Postpartum Consultations Research Articles

Factors associated with the absence of postpartum consultations in a high-risk population.

To assess the rate of missed postpartum appointments at a referral center for high-risk pregnancy and compare puerperal women who did and did not attend these appointments to identify related factors. This was a retrospective cross-sectional study with all women scheduled for postpartum consultations at a high-risk obstetrics service in 2018. The variables selected to compare women were personal, obstetric, and perinatal. The variables of interest were obtained from the hospital's electronic medical records. Statistical analyses were performed using the Chi-square, Fisher's exact, or Mann-Whitney tests. For the variable of the interbirth interval, a receiver operating characteristic curve (ROC) was used to best discriminate whether or not patients attended the postpartum consultation. The significance level for the statistical tests was 5%. A total of 1,629 women scheduled for postpartum consultations in 2018 were included. The rate of missing the postpartum consultation was 34.8%. A shorter interbirth interval (p = 0.039), previous use of psychoactive substances (p = 0.027), current or former smoking (p = 0.003), and multiparity (p < 0.001) were associated with non-attendance. This study showed a high rate of postpartum appointment non-attendance. This is particularly relevant because it was demonstrated in a high-risk obstetric service linked to clinical severity or social vulnerability cases. This highlights the need for new approaches to puerperal women before hospital discharge and new tools to increase adherence to postpartum consultations, especially for multiparous women.

(211) Study of Postpartum Sexuality in Tunisian Women

Abstract Introduction Childbirth is a period of imbalance responsible for multidimensional changes that can influence sexual life. The aim of the study is to study the sexuality of women after childbirth, to specify the factors that influence it and to analyze the aspects of sexual dysfunction that accompany this period. Objective Evaluate women's postpartum experience and sexuality, while identifying difficulties that may arise during this high-risk period. Assess women's satisfaction with the information they receive on sexuality during perinatal and post-partum consultations. Methods This was a descriptive study that was spread over a period of 6 months from July 1, 2021 to December 31, 2021.200 women who gave birth in the six months preceding the study were included in the study. Two self-questionnaires were sent by internet through a social network. Results Our population of 200 women had a mean age of 34.3 years and the majority of women were urban, and university-educated. fourty-five per cent were second gestations and 58,5% of them had given birth by cesarean section. The average FSFI score in our sample was 21,99/36 postpartum, which implied sexual dysfunction in 72% of the women in our population. The delay in resumption of sexual activity was later in primiparous women, women with vaginal delivery and breastfeeding women. There was an association between instrumental delivery and the degree of dyspareunia. No difference was found in sexuality between vaginal delivery and caesarean section, nor for scheduled or emergency caesarean section. All areas of female sexual function were affected with mainly pain associated with sexuality. Some factors influencing the resumption of sexual activity could be identified such as breastfeeding, the presence of perineal tears, lack of lubrication and fear of becoming pregnant. Conclusions The majority of women in our population had sexual dysfunction in the postpartum period. The different areas of female sexual function were affected and correlated with the different parameters related to childbirth and the postpartum period. Disclosure No.

Community health workers' involvement in mother-child care during the 1st year after birth, in Kaya health district, Burkina Faso: A contribution analysis.

Maternal and infant morbidity and mortality remain high in sub-Saharan Africa. However, actions to strengthen postpartum care are still weak and mainly limited to health facilities (HFs). In Kaya health district, Burkina Faso, community health workers (CHWs) were involved in mother and child care during the 1st year postpartum through home visits, outreach sessions and accompanying mothers to health facilities. The aim of this study was to assess the contribution of CHWs to postpartum women's attendance at the health facilities. We conducted an effect assessment using Mayne and Lemire's contribution analysis framework. Qualitative and quantitative data were collected through project documents review and individual semi-structured interviews with key-informants. All the participants interviewed acknowledged that the number of women, who came to postpartum care, had increased since the implementation of the project activities. Postpartum consultation rates within the 1st week postpartum increased from 29% in 2011 to 80% in 2015 and from 19 to 50% within 6 weeks. Others interventions such as Performance based financing, Save The Children nutritional project and the health services component of Missed Opportunities in Mother and Infant Health (MOMI) were the alternative explanations. CHWs involvement in women care contributed to improve their adherence to postpartum consultations in Kaya health district.

Prevalence and associated factors of common mental disorders in primary care settings in Sofala Province, Mozambique.

