Intrapartum Period Research Articles

Assessing Adverse Neonatal Outcomes Associated With Intrapartum Narcotic Administration [ID 2683477

INTRODUCTION: Approximately 83% of U.S. deliveries include pain control, with 67% incorporating epidural analgesia, and 16% utilizing narcotics. Research suggests intrapartum fentanyl predicts poor neonatal suckling, and thus impaired breastfeeding. Unclear are potential effects of other narcotics. We examined whether use of intrapartum narcotics increases risk of adverse neonatal outcomes. METHODS: Charts of patients admitted for delivery at a single academic institution were reviewed for drugs administered in the intrapartum period and neonatal outcomes. Institutional review board approval was obtained with a waiver of informed consent. Data were summarized using logistic regression, controlling for confounders. RESULTS: Of the 519 participants, 286 (55.1%) received at least one narcotic in the intrapartum period. Compared to the control group, those who received narcotics were significantly younger, had greater pregnancy weight gain, were less likely to deliver via cesarean section, were less likely to have had preeclampsia, had greater gestational age at delivery, and gave birth to babies that weighed more. Tylenol III predicted a three times higher adjusted risk of neonatal intensive care unit admission (odds ratio [OR] 3.03 [1.06–8.62]). Norco predicted greater than 2.5 times higher risk of 1-minute (OR 2.66 [1.26–5.60]) and 5-minute Apgar scores below 7 (OR 2.61 [1.08–6.31]), and requiring oxygen at birth (OR 2.68 [1.21–5.93]). Morphine predicted a three times higher risk of 5-minute Apgar scores below 7 (OR 3.00 [1.26–7.17]). When adjusting for receipt of epidural analgesia, epidural did not significantly increase risk of any study outcomes. CONCLUSION: Adverse neonatal outcomes were observed following intrapartum Norco, morphine, and Tylenol III, and were unrelated to use of epidural analgesia. Findings support growing evidence that intrapartum narcotics pose risk to neonates, and further research is needed to elucidate potential longer-term effects.

Informational continuity by midwives during birth at primary care settings in the Western Cape.

Informational continuity ensures that all health and psychosocial information of the pregnant women is available at all encounters with healthcare providers. The World Health Organization recognised that ineffective informational continuity during birth contributed to fragmented care and duplication of services, which ultimately influenced the morbidity and mortality rates of the pregnant women. The aim of this study was to delve into the midwives' experiences on informational continuity approaches that enable effective care coordination during birth within the primary health care setting. The study setting was two maternity obstetric units (MOUs) in the Western Cape, South Africa. A qualitative descriptive phenomenological design was used. Participants were recruited by using purposive sampling. Interviews were audiorecorded, transcribed verbatim and analysed. Three themes emerged from the findings. Theme one: adequate sharing of information with women during the intrapartum period. Theme two: efficient transition of information among midwives and other healthcare providers during the intrapartum period. Theme three: challenges to informational continuity during the intrapartum period. Communication with the women as well as with other healthcare providers during birth was effective. However, with minimal challenges, informational continuity was effectuated through communication among the midwives, the pregnant women and other healthcare providers. Informational continuity approaches among the midwives, with the women and between healthcare facilities are a prerequisite to ensure continuity of care and care coordination during birth.

Implementation barriers and facilitators of Moyo foetal heart rate monitor during labour in public hospitals in Nepal

ABSTRACT Background Globally, every year, approximately 1 million foetal deaths take place during the intrapartum period, fetal heart monitoring (FHRM) and timely intervention can reduce these deaths. Objective This study evaluates the implementation barriers and facilitators of a device, Moyo for FHRM. Methods The study adopted a qualitative study design in four hospitals in Nepal where Moyo was implemented for HRM. The study participants were labour room nurses and convenience sampling was used to select them. A total of 20 interviews were done to reach the data saturation. The interview transcripts were translated to English, and qualitative content analysis using deductive approach was applied. Results Using the deductive approach, the data were organised into three categories i) changes in practice of FHRM, ii) barriers to implementing Moyo and iii) facilitators of implementing Moyo. Moyo improved adherence to intermittent FHRM as the device could handle higher caseloads compared to the previous devices. The implementation of Moyo was hindered by difficulty to organise training ondevice during non-working hours, technical issue of the device, nurse mistrust towards the device and previous experience of poor implementation to similar innovations. Facilitators for implementation included effective training on how to use Moyo, improvement in intrapartum foetal monitoring and improvement in staff morale, ease of using the device, Plan Do Study Act (PDSA) meetings to improve use of Moyo and supportive leadership. Conclusion The change in FHRM practice suggests that the implementation of innovative solution such as Moyo was successful with adequate facilitation, supportive staff attitude and leadership.

