Time Of Postpartum Research Articles

Maternal health care services utilization and associated factors among women in Zoba Maekel, Eritrea 2022: a community based study

Introduction: Studies reveal that regular utilization of maternal health care services reduces maternal morbidity and mortality in which these services are affected by complex factors which may be similar across populations. Methods: A community based cross sectional study was conducted from February to May of 2022. A total of 607 women who gave birth in the last 2 years and residing in the area for at least 6 months were selected by two stage cluster sampling technique. A predesigned and pretested questionnaire was used to collect data via face to face interview technique. Chi-square test and multivariable logistic regression were used for data analysis using SPSS (Version 26). Results: Magnitude of maternal health care services utilization was found as; attending antenatal care 99.9%, institutional delivery 99.3% and postnatal care 91.4%. The majority (91.4%) were aware of postnatal care. The proportion (91.5%) of women who utilized postnatal care among those with awareness about it was significantly greater (p<0.001) than the proportion of women who utilized it and with no awareness (63.5%). The nationwide lockdown due to COVID- 19, sudden onset of labor, feeling well were barriers to attending antenatal care, institutional delivery and postnatal care services respectively. Conclusion: Prevalence of antenatal care, institutional delivery and postnatal care services was higher than the national estimate. Improving the quality of care around the time of pregnancy, birth and postpartum is recommended to continuously sensitize the community about the services and further increase the utilization.

COMPREHENSIVE MIDWIFERY OF MRS. E IN PMB E CIBEBER DISTRICT CIANJUR REGENCY: CASE REPORT

Introduction: Pregnancy is a woman's highly anticipated life cycle. After pregnancy, the woman will enter the process of childbirth, postpartum, and intermediate period. This cycles can cause physical and psychological changes that can cause discomfort for women who cannot adapt. Objectives: The aim of this study was to provide comprehensive care starting from pregnancy, childbirth, postpartum and infants. Method: This Final Project report used a case study method with data collection carried out from March to May 2022 in PMB E, Cibeber District, Cianjur Regency. Result: Mrs. E did an USG before giving birth and the result showed that her amniotic water had begun to decrease so she was referred to the hospital for induction. Induction of labor using 5 IU oxytocin drip infused into 500 ml RL at a speed of 20tpm. The delivery process was done in a spontaneous way without complications. At the time of postpartum Mrs. E's legs were swollen and Mrs. E had given formula to her baby in the first week of postnatal. The author carried out care of the problems experienced by the mother, such as counseling for mobilization and the importance of exclusive breastfeeding. This treatment was successful in overcoming the mother's problems and preventing complications. Conclusion: Comprehensive midwifery care has proven to be beneficial and important to do. Midwives as service providers need to implement and improve this method in the care they do.

Maternal and neonatal factors affecting neonatal behaviour in West African Dwarf goats.

There is a paucity of information on neonatal behaviour of tropical livestock species despite its adaptive value. One hundred and ninety West African Dwarf (WAD) kids and their mothers were studied to establish the influence of neonatal and maternal factors on neonatal behaviour. Environmental temperatures and relative humidity (RH) at birth were also recorded. Single born kids and those dropped by older and multiparous mothers sucked earlier (p < 0.05). Vigour levels were higher (p < 0.05) in kids dropped by multiparous does and those whose grooming commenced earlier than those dropped by primiparous does and those with long latency to groom, respectively. Moderate negative correlations (p < 0.01) existed between duration of grooming and birthweight and duration of grooming and latency to groom. Similarly, strong and positive correlations (p < 0.01) existed between duration of grooming and neonatal vigour and time of first successful sucking and number of attempts at standing postpartum. Moderate positive correlations (p < 0.01) existed between time of first successful standing and number of attempts at standing postpartum, birthweight and vigour, rectal and ambient temperatures, latency to groom and birthweight, latency to groom and time of first successful sucking postpartum and number of attempts at sucking and time of first successful sucking postpartum. Strong negative correlations (p < 0.01) existed between RH and latency to groom (p < 0.01) and latency to groom and number of attempts at standing postpartum. Maternal care was higher in WAD goats during periods of higher RH and also in vulnerable and low birth weight kids.

Racial/Ethnic Disparities in Postpartum Health Insurance Coverage Among Rural and Urban U.S. Residents.

