Full-term Childbirth Research Articles

The Influence of Dental Status and Blood Parameters Characterizing Endogenous Intoxication on the Timing of Childbirth.

Background and Objectives: Epidemiological and microbiological-immunological studies have led to the conclusion that periodontal disease may be a risk factor for preterm birth. The aim of this study was to investigate and identify the relationship of some hematological cellular biomarkers characterizing the chronic oral focus of infection with pregnancy outcomes and their impact on those outcomes. Materials and Methods: Clinical and laboratory tests were conducted on 100 pregnant women, grouped by full-term or preterm births, with the assessment of the following markers: DMF, CPI and PIRI, PHP, microbiological examination of periodontal pockets and amniotic fluid, WBS count, WBCSI, LGI, and NMR. A statistical analysis was carried out with SPSS Statistics version 19.0. Results: Women with preterm labor had higher-grade caries (CSL > 0.3), while women with full-term childbirth had moderate caries (CSL < 0.3). A satisfactory level of oral hygiene efficiency was found in 50% (group 1) and 38.1% (group 2) of the expectant mothers. The periodontal status by the PIRI showed tissue lesions in 20.7% (group 1) and 92.9% (group 2) of the women. The WBCSI was 2.27 ± 0.82 and 2.15 ± 0.68, the NMR was 9.29 ± 5.119 and 11.62 ± 7.78, and the LGI was 3.54 ± 1.1 and 3.73 ± 0.81 in groups 1 and 2, respectively. Comparative analysis of bacterial contamination of the amniotic fluid revealed the predominance of Fusobacterium nucleatum (64.3%), Tannerella forsythia (57.1%), Prevotella intermedia (50%), Porphyromonas gingivalis (57.1%), Staphylococcus aureus (45.2%), and Candida albicans (50%) in women with premature birth. Conclusions: In women with preterm birth, the values of the indices characterizing a chronic oral focus of infection evoke more significant correlations with the timing of delivery, which indicates the significant role of an oral focus of infection. The presence of microbial invasion of amniotic fluid may indicate the role of periodontopathogenic bacteria in pregnant women diagnosed with a risk of preterm birth.

Management and follow-up of pregnancy-onset thrombotic thrombocytopenic purpura: the French experience

AbstractPregnancy-onset thrombotic thrombocytopenic purpura (TTP) is a rare and life-threatening disease of which diagnosis and management requires experienced multidisciplinary teams. The mechanisms responsible for a deficiency in the disintegrin and metalloprotease with thrombospondin type 1 repeats, member 13 (ADAMTS13) leading to pregnancy-onset TTP may be congenital or acquired, and studying ADAMTS13 conformation could be of interest. The differential diagnosis between TTP and other pregnancy-associated thrombotic microangiopathies (TMA) is often challenging. Our retrospective multicenter study highlights the significance and the challenges associated with pregnancy-onset TTP and childbirth in terms of diagnosis, obstetric management, and follow-up aspects. Among 1174 pregnancy-onset TMA enrolled in the French Registry for TMA from 2000 to 2020, we identified 108 pregnancy-onset TTP: 52 immune-mediated TTP (iTTP, 48.1%), 27 acquired TTP of unidentified mechanism (uTTP, 25%), and 29 congenital TTP (cTTP, 26.9%). Data show that maternal outcome is good (survival rate: 95%) and fetal outcome is linked to the gestational age at the onset of the disease (survival rate: 75.5%). Three distinct entities with different natural histories emerged: pregnancy-onset iTTP appears similar to idiopathic iTTP, with an open ADAMTS13 conformation, and is marked by a relapse risk independent of subsequent pregnancies; pregnancy-onset uTTP appears to have a different pathophysiology with an unexpected open ADAMTS13 conformation and a very low relapse risk independent of subsequent pregnancies; finally, pregnancy-onset cTTP is characterized by the necessity of pregnancy as a systematic and specific trigger and a need for prophylactic plasmatherapy for subsequent pregnancies. This trial was registered at www.clinicaltrials.gov as #NCT00426686, and at the Health Authority and the French Ministry of Health (P051064/PHRC AOM05012).

