Postnatal Ward Research Articles

The impact of maternity service restrictions related to COVID-19 on women's experiences of giving birth in England: A qualitative study

BackgroundThe COVID-19 pandemic led to significant changes in maternity service delivery in England, including: antenatal appointments being cancelled or held by phone; women having to attend antenatal scans alone; partners not being allowed to accompany women during labor; visitor restrictions on postnatal wards; and limited postnatal support. MethodsWe conducted semi-structured interviews with 46 women aged 18–45 who had low-risk pregnancies and gave birth to their babies using NHS services in England between 1st March 2020 and 1st March 2021. ResultsOur thematic analysis of interview data generated key themes: profound negative impacts of birth partners not being allowed to accompany women (including on emotional wellbeing, birth preferences and care-seeking choices); deep frustration about policy variation between trusts and inconsistent implementation of guidance; women being more concerned about the risk of giving birth alone than of COVID-19 infection; and women turning towards private care or delaying seeking NHS care so that they could have the birth experience they desired. The latter two results are, to the best of our knowledge, unique to this paper. ConclusionOur participants reported significant negative affects to their emotional and physical wellbeing because of maternity service restrictions. Going forward, efforts are required by policymakers and health service providers to re-establish trust in NHS maternity care and ensure capacity to provide for potential shifts in birthplace preferences. Health systems strengthening efforts should prioritise protecting the rights of women to access high quality, person-centred care in the event of future health emergencies that strain NHS capacity.

Psychosocial and Perceived Stress Associated with Pre-eclampsia in a Periurban Hospital

Pre-eclampsia complicates about 2% of pregnancy Exact aetiology of Pre-eclampsia is not known, however a number of psychosocial factors are often found to be associated with it. The purpose of the study was to ascertain the prevalence of psychosocial factors and perceived stress among patients with Pre-eclampsia. This was a cross sectional study done at institute of child and mother health during July to September, 2015. Total 71 women admitted for delivery with diagnosis of Preeclampsia were interviewed in the postnatal ward within three days of delivery using a structured questionnaire. Informed consent was taken. Data analyzed using SPSS version 22. Mean age was 23.9± 4.3 years with a range of 18-36 years, about a quarter were illiterate. Majority of them stay within extended family and mean household family member was 6.25± 1.93 about 77.5% of husbands were smokers, history of abortion was present in 21.1%. More than half of them have history of hypertension or diabetes in the family. Mean Systolic BP was 122.6±21.3 and mean diastolic BP was 83.5±14.6. About 42.2% reported that their family members were not aware of need of proper nutrition during pregnancy rather were indifferent. Ability to spend money by her was limited, sometimes by 33.8%, 28.2% if they ask for and 36.6% never have the opportunity. On recall of last one month period a significant proportion of women stated that they felt to be stressed sometimes during pregnancy. Risk factors for Preeclampsia like family history of Hypertension and Diabetes, passive smoking, low education level was found quite prevalent among women with pre-eclampsia. Majority of women reported to experience moderate stress and prevalence of stress was more among 19-24 years age group. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 119-126

Assessment of antenatal care satisfaction amongst postpartum women at the University College Hospital, Ibadan, Nigeria

