ADDICTION, Issue 2 2007
Lucy Burns
ABSTRACT Aim To examine the association between retention in methadone treatment during pregnancy and key neonatal outcomes. Design Client data from the New South Wales Pharmaceutical Drugs of Addiction System was linked to birth information from the NSW Midwives Data Collection and the NSW Inpatient Statistics Collection from 1992 to 2002. Measurements Obstetric and perinatal characteristics of women who were retained continuously on methadone maintenance throughout their pregnancy were compared to those who entered late in their pregnancies (less than 6 months prior to birth) and those whose last treatment episode ended at least 1 year prior to birth. Findings There were 2993 births to women recorded as being on methadone at delivery, increasing from 62 in 1992 to 459 births in 2002. Compared to mothers who were maintained continuously on methadone throughout their pregnancy, those who entered treatment late also presented later to antenatal services, were more likely to arrive at hospital for delivery unbooked, were more often unmarried, indigenous and smoked more heavily. A higher proportion of neonates born to late entrants were born at less than 37 weeks gestation and were admitted to special care nursery more often. Conclusion Continuous methadone treatment during pregnancy is associated with earlier antenatal care and improved neonatal outcomes. Innovative techniques for early engagement in methadone treatment by pregnant heroin using women or those planning to become pregnant should be identified and implemented. [source]

Community-based, Prospective, Controlled Study of Obstetric and Neonatal Outcome of 179 Pregnancies in Women with Epilepsy

EPILEPSIA, Issue 1 2006
Katriina Viinikainen
Summary:,Purpose: This study evaluated obstetric and neonatal outcome in a community-based cohort of women with active epilepsy (WWAE) compared with the general pregnant population receiving modern obstetric care. Methods: We reviewed the total population who gave birth between January 1989 and October 2000 at Kuopio University Hospital. Obstetric, demographic, and epilepsy data were collected prospectively from 179 singleton pregnancies of women with epilepsy and from 24,778 singleton pregnancies of unaffected controls. The obstetric data from the pregnancy register was supplemented with detailed neurologic data retrieved from the medical records. The data retrieved were comprehensive because of a follow-up strategy according to a predecided protocol. Results: During pregnancy, the seizure frequency was unchanged, or the change was for the better in the majority (83%) of the patients. We found no significant differences between WWAE and controls in the incidence of preeclampsia, preterm labor, or in the rates of caesarean sections, perinatal mortality, or low birth weight. However, the rate of small-for-gestational-age infants was significantly higher, and the head circumference was significantly smaller in WWAE. Apgar score at 1 min was lower in children of WWAE, and the need for care in the neonatal ward and neonatal intensive care were increased as compared with controls. The frequency of major malformations was 4.8% (,0.6,10.2%; 95% confidence interval) in the 127 children of WWAE. Conclusions: Pregnancy course is uncomplicated and neonatal outcome is good in the majority of cases when a predecided protocol is used for the follow-up of WWAE in antenatal and neurologic care. Long-term follow-up of the neurologic and cognitive development of the children of WWAE is still needed. [source]

The AWHONN Near-Term Infant Initiative: A Conceptual Framework for Optimizing Health for Near-Term Infants

JOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 6 2005
Barbara Medoff-Cooper
In June 2005, the Association of Women's Health, Obstetric and Neonatal Nurses launched a multiyear initiative to address the unique physiologic and developmental needs of near-term infants (NTIs) defined as those born between 34 and 37 weeks post-menstrual age. The Optimizing Care for the Near-Term Infant Conceptual Model integrates the concepts of neonatal physiologic functional status, nursing care practices, care environment, and the essential role of the family both in the hospital and beyond. The elements of the model will serve to guide program and resource development within the Near-Term Infant Initiative. Goals of the initiative are to raise awareness of the NTI population's unique needs, emphasize the need for research, encourage development and adoption of evidence-based guidelines to promote safe care, and provide resources that assist nurses and other health care professionals in risk-based assessment of NTIs. [source]

Smoking Cessation Counseling for Pregnant Women Who Smoke: Scientific Basis for Practice for AWHONN's SUCCESS Project

JOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 3 2004
FAAN, Susan A. Albrecht PhD
Objectives: To review the literature addressing smoking cessation in pregnant women. To develop the project protocol for the Association of Women's Health, Obstetric and Neonatal Nurse's (AWHONN) 6th research-based practice project titled "Setting Universal Cessation Counseling, Education and Screening Standards (SUCCESS): Nursing Care of Pregnant Women Who Smoke." To evaluate the potential of systematic integration of this protocol in primary care settings in which women seek care at the preconception, pregnant, or postpartum stages. Literature Sources: Computerized searches in MEDLINE and CINAHL, as well as references cited in articles reviewed. Key concepts in the searches included low-birth-weight infants and effects of prenatal smoking on the infant and the effects of preconception and prenatal smoking cessation intervention on premature labor and birth weight. Literature Selection: Comprehensive articles, reports, and guidelines relevant to key concepts and published after 1964 with an emphasis on new findings from 1996 through 2002. Ninety-eight citations were identified as useful to this review. Literature Synthesis: Tobacco use among pregnant women and children's exposure to tobacco use (secondhand smoke) are associated with pregnancy complications such as placental dysfunction (including previa or abruption), preterm labor, premature rupture of membranes, spontaneous abortions, and decreased birth weight and infant stature. Neonates and children who are exposed to secondhand smoke are at increased risk for developing otitis media, asthma, other respiratory disorders later in childhood; dying from sudden infant death syndrome; and learning disorders. The "5 A's" intervention and use of descriptive statements for smoking status assessment were synthesized into the SUCCESS project protocol for AWHONN's 6th research-based practice project. Conclusions: The literature review generated evidence that brief, office-based assessment, client-specific tobacco counseling, skill development, and support programs serve as an effective practice guideline for clinicians. Implementation and evaluation of the guideline is under way at a total of 13 sites in the United States and Canada. [source]