Experience of Fathers Who Participate During Their Wive's Childbirth: A Phenomenological Study

It is important to know the experience of fathers who provide support during childbirth in terms of improving the childbirth results. This study describes the experiences of fathers who participate during their wives’s childbirth in Türkiye. The research design is qualitative and descriptive, based on a phenomenological approach. Research data were collected through online in-depth interviews between January and February 2021. The sample comprised 12 fathers, reached by criterion sampling. The two data collection tools were the Individual Identification Form and the Semi-Structured Interview Form. Content analysis of the research data was conducted using Maxqda. Four themes emerged to describe the father’s birthing experiences: “prenatal preparation”, “fathers’ birthing support”, “emotions experienced during the birthing”, and “fathers’ views of the birth”. The fathers experienced many contrary emotions during the birth process. Fathers have a positive experience from participating during their partner’s birthing process due to the midwife’s support. Fathers who want to support their partners during birth should be informed about the importance of participating in prenatal courses.

Sensory Profile in Infant/Toddler: Birth to 36 Months

Objectives: Sensory processing patterns refer to a person’s ability to receive and respond to sensory events which are important to succeed in daily routine activities. This study aims to determine the sensory processing patterns in infants/toddlers. Methods: This is a cross-sectional study. A total of 518 infants/toddlers participated in this study. Their ages ranged from birth to 36 months. Parents completed the infant/toddler sensory profile for all participants. Results: No significant difference was observed between girls and boys in sensory processing from birth to 6 months; however, there is a significant difference between girls and boys in low registration, sensory sensitivity, and sensory avoidance from 7-36 months. In addition, no significant difference was detected between children born by cesarean and those born through natural childbirth in terms of sensory processing (quadrants and scores) from birth to 6 months and 7-36 months. There is a significant difference between preterm and full-term children (birth to 6 months) in auditory processing. The findings also indicate only a significant difference in oral sensory processing between the preterm and full-term children (7-36 months). Discussion: We discussed sensory processing patterns in children and their differences based on different factors. The results of this study can provide considerations for Iranian occupational therapists and psychologists.

Psychosocial well-being in postpartum women with congenital heart disease.

BackgroundImproved treatment options for congenital heart disease (CHD) lead to a growing number of women with CHD at reproductive age. Due to physical and psychological burden, pregnancies in women with CHD often count for high-risk. Resulting emotional distress can adversely impact pregnancy, motherhood and fetal health. The present study aims to retrospectively investigate mental outcomes and indices of adjustment in women with CHD before, during and after pregnancy. The novel concept of illness identity is applied to explain how patients experience and integrate their CHD into their identities.MethodsPatient-reported outcome measures on mental functioning and illness identity were assessed in a sample of 121 postpartum women with CHD [mean age: 42.7±9.2 (range, 27–81) years] at the German Heart Centre Munich between August and November 2021 in a cross-sectional design. Descriptive analyses, correlations and linear regression models were calculated.ResultsRetrospectively assessed prevalence of emotional distress before giving birth was high (47.0%) and peaked shortly after childbirth in terms of elevated symptoms of postpartum depression and trauma. During the course of maternity, emotional distress decreased significantly (24.1%, P<0.001). Overall, postpartum women demonstrated high scores in functional illness identity states (i.e., acceptance and enrichment) and low scores in dysfunctional states (i.e., rejection and engulfment). CHD severity was not directly associated with mental outcomes (P>0.05), whereas maternal cardiovascular risk, according to the WHO classification, was significantly associated with a higher prevalence of postpartum trauma (t=2.485, P=0.015).ConclusionsPostpartum mental health problems, such as (postpartum) depression, anxiety, and posttraumatic stress can become a serious burden which might be detrimental to the mother’s well-being and her infant’s development. Present findings emphasise the urgent need for a holistic approach focusing on pregnant women with CHD starting at the prepartum stage to prevent adverse consequences and promote maternal well-being. Illness identity might become an important target construct for clinical practice as it may positively and enduringly influence mental well-being of pregnant women with CHD.

