Early Pregnancy Problems Research Articles

Maternal concentrations of environmental phenols during early pregnancy and behavioral problems in children aged 4 years from the Shanghai Birth Cohort

BackgroundPrenatal exposure to environmental phenols such as bisphenol (BPs), paraben (PBs), benzophenone (BzPs), and triclosan (TCS) is ubiquitous and occurs in mixtures. Although some of them have been suspected to impact child behavioral development, evidence is still insufficient, and their mixed effects remain unclear. ObjectivesTo explore the association of prenatal exposure to multiple phenols with child behavioral problems. MethodIn a sample of 600 mother–child pairs from the Shanghai Birth Cohort, we quantified 18 phenols (6 PBs, 7 BPs, 4 BzPs, and TCS) in urine samples collected during early pregnancy. Parent-reported Strengths and Difficulties Questionnaires were utilized to evaluate child behavioral difficulties across four subscales, namely conduct, hyperactivity/inattention, emotion, and peer relationship problems, at 4 years of age. Multivariable linear regression was conducted to estimate the relationships between single phenolic compounds and behavioral problems. Additionally, weighted quantile sum (WQS) regression was employed to examine the overall effects of the phenol mixture. Sex-stratified analyses were also performed. ResultsOur population was extensively exposed to 10 phenols (direction rates >50 %), with low median concentrations (1.00 × 10−3–6.89 ng/mL). Among them, single chemical analyses revealed that 2,4-dihydroxy benzophenone (BP1), TCS, and methyl 4-hydroxybenzoate (MeP) were associated with increased behavior problems, including hyperactivity/inattention (BP1: β = 0.16; 95 % confidence interval [CI]: 0.04, 0.30), emotional problems (BP1: β = 0.11; 95 % CI: 0.02, 0.20; TCS: β = 0.08; 95 % CI: 0.02, 0.14), and peer problems (MeP: β = 0.10; 95 % CI: 0.02, 0.18); however, we did not identify any significant association with conduct problems. Further phenol mixture analyses in the WQS model yielded similar results. Stratification for child sex showed stronger positive associations in boys. ConclusionOur findings indicated that maternal phenol levels during early pregnancy, specifically BP1, TCS, and MeP, are associated with high behavioral problem scores in 4-year-old children.

The Role Of Systemic Immune-Inflammation Index In The Severity Of Hyperemesis Gravidarum.

Hyperemesis gravidarum(HEG) is one of the severe health problems in early pregnancy. Obstetricians should be aware of systemic inflammation in HEG patients to provide better preventive strategies. Hyperemesis gravidarum(HEG) is one of the most common causes of hospitalization in early pregnancy. Complete blood count parameters can be used as inflammatory markers in patients with HEG. We aimed to investigate the Systemic Immune-Inflammation Index (SII)in predicting the severity of HEG. This cross-sectional study was performed with 469 pregnant women diagnosed and hospitalized with HEG. The study parameters were calculated from complete blood count tests and urine analysis. Demographic characteristics, the Pregnancy Unique Quantification of Emesis (PUQE) scale values, and ketonuria levels at hospital admission were recorded. The neutrophil‑to‑lymphocyte ratio (NLR), platelet‑to‑lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and SII, calculated by the formula (neutrophil × platelet/lymphocyte), were evaluated for predicting the severity of HEG. There was a positive correlation between the increased degree of ketonuria and SII. The cut-off value of SII for predicting the severity of HEG was 1071.8 (AUC 0.637, 95% CI (0.582-0.693), p<.001), and sensitivity and specificity were 59% and 59%, respectively. The cut-off value of SII to predict the length of hospitalization was 1073.6(AUC: 0.565, 95% CI: (0.501-0.628), p= 0.039); sensitivity and specificity were 56.3% and 55.5%, respectively CONCLUSIONS: : The clinical utility of SII in predicting HEG severity is limited due to relatively low sensitivity and specificity. Further research is needed to determine the importance of inflammatory indices in HEG patients.

