Maternal Care Unit Research Articles

Strategies for Promoting Positive Childbirth Experiences: Delphi Approach

Background:: The experiences that women gain during childbirth remain with them throughout life. This study aimed to provide strategies to promote positive childbirth experiences. Method:: This Delphi study was conducted in three rounds from September to November 2019. A purposively selected 17 national experts, including obstetricians, reproductive health professionals, and midwives, participated in this study. Results:: Most of the 52 initial strategies in the first round (50 strategies) were approved with a few corrections in the first and second rounds, and 23 strategies were presented in the third-round questionnaire; most panelists agreed upon them. Finally, they approved 73 strategies with five categories: promoting professional support, enhancing control skills, encouraging empowerment, promoting spouse and other important support, and improving childbirth preparation. Conclusion:: The Delphi approach allows for developing a consensus that will serve as a template for education, practice, and future research in maternity care units. Hence, multidimensional approaches are required to promote positive childbirth experiences that can potentially improve mothers’ well-being outcomes.

Assessment of Women's Knowledge about the Risks of Medication Use During Pregnancy in Al - Najaf Provence

Objective: The current study aims to assess women's knowledge about the Risks of Medication Use during Pregnancy and determine the relationship between Women's Knowledge about the Risks of Medication Use during Pregnancy and demographic characteristics. Methodology: A descriptive design /cross sectional study was conducted using analytical utilities to accomplish the stated objectives. In the time frame of 1st November 2023 to 19th July 2024. A non-probability sampling (Purposive sample) approach was used, based on the following criteria: pregnant women in any stage of the pregnancy, including the first, second, and third trimesters (primi gravida and multigravida). A sample of 250 pregnant women was chosen from those admitted to Al-Zahraa Maternity Teaching Hospital/ Al-Furat Teaching Hospital/ AL-Hakim Teaching hospital / primary Health care centers (Maternal, child, and infant care units). Results: the results show the level of knowledge differs significantly (P<0.05) according to level of education in which women who have institute and above exhibited the highest level of knowledge (MS=2.05). On the other hand, women whose husbands work in free jobs showed the highest level of knowledge (MS=1.97) while those whose husbands are retired exhibited the lowest level of knowledge (MS=1.50). Regarding gestational age, pregnant women within the (18-22) weeks exhibited the highest knowledge (MS=2.03). Conclusion: The study found that Women knew very little about the possible effects of some medications on fetal development, on the other hand the participants had little awareness of the safety of anticonvulsants and medications for the common cold and flu. Women had moderate levels of knowledge regarding the safety of using paracetamol (acetaminophen) for pain and fever during pregnancy.

ENhancinG vAGinal dElivery in Greece through educational and behavioral interventions among maternity care providers regarding labor management: the ENGAGE stepped-wedge randomized prospective trial protocol

BackgroundThere is an emerging need to systematically investigate the causes for the increased cesarean section rates in Greece and undertake interventions so as to substantially reduce its rates. To this end, the ability of the participating Greek obstetricians to follow evidence-based guidelines and respond to other educational and behavioral interventions while managing labor will be explored, along with barriers and enablers. Herein discussed is the protocol of a stepped-wedge designed intervention trial in Greek maternity units with the aforementioned goals in mind, named ENGAGE (ENhancinG vAGinal dElivery in Greece).MethodsTwenty-two selected maternity units in Greece will participate in a multicenter stepped-wedge randomized prospective trial involving 20,000 to 25,000 births, with two of them entering the intervention period of the study each month (stepped randomization). The maternity care units entering the study will apply the suggested interventions for a period of 8–18 months depending on the time they enter the intervention stage of the study. There will also be an initial phase of the study lasting from 8 to 18 months including observation and recording of the routine practice (cesarean section, vaginal birth, and maternal and perinatal morbidity and mortality) in the participating units. The second phase, the intervention period, will include such interventions as the application of the HSOG (the Hellenic Society of Obstetrics and Gynecology) Guidelines on labor management, training on the correct interpretation of cardiotocography, and dealing with emergencies in vaginal deliveries, while the steering committee members will be available to discuss and implement organizational and behavioral changes, answer questions, clarify relevant issues, and provide practical instructions to the participating healthcare professionals during regular visits or video conferences. Furthermore, during the study, the results will be available for the participating units in order for them to monitor their own performance while also receiving feedback regarding their rates. Τhe final 2-month phase of the study will be devoted to completing follow-up questionnaires with data concerning maternal and neonatal morbidities that occurred after the completion of the intervention period. The total duration of the study is estimated at 28 months. The primary outcome assessed will be the cesarean section rate change and the secondary outcomes will be maternal and neonatal morbidity and mortality.DiscussionThe study is expected to yield new information on the effects, advantages, possibilities, and challenges of consistent clinical engagement and implementation of behavioral, educational, and organizational interventions described in detail in the protocol on cesarean section practice in Greece. The results may lead to new insights into means of improving the quality of maternal and neonatal care, particularly since this represents a shared effort to reduce the high cesarean section rates in Greece and, moreover, points the way to their reduction in other countries.Trial registrationNCT 04504500 (ClinicalTrials.gov). The trial was prospectively registered.Ethics Reference No: 320/23.6.2020, Bioethics and Conduct Committee, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

