Maternity Units Research Articles

Body and Mind: Feminist Reading of The Pull of the Stars

Diseases are fundamentally a human trait. Pandemics, on the other hand, create more intense experiences than world wars. They then become part of the emotional history. Most of the plagues that have ravaged the world have given rise to a variety of expressions and plagues have also found a special place in novel literature. The novel The Pull of the Stars by renowned Irish-Canadian author Emma Donoghue stands out among recently released pandemic literature. The novel takes place in a 1918 maternity unit in Dublin, a city devastated by the Great Famine, World War I, and the 1916 Irish Rebellion. This paper is a feminist reading of the novel The Pull of the Stars and further it explores the impact of pandemic on the marginalized body.

How well are we collecting umbilical cord lactate and gas samples?

The aim of this study is to measure staff compliance with the local umbilical cord lactate (UCL) sampling guideline and investigate the quality of paired UCG samples at a tertiary maternity unit. We performed a retrospective consecutive sampling of 100 babies delivered via emergency caesarean section and 50 babies with each of all other guideline-based indications for UCL sampling born on and before 31 December 2021. Data were extracted from physical and electronic records. Compliance with guideline-based indications for UCL at birth was measured. The proportion of valid UCG samples was calculated. Samples were considered invalid under the following cases: (i) inadvertently collecting from the same vessel, (ii) switching arterial and venous samples, (iii) collecting from only one vessel or (iv) committing errors during sample collection and handling. Of the samples collected at birth from 321 babies, 280 (87%) had UCL. Small for gestational age and concerns about fetal well-being in labour were indications associated with poorer compliance, 66% and 78%, respectively. About 99 (44%) babies of 226 babies with UCG performed had valid UCG samples. The most common reasons for invalid samples were collection and handling errors (22%) and inadvertent collection from the same vessel (15%). Generally, compliance with the guidelines is good. However, invalid UCG samples were more frequent than expected.

Normal values of the fronto-occipital relationship in fetuses between 18 and 40 weeks at two maternal fetal medicine units: Bogotá, Colombia.

To establish nomograms for linear measurements of the frontal and occipital horns of the lateral ventricle and their relationship, in pregnant patients between 18 and 40 weeks of gestation and having attended 2 units of Maternal Fetal Medicine in Bogotá-Colombia. A descriptive cross-sectional study with an analytical component was carried out on pregnant patients who utilized the ultrasound services at 2 Maternal-Fetal Medicine units in Bogotá, between 18 and 40 weeks of pregnancy who underwent measurement. From the anterior and posterior horns of the lateral ventricles, the fronto-occipital ratio was calculated at each gestational week, and nomograms were created for each of these variables. Nine hundred and seventy-eight patients were included in the study. The distance of the frontal horns ranged between 6.9 and 51.6 mm with a mean of 19.1 ± 5.8 mm; that of the occipital horns had a measurement between 8.7 and 53 mm with a mean of 28, 1 ± 8.9 mm; on the other hand, the fronto-occipital ratio (FOR) yielded a mean of 0.365 ± 0.067 (0.136-0.616) without bearing any relation to gestational age. The trend of normal values for the studied population is displayed, plotted in percentile curves and nomograms for each gestational age. The measurement of the frontal and occipital horns, and the calculation of the fronto-occipital relationship is technically possible between 18 and 40 weeks, finding that the anterior and posterior horns have a positive linear relationship with gestational age. Contrarily, the FOR does not correlate with the gestational age, it was possible to establish a table of percentiles that allows determining the normal values for these measurements during pregnancy.

Management of neonatal hypoglycaemia in a tertiary maternity unit-A multidisciplinary quality improvement project.

