Health Of Mothers Research Articles

Effects of Drospirenone only pill contraception on postpartum mood disorders: A prospective, comparative pilot study

ObjectiveThe aim of this non-randomized control study was to assess the effect of Drospirenone (DRSP) only pill (DOP) 4 mg, in a 24 active/4 placebo regimen, on the mood of postpartum women who wanted to use a hormonal contraceptive. Study designSeventy-one women in the study group, and 78 in the control group, were included in intention-to-treat analyses. The depression score was assessed using the self-administrated Edinburgh Postnatal Depression Scale (EPDS) at the childbirth preparation course (T0), and at 2 (T1), 12 (T2), and 24 (T3) weeks postpartum follow-ups. ResultsFrom T0 to T1 an increase in the scores was observed in both groups: in the study group from 9.2 ± 2.5 to 10.1 ± 2.4 (p = 0.02), and in the control group from 8.7 ± 2.7 to 10.3 ± 2.2 (p < 0.001). At the T2 follow-up, the EPDS score reduction was statistically significant in the study group (p < 0.001) but not in the control group (p = 0.16). Similarly, at the T3 follow-up, the score was statistically reduced in the study (p < 0.01), but not in the control group (p = 0.35). The intergroup statistical analysis showed no differences between groups at T0 (p = 0.19) and at T1 (p = 0.55). Instead, they were statistically significant at T2 and T3 (p < 0.001). EPDS scores had no significant correlation with the mode of delivery (r = 0.2; p > 0.05) and with the mode of breastfeeding (r = 0.3; p > 0.05). On the other hand, EPDS scores demonstrated a positive correlation with the social status of single (r = 0.99; p < 0.002) and low education level (r = 0.82; p < 0.004). ConclusionPostpartum mood disorders may have persistent effects that compromise the mother's health and newborn development. DRSP, used as DOP, could modulate mood disorders of the postpartum period in women with individual sensitivity to steroid levels.

Investigation of Placental Modifications in Patients with Preeclampsia: Examination using Light and Electron Microscopy

Preeclampsia can have an effect on both the mother's health as well as the unborn child, and it only occurs during gestation and after delivery. Proteins in urine as well as high levels of blood pressure are two signs of this disease that advances swiftly. The study's goal was to look at the histology and to examine for ultrastructural alterations in the placentas of preeclampsia-affected pregnancies. Slices of paraffin were made from placenta specimens used for light microscopic analysis while an electron microscope with scanning technology was employed to produce and observe specimens for ultrastructural analysis. The syncytiotrophoblast layer nuclei were found to be arranged in many sprouts and lengthy anastomosing strands, according to light microscopic examinations. The foetal placental capillaries receded up to total absence as the villus connective tissue core gradually contracted. Endothelial degeneration and atheromatous changes were present in placental stem arteries, whereas endothelial degeneration, escalating fibrosis, and obliteration were seen in lower decidual arterioles. These results are compatible with a rise in fetoplacental vascular impedance, which was shown to be present when lacking end-diastolic flow velocity was established that it existed in the umbilical artery just before birth. The results clarify how this issue has interfered with the movement of nutrients and gas.

#4772 DOUBLE FILTRATION PLASMAPHERESIS DURING HETEROLOGOUS FERTILIZATION PREGNANCY FOR THE TREATMENT OF HETEROZYGOUS FAMILIAL HYPERCHOLESTEROLEMIA

