High-risk Pregnancy Care Research Articles

Harmonizing high-risk pregnancies: A comprehensive investigation into maternal and fetal well-being

High-risk pregnancies are a global concern, with maternal and fetal well-being at the forefront of clinical care. Pregnancy’s three trimesters bring distinct changes to mothers and fetal development, impacting maternal health through hormonal, physical, and emotional shifts. Fetal well-being is influenced by organ development, nutrition, oxygenation, and environmental exposures. Effective management of high-risk pregnancies necessitates a specialized, multidisciplinary approach. To comprehend this integrated approach, a comparative literature analysis using Atlas.ti software is essential. Findings reveal key aspects vital to high-risk pregnancy care, including intervention effectiveness, case characteristics, regional variations, economic implications, psychosocial impacts, holistic care, longitudinal studies, cultural factors, technological influences, and educational strategies. These findings inform current clinical practices and drive further research. Integration of knowledge across multidisciplinary care teams is pivotal for enhancing care for high-risk pregnancies, promoting maternal and fetal well-being worldwide.

SUCCESSFUL CONCEPTION AND FIRST PREGNANCY IN A 28-YEAR-OLD WOMAN WITH CERVICAL UTERINE MYOMA AND TOTAL PLACENTA PREVIA: A CASE REPORT

Background: Placenta previa is a major pregnancy complication associated with life-threatening hemorrhage. Cervical Uterine Myomas, benign smooth muscle tumors, increase the risk of placenta previa by two to three times, contributing to adverse pregnancy outcomes such as infection, urinary retention, preterm labor, and bleeding. Understanding the interaction between Cervical Uterine Myomas and placenta previa is crucial for optimizing care in high-risk pregnancies and improving maternal and fetal outcomes. Case Description: A 28-year-old primigravida (G1P0A0) patient was diagnosed with a breech presentation, Cervical Uterine Myoma, and total placenta previa at Klungkung Regional Hospital. The patient had a regular menstrual cycle and no history of comorbid conditions. The patient's management includes hospitalization with strict bed rest, followed by a scheduled elective cesarean section (CS). Fluid therapy will be administered using Ringer's lactate, and preoperative prophylactic antibiotics will be provided. Discussion: Cervical Uterine Myoma, particularly cervical myomas, can significantly impact pregnancy outcomes, with a prevalence of 1.6% to 10.7%. These fibroids, particularly large ones, increase the risk of placenta previa, a condition where the placenta partially or completely covers the cervix. The combination presents significant risks for both the obstetrician and the patient, including urinary retention, myoma degeneration, preterm labor, obstructed labor, and postpartum hemorrhage. Careful surgical planning and management strategies are crucial. Conclusion: A 28-year-old primigravida with breech presentation, Cervical Uterine Myoma, and total placenta previa was admitted after three days of abdominal pain and scheduled for an elective cesarean section at 36 weeks. The cesarean successfully delivered a healthy male infant, and a 10 x 10 cm cervical myoma was identified without complications. Postoperatively, the patient had a normal recovery with well-healing surgical wounds and was discharged in stable condition with appropriate medications.

Anxiety in Pregnancy: Comparing High-Risk and Normal Pregnant Women through the Beck Anxiety Inventory

Aim: Pregnancy is a critical life event that necessitates adaptation to numerous physical and psychological changes. While it often brings positive emotions, it can also induce significant stress and anxiety, especially in high-risk scenarios with potential maternal and fetal health concerns. This study aims to investigate whether there is a difference in anxiety levels between pregnant women under routine obstetric care and those under perinatology care for high-risk pregnancies. Material and Method: This cross-sectional survey was conducted at the Giresun Training and Research Hospital Obstetrics and Gynecology Hospital. Ninety pregnant women aged 18-40 were divided into two groups: 45 women receiving routine obstetric care (Group I) and 45 women receiving perinatology care for high-risk pregnancies (Group II). Data were collected using a 20-question socio-demographic and medical characteristics questionnaire, along with the Beck Anxiety Inventory. Results: The study found no significant difference in socio-demographic characteristics such as education, employment, and income status between the two groups (p>0.05). The Beck Anxiety Inventory scores indicated that both groups predominantly experienced low-level anxiety: 82.2% in Group I and 86.7% in Group II. Moderate anxiety was reported by 15.6% of Group I and 11.1% of Group II. Only 2.2% of participants in each group experienced severe anxiety. There was no significant difference in the overall anxiety levels between the two groups (p>0.05), although Group I reported higher heart palpitations (p

Neonatal screening of ABO/RhD blood group and direct antiglobulin Coombs test. Experience of a single institution.