Evaluating the Level of Evidence of Qualitative Research

JOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 6 2002
Sandra Cesario RNC
Guidelines for evaluating the levels of evidence based on quantitative research are well established. However, the same cannot be said for the evaluation of qualitative research. This article discusses a process members of an evidence-based clinical practice guideline development team with the Association of Women's Health, Obstetric and Neonatal Nurses used to create a scoring system to determine the strength of qualitative research evidence. A brief history of evidence-based clinical practice guideline development is provided, followed by discussion of the development of the Nursing Management of the Second Stage of Labor evidence-based clinical practice guideline. The development of the qualitative scoring system is explicated, and implications for nursing are proposed. [source]

Obstetric and Gynecologic Dermatology, 3rd Edition

AUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 1 2010
Helen Saunders
No abstract is available for this article. [source]

Assessment of fetal liver volume and umbilical venous volume flow in pregnancies complicated by insulin-dependent diabetes mellitus

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 11 2003
Simona M. Boito
Objectives To determine fetal liver volume and its relation with umbilical venous volume flow and maternal glycosylated haemoglobin (HbA1c) in pregnancies complicated by diabetes mellitus type I. Design A cross sectional matched control study. Setting Obstetric out patient clinic, Erasmus MC,University Medical Centre, Rotterdam. Population Data from fetuses of diabetic women (n = 32; 18,36 weeks) were compared with data from normal controls (n = 32) matched for gestational age. Methods Umbilical venous cross sectional area (mm2) and time-averaged velocity (mm/s Doppler) were determined for calculation of volume flow (mL/min) and flow per kilogram fetal weight (mL/min/kg). Umbilical artery pulsatility index was determined. Fetal liver volume measurements were obtained using a Voluson 530-D. Main outcome measures Fetal liver volume, umbilical venous volume flow and downstream impedance. Results A statistically significant difference between fetuses of diabetic women and normal controls was found for liver volume (mean [SD]: 45.9 [34.0] vs 38.3 [28.7] mL), abdominal circumference (22.2 [6.6] vs 21.3 [5.6] cm), estimated fetal weight (1162 [898] vs 1049 [765] g) and fetoplacental weight ratio (0.22 vs 0.19) and liver volume/estimated fetal weight ratio (4.13% [0.007] vs 3.62% [0.009]). Umbilical venous volume flow (mL/min) and umbilical artery pulsatility index were not essentially different between the two study groups, but umbilical venous volume flow per kilogram fetal weight was lower (P < 0.05) in the diabetes group (94.3 [26.1] mL/min kg) compared with normal controls (109.5 [28.0] mL/min/kg). A positive correlation existed between fetal liver volume and maternal HbA1c (P = 0.002). Conclusions Measurement of fetal liver volume by three-dimensional ultrasound may play a role in identifying fetal growth acceleration in diabetic pregnancies. Fetal liver volume increase is positively related to maternal HbA1c levels reflecting degree of maternal glycemic control. Fetal liver volume normalised for estimated fetal weight is significantly higher in the fetuses of diabetic women. In the present study, umbilical venous volume flow and fetoplacental downstream impedance are not different between diabetic and normal pregnancies. [source]

Pregnancy and delivery: a urodynamic viewpoint

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 11 2000
C. Chaliha Research Fellow (Urogynaecology)
Objective The aims of this study were to establish prospectively the prevalence of objective bladder dysfunction before and after delivery by means of urodynamic investigations and to assess the effect of obstetric variables on bladder function. Design Prospective longitudinal study. Twin channel subtracted cystometry was performed in the standing and sitting position, with a cough stress test at the end of filling. The investigations were repeated three months postpartum. Participants Two hundred and eighty-six nulliparae with singleton pregnancies who were delivered between April 1996 and November 1997 attended for antenatal assessment after 34 weeks of gestation and 161 who returned postpartum. Setting Department of Obstetrics and Gynaecology in a London teaching hospital. Results The mean urodynamic values both in pregnancy and postpartum lower than values defined in a non-pregnant population. The prevalence of genuine stress incontinence and detrusor instability were antenatally 9% and 8%, respectively, and postpartum 5% and 7%, respectively. Obstetric and neonatal factors were not related to urodynamic variables. Conclusions Despite the reported high prevalence of urinary incontinence related to pregnancy and childbirth, neither pregnancy nor delivery resulted in any consistent effects on objective bladder function. Postpartum urodynamic measurements were not related to either obstetric or neonatal variables, but were dependent on antenatal values. [source]

Early predictors of antisocial developmental pathways among boys and girls

ACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2010
M. Pitzer
Objective:, We investigated in a high-risk sample the differential impact of biological and psychosocial risk factors on antisocial behaviour pathways. Method:, One hundred and thirty-eight boys and 155 girls born at differing degrees of obstetric and psychosocial risk were examined from birth until adolescence. Childhood temperament was assessed by a highly-structured parent-interview and standardized behavioural observations, adolescent temperament was measured by self-report. Neurodevelopmental variables were assessed by age-specific developmental tests. Emotional and behaviour problems were measured at the ages of 8 and 15 by the Achenbach scales. Results:, In both genders, psychosocial adversity and early self-control temperament were strongly associated with early-onset persistent (EOP) antisocial behaviour. Psychosocial adversity and more severe externalizing problems differentiated the EOP from childhood-limited (CL) pathway. In girls, adolescent-onset (AO) antisocial behaviour was strongly associated with novelty seeking at 15 years. Conclusion:, Our findings emphasize the need for early support and intervention in psychosocially disadvantaged families. [source]