Health care providers attitude towards safe abortion care and its associated factors in Northwest, Ethiopia, 2021: a health facility-based cross-sectional study

BackgroundA negative attitude towards abortion among health care providers providing abortion services could be an obstacle even under a law, which permits abortion on request. Healthcare providers are expected to perform and be change agents of abortion services. However, little information is known about the attitude toward safe abortion among healthcare providers in Ethiopia.ObjectiveThis study aimed to assess health care provider’s attitudes towards safe abortion care and its associated factors at the public health facilities of Bahir Dar City, Northwest Ethiopia.MethodsA health facility-based cross-sectional study was employed from March 1 to 30/2021 among 416 health-care providers. The data were collected by computer-based generated simple random sampling technique, entered, coded, and cleaned using Epi data version 4.2 and analyzed using Statistical Package of Social Sciences version 25.0. Bivariate and multivariable logistic regression analyses were employed to estimate the crude and adjusted odds ratio with a confidence interval of 95% and a P-value of less than 0.05 considered statistically significant.ResultsThe response rate of the study was 99.3%, and 70.2% [95% CI: 65.6–74.6] of health-care providers had a favorable attitude towards safe abortion care. Multivariable analysis indicated that health care providers who are found in the age group of 25–29, 30–34, and ≥ 35 years [AOR = 3.34, 95% CI = 1.03–10.85], [AOR = 4.58, 95% CI = 1.33- 15.83] and [AOR = 5.30, 95% CI = 1.43–19.66] respectively, male health care providers [AOR = 3.20, 95% CI = 1.55–6.60], midwives [AOR = 6.50, 95% CI = 2.40–17.44], working at hospital [AOR = 4.77, 95% CI = 1.53–14.91], ever trained on safe abortion [AOR = 5.09, 95% CI = 2.29–11.32], practicing of an abortion procedure [AOR = 2.52, 95%, CI = 1.13–5.60], knowledge of abortion [AOR = 7.35, 95% CI = 3.23–16.71], awareness on revised abortion law [AOR = 6.44, 95% CI = 3.15–13.17] and need further legalization of abortion law [AOR = 11.78, 95% CI = 5.52–24.26] were associated with a favorable attitude towards safe abortion care.ConclusionsHealthcare providers who had a favorable attitude toward safe abortion care were relatively high compared to the previous studies. Age, sex, profession, workplace, training, knowledge, and practice-related factors were associated with a favorable attitude toward safe abortion. This study indicated that, a need for intervention to help improve the attitude of healthcare providers toward safe abortion care, especially for those working in the maternity care units.