Objective: Half of maternal deaths occur during the postpartum year, with data suggesting greater risks among Black, Indigenous, and people of color (BIPOC) and rural residents. Being insured after childbirth improves postpartum health-related outcomes, and recent policy efforts focus on extending postpartum Medicaid coverage from 60 days to 1 year postpartum. The purpose of this study is to describe postpartum health insurance coverage for rural and urban U.S. residents who are BIPOC compared to those who are white. Materials and Methods: Using data from the 2016-2019 Pregnancy Risk Assessment Monitoring System (n = 150,273), we describe health insurance coverage categorized as Medicaid, commercial, or uninsured at the time of childbirth and postpartum. We measured continuity of insurance coverage across these periods, focusing on postpartum Medicaid disruptions. Analyses were conducted among white and BIPOC residents from rural and urban U.S. counties. Results: Three-quarters (75.3%) of rural white people and 85.3% of urban white people were continuously insured from childbirth to postpartum, compared to 60.5% of rural BIPOC people and 65.6% of urban BIPOC people. Postpartum insurance disruptions were frequent among people with Medicaid coverage at childbirth, particularly among BIPOC individuals, compared to those with private insurance; 17.0% of rural BIPOC residents had Medicaid at birth and became uninsured postpartum compared with 3.4% of urban white people. Conclusions: Health insurance coverage at childbirth, postpartum, and across these timepoints varies by race/ethnicity and rural compared with urban residents. Policy efforts to extend postpartum Medicaid coverage may reduce inequities at the intersection of racial/ethnic identity and rural geography.

1064-P: Use of the inControl Algorithm for Automated Insulin Delivery during Childbirth: A Case Series

Background: Automated Insulin Delivery systems (AIDs) can improve glucose control in people with type 1 diabetes but study of their use during childbirth is limited. Some commercially available AIDs use the inControl algorithm (iCa) to automate insulin dosing. Tight glycemic control during labor and childbirth is believed to reduce the risk of neonatal hypoglycemia. Immediately postpartum insulin resistance drops leading to large reductions in insulin requirements. Aim: To examine the performance of the iCa at time of childbirth and develop guidance for pump setting adjustments to maintain euglycemia during labor and childbirth and to prevent hypoglycemia postpartum. Cases: Five women chose to use iCa during childbirth. Two had scheduled caesarean births (CS) . One had a CS after a failed induction of labour. Two had vaginal births. All switched to lower basal rates (at least two-thirds less than their prepregnancy dose) and higher insulin sensitivity factors at least 1 hour prior to childbirth. Sleep activity (SA) was maintained prior to and during CS. Those with vaginal births switched from SA to exercise activity (EA) at time of pushing. iCa stops insulin delivery when glucose is predicted to go below 70 mmol/L in SA or 80 mmol/L in EA in the next 30 minutes. Results: Hypoglycemia during childbirth and early postpartum was avoided in all five cases despite substantial reduction in insulin need following childbirth. Glucose levels increased after the insulin adjustments were made prior to childbirth, but rose especially after childbirth. There were larger glucose increments among those who changed from SA to EA. Conclusion: Early adopters of iCa safely used iCa during childbirth. Precautionary reductions in insulin doses made prior to childbirth prevented hypoglycemia at time of childbirth and early postpartum. Mild hyperglycemia resulted in some. Further study is required to assess if these precautionary pump setting adjustments are necessary during labor and childbirth when using the iCa. Disclosure L.E.Donovan: Other Relationship; Dexcom, Inc., Inner Analytics, Medtronic, Tandem Diabetes Care, Inc. J.Mckeen: None. D.Feig: Advisory Panel; Novo Nordisk, Research Support; Apotex.