Effectiveness of Psychological Interventions to Improve the Mental Well-Being of Parents Who Have Experienced Traumatic Childbirth: A Systematic Review and Meta-Analysis

Considering the adverse impact that traumatic childbirth experiences can have on parental mental well-being, studies that have investigated the potential of providing postnatal psychological support for this group of parents require evaluation. This systematic review aimed to examine the effectiveness of psychological interventions at improving the mental well-being of parents who have experienced traumatic childbirth in terms of anxiety, depression, fear of childbirth, and post-traumatic stress disorder (PTSD) symptoms. Seven electronic databases were searched from their respective inception dates up to January 2021. Only quantitative studies that reported the effects of psychological interventions on anxiety, depression, fear of childbirth, and/or PTSD symptoms in selective (at risk of traumatic childbirth experience) or indicated (self-defined childbirth experience as traumatic for any reason) populations of parents (mothers and/or fathers) were included. Eight studies were included and meta-analyses were conducted using a random-effect model. All studies were conducted on mothers only, and one study had minimal father involvement. Results showed that psychological interventions were more effective in reducing fear of childbirth and improving PTSD symptoms compared to anxiety and depression. Greater improvement in depression was reported at 3–8 weeks’ follow-up than at immediate post-intervention. Subgroup analyses showed that technology-based interventions were feasible, and indicated interventions were more effective than selective interventions. Conducting future interventions in more geographical regions, engaging and including fathers more actively, incorporating both personalized professional therapy and informal peer support, striving for flexibility and convenience, as well as addressing topics on self-doubt and coping skills can improve current interventions.

Early psychological interventions for prevention and treatment of post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms in post-partum women: A systematic review and meta-analysis.

Pre-term or full-term childbirth can be experienced as physically or psychologically traumatic. Cumulative and trans-generational effects of traumatic stress on both psychological and physical health indicate the ethical requirement to investigate appropriate preventative treatment for stress symptoms in women following a routine traumatic experience such as childbirth. The objective of this review was to investigate the effectiveness of early psychological interventions in reducing or preventing post-traumatic stress symptoms and post-traumatic stress disorder in post-partum women within twelve weeks of a traumatic birth. Randomised controlled trials and pilot studies of psychological interventions preventing or reducing post-traumatic stress symptoms or PTSD, that included women who had experienced a traumatic birth, were identified in a search of Cochrane Central Register of Randomised Controlled Trials, MEDLINE, Embase, Psychinfo, PILOTS, CINAHL and Proquest Dissertations databases. One author performed database searches, verified results with a subject librarian, extracted study details and data. Five authors appraised extracted data and agreed upon risk of bias. Analysis was completed with Rev Man 5 software and quality of findings were rated according to Grading of Recommendation, Assessment, Development, and Evaluation. Eleven studies were identified that evaluated the effectiveness of a range of early psychological interventions. There was firm evidence to suggest that midwifery or clinician led early psychological interventions administered within 72 hours following traumatic childbirth are more effective than usual care in reducing traumatic stress symptoms in women at 4-6 weeks. Further studies of high methodological quality that include longer follow up of 6-12 months are required in order to substantiate the evidence of the effectiveness of specific face to face and online early psychological intervention modalities in preventing the effects of stress symptoms and PTSD in women following a traumatic birth before introduction to routine care and practice. CRD42020202576, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=202576.

Interventions for fear of childbirth including tocophobia.

