Home About us Contact
|
Home About us Contact | ||
|
|
||
Antenatal Care (antenatal + care)
Kinds of Antenatal Care Selected AbstractsLatest news and product developmentsPRESCRIBER, Issue 8 2008Article first published online: 12 MAY 200 Glargine preferred to lispro as type 2 add-on Basal insulin glargine (Lantus) and insulin lispro (Humalog) at mealtimes improved glycaemic control equally well in patients with type 2 diabetes poorly controlled by oral agents, but patient satisfaction was greater with basal insulin (Lancet 2008;371:1073-84). The 44-week APOLLO trial, funded by Sanofi Aventis, was a nonblinded randomised comparison of basal and prandial insulin regimens added to oral treatment in 418 patients. It found similar reductions in HbA1C (,1.7 vs ,1.9 per cent respectively). Fasting and nocturnal glucose levels were lower with insulin glargine and postprandial levels were lower with insulin lispro. The basal regimen was associated with fewer hypoglycaemic events (5.2 vs 24 per patient per year), less weight gain (3.01 vs 3.54kg) and greater improvement in patient satisfaction scores. Treating hypertension cuts mortality in over-80s Treating hypertension in the over-80s reduces all-cause mortality by 21 per cent, the HYVET study has shown (N Engl J Med online: 31 March 2008; doi: 10.1056/NEJMoa 0801369). Compared with placebo, treatment with indapamide alone or with perindopril for an average of 1.8 years also reduced the incidence of fatal stroke by 39 per cent, cardiovascular death by 23 per cent and heart failure by 64 per cent. The incidence of stroke was reduced by 30 per cent but this was of borderline statistical significance. Fewer serious adverse events were reported with treatment than with placebo. New work for NICE The DoH has announced the 18th work programme for NICE. Seven public health interventions include preventing skin cancer, smoking by children and excess weight gain during pregnancy. Public health guidance will include the provision of contraceptive services for socially disadvantaged young people. Two new clinical guidelines are sedation in young people and management of fractured neck of femur. New technology appraisals may include eight therapies for cancer, two new monoclonal antibodies for psoriasis and rheumatoid arthritis, an oral retinoid for severe chronic hand eczema and methylnaltrexone for opioid-induced bowel dysfunction. Combinations no better against CV disease Taking ezetimibe and simvastatin (Inegy) does not appear to slow the progression of atherosclerosis more than high-dose simvastatin alone, say researchers from The Netherlands (N Engl J Med 2008;358: 1431-43). In patients with hypercholesterolaemia, there was no difference in regression or progression of atherosclerosis after two years' treatment with simvastatin 80mg per day alone or combined with ezetimibe 10mg per day. Adverse event rates were similar. In patients with vascular disease or high-risk diabetes, there was no difference between the ACE inhibitor ramipril 10mg per day or the ARB telmisartan (Micardis) 80mg per day as monotherapy, or their combination, in the risk of a composite outcome of cardiovascular death, MI, stroke and admission for heart failure (N Engl J Med 2008;358:1547-59). Combined treatment was associated with higher risks of hypotensive symptoms, syncope and renal dysfunction. Twice-daily celecoxib increases CV risk Taking celecoxib (Celebrex) twice daily carries a higher risk of cardiovascular events than the same total dose taken once daily, a metaanalysis suggests (Circulation 2008; doi: 10.1161/ CIRCULATIONAHA.108. 764530). The analysis of six placebo-controlled trials involving a total of 7950 patients taking celecoxib for indications other than rheumatoid arthritis found that the combined risk of cardiovascular death, myocardial infarction, stroke, heart failure or thromboembolic event increased with dose over the range 400-800mg per day. The risk was significantly greater with 200mg twice daily (HR 1.8) than 400mg once daily (HR 1.1). Patients at greatest baseline risk were at disproportionately increased risk from celecoxib. Long-term etanercept effective in AS An open-label study suggests that etanercept (Enbrel) remains effective in the treatment of ankylosing spondylitis in the long term (Ann Rheum Dis 2008;67:346-52). Of 257 patients who completed six months' treatment with etanercept and who entered the nonblinded extension study, 126 completed a total of 168-192 weeks' treatment. The commonest adverse events were injection-site reactions (22 per cent), headache (20 per cent) and diarrhoea (17.5 per cent). The annual rate of serious infections was 0.02 per person. Response and partial remission rates after 192 weeks were similar to those reported after 96 weeks. Metformin reduces risk Metformin reduces the risk of developing diabetes in individuals at increased risk, a meta-analysis suggests (Am J Med 2008;121:149-57.e2). The study included 31 mostly small, randomised, controlled trials involving a total of 4570 participants and lasting at least eight weeks (8267 patient-years of treatment). Metformin was associated with reductions in body mass (,5.3 per cent), fasting glucose (,4.5 per cent) and insulin resistance (,22.6 per cent); lipid profiles also improved. The odds of developing diabetes were reduced by 40 per cent,an absolute risk reduction of 6 per cent over 1.8 years. MHRA clarifies cough and colds advice Press reports mistakenly suggested that the MHRA had banned some cough and cold remedies when it issued new guidance on treating young children, the MHRA says. The Agency's advice followed a review of over-thecounter cough and cold medicines for children by the Commission on Human Medicines. Children under two are at increased risk of adverse reactions and should no longer be treated with products containing antihistamine (chlorphenamine, brompheniramine, diphenhydramine), antitussives (dextromethorphan, pholcodine), expectorants (guaifenesin, ipecacuanha) and decongestants (phenylephrine, pseudoephedrine, ephedrine, oxymetazoline and xylometazoline). The MHRA said these products, which are classified as general sale medicines, should be removed from open shelves until available in new packaging that complies with the advice. They may still be supplied by a pharmacist for the treatment of older children. Coughs and colds should be treated with paracetamol or ibuprofen for fever, a simple glycerol, honey or lemon syrup for cough, and vapour rubs and inhalant decongestants for stuffy nose. Saline drops can be used to thin and clear nasal secretions in young babies. Parents are being urged not to use more than one product at a time to avoid inadvertently administering the same constituent drug twice. Perindopril brand switch Servier Laboratories is replacing its current formulations of perindopril (Coversyl, Coversyl