Improved identification and treatment of infants at risk of hypoglycaemia using evidence-based guidelines. Design: Prospective, multidisciplinary quality improvement project (QIP). Tertiary maternity hospital, Dublin (2016-2023). Infants at risk for neonatal hypoglycaemia. Plan-Do-Study-Act methodology. A hospital-wide survey and ongoing audit informed our initiatives including staff education, antenatal maternal education and standardisation of equipment. Our guidelines were continually evaluated and updated based on emerging evidence. Neonatal unit (NNU) admissions, adherence to guidelines and use of glucose gel. NNU admissions decreased by 70%, from 3% (118/3883) to 0.9% (34/3806 infants). The number requiring an IV glucose bolus reduced from 25% (29/118) to 6% (2/34). Improved antenatal education, antenatal expression of colostrum and early and frequent feeding also contributed to a reduction in glucose gel use of 94% (1009 tubes in 2018-v-62 in 2022). There were no adverse side effects related to hypoglycaemia. Our QIP resulted in a significant reduction in NNU admissions leading to significant cost reductions and NNU workload. More importantly, this resulted in less maternal-infant separation and potentially less parental anxiety and a more supportive environment for breastfeeding. These low-cost initiatives can be implemented in other tertiary maternity hospitals to improve maternity and newborn care.

L’accouchement des femmes enceintes de jumeaux : les enseignements de l’étude nationale observationnelle prospective comparative JUMODA

ObjectivesTo summerize the results of the JUMODA study (JUmeaux MODe d’Accouchement) on the planned mode of delivery of twin pregnancy and the management of second twin delivery. MethodsJUMODA was a national observational prospective comparative study that took place between february 2014 and march 2015 in 176 french maternity units performing more than 1500 deliveries per year. Its main objectives were the comparison of neonatal and maternal morbidity according to the planned mode of delivery and the determination of the managements of second twin delivery associated with the best neonatal outcomes. To control for potential confounding factors and indication biases, statistical analyses comprized multivariate logistic regressions and matching on propensity scores. ResultsThe JUMODA study recruited 8823 women with twin delivery at or beyond 22 weeks of gestation. For twin pregnancies with a cephalic first twin at 32 weeks of gestation and beyond, severe neonatal morbidity was higher in the planned cesarean (150/2908 (5.2 %) than in the planned vaginal delivery group (199/8922 (2.2 %), aOR 1.56, 95 % CI 1.19-2.04). Increased neonatal morbidity in the planned cesarean delivery group was explained by higher severe morbidity in neonates born preterm (aOR 1.64, 95 % CI 1.13-2.39, for deliveries between 32+0 and 34+6 weeks of gestation, aOR 2.04, 95 % CI 1.22-3.41, for deliveries between 35+0 SA and 36+6 weeks of gestation) but not in neonates born at term (aOR 1.19, 95 % CI 0.58-2.44). In comparison with planned cesarean delivery, planned vaginal delivery was not associated with increased severe neonatal morbidity in case of breech presenting first twin after 32 weeks of gestation or with decreased survival witout severe neonatal morbidity in case of delivery before 32 weeks of gestation whatever the first twin presentation. In comparison with planned vaginal delivery, planned cesarean delivery was associated with increased severe maternal morbidity only in women aged 35 and higher. Delivery of non cephalic second twin was associated with similar severe neonatal morbidity rate than delivery of cephalic second twin. Finally, in case of cephalic second twin, internal version followed by total breech extraction was associated with less cesarean for the second twin but with higher severe neonatal morbidity in case of preterm birth in comparison with pushing efforts, ocytocin perfusion and artificial rupture of membranes. ConclusionsPlanned vaginal delivery is the planned mode of delivery to encourage for the majority of pregnant women with twins, whatever first twin presentation and gestational age at delivery. No management of cephalic second twin appears better than an other, its choice will rest on obstetrician preferences.

Epidemiological Profile of Pregnant Women with Anemia Admitted at the Maternity Unit of the Health District Hospital of Keita, Tahoua from 2018 to 2020