Many women experience fear of childbirth (FOC). While fears about childbirth may be normal during pregnancy, some women experience high tosevereFOC. At the extreme end of the fear spectrum is tocophobia, which is considereda specific condition that may cause distress,affect well-being during pregnancy and impede the transition to parenthood.Various interventions have been trialled, which support women to reduce and manage high to severeFOC, including tocophobia. To investigate the effectiveness of non-pharmacological interventions for reducing fear of childbirth (FOC) compared with standard maternity care in pregnant women with high to severe FOC, including tocophobia. In July 2020, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and reference lists of retrieved studies. We contacted researchers of trials which were registered and appeared to be ongoing. We included randomised clinical trials which recruited pregnant women with high or severe FOC (as defined by the individual trial), for treatment intended to reduce FOC. Two review authors independently screened and selected titles and abstracts for inclusion. We excluded quasi-randomised and cross-over trials. We used standard methodological approaches as recommended by Cochrane. Two review authors independently extracted data and assessed the studies for risk of bias. A third review author checked the data analysis for accuracy. We used GRADE to assess the certainty of the evidence. The primary outcome was a reduction in FOC. Secondary outcomes were caesarean section, depression, birth preference for caesarean section or spontaneous vaginal delivery, and epidural use. We included seven trials with a total of 1357participants. The interventions included psychoeducation, cognitive behavioural therapy, group discussion, peer education and art therapy. We judged four studies as high or unclear risk of bias in terms of allocation concealment; we judged three studies as high risk in terms of incomplete outcome data; and in all studies, there was a high risk of bias due to lack of blinding. We downgraded thecertainty of the evidence due to concerns about risk of bias, imprecision and inconsistency. None of the studies reported data about women's anxiety. Participating in non-pharmacological interventions may reduce levels of fear of childbirth, as measured by the Wijma Delivery Expectancy Questionnaire (W-DEQ), but the reduction may not be clinically meaningful (mean difference (MD) -7.08, 95% confidence interval (CI) -12.19 to -1.97; 7 studies, 828 women; low-certainty evidence). The W-DEQ tool is scored from 0 to 165 (higher score = greater fear). Non-pharmacological interventions probably reduce the number of women having a caesarean section(RR 0.70, 95% CI 0.55 to0.89; 5 studies, 557 women; moderate-certainty evidence). There may be little to no difference between non-pharmacological interventions and usual care in depression scores measured with the Edinburgh Postnatal Depression Scale (EPDS) (MD 0.09, 95% CI -1.23to 1.40;2 studies, 399 women;low-certainty evidence). The EPDS tool is scored from 0 to 30 (higher score = greater depression). Non-pharmacological interventions probably leadto fewer women preferring a caesarean section (RR0.37, 95% CI 0.15 to 0.89; 3 studies, 276 women; moderate-certainty evidence). Non-pharmacological interventions may increase epidural use compared with usual care, but the 95% CI includes the possibility of a slight reduction in epidural use (RR 1.21, 95% CI 0.98 to 1.48;2 studies, 380 women; low-certainty evidence). The effect of non-pharmacological interventionsfor women with high to severe fear of childbirth in terms of reducing fear is uncertain.Fear of childbirth, as measured by W-DEQ, may be reduced but it is not certain if this represents a meaningful clinical reduction of fear. There may be little or no difference in depression, but there may be a reduction in caesarean section delivery. Future trials should recruit adequate numbers of women and measure birth satisfaction and anxiety.

Women Health Right and Empowerment during Childbirth

Background: Women health right and empowerment during childbirth is an emerging important topic worldwide. Violation of women dignity, privacy, and confidentiality impact birth outcomes as consequence influencing both morbidity and mortality rate. This occurs as result to complex reasons that attributable to health services which include inadequate coverage of health care, lack of trained assistance, insufficient essential obstetric care and poor health referral system.&#x0D; &#x0D; Objective: To explore women experience during childbirth in terms of health rights and the quality of care provided and to further study women attuited and experience with midwives and their future role in obstetric care.&#x0D; &#x0D; Method: Based on informant report, a random snowballing sampling technique was carried out through using an anonymous online - based questionnaire. Participants in this study were (n=360) women. Ethical approval was obtained by the institutional review board at King Saud University (IRB No. E-18-32836).&#x0D; &#x0D; Results: The majority of women reported their childbirth experience as unfavourable. According to our findings, women encounter various kinds of obstetric violence including denial of access to a health care, restriction of analgesia, violation of privacy and failure of obtaining an informed consent which found to be high as (91.0%), (53.0%) respectively. &#x0D; &#x0D; Conclusion: Optimal maternity care can be assured through appropriate access to medical resources and health care expertise with a higher priority committed to supporting midwife-led care during childbirth.

Past experience of women during childbirth in the periphery of western mountain region of Nepal during childbirth

Aims: To explore the past experience of women during childbirth in terms of respectful maternity on institutional deliveries in the region.&#x0D; Methods: This is a cross sectional descriptive study among women during outdoor visit at Karnali Academy of Health Sciences in Jumla from April to August 2020. Data were analyzed in terms of seven components of respectful maternity care.&#x0D; Results: The prevalence of obstetrics mistreatment was 78.5%. From 200 respondents, more than half had hospital delivery and one-fourth at local birthing center. Two-third of them perceives the care provided to them was proper and 85% opt to visit again to the same center in next pregnancy. Around 70-80% by ethnic group and at least three-fourth by the site of delivery have experienced at least one type of mistreatment.&#x0D; Conclusions: Indicators of respectful maternity care are not satisfactory in the western mountainous region.&#x0D; Keywords: institutional delivery, mistreatment, respectful maternity care

Years of healthy life lost due to adverse pregnancy and childbirth outcomes among adolescent mothers in Thailand.

