Perinatal Setting Research Articles

Passive neutralizing antibody controls SHIV viremia and enhances B cell responses in infant macaques

Maternal HIV-1-specific antibodies are efficiently transferred to newborns; their role in disease control is unknown. We administered non-sterilizing levels of neutralizing IgG, including the human neutralizing monoclonal IgG1b12, to six newborn macaques before oral challenge with SHIVSF612P3. All rapidly developed neutralizing antibodies and had significantly reduced plasma viremia for 6 months. These studies support the use of neutralizing antibodies in enhancing B cell responses and viral control in perinatal settings.

Using OB Simulation as an Innovative Strategy to Improve Outcomes in the Perinatal Setting

The technique of simulation has been used in crew resource management (CRM) training for many years. Developed by the aviation industry in response to accidents and safety issues, these team training techniques have shown to decrease medical errors and provide for safer outcomes. As the attention toward safety in the medical practice setting has gained attention, the use of simulation for team training in the perinatal setting has increased. The goal of CRM is to take a group of individuals and organize them into a team that can think and act as on unit in an emergency situation.

Intimate partner violence against Japanese and non‐Japanese women in Japan: A cross‐sectional study in the perinatal setting

To identify the prevalence of intimate partner violence (IPV) against Japanese women (JW) and non-Japanese women (NJW) in a perinatal setting. Additional purposes were to identify the associated factors of IPV, describe the characteristics of IPV against NJW, and assess the acceptability of the Violence Against Women Screen (VAWS) instrument as a screening tool. A cross-sectional survey was conducted from September to November 2007 in an urban hospital maternity clinic in Tokyo, Japan. Women who attended the maternity clinic received the VAWS instrument, which was translated into four languages (Japanese with Kanji and Hiragana, English, Chinese, and Tagalog) and was used to identify IPV. A total of 400 women participated in the study: 357 were JW and 43 were NJW. The prevalence rate of IPV among the JW was 31.4% and 21.4% among the NJW. There was no statistical significance between the two groups. A multiple logistic regression with adjusted odds ratio identified two associated factors for IPV: being multipara and previous experience of physical violence from a partner. The prevalence of IPV was not statistically different among JW and NJW. Screening for IPV, early intervention, and support should be expanded in hospitals and maternity clinics in Japan.

Retracted: Investigating factors associated with nurses’ attitudes towards perinatal bereavement care: a study in Shandong and Hong Kong

To explore nurses' attitudes towards perinatal bereavement care and to identify factors associated with these attitudes. It is likely that the attitude of nursing staff can influence recovery from a pregnancy loss and that nurses with positive attitudes to bereavement care can help bereaved parents to cope during their grieving period. Survey. Data were collected through a structured questionnaire; 657 nurses were recruited from Obstetrics and Gynaecology units in Hong Kong and Shandong during 2006. Outcome measures included attitudes towards perinatal bereavement care, importance of hospital policy and training support for bereavement care. The majority of nurses in this study had a positive attitude to bereavement care. Results show that only 21.6% (n = 141) of the nurses surveyed had bereavement-related training. In contrast, about 89.8% (n = 300) believed they needed to be equipped with relevant knowledge, skills and understanding in the care and support of bereaved parents and more than 88.5% (n = 592) would share their experiences with their colleagues and seek support when feeling under stress. A regression model showed that age, past experience in handling grieving parents, recent ranking and nurses' perceived attitudes to hospital policy and training provided for bereavement care were the factors associated with nurses' attitudes to perinatal bereavement care. Nurses in both cities emphasised their need for increased knowledge and experience, improved communication skills and greater support from team members and the hospital for perinatal bereavement care. These findings may be used by nursing educators to educate their students on issues related to delivery of sensitive bereavement care in perinatal settings and to enhance nursing school curricula.

Tobacco-Related Practices and Policies in Residential Perinatal Drug Treatment Programs

Despite serious health consequences from high rates of smoking among perinatal women, smoking cessation and/or nicotine treatment practices have yet to be broadly adopted into perinatal substance abuse treatment settings. This correlational cross-sectional survey examined tobacco-related policies, practices, knowledge, and attitudes of 31 directors of perinatal residential substance abuse treatment programs in California. We found that the directors' programs had limited on-site adoption of evidence-based practices for smoking cessation, and that directors had gaps in their knowledge of perinatal tobacco effects. Implications for tobacco policy initiatives in perinatal substance abuse treatment are discussed.

