Obstetric Experience Research Articles

Knowledge, attitudes, and support needs of obstetric and gynecological nurses and midwives toward perinatal mental health disorders screening in Central China: a multicenter cross-sectional survey.

The perinatal period is a time of increased vulnerability regarding maternal mental health status. Although guidelines and policies have been published for perinatal mental health disorders (PMHDs) screening in China, the knowledge, attitudes, and support needs of nurses and midwives toward implementing mental health screening programs during pregnancy remain unclear. Thus, this study aimed to investigate the knowledge of PMHDs, attitudes and support needs related to implementing mental health screening during pregnancy among obstetrics and gynecology (OB/GYN) nurses and midwives in the central region of China while identifying the related influencing factors. A cross-sectional survey was conducted in 14 cities in Hubei, China, using convenience sampling from July to October 2023. The Chinese version of the Perinatal Mental Health Knowledge Questionnaire, the Chinese version of the Perinatal Mental Health Attitudes Scale, and the Health Care Facilities Support Needs Scale were used to investigate the PMHDs knowledge, attitudes, and support needs of OB/GYN nurses and midwives, respectively. Data were analyzed using SPSS version 27.0. Descriptive and inferential statistics were performed, with a p-value of <0.05 considered statistically significant. The average scores for knowledge, attitudes, and support needs were 6.09 ± 1.99 (total score: 13), 47.67 ± 8.80 (total score: 80), and 29.35 ± 4.66 (total score: 35), respectively. After adjusting for years of nursing experience and years of obstetrics and gynecology nursing experience, the multivariate logistic regression analysis indicated that having mental health-related education or work experience [adjusted OR (aOR) = 1.43, p = 0.01], being midwives (aOR = 1.78, p < 0.001), and working in specialist maternity hospitals (aOR = 1.55, p < 0.001) were significantly associated with higher knowledge scores; having mental health related education or work experience (aOR = 1.59, p = 0.014) and working in specialist maternity hospitals (aOR = 1.42, p < 0.01) were significantly associated with higher support needs scores. OB/GYN nurses and midwives demonstrated insufficient knowledge and moderate attitudes toward PMHDs screening, and have great support need for PMHDs screening. To address these issues, medical organizations and relevant government sectors should enhance training for nurses and midwives on PMHDs and provide professional support to promote routine maternal mental health screening programs and improve perinatal mental health outcomes.

Obstetric healthcare experiences and information needs of Dutch women in relation to their vegan diet during pregnancy

ObjectivesThe prevalence of a vegan (strict plant-based) diet is increasing. Adequate access to nutritional information for pregnant women on a vegan diet is vital, as optimal maternal nutrition is important in order to prevent maternal and fetal complications. This study evaluated the obstetric healthcare experiences and information needs of pregnant women following a vegan diet in the Netherlands. MethodsAn online survey examined women’s experiences with obstetric healthcare in relation to their vegan diet during pregnancy. In total, 195 women, all of whom followed a vegan diet during their pregnancy and gave birth between January 2018 and April 2020, completed an online survey about their experiences. Descriptive statistics were used to present the data. ResultsIn total, 36.5% of participants reported that an obstetric healthcare provider had inquired about their diet in general during the first prenatal consultation, and an additional 43.1% of participants proactively informed their healthcare provider about their diet. Only 19.0% of all participants received specific information about their vegan diet during pregnancy, and 25.2% reported having had extra checks, mostly blood tests, during their pregnancy. Of all participants, 35.9% would have preferred to receive additional information regarding their diet. ConclusionsOur data shows that only a minority of pregnant women following a vegan diet received information and recommendations about their diet from their healthcare providers. It is our recommendation that healthcare providers inquire about pregnant women’s diets, and refer those following a vegan diet to reliable sources of dietary information or to a specialized dietitian.

