Obstetric Experience Research Articles

Peripartum Ηysterectomy: A Four-Year Obstetric and Anesthetic Experience in a Tertiary Referral Hospital in Greece.

BackgroundAlthough peripartum hysterectomy (PH) is a life-saving procedure in cases of abnormal placentation and postpartum hemorrhage, it can be associated with major obstetric and anesthetic complications. This retrospective study aimed to evaluate the incidence, etiology, perioperative anesthetic and obstetric management, complications, and fetal outcomes in women undergoing PH in a single tertiary referral hospital in Greece.MethodologyThis was a retrospective analysis of medical records of women who underwent emergency or elective PH in our hospital between January 2015 and December 2018.ResultsDuring the study period, 69 women who underwent a PH were identified. The incidence rate of elective and emergency PH was 4 and 1.2 per 1,000 deliveries, respectively. The main indication for PH was abnormal placentation (81.2%), followed by uterine atony (13%). Conversion to general anesthesia (GA) was performed in 21 (30.4%) cases.ConclusionsThis study showed a high prevalence of PH in our hospital compared to high-income countries. A neuraxial-only technique may be a safe alternative in individual cases of abnormal placentation. Conversion to GA can be reserved for complex surgical cases when massive hemorrhage is anticipated and, if possible, after the neonate has been delivered.

Qualitative Evaluations of Obstetric Transport Experiences During the COVID-19 Pandemic [A211

INTRODUCTION: The COVID-19 pandemic drastically affected the emergency obstetric transport experience on a multidimensional level. The objective of this study is to understand how the pandemic has affected the physical and emotional health of these patients prior to, during, and after their transport to the University of New Mexico Hospital (UNMH). METHODS: Participants transported for emergency obstetric indications were recruited at UNMH. Patient informed consent, demographic questionnaires, interviews, and surveys were obtained and graded on a 5-point Likert scale. These were delivered in person, via telephone, or via Zoom software and securely recorded. English interviews were transcribed via Otter.ai, and interviews conducted in Spanish were manually translated. Institutional review board approval was obtained. RESULTS: Preliminary results consisted of 10 participants. A majority (90%) felt that they had a good experience with the transport service and 70% of the individuals felt that proper protocols were put in place to protect them from a COVID-19 exposure. However, 40% of respondents had concerns about their safety during the transport process and 50% had concerns about their baby’s safety. Additionally, 60% of participants felt that COVID-19 overall had a negative effect on their transport experience. CONCLUSION: A significant portion of participants felt that the COVID-19 pandemic had a negative effect on their obstetric transport experience. Understanding the needs of these patients during the COVID-19 pandemic is important given the safety-restrictions that have been in place. This highlights the need for studies identifying barriers for patients during the transport process to improve the patient experience.

Factors influencing acceptability of caesarean section among multiparous pregnant women attending antenatal clinic at Mother and Child Hospital, Akure

Overview: Caesarean section is the most common obstetric operation performed worldwide and has contributed to improving maternal and foetal outcome. This study assesses the factors influencing the acceptability of caesarean section among multiparous pregnant women attending antenatal clinic at Mother and Child Hospital, Akure, Ondo state. Method: A total number of 306 respondents were recruited for this study and 300 presented for analysis which translates to a response rate of 98%. Pertinent and relevant literatures were reviewed both conceptually and empirically and inferences made where necessary. Results: Findings of the study showed that majority were between 30 and 39 years, married and belong to Yoruba tribe. Only few (29%) have had caesarean section in the past with major indications being prolonged labour (19.5%), fetal distress (20.7%), prolonged pregnancy (7%) and congenital abnormalities (7%). Majority (70%) agreed that Caesarean section is a method of delivery of babies and 46% agreed that CS is a safe method of delivery. Overall, 60% and 66.7% of the pregnant women have good knowledge of CS and perception about CS respectively. Furthermore, only 16% agreed to have CS in the next pregnancy if indicated. The following were agreed to and accepted by the respondents to influence acceptance of Caesarean section: fear of death, cost of the procedure, fear of discrimination, fear of husbands’ rejection, pain of previous labor, concerns about babies’ safety and desire to keep genital tract intact. Furthermore, there is a significant relationship between educational status, tribe, religion and acceptability of caesarean section among respondents (p < 0.05) while there is no significant relationship between previous obstetric experiences and acceptability of caesarean section. Conclusion: Conclusively, this study has shown that most of the respondents have good knowledge and perception of Caesarean Section (CS); however, the rate of acceptance of CS as a mode of delivery is low with factors influencing such including fear of death, cost of the procedure, fear of discrimination, fear of husbands’ rejection and concerns about babies’ safety.

