Perinatal Medical Care Research Articles

Determinants of perinatal medical care at the ambulatory level in the conditions of the COVID-19 pandemic

It is important to determine mothers’ perceptions of health care services during the pandemic to ensure equity in the provision of such services in the future.The objective: to determine the determinants of pregnant women’s perception of perinatal care services during the COVID-19 pandemic.Materials and methods. An original sociological study was conducted to assess the state of perinatal care during the COVID-19 pandemic using a questionnaire. 110 questionnaires were included in the analysis. Group 1 included 45 female respondents were sick with COVID-19 during pregnancy, group 2 – 65 women were not sick with COVID-19 during pregnancy. All questionnaires were analysed both in the general sample and in the section of COVID-19 during pregnancy.Results. Certain shortcomings in the provision of perinatal care during the COVID-19 pandemic at the ambulatory level were identified. Insufficient vaccination coverage of pregnant women (65.5% of respondents were vaccinated during pregnancy). 87.3% of patients considered insufficient information about vaccination of pregnant women. A negative attitude towards vaccination during pregnancy was expressed by 30.0% of respondents. 65.4% of respondents considered insufficient availability of perinatal care in the conditions of the COVID-19 pandemic. Remote counseling was received by less than half of patients (41.8%), and mainly those who were sick with COVID-19 (62.2%). A negative attitude towards remote counseling was expressed by 49.1% of women. More than half (56.4%) of the respondents considered the provided information about COVID-19, treatment and prevention to be insufficient. Only 9.1% of patients received full psychological support. Half of the patients were not satisfied with the qualifications of the medical staff, and 59.1% were not satisfied with the staff’s attitude. More than half (55.4%) of patients were not satisfied with the care provided at the outpatient stage in general, especially those who did not suffer from COVID-19, which may be due to a shift in the focus of attention on infected pregnant women.Conclusions. The following positions can be recommended to improve perinatal care: expansion of information provision of the population, in particular with the involvement of mass media; conducting explanatory work with patients on prevention, vaccination, treatment, possible complications during pregnancy; provision of remote counseling in possible cases; psychological support of the pregnant woman and her family at all stages of perinatal care.

A Case of Severe Polyhydramnios During Pregnancy Associated with Long-Term Use of Lithium

IntroductionThe perinatal period poses heightened vulnerability to bipolar affective episodes. Lithium serves as first line in the management of bipolar disorder, demonstrating efficacy in stabilizing mood episodes and preventing relapses. Therefore, it also a recommended treatment during the pregnancy period. However, its use presents potential risks for both the mother and the developing fetus. Given the prevalence of bipolar disorder in reproductive-age women, it is crucial to investigate the risks associated with lithium use during pregnancy, along with its subsequent obstetric and neonatal complications.ObjectivesThis report outlines a case of severe polyhydramnios in a 42-year-old primigravida patient, under long-term lithium and antipsychotic treatment. Additionally, a systematic search for similar case reports was conducted to provide an overview of the existing literature.Methods The patient’s medical history and perinatal medical care are documented in this case report. A systematic literature search on MEDLINE (PubMed) was conducted using Boolean operators.ResultsThe patient was diagnosed with bipolar disorder type I and had a history of lithium treatment for over 20 years, supplemented later with antipsychotics. During her pregnancy, she experienced a polyuria-polydipsia syndrome and a severe polyhydramnios. She also suffered renal impairment. Together, it is indicative of a nephrogenic diabetes insipidus (NDI), likely induced by prolonged lithium treatment. As the pregnancy progressed, she experienced premature rupture of membranes at 34 weeks and 5 days. The newborn needed medical support and was admitted to the neonatal unit, without further complications.Systematic research showed three published case reports describing nephrogenic diabetes insipidus (NDI) and polyhydramnios associated to lithium treatment.ConclusionsChronic administration of lithium may contribute to the development of resistance to antidiuretic hormone (ADH), leading to polyuria-polydipsia syndrome and potentially severe obstetric complications. The co-administration of lithium and antipsychotics may exacerbate these effects. Further research is needed to elucidate their combined clinical impacts.Disclosure of InterestNone Declared

Reproductive psychiatric advance directives: promoting autonomy for perinatal people with serious mental illness diagnoses.

