Labor And Delivery Research Articles

A comparison of peripheral blood smear microscopy and detection of histidine-rich protein 2 in blood in the diagnosis of malaria in pregnancy.

Detection of malaria in pregnancy poses a huge challenge in Sub-Saharan Africa. Accurate diagnosis enables timely and appropriate clinical management. This study aimed to compare the accuracy of peripheral venous blood smear microscopy (PVBSM) and a rapid diagnostic test detecting histidine-rich protein 2 in the blood (RDT-HRP2) with placental histology as the control in the diagnosis of malaria in pregnancy in Nigerian women. This was a comparative, cross-sectional study conducted between January and July 2017. Asymptomatic pregnant women who presented to the labor ward and who gave informed consent had peripheral venous blood samples as well as placental tissue obtained following delivery. The blood samples obtained were tested for malaria parasites using PVBSM and RDT-HRP2 in blood, while the placenta was subjected to histology. A total of 326 patients participated in the study. The prevalence of malaria in pregnancy was 13.8%, 17.8%, and 32.8% using PVBSM, RDT-HRP2, and placental histology. The sensitivity, specificity, and accuracy of PVBSM were 40.2%, 99.1%, and 79.8% and the corresponding values for RDT-HRP2 were 49.5%, 97.7%, and 81.9%. The positive predictive value was 95.6% for PVBSM and 91.4% for RDT-HRP2 and the negative predictive value was 77.2% for PVBSM and 79.9% for RDT- HRP2. The diagnostic performances of both tests were comparable; however, RDT-HRP2 had a higher sensitivity and accuracy than PVBSM for the diagnosis of malaria in pregnancy.

Assessment of Women Satisfaction with Pregnancy Outcome and Using of Immediate Contraceptive Postnatal at Baghdad Maternity Hospitals

Back ground: Contraceptive following delivery or an induced abortion reduces the risk of an early unintended pregnancy and it's associated to adverse health consequences The Study aims to assess the women satisfaction in the use of contraceptive devices in the period immediately following delivery or abortion and it's relation to pregnancy outcome. Patients and Methodology: A randomized cross sectional descriptive study carried out In 2 maternity hospitals (AL-Elwiya maternity teaching hospital, AL-Karkh maternity hospital) from both sides of Baghdad. The study sample includes 434 cases of women who were in the labor and abortion wards in the period immediately following delivery or abortion before being discharged home. Data were collected during the period from the 1st of November 2015 to the end of April 2016. Results: revealed that more than half (54.4%) of studied women were married in young age group (18-24 years) and 48.6% of them were at young age (18-24 years) at their first delivery, 36.4% were graduated from university, (90.3%) were living in urban areas . The pregnancy ended with delivery in 65.2% of the studied women and ended with miscarriage in 34.8% of them. A significant association was observed between young age of women and high satisfaction with immediate contraception (p=0.02). The most common cause of non-satisfaction with contraception among studied women was not knowing about the possibility of contraception (97.67%), followed by their wish to increase their family size (39.5%), fear from complications (23.2%), economic causes (18.6%), un cooperation of the family (13.9%), bad effect on breast feeding (9.3%) and unavailability (6.9%). one third (31.1%) of the participants were satisfied with immediate contraception while it is about half (49.1%) of the delivered mothers were satisfied on immediate contraceptive with significant difference found between pregnancy outcome and the women's satisfaction. Conclusion: 49.1% of the mothers were satisfied on immediate contraception after delivery while only 31.1% of the miscarried women were satisfied with immediate contraception. Women from low income families had higher satisfaction with contraception and significant association was found between types of pregnancy outcome and women satisfaction with immediate use of contraceptive devices. Keywords: Assessment, Women Satisfaction, Pregnancy Outcome, Immediate Contraceptive, Postnatal

Audit of caesarean deliveries in ESUT Teaching Hospital (ESUTH) Enugu: A 3-year review

