Part Of Routine Antenatal Care Research Articles

Hepatitis B Virus Prevalence and Transmission in the Households of Pregnant Women in Kinshasa, Democratic Republic of Congo.

The World Health Organization Africa region has high regional hepatitis B virus (HBV) prevalence, and evidence suggests more frequent horizontal HBV transmission than other regions. Context-specific epidemiological studies are needed to inform additional HBV prevention measures. In the cross-sectional Horizontal and Vertical Transmission of Hepatitis B (HOVER-HBV) study, we introduced HBV surface antigen (HBsAg) screening alongside existing HIV screening as part of routine antenatal care in high-volume maternity clinics in Kinshasa, Democratic Republic of Congo. We recruited households of pregnant women ("index mothers") who were HBsAg-positive and HBsAg-negative, defining households as index-positive and index-negative, respectively. Household members underwent HBsAg testing and an epidemiological survey. We evaluated HBsAg prevalence and potential transmission correlates. We enrolled 1006 participants from 200 households (100 index-positive, 100 index-negative) across Kinshasa. HBsAg-positivity prevalence was more than twice as high in index-positive households (5.0% [95% confidence interval {CI}, 2.8%-7.1%]) as in index-negative households (1.9% [95% CI, .6%-3.2%]). HBsAg-positivity prevalence was 3.3 (95% CI, .9-11.8) times as high among direct offspring in index-positive versus index-negative households. Factors associated with HBsAg positivity included older age, marriage, and having multiple recent partners or any new sexual partners among index mothers; and older age, lower household wealth, sharing nail clippers, and using street salons among offspring in index-positive households. Vertical and horizontal HBV transmission within households is ongoing in Kinshasa. Factors associated with infection reveal opportunities for HBV prevention efforts, including perinatal prevention, protection during sexual contact, and sanitation of shared personal items.

Midwives' experiences of performing obstetric ultrasounds in antenatal care in eastern Ethiopia: Qualitative exploratory study.

In 2016, the World Health Organization recommended inclusion of an ultrasound scan as part of routine antenatal care to improve pregnancy outcomes. However, most rural women in Ethiopia do not have access to ultrasound scanning as part of their routine antenatal care. Recently, ultrasonography services were introduced at health centers in Harar, Kersa, and Haramaya districts in Eastern Ethiopia. This expoloratory study aimed to examine experiences of pregnancy surveillance midwives in the Child Health and Mortality Prevention Surveillance (CHAMPS) who performed ultrasonography at health centers that are in the catchment area of Health and Demographic Surveillance Systems, in Eastern Ethiopia. To explor midwives' experiences across 14 health centers in Eastern Ethiopia, located in the Kersa, Haramaya, and Harar Health and Demographic Surveillance Systems from February to April 2022. Exploratory qualitative study. The methods used were based on the Standards for Reporting Qualitative Research framework. Purposeful sampling was used to explore experiences of midwives who performed ultrasonography at selected health centers. The Midwives are recurited, trained and stationed at the health ceners to do ultrasound scanning and other activities by the Child Helath and Mortality Prevention Surveillance (CHAMPS) pregancny surveillance activities. Among 17 midwives who had undergone ultrasonography training and who were actively involved in ultrasound scanning at health centers in Kersa, Haramaya, and Harar Health and Demographic Surveillance Systems, three midwives who worked at health centers with no power or near a hospital were excluded. Using tape recordings and note-taking, data were collected through in-depth interviews based on a semi-structured interview guide. Thematic analysis used for data categorization, and the trustworthiness of data was kept throughout the procedure using credibility, dependability, confirmability, and transferability. In this study, we identified five main themes: Ultrasonography positively impacts midwives trained as sonographers; performing ultrasound scans enhances the skills and confidence of midwives, improving their professional development, Individual perception of self-efficacy; midwives' belief in their abilities to perform ultrasound scans effectively influences their job satisfaction and motivation, Provision of care; integrating ultrasound into antenatal care enhances the quality, therapeutic communication, and personalized nature of care provided to pregnant women, Barriers to providing ultrasonography services; challenges such as shortage of ultrasonography-trained staff and workload can hinder the delivery of ultrasound services in rural areas, Community acceptance; the level of community understanding, trust, and support towards ultrasound technology and midwives as sonographers impacts the successful implementation and sustainability of ultrasound services. Ultrasonography performed by midwives at rural health centers had a considerable impact on antenatal care services and incareased confidence of midwives.