Plus) with a new product that is not bioequivalent. The current Coversyl brand contains perindopril erbumine (also known as tert -butylamine). The new formulation contains perindopril arginine; it will be distinguished by new brand names (Coversyl Arginine, Coversyl Arginine Plus) and new packaging. Coversyl 2, 4 and 8mg tablets are equivalent to Coversyl Arginine 2.5, 5 and 10mg. Servier says the change is part of the simplification and harmonisation of global manufacturing; the arginine salt is already used in other countries and offers greater stability and a longer shelf-life. Both Coversyl and Coversyl Arginine will be in the supply chain for the next few weeks. Generic perindopril will continue to be the erbumine salt and prescriptions for generic perindopril are not affected. New from NICE Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. Clinical Guidance No. 63, March 2008 This clinical guideline focuses on additional aspects of care for women with gestational diabetes (88 per cent of cases) or pre-existing diabetes (of which about 40 per cent is type 2 diabetes) and their babies. To date, insulin aspart (NovoRapid) is the only drug in the guideline specifically licensed for use in pregnancy and NICE advises obtaining informed consent to implement its recommendations for using other insulins and oral hypoglycaemic agents. As with other guidelines, NICE begins by stressing the importance of patient-centred care and involving women in decisions about their treatment. The guideline is divided into six sections, dealing with consecutive periods of pregnancy. Preconceptual planning should include empowering women to help them reduce risks, optimising glycaemic control (after retinal assessment) and increasing monitoring intensity, and providing information about the effects of pregnancy on diabetes. Metformin may be recommended as an adjunct or alternative to insulin, but other oral hypoglycaemic agents should be replaced with insulin, although glibenclamide is an option during pregnancy. Isophane insulin is the preferred long-acting insulin; lispro (Humalog) and aspart are considered safe to use. ACE inhibitors and angiotensin-II receptor blockers should be replaced with other antihypertensive agents and statins should be discontinued. Recommendations for screening and treatment of gestational diabetes build on previous guidance (CG62). Drug treatment will be needed by 10-20 per cent , this includes insulin (soluble, aspart or lispro) and/or metformin or glibenclamide, tailored to individual need. Antenatal care includes optimising glycaemic control. Insulin lispro or aspart should be considered in preference to soluble insulin. If glycaemic control cannot be achieved with insulin injections, an insulin pump may be indicated. The guideline includes a timetable for appointments and the care that should offered after each interval. Recommendations for intrapartum care, which supplement those in CG55, include frequent monitoring of blood glucose. Neonatal care includes recommendations for monitoring and screening the infant and the management of hypoglycaemia. Postnatal care (supplementing CG37) involves adjusting maternal treatment to avoid hypoglycaemia and recommendations for returning to community care. Metformin and glibenclamide are the only oral agents suitable for breastfeeding women. Women with gestational diabetes need advice about glycaemic control and planning for future pregnancies. Lifestyle advice and measurement of annual fasting plasma glucose should be offered. Inhaled corticosteroids for the treatment of chronic asthma in adults and in children aged 12 years and over. Technology Appraisal No. 138, March 2008 The latest technology appraisal of asthma treatments covers inhaled steroids for adults and children over 12 with chronic asthma. It makes only two recommendations. First, the cheapest appropriate option is recommended. Second, when a steroid and a long-acting beta2-agonist are indicated, the decision to prescribe a combined inhaler or separate devices should take into account therapeutic need and likely adherence. Combined inhalers are currently less expensive than separate devices, though they may not remain so. When a combined inhaler is chosen it should be the cheapest. NICE concludes that, at equivalent doses, there is little difference in the effectiveness or adverse event profile of the available steroids or the fixed-dose combinations. According to specialist advice, choosing the best device for an individual remains the overriding concern. Continuous positive airway pressure for the treatment of obstructive sleep apnoea/hypopnoea syndrome. Technology Appraisal No. 139, March 2008 NICE recommends continuous positive airway pressure (CPAP) for adults with moderate or severe obstructive sleep apnoea, and for those with a milder disorder if quality of life and functioning are impaired and alternative strategies such as lifestyle change have failed. Diagnosis and treatment is the responsibility of a specialist team. A CPAP device costs £250-£550 and lasts for seven years. Copyright © 2008 Wiley Interface Ltd [source] Using Evidence to Improve Reproductive Health Quality along the Thailand-Burma BorderDISASTERS, Issue 3 2004Tara M. Sullivan The Mae Tao Clinic, located on the Thailand-Burma border, has provided health services for illegal migrant workers in Thailand and internally displaced people from Burma since 1989. In 2001, the clinic launched a project with the primary aim of improving reproductive health services and the secondary aim of building clinic capacity in monitoring and evaluation (M&E). This paper first presents the project's methods and key results. The team used observation of antenatal care and family-planning sessions and client exit interviews at baseline and follow-up, approximately 13 months apart, to assess performance on six elements of quality of care. Findings indicated that improving programme readiness contributed to some improvement in the quality of services, though inconsistencies in findings across the methods require further research. The paper then identifies lessons learned from introducing M&E in a resource-constrained setting. One key lesson was that a participatory approach to M&E increased people's feelings of ownership of the project and motivated staff to collect and use data for programme decision-making to improve quality. [source] Multidisciplinary antenatal care for opiate-using women: Child-care issuesDRUG AND ALCOHOL REVIEW, Issue 2 2010ADERONKE A. ADENIJI Abstract Introduction and Aims. The fact that particular parents suffer afflictions limiting their ability to care does not mean that they should automatically be deemed unsuitable parents. Prompted by neonatal team concerns about child-care issues, a local multidisciplinary group was set up to care for substance-abusing