Abstract Background and Aims Pregnancy in women affected by familial hypercholesterolemia is rare. Estrogen and progesterone fluctuations, featuring pregnancy, adversely influence lipid metabolism, causing considerable increase of LDL-C, triglyceride and lipoprotein A levels. These changes in fatty metabolism, essential for embryonic development, might be critical for placental circulation and for mother's health. Indeed, high lipoprotein amount can raise uteroplacental vascular resistance and it is associated with intrauterine growth restriction because of oxidative stress, whereas hypertriglyceridemia and hypercholesterolemia might cause an increased risk of cardiovascular accidents and pancreatitis. Lipid-lowering drugs, such as statins, ezetimibe or PCSK9 inhibitors are discontinued due to possible teratogen effects. Thus, LDL apheresis is the only available therapy for severe hypercholesterolemia during pregnancy. Method A 46 years old woman affected by heterozygous familial hypercholesterolemia in treatment with PCSK9 inhibitors and statins, decided to undergo an heterologous in vitro fertilization with oocyte donation. Hence, pharmacological therapy was stopped to avoid teratogen effects. We started a 10-months apheresis program with double filtration plasmapheresis (DFPP). The treatment was performed by a temporary double lumen central venous catheter. Initially, she underwent apheresis twice a month with an average exchange volume of 1.2, low blood flow (≤ 90 ml/min) and incremental plasma flow (from 5 to 30 ml/min every 10 minutes of treatment), to ensure a physiological procedure. We gradually modulated the exchange volume monitoring blood levels of LDL-C, Lp(a) and triglycerides before and after each procedure. We aimed to keep mean LDL-C level &amp;lt; 200 mg/dl. We did not use anti-coagulation during the procedure, monitoring TMP values and arterial-venous pressure. Results LDL-C levels remained about 227.2 ± SD 91 mg/dl, with a median of 186.8 mg/dl, complying with the target range (Figure 1). Mean triglycerides and Lp(a) values were, respectively, 180.3±94 mg/dl (median 146 mg/dl) and 77.3±36.3 mg/dl (median 55.7 mg/dl) (Figure 1). Our patient did not face any complications related to pregnancy or to the procedure, and gave birth at 38th gestational week to an healthy full-term male baby of 52 centimeters and 3.34 kilograms. Conclusion Although there is a widespread hesitation in performing extracorporeal blood purification treatment in pregnancy, this case underlines the essential role of LDL apheresis in in this setting, giving spark to standardize the procedure and to encourage its use also in pregnancy.

INCREASING KNOWLEDGE OF PREGNANT WOMEN ABOUT DANGER SIGNS DURING PREGNANCY

Premature membrane rupture, extreme stomach pain, severe headaches, and bleeding are all warning signs of pregnancy. impacts such as miscarriage, early pregnancy, fetal discomfort, and pregnancy-related toxicity that could affect the mother's health and the safety of the unborn child. If the mother and family are aware of the risk indicators of pregnancy and take prompt action to overcome them, complications can be prevented and addressed early. In light of this, it is crucial for moms to be aware of the pregnancy's risk indicators, such as bleeding and an early rupture of the membranes, through education in order to prevent difficulties and assist mothers in recognizing their pregnancy. The technique employed in this activity is to coach participants about pregnancy-hazard symptoms. Online games are played with expectant mothers and their families. Following the counseling, there was an improvement in knowledge of the pregnancy danger signals, going from 76 (pre-test) to 97 (post-test).

Term alpaca placenta glycosylation profile and its correlation with pregnancy maintenance and fetal survival.

Alpaca is a South American camelid, particularly present in Peruvian highlands, where oxygen concentration and atmospheric pressure are very low. Due to this fact, gestational physiology has adapted to preserve the conceptus' and mother's health. In this context, several cellular and molecular features play an essential role during and at the end of gestation. Structural carbohydrates act on maternal-fetal communication, recognize exogenous molecules, and contribute to placental barrier selectivity. Therefore, this study aimed to characterize the structural carbohydrate profiles that are present in the term alpaca placenta, kept in their natural habitat of around 4,000m height. For this propose, 12 term alpaca placentas were collected, and the material was obtained at the time of birth from camelids raised naturally in the Peruvian highlands, in the Cusco region. All placenta samples were processed for histological analysis. A lectin histochemical investigation was performed using 13 biotinylated lectins, allowing us to determine the location of carbohydrates and their intensity on a semi-quantitative scale. Our results demonstrated that during term gestation, the epitheliochorial alpaca placenta shows a high presence of carbohydrates, particularly glucose, α-linked mannose, N-acetylglucosamine β (GlcNAc), galactose (αGal), and N-acetylgalactosamine α (GalNAc), present in the trophoblast, amnion epithelium, and mesenchyme, as well as the presence of sialic acid residues and low affinity for fucose. In fetal blood capillaries, the presence of bi- and tri-antennary complex structures and α-linked mannose was predominated. In conclusion, we characterized the glycosylation profile in the term alpaca placenta. Based on our data, compared to those reported in the bibliography, we suggest that these carbohydrates could participate in the labor of these animals that survive in Peruvian extreme environments.

