Tertiary Maternity Research Articles

‘It will dictate how many children I will have”- Women's decision-making in pregnancy following a previous caesarean birth (CB)

Vaginal birth after caesarean (VBAC) is supported in systematic reviews (Wu et al., 2019) and national guidelines (RCOG, 2015) and women are expected to be involved in the decision-making process for either a repeat caesarean birth or planned VBAC. AimTo develop a Grounded Theory (GT) of women's decision making of their birth choices in pregnancy following a previous caesarean birth (CB) ObjectiveTo explore what determines women's birth choice and their decision making for birth following a previous CB. DesignSemi structured interviews with pregnant women were undertaken in order to develop a Glasserian Grounded Theory SettingAntenatal clinics and wards in a large tertiary level maternity hospital. FindingsThe theory of ‘Mentalizing Possibilities’ is a substantive theory which explains pregnant women's decision making about their birth choices after a previous CB. Women's main concern is to achieve a positive experience. The core category of ‘Mentalizing Possibilities’ explains how women process their previous experience, adapt to uncertainty and deal with the decisional conflict. There are behavioural and cognitive strategies which women use to go through this process. ConclusionWomen want a positive birth experience after a previous CB and require support and continuity in decision making to help them decide the optimal birth choice for their current pregnancy.

Midwives experiences of interventions to improve breast expression following preterm birth: A qualitative study

ObjectivePreterm birth impacts approximately 10% of women globally. Midwives are often the first point of care after the birth of a preterm infant providing mothers with information and support for breast expression. However, despite guidelines that suggest expression within the first hour of birth, most first expressions occur much later. This study aimed to seek an understanding of midwives’ experiences with the first expression for mothers of preterm infants, including the barriers and facilitators that midwives may face. DesignA qualitative design using semi-structured interviews via focus groups. Thematic analysis was used to identify relevant themes and sub-themes. ParticipantsParticipants included midwives providing care to women in preterm labour and birth at a tertiary maternity hospital in Australia (N=12). All participating midwives cared for mothers of preterm infants between 28 and 35 weeks’ gestation up to six hours following birth. FindingsTwo major themes resulted from the data, including the changing expectations of infant feeding and the responsibility versus expectation to support a woman to express in the first hour of birth with other competing clinical and organisational tasks. Key conclusions and implications for practiceWhilst individual philosophies on the benefits of human milk were positive, expressing in the birth suite was dictated by essential clinical tasks and by the institutions value placed on expressing in the first hour. Clear objectives to undertake expressing within the first hour or within the birth suite stay, need to be included in policy and supported by management and team leaders, to increase early expressing rates.

Outcome of transurethral resection of bladder tumour under spinal anaesthesia combined with obturator nerve block.

Regional differences in thyroid hormones are noted, especially during pregnancy. Establish reference values for thyroid function tests for Sri Lankan pregnant women and to determine their comparability with regional data; and determine the prevalence of 2. Thyroid Peroxidase (TPO) antibody positivity and 3. Iodine deficiency among pregnant women with uncomplicated clinical history. A cross-sectional study conducted in antenatal clinics of a tertiary care maternity center recruited a minimum of 56 women in each trimester in a multistep approach to derive an "ideal-reference population"; Participants with clinically manifested thyroid disease, followed by subjects with sonographically abnormal thyroids and finally those at high risk for thyroid disease as shown by positive TPO levels and urine iodine deficiency were excluded in sequence. Thyroid hormones were measured by chemiluminescence in the ideal reference population. Reference ranges were derived using median and 5th and 95th centiles. Final sample included 369 women. TSH reference ranges of the first (n=64), second (n=188) and third (n=117) trimesters were 0.014-2.77mIU/L, 0.31-3.2 mIU/L and 0.34-3.4 mIU/L, respectively. TPO antibody level showed a weak but significant correlation with TSH (r=0.10,p 0.021) in the final sample. No significant association was found between urine iodine and thyroid function tests. TSH reference ranges observed in this study are concordant with the Caucasian reference values more than the regional values. Discrepancies in study methodology, defining and selection of reference population and methods employed in measuring thyroid hormones in different studies may have accounted for these differences.

Maternal plasma diacylglycerols and triacylglycerols in the prediction of gestational diabetes mellitus.