Identifying Obstetric Mistreatment Experiences in U.S. Birth Narratives: Application of Internationally Informed Mistreatment Typologies.

Background:Traumatic births are those resulting in feelings of distress that persist after the birth experience. Health care providers may play a role in these experiences through various forms of mistreatment. Analyses of global birth experiences have generated several domains of mistreatment. This study applies these evidence-based domains of mistreatment as an a priori coding scheme for analysis of 96 oral narratives of U.S.-based births to describe the nature of perceived mistreatment using participants' own descriptions of experiences.Method:Ninety-six transcripts of oral birth stories from 61 participants were coded using the domains of mistreatment experiences described by the Bohren et al.'s (2015) systematic review of obstetric mistreatment.Results:N = 131 individual experiences of perceived obstetric mistreatment were identified in 41 out of 96 narratives (42.7%). The most frequent types of experiences were Poor Rapport (90 incidences) and Failure to Meet Professional Standards of Care (29).Clinical Implications:Although most women in our study did not perceive any instances of obstetric mistreatment during their childbirth, over 40% of participants noted at least one event that fit one of the typologies we used as a framework for analysis. Visibility and review of the types of perceived mistreatment experiences that occur during birth enables health system leaders to implement prevention and accountability strategies. Most instances of perceived mistreatment during birth may be prevented through intentional implementation of individualized, respectful, supportive care during labor and birth.

Experiences of midwives on Vscan limited obstetric ultrasound use: a qualitative exploratory study

BackgroundEthiopia is a low-income country located in the horn of Africa’s sub-Saharan region, with very high incidences of maternal and neonatal mortality. Quality antenatal care improves perinatal health outcomes. The USAID funded Transform: Primary Health Care Activity in collaboration with the Ministry of Health and GE Healthcare introduced Vscan limited obstetric ultrasound services in 120 health centers in Ethiopia. So far, the experiences and opinions of midwives on their use have not been explored and described within the local context. This study therefore aims to explore and describe the experiences and opinions of midwives on Vscan limited obstetric ultrasound services at health centers within Ethiopia.MethodsAn exploratory and descriptive qualitative study was conducted in Amhara, Oromia, and Southern Nations, Nationalities and Peoples’ (SNNP) regions of Ethiopia. Twenty-four participants were selected through a purposeful sampling technique. In-depth individual interviews with trained midwives with practical hands-on limited obstetric ultrasound service provision experience were conducted. The thematic analysis was conducted manually.ResultsThe qualitative data analysis on the experiences and opinions of midwives revealed three themes, namely: individual perception of self-efficacy, facilitators, and barriers of limited obstetric ultrasound services. The basic ultrasound training, which was unique in its organization and arrangement, prepared and built the self-efficacy of trainees in executing their expected competencies. Support of health systems and health managers in dedicating space, availing essential supplies, and assigning human resources emerged as facilitators of the initiated limited obstetric ultrasound services, whereas high workload on one or two ultrasound trained midwives, interruption of essential supplies like paper towels, gel, and alternative power sources were identified as barriers for limited ultrasound services.ConclusionThis study explored the experiences and opinions of midwives who were trained on the provision of limited obstetric ultrasound services and served the community in health centers in rural parts of Ethiopia. The results of this study revealed the positive impacts of the intervention on the perceived self-efficacy, facilitation, and breaking-down of barriers to obstetric ultrasound services. Before scaling-up limited obstetric ultrasound interventions, health managers should ensure and commit to availing essential supplies (e.g., paper towels, ultrasound gel, and large memory hard discs), arranging private rooms, and training other mid-level health professionals. In addition, improving pregnant women’s literacy on the national schedule for ultrasound scanning services is recommended.