A roller coaster of emotions. A content analysis of experiences and evaluations of hospitalization after birth

BackgroundMost new parents spend the first few days with their newborns in the hospital. Problem: Although negative hospital care experiences can have short- and long-term negative consequences (e.g., risk of postnatal depression), only a handful of studies have investigated experiences of maternity care after birth. Aim of the studyThe aim was to gather more detailed information on the experiences during the immediate postpartum period at the maternity ward, in order to confirm and complement previous findings with additional data sources. MethodsA content analysis was conducted on 524 textual units comprising ratings of maternity care units in Germany provided by mothers or accompanying individuals. These units were sourced from a publicly accessible website. FindingsThe analysis identified three overarching themes that influenced positive or negative experiences: Hospital and Maternity Ward Infrastructure; Midwifery, Medical, and Nursing Care; and Breastfeeding and Establishing a Breastfeeding Relationship. DiscussionThe findings indicate systemic challenges within the medical system, including persistent issues such as staff shortages and overworked personnel. Additionally, critical primary support structures related to early parental mental health care and breastfeeding initiation were found to be lacking in certain hospitals. ConclusionThese results underscore the necessity for structural reforms within hospitals to establish a comprehensive prevention network capable of early problem detection and intervention.

Intrapartum time intervals and transfer of nulliparae from community births to maternity care units in Germany.

Over one-third of nulliparae planning births either at home or in freestanding midwife-led birthing centers (community births) in high-income countries are transferred during labor. Perinatal data are reported each year in Germany for women planning community birth. So far, data sets have not been linked to describe time-related factors associated with nulliparous transfer to hospital. To describe the prevalence of referral for nulliparae and assess maternal and labor characteristics associated with intrapartum transfer. Perinatal data from 2010 to 2015 were linked (n = 26,115). Women were reviewed with respect to international eligibility criteria for community birth; 1997 women were excluded (7.6%). Descriptive statistics were reported; unadjusted and adjusted odds ratios with 95% confidence intervals (CI) tested the predictive effect of demographic and labor factors on rates of intrapartum transfer. One in three nulliparous women (30.6%) were transferred to hospital. Compared with community births, transferred women were significantly more likely to experience longer time intervals during labor: from rupture of membranes (ROM) until birth lasting 5 to 18 h (OR 6.05, CI 5.53-6.61) and 19 to 24 h (OR 10.83, CI 9.45-12.41) compared to one to 4 h; and from onset of labor until birth 11 to 24 h (OR 6.72, CI 6.24-7.23) and 25 to 29 h (OR 26.62, CI 22.77-31.11) compared to one to 10 h. When entering all factors into the model, we found the strongest predictors of transfer to be fetal distress, longer time intervals between ROM until birth and onset of labor until birth. Nulliparous transfer rates were similar to rates in other high-income countries; 94% of referrals were non-urgent. Time was found to be an independent risk factor for the transfer of nulliparae planning community birth.

Maternity Access in Rural America: The Role of Family Physicians in Providing Access to Cesarean Sections.

As an increasing number of rural hospitals close their maternity care units, many of the approximately 28 million reproductive-age women living in rural America do not have local access to obstetric services. We sought to describe the characteristics and distribution of cesarean section-providing family physicians who may provide critical services in maintaining obstetric access in rural hospitals. Using a cross-sectional study design, we linked data from the 2017 to 2022 American Board of Family Medicine's Continuting Certification Questionnaire on provision of cesarean sections as primary surgeon and practice characteristics to geographic data. Logistic regression determined associations with provision of cesarean sections. Of 28,526 family physicians, 589 (2.1%) provided cesarean sections as primary surgeon. Those who provided cesarean sections were more likely to be male (odds ratio (OR) = 1.573, 95% confidence limits (CL) 1.246-1.986), and work in rural health clinics (OR = 2.157, CL 1.397-3.330), small rural counties (OR = 4.038, CL 1.887-8.642), and in counties without obstetrician/gynecologists (OR = 2.163, CL 1.440-3.250). Although few in number, family physicians who provide cesarean sections as primary surgeon disproportionately serve rural communities and counties without obstetrician/gynecologists, suggesting that they provide access to obstetric services in these communities. Policies that support family physician training in cesarean sections and facilitate credentialing of trained family physicians could reverse the trend of closing obstetric units in rural communities and reduce disparities in maternal and infant health outcomes.