Review article: Emergency department implications of the TASER

EMERGENCY MEDICINE AUSTRALASIA, Issue 4 2009
Megan Robb
Abstract The TASER is a conducted electricity device currently being introduced to the Australian and New Zealand police forces as an alternative to firearms in dealing with violent and dangerous individuals. It incapacitates the subject by delivering rapid pulses of electricity causing involuntary muscle contraction and pain. The use of this device might lead to cardiovascular, respiratory, biochemical, obstetric, ocular and traumatic sequelae. This article will summarize the current literature and propose assessment and management recommendations to guide emergency physicians who will be required to review these patients. [source]

Community-based, Prospective, Controlled Study of Obstetric and Neonatal Outcome of 179 Pregnancies in Women with Epilepsy

Case-Mix Adjustment of the CAHPS® Hospital Survey

HEALTH SERVICES RESEARCH, Issue 6p2 2005
A. James O'Malley
Objectives: To develop a model for case-mix adjustment of Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Hospital survey responses, and to assess the impact of adjustment on comparisons of hospital quality. Data Sources: Survey of 19,720 patients discharged from 132 hospitals. Methods: We analyzed CAHPS Hospital survey data to assess the extent to which patient characteristics predict patient ratings ("predictive power") and the heterogeneity of the characteristics across hospitals. We combined the measures to estimate the impact of each predictor ("impact factor") and selected high impact variables for adjusting ratings from the CAHPS Hospital survey. Principle Findings: The most important case-mix variables are: hospital service (surgery, obstetric, medical), age, race (non-Hispanic black), education, general health status (GHS), speaking Spanish at home, having a circulatory disorder, and interactions of each of these variables with service. Adjustment for GHS and education affected scores in each of the three services, while age and being non-Hispanic black had important impacts for those receiving surgery or medical services. Circulatory disorder, Spanish language, and Hispanic affected scores for those treated on surgery, obstetrics, and medical services, respectively. Of the 20 medical conditions we tested, only circulatory problems had an important impact within any of the services. Results were consistent for the overall ratings of nurse, doctor, and hospital. Although the overall impact of case-mix adjustment is modest, the rankings of some hospitals may be substantially affected. Conclusions: Case-mix adjustment has a small impact on hospital ratings, but can lead to important reductions in the bias in comparisons between hospitals. [source]

Serial factitious disorder and Munchausen by proxy in pregnancy

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 12 2006
M. D. FELDMAN
Summary Factitious disorder, including Munchausen syndrome, is seldom documented among pregnant patients but can have powerful consequences. We report on a 44-year-old woman who, over a period of two decades, self-induced labour and delivery in five consecutive pregnancies. She precipitated labour by rupturing her own amniotic sac with a fingernail or cervical manipulation, or misappropriating and self-administering prostaglandin suppositories from the hospital unit on which she worked as a nurse. Preterm deliveries resulted in fetal demise in one case and in neonatal intensive care treatment for two of the offspring. One of the surviving children has cerebral palsy attributable to the mother's factitious illness behaviour, which raises the spectre of Munchausen by proxy maltreatment. The patient sought attention and care through the ruses, which have never been uncovered by her obstetric and gynaecologic caregivers. Indeed, she underwent an unnecessary hysterectomy because of the illusion of heavy menstrual bleeding. Most recently, the patient has been engaging in surreptitious autophlebotomy to force blood transfusions. [source]

Cutaneous and neurologic manifestations of biotinidase deficiency

INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 5 2000
Paloma Cornejo Navarro
A male newborn with no obstetric or familial antecedents, except that his parents were cousins, developed hypotonia, lethargy, and feeding problems from birth. Analysis revealed a marked metabolic acidosis and hyperammonemia. Three weeks later, he was admitted to hospital in order to receive parenteral nutrition and to undertake a study for metabolic diseases. The boy did not improve in spite of the use of parenteral nutrition and began to present with inspiratory stridor and tachypnea. One week later, he presented with an erythematous scaling eruption, which was especially intense in the lumbosacral region ( Fig. 1a,b). The scalp was only slightly affected. Figure 1. Erythematous scaling eruption, more intense in the lumbosacral region Laboratory findings were compatible with biotinidase deficiency diagnosed by demonstrating absent enzyme activity. His parents were also studied and they were found to have partial biotinidase deficiency (30% of enzyme activity). After 37 days of life, the baby was given a treatment consisting of 20 mg of biotin per day intravenously. Biochemical and neurologic alterations improved quickly. Meckel's diverticulum and a duodenal membrane were detected at the second month of life after a gastroduodenal survey, and both were operated on. The skin lesions did not improve, however, and intravenous biotin had to be increased to 40 mg/day. The eruption disappeared after 10 days. On his first birthday, he remained asymptomatic with 40 mg of oral biotin. [source]

Association between pacifier use and breast-feeding, sudden infant death syndrome, infection and dental malocclusion

INTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 6 2005
Ann Callaghan RN RM BNurs(Hons)
Executive summary Objective, To critically review all literature related to pacifier use for full-term healthy infants and young children. The specific review questions addressed are: What is the evidence of adverse and/or positive outcomes of pacifier use in infancy and childhood in relation to each of the following subtopics: ,breast-feeding; ,sudden infant death syndrome; ,infection; ,dental malocclusion. Inclusion criteria, Specific criteria were used to determine which studies would be included in the review: (i) the types of participants; (ii) the types of research design; and (iii) the types of outcome measures. To be included a study has to meet all criteria. Types of participants,The participants included in the review were healthy term infants and healthy children up to the age of 16 years. Studies that focused on preterm infants, and infants and young children with serious illness or congenital malformations were excluded. However, some total population studies did include these children. Types of research design, It became evident early in the review process that very few randomised controlled trials had been conducted. A decision was made to include observational epidemiological designs, specifically prospective cohort studies and, in the case of sudden infant death syndrome research, case,control studies. Purely descriptive and cross-sectional studies were excluded, as were qualitative studies and all other forms of evidence. A number of criteria have been proposed to establish causation in the scientific and medical literature. These key criteria were applied in the review process and are described as follows: (i) consistency and unbiasedness of findings; (ii) strength of association; (iii) temporal sequence; (iv) dose,response relationship; (v) specificity; (vi) coherence with biological background and previous knowledge; (vii) biological plausibility; and (viii) experimental evidence. Studies that did not meet the requirement of appropriate temporal sequencing of events and studies that did not present an estimate of the strength of association were not included in the final review. Types of outcome measures,Our specific interest was pacifier use related to: ,breast-feeding; ,sudden infant death syndrome; ,infection; ,dental malocclusion. Studies that examined pacifier use related to procedural pain relief were excluded. Studies that examined the relationship between pacifier use and gastro-oesophageal reflux were also excluded as this information has been recently presented as a systematic review. Search strategy, The review comprised published and unpublished research literature. The search was restricted to reports published in English, Spanish and German. The time period covered research published from January 1960 to October 2003. A protocol developed by New Zealand Health Technology Assessment was used to guide the search process. The search comprised bibliographic databases, citation searching, other evidence-based and guidelines sites, government documents, books and reports, professional websites, national associations, hand search, contacting national/international experts and general internet searching. Assessment of quality, All studies identified during the database search were assessed for relevance to the review based on the information provided in the title, abstract and descriptor/MeSH terms, and a full report was retrieved for all studies that met the inclusion criteria. Studies identified from reference list searches were assessed for relevance based on the study title. Keywords included: dummy, dummies, pacifier(s), soother(s), comforter(s), non-nutritive sucking, infant, child, infant care. Initially, studies were reviewed for inclusion by pairs of principal investigators. Authorship of articles was not concealed from the reviewers. Next, the methodological quality of included articles was assessed independently by groups of three or more principal investigators and clinicians using a checklist. All 20 studies that were accepted met minimum set criteria, but few passed without some methodological concern. Data extraction, To meet the requirements of the Joanna Briggs Institute, reasons for acceptance and non-acceptance at each phase were clearly documented. An assessment protocol and report form was developed for each of the three phases of review. The first form was created to record investigators' evaluations of studies included in the initial review. Those studies that failed to meet strict inclusion criteria were excluded at this point. A second form was designed to facilitate an in-depth critique of epidemiological study methodology. The checklist was pilot tested and adjustments were made before reviewers were trained in its use. When reviewers could not agree on an assessment, it was passed to additional reviewers and discussed until a consensus was reached. At this stage, studies other than cohort, case,control and randomised controlled trials were excluded. Issues of clarification were also addressed at this point. The final phase was that of integration. This phase, undertaken by the principal investigators, was assisted by the production of data extraction tables. Through a process of trial and error, a framework was formulated that adequately summarised the key elements of the studies. This information was tabulated under the following headings: authors/setting, design, exposure/outcome, confounders controlled, analysis and main findings. Results, With regard to the breast-feeding outcome, 10 studies met the inclusion criteria, comprising two randomised controlled trials and eight cohort studies. The research was conducted between 1995 and 2003 in a wide variety of settings involving research participants from diverse socioeconomic and cultural backgrounds. Information regarding exposure and outcome status, and potential confounding factors was obtained from: antenatal and postnatal records; interviews before discharge from obstetric/midwifery care; post-discharge interviews; and post-discharge postal and telephone surveys. Both the level of contact and the frequency of contact with the informant, the child's mother, differed widely. Pacifier use was defined and measured inconsistently, possibly because few studies were initiated expressly to investigate its relationship with breast-feeding. Completeness of follow-up was addressed, but missing data were not uniformly identified and explained. When comparisons were made between participants and non-participants there was some evidence of differential loss and a bias towards families in higher socioeconomic groups. Multivariate analysis was undertaken in the majority of studies, with some including a large number of sociodemographic, obstetric and infant covariates and others including just maternal age and education. As might be expected given the inconsistency of definition and measurement, the relationship between pacifier use and breast-feeding was expressed in many different ways and a meta-analysis was not appropriate. In summary, only one study did not report a negative association between pacifier use and breast-feeding duration or exclusivity. Results indicate an increase in risk for a reduced overall duration of breast-feeding from 20% to almost threefold. The data suggest that very infrequent use may not have any overall negative impact on breast-feeding outcomes. Six sudden infant death syndrome case,control studies met the criteria for inclusion. The research was conducted with information gathered between 1984 and 1999 in Norway, UK, New Zealand, the Netherlands and USA. Exposure information was obtained from a variety of sources including: hospital and antenatal records, death scene investigation, and interview and questionnaire. Information for cases was sought within 2 days after death, within 2,4 weeks after death and in one study between 3 and 11 years after death. Information for controls was sought from as early as 4 days of a nominated sudden infant death syndrome case, to between 1 and 7 weeks from the case date, and again in one study some 3,11 years later. In the majority of the studies case ascertainment was determined by post-mortem. Pacifier use was again defined and measured somewhat inconsistently. All studies controlled for confounding factors by matching and/or using multivariate analysis. Generally, antenatal and postnatal factors, as well as infant care practices, and maternal, family and socioeconomic issues were considered. All five studies reporting multivariate results found significantly fewer sudden infant death syndrome cases used a pacifier compared with controls. That is, pacifier use was associated with a reduced incidence of sudden infant death syndrome. These results indicate that the risk of sudden infant death syndrome for infants who did not use a pacifier in the last or reference sleep was at least twice, and possibly five times, that of infants who did use a pacifier. Three studies reported a moderately sized positive association between pacifier use and a variety of infections. Conversely, one study found no positive association between pacifier use at 15 months of age and a range of infections experienced between the ages of 6 and 18 months. Given the limited number of studies available and the variability of results, no meaningful conclusions could be drawn. Five cohort studies and one case,control study focused on the relationship between pacifier use and dental malocclusion. Not one of these studies reported a measure of association, such as an estimate of relative risk. It was therefore not possible to include these studies in the final review. Implications for practice, It is intended that this review be used as the basis of a ,best practice guideline', to make health professionals aware of the research evidence concerning these health and developmental consequences of pacifier use, because parents need clear information on which they can base child care decisions. With regard to the association between pacifier use and infection and dental malocclusion it was found that, due to the paucity of epidemiological studies, no meaningful conclusion can be drawn. There is clearly a need for more epidemiological research with regard to these two outcomes. The evidence for a relationship between pacifier use and sudden infant death syndrome is consistent, while the exact mechanism of the effect is not well understood. As to breast-feeding, research evidence shows that pacifier use in infancy is associated with a shorter duration and non-exclusivity. It is plausible that pacifier use causes babies to breast-feed less, but a causal relationship has not been irrefutably proven. Because breast-feeding confers an important advantage on all children and the incidence of sudden infant death syndrome is very low, it is recommended that health professionals generally advise parents against pacifier use, while taking into account individual circumstances. [source]