BackgroundPreventing adolescent pregnancy and childbirth is one of the targets of Sustainable Development Goals. Measuring the burden pregnancy and childbirth places on adolescents is required to convince society and decision makers that this is an important goal.ObjectiveThis study aimed to estimate (1) the years of healthy life lost due to adolescent pregnancy and childbirth in terms of disability adjusted life years (DALYs), (2) the contribution of adolescent pregnancy and childbirth to the total DALYs lost from all reproductive ages, and (3) the magnitude of the burden due to five main direct obstetric causes and sequelae in adolescent mothers in Thailand in 2014.MethodsData were retrieved from a national in-patient registered database and a vital registration database. Health consequences of five main direct obstetric causes were extracted from the Global Burden of Diseases (GBD) 2000 study. The DALYs were calculated by the combination of Years of Life Lost (YLL) due to premature death and Years Lived with Disability (YLD) due to adverse pregnancy and childbirth in adolescent mothers.ResultsThere were a total of 2599 years of DALYs lost from the consequences of adolescent pregnancy and childbirth, and unsafe abortion resulted in the highest burden. Mortality was the primary driver for the total DALYs lost with 1704 years, and maternal hemorrhage dominated in the total YLL. Unsafe abortion contributed the highest burden to nonfatal morbidity. Obstructed labor commonly occurred in adolescent pregnancies.ConclusionAmong the DALYs lost due to pregnancy and childbirth for all reproductive aged women, 15.4% were attributed to adolescents. The five main obstetric causes of mortality and morbidity are all preventable conditions. Increased efforts from all stakeholders are essential to implement appropriate interventions to minimize adverse health outcomes in adolescent mothers.

Placenta response of inflammation and oxidative stress in low-risk term childbirth: the implication of delivery mode

BackgroundCaesarean delivery rate is increasing gradually in China and there is no doubt that delivery mode is closely associated with the maternal health and infant development.This study examined the independent effect of delivery mode on placenta inflammation response and oxidative stress response.MethodsA total of 3474 pregnant women recruited in Ma’anshan Birth Cohort Study were the initial study population. Data on maternal socio-demographic characteristics and pre-pregnancy BMI were collected at their 1st antenatal checkups. Pregnancy-specific anxiety was assessed during the three trimesters of pregnancy. Common pregnant complications were monitored in the whole pregnancy period. Delivery modes, as well as newborn characteristics were abstracted from medical records. Delivery modes included vaginal deliveries (VD), caesarean delivery with medical indications (CDMI), caesarean delivery on maternal request (CDMR) and urgent cesarean delivery (UCD). Placentas were collected during childbirth. The mRNA expression of IL-1β, TNF-a, IL-6, IFN-γ, IL-4, IL-10, IL-8, and HO-1 were assessed in the final sample of 1978 low-risk women with singleton term-births.ResultsThe overall rate of caesarean delivery (CD) was 50.5% (1650/3265) in singleton term childbirths in this study. Among women who reported definite CD reasons, 56.8%of them chose the surgery without any medical indications.It shows a non-linear relationship between cytokines related with placenta inflammatory response, oxidative stress response and different delivery modes. At high percentiles of IL-1β, IFN-γ and IL-8, women with CDMR had higher expression levels compared to women with VD. Women with CDMI had higher levels at median percentiles of IL-1β, IFN-γ and IL-8. Women with CDMR had higher expression compared with VD at high percentiles of IL-6 and HO-1, and women with CDMI had higher levels of these two cytokines at their low percentiles. It is worth noting that at high percentiles, compared with normal delivery, the expression of IL-1β, IFN-γ, IL-8 and HO-1 have significantly altered in women with CDMR.ConclusionA high overall CD rate was found in this study, and caesarean delivery on maternal request was the major contributor to the high prevalence. Maternal placental oxidative stress and inflammatory response were closely associated with delivery mode. The effect is much amplified at high levels of expression in women who chose CD on maternal request.Such difference needs to be noticed and may have important implications for obstetricians, midwives and other perinatal health care workers.

US Term Stillbirth Rates and the 39-Week Rule: A Cause for Concern?

