Home About us Contact
|
Home About us Contact | ||
|
|
||
Prenatal Visit (prenatal + visit)
Kinds of Prenatal Visit Selected AbstractsPossible association between screening BV at the prenatal visit and reduced cervical cerclage: Multi-center questionnaire in Hokkaido, JapanJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 2 2009Satoshi Shimano Abstract Aims:, To study the screening frequency for cervical cancer, Chlamydia trachomatis (CT) infection, and bacterial vaginosis (BV) among pregnant women, and to study the association between administration of these three screening tests and performance of cervical cerclage (CC) in Hokkaido during 2004. Methods:, Questionnaires were mailed to 70 clinics providing prenatal care only and to 113 hospitals providing prenatal care and performing deliveries. Responses were obtained anonymously. Results:, A total of 6744 pregnant women received prenatal care at the 36 responding clinics and 24 050 deliveries were performed at the 56 hospitals. The percentage of clinics that screened all pregnant women for cervical cancer, CT infection or BV was 66.7%, 69.4% and 33.3%, respectively, and the corresponding percentages among the hospitals were 87.5%, 87.5% and 57.1%, respectively. Pregnant women found to have CT infection or BV, were all treated. Screening for cervical cancer or CT infection was not associated with the frequency of CC. On the other hand, screening for BV was significantly associated with the frequency of CC (P = 0.0006). The frequency of emergency CC was 0.8% among women who received prenatal care at hospitals that did not perform BV screening, while it was only 0.2 or 0.3% among women who received prenatal care at hospitals that performed BV screening on all pregnant women or on those women who were suspected of having BV, respectively. Conclusion:, Our results suggest that the frequency of emergency CC may be reduced in women who receive BV screening and subsequent treatment of positive cases during pregnancy. [source] Healthy Behaviors and Sources of Health Information Among Low-Income Pregnant WomenPUBLIC HEALTH NURSING, Issue 3 2004Lynne Porter Lewallen PhD Abstract This article addresses responses from two open-ended questions, describing the healthy behaviors and sources of health information in 150 low-income pregnant women. Data for this exploratory study were collected as part of a larger descriptive correlational study. Qualitative content analysis was used in the analysis. One hundred fifty English-speaking pregnant women aged 18 and over were interviewed at a public prenatal clinic in the Southeastern United States at their first prenatal visit. Health behaviors were placed into seven mutually exclusive categories: food-related behaviors, substance-related behavior, exercise/rest/activity, self-awareness/appearance, learning, focus on baby, and no specific behaviors. Sources of information questions were placed into seven mutually exclusive categories: family, health personnel, reading, hearing, other people, self-intuitive, and no response. Low-income pregnant women are aware of healthy behaviors and report practicing them during their pregnancies. Because family members are a common source of information for health practices, they should be included in health education efforts. [source] Perceived Discrimination and Depressive Symptoms, Smoking, and Recent Alcohol Use in PregnancyBIRTH, Issue 2 2010Ian M. Bennett MD Abstract:, Background:, Perceived discrimination is associated with poor mental health and health-compromising behaviors in a range of vulnerable populations, but this link has not been assessed among pregnant women. We aimed to determine whether perceived discrimination was associated with these important targets of maternal health care among low-income pregnant women. Methods:, Face-to-face interviews were conducted in English or Spanish with 4,454 multiethnic, low-income, inner-city women at their first prenatal visit at public health centers in Philadelphia, Penn, USA, from 1999 to 2004. Perceived chronic everyday discrimination (moderate and high levels) in addition to experiences of major discrimination, depressive symptomatology (CES-D , 23), smoking in pregnancy (current), and recent alcohol use (12 months before pregnancy) were assessed by patients' self-report. Results:, Moderate everyday discrimination was reported by 873 (20%) women, high everyday discrimination by 238 (5%) women, and an experience of major discrimination by 789 (18%) women. Everyday discrimination was independently associated with depressive symptomatology (moderate = prevalence ratio [PR] of 1.58, 95% CI: 1.38,1.79; high = PR of 1.82, 95% CI: 1.49,2.21); smoking (moderate = PR of 1.19, 95% CI: 1.05,1.36; high = PR of 1.41, 95% CI: 1.15,1.74); and recent alcohol use (moderate = PR of 1.23, 95% CI: 1.12,1.36). However, major discrimination was not independently associated with these outcomes. Conclusions:, This study demonstrated that perceived chronic everyday discrimination, but not major discrimination, was associated with depressive symptoms and health-compromising behaviors independent of potential confounders, including race and ethnicity, among pregnant low-income women. (BIRTH 37:2 June 2010) [source] Determinants of Early Medical Management of Nausea and Vomiting of PregnancyBIRTH, Issue 1 2009Anaïs Lacasse BSc ABSTRACT: Background: Early medical management of nausea and vomiting during pregnancy is desirable but less than optimal. The aims of this study were to describe the management of nausea and vomiting during the first prenatal visit and to identify the determinants of 1) addressing the subject of nausea and vomiting during pregnancy with the health practitioner and 2) receiving an antiemetic prescription.Methods: A prospective study was conducted of 283 women who reported nausea and vomiting during the first trimester of pregnancy. Women were eligible if they were at least 18 years of age and , 16 weeks' gestation at the time of their first prenatal visit. Participants completed a questionnaire to determine their maternal characteristics, the presence of nausea and vomiting during pregnancy, and its management.Results: Of the 283 study participants, 79 percent reported that the condition was addressed during their first prenatal visit, 52 percent reported being asked about the intensity and severity of their symptoms, and 22 percent reported being questioned about the extent to which it disrupted their daily tasks. Health practitioners prescribed an antiemetic for 27 percent of women and recommended a nonpharmacological method for 14 percent. Multivariate models showed that the severity of the nausea and vomiting, previous use of an antiemetic, and smoking before pregnancy were significantly associated with an increased likelihood of addressing the subject of nausea and vomiting during pregnancy. Variables associated with an increased likelihood of women receiving an antiemetic prescription included nausea and vomiting severity, excessive salivation, previous antiemetic use, and work status.Conclusions: Health practitioners can improve their management of nausea and vomiting during pregnancy based on the available guidelines for treatment and they should address important factors such as symptom severity and work status at the first prenatal visit to assess women's need for antiemetic treatment. (BIRTH 36:1 March 2009) [source] Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancyBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 10 2009GG Donders Introduction, Abnormal vaginal flora (AVF) before 14 gestational weeks is a risk factor for preterm birth (PTB). The presence of aerobic microorganisms and an inflammatory response in the vagina may also be important risk factors. Aim, The primary aim of the study was to investigate the differential influences of AVF, full and partial bacterial vaginosis, and aerobic vaginitis in the first trimester on PTB rate. The secondary aim was to elucidate why treatment with metronidazole has not been found to be beneficial in previous studies. Setting, Unselected women with low-risk pregnancies attending the prenatal unit of the Heilig Hart General Hospital in Tienen, Belgium, were included in the study. Materials and methods, At the first prenatal visit, 1026 women were invited to undergo sampling of the vaginal fluid for wet mount microscopy and culture, of whom 759 were fully evaluable. Abnormal vaginal flora (AVF; disappearance of lactobacilli), bacterial vaginosis (BV), aerobic vaginitis (AV), increased inflammation (more than ten leucocytes per epithelial cell) and vaginal colonisation with Candida (CV) were scored according to standardised definitions. Partial BV was defined as patchy streaks of BV flora or sporadic clue cells mixed with other flora, and full BV as a granular anaerobic-type flora or more than 20% clue cells. Vaginal fluid was cultured for aerobic bacteria, Mycoplasma hominis and Ureaplasma urealyticum. Outcome was recorded as miscarriage ,13 weeks + 6 days [early miscarriage (EM), n = 8 (1.1%)], between 14 + 0 and 24 weeks + 6 days [late miscarriage (LM), n = 7 (0.9%)], delivery or miscarriage ,34 weeks + 6 days n = 29 (3.8%)], ,36 weeks + 6 days n = 70 (9.2%)]. PTB between 25 + 0 and 36 weeks + 6 days was further divided in severe PTB (SPTB, 25 + 0 to 34 weeks + 6 days) and mild PTB (MPTB, 35 + 0 to 36 weeks + 6 days). Results, Women without abnormalities of the vaginal flora in the first trimester had a 75% lower risk of delivery before 35 weeks compared with women with AVF [odds ratio (OR) 0.26; 95% confidence