Evaluating the ABO/RhD blood group and the direct antiglobulin Coombs test (DAT) at birth is recommended good practice, but there is variability in its universal implementation. This study aims to show the comparative results in various variables of clinical impact during the hospital stay of neonates with positive DAT compared with those with negative DAT, based on the systematic detection of the ABO/RhD group and DAT at birth. Newborns between 2017 and 2020 in a high-risk pregnancy care hospital were included. The ABO/RhD and DAT group was determined in umbilical cord samples or the first 24 hours of life. Demographic, maternal, and neonatal variables were recorded. The association between the variables was estimated using the odds ratio (OR). 8721 pairs were included. The DAT was positive in 239 newborns (2.7%), with the variables associated with positive PDC being maternal age > 40 years (OR: 1.5; 95% CI: 1.0 to 2.3), birth by cesarean section (1.4; 1.1-2.0), mother group O (6.4; 3.8-11.8), prematurity (3.6; 2.6-5.0), birth weight < 2500 g (2.1; 1.6-2.8), newborn group A (15.7; 10.7-23.1) and group B (17.6; 11.4-27.2), hemoglobin at birth < 13.5 g/dl (4.5; 2.8-7.1) and reticulocytosis > 9% (1.9; 1.2 to 3.1). The frequency of neonatal positive PDC was 2.7%, with a significant association with maternal/neonatal incompatibility to the ABO and RhD group, with a substantial impact on various neonatal variables. These results support the policy of universal implementation at the birth of the ABO/RhD and DAT determination.

Developing a Maternal Health Worker Training Program in Rural Mississippi [ID 2683576

INTRODUCTION: Mississippi faces the highest infant mortality rate and maternal mortality rate in the United States, with rates for Black women four times higher than for White women. Using community maternal health workers (MHWs) to support patients during pregnancy and postpartum has proven beneficial in other locations and could be transformative in rural Mississippi. We aimed to identify key patient needs to create a MHW training program in the rural Mississippi Delta, as a component of a broader maternal health quality improvement project. METHODS: We conducted quality improvement interviews with 18 obstetric patients (10 prenatal, 8 postpartum) at Delta Health Center, a federally qualified health center in Mound Bayou, Mississippi. We queried patients about strengths and gaps in their prenatal care and their opinions on MHWs. We also queried the obstetrics and gynecology and pediatrics teams at Delta Health Center to identify key pregnancy, postpartum, and infant care and development topics needed for MHW training. RESULTS: 17/18 (94%) of the patients interviewed were in support of the MHW program. The following themes emerged in patient interviews: desire for psychologic support, connection to community resources, and help managing high-risk pregnancy conditions. We designed a 2-week training for MHWs that covers: MHW Responsibilities, Pregnancy Care, Childbirth, Postpartum Care, and Newborn Care and Infant Development. Based on patient feedback, the training prioritizes content related to psychological support and high-risk pregnancy care. CONCLUSION: Patients expect MHWs to be valuable assets for their care. Maternal health workers have the potential to support pregnant women in rural health care settings, ultimately enhancing maternal–fetal health outcomes.