Investigating factors associate to nurses’ attitudes towards perinatal bereavement care

The purpose of this study was to explore nurses' attitudes towards perinatal bereavement care and to identify factors associate with such attitudes. Caring for and supporting parents whose infant has died is extremely demanding, difficult and stressful. It is likely that the attitude of nursing staff can influence recovery from a pregnancy loss and nurses with positive attitude to bereavement care can help bereaved parents to cope during their grieving period. Data were collected through a structured questionnaire; 334 nurses were recruited (63% response rate) from the Obstetrics and Gynaecology unit in five hospitals in Hong Kong during May-August 2006. Outcome measures including attitudes towards perinatal bereavement care, importance on hospital policy and training support for bereavement care. Majority of nurses in this study held a positive attitude towards bereavement care. Results showed that only 39.3% (n = 130) of nurses had bereavement related training. By contrast, about 89.8% of nurses (n = 300) showed they need to be equipped with relevant knowledge, skills and understanding in the care and support of bereaved parents and more than 88.0% (n = 296) would share experiences with colleagues and seek support when feeling under stress. Regression model showed that age, past experience in handling grieving parents and nurses' perceived attitudes to hospital policy and training provided for bereavement cares were factors associate with nurses' attitudes towards perinatal bereavement care. Hong Kong nurses emphasized their need for increased knowledge and experience, improved communication skills and greater support from team members and the hospital for perinatal bereavement care. These findings may be used for health policy makers and nursing educators to ensure delivery of sensitive bereavement care in perinatal settings and to enhance nursing school curricula respectively.

Determination of asymmetric dimethylarginine, an endogenous nitric oxide synthase inhibitor, in umbilical blood

Endothelial cells produce nitric oxide (NO), a potent vasodilator. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of NO synthase. Little is known about the potential physiological roles of ADMA in a perinatal setting. This study measures concentrations of ADMA in umbilical blood using enzyme-linked immunosorbent assay and those of NO as nitrite/nitrate (NOx −) using the Griess assay. Their relationship to the degree of prematurity and maternal clinical condition is examined. Results show that ADMA concentrations in umbilical blood from control newborns were about twice as high as those of lactating women, healthy children, and healthy adults. Umbilical blood NOx − concentrations from control newborns were about half of those of lactating women, healthy children, and healthy adults. Consequently, the levels of ADMA relative to NOx − were about 4-fold higher in umbilical blood from control newborns than in blood from lactating women, healthy children, and healthy adults. Furthermore, the umbilical blood ADMA concentrations and the ratios of ADMA to NOx − in newborns were higher according to their birth prematurity and lower birth weight. The umbilical ADMA concentrations were independent of the delivery mode and maternal preeclampsia. We infer that the high ADMA levels play physiological roles in maintaining vascular tone and blood redistribution to vital organs during birth, thereby favoring the circulatory transition from fetal to neonatal life.

Acceptability of perinatal rapid point-of-care HIV testing in an area of low HIV prevalence in the UK

Objective: To determine the uptake of current antenatal HIV testing, the prevalence of risk factors for HIV in pregnant women and the acceptability of the rapid point-of-care HIV test (RPOCT)...

Examining the relationship between antenatal anxiety and postnatal depression

Background Antenatal anxiety has received increased attention with regards to both its impact on infant outcomes and as a risk factor for postnatal depression. The measurement of anxiety in the perinatal setting, however, has proven to be challenging. The aims of the present study are to: determine whether antenatal anxiety as measured by the Brief Measure of Worry Severity (BMWS) is a significant predictor of postnatal depression (PND); examine the psychometric properties of a new measure of anxiety – the BMWS – in an antenatal sample; and examine the comparative capacity of the BMWS to the Speilberger State Trait Anxiety Inventory (STAI) in predicting PND. Method A sample of 748 women completed the BMWS and STAI during the third trimester of pregnancy and returned the Edinburgh Postnatal Depression Scale (EPDS) at 8 weeks postpartum. Results Women with high antenatal anxiety on the BMWS were 2.6 times more likely to have probable PND than those with low scores, even after controlling for confounding factors, including level of antenatal depression on the EPDS. In contrast, the STAI was no longer a significant predictor of PND after controlling for these variables. The BMWS has good construct validity, with scores on this scale correlating strongly with scores on other measures of anxiety, depression and perinatal risk. Limitations When compared to those who participated in the follow-up at 8 weeks postnatally, those who did not participate appeared to be at greater risk of developing PND, raising the possibility of attrition bias within this sample. Conclusions The findings from this study suggest that the BMWS has utility in measuring antenatal anxiety in both clinical and research settings and that antenatal anxiety is an important precursor of PND.

