Pregnancy Planning Research Articles

QUALITY OF LIFE DURING PREGNANCY: A COMPARATIVE STUDY BETWEEN URBAN AND RURAL AREAS IN INDONESIA

Assessing quality of life during pregnancy is vital to find timely preventive measures against pregnancy complications. The quality of life during pregnancy determines pregnant women’s health. This study aims to identify the differences in the quality of life during pregnancy who participated in antenatal care (ANC) visits in primary healthcare centers in rural and urban areas. This study used a cross-sectional design and collected data through survey. The research population was 800 pregnant women who participated in ANC in three primary healthcare centers in urban areas and three others in rural areas. The quality of life during pregnancy questionnaire was used for data collection. The analysis was done using the Chi-square test and ordinal regression. Results showed no difference in the quality of life during pregnancy between women in urban areas and those in rural areas. Some factors that affected the quality of life during pregnancy included education, fetal age, number of pregnancies, number of live children, and pregnancy plans in women living in urban areas. Meanwhile, in women living in rural areas, the quality of life during pregnancy was affected by education level, occupation, fetal age, number of pregnancies, number of live children, and pregnancy plans. There are influences of age, education level, occupation, gestational age, number of pregnancies, number of living children, and pregnancy plans on the quality of life of pregnant women in rural areas.

Associated Factors of Exclusive Breastfeeding Intention among Pregnant Women in Najran, Saudi Arabia.

The exclusive breastfeeding (EBF) intention conceived by pregnant women is the most important predictor of breastfeeding (BF) initiation, duration, and continuation. This study explores the associated factors of EBF intention among pregnant women. This was a descriptive cross-sectional study conducted from November 2022 to January 2023 with 382 pregnant women who came to the outpatient clinic in the Maternal and Children Hospital (MCH). Four instruments were used for data collection: the Infant Feeding Intention scale, the Gender-Friendly BF Knowledge scale (GFBKS), the Iowa Infant Feeding Attitude scale (IIFAS), and the basic data questionnaire. The study findings indicated that 51.8% and 75.9% of gravida women had adequate knowledge and a positive attitude regarding BF. Furthermore, 56.3% of the participants had a high intention for EBF. Binary logistic regression illustrated that occupational status, antenatal care, plan for the current pregnancy, BF practice, last child delivery mode, medical disorder during the current pregnancy, age, BF knowledge, and attitude are potential predictors. The goodness of fit test revealed that 46.8% of the EBF intention could be anticipated through the positive pre-mentioned factors. The low EBF intention is modifiable by addressing the previously positive predictors. BF educational interventions should be tailored based on EBF intention predictors in order to be effective and lead to behavior change.

Voices on Zika: Reproductive Autonomy and Shared Decision-Making During an Evolving Epidemic.

We aimed to understand the degree to which pregnant individuals exposed to emerging infections, such as Zika, are engaged by providers in shared decision-making and explore potential barriers to inform strategies to improve care for those most at risk for inequities. Studies have demonstrated that Latinx and Black people are less likely to engage in shared decision-making and are less engaged by providers. Limited research explores factors impacting shared decision-making in prenatal care and in the setting of recent epidemics. We conducted an exploratory qualitative study of individuals eligible for prenatal screening owing to Zika exposure during pregnancy. Given an established connection between autonomy and shared decision-making, we used the Reproductive Autonomy Scale and the Three Talk Model for shared decision-making to inform our semistructured interview guide. Interviews were conducted in Spanish or English. and participants were recruited from a federally qualified health center and a tertiary care obstetric clinic until thematic saturation was achieved. Interviews were recorded, translated, and transcribed and two coders used modified grounded theory to generate themes. We interviewed 18 participants from May to December 2017. Participant narratives demonstrated reproductive autonomy in pregnancy decision-making, with decision support from families, fatalism in pregnancy planning, and limited engagement by providers around decisions and implications of Zika virus testing. Hierarchy in provider dynamics, perceived stigma around emigration and travel, and language barriers impacted participant engagement in shared decision-making. Participants demonstrated personal autonomy in reproductive decision-making, but demonstrated limited engagement in shared decision-making with regard to prenatal Zika testing. Provider promotion of shared decision-making using culturally centered decision tools to elicit underlying beliefs and deepen context for option, choice, and decision talk is critical in prenatal counseling to support equitable outcomes during evolving pandemics.