To define the lipidomic profile in plasma across pregnancy, and identify lipid biomarkers for gestational diabetes mellitus (GDM) prediction in early pregnancy. Case-control study. Tertiary referral maternity unit. Plasma samples from 100 GDM and 100 normal glucose tolerance (NGT) women, divided into a training set (GDM first trimester=50, GDM second trimester=40, NGT first trimester=50, NGT second trimester=50) and a validation set (GDM first trimester=45, GDM second trimester=34, NGT first trimester=44, NGT second trimester=40). Plasma samples were collected in the first (11+0 to 13+6 weeks), second (19+0 to 24+6 weeks), and third trimesters (30+0 to 34+6 weeks), and tested by ultra-high-performance liquid chromatography coupled with electrospray ionisation-quadrupole-time of flight-mass spectrometry; The GDM prediction model was established by the machine-learning method of random forest. Gestational diabetes mellitus. In both the GDM and NGT group, lyso-glycerophospholipids were down-regulated, whereas ceramides, sphingomyelins, cholesteryl ester, diacylglycerols (DGs) and triacylglycerols (TGs) and glucosylceramide were up-regulated across the three trimesters of pregnancy. In the training dataset, seven TGs and five DGs demonstrated good performance in the prediction of GDM in the first and second trimesters (area under the curve [AUC]=0.96 with 95% confidence interval [CI] of 0.93-1 and AUC=0.97 with 95% CI of 0.95-1, respectively), independent of maternal body mass index (BMI) and ethnicity. In the validation dataset, the predictive model achieved an AUC of 0.88 and 0.94 at the first and second trimesters, respectively. Our results have proposed new lipid biomarkers for the first trimester prediction of GDM, independent of ethnicity and BMI.

Smoking cessation Through Optimization of clinical care in Pregnancy: the STOP pragmatic randomized controlled trial

Smoking cessation improves pregnancy outcomes, yet there is uncertainty around the efficacy of models of antenatal intervention for smoking cessation in pregnancy. This study aimed to test the Smoking cessation Through Optimization of clinical care in Pregnancy (STOP) clinic as an antenatal care pathway for smoking cessation in pregnancy. The STOP intervention is a smoking cessation clinic staffed by a dedicated multidisciplinary team of obstetricians, midwives, and smoking cessation practitioners, who provide motivational and psychological support and intensive clinical monitoring of pregnancy. This was a pragmatic randomized controlled trial of the STOP clinic compared with routine antenatal care at a tertiary urban maternity hospital delivering >8000 infants per year. The primary outcome measured was continuous abstinence from smoking before 28+0 weeks' gestation, sustained throughout the duration of the pregnancy, and validated using biological measures. The secondary outcomes included maternal and fetal morbidity, delivery and neonatal outcomes, smoking outcomes, and qualitative measures. A total of 436 women were randomized, with 430 women included in the primary outcome analysis. Women attending the STOP antenatal clinic were more likely to quit smoking compared with those in routine care (odds ratio, 3.62; 95% confidence interval, 1.43-9.17). In addition, women who continued to smoke in the STOP clinic smoked fewer cigarettes daily at the time of delivery compared with controls: 5±4 in the STOP clinic and 7±5 in the control group (odds ratio, 0.28; 95% confidence interval, 0.13-0.59). However, this intervention did not alter postpartum relapse rates (4.3% intervention arm vs 1.5% control arm, not significant) at 4 to 6 months following delivery. The mean birthweight was similar in the intervention and control arms; however, quitters in both groups had infants with significantly higher birthweights compared with those of continued smokers. The STOP antenatal model of care leads to higher smoking cessation rates among pregnant smokers and lower daily cigarette consumption at time of delivery. Currently, there is no defined or dedicated antenatal pathway for pregnant smokers, despite the high-risk nature of their pregnancies. Our findings suggest that improved smoking cessation rates in pregnancy may be achieved using the holistic approach of the STOP model of care.

Profile of insulin resistance of pregnant women at late third trimester in Nigeria: A descriptive cross-sectional report.