The meaning of obstetric violence experiences: A qualitative content analysis of the Break the Silence Campaign

BackgroundObstetric violence involves the mistreatment, disrespect, and abuse of birthing people and the problem has been recognized in healthcare systems worldwide. Obstetric violence is a gendered, sex-specific form of violence against women that is a public health problem and a violation of human rights. There are an unknowable number of online posts and social media messages that describe obstetric violence experiences. There are no known studies about self-published experiences of obstetric violence in the US maternity care system. ObjectiveTo understand the meaning of obstetric violence experiences in the US maternity care system from a naturally occurring, purposive sample. DesignA secondary analysis of the textual data from the original Break the Silence social media campaign using qualitative content analysis. The theory of social justice in nursing provided a theoretical framework. A healthcare systems approach was used for a wide-angle view of the multidirectional structure, processes, and outcome of obstetric violence. SettingThe study setting is the public Facebook page where the Break the Silence social media campaign can be seen. Break the Silence was an online activism response to the problem of obstetric violence in the US maternity care system with signboard messages posted from 31 known US states. The setting is bounded by the digital page where the campaign is published. ParticipantsThere were 139 participants, and 11 of them posted more than one signboard message. Most participants were birthing people (n = 125) followed by doulas (n = 10). MethodsKrippendorff's methodology for qualitative content analysis was applied to 156 signboard messages posted on Break the Silence from 2014 to 2016. Qualitative content analysis was supported by Atlas.ti 23. ResultsFour themes illustrated the meaning of obstetric violence in US maternity care: 1) pregnancy and birth as a battle with healthcare providers and the healthcare system, 2) sacrifice of the maternal body normalized and assumed as a gender stereotype, 3) disrupted rites of passage from childbirth, and 4) abuse of fiduciary power by healthcare providers. ConclusionsThis study demonstrated thematic meanings for the experience of obstetric violence in US maternity care with a healthcare systems approach that included structural and organizational considerations to increase understanding. Categories and forms of obstetric violence from the existing literature were expanded and strengthened by findings from this study. Themes were validated in principle with consistency in findings across the international evidence base on obstetric violence.Tweetable abstract: The meaning of #obstetricviolence experiences is interpersonal and structural with thematic consistency across international studies.

Enhancing trainee performance in obstetric ultrasound through an artificial intelligence system: randomized controlled trial.

Performing obstetric ultrasound scans is challenging for inexperienced operators; therefore, the prenatal screening artificial intelligence system (PSAIS) software was developed to provide real-time feedback and guidance for trainees during their scanning procedures. The aim of this study was to investigate the potential benefits of utilizing such an artificial intelligence system to enhance the efficiency of obstetric ultrasound training in acquiring and interpreting standard basic views. A prospective, single-center randomized controlled study was conducted at The First Affiliated Hospital of Sun Yat-sen University. From September 2022 to April 2023, residents with no prior obstetric ultrasound experience were recruited and assigned randomly to either a PSAIS-assisted training group or a conventional training group. Each trainee underwent a four-cycle practical scan training program, performing 20 scans in each cycle on pregnant volunteers at 18-32 gestational weeks, focusing on acquiring and interpreting standard basic views. At the end of each cycle, a test scan evaluated trainees' ability to obtain standard ultrasound views without PSAIS assistance, and image quality was rated by both the trainees themselves and an expert (in a blinded manner). The primary outcome was the number of training cycles required for each trainee to meet a certain standard of proficiency (i.e. end-of-cycle test scored by the expert at ≥ 80%). Secondary outcomes included the expert ratings of the image quality in each trainee's end-of-cycle test and the discordance between ratings by trainees and the expert. In total, 32 residents and 1809 pregnant women (2720 scans) were recruited for the study. The PSAIS-assisted trainee group required significantly fewer training cycles compared with the non-PSAIS-assisted group to meet quality requirements (P = 0.037). Based on the expert ratings of image quality, the PSAIS-assisted training group exhibited superior ability in acquiring standard imaging views compared with the conventional training group in the third (P = 0.012) and fourth (P < 0.001) cycles. In both groups, the discordance between trainees' ratings of the quality of their own images and the expert's ratings decreased with increasing training time. A statistically significant difference in overall trainee-expert rating discordance between the two groups emerged at the end of the first training cycle and remained at every cycle thereafter (P < 0.013). By assisting inexperienced trainees in obtaining and interpreting standard basic obstetric scanning views, the use of artificial intelligence-assisted systems has the potential to improve training effectiveness. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Placental Abruption: Unveiling Persistent Challenges and Management Strategies from the Obstetrical Intensive Care Unit Experience in Fes, Morocco