Pre-pregnancy complications - associated factors and wellbeing in early pregnancy: a Swedish cohort study

BackgroundMany couples experience difficulties to become pregnant or carry a pregnancy to term due to unknown causes. Here we define pre-pregnancy complications as having prior recurrent pregnancy loss, prior late miscarriages, time to pregnancy more than one year, or the use of artificial reproductive technologies. We aim to identify factors associated with pre-pregnancy complications and poor well-being in early pregnancy.MethodsOnline questionnaire data from 5330 unique pregnancies in Sweden were collected from November 2017 – February 2021. Multivariable logistic regression modelling was used to investigate potential risk factors for pre-pregnancy complications and differences in early pregnancy symptoms.ResultsPre-pregnancy complications were identified in 1142 participants (21%). Risk factors included diagnosed endometriosis, thyroid medication, opioids and other strong pain medication, body mass index > 25 kg/m2 and age over 35 years. Different subgroups of pre-pregnancy complications had unique risk factors. The groups also experienced different pregnancy symptoms in early pregnancy, where women that had experienced recurrent pregnancy loss were at higher risk of depression in their current pregnancy.ConclusionWe report one of the largest pregnancy cohorts with high frequency of pre-pregnancy complications compared to the Swedish population. Prescribed drug use and body weight were the top potentially modifiable risk factors in all groups. Participants that experienced pre-pregnancy complications also had higher risk of depression and pregnancy problems in early pregnancy.

124 Is there any impact of age on psychological well-being when facing early pregnancy problems?

Background: Threatened miscarriage is one of the most common early pregnancy complication. About 20% of women may end up with miscarriage. Women may face a significant social and psychological morbidity. Objective: This study investigated if age of pregnant women would affect their psychological well-being on facing the early pregnancy problems. Method: All Chinese women attending the early pregnancy assessment clinic for early pregnancy problem of abdominal pain and vaginal bleeding were recruited. Exclusion criteria included women requested for termination of pregnancy or referred for suspected ectopic pregnancy. Informed consent was obtained. Demographic data, pain and bleeding severity were collected. They were invited to fill in questionnaire before the consultation, including the Chinese versions of 12-item General Health Questionnaire (GHQ-12), Beck Depression Inventory (BDI), Spielberger’s State Anxiety Inventory (STAI), and Fatigue Scale (FS). After that, gynecological examination and transvaginal ultrasound scan were performed by qualified gynecologists. Diagnosis of first trimester miscarriage, unknown viability and viable pregnancy was made. Women would be further follow-up in 1–2 weeks if the first diagnosis was unknown viability to determine the viability.Comparison was made between women who were aged ≤ 20 years (Group A) and aged ≥ 21 years old (Group B). Results: In all, 18 women were aged ≤ 20 years. Significantly more women aged ≤ 20 years were nulliparous and smoker. More of them also reported bleeding symptoms. Overall, the mean scores of GHQ12, BDI, STAI and FS questionnaires were 4.0 ± 3.1 (range 0–12), 9.2 ± 6.9 (range 0–55), 54.3 ± 10.7 (range 21–80), 2.4 ± 0.5 (1–4) respectively. There was no significant difference in all the GHQ-12, BDI, STAI and FS scores. Conclusion: There was no significant difference on psychological well-being between women aged ≤ 20 years or ≥ 21 years when facing the early pregnancy problems. Table 1 Table 1Demographics and scores of different questionnaires on psychological well-being. AllN = 1271 Group A (n = 18) Group B (n = 1253) P-value Nulliparity 750 (59.0%) 15 (83.3%) 735 (58.7%) 0.035 Smoking 177 (13.9%) 8 (44.4%) 169 (13.5%) 0.002 Presence of bleeding 1002 (78.8%) 8 (44.4%) 994 (79.3%) <0.001 Presence of abdominal pain 866 (68.1%) 14 (77.8%) 852 (68.0%) 0.38 GHQ-12 4.0 ± 3.1 4.1 ± 2.7 4.0 ± 3.2 0.92 BDI 9.2 ± 6.9 10.9 ± 9.2 9.2 ± 6.9 0.28 STAI 54.3 ± 10.7 52.8 ± 9.2 54.3 ± 10.7 0.56 FS 2.4 ± 0.5 2.3 ± 0.5 2.4 ± 0.5 0.39 Outcome of pregnancy - Viable pregnancy 1111 (87.4%) 17 (94.4%) 1094 (87.3%) 0.72 -Miscarriage 160 (12.6%) 1 (5.6%) 159 (12.7%) Open table in a new tab

