Pregnancy Care Research Articles

Mental health and its relationship with quality of life in pregnant Iranian women with a history of primary infertility

Introduction: Considering the relatively high prevalence of infertility and its numerous psycho-social problems, the present study was conducted with the aim of investigating stress, depression, and anxiety and their relationship with the quality of life in pregnant women with a history of primary infertility. Method: This descriptive-analytical cross-sectional study was conducted on 120 pregnant women with a history of primary infertility who referred to the infertility clinic of Al-Zahra Hospital in Tabriz. Eligible participants were selected using a convenient sampling method. Data were collected using an individual-social questionnaire, the Cohen's Perceived Stress Scale, Edinburgh Postnatal Depression Scale, Vandenberg's Pregnancy-Related Anxiety Questionnaire, and Quality of Life Gravidarum. Data analysis was done in SPSS24 software using Pearson and Spearman correlation tests, independent t-test, one-way ANOVA, and multivariate linear regression. Results: The median (percentile 25-75) of perceived stress score in mothers was 44.0 (40.2-46.0). The mean±standard deviation scores of anxiety, depression, and quality of life were 66.1±11.4 (score range: 17-119), 16.3±3.2 (score range: 0-30), and 32.3±5.2 (score range: 9-63), respectively. There was no significant correlation between perceived stress and depression and quality of life; however, a significant negative correlation was observed between anxiety and quality of life. Conclusion: The results of the present study indicated a decrease in mental health in pregnant women following primary infertility. Moreover, anxiety scores had a significant and inverse correlation with quality of life. Therefore, it seems necessary to provide programs to improve the mental health of these women along with routine pregnancy care by health care providers.

Prevalence of hyperuricemia and associated factors among pregnant women in Vietnam: A cross-sectional study

PurposeHyperuricemia is a significant health concern worldwide. It is important to identify pregnant women who may be at risk to enhance pregnancy care. This study aims to investigate the prevalence of hyperuricemia and identify some factors associated with hyperuricemia among Vietnamese pregnant women. MethodsIn this cross-sectional study, 340 pregnant women were enrolled from May 2021 to December 2021. Demographic information, anthropometric data, and food frequency consumption (within 1 month before delivery) were collected from the participants. In addition, the biochemical indices of the participants were collected from medical records. Multivariate logistic regression was deployed to identify associated factors (p < 0.05). ResultsThe prevalence of hyperuricemia was estimated at 20.3 %. Factors associated with hyperuricemia risk among Vietnamese pregnant women include eating red meat (aOR: 2.3), eating animal organs (aOR: 2.5), not meeting vegetable recommendations (aOR: 6.7), hyper-total cholesterol (aOR: 2.4), disease during pregnancy (aOR: 3.5) and gestational weight gain below recommendations (aOR: 0.2). ConclusionsThe prevalence of hyperuricemia among pregnant women was relatively high at the National Hospital of Obstetrics and Gynecology, Hanoi, Vietnam. Consuming red meat and animal organs, not meeting vegetable recommendations, having high total cholesterol, and experiencing pregnancy-related diseases are the major factors associated with higher rates of hyperuricemia in this study.

Exploring Patient–Clinician Trust During Pregnancy Care

OBJECTIVE: To explore patient experiences and perspectives regarding trust in clinicians during pregnancy care among Latine patients, focusing on those with Spanish as their preferred language. METHODS: We conducted a qualitative focus group study to explore trust in pregnancy care clinicians. Eligible participants self-identified as Hispanic/Latine, reported Spanish or English as their preferred language, were pregnant or had given birth in the previous year, and were at least 18 years old. Participants completed a brief demographic survey. We report descriptive statistics for survey responses. A semistructured discussion guide was developed from a literature review and feedback from a patient advisory panel. We report emerging themes using a modified grounded theory approach with an analysis of focus group transcripts. We mapped themes to the five dimensions of trust according to the Building Trust Initiative—communication, caring, comfort, cost, and competency—and barriers to trust. RESULTS: We conducted eight focus groups (five in Spanish, three in English) through Zoom between July and September 2023. Cost was not discussed in any of the focus groups. Rather, there was an emerging theme around acompañamiento (accompaniment is a distinct form of companionship in which there is shared power during a shared journey), particularly in the Spanish focus groups. Barriers to building trust exist at the interpersonal and health system levels, including miscommunication, lack of continuity, and brevity of appointments. CONCLUSION: This study explores how trust is conceptualized in pregnancy care according to the perspectives of Latine patients. We found that acompañamiento is a unique and crucial dimension of trust among Spanish-speaking patients.