(Am J Obstet Gynecol. 2016;214(5):621.e1–621.e9) The restriction of the use of “elective” delivery before 39 weeks 0 days of gestation, known as “the 39-week rule” or “the Rule,” was mandated in 2010 in the United States. The Rule was applicable to both labor induction and prelabor cesarean delivery, and was developed as higher rates of adverse childbirth outcomes, including infant morbidity and mortality, subsequent to deliveries that occurred before 39 weeks 0 days of gestation had been reported. However, the prospective risk of term stillbirth was known to increase as a function of increasing gestational age, and hence it was speculated that the Rule might increase the overall rate of term stillbirth. This study aimed to determine whether the term stillbirth rate increased during the 7-year period that the 39-week rule was adopted. The number of live births and the number of stillbirths that occurred within each week of gestational age at and further than 37 weeks were obtained from the state health departments for the years 2007 to 2013. The patterns of the timing of term childbirth and term stillbirth were determined as a function of calendar year and gestational age for each state and for the United States overall. The number needed to treat, which represented the number of women who would need to have an early-term delivery without an accepted indication to prevent one term stillbirth, was estimated based on the change in the proportion of deliveries that occurred before the 39th week of gestation in 2013 compared with 2007, and by the estimated change in the incidence of term stillbirth that occurred in 2013 compared with 2007.

The Relationship Between Infant Feeding Outcomes and Maternal Emotional Well-being Among Mothers of Late Preterm and Term Infants: A Secondary, Exploratory Analysis.

Late preterm birth is associated with lower rates of breastfeeding and earlier breastfeeding cessation than term birth. The objectives of this secondary analysis were to compare the incidence of exclusive breastfeeding after late preterm and term childbirth and to examine the association between infant feeding outcomes and maternal emotional well-being. Participants were 105 mother-infant dyads (54 late preterm and 51 term) at a southeastern US medical center. Face-to-face data collection and telephone follow-up occurred during 2009-2012. Late preterm mothers were less likely to exclusively provide their milk than were term mothers during hospitalization. Feeding at 1 month did not differ between late preterm and term infants. Among late preterm mothers, (1) formula supplementation during hospitalization was associated with greater severity of anxiety than among those exclusively providing formula and (2) exclusive provision of human milk at 1 month was associated with less severe depressive symptoms than among those supplementing or exclusively formula feeding. Among term mothers, feeding outcome was not related to emotional well-being measures at either time point. Mothers of late preterm infants may particularly benefit from anticipatory guidance and early mental health screening, with integrated, multidisciplinary lactation teams to support these interrelated healthcare needs. Prospective research is critical to document women's intentions for infant feeding and how experiences with childbirth and the early postpartum period impact achievement of their breastfeeding goals.

US term stillbirth rates and the 39-week rule: a cause for concern?

More than a decade ago an obstetric directive called "the 39-week rule" sought to limit "elective" delivery, via labor induction orcesarean delivery, before 39 weeks 0 days of gestation. In 2010 the 39-week rule became a formal quality measure in the United States. The progressive adherence to the 39-week rule throughout the United States has caused a well-documented, progressive reduction in the proportion of term deliveries occurring during the early-term period. Because of the known association between increasing gestational age during the term period and increasing cumulative risk of stillbirth, however, there have been published concerns that the 39-week rule-by increasing the gestational age of delivery for a substantial number of pregnancies-might increase the rate of term stillbirth within the United States. Although adherence to the 39-week rule is assumed to be beneficial, its actual impact on the US rate of term stillbirth in the years since 2010 is unknown. To determine whether the adoption of the 39-week rulewas associated with an increased rate of term stillbirth in the United States. Sequential ecological study, based on state data, of US term deliveries that occurred during a 7-year period bounded by 2007 and 2013. The patterns of the timing of both term childbirth and term stillbirth were determined for each state and for the United States as a whole. A total of 46 usable datasets were obtained (45 states and the District of Columbia). During the 7-year period, there was a continuous reduction in all geographic entities in the proportion of term deliveries that occurred before 39 weeks of gestation. The overall rate of term stillbirth, when we compared 2007-2009 with 2011-2013, increased significantly (1.103/1000 vs 1.177/1000, RR 1.067, 95% confidence interval 1.038-1.096). Furthermore, during the 7-year period, the increase in the rate of US term stillbirth appeared to be continuous (estimated slope: 0.0186/1000/year, 95% confidence interval 0.002-0.035). Assuming 3.5 million term US births per year, and given 6 yearly "intervals" with this rate increase, it is possible that more than 335 additional term stillbirths occurred in the United States in 2013 as compared with 2007. In addition, during the 7-year period, there was a progressive shift in the timing of delivery from the 40th week to the 39th week. Absent this confounding factor, the magnitude of association between the adoption of the 39-week rule and the increase in rate of term stillbirth might have been greater. Between 2007 and 2013 in the United States, the adoption of the 39-week rule caused a progressive reduction in the proportion of term births occurring before the 39th week of gestation. During the same interval the United States experienced a significant increase in its rate of term stillbirth. This study raises the possibility that the 39-week rule may be causing unintended harm. Additional studies of the actual impact of the adoption of the 39-week rule on major childbirth outcomes are urgently needed. Pressures to enforce the 39-week rule should be reconsidered pending the findings of such studies.