Literature Review: Pemberian Konseling Keluarga Berencana terhadap Pengambilan Keputusan Akseptor Memilih Keluarga Berencana Pasca Persalinan

One of the causes of the relatively fast population growth rate is because the average fertility rate or Total Fertility Rate (TFR) increases. The increase in TFR is also due to an increase in unmet need for family planning, especially in postpartum mothers. So that if the increase in TFR is not overcome by family planning programs, especially post-delivery family planning, there will be four too (4T), namely too young, too old, too many children, too often pregnancy is the cause of increased maternal and infant mortality. Objective: To review articles that discuss the provision of family planning to post-partum mothers. Methods: The author uses a literature review. In searching for several articles, this literature uses the Google Scholar, Pubmed and Scientific Director databases with inclusion criteria, namely using Indonesian and English, respondents are pregnant women in the third trimester or postpartum mothers. The articles obtained are from primary sources with a time span of 5 years (2017-2021). Results: Based on the literature review, it was found that the coverage of family planning acceptors in choosing post-delivery family planning was more likely to choose Long-Term Contraception Methods (LTCM) such as implants and IUDs, so it can be concluded that there is a significant relationship in the provision of post-delivery family planning counseling when pregnant women are in the third trimester. and at the time of postpartum to choose and decide on postnatal family planning.

Literature Review: Pemberian Konseling Keluarga Berencana terhadap Pengambilan Keputusan Akseptor Memilih Keluarga Berencana Pasca Persalinan

One of the causes of the relatively fast population growth rate is because the average fertility rate or Total Fertility Rate (TFR) increases. The increase in TFR is also due to an increase in unmet need for family planning, especially in postpartum mothers. So that if the increase in TFR is not overcome by family planning programs, especially post-delivery family planning, there will be four too (4T), namely too young, too old, too many children, too often pregnancy is the cause of increased maternal and infant mortality. Objective: To review articles that discuss the provision of family planning to post-partum mothers. Methods: The author uses a literature review. In searching for several articles, this literature uses the Google Scholar, Pubmed and Scientific Director databases with inclusion criteria, namely using Indonesian and English, respondents are pregnant women in the third trimester or postpartum mothers. The articles obtained are from primary sources with a time span of 5 years (2017-2021). Results: Based on the literature review, it was found that the coverage of family planning acceptors in choosing post-delivery family planning was more likely to choose Long-Term Contraception Methods (LTCM) such as implants and IUDs, so it can be concluded that there is a significant relationship in the provision of post-delivery family planning counseling when pregnant women are in the third trimester. and at the time of postpartum to choose and decide on postnatal family planning.

Risk of Recurrent Venous Thromboembolism and Hemorrhage Following Interruption of Anticoagulation at Delivery

Background: Current guidelines for regional anesthesia advise for the discontinuation of prophylactic and therapeutic low molecular weight heparin (LMWH) 12 hours and 24 hours, respectively prior to the use of neuraxial anesthesia (NA) for obstetric patients. Re initiating a prophylactic dose 12 hours following epidural catheter insertion/spinal anesthesia (SA) and at least 4 hours following epidural catheter removal is also recommended. There are limited data on the recurrent risk of venous thromboembolism (VTE) and bleeding using these standards. We conducted a retrospective single center study to assess the risk of VTE and/or bleeding in pregnant women using these criteria.Methods: Consecutive patients from 2013 to 2018 at Mount Sinai Hospital, a university affiliated tertiary care center in Toronto, Canada who were prescribed therapeutic or prophylactic LMWH antenatally and postpartum and who had NA were included. Hospital records were reviewed to determine the indication and dosage of LMWH, presence of thrombophilia, time of first LMWH injection postpartum, the mode of neuraxial anesthesia and delivery, the time of epidural catheter/spinal anesthesia, the time of epidural catheter removal, laboratory parameters and comorbid illnesses. Patients requiring therapeutic or prophylactic LMWH were assessed in the Hematology clinic and were advised to discontinue anticoagulation according to current recommendations. The primary outcomes were frequency of VTE, spinal hematoma and volume of postpartum blood loss. Statistical Analysis: Continuous variables were summarized as medians and interquartile ranges. Categorical variables were summarized as percentages. Characteristics associated with VTE and hemorrhage were analyzed using regression analysis.Results: Of 169 pregnancies, 158 fulfilled criteria, and 110 had complete data for the time of epidural catheter removal and initiation of LMWH. Median age was 34 (IQR 5) years and median weight 90 (IQR 70) kgs. Diagnoses included antiphospholipid syndrome, Budd Chiari, provoked and unprovoked VTE. Median platelet count at delivery was 185 (IQR 76) x 10(9)/L. Thirty-three percent were using concomitant ASA antenatally. Forty-four percent (n=48) had a vaginal delivery (VD). Sixty five (59%) had epidural anesthesia, 43 (39%) had SA and, two had combined spinal/epidural anesthesia. Median time to restarting LMWH was 7.8 (IQR 4.7) hours from epidural catheter removal/spinal insertion and 9 (IQR 3.9) hours from SA. There were no spinal hematomas. Median blood loss was 500 (IQR 400) ml. One patient, who received prophylactic dose LMWH antepartum, had a Caesarean delivery, spinal anesthesia and a prophylactic dose re-started 13.7 hours after SA, developed a delayed postpartum hemorrhage. One patient developed a VTE (1%). She developed a distal and superficial thrombus immediately after delivery. She was using antenatal prophylactic LMWH as she had an unprovoked VTE predating pregnancy, was heterozygous for the prothrombin gene mutation, had epidural anesthesia and VD. She received prophylactic LMWH three hours after catheter removal which was also 10 hours after catheter insertion.Limitations: Time of discontinuation of LMWH prior to induction could not be confirmed definitively as this was a retrospective review.Conclusion: Prospective studies are required to confirm these findings and to determine the safety of current recommendations of interrupting anticoagulation prior to regional anesthesia and delivery and to identify risk factors for hemorrhage and recurrent VTE to optimize anticoagulation regimens for these patients. DisclosuresMalinowski: Alexion: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy.