Early Triage and Emergency Obstetric Care in High-Risk Pregnancies and Impact on Their Outcome; A Cross-Sectional Study

Objective: To assess the role of early triage and emergency obstetric care for high-risk pregnancies and their outcome. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Bahawalpur Pakistan, from Jan 2021 to Jun 2022. Methodology: Women with high-risk pregnancies, aged 18-40 years, gestational age &gt;28 weeks, were included. Emergency obstetric care was provided to participants of the study. Maternal outcome was assessed regarding their hospital stay duration, morbidity, mortality and mode of delivery. The fetal outcome was in terms of intra-uterine death (IUD), Early neonatal death (ENND), and live births. Results: The mean age of patients was 28.1±3.49 years. Most of the patients belonged to high-order cesarean section and hypertensive disorders of pregnancy. 94.3% were delivered by cesarean section due to obstetric reasons, and hospital stay was an average of&gt; 72 hours in 57.7 %. Maternal mortality and morbidity were not observed. 99.9% of babies were live births, 0.7% ended into ENND, and one received an IUD. Conclusion: Early triage followed by the provision of emergency obstetric emergency care is recommended in high-risk pregnancies for optimum feto-maternal outcome.

Trends in cardiovascular complications of pregnancy: A nationwide inpatient sample analysis

BackgroundCardiovascular disease (CVD) is the leading cause of pregnancy-related mortality in the United States. Physiologic stress of pregnancy can induce several hemodynamic changes that contribute to an increased risk of cardiac complications in the peripartum period. There are ongoing efforts to improve cardiovascular mortality in pregnant patients. Understanding trends in cardiovascular complications during pregnancy may provide insight into improving care for high-risk pregnancies. MethodsWe retrospectively analyzed data from the National Inpatient Sample (NIS) Database and identified all inpatient hospitalizations for pregnancy and delivery. We then analyzed trends in the rates of cardiac complications in the pregnant patient. ResultsThere are concerning increases in trends of cardiac complications and comorbidities in pregnant people including: acute coronary syndrome, spontaneous coronary artery dissection, cardiogenic shock, pulmonary hypertension, chronic congestive heart failure, heart transplant, aortic syndromes, stroke, and pulmonary embolism. While the rates of STEMI have decreased, the incidence of peripartum cardiomyopathy has remained stable. ConclusionThere are concerning increases in certain cardiac complications during pregnancy. This is likely due to increasing age at the time of pregnancy and associated comorbidities.

What helps define outcomes in persistent uninterpretable non-invasive prenatal testing: Maternal factors, fetal fraction or quality scores?

To assess maternal characteristics and comorbidities in patients with persistent uninterpretable non-invasive prenatal testing (NIPT) and to evaluate the association with adverse pregnancy outcome in a general risk population. A retrospective cohort study (July 2017-December 2020) was conducted of patients with persistent uninterpretable NIPT samples. Maternal characteristics and pregnancy outcomes were compared with the general Belgian obstetric population. Of the 148 patients with persistent uninterpretable NIPT, 37 cases were due to a low fetal fraction (LFF) and 111 due to a low quality score (LQS). Both groups (LFF, LQS) showed more obesity (60.6%, 42.4%), multiple pregnancies (18.9%, 4.5%) and more obstetrical complications. In the LQS group, a high rate of maternal auto-immune disorders (30.6%) was seen and hypertensive complications (17.6%), preterm birth (17.6%) and neonatal intensive care unit (NICU) admission (22%) were significantly increased. In the LFF group hypertensive complications (21.6%), gestational diabetes (20.6%), preterm birth (27%), SGA (25.6%), major congenital malformations (11.4%), c-section rate (51.4%) and NICU admission (34.9%) were significantly increased. Chromosomal abnormalities were not increased in both groups. Patients with persistent uninterpretable NIPT have significantly more maternal obesity, comorbidities and adverse pregnancy outcome than the general population and should receive high-risk pregnancy care. Distinguishing between LFF and LQS optimizes counseling because maternal characteristics and pregnancy outcome differ between these groups.

Socioeconomic risk factors for low birth weight newborns: A population-based study.