pregnant women in our region. Design and Methods. This project was conducted in order to review the records of all the women who had been discussed at our management planning meetings over the past 5 years. Our assessment tool records were reviewed and analysed using spss. Results. A total of 233 women were assessed. The majority of patients booked before 20 weeks (62%) and 96 women (41%) attended over 80% of their antenatal appointments. There was little change in substance use during the course of pregnancy. Overall, at delivery, 196 of the 233 women (84%) used methadone and 89(38%) used heroin. There was no correlation between usage and foster care of the baby (methadone: ,2 = 0.5, P = 0.8 NS) (heroin: ,2 = 3.1, P = 0.08 NS). There was an absolute correlation between social services involvement and foster care (,2 = 2.33, P < 0.0001). Adherence with planned antenatal appointments significantly increased the likelihood of a child being discharged with his mother (,2 = 6.7, P = 0.009). Discussion and Conclusions. The majority of newborns were discharged home with their mothers directly with the most significant factor in placing a child in foster care being prior involvement of social services. However, many of these families will continue to need support during the children's early years.[Adeniji AA, Purcell A, Pearson L, Antcliffe JM, Tutty S, Sinha C, Pairaudeau PW, Lindow SW. Multidisciplinary antenatal care for opiate-using women: Child-care issues. Drug Alcohol Rev 2009] [source] Methadone in pregnancy: treatment retention and neonatal outcomesADDICTION, Issue 2 2007Lucy 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] Pregnancy and the maintenance of self-identity: implications for antenatal care in the communityHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2000BA (Hons) PhD Sarah Earle Abstract It is widely acknowledged that many women prefer to receive their antenatal care in the community. This paper explores one explanation for why this may be the case. The paper is based on a qualitative study of 19 primagravidae, aged between 16 and 30 years, who were interviewed using the technique of repeated in-depth interviewing. The aim of the research was to explore the relationship between women's experiences of pregnancy and the maintenance of self-identity during this time. The research findings indicate that the relationship between the midwife and her antenatal patient can foster both a sense of similarity to others and a sense of personal uniqueness, which appear essential to the maintenance of self-identity during pregnancy. Good communication seems to be an essential tool for the community midwife, as it allows patients to normalise their experiences and yet feel that their experiences of pregnancy are unique. The findings indicate that continuity of care may be important in fostering a sense of similarity to others and that continuity of carer may be required to ensure uniqueness. [source] Prevention of mother to child transmission of HIV infection in Pacific countriesINTERNAL MEDICINE JOURNAL, Issue 4 2007P. Rupali Abstract Introduction: A generalized epidemic of HIV infection has been evolving in Papua New Guinea over the last decade, whereas in other Pacific Island countries and territories (PICT) HIV transmission has generally been less widespread. Programmes to detect HIV infection in pregnant women and to prevent mother to child transmission (MTCT) during either delivery or breast-feeding can decrease the incidence of infection in infants. The limited health infrastructure present in some PICT may delay the implementation of effective programmes to decrease MTCT of HIV. Methods: We used a standardized questionnaire to survey health-care providers in 22 PICT for information on the epidemiology of HIV infection and strategies used during 2004 to prevent MTCT of HIV infection in their country. We supplemented these survey responses with data obtained from regional organizations supporting national responses to HIV. Results: We obtained responses from 21 PICT. The reported prevalence of known HIV infection was >150 per 100 000 persons in Papua New Guinea, approximately 100 per 100 000 persons in French Polynesia, Guam, New Caledonia and Tuvalu and <50 per 100 000 persons in the remaining 14 PICT. Other than in Papua New Guinea, where an estimated 500 pregnant women had HIV infection diagnosed in 2004, reported HIV infection among pregnant women was rare. Ten PICT reported that an HIV antibody test was offered as a routine component of antenatal care and 11 reported that antiretroviral medications were available for the prevention of MTCT of HIV infection. Conclusion: The prevalence of HIV infection differs greatly between PICT with a varying risk of MTCT of HIV infection. Successful prevention of MTCT of HIV infection throughout the PICT will require improved uptake of antenatal HIV antibody testing and better access to antiretroviral medications. [source] Healthy babies for mothers with serious mental illness: A case management framework for mental health cliniciansINTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 6 2008Yvonne 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] A systematic review of counselling for HIV testing of pregnant womenJOURNAL OF CLINICAL NURSING, Issue 13 2009Karin S Minnie Background., Evidence-based strategies have made it possible to limit mother-to-child transmission of the HI-virus to a large extent and enable HIV-positive women to stay healthy for longer, provided their HIV status is known. Although voluntary counselling and testing for HIV is part of routine antenatal care in South Africa, the uptake of testing varies and a large number of pregnant women's HIV status is not known at the time of birth. Aim., The aim of the study was to establish research evidence regarding factors influencing counselling for HIV testing during pregnancy by means of systematic review, forming part of a larger study using a variety of evidence to develop best practice guidelines. Design., Systematic review. Methods., The question steering the review was: ,What factors influence counselling for HIV testing during pregnancy?'