Maternal Care Center Research Articles

A Systemwide Postpartum Inpatient Maternal Mental Health Education and Screening Program

ObjectiveTo expand a hospital system’s maternal mental health program to standardize screening for perinatal mood and anxiety disorders. DesignQuality improvement initiative using a continuous Plan–Do–Study–Act (PDSA) cycle. Setting/Local ProblemIn a hospital system consisting of 66 maternity care centers across the United States, there was significant variation in maternal mental health screening, referral, and education practices. The COVID-19 pandemic and increasing rates of severe maternal morbidity further elevated system-level concern about the quality of maternal mental health care being provided. ParticipantsPerinatal nurses. MethodsAn “all-or-none” bundle methodology was used to measure adherence to a system standard for maternal mental health screening, referral, and education. InterventionsA toolkit was designed internally to support streamlined implementation and ensure standardization for screening, referral, and education. This comprehensive toolkit includes screening forms, a referral algorithm, staff education, patient education literature, and a community resource list template. Training on how to use the toolkit was provided to nurses, chaplains, and social workers. ResultsThe initial system bundle adherence rate was 76% (2017) in the first year of the program. The following year, the bundle adherence rate increased to 97% (2018). Despite the disruption caused by the COVID-19 pandemic, this mental health initiative has maintained an overall adherence rate of 92% (2020–2022). ConclusionThis nurse-led quality improvement initiative has been successfully implemented across a geographically and demographically diverse hospital system. The initial and sustained high rates of adherence with the system standard for screening, referral, and education illustrate perinatal nurses’ commitment to the delivery of high-quality maternal mental health care in the acute care setting.

Newborn blood spot screening – knowledge of genetic testing among mothers

Introduction and aim. Newborn blood spot screening (NBS) uses genetic technology to screen for selected genetic, endocrine, and metabolic disorders. The purpose of the study was to assess the knowledge of newborn blood spot genetic screening among expectant mothers. Material and methods. Between October 2015 and January 2016, a 20 question, multiple-choice questionnaire was administered to expectant mothers presenting for a pre-natal ultrasound at the Maternal Fetal Care Center in Milwaukee, Wisconsin Froedtert Hospital. Statistical analysis used Chi-Square or Fisher’s exact test for categorical variables. Results. 103 women completed the survey; 34% believed that education regarding screening is incomplete and 39% believed that it needs improvement. 27% knew the purpose of newborn screening. Conclusion. Many mothers lack general and specific knowledge about NBS and the diseases screened for. Health education that provides accurate and complete information on the newborn blood spot screening should be provided to all parents prior to the administering of any genetic testing. Key areas that should be targeted include: purpose of NBS, screened diseases and how to interpret the results of the test.

Expectations and Participatory Performance of Husbands in Improvement of Anxiety Disorders in Pregnant Women: A Qualitative Study

Purpose. Husbands’ participation is important in the success of maternal health programs. This participation is emphasized in all dimensions including mental health. This study was conducted to examine the husband’s expectations and participatory performance to improve anxiety in pregnant women. Design and Methods. A descriptive qualitative study was conducted via targeted convenience sampling in two public and private maternity care centers. 30 women who were 13–38-week pregnant were diagnosed with anxiety disorder in a Structured Clinical Interview for the DSM-5 (SCID-5), and 16 husbands experienced a semistructured in-depth qualitative interview. Data were extracted by the conventional content analysis using MAXQDA software (version 18). Findings. Husbands’ expectations and participatory performance to reduce the anxiety of pregnant women were produced in three themes of emotion, behavior, and cognition in terms of the men’s and women’s perspectives. Approximately 70% of subthemes were common among women and men which included emotion (emotional psychological support, strengthening verbal communication, receiving attention and love, and creating a field of entertainment), behavior (following up on mother and fetus’s health, participation in housekeeping, compatibility to mood changes, material and financial provision, and companionship during childbirth), and cognition (increasing the knowledge in the field of pregnancy and the ability to resolve conflict). However, the men’s and women’s themes had some differences. Practice Implications. While men emphasized adjusting communication expectations and making positive changes in lifestyle, anxious women emphasized the themes of receiving attention and love, well-posedness, companionship in childbirth, and loyalty as important factors influencing the improvement of their disease.

