Obstetric Ward Research Articles

Surgical Site Infection in a 1000-Bed Tertiary-Care Teaching Hospital in New Delhi, India

Background: Surgical site infection (SSI) includes infections occurring after 48 hours of any surgery and accounts for most of the healthcare-associated infections (HAIs) in surgical centers. Surgical site infections can result in pain, discomfort, prolonged hospital stay, increased exposure to antimicrobials, and consequentially, increased healthcare costs. Objectives: The study intended to characterize the incidence, etiology, and emerging resistance of SSI in a 1000-bed tertiary-care teaching hospital in New Delhi. Methods: The ambispective study was conducted in a 1000-bed tertiary-care teaching hospital in New Delhi. Clinical, laboratory, and environmental surveillance and screening of health care providers (HCPs) were conducted using the National Healthcare Safety Network (NHSN) definitions and methods given by the US Centers for Disease Control and Prevention (CDC). Results: With 3,541 patients admitted to the Gynecology and Obstetrics Ward and General Surgical Ward of the hospital, the total episodes of SSI were 80 (2.26%). The mean rates of superficial, deep, and organ space SSI were 46.25%, 47.5%, and 6.25%, respectively. The most common organisms isolated were Acinetobacter baumannii (23.75%), Pseudomonas aeruginosa (17.5%), Escherichia coli (15%), and Staphylococcus aureus (12.5%). Conclusions: The rate of SSI in our study was comparable to the unadjusted rates in India, lower-middle, upper-middle, and high-income countries worldwide. Patients with pre-existing medical illness, prolonged operation time, and wound contamination are strongly predisposed to surgical site infection.

Surgical referrals in Northern Tanzania: a prospective assessment of rates, preventability, reasons and patterns

BackgroundAn effective referral system is essential for a high-quality health system that provides safe surgical care while optimizing patient outcomes and ensuring efficiency. The role of referral systems in countries with under-resourced health systems is poorly understood. The aim of this study was to examine the rates, preventability, reasons and patterns of outward referrals of surgical patients across three levels of the healthcare system in Northern Tanzania.MethodsReferrals from surgical and obstetric wards were assessed at 20 health facilities in five rural regions prospectively over 3 months. Trained physician data collectors used data collection forms to capture referral details daily from hospital referral letters and through discussions with clinicians and nurses. Referrals were deemed preventable if the presenting condition was one that should be managed at the referring facility level per the national surgical, obstetric and anaesthesia plan but was referred.ResultsSeven hundred forty-three total outward referrals were recorded during the study period. The referral rate was highest at regional hospitals (2.9%), followed by district hospitals (1.9%) and health centers (1.5%). About 35% of all referrals were preventable, with the highest rate from regional hospitals (70%). The most common reasons for referrals were staff-related (76%), followed by equipment (55%) and drugs or supplies (21%). Patient preference accounted for 1% of referrals. Three quarters of referrals (77%) were to the zonal hospital, followed by the regional hospitals (17%) and district hospitals (12%). The most common reason for referral to zonal (84%) and regional level (66%) hospitals was need for specialist care while the most common reason for referral to district level hospitals was non-functional imaging diagnostic equipment (28%).ConclusionsImproving the referral system in Tanzania, in order to improve quality and efficiency of patient care, will require significant investments in human resources and equipment to meet the recommended standards at each level of care. Specifically, improving access to specialists at regional referral and district hospitals is likely to reduce the number of preventable referrals to higher level hospitals, thereby reducing overcrowding at higher-level hospitals and improving the efficiency of the health system.

Patient Satisfaction and Food Waste in Obstetrics And Gynaecology Wards.

IntroductionPatient satisfaction is an indicator of healthcare quality, and expectation is an important determinant. A component of patient satisfaction is the quality of foodservice. An indicator of this quality is the food wasted by hospitalised patients. In the present study, we investigated patient satisfaction regarding food and foodservice, the expectation on food quality and the amount of food wasted in two obstetrics and gynaecology wards in Northern and Southern Italy.Patients and MethodsA questionnaire, including sociodemographic data, rate of food waste, expectations of food quality and characteristics of food and foodservice, was administrated to 550 inpatients in obstetrics and gynaecology wards (275 for each hospital). Univariate analysis was performed to describe the results, and multivariate analysis was carried out to control for sociodemographic data.ResultsNorthern patients were more satisfied with the quality of food (54.2% vs 36.0%) and foodservice (54.5% vs 38.2%) than southern patients. Northern patients had more positive expectations about the quality of food (69.5% vs 31.6%), whereas southern patients stated that they had no expectations. Southern patients gave more importance to mealtime (72.7% vs 26.2%), and many of them brought food from home to the hospital (30.2% vs 2.2%) through relatives who came to visit them. Southern patients discarded about 41.7% of food served, whereas northern patients discarded only about 15.3%.DiscussionFood waste is a worldwide problem due to its economic, social and environmental effects. Especially in hospitals, food waste could have a negative impact on the overall patient satisfaction.