ОПЫТ ОРГАНОСОХРАНЯЮЩЕЙ ТАКТИКИ ВЕДЕНИЯ ПРИ ВРАСТАНИИ ПЛАЦЕНТЫ

The purpose of this study is to substantiate the possibility of successful organ-preserving management tactics for placenta accretion based on the study of a clinical case. We studied the results of examination and treatment of a pregnant woman, a woman in labor and a maternity ward, 32 years old, who received medical care in inpatient conditions at the Perinatal Center of the V.D. Seredavin State Medical University. It can be assumed that the cause of the abnormal attachment of the placenta in this patient could be an infection, in particular, chronic endometritis. This is evidenced by the premature rupture of the fetal membranes, the cause of which is most often an infectious factor. Diagnosis of anomalies of placental attachment is based on the data of instrumental studies. It should be detected in the antenatal period with ultrasound. Despite the presence of placenta accretion, this pathology, unfortunately, was not detected at the stage of pregnancy, which would make it possible to draw up a plan for pregnancy and childbirth in accordance with the tactics recommended for this pathology. In this clinical case, an additional placental lobule isolated from the main part of the placental tissue apparently grew in, which made it possible to avoid massive bleeding in the postpartum period before attempting to separate this part. Careful observation of the patient in the postpartum period with dynamic ultrasound control allowed the diagnosis of placental ingrowth. With diagnostic hysteroscopy, the diagnosis was confirmed, an organ-preserving operation was performed: hysteroesectoscopy with electrosurgical resection of placenta increta. During the control examination, no pathology of the myometrium was detected. It is necessary to take into account the presence of all causes that can lead to abnormalities of placental attachment, in particular, an infectious factor. Active identification of risk factors and early diagnosis of placental abnormalities are the main conditions in the prevention of massive obstetric bleeding and reduction of maternal mortality rates. It is necessary to strive to perform organ-preserving surgical interventions, if there are conditions that ensure their implementation. In this clinical case, despite the presence of a difficult-to-diagnose variant of placental ingrowth, it was possible to perform an organ-preserving operation and preserve the patient's ability to realize reproductive function in the future.

Systemic lupus erythematosus and pregnancy: Before gestation, during and after childbirth

Systemic lupus erythematosus (SLE) is a disease of women of reproductive age. Up to a certain time, pregnancy was contraindicated in patients with SLE, improving the management of the disease itself (monitoring), as well as understanding the safety of drugs make pregnancy possible for most patients with SLE. Careful pregnancy planning is crucial when the disease is well controlled with pregnancy-compatible medications. This is also facilitated by the management of patients jointly by doctors of different specialties (rheumatologist, neurologist, endocrinologist, etc.) with obstetricians. The article discusses the achievements of managing women with SLE during pregnancy planning, during pregnancy and after delivery.

Medicinal plants traditionally used in the health care practices by the indigenous communities of the Trans-Himalayan region of Ladakh, India