Introduction: Postpartum haemorrhage (PPH) remains the leading cause of maternal mortality, with placental abruption (PA) being a serious and challenging etiology. Late diagnosis and inadequate management of PA can exacerbate PPH and worsen maternal outcomes. This work aims to analyse the epidemiological, clinical and Para-clinical profile of PA in the Intensive Care Unit (ICU); as well as to determine the profile of coagulopathy in PPH and to discuss various treatment modalities. Materials &amp; Methods: This retrospective, descriptive, non-interventional study reviews cases of PA requiring ICU admission at Hassan II University Hospital in Fez from January 2019 to December 2023. Results: Forty-two patients met the inclusion criteria, with a mean age of 32 years. Primiparae constituted 33.4% of the cohort. 78.6% lacked prenatal care. The average gestational age was 32 weeks. Preeclampsia was the predominant risk factor (57.1%). Symptoms included mostly slow fetal movements, hemorrhage, and abdominal rigidity. At admission, 26% of patients exhibited hemorrhagic shock. General anesthesia was used in 82.5% of cases. In the operating room, 12% of patients received fibrinogen, and 50% received tranexamic acid. Blood transfusions were administered to 67% of patients, with an average of 2.14 packed red blood cells (PRBCs), 5.3 platelets (PLTs), and 3.5 fresh frozen plasma (FFP). Surgical interventions included hysterectomy, B-Lynch procedure, and vascular ligature. The mean duration of mechanical ventilation in the ICU was 3.66 days. The maternal mortality rate was 9.5%, and five newborns survived to discharge. Conclusion: This study emphasizes the need for a multidisciplinary approach and early intervention to manage PPH from PA effectively, and highlights the importance of national programs to address modifiable risk factors. Keywords: Fibrinogen, Placental Abruption, Postpartum Hemorrhage, Tranexamic Acid, Transfusion, Morocco

Pediatric and Adolescent Gynecology Experience in Obstetrics and Gynecology Residency Training Across the United States

Study ObjectiveThe purpose of this study is to better understand the pediatric and adolescent gynecology (PAG) experience from the obstetrics and gynecology (OBGYN) resident perspective and its impact on physician comfort with caring for younger patients. MethodsThis is a cross-sectional survey study of physicians enrolled in OBGYN residency programs in the United States. For each program, an internet search was also performed to identify the closest PAG providers. Chi-square and Fisher's exact tests were performed to compare categorical variables. This study was IRB approved. Results74 resident responses from 42 unique OBGYN training programs were included. The majority (62%) of programs offered no PAG clinical experience. Of programs with no PAG clinical experience, 45% had unaffiliated self-identified PAG providers within 30 miles of their institution. Only 26% of residents reported having a dedicated PAG rotation. 68% of residents felt they did not have enough PAG exposure in training. Residents who had a dedicated PAG rotation were more comfortable caring for patients <7 years old (p=0.016) and patients 8-14 years old (p=0.019) than residents without a rotation. The majority (88%) of residents believe that PAG experience will be useful for their future practice. ConclusionResidents with PAG training are more comfortable in caring for patients <14 years than those in programs who lack this training. Residencies without PAG-trained staff physicians could consider partnering with PAG-practicing community physicians with the aim of broadening clinical experience. Improvement in PAG education helps provide graduating obstetrician-gynecologists with the necessary knowledge to provide needed care to younger patients.

Medicaid-Insured Women’s Perceptions of Obstetric Care Quality: Implications for Reproductive Health Equity in the United States

Racial and socioeconomic disparities in maternal health outcomes are significant in the United States. Expanded access to obstetric care through Medicaid, a public health insurance program, aims to address these disparities among racially and economically marginalized birthing people. However, limited research has examined the experiences of women whose obstetric care was covered by Medicaid. This study utilized a birth equity framework informed by reproductive justice principles to analyze interviews with 30 Medicaid-insured women in South Carolina. The analysis focused on study participants’ perceptions of their obstetric care experiences during their most recent pregnancy and hospital stay for labor and delivery. Thematic analysis revealed that participants felt disrespected, dismissed, and ignored by their obstetric care providers. Problems included insurance-related discrimination, insufficient explanations about treatment protocols, mismanagement of pregnancy complications, disregarded pain medication requests, inadequate monitoring of labor progression, and physician absences during delivery. The results substantiate the need for birth equity–informed interventions that facilitate structural competency and cultural humility among medical professionals to improve obstetric care quality among marginalized patients.

Drug Testing Interpretation in the Peripartum Setting: Results of Clinician Survey.