One Year Obstetric Experience with Extreme Complications in a Tertiary Center in Somalia

Objective: The maternal mortality rate is very high in Sub-Saharan African countries with extreme complications not seen in developed countries. We aimed to analyze and compile data on obstetric emergencies and complications in a tertiary center in Somalia. Study Design: The files of all patients who visited the obstetrics clinic in Somalia Recep Tayyip Erdogan Training and Research Hospital between January 2018 and December 2018 were retrospectively scanned. All maternal demographic data, prenatal hemoglobin levels, serological markers, and complications were recorded. The correlation between the birth process and hemoglobin change was examined. Results: A total of 825 cases were identified. Overall, we found serious maternal complications: eclampsia, 12.4%; postpartum bleeding, 8.7%; placenta previa, 2.1%; placenta insertion anomalies, 1.4%; uterine rupture, 2.4%; and placental abruption, 2.5%. The mean hemoglobin value on admission was 10.39±1.74 g/dL. Further, the hemoglobin difference increased in low and high dilatation numbers. A low-level positive correlation was found between delivery time and the hemoglobin difference (r=0.23) and between delivery time and fetal complications (r=0.2). Conclusion: Postpartum bleeding and eclampsia were among the leading causes of maternal mortality in Somalia. In addition, insufficient surgical techniques and unsuitable environments increase maternal mortality.

Obstetric violence experiences of women: A systematic review

Amaç: Bu çalışmanın amacı kadınların maruz kaldıkları obstetrik şiddete ilişkin deneyimlerini inceleyen çalışma sonuçlarını değerlendirmektir. Yöntem: Literatür taraması “Pubmed, Scopus, Medline” veri tabanlarında 01-27 Ekim 2019 tarihleri arasında, “obstetric violence” anahtar kelimesi kullanılarak gerçekleştirildi Dahil etme kriterleri doğrultusunda araştırma kapsamına 15 çalışma alındı. Bulgular: Sistematik derleme sonucunda elde edilen bulgular; obstetrik şiddet prevalansı, obstetrik şiddete ilişkin farkındalık, rızasız bakım, onursuz bakım, fiziksel taciz, ihmal edilmiş bakım, mahremiyetsiz bakım, ayrımcılık içeren bakım olmak üzere sekiz başlık altında toplanmıştır. Obstetrik şiddet prevalansının %12-75 arasında değiştiği, kadınların obstetrik şiddete ilişkin bilgi sahibi ve farkındalığının olmadıkları belirlenmiştir. Kadınların %17.1-63.6’sının bakıma ilişkin rızalarının alınmadığını, %19.3-55.3’ünün sağlık personelinin küçümseyici, hakaret içerikli sözlerine maruz kaldığı, %13.4-46.9’unun sağlık personelinin tokat, vurma gibi kötü muamelelerine maruz kaldığı belirlenmiştir. Kadınların %8.5-10.6’sının bakımlarının ihmal edildiği, %3-9.3’ünün bakım alırken negatif ayrımcılığa uğradığı bildirilmiştir. Sonuç: Kadın yaşamının en özel dönemlerinden olan doğum sürecinde kadınların maruz kaldıkları obstetrik şiddet kavramı tanımlanmalı, bu şiddete karşı tüm sağlık profesyonelleri ortak bir hareketle mücadele etmelidirler.

Birth Satisfaction During the Early Months of the COVID-19 Pandemic in the United States.

Purpose:The purpose of this study was to describe birth satisfaction in women who gave birth in U.S. hospitals during the earliest months of the COVID-19 pandemic (March–July 2020).Study Design and Methods:A cross-sectional survey of 747 postpartum women who gave birth in the United States during the early COVID-19 pandemic was conducted. Participants in the United were recruited via social media. They completed a questionnaire that included demographic, health, and obstetric experience questions, and the Birth Satisfaction Scale-Revised. Descriptive statistics, t-tests, analysis of variance (ANOVA) models, and nonparametric correlations were performed.Results:Higher birth satisfaction scores were associated with higher income, marriage, white race, vaginal birth, having a birth partner present, and sufficient support during birth. Factors negatively associated with birth satisfaction were separation from infant, unplanned cesarean birth, neonatal intensive care unit admission, hypertension, preeclampsia, hemorrhage, depression, and anxiety.Clinical Implications:Presence of birth partners, sufficient birth support, and minimizing separation of mother and infant improve birth satisfaction. Obstetric complications, including unplanned cesarean birth, negatively affect birth satisfaction. There are racial disparities in birth satisfaction. It is critical to develop further interventions to end racism in maternal health care.