Exaggerated level of insulin resistance (IR) is associated with poor pregnancy outcomes. Identifying affected women may forestall these outcomes. There are few reports on IR and its predictors among pregnant women in Nigeria. To determine the profile of IR, using the homeostatic model assessment of insulin resistance (HOMA-IR), and its predictors among parturient Nigerian women in third trimester. A cross-sectional baseline data of healthy pregnant women in third trimester, consecutively recruited into a cohort study that evaluated IR and neonatal outcomes at a tertiary maternity. Sociodemographic and clinical data were obtained. Fasting venous blood was analyzed for glucose and insulin and HOMA-IR was calculated. We consecutively recruited 401 healthy pregnant women between 28 and 41 weeks [means ± SD = 37.4 ± 0.8 weeks]; mean age 31.52 ± 4.3 years (range: 20-41 years). Median (IQR) HOMA-IR was 1.15 (0.63, 1.96; range: 0.02-11.73). Binary multivariable logistic regression showed overweight- [aOR (95% CI) = 3.29 (1.18, 9.13)], hyperglycemia- [aOR (95% CI) = 2.98 (1.19, 6.90)], and hypertension as independent predictors of IR [aOR (95% CI) = 2.85 (1.18, 6.90)]. Among nondiabetic Nigerian pregnant women in late third trimester, IR was independently associated with overweight, hypertension, and hyperglycemia. Control of adiposity is a potential target for control of IR and consequently its outcomes.

Using a scheduled caesarean birth plan: A cross-sectional exploration of women’s perspectives

ProblemThere is minimal evidence regarding the role or impact of birth plans from the perspective of women experiencing scheduled caesarean birth. BackgroundQuality maternity care requires respect for women’s preferences. Evidence suggests birth plans enable communication of women’s preferences and may enhance agency when vaginal birth is intended, however there is limited evidence of how this translates in the perioperative environment where caesarean birth is the intended outcome. AimExplore the experiences and perspectives of women who had utilised a scheduled caesarean birth plan at an Australian tertiary maternity hospital. MethodsA cross-sectional design was used; 294 participants completed the survey within two weeks post-birth. Descriptive statistics were used to analyse quantitative data, qualitative responses were analysed using content analysis. FindingsOver half of the women requested lowering of the surgical-screen at birth, most requested immediate skin-to-skin with their babies; around two-thirds of these preferences were met. Use of a birth plan for scheduled caesarean section supported women’s ability to communicate their desires and choices, enhancing agency and reinforcing the significance of the caesarean birth experience. Qualitative data revealed two main categories: Perceptions and experiences; and Recommendations for improvement, with corresponding sub-categories. DiscussionFindings provide unique opportunities to consider the provision of woman-centred care within the highly technocratic perioperative environment. ConclusionAll women, regardless of birth mode, have a right to respectful maternity care that prioritises their wishes and agency. This study provides evidence for the positive utility of birth plans in caesarean birth, local adaptation is encouraged.

Evaluating the implementation of the Birmingham Symptom-specific Obstetric Triage System (BSOTS) in Australia

BackgroundObstetric triage is usually undertaken by a midwife and involves conducting a physical assessment to identify a woman’s presenting problem. The Birmingham Symptom-specific Obstetric Triage System (BSOTS) was developed in the United Kingdom (UK) to overcome challenges associated with triaging women by standardising the maternity triage process. The Australian study site is the first hospital outside the UK to implement this approach. AimTo evaluate the implementation of the BSOTS in an Australian tertiary maternity service. MethodsA multi-method approach including pre-implementation BSOTS education evaluations (n = 26), post-implementation clinical data audit (n = 660), and staff focus groups (n = 9) was undertaken. Participants included midwives who worked in the Maternity Assessment Centre. Data of women who had attended the service during BSOTS implementation was analysed in the audit component. FindingsStaff valued the BSOTS standardised approach to maternity triage, particularly for midwives new to the role. The retrospective audit showed that time to triage and time to care outcomes for women improved from pre-implementation audits and were mostly adhering to auditable standards. Lack of knowledge amongst staff (especially medical staff) regarding the BSOTS was considered a barrier to the effective flow of care of women through the centre. DiscussionThe BSOTS is a useful approach for prioritising women’s care. Ensuring that all staff are aware of the system and its benefits is likely to enhance implementation and improve triage outcomes. ConclusionThe BSOTS is an innovative midwife led practice change that is applicable to the Australian context, and benefits women, midwives, and the maternity service.