Data was collected from a 4-year maternal-newborn registry. There were 5,316 LBW and 54,029 normal birth weight (NBW). The prevalence of LBW was 9%. The Native women in the LBW group compared to non-native women were 10.4% (1784/5316) vs. 8.4% (3532/5316) with a P-value of 0.001. There were more illiterate mothers in the LBW compared to the NBW, respectively: 8.1% (1597/19497) vs. 7.5% (1763/23230) with a P-value of 0.001. Working mothers tend to have more LBW infants compared to mothers with NBW, 8.4% (1588/17217) vs. 7.9% (2532/31891) and P-value 0.001. Young mothers (<20 years old) with early childbearing had more LBW compared to older mothers, respectively 12.7% (180/1414) vs. 8.9% (5149/52919) P-value <0.001. Women with no antenatal care reported a high rate of LBW compared to women with regular antenatal care: 14.2% (516/3696) vs. 8.6% (4741/55691) P-value <0.001. LBW babies were born more from assisted conception pregnancies (38% compared to 8.4% of normal pregnancies) P-value <0.001. Smoking mothers scored higher with LBW at 13.6% vs. 8.3% and a P-value of 0.001. There were no differences between the two groups regarding religion, consanguinity, marital status, or family income. Risk factors for low birth weight can be improved by providing antenatal care, smoking cessation, optimizing high-risk pregnancy care, and governing assisted reproduction regulations.

Performance of comprehensive first trimester fetal anatomy assessment.

Ultrasound assessment of the fetal anatomy and fetal echocardiography are feasible in the first trimester of pregnancy. This study was designed to assess the performance of a comprehensive fetal anatomy assessment in a high-risk population at a tertiary fetal medicine unit. A retrospective review of high-risk patients undergoing comprehensive fetal anatomy ultrasound assessment between 11weeks and 13+6weeks of gestation was conducted. Findings of the early anatomy ultrasound scan were compared with those of the second trimester anatomy scan, and birth outcomes or post-mortem results. Early anatomy ultrasounds were performed in 765 patients. The sensitivity of the scan for detecting fetal anomalies compared to the birth outcome was 80.5% (95% CI 73.5-86.3) and specificity was 93.1% (95%CI 90.6-95.2). Positive and negative predictive values were 78.5% (95% CI 71.4-84.6) and 93.9% (95% CI 91.4-95.8), respectively. The most missed and overdiagnosed abnormalities were ventricular septal defects. The second trimester ultrasound had sensitivity of 69.0% (95% CI 55.5-80.5) and specificity of 87.5% (95% CI 84.3-90.2). In a high-risk population, early assessments had similar performance metrics as the second trimester anatomy ultrasound. We advocate for a comprehensive fetal assessment in the care of high-risk pregnancies.

Obstetric vascular Doppler velocimetry: clinical applications and overuses.

A safe and non-intrusive assessment of fetal health is not only crucial in low-risk gestations, but it is also the standard of care in high-risk pregnancies. Therefore, measuring blood flow across different vessels with non-invasive ultrasound methods has been accurately and painstakingly studied and published. Amongst these state-of-the-art techniques, umbilical artery (blood flow) Doppler velocimetry (UADV) has allowed for fetal well-being follow-ups and assess uteroplacental function, which obtains a more complete and clearer picture; particularly in regard to complicated pregnancies. Additionally, there are other modalities with diverse clinical applications that have emerged, including their clinical and research utilization in conditions such as fetal growth restriction (FGR), preeclampsia, fetal anemia, monochorionic twins vascular blood flow mismatch such as is in twin-to-twin transfusion syndrome, twin anemia polycythemia sequence, and twin reverse arterial perfusion sequence. Nevertheless, their applications regarding various other maternal-fetal diagnoses in the same way as premature births and/or multiple gestation surveillance have not been reported to hold strong clinical evidence. With that in regard, the purpose of this unique study was to give update of the multiple clinical applications of this very important obstetrical tool. Additionally, to review the pathophysiology as well as revisit their reported significant valid uses and occasional overuses. We also delved into quality control measures as related to the application of Doppler in obstetrics. Lastly, it is essential to look through and reflect on the future developments of this valuable, non-invasive, high-risk marvelous modern device.