Prevalence of Syphilis among Pregnant Women attending antenatal care clinic, Udaipur, Southern Rajasthan

Background Maternal syphilis is an important cause of adverse pregnancy outcome . Syphilis, caused by infection with Treponema pallidum, is a mucocutaneous sexually transmitted infection (STI) with high infectivity in the early stages. Untreated maternal syphilis is strongly associated with adverse birth outcomes including increased incidence of stillbirths, low birth weight and premature live births compared with uninfected women. The WHO recommends serological test for syphilis in pregnancy and treatment with injectable penicillin, including the partner, as a routine part of antenatal care. Ideally this screening should be done in the first trimester or at first antenatal visit and again early in the third trimester. Method A retrospective, quantitative study of hospital and laboratory records of all pregnant women booked at the RNT Medical college for antenatal care in a one-year period (1ST JULY 2021 to 30TH JUNE 2022) was carried out. Data were collected from department register maintained by authority. VDRL testing was done to screen the patient. Data were analysed. Result : During the study period, 10194 antenatal clinic patients had VDRL screening out of which 27 were positive. The overall prevalence rate in this study was 0.26% Conclusion Universal screening of all pregnant women at first antenatal visit with a non-treponemal test should be used for screening for syphilis in pregnancy. Also considering prevalence of gestational syphilis in Udaipur region , policy translation is required at state and national level to scale up prevention, screening, and management of syphilis.

Association between maternal haemoglobin concentrations and maternal and neonatal outcomes: the prospective, observational, multinational, INTERBIO-21st fetal study

Anaemia in pregnancy is a global health problem with associated maternal and neonatal morbidity and mortality. We aimed to investigate the association between maternal haemoglobin concentrations during pregnancy and the risk of adverse maternal and neonatal outcomes. In this prospective, observational, multinational, INTERBIO-21st fetal study conducted at maternity units in Brazil, Kenya, Pakistan, South Africa, and the UK, we enrolled pregnant women (aged ≥18 years, BMI <35 kg/m2, natural conception, and singleton pregnancy) who initiated antenatal care before 14 weeks' gestation. At each 5±1 weekly visit until delivery, information was collected about the pregnancy, as well as the results of blood tests taken as part of routine antenatal care, including haemoglobin values. The outcome measures were maternal (gestational diabetes, pregnancy-induced hypertension, and preterm premature rupture of membranes) and neonatal outcomes (small for gestational age, preterm birth, and acute respiratory distress syndrome). Between Feb 8, 2012, and Nov 30, 2019, 2069 women (mean age 30·7 years [SD 5·0]) had at least one routinely haemoglobin concentration measured at 14-40 weeks' gestation, contributing 4690 haemoglobin measurements for the analysis. Compared with a haemoglobin cutoff of 110 g/L, the risk was increased more than two-fold for pregnancy-induced hypertension at haemoglobin concentrations of 170 g/L (risk ratio [RR] 2·29 [95% CI 1·19-4·39]) and higher, for preterm birth at haemoglobin concentrations of 70 g/L (RR 2·04 [95% CI 1·20-3·48]) and 165 g/L (RR 2·06 [95% CI 1·41-3·02]), and for acute respiratory distress syndrome at haemoglobin concentrations of 165 g/L (RR 2·84 [95% CI 1·51-5·35]). Trimester-specific results are also presented. Our data suggests that the current WHO haemoglobin cutoffs are associated with reduced risk of adverse maternal and neonatal outcomes. The current haemoglobin concentration cutoffs during pregnancy should not only consider thresholds for low haemoglobin concentrations that are associated with adverse outcomes but also define a threshold for high haemoglobin concentrations given the U-shaped relationship between haemoglobin concentration and adverse neonatal and maternal outcomes. Bill & Melinda Gates Foundation.