#4109 THE IMPACT OF IMPLEMENTING AN INNOVATIVE OBSTETRIC NEPHROLOGY SERVICE ON MATERNAL AND FETAL OUTCOMES IN WOMEN AT RISK OF PR-AKI

Abstract Background and Aims Pregnancy Related Acute kidney injury (PR-AKI) is a global health problem with substantial maternal and fetal morbidity and mortality. Late referral, and late diagnosis of women with risks of PR-AKI represent the major barriers for curtailment of this ugly trend, particularly in the developing world. Our past experience per se revealed striking maternal and fetal mortality of women with PR-AKI. Great strides are strongly needed to save maternal and fetal lives. This study assessed the impact of implementing an innovative obstetric nephrology service (ONS) and healthcare program on maternal and fetal outcomes in women at risk of PR-AKI. Method An innovative interdisciplinary obstetric nephrology clinic was established in 2020 to improve the quality of care for pregnant women at risk of PR-AKI. The service was staffed by both nephrologists and obstetricians. Women who presented to the clinic were stratified into low, moderate, and high-risk groups. A risk stratification-based care program was adopted. Very high-risk women were admitted to the maternal care unit. The study compared the outcomes of ONS-treated women who completed their follow up (n = 43) versus two groups of conventionally treated women (n = 40) and women presented before service (n = 40). Results Although they had greater pre-existing risks, ONS-treated women had no reported maternal or fetal mortality compared to women in the conventionally treated group (11.8% and 51.5% respectively), and to women presented before service (22.5% and 45% respectively). Progression to end-stage renal disease was significantly less in ONS-treated women compared to both conventionally treated and those treated before service (3% versus 13.2% and 37.5% respectively). Conclusion Easily feasible Obstetric nephrology service implementation and adoption of early referral program and diagnosis policies were associated with better maternal and fetal survival as well as better renal outcomes. Provision of parallel services is strongly recommended to decrease the magnitude of PR-AKI.

Comprehensive assessment of the implementation of maternal immunization programs in Italy: A national survey across maternity care units.

The authors aimed to assess the characteristics and integration of immunization services into the prenatal care provided by maternity care units (MCUs) in Italy. A cross-sectional nationwide study using a web-based survey was conducted from June to August 2021. The study population consisted of 342 obstetricians/gynecologists (OB/GYNs), members of the Italian Society of Gynecology and Obstetrics, and heads of MCUs. The main outcome was to assess the performance of several vaccine-related services among the surveyed MCUs. Overall, 112 of 342 MCUs completed the survey, for an overall response rate of 32.7%. Almost all MCUs (96.4%) provided vaccine information, but only 22% had an onsite vaccination clinic. Less than half (43.8%) offered vaccines during prenatal visits and 75% of those sites required women to set up an extra appointment for vaccination. Although 68% MCUs recorded vaccines administered, only 20% of them managed to record vaccines in their own medical records. The institutional-logistic issues were the most voted vaccination barrier (40.2%). Institutional barriers and lack of certain vaccine-related services offered during prenatal care in Italian MCUs might be responsible for many missed vaccination opportunities. Embedding maternal immunization programs within the current prenatal care services might optimize vaccine coverage.

Clinical Characteristics and Outcomes of an Intensive Maternal Care Unit in a Tertiary Hospital in the Philippines

Objectives. This is the first study that provides an overview of the characteristics of a specialized Intensive Maternal Care Unit (IMU) that caters to obstetric-related conditions in the Philippines. This study aims to describe the different kinds of cases admitted into this facility, the different medical and surgical interventions employed, length of hospital stay, and maternal and fetal outcomes of these patients.Methods. This is a cross-sectional descriptive study based on a chart review of medical records and admissioncharts of patients admitted to the Intensive Maternal Unit of a tertiary hospital in Manila from January 2017 toDecember 2019.Results. There were a total of 17,185 obstetric admissions from 2017-2019. There were a total of 841 admissions(4%) into the Intensive Maternal Unit, with an average of 280 admissions per year. The average length of Intensive Maternal Unit stay was 10.46 days and the average length of hospital stay was 12.98 days. Maternal outcomes were the following: 56.89% were discharged undelivered while 38.92% delivered on their initial admission. The maternal mortality rate was 2.39% among those admitted to the IMU. Among those discharged undelivered, 43% were re-admitted, 6% were admitted twice, and 4% were admitted three times. The most common reason for admission was pregnancy-related hypertensive diseases (34%). Blood transfusion (2.4%), the use of ventilator support (0.6%), and the use of inotropic drugs (0.6%) were the major medical interventions. Cesarean section was the most common surgical intervention, seen in 54.49% of patients. Most neonates were admitted to the neonatal ICU (23.95%), at an average pediatric age of 33 weeks, with an average length of stay in the Neonatal ICU of 12.33 days.Conclusion. Pregnant women are a special group of patients with different needs compared to the general patient population. Pregnancy-associated hypertensive disease is the most common cause of admission to the IMU and hospitals should be able to cater to these patients who will present in their institutions, as this may lead to poor maternal and neonatal outcomes. An Intensive Care Unit dedicated to complicated obstetric care in institutions is recommended to cater to high-risk pregnancies.