BackgroundMaternal mortality is unacceptably high especially in developing countries. About 287,000 women died during and following pregnancy and childbirth in 2020. The vast majority of these deaths (95 %) occurred in low and lower middle countries in 2020 and most could have been prevented. Every day in 2020, approximately 800 women died from preventable causes related to pregnancy and childbirth. Utilization of antenatal visit has been shown to improve birth outcome as well as the maternal outcome during pregnancy-related events, giving a positive impact when the visit frequency and care are adequate while satisfaction has equally been an important outcome measures of quality of care. In order to improve feto-maternal outcome and turn the tide against maternal deaths, it is expedient to assess the satisfaction of women who had experienced antenatal care with the aim of identifying areas requiring additional attention. ObjectiveThis study aimed to assess the level of antenatal care satisfaction of postpartum women and factors associated with satisfaction at the University College Hospital (UCH), Ibadan and their future intention for subsequent utilization of antenatal care. MethodsA descriptive cross-sectional study of 261 women in the postnatal ward using simple random sampling technique was conducted with an interviewer-administered structured questionnaire. Items in the questionnaire included sociodemographic and obstetric variables, assessment of quality of amenities, waiting time and level of satisfaction. Data was entered, cleaned and analyzed by computer using the Statistical Package for Social Sciences Version 23.0 (SPSS, IBM). The variables were summarized using frequencies, proportions, means and standard deviation. Chi Square was used for test of significance with the p-value set at P < 0.05. ResultsOf the 261 participants 176 (67.5 % percent) were aged 25–34 years; majority (244,93.5 %) had tertiary education while (189, 72.4 %) were skilled workers or professionals. Most of the women (243, 93.2 %) were Para 1–3 and the pregnancy was planned (80.8 %) while financing was mostly out of pocket (60.9 %). Only one-third of the participants has at least eight (8) antenatal contacts. In overall rating, most women (90.0 %) were satisfied with the antenatal care services received. The highest rating of satisfaction was with the competence of the service providers (90.4 %) especially with the care given to them and their unborn babies (90.4 %). The parity, distance of their home from antenatal clinic, number of antenatal contacts, number of health education sessions attended, total time spent, attitude of health workers, cost of services and desire to register again at the facility were statistically associated with patient’s satisfaction. Also, the number of antenatal visits was statistically associated with the fetal outcome. ConclusionThere is a high overall level of satisfaction with antenatal services among postpartum women in UCH. It is important to encourage women to register early to ensure they have adequate number of antenatal contacts and also participate in the health education sessions.

Development of neonatal-specific sequences for portable ultralow field magnetic resonance brain imaging: a prospective, single-centre, cohort study

Magnetic Resonance (MR) imaging is key for investigation of suspected newborn brain abnormalities. Access is limited in low-resource settings and challenging in infants needing intensive care. Portable ultralow field (ULF) MRI is showing promise in bedside adult brain imaging. Use in infants and children has been limited as brain-tissue composition differences necessitate sequence modification. The aim of this study was to develop neonatal-specific ULF structural sequences and test these across a range of gestational maturities and pathologies to inform future validation studies. Prospective cohort study within a UK neonatal specialist referral centre. Infants undergoing 3T MRI were recruited for paired ULF (64mT) portable MRI by convenience sampling from the neonatal unit and post-natal ward. Key inclusion criteria: 1) Infants with risk or suspicion of brain abnormality, or 2) preterm and term infants without suspicion of major genetic, chromosomal or neurological abnormality. Exclusions: presence of contra-indication for MR scanning. ULF sequence parameters were optimised for neonatal brain-tissues by iterative and explorative design. Neuroanatomic and pathologic features were compared by unblinded review, informing optimisation of subsequent sequence generations in a step-wise manner. Main outcome: visual identification of healthy and abnormal brain tissues/structures. ULF MR spectroscopy, diffusion, susceptibility weighted imaging, arteriography, and venography require pre-clinical technical development and have not been tested. Between September 23, 2021 and October 25, 2022, 102 paired scans were acquired in 87 infants; 1.17 paired scans per infant. Median age 9 days, median postmenstrual age 40+2 weeks (range: 31+3-53+4). Infants had a range of intensive care requirements. No adverse events observed. Optimised ULF sequences can visualise key neuroanatomy and brain abnormalities. In finalised neonatal sequences: T2w imaging distinguished grey and white matter (7/7 infants), ventricles (7/7), pituitary tissue (5/7), corpus callosum (7/7) and optic nerves (7/7). Signal congruence was seen within the posterior limb of the internal capsule in 10/11 infants on finalised T1w scans. In addition, brain abnormalities visualised on ULF optimised sequences have similar MR signal patterns to 3T imaging, including injury secondary to infarction (6/6 infants on T2w scans), hypoxia-ischaemia (abnormal signal in basal ganglia, thalami and white matter 2/2 infants on T2w scans, cortical highlighting 1/1 infant on T1w scan), and congenital malformations: polymicrogyria 3/3, absent corpus callosum 2/2, and vermian hypoplasia 3/3 infants on T2w scans. Sequences are susceptible to motion corruption, noise, and ULF artefact. Non-identified pathologies were small or subtle. On unblinded review, optimised portable MR can provide sufficient contrast, signal, and resolution for neuroanatomical identification and detection of a range of clinically important abnormalities. Blinded validation studies are now warranted. The Bill and Melinda Gates Foundation, the MRC, the Wellcome/EPSRC Centre for Medical Engineering, the MRC Centre for Neurodevelopmental Disorders, and the National Institute for Health Research (NIHR) Biomedical Research Centres based at Guy's and St Thomas' and South London & Maudsley NHS Foundation Trusts and King's College London.