The social organisation of decision-making about intrapartum fetal monitoring: An Institutional Ethnography

BackgroundInternational guidelines recommend intrapartum cardiotocograph (CTG) monitoring for women at risk for poor perinatal outcome. Research has not previously addressed how midwives and obstetricians enable or hinder women’s decision-making regarding intrapartum fetal monitoring and how this work is structured by external organising factors. AimTo examine impacts of policy and research texts on midwives’ and obstetricians’ work with labouring women related to intrapartum fetal monitoring decision-making. MethodsWe used a critical feminist qualitative methodology known as Institutional Ethnography (IE). The research was conducted in an Australian tertiary maternity service. Data collection included interviews, observation, and texts relating to midwives’ and obstetricians’ work with the fetal monitoring system. Textual mapping was used to explain how midwives’ and obstetricians’ work was organised to happen the way it was. FindingsCTG monitoring was initiated predominantly by midwives applying mandatory policy. Midwives described reluctance to inform labouring women that they had a choice of fetal monitoring method. Discursive approaches used in a national fetal surveillance guideline, a Cochrane systematic review, and the largest randomised controlled trial regarding CTG monitoring in labour generated and reproduced assumptions that clinicians, not labouring women, were the appropriate decision-maker regarding fetal monitoring in labour. Discussion and conclusionGuidelines structured midwives’ and obstetricians’ work in a manner that undermined women’s participation in decisions about fetal monitoring method. Intrapartum fetal monitoring guidelines should be critically reviewed to ensure they encourage and enable midwives and obstetricians to support women to make decisions about intrapartum care.

Reviewing the past to inform the future: an 8-year review of severe maternal morbidity

Maternal morbidity is becoming a key indicator used to compare health systems in the developed world and also to inform clinical practice. This study aimed to evaluate a single center experience of severe maternal morbidity over an 8-year period. We conducted a retrospective review of all cases of severe maternal morbidity from 2012 to 2019 at a tertiary level maternity hospital in the Republic of Ireland with approximately 9000 births per year. We examined maternal demographics, pregnancy characteristics, and care requirements. Descriptive statistics were used throughout. There were 81,504 maternity cases and 67,894 births during the study period. A total of 504 women had a severe maternal morbidity, giving a rate of 6.1 per 1000 maternity cases overall, peaking in 2017 at 8.8 per 1000. When individual severe maternal morbidity events were evaluated, the rate increased from 6 per 1000 to 9 per 1000 over the 8-year period. There were no differences in maternal age, nationality, or body mass index during the years analyzed. Interestingly, 8.9% (n=45) were multiple gestations, and nearly one-fifth (19.4%; n=98) required escalation of care to a general hospital; of these, 14.0% (n=74) required cardiac or intensive care management. The majority of morbidities manifested in the third trimester (58.7%; n=296) or postnatally (42.8%, n=216). The most common severe maternal morbidities were hypertensive disorders of pregnancy, followed by postpartum hemorrhage and sepsis (45.0%, 44.2%, and 12.7%, respectively). We provide a longitudinal overview of severe maternal morbidity in a large maternity hospital that replicates other international findings. This information can be used for healthcare comparisons and for resource planning and allocation.

Barriers to attendance at a tertiary hospital’s perinatal mortality meeting

BackgroundPerinatal mortality multi-disciplinary team meetings (PM-MDTMs) offer a forum for multi-disciplinary discussion of poor perinatal outcomes. They ensure a thorough understanding of individual cases and present an important learning opportunity for healthcare professionals (HCPs). Attendance at PM-MDTMs in this tertiary maternity hospital has been low.AimsWe aimed to identify barriers which may be targeted to improve attendance and engagement.MethodsAn anonymous questionnaire was developed, and all HCPs invited to participate. Demographic data on respondents was collected, as was knowledge of PM-MDTMs, their purpose and relevance to clinical practice, and barriers to attendance at meetings. A total of 78 responses were obtained and analysed.ResultsSelf-reported understanding of the purpose and format PM-MDTMs was high (84.6% (66/78) and 65.4% (51/78), respectively), while only 50% (39/78) of respondents provided an accurate description of either. Only 50% (39/78) reported having attended a meeting in the hospital, of whom 61.5% (24/39) described the correct meeting. Of these, 37.5% (9/24) reported attending regularly and 70.8% (17/24) found the meeting relevant to their clinical practice. Of the 33.33% (26/78) who reported attending a PM-MDTM in another hospital, 73.1% (19/26) accurately described the meeting, 63.1% (12/19) of these attended regularly, and 100% (19/19) found it relevant. Three main qualitative themes emerged as barriers to attendance and were areas for suggested improvements: workload and staffing levels, meeting logistics, and lack of communication and education regarding PM-MDTMs.ConclusionsCommunication regarding PM-MDTMs and their learning opportunities needs to improve. Lack of engagement is likely compounded by high workloads and staffing levels, but these issues should be surmountable.