People with serious mental illness (SMI) diagnoses who become pregnant are particularly vulnerable to symptom recurrence and resulting potential lack of decision-making capacity (Taylor et al. J Psychiatr Res 104:100-107, 2018; Bagadia et al. Int J Soc Psychiatry 66:792-798, 2020). In these situations, prenataland behavioral health providers have little legally viable guidance on what medical and/or psychiatric care the patient desires (Aneja and Arora Indian J Med Ethics V:133-139, 2020). We created a "Reproductive Psychiatric Advance Directive (PAD)," grounded in Reproductive Justice principles, that promotes patient autonomy by proactively articulating perinatal medical and psychiatric care preferences. We conducted a medical and legal literature review using two sets of terms related to (1) PADs and (2) reproductive health. We convened an expert working group of legal, medical, psychiatric, peer, and advocacy leaders and community-based organizations to develop a Reproductive PAD. Our literature review yielded no results about Reproductive PADs. We created de novo a Reproductive PAD template with sections on medical and psychiatric history, informed consent for critical medical and psychiatric care, family planning and custody preferences, and optional sections on abortion and on electroconvulsive therapy. The Reproductive PAD provides a possible legal mechanism for people of childbearing age with SMI diagnoses to articulate their medical and psychiatric care choices around reproduction and pregnancy. Future research should evaluate the Reproductive PAD as an effective tool for protecting patient autonomy during pregnancy and postpartum and guiding medical and psychiatric providers.

Childbirth experience during the COVID-19 pandemic: A qualitative thematic analysis

IntroductionPregnancy is a period of special vulnerability for the mental health of women. The arrival of the COVID-19 pandemic altered the routines of pregnant women, its effects on this population are thus far unknown. Therefore, the objective of this study is to understand the impact of the pandemic on the birth experience of women during the state of emergency in Andalusia, Spain. MethodsA qualitative study was conducted with 14 women, using semistructured interviews via telematics. These were recorded and later transcribed using the F4transkript software. In order to analyze the data retrieved from the interviews and identify the main patterns of meaning/responses, the thematic analysis method was applied. ResultsThe main emerging themes were 'prenatal medical care', 'hospital safety', and 'postpartum with COVID-19 restrictions'. The results indicated that the reorganization of perinatal medical care, the lack of information, and the fear of contagion were the factors that most negatively influenced the participants. Instead, the security during the birth process and the tranquility in postpartum were the positive aspects of the birth experiences during COVID-19. ConclusionThis is the first qualitative study in Andalusia that identifies the specific aspects of the COVID-19 pandemic that have affected the mental health of pregnant women. The results contribute to a broader perception of the experience of women and the creation of health protocols for emergencies akin to the COVID-19 pandemic.

Development and application of a large-scale disaster preparedness system in the perinatal field.

To introduce the Perinatal Early Assessment and Communication system for Emergencies (PEACE), a dedicated internet-based system for sharing maternal and newborn health information during large-scale disaster. PEACE was developed by the Japan Society of Obstetrics and Gynecology (JSOG) to enable internet-based sharing of maternal and newborn support information between facilities and rescue teams in disaster areas. PEACE input rates during prefecture-scale disasters and in disaster drills were surveyed for two facility categories: centers for perinatal medical care (CPMs) and combined clinics + regional general hospitals. The PEACE input rate was 60%-100% (mean 86%) for CPMs and 5%-86% (mean 47%) among clinics + regional general hospitals. After encouraging PEACE input from JSOG, the Japan Association of Obstetricians and Gynecologists (JAOG), and the disaster response departments of prefectural governments, input rates increased significantly from 74% to 98% in CPMs (P= 0.018) and from 14% to 80% in clinics + regional general hospitals (P= 0.020). JSOG has established the first national system for sharing health information of pregnant women and newborns for use during disasters. The cooperation of prefectures and experience during disaster drills were critical to improving PEACE input rates.