Ethnopharmacological relevanceLadakh, “the land of high-rising passes,” is a cold arid desert located in the India's northernmost part of the Trans-Himalayan region. Traditional knowledge of medicinal plants in this fragile ecosystem is an important part of the primary healthcare system, particularly in remote areas where modern medical facilities are not fully operational. There is a need to update the traditional information on medicinal plants from time to time to understand any addition of plants or uses to assist in developing new drugs through pharmacological and phytochemical studies. Aim of the studyThe study was conducted to document the traditional knowledge and current therapeutic practices of the indigenous communities of Ladakh. Besides, the study strives to evaluate previous studies from Ladakh to identify plants that have not been previously reported for medicinal use. Material and methodsEthnomedicinal information was collected from 350 local informants through open and semi-structured questionnaires and field surveys in 35 villages of 8 regions of Ladakh. The primary data were analyzed for use reports (UR) and the informant consensus factor (ICF). The reported diseases were classified according to the International Classification of Primary Care-2 (ICPC-2). New reported medicinal plants and unreported medicinal uses in this study were identified and compared to 36 prior studies conducted in Ladakh. ResultsIn the study, 176 medicinal plants belonging to 45 families and 131 genera were reported to treat 116 diseases of 16 (ICPC-2) groups with a total of 4841 use reports. Based on the highest use reports (UR), the most utilized species were Thymus linearis Benth. (134), followed by Aconitum heterophyllum Wall. (127) The highest informant consensus factor (ICF) was reported for Pregnancy, Childbearing, and Family Planning (ICF = 1) followed by respiratory (ICF = 0.91), and digestive (ICF = 0.90) disorders. Based on the comparative literature review, a total of 518 plant species (502 previously reported plus 16 newly cited) are being used in the Ladakh region. A total of 133 use reports for 16 newly cited plants using 30 diseases were recorded. The highest degree of overlapping of medicinal plants and uses for medicines was recorded in regions with comparable ethnicity, and shorter geographical distances. Based on the IUCN Red List, recorded medicinal plants include 7 critically endangered, 9 endangered, and 13 vulnerable species. ConclusionLadakh's indigenous populations use a diverse range of medicinal plants to treat a variety of illnesses. The introduction of species and medicinal uses not previously cited in the primary health care system demonstrates that shared knowledge of traditional medicine among Ladakhi is still rich. The medicinal value of preferred medicinal plants has already been validated, but some medicinal plants lack scientific validation. We recommend further scientific studies on Aconitum violaceum Jacquem. ex Stapf,Anaphalis nepalensis var. monocephala (DC.) Hand.-Mazz., Allardia nivea Hook. f. & Thomson ex C.B. Clarke, Atriplex hortensis L., Eriophyton tibeticum (Vatke) Ryding, Iris lactea Pall. and Rheum webbianum Royle.

1052-P: Reproductive Health Counseling in the T1D Exchange Quality Improvement Collaborative (T1DX-QI)

Background: Preconception planning can reduce complications in pregnancy with type 1 diabetes. However, high periconception HbA1C is not uncommon and increases maternal and fetal risks. Due to limited data regarding preconception counseling, questions about education and contraception use were added to the 2022 T1DX-QI survey. Methods: The annual T1DX-QI survey was conducted August-September 2022 with a site response rate of 94% of 50 sites: 33 pediatric (66%), 17 adult (34%). Respondents answered questions relating to clinic resources and practices. Response data was cleaned and summarized. Results: Most sites report discussing contraception (74%) and pregnancy planning (72%) once a year or more. Of pediatric sites, 42% report always asking about menstruation history compared to 6% of adult sites. Only 12% of adult and 6% of pediatric sites have a formal preconception counseling protocol. Only 12% of adult and 9% of pediatric sites estimated that >80% of their patients of childbearing potential were using contraception, and all sites estimated that <60% had a HbA1C under 7%. Conclusions: Though most sites report discussing contraception and pregnancy planning, estimated rates of formal counseling programs, contraception use and attaining goal HbA1C remain low. QI efforts are needed to determine rates of preconception counseling and implement best practices to improve pregnancy outcomes. Disclosure G.O'malley: Research Support; Dexcom, Inc., Abbott Diabetes, Tandem Diabetes Care, Inc., Omnipod, Eli Lilly and Company. M.Basina: None. R.Fallurin: None. C.J.Levy: Advisory Panel; Dexcom, Inc., Research Support; Abbott Diabetes, Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc., T1D Exchange. T1dx-qi collaborative: n/a. S.J.Ogyaadu: None. C.Levister: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc., Abbott Diabetes. N.Rioles: None. H.Hardison: None. A.J.Roberts: None. S.Accacha: None. I.Guttmann-bauman: None. F.Vendrame: Consultant; Eli Lilly and Company. Funding The Leona M. and Harry B. Helmsley Charitable Trust

Determinants of antenatal care utilization – contacts and screenings – in Sao Tome & Principe: a hospital-based cross-sectional study