RETRACTED: Attitudes of midwives towards perinatal bereavement in Hong Kong

to explore attitudes towards perinatal bereavement care among midwives working in Hong Kong through examination of relationships between attitudes towards bereavement support, need for bereavement education and appropriate hospital policy. a descriptive correlational survey. the obstetric and gynaecology units at two hospitals. a structured self-report questionnaire on attitudes towards perinatal bereavement support; required support and education needs for midwives on bereavement care. 154 out of 202 midwives (76.2% response rate) working at the two units. two-step cluster analysis yielded two clusters. Cluster 1 consisted of 91 (59.1%) midwives and cluster 2 consisted of 63 (40.9%) midwives. Cluster 2 midwives were younger, had less obstetric and gynaecology experience, junior ranking and less post-qualification education than cluster 1 midwives. Cluster 1 midwives had additional personal grieving experiences and experience of caring for grieving parents. Attitudes towards bereavement care were positively correlated with educational needs (r(s)=0.55, p< 0.001) and hospital policy support (r(s)=0.50, p< 0.001). Hong Kong midwives require increased bereavement care knowledge and experience, improved communication skills, and greater hospital and team member support. Findings may be used to improve support of midwives, to ensure sensitive bereavement care in perinatal settings and to reflect training needs in the midwifery education curricula. Study findings highlight the universality of grief for a lost baby, irrespective of cultural differences in approaching emotional topics. This study may help midwives internationally to gain a broader perspective in this area.

Mother-to-infant transmission of hepatitis C virus and of other blood-borne viral infections from multi-infected mothers

Introduction. Previous studies demonstrated that in multi-infected patients, viral interactions can modify disease activity and in perinatal settings may affect mother-to-infant transmission of singles viruses. By contrast, it is still unknown whether the risk of transmission of multiple infections increases with the number of viruses infecting the mother. The aim of this study was to describe the risk of mother-to-infant transmission of multiple infections from multi-infected mothers.

Omega-3 Fatty Acid Supplementation in Perinatal Settings

The purpose of this article is (a) to explain the role of omega-3 fatty acids in human health, specifically in fetal/neonatal development, (b) to summarize the recent research behind the innovations in infant formula manufacturing and advertisement of omega-3 fatty acid supplementation for pregnant and lactating mothers, and (c) to relate the research findings to clinical practice. Omega-3 fatty acid supplementation in perinatal settings is discussed here from three vantage points: (a) supplementation of the third-trimester pregnant woman to enhance fetal development, (b) supplementation of the lactating mother to enhance development of the breastfeeding infant, and (c) supplementation of infant formulas to enhance development of the bottle-feeding infant. Supplementation can occur by increasing one's intake of foods high in omega-3 fatty acids or by ingesting fatty acid nutritional supplements. The challenge of supplementation for vegan and vegetarian women is also addressed.

Embracing the Role of the Advanced Practice Nurse in the Perinatal Setting

Embracing the Role of the Advanced Practice Nurse in the Perinatal Setting

Simulation of Perinatal Emergencies.

AIM – The purpose of this perinatal simulation project is to develop a guide for writing, implementing and evaluating crisis resource management scenarios for nurses working with a multidisciplinary team in the inpatient perinatal setting. Program goals include enhancing the nurses’ knowledge and skills related to critical events in the perinatal setting and meeting the organizational goal of improving patient safety by establishing a strong culture of teamwork and communication. PROJECT DESIGN: Obstetrical training scenarios will be created using a human patient simulator (METI Inc.) and the OB TraceVue (Philips Medical Systems). These scenarios will be designed to simulate intrapartum patients seen in the University of California, Davis Medical Center’s Birthing Suites. Nursing participants will be divided into groups and asked to play one of three roles per scenario: primary nurse, charge nurse, or staff nurse. Perinatal emergencies consisting of shoulder dystocia, prolapsed cord and prolonged deceleration will be presented. The project will focus on understanding the elements needed for effective communication, how proper communication can increase effective teamwork, and how communication and effective teamwork can play a role in patient safety using the scenarios and post-scenario team debriefing. PRIMARY OUTCOME: Improved communication and teamwork through simulating critical events in the perinatal setting. SECONDARY OUTCOME: Improved quality of training for new staff as well as the competency of experienced nurses related to perinatal emergencies.