Investigating short-stay admission to a neonatal intensive care unit as a risk factor for reduced breast feeding at discharge in infants ≥36 weeks’ gestation: a retrospective cohort study

ObjectiveThis study aims to determine the effect of infant–mother separation following a short-stay (≤72 hours) admission to a Level 5 neonatal unit versus no admission on infant-feeding outcomes at hospital...

Kaiser Permanente early-onset sepsis calculator as a safe tool for reducing antibiotic use among chorioamnionitis-exposed term neonates: Qatar experience

Being an important cause of early-onset neonatal sepsis, clinical chorioamnionitis in the mother results in frequent laboratory workup and antibiotic use for the neonate. Neonatal intensive care units (NICUs) in...

Midwife or doctor leader to implement a national guideline in babies on postnatal wards (DesIGN): A cluster-randomised, controlled, trial.

The aim of this trial was to determine if midwives or doctor leaders are more effective at implementing a clinical practice guideline for oral dextrose gel to treat neonatal hypoglycaemia. This was a cluster-randomised, controlled, trial. New Zealand maternity hospitals were randomised to guideline implementation by a midwife or doctor implementation leader. The primary outcome was the change in the proportion of hypoglycaemic babies (blood glucose concentration <2.6 mmol/L in the first 48 hours after birth), treated with dextrose gel from before, to three months after, implementation. Twenty-one maternity hospitals that cared for babies at risk of hypoglycaemia consented to participate, of which 15 treated babies with hypoglycaemia at both time points (7 randomised to midwifery led, 8 randomised to doctor led implementation). The primary outcome included 463 hypoglycaemic babies (292 midwifery led, 171 doctor led implementation). There was no difference in the primary outcome between hospitals randomised to midwifery or doctor led implementation (proportion treated with gel, mean(SD); midwifery led: before 71 (38)%, 3 months after 87 (12)%; doctor led: before 63 (43)%, 3 months after 86 (16)%; adjusted mean change in proportion (95%CI); 19.3% (-4.5-43.1), p = 0.11). There was an increase in the proportion of eligible babies treated with oral dextrose gel from before to 3 months after implementation of the guideline (122/153 (80%) v 144/163 (88%), OR (95%CI); 3.42 (1.67-6.98), p<0.001). Implementation of a clinical practice guideline improved uptake of oral dextrose gel. There was no evidence of a difference between midwife and doctor implementation leaders for implementing this guideline for treatment of hypoglycaemic babies. The trial was prospectively registered on the ISRCTN registry on the 20/05/2015 (ISRCTN61154098).

Assessing the safety and use of medicinal herbs during pregnancy: a cross-sectional study in São Paulo, Brazil.

Background: Despite the lack of evidence supporting the safety and clinical efficacy of herbal medicine (HM), its use among pregnant women continues to increase. Given the high prevalence of contraindicated herbs among the pregnant population in Brazil, it is crucial to examine the use of HM and evaluate its safety based on the current scientific literature to ensure that women are using HM appropriately. Methods: A cross-sectional study was conducted from October 2022 to January 2023 at a public teaching hospital in São Paulo, Brazil. A total of 333 postpartum women in the postnatal wards and postnatal clinic were interviewed using a semi-structured questionnaire. The survey instrument consisted of 51 items covering the use of HM during pregnancy, sociodemographic and health-related characteristics, COVID-19 experiences, and pregnancy outcomes. For data analysis, chi-square and multivariate logistic regression were conducted using SPSS ver. 26.0. Results: Approximately 20% of respondents reported using HM during their most recent pregnancy, with a higher use observed among women from ethnic minority groups and those with prior HM experience. Among the 20 medicinal herbs identified, 40% were found to be contraindicated or recommended for use with caution during pregnancy. However, only half of the women discussed their HM use with obstetric care providers. Conclusion: This study emphasizes the continued public health concern regarding the use of contraindicated or potentially harmful HM among pregnant women in Brazil, highlighting the need for sustained efforts to reduce the risk of inappropriate HM use. By updating antenatal care guidelines based on the latest scientific evidence, healthcare providers can make informed clinical decisions and effectively monitor pregnant women's HM use, ultimately promoting safer and more effective healthcare practices.