Patient Experience in Obstetrics in a Military Patient Satisfaction Survey: Findings and Recommendations for Improvement.

This study examines the care experience of obstetric patients within the Military Health System and compares them to those of medical and surgical care patients. Specifically, the study seeks to (1) examine how obstetric inpatient experience ratings differ from medical and surgical inpatient experience ratings, (2) understand specific aspects of care that drive overall experience ratings within this population, (3) test whether adherence to nursing practices such as hourly rounding and nurse leader visits affect experience ratings, and (4) describe ways that patient experience information can be presented to healthcare providers to improve performance. Data for this study include Military Health System patient experience survey data (based on the Hospital Consumer Assessment of Healthcare Providers and Systems) collected from 2011 through 2019. Analysis includes data collected from 338,124 patients aged 18 years and older. Our analysis involved z-test comparisons of patient experience measure scores, trend analysis, logistic regression-based driver analysis, and correlations. Obstetric ratings are generally lower than those of medical and surgical patients; however, they have been improving at a slightly faster rate year over year. Effective nurse communications with patients are a particularly strong driver for improving their overall care experiences, and practices like hourly nurse rounding, nurse leader visits, and nurse-patient shift change conversations are positively correlated with obstetric patient experience ratings. This study contextualizes how obstetric inpatient experience ratings differ from those of medical and surgical care patients. Healthcare administrators and policymakers should be aware that obstetric patients may have unique needs and expectations that lead to patient experience ratings differing from those of medical and surgical patients. Effective nurse-patient communications, hourly rounding, nurse leader visits, and nurse-patient shift change conversations could be strategies used to improve obstetric experience ratings.

Construction and validation of a preterm birth risk assessment model using fuzzy analytic hierarchy process.

Preterm births account for almost 1 million deaths globally. The objective of this study is to develop and evaluate a model that assists clinicians in assessing the risk of preterm birth, using fuzzy multicriteria analysis. The model allows experts to incorporate their intuition and judgment into the decision-making process and takes into consideration six (6) risk dimensions reflecting the socio-economic, behavioral and medical profile of pregnant women, thus adopting a holistic approach to risk assessment. Each risk dimension is further analyzed and measured in terms of risk factors associated with it. Data were collected from a selected group of 35 experts, each one with more than 20 years of obstetric experience. The model criteria were selected after a thorough literature analysis, so as to ensure a holistic approach to risk assessment. The criteria were reviewed by the experts and the model structure was finalized. The fuzzy analytic hierarchy method was applied to calculate the relative importance of each criterion and subsequent use of the model in assessing and ranking pregnant women by their preterm risk. The proposed model utilizes fuzzy logic and multicriteria analysis. It addresses the multifactorial nature of decision making when assessing the preterm birth risk. It also incorporates the obstetricians’ intuitive judgment during risk assessment, and it can be used to classify cases based on their risk level. In addition, it can be applied to evaluate the risk of individual cases in a personalized manner. The proposed model is compared and validated for its predictive value against judgments made by experts.

Providing Postpartum Care to Patients in COVID-19 Wards

To provide specific postpartum care to women admitted to hospital wards that were initially designed to house only patients who had been diagnosed with COVID-19. Postpartum women with COVID-19 were receiving nursing care primarily from nurses who had a medical–surgical background but who had no recent obstetric experience–competency.

Pregnancy and COVID-19 Pandemic Perception in Malaysia: A Cross-Sectional Study.

Pregnant women are susceptible to COVID-19 complications due to gestation-related physiological changes. We aimed to evaluate the level of maternal knowledge, perception, and practice during the pandemic. A cross-sectional study was conducted during the Malaysian Movement Control Order (MCO) between April and June 2020. A self-administered electronic questionnaire that included the knowledge and practice domains was distributed. A newly designed set of questions was used to evaluate (1) women’s perception of MCO and (2) maternal experience, which was subdivided into clinical care provision and maternal anxiety. The survey response rate was 93% with the final number for analysis of 415. The majority of women (95%) demonstrated an adequate level of knowledge on COVID-19, whilst 99% had a good practice. We found that tertiary education (p < 0.001), employment status (p = 0.03), higher household income (p < 0.001), and multiple sources of information (p < 0.001) were independent predictors of adequate maternal knowledge on COVID-19. Women with adequate knowledge also reported a more positive perception of MCO (p < 0.001) and better obstetric care experience (p = 0.037), as did those of Malay ethnicity. Younger (p < 0.001) and nulliparous (p = 0.01) women demonstrated greater anxiety levels. The majority of our women reported good practice and adequate knowledge, which contributed to a positive perception of MCO and better maternal obstetric experience. First-time mothers may benefit from extra support and reassurance during the pandemic to alleviate maternal anxiety.