Maternal-fetal outcomes of women with hypertensive disorders of pregnancy.

The objective of this study was to determine adverse maternal and perinatal outcomes in pregnant women with hypertensive disorders of pregnancy. An analytical cross-sectional study was conducted on women admitted with hypertensive disorders of pregnancies to a university maternity hospital from August 2020 to August 2022. Data were collected using a pretested structured questionnaire. Variables associated with adverse maternal and perinatal outcomes were compared using multivariable binomial regression. Of 501 women with pregnancies, 2, 35, 14, and 49% had eclampsia, preeclampsia, chronic hypertension, and gestational hypertension, respectively. Women with preeclampsia/eclampsia had significantly higher risks of cesarean section (79.4 vs. 65%; adjusted RR, 2,139; 95%CI, 1,386-3,302; p=0.001) and preterm delivery at <34 weeks' gestation (20.5 vs. 6%; adjusted RR, 2.5; 95%CI, 1.19-5.25; p=0.01) than those of women with chronic/gestational hypertension. Risks of prolonged maternal hospitalization (43.9 vs. 27.1%), neonatal intensive care unit admission (30.7 vs. 19.8%), and perinatal mortality (23.5 vs. 11.2%) were higher among women with preeclampsia/eclampsia. Women with preeclampsia/eclampsia had a higher risk of adverse maternal and neonatal outcomes than those with chronic or gestational hypertension. This major maternity care center requires strategies for preventing and managing preeclampsia/eclampsia to improve pregnancy outcomes.

Introduction of the London Measure of Unplanned Pregnancy at the booking visit and the midwives’ perspective

BackgroundPregnancy planning and preconception care benefit women, their children, and future generations. The London Measure of Unplanned Pregnancy (LMUP) is a tool that can be used in antenatal care to...

Incidence of iron deficiency Anaemia during pregnancy in Far North Queensland.

The WHO estimates the incidence of iron deficiency anaemia in Australia is 25%. However there is considerable variation during pregnancy and in regional areas. The aim of this investigation is to quantify the incidence of iron deficiency anaemia during pregnancy within Far North Queensland. This is a single-centre retrospective cohort study. Cairns Hospital is the main referral centre for complex maternity care in Far North Queensland with an estimated population of 280-000, which includes many people from rural and remote communities and a high proportion who identify as Aboriginal or Torres Strait Islander. This study included all births at the Cairns Hospital in 2018, a total of 2190 deliveries. The study randomly sampled 551 mothers from the cohort, and the incidence of iron deficiency anaemia was 34.9%. 48.7% of women who identified as Aboriginal or Torres Strait Islander within the region were anaemic. This was significantly higher than an incidence of 28.9% for the rest of the population. Other risk factors include booking appointment after 28-weeks, Asian ethnicity and age less than 25-years. A BMI greater than 35 was protective DISCUSSION: This study will inform antenatal care providers within the region and improve obstetric outcomes by increasing awareness. Identifying risk factors will also facilitate prompt treatment and improve maternity care for vulnerable patient groups. On a broader level, the study provides new data to inform population health estimates both nationally and internationally. The incidence of iron deficiency anaemia during pregnancy in Far North Queensland is significantly higher than previous estimates.

Clinical features of 19 children infected with the Omicron variant of severe acute respiratory syndrome coronavirus 2 in Hangzhou, China

To study the clinical features of children infected with the Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The medical data of 19 children who were diagnosed with SARS-CoV-2 Omicron variant infection from January 28 to March 3, 2022 in Hangzhou were retrospectively reviewed. Among the 19 children, there were 7 boys (37%) and 12 girls (63%), and their age ranged from 6 months to 16 years, with a median age of 2 years and 1 month. Most of these children were infants and young children (aged ≤3 years, accounting for 53%). Among these children, 11 (58%) were unvaccinated with SARS-CoV-2 vaccine and 8 (42%) were vaccinated with SARS-CoV-2 vaccine, and 3 children (16%) had a history of underlying diseases. All 19 children had a clear history of close contact with persons infected with SARS-CoV-2, and 10 children (53%) were involved in the cluster outbreak in a maternal and infant care center. In terms of clinical classification, 13 children (68%) had mild coronavirus disease 2019 (COVID-19) and 6 (32%) had common COVID-19, with no severe cases of COVID-19. The most common clinical symptoms were cough (100%) and fever (63%). The children with a normal peripheral white blood cell count accounted for 84%, and those with a normal lymphocyte count accounted for 68%. There were no significant abnormalities in platelet count, procalcitonin, liver function parameters (alanine aminotransferase and aspartate aminotransferase), and renal function parameters (creatinine and urea). Six children (32%) had obvious signs of pneumonia on chest CT. All 19 children were given symptomatic treatment, and 12 children (63%) were given aerosol inhalation of interferon α. All children were cured and discharged. Children infected with Omicron variant strains are more common in infants and young children, with mild symptoms and good prognosis. Most of the children have a history of close contact with persons infected with SARS-CoV-2, and epidemic prevention and control should be strengthened in places with many infants and children, such as maternal and infant care centers.