MTHFR and ERVFRD-1 polymorphisms and preeclampsia risk in Iran population: A case-control study

Background and aimsPreeclampsia (PE) is a complicated disease during pregnancy that could be a risk factor for the mother's health and fetus. The mechanisms of PE pathogenesis might associate with some candidate gene polymorphisms. This study is aimed to evaluate the relation between MTHFR (C677T) MTHFR (A1298C) and ERVFRD-1 (rs9393931) single nucleotide polymorphisms (SNPs) and PE in our patients. Material and methodsThe present study was a case-control study carried out between January 2019 and January 2021, in the Kamali hospital, Karaj, Iran. A total of 104 pregnant women who were diagnosed with Preeclampsia clinically as a case, and 100 healthy pregnant women as a control group were compared for the study. ResultsThere was not a 39 T allele of the ERVFRD-1 gene was observed in this studied population. There was a significant difference in frequency of 677CT genotype in PE pregnant women compared to controls (P = 0.002). Also, our result indicated that the frequency of the MTHFR 1298C allele was found to be significantly higher in the control group than in the case group (P = 0.021). ConclusionOur results suggested that C677T polymorphism in MTHFR might be related to an increased risk of Preeclampsia in pregnancy.

Relationship of Household Income, Age During Pregnancy and Low Birth Weight (LBW)

Low birth weight (LBW) is still a major problem in developing countries including Indonesia. The prevalence of LBW tends to decrease from 2013-2018, from 8.6% to 6.51%. Therefore, it is necessary to analyze the relationship between maternal age at pregnancy and household income with the incidence of low birth weight. The type of the study was analytic observational with quantitative method. The population in this study were all mothers who had children aged 6-24 months who resided in West Aceh District and met the inclusion and exclusion criteria by means of simple random sampling. The dependent variable of this study was LB W while the independent variables were maternal age during pregnancy and family income. The risk tendency for each variable was seen using the OR (odds ratio) value which used a Confidence Interval of 95%. The results showed that there was a significant relationship (p=0.049) between the two variables. The amount of household income influences the quality of the mother's health and nutrition intake during pregnancy impacts the weight and health of the child born.

Predictors of Neonatal Intensive Care Unit Admission and Adverse Outcomes Related to Gestational Diabetes.

Gestational diabetes mellitus (GDM) is a type of diabetes that manifests itself in pregnant women. It poses a significant risk to the mother's health as well as the health of the infant, including more babies being brought to the neonatal intensive care unit (NICU). It puts both the mother's and the child's health at serious risk, increasing the likelihood that newborns may need to be treated in a neonatal critical care unit. This study aimed to determine the factors that predict GDM-related NICU admission and other adverse newborn outcomes. The study was a cross-sectional analysis of 175 pregnant women who presented with gestational diabetes at the Maternity and Children's Hospital in Bisha (MCH-Bisha), Saudi Arabia, between January 1and December31, 2022. A logistic regression model was used to analyze the data to predict adverse outcomes for newborns and NICU admissions and identify associations between maternal variables and outcomes. Maternal characteristics highly associated with adverse neonatal outcomes included advanced maternal age (greater than 30 years), a family history of DM, and a history of greater than or equal to four previous pregnancies. Logistic regression models revealed that newborns delivered to mothers older than 30 years were 7.17 times more likely to be admitted to the NICU than newborns born to mothers younger than 30 years. Saudi nationality, urban residence, and cesarean section delivery factors account for nearly all adverse neonatal outcomes (91%, 75%, and 91%, respectively). Newborns delivered by cesarean section were 3.38 times more likely to be admitted to NICU, and the association was significant. Maternal age greater than 30 years and a history of more than or equal to four pregnancies were the strongest indicators of infant adverse outcomes and NICU admittance among women with gestational diabetes. These findings highlight the need for approaches to GDM management that are efficient, thorough, and multidisciplinary.