Measles and Pregnancy: Immunity and Immunization-What Can Be Learned from Observing Complications during an Epidemic Year.

Measles is a highly contagious airborne disease. Unvaccinated pregnant women are not only at risk of infection but also at risk of severe pregnancy complications. As measles causes a dysregulation of the entire immune system, we describe immunological variations and how immune response mechanisms can lead to adverse pregnancy outcomes. We evaluated data during the measles outbreak reported in the province of Catania, Italy, from May 2017 to June 2018. We controlled hospital discharge records for patients admitted to hospital obstetric wards searching the measles diagnostic code. We have indicated the case as “confirmed” when the IgM was found to be positive with the ELISA method. We registered 843 cases of measles and 51% were females (430 cases). 24 patients between the ages of 17 and 40 had measles while they were pregnant. Adverse pregnancy outcomes included 2 spontaneous abortions, 1 therapeutic abortion, 1 foetal death, and 6 preterm deliveries. Respiratory complications were more prevalent in pregnant women (21%) than in nonpregnant women with measles (9%). 14 health care workers (1.7%) were infected with measles, and none of these had been previously vaccinated. Immune response mechanisms were associated with adverse pregnancy outcomes in women with measles. To reduce the rate of measles complications, gynaecologists should investigate vaccination history and antibody test results in all women of childbearing age. During a measles outbreak, gynaecologists and midwives should be active proponents of vaccination administration and counteract any vaccine hesitancy not only in patients but also among health care workers.

Trends in the frequency of obesity and gestational diabetes in an eleven years period

The prevalence of gestational diabetes (GDM) is increasing along with obesity and gestational age. This prevalence varies in populations and with different guidelines used for the diagnoses. To estimate the change in prevalence of GDM and obesity in a period 11 years. Analysis of pregnancies attended at an obstetrics ward of a general hospital between 2001 and 2018. Those women who were diabetic prior to their pregnancy were excluded from the analysis. Annual crude and adjusted prevalence using direct standardization by age were estimated. We analyzed 33,985 pregnancies. GDM screening was performed in 20,139 (59%), and 1,466 (7%) had GDM. In 2007 the crude and adjusted prevalence of GDM were 4.9 and 5.2%, respectively. The figures in 2018 were 8.8 and 8.5%, respectively, with an annual percentage of change (APC) of 6.9% (p < 0.001). The frequency of obesity also increased with an APC of 4.1% (p < 0.001). In women with GDM the APC of obesity was 4.6% (p < 0.001). There was also an increase in the frequency of screening, with a joinpoint in 2011. The APC of screening in the periods 2007-2011 and 2011-2018 were 16.6 and 2.9%, respectively (p < 0.001). The prevalence of GDM increased in this period of eleven years along with the prevalence of obesity.

Analysis of day shift nurses’ and midwives’ locations and durations using information communication equipment: A prospective observational study of a mixed obstetric ward with critical patients in Japan

Analysis of day shift nurses’ and midwives’ locations and durations using information communication equipment: A prospective observational study of a mixed obstetric ward with critical patients in Japan

Impacted foetal head at caesarean section: a national survey of practice and training