An evaluation of the quality of care for women with low risk pregnanacy: The use of evidence-based practice during labour and childbirth in four public hospitals in Tehran

Objectivethere is a consensus that the adoption of evidence-based practice contributes to the improvement of maternity care. Iranian National Guidelines for Normal Childbirth included evidence-based practice and were disseminated to hospitals in 2006 but little is known about the success of implementation. This study investigates the provision of care during labour and childbirth in comparison with national guidelines in four public hospitals in Tehran. Designthis was a descriptive evaluation study and investigated the provision of care during labour and childbirth using current evidence-based practice as the indicator of quality. Participants and settingthe observational and interview data were collected using checklist and interview guide based upon standards for evidence-based care in four public hospitals in Tehran. In 24 women who were admitted in normal labour, practices were observed until the end of the third stage of labour, to determine concordance with Iranian National Guidelines for Normal Childbirth. A further 100 postpartum woman were interviewed about their care during labour and childbirth in the early postpartum period before discharge from the postnatal ward. Findingsbeneficial and lifesaving practices such as assessing mothers׳ well-being; removal of the placenta in the third stage of labour, as well as skin-to-skin contact and early initiating of breast feeding were recorded in most cases. However, the use of practices such as routine augmentation and induction of labour, fundal pressure, conducting routine episiotomy were noted. Key conclusionsthis evaluation study shows good practice and areas for improvement as practices fail to meet evidence based standards. Thus, there is potential for quality improvement and economic savings in Tehran maternity hospitals. However closing the gap between guidelines based on best evidence and actual clinical practice in childbirth is a challenge. Practical solutions to enable implementation of evidence-based guidelines for normal childbirth in low risk women require further studies, especially from the providers׳ perspective. Implications for practicenational programs which focus on organisational framework, interventions to change provider׳s attitudes towards the development of a culture of birth as a normal and physiological process are more likely to be important in the Iranian context. Involving professional midwives more in the care for normal childbirth may help to improve quality of care during normal labour and childbirth in terms of evidence-based practice.

Experiences of Nursing College Students attended to Delivery Practice at Midwifery Clinic.

The purpose of this study was to explore the experiences of nursing college students who attended delivery practices at midwifery clinic. This was a qualitative study using focus groups. Data were collected by group interviews with a total of 12 students who observed natural childbirth at midwifery clinic. Data were analyzed through Colaizzi's method in which meaningful statements were extracted. The meanings of experiences were identified five theme clusters from thirteen themes and thirty-one sub-themes. The five theme clusters were 'ultimate process of natural childbirth', 'allowed birth', 'role recognition of the midwife', 'positively changed perception', and 'barriers'. This study showed that observation of delivery at midwifery clinic was helpful for nursing students in terms of positive impression about natural childbirth with maternal and baby being centered. Nursing students expressed value and concern about delivery at midwifery clinic. Further in-depth study of natural childbirth in terms of husband and family perspective is required. For quality improvement of maternity nursing care, natural childbirth process needs to be included in nursing care at hospitals as well as students' clinical practicum.