BackgroundSao Tome & Principe (STP) has a high peri-neonatal mortality rate and access to high-quality care before childbirth has been described as one of the most effective means of reducing it. The country has a gap in the coverage-content of antenatal care (ANC) services that must be addressed to better allocate resources to ultimately improve maternal and neonatal health. Therefore, this study aimed to identify the determinants for adequate ANC utilization considering the number and timing of ANC contacts and screening completion.MethodsA hospital based cross-sectional study was undertaken among women admitted for delivery at Hospital Dr. Ayres de Menezes (HAM). Data were abstracted from ANC pregnancy cards and from a structured face-to-face interviewer-administered questionnaire. ANC utilization was classified as partial vs adequate. Adequate ANC utilization was defined as having ANC 4 or more contacts, first trimester enrolment plus one or more hemoglobin tests, urine, and ultrasound. The collected data were entered into QuickTapSurvey and exported to SPSS version 25 for analysis. Multivariable logistic regression was used to identify determinants of adequate ANC utilization at P-value < 0.05.ResultsA total of 445 mothers were included with a mean age of 26.6 ± 7.1, an adequate ANC utilization was identified in 213 (47.9%; 95% CI: 43.3–52.5) and a partial ANC utilization in 232 (52.1%; 95% CI: 47.5–56.7). Age 20–34 [AOR 2.27 (95% CI: 1.28–4.04), p = 0.005] and age above 35 [AOR 2.5 (95% CI: 1.21–5.20), p = 0.013] when comparing with women aged 14–19 years, urban residence [AOR 1.98 (95% CI: 1.28–3.06), p < 0.002], and planned pregnancy [AOR 2.67 (95% CI: 1.6–4.2), p < 0.001] were the determinants of adequate ANC utilization.ConclusionLess than half of the pregnant women had adequate ANC utilization. Maternal age, residence and type of pregnancy planning were the determinants for adequate ANC utilization. Stakeholders should focus on raising awareness of the importance of ANC screening and engaging more vulnerable women in earlier utilization of family planning services and choosing a pregnancy plan, as a key strategy to improve neonatal health outcomes in STP.

Peculiarities of contraceptive behavior among female medical students

BACKGROUND: This paper presents a review of the current literature on reproductive health problems and contraception in Russian girls. The history of the development and use of contraception in our country was considered, and the awareness, and choice of a suitable method of protection against unwanted pregnancies among Russian university students were analyzed. In addition, data on the contraceptive preferences of students in Europe, Asia, and United States were presented. The MEDLINE, Global Health, CyberLeninka, RSCI, and databases were searched for papers. Moreover, this review presents the results of the authors study aimed at determining the contraception methods preferred by third- and fifth-year female students of the I.M. Sechenov First Moscow State Medical University (Sechenov University) and assessing the level of awareness on pregnancy planning.&#x0D; MATERIALS AND METHODS: An anonymous online questionnaire was administered to third- and fifth-year girls at Sechenov University. A total of 360 questionnaires (filled out on the Yandex.Forms platform) administered to female students aged 1924 years were analyzed.&#x0D; RESULTS: The questionnaires of 176 third- and 184 fifth-year female students were evaluated. The majority of the third-year (72.2%) and fifth-year (83.8%) students had sexual experiences. The main contraception methods among third- and fifth-year female students were barrier methods and interrupted intercourse, hormonal methods of contraception were rarely used (up to 10% of the respondents), and no experience in using intrauterine contraceptives and spermicides was reported.&#x0D; CONCLUSIONS: The lack of awareness among medical students on modern and reliable contraception methods and their preference for ineffective methods indicate the need to cover reproductive health issues from the first year of study.