Predictors of successful trial of labor after cesarean section (TOLAC) in women with one prior transverse cesarean section at Tertiary Hospitals in northwest Ethiopia: a multicenter study

BackgroundTrials of labor after cesarean section is the preferred strategy to decrease the cesarean delivery rate and reducing complications associated with multiple cesarean sections. The success rate of trials of labor after cesarean section and associated factors have not been well documented in Ethiopia. Hence, this study was aimed to determine the success rate and factors associated with the trial of labor after one cesarean section in five Comprehensive Specialized Hospitals located in northwest Ethiopia.MethodsAn institutional-based cross-sectional study was conducted among 437 women who came for the trial of labor from December 1, 2021, to March 30, 2022. All women who fulfilled the eligibility criteria were included to this study. Data was collected using structured and pre-tested questionnaire. Then, the data was entered into Epi Data 4.6 software and exported to SPSS version 26 for analysis. To identify the variables influencing the outcome variable, bivariable and multivariable logistic regression analyses were conducted. The model’s fitness was checked using the Hosmer-Lemeshow goodness of fit test, and an adjusted odds ratio with a 95% confidence interval was used to declare the predictors that are significantly associated with TOLAC.ResultsThe success rate of the trial of labor after one cesarean section was 56.3% (95% CI, 51.3%, 61.2%). Maternal age ≥ 35 years (AOR: 3.3, 95% CI 1.2, 9.3), the fetal station at admission ≤ zero (AOR: 5. 6, 95% CI 3.3, 9.5), vaginal delivery before cesarean section (AOR: 1.9, 95% CI 1.2, 3.2), and successful vaginal birth after cesarean delivery (AOR 2.2, 95% CI 1.2, 4.1) were found to have a significant association with the success rate of trial of labor after cesarean section.ConclusionsIn this study, the success rate of the trial of labor after a cesarean section was low as compared to the ACOG guideline and other studies in different countries. Therefore, the clinicians ought to offer counsel during antenatal and intrapartum period, encourage the women to make informed decision on the mode of delivery, and the practitioners need to follow fetal and maternal conditions strictly to minimize adverse birth outcomes.

The PRECISE-DYAD protocol: linking maternal and infant health trajectories in sub-Saharan Africa.

PRECISE-DYAD is an observational cohort study of mother-child dyads running in urban and rural communities in The Gambia and Kenya. The cohort is being followed for two years and includes uncomplicated pregnancies and those that suffered pregnancy hypertension, fetal growth restriction, preterm birth, and/or stillbirth. The PRECISE-DYAD study will follow up ~4200 women and their children recruited into the original PRECISE study. The study will add to the detailed pregnancy information and samples in PRECISE, collecting additional biological samples and clinical information on both the maternal and child health.Women will be asked about both their and their child's health, their diets as well as undertaking a basic cardiology assessment. Using a case-control approach, some mothers will be asked about their mental health, their experiences of care during labour in the healthcare facility. In a sub-group, data on financial expenditure during antenatal, intrapartum, and postnatal periods will also be collected. Child development will be assessed using a range of tools, including neurodevelopment assessments, and evaluating their home environment and quality of life. In the event developmental milestones are not met, additional assessments to assess vision and their risk of autism spectrum disorders will be conducted. Finally, a personal environmental exposure model for the full cohort will be created based on air and water quality data, combined with geographical, demographic, and behavioural variables. The PRECISE-DYAD study will provide a greater epidemiological and mechanistic understanding of health and disease pathways in two sub-Saharan African countries, following healthy and complicated pregnancies. We are seeking additional funding to maintain this cohort and to gain an understanding of the effects of pregnancies outcome on longer-term health trajectories in mothers and their children.