Hurricane Harvey and the risk of spontaneous preterm and early-term birth

Background: Hurricane Harvey made landfall in August 2017 and resulted in catastrophic flooding in Houston, Texas. Prior studies of hurricanes and preterm birth have found conflicting results. We tested the hypotheses that exposure to Hurricane Harvey was associated with a higher risk of spontaneous pre- and early-term birth and assessed vulnerable subpopulations. Methods: We conducted a retrospective study of singleton births using administrative birth records in the nine-county greater Houston area from 2015 to 2019. We estimated the likelihood of pre- and early-term births using logistic regression, comparing births occurring during or within 1, 2, or 4 weeks of Hurricane Harvey to unexposed reference periods encompassing the same dates 2 years prior and after. Stratified models assessed effect modification by degree of flooding, birth parent age, high- vs. low-risk pregnancy, race/ethnicity, and prenatal care. Results: Among 15,564 births, we found no association between exposure to Hurricane Harvey and spontaneous preterm birth within 1 week adjusted (odds ratio [OR], 1.06; 95% confidence interval [CI] = 0.91, 1.25) but a 14% higher odds of spontaneous early-term birth (OR, 1.14; 95% CI = 1.04, 1.25). The odds of early-term birth were even higher in neighborhoods with severe flooding (OR, 1.21; 95% CI = 1.05, 1.38), segregated neighborhoods (OR, 1.23; 95% CI = 1.03, 1.47), and among foreign-born Hispanics (OR, 1.21; 95% CI = 1.04, 1.53) and pregnant people receiving no prenatal care (OR, 1.37; 95% CI = 1.03, 1.82). Effect estimates were attenuated or null when considering 2-week or 4-week lags to define exposure. Conclusions: Hurricane Harvey was associated with higher odds of spontaneous early-term birth up to 1 week later, especially among socially marginalized populations.

Postpartum recovery after severe maternal morbidity in Kilifi, Kenya: a grounded theory of recovery trajectories beyond 42 days

IntroductionThe burden of severe maternal morbidity is highest in sub-Saharan Africa, and its relative contribution to maternal (ill) health may increase as maternal mortality continues to fall. Women’s perspective of...

Time to initiation of antenatal care and its predictors among pregnant women who delivered in Arba Minch town public health facilities, Gamo Zone, southern Ethiopia, 2023: a retrospective follow-up study

BackgroundEarly antenatal care visit is important for optimal care and health outcomes for women and children. In the study area, there is a lack of information about the time to initiation of antenatal care. So, this study aimed to determine the time to initiation of antenatal care visits and its predictors among pregnant women who delivered in Arba Minch town public health facilities.MethodsAn institution-based retrospective follow-up study was performed among 432 women. A systematic random sampling technique was employed to select the study participants. The Kaplan-Meier survival curve was used to estimate the survival time. A Multivariable Cox proportional hazard regression model was fitted to identify predictors of the time to initiation of antenatal care. An adjusted hazard ratio with a 95% confidence interval was used to assess statistical significance.ResultsThe median survival time to antenatal care initiation was 18 weeks (95% CI = (17, 19)). Urban residence (AHR = 2.67; 95% CI = 1.52, 4.71), Tertiary and above level of education of the women (AHR = 1.90; 95% CI = 1.28, 2.81), having pregnancy-related complications in a previous pregnancy (AHR = 1.53; 95% CI = 1.08, 2.16), not having antenatal care for previous pregnancy (AHR = 0.39; 95% CI = 0.21, 0.71) and unplanned pregnancy (AHR = 0.66; 95% CI = 0.48, 0.91) were statistically significant predictors.ConclusionHalf of the women initiate their antenatal care visit after 18 weeks of their pregnancy which is not in line with the recommendation of the World Health Organization. Urban residence, tertiary and above level of education of the women, having pregnancy-related complications in a previous pregnancy, not having previous antenatal care visits and unplanned pregnancy were predictors of the time to initiation of antenatal care. Therefore, targeted community outreach programs including educational campaigns regarding antenatal care for women who live in rural areas, who are less educated, and who have no previous antenatal care experience should be provided, and comprehensive family planning services to prevent unplanned pregnancy are needed.