. A multi-stage search of relevant research studies was undertaken using a variety of sources. A total of 33 studies were retrieved and critically appraised. Data were extracted from the studies and assessed according to its applicability in the South African context. Results., The results are presented according to the following themes: effects of counselling, quality of counselling, group vs. individual counselling, ways of offering HIV testing, rapid testing, counselling and testing during labour, couple counselling and testing, counsellor and organisational factors. Conclusions., According to research evidence, factors such as whether counselling is presented in a group or individually, different ways to present HIV testing as well as counsellor and organisational factors can influence counselling for HIV testing during pregnancy. When developing best practice guidelines for settings very dissimilar from where the research was done, research evidence must be contextualised. Relevance to clinical practice., Implementation of the best practice guidelines may lead to the increased uptake of HIV testing in pregnancy in developing countries like South Africa and thus to an increase in the number of women whose status is known when their babies are born. [source] Identification of ,hot spots' of obesity and being underweight in early pregnancy in LiverpoolJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 3 2009J. C. Abayomi Abstract Background: Obesity and being underweight in pregnancy are related to an increased risk of maternal and foetal morbidity, yet their prevalence is often unknown. The present study aimed to identify neighbourhoods with a higher than average prevalence or ,hot spots' of obesity and/or being underweight among first trimester pregnant women. Methods: A database was compiled consisting of postcode, height and weight for 7981 women who had booked-in for antenatal care between July 2004 and June 2005 at Liverpool Women's Hospital. Body mass index (BMI) was calculated and women were categorised accordingly. Postcodes for 6865 cases across Merseyside were converted to geolocations (pin-points on a map) using conversion software (http://www.census.ac.uk/cdu/). Results: There was a very high prevalence of being overweight (27%) and obesity (17%); 3.8% of women were underweight and probably malnourished (BMI < 18.5 kg m,2); and a further 10.7% of women were possibly malnourished (BMI < 20.0 kg m,2. Deriving case density from the geolocations allowed visualisation and identification of six neighbourhoods with above average levels of obesity and three neighbourhoods had marked concentrations of both being underweight and obesity. Conclusions: These neighbourhoods, particularly those identified as ,hot spots' for both being underweight and obesity, include some of the most deprived wards in the UK. As dietetic intervention may help to promote optimal weight gain during pregnancy and improve dietary intake for pregnant women and their families, primary health care providers should target these localities with a high prevalence of low and high BMI as a priority. [source] Characteristics of antepartum and intrapartum eclampsia in the National Maternal and Child Health Center in CambodiaJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 2 2004Kanal Koum Abstract Aim:, To measure maternal and perinatal outcome and analyze risk factors for antepartum and intrapartum eclampsia, which is one of main causes of high maternal mortality at the top referral hospital in the Kingdom of Cambodia. Methods:, A hospital-based retrospective study of 164 antepartum and intrapartum eclampsia cases out of 20 449 deliveries. Results:, Overall case,fatality rate was 12%. Rate of stillbirth and low birth weight were 20% and 44%, respectively. Eighty percent of the cases presented signs of severe pre-eclampsia and 27% of the patients who gave birth received cesarean section. Living outside the capital city, teenage pregnancy and twin pregnancy are more frequently associated with eclampsia. Conclusion:, Antepartum and intrapartum eclampsia is associated with severe pre-eclampsia and with poor maternal and perinatal outcome. Recommendations to reduce the burden of eclampsia are promoting and improving quality of antenatal care and health education especially in the third trimester; increasing access to high-quality essential obstetric care; improving the service delivery in rural areas; and monitoring the progress by hospital data. [source] Maternal Mortality in Rural India: A Hospital Based, 10 Year Retrospective AnalysisJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 4 2001Dr. Kavita Verma Abstract Objectives: To estimate the maternal mortality ratio (MMR) in Ludhiana, a city of Northern India in order to determine the causes associated with MMR and to suggest ways to reduce it. Methods: Retrospective analysis of the mortality records of obstetrics cases in Christian Medical College, Ludhiana, India. Results: The mean MMR for the 10 year period was 785 per 100,000 live births. Of the total 116 reported maternal deaths, 44 (41.9%) were due to induced septic abortion. The reasons were unwanted pregnancy in 22 (50%) and 11 (25%) were female feticide. Conclusions: In our hospital based analysis, MMR was very high. Most maternal deaths are preventable by intervention at the appropriate time and it is important for health professionals, policy makers and politicians to implement the introduction of programs for reducing maternal mortality. Special emphasis should be placed on antenatal care, the establishment of a registration system and measures to abolish illegal abortion. [source] Bias modelling in evidence synthesisJOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES A (STATISTICS IN SOCIETY), Issue 1 2009Rebecca M. Turner Summary., Policy decisions often require synthesis of evidence from multiple sources, and the source studies typically vary in rigour and in relevance to the target question. We present simple methods of allowing for differences in rigour (or lack of internal bias) and relevance (or lack of external bias) in evidence synthesis. The methods are developed in the context of reanalysing a UK National Institute for Clinical Excellence technology appraisal in antenatal care, which includes eight comparative studies. Many were historically controlled, only one was a randomized trial and doses, populations and outcomes varied between studies and differed from the target UK setting. Using elicited opinion, we construct prior distributions to represent the biases in each study and perform a bias-adjusted meta-analysis. Adjustment had the effect of shifting the combined estimate away from the null by approximately 10%, and the variance of the combined estimate was almost tripled. Our generic bias modelling approach allows decisions to be based on all available evidence, with less rigorous or less relevant studies downweighted by using computationally simple methods. [source] "Seeing the Baby": Pleasures and Dilemmas of Ultrasound Technologies for Primiparous Australian WomenMEDICAL ANTHROPOLOGY QUARTERLY, Issue 1 2004Gillian Harris The practice of obstetric ultrasound scans has undergone significant expansion in the last two decades and is now a standard part of many women's antenatal care in Australia as elsewhere. This article reviews recent evidence about the value of obstetric ultrasound, summarizing debates and contradictions in research literature and practitioner guidelines. Pregnant women's interpretations of the