Person-centered maternity care during childbirth and associated factors at selected public hospitals in Addis Ababa, Ethiopia, 2021: a cross-sectional study

BackgroundPerson-centered maternity care is respectful and responsive care to individual women’s preferences, needs, and values and ensuring that their values guide all clinical decisions during childbirth. It is recognized as a key dimension of the quality of maternity care that increases client satisfaction and institutional delivery. However, little research has been conducted about person-centered maternity care in Ethiopia.ObjectiveThe aim of this study was to assess the status of person-centered maternity care and associated factors among mothers who gave birth at selected public hospitals in Addis Ababa city, Addis Ababa, Ethiopia, 2021.MethodA facility-based cross-sectional study was conducted at selected public hospitals in Addis Ababa city. A structured questionnaire was used to collect data from post-natal mothers selected by systematic random sampling. Data were collected using face-to-face interview technique. The data was coded and entered using Epi-data version 4.6 and analyzed using SPSS version 25. Bivariate and multivariable linear regression analysis was used to identify factors associated with person-centered maternity care. The strength of association between independent and dependent variables was reported by using unstandardized β at 95% CI and p-value < 0.05 were considered statistically significant.ResultsIn this study 384 mothers were participated with a response rate of 99.2%. The overall prevalence of person-centered maternity care was 65.8% and the percentage mean Person Centered Maternity Care (PCMC) score of the respondents was 65.8% with percentage standard deviation of 17.06. Respondents who had no ANC follow-up (β = -5.39, 95% CI: -10.52, -0.26), < 4 Antenatal Care (ANC) follow up (β = -3.99, 95% CI: -6.63, -1.36), night time delivery (β = -3.95, 95% CI: -5.91, -1.98) and complications during delivery (β = -3.18, 95% CI: -6.01, -0.35) were factors significantly associated with person-centered maternity care.Conclusion and RecommendationsThe finding of this study showed that the proportion of person-centered maternity care among mothers who gave birth in public hospitals of Addis Ababa was high as compared to previous studies. The factors affecting person-centered maternity care are manageable to interventions. Therefore, Policymakers should develop and implement guidelines about person-centered maternity care. Training should be given to health care providers on the importance of person-centered maternity care and patient and provider rights. Hospital managers should increase the number of staffs who got PCMC training, especially during nighttime to improve the provision of person-centered maternity care. Health care providers should implement person-centered maternity care for all mothers who gave birth in the health care facility.

Effect of the COVID-19 pandemic on racial disparities in neuraxial labor analgesia at a Texas level IV maternal care center

We hypothesized that racial disparities in labor epidural analgesia at our hospital that existed prior to the COVID-19 pandemic would be exacerbated during the COVID-19 pandemic. We examined patients who delivered vaginally at our hospital for the last 6 months of 2019 and the last 6 months of 2020. We performed joint testing of coefficient P values, and the interaction term between race and year of delivery was not significant (0.364). A multivariate logistic regression model found that Hispanic patients (odds ratio 0.555 [0.408, 0.756], P < 0.001) and Black or African American patients (odds ratio 0.613 [0.408, 0.921], P = 0.018) were less likely to receive labor epidural analgesia compared to White or Caucasian patients. Odds ratios of receiving labor epidural analgesia were higher with increasing gestational age (1.116 [1.067, 1.168], P < 0.001) and lower with increasing parity (0.789 [0.719, 0.867], P < 0.001). The year of birth that corresponded to before or during the COVID-19 pandemic did not predict whether a patient received labor epidural analgesia (1.247 [0.941, 1.652], P = 0.124). Because the interaction between race and year of birth was not statistically significant, we conclude that the COVID-19 pandemic did not exacerbate racial disparities in labor epidural analgesia at our hospital.