A Study of Etiological Spectrum of Maternal Near-miss Cases and Quality Care Indicators in Western Region of India

Background: Maternal death review has remained the fundamental quality care indicator for any maternal health-care governance program. Maternal near-miss (MNM) cases which are the forerunner of mortality cases could serve as a proxy indicator to evaluate the obstetric quality care. Objectives: To calculate MNM to mortality ratio of the institute and to study the etiological spectrum of MNM cases. Materials and Methods: A hospital-based prospective observational study was carried out. Cases were taken as defined based on the WHO MNM criteria. Data collection was done through information retrieval from case records and by in-depth interviews with the help of semi-structured questionnaire of MNM cases from 2 days after their admission up till discharge. Each case was documented with respect to the demographic details, adverse events and aetiology. Results: The MNM to mortality ratio was 1.16:1, MNM incidence ratio in our study was 4.12 and the mortality index was 46.23. Seventy-six per cent of cases were referred cases. The main causes for near-miss were post-partum haemorrhage (30%) followed by pre-eclampsia (26%). Hypertension was the most significant comorbidity in 28% of cases, while 26% had cardiac disease and 26% had severe anaemia. Conclusions: Studying near-miss mortality cases provides a valuable insight of the quality of care of the institute. MNM case review should be a part of regular governance process of the maternity care unit to plan and implement focused care.

Biochemical surveillance versus clinical observation of term infants born after prolonged rupture of membranes - A quality assurance initiative.

To examine whether biochemical surveillance vs clinical observation of term infants with prolonged rupture of membranes as a risk factor for early-onset sepsis is associated with differences in patient trajectories in maternity and neonatal intensive care units. A retrospective study of live-born infants with gestational age ≥ 37 + 0 weeks born after prolonged rupture of membranes (≥24h) in four Norwegian hospitals 2017-2019. Two hospitals used biochemical surveillance, and two used predominantly clinical observation to identify early-onset sepsis cases. The biochemical surveillance hospitals had more C-reactive protein measurements (p < 0.001), neonatal intensive care unit admissions (p < 0.001) and antibiotic treatment (p < 0.001). Hospitals using predominantly clinical observation initiated antibiotic treatment earlier in infants with suspected early-onset sepsis (p=0.04) but not in infants fulfilling early-onset sepsis diagnostic criteria (p=0.09). There was no difference in antibiotic treatment duration (p=0.59), fraction of infants fulfilling early-onset sepsis diagnostic criteria (p=0.49) or length of hospitalisation (p=0.30), and no early-onset sepsis-related adverse outcomes. The biochemical surveillance hospitals had more C-reactive protein measurements, but there was no difference in antibiotic treatment duration, early-onset sepsis cases, length of hospitalisation or adverse outcomes. Personnel resources needed for clinical surveillance should be weighed against the limitation of potentially painful procedures.