In Mozambique, the prevalence of common mental illness in primary care is not well established. This study aimed to assess the prevalence of, and associated factors for, common mental illness in patients accessing primary care services in three Ministry of Health clinics in Mozambique. Adult patients were recruited from the waiting rooms of prenatal, postpartum and general out-patient consultations. A mental health professional administered a diagnostic interview to examine prevalence of major depressive disorder (MDD), generalised anxiety disorder (GAD), post-traumatic stress disorder (PTSD) and any substance misuse or dependence. Generalised linear mixed models were used to examine the odds of each disorder and sociodemographic associations. Of 502 patients interviewed, 74.1% were female (n = 372) and the average age was 27.8 years (s.d. = 7.4). Of all participants, 23.9% (n = 120) met diagnostic criteria for at least one common mental disorder; 8.6% were positive for MDD (n = 43), 13.3% were positive for GAD (n = 67), 4.8% were positive for PTSD (n = 24) and 4.0% were positive for any substance misuse or dependence (n = 20). Patients attending prenatal or postpartum consultations had significantly lower odds of any common mental disorder than patients attending out-patient primary care. Age was negatively associated with MDD, but positively associated with substance misuse or dependence. Over 20% of patients attending primary care in Mozambique may have common mental disorders. A specific focus on patients attending general out-patient visits, young people for depression, and older people and men for substance misuse/dependence would provide a targeted response to high-risk demographics.

Association of pregestational obesity with anemia during pregnancy: A literature review

Relevance: Оbеse pregnant women have а mild inflammatory response associated with hepcidin overexpression. Inflammation affects iron metabolism by increasing hepcidin levels. Obesity and anemia are serious problems worldwide; expectant mothers often suffer from these conditions. Gravidas with obesity tend to gain more weight during pregnancy than gravidas with normal body mass index. Obesity before pregnancy is associated with a high risk in pregnancy, including hypoferremia and anemia due to iron deficiency, which are already common between expectant mother and their neonates. This review considers obesity-associated inflammatory mediator activation as a potential primary cause of iron deficiency (ID) or iron deficiency anemia (IDA) in obese pregnant women.The review aimed to summarize the current studies reporting the measurement of molecular markers of iron metabolism and inflammatory mediators in pregnant women with pregestational obesity. Methods: This review included all types of publications in English and Russian on anemia and obesity in pregnancy, published from March 2012 to March 2022. The literature search was performed in Medline, Scopus, Web of Science, Google Scholar, PubMed, and CyberLeninka databases by the following keywords: “pregnancy,” “iron deficiency,” “anemia,” “overweight,” “obesity,” “inflammation,” and “body mass index.”Results: This review assesses whether obesity-induced inflammation may contribute to the increased incidence of ID/IDA in pregnant women. Despite numerous studies, the effect of maternal weight on the risk of ID/IDA during pregnancy remains unclear. Iron status metabolism markers against inflammation are considered. PR-pregnancy obesity carries a greater risk of developing ID/IDA during pregnancy and the postnatal period for the mother and the baby. Conclusions: Thus, a more careful study of iron levels by trimester is required. The introduction of clearly defined procedures for trimester valuation of iron and inflammatory status in antenatal and postpartum consultations is necessary.

Refinement of the Well-being in Pregnancy (WiP) questionnaire: cognitive interviews with women and healthcare professionals and a validation survey

BackgroundMeasuring positive and negative aspects of well-being during pregnancy and childbirth is important for both healthy women and women who are living with long-term health conditions (LTCs). This study aimed to further refine the Well-being in Pregnancy (WiP) questionnaire and to incorporate LTC specific items where appropriate.MethodsA multi-method study. Cognitive interviews with pregnant or postpartum women (n = 11) and consultations with healthcare professionals (n = 11) and public representatives (n = 4) were conducted to explore the acceptability of existing WiP items and content. Items were refined and subsequently administered on an online survey (n = 768). Item reduction steps and exploratory factor analysis were performed on survey data. Convergent validity was examined using Pearson correlation coefficients to compare relationships with other included validated assessments.ResultsFollowing amendments to three items, the addition of eight core WiP items and five LTC specific items, a total of 25 items were considered relevant and appropriate for use with pregnant women. Analysis of survey data reduced the questionnaire to 12 items measuring three core WiP scales; 1) Concerns over support after birth, 2) Positive pregnancy and, 3) Confidence about motherhood, and a five item standalone LTC specific scale. All scales demonstrated good validity and internal reliability. Scores for the three core scales moderately correlated with established well-being measures indicating that they were measuring similar, yet distinct concepts.ConclusionsAnalyses confirmed good psychometric properties of the refined WiP questionnaire. The use of pregnancy specific well-being measures, such as the WiP, provide a route into asking women in more detail about how their care may be tailored to support them and also facilitates positive conversations with women about how care and experience of pregnancy and childbirth may be enhanced further.