Autistic women's experiences of the antenatal, intrapartum and early postnatal periods

Background/Aims Autism is a neurodevelopmental disability affecting interpersonal communication and interaction, and has a prevalence of more than 1% of the population. This review aimed to identify what midwives in England can learn from studies exploring the experiences of autistic women in the antenatal, intrapartum and early postnatal periods. Methods A systematic literature search was conducted using seven electronic databases. Thematic analysis was performed, based on Braun and Clarke. Results Three themes were found: autism diagnosis and disclosure, communication and interaction with healthcare professionals, babies and groups, and sensory difficulties. Conclusions Autistic women experience many challenges during the antenatal, intrapartum and early postnatal periods, and it is clear that midwives in England should treat all women as an individual, asking about their specific needs and any adjustments that can be made to provide inclusive care.

Quality of childbirth care and its determinants along the continuum of care among pregnant women who gave birth vaginally in Gondar town public health facility, Northwest Ethiopia, 2022: generalised structural equation modelling

ObjectiveTo assess the quality of childbirth care and its determinants along the continuum of care in Gondar town public health facility in Ethiopia.DesignAn institution-based, cross-sectional study was employed. Completed data...

Assessment of anthropometric measurements of premature children with physical developmental delays at preschool age

Assessment of child growth and development is crucial for paediatricians, as delays in these areas have significant socio-economic implications and their treatment can be costly. Aim. To evaluate the anthropometric measurements of premature children with physical developmental delay at preschool age. Materials and methods. The retrospective and prospective studies were conducted. A total of 108 children participated in the study. The children were classified into three groups: the main group, the comparison group, and the control group. The average age of children in the main group was 3.9±0.20 years, in the comparison group it was 4.2±0.19 years, and in the control group - 4.1±0.15 years. The main group (group I, n=57) was further divided into two subgroups: subgroup IA comprised 45 children born with a body weight appropriate for gestational age, subgroup IB consisted of 12 children with low body weight for gestational age (LBWGA). The comparison group (group II; n=31) was also divided into two subgroups: subgroup IIA included 26 children born with a normal body weight for their gestational age, subgroup IIB consisted of five children born with a low body weight for their gestational age. The control group comprised 20 premature infants born at 29-36 weeks of gestation with relatively satisfactory antenatal and intrapartum periods and no physical developmental delays. Physical development was evaluated based on anthropometry measurements, including height and body weight. Results. The study included 57% male and 43% female children. Among the children with physical developmental delay, 37% were from the first gestation, 44.3% from the second gestation, and 18.7% from the third gestation. When analysing the data, a significant difference was found in height (p=0.0002) and body weight (p=0.0006). In the main group, children born with low body weight for gestational age showed more pronounced growth retardation, while in the comparison group, premature children differed from full-term ones with more significant growth retardation. Conclusions. The study revealed that children born with low birth weight for gestational age have differences in body weight and height compared to children with appropriate weight for gestational age. The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee the aforementioned institution. Informed consent for the study was obtained from the parents of the children. The authors declare no conflict of interest.

Less than one in four mothers get quality intrapartum health care services in Ethiopia

Intrapartum care is a platform of comprehensive healthcare for pregnant women that is designed to improve birth outcomes for mother and child. However, complications during the intrapartum period continued to be the leading cause of death for women of reproductive age and newborns. Therefore, the aim of this study was to assess the prevalence of quality of intrapartum care and its associated factors among mothers in Ethiopia. A community based cross sectional study was conducted among 4469 mothers who gave birth in the last 2 years. Quality of intrapartum care was analyzed based on the assessment of health facility delivery, skilled birth attendants and early initiations of breast-feeding. Stata version 14 software was used for data cleaning and analysis. A mixed effect multilevel logistic regression was conducted to determine factors associated with quality of intrapartum care. An adjusted odds ratio with 95% confidence interval and a P value of less than or equal to 0.05 was used for the identification of both individual and community level factors. Overall, the prevalence of quality intrapartum care in Ethiopia was 23.8% (95% CI 22.6, 25.13). Primary education (AOR = 1.46, 95% CI = 1.14, 1.88), rich household class (AOR = 1.48, 95% CI = 1.10, 1.98), history of ANC (AOR = 2.91, 95% CI = 2.18, 3.86), perceived distance to the health facility as not a big issue (AOR = 1.63, 95% CI = 1.30, 2.05), urban residence (AOR = 2.97, 95% CI = 1.93, 5.09), Tigray region (AOR = 5.01, 95% CI = 1.25, 20.59), community level poverty (AOR = 0.63, 95% CI = 0.41, 0.97), and having 2–4 children (AOR = 0.74, 95% CI = 0.56, 0.97) were significantly associated with quality of intrapartum care. The finding conclude that less than one in four mothers received good quality intrapartum care. In order to optimize the quality of intrapartum care, the government should empower women through extensive education. It is also recommended for the Ministry of Health to evaluate the health facilities and community health workers to increase coverage of ANC and provide financial assistance to rural residents and the poor household class.