Competence of student accoucheurs on clinical practice as perceived by midwives in Limpopo Province, South Africa

Student accoucheurs were perceived to be uncomfortable conducting intimate clinical procedures, hence the struggle to attain the required clinical learning experiences when allocated in maternity wards. A qualitative explorative, descriptive, and contextual design was used. Five focus group discussions of midwives were purposively sampled. Data was collected through focus group discussion using a semi-structured interview guide. Data was collected until data saturation was reached. Data were analysed through Tesch’s open coding method. Trustworthiness was achieved through credibility, transferability, and confirmability. Ethical principles were adhered to and included were informed consent, beneficence, right to self-determination, confidentiality, and anonymity. The findings revealed two themes: the perceptions of the competence of student accoucheurs during clinical practice and the strengthening of clinical accompaniment. For improving the practice and competence of student accoucheurs, maternal directorate should consider recruiting, appointing, and placing or promoting existing accoucheur managers to manage maternity units to improve gender equity and role modelling for student accoucheurs in midwifery discipline. The willing and passionate must form part of the staff establishment in the maternity care units in order to familiarise women with nursing care rendered by student accoucheurs. The training institutions should incorporate cultural diversity in teaching student accoucheurs in midwifery care to ensure that they are equipped with knowledge to render maternal health to women of different cultures

Effect of Hoku point massage on postpartum afterpains intensity among multiparous women

Afterpains are high prevalent complaints. They lead to neuro-hormonal stress responses. Hoku point massage is used to relieve afterpains. Objective: determine the effect of Hoku point massage on postpartum afterpains intensity among multiparous women. Material and Methods: A quasi-experimental design was conducted at El-Shatby Maternity Hospital. A purposive sample of 100 women who were meeting the inclusion criteria. The control group was receiving routine hospital care and the experimental group was receiving Hoku point massage. Results: statistically significant difference was found between the control and experimental group regarding socio-demographic and reproductive data as well as physiological stability, as evidenced by vital signs, while there was a highly statically significant difference between the control and experimental groups in the favor of Hoku point massage. Conclusions and recommendations: Hoku point massage was effective in the reduction of postpartum afterpains intensity. multiparous women who receive Hoku point massage showed observable behaviors indicating less afterpains intensity than those who do not receive it. Researchers recommended that strict protocols should be established in maternity care units for a comprehensive and routine assessment of afterpains. Further studies should be conducted to verify the findings of this study.

Women's experiences of pregnancy after gastric bypass surgery.

INTRODUCTIONGlobally, 20% of women who become pregnant are obese at the time of conception. The prevalence of women becoming pregnant after gastric bypass (GBP) surgery has been increasing. Little is known regarding women’s experiences of pregnancy after GBP surgery and midwives can expect to care for an increasing number of women with prior GBP surgery. Midwives play an important role in supporting these women. The aim of this study was to describe women’s experiences of pregnancy after gastric bypass surgery.METHODSThis was a qualitative descriptive interview study using content analysis including 13 women who had a pre-pregnancy GBP surgery. Women were recruited at antenatal clinics, a specialist maternity care unit, and via social media.RESULTSThree categories emerged: ‘Importance of support’, which described the nature of support from midwives; ‘The presence of the baby in the womb’, which described the mother’s relationship to the unborn baby; and ‘Aggravating circumstances’, which described physical circumstances challenging the pregnancy and the experience of it.CONCLUSIONSWomen who became pregnant after GBP surgery described ambivalent feelings about their pregnant selves. More knowledge is needed in how prior GBP surgery affects pregnant women emotionally. The study found that specific training and guidelines for the care by midwives are warranted for this group of women. Employers should ensure highly competent midwives to care for pregnant women with pre-pregnancy GBP surgery. To increase the knowledge on women’s childbearing experiences after a GBP surgery, more research with a qualitative design is needed, as there is currently a large research gap on the topic.

Translated article] Implementation of Recommendations for the Management of Psoriasis During Preconception, Pregnancy, Postpartum, Breastfeeding, and Perinatal Care

ObjectiveTo analyze degree of implementation of recommendations on the management of psoriasis during preconception, pregnancy, postpartum, breastfeeding, and perinatal care published by the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV). MethodsWe designed a structured online survey consisting of closed questions. A link was emailed to all the members of the Psoriasis Working Group to collect their anonymous responses. We also collected sociodemographic, professional, and practice-related data related to the goals of the study and then compiled descriptive statistics to analyze the survey findings. ResultsWe received 53 responses for analysis. Overall, 96% of respondents were familiar with the recommendations, but very few of them worked in multidisciplinary maternity care units or had access to specific protocols on the management of psoriasis before, during, and after pregnancy in their departments. Seventy percent of dermatologists regularly ask their patients about pregnancy plans, but only 46% ask both men and women. Women also receive more preconception advice than men (54% vs. 19%). Significant variations were observed in the type of advice given. Ninety percent of the dermatologists interrupt topical treatments during pregnancy, and nearly all suspend conventional systemic drugs with the exception of cyclosporin A. Most biologics are also being discontinued in the third trimester, with the exception of certolizumab pegol. Almost all the respondents indicated that they use topical treatments, phototherapy, and certolizumab pegol in breastfeeding mothers. The main barriers to implementing the working group's recommendations are a lack of time, a lack of support, and a lack of robust data. ConclusionsAlthough the AEDV psoriasis working group's recommendations are widely known, areas for improvement remain.