O13 - Introduction of the London Measure of Unplanned Pregnancy at the booking visit and the midwives’ perspective

Pregnancy planning and preconception care benefit women, their children, and future generations. The London Measure of Unplanned Pregnancy (LMUP) is a tool that can be used in antenatal care to identify women with unintended pregnancies, who require improved access to such services. This tool has recently been implemented into routine antenatal care in two Sydney Maternity centres. To explore midwives’ attitudes to the LMUP and their understanding of its application to their scope of practice following 12 months after it was introduced into the booking visit. A qualitative study using in-depth semi structured interviews with midwives from the two maternity care centres in Sydney, New South Wales, Australia. All midwives performing antenatal booking visits were eligible to take part. Interviews were transcribed, analysed, and coded to define key themes. Recruitment ceased when thematic saturation was reached. Ten midwives from the two maternity centres were interviewed. Midwives support the inclusion of the LMUP into the booking visit and felt it was in their scope of practice to be using the tool. Time constraints, the impact of COVID-19 and lack of structured referral pathways were identified barriers to the implementation of the LMUP in routine care. Midwives support the inclusion of the LMUP into the antenatal booking visit and see that it falls within their scope of practice. Service barriers were identified at the individual, organisational and external context levels. These need to be addressed to enhance the potential of this tool.

Fetal Disseminated Malignant Rhabdoid Tumor.

Fetal Disseminated Malignant Rhabdoid Tumor.

Margin of Remnant

Margin of Remnant Meg Reynolds (bio) The nurse from the maternal care center callsto say my hormone levels are down. My bloodsays 5 hcg. I don't know what this meansexcept as a margin of remnant. Her call interruptsthe true crime podcast I was listening toon the walk to work. Trace evidence:a hair on a lapel, blood spatter,microscopic owl feathers or the concentratedstippling of gunpowder. dna nursessuch an urge toward decay, forensics has to hurryto preserve it. Soon, there will be no signthat I was pregnant at all. If my body were foundin the open dumpster behind the Shopping Bag,the autopsy would say, Female, 34, various injuries,found dusted with snow, but not pregnant.There's not even an itch of them left, nothingto protect or gentle into being. I can affordto be reckless. I go to the gym and run,increase the incline, sweat, letthe machine shake under me. [End Page 136] Meg Reynolds Meg Reynolds is a poet, artist, and teacher from New England. Her work has appeared in Mid-American Review, the Offing, RHINO, Indianapolis Review, Gigantic Sequins, and Exposition Review, among others. Her first collection of poetry comics, A Comic Year, was published in October 2021 with Finishing Line Press. Her second book, a collection of poems titled Does the Earth, was published by Harpoon Review Books in 2023. She lives in Burlington, Vermont with her family. Copyright © 2022 University of Nebraska Press

Perfil das adolescentes grávidas atendidas no Centro de Saúde Materno-Infantil da Mineira (Huambo, Angola)

Aim: The research aimed to describe the profile of pregnant adolescents assisted at the Mineira Maternal and Child Health Center (Huambo, Angola). Method: This was a descriptive study, where the data was submitted to a univariate analysis. A total of 170 pregnant adolescents between 14 and 19 years old were randomly surveyed in one of the largest maternal and child care centres in Huambo in Angola from July to December 2019. Results: The average age of the adolescents was 17.53 years old (SD = 1.28); most were single (85%), had completed the first cycle of primary education (59.0%), did not work (92.4%), lived (50.6%) and grew up (56.5%) with their parents, with the majority having the Catholicism as their religious confession (47.1%). The obstetric data reported that most of the adolescents were nulliparous (84.1%), had had no complications from childbirth (84.7%), and had no previous abortion (91.2%). The majority of the adolescents had their first sexual intercourse between 16–19 years (68.2%) with their boyfriend (77.1%), and it was consensual (91.2%). The majority of the partners were aged between 20–22 years, were working (57.0%) and had assumed paternity (89.0%). Conclusion: The results indicated the presence of multiple factors that may influence adolescent pregnancy and showed a need for a profound rethinking of public health policies regarding adolescence.

