Women In Postpartum Period Research Articles

Features of labor and postpartum period in women with iron deficiency anemia

Relevance . The relevance of improving the treatment of pregnant women with iron deficiency anemia (IDA) is due to an increase in morbidity and adverse effects on the course and outcome of the gestational process, the state of the fetus and newborn. The objective of this study was the comparative assessment of the frequency of complications of labor and the postpartum period in women who received intravenous and oral iron preparations during pregnancy. Material and methods. The study included 140 pregnant women. The mean age of the patients was 31.75 (19; 49) years. Results. Pregnant women with IDA, after a single administration of intravenous preparation of iron carboxymaltosate, had pronounced stable dynamics of hematological and ferrokinetic blood parameters, as well as the low frequency of postpartum complications, compared to the oral preparation of iron (III) hydroxide polymaltosate.

A comparison of sexual function in primiparous and multiparous women

Childbirth is one of the most important influencing factors for sexual function. Therefore, this study was conducted with the aim of comparing sexual function in primiparous and multiparous women. This cross-sectional analytical study was performed using systematic random sampling on 420 women in the postpartum period who referred to Bandar Abbas health Centres in 2018. The data were collected using an interview method which consisted of a Female Sexual Function Index questionnaire and a demographic questionnaire. The data analysis was performed using the SPSS Version 23 software. The results showed that sexual dysfunction was lower in multiparous women compared to primiparous women (p = .006). Low sexual activity in primiparous women can be due to less privacy and more time and energy loss. Several factors including housing situation, monthly income, episiotomy incision, and the education level of the couple were influential in the sexual function of the primiparous women (p < .05). Sexual function differs between primiparous and multiparous women in postpartum period and the number of deliveries can affect sexual performance.IMPACT STATEMENTWhat is already known on this subject? Sexual function in humans is affected by a complexity of interactions. Childbirth is among the most one of the important factors that influences sexual function. Pregnancy and childbirth affect all organs of the female body, especially the genital tract, and the resulting changes may cause problems in sexual intercourse. Negative childbirth experiences from previous deliveries can affect sexual performance.What do the results of this study add? Regarding the high prevalence of sexual problems during the postpartum period and the direct impact of this on spousal relationship, and also given the controversial data on the relationship between parity and sexual dysfunction, the present study was conducted to compare postpartum sexual function between primiparous and multiparous women.What are the implications of these findings for clinical practice and/or further research? The sexual and emotional intimacy of couples may be affected due to the changes in women’s sexual function as the result of physiological and anatomical changes during pregnancy and postpartum. Therefore, to improve the quality of sexual relations, screening and counselling for sexual disorders should not be limited to pregnancy and postpartum periods, but should also be included in pre-pregnancy counselling centres.

The risk of venous thromboembolism in women with inflammatory bowel disease during pregnancy and the postpartum period: A systematic review and meta-analysis.

Pregnancy and inflammatory bowel disease (IBD) are independent risk factors for venous thromboembolism (VTE). Nevertheless, the optimal VTE prevention strategy for women with IBD in pregnancy and postpartum period has not been established yet. We assessed VTE risks during pregnancy and the postpartum period in women with IBD through systematic review and meta-analysis.Systematic searches were conducted in MEDLINE (Ovid), Embase (Ovid), CENTRAL (Ovid), and Web of Science (Tomson Reuters) from the database inception till May 2017 to identify relevant studies reporting the risk of VTE during pregnancy and/or the postpartum period in women with IBD. Random effect meta-analyses were performed to compare VTE-related outcomes between women with IBD and without IBD. Our protocol was registered: CRD 42017060199 in the PROSPERO International prospective register of systematic reviews.In the analysis of 5 studies reviewed, IBD population (n = 17,636) had a significantly increased risk of VTE during pregnancy (pooled risk ratio (RR) 2.13, 95% confidence interval (CI) 1.66-2.73) and postpartum (RR 2.61, 95% CI 1.84-3.69), comparing to the non-IBD population (n = 11,251,778). According to the location of VTE, the risk of deep vein thrombosis increased significantly by RR of 2.74 (95% CI 1.73-4.36) during pregnancy, whilst risk increase of pulmonary embolism was not statistically significant. In the subgroup analysis, the degree of VTE risk was higher in both periods in the UC group than in the CD group, as compared to that in the non-IBD population (UC group, during pregnancy: RR 2.24, 95% CI 1.6-3.11; postpartum period: RR 2.85, 95% CI 1.79-4.52).Significantly increased risks of VTE during pregnancy were found in the women with IBD, according to the periods and type of IBD, which might support a detailed strategy regarding administration of prophylactic anticoagulants to women with IBD.