Https://he01.tci-thaijo.org/index.php/AIHD-MU/article/view/261309

During pregnancy, women are exposed to various psychosocial stressors that affect their quality of life, but few studies have looked at them additively in non-western contexts. This study aimed to assess the shared and unique contributions of perceived stress, financial strain, intimate partner violence, food insecurity, and social support to maternal quality of life. Data were gathered from a cross-sectional sample of 519 pregnant women who received antenatal care at various primary health care centers in Ibadan, Nigeria. Independent effects of and two-way interactions between psychosocial stressors in predicting maternal quality of life were explored using hierarchical linear regression. Higher scores for the main effects of food insecurity (β = -0.52, p &lt; 0.01) and social support (β = 0.11, p &lt; 0.01) were most strongly linked to a lower and better quality of life, respectively. Further, the two-way interaction effects were significant for financial strain in combination with intimate partner violence (β = -0.18, p &lt; 0.01) and food insecurity in combination with social support (β = 0.18, p &lt; 0.01) contributing to lower quality of life. The findings of this study were supported by the social determinants of health model, which recognizes that a person’s socioeconomic environment and psychosocial state affect his or her health and life experiences. It is recommended that health care practitioners should incorporate assessments of clinical factors of gestation with those of psychosocial needs as part of routine antenatal care in order to develop appropriate women-centered interventions.

Attention for and awareness of anemia in adolescents in Karnataka, India: A qualitative study.

Between 1990 and 2016 the number of adolescents with anemia world-wide increased by 20% to almost one in four. Iron deficiency in adolescence results in compromised growth, decreased cognitive function, and depressed immune function, and can increase the risk of negative outcomes in pregnancy, especially in the case of young adolescents. In India, despite several decades of governmental investment in anemia prevention and treatment, more than half of women of reproductive age are anemic, with rates even higher in the adolescent population. Although awareness of adolescence as a nutrition-sensitive developmental stage is increasing, there is a lack of qualitative research on the perspectives of adolescents and families on anemia and related services. In this study, we explored the issues influencing adolescents' awareness of anemia in three rural areas of Karnataka. Sixty-four in-depth interviews and six focus group discussions were conducted with adolescents (those who had never been pregnant, pregnant adolescents, and young mothers), community members, and nutrition-related service providers in the health and education sectors. An inductive analytical approach was used. We found that adolescent girls, particularly those who have not experienced pregnancy or motherhood, had very low awareness of anemia. State programs including school-based distribution of iron and folic acid supplements and nutrition talks were not seen to be resulting in knowledge and acceptance of the importance of preventing anemia. Pregnancy represents a turning point in which adolescents are systematically tested for anemia as part of routine antenatal care, increasing their awareness of, and access to, treatment for the condition. At the same time, pregnancy represents to family and community a period to insist on a nutritious diet. For progress in anemia reduction to be made, improved age-appropriate measures specific for adolescence are required. Improving school-based nutrition outreach is an important opportunity to reach adolescents.

Prevalence, Pattern, and Outcome of Congenital Anomalies Admitted to a Neonatal Unit in a Low-Income Country—a Ten-Year Retrospective Study

ObjectiveThe incidence of congenital abnormalities is highest in low-and-middle-income countries. However, the prevalence, spectrum, trends of neonatal congenital anomalies and their admission outcomes have not been well explored. This study was a 10 year retrospective hospital-based research in a low-income country to address the above.MethodsAll infants hospitalized in the Special Care Baby Unit at the Cape Coast Teaching Hospital in Ghana, between 1st January 2010 and 31st December 2019, had their demographic, obstetric, and clinical data recorded.ResultsOver the decade, 236 neonates with congenital abnormalities were admitted to the unit, accounting for 2.8% of total neonatal admissions and 8.6 per 1000 births. Mortality occurred in 33.2% of neonates with congenital abnormalities, corresponding to 4.6% of all neonatal deaths. Mortality was significantly associated with place of delivery and gravidity of more than five. The commonest anomalies were in the nervous system, particularly neural tube defects, followed by suspected chromosomal abnormalities and then cardiac defects. Neonates with cardiac defects had a higher chance of dying. Health center/clinic delivery proffered a better survival than hospital delivery, but this should be interpreted with caution.ConclusionNeural tube defects were the most predominant anomalies; hence, intensification of preconception and antenatal folic acid supplementation is pivotal towards their reduction. Making prenatal screening for early detection of fetal anomalies an integral part of routine antenatal care is also essential. This research was conducted in a single center and did not include stillbirths and abortions so cannot give an accurate estimation of the number of congenital abnormalities in the population. A national registry of congenital anomalies is recommended.