AN OVERVIEW ON EFFECTIVE FEEDING POSITIONS, BREAST FEEDING POLICIES AND FACILITIES PROVIDED IN MATERNITY AND NEW-BORN CARE CENTRES

Breastfeeding is very essential for the child survival, nutrition, development and maternal health. It is essential to know about the effective breast feeding positions, the available policies an facilities provided by the government and various other non governmental organizations for delivering an defective care to both mother and newborn. This particular study reviews the effective feeding positions, breast feeding policies and facilities provided in maternity and new-born care centres.

Prevalence and Reasons for Maternal Mortality: A Retrospective Study

Aim: To determine the prevalence and reasons for maternal mortality at a tertiary care hospital Study design: A retrospective study Place and duration: This study was conducted at Maternal and Child Care Center Hyderabad Pakistan from June 2018 to June 2020. Methodology: To gain access to the records, convenience sampling was utilized. A self-contained proforma was used to gather verified data on variables (age, year of death, cause of death, and domicile), Excel 2016 was used to examine the data and trend analysis was performed using Join point Analysis Software. Results: In three years, 279 maternal fatalities have been reported from "Hyderabad." With 29.4 % (CI= 0.68, SD= 10.42), hemorrhage remained the primary cause, subsequently, eclampsia 16.13 % (CI= 0.63, SD= 7.48), ruptured uterus 8.6 % (CI= 0.56, SD= 8) and sepsis 5.73 % (CI= 0.44, SD= 5.47). The highest rate of maternal fatalities was 40.50 % in women aged 26 to 30, followed by 25.1 % in women aged 15 to 25, 21.15 % in women aged 31 to 35, and 13.26 % in women aged 36 to 40. The P-value for post-partum bleeding was significant (0.003). Conclusion: Maternal mortality continued to increase in women of child bearing age, with principal reasons including hemorrhage, eclampsia, uterine rupture, and sepsis. To avoid these deaths, early referral, decreasing cesarean section rate, improved monitoring during labour and maternal care by skilled personals and community-based education are both in desperate need of improvement. Keywords: Maternal Mortality, Child-bearing age, Obstructed Labor, Eclampsia, Postpartum Hemorrhage, Ruptured uterus, Pulmonary Embolism.

Evidence based practice in midwifery care

Midwifery in India has climbed up the ladder of progression from before independence till the present day. Midwifery care introduces a system level shift from fragmented maternal and newborn care focused on identification and treatment of pathology, to skilled and compassionate woman-centric care. The maternity care gives priority to effective care with least harm. Evidence-based practice (EBP) is a conscientious, explicit and judicious use of the current best evidence in making decisions regarding the individual patients’ care. Evidence based midwifery are care that ensure the practices in the midwifery settings based on clear and acceptable evidence that supports their clinical practice. PICOT questions play a significant role in guiding evidence-based practice since they guide in conducting profound research in practice. EBP uses well-defined criteria to evaluate the quality of clinical research, creating a hierarchy of evidence. It has become a global phenomenon, and is at the forefront of practice. Indeed, it is the linchpin to contemporary woman–centered maternity care in the present era.

A retrospective study of maternal near miss in the Critical Maternal Care Center in Suqian City, Jiangsu Province, China: A single-center study.

Background and aimsThrough a retrospective study of maternal near miss (MNM) cases treated by the Suqian Critical Maternal Care Center in Suqian City, Jiangsu Province, we summarized the most common diseases that caused MNM, treatment measures, and short‐term prognosis in this region. The purpose of the research is to improve the clinical evidence of maternal health care in the region.MethodsThe study is a retrospective descriptive study. Among the pregnant women admitted to the Critical Maternal Care Center from 1 January 2015, to 31 December 2019, the pregnant women with severe pregnancy complications or comorbidities were identified as the research subjects. The study subjects were divided into an MNM group and a control group according to the MNM criteria recommended by the WHO.A retrospective analysis of the study subject data, including causes and clinical manifestations of MNM, treatment measures, and short‐term prognosis, was conducted.ResultsThe total number of deliveries was 27 619. There were 145 women in the control group and 65 women in the MNM group. The number of MNM cases accounted for 2.4% (65/27619) of the total number of deliveries. Placenta previa, postpartum hemorrhage, and hypertension accounted for 72.3% (47/65) of the causes of MNM cases observed. In the MNM group, the most common clinical manifestation was bleeding (80.0%, 52/65). Sixty‐three patients underwent massive blood transfusion (96.9%, 63/65), and 36 underwent hysterectomy (55.4%,36/65). The prevalence of interventional procedures and unplanned secondary operations in the MNM group was higher than that in the control group.ConclusionsThe top three causes of MNM were placenta previa, postpartum hemorrhage, and hypertension in pregnancy in Suqian area. Sufficient blood sources, convenient and fast blood transfusion procedures, and the use of large amounts of blood transfusion technology have an important impact on the success of treatment. Hysterectomy is still the main method of MNM treatment.