This is a national survey of UK obstetric trainees and consultant labour ward leads designed to investigate the current practice and training for an impacted foetal head (IFH) at Caesarean Section (CS). An anonymous, on-line survey was disseminated to trainees via Postgraduate Schools and RCOG trainee representatives, and to labour ward leads via their national network. Three hundred and forty-five obstetric trainees and consultants responded. The results show that IFH is variably defined and encountered by most UK obstetricians (98% had encountered IFH and 76% had experienced it before full cervical dilatation). There is significant variation in management strategies, although most respondents would use a vaginal push up to assist delivery prior to reverse breech extraction. Responses revealed a paucity of training and lack of confidence in disimpaction techniques: over one in ten respondents had not received any training for IFH and less than half had received instruction in reverse breech extraction. Impact statement What is already known on the subject? IFH is an increasingly recognised, technically challenging complication of intrapartum CS. A recent report suggested that birth injuries associated with IFH are now as common as with shoulder dystocia. However, there is no consensus nor guidelines regarding the best practice for management or training. What do the results of this study add? This study demonstrates that IFH is poorly defined and commonly encountered by UK obstetricians. It highlights that IFH is not restricted to CS at full dilatation and reveals the ubiquity of the vaginal push method in UK practice. We found evidence that UK obstetricians are using techniques which have not been investigated and are not recommended for managing an IFH. Moreover, this survey is an eye-opener as to the paucity of training, highlighting that UK obstetric trainees are not adequately prepared to manage this emergency. What are the implications of these findings for clinical practice and/or further research? There is a pressing need to standardise the definition, guidance and training for IFH at CS. Further research should clarify the appropriate techniques for IFH and establish consensus for the best practice. An evidence-based simulation training package, which allows clinicians to learn and practice recognised disimpaction techniques is urgently required.

Kommunikative Beteiligung von Partnern in der Schwangerenberatung

Abstract The interaction between midwifes or other medical professionals and pregnant women in the last trimester of pregnancy plays an important role during antenatal care and birth. The partners of the pregnant women are often present for these conversations and can affect the interaction with their contributions, e. g. their input to the birth plan and their experiences during pregnancy. In this interactional work, triadic interactions during antenatal care consultations were analysed. Using examples from a corpus of 37 primary consultations between midwifes, pregnant women and doctors in an obstetric ward, it is shown that partners can affect the information exchange during these interactions. With their utterances, partners can provide various information, such as facts about previous deliveries, information about the pregnant woman, own pregnancy experiences, information about past abortions and miscarriages as well as information about congenital diseases. In doing so, they enriched the conversation and provided emotional support for the pregnant woman. Only very few partners acted in the role of ‘critic’ or ‘opponent’ and controlled the informational exchange between midwife and pregnant woman or focused solely on themselves during these interactions.

Maternal Risk Factors, Clinical Profile and Short-Term Outcome of Pre-Term Low Birth Weight Babies

Background: Preterm Low Birth Weight babies carry relatively higher risk of perinatal and neonatal mortality, retarded growth and development subsequently. In this study, some maternal risk factors were investigated as it seems to be important to study these factors on regional basis.&#x0D; Objective: To find out the maternal risk factors, clinical profile and short term outcome of pre-term low birth weight neonates by gestational age, birth weight, Occipitofrontal Circumference, length, different presentation (asphyxia, hypothermia, feeding difficulties, signs of infection) on admission and the morbidity and mortality of preterm LBW.&#x0D; Materials and Methods: A descriptive type of cross sectional study was done in neonatal ward of Jalalabad Ragib Rabeya Medical College Hospital, Sylhet from May, 2015 to April, 2016. Hundred cases were selected from neonatal ward and 100 controls were selected from obstetrics ward.&#x0D; Results: Among 100 pre-term LBW neonates, 52 were male and 48 were female. Only 22% mother took regular antenatal check up in case group and 55% in control group. Mean gestational age of neonates were 33.3±2.1 weeks. Important risk factors were primi parity (58% in cases vs 34% in control), hypertension (19% vs 5%), pre-eclampsia (26% vs 12%), prolonged rupture of membrane (33% vs 7%), APH (22% vs 0%), acute infection (8% vs 1%), multiple birth (17% vs 2%). Common clinical presentations were prematurity and LBW. Commonest morbidity was feeding problem (70%). The overall survival rate was 87%. Most common cause of death was septicemia (30%).&#x0D; Conclusion: all the identified risk factors were significantly higher in pre-term LBW babies than those of control.&#x0D; KYAMC Journal Vol. 11, No.-2, July 2020, Page 77-82

Assessing the development and implementation of the Global Trigger Tool method across a large health system in Sicily.