Point of care obstetric ultrasound knowledge retention among mid-wives following a training program: a prospective cohort pilot study

BackgroundObstetric ultrasound has become a routine part of antenatal care in many parts of the world including low income settings. However, there is a shortage of radiologists and sonographers to perform routine obstetric scans in many areas especially in the rural settings of low income countries, despite having equipment available to do this. As a result, Point of care ultrasound (POCUS) has been suggested to bridge this gap by training other health workers such as midwives to perform basic obstetric ultrasound as part of their clinical care.MethodsIt was a prospective cohort pilot study in which trained midwives in point of care obstetric ultrasound were followed up at 6 months post training to assess their knowledge retention. Eleven trained midwives were purposively selected and followed up for knowledge retention. These were trained for 6 weeks and were given a knowledge assessment immediately after training, then given an assessment at 6 months following training. Data was analyzed using SPSS. Wilcoxon signed rank test was used to compare assessments and perceived knowledge as well as Spearman correlation to test the relationship between the number of scans performed and exam assessments, knowledge and exam assessments, and number of scans and knowledge.ResultsThere were eleven midwives, all female with an average age of 42.3 years. The mean exam score (out of 50) was 44.2 at the end of the training and 42.9 at 6-months follow up. The midwives demonstrated higher perceived knowledge at the end of the training when compared to the 6-months follow up. However, this perceived higher knowledge was not statistically significant when correlated with the exam scores either at the end of the training or at the follow up of 6 months.ConclusionThis pilot study has demonstrated that training midwives in point of care obstetric ultrasound can result into acceptable levels of knowledge retention that assist the midwives to apply this knowledge when making routine clinical decisions in relation to pregnant women.

Sero-Prevalence of Syphilis among Pregnant Women Attending Antenatal Clinic in Dogon Agogo Primary Health Care Centre Jos North, Plateau State, Nigeria

Background: Syphilis remains a public health problem in many parts of the world, including Nigeria, where is common during pregnancy.&#x0D; Design and Duration: This is a cross-sectional study involving pregnant women attending antenatal clinic in Dogon Agogo Primary Health Centre, Jos North, from March 2017 to November, 2021.&#x0D; Aim: The aim of this study is to seroprevalence of Syphilis among pregnant women attending Primary health care centre in Jos North,&#x0D; Materials and Methods: A total of one thousand, two hundred and nineteen blood samples were screened from 2017 to 2021, using rapid diagnostic tests Patient’s demographic variables, clinical profiles and information considered to be risk factors were also collected using structured questionnaires, Patient’s demographic details, clinical profiles and information considered to be risk factors were also collected using structured questionnaires.&#x0D; Results: The results showed that only 33 (2.7%) were positive. This includes 14(42.4%) patients between the age of 20 – 34 years as the highest frequency, followed by 12(36.4%) in 35 – 49 years of age. Most of the syphilis-positive patients are married 21(63.6%) and had attended tertiary level of education 13(39.4%), but mostly unemployed/Housewives 11(33.3%). The clinical profile of the participants revealed that the majority 14(42.5%) of the women that attended the facility throughout this period are in their third pregnancy and above (Multigravida). They were screened during the first-time visit (72.7%) and first trimester (33.3%). The pregnancy outcome among the seropositive patients showed that many 14(42.4%) undergo normal delivery, but 10(30.3%) had miscarriages. Blood transfusion (81.8%), multiple sex partners (75.8%), unprotected sexual intercourse with a person of unknown status (57.6%), and previous exposure to sexually transmitted infections (84.8%) were the most prevalent risks factors observed. The overall prevalence of syphilis across the five years of sampling was 2.71% (33 of 1219), where the highest number of cases 57.6% was recorded in the year 2020, followed by 18.2% in 2018, with 3.0% in 2019 as the least.&#x0D; Conclusion: This study found that the prevalence of syphilis over the five-year period among pregnant women in this area is low. However, the study advocates the improvement of screening programs during pregnancy as part of routine antenatal care.