Postpartum Depression and its Associated Factors: A Community-based Study in Nepal.

Postpartum depression is a type of mental disorder associated with childbirth during pregnancy or within the first postpartum year. It is reported as a common psychological health problem affecting 10-15% of women worldwide. The duration of postpartum depression frequently depends on its severity and the time of initiation of treatment. This study assessed depression and its associated factors among postpartum period women of Godavari municipality, Lalitpur, Nepal. A community-based cross-sectional study was conducted using Edinburg Postpartum Depression Scale among 195 mothers who were within six months of the postpartum period. The chi-square and logistic regression were applied to establish the association between postpartum depression and associated factors. Out of the total 195 postpartum women, 37(19%) women suffered from depression and out of those women 2.1% had suicidal thoughts. Among the associated factors, education, occupation, the intent of pregnancy, family support and pregnancy-related problems/complications were found to be significantly associated with Postpartum depression (p<0.05). Nearly one-fifth postpartum women suffered from some type of depression. It is one of the public health concerns which directly or indirectly corresponds to the socio-economic condition of the women. The improved education and economic status of women, intention of pregnancy, family care and support during pregnancy and the postpartum period and early diagnosis and management of health problems could reduce the magnitude of the postpartum depression.

Comparison of the breastfeeding outcomes and self-efficacy in the early postpartum period of women who had given birth by cesarean under general or spinal anesthesia

Objectives This study was conducted to compare the breastfeeding outcomes and self-efficacy in the early postpartum period of women who had given birth by cesarean under general (GA) or spinal anesthesia (SA). Methods This descriptive study was conducted with 190 women who had given birth under GA and SA at a training and research hospital. The data of the study were collected with the “Data Collection Form”, “LATCH Breastfeeding Assessment Tool” and the “Breastfeeding Self-Efficacy Scale- Short Form (BSES-SF)”. Results The time to first breastfeeding of the newborns was 78.71 ± 126.9 min and 23.7% of the women breastfed within 30 min. Those who gave birth under SA breastfed their newborn infants statistically significantly earlier (p < .05). However, there was no statistical difference between women giving birth by cesarean under GA and SA and their score medians from the LATCH or the BSES-SF (p > .05). Conclusion The percentage of women breastfeeding their infants within the first half hour and the self-efficacy and success rate was higher among women who gave birth under SA than those who had cesarean under GA. However, breastfeeding behaviors were not at the desired level in either group. Health care professionals should therefore support women who undergo a cesarean and especially those who give birth under GA to increase their breastfeeding success and self-efficacy.

Nutritional habits and levels of physical activity during pregnancy, birth and the postpartum period of women in Toledo (Spain): study protocol for a two-year prospective cohort study (the PrePaN study)

IntroductionPregnant women who eat a balanced diet usually practice physical activity (PA) regularly; there are many studies on PA during pregnancy and the results for the mother and baby. However,...

Intuitive eating is associated with weight and glucose control during pregnancy and in the early postpartum period in women with gestational diabetes mellitus (GDM): A clinical cohort study