Longitudinal care: factors associated with adherence to postpartum follow-up according to data from PMAQ-AB

The aim was to identify factors of longitudinal care associated with women´s adherence to postpartum consultation in Brazil. This was a cross-sectional study of data from 19,177 postpartum women who participated in the external assessment of the third cycle of the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ-AB), 2017. The dependent variable was postpartum consultation, and the independent variables, grouped hierarchically, were sociodemographic and economic at the distal level and issues analogous to longitudinal care at the proximal level. Multiple logistic regression analysis was performed with hierarchical entry of variables, where sociodemographic and economic variables were used to adjust the model. The results showed that 53% of women had undergone postpartum follow-up. The odds of adherence to postpartum follow-up were higher in women who received a home visit by a community health agents in the first week after childbirth (OR = 4.81), those with seven or more prenatal consultations (OR = 2.74), those who had sought care at the health unit in question (OR = 1.21), and those who had been seen by the same physician (OR = 1.14). In conclusion, the proportion of postpartum consultations was low (53%), and adherence to postpartum follow-up was higher when women received visits by community health agents, were accompanied by the same physician, had regular prenatal care, and had a specific healthcare unit as their regular source of care. Consistent longitudinal care was identified as an attribute of primary care that should be strengthened to improve postpartum care.

DO PRÉ-NATAL AO PUERPÉRIO: MUDANÇAS NOS SERVIÇOS DE SAÚDE OBSTÉTRICOS DURANTE A PANDEMIA DA COVID-19

ABSTRACT Objective: to analyze changes in maternal health care during the Covid-19 pandemic, according to reports by health professionals. Method: qualitative research, conducted with managers, physicians, nurses, residents and nursing technicians working in a prenatal outpatient clinic, obstetric emergency department, delivery center and obstetric inpatient ward of a high complexity federal public hospital in the Northeast of Brazil. Data were collected from December 2020 to August 2021. The sample, chosen intentionally, sought the diversity of characteristics and situations, was closed by the criterion of saturation of meaning. A structured questionnaire and a semi-structured interview script were used for data collection. The interviews were recorded and transcribed. Content analysis was used in the thematic modality. Results: 28 professionals were interviewed. Changes in the dynamics of obstetric care were identified and categorized as: prenatal care; and childbirth/postpartum. In prenatal care, there was a decrease in elective consultations; increased time between consultations; delayed care due to paramentation; implementation of new hygiene protocols; limitation of the number of companions; creation of new environments such as the Covid-19 isolation room for symptomatic pregnant women; teleservice and work overload due to the increased demand coming from Primary Health Care. In childbirth/postparum, the reports indicated a reduction in the number of beds; testing and isolation of symptomatic patients; limitating walking, restriction of companions and mandatory use of mask by pregnant woman. Conclusion: the restructuring of services and the creation of new spaces to care for patients with Covid-19 led to a reduction in the availability of vacancies for prenatal and postpartum consultations. The changes were accompanied by new service rules, with setbacks regarding the guarantee of rights.

Community's experience and perceptions of maternal health services across the continuum of care in Ethiopia: A qualitative study.