significance of ultrasound are examined through multiple interviews with 34 study participants. We find that ultrasound has become an integral part of women's embodied experience of pregnancy, with its own pleasures and dilemmas. The increasing use the technology has augmented the role of scientific biomedicine in the government of pregnancy. This must be understood in the light of trends toward individualized risk management in which the pregnant woman increasingly takes responsibility for the successful outcome of the pregnancy, in a context where pregnancy is discursively constructed as a risky domain of gendered experience in contemporary Australian society, [discourse, obstetric ultrasound, embodiment, pregnancy, feminist] [source] Anonymous non-response analysis in the ABCD cohort study enabled by probabilistic record linkagePAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 3 2009M. Tromp Summary Selective non-response is an important threat to study validity as it can lead to selection bias. The Amsterdam Born Children and their Development study (ABCD-study) is a large cohort study addressing the relationship between life style, psychological conditions, nutrition and sociodemographic background of pregnant women and their children's health. Possible selective non-response and selection bias in the ABCD-study were analysed using national perinatal registry data. ABCD-study data were linked with national perinatal registry data by probabilistic medical record linkage techniques. Differences in the prevalence of relevant risk factors (sociodemographic and care-related factors) and birth outcomes between respondents and non-respondents were tested using Pearson chi-squared tests. Selection bias (i.e. bias in the association between risk factors and specific outcomes) was analysed by regression analysis with and without adjustment for participation status. The ABCD non-respondents were significantly younger, more often non-western, and more often multiparae. Non-respondents entered antenatal care later, were more often under supervision of an obstetrician and had a spontaneous delivery more often. Non-response however, was not significantly associated with preterm birth (odds ratio 1.10; 95% CI 0.93, 1.29) or low birthweight (odds ratio 1.16; 95% CI 0.98, 1.37) after adjustment for sociodemographic risk factors. The associations found between risk factors and adverse pregnancy outcomes were similar for respondents and non-respondents. Anonymised record linkage of cohort study data with national registry data indicated that selective non-response was present in the ABCD-study, but selection bias was acceptably low and did not influence the main study questions. [source] Safe motherhood in Jamaica: from slavery to self-determinationPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 4 2005Affette McCaw-Binns Summary The development of maternal health care in Jamaica is reviewed by examining government documents and publications to identify social and political factors associated with maternal mortality decline. Modern maternity services began with the 1887 establishment of the Victoria Jubilee Hospital and Midwifery School. Community midwives were deployed widely by the 1930s and community antenatal care expanded in the 1950s. Social policies in the 1970s increased women's access to primary health care, education and social support; improved transportation in the 1990s facilitated hospital delivery. Maternal mortality declined rapidly from ,600/100 000 in the 1930s to 200/100 000 in 1960, led by a 69% decline in sepsis by 1950, and a 72% decline from all causes thereafter, settling at ,100/100 000 in the 1980s. Skilled birth attendant deliveries moved from 39% in 1950 to 95% in 2001 and hospital births from 31% in 1960 to 91% in 2001. Maternal mortality plateaued at 70,80% prevalence of skilled delivery care. Deployment of midwives into rural communities and social development focused on women and children were associated with the observed improvements. Further reductions will require greater attention to the quality of emergency obstetric care. [source] How effective is antenatal care in preventing maternal mortality and serious morbidity?PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 2001An overview of the evidence This is an overview of evidence of the effectiveness of antenatal care in relation to maternal mortality and serious morbidity, focused in particular on developing countries. It concentrates on the major causes of maternal mortality, and traces their antecedent morbidities and risk factors in pregnancy. It also includes interventions aimed at preventing, detecting or treating any stage along this pathway during pregnancy. This is an updated and expanded version of a review first published by the World Health Organization (WHO) in 1992. The scientific evidence from randomised controlled trials and other types of intervention or observational study on the effectiveness of these interventions is reviewed critically. The sources and quality of available data, and possible biases in their collection or interpretation are considered. As in other areas of maternal health, good-quality evidence is scarce and, just as in many aspects of health care generally, there are interventions in current practice that have not been subjected to rigorous evaluation. A table of antenatal interventions of proven effectiveness in conditions that can lead to maternal mortality or serious morbidity is presented. Interventions for which there is some promising evidence, short of proof, of effectiveness are explored, and the outstanding questions formulated. These are presented in a series of tables with suggestions about the types of study needed to answer them. [source] Factors determining prenatal HIV testing for prevention of mother to child transmission in Dar Es Salaam, TanzaniaPEDIATRICS INTERNATIONAL, Issue 2 2007MAYUMI KOMINAMI Abstract Background: The objectives of the study were (i) to evaluate the Prevention of Mother to Child Transmission (PMTCT) services in Temeke district, Tanzania and (ii) to identify factors for non-acceptance of HIV testing among pregnant mothers in the area. Methods: A structured questionnaire was used in face-to-face interviews at five health centers in the district. Univariate and multiple logistic regression analyses were used to assess the association of the refusal of human immunodeficiency virus (HIV) testing with risk factors. Results: Two hundred and seventy-three (68.1%) of the participants had already had HIV testing, while 128 (31.9%) had not. Participants' general knowledge of HIV was high, but specific knowledge of mother to child transmission (MTCT) was relatively low. In the multiple logistic regression analysis, frequencies of antenatal clinic visits, awareness of MTCT and intensive family support were