Implementación de las recomendaciones sobre las actuaciones a seguir durante la edad fértil, el embarazo, el posparto, la lactancia y el cuidado perinatal en pacientes con psoriasis

ObjectiveTo analyze degree of implementation of recommendations on the management of psoriasis during preconception, pregnancy, postpartum, breastfeeding, and perinatal care published by the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV). MethodsWe designed a structured online survey consisting of closed questions. A link was emailed to all the members of the Psoriasis Working Group to collect their anonymous responses. We also collected sociodemographic, professional, and practice-related data related to the goals of the study and then compiled descriptive statistics to analyze the survey findings. ResultsWe received 53 responses for analysis. Overall, 96% of respondents were familiar with the recommendations, but very few of them worked in multidisciplinary maternity care units or had access to specific protocols on the management of psoriasis before, during, and after pregnancy in their departments. Seventy percent of dermatologists regularly ask their patients about pregnancy plans, but only 46% ask both men and women. Women also receive more preconception advice than men (54% vs. 19%). Significant variations were observed in the type of advice given. Ninety percent of the dermatologists interrupt topical treatments during pregnancy, and nearly all suspend conventional systemic drugs with the exception of cyclosporin A. Most biologics are also being discontinued in the third trimester, with the exception of certolizumab pegol. Almost all the respondents indicated that they use topical treatments, phototherapy, and certolizumab pegol in breastfeeding mothers. The main barriers to implementing the working group's recommendations are a lack of time, a lack of support, and a lack of robust data. ConclusionsAlthough the AEDV psoriasis working group's recommendations are widely known, areas for improvement remain.

Maternal special care unit in the delivery suite: experience from Prince of Wales Hospital

Maternal special care unit in the delivery suite: experience from Prince of Wales Hospital

Effect of Educational Program on Nurse's Knowledge, Practice and Attitude Regarding Covid -19 at Maternity Care Units

Effect of Educational Program on Nurse's Knowledge, Practice and Attitude Regarding Covid -19 at Maternity Care Units

Prevalence and risk factors of labor-onset hypertension: A multicenter study in Japan.

To investigate the prevalence and risk factors of labor-onset hypertension (LOH), defined as hypertension first detected during labor among women without hypertension prior to admission for labor. In this multicenter retrospective study, clinical data of women who delivered vaginally at term between 2012 and 2018 were collected from 12 primary maternity care units. Blood pressure was measured at five time points from admission to 2h postpartum in a total of 30,129 normotensive women at the last prenatal check-up. LOH was defined as systolic blood pressure (SBP) of≥140mmHg or diastolic blood pressure (DBP) of≥90mmHg during the first to fourth stages of labor. Multivariate regression analyses were conducted to evaluate the risk factors of LOH and severe LOH (SBP of≥160mmHg or DBP of≥110mmHg). Among the 30,129 women, 8,565 (28.4%) presented with LOH and 734 (2.4%) with severe LOH. The prevalence of LOH was the highest at the second stage of labor (21.7%) and decreased rapidly after delivery. The independent risk factors of LOH were maternal age of≥35years, pre-pregnancy body mass index of≥25kg/m2, and pregnancy weight gain of≥15kg. LOH is common, with approximately one in four women experiencing LOH during labor and early postpartum. Meanwhile, severe LOH occurred in 2.4% of the pregnancies. Closer blood pressure monitoring during labor may enable obstetric caregivers to recognize LOH in a timely manner and reduce maternal adverse outcomes, such as eclampsia and stroke.