Challenges facing workstyle reform for Japanese obstetricians and gynecologists revealed from time studies

We aimed to grasp the actual working hours of Japanese obstetricians and gynecologists (OB/GYN doctors) as accurately as possible, using the same method of the Ministry of Health, Labour, and Welfare (MHLW). The time study targeted OB/GYN doctors working at 10 universities nationwide including Niigata University and 21 institutions which take a role of perinatal care in Niigata prefecture. Working hours per week were calculated based on the following categories: regular and overtime work inside the hospital, work outside the hospital, self-improvement, education, research, and others. Data on weekly working hours were converted to yearly data for analyses. A time study of 10 universities nationwide revealed that 30% of doctors work overtime for more than 1860 h even if they do not include on-call shifts in their working hours. In 21 institutions in Niigata, physicians in Niigata University worked more overtime than other hospitals. It became clear that community health care was supported by dispatching physicians working at university. Furthermore, the results of simulations predicted the pessimistic situation of perinatal medical care in Niigata. Our study showed the possibility to exist much more OB/GYN doctors who work more than 1860 h of overtime work per year than the data presented by the MHLW based on nation-wide survey in 2019. The fact that the working hours at the side jobs had a great influence on the increase in overtime work of physicians in University was the same result as the report of MHLW published in 2021.

Perinatal Care Preparedness in Kochi Prefecture for When a Nankai Trough Earthquake Occurs: Action Plans and Disaster Liaisons for Pediatrics and Perinatal Medicine.

A Nankai Trough earthquake is highly likely to occur in near future, and perinatal medical resources and care in Kochi Prefecture may be insufficient after such an event. Therefore, we evaluated the medical and public health measures needed to prepare for caring for pregnant women in Kochi Prefecture in the aftermath of such an earthquake and the potential action plans for the prefecture. We estimated that immediately after an earthquake, approximately 30 pregnant women will require urgent medical treatment, most of whom will be in the prefectural capital, Kochi City, and perinatal medical care in Kochi City may be insufficient. Therefore, we used the projected flooding areas to divide Kochi City and its surrounding areas into 3 areas and allocated at least one Disaster Liaison for Pediatrics and Perinatal Medicine (DLPPM) to each disaster base hospital in those 3 areas. In a disaster, the DLPPMs will serve as key individuals in their respective areas and coordinate the allocation of medical care. A DLPPM will be allocated also within the Disaster Medical Response Headquarters of Kochi Prefecture and be responsible for overseeing perinatal care in the whole of Kochi Prefecture. Our study shows that estimating the number of affected pregnant women and requirement for perinatal medical care is an effective way to prepare realistic disaster measures and to enable a specific plan to be formulated for effective allocation and management of DLPPMs. We believe that our system can serve as a model in perinatal disaster medicine.

Disaster Preparedness at Perinatal Medical Care Facilities and Supporting Factors—Current Status of Disaster Management and Disaster Education for Perinatal Women

Disaster Preparedness at Perinatal Medical Care Facilities and Supporting Factors—Current Status of Disaster Management and Disaster Education for Perinatal Women

Management skills required for nursing middle managers in the next generation in perinatal medical care

Learning of management skills is necessary for the training of nursing middle managers in the next generation. However, in perinatal medical care, there have been few studies on management skills for midwives as middle managers. The aim of this study was to determine whether advanced midwives have an awareness of probable future changes in perinatal nursing and what management skills they consider will be required for nursing middle managers in the next generation. This study was a qualitative descriptive design conducted for 761 advanced midwives who work in hospitals having 300 beds or more and having an independent department of nursing during the period from November 2018 to May 2019 in Japan. Self-reported questionnaires were sent after receiving acceptance from directors of nursing and questionnaire forms from 501 midwives in 91 hospitals were analyzed. The proportion of midwives who responded that perinatal care and nursing will change in the next 10 to 20 years was 86.8%, and the items of the top three were increase in the number of pregnant women with a high risk, development of reproductive medicine and development of prenatal diagnosis. According to the responses to the questionnaires, management skills that are required for nursing middle managers in the next generation include the ability to deal with different values of midwives, the ability to train midwives with high ethical values and the ability to cooperate with the community. Midwives recognize the need for systematic training for nursing middle managers in the next generation having a high level of management skill. Key words: Advanced midwives, nursing middle managers in the next generation, management skill, predicted change.