Analysis of domestic and international experience in the field of social support for young single mothers

This article analyzes the measures taken in our country and a number of foreign countries in the direction of social support for single young mothers. Social support for single mothers, including young ones, should be one of the points of family policy of each state, since young mothers are not able to cope with financial, moral and other situations arising from the birth of an illegitimate child on their own. The study of the process of social support for such mothers also determines the urgent need for preventive work on the problems of early pregnancy, motherhood in adolescence, social orphanhood. The main purpose of the article is to compare the work on social support for single mothers in our country, to determine effective measures for the implementation of work in this direction. The research method of the article is the analysis of materials of domestic and foreign scientific research, question- naires, official statistical indicators of the Bureau of National Statistics of the Agency for Strategic Plan- ning and Reforms of the Republic of Kazakhstan. The study interviewed 33 young single mothers tem- porarily residing in the «Mother’s House» and other crisis centers. In the article, in parallel with providing financial support to young mothers, a comparative analysis of work in Kazakhstan, Russia, France, Norway, the USA, Japan, China and a number of other countries is carried out in solving issues of social orientation: psychological support, stabilization of the psycho- emotional state, adaptation to the environment and others. The results of the analysis of social support for pregnant girls and young single mothers show that help is needed and the need to solve the problem in the social work system, as a result, measures to prevent this problem are presented. Key words: young single mothers, early pregnancy, abortion, social support, social adaptation.

Access and utilization of the youth-friendly sexual and reproductive health services in Nepal: What does literature show?

This study has attempted to assess the access and utilization of youth-friendly sexual and reproductive health services in Nepal. Different literature regarding youth-friendly sexual and reproductive health services has been reviewed using online databases. A total of 125 relevant articles were assessed for the study. The literature was categorized and analyzed with five key thematic areas: knowledge on SRH among youths, the prevalence of child marriage and teenage pregnancy, attitudes towards premarital sex, utilization of SRHs, and barriers to utilizing the SRHS. This study has found that youths do not always utilize SRHS. Various barriers exist for providing and using YFSRHs in Nepal. Nepal's adolescents and youths face problems of STIs, HIV/AIDS, early pregnancy and parenthood, difficulties accessing contraception, and safe abortion. The study has also found that many countries have single youth-friendly sexual and reproductive health policies and that utilization of SRHS is also high in those countries. Moreover, this review has also found that because of inadequate knowledge and information on SRHS, Nepalese youths are facing numerous reproductive health problems. Multiple factors contribute as barriers to utilizing the SRHS. Therefore, there is a need for a program to motivate youths to respect their right to access reproductive health information and service, ensure the availability of peer counselors in the health centers, and increase the awareness level of the community so that they can utilize the quality of SRHS.

TUBAL ECTOPIC PREGNANCY AND THE DETERMINANTS OF ITS DIFFERENT TREATMENT OPTIONS

Objective: To find out the determinants affecting the different management options of tubal ectopic pregnancy. Methodology: This cross sectional study was carried out in the Unit A of the department of obstetrics and gynecol­ogy, Hayatabad Medical Complex, Peshawar from December 2014 to March 2018. All the patients admitted with clinical/ultrasound diagnosis of tubal ectopic pregnancy were included in the study through convenient sampling technique after informed consent. Patients having other early pregnancy problems which would mimic tubal ec­topic pregnancy and those having any medical contraindications to Methotrexate were excluded. A pre-designed performa was used to collect the data, which was analyzed using SPSS v.22.0. Results: The mean age of the sample (n=78) was 27.0±7.8 years. Maximum patients were multigravida (n=41, 52.6%), followed by primigravida (n=25, 32.0%). In treatment modalities, maximum of the cases (n=43, 55.1%) were managed medically via methotrexate with success rate of 93.0%, while 18 (23.1%) cases were managed conservatively with success rate of 83.3%, and 17 (21.8%) of the cases were managed surgically with 100% suc­cess rate. The maximum size of adnexal mass was found to be as 8.6×7, 10×7, and 8×6 in three management options, i.e., conservative, medical and surgical respectively, while in the same categories, maximum Beta-Human Chorionic Gonadotropin (B-hCG) level was found to be as 978, 43220, and 29844 mIU/ml respectively. Conclusion: Hemodynamic instability and rising B-hCG were the core determinants in the management of tubal ectopic pregnancy. The size of the adnexal mass and the initial B-hCG did not affect the management.

