Guidelines For Management Of Pregnancy Research Articles

Intimate Partner Violence Screening in a Pregnant Military Population: Implementation of the E-HITS Protocol [ID 2683442

INTRODUCTION: The military population has higher rates of intimate partner violence (IPV) compared to the civilian population. This is further exacerbated in obstetrics patients, with an estimated rate of 4–29% of pregnant women affected. The American College of Obstetricians and Gynecologists and 2018 Department of Defense Clinical Practice Guidelines for Management of Pregnancy recommend routine screening for IPV at obstetric visits, although a preferred screening modality has not been identified. METHODS: The prevalence of IPV in pregnancy before and after implementation of the validated Extended-Hurt, Insult, Threaten, Scream (E-HITS) questionnaire at a single military treatment facility was compared. Retrospective chart review was conducted between January and December 2019 of patients who had been screened using a single question (“Do you feel safe at home?”). E-HITS was implemented in the obstetrics clinic in February 2022, and data were collected prospectively for 12 months. The difference between the two IPV screening modalities was analyzed using Fisher’s exact test. RESULTS: A total of 1,627 IPV screenings were reviewed. Of the 783 IPV screenings using the single question, there were 2 positive screens (0.26%). Using greater than 7 as the positive screening cutoff, there were 24 positives (2.84%) out of the 844 E-HITS screenings. Using greater than 6 as the cutoff for E-HITS, there were 54 positive screens (6.4%). There was a statistically significant difference in the detection rate between the two modalities at both cutoff levels (P<.0001). CONCLUSION: E-HITS is a more sensitive screening tool for IPV in this population, more closely mirroring previously published rates.

5612994 A ONE-YEAR AUDIT OF PREGNANCY MANAGEMENT AND OUTCOMES IN WOMEN WITH SICKLE DISORDERS AT A SINGLE UK CENTRE

Background: Women with sickle cell disorders (SCD) have increased morbidity and mortality in pregnancy due to increased sickle and pregnancy-related complications and require multidisciplinary team management, including obstetrician and midwife with experience of high-risk antenatal care and haematologist with links to a Specialized Hemoglobinopathy Team1. About 15,000 individuals live with SCD in the UK, with 110-200 pregnancies per annum1. Aims: To determine whether King’s College Hospital followed recently published British Society of Haematology (BSH) guidelines for the management of pregnancy in SCD. Pilot a proposed BSH audit proforma and assess mode of delivery, neonatal birth weight and special care baby unit (SCBU) requirements for this cohort. Methods: Pregnancy management and outcomes were audited using a proforma based on recent BSH guidelines (Appendix 1). Review of electronic patient records (EPR) for all women attending joint obstetric hemoglobinopathy clinics with SCD who completed a pregnancy between 01/10/20 and 01/10/21, including miscarriage and termination of pregnancy (TOP). Results: 23 pregnancies resulted in 19 live births (one twin pregnancy), 3 miscarriages (10/40 + 1, 10/40 + 1, 14/40 + 6); and 2 TOPs (10/40, 10/40). Maternal haemoglobin genotype was 74% HbSS, 23% HbSC, and 4% HbS other. The average maternal age at delivery (excluding miscarriage and TOP) was 33.6 years (24.8-40.8 years). Average gestational age at delivery (excluding miscarriage and TOP) was 37.9 weeks (32/40 + 1 to 40/40 + 1). 13 pregnancies were delivered by Caesarean section (9 emergency) and 5 by vaginal delivery (4 forceps). 14 women who had a live birth underwent transfusion during pregnancy, 1 was transfused postnatally and 3 were not transfused. Maternal complications were recorded in 94% pregnancies (excluding miscarriage and TOP). 47% of women had sickle vaso-occlusive crises, 56% had an infection, 17% had acute kidney injury and 6% required Intensive Therapy Unit care. Neonatal complications were recorded in four neonates. Three had intrauterine growth restriction, and were delivered at 32 + 1, 33 + 6 and 38 + 1 gestation respectively, with one requiring care in SCBU. One neonate had jaundice requiring five days of phototherapy. The average neonatal birth weight was 2770g (960-3715g) with a birthweight centile ranging from 0-0.4 to 75-91. Discussion: Audit barriers included an initial lack of access to information due to separate EPR system (BadgerNet) for maternal notes, rectified by collaboration with the obstetric team and access to BadgerNet. Summary/Conclusion: This pilot audit enabled assessment of collecting required data for a proposed BSH audit proforma; monitoring compliance with newly published BSH guidelines for management of pregnancy in SCD1; and provided insight into pregnancy outcomes in women with SCD who delivered within a 12-month period at a single large centre. The higher-than-expected transfusion rate during pregnancy was likely due to ongoing recruitment to the TAPS2 trial, with eligible women offered randomisation to usual practice or pre-emptive red cell exchange transfusion 6-10 weekly from 6-20 weeks gestation. A high proportion of live births were delivered by Caesarean section, reflecting a high proportion of multiparous women with previous Caesarean sections in this cohort. Although complication rates were high, most complications were relatively minor and non-life threatening. Keywords: Pregnancy, Sickle cell disease Reference 1. Oteng‐Ntim E et al. Br J Haematol 2021;194(6):980-995.

Guidelines for Pregnancy Management During the COVID-19 Pandemic: A Public Health Conundrum.