significantly and inversely associated with the refusal of HIV testing. Conclusions: Frequency of antenatal care visits, spreading information on HIV/acquired immune deficiency syndrome especially MTCT, and husbands' intensive support are significant factors for increase of HIV test acceptance among pregnant women in the study area. [source] A possible link between the pubertal growth of girls and breast cancer in their daughtersAMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 2 2008David J.P. Barker One hypothesis for the origins of breast cancer is that it is initiated by exposure of developing breast tissue in utero to maternal sex hormones. The sex hormone profile is established at puberty, when it regulates growth of the pelvic bones. The pubertal growth of girls is characterized by broadening and rounding of the pelvis. The maximal width between their iliac crests, the intercristal width, increases more rapidly than in boys. We hypothesized that higher sex hormone concentrations at puberty produce larger intercristal widths, and these are markers of increased breast cancer risk in the next generation. We followed up 6,370 women who were born in Helsinki during 1934,1944, and whose mothers' pelvic bones were measured during routine antenatal care. Women whose mothers had large intercristal widths had higher rates of breast cancer. In those born at or after 40 weeks gestation, the hazard ratio for breast cancer was 3.7 (95% CI: 2.1,6.6) if their mother's intercristal width was greater than 30 cm. Among women born to multiparous mothers this hazard ratio rose to 7.2 (3.4,15.4). Hazard ratios for breast cancer were also higher in the daughters of mothers with round iliac crests. Pelvic bone measurements which increase similarly in girls and boys at puberty did not predict breast cancer. We conclude that the intercristal width, and the roundness of the iliac crests, are markers of mothers' sex hormones, and postulate that high concentrations cause genetic instability in differentiating breast cells in their daughters in utero. Am. J. Hum. Biol., 2008. © 2007 Wiley-Liss, Inc. [source] Detection of fetal structural abnormalities at the 11,14 week ultrasound scanPRENATAL DIAGNOSIS, Issue 1 2002M. H. B. Carvalho Abstract The aim of this study was to evaluate the detection of fetal structural abnormalities by the 11,14 week scan. 2853 pregnant women were submitted to a routine ultrasound scan between the 11th and 14th week and the fetal skull, brain, spine, abdominal wall, limbs, stomach and bladder were examined. Following the scans the patientes were examined in the second or third trimester of pregnancy. An isolated increased nuchal translucency was not considered an abnormality. However, these patients had an early echocardiography assessment. Fetal structural abnormalities were classified as major or minor and of early or late onset. A total of 130 (4.6%) defects were identified and 29 (22.3%) of these were diagnosed at the 11,14 week scan, including nine cardiac defects associated with increased nuchal translucency. The antenatal ultrasound detection rate was 71.5%, and 31.2% were detected in the first-trimester assessment. 78.8% of the major defects were diagnosed by the prenatal scan and 37.8% by the 11,14 week scan. Fetal structural abnormalities at the 11,14 week scan were detected in approximately 22.3% of the cases, therefore, a second-trimester anomaly scan is important in routine antenatal care to increase the prenatal detection of fetal defects. Copyright © 2002 John Wiley & Sons, Ltd. [source] Evaluation of prenatal diagnosis of associated congenital heart diseases by fetal ultrasonographic examination in EuropePRENATAL DIAGNOSIS, Issue 4 2001C. Stoll Abstract Ultrasound scans in the mid trimester of pregnancy are now a routine part of antenatal care in most European countries. With the assistance of Registries of Congenital Anomalies a study was undertaken in Europe. The objective of the study was to evaluate prenatal detection of congenital heart defects (CHD) by routine ultrasonographic examination of the fetus. All congenital malformations suspected prenatally and all congenital malformations, including chromosome anomalies, confirmed at birth were identified from the Congenital Malformation Registers, including 20 registers from the following European countries: Austria, Croatia, Denmark, France, Germany, Italy, Lithuania, Spain, Switzerland, The Netherlands, UK and Ukrainia. These registries follow the same methodology. The study period was 1996,1998, 709,030 births were covered, and 8126 cases with congenital malformations were registered. If more than one cardiac malformation was present the case was coded as complex cardiac malformation. CHD were subdivided into ,isolated' when only a cardiac malformation was present and ,associated' when at least one other major extra cardiac malformation was present. The associated CHD were subdivided into chromosomal, syndromic non-chromosomal and multiple. The study comprised 761 associated CHD including 282 cases with multiple malformations, 375 cases with chromosomal anomalies and 104 cases with non-chromosomal syndromes. The proportion of prenatal diagnosis of associated CHD varied in relation to the ultrasound screening policies from 17.9% in countries without routine screening (The Netherlands and Denmark) to 46.0% in countries with only one routine fetal scan and 55.6% in countries with two or three routine fetal scans. The prenatal detection rate of chromosomal anomalies was 40.3% (151/375 cases). This rate for recognized syndromes and multiply malformed with CHD was 51.9% (54/104 cases) and 48.6% (137/282 cases), respectively; 150/229 Down syndrome (65.8%) were livebirths. Concerning the syndromic cases, the detection rate of deletion 22q11, situs anomalies and VATER association was 44.4%, 64.7% and 46.6%, respectively. In conclusion, the present study shows large regional variations in the prenatal detection rate of CHD with the highest rates in European regions with three screening scans. Prenatal diagnosis of CHD is significantly higher if associated malformations are present. Cardiac defects affecting the size of the ventricles have the highest detection rate. Mean gestational age at discovery was 20,24 weeks for the majority of associated cardiac defects. Copyright © 2001 John Wiley & Sons, Ltd. [source] Determinants of Antenatal Care Utilization in Three Rural Areas of VietnamPUBLIC HEALTH NURSING, Issue 4 2007Lieu Thi Thuy Trinh ABSTRACT Objective: To identify factors associated with any use of antenatal care (ANC), gestational age at entry to ANC, number of visits, and overall ANC utilization in the three provinces of Long an, Ben tre, and Quang ngai. Data: The Vietnam-Australia Primary Health Care Project conducted cross-sectional surveys in 1998,1999. Data from 1,335 eligible