The experiences of pregnancy and NHS maternity care for women who have been trafficked: A qualitative study

ProblemLittle is known about the maternity experiences of women who have been trafficked and further investigation is needed to better inform midwifery practice and to ensure that the voices of women are heard when developing guidance. BackgroundPeople who have been trafficked experience a range of health problems that could impact on pregnancy. AimThe aim of this study was to explore the experiences of pregnancy and NHS maternity care for women who have been trafficked, as well as increasing understanding of social and health factors that may impact on pregnancy outcomes. MethodsA qualitative interview study was conducted. Participants (professionals and service users) were recruited using purposive sampling. Data were analysed using thematic analysis.Findings: Seventeen interviews were conducted (5 service users and 12 professionals). Five themes were identified: ‘One Size Fits All’, ‘Loss of Control’, ‘Social Complexity’, ‘Bridging Gaps’, and ‘Emotional Load’. DiscussionOur findings identify that women are expected to fit into a standardised model of maternity care that does not always recognise their complex individual physical, emotional or social needs, or provide them with control. Support workers play a vital role in helping women navigate and make sense of their maternity care. ConclusionDespite the issues identified, our research highlighted the positive impact of individualised care, particularly when women received continuity of care. A joined-up, trauma-informed approach between midwives and support workers could help improve care for women who have been trafficked.

Antenatal care attendance, intermittent preventive treatment in pregnancy, and malaria knowledge: A cross-sectional study in government and private district hospitals

Ghana has made significant strides in maternal health care under the National Health Insurance Scheme, but more effort is required to achieve the Sustainable Development Goal (SDG) 3.1 target of fewer than 70 maternal deaths/100,000 live births, down from the current rate of 308 maternal deaths/100,000 live births. This study aimed to explore knowledge about antenatal care (ANC), antenatal attendance, malaria, and intermittent preventive treatment in pregnancy (IPTp) among pregnant women from two high malaria endemic areas: Mafi-Adidome (a rural community) visiting Adidome Government Hospital and Battor Dugame (a rural-urban community) visiting Battor Catholic Hospital. A total of 1295 consenting pregnant women participated in the study. Information on sociodemographic characteristics, as well as knowledge about ANC, IPTp, and malaria, were collected via questionnaires. Chi-square tests were used to compare the proportions of variables across the two study sites. A higher proportion of participants at Battor Catholic Hospital (70.8%) showed adequate knowledge about ANC compared to those at Adidome Government Hospital (38.1%) (&amp;chi;2[7] = 105.11; p &lt; 0.001). In addition, more participants at Battor Catholic Hospital (46.6%) showed adequate knowledge about the timing for IPTp administration compared to those at Adidome Government Hospital (21.1%) (&amp;chi;2[2] = 83.37; p &lt; 0.001). Although knowledge about malaria was generally low (0&amp;ndash;33.3%) at both health centers, a high proportion of participants (&gt;80%) possessed and used mosquito bed nets for malaria prevention. A lower proportion (46.6%) of participants at Battor Catholic Hospital made the WHO-recommended four to seven visits compared to 50.2% of participants at Adidome Government Hospital. Age, marital status, employment, and education influenced the utilization of antenatal and delivery services. Increased sensitization on the importance of ANC and hospital delivery is needed in these study areas.

Ethnic differences in physical activity participation when managing gestational diabetes mellitus: a mixed-methods study comparing ethnic Chinese migrants and Australian women

ABSTRACT Background Physical activity is a key component in gestational diabetes mellitus management to optimise glycaemic control and reduce adverse pregnancy outcomes. However, inadequate physical activity during pregnancy is common. Underpinned by a woman-centred pregnancy care model, appropriate strategies targeting patients’ cultural needs may facilitate physical activity participation. Ethnic Chinese migrants have a four-fold higher risk of gestational diabetes mellitus than the Australian Caucasian host population. To identify potentially effective disease management strategies to improve physical activity participation, understanding and comparing ethnic Chinese migrants’ and Caucasian women’s views will provide insights into developing an end-user-informed intervention. Aims This study aimed to compare perceptions and practices around physical activity participation during pregnancy between 44 ethnic Chinese migrants and 39 Australian-born Caucasian women with gestational diabetes mellitus. Methods This mixed-methods study used in-depth, semi-structured audio-recorded interviews, validated pregnancy physical activity questionnaires and pedometers. Qualitative data were thematically analysed and compared between ethnicities. SPSS (SPSS Inc) was used in quantitative data analysis. Data triangulation was made to identify patterns in participant characteristics, physical activity beliefs and participation. Results Despite both ethnic groups doing less physical activity than recommended, Chinese participants were less physically active than Caucasian participants. Chinese participants expressed greater safety concerns about physical activity and opted for a more sedentary lifestyle. Data triangulation indicated that non-Australian-born Chinese participants whose husbands were Asian were overcautious about miscarriage risk related to physical activity, which promoted a sedentary lifestyle. Chinese participants suggested individualised, specific physical activity advice on safe physical activity during pregnancy would mitigate their concerns. Caucasian participants reported that digital step measurement technologies motivated their participation in physical activity. Conclusion Different strategies are suggested by Chinese and Caucasian participants to improve physical activity participation to manage gestational diabetes mellitus among ethnic Chinese and Caucasian populations, which will be evaluated in future interventions.