Continuum of care is an effective strategy to ensure that every woman receives a series of maternal health services continuously from early pregnancy to postpartum stages. The community perceptions regarding the use of maternal services across the continuum of care are essential for utilization of care in low-income settings but information in that regard is scanty. This study explored the community perceptions on the continuum of care for maternal health services in Ethiopia. This study employed a phenomenological qualitative research approach. Four focus group discussions involving 26 participants and eight in-depth interviews were conducted with women who recently delivered, community health workers, and community leaders that were purposively selected for the study in West Gojjam zone, Amhara region. All the interviews and discussions were audio-taped; the records were transcribed verbatim. Data were coded and analyzed thematically using ATLAS.ti software. We identified three primary themes: practice of maternal health services; factors influencing the decision to use maternal health services; and reasons for discontinuation across the continuum of maternal health services. The study showed that women faced multiple challenges to continuously uptake maternal health services. Late antenatal care booking was the main reasons for discontinuation of maternal health services across the continuum at the antepartum stage. Women's negative experiences during care including poor quality of care, incompetent and unfriendly health providers, disrespectful care, high opportunity costs, difficulties in getting transportation, and timely referrals at healthcare facilities, particularly at health centers affect utilization of maternal health services across the continuum of care. In addition to the reverberation effect of the intrapartum care factors, the major reasons mentioned for discontinuation at the postpartum stage were lack of awareness about postnatal care and service delivery modality where women are not scheduled for postpartum consultations. This study showed that rural mothers still face multiple challenges to utilize maternal health services as recommended by the national guidelines. Negative experiences women encountered in health facilities, community perceptions about postnatal care services as well as challenges related to service access and opportunity costs remained fundamental to be reasons for discontinuation across the continuum pathways.

Effects of a Midwife-Coordinated Maternity Care Intervention (ChroPreg) vs. Standard Care in Pregnant Women with Chronic Medical Conditions: Results from a Randomized Controlled Trial.

The proportion of childbearing women with pre-existing chronic medical conditions (CMC) is rising. In a randomized controlled trial, we aimed to evaluate the effects of a midwife-coordinated maternity care intervention (ChroPreg) in pregnant women with CMC. The intervention consisted of three main components: (1) Midwife-coordinated and individualized care, (2) Additional ante-and postpartum consultations, and (3) Specialized known midwives. The primary outcome was the total length of hospital stay (LOS). Secondary outcomes were patient-reported outcomes measuring psychological well-being and satisfaction with maternity care, health utilization, and maternal and infant outcomes. A total of 362 women were randomized to the ChroPreg intervention (n = 131) or Standard Care (n = 131). No differences in LOS were found between groups (median 3.0 days, ChroPreg group 0.1% lower LOS, 95% CI −7.8 to 7%, p = 0.97). Women in the ChroPreg group reported being more satisfied with maternity care measured by the Pregnancy and Childbirth Questionnaire (PCQ) compared with the Standard Care group (mean PCQ 104.5 vs. 98.2, mean difference 6.3, 95% CI 3.0–10.0, p < 0.0001). In conclusion, the ChroPreg intervention did not reduce LOS. However, women in the ChroPreg group were more satisfied with maternity care.

Experiences of Dutch maternity care professionals during the first wave of COVID-19 in a community based maternity care system.

During the COVID-19 pandemic the organization of maternity care changed drastically; this study into the experiences of maternity care professionals with these changes provides suggestions for the organization of care during and after pandemics. An online survey among Dutch midwives, obstetricians and obstetric residents. Multinomial logistic regression analyses were used to investigate associations between the respondents' characteristics and answers. Reported advantages of the changes were fewer prenatal and postpartum consultations (50.1%). The necessity and safety of medical interventions and ultrasounds were considered more critically (75.9%); 14.8% of community midwives stated they referred fewer women to the hospital for decreased fetal movements, whereas 64.2% of the respondents working in hospital-based care experienced fewer consultations for this indication. Respondents felt that women had more confidence in giving birth at home (57.5%). Homebirths seemed to have increased according to 38.5% of the community midwives and 65.3% of the respondents working in hospital-based care. Respondents appreciated the shift to more digital consultations rather than face-to-face consultations. Mentioned disadvantages were that women had appointments alone, (71.1%) and that the community midwife was not allowed to join a woman to obstetric-led care during labour and subsequently stay with her (56.8%). Fewer postpartum visits by family and friends led to more tranquility (59.8%). Overall, however, 48.0% of the respondents felt that the safety of maternity care was compromised due to policy changes. Maternity care professionals were positive about the decrease in routine care and the increased confidence of women in home birth, but also felt that safety in maternity care was sometimes compromised. According to the respondents in a future crisis situation it should be possible for community midwives to continue to deliver a personal handover after the referral of women to the hospital, and to stay with them.