GAMBARAN TINGKAT PENGETAHUAN IBU NIFAS TENTANG PENCEGAHAN INFEKSI LUKA PERINEUM DI KLINIK KRISTINA SIDIKALANG TAHUN 2021

Background:Rupture is an injury to the perineum caused by natural tissue damage due to pressure on the fetal head or shoulders during delivery. Postpartum infection (puerpuralis) is an infection of the genitalia after childbirth, which is characterized by an increase in temperature to 38ºC or more for 2 days in the first 10 days after delivery, excluding the first 24 hours. Postpartum infection includes all inflammation caused by entry of germs. or bacteria into the genital tract at the time of delivery and postpartum.&#x0D; Objective:The specific purpose of this study was to describe the level of knowledge of the mother about the prevention of perineal wound infection at the Kristina Clinic in 2021. This study used Non Probability Technique Sampling which is the total sampling method. The samples in this study were all postpartum mothers, both those who experienced rupture and those who did not at Kristina Clinic 2021, as many as 20 people. The research was conducted by distributing questionnaires to all postpartum mothers.&#x0D; The results: obtained based on the knowledge of postpartum mothers about the prevention of perineal wound infection based on education, it can be seen from the majority of respondents having good knowledge with 11 people (55.0%) and the minority having knowledge less with the number of 7 people (35.0%).&#x0D; Conclusion: It is hoped that midwives will be able to conduct postnatal visits for 6 weeks in order to monitor the healing process of perineal wounds in patients to avoid infection of perineal wounds and provide education on how to prevent perineal wound infections and the signs and dangers of perineal wounds.

Early Hospital Discharge and Early Puerperal Complications

The study aimed to evaluate the association between the time of postpartum discharge and symptoms indicative of complications during the first postpartum week. The cross-sectional study included 753 women with vaginal delivery at Al-Jamhorya teaching public hospital without complications were interviewed before the hospital discharge and seven days after. The time of postpartum discharge was classified as early (≤24hours) or late (&gt;24hours). A total of 753 mothers were enrolled in the study. The majority (94.3%) of the mothers stayed in the hospital ≤24hours, 4.1% &gt;24hours, and 1.6 % were discharged against medical advice. The mean duration of hospital stay was 12.1±6.1 hours, with a minimum hospital stay of 2 hours and a maximum stay of 46 hours. The prenatal care was satisfactory in 91.2%. Prenatal care was satisfactory in 91% of early discharge mothers and 93.5% in the late group. This slight difference was not statistically significant. After delivery, 8.4% had urinary tract infections. Urinary tract infection after delivery occurred in 8.2% of mothers with early discharge and 12.9 % in mothers with late discharge. This difference was not statistically significant. Complications of episiotomy were recorded in 79.9% of mothers with early discharge and 61.3% in late discharge. This difference was statistically significant. The study’s conclusions indicated that late discharge mothers had received anesthesia and performed episiotomy more than early discharge mothers. Complications of episiotomy were recorded more in mothers with early discharge than in late discharged mothers. It is recommended that a randomized clinical trial is best to evaluate the association between the time of discharge postpartum and the presence of complications, also to attain safety and possible benefits of shorter hospital stay.