Background: Caesarean delivery or abdominal delivery is a common intervention in current obstetric practice which has significantly reduced maternal and neonatal morbidities and mortality. The World Health Organization (WHO) in 1985 pegged the acceptable rate at 10-15% but the rate of caesarean sections has been increasing in both the developed and developing countries. However, the rates have been exceeded in many developed countries while in the developing countries with a lot of unmet needs, the rates are quite low. When absolutely indicated, the rate should not prevent the timely recourse to the procedure which is life-saving. Aim: The aim was to determine the rate of caesarean section in ESUT Teaching Hospital over t a 3-year period. Materials and Method: This was a retrospective study of all the caesarean sections done in ESUT Teaching Hospital Enugu from December 31, 2020 to January 1, 2018. The necessary data was collected from the registers of the theatre and labour ward of ESUT Teaching Hospital and patients’ case notes using a structured proforma. Statistical Analysis: Data collected from the study was analyzed with the Statistical Package for Social Sciences (SPSS) computer software for Windows version 20.0. Results were presented using simple percentages, frequencies and tables. Result: Out of the 4719 deliveries in the centre over the period, the caesarean rate was 29.6% out of which 73.7% were booked; 26.3% unbooked; 59.2% were emergencies and 40.8% elective. The major indications were previous caesarean 20.2%, hypertensive diseases in pregnancy 14.6% and poor progress of labour 11.4%. Maternal complications were PPH, 8.4%; UT injuries, 2.9% and maternal death, 0.5%. The neonatal intensive care admission was 2.49% and neonatal death, 8.5%. Conclusion: There is a relatively high caesarean section rate in ESUT Teaching Hospital when compared with the Nigerian national figures but this is still lower than what is obtainable in the developed countries.

Midwives’ decision-making process when a non-vigorous neonate is born – a Swedish qualitative interview study

Midwives are often the first ones to make decisions when a neonate is unexpectedly born non-vigorous. This study aimed to understand how midwives reason and what they experience when deciding what to do when a non-vigorous neonate is born. In present practice, the decision to cut the umbilical cord early is strongly affected bythe decision that the neonate needs resuscitation. To better understand the decisions taken during the first minutes of the non-vigorous neonate’s life, this study focused on the midwives’ decision to cut the umbilical cord. A qualitative study with an inductive and descriptive design using the Critical Incident Technique was chosen to gain a more in-depth understanding of the factors influencing the midwife’s decision-making process concerning cutting the umbilical cord in a critical situation. Semi-structured interviews were conducted, and thematic analysis, as described by Braun and Clarke, was performed. Eligible study participants were midwives currently working in labour wards in Sweden. In total, 14 midwives were interviewed between November 2019 and March 2020. The interviews rendered an understanding about midwives' decision-making on the timing of cord clamping in the non-vigorous neonates. An overarching theme was generated: "The balancing act of clamping the umbilical cord" which consisted of three themes, "Assessing the neonate in need of resuscitation", "Valuing own knowledge and experience" and "Influencing decision-making", and seven sub-themes. Many factors in addition to clinical reasoning influenced the midwives' decision-making processes. Feelings, intuition, and experience also had an effect to varying degrees.

Clinical observership as an aid to learning and understanding of human embryology

Hands-on learning approach such as ‘Clinical observership’ is globally applicable in learning. This study evaluated clinical observership as an aid to pre-clinical medical students’ understanding of human embryology. Students were grouped into A and B; group B took calls as studentobservers in the labour ward of Ekiti State University Teaching Hospital in addition to taking regular classes in embryology while group A was the control group. Previously validated selfadministered questionnaires were used to test students’ intelligence quotient and knowledge of embryology before and after lectures and clinical observership. The short-term effect of clinical observership was tested by comparing the pre-field and post-field responses of the studentvolunteers while the long-term effect was tested by evaluating their performance in the first professional exams after the completion of pre-clinical program. The perception of group B participants on the observership program was assessed with a pre-tested questionnaire. There was no significant difference (p=0.4162) in the IQ between the control (77±1.2) and the experimental group (79±1.4). There was no significant difference (p= 0.0795) in the mean preobservation test score between the control (33±1.7) and the experimental group (38±1.7). However, a significant increase (p=0.0282) was observed in the mean post-observation test score in the experimental (29±2.4) when compared with the control (22±1.9). Although there was an increase in the mean score in the MBBS exam in the experimental group (59±2.7) when compared with the control (57±2.0), it was not statistically significant. On the perception of the method in improving learning, majority of the students were affirmative. Clinical observership enhances the learning of embryology hence we recommend its incorporation into the teaching methods of embryology in medical schools.