Time to non-adherence to iron and folic acid supplementation and associated factors among pregnant women in Hosanna town, South Ethiopia: Cox-proportional hazard model.

Micronutrient deficits in women of reproductive age have been linked to poor pregnancy outcomes. The most common micronutrient deficits in women are iron and folate. The World Health Organization recommends daily oral iron and folic acid supplementation (IFAS) as part of routine antenatal care to lower the risk of maternal anemia and adverse pregnancy outcomes. However, the effectiveness of the supplementation relies on client's strict adherence. The aim of this study was to determine time- to- non-adherence to IFAS and associated factors among pregnant women in Hosanna Town, South Ethiopia. A community based cross sectional study design was employed from May 15-June11, 2021. Data were entered into Epi-Data version 3.1 and exported to SPSS version 23 for analysis. The Cox regression hazard model was applied. The threshold of statistical significance was declared at a p-value <0.05 and adjusted hazard ratios (AHRs) with corresponding 95% confidence intervals were used to report. The median time-to-non-adherence was 74 days (95 percent CI: 65.33-82.67). After adjusting for the confounders, age (AHR = 1.05, 95% CI: 1.01-1.09), education status (AHR = 2.43 95%CI 1.34-4.40, AHR 3.00, 95% CI: 2.09-4.31, AHR 1.91, 95% CI: 1.32-2.77), household's wealth index (AHR = 1.73, 95% CI: 1.19-2.51, AHR = 1.64, 95% CI:1.15-2.35), and counseling at service delivery (AHR = 2.53, 95% CI: 1.88-3.41) were independent predictors of time to non-adherence to IFAS among pregnant women. The median time to non-adherence was short and women became non-adherent before the recommended duration. Improving women's education and counseling pregnant women on IFAS during pregnancy would make a change.

Escherichia coli from urine samples of pregnant women as an indicator for antimicrobial resistance in the community: a field study from rural Burkina Faso

BackgroundIn low- and middle-income countries, surveillance of antimicrobial resistance (AMR) is mostly hospital-based and, in view of poor access to clinical microbiology, biased to more resistant pathogens. We aimed to assess AMR among Escherichia coli isolates obtained from urine cultures of pregnant women as an indicator for community AMR and compared the AMR results with those from E. coli isolates obtained from febrile patients in previously published clinical surveillance studies conducted within the same population in Nanoro, rural Burkina Faso. We furthermore explored feasibility of adding urine culture to standard antenatal care in a rural sub-Saharan African setting.MethodsBetween October 2016–September 2018, midstream urine samples collected as part of routine antenatal care in Nanoro district were cultured by a dipslide method and screened for antibiotic residues. Significant growth was defined as a pure culture of Enterobacterales at counts of ≥ 104 colony forming units/ml.ResultsSignificant growth was observed in 202/5934 (3.4%) cultures; E. coli represented 155 (76.7%) of isolates. Among E. coli isolates, resistance rates to ampicillin, cotrimoxazole and ciprofloxacin were respectively 65.8%, 64.4% 16.2%, compared to 89.5%, 89.5% and 62.5% among E. coli from clinical isolates (n = 48 of which 45 from blood cultures). Proportions of extended spectrum beta-lactamase producers and multidrug resistance were 3.2% and 5.2% among E. coli isolates from urine in pregnant women versus 35.4%, and 60.4% respectively among clinical isolates.ConclusionsThe E. coli isolates obtained from healthy pregnant women had significantly lower AMR rates compared to clinical E. coli isolates, probably reflecting the lower antibiotic pressure in the pregnant women population. Adding urine culture to the routine urine analysis (dipstick) of antenatal care was feasible. The dipslide culture method was affordable and user-friendly and allowed on-site inoculation and easy transport; challenges were contamination (midstream urine sampling) and the semi-quantitative reading. Provided confirmation of the present findings in other settings, E. coli from urine samples in pregnant women may be a potential indicator for benchmarking, comparing, and monitoring community AMR rates across populations over different countries and regions.