#796 Obstetric nephrology in Europe: a survey of nephrologists’ self-reported experience and training

Abstract Background and Aims Chronic kidney disease (CKD) is estimated to affect 3% of pregnant women in high-income countries. The prevalence of CKD in pregnancy is predicted to rise due to advancing maternal age, obesity, and co-morbidities. There is a paucity of evidence regarding nephrologists’ experience in and exposure to women's health in Europe. North American literature reports two thirds of nephrologists self-reported a lack of confidence in women's health issues. This survey aimed to assess the confidence in and exposure to women's health among nephrologists in Europe. Method An anonymized online survey was conducted using the survey monkey platform from March to April 2023. A validated survey was utilised to ensure internal and external validity with minimal modifications made (Hendren, 2019). It was disseminated via email to Irish Nephrology Society membership, via link sharing on social media and messaging applications. Results were analysed using GraphPad prism. Results Demographics: A total of 75 participants responded, of those 52 identified as practising in Europe (22 Ireland and 30 other European countries). The results of respondents from Europe are detailed below. 63.46% (33) of respondents identified as female. 9.61% (5) were under 30 years of age, 42.3% (22) were aged from 30-40 years, 23.07% (12) were aged from 40-50 years, 23.07% (12) were aged from 50-60 years, and 1.92% (1) respondent over 60 years of age. Service provision: Women with kidney disease who are planning pregnancy are seen by the following Physicians: General or Transplant Nephrologist 63.46% (33), Nephrologist who specializes in pregnancy 42.31% (22), High Risk Obstetrician or Maternal Foetal Medicine Specialist 38.42% (20), Specialized interdisciplinary kidney disease in pregnancy clinic (Obstetrician and Nephrologist) 26.92% (14),Primary care doctor/family doctor 15.38% (8), Obstetrical Internal Medicine specialist 7.69% (4). Women with kidney disease who are pregnant are seen by the following Physicians: Nephrologist who specializes in pregnancy 40.38% (21), Specialized interdisciplinary kidney disease in pregnancy clinic (Obstetrician and Nephrologist) 34.62% (18),High Risk Obstetrician or Maternal Foetal Medicine Specialist 50% (26), General or Transplant Nephrologist 50% (26), Primary care doctor/family doctor 11.54% (6), Obstetrical Internal Medicine specialist 7.69% (4). 17.42% (9) of respondents had cared for &amp;lt;1 pregnant woman in the last year. Education: 73.07% (38) of respondents noted receiving dedicated education in women's health while in specialty training. Resources that were identified as potentially be helpful for counselling and management of women of childbearing age with CKD included: Interdisciplinary guidelines established by Obstetrics and Nephrology 80.77% (42), continuing education seminars or case based materials 78.85% (41), referral to a nephrologist with special interest and/or training in women's health 53.85% (28), patient education pamphlets or videos with shared decision making tools 44.23% (23), and access to e-consultation in 21.15% (11). Pregnancy counselling: 57.69% (30) of Nephrologists were confident/very confident in counselling on pregnancy outcomes by CKD stage. 48.08% (25) of Nephrologists were confident/very confident in counselling on foetal outcomes by CKD stage. 63.46% (33) of respondents offer pre-conception counselling to less than one women per month. Conclusion Nephrologists practising in Europe have varied exposure to and confidence in caring for women with kidney disease who are planning pregnancy or are pregnant. There is potential for improvement in training and expansion of combined obstetric and nephrology pre-conceptual counselling and pregnancy care. Further consultation with patient advocacy groups is required to plan future care delivery.