Healthy babies for mothers with serious mental illness: A case management framework for mental health clinicians

INTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 6 2008
Yvonne Hauck
ABSTRACT Women with a serious mental illness (SMI), notably schizophrenia, bipolar disorder, and personality disorders are considered high risk for adverse pregnancy and birth outcomes, which in turn, are associated with poor neurodevelopment in the child. Failure to access antenatal care, poor adherence with folate supplementation, an unhealthy lifestyle, and inappropriate health decisions can contribute to poor outcomes. Many women with SMI continue contact with mental health services while pregnant. This primary prevention project aimed to develop a framework for community mental health clinicians to improve the reproductive health outcomes for women with SMI. The consultation process involved discussions with key stakeholders, an environmental scan to determine current service delivery issues, a literature review, and individual and group interviews with community mental health clinicians, consumers, general practitioners, and midwives. Three key elements underpin the framework: early detection and monitoring of pregnancy, providing reproductive choices, and implementing a ,small known team approach' in the management of the pregnant client. Specific modules within the framework focus upon establishing a professional support network, assessing the risk of pregnancy, the early detection of pregnancy, monitoring during pregnancy, preparing for birth, and planning for the postnatal period. Implementation of the framework has the potential to significantly improve obstetric and neonatal outcomes for this high-risk group. [source]

Retention of Pregnancy-Related Weight in the Early Postpartum Period: Implications for Women's Health Services

JOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 4 2005
Lorraine O. Walker
Objective: To examine the proportion of women who reached their prepregnant weight at 6 weeks postpartum and the average amount of weight retained or lost by this time; to determine predictors of early (6 week) postpartum weight retention; and to propose related implications for women's health care and services. Data Sources: The literature review was based on a search of Medline for the years 1986 to 2004 using the keywords postpartum weight with inclusion of additional articles known to the authors that did not appear in the electronic search. Study Selection: The resulting 83 articles were scrutinized to identify those that reported data on weight retention at 6 weeks postpartum (range, delivery to 3 months) and associated anthropometric, social, obstetric, or behavioral predictors. A total of 12 articles met inclusion criteria for the review. Data Extraction: Data were extracted related to the proportion of women achieving their postpartum weight at 6 weeks postpartum, the amount of weight retained or lost up to 6 weeks postpartum, and predictors of amount of weight retained or lost. Data Synthesis: On average, at 6 weeks postpartum, women retain 3 to 7 kg of the weight gained during pregnancy, with at least two thirds exceeding their prepregnant weights. Gestational weight gain is the most significant predictor of weight retention. Conclusions: Women vulnerable to obesity and weight gain need weight-related health care and improved access to such care to promote weight loss after 6 weeks postpartum. [source]

Caring for Pregnant Teenagers: Medicolegal Issues for Nurses

JOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 2 2001
CRNP, Holly M. Harner MSN
From statutory rape, pregnancy options, mandatory reporting, and emancipation, a wide range of medicolegal issues face teenagers. These issues become even more complex when the teenager is pregnant. Nurses caring for pregnant and parenting teenagers are in a position to offer advocacy and support in family planning, prenatal, obstetric, and pediatrics settings. A comprehensive understanding of common medicolegal issues facing teenagers will help to ensure appropriate patient advocacy. [source]

Doctors' attitudes towards invasive prenatal diagnosis

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 1 2009
Somsri Pitukkijronnakorn
Abstract Aim:, To assess the influence of a doctor's gender, age group, religion and invasive prenatal diagnosis (PND) knowledge on their attitude towards invasive PND. Methods:, All non,obstetric and gynecologic doctors were surveyed using a structured questionnaire. The questionnaire enquired about demographic information, and doctors' knowledge, attitude and experience regarding invasive PND for themselves, and their spouses, relatives, friends, colleagues and patients. Results:, Responses from the 289 respondents revealed that two-thirds of respondents knew only a little about invasive PND. Most males and females were in the 31,39 and ,30-year-old groups, respectively. There were no statistically significant differences in gender, age group, religion and invasive PND knowledge when recommending of invasive PND. If fetal anomalies were detected, most of the females in the Buddhist group (P < 0.05), males with quite a lot of PND knowledge group (p < 0.05) and younger doctors group (P < 0.05) would their own terminate pregnancies, or those of wives and relatives. Conclusion:, Attitudes towards invasive PND and pregnancy termination was influenced by gender, age group, religion and PND knowledge. Females and younger doctors from both gender groups tended to recommend the termination of pregnancy if they found fetal anomalies. [source]