Experiences of pregnant women and healthcare professionals of participating in a digital antenatal CMV education intervention

ObjectiveThe study aimed to explore the perspectives of participating pregnant women and Health Care Professionals (HCPs) towards receiving and providing cytomegalovirus (CMV) education so that barriers and facilitators towards incorporating CMV in routine antenatal care could be better understood. DesignThis process evaluation phase employed a qualitative design using individual, semi-structured, face-to-face interviews. SettingRecruitment and interviews took place within a large teaching hospital from an ethnically diverse area of South-west London ParticipantsThe study sample included 20 participants: 15 pregnant women, and five HCPs. All participants were involved in a single centre randomized controlled trial of a digital CMV educational intervention in pregnancy. FindingsPregnant participants expressed a strong desire to receive information about CMV as part of routine antenatal care. Although HCPs were accepting of the need for CMV education, it was evident that they felt unequipped to provide this; reasons included lack of time, uncertainty about clinical pathways and concern about the potential emotive impact of CMV education. Pregnant women suggested that expressing behaviour changes as risk reduction rather than prevention, made the behaviours feel more achievable and realistic. The support of partners was considered a key factor in the successful adoption of behavioural changes by pregnant women. Key conclusions and implications for practiceThere is an onus on HCPs to consider how CMV can be included as part of antenatal education, with messaging framed as risk reducing rather than prevention.

First and second trimester ultrasound in pregnancy: A systematic review and metasynthesis of the views and experiences of pregnant women, partners, and health workers.

The World Health Organization (WHO) recommends one ultrasound scan before 24 weeks gestation as part of routine antenatal care (WHO 2016). We explored influences on provision and uptake through views and experiences of pregnant women, partners, and health workers. We undertook a systematic review (PROSPERO CRD42021230926). We derived summaries of findings and overarching themes using metasynthesis methods. We searched MEDLINE, CINAHL, PsycINFO, SocIndex, LILACS, and AIM (Nov 25th 2020) for qualitative studies reporting views and experiences of routine ultrasound provision to 24 weeks gestation, with no language or date restriction. After quality assessment, data were logged and analysed in Excel. We assessed confidence in the findings using Grade-CERQual. From 7076 hits, we included 80 papers (1994-2020, 23 countries, 16 LICs/MICs, over 1500 participants). We identified 17 review findings, (moderate or high confidence: 14/17), and four themes: sociocultural influences and expectations; the power of visual technology; joy and devastation: consequences of ultrasound findings; the significance of relationship in the ultrasound encounter. Providing or receiving ultrasound was positive for most, reportedly increasing parental-fetal engagement. However, abnormal findings were often shocking. Some reported changing future reproductive decisions after equivocal results, even when the eventual diagnosis was positive. Attitudes and behaviours of sonographers influenced service user experience. Ultrasound providers expressed concern about making mistakes, recognising their need for education, training, and adequate time with women. Ultrasound sex determination influenced female feticide in some contexts, in others, termination was not socially acceptable. Overuse was noted to reduce clinical antenatal skills as well as the use and uptake of other forms of antenatal care. These factors influenced utility and equity of ultrasound in some settings. Though antenatal ultrasound was largely seen as positive, long-term adverse psychological and reproductive consequences were reported for some. Gender inequity may be reinforced by female feticide following ultrasound in some contexts. Provider attitudes and behaviours, time to engage fully with service users, social norms, access to follow up, and the potential for overuse all need to be considered.