The Role of Rapid vs Conventional Human Immunodeficiency Virus Testing for Inpatients

Rapid testing for human immunodeficiency virus (HIV) has improved HIV screening in the outpatient and perinatal settings, but few data report how it may be used to improve the quality of inpatient care. We compared quality of care for inpatients diagnosed in the emergency department via rapid testing vs patients whose conditions were diagnosed via conventional testing during their hospital admission. We reviewed medical records to identify patients with first-time positive HIV tests and concurrent hospital admission who were tested via either rapid testing in the emergency department or conventional testing during their hospital admission. We compared quality-of-care end points for these patients. We identified 103 HIV-infected inpatients with no previous HIV diagnosis; the conditions of 48 patients (47%) were diagnosed by rapid testing and 55 (53%) by conventional testing. Mean length of stay was 6 days for the rapid test group vs 13 days for the conventional test group (P<.001); multivariate regression analysis showed that testing modality had an independent, statistically significant effect on length of stay. Nine (16%) of the patients in the conventional test group vs none in the rapid test group were discharged without receiving their HIV test results (P = .002). Patients in the rapid test group attended the outpatient HIV clinic in a mean of 22 days vs 50 days for the conventional test group patients (P = .05). Rapid HIV testing in the emergency department preceding admission may shorten hospital stay, increase the number of newly diagnosed patients with HIV who are discharged from the hospital aware of their HIV status, and improve entry into outpatient care for patients admitted at the time of their initial HIV diagnosis.

Attitudes of Nurses Toward Perinatal Bereavement

Nurses' attitudes toward perinatal bereavement care are explored by identifying profiles of nurses working in 2 obstetrics and gynecology units in Hong Kong. Relationships between nurses' attitudes toward bereavement supports, need for bereavement education, and hospital policy are explored. A descriptive, correlational survey design was used, and 169 nurses recruited from an obstetric and gynecology (ob-gyn) unit at 2 local public hospitals in Hong Kong completed a structured questionnaire. Attitudes toward perinatal bereavement support; required support and education needs for nurses on bereavement care. Two-step cluster analysis yielded 2 clusters. Cluster 1 consisted of 55.6% (n = 94) and cluster 2 consisted of 44.3% (n = 75) of nurses. Cluster 2 nurses were younger and had less ob-gyn experience, more junior ranking, and less education than cluster 1 nurses. Cluster 1 nurses had additional midwifery and bereavement care education, personal grieving experiences, and experience handling grieving clients. The majority held positive bereavement care attitudes, but only 29.6% (n = 50) had bereavement-related education. Attitudes toward bereavement care were positively correlated with educational needs (r(s) = 0.52) and hospital policy support (r(s) = 0.56). Hong Kong nurses emphasized the need for increased bereavement care knowledge and experience, improved communication skills, and greater hospital and team members' support. Findings may be used to improve support of nurses, to ensure sensitive bereavement care in perinatal settings, and to enhance nursing curricula. The desire of Hong Kong nurses for bereavement education highlights the universality of grief for a lost infant, regardless of cultural differences in approaching emotional topics. This study may help nurses in the United States and elsewhere gain a broader perspective in this area.