MEDICAL MANAGEMENT OF THE COMPLICATIONS OF EARLY PREGNANCY WITH MISOPROSTOL

OBJECTIVE: The study’s goal was to ascertain if misoprostol is beneficial for people who have early pregnancycomplications. And to prevent these individuals from undergoing surgical evacuation.METHODOLOGY: Between 2015 and 2017, an experimental investigation was carried out at the MardanMedical Complex Hospital in Mardan at the Department of Obstetrics and Gynecology, Unit A. For misoprostoltherapy, 200 women with early pregnancy problems were included. Patients with early pregnancy problems who werehemodynamically stable and had a gestational age of fewer than 15 weeks met the inclusion criteria. Patients having ahistory of ectopic pregnancy, gestational trophoblastic illness, hemodynamic instability, uterine rupture, hypersensitivityto prostaglandin, and hemoglobin levels below 9 g were excluded. The ability to successfully resolve miscarriages withoutthe need for surgery was the primary outcome measure. Incidence of discomfort, vaginal bleeding, infection, pyrexia,and adverse gastrointestinal symptoms were secondary outcomes. The research included 200 women in total. They wereprimigravida to grand multigravida, ranging in age from 16 to 45. Thirty (15%) had an embryonic pregnancy, 88(44%) had an incomplete abortion, and 82 (41%) had an early fetal death. When misoprostol was the only medicationused for therapy, 140 (or 70%) women entirely expelled the conceptual products; nevertheless, 60 (30%) patients neededsurgery since their conceptual products had not been fully expelled and they were bleeding excessively. The average timebetween induction and expulsion was 16 hours. The most common adverse effects reported were diarrhea, vomiting,pyrexia, discomfort, and nausea. In 14 individuals, more than one side event was reported. For individuals with earlypregnancy difficulties, misoprostol is an appropriate and effective treatment for early pregnancy loss. It may be kept atroom temperature and is inexpensive and heat stable.RESULTS: The study concerned a diverse institution of women, starting from primigravida to grand multigravida,and spanning a while sixteen to 45. The distribution of pregnancy headaches covered 15% with embryonic pregnancy,44% with incomplete abortion, and 41% with early fetal demise. Out of the 2 hundred girls, one hundred forty (70%)effectively expelled the conceptual products solely through misoprostol therapy. However, 30% of sufferers requiredsurgical operation because of incomplete expulsion and excessive bleeding. The common time between misoprostolinduction and complete expulsion changed into reported as sixteen hours.The look at additionally referred to notunusual adverse consequences, such as diarrhea, vomiting, pyrexia, pain, and nausea. In some instances, a couple ofside impact became reported, affecting 14 people.CONCLUSION: The observe contributes treasured insights into the scientific management of early pregnancycomplications using misoprostol. It emphasizes the effectiveness of misoprostol in resolving miscarriages without theneed for surgery in a significant proportion of instances. The documented negative consequences, while present, shouldbe weighed towards the blessings of averting surgical processes.KEYWORDS: Misoprostol, medical treatment, miscarriage.

Patient Experiences With Miscarriage Management in the Emergency and Ambulatory Settings.