Aims: The objective of this study is to provide data on the epidemiological profile of pregnant women aged 15-45 years with anemia in Keita department, Tahoua regional state of Niger republic.
 Methodology: A retrospective cross-sectional study was conducted from January 1st, 2018 to December 31st, 2020, on pregnant women who attended antenatal care at the maternity unit of the health district of Keita. Structured questionnaire was used to retrieve data regarding pregnancy from the medical record files which are archived at the maternity unit and entered into Epi Info version 7.2.4.0 for further analysis.
 Results: Of the 1571 registered pregnant women, 310 suffered from anemia, with the prevalence of 19.7%. The prevalence of the severity of anemia was 17.7% mild, 49.0% moderate, and 33.2% severe anemia. The mean age of the pregnant women with anemia was 25.3±6.97 years and most were at third trimester (53.5%). Out of 310 patients, 244(78.7%) were either illiterate or had primary education level. Most of them 262(84.5%) are housewives and only 2(0.7%) visited hospital for antenatal care more than four times. About 249(80.3%) were multigravida. 52(16.8%) deliveries were by cesarean section with a higher recourse to blood transfusion. Major maternal complications were postpartum hemorrhage (28.4%), abortion (31.9%), malaria (15.2%) and maternal deaths (5%). Neonatal outcome was analyzed in terms of stillbirth (9%) and neonatal deaths (7%).
 Conclusion: Anemia in pregnancy is a real public health problem in Niger republic and was mild in severity in the study setting of Keita, especially during the third trimester. Pregnant women who were younger, housewives, illiterates, multiparous and multigravida constitute the most vulnerable segments of the population at risk of anemia. Therefore, further strengthening of the existing health care system through awareness and education on early and regular antenatal care visits for a positive pregnancy experience should be reinforced.

The Delivery of Obstetric Anesthetic Care in UK Maternity Units: A Survey of Practice in 2021

(Int J Obstet Anesth. 2023;53:103618) Anesthesiologists play an integral role in the care provided to patients in maternity units by administering peripartum anesthesia and analgesia and sharing the responsibility of safe care. Yet the efficacy of their role is dependent on the organization of anesthesia services and how they are resourced. As the information on how obstetric anesthetic resources are lacking in the United Kingdom, the aim of this survey was to determine current obstetric anesthesia service delivery and staffing resources in the United Kingdom to guide care teams and achieve key national recommendations and benchmarks.

'There is no other option': Exploring health care providers' experiences implementing regional multisite midwifery model of care in South Australia.

In the past 30 years, 60% of South Australia's rural maternity units have closed. Evidence demonstrates midwifery models of care offer regional Australia sustainable birthing services. Five birthing sites within the York and Northern Region of South Australia, designed in collaboration with key stakeholders, offered a new all-risk midwifery continuity of care model (MMoC). All pregnant women in the region were allocated to a known midwife once pregnancy was confirmed. In July 2019, the pilot program was implemented and an evaluation undertaken. The study aimed to evaluate the effectiveness, acceptability, and sustainability of the new midwifery model of care from the perspective of health care providers. The evaluation utilised a mixed methods design using focus groups and surveys to explore experiences of health care providers impacted by the implementation of the MMoC. This paper reports on midwives, doctors and nurses experiences at different time points, to gain insight into the model of care from the care providers impacted by the change to services. The first round of focus groups included 14 midwives, 6 hospital nurses/midwives and 5 doctors with the overarching theme that the 'MMoC was working well.' The second round of focus groups were undertaken across the five sites with 10 midwives, 9 hospital nurses/midwives and 5 doctors. The overarching theme captured all participants commitment to the MMoC, with agreement that 'there is no other option - it has to work'. All participants reported positive outcomes and a strong commitment to navigate the changes required to implement the new model of care. Collaboration and communication was expressed as key elements for success. Specific challenges and complexities were evident including a need to clarify expectations and the workload for midwives, and for nurses who were accustomed to having midwives 24 hours a day in hospitals. This innovative model responds to challenges in providing rural maternity care and offers a sustainable model for maternity services and workforce. There is an overwhelming commitment and consensus that there is 'no other option-it has to work'.

Type of delivery and perinatal outcomes in pregnant women diagnosed with COVID-19: A systematic review and meta-analysis