IntroductionHigh pre-pregnancy weight and body mass index (BMI) increase the risk of gestational diabetes mellitus (GDM) and diabetes after pregnancy. To tackle weight and metabolic health problems, there is a need to investigate novel lifestyle approaches. Outside of pregnancy, higher adherence to intuitive eating (IE) is associated with lower BMI and improved glycemic control. This study investigated the association between IE and metabolic health during pregnancy and in the early postpartum period among women with GDM. MethodsTwo-hundred and fourteen consecutive women aged ≥18, diagnosed with GDM between 2015 and 2017 and completed the “Eating for Physical rather than Emotional Reasons (EPR)” and “Reliance on Hunger and Satiety cues (RHSC) subscales” of the French Intuitive Eating Scale-2 (IES-2) questionnaire at the first GDM clinic visit were included in this study. ResultsParticipants' mean age was 33.32 ± 5.20 years. Their weight and BMI before pregnancy were 68.18 ± 14.83 kg and 25.30 ± 5.19 kg/m2 respectively. After adjusting for confounding variables, the cross-sectional analyses showed that the two subscales of IES-2 at the first GDM visit were associated with lower weight and BMI before pregnancy, and lower weight at the first GDM visit (β = −0.181 to −0.215, all p ≤ 0.008). In addition, the EPR subscale was associated with HbA1c and fasting plasma glucose at the first GDM visit (β = −0.170 and to −0.196; all p ≤ 0.016). In the longitudinal analyses, both subscales of IES-2 at first GDM visit were associated with lower weight at the end of pregnancy, BMI and fasting plasma glucose at 6–8 weeks postpartum (β = −0.143 to −0.218, all p ≤ 0.040) after adjusting for confounders. ConclusionsIncrease adherence to IE could represent a novel approach to weight and glucose control during and after pregnancy in women with GDM.

Predicting postpartum cardiac events in pregnant women with complete atrioventricular block

BackgroundWomen with complete atrioventricular block (CAVB) can tolerate hemodynamic changes during pregnancy; however, the incidence of cardiac events in women with CAVB may increase after delivery. The aim of this study was to investigate predictive factors for postpartum cardiac events in pregnant women with CAVB. Methods and resultsPregnant women with CAVB who received perinatal management at a tertiary cardiac center from 1981 to 2015 were retrospectively reviewed. Univariate and multivariate logistic analyses of postpartum cardiac events were performed. Postpartum cardiac event was defined as cardiopulmonary arrest, cardiac failure, or the need for permanent pacemaker implantation (p-PMI) within 3 months after delivery. A total of 63 pregnancies in 36 women with CAVB were included in this study; 25 had undergone p-PMI before pregnancy. Regardless of p-PMI status, women with CAVB had no further increases in heart rate during the second and third trimesters. No heart failure was found during pregnancy and delivery. Postpartum cardiac events occurred in 9 pregnancies (14.3%) in 8 women with CAVB; 3 had cardiac failure and p-PMI, 3 had cardiac failure, 2 required p-PMI, and 1 had cardiopulmonary arrest. Multivariate analysis showed that perinatal ventricular pause (odds ratio 11.60, 95% confidence interval 1.90–82.18, p<0.01) and family history of CAVB (odds ratio 10.59, 95% confidence interval 1.36–90.56, p=0.03) were associated with postpartum cardiac events. ConclusionsAll cardiac events occurred during the postpartum period among women with CAVB, and ventricular pause during the perinatal period and a family history of CAVB were predictors of postpartum cardiac events. Close follow-up should be considered during the postpartum period for women with high-risk CAVB.

Trajectories of stress biomarkers and anxious-depressive symptoms from pregnancy to postpartum period in women with a trauma history

ABSTRACT Background: Cross-sectional studies have found that a trauma history can be associated with anxious-depressive symptomatology and physiological stress dysregulation in pregnant women. Methods: This prospective study examines the trajectories of both anxiety and depressive symptoms and salivary cortisol and α-amylase biomarkers from women with (n = 42) and without (n = 59) a trauma history at (i) 38th week of gestation (T1), (ii) 48 hours after birth (T2), and (iii) three months after birth (T3). Results: The quantile regression model showed that trauma history was associated with higher cortisol levels at T1 and this difference was sustained along T2 and T3. Conversely, there were no significant differences in α-amylase levels between groups across the three time points and both groups showed an increase in α-amylase levels from T2 to T3. The ordinal mixed model showed that trauma history was associated with higher anxiety symptoms at T1 and this remained constant from T1 to T2 but was reversed from T2 to T3. In contrast, both groups showed similar depressive symptoms across the three time points. Conclusions: Whereas physiological stress dysregulation (in terms of higher cortisol levels) was maintained from pregnancy to postpartum period, pregnancy and childbirth were the most vulnerable stages for developing anxious symptoms in mothers with trauma history.