The objectives of this study were to (1) survey obstetrical and pediatric clinicians' experience, confidence, and training in maternal and neonatal drug testing interpretation; (2) determine their proficiency in drug test interpretation; and (3) assess predictors of correct interpretation. We conducted a cross-sectional survey of clinicians caring for pregnant people or newborns at an urban academic center. We assessed clinicians' demographic characteristics, experience, confidence, and prior training in interpretation of maternal and newborn drug tests. We assessed proficiency in interpreting drug tests using 11 clinical vignettes and categorized scores as poor (0-2), fair (3-5), and good (≥6) performance to facilitate data interpretation. We used descriptive statistics to summarize responses. Multinomial logistic regression was used to determine associations of clinician characteristics and score category (reference category: poor performance). In total, 103 respondents completed the survey including 60 obstetrical clinicians (58.3%), 19 family medicine physicians (18.5%), 21 pediatric clinicians (20.4%), and 3 social workers (2.9%) (response rate, ~40%). The mean correct response was 4.1 (SD, 2.17; range, 0-11). Most respondent scores were fair (n = 47.6%), followed by good (n = 28.2%) and poor (n = 24.3%). Increased frequency, confidence, and training in interpreting maternal screening and confirmatory tests were associated with higher proficiency. Increased confidence and training in interpreting neonatal screening and confirmatory tests, but not frequency, were associated with higher proficiency. Most clinicians demonstrated fair proficiency in interpreting drug tests. Predictors of proficiency were confidence and prior training for drug test interpretation, suggesting that educational interventions could improve proficiency.

Investigating racial/ethnic differences in procedure experience in obstetrics & gynecology trainees at a single academic institution: a retrospective cohort study

BackgroundDiscrimination is common in medical education. Resident physicians of races and ethnicities underrepresented in medicine experience daily discrimination which has been proven to negatively impact training. There is limited data on the impact of resident race/ethnicity on OB/GYN surgical training. The objective of this study was to investigate the impact of race/ethnicity on procedural experience in OB/GYN training.MethodsA retrospective analysis of graduated OB/GYN resident case logs from 2009 to 2019 was performed at a single urban academic institution. Self-reported race/ethnicity data was collected. Association between URM and non-URM were analyzed using t-tests. Trainees were categorized by self-reported race/ethnicity into underrepresented in medicine (URM) (Black, Hispanic, Native American) and non-URM (White, Asian).ResultsThe cohort consisted of 84 residents: 19% URM (N = 16) and 79% non-URM (n = 66). Difference between URM and non-URM status and average case volume was analyzed using t-tests. There was no difference between non-URM and URM trainees and reported mean number of Total GYN (349 vs. 334, p = 0.31) and Total OB (624 vs. 597, P = 0.11) case logs. However, compared with non-URM, on average URM performed fewer Total procedures (1562 vs. 1469, P = 0.04). Analyzing individual procedures showed a difference in average number of abortions performed between URM and non-URM (76 vs. 53, P = 0.02). There were no other statistically significant differences between the two groups.ConclusionsThis single institution study highlights potential differences in trainee experience by race/ethnicity. Larger national studies are warranted to further explore these differences to identify bias and discrimination, and to ensure equitable experience for all trainees.

Evaluating TeamBirth's Effect on Autonomy for Minoritized Populations in Labor [ID 2683585

INTRODUCTION: Prioritization of maternal autonomy and communication can greatly affect obstetric care experiences. We implemented TeamBirth—an initiative designed to center the patient, their preferences, and autonomy through standardized team communication in labor. We sought to understand how TeamBirth affected obstetric care experiences, through self-reported autonomy, for minority populations. METHODS: TeamBirth “huddles” in labor included patients, labor support persons, physicians, and nursing team members participating in standardized communication approaches, supplemented with whiteboard and decision-support guides. From May 2021 to May 2022, surveys administered postpartum inpatient were collected from birthing persons. We used the Mother’s Autonomy in Decision Making Scale (MADM) to measure autonomy. MADM scores in the highest quartile (scores ranged 34–42) were considered as having high autonomy. RESULTS: Over one-third (36.4%) of the 762 respondents were of minoritized populations (eg, Black, Hispanic) versus White (63.3%). When considering race/ethnicity, high autonomy was not related to minoritized group (P=.944). The majority (86%) of high autonomy respondents had one or more huddles, compared to 71% with low autonomy (P&lt;.001). When evaluating the relationship of number of huddles to high autonomy, the minority group was not different compared to White patients (interaction P=.915). CONCLUSION: Patients who experienced huddles during intrapartum care reported higher autonomy regardless of minority status. Use of the TeamBirth initiative has potential to increase autonomy and improve obstetric experiences. Early data indicate that patient experiences of minoritized populations can be improved with TeamBirth; additional investigation is indicated.