Proportion of stillbirth and associated factors among women who deliver at public hospitals in Bahir Dar city, north-West Ethiopia

IntroductionThe annual global burden of stillbirths is estimated to be 3.2 million, of which 98% occur in low and middle-income countries (LMICs). In the Amhara region of Ethiopia, the prevalence of stillbirth outcomes was 85 per 1000. Ethiopia is experiencing an increase in the number of health professionals attending deliveries, however, stillbirth rates are not decreasing as anticipated. However, there are limited numbers of studies done related to the proportion of stillbirths and associated factors in the study area. This study aimed to assess the proportion of stillbirths and associated factors among women who attended deliveries at Tibebe Ghion Specialized Hospital and Felege Hiwot Comprehensive Specialized Hospital.MethodsAn institutional-based cross-sectional study was conducted on 366 women who delivered at two referral hospitals in Bahir Dar from April 1, 2020, to August 30, 2020. Study participants were selected using systematic random sampling techniques. A checklist and structured questionnaire were used to retrieve information from the clients and their attendants. The collected data were cleaned, coded, and entered into Epi-data version 3.1 and then exported into SPSS 23 for analysis. Bivariate and multivariable logistic regression analysis was computed to identify statistically significant associated factors with a P value < 0.05. The results were presented in tables and charts.ResultThe proportion of stillbirths was 3.8% in this study area. This study showed that level of education, who completed primary school (AOR = 0.12; 95% CI (0.01, 0.98)), not using partograph (AOR = 3.77, 95%; CI (1.02; 13.93)), and obstetric complication (AOR = 6.7; 95% CI (1.54, 29.79) were the major factors affecting the stillbirth.ConclusionOur study found that stillbirth rate remains a major public health problem. Illiteracy, not using a partograph, and having obstetric complications were major associated factors for stillbirth. The risk factors identified in this study can be prevented and managed by providing appropriate care during preconception, antepartum, and intrapartum periods.

Association of Peripartum Lactate Levels With Infection Outcomes

ObjectiveTo determine whether lactate levels were associated with maternal infection and infection-related outcomes in the antepartum, intrapartum, and early postpartum periods. DesignRetrospective, observational cohort. SettingEleven hospitals from a single health system. ParticipantsWomen (N = 783) with at least one lactate and blood culture test for obstetric sepsis screening in the antepartum period (n = 154), intrapartum period (n = 348), and early postpartum period (n = 281) from January 2, 2018, to October 21, 2020. MethodsWe reported the proportion of participants with adverse outcomes by lactate cut points (≤2.0 and >2.0 mmol/L). We used logistic regression to model the association of infection-related outcomes with lactate levels and calculated receiver operating characteristic curves. ResultsLactate was associated with bacteremia among participants in the antepartum period (odds ratio [OR] = 1.60, 95% confidence interval [CI] [1.00, 2.56]) but not among participants in the intrapartum and early postpartum periods. Higher lactate levels were significantly associated with a composite measure of infection-related outcomes (OR = 1.41, 95% CI [1.14, 1.81]), with no differential association by antepartum, intrapartum, or early postpartum periods. Lactate levels were positively associated with intraamniotic infection in the antepartum period (OR = 1.57, 95% CI [1.06, 1.81]) but not in the intrapartum period. The receiver operating characteristic curve indicated that the lactate threshold of 2.0 mmol/L has poor sensitivity. Overall, participants in the antepartum period had lower lactate values than participants in the intrapartum and early postpartum periods. ConclusionLactate levels were not consistently associated with infection-related measures across all periods. We suggest caution when interpreting lactate levels when sepsis is suspected.

Awareness and Safety of COVID-19 Vaccination in Pregnancy.