women were available for analysis. Methods: Explanatory variables were selected using the Andersen Health Seeking Behavior Model and analyzed using multivariate regression techniques. Results: External environment, predisposing characteristics, and need, which existed before contact with ANC providers, were most related to using any ANC and gestational age at entry to ANC. However, ANC services provided to women and personal health care during pregnancy, which could have resulted from initial contact with ANC providers, were most related to continuation of ANC visits and overall ANC utilization. Significant variability in the use of ANC existed between provinces and between subsets of women in each province. Conclusion: To have more women who attend ANC and attend early, promotion should be targeted at high-risk groups of women. However, to improve the number of ANC visits and overall utilization, the quality of ANC services should be improved. [source] Is there a correlation between bacterial vaginosis and preterm labour in women in the Otago region of New Zealand?AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2010Kah Heng LIM Context:, While an association between bacterial vaginosis and preterm labour has been established, the relative contribution of this condition remains controversial. Objective:, To determine whether bacterial vaginosis is likely to be an important contributing factor in preterm births in Otago, New Zealand, a region with a historically high rate of such births. Design and setting:, Women receiving antenatal care from Queen Mary Maternity Services were studied prospectively. Cases were women presenting with preterm labour or premature rupture of membranes. Controls had uncomplicated pregnancies and delivered at term. Patients and methods:, Vaginal swabs from 44 cases and 72 controls were examined by amplification of bacterial 16S rRNA genes followed by denaturing gel gradient electrophoresis. Atopobium vaginae, a bacterial vaginosis-associated bacterium, was detected in a separate polymerase chain reaction. Nugent Gram stain scoring of vaginal swabs from 44 cases and 69 controls was also carried out. Results:, Denaturing gel gradient electrophoresis revealed three major types of band profiles corresponding to normal, intermediate and bacterial vaginosis microflorae. There were significantly more cases with bacterial vaginosis band profiles compared with controls (P = 0.024). More cases had intermediate or bacterial vaginosis Nugent scores compared with controls (P = 0.022). Conversely, controls were more likely to have normal scores than cases (P = 0.022). Atopobium vaginae was equally distributed between the cases and controls. Conclusions:, Women in the Otago region undergoing preterm labour were approximately twice as likely to have a bacterial vaginosis type vaginal microflora as controls. In preterm labour, the incidence of bacterial vaginosis was comparable with that found elsewhere, suggesting that current guidelines for treatment and detection of this condition are appropriate. [source] A review of maternal deaths at Goroka General Hospital, Papua New Guinea 2005,2008AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2010Karen SANGA Background:, Papua New Guinea is a developing country with a population of six million, facing significant geographical, cultural and economic barriers to the provision of antenatal and intrapartum care. The maternal mortality ratio (MMR) is an internationally regarded index of the quality of a country's maternity services; the most recently reported MMR for Papua New Guinea of 773 deaths per 100 000 births is one of the highest in the world. Aims:, To review information about women who died from pregnancy-related causes, both direct and indirect, in the Goroka General Hospital (GGH) during the period 1st January 2005 to 31st May 2008. Methods:, A retrospective review was undertaken of the charts of women recorded as dying in the Obstetrics and Gynecology (O&G) ward of GGH in the study period. Results:, The charts of 21 women who died from pregnancy-related causes were reviewed and information collated. Puerperal sepsis and sepsis complicating unsafe abortion were the most common causes of maternal death accounting for 48% deaths. Other causes included ectopic pregnancy and postpartum haemorrhage. Contributing factors included residence in a rural area, geographical and transport difficulties accessing care, non-use of family planning services, non-booking for antenatal care and late presentation in pregnancy or labour, and under-resourcing of services at GGH. The socio-economic status of most of the women was low, and where educational attainments were recorded these were also low. 71% of women identified themselves as practising Christians. Conclusions:, Better outreach services to provide health information and antenatal care, with specific counselling about the need for supervised delivery, are urgently required in the Eastern Highlands Province that GGH serves if numbers of maternal deaths are to be reduced. Working through churches in the region may be the most appropriate way to provide information and services to women because a majority of women adhere to Christianity and can be reached in this way. [source] Role of general practitioners in primary maternity care in South Australia and VictoriaAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 6 2009Georgina SUTHERLAND Background:, Recent policy debates about the challenges facing maternity services in Australia provide an opportunity to reflect on current care practices. Aims:, To identify the provision of primary maternity care models in two Australian states: South Australia (SA) and Victoria. Methods:, All public and private hospitals with maternity facilities in SA and Victoria were mailed a survey requesting information about the organisation and provision of maternity care. Results:, All hospitals in SA (35) and 99% (75/76) in Victoria completed the survey. Among public hospitals, approximately 50% (14/30 in SA and 29/56 in Victoria) reported primary care arrangements where all antenatal care is provided by medical practitioners working in the community. The vast majority of hospitals offering this type of care were located outside metropolitan areas. Twenty per cent of public hospitals in SA (6/30) and 36% in Victoria (20/59) reported offering primary midwifery models, such as team, caseload and/or birth centre care. In SA, hospitals offering these models were located in both metropolitan and regional areas. In Victoria, 60% of hospitals offering women primary midwifery care were large hospitals with more than 1000 births per annum. Conclusions:, This study shows that community-based medical practitioners, general practitioners in particular, are major providers of maternity care despite the emergence of primary