The Silent Suffering: Obstetric Fistula in Ethiopia

Obstetric fistula is a maternal morbidity that accounts for 6% of all maternal deaths worldwide. This condition occurs most commonly in areas of sub-Saharan Africa and rural south Asia where access to medical care and maternal education is not readily available. During prolonged or obstructed labor, a fistula can form connecting the rectum or urinary tract with the vagina. The condition is more common in young mothers who are pressured by their community, culture, or partner to have children early. This has severe and devastating potentially lifelong consequences. Women living with obstetric fistula experience chronic incontinence and associated odors, social and psychological isolation, and severe pain. Despite the condition being preventable and treatable with surgery, there is still a high prevalence in low-income countries. Although the incidences of obstetric fistula are difficult to document due to the lack of medical reporting, this analysis will focus on the effects of the disease in Ethiopia, one of the poorest countries in the world.

Missed opportunities in postpartum contraception: Bridging the gaps for patients who deliver at Catholic hospitals in Illinois

AbstractIntroductionCatholic hospitals' religious restrictions limit postpartum contraceptive care and reproductive counselling. This qualitative study explores opportunities for patients and providers to ensure access to desired postpartum contraception care.MethodsWe interviewed people who had obstetric experiences in Illinois Catholic hospitals: 21 patients and 23 providers, including clinicians, doulas, nurses, and maternal health home visitors. We transcribed interviews and coded transcripts then used a thematic content approach for analysis. To guide future interventions, we sought interviewees' perspectives on opportunities to improve postpartum contraceptive care for patients affected by these restrictions.ResultsPatients delivered in Catholic hospitals for varied reasons unrelated to religious affiliation and were generally unaware of limits on access to contraception. Some providers offered referrals or workarounds for some contraceptive methods. The majority of providers described the importance of initiating contraceptive counselling during the prenatal period, but few patients reported receiving comprehensive contraceptive counselling during this time. Patients who received contraceptive counselling often had these experiences with doulas and maternal health home visitors who were not affiliated with religious health centres.ConclusionContraceptive counselling in the prenatal period can be a particularly helpful tool for patients delivering in hospitals that limit access to postpartum contraception, particularly in Catholic hospitals. Prenatal counselling can support advance planning if a patient needs to transfer or seek care outside their preferred health system. Where counselling and referrals are prohibited by religious restrictions, doulas and other maternal health home visitors can bridge gaps and support patient decision‐making and navigation to receive postpartum contraceptive care.

Effect of lite touch on the anxiety of low-risk pregnant women in the latent phase of childbirth: a randomized controlled trial.

Women with perinatal anxiety have reduced coping capacity during labor, which affects labor progress and increases the likelihood of a cesarean section. Several non-pharmacological interventions for anxiety during childbirth are available. This study used the "lite touch" method, a non-pharmacological intervention based on physiological responses and obstetric clinical experience in women. We aimed to evaluate whether lite touch could relieve perinatal anxiety and investigate the effect of light skin stroking on the maternal hormones, catecholamine, and cortisol. This randomized clinical trial involved women with low-risk singleton pregnancies at full term or near term. Eligible pregnant women who were latent and did not undergo epidural anesthesia were randomized into two groups. Participants in the intervention group underwent routine prenatal care, including lite touch, whereas the control group underwent routine prenatal care alone. Demographic data were collected through a questionnaire. Labor anxiety was assessed using the State Anxiety Inventory, and saliva was collected before and after the intervention. Changes in saliva cortisol and catecholamine levels were analyzed using a double-antibody sandwich enzyme-linked immunosorbent assay. In total, 83 participants were included, with 43 and 40 in the intervention and control groups, respectively. In the intervention group, pre-intervention anxiety scores were significantly lower (p < 0.01) than post-intervention anxiety scores, whereas the control group showed no difference in anxiety scores before and after intervention (p > 0.05). Cortisol and catecholamine levels in saliva were significantly lower in the intervention group than in the control group after the intervention (p < 0.01). Lite touch can reduce the latent anxiety state of low-risk pregnant women, thereby maintaining in vivo stability and facilitating labor. https://www.chictr.org.cn/aboutEN.html, ChiCTR2300070905, Retrospectively Registered Date: April 26, 2023.