O8 - Re-defining Antenatal Care - development and implementation of IMAP in a Large Tertiary Referral Maternity Service

Initial Maternity Assessment and Planning – IMAP The staged roll out of a project to offer all women planning to birth at a large tertiary referral maternity service publicly funded first trimester screening had only just begun when the COVID19 pandemic hit in early 2020. What quickly became apparent was the urgent need for change in the way services were delivered and what ensued was the early implementation of First Trimester Screening Service (FTSS) and the development of policy to support the safety of our women, our staff and the wider community. The early implementation of the FTSS saw a number of further developments: 1. Increased rates of reported Domestic violence and or psychosocial vulnerabilities 2. Highlighted duplication of midwifery and obstetric assessments in the FTSS and a traditional booking in visit. 3. Highlighted lack of information available to women regarding models of care and maternity service in general A clinical redesign project, Initial Maternity Assessment and Planning (IMAP) commenced in November 2020 and was implemented in November 2021. The project delivered: 1. A universal entry into the Service via a single electronic referral 2. Detailed patient information regarding the IMAP visit, FTS, pathways and options for models of maternity care provided prior to initial appointment 3. IMAP visit – comprehensive, holistic, multidisciplinary screening assessment of the pregnant woman and baby in the early pregnancy period, detailed risk assessment and risk appropriate management plan and allocated model of care 4. Elements of antenatal care, Low and high risk pathways – schedule of antenatal visits, recommended content and supporting education and resource for women and families. 5. Focussed visits at 16-18 weeks – welcome to your model of care and 36 weeks – Review pregnancy and recommended timing, model and place of birth 6. Comprehensive suite of educational resources accessed via QR code. At this stage the project evaluation is just commencing. We expect to be able to present preliminary outcomes at the conference.

O18 - Benchmarking nitrous oxide use in maternity care: Clinical audit and consumer perspectives

Nitrous oxide is commonly used by women in Australia to enhance comfort during labour and birth. The evidence on the prevalence and usefulness of nitrous oxide during labour and for obstetric procedural analgesia is limited. The aim of this study was to audit the use of nitrous oxide (N2O) within a tertiary and secondary Australian maternity unit and then explore women’s perspectives on its use.

O66 - Evaluation of the implementation of the Birmingham Symptom-specific Obstetric Triage System (BSOTS) in an Australian maternity service

Obstetric triage is usually undertaken by a midwife and involves identifying the woman’s presenting problem and conducting physiological and vital signs assessment. Triage of a pregnant woman poses challenges, as the physiological changes associated with pregnancy do not match the general parameters of standard emergency department triage measures. For these reasons, the Birmingham Symptom-specific Obstetric Triage System (BSOTS) was developed to standardise triage within maternity care. The BSOTS is currently being rolled out in all National Health Service maternity hospitals in the United Kingdom, however our site is the first in Australia to trial this approach. The aim of the study was to evaluate the implementation of the BSOTS in an Australian tertiary maternity service. A mixed-methods approach including surveys, focus groups, and retrospective data audit was undertaken. Participants included midwives and doctors who worked in the Maternity Assessment Centre (MAC) and women who had attended the MAC during the BSOTS implementation. Key outcome measures included: • knowledge and confidence in using BSOTS following the pre-implementation education • time to triage and time to treatment for women in accordance with the BSOTS prioritisation of care • staff experiences and satisfaction of the BSOTS implementation • women’s satisfaction of triage following the BSOTS implementation The findings showed that staff valued the BSOTS standardised approach to maternity triage. The clinical audit showed that women’s time to triage and treatment times were generally being achieved within auditable standards. Almost all women were satisfied with their experience of triage. Lack of knowledge amongst staff (especially medical staff) regarding the approach was perceived to be a barrier to effective implementation. The implementation of the BSOTS demonstrates an innovative midwife led practice change. The BSOTS is applicable to the Australian context, benefiting women, midwives, and the maternity service.

Predicting Placenta Accreta Spectrum Disorders in a Cohort of Pregnant Patients in the North-East Region of Romania-Diagnostic Accuracy of Ultrasound and Magnetic Resonance Imaging.