RELATIONSHIP BETWEEN HUSBAND AND HEALTH WORKERS' SUPPORT WITH MOTHER'S INTEREST IN USING IUD CONTRACEPTION

&#x0D; Intrauterine Contraception Device (IUD) is a method of contraception that is quite safe and is the most recommended in the national family planning program in Indonesia. This study aims to study the significant relationship between the support of husbands and health workers with mothers' interest in using IUD contraception in the working area of the Taba Lagan Health Center, Central Bengkulu Regency. The approach of this study used a descriptive correlation with a cross sectional approach. The population in this study were all couples of childbearing age who came to visit the Taba Lagan Health Center in February 2022, as many as 91 people were taken using accidental sampling. Data collection in this study uses primary data by distributing questionnaires. Data analysis was carried out by the Chi Square test (x) with the Contingency Coefficient test (c). The results of the study from 91 samples there were 53 people with low interest, 52 husbands did not support and 72 people got good information from health workers. The results of the Bivariate analysis show that there is husband support in the very weak category, and information on health workers in the weak category in the working area of the Taba Lagan Health Center, Central Bengkulu Regency. It is hoped that they can use appropriate contraception according to the age and parity of the mother to manage pregnancy spacing and reduce the impact of contraceptive use on mother's health

PEMAHAMAN IBU TENTANG PERMASALAHAN GIZI SERTA PERANNYA DALAM MENGATASI PERMASALAHAN GIZI BADUTA DI DESA BAN, KECAMATAN KUBU, KABUPATEN KARANGASEM, PROVINSI BALI

Children who don’t get nutritional intake according to their needs can cause malnutrition which affects their growth and development process. Children aged 0-2 years will generally be very dependent on their mothers, because in this age group they need breast milk and full attention. The purpose of this study was to find out about mother’s understanding of nutritional problems and their role in overcoming nutritional problems of children under two in the village of Ban, Sub-district of Kubu, District Karangasem, Bali Province. This research is a qualitative research with a descriptive approach. The main informant of this research were 10 moms with children under two years old that selected by the sampling technique used purposive sampling method. The research was conducted in 10 hamlets in Ban village, Karangasem from July-October 2019. Data collected through in-depth interview and observation. Data were analyzed using thematic analysis techniques. The results showed the mother's understanding of nutritional problems was seen from the physical condition of the child, and the mother's understanding about the causes of nutritional problems were caused by a lack of food intake. Mother's role in overcoming nutritional problems are trying to meet the nutritional needs of children, paying attention to food safety and child hygiene, utilizing health services, and doing house cleaning activities. Obstacles that barrier mother's behavior in preventing undernutrition of children under two years old are: economy, distance, dry season, child refuse to breastfeed, busy, mother's health condition, living environment, belief and limited water. Suggestions that can be given are: Health workers routinely increase counseling related to the importance of fulfilling child nutrition and environmental sanitation; Mothers should buy a breast pump when they cannot breastfeed their children directly; Karangasem Health Office conducts tests on the quality of the water that is accessed to ensure water safety, and then conducts counseling activities to the community regarding proper and correct drinking water treatment processes.&#x0D; Keywords: Nutrition, Understanding, Role, Ban village

Inflammatory bowel diseases in pregnant women - current state of knowledge

Introduction and objective: Inflammatory bowel diseases (IBD) are a group of chronic inflammatory diseases. Usually they affect young people, often during pregnancy. Insufficient knowledge about the evolution of the disease during pregnancy, as well as the effects of drugs used, often result in resignation from motherhood, while unfamiliarity with the principles of therapy or discontinuation of treatment during pregnancy are significant causes of obstetric failures. The aim of the study was to summarize the data available in the literature as well as recent reports, to enable a better understanding of the disease and care of pregnant women with IBD.Materials and methods: The literature was reviewed in the Pubmed database, in the Via Medica Journals database, and in the guidelines of the Polish Society of Gastroenterology with the use of keywords.State of knowledge: 85% of women with IBD become pregnant without complications, but the inflammation has a negative impact on both the course of pregnancy and the fetus itself. Complications, which often depend on the activity of the disease before and during pregnancy, may occur: i.e. premature birth, inadequate fetal weight, miscarriage, as well as complications in the child itself and flares of the underlying disease. Therefore, it is important to know rules of safe pharmacotherapy that apply before and after pregnancy in order to prevent the negative effects of the disease. Special situations caused by IBD, i.e. surgical or endoscopic procedures, can be successfully performed in pregnant patients with the observance of certain rules.Conclusions: Understanding the causes of complications that may occur in the patient and the child allows them to be prevented. Both for the mother's health and for a positive course of pregnancy, education and pregnancy planning, preceded by the change of medications to safe for the fetus, are extremely important.