Naturopaths' engagement with preconception and perinatal care: A secondary analysis of the practitioner research collaboration and initiative

ObjectivesNaturopaths provide care to patients across all life stages and are visited by some members of their community for assistance with preconception, fertility, pregnancy and postnatal care. This study aims to describe the practice behaviours of naturopaths with a special interest in women’s health and who regularly provide care to pregnant women. MethodsA secondary analysis of data collected through the Practitioner Research and Collaboration Initiative (PRACI). ResultsOf the 281 naturopaths included in the analysis, 79.4% (n=223) indicated they have an interest in women’s health and 70.1% (n=110/157) reported regularly treating pregnant women. Naturopaths who identified as having a clinical interest in women’s health were more likely to be female rather than male (OR 12.9) and were more likely to regularly prescribe herbal infusions (OR 3.5). Naturopaths who regularly treated pregnant women were more likely to also treat infants and toddlers (OR 8.8). Naturopaths were also less likely to report having received their first qualifications 15 or more years ago compared to less than 15 years ago if they reported regularly treating pregnant women (OR 0.1–0.2). ConclusionsThe self-reported practice behaviours of naturopaths providing care to women for reproductve and maternal health suggest a possible alignment with the domains prioritised in global health recommendations, however the degree to which naturopaths are providing accurate information is unclear. Naturopaths may play a role in the contemporary delivery of maternal and child health care, but a closer examination is needed to ensure women are receiving the appropriate care during this important life stage.

#2130 Pregnancy in patients with chronic kidney disease stage 3 to 5: what to expect?

Abstract Background and Aims Chronic Kidney disease (CKD) has long been recognized as a risk factor for adverse pregnancy outcomes. Advanced CKD is also associated with decrease fertility, raising the importance of an early approach of pre- menopausal CKD women to discuss pregnancy planning and avoid long term kidney function deterioration or prematurity sequelae in their child-to-be. Method Retrospective analysis of maternal, obstetric and perinatal outcomes of patients with CKD stage 3 to 5, followed by the Nephro-obstetric clinical team between 2011 until 2023. Results We evaluated 31 gestations in 28 patients, with mean age of 32 years [19-43], 21 Caucasian and 7 African, 15 nulliparous, 21/28 with hypertension (HTN), 6/28 diabetic, 2/28 with HIV and 3/28 with systemic lupus erythematosus (SLE). CKD diagnosis occurred during pregnancy in 4/28 patients. Mean pre-pregnancy SCr was 2,1 ± 1 mg/dL [1,1-4,3] and mean proteinuria was 1535 ± 1874 mg/day [5 - 6000], and 11 patients had proteinuria &amp;gt;1 g/day. At gestation baseline, patients evaluated in each pregnancy were in CKD stage 3a (9/31), 3b (10/31), 4 (8/31) and 5 (4/31). CKD etiologies were heterogenous, with most common diagnosis being hereditary nephropathies (7/28), Diabetic nephropathy (6/28) and lupus nephritis (3/28). Exposure to teratogenic therapy occurred in 10/31 gestations (mean time of 11 weeks; 2 - 15), generally ACE/ARBs. Medical termination of pregnancy occurred in 3 gestations due to active SLE and severe growth restriction, 1 abortion at 16 weeks and 1 stillbirth due to cervical insufficiency. HTN aggravation occurred in 16/31 (52%) gestations and de novo proteinuria or proteinuria increase occurred in 7/31(22,5%) and 20/31 (64.5%) gestations, respectively due to pregnancy hyperfiltration, active lupus nephritis and preeclampsia. Considering pregnancies that progressed, renal function (RF) deterioration occurred 10/19 (53%) patients in CKD stage 3 with 20%/60%/20% with full/partial and no RF recovery, respectively. In CKD4 6/7 patients (86%) had RF aggravation with 17% and 83% with partial or no RF recovery. Of the 2 Patients in CKD stage 5 with gestation &amp;gt;20 weeks, 1 started dialysis during pregnancy and the other 4 months postpartum. Dialysis was initiated in 3 patients during pregnancy (2 CKD stage 4 and 1 CKD stage 5) due to urea level &amp;gt;100 mg/dL. RF deterioration was mainly due to pregnancy hyperfiltration and preeclampsia (11/26 gestations; 42%). Mean gestation age at delivery was 34 ± 4 weeks (28-41), with 73% and 53,8% pregnancies with gestational age &amp;lt;37 and 34 weeks, respectively. Mean birth weight was 1866 ± 707 g (555–3095 g), with 73% low birth weight (&amp;lt;2500 g). Mean Apgar 1/5/10 was 9/10/10, respectively. Cesarean was performed in 53,8% gestations and 61,5% newborns were admitted to the neonate care unit (NICU) due to prematurity Conclusion CKD patients with stage 3 to 5 are at increased risk of worse maternal outcomes, namely HTN aggravation (52%), de novo or increase proteinuria (87%) and RF deterioration (53% stage 3 and 86% stage 4) with significant permanent loss of kidney function. Obstetric and perinatal results were also significantly worse with a high incidence of preeclampsia (42%), prematurity (73%), low birth weight (73%) and the need of NICU (61.5%). It is of sum importance, that advanced CKD patients are previously counseled about those risks and are managed in a multidisciplinary feto- maternal clinic experienced in CKD pregnancy care that has a dialysis unit.