Prevalence and Factors Associated with Syphilis among Mothers with Missed Opportunities for Antenatal Syphilis Testing in Rural Western Uganda: A Cross-Sectional Study.

Early prenatal syphilis testing and treatment are essential preventative measures for maternal syphilis and associated adverse pregnancy outcomes of pregnancy; however, data shows that two-thirds of all cases are missed among women who visit prenatal care center at least once but are not tested for syphilis. This study determined the prevalence and factors associated with syphilis infection among mothers with missed opportunities for antenatal syphilis testing in rural western Uganda delivered at Fort Portal Regional Referral Hospital (FRRH). A cross-sectional study was done during the period from April 2022 to June 2022. A total of 124 participants had been recruited consecutively from postnatal ward of FRRH. Pretested questionnaires were used to obtain information on data required for analysis. Venous blood sampling (2 ml taken from the forearm using anticoagulant free vacutainer) was done for all mothers who missed opportunity for prenatal syphilis testing using both RPR and TPHA. Descriptive statistics followed by binary logistic regression analysis was done using SPSS version 22.0. The prevalence of syphilis infection was 27 (21.8%). After adjusted analysis, having more than one sexual partners in the past one year was associated with higher odds of syphilis infection (aOR = 24.922, 95% CI: 4.462-139.201, p < 0.001), and staying with the partner was found to be associated with lower odds of syphilis infection (aOR = 0.213, 95% CI: 0.040-1.142, p = 0.050). The study identified high prevalence of syphilis infection among mothers with missed opportunities for antenatal syphilis testing, and this was positively associated with having more than one sexual partners in the past one year and negatively associated with not staying with partner.

RESPECTFUL MATERNITY CARE AND THEIR POSTPARTUM EFFECTS IN WOMEN

Aim:To recognise the benefits of Respectful Maternity Care during labor and encouraging the practice of the same. Design: Cross Sectional Study Methodology : Sample Size : 100 patients Inclusion Criteria :Antenatal patients in Active Phase of Labor proceeding for Normal Vaginal Delivery Procedure : The study is a questionnaire based study. The study population will be antenatal patients admitted in a Tertiary Care Hospital. After getting informed consent , the procedure will be explained thoroughly to the participants and only the participants who are willing to take part in the study will be selected. The participants were observed in the labor ward and the post natal ward during their stay in the hospital .They were asked to answer a questionnaire postnatally . The questionnaire contains questions related to the WHO recommendations of the Respectful Maternity Care which includes topics like dignity, privacy and confidentiality, ensuring freedom from harm and mistreatment, and enabling informed choice and continuous support during labour and childbirth. This study is complelety a non invasive study. Study Duration: 4 Months Results: The study population included 100 participants admitted for labor in a tertiary care hospital where they received proper Respectful Maternity Care both antenatally and Postnatally. It was observed that women who were treated with proper RMC had more bonding with their babies and were able to breastfeed more effectively. The participants did not have common complaints of post partum depression, hesitancy to breastfeed, insomnia, lack hesitancy to Breast feed and reduced incidence of Traumatic Deliveries. Conclusion: Providing Respectful Maternity Care to antenatal patients has more positive outcomes in both antenatal and postnatal periods of a patient. It reduces common post partum ailments and promotes maternal and neonatal well being by reducing maternal and neonatal morbidity and mortality rate.

Depression and Its Determinants among Postpartum Mothers Attending at Universal College of Medical Sciences and Teaching Hospital, Bhairahawa, Rupandehi, Nepal.