Maternal and neonatal characteristics that influence early neonatal deaths in a maternity teaching hospital

Background and objective: Low early neonatal death reflects health care progress in any country. We aimed to determine the prevalence of early neonatal deaths and the associated maternal and neonatal factors in a hospital-based study. Methods: This audit study was conducted on all newborns in the labor ward and neonatal intensive care unit of a maternity teaching hospital in Erbil city, Kurdistan Region, Iraq, from January 1, 2020, to December 31, 2020. Fetal and maternal factors were determined and correlated with early neonatal deaths. Results: The early neonatal death rate was 6.7%. All categories of preterm deliveries (extreme, very, and moderate preterm) were significantly associated with early neonatal deaths (odds ratios [ORs] = 45.1, 6.2, and 2.1, respectively). The primiparous and grand multiparous women had a higher risk of early neonatal deaths (ORs = 8.4 and 13.0, respectively). Obese women had a higher risk of early neonatal deaths (OR = 3.3). The risk of early neonatal deaths was significantly high when the number of antenatal care visits was less than four (OR = 8.1). Delivery by cesarean section was associated with high risk (OR = 3.8). Regarding the Apgar scores in the first and fifth minutes after birth, early neonatal death was significantly higher among those with severely depressed scores. Conclusion: High parity, inadequate antenatal attendance, obesity, and mode of delivery, were contributing factors to early neonatal deaths. Early prenatal care can assist in the rapid identification and management of risk factors for early neonatal deaths. Keywords: Early neonatal death; Parity; Low birth weight; Maternal characteristics; Overweight.

The sonographic measurement of the ratio between the fetal head circumference and the obstetrical conjugate is accurate in predicting the risk of labor arrest: results from a multicenter prospective study

Labor arrest is estimated to account for approximately one-third of all primary cesarean deliveries, and is associated with an increased risk of adverse maternal and perinatal outcomes. One of the main causes is the mismatch between the size of the birth canal and that of the fetus, a condition usually referred to as cephalopelvic disproportion. This study aimed to describe a new ultrasound predictor of labor arrest leading to cesarean delivery because of suspected cephalopelvic disproportion. This was a multicenter prospective study conducted at 3 maternity units from January 2021 to January 2022. A nonconsecutive series of singleton pregnancies with cephalic-presenting fetuses, gestational age of 34 weeks+0 days or above, and no contraindication to vaginal delivery attending at the antenatal clinics of each institution were considered eligible. Between 34+0 and 38+0 weeks of gestation, all eligible patients were submitted to transabdominal 2D ultrasound measurement of the obstetrical conjugate. On admission to the labor ward, the fetal head circumference was measured on the standard transthalamic plane by transabdominal ultrasound. The primary outcome of the study was the accuracy of the ratio between the fetal head circumference and the obstetrical conjugate measurement (ie, head circumference/obstetrical conjugate ratio) in predicting the occurrence of cesarean delivery secondary to labor arrest. The secondary outcome was the relationship between the head circumference/obstetrical conjugate ratio and labor duration. A total of 263 women were included. Cesarean delivery for labor arrest was performed in 7.6% (20/263) of the included cases and was associated with more frequent use of epidural analgesia (95.0% vs 45.7%; P<.001), longer second stage of labor (193 [120-240] vs 34.0 [13.8-66.5] minutes; P=.002), shorter obstetrical conjugate (111 [108-114] vs 121 [116-125] mm; P<.001), higher head circumference/obstetrical conjugate ratio (3.2 [3.2-3.35] vs 2.9 [2.8-3.0]; P<.001), and higher birthweight (3678 [3501-3916] vs 3352 [3095-3680] g; P=.003) compared with vaginal delivery. At logistic regression analysis, the head circumference/obstetrical conjugate ratio expressed as Z-score was the only parameter independently associated with risk of cesarean delivery for labor arrest (odds ratio, 8.8; 95% confidence interval, 3.6-21.7) and had higher accuracy in predicting cesarean delivery compared with the accuracy of fetal head circumference and obstetrical conjugate alone, with an area under the curve of 0.91 (95% confidence interval, 81.7-99.5; P<.001). A positive correlation between the head circumference/obstetrical conjugate ratio and length of the second stage of labor was found (Pearson coefficient, 0.16; P=.018). Our study, conducted on an unselected low-risk population, demonstrated that the head circumference/obstetrical conjugate ratio is a reliable antenatal predictor of labor arrest leading to cesarean delivery.