The prevalence and risk factors associated with Iron, vitamin B12 and folate deficiencies in pregnant women: A cross-sectional study in Mbeya, Tanzania.

Maternal nutrition is an important forecaster of infant's and mother's health status in most developing countries. This study aimed at assessing the prevalence and associated risk factors of iron, vitamin B12, and folate deficiencies among pregnant women in Mbeya Tanzania. A cross-sectional study using a cluster randomized sampling was conducted among 420 pregnant women. A structured questionnaire was used to collect socio-demographic and dietary assessment. Body iron store was assessed using serum ferritin measured by immunoturbidimetric assays using a Roche Cobas 400+ biochemistry analyzer. Serum folate was measured by folate microbiological assay, while serum vitamin B12 was measured by immunochemiluminescence assay using a Roche Cobas e411 immunoassay analyzer. Multivariate analysis was performed using Poisson regression. The prevalence of iron, folate, and vitamin B12 deficiencies among pregnant women in Mbeya was 37.8%, 24.0%, and 9.7% respectively. Higher odds of iron deficiency were seen in pregnant women aged 20-24 years older [Adjusted OR = 1.20 (95%CI 1.03, 1.35)], not employed [Adjusted OR = 3.0(95%CI 1.03-1.77)] and, not received iron/folic acid supplementation [Adjusted OR = 1.11 (95%CI 1.003-1.23)]. Pregnant women with highest and middle socio-economic statuses had lower odds of vitamin B12 deficiency [Adjusted OR = 0.83 (95%CI 0.76-0.92)] and [Adjusted OR = 0.89 (95%CI 0.81-0.98)] respectively. Pregnant women who were not employed, not received iron and folic acid supplement during pregnancy and, not consumed edible vegetable cooking oil had significant higher odds of serum folate deficiency [Adjusted OR = 3.0 (95%CI 1.58-5.68)], [Adjusted OR = 1.53 (95%CI 1.21-1.93)] and, [Adjusted OR = 2.77 (1.03-7.44)] respectively. This study confirms that iron, folate and vitamin B12 deficiencies are still a major challenge among pregnant women in Tanzania. We recommend for public health interventions for the provision of vitamin B12 along with iron and folic acid supplementations, especially in pregnant women belong to low socio-economic status and limited knowledge of healthy diet.

Gratitude, fragility and strength: Perspectives of adults born preterm about prematurity.

The aim of the study was to explore how young adults thought that being born preterm had affected their lives. Adult participants of a research cohort were questioned about their perspectives. Answers were analysed using mixed methods. Forty-five participants evaluated their health at median score of 8/10. When asked about the meaning of being born preterm, 65% had positive self-centred answers, invoking two main themes: being stronger/'a fighter'/more resilient and being a survivor/chosen; 42% also reported negative themes, such as having health problems and a difficult start. All heard about their prematurity from their parents, 55% with positive child-centred or healthcare system-centred themes, 19% with neutral themes; 35% also heard negative parent-centred themes (tragic experience, guilt, mother's health). When asked which words were associated with prematurity, participants mainly chose positive words for themselves and their family, but more negative words for how the media and society depicted prematurity. Answers were not correlated with adverse objective health measures. Participants evaluated their health in a balanced fashion. Preterm-born adults often feel that they have experienced positive transformations as a result of their traumatic start. They often have feelings of gratitude and strength, independent of health problems.