Postpartum depression is a serious mental health issue linked to maternal morbidity and negative effects for infant's normal growth, development, and well-being. This study is aimed at assessing the prevalence and factors associated with postpartum depression among mothers attending a tertiary hospital in Nepal. A hospital-based cross-sectional study was conducted among 173 postpartum mothers (<6 weeks postdelivery) who were receiving care either at the postnatal ward or immunization clinic of Universal College of Medical Sciences and Teaching Hospital in Bhairahawa, Rupandehi district, Nepal. The study was carried out from October 2020 to February 2021 by using purposive sampling technique for selecting respondents. The variables that showed significant association with the dependent variable having p value < 0.05 in bivariate analysis were entered into multivariate logistic regression model to find the final associated factors. The prevalence of postpartum depression was 20.2% among mothers attending a tertiary hospital in Nepal. The mean age of the respondents was 24.77 ± 3.47. Factors such as mothers having female child (AOR = 6.39, CI = 1.54 - 26.46), unplanned pregnancy (AOR = 10.08, CI = 2.91 - 34.94), pregnancy-induced health problems (AOR = 9.68, CI: 3.51-26.64) were associated with an increased risk of postpartum depression. Similarly, mothers having formal education (AOR = 0.28, CI: 0.08-0.91), whose spouses have secondary and above education (AOR = 0.16, CI: 0.03-0.85), and who have ≥4 ANC visits (AOR = 0.15, CI = 0.05 - 0.40) were significantly associated but have a protective effect with postpartum depression. Sex of newborn, mother's and spouse's education, intention of pregnancy, ANC visits, and pregnancy-induced health problems were found to be significantly associated with postpartum depression. Hence, specific health education program regarding maternal and child health integrating mental health should be provided to pregnant women, mothers, and their husbands, focusing on gender discrimination. Similarly specific orientation program should be provided to local health worker about the importance of planned pregnancy, in order to reduce pregnancy related health problems during ANC visits and to mothers after their delivery to reduce further chances of postpartum depression.

The Green Maternity project: A midwife-led initiative to promote correct waste segregation on an Australian postnatal ward.

Healthcare waste production is a significant contributor to carbon emissions, negatively impacting the environment. Ineffective healthcare waste disposal results in greater measures to manage it which is costly to both the environment and healthcare organizations. This study aimed to improve waste management in a tertiary maternity hospital. Specifically, the impact of a midwife-led intervention to improve waste segregation, staff knowledge and attitudes and waste management-related costs was investigated. A multi-method study including pre- and post-intervention staff waste management knowledge and attitude surveys and waste audits of bins located on the postnatal ward. The intervention included education sessions, posters and signage by waste bins and monthly newsletters distributed throughout 2021 to raise staff awareness of correct waste segregation processes. Pre- and post-intervention surveys were distributed in early 2021 and early 2022, respectively. The waste audits occurred on three occasions, January, July and December of 2021. The waste audit included total waste in kilograms (kg), waste in kg by segregation and identification of correct and incorrect segregation. Waste audit and quantitative staff survey data were analysed using descriptive statistics and chi square. Qualitative data from the staff surveys were analysed using content analysis. Knowledge and attitudes to waste management were similar across pre- and post-intervention staff surveys. Knowledge of accurate allocation of specific items to waste streams was variable with errors identified in both the pre- and post-surveys. Waste audit data showed reductions in clinical waste at each measurement, with a 71.2% decrease in clinical waste from baseline to the final audit. Accuracy of waste segregation also improved from the baseline to final audit, resulting in a 48% reduction in waste management costs. The midwife-led initiative improved waste segregation and achieved the associated waste management cost reduction. A midwifery-led initiative to address waste production and segregation on a maternity ward had a positive impact on waste segregation practices and associated waste management costs. The existence of change champions along with in-service sessions, posters and newsletters to raise awareness of correct waste segregation resulted in a 71% reduction of incorrect items being placed in clinical waste bins. Challenges such as COVID-19 pressures and workload made it difficult for midwives to engage in waste management education and effective waste segregation. No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Implementing clinician-led waste management interventions across hospital wards while addressing workload issues are likely to have significant cost benefits for organisations and minimise the environmental impacts of healthcare settings.

Healthcare professionals and pregnant and post-natal women's perceptions of interprofessional collaboration in a maternity care facility: A qualitative study from Botswana

ObjectiveTo explore the perceptions of healthcare professionals and pregnant and post-natal women regarding interprofessional collaboration in a maternity care setting in Botswana, a low-to-middle-income country in Sub-Sahara Africa. DesignA descriptive qualitative design using in-depth interviews with forty participants, including healthcare professionals and women in maternity wards. Data were transcribed and thematically analysed. SettingAntenatal, delivery and post-natal maternity wards in a referral hospital that provides basic and specialist care in Botswana. ParticipantsWe interviewed 13 pregnant and post-natal women and 27 healthcare professionals in the maternity care wards. FindingsParticipants perceived several interrelated factors that influenced the delivery of interprofessional collaborative care. Interpersonal factors such as poor communication, disrespectful behaviours and inadequate teamwork practices prevented interprofessional collaboration. Other barriers to collaboration included lack of understanding of each other's roles and responsibilities, ineffective coordination of resources, hierarchical power struggles and poor collaborative leadership. Key conclusionsEffective interprofessional collaboration remains elusive in this maternity care setting. Healthcare systems in low-to-middle-income countries may benefit from interventions for healthcare professionals to learn and practice interprofessional collaborative care.