Worldwide Incidence of Peripartum Cardiomyopathy and Overall Maternal Mortality.

Peripartum cardiomyopathy (PPCM) is a specific cardiomyopathy in which heart failure develops due to reduced myocardial contraction during pregnancy or in the postpartum period in women without a previous history of heart disease. The epidemiology of PPCM has been reported in various countries and areas, and the incidence of PPCM differed among these reports. The incidence was highest (1 in 102 deliveries) in Nigeria and lowest (1 in 15,533 births) in Japan. The incidence was higher in African-Americans than in other races in several reports from the United States, and was also high in African countries and Haiti, indicating that the risk for PPCM is highest in the black race. However, the study design and definition of PPCM differ among studies, and these differences may influence the incidence. Moreover, the incidence of PPCM and the maternal mortality rate were well correlated. Since maternal mortality reflects the level of perinatal health care and hygiene, this finding suggests that the extent of perinatal care is partly related to the incidence of PPCM, which reflects heart failure and cardiomyopathy of unknown cause in women.

Stroke recurrence in pregnancy: Experience at a regional referral center

BackgroundAlthough stroke is more common with advancing age, especially in the elderly, women of reproductive age may still suffer from stroke, and from its deleterious consequences. Women of reproductive age who suffer a stroke may do so either due to a specific predisposition, or due to pregnancy-related hypertensive emergencies. ObjectiveTo assess the risk of stroke recurrence in pregnancy and the postpartum period in women who have suffered a stroke before pregnancy. Study designThis was a retrospective cohort study conducted at Thomas Jefferson University Hospital from January 2005 to December 2015. This is a tertiary referral center for high-risk obstetrics and one of the largest stroke referral centers for neurosurgery. All consecutive pregnant women that had a viable pregnancy (≥24 weeks of gestation) and a history of stroke prior to pregnancy were identified. The primary outcome of this study was stroke recurrence in pregnancy or the postpartum period defined as 6 weeks after delivery. ResultsForty-eight pregnancies with a history of stroke before pregnancy were identified in 24 women. Thirty-one pregnancies (64.6%) had a history of an ischemic stroke, 11 (22.9%) had a history of transient ischemic attack, and 6 (12.5%) had a history of a hemorrhagic stroke. There was no stroke recurrence during pregnancy or the postpartum period for the three groups of stroke. In the ischemic stroke group, 8 (25.8%) had recurrence in the non-pregnant state compared to none in the TIA and the hemorrhagic stroke group. ConclusionThere was no stroke recurrence during pregnancy or the postpartum period for the three groups of stroke.

Involution of uterus in postpartum period in ultrasound examination

Retrospective analysis of 558 women in postpartum period is presented. In all cases delivery was urgent, one live fetus; vaginal birth happened at 454 (81.4%) patients and by Caesarean section — 104 (18.6%). Ultrasound examination was performed by one doctor, using transabdominal access. The value for assessment of a current of postpartum period has a condition of a cavity of the uterus which decreases on thickness and the volume. Advancement of uterine cavity contraction compared with myometrium shows the ratio of cavity volume to uterine volume, which decreases from 8.0% on day 3 to 4.7% on the 5th day. In a cases of hematometra, no significant increase in uterine volume was obtained.

Effect of Ibuprofen Versus Acetaminophen on Postpartum Hypertension in Preeclampsia With Severe Features: A Double-masked, Randomized Controlled Trial

(Am J Obstet Gynecol. 2018;218:616.e1–e8) Hypertensive disorders of pregnancy contribute to maternal morbidity and mortality. Women with hypertension are at increased risk for cesarean delivery. The American College of Obstetricians and Gynecologists suggests avoiding the use of nonsteroidal antiinflammatory drugs (NSAIDS) in women with preeclampsia as they have been shown to increase blood pressure in nonpregnant adults. The purpose of this study was to evaluate the effect of ibuprofen compared with acetminophen on blood pressure control in the postpartum period in women diagnosed with preeclampsia with severe features. They hypothesized that NSAIDs would adversely affect postpartum blood pressure control in women with preeclampsia with severe features.