Ultrasound in labor: clinical practice guideline recommendation by the World Association of Perinatal Medicine (WAPM) and the Perinatal Medicine Foundation (PMF)

This recommendation document follows the mission of the World Association of Perinatal Medicine (WAPM) in collaboration with the Perinatal Medicine Foundation (PMF). We aim to bring together groups and individuals throughout the world for standardization to implement the ultrasound evaluation in labor ward and improve the clinical management of labor. Ultrasound in labor can be performed using a transabdominal or a transperineal approach depending upon which parameters are being assessed. During transabdominal imaging, fetal anatomy, presentation, liquor volume, and placental localization can be determined. The transperineal images depict images of the fetal head in which calculations to determine a proposed fetal head station can be made.

Future of Work and Technology: Technology, Identity, Self-Quantification, and Autonomy

In many parts of the economy, technology plays an increasingly important role in the control and management of workers. In this presenter symposium, we bring together four studies that offer novel insight into different dimensions of the relationship between technology and work, including behavioral experiments, identity control, the importance of social and cultural context, and effects for professional identity and autonomy. Our studies taken together show the importance of technology in a wide range of settings—platform-mediated work, such as ride-hailing and software development, platform-work, such as Instagram influencers, and professional work performed in labor and delivery wards. By offering examinations of the intersections between technology and control in a variety of work contexts, both newer and more traditional, using both quantitative and qualitative methods, our symposium promises novel insights into the evolving and future role of technology in relationship between work and workers. The Experimental Hand: Experimentation as a Mode of Platform Governance Presenter: Hatim A. Rahman; Northwestern Kellogg School of Management Metrics as Identity Baits Presenter: Farnaz Ghaedipour; McMaster U. The Platform is Not Neutral: An Investigation of App-Based Work through a Global Comparative Ethnogr Presenter: Lindsey Cameron; The Wharton School, U. of Pennsylvania Presenter: Nicholas Occhiuto; EMLYON Business School Presenter: Bobbi Thomason; Pepperdine Graziadio Business School Technologies of Quantification and the Autonomy of Action: The Case of Electronic Fetal Monitoring Presenter: Melissa Mazmanian; U. of California, Irvine Presenter: Kathleen Pine; Arizona State U.