BackgroundThere is paucity in the literature that provides a comprehensive and evidence-based conclusion regarding this topic. ObjectiveTo compare perinatal outcomes of vaginal and caesarean section delivery in women diagnosed with COVID-19 by meta-analysis of literature. Search StrategyThe search was conducted on MEDLINE, EMBASE, LILACS, CINAHL, Scopus, Web of Science and Cochrane Database of Systematic Reviews by 25th May 2022. Selection criteriaThe inclusion criteria involved pregnant women diagnosed with COVID-19 who underwent caesarean section and those who had vaginal deliveries. Data collection and analysisThe included studies were meta-analyzed for various outcomes including: Gestational age, maternal intensive care unit admission, maternal death, prematurity, newborn birth weight, newborn intensive care unit admission, Apgar scores, newborn death, and newborn vertical transmission of COVID-19. The meta-analysis was conducted using Comprehensive Meta-Analysis (CMA) software, version 3.3.070. Main resultsThe meta-analyses included 2,566 deliveries (866 caesarean sections and 1,700 vaginal deliveries) and identified that caesarean section was significantly associated with increased prematurity (OR 2.5 [1.7; 3.6], p < 0.001), lower birth weight (−118 g [−170; −66], p < 0.001), and a higher need for maternal (OR 9.54 [5.22; 17.43], p < 0.01) and neonatal intensive care unit intervention (OR 3.67 [2.71; 4.96], p < 0.01) compared to vaginal delivery. ConclusionCOVID-19 infection alone should not be an indication for caesarean section as there is insufficient evidence that caesarean section reduces mortality, improves birth conditions, or prevents vertical transmission. Additionally, caesarean section is associated with poorer perinatal outcomes compared to vaginal delivery.

The Association Between Maternal Short Stature and Neonatal Intensive Care Unit Admission: A Longitudinal Study in Sabah.

The rising number of newborns requiring neonatal intensive care unit (NICU) care poses immediate threats to their health and places emotional and financial burdens on families and healthcare systems. This study investigates the direct effect of maternal short stature on NICU admission in Sabah, Malaysia. A longitudinal study at Hospital Wanita Dan Kanak-Kanak Sabah (HWKKS) from 2018 to 2022 included 254 Malaysian women with singleton pregnancies and neonates born after the 37th week, excluding significant disorders, smoking/alcohol use, fetal death, and malformations. Birth weight, gestational age, and neonatal condition were recorded. The association between maternal height, low birth weight(LBW), and NICU admission was analyzed. LBW prevalence was 15.35%, with an average participant height of 147.37 cm. Maternal stature was significantly associated with LBW, with the shortest quartile (Q1) having the highest risk. LBW was significantly associated with NICU admission, with LBW newborns at a sixfold higher risk. Maternal height was also significantly associated with NICU admission, with Q1having the highest risk. The receiver operating characteristic (ROC) curve suggested combining Q1 and Q2 for the best prediction of NICU admission, indicating that shorter mothers face a higher risk of neonates requiring NICU care. Maternal short stature could be a valuable predictor of LBW and NICU admission risk. It may be a screening tool to assess these risks in healthcare settings. However, further research is needed to explore this association's underlying mechanisms and potential interventions.

Characteristics and outcomes of pregnant women hospitalized with severe maternal outcomes in eastern Ethiopia: Results from the Ethiopian Obstetric Surveillance System study.

The aim of the present study was to identify facility-based incidence of severe obstetric complications through a newly established obstetric surveillance system in eastern Ethiopia. Monthly registration of obstetric hemorrhage, eclampsia, uterine rupture, severe anemia and sepsis was introduced in 13 maternity units in eastern Ethiopia. At each hospital, a designated clinician reported details of women admitted during pregnancy, childbirth or within 42 days of termination of pregnancy from April 01, 2021 to March 31, 2022 developing any of these conditions. Detailed data on sociodemographic characteristics, obstetric complications and status at discharge were collected by trained research assistants. Among 38 782 maternities during the study period, 2043 (5.3%) women had any of the five conditions. Seventy women died, representing a case fatality rate of 3.4%. The three leading reasons for admission were obstetric hemorrhage (972; 47.6%), severe anemia (727; 35.6%), and eclampsia (438; 21.4%). The majority of the maternal deaths were from obstetric hemorrhage (27/70; 38.6%) followed by eclampsia (17/70; 24.3%). Obstetric hemorrhage, severe anemia and eclampsia were the leading causes of severe obstetric complications in eastern Ethiopia. Almost one in 29 women admitted with obstetric complications died. Audit of quality of care is indicated to design tailored interventions to improve maternal survival and obstetric complications.