High-intensity breastfeeding improves insulin sensitivity during early post-partum period in obese women with gestational diabetes.

To investigate whether high-intensity breastfeeding (HIB) reduces insulin resistance during early post-partum period in women with gestational diabetes (GDM), independent of post-partum weight change (PWC). In this multicentre prospective study, we included Japanese women with GDM who underwent a 75-g oral glucose tolerance test (OGTT) during early post-partum. We measured plasma insulin during OGTT to obtain a homeostasis model of assessment of insulin resistance (HOMA-IR). We defined the condition in which infants were fed by breastfeeding alone or greater than or equal to 80% of the volume as HIB, and other statuses, including partial and nonbreastfeeding, as non-HIB. We investigated the association between post-partum HOMA-IR and the breastfeeding status after adjusting for confounders including PWC. Among 222 women with GDM who underwent the OGTT at 7.9±2.3weeks post-partum with a PWC of -7.8±3.4kg, although the rate of abnormal glucose tolerance (prediabetes and diabetes) did not differ between the groups (33% vs 32%), the HOMA-IR in the HIB women (n=166) was significantly lower than that in the non-HIB women (n=56) (1.12±0.85 vs 1.72±1.43, P=0.0002). The effect of the HIB was independently associated with lower HOMA-IR after adjusting for confounders including PMC. However, the subgroup analysis according to their pre-pregnancy obesity states showed that the effect was seen only in the obese subjects (BMI≥25). In obese Japanese women with GDM, HIB has a significant effect in reducing insulin resistance during early post-partum, independent of the post-partum weight loss.

Contraceptive Choices in the Immediate Postpartum Period in Women With Cardiac Disease

Maternal cardiac disease (MCD) is associated with increased maternal and neonatal morbidity and mortality. Because unplanned pregnancies are especially risky, active use of reliable contraception is critical in this population. Studies in the noncardiac population have demonstrated that the postpartum period is an ideal time to address contraceptive plans. This retrospective cohort study was designed to describe contraceptive choices in women with MCD in the immediate postpartum period and to identify factors associated with specific contraceptive plans. We included women with MCD who delivered from January 2008 to September 2017 at a tertiary care institution with a multidisciplinary obstetrics and cardiology team. Maternal demographics, specifics of MCD, obstetrical outcomes, and contraceptive plans were obtained through chart review. Contraceptive plans were categorized into highly reliable methods (sterilization or long-acting reversible contraceptive methods) or less reliable methods (nonlong-acting reversible contraceptive methods or no contraception). In the 254 women included in this study, 40% planned to use highly reliable methods, while 60% planned to use less reliable methods. Women with cardiomyopathy were more likely to choose a highly reliable method of contraception (adjusted odds ratio 2.6, 95% confidence interval 1.2 to 5.7), a reassuring finding, given the particularly high risk of poor pregnancy outcome with this diagnosis. There were no differences in other cardiac diagnoses between the 2 contraceptive groups. In conclusion, the finding that <50% of postpartum women with MCD plan to use a highly reliable method of contraception warrants further examination to identify and address barriers to reliable contraceptive plans in this high-risk population.

Depression, anxiety, and bodily pain independently predict poor sleep quality among adult women attending a primary health center of Puducherry, India.