Anaesthetic Management of a Morbidly Obese Parturient Undergoing Cesarean Section

An increasing number of women with a morbid obesity are requiring anaesthetic care for labour anddelivery. Management of these patients presents obstetric, anesthetic, and logistical challenges. Wereport our experience in the management of elective Caesarian section of a morbidly obese (BMI 61.6kg/m2) parturient under epidural anaesthetictechnique. Despite the increased risk of morbidity andmortality, our patient had an optimal outcome. An awareness of the hemodynamic and respiratorystability during anaesthetic management, postoperative analgesia and careful thromboprophylaxiswillbenefit parturient with morbid obesity. JBSA 2022; 35 (2) : 58-62

Care of Labour by Trained Midwife and Effect on Maternal Outcome in a Hospital Based Labour Ward

Midwifery service quality affects delivery outcomes the most. The aim of the study was to analyze the maternal outcome of pregnancies managed by the midwives and various factors which can affect the incidence of adverse maternal outcomes. Methodology: This retrospective study at DHQ Hospital MishtiMela Orakzai studied the district's rural midwife-led maternity healthcare system from July 2019 till June 2020. All midwives' cases were recorded and analyzed to establish the frequency of various maternal outcomes. All rural pregnant patients between 15 and 45 who presented to the government facility midwife at any stage of labor were recorded and maternal outcome and related factors were gathered. The aim of the study was to analyze the maternal outcome of pregnancies managed by the midwives and various factors which can affect the incidence of adverse maternal outcomes. Results: In our study, mean age of the patients was 27 SD 5.9 years (from 15 to 45) with gestational age of the patients from 14 to 42 weeks (mean 37.3 SD 2.5 weeks). Among the total 635 cases, 54% of the cases were of the age group 20 to 29 years. Around 19% of the cases in the labor room landed were preterm (&lt;37 weeks of gestation), and 78% of the patients were multigravida. Incidence of LSCS in mid-wife managed pregnancies was 4.1% (26 of 635 cases), and successful vaginal deliveries were carried out in 92.9% cases (590 of 635). Conclusion: Researchers are hopeful that the findings will serve as a solid basis for further research and help them better understand how midwives and expectant mothers communicate and how to strengthen the relationship. These findings can be implemented as the basis for future courses in midwifery education. Efforts should be made to evaluate these educational programmes and their outcomes in the delivery room. Keywords: Mid-wife, LSCS, SVD, Vaginal delivery, Maternal Outcome

Self-compassion and professional quality of life among midwives and nurse assistants: A cross-sectional study.

INTRODUCTIONSelf-compassion and satisfaction derived from helping others is part of healthcare providers’ professional quality of life. The aim of this study was to explore and psychometrically test two instruments measuring self-compassion and professional quality of life among midwives and nurse assistants.METHODSThis was a cross-sectional study with midwives and nurse assistants working with intrapartum care at five different labor wards in Sweden. The Self-Compassion Scale (SCS) and the modified Professional Quality of Life Measurement (ProQOL) were validated and correlation analyses were calculated between the different subscales. Descriptive statistics, t-test, were calculated to analyze associations between the subscales of the SCS, the ProQOL and the background variables.RESULTSMidwives were more self-critical than nurse assistants, and the midwives who were negative towards the new clinical practice scored higher for compassion fatigue. The principal component analysis showed a two-factor solution for both the SCS and the modified ProQOL. The two SCS subscales were named ‘self-criticism’ (α=0.85) and ‘self-kindness’ (α=0.87). The two ProQOL subscales were named ‘compassion satisfaction’ (α=0.83) and ‘compassion fatigue’ (α=0.78). A negative correlation was found between self-kindness and compassion fatigue subscales, between compassion satisfaction and compassion fatigue, and between self-kindness and self-criticism.CONCLUSIONSThe SCS and modified ProQOL are considered as valid questionnaires for use in a Swedish maternity setting and a correlation between the scales was found. Midwives are more self-critical than nurse assistants. Understanding and identifying compassion fatigue among midwives is important to managers responsible for quality improvement and practice changes.