Background: The Institute for Healthcare Improvement (IHI) has proposed a new method, the Global Trigger Tool (IHI GTT), to detect and monitor adverse events (AEs) and provide information to implement improvement. In 2015, the Sicilian Health System adopted IHI GTT to assess the number, types and severity levels of AEs. The GTT was implemented in 44 of 73 Sicilian public hospitals and 18,008 clinical records (CRs) were examined. Here we present the standardized application of the GTT and the preliminary results of 14,706 reviews of CRs. Methods: IHI GTT was adapted, developed and implemented to the local context. Reviews of CRs were conducted by 199 professionals divided into 71 review teams consisting of three individuals: two of whom had clinical knowledge and expertise, and a physician to authenticate the AE. The reviewers entered data into a dedicated IT-platform. All 44 of the public hospitals were included, with approximately 300,000 yearly inpatient admissions out of a population of approximately 5 million. In total, 14,706 randomized CRs of inpatients from medicine, surgery, obstetric and ICU wards, from June 2015 to June 2018 were reviewed. Results: In 975 (6.6%) CRs at least one AE was found. Approximately 20,000 patients of the 300,000 discharged each year in Sicily have at least one AE. In 5,574 (37.9%) CRs at least one trigger was found. A total of 1,542 AEs were found. The analysis of ROC curve shows that the presence of two triggers in a CR indicates with high probability the presence of an AE. The most frequent type of AE was in-hospital related infection. Conclusions: The GTT is an efficient method to identify AEs and to track improvement of care. The analysis and monitoring of some triggers is important to prevent AEs. However, it is a labor-intensive method, particularly if the CRs are paper-based.

The normal range of separation time of the umbilical cord in Iraqi Newborn

A prospective study was performed on 150 healthy term newborn babies who had been examined in postnatal ward of gynecology and obstetrics department at Al-Mahmodyia general hospital during the period from of April to December 2019. Among the total 150 surveyed cases, 71 cases were males (47%), 79 cases were females (53%). The mean time of umbilical cord separation for the male cases was 8.5 days, whereas that of the female cases was 8.3 days. In the studied newborns, the mean time of umbilical cord separation was 8.4 days, shortest documented time of separation was 4 days (3 cases) while the longest time of separation was 14 days (one case only). Most of the cases; 71 (47.33%) cases had separated the umbilical cord in the time period (>8 to 11 days), whereas the least group separated the UC in the time period (>11 days).

Efficacy and safety of extra amniotic insertion of Foley catheter verses intra cervical application of PGE2 gel in pre-induction cervical ripening among primi mothers at 40 weeks +5 days or beyond – a randomized controlled study

<strong>Objectives:</strong> The aim of this study was to compare the efficacy, safety and side effects of extra amniotic insertion of Foley catheter and intra-cervical application of prostaglandin E₂ vaginal gel (PGE2) among primi mothers who were 40 weeks or beyond, as a pre induction ripening method. <strong>Method:</strong> This randomized study was conducted at Obstetrics ward, Kandy Teaching Hospital, between August 2010 to March 2011. Hundred and fourty-five mothers were randomly allocated to two groups. Age, BMI, period of gestation and, pre ripening Bishop’s score were measured as base line features to compare two groups. Group A (n=72) was ripened with prostaglandin E₂ vaginal gel (Dinoprostone 0.5 mg) and Group B (n=73) with insertion of Foley catheter (18 G and filled with 70 ml of distilled water) without tension. Primary outcome measures were spontaneous onset of labour within 24 hours and the mode of delivery. Maternal and fetal adverse effects were measured as secondary outcomes. Maternal age, period of gestation, pre induction cervical ripening Bishop's score and maternal BMI were compared as baseline characters of two groups. As measures of efficacy, spontaneous onset of labour, vaginal delivery rate and caesarean section rate were compared. Maternal and fetal adverse effects were used to compare the safety of the two methods. <strong>Results:</strong> Mean maternal ages were 27 and 28 years in group A and B respectively. Mean period of gestation was 40 weeks +5 days in both groups. Mean pre ripening Bishop’s scores in group A was 4.24 ± 0.41and 4.63 ± 0.38 for group B. BMI of group A was 26.9 ± 1.43Kg/m² and 27.2 ± Kg/m² in group B. However, a significant difference was not observed between these two groups. While mothers in group A had 30.5% spontaneous onset of labour, only 24.6% mothers went into spontaneous onset of labour (<em>p=0.78</em>) in group B. Vaginal delivery rates were 77% and 72% in group A and B respectively (<em>p=0.78</em>). Respective Caesarean section rates of group A and group B were 22.8% and 27% (<em>p=0.64</em>). Mothers who had PGE2 had significantly higher chances of experiencing side effects (44%) in compared to mothers who had Foley catheters (22%) (<em>p=0.016</em>). Mothers who had PGE2 had significantly higher rates of uterine hyper-stimulation (<em>p=0.01</em>), nausea and vomiting (<em>p=0.03</em>) and fever more than 38 C⁰ (<em>p=0.03</em>) while post-partum haemorrhage was not significant (<em>p=0.071</em>). Similar rates of meconium at ARM, fetal distress, APGAR&lt;7 at 5 min and SBU admissions were experienced by fetuses and neonates in both groups (<em>p=0.63</em>). <strong>Conclusion:</strong> Insertion of Foley catheter to extra amniotic space is as effective as intra-cervical application of PGE₂ gel for pre induction cervical ripening. Due to lower maternal adverse effects, extra amniotic insertion of Foley catheter is safer than intra-cervical application of PGE₂ gel.