Concentrations of thioredoxin, a redox-regulating protein, in umbilical cord blood and breast milk

Growing evidence indicates that oxidative stress occurs during the fetal-to-neonatal transition. Such stress plays an important role in the pathogenesis of many neonatal diseases. Thioredoxin (TRX), a redox-regulating protein with antioxidant activity, is induced in various cells against oxidative stress and is secreted extracellularly. This study was undertaken to examine the clinical and biological importance of TRX in the perinatal setting. We measured concentrations of TRX in umbilical cord blood and breast milk using a sandwich ELISA. Our study demonstrated that concentrations of TRX in umbilical cord blood were six to seven times higher than those in blood of healthy adults. This study also showed that umbilical concentrations of TRX were correlated significantly with the extent of prematurity of the newborn, and that they were elevated significantly in newborns of mothers with preeclampsia compared to those of mothers without preeclampsia. In contrast, concentrations of coenzyme Q10 and vitamin E in umbilical blood were lower than adult blood levels. Breast milk concentrations of TRX during the early postpartum period were seven to eight times higher than those in blood of lactating women. Those of the coenzyme Q10 were lower than adult blood levels, while those of vitamin E were comparable to adult blood levels. Our findings suggest that the systemic release of TRX is enhanced at birth, and that early breast milk is a rich source of this protein. Consequent high levels of TRX in newborns may provide a unique protective mechanism that allows the maintenance of redox balance during the fetal-to-neonatal transition.

Screening of domestic violence against women in the perinatal setting: A systematic review

AbstractAim: To review published studies focusing on the screening of domestic violence (DV) against women, in particular, the instruments, the screening methods and the interventions used to help abused women after screening. Based on the results of the review, the suitability of introducing routine screening for DV in the perinatal setting in Japan would be assessed.Methods: National Guideline Clearinghouse database, HSTAT, PubMed, CINAHL, the Cochrane Library and the Ichushi‐Web were all used to searched from when records were first held until February 2003 for eligible primary studies and systematic reviews for this literature review. Each selected article was independently read and appraised by two reviewers who finally selected 12 primary studies and three systematic reviews that fulfilled the criteria for inclusion.Results: Three studies evaluated screening instruments for DV (i.e. Abuse Assessment Screen, Partner Violence Screen and Violence Against Women Screen) and of these, the Violence Against Women Screen was the most valid, reliable and suitable for use in the clinical setting in Japan. The three studies that examined the screening method had differing results, but the one conducted in Japan showed a significantly higher rate of identification in the self‐administered questionnaire group compared with the interview group. The six studies that tested the effectiveness of interventions for abused women showed that counseling sessions after screening and the advocacy program for postsheltered women were effective in reducing DV.Conclusion: Routine screening of all pregnant women in Japan for DV should be introduced, considering the high burden of suffering that women expose to DV experience, and the existence of both acceptable screening instruments and effective interventions.

A pilot study on nurses' attitudes toward perinatal bereavement support: a cluster analysis

Aim: Nurses' attitudes towards perinatal bereavement care are explored by identifying profiles of nurses working in a Hong Kong Obstetrics and Gynaecology (OAG) unit. Relationships between nurses' attitudes towards bereavement support, need for bereavement training and hospital policy are explored. Research method: 110 nurses recruited from the OAG unit of a large Hong Kong public hospital completed a structured questionnaire. Outcome measures: Attitudes towards perinatal bereavement support; required support and training needs for nurses on bereavement care. Results: Two-step cluster analysis yielded two clusters. Cluster A consisted of 55.5% ( n=61) and cluster B consisted of 44.5% ( n=49) of nurses. Cluster A nurses were younger, had less OAG experience, more junior ranking and less education than cluster B nurses. Cluster B nurses had additional midwifery and bereavement care training, personal grieving experiences and experience handling grieving clients. The majority held positive bereavement care attitudes. Significant differences towards perinatal bereavement support were found. Only 25.5% ( n=28) had bereavement related training. Attitudes towards bereavement care were positively correlated with training needs ( r s=0.59) and hospital policy support ( r s=0.60). Conclusion: Hong Kong nurses emphasized need for increased bereavement care knowledge and experience, improved communication skills, and greater hospital and team members' support. Findings may be used to improve support of nurses, to ensure sensitive bereavement care in perinatal settings, and to enhance nursing curricula.

Adverse Perinatal Outcomes & Preventing Common Accidents

To minimize patient harm and injury, it's important that perinatal nurses, and those who care for women in the perinatal setting, be familiar with themes commonly associated with patient harm and accidents. These five cases will help determine whether an accident framework would be useful for a better understanding of causation, and using such a framework, strategies designed to decrease the probability of recurrence will be discussed, thereby increasing patient safety as well as minimizing adverse consequences to providers.