Screening of COVID‐19 polymerase chain reaction tests using saliva for pregnant women and their partners in Himeji city

A screening of coronavirus disease 2019 (COVID-19) polymerase chain reaction (PCR) tests using saliva for pregnant women and their partners was performed at all 12 maternity facilities located in Himeji city between May 29 and September 5, 2020. Pregnant women at 37 or more weeks of gestation or who experienced threatened labor and their partners who cared for an infant underwent a saliva PCR test with informed consent. As a result, all of 1475 pregnant women and 1343 partners tested negative for COVID-19 PCR. There were no cases of false positive or false negative PCR tests. This cohort study revealed for the first time that a screening of COVID-19 PCR tests using saliva may be useful to sustain perinatal medical care during the pandemic period in Japan.

Weekend and off-hour effects on the incidence of cerebral palsy: contribution of consolidated perinatal care

ObjectiveThis study estimated the effects of weekend and off-hour childbirth and the size of perinatal medical care center on the incidence of cerebral palsy.MethodsThe cases were all children with severe cerebral palsy born in Japan from 2009 to 2012 whose data were stored at the Japan Obstetric Compensation System for Cerebral Palsy database, a nationally representative database. The inclusion criteria were the following: neonates born between January 2009 and December 2012 who had a birth weight of at least 2000 g and gestational age of at least 33 weeks and who had severe disability resulting from cerebral palsy independent of congenital causes or factors during the neonatal period or thereafter. Study participants were restricted to singletons and controls without report of death, scheduled cesarean section, or ambulance transportation. The controls were newborns, randomly selected by year and type of delivery (normal spontaneous delivery without cesarean section and emergency cesarean section) using a 1:10 case to control ratio sampled from the nationwide Japan Society of Obstetrics and Gynecology database.ResultsA total of 90 cerebral palsy cases and 900 controls having normal spontaneous delivery without cesarean section were selected, as were 92 cerebral palsy cases and 920 controls with emergent cesarean section. A significantly higher risk for cerebral palsy was found among cases that underwent emergent cesarean section on weekends (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.06–2.81) and during the night shift (OR 2.29, 95% CI 1.30–4.02). No significant risk was found among normal spontaneous deliveries on weekends (OR 1.63, 95% CI 0.97–2.73) or during the quasi-night shift (OR 1.26, 95% CI 0.70–2.27). Regional perinatal care centers showed significantly higher risk for cerebral palsy in both emergent cesarean section (OR 2.35, 95% CI 1.47–3.77) and normal spontaneous delivery (OR 2.92, 95% CI 1.76–4.84).ConclusionLabor on weekends, during the night shift, and at regional perinatal medical care centers was associated with significantly elevated risk for cerebral palsy in emergency cesarean section.

Current status of perinatal medical care in remote islands of Tokyo

Current status of perinatal medical care in remote islands of Tokyo

Eight principles for patient-centred and family-centred care for newborns in the neonatal intensive care unit

Despite the recent improvements in perinatal medical care leading to an increase in survival rates, adverse neurodevelopmental outcomes occur more frequently in preterm and/or high-risk infants. Medical risk factors for...

Structural Chromosomal Rearrangements Require Nucleotide-Level Resolution: Lessons from Next-Generation Sequencing in Prenatal Diagnosis