To quantitatively and qualitatively describe the patient experience for clinically stable patients presenting with miscarriage to the emergency department (ED) or ambulatory clinics. We present a subanalysis of a mixed-methods study from 2016 on factors that influence miscarriage treatment decision-making among clinically stable patients. Fifty-four patients were evaluated based on location of miscarriage care (ED or ambulatory-only), and novel parameters were assessed including timeline (days) from presentation to miscarriage resolution, number of health system interactions, and number of specialty-based provider care teams seen. We explored themes around patient satisfaction through in-depth narrative interviews. Median time to miscarriage resolution was 11 days (range 5-57) (ED) and 8 days (range 0-47) (ambulatory-only). We recorded a mean of 4.4±1.4 (ED) and 3.0±1.2 (ambulatory-only) separate care teams and a median of 13 (range 8-20) (ED) and 19 (range 8-22) (ambulatory-only) health system interactions. Patients seeking care in the ED were younger (28.3 vs 34.0, odds ratio [OR] 5.8, 95% CI 1.8-18.7), more likely to be of black race (28.3 vs 34.0, OR 3.3, 95% CI 1.1-10.0), uninsured or insured through Medicaid (16 vs 6, OR 6.8, 95% CI 2.1-22.5), and more likely to meet criteria for posttraumatic stress disorder when compared with ambulatory-only patients (10 vs 3, OR 6.0, 95% CI 1.5-23.4). Patients valued diagnostic clarity, timeliness, and individualized care. We found that ED patients reported a lack of clarity surrounding their diagnosis, inefficient care, and a mixed experience with health care provider sensitivity. In contrast, ambulatory-only patients described a streamlined and sensitive care experience. Patients seeking miscarriage care in the ED were more likely to be socioeconomically and psychosocially vulnerable and were less satisfied with their care compared with those seen in the ambulatory setting alone. Expedited evaluation of early pregnancy problems, with attention to clear communication and emotional sensitivity, may optimize the patient experience.

Association between early pregnancy bisphenol A exposure and sleep problems among preschool children

Objective: To analyze the association between maternal bisphenol A exposure during early pregnancy and sleep problems among preschool children. Methods: Research subjects were from one of the sub-cohorts(Ma'anshan Cohort) of the China-Anhui Birth Cohort Study (C-ABCS) in Ma'anshan city. The basic situation of pregnant women and sleep information of preschool children were investigated. We selected preschool children whose mother's maternal serum bisphenol A concentrations of the first trimester had been already detected between December 2012 to Januray 2014. 1 259 pairs of mothers and children were included. The concentrations of bisphenol A exposure during early pregnancy were divided into low, medium and high exposure groups according to 25(th) percentile (P(25)) and 75(th) percentile (P(75)) levels. Multivariate multinomial logistic regression model was used to analyze the association between maternal bisphenol A exposure during early pregnancy and sleep-related problems in preschool children. Results: The P(50) (P(25)-P(75)) of serum bisphenol A exposure level during early pregnancy was 0.231 (0.106-0.512) ng/ml. The sleep-related problems scores of 1 259 preschool children were (16.43±3.82) points. The occasional sleep-related problems were detected about 47.8% (602 cases) and frequent sleep-related problems were detected about 18.3% (230 cases). After the adjustment of the confounding factors such as children's gender, age, BMI, sleep position (lying down, sleeping on one's back), the length of time to sleep and the length of sleep at night, in comparison with bisphenol A low exposure group, the OR (95%CI) value of preschool children with occasional sleep-related problems in maternal bisphenol A high exposure group during early pregnancy was 1.44 (1.01-2.06). After the gender stratification, the results showed that in comparison with bisphenol A low exposure group, the OR (95%CI) value of preschool girls with occasional sleep-related problems in maternal bisphenol A medium and high exposure group during early pregnancy were 1.61 (1.05-2.46) and 2.40 (1.42-4.04), respectively. The OR (95%CI) value of preschool girls with frequent sleep-related problems in maternal bisphenol A high exposure group during early pregnancy was 2.64 (1.34-5.17). However, in boys, there was no statistically significant association between maternal bisphenol A exposure during early pregnancy and sleep-related problems (P>0.05). Conclusion: Maternal bisphenol A exposure during early pregnancy might be related to sleep-related problems in preschool children.

Poor sleep during early pregnancy increases subsequent risk of gestational diabetes mellitus