COVID-19 vaccines are safe in pregnancy, as they do not contain a live attenuated virus. Mass vaccination is a key to control the pandemic. Neonates have been shown to be susceptible to severe illness, so maternal vaccination is important to provide neonatal vaccination. The present study was conducted for a period of one year from November 21, 2021 to October 2O, 2022 at the Department of Obstetrics and Gynecology A.S.J.S.A.T.D.S. medical college, Fatehpur. It was a hospital-based cross-sectional study. This study aimed to investigate the efficacy, safety, attitude, side effect and maternal neonatal outcome of COVID-19 vaccination among pregnant women. Out of 3320 pregnant women delivered, only 1170 (35.24%) received at least one dose of COVID-19 vaccine. 69.23% were unaware of the type of COVID-19 vaccine. 66.15% were vaccinated for both the doses before pregnancy. 12.30% of women had taken only the first dose of COVID vaccine before pregnancy. Majority had fever with chills after the first dose. Fatigue was most common side effect after second dose, and no one had any rash or allergic reaction. 56.15% delivered vaginally, 37.69% had LSCS for different obstetric indications, and 6.15% had instrumental delivery. During the antenatal period, 38.46% developed anemia, 11.54% had preterm labor, 2.05% had gestational diabetes, 2.30% developed preeclampsia, and 3.85% developed hypothyroidism. 3.07% prolonged labor in intrapartum period, and 6.92% women developed PPH. 50.77% newborns were between 2.5 and 2.9 kg, and majority 71.54% newborns had an APGAR score of 7 or more at 5 minutes. 14.62% newborns had meconium aspiration syndrome, 3.84% had respiratory distress syndrome, and 20.34% needed NICU admission more than 24 hours. Available data do not support increased risk of adverse outcome following COVID-19 vaccination. We recommend vaccination during pregnancy as benefit outweigh the potential risk. The online version contains supplementary material available at 10.1007/s13224-023-01918-w.

WHO Labour Care Guide: New Generation Partograph

WHO Labour Care Guide (LCG) aims to provide evidence-based, good quality and respectful maternity care during intrapartum period, regardless of the setting or available resources. On contrary to the conventional partograph, LCG is an innovative labour monitoring-to-decision tool which provides monitoring of labour progress and timely reminders on required interventions. Various available sections of LCG also facilitates early identification of potential complications and timely referral if required. The present manuscript provides a comprehensive insight on WHO LCG – its relevance, various sections and need for implementation in present scenario.

What is known about changes in pelvic floor muscle strength and tone in women during the childbirth pathway? A scoping review.

This scoping review aims to comprehensively explore the existing research on the changes in pelvic floor function that occur throughout the childbirth pathway (antenatal, intrapartum, and postnatal period). Furthermore, it seeks to identify new opportunities and directions for future research in this field. In particular, this review focuses on investigating pelvic floor muscle strength and tone in women during the childbirth pathway. The following databases were investigated from their inception: PubMed, OVID, Medline, ScienceDirect, The Cochrane Central Library, Scopus, Web of Science, PEDro, Scholar Google, Embase, and CINHAIL. Literature research was carried out from March to October 2022. Records identified through database searching were imported to Covidence. According to Arksey and O'Malley's five-stage scoping review framework, researchers screen titles and abstracts for eligibility and exclude records that do not meet the inclusion criteria. A total of 40 studies were included in the data extraction phase. These articles underwent a review, with a specific emphasis on examining the tone, strength, and distensibility of the pelvic floor throughout the childbirth pathway. Among the selected studies, 22 investigated pelvic floor strength, 7 the distensibility, and 3 articles the tone. This review identified both areas of agreement and disagreement across all three themes examined, with a particular emphasis on labor and the postpartum period. Notably, the review unveiled a significant scarcity of data concerning the tone of pelvic floor muscles throughout the childbirth pathway. Further studies to investigate the relationship between midwifery care and pelvic floor outcomes are required to improve clinical practice.