interval (CI) 0.12,0.56]. The absence of lactobacilli (AVF) was associated with increased risks of PTB (OR 2.4; 95% CI 1.2,4.8), EPTB (OR 6.2; 95% CI 2.7,14) and miscarriage (OR 4.9; 95% CI 1.4,17). BV was associated with increased risks of PTB (OR 2.4; 95% CI 1.1,4.7), EPTB (OR 5.3; 95% CI 2.1,12.9) and miscarriage (OR 6.6; 95% CI 2.1,20.9) and coccoid AV was associated with increased risks of EPTB (OR 3.2; 95% CI 1.2,9.1) and miscarriage (OR 5.2; 95% CI 1.5,17). In women with BV, partial BV had a detrimental effect on the risk of PTB for all gestational ages, but full BV did not. Preterm deliveries later than 24 weeks+ 6 days were more frequent when M. hominis was present (EPTB OR 13.3; 95% CI 3.2,55). Discussion, Bacterial vaginosis, AV and AVF are associated with PTB, especially LM and severe PTB between 25 and 35 weeks. The absence of lactobacilli (AVF), partial BV and M. hominis, but not full BV, were associated with an increased risk of preterm delivery after 24 weeks+ 6 days. As metronidazole effectively treats full BV, but is ineffective against other forms of AVF, the present data may help to explain why its use to prevent PTB has not been successful in most studies. [source] IDentify, Educate and Alert (IDEA) trial: an intervention to reduce postnatal depressionBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 9 2003Joan Webster Objective To test the effectiveness of a prenatal intervention in reducing the incidence of postnatal depression. Design A randomized controlled trial. Setting A large metropolitan obstetric hospital. Population or sample Pregnant women with risk factors for postnatal depression. Methods Women attending their first prenatal visit at the Royal Women's Hospital, Brisbane, were screened for risk factors for postnatal depression (IDentify). Positively screened women were randomly allocated to the intervention group or the control group. The intervention consisted of a booklet about postnatal depression, which included contact numbers; prenatal screening using the Edinburgh Postnatal Depression Scale; a discussion with the woman about her risk of developing postnatal depression (Educate); and a letter to the woman's referring general practitioner and local Child Health Nurse, alerting them of the woman's risk for postnatal depression (Alert). Main outcome measure Edinburgh Postnatal Depression Scale Score> 12 at 16 weeks postpartum. Results Of the 509 women who were sent a follow up questionnaire, 371 (72.9%) responded. The proportion of women who reported an Edinburgh Postnatal Depression Scale score of>12 was 26%. There were no significant differences between intervention (46/192, 24%) and control groups (50/177, 28.2%) on this primary outcome measure (OR 0.80; 95% CI 0.50,1.28). Conclusion Over one-quarter of women with risk factors will develop postnatal depression. It is a treatable disorder but under-diagnosis is common. Efforts to reduce postnatal depression by implementing interventions in the prenatal period have been unsuccessful. [source] The Impact of Medicaid Managed Care on Pregnant Women in Ohio: A Cohort AnalysisHEALTH SERVICES RESEARCH, Issue 4p1 2004Embry M. Howell Objective. To examine the impact of mandatory HMO enrollment for Medicaid-covered pregnant women on prenatal care use, smoking, Cesarean section (C-section) use, and birth weight. Data Sources/Study Setting. Linked birth certificate and Medicaid enrollment data from July 1993 to June 1998 in 10 Ohio counties, 6 that implemented mandatory HMO enrollment, and 4 with low levels of voluntary enrollment (under 15 percent). Cuyahoga County (Cleveland) is analyzed separately; the other mandatory counties and the voluntary counties are grouped for analysis, due to small sample sizes. Study Design. Women serve as their own controls, which helps to overcome the bias from unmeasured variables such as health beliefs and behavior. Changes in key outcomes between the first and second birth are compared between women who reside in mandatory HMO enrollment counties and those in voluntary enrollment counties. County of residence is the primary indicator of managed care status, since, in Ohio, women are allowed to "opt out" of HMO enrollment in mandatory counties in certain circumstances, leading to selection. As a secondary analysis, we compare women according to their HMO enrollment status at the first and second birth. Data Collection/Extraction Methods. Linked birth certificate/enrollment data were used to identify 4,917 women with two deliveries covered by Medicaid, one prior to the implementation of mandatory HMO enrollment (mid-1996) and one following implementation. Data for individual births were linked over time using a scrambled maternal Medicaid identification number. Principal Findings. The effects of HMO