#5268 PREGNANCY OUTCOMES IN DIALYSIS PATIENTS: A TEN-YEAR SERIES FROM A TERTIARY CENTER

Abstract Background and Aims Pregnancy in dialysis patients was almost prohibited a decade ago, as fetal and maternal outcomes were very poor. In the last years, there has been a paradigm shift, as the introduction of intensive hemodialysis (HD) schedules has been associated with an impressive improvement on fetal outcomes, making motherhood a possibility in these women. Nevertheless, pregnancy in women on dialysis remains associated with a high incidence of complications and is extremely demanding for both patients and clinicians. We describe the maternal, obstetric, and perinatal outcomes of pregnancies in women on dialysis followed at the Nephro-Obstetric Clinic at Centro Hospitalar Universitário Lisboa Norte (CHULN). Method Retrospective analysis of pregnancies in women on dialysis and surveilled at the Nephro-Obstetric Clinic at CHULN from 2011 to 2022. Results We considered 17 pregnancies from 16 women. One of the women accounted was submitted to voluntary termination of pregnancy. Mean age was 31.5 ± 6.1 years; 70.6% were Black (n = 11) and 29.4% (n = 5) Caucasian; 58.8% were nulliparous (n = 10). All patients had chronic hypertension (HTN), although only 75.0% were under therapy (12/16). Additionally, 3/16 patients had diabetes and 2/16 hyperthyroidism. The mean of overall renal replacement therapy (RRT) duration was 9.1 ± 8.2 years (dialysis and renal transplantation time), being on dialysis program 43.7 ± 37.5 months before gestation. One patient was on peritoneal dialysis (PD) and two patients started HD during pregnancy. Five patients (31.2%) were exposed to teratogenic drugs during gestation. Pregnancy diagnosis occurred at 13.4 ± 5.6 weeks; 70.6% of the patients were on low dose acetylsalicylic acid (n = 12). HD mean time per week according to each trimester was 13.7 ± 2.8 hours/week, 24.5 ± 7.3 hours/week and 28.0 ± 8.0 hours/week during the 1st/2nd/3rd respectively. Mean pre-dialysis urea was 62.1 ± 28.0 mg/dL during gestation. Regarding maternal outcomes, worsening HTN occurred in 62.5% (n = 10) of patients during the 1st (4/10) and 2nd trimester (7/10) and pre- eclampsia (PE) occurred in 6/16 patients (1 with HELLP syndrome). One patient developed polyhydramnios and another one cholestasis of pregnancy. Premature rupture of membranes (PRM) occurred in 3 patients (at 17, 25 and 36 weeks); One patient asked for medical termination of pregnancy due to severe growth restriction and oligohydramnios at 20 weeks. Stillbirth occurred in 4 gestations (cervical insufficiency in a twin pregnancy, severe congenital fetal cardiopathy in a patient with PE, severe growth restriction and premature rupture of membranes (PRM). In the 2 patients with early PRM, the neonates died in the following week due to severe prematurity complications. Labor was induced in 9 patients, mainly due to PE (7/9). Cesarean was performed in 10/17 patients and mean gestation age at delivery was 29.8 ± 6.6 weeks. Extreme prematurity (&amp;lt;28 weeks) occurred in 3 pregnancies and there were three term babies. Mean birth weight was 1554.0±613.6 grams with 4 newborns having extremely low birth weight (&amp;lt;1000g) and 6 requiring neonatal care. Conclusion Our study reveals that pregnancy in women on dialysis is challenging and still associated with significant maternal, obstetric and perinatal complications. This population was highly heterogenous, with a significant number of patients living under unfavorable social conditions, and with significant comorbidities. The diagnosis of pregnancy took place mainly during the 2nd trimester, preventing early initiation of intensive dialysis schedules which could have significantly improved outcomes. Pregnancy planning, early diagnosis and management by a multidisciplinary experienced team are of paramount importance to improve outcomes and reduce complications.

Analisis Perbedaan antara Bidan Delima dengan Non Delima dalam Pemberian Pelayanan KIA dan KBKR selama Masa Pandemi Covid-19

The Covid-19 pandemic has had an impact on the life sector, one of which is the decline in the quality of midwifery services. The aim of this study was to analyze the differences between midwives in Delima and non-Delima in the delivery of Maternal and Child Health (MCH) and Reproductive Health Family Planning (KBKR) services during the Covid-19 Pandemic. The study was conducted comparatively with a cross-sectional approach. The research population was midwives supervising clinical practice students of the D3 Midwifery Study Program, STIKES Karya Husada Kediri. The sampling technique used simple random sampling, a sample of 92 respondents (delima and non-pomegranate midwives each 46 respondents). Data collection used a questionnaire from March 25 to July 26, 2021. Descriptive and bivariate univariate analysis techniques using the Mann Whitney test with a significance value (α=0.05) obtained all p values for each of the results of the analysis of differences in the status of pomegranate midwives and non-delima by providing pregnancy, delivery, post partum, postpartum, breastfeeding and family planning services &gt; (more) than a significance value of α=0.05, it is stated that there is no difference between these variables. The conclusion is that there is no difference between the services provided by midwives with Delima midwife status and non-Delima midwives. Suggestions for further research other variables are the level of client satisfaction between the services of pomegranate and non pomegranate midwives.