Reported case numbers and variability in delivery route and volume by obstetrics and gynecology residents from 2003 to 2019

The obstetrical landscape in the United States has changed over the past several decades, during which there has been a decline in the number of operative vaginal deliveries performed. Procedural cases of obstetrics and gynecology residents are tracked in the Accreditation Council for Graduate Medical Education database, with a minimum requirement of 15 operative vaginal deliveries before graduation. Nowadays, it is unknown whether the decreasing numbers of operative vaginal deliveries are affecting the delivery case volume and experience of obstetrics and gynecology residents. This study aimed to analyze the trends in the number and route of obstetrical deliveries, including operative vaginal deliveries, performed by graduating obstetrics and gynecology residents in the United States as logged within the Accreditation Council for Graduate Medical Education database. The Accreditation Council for Graduate Medical Education case log data were examined for graduating obstetrics and gynecology residents between 2003 and 2019. Delivery case volume numbers for spontaneous vaginal delivery, cesarean delivery, forceps-assisted vaginal delivery, and vacuum-assisted vaginal delivery were extracted and analyzed over time using linear regression. To compare the variability in logged cases, residents at the 70th percentile for number of cases logged were compared with residents at the 30th percentile for number of cases logged for each delivery type (spontaneous vaginal delivery, cesarean delivery, forceps-assisted vaginal delivery, and vacuum-assisted vaginal delivery). Overall, obstetrical delivery data for 20,268 obstetrics and gynecology residents were collected from 2003 to 2019. Over this period, the mean number of spontaneous vaginal deliveries significantly decreased over time by 20% from 320.8±138.7 to 256.1±75.6 (slope, -2.6; P<.001); however, no significant difference was noted in the reported cesarean delivery cases, with an 8% increase from 191.8±80.1 to 206.8±69.7 per graduating resident (slope, 0.136; P=.873). Notably, the mean reported cases of forceps-assisted vaginal deliveries decreased by 75% from 23.8±21.9 to 6±6.8 per graduating resident (slope, -0.851; P<.001). Similarly, the mean logs of vacuum-assisted vaginal delivery decreased by 37% from 23.8±17.1 to 15±9.5 (slope, -0.542; P<.001). The ratio of reported resident case logs comparing the volume at the 70th percentile with the volume at the 30th percentile demonstrated a significant decrease over time for spontaneous vaginal delivery (slope, -0.015; P<.001), cesarean delivery (slope, -0.015; P<.001), and vacuum-assisted vaginal delivery (slope, -0.033; P<.001) but was significantly increased for forceps-assisted vaginal delivery (slope, 0.07, P=.0065). In the reported Accreditation Council for Graduate Medical Education case logs, we identified that the reported number of obstetrical deliveries performed by obstetrics and gynecology residents in the United States is changing, with a significant decline recognized from 2003 to 2019 in logged numbers of spontaneous vaginal deliveries, vacuum-assisted vaginal deliveries, and forceps-assisted vaginal deliveries, without a difference in reported cesarean delivery cases per graduating resident. Furthermore, substantial variation is seen among resident volume nationwide, with the difference in high- and low-volume resident forceps-assisted vaginal delivery experience increasing over time. Awareness of these data should notify the Accreditation Council for Graduate Medical Education and educators about reasonable targets, increased need for simulation, and new ways to teach all modes of deliveries effectively in all residency programs.

Comparison of Maternity Care Training in Family Medicine Residencies 2013 and 2019: A CERA Program Directors Study.