Background:Sleep disorders and mental health problems are common diagnoses in primary care settings. The objective of this study was to estimate the magnitude of poor sleep, depression, and anxiety through opportunistic screening and to find out the independent predictors of poor sleep quality among female participants.Materials and Methods:A hospital-based study was conducted in the outpatient department (OPD) of an urban primary health center of Puducherry. Patients and accompanying healthy attendants ≥ 18 years of age who visited the OPD for any reason were included. Those with serious acute illness, previously diagnosed mental illness, pregnant women, and women in postpartum period (upto 6 weeks) were excluded. Systematic random sampling was used to select the participants. A semi-structured questionnaire was used to collect sociodemographic and clinical details along with the Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale. Height and weight were also measured.Results:A total of 301 participants were recruited. Mean age of the participants was 49.4 (standard deviation 15.2) years. Magnitude of poor sleep (PSQI score > 5), abnormal anxiety, and abnormal depression were 118 (39.2%), 60 (19.9%), and 28 (9.3%) respectively. Multivariate logistic regression analysis showed that history of pain [odds ratio (OR) 3.2 (1.6–6.5), P = 0.001], abnormal anxiety [OR 2.5 (1.2–5.6), P = 0.021], and abnormal depression [OR 4.3 (1.4–13.2), P = 0.01] independently predicted poor sleep quality among females.Conclusion:OPD-based opportunistic screening for sleep and mental health problems should be routinely conducted by primary care and family physicians.

Mortalidad por suicidio relacionado con el embarazo en Antioquia (Colombia), 2004-2014

Objetivo: caracterizar la población de mujeres que murieron por suicidio durante el embarazo, el parto y el puerperio en Antioquia entre 2004 y 2014, y calcular la proporción de muertes por suicidio.Materiales y métodos: estudio descriptivo de muertes por suicidio de mujeres residentes en el departamento de Antioquia, región central de Colombia, durante el embarazo, el parto y el puerperio, identificados entre 2004 y 2014. Se incluyeron todos los casos detectados a partir de los reportes al Sistema Nacional de Vigilancia en Salud Pública (SIVIGILA) y el certificado de defunción; la información se obtuvo de historias y registros clínicos. Se evaluaron las características clínicas y sociodemográficas; como factores de riesgo se tuvo en cuenta el antecedente personal o familiar de trastorno mental, el uso de sustancias psicoactivas, los intentos de suicidio, la violencia intrafamiliar y la violencia de pareja. Las variables categóricas se agruparon según su frecuencia como proporciones y porcentajes; para las variables continuas se calculó la mediana y el respectivo rango intercuartílico. Se calcularon la proporción de muertes por suicidio sobre el total de muertes maternas ocurridas en el departamento en este periodo, y la razón de mortalidad específica por grupos de edad teniendo en cuenta el número de muertes identificadas en la investigación por grupo etario, y el número total de nacidos vivos reportados por el Departamento Administrativo Nacional de Estadística (DANE), en mujeres de esa edad en ese periodo de 11 años, expresados como número de muertes maternas/1000 nacidos vivos.Resultados: entre el 2004 y el 2014 se presentaron 476 muertes maternas y 24 casos de muerte por suicidio, para una proporción de 4,8 %. En 18 casos se contó con información para la descripción. El mayor número de suicidios se presentó en el grupo de 20 a 29 años de edad, solteras, dedicadas a las labores del hogar o a estudiar, residentes en zonas rurales, pertenecientes al régimen subsidiado y con niveles de escolaridad inferiores a bachillerato completo; la mitad de las pacientes había realizado control prenatal; el 70% murieron por envenenamiento y 30% por ahorcamiento; hubo una distribución similar de las muertes en los 2 primeros trimestres del embarazo y el posparto tardío. No se encontró información sobre factores de riesgo para suicidio en el 44,4% de los casos en la historia personal, y 72,2% en la familiar.Conclusiones: la muerte por suicidio relacionado con el embarazo es una importante causa de mortalidad materna, potencialmente evitable; hace falta identificar las pacientes vulnerables para ofrecer un tratamiento activo y reforzar el seguimiento. Se requiere mayor compromiso con el diligenciamiento de los registros, la notificación, el seguimiento y el análisis de los eventos.

Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: a systematic review and meta-analysis.