#2095 Genetic kidney disease in pregnancy – experience of tertiary referral hospital

Abstract Background and Aims Genetic kidney diseases (GKD) are rarely seen in pregnancy and some diagnosis will only be made during gestation, due to a high proportion of chronic kidney diseases (CKD) of unknown etiology and recent advances in genetic testing. Genetic counseling and, when possible, preimplantation genetic testing (PGT) should be offered pre-pregnancy to this specific CKD population. Method Retrospective analysis of maternal, obstetric and perinatal outcomes of pregnant women with GKD surveilled at Hospital Santa Maria, at the nephro-obstetric clinic from 2011 to 2023. Results We evaluated 34 pregnancies in 28 women, mean maternal age 30±6 years-old [21-37], 89% Caucasian. Molecular genetic testing was performed pre-pregnancy, during and post-pregnancy in 12/19, 2/19 and 5/19 patients, respectively. At baseline, mean serum creatinine (SCr) and proteinuria (Pr) was 1.0±0.9 mg/dL and 222±516 mg/g, with CKD stage 1/2/3/4/5 in 27/2/2/1/2 gestations and chronic hypertension (HTN) in 11/34 pregnancies. Only 1/28 patients performed PGT, while 1/28 patient declined it. De novo or increased Pr occurred in 10/34 gestations and de novo or worsening HTN in 5/34 gestations. Deterioration of renal function occurred in one patient (CKD3) without recovery and one patient (CKD5) induced dialysis 4 months post-pregnancy. Nephrotic Pr developed in 4/34 gestations. One patient (FSGS APOL1) was treated with tacrolimus and low dose steroids. The patient with TSC re-started sirolimus on week 22 to treat severe fetal ventricular rhabdomyoma. Miscarriage occurred in 2 pregnancies. The C section rate was 21,8%. There were 7 preterm deliveries of which 3 before 32 weeks of pregnancy, mainly due to severe preeclampsia. Mean gestational age at delivery was 37,6 ± 4 weeks (26-41), mean birth weight 2756 ± 831 g (560-3835). Eight newborns were admitted to neonatal ICU due prematurity, fetal TSC, and feeding difficulties. Pulmonary hemorrhage and sepsis caused the death of 2 newborns. We found 1 maternal death, due to rupture of a cerebral aneurism 1 month postpartum (PKD patient). Conclusion Our cohort was very heterogenous regarding CKD etiologies, but generally with good kidney function, which allowed overall good obstetric outcomes. Still, maternal, obstetric and fetal complications, namely HTN, Pr, PE and prematurity had an increased incidence compared to pregnancy in healthy patients. This particular population should be approached by an experienced multidisciplinary team in CKD pregnancy care to optimize outcome.

Midwives' and registered nurses' role and scope of practice in acute early pregnancy care services: a scoping review.

