IDA, (c) Current health history of women included: medical, surgical and also family history (d) History of iron deficiency anemia during current pregnancy. Tool (II): Women's knowledge assessment interview: it included two parts: a) Women's knowledge about iron deficiency anemia and b): Assessment of pregnant women's self-care measures and nutritional habits regarding iron deficiency anemia. Tool (III): Iron Intake Calculation Food Frequency Questionnaire it was used to assess women's iron dietary intake. Tool (IV): Bio-physiological measurement included: (a) Anthropometric measurements :Body Mass Index and Mid Upper Arm Circumference (MUAC), (b) Physical examination: to assess signs of iron deficiency anemia, (c) Measurement of serum hemoglobin level on capillary blood using one touch hemoglobin device(d) Stool analysis: was done to exclude parasitic infestation. Tool (V): Outcome assessment tool: included two parts, (a) Maternal outcome assessment sheet and (b) Neonatal outcome assessment sheet. Results: Itrevealed that mean blood hemoglobin level had increased from (9.05±0.98) pre-program to (11.8±0.95) at the end of the 2nd trimester and (10.74±0.93) at the end of the 3rd trimester. Conclusion: Significant improvement of the level of knowledge, dietary habits, anemic status (hemoglobin level) and the maternal & neonatal outcome were found after implementation of the program. Therefore, the study recommended: developing antenatal educational classes for all pregnant women to increase their awareness about importance of early and regular antenatal care as well as proper screening for early diagnosis and effective management of IDA to improve their pregnancy outcome.

Effect of effleurage massage versus water immersion with exercise on physiological foot edema among primigravidae

Introduction: Leg edema is a prevalent problem during pregnancy causing activity limitations for pregnant women. The study aimed to compare the effect of effleurage foot massage versus water immersion with exercise on physiological foot edema among primigravidae. Study design: A quasi experimental, comparative study was utilized. Setting: study was conducted at the outpatient clinic of antenatal unit at El Shatby Maternity Hospital. Subjects: The subjects of the study included 90 primigravida women who attended to antenatal unit. Tools: Three tools were used to collect the data: Tool 1: Pregnant women basic data structured interview schedule, Tool 2: Assessment Chart for Pitting Edema and Tool 3: Anon-elastic tape measure. Results: there was statistically significant decreased in mean circumferences of left and right (Ankle, Instep and MP joint) foot among the massage and immersion groups, compared to the control group immediately and After 5 days of intervention. Additionally +3 & +4 degrees of edema didn't observe among the massage and immersion groups, while they were observed among 56.7% and 23.3% respectively of the control group. There was statistically significant improvement in the degree of edema among both massage and immersion groups in favor of the massage group compared to the control group immediately after intervention (p=0.003), and after 5 days of intervention (P <0.001).Conclusion: the effleurage foot massage and water immersion exercise was significantly improved foot edema, when compared to control group. However, the effleurage foot massage was more effective than water immersion exercise in this respect. Recommendations: Effleurage massage and water immersion with exercise should be recommended in hospital protocols for management of physiological foot edema.

Elimination of Intravenous Di-2-Ethylhexyl Phthalate Exposure Abrogates Most Neonatal Hypertension in Premature Infants with Bronchopulmonary Dysplasia.

(1) Background: The incidence of hypertension in very low birthweight (VLBW) infants in a single neonatal intensive care unit (NICU) dropped markedly during a 2-year period when the IV fluid (IVF) in both the antenatal unit and the NICU temporarily changed to a di-2-ethylhexyl phthalate (DEHP)-free formulation. The objective of the current report is to document this observation and demonstrate the changes in incidence of hypertension were not associated with the variation in risk factors for hypertension; (2) Methods: The charts of all VLBW infants born in a single NICU during a 7-year span were reviewed. This time includes 32 months of baseline, 20 months of DEHP-free IVF, 20 months of IVF DEHP re-exposure, and two 4-month washout intervals. The group of interest was limited to VLBW infants with bronchopulmonary dysplasia (BPD). Chi-square analysis was used to compare incidence of hypertension among periods. Vermont Oxford NICU Registry data were examined for variation in maternal and neonatal risk factors for hypertension; Results: Incidence of hypertension in VLBW infants with BPD decreased from 7.7% (baseline) to 1.4% when IVF was DEHP-free, rising back to 10.1% when DEHP-containing IVF returned to use. Risk factors for neonatal hypertension were stable across the 3 study periods in the NICU’s group of VLBW infants; (3) Conclusions: Serendipitous removal of IVF containing DEHP resulted in near elimination of hypertension in one NICU—an effect entirely reversed after the same brand of DEHP-containing IVF returned to clinical use. These results suggest that DEHP exposure from IVF plays a major role in neonatal hypertension.

The Investigation of Streptococcus Agalactiae Colonization in Last Trimester Pregnants by Using Standard Culture and Molecular Methods

Objective: We aimed to detect and compare group B streptococcus (GBS) colonization in pregnant women at third trimester using real-time polymerase chain reaction (real-time PCR) and culture methods. Methods: Vaginal swab specimens were taken for screening of GBS from 100 women between 35-37 weeks of gestation who were attending to antenatal outpatient unit of Obstetrics and Gynecology Department of Cerrahpasa Medical Faculty from May 2014 to September 2014. Results: Rates of GBS colonization was %5 and %7 by culture and real-time PCR methods, respectively. Using culture as the gold standard; sensitivity and specificity for real-time PCR were 100% and 97.9%, respectively. Any significant difference was not detected between GBS colonization with age groups, education levels, number of previous pregnancies, smoking habits, history of antibiotic use, and contraceptive method. Conclusion: Real-time PCR technique has proven to be as sensitive as the culture method. Also, real-time PCR may provide a rapid diagnostic tool for GBS detection potentially allowing a more effective intrapartum antibiotic prophylaxis and lower infant morbidity and mortality. However, the inability to use PCR test in every laboratory and its high cost creates a handicap.