Mental Health Problems during Pregnancy and the Postpartum Period: A Multicenter Knowledge Assessment Survey among Healthcare Providers.

Background Mental illness related to pregnancy can have long-lasting consequences. Healthcare providers are often the most frequent medical contact with the potential for early detection of these. Objectives were to study the awareness regarding mental health problems during pregnancy and the postpartum period among healthcare providers. Methods A cross-sectional study was carried out with healthcare providers including the nursing staff, midwifery staff, and medical officers working at obstetric wards in three tertiary care hospitals in Sri Lanka. A self-administered questionnaire assessed staff experience with mothers having mental problems, knowledge on mental health problems related to pregnancy, and knowledge about risk factors, common symptoms, and possible consequences on a five-point Likert scale from “Strongly Agree” to “Strongly Disagree.” Results A total of 300 staff were approached and invited to participate. Only 152 responded to the questionnaire (response rate of 50.1%). Mean (SD) age was 35.8 (9.7) years and mean (SD) years of experience was 10.1 (9.1) years. Age more than 35 years of healthcare providers is associated with statistically significant (p = 0.02) average knowledge scores on the consequences of maternal mental health problems. The symptom of “excessively worrying about baby's health” had the lowest score across all three categories with an average of 34.2%. Only 42.8% have ever heard of EPDS. Overall awareness and knowledge about risk factors, symptoms, and consequences regarding pregnancy-related maternal mental health problems are generally good among the healthcare providers studied. However, some of the few aspects are not satisfactory. Health education of pregnant women, promoting regular in-service training sessions, improvement of infrastructure, and involvement of family members from the antenatal period were discussed by the majority. Conclusion Despite good overall awareness and knowledge, application into practice with the utilization of validated assessments is poor. This may probably explain why Sri Lanka has a high prevalence of postpartum depression suggesting urgent attention.

Gut feelings in obstetrics and midwifery: the role of intuition in deciding when to perform cesarean section during labor

Purpose To describe the role of intuition for maternity care workers in deciding when a cesarean section should be advised during labor. Material and methods Focus group discussions with midwives and gynecologists, and nonparticipating observation at an obstetric ward. Results The decision about when to propose a cesarean section during labor is the result of interaction between objective and intuitive factors. Junior delivery ward workers report that they use more analytic reasoning for objective diagnosis of fetal distress, non-progressive labor, macrosomia or other indications for cesarean section; with increasing experience, however, non-analytic reasoning takes the overhand. Both consciously and unconsciously, other activities going on outside the individual delivery room seem to influence the decision. Out of the 50 deliveries observed, 38 births occurred through vaginal deliveries and 12 through cesarean sections. Maternity care workers clearly have “gut feelings” that the course of labor is moving toward a cesarean section. We were unable to detect any predictable pattern in the transition from gut feeling to decision. Conclusion Intuition plays a still not completely uncovered role in the decision to advise cesarean section during labor. The level of consciousness at which professionals use intuition or gut feeling and are aware of it in decision making is variable. Intuition or gut feelings seem to contribute more to the decision process as the level of experience increases.

Obstetric oxytocin exposure and ADHD and ASD among Danish and Finnish children.