Predictors of Antenatal Depression in a Tertiary Hospital in Nigeria

Background: Antenatal depression is very common in pregnant women all over the world. Women in the developing and poor countries are more at risk. Several risk factors have been identified and some of them may lead to unbearable pregnancy situations, that pose a threat to mother and the baby. If pregnancy must be made pleasurable for mothers, then the risk factors which predict depression in pregnancy must be identified and considered in antenatal care.&#x0D; Objective: To identify risk factors which are predictors to antenatal depression in pregnant women.&#x0D; Methods: Within the months of January and February 2021, all the pregnant women who registered for antenatal care in the teaching hospital, who met the study inclusion criteria were assessed for depression using the English version of Edinburgh Postnatal Depression scale (EPDS) and a study designed risk factor questionnaire, which contained socio-demographic variables and other factors. Data obtained were analyzed using the statistical package for social sciences (SPSS) version 23. Variables were compared using chi squared and t-tests and p values &lt; 0. 05 were statistically significant.&#x0D; Results: Five hundred (500) respondents completed the study, 158 (31.6%) were depressed. Risk factors of co-habiting, threats to life, and/or pregnancy, fight with spouse and other forms of abuse, previous abortions and child health challenges, were predictors of antenatal depression.&#x0D; Conclusion: Depression in pregnancy should be part of routine antenatal care by obstetricians noting the predictors.

Vaccination of pregnant women against COVID-19 in India and Indonesia: Moving beyond the opt-in to the opt-out option.

SynopsisIn view of the continued threat of COVID‐19, and to synergize with routine antenatal care, COVID‐19 vaccination should become a default part of routine antenatal care with an opt‐out option.

An evaluation of an influenza vaccination campaign targeting pregnant women in 27 clinics in two provinces of South Africa, 2015 \u2013 2018

IntroductionDespite prioritization, routine antenatal influenza vaccine coverage is < 16% in South Africa. We aimed to describe maternal influenza vaccine coverage in 27 antenatal clinics (ANCs) in Gauteng and Western Cape (WC) Provinces, where in collaboration with the Department of Health (DoH), we augmented the annual influenza vaccination programme among pregnant women.MethodsFrom 2015 through 2018, 40,230 additional doses of influenza vaccine were added to the available stock and administered as part of routine antenatal care. Educational talks were given daily and data were collected on women attending ANCs. We compared characteristics of vaccinated and unvaccinated women using multivariable logistic regression.ResultsWe screened 62,979 pregnant women during the period when Southern Hemisphere influenza vaccines were available (27,068 in Gauteng and 35,911 in WC). Vaccine coverage at the targeted clinics was 78.7% (49,355/62682), although pregnant women in WC were more likely to be vaccinated compared to those in the Gauteng (Odds ratio (OR) =3.7 p < 0.001). Women aged 25—29 and > 35 years were less likely to be vaccinated than women aged 18—24 years (OR = 0.9 p = 0.053; OR = 0.9 p < 0.001). HIV positive status was not associated with vaccination (OR = 1.0 p = 0.266). Reasons for not vaccinating included: vaccine stock-outs where ANCs depleted available stock of vaccines and/or were awaiting delivery of vaccines (54.6%, 6949/12723), refusal/indecision (25.8%, 3285), and current illness that contraindicated vaccination (19.6%, 2489).ConclusionAntenatal vaccination uptake was likely improved by the increased vaccine supply and vaccine education offered during our campaign.

Informed consent and birth preparedness/complication readiness: A qualitative study at two tertiary maternity units.

Informed consent in obstetrics should involve full disclosure of risks, benefits and alternative interventions. However, we have found no evidence of a formal informed consent process before an attempt at vaginal delivery in published policy or practice. The idea of informed consent in vaginal birth has attracted controversy and has been the subject of some debate. To explore the perspectives and experiences of informed consent and birth preparedness/complication readiness for birthing women in a high resource setting. Qualitative study using semi-structured interviews to examine experiences and perspectives of women following birth. Forty telephone interviews were concluded. Eight statement categories were identified: (i) no issues of consent, (ii) absent/inadequate informed consent, (iii) adequate birth preparedness/complication readiness, (iv) inadequate birth preparedness/complication readiness, (v) desire to forfeit decision making to a trusted and accountable health professional, (vi) belief that informed consent is not realistic in birth under some circumstances, (vii) negative feelings related to birth and (viii) poor postnatal follow-up. When complications arose during birth, 20% of participants felt that informed consent was absent/inadequate, 25% of participants suggested policy change in favour of a formal informed consent process and 55% of participants suggested policy change in favour of increased birth preparedness/complication readiness. Our study suggests that informed consent for vaginal birth and formal birth preparedness/complication readiness should form part of routine antenatal care. Women's preferences for decision-making and informed consent should be established before birth.