Place Of First Trimester Ultrasound at The University Teaching Hospital of Bogodogo (UTH-B) in Burkina Faso

Objective: To describe the experience of the UTH-Bogodogo obstetrics and gynecology department in ultrasound determination of fetal sex in the first trimester of pregnancy. Patients and methods: This was a prospective descriptive study conducted over a 30-month period from February 1, 2021 to June 30, 2022 in the gynecological and obstetric ultrasound unit of the UTH-Bogodogo in Ouagadougou. The study sample consisted of 311 fetuses. The sample included all pregnant women who came for an obstetrical ultrasound scan in a non-emergency situation, whose gestational age was between the 11th and 14th week of amenorrhea, and who expressed a wish to know the fetal sex. The methods described by Mazza and Efrat were used to determine fetal sex. Patients were followed until delivery, after clinical verification of the sex of their newborns. Data were collected using an individual data collection form. Participation in the study was conditional on patients signing an informed consent form. Results: Fetal sex determination was possible in 280 of 311 fetuses, for a feasibility rate of 89.7%. In the remaining 31 cases, it was not possible to determine the fetal sex, as the position of the fetus did not allow a clear view of the genital bud. In terms of reliability, of the 238 fetuses monitored, fetal sex determination was correct in 204 fetuses, for a success rate of 85.7%. Accuracy was better when sex determination was performed after 12 weeks of amenorrhea. There was no significant difference in measurements between single and multiple fetuses. Conclusion: ultrasound determination of fetal sex at first birth could be an effective, simple, available and inexpensive option in developing countries.

PLACE OF FIRST TRIMESTER ULTRASOUND AT THE UNIVERSITY TEACHING HOSPITAL OF BOGODOGO (UTH-B) IN BURKINA FASO

AbstractObjective: To describe the experience of the UTH-Bogodogo obstetrics and gynecology department in ultrasound determination of fetal sex in the first trimester of pregnancy.Patients and methods: This was a prospective descriptive study conducted over a 30-month period from February 1, 2021 to June 30, 2022 in the gynecological and obstetric ultrasound unit of the UTH-Bogodogo in Ouagadougou. The study sample consisted of 311 fetuses. The sample included all pregnant women who came for an obstetrical ultrasound scan in a non-emergency situation, whose gestational age was between the 11th and 14th week of amenorrhea, and who expressed a wish to know the fetal sex. The methods described by Mazza and Efrat were used to determine fetal sex. Patients were followed until delivery, after clinical verification of the sex of their newborns. Data were collected using an individual data collection form. Participation in the study was conditional on patients signing an informed consent form.Results: Fetal sex determination was possible in 280 of 311 fetuses, for a feasibility rate of 89.7%. In the remaining 31 cases, it was not possible to determine the fetal sex, as the position of the fetus did not allow a clear view of the genital bud. In terms of reliability, of the 238 fetuses monitored, fetal sex determination was correct in 204 fetuses, for a success rate of 85.7%. Accuracy was better when sex determination was performed after 12 weeks of amenorrhea. There was no significant difference in measurements between single and multiple fetuses.Conclusion: ultrasound determination of fetal sex at first birth could be an effective, simple, available and inexpensive option in developing countries.

Knowledge, attitude, and practice of physicians towards familial hypercholesterolaemia in north regions of Saudi Arabia.