ObjectivesTo examine the relationship between poor sleep quality during pregnancy and the risk of gestational diabetes mellitus (GDM). MethodsA total of 4066 singleton pregnant women from the Tongji Maternal and Child Health Cohort (TMCHC) without overt diabetes before pregnancy were analyzed. Sleep quality and duration during early pregnancy were self-reported by enrolled women at their first antenatal care visit before 16 weeks of gestation. Gestational diabetes mellitus (GDM) was assessed with a 75-g, 2-h oral glucose tolerance test at 24–28 weeks of gestation. Information about self-reported sleep quality and duration in mid-pregnancy were also collected at this time. Odds ratios (OR) and 95% CIs were calculated by multivariable logistic regression models, and adjusted for potential confounders to estimate the effect of poor sleep quality and the interaction between sleep quality and duration on the development of GDM. Stratified analyses were performed according to age, parity, family history of diabetes and napping. ResultsA total of 335 (8.2%) participants were diagnosed with GDM. Poor sleep quality was reported in 259 (6.4%) women during early pregnancy and 248 (6.1%) in mid-pregnancy. The risk of GDM was increased in women with poor sleep quality during early pregnancy (OR 1.77, 95% CI 1.20–2.61). No association was found between poor sleep quality during mid-pregnancy and the risk of GDM. The risk of GDM was highest in women with poor sleep and longer nighttime sleep duration during early pregnancy (OR 2.27, 95% CI 1.20–4.29) when compared with those who reported good sleep and 7.0–8.5 h of sleep duration per night. Stratified analysis found that the association between poor sleep quality in early pregnancy and the risk of GDM was stronger among women aged ≥30 years (OR 2.35, 95% CI 1.35–4.09) and those with a family history of diabetes (OR 4.02, 95% CI 1.54–10.48). ConclusionsPoor sleep quality during early pregnancy was associated with an increased risk of GDM. Screening for and treating sleep problems in early pregnancy could potentially reduce the risk of GDM.

Détresse psychologique et dimensions psychopathologiques des adolescents en situation difficile à Kinshasa

ContextIn the Democratic Republic of Congo, the management of psychosocial problems of adolescents is confronted with phenomena of resistance and poorly-elucidated recurrence. In addition, the distress and the associated psychopathological dimensions are not integrated. ObjectivesThe first objective was to assess the level of psychological distress of adolescents facing problems of early pregnancy and motherhood, antisocial behavior, drug abuse, maltreatment, witchcraft, street children. The second objective was to determine the psychopathological dimensions such as somatization, interpersonal sensitivity, depression, obsession-compulsion, anxiety, paranoid ideation, hostility, phobic anxiety and psychotic traits associated with psychosocial problems of adolescents. MethodsA cross-sectional study was conducted among 66 adolescents experiencing difficulties (27 boys and 39 girls) aged 17.53 (±2.33) years in the health zone of Masina 2, between May and October 2010. The global severity index of psychological distress and psychopathological dimensions were assessed by a mental health tool, the Symptom Checklist-90-Revised. Kruskal–Wallis, Tukey–Kramer and multiple correspondence analyzes were used to analyze the variables with P<0.05. ResultsThe global severity index varied according to psychopathological dimensions (P<0.0001) and psychosocial problems (P=0.001). The average score was 0.92. The significant differences in average scores were observed between firstly abuse and addiction, for which the scores were higher, and other antisocial behavior, street children, early pregnancies and motherhood and witchcraft (P<0.0001). Interpersonal sensitivity was the most common dimension, and each psychosocial problem presented a preponderant psychopathological dimension. ConclusionThis study allowed the characterization of psychic suffering and mental health related to psychosocial problems of adolescents in Kinshasa. These results could contribute to research on the psychopathology of adolescence in difficult situations in order to improve the personalization of social and psychotherapeutic care of adolescents according to the psychosocial factors that are causing their distress and maladjustment.

Face and content validity of the virtual reality simulator \u2018ScanTrainer\xae\u2019

BackgroundUltrasonography is a first-line imaging in the investigation of women’s irregular bleeding and other gynaecological pathologies, e.g. ovarian cysts and early pregnancy problems. However, teaching ultrasound, especially transvaginal scanning, remains a challenge for health professionals. New technology such as simulation may potentially facilitate and expedite the process of learning ultrasound. Simulation may prove to be realistic, very close to real patient scanning experience for the sonographer and objectively able to assist the development of basic skills such as image manipulation, hand-eye coordination and examination technique.ObjectiveThe aim of this study was to determine the face and content validity of a virtual reality simulator (ScanTrainer®, MedaPhor plc, Cardiff, Wales, UK) as reflective of real transvaginal ultrasound (TVUS) scanning.MethodA questionnaire with 14 simulator-related statements was distributed to a number of participants with differing levels of sonography experience in order to determine the level of agreement between the use of the simulator in training and real practice.ResultsThere were 36 participants: novices (n = 25) and experts (n = 11) who rated the simulator. Median scores of face validity statements between experts and non-experts using a 10-point visual analogue scale (VAS) ratings ranged between 7.5 and 9.0 (p > 0.05) indicated a high level of agreement. Experts’ median scores of content validity statements ranged from 8.4 to 9.0.ConclusionsThe findings confirm that the simulator has the feel and look of real-time scanning with high face validity. Similarly, its tutorial structures and learning steps confirm the content validity.