Pregnant women utilization of dental services: still a challenge in low resource setting

BackgroundPoor oral health in pregnancy can be associated with poor pregnancy outcome, however, dental consultation among pregnant women appears to be low.MethodsThis was a questionnaire-based study of 413 women who attended the antenatal clinic of University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu. The information obtained was analyzed using SPSS version 22. A p-value of less than 0.05 was considered statistically significant.ResultsOnly 36 (8.7%) of the respondents had dental consultations in index pregnancy for complaints such as tooth ache and decay (66.7%) and pain as well as swelling of the gum (33.3%). The most common reason given for not visiting a dentist during the index pregnancy was the visit not being relevant to their pregnancy outcome (69.2%). After counseling them, only 249 (60.3%) agreed to have dental consultation during subsequent pregnancies. The relationship between visiting the dentist and place of residence (< 0.001), occupation (0.019) and frequency of brushing/ changing of brush (0.005, < 0.001 respectively) were statistically significant.ConclusionThe prevalence of dental consultation during pregnancy is very low. Pregnant women should be encouraged to have routine dental consultation with oral health counseling and check-up incorporated as part of routine antenatal care.

Urinary symptoms in pregnant women in their third trimester-a cross-sectional study.

Urinary symptoms are common in pregnancy. Our study aims to understand the extent of these symptoms in a cohort of pregnant women in the third trimester and their impact on quality of life (QOL) from the women's perspective. A single-centre cross-sectional study of self-reported urinary symptoms of pregnant women in the third trimester conducted from August 2018 at the Diana Princess of Wales Hospital, Northern Lincolnshire, and Goole NHS Foundation Trust, Grimsby, UK. We used an international validated questionnaire (ICIQ-FLUTS questionnaire) (Brookes et al. Am J Obstet Gynecol. 191(1):73-82, 2004). A total of 302 women were included in this study. Nocturia was the most common symptom, reported by 97%, affecting QOL in 80%. Urgency of micturition was the second most common, present in 83%, adversely affecting QOL in 75%. Our study showed a startling finding of bladder pain in 47% (95% CI 41.1%, 52.3%) of these women. There was a high prevalence of nocturnal enuresis in 9.9% (95% CI 7.05%, 13.8%). Straining during micturition is not a well-known symptom in pregnancy, however reported by 18.2% (95% CI 14.2%, 23.0%). The high prevalences of bladder pain, nocturnal enuresis and straining in the third trimester of pregnancy are novel findings. Our study also confirms that the prevalence of all voiding, filling and incontinence symptoms in pregnancy is significantly higher than in the non-pregnant population, having a negative impact on QOL, and yet is not discussed as part of routine antenatal care.

"Silent sufferers: A study of domestic violence among pregnant women attending the ANC OPD at a Primary Health Care Centre".

Introduction:Domestic violence against women is one of the most pervasive abuses of human rights in the world. Violence during pregnancy leads to both acute injuries and profound long-term challenges to health and wellbeing. Pregnancy provides a good opportunity for healthcare personal to screen women for domestic violence.Aim:To identify the pattern of domestic violence amongst pregnant women and to plan appropriate interventions.Settings and Design:This cross-sectional study was carried out at Primary Health Care Centre.Methods and Material:90 pregnant women attending the ANC OPD and fulfilling the inclusion criteria were interviewed using a semi-structured questionnaire. Data were compiled and analyzed using SPSS version 24. Percentages were calculated and Chi-square test was used wherever applicable.Results:Violence was mostly seen in the women who were married for five years (47.36%) and many among them experienced it within one year of marriage (34.28%). The most common violence faced by the women was verbal violence (44.73%), followed by financial violence (27.63%). Physical violence was experienced by 22.36% women. The Perceived risk factor for violence was mostly addiction of spouse in 26.31% of women and insufficient dowry and demand for male child in 19.73%.Conclusions:As occurrence of violence was found to be significantly associated with duration of marriage, educational status, and earning status of women asking about intimate partner violence should be a part of routine antenatal care for early detection and identification of cases, their counseling, and appropriate interventions.