English

This study investigates why postpartum women cannot or will not receive postpartum consultations at the maternity ward in Sokoura, C&ocirc;te d&rsquo;Ivoire. It aims to present the sociocultural, economic, infrastructural and organisational factors limiting new mothers&rsquo; access to postpartum care and to suggest ways to encourage them to seek out such care. A qualitative approach was adopted and data was collected from individual interviews with new mothers and midwives. The results have elucidated the factors hindering postpartum consultations at the maternity ward in Sokoura and the broader sociological context in which they need to be assessed. The relevant factors are deficient knowledge about the post-partum period, new mothers&rsquo; professional obligations, their spouses&rsquo; limited financial means, the distance of the maternity ward, unfavourable transport conditions, tensions between new mothers and midwives, and inadequate organisation and management of the postpartum consultation services at the maternity ward. These obstacles to postpartum care can be broadly categorised as insufficient education, scarce social support and unfavourable environmental and medical conditions. To remedy these issues, it is necessary to foster community action targeting new mothers and their spouses, to develop midwives&rsquo; cross-cultural skills, notably their capacity for anthropological observation, and to involve public authorities in the changes. &nbsp; Key words: Postpartum women, accessibility, postpartum consultations, obstacles, social change, maternal and neonatal health.

THE NURSING PROFESSIONAL OF THE HEALTH STRATEGY OF FAMILY FACING POSTPARTUM DEPRESSION

Care in Primary Health Care for women in the pregnancy-puerperal cycle must take place in an integral way, with individualized care that considers the life history, feelings and the environment in which the woman lives, seeking her physical and mental well- being to prevent postpartum depression. Given this fact, a postpartum consultation is recommended as essential by the Ministry of Health for the early detection of preventable complications common in the period, such as puerperal depression (BRAZIL, 2012). It is known that each woman has a way of reacting to the postpartum due to the different situations that occur, such as the relationship with her partner and her family, her social and cultural life, meaning that, each pregnancy is a unique and individual experience. . (SARMENTO, SETÚBAL, 2012). Therefore, we will address the relationship between nurses and postpartum depression in family health strategies in a city in the state of Rio de Janeiro. It will be a qualitative, descriptive and exploratory study, whose overall objective is to analyze how nurses perform to postpartum women with postpartum depression. OBJECTIVE: The objective of this study is to find out about the role of nurses in Family Health Strategies (FHS) in the city of Valença, RJ. METHOD: This is a descriptive and exploratory study, with a qualitative approach. There are 19 ESFs in the municipality, but 9 strategies were selected, however only 5 wanted to participate. A Google Forms form was sent along with the Free and Informed Consent Form to the email of the selected nurses, but only 5 were returned. Data was collected through a semi-structured interview. RESULTS: Through the data gathered, it was seen that nurses have difficulties in identifying the signs and symptoms of PPD, as well as an approach due to the difficulties encountered both because of the non- adherence of pregnant women in prenatal consultations, which makes it difficult for these pregnant women to adhere to postpartum consultations at the unit and the nurses' work routine, which makes tracking difficult. The use of the Edinburgh Postnatal Depression Scale is being questioned. CONCLUSIONS: With the lack of adherence of these puerperal women in the consultations, it is very difficult to identify the signs and symptoms of Postpartum Depression, the nurse must seek the population closer to the unit in carrying out health education in the strategy, creating bonds besides giving the postpartum autonomy over their care. The professional must work together with their team in the actions of permanent education, thus, empowering community health workers in the identification, therefore this professional brings the community closer to the strategy, which facilitates users' adherence to the health service.

The nursing process in postpartum consultations at Primary Health Care Units.

To identify the steps of the Nursing Process and integral care. Document analysis study on medical and nursing consultations records during postpartum conducted in primary health units in inland São Paulo state. The analysis comprised the registered steps, the sequence of steps, and the approach of psychosocial questions. The data are presented by frequency, percentage, and the expressed content of care. The analyzed records amounted to 341. Out of these, 100% presented History; 62.2%, Nursing Diagnosis; 5.3%, Planning; 99.1%, Implementation; and 50.1%, Evaluation. Regarding the sequence of steps, 47.5% of the medical records presented three steps. In the incorporation of the principle of integrality, a more frequent presence of the biological approach was observed. This study shows the change of practice of nurses, with efforts to register the Nursing Process, and that the integrality of care constitutes a challenge to surpass a model of care which is fragmented and decontextualized from the life conditions of people.