Incidencia de parálisis braquial obstétrica tras programa de entrenamiento en distocia de hombros

IntroductionShoulder dystocia is a nonpreventable obstetric emergency that causes severe complications, such as obstetric brachial plexus palsy. The objective of the study was to determine the incidence of obstetric brachial plexus palsy and other neonatal complications associated with shoulder dystocia in deliveries managed in a university hospital after the implementation of a simulation-based training that was offered to all the labour and delivery staff on a voluntary basis. Material and methodsRetrospective observational study including all cases of shoulder dystocia and associated complications (mainly obstetric brachial plexus palsy) documented between January 2017 and December 2020, after the implementation of the training. In addition, we collected retrospective data on cases of obstetric brachial plexus palsy that developed in the hospital before the training (2008–2016). ResultsIn 2017–2020 period, in the total of 125 cases of shoulder dystocia (amounting to 1.38% of vaginal deliveries), there were 14 cases of obstetric brachial plexus palsy (11.2% of the cases of shoulder dystocia), 7 clavicle fractures and 1 humerus fracture; none of the cases of obstetric brachial plexus palsy was permanent or required treatment or rehabilitation past six months. In the years preceding the training, there were 7 cases of obstetric brachial plexus palsy, 2 permanent and 5 temporary (3 of which required rehabilitation). ConclusionThese results reflect the importance of knowing the morbidity present in the labour and delivery ward and the potential benefit of simulation-based training programmes in the resolution of these obstetric complications.

The Role of Cardiotocography in Monitoring Fetal Condition During Labour in High Risk Pregnancy and Its Correlation with Perinatal Outcome

Background: Cardiotocography (CTG) is considered to be a non-invasive prenatal screening technique. It is used to monitor fetal condition during labor. Objectives: this study aimed to evaluate the role of Cardiotocography as a screening tool during labor in high risk pregnancy for determining perinatal outcomes. Methods: In this cross-sectional study, Cardiotocography was performed randomly on 200 pregnant women with risk factors (postdate, oligohydronomia, Pregnancy-induced hypertension, diabetes mellitus, anemia, intrauterine growth retardation, Antepartum hemorrhage, and pre-labor rupture of membrane who attended the labor ward of Duhok Teaching Hospital of Obstetrics and Gynecology from 20 October 2019 to 15 February 2020 and the results of CTG were categorized a reactive and non-reactive cardiotocography tracing groups and the perinatal outcomes were correlated with cardiotocography results. Results: In this study, the mean age of patients was 27.41±6.09 years; ranged 18-42 years. There was no significant difference in the mean age of the patients (27.48±6.17 vs. 27.33±6.05 years), gravida (2.49±1.73 vs. 2.10±1.53) and gestational age (39.85±1.40 vs. 39.84±1.41weeks) between patients with reactive and non-reactive cardiotocography tracing, respectively. Patients with reactive cardiotocography were significantly more likely to have live babies (1.52±1.77 vs. 0.54±0.67) and no dead babies was recorded between reactive and non-reactive cardiotocography groups. The rate of caesarean section was significantly higher in patients with non-reactive cardiotocography (64.4% vs. 38.4%) and for bloody liquor (7.9% vs. 2.0%). It was also observed that low Apgar score 0-4 in first minute (12.9% vs. 4.0%) and 5-7 Apgar score in five minutes (34.7% vs. 9.1%) and admission to neonatal intensive care unit were significantly higher in patients with non-reactive than in those with reactive cardiotocography (59.4% vs. 26.3%), respectively. Conclusions: This study showed that cardiotocography is a useful technique to determine perinatal outcomes in high-risk pregnancies.

Moderate to severe neonatal encephalopathy with suspected hypoxic-ischaemic encephalopathy in cooled term infants born in Tygerberg Academic Hospital: Characteristics of fetal monitoring and modifiable factors