In this exciting era of "next-gen cytogenetics," integrating genomic sequencing into the prenatal diagnostic setting is possible within an actionable time frame and can provide precise delineation of balanced chromosomal rearrangements at the nucleotide level. Given the increased risk of congenital abnormalities in newborns with de novo balanced chromosomal rearrangements, comprehensive interpretation of breakpoints could substantially improve prediction of phenotypic outcomes and support perinatal medical care. Herein, we present and evaluate sequencing results of balanced chromosomal rearrangements in ten prenatal subjects with respect to the location of regulatory chromatin domains (topologically associated domains [TADs]). The genomic material from all subjects was interpreted to be "normal" by microarray analyses, and their rearrangements would not have been detected by cell-free DNA (cfDNA) screening. The findings of our systematic approach correlate with phenotypes of both pregnancies with untoward outcomes (5/10) and with healthy newborns (3/10). Two pregnancies, one with a chromosomal aberration predicted to be of unknown clinical significance and another one predicted to be likely benign, were terminated prior to phenotype-genotype correlation (2/10). We demonstrate that the clinical interpretation of structural rearrangements should not be limited to interruption, deletion, or duplication of specific genes and should also incorporate regulatory domains of the human genome with critical ramifications for the control of gene expression. As detailed in this study, our molecular approach to both detecting and interpreting the breakpoints of structural rearrangements yields unparalleled information in comparison to other commonly used first-tier diagnostic methods, such as non-invasive cfDNA screening and microarray analysis, to provide improved genetic counseling for phenotypic outcome in the prenatal setting.

Incidence of postpartum mood disorders depending on selected risk factors – a logistic regression model

The aim of the study was to assess the severity of mood disorders in women in the first and sixth week postpartum and to determine the incidence of baby blues depending on selected risk factors. Material and methods. 285 postpartum women were enrolled in the study. The research project was divided into two stages (first and sixth week postpartum). The Edinburgh Postnatal Depression Scale (EPDS) was used to assess the severity of mood disorders. The indicator of the presence of disorders was set at ≥ 12 points on the 30-point EPDS scale. In order to determine the impact of selected independent variables on the dichotomous dependent variable (baby blues), a logistic regression model was used based on the formula. Results. In the first week postpartum, baby blues was found in 23.2% of the postpartum women. The risk for postnatal depression after six weeks postpartum was determined in 17.3% of the women. The odds ratio for baby blues correlated with: unfavorable financial situation of the women (OR=2.56), a family history of mental disorders (OR=3.87), and dissatisfaction with medical care received during childbirth (OR=5.24). Conclusions Cases of baby blues were determined in every fourth woman from the sample group. The risk for postnatal depression was found in 17.3% of women after six weeks postpartum. The odds ratio for baby blues was affected by the following statistically significant factors: unfavorable financial situation of the women, genetic predispositions and dissatisfaction with perinatal medical care.

Absence of neonatal intensive care units in secondary medical care zones is an independent risk factor of high perinatal mortality in Japan.

National medical projects are carried out according to medical care plans directed by the Medical Care Act of Japan. In order to improve Japanese perinatal medical care, it is necessary to determine the factors that might influence perinatal outcome. Statistical data of births and perinatal deaths were obtained for all municipalities in Japan from 2008 to 2012 from the Portal Site of Official Statistics of Japan (e-Stat). The perinatal mortality of all 349 Japanese secondary medical care zones was calculated. The number of neonatal intensive care units (NICUs), maternal-fetal intensive care units (MFICUs), pediatricians and obstetricians in 2011 were also obtained from e-Stat. Nine secondary medical care zones in two prefectures, Fukushima (7) and Miyagi (2) were excluded to eliminate the influence of the 2011 Great East Japan Earthquake. The 340 secondary medical care zones were divided into three groups according to population size and density: metropolis, provincial city, and depopulation. The number of secondary medical care zones in each group were 52, 168, and 120, respectively. The secondary medical care zones in the depopulation group had fewer pediatricians and significantly fewer NICUs and MFICUs than the metropolis group, but there was no significant difference in perinatal mortality. The only independent risk factor for high perinatal mortality, determined by multivariable analysis, was the absence of an NICU (P = 0.011). To consider directions in perinatal medical care, planned arrangement and appropriate access to NICUs is indispensable.