Indications for childbirth evacuation and obstetric outcomes among Nunavimmiut: A 5-year retrospective medical chart review

Childbirth evacuation, the transfer of Indigenous patients to tertiary centers for high-risk pregnancy care or childbirth, is linked to widening health disparities between Indigenous and non-Indigenous women in Quebec. We examined the indications and outcomes of childbirth evacuation among Nunavimmiut transferred to a single tertiary care center.

Impact of the COVID-19 pandemic on obstetrical care at a tertiary care facility in Mombasa, Kenya: Time-series analyses and staff perspectives.

The COVID-19 pandemic caused disruption in healthcare delivery due to reductions in both health facility capacity and care-seeking behavior. For women experiencing obstetric complications, access to comprehensive emergency obstetric care is critical for maternal and child health. In Kenya, pandemic-related restrictions began in March 2020 and were compounded by a healthcare worker strike in December 2020. We examined medical record data at Coast General Teaching and Referral Hospital, a large public hospital, and conducted staff interviews to understand how healthcare disruptions impacted care delivery and perinatal outcomes. Routinely collected data from all mother-baby dyads admitted to the Labor and Delivery Ward from January 2019 through March 2021 were included in interrupted time-series analyses. Outcomes included number of admissions and proportion of deliveries that resulted in caesarean sections and adverse birth outcomes. Interviews were conducted with nurses and medical officers to understand how the pandemic impacted clinical care. Pre-pandemic, the ward averaged 810 admissions/month, compared to 492 admissions/month post-pandemic (average monthly decrease: 24.9 admissions; 95% CI: -48.0, -1.8). The proportion of stillbirths increased 0.3% per month during the pandemic compared to the pre-pandemic period (95% CI: 0.1, 0.4). No significant differences were seen in the proportion of other adverse obstetrical outcomes. Interview results suggested that pandemic-related disruptions included reduced access to surgical theaters and protective equipment, and absence of COVID-19 guidelines. While these disruptions were perceived as impacting care for high-risk pregnancies, providers believed that overall quality of care did not diminish during the pandemic. However, they expressed concern about a likely increase in at-home births. In conclusion, while the pandemic had minimal adverse impact on hospital-based obstetrical outcomes, it reduced the number of patients able to access care. Emergency preparedness guidelines and public health messaging promoting timely obstetrical care are needed to ensure continuation of services during future healthcare disruptions.

The Impact of the COVID-19 Pandemic on Neonatal Services: A Review Article

Introduction: The COVID-19 pandemic has significantly impacted healthcare systems worldwide, including neonatal services. The pandemic has disrupted the delivery of neonatal care, leading to challenges in providing essential services to newborns and their families. This review article aims to explore the impact of COVID-19 on neonatal services and identify strategies for mitigating the effects of the pandemic.&#x0D; Methods: A literature search was conducted using PubMed, Embase, and Cochrane Library databases. The search terms used were "COVID-19," "neonatal care," "neonatal services," "prematurity," "low birth weight," and "infant mortality." Articles published between January 2020 and August 2021 were included in this review.&#x0D; Results: The COVID-19 pandemic has reduced the number of antenatal visits, delayed referrals, and decreased access to specialized care for high-risk pregnancies. The pandemic has also disrupted the delivery of essential neonatal care services such as breastfeeding support, kangaroo mother care, and immunization programs. Moreover, there has been an increase in maternal stress and anxiety due to restrictions on visitation policies in neonatal intensive care units (NICUs). These factors have contributed to increased preterm births, low birth weight infants, and infant mortality rates.&#x0D; Conclusion: The COVID-19 pandemic has significantly impacted neonatal services worldwide. Maintaining essential neonatal care services during pandemics is crucial to prevent adverse outcomes for newborns and their families. Healthcare providers must implement strategies to mitigate the effects of the pandemic on neonatal care delivery. These strategies include telemedicine consultations for antenatal visits, home-based follow-up programs for high-risk pregnancies, virtual breastfeeding support groups, and modified visitation policies in NICUs.

Care Providers' Perspectives on Quality Prenatal Care in High-risk Pregnancies: A Qualitative Study.