Vliv episiotomie na výskyt močové inkontinence u žen 2-5 let po porodu

Cíl: Cílem práce bylo zjistit vliv episiotomie na výskyt močové inkontinence u žen. Získané výsledky jsme porovnávali s ženami, které během porodu utrpěly spontánní ruptury hráze I. a II. stupně a skupinou žen bez porodního poranění hráze. Metodika: Výzkumný soubor tvořilo 211 žen, které byly 2-5 let po spontánním termínovém porodu. Data byla získávána pomocí dotazníku International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Výsledky: Nebyly zjištěny rozdíly ve výskytu močové inkontinence mezi ženami s epiziotomií a ženami se spontánními rupturami hráze nebo bez porodního poranění hráze. Výskyt močové inkontinence ovlivňuje BMI ženy, parita a přítomnost problémů s únikem moče již před porodem. Závěr: Nebylo prokázáno, že by epiziotomie zvyšovala nebo snižovala výskyt močové inkontinence u žen 2-5 let po porodu.

Reproductive factors and risk of hormone receptor positive and negative breast cancer: a cohort study

BackgroundThe association of reproductive factors with hormone receptor (HR)-negative breast tumors remains uncertain.MethodsWithin the EPIC cohort, Cox proportional hazards models were used to describe the relationships of reproductive factors (menarcheal age, time between menarche and first pregnancy, parity, number of children, age at first and last pregnancies, time since last full-term childbirth, breastfeeding, age at menopause, ever having an abortion and use of oral contraceptives [OC]) with risk of ER-PR- (n = 998) and ER+PR+ (n = 3,567) breast tumors.ResultsA later first full-term childbirth was associated with increased risk of ER+PR+ tumors but not with risk of ER-PR- tumors (≥35 vs. ≤19 years HR: 1.47 [95% CI 1.15-1.88] ptrend < 0.001 for ER+PR+ tumors; ≥35 vs. ≤19 years HR: 0.93 [95% CI 0.53-1.65] ptrend = 0.96 for ER-PR- tumors; P het = 0.03). The risk associations of menarcheal age, and time period between menarche and first full-term childbirth with ER-PR-tumors were in the similar direction with risk of ER+PR+ tumors (phet = 0.50), although weaker in magnitude and statistically only borderline significant. Other parity related factors such as ever a full-term birth, number of births, age- and time since last birth were associated only with ER+PR+ malignancies, however no statistical heterogeneity between breast cancer subtypes was observed. Breastfeeding and OC use were generally not associated with breast cancer subtype risk.ConclusionOur study provides possible evidence that age at menarche, and time between menarche and first full-term childbirth may be associated with the etiology of both HR-negative and HR-positive malignancies, although the associations with HR-negative breast cancer were only borderline significant.

Obstetric outcome after intervention for severe fear of childbirth in nulliparous women – randomised trial

To compare the numbers of vaginal deliveries and delivery satisfaction among women with fear of childbirth randomised to either psychoeducation or conventional surveillance during pregnancy. Randomised controlled trial. Maternity unit of Helsinki University Central Hospital. Fear of childbirth was screened during early pregnancy by the Wijma Delivery Expectancy Questionnaire (W-DEQ-A). Of 4575 screened nulliparous women, 371 (8.1%) scored ≥ 100, showing severe fear of childbirth. Women with W-DEQ-A ≥ 100 were randomised to intervention (n = 131) (psychoeducative group therapy, six sessions during pregnancy and one after childbirth) or control (n = 240) (care by community nurses and referral if necessary) groups. Obstetric data were collected from patient records and delivery satisfaction was examined by questionnaire. Delivery mode and satisfaction. Women randomised to the intervention group more often had spontaneous vaginal delivery (SVD) than did controls (63.4% versus 47.5%, P = 0.005) and fewer caesarean sections (CSs) (22.9% versus 32.5%, P = 0.05). SVD was more frequent and CSs were less frequent among those who actually participated in intervention (n = 90) compared with controls who had been referred to consultation (n = 106) (SVD: 65.6% versus 47.2%, P = 0.014; CS: 23.3% versus 38.7%, P = 0.031). Women in intervention more often had a very positive delivery experience (36.1% versus 22.8%, P = 0.04, n = 219). To decrease the number of CSs, appropriate treatment for fear of childbirth is important. This study shows positive effects of psychoeducative group therapy in nulliparous women with severe fear of childbirth in terms of fewer CSs and more satisfactory delivery experiences relative to control women with a similar severe fear of childbirth.