Maternity care training is a standard requirement for all family medicine residents, and family physicians play a critical role in the US maternity care workforce. In 2014, the Accreditation Council for Graduate Medical Education (ACGME) updated the required obstetrical experience during family medicine residency training from a volume-based to a competency-based requirement of 200 hours (2 months rotation). This study aimed to determine if family medicine resident maternity care training experience differed after this change in requirements. A nationwide survey of family medicine program directors was conducted as part of the 2019 Council of Academic Family Medicine Educational Research Alliance (CERA) survey, replicating a 2013 CERA survey to determine if there was a change in family medicine resident maternity care experience after the ACGME requirements update. The priority programs place on residents' continuity deliveries and family medicine faculty attending deliveries decreased between 2013 and 2019. The reported number of continuity deliveries and vaginal deliveries performed by residents also decreased significantly between 2013 and 2019, yet the program directors' estimate of the number of graduates going on to provide obstetric deliveries or pursue a maternity care fellowship did not change significantly. Programs reporting more than 25% of graduates continuing to conduct vaginal deliveries have reported similar numbers of vaginal deliveries per resident as in 2013. The majority of family medicine residents are graduating with less delivery experience, and residency programs are placing less priority on continuity deliveries and modeling by family physician faculty following the 2014 ACGME Family Medicine Requirements update. This trend may have major implications on the comprehensive nature of our specialty and further widen gaps in the maternity care workforce. Further studies are needed to determine the impact on the competency of graduating family medicine residents in providing maternity care and for the long-term effects on the maternity care workforce.

The impact of COVID-19 on obstetrics and gynaecology trainees; how do we move on?

Obstetrics and Gynaecology (O&G) is an evolving specialty that encompasses women's health at its core. The COVID-19 pandemic has caused significant patient care challenges, however simultaneously it has resulted in the interruption of clinical training and cessation of all elective work. Our primary aim was to assess the impact of the pandemic on the experiences of O&G trainees. An email invite was sent to all 127 O&G trainees in Kent, Surrey and Sussex (KSS), inviting them to participate in an anonymous 33-question survey. The survey data was collected and analysed over a 4-week period. Of the 127 trainees sent the survey, 87 responded (69%). 39% and 75% of trainees agreed that the pandemic had a negative impact on their overall physical and mental wellbeing respectively. 43% agreed that the COVID-19 pandemic had adversely affected their obstetric training experience whilst almost all trainees stated a significant negative impact on benign gynaecology surgical training. Reassuringly, over 80% were positive they would recover from the negative impacts of COVID-19. It is evident that COVID-19 has impacted O&G trainees in several ways. Whilst we face uncertain times, we must firstly ensure the physical and mental well-being of all trainees. It is encouraging that non-emergency consultations and benign surgery are being restarted nationwide and whilst this will inevitably help with re-booting surgical training, we must also think "outside" the box and utilise other modes of teaching and training to safeguard learning whilst mitigating against the negative impacts of subsequent waves.

Obstetrics and birth: effects of experiences and gender bias on student test scores

Objectives: Paramedic education requires all students have the experience of attending childbirth. Obstetric (OB) experiences are limited for students in hospitals and even more so in the field. Gender bias may exist in hospital OB rotations for paramedic students but research on this is limited. This study is intended to examine whether a sex bias exists in field or hospital placements and if that bias correlates to OB test scores. Methods: Using data from Fisdap, numbers of OB experiences were analysed and compared to individual student sex and experience type (hospital clinical, field or skills laboratory). The number of experiences were compared to that student's score on the OB section of the Fisdap paramedic readiness examinations version 3 (PRE3) or version 4 (PRE4). Results: Of 12 090 paramedic students, male (n=5625) and female (n=2682) students who took the PRE3 had equal average scores of 0.76 and male (n=2498) and female (n=1285) students who took the PRE4 had average scores of 0.77 and 0.79 respectively. Students who took the PRE3 saw a mean of 4.32 births, a majority of which were in hospital (3.68); there was minimal difference in experiences between male and female students in field or skills laboratory settings, but women saw more births in hospital settings (3.92) than men (3.43). Students who took the PRE4 saw a mean of 4.54 births, a majority of which were in hospital (3.8) and there was minimal difference in experiences between male and female students in field or laboratory settings but women students saw more births in hospital (4.06) than men (3.54). Conclusions There is no correlation between the number of OB emergency encounters by paramedic students and their OB test scores. However, a potential gender bias exists as female students tend to have more labour and birth experiences in hospital settings than their male counterparts, while number of experiences in lab and field settings were similar.