Soluble Flt1 levels are associated with cardiac dysfunction in Black women with and without severe preeclampsia

ABSTRACT Background: We evaluate soluble fms-like tyrosine kinase-1 (sFlt-1) levels and cardiac function during pregnancy and postpartum among Black women with and without preeclampsia. Study design: Prospective longitudinal cohort study from 2015 to 2017 of Black women with preterm severe preeclampsia and normotensive pregnant controls.We obtained echocardiograms and sFlt-1 levels during pregnancy and postpartum. Results: 93 Black women were included (43 cases, 50 controls). Higher sFlt1 levels were correlated with worse longitudinal strain, diastolic dysfunction, decreased ventricular-arterial coupling, and increased chamber and arterial elastance at the time of preeclampsia diagnosis and postpartum. Conclusions: Higher sFlt1 levels are associated with cardiovascular dysfunction during pregnancy and postpartum.

"Parirás com Dor": a violência obstétrica revisitada

Diante de um contexto social em que predominam os partos instrumentais, via cirurgia cesariana, nos hospitais particulares, e a “cascata de intervenções” nos partos vaginais dos hospitais públicos brasileiros, o movimento de mulheres marcou o início do século XXI com a nomeação da “violência obstétrica”. A compreensão da violência obstétrica abarca desde agressões físicas, psicológicas, verbais, simbólicas, sexuais até negligências nas assistências, discriminação, medicalização excessiva e inapropriada, adesão a práticas obstétricas desaconselhadas, dolorosas, prejudiciais e sem embasamento em evidências científicas,vividas no momento da gestação, parto, nascimento e pós-parto. Os aspectos dessa violência – com imposição de dor, sofrimentos e mortes evitáveis – se encontram legitimados pela ciência obstétrica eautorizados pelo Estado como assistência à saúde sexual e reprodutiva. Argumentamos que a violência obstétrica é um ato misógino de punição às mulheres, resultado de séculos de negação de sua sexualidade e capacidade de decidir. A proposta do artigo é refletir sobre como se deu tal autorização política para violentar os corpos de mulheres, assim como sua naturalização e invisibilização justificadas pela ciência e porcertas práticas obstétricas. Sendo parte de uma pesquisa mais ampla, foram privilegiadas, aqui, análises históricas de cunho feministas cujo acervo de conhecimentos permitiu rastrear o processo de elaboração doconceito e mostrar como as relações intrínsecas entre parto e políticas de Estado, via diferentes assistências – pública e privada –, coordenam a disciplina sobre os corpos expropriados das mulheres.

Birth Preparedness and Complication Readiness among Women with Pregnancy and Childbirth related Complications at Kenyatta National Teaching and Referral Hospital, Kenya.

Background:In developing countries, particularly those in Sub-Saharan Africa, women and newborns continue to face increased risks of mortality and morbidity during the time of pregnancy, birth and postpartum. Preparing for childbirth and being ready for complications is a key strategy in reducing maternal mortality and morbidity as this would reduce delay in obtaining skilled maternal care especially during childbirth. This survey was evaluating birth preparedness and complication readiness (BPCR) among women seeking services at Kenyatta National Teaching and Referral Hospital.Methods:A cross-sectional hospital-based study was conducted among women admitted in the antenatal and postnatal ward. Data was collected using a standardised questionnaire. A respondent was considered to have satisfactory BPCR if she reported that she had identified the place of delivery, made prior financial arrangements and organised for means of transport to place of childbirth and/or for the time of obstetric emergencies ahead of childbirth.Results:The survey recruited 353 women aged between 15 and 44 years. Majority were married (n=288, 81.6%) and unemployed (n=232, 65.7%). Additionally, most of the participants were multiparous (n=345,97.7%) and had made at least 1 visit at the Antenatal Clinic during their current pregnancy (n=331, 93.8%). The proportion of women whose BPCR was rated as satisfactory was 56.7% (95% confidence interval, (CI) 49.7% - 63.6%). Factors associated with satisfactory BPCR included: being married (OR10.66, 95%CI5.21-21.83), having post-secondary education (OR 11.52, 95% CI 6.62-20.05), being in formal employment (OR 4.14, 95%CI2.51-6.82), gestation >28 weeks (OR=1.83,95%CI1.08-3.09), multiparity (OR=1.87,95%CI1.21-2.88), visiting Ante-natal Care Clinic (OR=9.31, 95% CI 2.70-32.09)and particularly visiting the clinic more than 2 times (OR=4.43, 95% CI 2.75-7.13).Conclusions:The study documented sub-optimal BPCR. This highlights the need to review the current strategies and approaches being utilised to promote BPCR.