Literature Review: Factors affecting the implementation of Early Initiation of Breastfeeding (EIBF) in maternity and breastfeeding mothers

&lt;p&gt;&lt;strong&gt;&lt;em&gt;Background: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;Early initiation of breastfeeding (EIBF) is the process of direct skin contact between the mother and the baby within the first hour after delivery. EIBF affects the welfare and survival of newborns. Implementation of early breastfeeding initiation globally according to WHO is 42% and the low implementation of EIBF is influenced by several factors.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Objectives: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;To identify factors that influence the implementation of Early Breastfeeding Initiation (EIBF) in mothers who give birth and breastfeed based on empirical studies in the last five years.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Methods: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;The research method in this study was a literature review with the type of narrative literature review by using flowcharts to determine screening studies that were adjusted to the research objectives. A search for literature reference sources was carried out from August 2021 to March 2022 with secondary data. Research reference sources are 31 international articles using 3 databases, namely PubMed, Sciencedirect, and Springer.&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Results: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;The results of the study show that the mother's knowledge can be influenced by the availability of EIBF information, and the level of education of the mother. Parity has an influence on EIBF, because it is related to the mother's experience of breastfeeding. In caesarean delivery, it is influenced by post-delivery factors such as caesarean incision pain, the effect of anesthesia, and the mother's perception of milk production, whereas in normal delivery there are conditions of the mother's health that can affect the implementation of EIBF. Social support (husband, family and health workers) can encourage mother's confidence in the implementation of EIBF.&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;&lt;strong&gt;&lt;em&gt;Conclusions: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;There are several factors that influence and relate to the mother's knowledge, parity, type of delivery, social support, and health services on the success of EIBF in the implementation of EIBF in labor and breastfeeding mothers&lt;/em&gt;.

Anxiety and perinatal depression in high-risk pregnancies at the fetomaternal polyclinic RSUP Prof. Dr. IGNG Ngoerah

Background: In this phase, a woman is prone to experiencing mental disorders due to an increase in psychological distress. There is some evidence that psychological stress during this period can have deleterious effects on the mother's health and may harm the child. The most common psychiatric disorders in the perinatal period are anxiety disorders and depression. Objective: To determine the prevalence of perinatal anxiety and depression in high-risk pregnancies. Method: The research sample was pregnant and postpartum women who checked themselves into the fetomaternal polyclinic at RSUP Prof. dr. IGNG Ngoerah as many as 41 people. The research was conducted by distributing the Beck Anxiety Inventory and Beck Depression Inventory questionnaires to the research sample. The research was conducted from October 1 2022 to October 31, 2022. Results: In this study, 7 people (17.1%) experienced mild anxiety and 11 people (26.8%) experienced moderate anxiety. For the prevalence of depression, 6 people (14.6%) had mild depression and 15 people (36.6%) had moderate depression. Perinatal anxiety and depression disorders are most commonly found in pregnant women with Human Immunodeficiency Virus (HIV) infection.

Asthma in pregnant woman and its management : a review

Asthma is the most common comorbidity in pregnant women and gives 30% of exacerbation experience. The other 30% will see improvement of their symptoms, and the rest will not see the changes. Exacerbations have become a major clinical concern in pregnant women. Medical concerns for the mother and the childbirth included low birth weight, preeclampsia, and preterm delivery. The major goal is to keep asthma under control to ensure mother's health and well-being, as well as fetal growth. Controlling asthma and preventing exacerbations are the main goals of asthma treatment during pregnancy. Treatment for asthma should ideally begin before conception. This is to avoid day-time and night-time symptoms, as well as to keep lung function. Furthermore, fetal oxygenation is a crucial factor during the pregnancy. With a few exceptions, asthma drugs are basically the same in pregnancy as they are in non-pregnant people. Inhaled corticosteroids (ICS) are often used as a controlling treatment. Budesonide is the recommended ICS. Short-acting β-agonist (SABA) preferable as reliever in acute asthma and to relieve exacerbation. As an add-on therapy for medium to high dose ICS, long-acting β-gonists (LABA) is often used. Virus infections and ICS nonadherence are the two most common causes of asthma exacerbations during pregnancy.