774 Development of an obstetric discrimination scale for examining impact of racism on pregnancy outcomes

To develop a Discrimination Scale as a Screening Tool to Assess Impact of Racism on Pregnancy Outcomes Data was collected from the Saving Our Ladies from Early Births and Reducing Stress (SOLARS) study. SOLARS is a cross-sectional study (n=62) aimed at describing Black and Hispanic women's exposure to chronic stress, coping and resiliency strategies during pregnancy and postpartum in Oakland, California. To be eligible, women had to identify as Black or Hispanic, be 18 years or older, currently pregnant or 6 weeks postpartum, singleton pregnancy, and live/work in Oakland, California. Surveys were distributed online via Qualtrics and written surveys for those in person. Previously validated surveys for discrimination, coping mechanisms, and racism were utilized to create this scale including the: Perceived Stress Scale (PSS); Experiences of Discrimination (EOD); Brief COPE Inventory; and items from the CDC Health Behavior Survey. Principle component analysis with varimax rotation to identify domains of obstetric care experiences with stress and coping strategies during pregnancy and postpartum periods. No. of components was based on Eigen values greater than 1. Emerging components were refined by selecting items with factor loadings greater than 0.62. Reliability of all items using Cronbach tests. All analyses were conducted in SPSS 24 Table 1 shows the results from the principle component analysis (n=55). 14 components emerged, accounting for 79.3% of variance. After exploring factor loadings, only four components emerged. The cumulative percentage of the explained variance across the four components was 47.3%. The principle component analysis identified 19-items and four subdomains. Cronbach for the 19-item scale was 0.60, 5 items were removed resulting in a Cronbach of 0.65. The final scale consists of three subdomains measuring stress, coping, and discrimination Development of a Obstetric Discrimination Scale would allow for an objective tool to directly measure pregnancy outcomes, maternal morbidity and mortality in relation to perceived bias and racism

Epidemiological Profile of Childbirth among Primiparous Women in Rural Areas of Tanganyika Province, Democratic Republic of Congo

Introduction: Sub-Saharan Africa remains one of the areas where maternal deaths are most prevalent. This situation is linked to a number of maternal risk factors including obstetric experience, age, disease history, socio-economic conditions and the quality of the health system. The objective of this study is to determine the epidemiological profile of childbirth in rural primiparous women. Methods: This is a multi-centre, retrospective and descriptive cross-sectional study among primiparous women in Moba (DR. Congo). The period from 2015 to 2016 was chosen. Epi Info 7 and Excel software were used for data analysis. Results: Of the 2644 deliveries selected for this study, 474 (17.9%) were among primiparous women. The average age of primiparous women was 18.4 ± 1.9 years (extremes 15 to 24 years). The majority of primiparous women were educated, married, housewives, with poor prenatal monitoring of pregnancies, having given birth by eutocic mode (53.6%) and vaginal route (92.0%). Maternal and early neonatal mortality was 0.8% and 1.7% respectively. This mortality only significantly (p < 0.05) concerned dystocic deliveries and the 18- to 21-year-old age group. Maternal age (p < 0.001), especially before the age of 18 (p < 0.000), and occupation (p < 0.01) significantly determine the mode of childbirth. Conclusion: The primiparous under 18 years of age presents risks of dystocic childbirth. Dystocia is responsible for several complications that can lead to maternal or neonatal death. Efforts should be made to discourage early pregnancy and improve the quality of obstetric care.