Efficacy of auricular acupressure combined with drugs in parturient woman with postpartum hemorrhage after secondary cesarean section

Objective To investigate the efficacy of auricular acupressure combined with drugs in parturient woman with postpartum hemorrhage after secondary cesarean section. Methods A total of 75 parturient women with postpartum hemorrhage after secondary cesarean section,selected from January 2015 to April 2017,were randomly divided into 3 groups. Control group was given intrauterine injection of oxytocin 20 IU and intravenous infusion of oxytocin 20 IU, as well as sublingual carboprost 1 mg; combined group was given intrauterine injection of hemabate 250 μg on the basis of control group; auricular group was treated with comprehensive therapy (auricular point sticking on the basis of combined group). Postpartum 2 h, 24 h bleeding, postpartum 1 d, 3 d, 5 d height of fundus of uterus were recorded, and the initial time of lactation and postpartum 48 h lactation amount scores were observed. Results Postpartum 2 h, 24 h bleeding in combined group (152.3 ± 31.1 ml, 326.7 ± 80.2 ml) and auricular group (144.7 ± 35.6 ml, 266.5 ± 62.3 ml) were significantly less than those in control group (240.4 ± 52.5 ml, 374.9 ± 74.6 ml, P 0.05), and the postpartum 24 h hemorrhage in auricular group were significantly less than the combined group (P<0.05). Postpartum 1 d, 3 d, 5 d height of fundus of uterus in combined group (12.6 ± 1.5 cm, 10.8 ± 1.6 cm, 9.5 ± 1.8 cm) and auricular group (11.4 ± 1.7 cm, 9.5 ± 1.3 cm, 8.4 ± 1.5 cm) were significantly lower than those in control group (13.7 ± 1.9 cm, 11.7 ± 1.6 cm, 10.5 ± 1.4 cm, P<0.05), which in auricular group were significantly lower than those in combined group (P<0.05). The initial time of lactation in combined group (30.44 ± 3.64) h, and auricular group (26.36 ± 3.95) h were significantly less than those in control group (34.84 ± 6.02) h, (P<0.05), which in auricular group were significantly less than in combined group (P<0.05); the postpartum 48 h lactation amount scores in combined group (1.84 ± 0.75) and auricular group (2.12 ± 0.74) were significantly higher than those in control group (1.36 ± 0.81), (P<0.05), which in auricular group were significantly higher than those in combined group (P<0.05). Conclusions Comprehensive therapy could reduce postpartum hemorrhage, promote uterine involution and improve postpartum lactation in parturient woman with postpartum hemorrhage after secondary cesarean section. Key words: Cesarean section, repeat; Postpartum hemorrhage; Lactation; Auricular point sticking, semen vaccariae; Clinical study

Advancing People-Centered Maternal and Newborn Health Care through Birth Preparedness and Complication Readiness in Rural Bangladesh