Ethics and Legal Aspect of Termination of Pregnancy with Trisomy 13 (Patau Syndrome)

Trisomy 13 is a serious genetic anomaly in the fetus that is one of the causes of abortion as a result of the chromosomal aneuploidy. Trisomy 13 affects roughly 1 in 10,000 to 20,000 live births, and more than 95% of pregnancies end in prenatal death. Due to the higher prevalence of preeclampsia and the danger of maternal death associated with early birth, abnormalities in these infants also have an impact on the mother's health. According to Law No. 36 of 2009 concerning Health, women who eligble for abortions if there are medical reasons to do so. The problems in this paper are 1) What are the ethical problems found in pregnancies with a fetus diagnosed with a genetic disorder due to trisomy 13? 2) What is the procedure for implementing medical abortion provocation that fulfills ethical aspects and complies with applicable regulations. To answer these problems, a research using normative legal research, accompanied by reports of cases of abortion. This normative legal research focuses on ethical and legal aspects of the implementation of provocative medical abortion following statutory regulations. This normative legal research starts with articles and case reports of fetal pregnancies with genetic disorders from the Gatot Soebroto Army Hospital. The results of the study show that consent to termination of pregnancy with medical indications by the patient and approved by the husband/family. T

Prenatal syphilis screening among pregnant Medicaid enrollees by sexually transmitted infection history as well as race and ethnicity

Congenital syphilis can cause severe morbidity, including miscarriage and stillbirth, and rates are increasing rapidly within the United States. However, congenital syphilis can be prevented with early detection and treatment of syphilis during pregnancy. Current screening recommendations propose that all women should be screened early in pregnancy, whereas women with elevated risks for congenital syphilis should be screened again later in pregnancy. The rapid increase in congenital syphilis rates suggests that there are still gaps in prenatal syphilis screening. This study aimed to examine associations between the odds of prenatal syphilis screening and sexually transmitted infection history or other patient characteristics across 3 states with elevated rates of congenital syphilis. We used the Medicaid claims data from Kentucky, Louisiana, and South Carolina for women with deliveries between 2017 and 2021. Within each state, we examined the log-odds of prenatal syphilis screening as a function of the mother's health history, demographic factors, and Medicaid enrollment history. Patient history was established using a 4-year lookback period of the Medicaid claims data; in state A, sexually transmitted infection surveillance data were used to improve the sexually transmitted infection history. The prenatal syphilis screening rates varied by state, ranging from 62.8% to 85.1% of deliveries to women without a recent history of sexually transmitted infections and from 78.1% to 91.1% of deliveries to women with a previous sexually transmitted infection. For the main outcome of syphilis screening at any time during pregnancy, deliveries associated with previous sexually transmitted infections had 1.09 to 1.37 times higher adjusted odds ratios of undergoing screening. Deliveries to women with continuous Medicaid coverage throughout the first trimester also had higher odds of syphilis screening at any time (adjusted odds ratio, 2.45-3.15). Among deliveries to women with a previous sexually transmitted infection, only 53.6% to 63.6% underwent first-trimester screening and this rate was still just 55.0% to 69.5% when considering only deliveries to women with a previous sexually transmitted infection and full first-trimester Medicaid coverage. Fewer delivering women underwent third-trimester screening (20.3%-55.8% of women with previous sexually transmitted infection). Compared with deliveries to White women, deliveries to Black women had lower odds of first-trimester screening (adjusted odds ratio, 0.85 in all states) but higher odds of third-trimester screening (adjusted odds ratio, 1.23-2.03), potentially impacting maternal and birth outcomes. For state A, linkage to surveillance data doubled the rate of detection of a previous sexually transmitted infection because 53.0% of deliveries by women with a previous sexually transmitted infection would not have had sexually transmitted infection history detected using Medicaid claims alone. A previous sexually transmitted infection and continuous preconception Medicaid enrollment were associated with higher rates of syphilis screening, but Medicaid claims alone do not fully capture the sexually transmitted infection history of patients. The overall screening rates were lower than would be expected given that all women should undergo prenatal screening, but the rates in the third trimester were particularly low. Of note, there are gaps in early screening for non-Hispanic Black women who had lower odds of first-trimester screening when compared with non-Hispanic White women despite being at elevated risk for syphilis.