Background: Placenta accreta spectrum (PAS) disorders are associated with high mortality and morbidity due to postpartum hemorrhage, hysterectomy, and organ injury, and a multidisciplinary team is required for an individualized case management. In this study, we assessed the diagnostic and prognostic accuracy of the most important ultrasonographic (US) and magnetic resonance imagining (MRI) markers for PAS disorders. Material and Methods: The study included 39 adult pregnant patients with at least one previous cesarean delivery and both US and MRI investigations for placenta previa evaluated at the tertiary maternity hospital ‘Cuza Voda’, Iasi, between 2019 and 2021. The following US signs were evaluated: intra-placental lacunae, loss of the retroplacental hypoechoic zone, myometrial thinning < 1 mm, bladder wall interruption, placental bulging, bridging vessels, and the hypervascularity of the uterovesical or retroplacental space. The MRI signs that were evaluated were intra-placental dark T2 bands, placental bulging, loss of the retroplacental hypointense line on T2 images, myometrial thinning, bladder wall interruption, focal exophytic placental mass, and abnormal vascularization of the placental bed. Results: The US and MRI signs analyzed in our study presented adequate sensitivities and specificities for PAS, but no sign proved to be a useful predictor by itself. The presence of three or more US markers for accretion was associated with a sensitivity of 84.6.6% and a specificity of 92.3% (p < 0.001). The presence of three or more MRI signs supplemented these results and were associated with a sensitivity of 92.3% and a specificity of 61.5% for predicting PAS (p < 0.001). Moreover, US and MRI findings were correlated with FIGO grading and severity of PAS. Conclusions: Even though no US or MRI finding alone can predict PAS with high sensitivity and specificity, our study proves that the presence of three or more imagistic signs could significantly increase the diagnostic accuracy of this condition. Furthermore, US and MRI could be useful tools for evaluating prognostic and perinatal planning.

O1 - Midwives: Let’s talk about sex and reproductive health

Despite being primary providers of public health education regarding sexual and reproductive health care, there is limited evidence regarding midwives’ confidence and practices of this important role. The aim of this study was to explore midwives’ confidence and practices around providing education to women on three key areas of sexual and reproductive health: i) contraception and family planning; ii) sexual activity; and iii) sexual health. A cross-sectional exploratory study was conducted with responses from n=164 midwives (43.1% response rate) working in a public tertiary maternity hospital in Western Australia. The survey included items measuring confidence; method and frequency of practice. Open-ended questions captured qualitative data. Data analysis was conducted using descriptive statistics for quantitative data and content analysis for qualitative data. Midwives’ age, years of clinical experience (p=0.001) and work setting (p=0.032) were all significantly associated with the confidence to provide education on sexual activity. Most (92.1%) midwives indicated that they wanted further education, with a preference for online learning. Lack of time, knowledge and language barriers were key factors preventing education. Midwives’ provision of education to women is critical for improving health literacy and health outcomes for women and their families. Results impress the importance of including sexual and reproductive health education in entry to registration courses and the importance of continuing professional development. Evidence from this novel study offers utility for leaders and educators in midwifery to prepare and equip midwives to fulfil this important primary and public health role of providing sexual and reproductive health care. Attending to identified professional development needs of midwives, enables practitioners to work to their full scope of practice providing comprehensive care to women and their families.

O11 - A Vision for Women

To provide a contemporary, evidence based and consumer driven maternity service that ensures each woman achieves her optimal outcome. Australian healthcare services measure the quality of their maternity care via clinical outcomes e.g. Perinatal statistics, Healthcare Acquired Conditions (HAC’s) and Clinical Indicators. The increasingly broad variation in maternal demographics between health services Australia wide make accurate benchmarking difficult e.g. rates of obesity, assisted fertility, maternal age >35 years and poor education and socio economic status. A Tertiary maternity service in NSW reviewed how women Australia wide measure their healthcare during pregnancy, labour and birth. The search identified that the factors that are important to women do not correlate with the priorities of health care services. The maternity service responded by reviewing how it would provide maternity care through a different lens. Core business was no longer ‘4000 births’ per annum but became the creation of ‘4000 mothers’ per annum. The team ensured that the evidence based strategies that impact physical birth outcomes were in place and aligned with evidence e.g. models of care, medical and non-medical interventions and provision of information. However a new approach saw the hospital team aligned in their language, energy and actions when interacting with the woman. This approach brought a new philosophy and energy to the team, impacting the emotional outcome for each woman following her birth experience. Obstetric interventions have been increasing nationwide for a number of decades with no demonstrated improvement in outcomes and in some cases a deterioration e.g. increasing rates of postpartum haemorrhage. An alternate strategy was required that would engage both women, medical and midwifery clinicians and optimise each woman’s pregnancy and birth outcome. A multidisciplinary hospital team aligned in their vision and belief resulting in the creation of strong and confident mothers…. ‘this is the moment I dreamed about’.