Empowering Adolescent Mothers in the Choice of Contraception at Postpartum Period: Avoiding a Subsequent Pregnancy

Background: Almost 80% of adolescent pregnancies are unplanned and 28-63% of adolescent mothers had a repeated pregnancy within 18 months. Among girls with repeated pregnancies, two-thirds reported that the pregnancy was unplanned. We aim to assess contraceptive use by adolescents mothers with increasing choice for LARC methods in postpartum consultation after a semi-structured group intervention involving adolescent mothers. Methods: Retrospective observational study conducted at University of Campinas, Brazil. The intervention involved antenatal and postpartum education groups for adolescents. At postpartum consultations, the adolescents chose their contraception. The data was compared to previous series followed in a period before the education group's implementation - an historical control group. Findings: We included 129 adolescent after childbirth from January 1st, 2015 through July 31st, 2017. Contraception methods before pregnancy were ever-used by 63%, and the most frequent method was combined oral contraceptives (33%) followed by condoms (21%). At the first postpartum consultation, the most common contraceptive chosen was IUC (37.2%) and depot-medroxyprogesterone acetate (DMPA) (34.1%). When comparing the rates before and after the education interventions - there was a 3-fold increase in IUC use. Interpretation: Antenatal and postpartum education increased the choice of IUCs by adolescents. Funding Statement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Declaration of Interests: The authors declare no conflict of interests Ethics Approval Statement: A retrospective observational study was performed at the Department of Obstetrics and Gynaecology, School of Medical Sciences University of Campinas (UNICAMP), Campinas, SP, Brazil. Ethical Committee of the University of Campinas approved this research (CAAE: 1909413.6.0000.5404). All items of the Strengthening the Reporting of Observational Studies in Epidemiology were followed.

Empowering Adolescent Mothers in the Choice of Contraceptive Methods at the Postpartum Period: Avoiding a Subsequent Pregnancy

Almost 80% of adolescent pregnancies are unplanned, and between 28 and 63% of adolescent mothers had a repeated pregnancy within 18 months. Among girls with repeated pregnancies, two-thirds reported that the pregnancy was unplanned. We aim to assess contraceptive use by adolescent mothers with increasing choice for long-acting reversible contraception (LARC) methods in postpartum consultation after a semistructured group intervention involving adolescent mothers. Retrospective observational study conducted at the Universidade Estadual de Campinas, Campinas, state of São Paulo, Brazil, involving new antenatal and postpartum education groups for adolescents. At postpartum consultations, the adolescents chose their contraceptive. The data was compared with previous series followed in a period before the implementation of the education group - a historical control group. We included 129 adolescent after childbirth from January 1st, 2015 through July 31st, 2017. Out of this total, 63% had ever used contraceptive methods before pregnancy, and the most frequent method was combined oral contraceptives (33%) followed by condoms (21%). At the first postpartum consultation, the most common contraceptive chosen was intrauterine contraception (IUC) (37.2%) and depot-medroxyprogesterone acetate (DMPA) (34.1%). When comparing the rates before and after the education interventions, there was a 3-fold increase in the use of IUCs. Antenatal and postpartum education have shown a significant increase in the choice for LARC methods among adolescent mothers, with very high acceptability after a period using the method. The educational groups performed during the antenatal care and beyond the gestational period are easy to be applied worldwide with low dependence on funding.

Australian general practice registrars and their experience with postpartum consultations: A cross-sectional analysis of prevalence and associations.

In Australia, general practitioners (GPs) are recognised as an essential source of postpartum care. However, there remains a paucity of research pertaining to this, and in particular, to that of GP trainees (in Australia, termed 'registrars'). Previous post-graduate experience in obstetrics and gynaecology (O&G) is not a prerequisite for GP training, and thus, it is imperative that vocational training provides adequate exposure to postpartum consultations. To investigate the prevalence and associations of Australian GP registrars' (trainees') experience in postpartum care. A cross-sectional study employing data from the Registrar Clinical Encounters in Training (ReCEnT) project. ReCEnT is an ongoing cohort study where GP registrars record 60 consecutive consultations mid-way through each training term. The outcome variable was postpartum problem/diagnosis (compared to all other problems/diagnoses). The independent variables included registrar, practice, patient, consultation, clinical and educational factors. Analyses employed univariate and multivariable regression. Analysis included 2234 registrars (response rate 96.1%), 289594 consultations, and 453786 problems/diagnoses. Postpartum care (897) comprised 0.2% (95% CI: 0.19-0.21) of all problems/diagnoses in 0.3% (95% CI: 0.27-0.31) of all consultations. Significant multivariable associations included registrar's gender (female) and obtainment of post-graduate O&G qualifications. Postpartum consultations were longer and resulted in more learning goals being generated. An overall low prevalence was established. Both male registrars, and those without pre-existing O&G qualifications, may have particularly limited experience. These findings should inform educational policy and practice regarding postpartum care experience in general practice training.