To assess knowledge, attitude and practice of physicians regarding familial hypercholesterolaemia. The cross-sectional study was conducted from October to December 2022 in Aljouf, Tabouk, Hail and northern border regions of Saudi Arabia after approval from the ethics review committee of Qurayyat Health Affairs. Those included were physicians specialising in familial hypercholesterolaemia and having experience in family medicine, endocrinology, paediatrics, cardiology, internal medicine and obstetrics and gynaecology. Their knowledge, attitude and practice were assessed using a predesigned questionnaire. Data were analysed using SPSS 20. Of the 430 subjects, 220(51.2%) were males, 89(20.7%) were aged 36-40 years, 169(39.3%) were residents, and 146(34%) had experience >15 years. Overall, 270(62.8%), 286(66.5%) and 287(66.7%) subjects did not know about the clinical diagnostic algorithms of Simon Broom, Dutch Lipid Clinic Network and United States MedPed programme investigated criteria, respectively. There were, 149(34.7%) subjects with high awareness level, and the level of awareness was significantly affected by gender, level of training, medical specialty, and familiarity with familial hypercholesteremia (p<0.05). There were 343(79.8%) subjects who said they had never diagnosed familial hypercholesterolaemia. There were knowledge gaps, low awareness, and inappropriate practices related to familial hypercholesterolemia, indicating the need for targetted programmes.

Instructional and didactic support tool for teaching-learning Post-Partum Haemorrhage care in simulated settings: Creation and validation

ObjectiveTo describe the creation and validation process of an instructional, didactic and self-applied support tool for teaching-learning Post-Partum Haemorrhage care in simulated settings. BackgroundStudents frequently face difficulties performing the actions in the proper sequence in Post-Partum Haemorrhage simulated cases. Even in a controlled environment, anxiety, nervousness and fear of making mistakes are evident, which render the simulated experience highly stressful. Having a tool with a guideline can help students perform these actions more assertively. DesignA methodological study to develop a didactic tool. MethodsThe creation process of the didactic tool, called Instructional Disk for the Management of Post-Partum Haemorrhage, was divided into five phases: Analysis, Design, Development, Implementation and Evaluation. Nine experts specialised in Obstetrics and Midwifery validated the tool by answering a questionnaire with nine items; in turn, 32 undergraduate Midwifery program students carried out the evaluation using a questionnaire on applicability, functionality, clarity, coherence and usability of the tool in Post-Partum Haemorrhage simulated stations. The data were analysed descriptively, considering absolute agreement when the answers to all questions in the five-point Likert scale corresponded to 5 (I totally agree). The Content Validity Index was calculated for the experts' questionnaires. ResultsIn the validation stage, the experts agreed or totally agreed with all nine items, reaching a Content Validity Index = 1. In the total scores assigned by the experts, there was a variation between 80.0% and 100% absolute agreement, with a mean of 95.6%. In the students' assessment, the variation was between 87.5% and 100% absolute agreement, with a mean of 97.7%, in the eight items evaluated. The agreement level above 90% among experts and students was considered high. ConclusionsThe Instructional Disk for the Management of Post-Partum Haemorrhage was validated by experts with extensive experience in Obstetrics and Midwifery care and teaching, ensuring that the content included in the guidelines for the management of Post-Partum Haemorrhage adopted in Brazil is covered. The students positively evaluated this support tool for learning the care to be provided in Post-Partum Haemorrhage cases in the simulated stations.

간호대학생의 시뮬레이션 기반 고위험분만실습 경험

This study is a qualitative research that analyzed structured debriefing data using content analysis to understand the meaning of nursing students' educational experiences after applying simulation-based high-risk delivery practice. The purpose of this study is to examine the educational experience of nursing students through debriefing analysis after conducting high-risk obstetric simulation training. This study aims to understand the practical aspects of simulation education and provide foundational data for the development of effective strategies for simulation-based learning among nursing students. The study participants are 47 fourth-year students who attended an integrated role-playing practice class in the nursing department at a university located in S city and who understood the purpose of this study and provided their consent to participate. The high-risk delivery simulation practice was conducted for 8 hours out of a total of 60 hours for the integrated role-playing classes. It consisted of orientation, pre-learning presentations, team-based case analysis, simulation implementation, viewing of recorded simulation videos, debriefing and discussions, writing nursing process reports and reflective journals, and self-assessment. The data analysis involved repeatedly reading the collected data using the content analysis method. After closely examining the relevance to high-risk obstetric simulation experiences, meaningful statements were selected from the described content and sentences. Similar content was then categorized and conceptualized. These categories were further classified into similar domains for categorization. Based on the analysis of the research data, out of the 47 participants, there were 40 female students (85.1%) and 7 male students (14.9%), indicating a higher proportion of female students. The average age was 23.48 years old. Based on the analysis of the research data, 29 participants (61.7%) expressed satisfaction with their major. In terms of the cumulative GPA until the last semester, 39 students (83%) fell within the range of 3.0 to 3.9, while 7 students (14.9%) achieved a GPA of 4.0 or higher. For the analysis of experiences in high-risk obstetric simulation training, a careful examination of 650 statements led to the integration of similar content, resulting in a total of 46 meaningful statements, 14 themes, and 5 categories. The five categories were “Vivid Immersion in the Field”, “Realization of Insufficiency Areas”, “Increased Importance of Further Training”, “Solid Teamwork in Unity”, and “Engaging Practical Experience”. The research findings indicate that through high-risk obstetric simulation education, students were able to experience engaging, practice-oriented education. This led to an enhancement in clinical performance and increased confidence in nursing practice. Therefore, it is suggested to develop various simulation education methods and expand their application to other nursing subjects. A limitation of this study is that it focused on nursing students from a single university, which may weaken the generalizability of the research results. However, considering the rarity of high-risk obstetric simulation education in the field of women's health nursing in South Korea, this study holds significance as a foundational research providing insights into the effectiveness and necessity of simulation education.