The objective of this scoping review was to investigate and describe what is reported on the role and scope of practice of midwives and registered nurses providing care for women with pregnancy complications under 20 weeks' gestation in acute clinical settings in Australia. In many high-income countries, women experiencing unexpected complications in early pregnancy attend an acute care service, such as an emergency department, rather than a maternity or obstetric unit. This service structure can impact the care women receive, and determine who provides it. Women and their partners, who are often experiencing emotional distress, have reported difficult experiences when accessing acute services, particularly emergency departments, which are not traditionally staffed by midwives. The role and scope of practice of both midwives and registered nurses providing acute early pregnancy care in most high-income countries, including Australia, is poorly reported. Documenting this area of practice is an important first step in facilitating ongoing research in this important aspect of pregnancy care. Published and gray literature that described the role and scope of practice of midwives and/or registered nurses providing care in acute early pregnancy settings in Australia were considered for this review. A scoping review of the literature was conducted following JBI methodological guidance and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist. A 3-step search strategy was conducted to explore evidence from databases and search engines, gray literature sources, and selected reference lists. After screening, data were extracted from records selected for the final review, mapped, and analyzed using content analysis. The evidence reviewed (n=23) included primary research studies, conference abstracts, and gray literature, such as clinical guidance documents, academic theses, and websites from January 2008 to October 2023. The most common setting for care provision was the emergency department. Midwives' and registered nurses' roles and scope of practice in acute early pregnancy care in Australia can be summarized into 4 areas: physical care, psychosocial support, care co-ordination, and communication. Women's access to midwifery care at this time in pregnancy appears to be limited. Registered nurses, usually employed in emergency departments, have the most prominent role and scope in the provision of care for women with acute early pregnancy complications. Descriptions of midwives' practice focuses more on psychosocial support and follow-up care, particularly in early pregnancy assessment service models. This review highlights the inconsistency in midwives' and registered nurses' roles and scope in acute early pregnancy in Australia, a finding which is relevant to other international settings. Both professions could further fulfill role and scope capacity in the provision of supportive, individualized, and timely care for women and families accessing a range of acute early pregnancy services. Emergency departments are the usual practice domain of registered nurses who may be limited in terms of the scope of care they can provide to women with early pregnancy complications. Leaders of the midwifery profession should conduct further research into innovative service models that embed a role for midwives in all settings that provide care for pregnant women, regardless of gestation. Open Science Framework osf.io/7zchu.

"If I am alive, I am happy": Defining quality of care from the perspectives of key maternal and newborn health stakeholders in Papua New Guinea.

Quality maternal and newborn healthcare is essential to improve experiences and health outcomes for mothers and babies. In many low to middle income countries, such as Papua New Guinea, there are initiatives to increase antenatal care attendance and facility births. To develop and implement initiatives that are appropriate, relevant, and contextualised to a community, it is important to understand how quality of care is perceived and defined by different maternal and newborn healthcare stakeholders. The aim of this study was to understand how women, their partners, healthcare professionals, healthcare managers, and provincial health administrators in East New Britain, Papua New Guinea define quality of pregnancy, childbirth, and immediate postnatal care. An exploratory qualitative study underpinned by a partnership-defined quality approach was undertaken. In total, 42 participants from five different healthcare facilities in East New Britain, Papua New Guinea, were interviewed. These included women, partners, healthcare professionals, healthcare managers, and provincial health administrators. Interviews were analysed using thematic analysis, assisted by NVivo computer software. Four themes were identified aligning with the journey a woman takes throughout the health system. These included (I) Ensuring Access: Arriving at the health centre, (II) Experiencing Positive Care: What the staff do, (III) Having the Bare Minimum: Resources available to the service, and (IV) Meeting Expectations: Outcomes of care. Stakeholder groups had significant overlap in how quality of care was defined, however women and partners focussed more on elements relating to experience of care, while clinical stakeholders focussed on elements relating to provision of care. There is a gap in how stakeholders define quality maternal and newborn healthcare, and the quality of the care which is administered and received.

Exploring the feasibility of conducting a randomised controlled trial of group-based pregnancy care and education: a pilot randomised controlled trial in Melbourne, Australia

BackgroundIn group-based pregnancy models, antenatal care and childbirth/parenting education are provided in groups of eight to 10 women, usually with two midwives, and six to eight sessions. Current evidence is inconclusive regarding potential benefit or harm. We aimed to explore the feasibility of implementing an adequately powered randomised controlled trial (RCT).MethodsA two-arm pilot RCT was conducted in a tertiary maternity hospital in Melbourne, Australia. Women were randomly allocated to either the intervention to receive group-based antenatal care and education (group care) or to usual care, which included hospital-based midwife, caseload midwifery, team midwifery, or GP shared care. Participants were English-speaking, primiparous, low risk, and < 24 weeks gestation at booking. Data collection: feasibility measures throughout pilot, baseline questionnaire at recruitment, clinical outcome data from the medical record, and a telephone-administered questionnaire 6 weeks postpartum. A focus group explored midwives’ views.ResultsSeventy-four women were recruited from May to June 2017 (group care = 40, usual care = 34). Study uptake was 35%. Women allocated to group care rated their overall pregnancy care more highly (88% good/very good vs 77% in usual care). There was no evidence of harm related to group care. Overarching themes from the midwives were that group care helped ‘build connections’ and ‘empower women’. All midwives would work in the model again and believed it should be expanded.ConclusionGroup care was acceptable to both women and midwives with no evidence of harm. The pilot demonstrated the feasibility of undertaking a large adequately powered RCT, important given the inconclusive evidence on clinical outcomes regarding the model, and its current relatively widespread implementation.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623000858695.