Efficacy of a midwife-coordinated, individualized, and specialized maternity care intervention (ChroPreg) in addition to standard care in pregnant women with chronic disease: protocol for a parallel randomized controlled trial

Background and objectivesThe number of women of childbearing age with chronic diseases is rising. Evidence has shown that obstetric complications and poor psychological well-being are more prevalent among this group, in addition to these women reporting experiences of less than satisfactory care. More research is needed to investigate how to best meet the special needs of this group during pregnancy and postpartum. Previous research has shown that care coordination, continuity of care, woman-centered care, and specialized maternity care interventions delivered to women with high-risk pregnancies can improve patient-reported outcomes and pregnancy outcomes and be cost-effective. However, no previous trials have examined the efficacy and cost-effectiveness of such interventions among pregnant women with chronic diseases. This paper describes the protocol of a randomized controlled trial (RCT) of a midwife-coordinated, individualized and specialized maternity care intervention (ChroPreg) as an add-on to standard care for pregnant women with chronic diseases.Methods/designThis two-arm parallel group RCT will be conducted from October 2018 through June 2020 at the Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Denmark. Pregnant women with chronic diseases are invited to participate; women will be randomized and allocated 1:1 to the ChroPreg intervention plus standard care or standard care alone. The ChroPreg intervention consists of three main components: (1) coordinated and individualized care, (2) additional ante- and postpartum consultations, and (3) specialized midwives. The primary outcome is length of hospital stay during pregnancy and in the postpartum period, and secondary outcomes are psychological well-being (five-item World Health Organization Well-Being Index, Edinburgh Postnatal Depression Scale, Cambridge Worry Scale), health-related quality of life (12-Item Short Form Health Survey), patient satisfaction (Pregnancy and Childbirth Questionnaire), number of antenatal contacts, and pregnancy and delivery outcomes. Data are collected via patient-administered questionnaires and medical records.DiscussionThis trial is anticipated to contribute to the field of knowledge on which planning of improved antenatal, intra-, and postpartum care for women with chronic disease is founded.Trial registrationClinicalTrials.gov, NCT03511508. Registered April 27, 2018.

Sensitivity and specificity of the three Whooley and Arroll questions for detecting perinatal depression in Mexican women.

To evaluate the sensitivity and specificity of the Two Whooley questions and the Arroll question, using the SCID, The Structured Clinical Interview (SCID-I) as the gold standard for detecting perinatal depression. We interviewed 210 women during pregnancy and 6 months postpartum. The criterion with the greatest sensitivity was responding positively to either Whooley question (pregnancy= 94.7 %; postpartum=100.0%), while the most specific criterion was responding positively to the two Whooley questions plus the Arroll question (Pregnancy=90.0% Postpartum = 85.7%). The Whooley and Arroll questions have adequate psychometric properties to detect possible cases of depression during the perinatal period. They can be applied during prenatal check-ups and postpartum consultations. Timely detection of women at risk of perinatal depression can contribute to their treatment for reducing their adverse consequences in mothers and infants.

The Challenges of Providing Postpartum Education in Dar es Salaam, Tanzania: Narratives of Nurse-Midwives and Obstetricians.

Postpartum education can save lives of mothers and babies in developing countries, and the World Health Organization recommends all mothers receive three postpartum consultations. More information is needed to better understand how postpartum education is delivered and ultimately improves postpartum health outcomes. The purpose of this qualitative study was to examine how postpartum care was delivered in three postnatal hospital clinics in Dar es Salaam, Tanzania. Semistructured interviews with 10 nurse-midwives and three obstetricians were conducted. Feminist poststructuralism guided the research process. Postpartum education was seen to be an urgent matter; there was a lack of supportive resources and infrastructure in the hospital clinics, and nurse-midwives and obstetricians had to negotiate conflicting health and traditional discourses using various strategies. Nurse-midwives and obstetricians are well positioned to deliver life-saving postpartum education; however, improvements are required including increased number of nurse-midwives and obstetricians.