enrollment on prenatal care use and smoking were confined to Cuyahoga County, Ohio's largest county. In Cuyahoga, the implementation of mandatory enrollment was related to a significant deterioration in the timing of initiation of care, but an improvement in the number of prenatal visits. In that county also, women who smoked in their first pregnancy were less likely to smoke during the second pregnancy, compared to women in voluntary counties. Women residing in all the mandatory counties were less likely to have a repeat C-section. There were no effects on infant birth weight. The effects of women's own managed care status were inconsistent depending on the outcome examined; an interpretation of these results is hampered by selection issues. Changes over time in outcomes, both positive and negative, were more pronounced for African American women. Conclusions. With careful implementation and attention to women's individual differences as in Ohio, outcomes for pregnant women may improve with Medicaid managed care implementation. Quality monitoring should continue as Medicaid managed care becomes more widespread. More research is needed to identify the types of health maintenance organization activities that lead to improved outcomes. [source] The Reliability and Validity of Birth CertificatesJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 1 2006Sally Northam Objectives:, To summarize the reliability and validity of birth certificate variables and encourage nurses to spearhead data improvement. Data sources:, A Medline key word search of reliability and validity of birth certificate, and a reference review of more than 60 articles were done. Study selection:, Twenty-four primary research studies of U.S. birth certificates that involved validity or reliability assessment. Data extraction:, Studies were reviewed, critiqued, and organized as either a reliability or a validity study and then grouped by birth certificate variable. Data synthesis:, The reliability and validity of birth certificate data vary considerably by item. Insurance, birthweight, Apgar score, and delivery method are more reliable than prenatal visits, care, and maternal complications. Tobacco and alcohol use, obstetric procedures, and delivery events are unreliable. Birth certificates are not valid sources of information on tobacco and alcohol use, prenatal care, maternal risk, pregnancy complications, labor, and delivery. Conclusions:, Birth certificates are a key data source for identifying causes of increasing U.S. infant mortality but have serious reliability and validity problems. Nurses are with mothers and infants at birth, so they are in a unique position to improve data quality and spread the word about the importance of reliable and valid data. Recommendations to improve data are presented. JOGNN, 35, 3-12; 2006. DOI: 10.1111/J.1552-6909.2006.00016.x [source] Teenage Pregnancy in the Texas PanhandleTHE JOURNAL OF RURAL HEALTH, Issue 3 2005Rosa Galvez-Myles MD ABSTRACT: Purpose: This study compares rural and small-city teenage and adult pregnancies, with respect to complication rates and pregnancy outcomes. Methods: Chart review of Medicaid patients (513 teenage [under 20 years] and 174 adult controls [ages 25,34]) delivered (excluding multiple gestation) in Amarillo, Texas, from January 1999 to April 2001. Demographic data collected included maternal race, gravidity, parity, smoking status, drug usage, presence of antenatally diagnosed sexually transmitted disease(s), county type (rural vs small city) and number of prenatal visits. Outcomes included mode of delivery, primary cesarean section rates, preterm birth (<34 or <37 weeks), birth weight, birth weight <2,500 g, preeclampsia, total maternal weight gain, hemoglobin changes after delivery, Apgar scores, and neonatal intensive care unit admissions. Statistical comparisons between groups were made for a number of factors and outcomes (P<.05). Results: Teenagers did not have a significantly higher frequency of either illicit drug or tobacco usage, but teenagers ,17 years had a greater incidence of sexually transmitted diseases (19.8% vs 10.4%, P<008) and preeclampsia (7.1% vs 2.3%, P<.025, odds ratio 3.2 [1.1 to 9.9]) when compared with adults. The total weight gain was highest for teens ,17 years (36.4 pounds vs adults: 28.2, P<.001). The primary cesarean section rate was higher in adults (all teens 18.5% vs adults 38.6%, P<.001). County rurality had no impact on any of the observed findings or variables tested. Conclusions: Young teenagers have a higher incidence of sexually transmitted diseases and preeclampsia and also gain significantly more weight with pregnancy than young adults. However, the pregnancy outcomes were no different for rural vs small city teens. [source] | |||||||||||||||||||