Implementation of the findings of a national enquiry into the misdiagnosis of miscarriage in the Republic of Ireland: impact on quality of clinical care

To describe the findings of a national inquiry into cases of misdiagnosis of miscarriage in the Republic of Ireland and to report the results of implementation of the findings of the inquiry, including investment in new equipment and training, new national guidelines, and rigorous annual audit of early pregnancy units. Narrative description of the inquiry and its findings and results of a subsequent audit. Not applicable. Women with problems of bleeding and/or pain in early pregnancy who were erroneously diagnosed as having a nonviable intrauterine pregnancy. After two cases of misdiagnosis of miscarriage that were widely reported in the Republic of Ireland in June 2010, a Miscarriage Misdiagnosis Review Team was commissioned by the Irish Health Service Executive (HSE) to undertake a national review of other possible cases of misdiagnosis of miscarriage. The Review Team made a series of recommendations that were subsequently implemented in full. The results of the implementation of the findings of the Review Team have been the subject of three annual audits across the country. The main outcome measure was the occurrence of misdiagnosis of miscarriage in the Republic of Ireland before and after implementation of the findings of the Review Team. Twenty-four confirmed cases of misdiagnosis of miscarriage were identified, mostly occurring between 2005 and 2010. Analysis led to a series of recommendations by the Review Team, which were implemented in full by the HSE. Over € 3 million was provided to fund implementation; 26 high-quality gynecological ultrasound machines were purchased to reequip 19 units involved in provision of care to women with suspected miscarriage. There was further allocation of resources for new equipment and improvement in the management and staffing of early pregnancy units across Ireland, with each center now having a dedicated and properly staffed Early Pregnancy Assessment Unit. A national training program in the management of early pregnancy problems has been implemented, along with regular national meetings to discuss early pregnancy problems. National clinical guidelines on the diagnosis and management of miscarriage for implementation have been distributed to all hospitals. No cases of miscarriage misdiagnosis were identified in any of the three annual audits, suggesting that implementation of the findings of the review has been successful. We believe that this is the first report of national change in practice leading to improvement in clinical outcomes in the management of suspected miscarriage.

A Novel early pregnancy assessment unit/Gynaecology assessment unit dashboard An experience from a UK district general hospital

The establishment of early pregnancy assessment units (EPAUs)/Gynaecology assessment units (GAUs) started more than 20 years ago in the UK to decrease hospital admissions of patients with early pregnancy problems. However, there are still wide variations in the quality of services provided by these units. The objective of this study was to create a method that can be used for continuous assessment of these units on a regular basis. We designed a dashboard covering all aspects of EPAU/GAU activities depending upon the early pregnancy unit association guidelines, and the department of health data and statistics. The EPAU/GAU dashboard has been used successfully in the early assessment pregnancy unit of Yeovil District hospital for few years and is still implemented until now. It is an excellent tool for continuous audit. It is a simple method that should be adopted by different EPAUs/GAUs for their objective assessment in order to improve the services provided by these units.

P26.13: Advances in urine pregnancy testing and implications for clinical problems of early pregnancy

<scp>P</scp>26.13: Advances in urine pregnancy testing and implications for clinical problems of early pregnancy

An evaluation of early pregnancy outcomes in one Australian Emergency Department: Part 2

Summary Background More than one in five pregnancies ends in miscarriage. Women experiencing complications associated with early pregnancy often present to the Emergency Department (ED). In 2005, an Early Pregnancy Assessment Clinic (EPAC) was implemented in one Australian ED to specifically address acute needs of women with complications of early pregnancy. Methods This mixed methods study incorporated two parts: Part 1 utilised content analysis of semi-structured interviews conducted with health care professionals and EPAC women to evaluate the EPAC structures and processes. Part 2 was an observational study describing characteristics and temporal trends of ED presentations involving problems of early pregnancy over a 6-year period (2004–2009). Results from Part 2 are presented in this paper; findings from Part 1 are presented in a previous paper. Results Over the 6-year period 4958 presentations were made to the ED from women with complications of early pregnancy. Outcomes that improved over time included: time to see a clinician, ED length of stay, hospital admission rate and the number of pathology tests ordered per presentation. These outcomes were particularly noted to improve following the implementation of the EPAC. Conclusions Changes to service delivery for a select patient group (in this case women presenting to the ED with complications during early pregnancy) can impact positively on patient and service provider outcomes.