TO COMPARE INTRAVENOUS FERRIC CARBOXYMALTOSE VERSUS INTRAVENOUS IRON SUCROSE IN POST-PARTUM WOMEN WITH IRON-DEFICIENCY ANEMIA

Objectives: The objective of this study was to compare intravenous ferric carboxymaltose (FCM) versus intravenous iron sucrose in post-partum women with iron-deficiency anemia (IDA). Methods: This was a hospital-based prospective randomized controlled study, comprising 100 post-natal women with IDA with hemoglobin level &lt;11 g/dL admitted in post-natal ward of the Obstetrics and Gynecology Department in SP Medical College, Bikaner, from June 2021 to May 2022. Results: In age, residence, socioeconomic status, the incidence of IDA in both the groups were comparable and is more among rural areas, low socioeconomic status. Improvement in hemoglobin, serum ferritin, and blood indices in both the iron sucrose and FCM groups, but it was faster and greater with ferric carboxymaltose when compared with iron sucrose. Other advantages are large dose administration at 1 time, therefore, lesser total number of doses required in the FCM group as compared to the IS group. Conclusion: FCM is well tolerated, safer, and effective than iron sucrose in treatment of post-natal IDA.

Relationship Between Maternal Vitamin D Deficiency and Newborn Anthropometry

Intrauterine development restriction and low birth weight in the newborn are two negative pregnancy outcomes that can result from maternal hypovitaminosis D. Objective: To determine the association between maternal vitamin D level and neonatal anthropometry (birth-weight, birth length and head circumference). Methods: This cross-sectional research was conducted in Post-Natal Ward of Liaquat University of Medical and Health Sciences, Hyderabad/Jamshoro, after getting official permission from July 2021 to Dec 2021. Healthy Mothers with alive Newborn aged &lt; 24 hours were enrolled via Non-probability, convenience sampling. After taking due approval and written informed consent from mothers. Data were collected into a structured questionnaire, containing enquiries pertaining to basic biodata, sociodemographic details, Vitamin D levels, and anthropometric measurements of baby. Results: The mean age of the mothers was 26.82 (SD ± 7.4) years, predominantly hailing from urban areas (78.5%), with a mean BMI of 23.702 kg/m2 (SD ± 4.32). A low birth weight was reported in 53% while very low birth weight was reported in 4% of the cases. Majority of neonates were found to be of small for gestational age irrespective of their gestational age of delivery. Conclusions: In compared to babies whose mothers had adequate levels of vitamin D, the study reported that babies of moms with lower levels of vitamin D have smaller birth weights and are smaller for gestational age

Knowledge of Postbirth Warning Signs and Postpartum Education Among Women in Ghana

ObjectiveTo assess the relationship between postpartum education and knowledge of postbirth warning signs among women in Ghana. DesignCross-sectional survey. SettingTamale West Hospital in Tamale Metropolitan Area, Ghana. ParticipantsWomen (N = 151) who gave birth to healthy newborns and were admitted to the postnatal ward. MethodsWe collected data from surveys distributed in the hospital. The survey included items for sociodemographic characteristics, obstetric history, postpartum education provided, and knowledge of nine common postbirth warning signs. We used descriptive statistics and multivariate logistic regression models to analyze the data. ResultsParticipants reported knowing an average of 5.2 of 9 (SD = 2.84) postbirth warning signs. Severe bleeding (94.70%, n = 143), fever (82.12%, n = 124), and severe headache (72.19%, n = 109) were the postbirth warning signs most frequently identified by participants. Swelling in the leg (37.09%, n = 56) and thoughts of hurting oneself (33.11%, n = 50) were the postbirth warning signs least frequently identified by participants. Knowledge about postbirth warning signs was positively associated with reports of receiving educational handouts on the postnatal ward (adjusted OR = 4.64, 95% confidence interval [1.27, 17.04]) and reports that four or more postpartum complications were taught before hospital discharge (adjusted OR = 27.97, 95% confidence interval [7.55, 103.57]) compared to zero to three postpartum complications. ConclusionAll women need comprehensive discharge education on the warning signs of complications after birth. Promoting knowledge of postbirth warning signs can decrease delays in seeking care and contribute to the reduction of maternal mortality in Ghana.