Some studies have indicated an increased risk of attention deficit hyperactivity disorder (ADHD) and a small, sex-specific association with autism spectrum disorder (ASD) among children prenatally exposed to obstetric oxytocin. Since oxytocin is widely used in the obstetric ward, these potentially deleterious effects are of concern. Thus, we aimed to examine whether obstetric oxytocin treatment for labour induction or augmentation is associated with ADHD and ASD in offspring born in a two-country design based on data from Denmark and Finland. This population-based study used data from national registers in Denmark and Finland. Singletons born in Denmark 2000-10 (n = 577380) and Finland 1991-2010 (n = 945543), who survived infancy, were followed until 31 December 2015. ADHD and ASD were defined using diagnostic codes. For ADHD, we also included information on prescribed and redeemed ADHD medication in the definition. Hazards ratios (HRs) with 95% confidence intervals (CI), modelled with age as the underlying time scale, were calculated to estimate the associations. Oxytocin was used in 31% and 46% of the included deliveries in Denmark and Finland, respectively. In crude analyses, prenatal oxytocin was associated with an approximately 20% increased risk of ADHD and ASD, but confounder adjustment attenuated the association. The adjusted HR was 1.03, 95% CI 1.01-1.05, for ADHD and 1.05, 95% CI 1.02-1.08, for ASD. The results were similar in across country and gender. We found an association between synthetic oxytocin and ADHD or ASD which is unlikely to reflect a causal association and thus should not support the concern of clinical use. Our results help to allay concerns of obstetric use of oxytocin causing ADHD or ASD.

Increased serum ferritin levels in women with preeclampsia

To study the correlation between serum ferritin level and the severity of preeclampsia. Methods: This was a case-control study conducted in the emergency ward of Obstetrics and Gynecology Department of Suez Canal University Hospitals. We recruited sixty patients with preeclampsia and 60 normal pregnant women before parturition. All women were subjected to complete history and routine obstetric ultrasonography evaluation. Serum ferritin, serum iron, transferrin saturation, total iron-binding capacity, and unsaturated iron-binding capacity were assessed for all participants. Results: The mean serum ferritin was significantly higher in mild and severe preeclampsia groups vs. the control group (33.27 ± 6.9 and 69.47 ± 20.1 ng/ml versus 16.9 ± 20.9ng ng/ml, respectively, p-value &lt; 0.001). Regarding, the mean serum iron level in the mild, severe preeclampsia and control groups, it was 201.87 ± 58.13, 219.4 ± 53.1 µg/dl and 173.9 ± 56.58 µg/dl respectively (p-value &lt; 0.05). There was a highly significant correlation between ferritin and each of systolic and diastolic blood pressures (r= 0.8, p&lt;0.001 and r=0.7, p&lt;0.001 respectively).

FEATURES OF DEPRESSIVE DISORDER IN WOMAN DURING PREGNANCY

Purpose of the article is to show features of depressive disorder during pregnancy and how it can be different according to various personal indicators. Pregnancy and depression often go hand in hand. This condition affects about every tenth pregnant woman. According to recent research, sudden surges and changes in the hormonal background that accompany the entire pregnancy can really affect brain biochemistry, which in turn can lead to real clinical depression. The procedure of research registered at the women's consultation and obstetric ward and pathology department of pregnancy in Maternity hospital No. 3 (Kyiv). It lasted for 5 months. The group of pregnant women consisted of 100 people aged 18 to 42 years. Among them were 35 women in 1 trimester of pregnancy, 40 women in 2 trimester of pregnancy, 25 women in 3 trimester of pregnancy. To identify the presence and severity of depression among pregnant women, we used the following methods: Hamilton Depression Scale, Behterev Depression Questionnaire (female version). Anxiety and depression in women during pregnancy require early detection and correction due to their significant negative impact on pregnancy, childbirth, postpartum and further psychophysical development and social adaptation of children. Different indicators of age and trimester affect the level of expression of the depressive disorder. If woman had problems with conception or she was treated for infertility, the probability of her depression in her pregnancy increases by 10 times. Depression may be more likely to eclipse pregnancy and women who have suffered mental illness, anxiety, or depression before conception. This disorder may also occur in problematic relationships, as well as in situations where relatives have had a depression or mental illness, a woman has already had a miscarriage or her current pregnancy is a high-risk group. Depression during pregnancy has significant implications for pregnancy outcomes and maternal and child health. There is a need to identify which family, physical and mental health factors are associated with depression during pregnancy.