Very low birth-weight as a risk factor for postpartum depression four to six weeks postbirth in mothers and fathers: Cross-sectional results from a controlled multicentre cohort study

BackgroundPreterm birth and survival rates of very low birth-weight (VLBW: <1.500g) infants have increased. Although new parents are frequently affected by depressive symptoms, little is known about prevalence, risk, and predictors of parental postpartum depression (PPD) following VLBW birth. Furthermore, most studies assessing PPD in parents of preterm children relied on self-report only. MethodsAs part of the HaFEn cohort-study, data from the index groups of parents with VLBW infants and the control group of parents with term infants were cross-sectionally analysed. Families were recruited at the three largest centres of perinatal medical care in Hamburg, Germany. PPD was evaluated one month postpartum using standardized questionnaires and clinical interviews. Socioeconomic status, social support, risks during pregnancy, and psychiatric lifetime diagnoses were also assessed. A multiple random coefficient model was used to examine predictors of PPD in both parents simultaneously. Results230 mothers and 173 fathers were included. Depending on the measure, the risk of being postnatally depressed was 4 to 18 times higher in mothers and 3 to 9 times higher in fathers from the index group. The most relevant risk factor for PPD was the birth of a VLBW infant, followed by female sex, lifetime psychiatric disorder, and low social support. LimitationsResults presented here, are based on cross sectional data. Therefore no temporal relationships can be established. ConclusionsOur findings highlight the importance of early screening for PPD in both parents of VLBW infants. Factors contributing to developing depression should also be considered in neonatal care.

Оценка степени участия биохимических маркеров перинатального поражения центральной нервной системы у детей

Pathology of the central nervous system in children of early age, due mainly hypoxic-ischemic brain damage in the antenatal period and delivery, which occupies a leading place among all factors of perinatal nervous system lesions in infants, is one of the most actual problems of modern medicine. Despite favourable demographic state, the improvement of the quality of perinatal care and medical care of newborns with a weight at birth from 500 grams, the tendency to reduction in the incidence of perinatal lesions of the central nervous system didn’t observed. On the contrary, there is progression of their course, which determines the subsequent mental and physical development of the child - from minimal brain dysfunction and gross motor and intellectual disorders, often resulting in disability. Purpose of the study is to evaluate the clinical features of central nervous system pathology in children of early age by means of neurobiochemistry markers and to develop prognostic criteria for the course and pathogenetic therapy regimens. Materials and methods. Comprehensive survey of 134 children (61 boys and 73 girls ) aged from 0 to 9 months was carried out with the assessment of neurological status and biochemical markers. Results of study. In formation of gravity of perinatal lesions all the studied markers participated, but to a greater extent – the parameters of neurotrophic lesions and endothelial dysfunction. The first component of the nervous tissue of the brain, responding to hypoxia, is microglial environment, which is caused by the growth of lesions S100- protein (i.e., the neuron at the stage of 0-1 months didn’t been metabolic changes – this is evidence of low levels of SOD and MDA).

Nature of Typical Ethical Problems Encountered by Midwives in Perinatal Medical Care in the Tokai Area of Japan

Nature of Typical Ethical Problems Encountered by Midwives in Perinatal Medical Care in the Tokai Area of Japan

Morphometric Study on the Anatomy of the Fetal Cricoid Cartilage and Comparison between its Inner Diameter and Endotracheal Tube Sizes

The high incidence of respiratory disorders is one of the main problems in perinatal medical care. With the increased use of intubation, the incidence of laryngeal injury causing stenosis has also increased. The principal constriction point in the infant's larynx is the midcricoid area. We sought to provide detailed morphometric data on the anatomy of the cricoid cartilage and its relationship with growth and body characteristics of fetuses at 5 to 9 months of gestational age. Nineteen larynges obtained from 17 stillborn infants and 2 newborn infants ranging in gestational age from 5 to 9 months were studied. Measurements of the cricoid cartilage were made with a millimeter-graded caliper. Weight was the variable most correlated with cricoid measurements. The cricoid lumen configuration showed an almost elliptic shape and did not change with gestational age. The mean inner subglottic cricoid area was 19.27 +/- 9.62 mm2 and was related to weight and body surface area. Cricoid growth was more pronounced at the outer portion of the cartilage. The cricoid lumen configuration was elliptic, and its mean area was smaller than that of available endotracheal tubes. This lumen area was most influenced by weight and height.