Immediate vs on-demand maternal oral full feeding after unplanned cesarean section during labor: a randomized controlled trial

The adoption of Enhanced Recovery After Cesarean is increasing, but evidence supporting individual interventions having a specific benefit to Enhanced Recovery After Cesarean is lacking. A key element in Enhanced Recovery After Cesarean is early oral intake. Maternal complications are more frequent in unplanned cesarean delivery. In planned cesarean delivery, immediate full feeding enhances recovery, but the effect of unplanned cesarean delivery during labor is not known. This study aimed to evaluate immediate oral full feeding vs on-demand oral full feeding after unplanned cesarean delivery in labor on vomiting and maternal satisfaction. A randomized controlled trial was conducted in a university hospital. The first participant was enrolled on October 20, 2021, the last participant was enrolled on January 14, 2023, and follow-up was completed on January 16, 2023. Women were assessed for full eligibility on arrival at the postnatal ward after their unplanned cesarean delivery. The primary outcomes were vomiting in the first 24 hours (noninferiority hypothesis and 5% noninferiority margin) and maternal satisfaction with their feeding regimen (superiority hypothesis). The secondary outcomes were time to first feed; food and beverage quantum consumed at first feed; nausea, vomiting, and bloating at 30 minutes after first feed, at 8, 16, and 24 hours after the operation, and at hospital discharge; parenteral antiemetic and opiate analgesia use; first breastfeeding and satisfactory breastfeeding, bowel sound, and flatus; second meal; cessation of intravenous fluid; removal of a urinary catheter; urination; ambulation; vomiting during the rest of hospital stay; and serious maternal complications. Data were analyzed using the t test, Mann-Whitney U test, chi-square test, Fisher exact test, and repeated measures analysis of variance as appropriate. Overall, 501 participants were randomized into immediate or on-demand oral full feeding (sandwich and beverage). Vomiting in the first 24 hours were reported by 5 of 248 participants (2.0%) in the immediate feeding group and 3 of 249 participants (1.2%) in the on-demand feeding group (relative risk, 1.7; 95% confidence interval, 0.4-6.9 [0.48%-8.28%]; P=.50), and the maternal satisfaction scores from 0 to 10 were 8 (6-9) for the immediate feeding group and 8 (6-9) for the on-demand feeding groups (P=.97). The times from cesarean delivery to the first meal were 1.9 hours (1.4-2.7) vs 4.3 hours (2.8-5.6) (P<.001), first bowel sound 2.7 hours (1.5-7.5) vs 3.5 hours (1.8-8.7) (P=.02), and second meal 7.8 hours (6.0-9.6) vs 9.7 hours (7.2-13.0) (P<.001). These intervals were shorter with immediate feeding. The participants were more likely to agree to recommend immediate feeding to a friend (228 [91.9%] in the immediate feeding group vs 210 [84.3%] in the on-demand feeding group; relative risk, 1.09; 95% confidence interval, 1.02-1.16; P=.009). However, at first feed for food, ate "nothing at all" rates were 10.4% (26/250) in the immediate group and 3.2% (8/247) in the on-demand group, and "eaten all" rates were 37.5% (93/249) in the immediate group and 42.8% (106/250) in the on-demand group (P=.02). Other secondary outcomes were not different. Compared with on-demand oral full feeding, immediate oral full feeding after unplanned cesarean delivery in labor did not increase the maternal satisfaction score and was not noninferior on postoperation vomiting. On-demand feeding with its emphasis on patient autonomy could be preferred, but the earliest full feeding should be encouraged and provided.