Pregnant women seem to be at risk for developing complications from COVID-19. Given the limited knowledge about the impact of COVID-19 on pregnancy, management guidelines are fundamental. Our aim was to examine the obstetrics guidelines released from December 2019 to April 2020 to compare their recommendations and to assess how useful they could be to maternal health workers. We reviewed 11 guidelines on obstetrics management, assessing four domains: (1) timeliness: the time between the declaration of pandemics by WHO and a guideline release and update; (2) accessibility: the readiness to access a guideline by searching it on a common browser; (3) completeness: the amount of foundational topics covered; and (4) consistency: the agreement among different guidelines. In terms of timeliness, the Royal College of Obstetricians and Gynaecologists (RCOG) was the first organization to release their recommendation. Only four guidelines were accessible with one click, while only 6/11 guidelines covered more than 80% of the 30 foundational topics we identified. For consistency, the study highlights the existence of 10 points of conflict among the recommendations. The present research revealed a lack of uniformity and consistency, resulting in potentially challenging decisions for healthcare providers.

Need for guidelines for the combined management of pregnancy and dengue: a retrospective study from an Indian tertiary care maternity hospital.

The incidence of dengue has risen in India in recent years. Evidence suggests that dengue in pregnancy may be associated with adverse maternal and fetal outcomes. The aim of our study was to analyse outcomes in pregnant women with confirmed dengue infection who had the benefit of close monitoring and intensive management at a tertiary maternity facility. We reviewed hospital data of 44 (0.11%) such women at Fernandez Hospital, a tertiary maternity unit, during the five-year period from 2011 to 2016. Maternal and fetal variables were collected from case sheets. Dengue haemorrhagic fever was seen in 15.9% and dengue shock syndrome in one fatal case (2.2%). Thrombocytopenia was seen in 31 cases (70.4%) and 14 (31.81%) received platelets transfusions. Fetal outcomes in our series were favourable, except for one stillbirth, with 45.4% preterm deliveries and 15.9% small for gestational age babies. Dengue in pregnancy is definitely associated with maternal and fetal morbidity and mortality. A high index of suspicion of dengue is required in pregnant women with pyrexia and thrombocytopenia.

Implementation of guidelines for multidisciplinary team management of pregnancy in women with pre-existing diabetes or cardiac conditions: results from a UK national survey

BackgroundDespite numerous publications stating the importance of multidisciplinary care for women with pre-existing medical conditions, there is a lack of evidence regarding structure or processes of multidisciplinary working, nor impact on maternal or infant outcomes. This study aimed to evaluate the implementation of guidelines for multidisciplinary team (MDT) management in pregnant women with pre-existing diabetes or cardiac conditions. These conditions were selected as exemplars of increasingly common medical conditions in pregnancy for which MDT management is recommended to prevent or reduce adverse maternal and fetal outcomes.MethodsNational on-line survey sent to clinicians responsible for management or referral of women with pre-existing diabetes or cardiac conditions in UK National Health Service (NHS) maternity units. The survey comprised questions regarding the organisation of MDT management for women with pre-existing diabetes or cardiac conditions. Content was informed by national guidance.ResultsOne hundred seventy-nine responses were received, covering all health regions in England (162 responses) and 17 responses from Scotland, Wales and Northern Ireland. 132 (74%) related to women with diabetes and 123 (69%) to women with cardiac conditions. MDT referral was reportedly standard practice in most hospitals, particularly for women with pre-existing diabetes (88% of responses vs. 63% for cardiac) but there was wide variation in relation to MDT membership, timing of referral and working practices. These inconsistencies were evident within and between maternity units across the UK. Reported membership was medically dominated and often in the absence of midwifery/nursing and other allied health professionals. Less than half of MDTs for women with diabetes met the recommendations for membership in national guidance, and although two thirds of MDTs for women with cardiac disease met the core recommendations for membership, most did not report having the extended members: midwives, neonatologists or intensivists.ConclusionsThe wide diversity of organisational management for women with pre-existing diabetes or cardiac conditions is of concern and merits more detailed inquiry. Evidence is also required to support and better define the recommendations for MDT care.

The Content of Prenatal Care and Its Relationship to Preterm Birth in Alberta, Canada

Prenatal care is universally acknowledged as the hallmark of preventive care for pregnant women, and it is commonly assumed to have a positive influence on birth outcomes. The results of studies that have examined the impact of prenatal care on adverse birth outcomes, however, have been equivocal. These investigations have focused primarily on initiation of prenatal care and its timing, and not on the content of care received. Using data obtained from maternal self-reports and an electronic perinatal database, we examined the relationship between selected components of prenatal care (i.e., medical management, health education, and health advice) and the birth of a preterm infant. We found that health care providers are meeting the clinical guidelines for the medical management of pregnancy, but they are not adequately meeting pregnant women's needs for health education and advice. We found no association between the content of prenatal care and the birth of a preterm infant. Prenatal care must focus more on providing health education and advice to pregnant women.

Acute Myocardial Infarction in a Pregnant Woman at Term

MANIFESTATIONS of arteriosclerotic cardiovascular disease are rare in pregnant women. We describe a case of acute myocardial infarction in a woman at 39 weeks' gestation. General guidelines for management of pregnancy associated with this complication are suggested. <h3>Report of a Case</h3> A 42-year-old woman (gravida 7, para 6) had a massive anterior-wall myocardial infarction within the 39th week of an otherwise normal pregnancy. Shortly after the onset of her first episode of chest pain, she sustained ventricular fibrillation and was resuscitated successfully. Twenty-four hours later, after severe postarrest congestive heart failure was treated, she was transferred to Beth Israel Hospital, Boston. The patient's first pregnancy had been complicated by preeclampsia, but her others had been uneventful. She had a 20-year history of mild hypertension (treated intermittently with diuretics and propranolol hydrochloride), a five-pack-year smoking history, and a family history of arteriosclerotic cardiovascular disease. Results of her serum lipid profile were