#6931 TWO CASES OF PREGNANCY IN PATIENTS WITH TUBEROUS SCLEROSIS COMPLEX

Abstract Background and Aims Tuberous sclerosis complex (TSC) is a rare autosomal dominant genetic disorder that is characterized by formation of benign tumors of the brain, kidney, eyes, heart, lung, liver and skin. The disease is frequently associated with adverse pregnancy outcomes. Our aim is to present two cases of Tuberous sclerosis complex in pregnancy which might be illustrative in the management of these patients. Method The first patient was a 32-year-old woman with a history of renal angiomyolipoma (AML) and pulmonic lymphangiomyomathosis (LAM) due to Tuberous sclerosis complex diagnosed at a young age. In the 35th gestational week she had an emergency Cesarean section due to acute retroperitoneal bleeding from angiomyolipoma of the right kidney and gave birth to a preterm male infant (birth mass 2077 g, Apgar 4/6). The patient did not take any medications during the course of pregnancy. Since 2015 she is being treated with everolimus (5 mg/day) due to complications for pulmonic lymphangiomyomathosis, subependymomas and epilepsy and AMLs. After eight years of treatment renal AMLs and LAM and subependymomas show no dynamic in size or number. The second patient was a 29-year-old nulliparous woman who has presented with seizures at the age of 2 and was diagnosed with TSC. At 37th gestational week of a twin pregnancy she gave birth to one male neonate (birth mass 2660 g, Apgar 8/9), while the other fetus died in utero. During the course of the pregnancy she was treated with phenobarbital, folic acid and iron supplementation. Her epilepsy is well-controlled and AMLs show no dynamic in size or number. Results: Conclusion We have showed two cases with relatively good outcomes which have long-term stable disease. Female patients with TSC have increased risk of hemorrhagic complications of AMLs during pregnancy and it can be complicated by intrauterine growth restriction. A multidisciplinary approach is needed in the planning and monitoring pregnancies in these patients to achieve optimal outcomes.

Two-year, real-world erenumab persistence and quality of life data in 82 pooled patients with abrupt onset, unremitting, treatment refractory headache and a migraine phenotype: New daily persistent headache or persistent post-traumatic headache in the majority of cases.

Patients diagnosed with New Daily Persistent Headache and Persistent Post-Traumatic Headache belong to a heterogeneous group of primary and secondary headache disorders, with the common clinical feature that these conditions start abruptly, continue unabated, and are refractory to conventional migraine preventive treatments. This is a real-world, medium-term audit to explore whether erenumab improves quality of life in a pooled group of 82 abrupt-onset, unremitting and treatment refractory patients, where the diagnosis is new daily persistent headache and persistent post-traumatic headache in the majority of cases. Eighty-two patients were treated with erenumab every 28 days over a two to three-year period, beginning in December 2018. These patients were "longstanding chronic" and refractory with a median of eight (IQR 4-12) prior failed migraine preventive treatments and median duration of disease of seven (IQR 3-11) years. The starting dose of erenumab was 70 mg in 79% of cases and 140 mg in the remaining patients (individuals with a BMI of more than 30). All patients were asked to complete three migraine specific Quality of Life questionnaires or Patient Reported Outcome Measures before starting treatment and typically at 3-12 intervals until the end of June 2021 or cessation of treatment. The Patient Reported Outcome Measures included: Headache Impact Test-6, Migraine Associated Disability Assessment test and Migraine-Specific Quality-of-Life Questionnaire. Patients generally only stayed on treatment after 6-12 months if there was deemed to be an improvement of at least 30% and there were no significant side effects. The longest treated cases have quality of life data for 30 months after starting erenumab. Of the 82 patients, 29 (35%) had improvement in Quality of Life scores, with no significant side effects, and wished to stay on treatment. Fifty-three patients (65%) stopped treatment during the first 6-25 months due to lack of efficacy and/or patient reported side effects (n = 33 and n = 17, respectively) or a combination of both, pregnancy planning (n = 2), and lost to follow up (n = 1). Significant improvements in Quality of Life scores were recorded by one-third of patients over a period of 11-30 months, with a 35% persistence after a median of 26 months of treatment. This contrasts with our recently published, treatment resistant, chronic migraine cohort where the persistence with erenumab treatment was almost 55% after a median time of 25 months.