A Study to Assess the Effectiveness of Planned Teaching Programme Regarding the Management of Selected Neonatal Health Problems among Mothers of Neonates in a Selected Hospital at Kolar District

Background: From birth to initial four weeks of life is known as Neonate. The term early neonatal phase describes fundamental week of life. While the late neonatal period refers to the time between 7 and 28 days of existence. Minor newborn health problems are the main cause of morbidity in several children. Particularly common in low birth weight and premature babies and these minor problems may be the indication of major underlying diseases. Methods : The main target of this research is to assess and compare the impact of organised teaching methods on selected minor neonatal health problems among the mother of neonates. The study was carried out at SNR District Hospital, Kolar. There are 60 mothers of neonates admitted in postpartum unit were chosen for the research. The Quantitative Pre experimental study design was employed for the investigation. Mothers of neonates (n=60) were admitted in postnatal ward at SNR district hospital, Kolar were picked up by convenient sampling method. Likelihood of the research clarification of that instrument was evaluated through pilot study. Pre-test was led by utilizing questionnaire method. Treatment then introduced as well as after seven days after testing was performed for the same group. Results : In this research, the investigator analyzed that the average mean percentile of the pre-test result was 27.16% with the mean (8.15) and standard deviation (2.18). The post-test average mean percentage was 77.86 % with mean (23.36) and standard deviation, too (2.33). Interpretation and conclusion: The research found that there is a remarkable advancement in relation to understanding of mothers of neonates after receiving the organised educational programme on management of neonatal health problems. Keywords: Neonates, Teaching, Effectiveness, Health problem

Effect of Kangaroo Care Following Immersion Bath on Body Temperature in Preterm Neonates

Objectives One of the aspects of routine care in stable preterm in the ward is bathing. However, during and after bath, drop in body temperature has been observed. Providing Kangaroo Mother Care (KMC) instead of routinely covering the baby with clothes following bath helps in better thermoregulation. The purpose of this study was to compare the effectiveness of standard care and KMC following immersion bathing in stable preterm neonates in postnatal ward. Patients and Methods Prospective nonrandomized interventional study done in the postnatal ward of a tertiary referral hospital. All consecutively born preterm neonates with corrected gestational age between 34 weeks and 37 weeks (mean 35 weeks +5) were enrolled in the study. Neonates received immersion bath in a tub using water temperature adjusted to 37 to 38℃. Neonates in this group were allocated to receive standard care and KMC immediately after bath on Day 1 and Day 2, respectively. Axillary temperature was recorded before bath (baseline), immediately after bath and subsequently at 15 min, 30 min, 45 min, and 60 min after bath. Data was analyzed to compare the effect of standard care and KMC immediately after bath. Results The pre-bath mean temperature between standard care and KMC were 36.27℃ and 36.47℃, respectively. In both standard care and KMC group immediately after bath there was no fall in temperature from baseline. Mean difference from baseline temperature between standard care and KMC group at 30 min, 45 min, and 60 min were 0.2℃, 0.25℃, and 0.18℃, respectively, all of which were statistically significant ( P &lt; .05). Conclusions In this pilot study on immersion bathing followed by KMC, temperature regulation was better with KMC after bathing, with a mean temperature difference ranging between 0.18 ℃ and 0.25℃ (95% CI –0.103 to0.374) between 30 min and 60 min of bathing.

Comparison of the accuracy of digital axillary thermometer (DAT) with infrared forehead skin thermometer (IFST) measurements in healthy newborns

Temperature is an important vital sign. Body temperature is generally measured whenever there is suspicion of fever, but in neonates’ hypothermia is considered even more serious than fever. There are studies in pediatric intensive care units comparing various invasive methods of temperature measurement.This was a cross sectional comparative study conducted in postnatal wards and outpatient department of a teaching hospital. All consecutive 348 healthy term neonates between 0-28 days of life whose parents consented for participation in the study were included. The axillary temp was taken with digital thermometer and forehead temperature were measured by temporal scanner device simultaneously. Doctor and caretaker both took the temperature measurement. Out of total 348 patients 114 (32.7%) were males and 234(67.2%) were females. Mean birth weight was 2800±400 grams. Mean axillary temperature was 98.34±0.81°F, and forehead temperature was 97.81±0.89°F (p=0.44). There was a positive correlation between temperature measured using digital and infrared thermometer (r=0.914, p=0.00). The mean difference was −0.07 with limits of agreement −0.71 to 0.57.Digital axillary temperature was higher and closer to normal than infrared forehead temperature. Temperature readings by forehead infrared thermometry agree well with those by axillary digital thermometry in neonates. Hence both methods of temperature measurement can be used in neonates although Infra-red temporal touch is much easier technique than digital axilla temperature measurement