A high-risk pregnancy (HRP) is adversely affects the health of the mother, baby, or both. Most prenatal care research, rather than quality concepts, focuses on the adequacy of prenatal care and describes the emotional-psychological experiences of women with HRP. The main purpose of this study was to explore the perspectives of healthcare professionals regarding the quality of prenatal care for women with HRP. This qualitative study was conducted in three university hospitals and 12 comprehensive health centers in Ahvaz (Iran) from December 2020 to May 2021. In the present study, 10 midwives, 2 executive directors, and 7 specialists were purposefully selected with maximum diversity. In-depth semi-structured individual interviews were used to collect the data. Data were analyzed concurrently using Elo and Kinga's content analysis. The MAXQDA software version 10 was used for data analysis. During data analysis, the 6 main categories "infrastructure for care provision", "optimal clinical care", "organizing referrals", "preconception care", "risk assessment", and "family-centered care" and 14 subcategories were identified. Our findings showed that professional groups focused on the technical aspects of caring. The findings from this study highlight several conditions that can affect the quality of prenatal care for women with HRP. Healthcare providers can use these factors to effectively manage HRPs, thereby improving pregnancy outcomes among women with HRPs.

Preeclampsia Onset, Days to Delivery, and Autism Spectrum Disorders in Offspring: Clinical Birth Cohort Study.

Maternal preeclampsia is associated with a risk of autism spectrum disorders (ASD) in offspring. However, it is unknown whether the increased ASD risk associated with preeclampsia is due to preeclampsia onset or clinical management of preeclampsia after onset, as clinical expectant management of preeclampsia allows pregnant women with this complication to remain pregnant for potentially weeks depending on the onset and severity. Identifying the risk associated with preeclampsia onset and exposure provides evidence to support the care of high-risk pregnancies and reduce adverse effects on offspring. This study aimed to fill the knowledge gap by assessing the ASD risk in children associated with the gestational age of preeclampsia onset and the number of days from preeclampsia onset to delivery. This retrospective population-based clinical cohort study included 364,588 mother-child pairs of singleton births between 2001 and 2014 in a large integrated health care system in Southern California. Maternal social demographic and pregnancy health data, as well as ASD diagnosis in children by the age of 5 years, were extracted from electronic medical records. Cox regression models were used to assess hazard ratios (HRs) of ASD risk in children associated with gestational age of the first occurrence of preeclampsia and the number of days from first occurrence to delivery. Preeclampsia occurred in 16,205 (4.4%) out of 364,588 pregnancies; among the 16,205 pregnancies, 2727 (16.8%) first occurred at <34 weeks gestation, 4466 (27.6%) first occurred between 34 and 37 weeks, and 9012 (55.6%) first occurred at ≥37 weeks. Median days from preeclampsia onset to delivery were 4 (IQR 2,16) days, 1 (IQR 1,3) day, and 1 (IQR 0,1) day for those first occurring at <34, 34-37, and ≥37 weeks, respectively. Early preeclampsia onset was associated with greater ASD risk (P=.003); HRs were 1.62 (95% CI 1.33-1.98), 1.43 (95% CI 1.20-1.69), and 1.23 (95% CI 1.08-1.41), respectively, for onset at <34, 34-37, and ≥37 weeks, relative to the unexposed group. Within the preeclampsia group, the number of days from preeclampsia onset to delivery was not associated with ASD risk in children; the HR was 0.995 (95% CI 0.986-1.004) after adjusting for gestational age of preeclampsia onset. Preeclampsia during pregnancy was associated with ASD risk in children, and the risk was greater with earlier onset. However, the number of days from first preeclampsia onset to delivery was not associated with ASD risk in children. Our study suggests that ASD risk in children associated with preeclampsia is not increased by expectant management of preeclampsia in standard clinical practice. Our results emphasize the need to identify effective approaches to preventing the onset of preeclampsia, especially during early pregnancy. Further research is needed to confirm if this finding applies across different populations and clinical settings.