2017 French health authority guidelines for neonates at risk of early-onset sepsis: Adherence and barriers in a tertiary hospital

The objective of this study was to evaluate the adherence to the French Health Authority's 2017 guidelines concerning early-onset sepsis (EOS) in neonates. This 6-month prospective observational study was conducted in 2020 in a tertiary hospital maternity unit. Neonates were classified according to their risk of EOS and the level of appropriate surveillance was analyzed. The risk of EOS was determined for 69.9% of the 1024 included neonates. Of the 123 neonates with a moderate or high risk of EOS, the optimal clinical surveillance was 88%. Even in a tertiary hospital, with training of caregivers, adherence to guidelines was incomplete. Some corrective measures are suggested and should be applied to enhance the adherence.

Seroprevalence of SARS-CoV-2 among Children Visiting a Tertiary Hospital during the Prevaccination Period, Southwest Region, Saudi Arabia.

Background: In the early days of the COVID-19 pandemic, tests to ascertain whether individuals were infected with SARS-CoV-2 were often unavailable. One method to deal with this issue is to test for SARS-CoV-2 antibodies. This study sought to determine the seroprevalence of SARS-CoV-2 in children in Saudi Arabia before vaccines were available to them. Methods: This study was conducted among children who visited the tertiary Maternity and Children Hospital in Abha city, Saudi Arabia. Serum samples were screened for SARS-CoV-2-specific IgG, IgM, and IgA antibodies using ELISA. The crude and adjusted seroprevalence values among the studied children were calculated. Results: Among the 413 children studied, the ages of enrolled patients ranged from newborn to 12 years, with a median age of three years. We identified 127 (30.7%) seropositive children. IgG was exclusively positive in 43 (10.4%); IgM was exclusively positive in 8 (1.9%), and IgA was exclusively positive in 15 (3.6%) children. Conclusions: This study is the first to estimate the seroprevalence of SARS-CoV-2 among the pediatric population seeking medical care in southwestern Saudi Arabia. The findings shed light on the dynamics of virus transmission in the community and provide a good reference for future studies. Future research should examine factors related to SARS-CoV-2 infection and seroprevalence among pediatric populations.

Prediction of labor outcome pilot study: evaluation of primiparous women at term

Emergency operative delivery is associated with high fetal and maternal morbidity and mortality. It is of high importance to find means to predict the delivery mode before the onset of labor. This study aimed to investigate the potential of combined sonographic and clinical determination to predict the mode of delivery at term. An observational prospective cohort study was deployed in a tertiary maternity hospital (Emergency County Hospital Craiova). Unselected low-risk primiparous pregnant women were evaluated weekly at term for ultrasound determinations (estimated fetal weight, head descent parameters, occiput posterior, cervical length), Bishop score, and maternal characteristics (age, height, weight). A thorough statistical analysis determined which variables were significantly correlated with the delivery mode. Data from 276 term primiparous women were analyzed. Head descent parameters were strongly and significantly correlated with each other, but only progression distance was correlated with the delivery mode (gestational weeks 37, 38, 41, and the week before delivery). In the week before delivery, measurements of head-to-perineum distance and angle of progression reached almost significant P levels of.055 and.07, respectively. The following variables were significantly correlated with the delivery mode: body mass index in all term evaluations; progression distance for weeks 37 and 38; maternal age for week 39; Bishop score, estimated fetal weight, and occiput posterior for week 40; and body mass index, estimated fetal weight, and progression distance for the week before delivery. We also provided logistic regression equations for each week with correct delivery mode prediction, except for week 38. Cutoff values were established for each significant parameter per week. The cutoff values must be read in conjunction with the area under the curve, which ranged from 0.55 to 0.73, depending on the variable. There are strong and significant correlations among the "head descent" ultrasound measurements at term. Body mass index is predictive of labor outcomes throughout term evaluations. Progression distance and body mass index measured at 37 to 38 weeks' gestation correlate with the delivery mode and apparently can be used to forecast the delivery mode when the pregnancy reaches term. For the week before delivery, measurements of estimated fetal weight and progression distance can be used to forecast the delivery mode, perhaps as part of a policy for pregnant women with prelabor clinical signs. Larger studies with more data, particularly better-balanced data, are needed.