Information sources and factors influencing the use of herbal medicine among women during pregnancy and childbirth in rural Lilongwe, Malawi: A qualitative study

Existing literature shows increased use of herbal medicine during pregnancy, childbirth, and when tackling associated problems among Malawian women. Beyond Malawi, herbal medicine use is also common among women during pregnancy and childbirth in other parts of the world. However, little is known about the precise information sources and factors that affect women&amp;rsquo;s use of herbal medicine in Malawi, especially in rural areas where it is commonly practiced. This study aimed at exploring information sources and understanding factors that influence herbal medicine use during pregnancy and childbirth among women living in the rural Lilongwe, Malawi. This is a qualitative descriptive study on 28 female participants purposively identified from four villages (Kagona, Champsinja, Mthupi, and Manja) of Traditional Authority Malili in rural Lilongwe, Malawi. Data were collected from four focus group discussions, with each group consisting of 6 &amp;ndash; 8 women, and their discussions were transcribed and analyzed using content analysis method. The findings indicated that previous obstetric experiences (negative and positive), quick relief from labor pain, hastened delivery process, fear of abandonment by guardian during childbirth, and encouragement from peers (friends) are key factors influencing herbal medicine use in rural Lilongwe. We also found that peers (friends), parents, and traditional birth attendants are major sources of information regarding herbal medicine use in Malawi. This study concludes that herbal medicine use during pregnancy and childbirth in rural Malawi is largely influenced by previous labor experiences and fears of being abandoned during labor and childbirth, and that information on herbal medicine use is often sourced from peers, parents, and traditional birth attendants. Thus, this study sheds light on how the community-led pathways can be exploited to influence the decisions to use herbal medicine among women in the rural areas of Malawi.

Controlled prospective study on ultrasound simulation training in fetal echocardiography: FESIM II

PurposeTo analyze the learning curves of ultrasound novices in fetal echocardiography during structured simulation-based ultrasound training (SIM-UT) including a virtual, randomly moving fetus.Methods11 medical students with minimal (< 10 h) prior obstetric ultrasound experience underwent 12 h of structured fetal echocardiography SIM-UT in individual hands-on sessions during a 6-week training program. Their learning progress was assessed with standardized tests after 2, 4, and 6 weeks of SIM-UT. Participants were asked to obtain 11 fetal echocardiography standard planes (in accordance with ISUOG and AHA guidelines) as quickly as possible. All tests were carried out under real life, examination-like conditions on a healthy, randomly moving fetus. Subsequently, we analyzed the rate of correctly obtained images and the total time to completion (TTC). As reference groups, 10 Ob/Gyn physicians (median of 750 previously performed Ob/Gyn scans) and 10 fetal echocardiography experts (median of 15,000 previously performed Ob/Gyn scans) were examined with the same standardized tests.ResultsThe students showed a consistent and steady improvement of their ultrasound performance during the training program. After 2 weeks, they were able to obtain > 95% of the standard planes correctly. After 6 weeks, they were significantly faster than the physician group (p < 0.001) and no longer significantly slower than the expert group (p = 0.944).ConclusionSIM-UT is highly effective to learn fetal echocardiography. Regarding the acquisition of the AHA/ISUOG fetal echocardiography standard planes, the students were able to reach the same skill level as the expert group within 6 weeks.