Women’s Satisfaction with Hospital Based Intrapartum Care in a Medical College of Western Nepal

INTRODUCTION Birth satisfaction is a multi-dimensional concept comprising structure, process and outcome of care that influence postnatal adjustment. Mother’s satisfaction during the birthing process is an important indicator in evaluating quality of maternity services. The aim of the study is to find out the women’s satisfaction with hospital based intrapartum care in a medical college of western Nepal. MATERIAL AND METHODS Cross-sectional analytical study was conducted to find women’s satisfaction with hospital based intrapartum care in a medical college of western Nepal among 332 postpartum inpatient women delivered in Lumbini Medical College and Teaching Hospital, Pravas, Palpa, who were selected by using purposive sampling technique. A pretested interview schedule was used for data collection. Descriptive statistics and inferential statistics were used for data analysis. RESULTS The study findings revealed that about half of the respondents (50.9%) were satisfied with hospital based intrapartum care. The level of satisfaction was significantly associated with gravida (p=0.008), type of labor onset (p=0.007) and episiotomy status (p&lt;0.001). CONCLUSION The study findings conclude that women attending teaching hospital for delivery tend to be somewhat satisfied with hospital based intra-partum care. Adequate counseling, reassurance and supportive care of women during intrapartum period might increase their satisfaction with intrapartum care.

Cohort profile: the Pregnancy Risk Infant Surveillance and Measurement Alliance (PRISMA) – Pakistan

PurposePakistan has disproportionately high maternal and neonatal morbidity and mortality. There is a lack of detailed, population-representative data to provide evidence for risk factors, morbidities and mortality among pregnant women...

Normal value and changes in CRP values on maternal and fetal umbilical cord blood with the labor and intrapartum interventions

Introduction: C-reactive protein (CRP) is widely used as an inflammatory marker. Since labour is an inflammatory process, CRP values vary during the intrapartum and postpartum period due to multiple factors.Methods: A descriptive-analytical study was carried out at Castle Street Hospital for Women. Mothers who have term singleton pregnancies with uneventful antenatal periods and have undergone vaginal delivery were recruited for the study. Samples were obtained just after admission to the labour ward (S1), 24 hours after the delivery (S2), and the fetal umbilical cord blood (S3). Reference ranges for S2 and S3 were determined using the interquartile range (IQR).Results: Out of 300 mothers recruited for the study, the mean age was 26.73 years (95% Confidence interval 19.5-36.9). There were 266 samples of S1,177 samples of S2, and 173 samples of S3 were collected. The reference range for S2 is 12.70-150.83 mg/dl, and for S3 is 0.1-8.1 mg/dL. The S2 value is significantly associated with duration of labor (r=0.47, p=0.046), number of vaginal examinations (VEs) (p &lt; 0.001), augmentation of labor (AOL) (p=0.001), method of cervical ripening (p=0.014) and intrapartum intervention (p &lt; 0.001). The number of vaginal examinations (p=0.02) and augmentation of labor (p=0.025) are significantly associated with fetal umbilical cord blood (S3).Conclusion: Early postpartum CRP can be risen up to 151 mg/dL after 24 hours of vaginal delivery. It may be associated with prolonged labor, number of VEs performed, AOL, method of cervical ripening, and episiotomy. Fluctuation of normal CRP values during the periods of antenatal, intrapartum, and postpartum needs to be assessed in the Sri Lankan community.

The Precise-DYAD Neurodevelopmental substudy protocol: neurodevelopmental risk in children of mothers with placental complications

Background: Over 250 million children are not reaching their developmental potential globally. The impact of prenatal factors then influenced by postnatal environmental factors on child neurodevelopment, is still unclear—particularly in low- and middle-income settings. This study aims to understand the impact of placental complications as well as environmental, psychosocial, and biological predictors on neurodevelopmental trajectories. Methods: This is an observational cohort study of female and male children (≈3,950) born to women (≈4,200) with and without placental disorders (pregnancy-induced hypertension, foetal growth restriction, and premature birth) previously recruited into PREgnancy Care Integrating Translational Science, Everywhere study with detailed biological data collected in intrapartum and post-partum periods. Children will be assessed at six weeks to 6 months, 11-13 months, 23-25 months and 35-37 months in rural and semi-urban Gambia (Farafenni, Illiasa, and Ngayen Sanjal) and Kenya (Mariakani and Rabai). We will assess children's neurodevelopment using Prechtls General Movement Assessment, the Malawi Development Assessment Tool (primary outcome), Observation of Maternal-Child Interaction, the Neurodevelopmental Disorder Screening Tool, and the Epilepsy Screening tool. Children screening positive will be assessed with Cardiff cards (vision), Modified Checklist for Autism in Toddlers Revised, and Pediatric Quality of Life Inventory Family Impact. We will use multivariate logistic regression analysis to investigate the impact of placental complications on neurodevelopment and conduct structural equation modelling using latent class growth to study trajectories and relationships between biological, environmental, and psychosocial factors on child development. Conclusions: We aim to provide information regarding the neurodevelopment of infants and children born to women with and without placental complications at multiple time points during the first three years of life in two low-resource African communities. A detailed evaluation of developmental trajectories and their predictors will provide information on the most strategic points of intervention to prevent and reduce the incidence of neurodevelopmental impairments.