Effect of Labour and Delivery on Plasma Hepatic Enzymes in the Newborn

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 1 2000
Dr. Max Mongelli
Abstract Objective: To study the relationship between cord blood hepatic enzymes and obstetric and neonatal outcome in a Chinese population. Materials and Methods: The study group consisted of 288 low-risk Chinese women with singleton term pregnancies. The following enzymes were assayed in cord blood: lactate dehydrogenase (LDH), glutamyl transferase (GGT), aspartate aminotransferase (AST) and alanine transferase (ALT). These were correlated to maternal and neonatal characteristics. Results: A strong correlation was noted between cord blood AST and LDH (R = 0.582, p < 0.01), which was absent amongst those infants delivered by elective cesarean section. LDH, AST and ALT were negatively correlated with cord arterial pH and base excess (BE). GGT was inversely related only to gestational age (R = - 0.18, p < 0.01). Both LDH and AST were weakly correlated with the duration of the first and second stages of labour. LDH was most closely linked to arterial pH, whereas AST was related to both arterial BE and duration of the second stage. Conclusions: The reference values are comparable to those published for Caucasian populations. There are moderate elevations in LDH and AST associated with the onset of labour and changes in acid-base status. [source]

Classification of perinatal deaths: Development of the Australian and New Zealand classifications

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7 2004
A Chan
Abstract: Classifications of perinatal deaths have been undertaken for surveillance of causes of death, but also for auditing individual deaths to identify suboptimal care at any level, so that preventive strategies may be implemented. This paper describes the history and development of the paired obstetric and neonatal Perinatal Society of Australia and New Zealand (PSANZ) classifications in the context of other classifications. The PSANZ Perinatal Death Classification is based on obstetric antecedent factors that initiated the sequence of events leading to the death, and was developed largely from the Aberdeen and Whitfield classifications. The PSANZ Neonatal Death Classification is based on fetal and neonatal factors associated with the death. The classifications, accessible on the PSANZ website (http://www.psanz.org), have definitions and guidelines for use, a high level of agreement between classifiers, and are now being used in nearly all Australian states and New Zealand. [source]

Use of Record Linkage to Examine Alcohol Use in Pregnancy

ALCOHOLISM, Issue 4 2006
Lucy Burns
Background: To date, no population-level data have been published examining the obstetric and neonatal outcomes for women with an alcohol-related hospital admission during pregnancy compared with the general obstetric population. This information is critical to planning and implementing appropriate services. Methods: Antenatal and delivery admissions to New South Wales (NSW) hospitals from the NSW Inpatient Statistics Collection were linked to birth information from the NSW Midwives Data Collection over a 5-year period (1998,2002). Birth admissions were flagged as positive for maternal alcohol use where a birth admission or any pregnancy admission for that birth involved an alcohol-related International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM) code. Key demographic, obstetric, and neonatal variables were compared for births to mothers in the alcohol group with births where no alcohol-related ICD10-AM was recorded. Results: A total of 416,834 birth records were analyzed over a 5-year period (1998,2002). In this time, 342 of these were coded as positive for at least 1 alcohol-related ICD-10-AM diagnosis. Mothers in the alcohol group had a higher number of previous pregnancies, smoked more heavily, were not privately insured, and were more often indigenous. They also presented later on in their pregnancy to antenatal services and were more likely to arrive at hospital unbooked for delivery. Deliveries involved less epidural and local and more general anesthesia. Cesarean sections were more common to women in the alcohol group and were performed more often for intrauterine growth retardation. Neonates born to women in the alcohol group were smaller for gestational age, had lower Apgar scores at 5 minutes, and were admitted to special care nursery more often. Conclusions: This study shows that linked population-level administrative data provide a powerful new source of information for examining the maternal and neonatal outcomes associated with alcohol use in pregnancy. [source]

Birth-related factors and doctor-diagnosed wheezing and allergic sensitization in early childhood

ALLERGY, Issue 9 2010
L. Keski-Nisula
To cite this article: Keski-Nisula L, Karvonen A, Pfefferle PI, Renz H, Büchele G, Pekkanen J. Birth-related factors and doctor-diagnosed wheezing and allergic sensitization in early childhood. Allergy 2010; 65: 1116,1125. Abstract Background:, To investigate the associations between clinical obstetric factors during birth and doctor-diagnosed wheezing and allergic sensitization during early childhood. Methods:, We followed 410 Finnish women from late pregnancy until 18 months age of their children. All children were delivered at term. Doctor-diagnosed wheezing among children was established by questionnaires, while specific immunoglobulin E antibodies to inhalant and food allergens were measured in 388 children at 1 year of age. Data on maternal obstetric variables were recorded at the time of delivery. Results:, Children of mothers with longer duration of ruptured fetal membranes before birth had significantly higher risk of doctor-diagnosed wheezing during early childhood compared to those children with shorter period of ruptured fetal membranes (III vs I quartile; aOR 6.65, 95% CI 1.99,22.18; P < 0.002 and IV vs I quartile; aOR 3.88, 95% CI 1.05,14.36, P < 0.043). Children who were born by Cesarean delivery had significantly less allergic sensitization at the age of 1 year compared to those who were born by vaginal route (16.0%vs 32.2%; aOR 0.34, 95% CI 0.14,0.80; P < 0.013). Furthermore, allergic sensitization tended to be more common in children with longer duration of labor before birth. No other birth-related obstetric factors, such as induction, the type of fetal membrane rupture during birth or quality of amniotic fluid were associated significantly with the examined outcomes. Conclusion:, The longer duration of the ruptured fetal membranes possibly reflected the higher risk of intrapartum infection at birth, and further increased the risk of doctor-diagnosed wheezing among offspring. [source]