A qualitative study of infection prevention and control practices in the maternal units of two Ghanaian hospitals

IntroductionHealthcare-associated infections (HAIs) remain a common challenge in healthcare delivery, with a significant burden in low- and middle-income countries. Preventing HAIs has gained enormous attention from policy makers and healthcare managers and providers, especially in resource-limited settings. Despite policies to enforce infection prevention and control (IPC) measures to prevent HAIs, IPC compliance remains a challenge in hospital settings. In this study, we explore the experiences of healthcare providers and women in the post-natal phase and investigate factors influencing IPC practices in two hospitals in Ghana.MethodsThe study used a qualitative approach involving semi-structured interviews, focus group discussions, and observations among healthcare providers and women in the postnatal phase in two maternity units from January 2019 to June 2019. Interviews were recorded and transcribed verbatim for thematic analysis. The data sets were uploaded into the qualitative software NVivo 12 to facilitate coding and analysis.FindingsHealthcare providers were driven by the responsibility to provide medical care for their patients and at the same time, protect themselves from infections. IPC facilitators include leadership commitment and support, IPC training and education. Women were informed about IPC in educational talks during antenatal care visits, and their practices were also shaped by their background and their communities. IPC barriers include the poor documentation or ‘invisibility’ of HAIs, low prioritization of IPC tasks, lack of clear IPC goals and resources, discretionary use of guidelines, and communication-related challenges. The findings demonstrate the need for relevant power holders to position themselves as key drivers of IPC and develop clear goals for IPC. Hospital managers need to take up the responsibility of providing the needed resources and leadership support to facilitate IPC. Patient engagement should be more strategic both within the hospital and at the community level.

Cohort profile: Improved Pregnancy Outcomes via Early Detection (IMPROvED), an International Multicentre Prospective Cohort

Background Improved Pregnancy Outcomes via Early Detection (IMPROvED) is a multi-centre, European phase IIa clinical study. The primary aim of IMPROvED is to enable the assessment and refinement of innovative prototype preeclampsia risk assessment tests based on emerging biomarker technologies. Here we describe IMPROvED’s profile and invite researchers to collaborate. Methods A total of 4,038 low-risk nulliparous singleton pregnancies were recruited from maternity units in Ireland (N=1,501), United Kingdom (N=1,108), The Netherlands (N=810), and Sweden (N=619) between November 2013 to August 2017. Participants were interviewed by a research midwife at ~11 weeks (optional visit), ~15 weeks, ~20 weeks, ~34 weeks’ gestation (optional visit), and postpartum (within 72-hours following delivery). Findings to date Clinical data included information on maternal sociodemographic, medical history, and lifestyle factors collected at ~15 weeks’ gestation, and maternal measurements, collected at each study visit. Biobank samples included blood, urine, and hair collected at each study visit throughout pregnancy in all units plus umbilical cord/blood samples collected at birth in Ireland and Sweden. A total of 74.0% (N=2,922) had an uncomplicated pregnancy, 3.1% (N=122) developed preeclampsia, 3.6% (N=143) had a spontaneous preterm birth, and 10.5% (N=416) had a small for gestational age baby. We evaluated a panel of metabolite biomarkers and a panel of protein biomarkers at 15 weeks and 20 weeks’ gestation for preeclampsia risk assessment. Their translation into tests with clinical application, as conducted by commercial entities, was hampered by technical issues and changes in test requirements. Work on the panel of proteins was abandoned, while work on the use of metabolite biomarkers for preeclampsia risk assessment is ongoing. Future plans In accordance with the original goals of the IMPROvED study, the data and biobank are now available for international collaboration to conduct high quality research into the cause and prevention of adverse pregnancy outcomes.

Why is safety in intrapartum electronic fetal monitoring so hard? A qualitative study combining human factors/ergonomics and social science analysis

BackgroundProblems in intrapartum electronic fetal monitoring with cardiotocography (CTG) remain a major area of preventable harm. Poor understanding of the range of influences on safety may have hindered improvement. Taking...