Preconception preparation for pregnancy

Background. Experience in high-risk obstetrics shows that a significant part of the determining factors affects the woman and the fetus before the first visit to the doctor. Improving a woman’s health before conception can improve her reproductive performance and reduce financial costs spent on obstetric medical aid.&#x0D; Objective. Describe the key concepts of preconception training.&#x0D; Materials and methods. Analysis of literature sources on this topic; own study involving 42 pregnant women (22 women with systemic lupus erythematosus (SLE), 20 women with congenital heart disease (CHD) and hypertensive complications of previous pregnancies), who were divided into two groups. Group 1 received routine drugs and L-arginine (Tivortin, “Yuria-Pharm”) in doses recommended for cardiac patients, and group 2 – only routine drugs.&#x0D; Results and discussion. The components of preconception programs include the individual responsibility of women throughout life, awareness of women, preventive visits, interventions on identified risks, pre-pregnancy examinations and pregnancy supervision, health insurance for low-income women, health programs and strategies, medical research, and the improvement of monitoring. Target groups of preconception include women with unfavorable obstetric history (premature birth, cessation of fetal development, cesarean section, stillbirth, multiple miscarriages, birth of children with birth defects, hypertensive complications of pregnancy) and chronic diseases (type 1 diabetes mellitus, SLE, antiphospholipid syndrome, severe cardiovascular pathology, arterial hypertension, pulmonary hypertension). An important role in the management of pregnant women belongs to the prevention of preeclampsia (PE). Administration of acetylsalicylic acid reduces the likelihood of PE by 10 % in low-risk pregnant women and by 25 % in high-risk pregnant women, but the drug should be started during gestation. The use of calcium (1000 mg) reduces the risk of PE in high-risk pregnant women by 37 %. Preconception preparation is especially important, because some processes, such as the implantation of placental structures, begin and end before a woman learns she is pregnant. Remodeling of the spiral arteries also begins in the early stages of pregnancy, so its correction after the confirmation of pregnancy is less effective than prevention before it occurs. E.E. Camarena Pulido et al. (2016) studied the role of L-arginine (5 tablets of 600 mg per day from the 20th week of gestation before delivery) in the prevention of PE in high-risk women. In the L-arginine group significantly fewer cases of PE (3/49 vs. 11/47 in the placebo group; p=0.01) and a lower incidence of preterm birth were detected. In the another study, pregnant women with chronic hypertension received oral L-arginine or placebo. In the arginine group, there was a lower need for antihypertensive drugs, as well as lower frequency of births before 34 weeks, PE and neonatal complications (Neri I. et al., 2010). In the own study, favorable obstetric results of Tivortin were found. The percentage of births at &gt;37 weeks in the Tivortin group among women with SLE was 90.9 %, and in the group of standard therapy – 50 % (p&lt;0.01), among women with CHD – 90 % and 75 % respectively; p&lt;0.05). No newborns with an Apgar score of &lt;7 were found in the Tivortin group. In the comparison group their number was 27.7 %. Laboratory studies have shown that there is a significant increase in endothelial progenitor cells in the Tivortin group.&#x0D; Conclusions. 1. Preconception preparation of pregnant women is a multifaceted set of measures. 2. A significant number of physiological and pathological processes occur in the early stages of pregnancy, so they can be influenced only in the preconception period. 3. The use of L-arginine during gestation reduces the risk of PE, premature birth and other complications in all women and especially in women with hypertension.

Evaluation of Suzor forceps training by studying obstetric anal sphincter injuries: a retrospective study

BackgroundInstrumental deliveries are an unavoidable part of obstetric practice. Dedicated training is needed for each instrument. To identify when a trainee resident can be entrusted with instrumental deliveries by Suzor forceps by studying obstetric anal sphincter injuries.MethodsA French retrospective observational study of obstetric anal sphincter injuries due to Suzor forceps deliveries performed by trainee residents was conducted from November 2008 to November 2016 at Limoges University Hospital. Perineal lesion risk factors were studied. Sequential use of a vacuum extractor and then forceps was also analyzed.ResultsTwenty-one residents performed 1530 instrumental deliveries, which included 1164 (76.1%) using forceps and 89 (5.8%) with sequential use of a vacuum extractor and then forceps. Third and fourth degree perineal tears were diagnosed in 82 patients (6.5%). Residents caused fewer obstetric anal sphincter injuries after 23.82 (+/− 0.8) deliveries by forceps (p = 0.0041), or after 2.36 (+/− 0.7) semesters of obstetrical experience (p = 0.0007). No obese patient (body mass index> 30) presented obstetric anal sphincter injuries (p = 0.0013). There were significantly fewer obstetric anal sphincter injuries after performance of episiotomy (p < 0.0001), and more lesions in the case of the occipito-sacral position (p = 0.028). Analysis of sequential instrumentation did not find any additional associated risk.ConclusionTraining in the use of Suzor forceps requires extended mentoring in order to reduce obstetric anal sphincter injuries. A stable level of competence was found after the execution of at least 24 forceps deliveries or after 3 semesters (18 months) of obstetrical experience.