The impact of caesarean delivery and type of feeding on cow's milk allergy in infants and subsequent development of allergic march in childhood

ALLERGY, Issue 6 2009
F. Sánchez-Valverde
Background:, The incidence of IgE-mediated cow's milk allergy (CMA) has increased over the last few years. There are several genetic and environmental risk factors that may be related to this allergy and the subsequent allergic march (AM). Methods:, A prospective, cohort study was conducted in patients recruited into the study between 1998 and 2002. Information on clinical variables and complementary tests, perinatal and obstetric factors and the type of hydrolysed formula used was recorded. A cross sectional study on the prevalence of allergic diseases in this cohort was performed in 2004. Results:, We compared IgE-mediated CMA patients with non-IgE-mediated CMA patients and found that IgE-mediated CMA is associated with caesarean delivery (OR = 2.14 95% CI: 1.02,4.49), duration of breast feeding (>2 months, OR = 4.14; 95% CI: 2.17,7.89) and the use of supplementary artificial formula whilst breast feeding (OR = 2.86; 95% CI: 1.33,6.13). The factors associated with AM in IgE-mediated CMA patients were caesarean delivery (OR = 0.42; 95% CI: 0.19,0.92) and the use of more extensively hydrolysed high grade hydrolysates (+EH/HGH) (OR = 0.44; 95% CI: 0.20,0.98), both as protective factors. Conclusions:, Caesarean delivery is demonstrated as being a risk factor for IgE-mediated CMA, but it does not increase the risk of AM in these infants. The use of +EH/HGH appears to protect IgE-mediated CMA patients from eventually developing AM. [source]

Factors related to lower urinary tract symptoms among a sample of employed women in Taipei,,§

NEUROUROLOGY AND URODYNAMICS, Issue 1 2008
Yuan-Mei Liao
Abstract Aim To identify factors associated with lower urinary tract symptoms (LUTS) among female elementary school teachers in Taipei. Methods This study is a cross-sectional, descriptive study. A total of 520 surveys were distributed to 26 elementary schools in Taipei. Logistic regression was used to identify possible factors related to individual LUTS. Results Study results were based on the information provided by 445 participants. Of the 445 teachers, 293 (65.8%) experienced at least one type of LUTS. Factors associated with urinary incontinence were body mass index (BMI), vaginal delivery, obstetric and/or gynecological surgery, bladder habits, and job control. Increased daytime urinary frequency was associated with chronic cough and chronic constipation. Bladder habits, straining to lift heavy objects at work and chronic constipation were associated with urgency. Nocturia was associated with age and caffeine consumption while intermittent stream was associated with the presence of a family history of LUTS and chronic constipation. Bladder habits and regular exercise were associated with weak urinary stream. Incomplete emptying was more likely to occur in teachers with chronic constipation and in those who did not exercise regularly. Conclusion All the LUTS under logistic regression analyses were associated with 1,3 modifiable factors. Identification of these modifiable contributing factors may be useful to health care providers. Education of women may include the importance of maintaining normal body weight, good bladder/bowel habits, and regular exercise, treating chronic cough, decreasing daily caffeine consumption, and implementing feasible environmental modifications in employment settings. Neurourol. Urodynam. © 2007 Wiley-Liss, Inc. [source]

The risk of lower urinary tract symptoms five years after the first delivery,

NEUROUROLOGY AND URODYNAMICS, Issue 1 2002
Lars Viktrup
Abstract Aim of the study To estimate the prevalence and 5-year incidence of lower urinary tract symptoms (LUTS) after the first delivery and to evaluate the impact of pregnancy per se and delivery per se on long-lasting symptoms. Materials and methods A longitudinal cohort study of 305 primiparae questioned a few days, 3 months, and 5 years after their delivery. The questionnaire used was tested and validated, and the questions were formulated according to the definitions of the International Continence Society (ICS). Maternal, obstetric, and neonatal data concerning every delivery and objective data concerning surgeries during the observation period were obtained from the records. From the sample of 278 women (91%) who responded 5 years after their first delivery, three subpopulations were defined: 1) women without initial LUTS before or during the first pregnancy or during the puerperal period, 2) women with onset of LUTS during the first pregnancy, and 3) women with onset of LUTS during the first puerperium. The risk of LUTS 5 years after the first delivery was examined using bivariate analyses. The obstetric variables in the bivariate tests with a significant association with long-lasting urinary incontinence were entered into a multivariate logistic regression. Results The prevalence of stress and urge incontinence 5 years after first delivery was 30% and 15%, respectively, whereas the 5-year incidence was 19% and 11%, respectively. The prevalence of urgency, diurnal frequency, and nocturia 5 years after the first delivery was 18%, 24%, and 2%, respectively, whereas the 5-year incidence was 15%, 20%, and 0.5%, respectively. The prevalence of all LUTS except nocturia increased significantly during the 5 years of observation. The risk of long-lasting stress and urge incontinence was related to the onset and duration of the symptom after the first pregnancy and delivery in a dose-response,like manner. Vacuum extraction at the first delivery was used significantly more often in the group of women with onset of stress incontinence during the first puerperium, whereas an episiotomy at the first delivery was performed significantly more often in the group of women with onset of stress incontinence in the 5 years of observation. The prevalence of urgency and diurnal frequency 5 years after the first delivery was not increased in women with symptom onset during the first pregnancy or puerperium compared with those without such symptoms. The frequency of nocturia 5 years after the first delivery was too low for statistical analysis. Conclusion The first pregnancy and delivery may result in stress and urge incontinence 5 years later. Women with stress and urge incontinence 3 months after the first delivery have a very high risk of long-lasting symptoms. An episiotomy or a vacuum extraction at the first delivery seems to increase the risk. Subsequent childbearing or surgery seems without significant contribution. Long-lasting urgency, diurnal frequency, or nocturia cannot be predicted from onset during the first pregnancy or puerperium. Neurourol. Urodynam. 21:2,29, 2002. © 2002 Wiley-Liss, Inc. [source]