Women's experience of early pregnancy care in the emergency department: A qualitative study

Summary Background Women who have problems in early pregnancy frequently present to the emergency department (ED). The aim of this qualitative study was to describe the experience of early pregnancy care in the ED from the perspective of women. Methods This study used a qualitative design involving semi-structured interviews with women who attended five hospital EDs in Hunter New England Area Health Service during late 2009 and early 2010. Out of 200 letters sent, 16 women agreed to be interviewed to describe their experience of care in the ED. Thematic analysis was used to analyse the interview transcripts. Results Privacy, dignity, compassion and respect were important to participants. Many women reported that they were not given a private room in the ED and were distressed by the constant traffic of people nearby. Overall, participants reported that ED staff treated them with compassion and respect, though this was sometimes limited by the busy environment. Most participants wanted more information such as pamphlets and few were offered follow-up support or a counselling referral. Conclusions The findings of this study suggest that EDs should enhance their management of women with problems in early pregnancy including allocating them to beds with sufficient privacy, providing them with access to written information and referrals to counselling.

A structure and process evaluation of an Early Pregnancy Assessment Clinic (EPAC) in one Australian Emergency Department: Part 1

Summary Background Women experiencing complications associated with early pregnancy often present to the Emergency Department (ED). An Early Pregnancy Assessment Clinic (EPAC) was implemented in one Australian ED to specifically address acute needs of women with complications of early pregnancy. Methods This mixed methods study incorporated two parts: Part 1 utilised content analysis of semi-structured interviews conducted with health care professionals and EPAC women to evaluate the EPAC structures and processes. Part 2 was an observational study describing characteristics and temporal trends of women presenting to an ED with problems of early pregnancy over a 6-year period. Findings from Part 1 are presented in this paper; results from Part 2 are presented in an ensuing paper. Findings EPAC structures included the utilisation of a private environment situated within the ED as well as primary care management and delivery from a nurse who had ED experience and advanced pregnancy related knowledge. EPAC processes included appropriate referral and good communication. These processes enabled the delivery of a service between a variety of healthcare providers located within the hospital and community. Conclusions The multi-disciplinary, nurse-led, ED based EPAC model of care implemented facilitated continuity of care for a subset of ED patients. It may be useful in EDs elsewhere.

Maternal depression and physical health problems in early pregnancy: Findings of an Australian nulliparous pregnancy cohort study

Objectiveto investigate the relationship between physical health problems and depressive symptoms in early pregnancy. Designbaseline questionnaire, prospective pregnancy cohort study. Settingsix metropolitan public maternity hospitals in Victoria, Australia. Participants1507 nulliparous women recruited in early pregnancy. Findingsnine per cent of women (131/1500) scored ≥13 on the EPDS indicating probable clinical depression in early pregnancy (mean gestation=15 weeks). The five most commonly reported physical health problems were as follows: exhaustion (86.9%), morning sickness (64.3%), back pain (45.6%), constipation (43.5%) and severe headaches or migraines (29.5%). Women scoring ≥13 on the EPDS reported a mean of six physical health problems compared with a mean of 3.5 among women scoring <13 on the EPDS. Women reporting five or more physical health problems had a three-fold increase in likelihood of reporting depressive symptoms (Adj OR=3.13, 95% CI 2.14–4.58) after adjusting for socio-demographic factors, including maternal age. Conclusionsthe findings from this large multi-centre study show that women experiencing a greater number of physical health problems are at increased risk of reporting depressive symptoms in early pregnancy. Implications for practiceearly detection and support for women experiencing physical and psychological health problems in pregnancy is an important aspect of antenatal care. The extent of co-morbid physical and psychological health problems underlines the need for comprehensive primary health care as an integral component of antenatal care.