Postpartum depression and its correlates in middle‐class women in Hunan, China

AbstractPostpartum depression (PPD) has a negative impact on both infants and women. The middle‐class group is rapidly expanding with increased but unmet psychological needs. To determine the risk and its correlates of PPD in middle‐class women in Hunan, China. A sample of 306 middle‐class puerperae from obstetric wards of a large general hospital was enrolled in the study. Our results showed 55.6% middle‐class women were suspected PPD. Related risk factors included a history of complications, pregnancy stress, subjective support, and interaction effect between objective support and negative coping. The protective factors included objective support and an interaction effect between subjective support and negative coping. Early assessment and individualized guidance in terms of social support and coping to identify and prevent PPD in this population are required.

Management of the mother-infant dyad with suspected or confirmed SARS-CoV-2 infection in a highly epidemic context.

In the context of SARS-CoV-2 pandemic, the hospital management of mother-infant pairs poses to obstetricians and neonatologists previously unmet challenges. In Lombardy, Northern Italy, 59 maternity wards networked to organise the medical assistance of mothers and neonates with suspected or confirmed SARS-CoV-2 infection. Six “COVID-19 maternity centres” were identified, the architecture and activity of obstetric and neonatal wards of each centre was reorganised, and common assistance protocols for the management of suspected and proven cases were formulated. Here, we present the key features of this reorganization effort, and our current management of the mother-infant dyad before and after birth, including our approach to rooming-in practice, breastfeeding and neonatal follow-up, based on the currently available scientific evidence. Considered the rapid diffusion of COVID-19 all over the world, we believe that preparedness is fundamental to assist mother-infant dyads, minimising the risk of propagation of the infection through maternity and neonatal wards.

STUDY OF CALCIUM, PHOSPHORUS AND ACID PHOSPHATASE IN PRE-AND POST-MENOPAUSAL WOMEN

Introduction: More than 75 million individuals overall experience the ill effects of osteoporosis of which 80 % for example 44 million are postmenopausal ladies. Osteoporosis is second just to cardiovascular disease as a main medicinal services issue, as per the World Health Organization. Around the world, the lifetime hazard for ladies to have an osteoporotic break is 30 – 40%. Menopauseis one of the most significant physiological occasions; it is identified with the suspension of ovarian capacity and the finish of conceptive cycle. The occurrence of osteoporosis in postmenopausal ladies keeps on expanding with continuously maturing populaces. Pre-menopause refers to a ladies' regenerative or rich life, from the main menstrual period to the last. Post-menopause is characterized as the time after menopause, in any event one year without a period. Osteoporosisis a dynamic infection which prompts the exhaustion in the bone structure with loss of bone mineral thickness (BMD) expanding the hazard factor of breaks throughout the years. High danger of creating osteoporosis is described by low BMD and shows a disintegration of the smaller scale engineering with the BMD is the consequence of a harmony between bone resorption because of osteoclasts and bone arrangement because of osteoblasts, during an on-going renovating process.&#x0D; Aim: Study of Calcium, Phosphorus, Acid Phosphatase and BMD T score in Pre-and Post-Menopausal Women.&#x0D; Material and Methods: The present study includes total 100 subjects that include&#x0D; 50 pre-menopausal women (age 35 to 45 years) and 50 post -menopause women (age 46 to 60 years). Blood samples were collected from the subjects were obtained for Calcium, Phosphorus and Acid Phosphatase from Medicine /Orthopaedics/ Obstetrics and Gynaecology Wards.&#x0D; Conclusion: Menopause is one of the most significant physiological occasions: it is identified with the end of ovarian capacity and the finish of conceptive cycle. The rate of osteoporosis in postmenopausal ladies keeps on expanding with continuously maturing populaces. Pre-menopause alludes to a lady's regenerative or prolific life, from the principal menstrual period to the last. Post-menopause is the time after menopause, in any event one year without a period. Beginning stage of menopause builds hazard for some postmenopausal wellbeing inconveniences, for example, osteoporosis, ischemic ailment, and ovarian malignancy, though later menopause is a hazard factor for endometrial and bosom disease.&#x0D; Abbreviation: Menopause, Osteoporosis, BMD T score, Calcium, Phosphorus, Acid phosphatase.