Considerations for Outpatient Prenatal Care for High-Risk Pregnancies

Considerations for Outpatient Prenatal Care for High-Risk Pregnancies

CASE STUDY IN HIGH RISK PREGNANCY

Background : The period of pregnancy, childbirth, postpartum and newborn is a physiological condition. However, normal conditions can become pathological so that every pregnant woman has a risk of experiencing complications. One condition that can cause complications is a high-risk pregnancy. Some categories of high-risk pregnancies are too young, too old, too close, and too many. With comprehensive midwifery care, midwives can perform early detection of complications that occur both during pregnancy, childbirth, postpartum and newborns.&#x0D; Methods : The aim of this case report is to provide comprehensive midwifery care for high risk pregnancies. The process of childbirth and the puerperium went normally without complications.&#x0D; Results :The client uses a depo progestin injection contraception device and the baby has received Hb0, BCG and Polio I immunizations and has gained 800 grams of weight. Conclussion : Optimal comprehensive midwifery care can prevent complications.

Start here- principles of effective undergraduate training.

Obstetric and gynaecology undergraduate training is an intense time for learners as they encounter various health conditions related to women's health and also learn about pregnancy care and birth. The experience is directed to familiarise students with basic clinical management of gynaecological conditions, also develop communication and related core examination and procedural skills. Similarly, midwifery training encompasses independent care of low-risk pregnant women and assist in care of high-risk pregnancy in partnership with obstetricians. Although its necessary to acquaint most learners with core clinical skills in obstetrics and gynaecology, learning opportunities on patients can be limited, due to the intrusive nature of women's health examination. Simulation Based Education (SBE) can facilitate learning hands-on clinical examination and procedural skills, using realistic part-task and high-fidelity simulators prior to approaching patients. This can apply to both medical and midwifery undergraduate training, further creating opportunities for professional interaction and shared learning space to facilitate interprofessional education. IPE has been shown to improve professional relationships in practicing clinicians. This learning pedagogy can be applied in the undergraduate setting as well, to decrease risk of conflict and appreciate roles of other interprofessional staff in future clinical practice. In this chapter we highlight some challenges faced by medical and midwifery undergraduates in their learning from a global perspective. We also describe some teaching and learning initiatives that can be applicable across various settings of obstetrics, gynaecology medical undergraduate and midwifery teaching with relevant case studies to facilitate new graduates preparedness for practice.

Antenatal screening of depressive and manic symptoms in south Brazilian childbearing women: A transversal study in advance of the pandemic scenario.

The diagnosis of mood disorders (MD) during pregnancy is challenging and may bring negative consequences to the maternal-fetal binomial. The long waitlist for specialized psychiatric evaluation in Brazil contributes to the treatment omission. Almost 20.0% of women treated with antidepressants have a positive screening for bipolar disorder. Therefore, it has been recommended the investigation of depressive and bipolar disorder during prenatal care. Unfortunately, the screening for mood disorders is not a reality in Brazil and many childbearing women remain undiagnosed. The objective of this study is to observe the frequency of MD and the effectiveness of screening scales for routine use by health professionals during prenatal care in high-risk pregnancies. This cross-sectional study included 61 childbearing women in their second trimester who were interviewed using the Edinburgh Postnatal Depression Scale (EPDS) and the Mood Disorder Questionnaire (MDQ). The cut-off point was EPDS ≥ 13 and MDQ ≥ 7 and the SCID-5 was the gold standard diagnosis. MD were diagnosed in 24.6% of the high-risk pregnancies. EDPS was positive in 19.7% and the frequency of major depression was 8.2%. 16.4% of the childbearing women were diagnosed with bipolar disorder, while MDQ was positive in 36.1%. 11.5% of the women had EPDS and MDQ positive. EPDS sensitivity was 80.0% and specificity 92.1%, whereas MDQ presented a sensitivity of 70.0% and specificity of 70.6%. There is a high prevalence of MD in high-risk pregnancies. The routine use of EPDS simultaneously to MDQ during antenatal care is effective and plays an important role in early diagnosis, counselling, and promotion of perinatal mental health.