Background: In Bangladesh, women and newborns continue to face elevated risks around the time of pregnancy, birth and postpartum. Applying a people-centered approach to maternal and newborn (MNH) services is a priority in such contexts to increase appropriate use of services and improve the health of women and newborns. In 2009, Enfants du Monde and PARI Development Trust began supporting the Ministry of Health at local level to implement birth preparedness and complication readiness (BPCR) for improving MNH in Netrokona district, Bangladesh. Objective: To assess the contribution of the BPCR intervention in advancing people-centered MNH care in Netrokona district, Bangladesh. Methods:We conducted 15 in-depth interviews (IDIs), one focus group discussion (FGD) and four group discussions with different stakeholders. In addition, a household survey was conducted with 725 women (intervention n=444, control n=281) and 317 of their husbands (intervention n=178, control n=139) at baseline and with 737 women (intervention n=442, control n=295) and 732 husbands at endline.Results: The BPCR intervention was co-designed through a consultative process with national and local stakeholders, ensuring the reflection of local context. Training health care providers to improve their counseling skills allowed them to apply effective BPCR counseling during ANC visits and be responsive to women’s situations and individual needs. In addition, discussion on BPCR in households and courtyard meetings provoked families’ and communities’ engagement in MNH. Consequently. there was significant increase across most indicators related to BPCR practice among women and husbands’ involvement between baseline and endline.Discussion: The BPCR intervention was successful in advancing people-centered MNH care by empowering women and increasing the engagement of men, families and communities in MNH care. Our study findings are coherent with the findings of studies conducted in similar settings. Conclusions: Carefully co-designed BPCR interventions should be further expanded within Bangladesh and beyond in order to advance people-centered care and progress toward the Sustainable Development Goals (SDGs).

Evaluation of Seasonal Serum Level of Estradiol and Progesterone Hormones in Iranian Female Caucasian Viper

Steroids hormones have a basic role in animals' reproductive activity and their secretion amounts are changed during the year with animal physiological conditions. There is no study reporting Iranian female snake's hormones controlling reproductive activity. In this study the estradiol (E2) and progesterone (P4) hormones level in serum samples of 26 female Caucasian vipers were examined by electrochemiluminescence (ECL). The results show the average concentration of estradiol (E2) hormone in the autumn (157.2±47.53 nmol/ Lt) is less than the early winter (December-January), 318.33±156nmol/l (p≤0.1) and again the concentration of this hormone reduced in the summer, 188.94±33.57 nmol/Lt (p≤0.78). The average concentration of P4 hormone in the autumn was 0.45±0.14nmol/Lt and in winter was 0.96±0.57 nmol/Lt, that show increasing process (p≤0.22). The average concentration of this hormone is decreasing in the summer, 0.82±0.23 nmol/Lt as compared to the winter (p≤0.78). In the fertile snacks the amount of serums estradiol is increased during the vitellogenesis and progesterone is increased during pregnancy and the amount of these hormones is low throughout the year in unfertile snacks. According to these hormones changing during the seasons it seems that the Iranian Caucasian viper from Lar area in Tehran province, during the winter season is in the vitellogenesis phase and summer is the pregnancy time and the autumn is the time of postpartum. Although the maximum amount of progesterone is inconsistent with the winter but like this case is reported before.

Isolated proteinuria is a risk factor for pre-eclampsia: a retrospective analysis of the maternal and neonatal outcomes in women presenting with isolated gestational proteinuria.

To examine maternal and neonatal outcomes of isolated proteinuria and define maternal characteristics for progression to pre-eclampsia. Retrospective cohort study. Data from all hospitalized pregnant women between 2009 and 2014 with new onset isolated proteinuria of over 300 mg/24 h at admission were obtained. Follow-up was performed from the time of admission to the hospital to the time of discharge postpartum. Obstetrical, maternal and neonatal outcomes were obtained. Ninety-five pregnant women diagnosed with new onset isolated proteinuria were followed to term. Thirteen women developed pre-eclampsia during pregnancy and eight developed pre-eclampsia postpartum. Maternal characteristics for progression to pre-eclampsia were greater maximal values of proteinuria. Earlier pre-eclampsia onset was associated with early-onset proteinuria and multiple gestation. Although greater values of proteinuria were associated with increased risk for intrauterine growth restriction and lower Apgar scores, maternal outcome was favorable, regardless of pre-eclampsia progression. Isolated proteinuria progressing to pre-eclampsia was associated with late pre-eclampsia onset and favorable maternal and neonatal outcomes. A significant proportion of women with new onset isolated proteinuria will develop pre-eclampsia. In these women, close follow-up is recommended until after delivery.