OEIS Syndrome: Omphalocele, Exstrophy of the Cloaca, Imperforate Anus, and Spinal Defects

OEIS Syndrome: Omphalocele, Exstrophy of the Cloaca, Imperforate Anus, and Spinal Defects

Experience of undergraduate midwifery students faced with perinatal death in clinical practice: A qualitative study

BackgroundStudent midwives often encounter perinatal loss including stillbirth and neonatal death as part of their clinical training. There has been limited research on how student midwives cope with perinatal death. ObjectiveTo explore the experiences of undergraduate midwifery students facing perinatal death during their internships. DesignQualitative research design based on interpretive phenomenological approach and COREQ-guided reporting. SettingTertiary maternal and child care center or general hospital. ParticipantsUndergraduate midwifery students from a medical university in Guangzhou, China. MethodsStudy participants were recruited through purposive sampling. Semi-structured in-depth interviews were conducted between October 2020 and March 2021 with 12 midwifery students. Transcripts of the interviews were analyzed using Diekelmann's interpretive method. ResultsFour themes were identified from the data: unavoidable anxiety and avoidance response; overwhelming fear and taboos related to death; self-blame and emotional inhibition; and ethical conflict and reflection on practice. ConclusionsUndergraduate midwifery students believed they were ill-prepared to care for women who experienced perinatal loss, consciously endured their own negative emotions such as anxiety and fear, and hoped for improved bereavement and stillbirth care in future clinical practice. Students valued support from the bereavement midwife and identified effective strategies that would help them cope with their feelings. It is recommended that adequate education and emotional support be provided to midwifery students, who should be encouraged to provide appropriate care to grieving families.

Understanding Women's Choices: How Women's Perceptions of Quality of Care Influences Place of Delivery in a Rural Sub-County in Kenya. A Qualitative Study.

Maternal mortality is still unacceptably high in Kenya. The Kenyan Government introduced a free maternity service to overcome financial barriers to access. This policy led to a substantial increase in women's delivery options. This increase in coverage might have led to a reduction in quality of care. This study explores women's perceptions of quality of delivery services in the context of the free policy and how the perceptions lead to the choice of a place for delivery. Our study site was Naivasha sub-County in Kenya, a rural context, whose geography encompasses pastoralists, rural agrarian, and high population density informal settlements near flower farms. Women from this area are from the lowest wealth quintile in Kenya. We conducted a qualitative study to explore the women's perceptions of quality of care based on their experiences during maternity care. The participants were women of reproductive age (18-49years) attending antenatal care clinics at six health facilities in the sub-county. Six focus group discussions with 55 respondents were used. For inclusion, the women needed to have delivered a baby within the six months preceding the study. Interviews were recorded with consent, translated and transcribed. The interviews were analyzed using a thematic content approach. Four broad themes that determined the choice of health facility for delivery were identified: women's perceptions of clinical quality of care; the cost of delivery; distance to the health facility and management of primary health facilities. An unexpected theme was the presence of home deliveries amongst pastoralist women. These findings suggest that in this setting both process and structural dimensions of quality of care and financial and physical accessibility influence women's choices for place of delivery. This study expands our understanding of how women make choices regarding place of delivery. Understanding women's perceptions can provide useful insights to policy makers and facility managers on providing high quality patient centered maternity care necessary to sustain the increased utilization of maternity services at health facilities under the free maternity policy and further reductions in maternal mortality.