Factors associated with Australian preconception and pregnant women's nutrition and nutrient supplement knowledge

AbstractAimTo describe factors associated with women's knowledge of nutrition, knowledge of nutrient supplements and use of supplements that are routinely recommended during preconception and pregnancy.MethodsParticipants (women 18–45 years, pregnant or planning pregnancy) were recruited from a consumer survey panel and completed an online, custom‐built questionnaire. Responses were used to calculate individual scores for nutrition knowledge (range 0–30) and supplements knowledge (range 0–10), where higher scores indicated better knowledge, and determine use of routinely recommended supplements (yes/no). Statistical tests of independence were used to explore associations between these outcomes and 68 variables derived from the survey.ResultsOf 2289 respondents, 776 were eligible and 624 (80.4%) completed the survey. Among pregnant women (N = 144) and those planning a pregnancy (N = 480), nutrition knowledge and supplements knowledge was limited, and daily use of routinely recommended supplements was low (63.5% pregnant, 40.1% planners). The odds of appropriate supplement use was strongly associated with health literacy adequacy. There was a low positive correlation between supplements beliefs and nutrition/supplements knowledge. Nutrition and supplements knowledge was associated with information provided by a wider number of health and allied health services during preconception than during pregnancy.ConclusionHealthcare providers are central to preconception and pregnancy dietary and nutrient supplement advice. Our data reinforce the role of adequate health literacy in applying this advice and suggest that an understanding of women's beliefs about supplements and targeting the source of the information to women at different stages (preconception or pregnant), could be used to better tailor these communications.

Unplanned pregnancy and the association with maternal health and pregnancy outcomes: A Swedish cohort study.

Unplanned pregnancies are common and associated with late initiation and inadequate antenatal care attendance, which may pose health risks to mother and child. How pregnancy planning relates to maternal health and delivery in Sweden, a country with free antenatal care and free abortion, has not been studied previously. Our aims were to study whether pregnancy planning was associated with antenatal care utilization and pregnancy outcomes in a Swedish setting. Data for 2953 women, who answered a questionnaire when recruited at antenatal clinics in Sweden and later gave birth, was linked to the Swedish Medical Birth Register. The degree of pregnancy planning was estimated using the London Measure of Unplanned Pregnancy. Unplanned (comprising unplanned and ambivalent intention to pregnancy) was compared to planned pregnancy. Differences between women with unplanned and planned pregnancy intention and associated pregnancy outcomes were analyzed using Fisher's exact test and logistic regression. There were 31% unplanned (2% unplanned and 29% ambivalent) pregnancies, whereas most woman (69%) reported their pregnancy to be planned. Women with an unplanned pregnancy enrolled later to antenatal care, but there was no difference in number of visits compared with planned pregnancy. Women with an unplanned pregnancy had higher odds to have induced labor (17% versus 13%; aOR 1.33 95% CI 1.06-1.67) and a longer hospital stay (41% versus 37%; aOR 1.21 95% CI 1.02-1.44). No associations were found between pregnancy planning and pregnancy-induced hypertension, gestational diabetes mellitus, preeclampsia, epidural analgesia use, vacuum extraction delivery, Caesarean section or sphincter rupture. Unplanned pregnancy was associated with delayed initiation of antenatal care, higher odds for induction of labor and longer hospital stay, but not with any severe pregnancy outcomes. These findings suggest that women with an unplanned pregnancy cope well in a setting with free abortion and free health care.

КОМУНІКАЦІЙНІ ІНСТРУМЕНТИ БРЕНДИНГУ МЕДИЧНИХ УСТАНОВ У СОЦІАЛЬНИХ МЕРЕЖАХ

&lt;p&gt;&lt;strong&gt;&lt;em&gt;The purpose of the study&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; is to represent communication tools for the &lt;/em&gt;&lt;em&gt;development of a branding strategy for a medical institution in social networks.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Research methodology.&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; To understand the phenomenon of branding, methods of analysis and synthesis, and descriptive method were used; ascertainment of the specifics of medical institutions branding required the use of monitoring, content analysis, comparison and survey methods.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Results.&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; The trends and specifics of branding &lt;/em&gt;&lt;em&gt;in the medical field («medical marketing»/«medical services marketing») were represented. Modern ways of updating content for information and communication interaction with the audience of a medical institution, in particular a maternity hospital, were described. The dominant communication tools for establishing contact with clients through social networks were characterized, in particular: video stories about the institution and its employees; materials with expert comments of specialists (doctors); live broadcasts with medical workers of the institution. The designed and implemented concept of content strategy in social networks for the maternity hospital number 9 of Zaporizhzhia was presented. The main components of corporate style and their implementation on the pages of the «Ninth» in social networks were revealed. As a result of the conducted online survey, a high assessment of the quality of the page information content on the Instagram platform was observed. It was found that the basic share of the target audience of the maternity hospital pages in social networks is pregnant women and women who have given birth, and therefore, in order to expand the circle of interested people, it is necessary to increase the percentage of content for those who are at the stage of pregnancy planning.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Novelty of the research&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; consists in studying the specifics of &lt;/em&gt;&lt;em&gt;branding such a type of medical institution as a maternity hospital; formation and implementation of the content strategy concept for organizing its pages in social networks, as well as studying the effectiveness of their content for information and communication interaction with the target audience.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Practical significance.&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; The conducted research contributed to the generalization of the main areas of information support for clients of medical institutions, in particular the regional maternity hospital, as well as to the identification of dominant trends in the development and implementation of the concept and content strategy of pages in social networks of such institutions.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Key words:&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; brand, branding, medical branding,&lt;/em&gt;&lt;em&gt; medical marketing, marketing of medical services, content strategy, social networks, information and communication interaction.&lt;/em&gt;&lt;/p&gt;