The purpose of this review was to investigate the relationship between prenatal exercise, and low back (LBP), pelvic girdle (PGP) and lumbopelvic (LBPP) pain. Systematic review with random effects meta-analysis and meta-regression. Online databases were searched up to 6 January 2017. Studies of all designs were eligible (except case studies and reviews) if they were published in English, Spanish or French, and contained information on the population (pregnant women without contraindication to exercise), intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone ["exercise-only"] or in combination with other intervention components [eg, dietary; "exercise + co-intervention"]), comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and outcome (prevalence and symptom severity of LBP, PGP and LBPP). The analyses included data from 32 studies (n=52 297 pregnant women). 'Very low' to 'moderate' quality evidence from 13 randomised controlled trials (RCTs) showed prenatal exercise did not reduce the odds of suffering from LBP, PGP and LBPP either in pregnancy or the postpartum period. However, 'very low' to 'moderate' quality evidence from 15 RCTs identified lower pain severity during pregnancy and the early postpartum period in women who exercised during pregnancy (standardised mean difference -1.03, 95% CI -1.58, -0.48) compared with those who did not exercise. These findings were supported by 'very low' quality evidence from other study designs. Compared with not exercising, prenatal exercise decreased the severity of LBP, PGP or LBPP during and following pregnancy but did not decrease the odds of any of these conditions at any time point.

Pengaruh Konseling Antenatal terhadap Penerimaan AKDR pascasalin sebuah uji klinis non randomisasi

Background: During postpartum period women have a high motivation to start using contraception and postpartum IUD is an ideal method to offer. The rate of IUD use is still low, 14.06% of all postpartum contraceptive use. This might be attributed to lack of information and counseling from health providers.Objective: To compare the number of postpartum IUD used among groups of clients who were counseled during ANC and re-counseled during latent phase (exposed group), and group counseled during latent phase only (control group).Method: This study was a prospective quasi-experimental or randomised clinical trial. The first group was those counseled during ANC and latent phase, and the second was those counseled at latent phase only. Chi square and relative risk were used for statistical test two proportions.Result and Discussion: A total of 342 subjects who met inclusion and exclusion criteria were recruited. They consisted of the 210 subjects (61,4%) for the first group and 132 subjects (38,6%) for the second.The rate of IUD used in the first group was 82 of 210 (39%) and 30 of 132 (22.7%) in the second, RR 1,72 (95% CI 1.20 – 2.46), p 0,002. The rate of IUD used was also significantly influenced by a history of IUD acceptor RR 2,90 with 95% CI 2.23 – 3.77), a history of contraceptive used (RR 1,79 with95% CI 1,18 – 2,71) and a history of contraceptive counselling (RR 1,50 with 95% CI 1,03 – 2,19).Conclusion: Clients who were counseled twice (during ANC and repeated at latent phase) had higher rate of postpartum IUD used significantly than those who were counseled at latent phase only. Other factors that significantly affected the rate of postpartum IUD used were history of IUD acceptor, history of contraceptive used.Keywords: Postpartum IUD; counseling; rate of postpartum IUD use; antenatal care

319. Maternal ICU admissions at the McGill University Health Centre and impact of advanced maternal age on outcomes: Retrospective chart review

Introduction Severe maternal morbidity (SMM) necessitating intensive care unit (ICU) admission is rising. Advanced maternal age (⩾35 years, AMA) is associated with SMM, but its impact on ICU outcomes is not clear. Objectives We aimed to describe characteristics of pregnant and postpartum women admitted to the ICU at our institution, and to evaluate the impact of AMA on length of stay, need for invasive intervention, number of SMM indicators, and death. Methods We conducted a retrospective chart review of ICU admissions during, or within 42 days, of pregnancy, from January 1, 2006 to December 31, 2016. Impact of AMA on outcomes will be assessed with linear and log-linear regression. Results 205 women were admitted to the ICU during pregnancy or postpartum. We report descriptive analysis on a subset of patients (n = 97). Mean age was 32.5 ± 6 years; 39 (40.1%) had AMA. Most admissions (70.1%) occurred during postpartum period. High prevalence of hypertensive disorders of pregnancy (19.6%) and gestational diabetes (13.4%) was noted. One third delivered prematurely ( Discussion The majority of maternal ICU admissions are in the postpartum period in women with at least one maternal or fetal complication. Further analyses will explore outcomes according to maternal age.