Cardiovascular Guidelines for Women Released

NURSING FOR WOMENS HEALTH, Issue 6 2001
Article first published online: 28 JUL 200
This month, AWHONN is releasing the highly anticipated Cardiovascular Health for Women: Primary Prevention evidence-based clinical practice guideline. The release of the guideline coincides with news that all of AWHONN's guidelines to date have been accepted by the Agency for Healthcare Research and Quality for inclusion in the National Guideline Clearinghouse. This achievement truly demonstrates AWHONN's commitment to promoting evidence-based nursing practice to improve the health of women and newborns. Equally important is the national recognition of AWHONN as a leader in women's health, obstetric and neonatal nursing. [source]

Prospective community-based cluster census and case-control study of stillbirths and neonatal deaths in the West Bank and Gaza Strip

PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 4 2008
Henry D. Kalter
Summary Obstetric complications and newborn illnesses amenable to basic medical interventions underlie most perinatal deaths. Yet, despite good access to maternal and newborn care in many transitional countries, perinatal mortality is often not monitored in these settings. The present study identified risk factors for perinatal death and the level and causes of stillbirths and neonatal deaths in the West Bank and Gaza Strip. Baseline and follow-up censuses with prospective monitoring of pregnant women and newborns from September 2001 to August 2002 were conducted in 83 randomly selected clusters of 300 households each. A total of 113 of 116 married women 15,49 years old with a stillbirth or neonatal death and 813 randomly selected women with a surviving neonate were interviewed, and obstetric and newborn care records of women with a stillbirth or neonatal death were abstracted. The perinatal and neonatal mortality rates, respectively, were 21.2 [95% confidence interval (CI) 16.5, 25.9] and 14.7 [95% CI 10.2, 19.2] per 1000 livebirths. The most common cause (27%) of 96 perinatal deaths was asphyxia alone (21) or with neonatal sepsis (5), while 18/49 (37%) early and 9/19 (47%) late neonatal deaths were from respiratory distress syndrome (12) or sepsis (9) alone or together (6). Constraint in care seeking, mainly by an Israeli checkpoint, occurred in 8% and 10%, respectively, of 112 pregnancies and labours and 31% of 16 neonates prior to perinatal or late neonatal death. Poor quality care for a complication associated with the death was identified among 40% and 20%, respectively, of 112 pregnancies and labour/deliveries and 43% of 68 neonates. (Correction added after online publication 5 June 2008: The denominators 112 pregnancies, labours, and labour/deliveries, and 16 and 68 neonates were included; and 9% of labours was corrected to 10%.) Risk factors for perinatal death as assessed by multivariable logistic regression included preterm delivery (odds ratio [OR] = 11.9, [95% CI 6.7, 21.2]), antepartum haemorrhage (OR = 5.6, [95% CI 1.5, 20.9]), any severe pregnancy complication (OR = 3.4, [95% CI 1.8, 6.6]), term delivery in a government hospital and having a labour and delivery complication (OR = 3.8, [95% CI 1.2, 12.0]), more than one delivery complication (OR = 4.4, [95% CI 1.8, 10.5]), mother's age >35 years (OR = 2.9, [95% CI 1.3, 6.8]) and primiparity in a full-term pregnancy (OR = 2.6, [1.1, 6.3]). Stillbirths are not officially reportable in the West Bank and Gaza Strip and this is the first time that perinatal mortality has been examined. Interventions to lower stillbirths and neonatal deaths should focus on improving the quality of medical care for important obstetric complications and newborn illnesses. Other transitional countries can draw lessons for their health care systems from these findings. [source]

The Kalgoorlie Otitis Media Research Project: rationale, methods, population characteristics and ethical considerations

PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 1 2008
Deborah Lehmann
Summary Otitis media (OM) is one of the most common paediatric illnesses for which medical advice is sought in developed countries. Australian Aboriginal children suffer high rates of OM from early infancy. The resultant hearing loss can affect education and quality of life. As numerous factors contribute to the burden of OM, interventions aimed at reducing the impact of single risk factors are likely to fail. To identify key risk factors and understand how they interact in complex causal pathways, we followed 100 Aboriginal and 180 non-Aboriginal children from birth to age 2 years in a semi-arid zone of Western Australia. We collected demographic, obstetric, socio-economic and environmental data, breast milk once, and nasopharyngeal samples and saliva on seven occasions. Ear health was assessed by clinical examination, tympanometry, transient evoked otoacoustic emissions and audiometry. We considered the conduct of our study in relation to national ethical guidelines for research in Aboriginal and Torres Strait Islander health. After 1 year of community consultation, the study was endorsed by local committees and ethical approval granted. Fieldwork was tailored to minimise disruption to people's lives and we provided regular feedback to the community. We saw 81% of non-Aboriginal and 65% of Aboriginal children at age 12 months. OM was diagnosed on 55% and 26% of routine clinical examinations in Aboriginal and non-Aboriginal children respectively. Aboriginal mothers were younger and less educated, fewer were employed and they lived in more crowded conditions than non-Aboriginal mothers. Sixty-four per cent of Aboriginal and 40% of non-Aboriginal babies were exposed to environmental tobacco smoke. Early consultation, provision of a service while undertaking research, inclusion of Aboriginal people as active members of a research team and appropriate acknowledgement will assist in ensuring successful completion of the research. [source]