Midwives' and obstetricians' practice, perspectives and experiences in relation to altered fetal movement: A focused ethnographic study

BackgroundReducing avoidable stillbirth is a global priority. The stillbirth rate in England compares unfavourably to that of some other high-income countries. Poorly-managed episodes of altered fetal movement have been highlighted as a key contributor to avoidable stillbirth, and strategies introduced in England in 2016 to reduce perinatal mortality included recommendations for the management of reduced fetal movement. Despite a downward trend in stillbirth rates across the UK, the effects of policies promoting awareness of fetal movement remain uncertain. ObjectiveTo provide in-depth knowledge of how practice and clinical guidance relating to altered fetal movement are perceived, enacted and experienced by midwives and obstetricians, and explore the relationship between recommended fetal movement care and actual fetal movement care. DesignA focused ethnographic approach comprising over 180 h of observation, 15 interviews, and document analysis was used to explore practice at two contrasting UK maternity units. SettingsAntenatal services at two UK maternity units, one in the Midlands and one in the North of England. ParticipantsThirty-six midwives, obstetricians and sonographers and 40 pregnant women participated in the study across 52 observed care episodes and relevant unit activity. Twelve midwives and three obstetricians additionally participated in formal semi-structured interviews. MethodsFieldnotes, interview transcripts, policy documents, maternity notes and clinical guidelines were analysed using a modified constant comparison method to identify important themes. Resultsfetal movement practice was mostly consistent and in line with guideline recommendations. Notwithstanding, most midwives and obstetricians had concerns about this area of care, including challenges in diagnosis, conflicting evidence about activity, heightened maternal anxiety, and high rates of monitoring and intervention in otherwise low-risk pregnancies. To address these issues, midwives spent considerable time reassuring women through information and regular monitoring, and coaching them to perceive fetal movement more accurately. ConclusionsPractice relating to altered fetal movement might be more uniform than in the past. However, a heightened focus on fetal movement is associated by some midwives and obstetricians with potential harms, including increased anxiety in pregnancy, and high rates of monitoring and intervention in pregnancies where there are no ‘objective concerns’. Challenges in diagnosing a significant change in fetal movement with accuracy might mean that interventions and resources are not being directed towards those pregnancies most at risk. More research is needed to determine how healthcare professionals can engage in conversations about fetal movement and stillbirth to support safe outcomes and positive experiences in pregnancy and birth. RegistrationNot registered. Tweetable abstractMidwives and obstetricians take #reducedfetalmovement seriously but worry this ‘unreliable’ symptom increases anxiety, monitoring and intervention in many ‘low risk’ pregnancies.

Impact of discontinuing oxytocin in active labour on neonatal morbidity: an open-label, multicentre, randomised trial

Oxytocin is effective in reducing labour duration but can be associated with fetal and maternal complications that could potentially be reduced by discontinuing the treatment during labour. We aimed to assess the impact of discontinuing oxytocin during active labour on neonatal morbidity. STOPOXY was a multicentre, randomised, open-label, controlled, superiority trial conducted in 21 maternity units in France. Participants who received oxytocin before 4 cm dilation were randomly assigned 1:1 to either discontinuous oxytocin (oxytocin infusion stopped beyond a cervical dilation equal to or greater than 6 cm) or continuous oxytocin (administration of oxytocin continued until delivery). Randomisation was stratified by centre and parity. The primary outcome, neonatal morbidity, was assessed at birth using a composite variable defined by an umbilical arterial pH at birth less than 7·10, a base excess greater than 10 mmol/L, umbilical arterial lactates greater than 7 mmol/L, a 5-min Apgar score less than 7, or admission to the neonatal intensive care unit. Efficacy and safety was assessed in participants who were randomly assigned (excluding those who withdrew consent or were deemed ineligible after randomisation) and had reached a cervical dilation of at least 6 cm. This trial is registered with ClinicalTrials.gov, NCT03991091. Of 2459 participants randomly assigned between Jan 13, 2020, and Jan 24, 2022, 2170 were eligible to receive the intervention and were included in the final modified intention-to-treat analysis. The primary outcome occurred for 102 (9·6%) of 1067 participants (95% CI 7·9 to 11·5) in the discontinuous oxytocin group and for 101 (9·2%) of 1103 participants (7·6 to 11·0) in the continuous oxytocin group; absolute difference 0·4% (95% CI -2·1 to 2·9); relative risk 1·0 (95% CI 0·8 to 1·4). There were no clinically significant differences in adverse events between the two groups of the safety population. Among participants receiving oxytocin in early labour, discontinuing oxytocin when the active phase is reached does not clinically or statistically significantly reduce neonatal morbidity compared with continuous oxytocin. French Ministry of Health and the Département de la Recherche Clinique et du Développement de l'Assistance Publique-Hôpitaux de Paris.