Trends and spatial distribution of neonatal sepsis, Uganda, 2016–2020

BackgroundIn Uganda, sepsis is the third-leading cause of neonatal deaths. Neonatal sepsis can be early-onset sepsis (EOS), which occurs ≤ 7 days postpartum and is usually vertically transmitted from the mother to newborn during the intrapartum period, or late-onset sepsis (LOS), occurring 8–28 days postpartum and largely acquired from the hospital environment or community. We described trends and spatial distribution of neonatal sepsis in Uganda, 2016–2020.MethodsWe conducted a descriptive incidence study using routinely-reported surveillance data on in-patient neonatal sepsis from the District Health Information System version 2 (DHIS2) during 2016–2020. We calculated incidence of EOS, LOS, and total sepsis as cases per 1,000 live births (LB) at district (n = 136), regional (n = 4), and national levels, as well as total sepsis incidence by health facility level. We used logistic regression to evaluate national and regional trends and illustrated spatial distribution using choropleth maps.ResultsDuring 2016–2020, 95,983 neonatal sepsis cases were reported, of which 71,262 (74%) were EOS. Overall neonatal sepsis incidence was 17.4/1,000 LB. EOS increased from 11.7 to 13.4 cases/1,000 LB with an average yearly increase of 3% (p < 0.001); LOS declined from 5.7 to 4.3 cases/1,000 LB with an average yearly decrease of 7% (p < 0.001). Incidence was highest at referral hospitals (68/1,000 LB) and lowest at Health Center IIs (1.3/1,000 LB). Regionally, total sepsis increased in Central (15.5 to 23.0/1,000 LB, p < 0.001) and Northern regions (15.3 to 22.2/1,000 LB, p < 0.001) but decreased in Western (23.7 to 17.0/ 1,000 LB, p < 0.001) and Eastern (15.0 to 8.9/1,000, p < 0.001) regions.ConclusionThe high and increasing incidence of EOS in Uganda suggests a major gap in sepsis prevention and quality of care for pregnant women. The heterogenous distribution of neonatal sepsis incidence requires root cause analysis by health authorities in regions with consistently high incidence. Strengthening prevention and treatment interventions in Central and Northern regions, and in the most affected districts, could reduce neonatal sepsis. Employment of strategies which increase uptake of safe newborn care practices and prevent neonatal sepsis, such as community health worker (CHW) home visits for mothers and newborns, could reduce incidence.

A Neglected Area: Restless Leg Syndrome in Pregnancy and The Role of the Obstetric and Gynecology Nurse

Restless legs syndrome is the most common movement disorder in pregnancy and is more common in pregnant women than in healthy women and men. However, it is not well known among obstetricians. Similarly, the awareness of pregnant women about restless legs syndrome is also low. Genetics, the brain’s dopamine system and iron metabolism are thought to be effective in the pathophysiology of the disease in pregnancy. The disease usually disappears after delivery, but if not treated, sleep disorders, psychological problems, decreased quality of life, as well as symptoms of pregnancy and birth-related complications such as preeclampsia, the threat of miscarriage, premature birth, difficult birth, cesarean delivery and intrauterine growth retardation may occur. Diagnosis in pregnancy is made using the basic criteria of the International Restless Legs Syndrome Working Group. Non-pharmacological methods are primarily recommended for treatment. However, if symptoms are severe, more reliable drugs should be considered. In symptom management, it is essential to control anemia, sleep apnoea, and drug use that exacerbate restless legs syndrome. To reduce the severity of restless legs syndrome during pregnancy, non-pharmacological treatments such as moderate exercise, yoga, hot/cold water applications, relaxation exercise, relaxing background music, and sleep hygiene can be recommended. Obstetrics and gynecology nurses, who have a crucial role and responsibility in pregnancy follow-up, should be able to provide effective and quality care to women in the prepartum, peripartum, intrapartum, and postpartum periods with a comprehensive approach in line with evidence-based practices.