Serum endocan levels in patients with habitual abortion.

The aim of this study was to investigate whether there is a new factor in the etiology of recurrent loss of pregnancy. For this purpose, serum malondialdehyde (MDA) and nitric oxide (NO) levels as indicators of oxidative stress, and endocan levels, a marker of vascular dysfunction, were investigated in patients diagnosed with habitual abortion. The research was conducted as a prospective case-control study. Patients aged 18-40 years with two or more consecutive pregnancy losses revealed by ultrasonographic or histopathological examination, and with no pathology capable of causing habitual abortion were included in the study group. Patients with no history of abortion, with at least one healthy pregnancy, who were planning pregnancies, and who presented to the outpatient clinic for routine prepregnancy tests were selected as the control group. Two groups were established-habitual abortion (n = 30) and control (n = 29). At the end of the menstrual cycle, blood samples were collected and centrifuged. Serum NO, MDA, and endocan levels were studied. Serum endocan, NO, and MDA levels were higher in women with habitual abortion compared to healthy controls. Pearson's correlation analysis revealed a positive correlation between serum endocan levels and NO and MDA levels. A positive correlation was also observed between serum MDA and NO levels. Multiple regression was run to predict serum endocan levels from MDA and NO levels. These variables emerged as statistically significant predictors of endocan. These findings suggest the presence of vascular endothelial dysfunction in patients with habitual abortion.

Spontaneous perirenal hemorrhage (Wunderlich syndrome) in the fetus: a case report

BackgroundSpontaneous perirenal hemorrhage (Wunderlich syndrome) in the fetus is a rare urinary system disease. Prenatal ultrasound diagnosis presents challenges due to the lack of specific clinical features.Case presentationA 27-year-old Chinese woman gravida 2 para 0 found her fetus with the left Wunderlich syndrome accompanying bilateral hydronephroses and bladder dysfunction with an early diagnosis through prenatal ultrasound and postnatal magnetic resonance imaging. After a timely emergency cesarean section, the infant was administrated antimicrobial prophylaxis and an indwelling catheter treatment. Ultrasound follow-up showed his urinary system gradually developed normally.ConclusionA fetus with bilateral hydronephroses accompanying bladder dysfunction should be observed because of the risk of spontaneous renal rupture with hemorrhage formation. Ultrasound and magnetic resonance imaging play a vital role in the diagnosis and follow-up of Wunderlich syndrome. Early diagnosis facilitates better pregnancy planning and appropriate care of newborns.

Contraception consultation and assessment for women over 40

Access to contraception is a basic human right, and one that empowers women to support pregnancy planning. When assessing a woman over the age of 40 for contraception, concerns such as co-morbidity, changes to menstrual pattern, irregular bleeding and the management of additional perimenopausal and menopausal symptoms are essential considerations. While many methods of contraception can be used in menopause, some may need to be changed to safer, alternative methods. Most women will require some form of contraception (often taken alongside hormone replacement therapy) until the age of 55. This article will focus on contraception consultation and assessment, prescribing considerations in relation to age and menopause, contraceptive formulations (hormonal methods and the copper IUD and the potential health implications of using specific forms of contraception.

Research Priorities to Support Women Veterans' Reproductive Health and Health Care Within a Learning Health Care System.

Research Priorities to Support Women Veterans' Reproductive Health and Health Care Within a Learning Health Care System.