Childminder knowledge of shaken baby syndrome and the role played by childminders in prevention: An observational study in France

BackgroundShaken baby syndrome (SBS) triggers negative short- and long-term outcomes. In France, registered childminders are the principal source of daycare. They may encounter SBS imparted by caregivers or simply excessive infant crying. The aim of the study was to explore childminder knowledge on SBS, the source of information, the responses to infant crying, how childminders perceived their roles in terms of caregiver SBS prevention, and the factors associated with a good knowledge of SBS. MethodsThe participants were registered childminders working in the French department of Gironde who had email accounts. This observational study employed an anonymous online questionnaire distributed by the maternal and child health services unit of the Gironde department over 5 weeks from 16 September 2021. Data on childminder characteristics, knowledge on SBS, responses to infant crying, and perceptions of their roles in SBS prevention were collected. The knowledge score ranged from 0 (all wrong answers) to 30 (all correct answers). ResultsA total of 779 registered childminders participated; 43.9 % had learnt about SBS during their initial training and 75 % before (other training) or after initial training. The median knowledge score was 19/30 (interquartile range [16; 21]). A higher educational level, previous other professional experience, training on SBS, and responsibility for few children were associated with higher scores. Ten reported that they did not advise caregivers who complained of infant crying. ConclusionChildminders require training on SBS and SBS prevention.

An appraisal of the East of England ‘sixty supportive steps to safety’ tool

Universally, maternity care is particularly susceptible to risk. In England, the safety of maternity services has been the subject of many recent enquiries, leading to media scrutiny and concerns regarding safe outcomes and positive maternity experiences. During 2020–2021, an increased number of maternity units in the East of England were placed on the national Maternity Safety Support Programme, indicating that enhanced regional support was necessary. To establish exactly what support was required, both as a region and for individual maternity units, a tool was developed and launched April 2021: the ‘sixty supportive steps to safety’. This framework was intended to provide support to maternity units, so that the maternity quadrumvirate, the local maternity and neonatal system, the trust board and the integrated care board could have confidence and assurance that their maternity services had identified any required areas of improvement. Completion of the framework also enabled units to complete the tool, as well as to showcase and share best practice across the region.

Meconium Concentrations of Pesticides and Risk of Hypospadias: A Case-Control Study in Brittany, France.

Hypospadias is a male genital tract defect for which an increase in prevalence has been documented over the last few decades. A role for environmental risk factors is suspected, including prenatal exposure to pesticides. To study the risk of hypospadias in association with multiple pesticide measurements in meconium samples. The Brittany Registry of Congenital Anomalies (France) conducted a case-control study between 2012 and 2018. Cases were hypospadias, ascertained by a pediatrician and a pediatric surgeon, excluding genetic conditions, following European Surveillance of Congenital Anomalies guidelines (N = 69). Controls (N = 135) were two male infants without congenital anomaly born after each case in the same maternity unit. Mothers in the maternity units completed a self-administered questionnaire, we collected medical data from hospital records, and medical staff collected meconium samples. We performed chemical analysis of 38 pesticides (parent compound and/or metabolite) by UHPLC/MS/MS following strict quality assurance/quality control criteria and blind to case-control status. We carried out logistic regression accounting for frequency-matching variables and major risk factors. Among the 38 pesticides measured, 16 (42%) were never detected in the meconium samples, 18 (47%) were in <5% of samples, and 4 (11%) in ≥5% of the samples. We observed an association between the detection of fenitrothion in meconium and the risk of hypospadias (OR = 2.6 [1.0-6.3] with n cases = 13, n controls = 21), but not the other pesticides. Our small study provides a robust assessment of fetal exposure. Fenitrothion's established antiandrogenic activities provide biologic plausibility for our observations. Further studies are needed to confirm this hypothesis.

An Ethnographic Study of the Philosophy, Culture and Practices Within an Urban Freestanding Midwifery Unit: Part 3 – Service Users’ Perspectives

This study focused on reflecting on the key characteristics that ensure the effective functioning of maternity units (MUs). This third article focuses on service users’ experiences and perspectives of the freestanding maternity unit (FMU) and what they perceived as important to feel safe and in control.