Health reforms, facility-based delivery, and newborn's health: evidence from Rwanda

Abstract Since 2006, Rwanda has experienced a substantial rise in the facility-based delivery (FBD) rate, attributed to various health initiatives. This paper investigates the impact of multiple health reforms on maternal service utilization and neonatal mortality rates. Employing a difference-in-differences framework utilizing geographical variation in the baseline FBD rate, our estimates indicate a 10–17 percentage point increase in FBD and a 0.15–0.18 times increase in the number of antenatal care visits. While our analysis indicates some evidence of a reduction in neonatal mortality rates, the findings are inconclusive. Nevertheless, our results suggest that the effect of the reforms on neonatal mortality rates was weakly intensified for those residing near district hospitals providing care for complicated pregnancies.

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.

An online survey of women’s views of respectful and disrespectful pregnancy and early labour care in the Czech Republic

ObjectiveTo ascertain and explore the views of women and their partners, giving birth in the Czech Republic, of the level of respectful or disrespectful care provided during pregnancy and early labour.DesignEthical approval was granted for a descriptive, online anonymous survey of 65 questions, with quantitative and qualitative responses.SettingThe Czech Republic.The survey was completed by 8,767 women and 69 partners in 2018. Measurements and findingsDescriptive statistics and thematic analysis were used to present results. The majority of women were aged 26-35 years. Most had birthed in one of 93 hospitals, with 1.5% home births. Almost 40% never had an abdominal examination.in pregnancy. Quantitative data analysis revealed that less than half were given information on place of birth, or how to keep labour normal or non-interventionist. Almost 60% did not get information on positions for birth. Most (68%) commenced labour naturally, 25% had labour induced, 40% of them before term, and 7% had an elective caesarean section; 55% stated they had not been given any choice in the decision. Over half of those who had a membrane sweep said permission had not been sought. Half (54%) only had ‘checking’ visits from the midwife in labour.Key conclusionsFindings reveal a lack of information-giving, discussion and shared decision-making from healthcare professionals during pregnancy and early labour. Some practices were non-evidenced-based, and interventions were sometimes made without consent.Implications for practiceThe examples of disrespectful care described in this study caused women distress during childbirth, which may result in an increased fear of childbirth or an increase in free-birthing.

Foundational features of indigenous pregnancy care: Lessons learned from indigenous pregnancy care providers

ProblemIndigenous populations experience higher odds of poor maternal and infant health outcomes than non-Hispanic White mothers yet have lower odds of receiving adequate prenatal care. BackgroundMany Indigenous communities rely on modern Western medical institutions to provide pregnancy related health care. These systems were not developed with or for Indigenous communities and often fail to meet the needs of Indigenous pregnant patients. Offering culturally congruent models of care may increase prenatal care utilization. Question, hypothesis or aimThis paper used qualitative inquiry to identify Indigenous approaches to caring for pregnancy. MethodsOur team conducted 16 semi-structured individual interviews and one group interview with a total of 19 respondents. To arrive at thematic categories, the research team engaged in a modified pile sorting technique. The final set of categories, along with sub-themes, descriptions and example quotes, were sent to interviewees for approval. FindingsTen Foundational Features of Indigenous Pregnancy Care were identified. These covered themes related to Indigenous cultural practices, relationships, Indigenous sovereignty, local Indigenous community, full spectrum care, wholistic care, birthing person's wisdom, power and autonomy, flexibility, historical trauma, and cultural awareness. DiscussionModern midwifery care delivered by Indigenous practitioners may partially bridge the cultural gap; however, intentional effort is needed to integrate Indigenous ways into medical doctor practice models and facilities. ConclusionThis paper identifies ten foundational features of Indigenous pregnancy care and demonstrates the importance of recognizing the effects of trauma and providing opportunities for healing, upholding sovereignty, and centering relationships when caring for Indigenous pregnancies.