&#x0D; Background. In South Africa, in babies &gt;2 500 g, intrapartum asphyxia is the main cause of neonatal death or stillbirth in those who were alive prior to labour. In a developing population, ~60% of neonatal encephalopathy (NE) has evidence of intrapartum hypoxic ischaemia. Therapeutic hypothermia for term babies born with NE can improve neonatal prognosis and long-term survival.&#x0D; Objectives. To identify the healthcare worker- and system-related modifiable factor(s) that were associated with NE in babies of ≥36 weeks’ gestation born at Tygerberg Hospital (a secondary/tertiary referral hospital) between 1 January 2016 and 30 December 2018.&#x0D; Methods. This was an observational cross-sectional study analysing data from the Tygerberg Hospital Hypoxic Ischaemic Encephalopathy database, the electronic labour ward register, the mortality database and clinical data from patient folders.&#x0D; Results. A total of 118 babies were admitted for head cooling, and therefore included in the study. The hospital in-born rate for serious encephalopathy is 5.5/1 000 in singleton live-born babies (9/1 000 rate for live-born deliveries ≥36 weeks). A sentinel event was identified in 19 (16%) cases. Delay in accessing theatre was the main system-related modifiable factor (25/58 or 43% of cases delivered by emergency caesarean delivery). The average decision-to-incision time was 1 hour 40 minutes, while the average bed occupancy in the emergency maternity centre was 102%. Failure to recognise or respond to an abnormal cardiotocograph was the dominant avoidable factor related to healthcare workers in 34 cases (36.4%).&#x0D; Conclusion. Babies born with severe NE place a burden on parents, healthcare staff and resources. Careful intrapartum care, including utilisation of protocols for the use of oxytocin, are imperative. It is recommended that improved access to emergency theatres and appropriately trained staff for maternity units should be a priority for healthcare planners.&#x0D;

Migrant Somali women's experiences with their first contact with the labor ward prior to admission: A qualitative study.

INTRODUCTIONThe first contact with the labor ward is a crucial moment in any birth and can be especially challenging when the woman has a migrant background. The aim of the study was to explore migrant Somali women’s experiences with their first contact with the labor ward prior to admission, in Norway.METHODSIn this qualitative study, data were collected through semi-structured individual interviews and Systematic Text Condensation was the method used to analyze the data. Ten Somali-born women who had given birth in Norway were included.RESULTSThe migrant Somali women’s first contact with the labor ward prior to admission was challenging, due to one-way communication, poor health literacy, and a fear of interventions or adverse outcomes. To improve care, the migrant Somali women highlighted a need for: 1) flexibility, tailored information and practical guidance before birth; and 2) face-to-face assessment in early labor.CONCLUSIONSThe findings in this study indicate that the needs of laboring migrant Somali women are not fully met by antenatal or pre-hospital maternity care services. To improve the critical first contact with the labor ward for migrant Somali women, this study suggests that antenatal care services offer practical guidance on whom to contact and what to expect at the hospital in early labor. Face-to-face assessment of maternal and fetal well-being should be the first choice of care for Somali women in early labor who are unfamiliar with the healthcare system after immigration. Interpretation services need strengthening and our findings support a need for increased continuity of care.

Language-supported labor ward visits for pregnant migrant women: Staff experiences in a Swedish hospital.

INTRODUCTIONThe aim of this study was to explore midwives’ and assistant nurses’ experiences of providing extra support to non-Swedish-speaking migrants by offering individual language-supported visits to the labor ward during pregnancy.METHODSSemi-structured interviews were conducted with six guides, midwives or assistant nurses, working in the INFÖR (Individuell förlossningsförberedelse) project at Södertälje hospital in Sweden. INFOR includes a two-hour individual language-supported visit at the labor ward, for non-Swedish speaking pregnant women and their partners. An inductive thematic analysis was conducted.RESULTSThe guides described INFOR as being a bridge and creating safety, achieved by meeting with women and providing practical information. The guides felt that they fulfilled an important purpose, they were dedicated and adapted to the women’s individual needs. Providing extra language-assisted support to migrant pregnant women was developing and enriching, but the guides highlighted some barriers. Communicating via an interpreter was a challenge and the women were in need of more and extended meetings. The guides wished that INFOR could become a standard part of antenatal care, but the model needs to be further developed, and a better system for recruitment must be introduced.CONCLUSIONSThe guides experienced that the INFOR model is valuable in creating safety to pregnant migrant women before birth. The model is appreciated by the expectant couples, midwives and assistant nurses, and could be implemented as standard care. However, it is important to adapt the visits to the women’s and their families’ needs and goals, and structure needs to be developed before implementation.