P17.42 Scientific production of nursing care about the child born exposed to hiv

Introduction The vertical HIV transmission occurs from mother to child at the time of pregnancy, labour or postpartum. During postpartum stand out some specific care, such as: administration of chemoprophylaxis with zidovudine in the first two hours to six weeks of life; prophylaxis with trimethoprim-sulfamethoxazole from six weeks to one year; routine clinical/laboratory monitoring; systematic evaluation of the growth/development; immunisation and supply of infant milk formula. This study aimed to evaluate the scientific production of nursing care about the unborn child exposed to HIV. Methods Integrative Review held in March 2015 in the databases: Latin American and Caribbean Literature in Health Sciences (Lilacs), Medline and Scientific Electronic Library Online (SciELO). The descriptors - Child, HIV, Vertical Transmission of Infectious Disease and Nursing - were combined using the Boolean operators AND and OR. Results The sample consisted of nine articles in English and Portuguese published from 2006 to 2014. The categories of nursing care were addressed in articles: investigation of maternal perception of this experience; stimulating attachment between mother and child during pregnancy; encouraging verbal and nonverbal communication in maternal care actions - bathing, feeding, changing clothes; assessment of the risks of accidents and other vulnerabilities with focus in the home environment; analysis of vaccination status and awareness of the importance of immunisation; development of management actions of maternal and child care; analysis of the mother’s ability to care for and empowerment. The identified care converge with the recommendations found in the literature and surpass the vertical transmission include broad actions to promote for the mother and child health. Conclusion Research on this approach can contribute to design of nursing care proposals with a focus on providing comprehensive care to children exposed to HIV. Disclosure of interest statement This study was funded by CAPES (Higher Education Personnel Training Coordination) and CNPq (National Council for Scientific and Technological Development). No pharmaceutical grants were received in the development of this study.

MANAGEMENT OF HIV/AIDS INFECTION IN PREGNANCY

Twenty years since identified for the first time, the disease of HIV/AIDS spread and cause greater damage than the previous prediction. According to the Director General of P2M and Environmental Sanitation Department of Health by the end of 1999, there were 1066 people in Indonesia who are infected with HIV even though this must be realized that the rate is still far lower than the actual numbers, because there are many cases of HIV infection reported in addition to energy awareness health of the possibility of HIV infection has not been evenly distributed. Management of HIV infection/AIDS in pregnancy is done in time of antepartum, intrapartum and post partum, for mother and the baby, in general and specific. The important matters include the use of ART, nutrition and psychological support. Prevention and management of opportunistic infections to PWHA are not different with that of non pregnant woman. However, it is not routinely advised because of drug toxicity.

72-OR

Objectives In 2013 the American Task force on Hypertensive diseases defined new criteria for preeclampsia (pet) without proteinuria and excluded the severity of proteinuria from criteria defining pet with severe signs. Still, the majority of women presenting with pet also exhibit proteinuria. It remains disputed whether isolated proteinuria is part of the pet continuum or whether it is a physiological alternation in kidney function in pregnancy. Our aim was to examine maternal and neonatal outcomes of isolated proteinuria and define risk factors for progression to pet. Methods Retrospective cohort study. Data from all hospitalized pregnant women with isolated proteinuria of over 300 mg/24 h at admission between 2009 and 2014, was obtained. We followed this study group from the time of admission to the hospital to the time of discharge postpartum, obtaining maternal and neonatal outcomes. Results During the 5 year period 99 women were diagnosed with isolated proteinuria. 13 women developed pet during pregnancy, and an additional 8 developed pet postpartum (21%). No risk factors for proteinuria were found, however the earlier the diagnosis of proteinuria the higher were the maximal values of proteinuria reached. Risk factors for progression of pet were primiparity (p = 0.01) and greater values of proteinuria (p = 0.005). Among women who developed pet, an earlier diagnosis was made for those with early onset proteinuria (p = 0.002), well established risk factors for pet (p = 0.01) and multiple gestations (p = 0.002). Neonatal outcome was equivocal regardless of progression to pet and levels of proteinuria. Conclusions To date this is the largest series of women with isolated proteinuria followed to term. We conclude that isolated proteinuria is a risk factor for pet, with greater chances of developing pet among primiparous women with higher values of proteinuria. While proteinuria itself is negligible, chances of pet are high and close follow-up is recommended until after delivery. Disclosures S. Shinar: None. A. Schwartz: None. M. Ram-Weiner: None. M. Kupferminc: None. A. Many: None.