Foreigner

Foreigner Cristina Rivera Garza (bio) Translated by Sarah Booker (bio) I stopped at the restaurant off the highway because I couldn't stay awake. I'd been driving for eight hours after learning that my mother's health was quickly deteriorating. As soon as I hung up the phone with her, I put a few things in a little suitcase and, knowing it would be difficult to find a flight at that late hour, grabbed the car keys and ran out the door. Following by memory the route I hadn't driven in years, I took the interstate as far as I could. Then I turned right onto a state highway, and later, as it got dark, I proceeded down local roads. I'd forgotten about the beauty of that drive. The evening hues outside [End Page 55] the city. The way the wind softly bends the grass on the hills. The shapes of certain clouds. I stopped several times along the way to drink coffee and ask myself, silently and guiltily, whether my quick response really had to do with a concern for my mother's health or just the overwhelming desire to leave everything behind. Tabula rasa. My life in the city was a disaster. I was working more hours than necessary and living off cheap food, coffee, and cigarettes. I hadn't gotten a haircut in months, and I was wearing the same clothes I'd acquired years before, when I'd first arrived, full of dreams. Desires. Ideas for the future. None of it had come to fruition, I had to admit more than once during the drive. Other things had been achieved, that was true, but not the ones I wanted. Not the ones that had brought me there. The sense of failure, at first discreet and bearable, had become a permanent bitter taste in my mouth. An invisible snake slithering across the backs of my thighs, steadily creeping up my torso, under my clothes. An inner clatter that kept me from sleeping. I was not a happy man. The person who was driving these narrow country roads, now skillfully avoiding the body of some nocturnal animal, was as bitter as the saliva he couldn't swallow. I screamed it to the heavens: I am not a happy man. I shouted it out to the deer that forced me to screech to a stop in the middle of the road, the deer that kept looking at me with its big, bright eyes as I got out of my car and fell to my knees on the asphalt, crying. Who are you? I yelled. What the hell are you doing out here? I realized it was just a fawn, cocking its head to the left. I said it once I could finally stand and get back in the car, looking into the rearview mirror: I am not a happy man. I am barely a man. I was wiping away snot when I remembered my mother's youthful face. She'd also moved away, but in the opposite direction. Instead of going to the city, she'd bought a little cabin in a place difficult to find, even on a map. There, she told me, she would have time to think. She said nothing more, as if no further explanation were necessary. Time to think about what? I wondered for the first [End Page 56] time, keeping an eye on the speedometer as I counted the insects crashing into the windshield. Time to think, I guess, about how to get even farther away. That's what she did, anyway. She drifted away, to places I knew little about. One morning she woke up having finally become what she'd always wanted to be: a foreigner. Someone not from here. A person recently arrived. Tabula rasa. For years she'd talked about that with my father. At night, lying next to one other, sharing private landscapes, she'd always end up whispering: somewhere else. That was the only thing I could hear from my room. Sometimes it sounded like a plea. Sometimes it echoed threateningly. Somewhere else. Anywhere, but elsewhere. Not here. That's what she'd said...

Pengaruh Pengetahuan Ibu dan Peran Petugas Kesehatan Terhadap Konsumsi Vitamin A pada Ibu Nifas di Wilayah Kerja Puskesmas Indrapuri Aceh Besar Tahun 2022

During the postpartum recovery and breastfeeding process, postpartum mothers should get 2 capsules of vitamin A. Provision of vitamin A capsules for postpartum mothers can increase the amount of vitamin A in breast milk and help restore the mother's health, so giving 200,000 units of vitamin A capsules to postpartum mothers is very important. The coverage of giving vitamin A to postpartum women at the Indrapuri health center is 58% or 271 people of the target number of 100% (463 people). This study was to determine the effect of maternal knowledge and the role of health workers on vitamin A consumption in postpartum mothers. The method in this research is descriptive analytic research with a cross sectional approach. The population in this study were all postpartum mothers in the working area of ​​the Indrapuri Public Health Center in October-November 2022, namely 75 postpartum mothers. The sampling technique is total sampling. The results showed that there was an effect of mother's knowledge (P Value 0.045) and the role of health workers (P Value 0.020) on vitamin A consumption in postpartum mothers. It can be concluded: there is an influence of mother's knowledge and the role of health workers on vitamin A consumption in postpartum mothers. It is hoped that health workers, especially midwives, can monitor during postpartum visits to postpartum mothers and increase mothers' motivation by providing counseling about the importance of consuming vitamin A capsules during the postpartum period.