Exploring midwives' coping and functioning in the labour wards during the Covid-19 pandemic from the Labour Ward Head Nurses' perspective: A qualitative study.

AimThe aim of this study is to explore midwives' coping and functioning in the labour wards during the Covid‐19 pandemic from the Labour Ward Head Nurses' perspective.BackgroundThe World Health Organization announced the Covid‐19 outbreak to be a pandemic in March 2020. Midwives worldwide were affected by this outbreak, working in risky environments, confronting the anxiety and fear of childbearing women.MethodsA qualitative study using thematic analysis was conducted using semi‐structured interviews done over the telephone. Thirteen Labour Ward Head Nurses were interviewed, and the texts were analysed. The study took place in April 2020 during the first Covid‐19 lockdown in Israel.ResultsThree main themes were generated in the coding process: (a) stress, fear and anxiety, (b) joint efforts and (c) frustration.ConclusionOur study illustrates the difficulties that arose at the beginning of the pandemic, a new and unfamiliar chaotic period. Midwives' managers can use the current research to learn about actions that may assist in improving staff resilience and cohesion during times of crisis.Implications for Nursing ManagementUnderstanding the psychological impact of the Covid‐19 pandemic among health care professionals is crucial for guiding policies and interventions to maintain staff's psychological well‐being.

Recruitment and Retention of Urban Pregnant Women to a Clinical Study Administering an Oral Isotope Dietary Tracer.

Introduction:Pregnant women are a vulnerable population that are difficult to engage in clinical research. We report successful recruitment and retention strategies used in a longitudinal pilot study of urban racially/ethnically diverse pregnant women that involved administration of an orally ingested isotope tracer, multiple venipunctures, biopsy of placenta after delivery, and cord or placental blood collection.Materials and Methods:We used direct strategies to recruit English-speaking obese and nonobese pregnant women aged 17–45 years, who were in the third trimester of pregnancy. The study required data collection at 32–34 and 34–36 gestational weeks and delivery. Strategies included frequent personal engagement with participants and staff to build relationships and trust, tangible appreciation, and the study team being present at delivery. In addition, leveraging hospital information technology (IT) services was critical to ensure retention through labor and delivery (LD).Results:A racially (52% Black, 23% White, and 10% other) and ethnically (15% Hispanic or Latinx) diverse sample of pregnant women was enrolled. Of the 52 women enrolled, 85% of women completed all procedures.Conclusions:This is the first report of successful strategies for recruitment and retention of racially/ethnically diverse pregnant women in a longitudinal study requiring oral administration of an isotope tracer. Personal engagement with multiple touch points, starting with recruitment and continuing regularly throughout the third trimester, was the most successful strategy. Creating and maintaining relationships with the LD providers and staff and utilizing hospital IT, including targeted electronic medical record alerts, ensured successful retention for the duration of the study.Trial Registration:Not applicable.

A rare case report of bilateral ruptured tubal ectopic pregnancy

Implantation of the fertilized ovum outside the uterine cavity is called ectopic gestation. The common presenting symptoms are per vaginal bleeding till 12 weeks, pain in the lower abdomen, and absence of menses. ß-HCG level is increased (&gt;1000IU/L) and transvaginal ultrasonography shows an empty uterus. These findings essentially confirm the diagnosis. In this, we have a 23-year-old, G2P1L1 with a history of 3 months of amenorrhea, presenting to the labor ward with a history of per vaginal bleeding and lower abdominal pain. The diagnosis was 10 weeks right-sided ruptured ectopic pregnancy and intraoperatively found to be ruptured ectopic pregnancy in both fallopian tubes which we managed successfully by performing emergency laparotomy with bilateral partial salpingectomy.