midwifery models of care. With 25% of the population living outside metropolitan areas in both states, providing access to choice and continuity of care for women living in regional and rural areas will be a challenge for maternity reform. [source] Detection and management of decreased fetal movements in Australia and New Zealand: A survey of obstetric practiceAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2009Vicki FLENADY Background:, Decreased fetal movement (DFM) is associated with increased risk of adverse pregnancy outcome. However, there is limited research to inform practice in the detection and management of DFM. Aims:, To identify current practices and views of obstetricians in Australia and New Zealand regarding DFM. Methods:, A postal survey of Fellows and Members, and obstetric trainees of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Results:, Of the 1700 surveys distributed, 1066 (63%) were returned, of these, 805 (76% of responders) were currently practising and included in the analysis. The majority considered that asking women about fetal movement should be a part of routine care. Sixty per cent reported maternal perception of DFM for 12 h was sufficient evidence of DFM and 77% DFM for 24 h. KICK charts were used routinely by 39%, increasing to 66% following an episode of DFM. Alarm limits varied, the most commonly reported was < 10 movements in 12 h (74%). Only 6% agreed with the internationally recommended definition of < 10 movements in two hours. Interventions for DFM varied, while 81% would routinely undertake a cardiotocograph, 20% would routinely perform ultrasound and 20% more frequent antenatal visits. Conclusions:, While monitoring fetal movement is an important part of antenatal care in Australia and New Zealand, variation in obstetric practice for DFM is evident. Large-scale randomised controlled trials are required to identify optimal screening and management options. In the interim, high quality clinical practice guidelines using the best available advice are needed to enhance consistency in practice including advice provided to women. [source] Avoidable risk factors in perinatal deaths: A perinatal audit in South AustraliaAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2008Titia E. DE LANGE Objectives: To analyse risk factors of perinatal death, with an emphasis on potentially avoidable risk factors, and differences in the frequency of suboptimal care factors between maternity units with different levels of care. Methods: Six hundred and eight pregnancies (2001,2005) in South Australia resulting in perinatal death were described and compared to 86 623 live birth pregnancies. Results: Two hundred and seventy cases (44.4%) were found to have one or more avoidable maternal risk factors, 31 cases (5.1%) had a risk factor relating access to care, while 68 cases (11.2%) were associated with deficiencies in professional care. One hundred and four women (17.1% of cases) presented too late for timely medical care: 85% of these did have a sufficient number of antenatal visits. The following independent maternal risk factors for perinatal death were found: assisted reproductive technology (adjusted odds ratio (AOR) 3.16), preterm labour (AOR 22.05), antepartum haemorrhage (APH) abruption (AOR 6.40), APH other/unknown cause (AOR 2.19), intrauterine growth restriction (AOR 3.94), cervical incompetence (AOR 8.89), threatened miscarriage (AOR 1.89), pre-existing hypertension (AOR 1.72), psychiatric disorder (AOR 1.85) and minimal antenatal care (AOR 2.89). The most commonly found professional care deficiency in cases was the failure to act on or recognise high-risk pregnancies/complications, found in 49 cases (8.1%). Conclusion: Further improvements in perinatal mortality may be achieved by greater emphasis on the importance of antenatal care and educating women to recognise signs and symptoms that require professional assessment. Education of maternity care providers may benefit from a further focus on how to recognise and/or manage high-risk pregnancies. [source] The utilisation of nuchal translucency as a prenatal marker of Down syndrome, 1993,1999AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2000Sheila F Mulvey Summary: A sample of 6038 obstetric ultrasound referrals and reports between January 1993 and June 1999 in a single Melbourne private ultrasound practice was reviewed to determine whether the referral and reporting pattern for nuchal translucency (NT) measurement has changed. The proportion of both 10,14 week ultrasound scans and mid trimester fetal anatomy scan referrals increased significantly over the study period (p < 0.001 and p < 0.001, respectively). There was also a significant increase in NT reporting and the number of specific referrals for an NT measurement over the study period (p = 0.01 and p < 0.001, respectively). If current trends continue it is likely that the 10,14 week scan for NT measurement will become a routine component of antenatal care. Therefore, as a matter of urgency, it is imperative that the best and most cost-effective screening strategy for Down syndrome in an Australian population is defined [source] Risk factors for preterm, low birth weight and small for gestational age birth in urban Aboriginal and Torres Strait Islander women in TownsvilleAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2006Katie Panaretto Objectives: To assess the characteristics of Indigenous births and to examine the risk factors for preterm (<37 weeks), low birth weight (<2,500 g) and small for gestational age (SGA) births in a remote urban setting. Design: Prospective cohort of singleton births to women attending Townsville Aboriginal and Islander Health Services (TAIHS) for shared antenatal care between 1 January 2000 and 31 December 2003. Main outcome measures: Demographic, obstetric, and antenatal care characteristics are described. Risk factors for preterm birth, low birth weight and SGA births are assessed. Results: The mean age of the mothers was 25.0 years (95% Cl 24.5,25.5), 15.8% reported hazardous or harmful alcohol use, 15.1% domestic violence, 30% had an inter-pregnancy interval of less than 12 months and 9.2% an unwanted pregnancy. The prevalence of infection was 50.2%. Predictors of preterm birth were a previous preterm birth, low body mass index (BMI) and inadequate antenatal care, with the subgroup at greatest risk of preterm birth being women with a previous preterm birth and infection in the current pregnancy. Predictors of a low birth weight birth were a previous stillbirth, low BMI and an interaction of urine infection and non-Townsville residence; predictors of an SGA birth were tobacco use, pregnancy-induced hypertension and interaction of urine infection and harmful alcohol use. Conclusion: The prevalence of demographic and clinical risk factors is high in this group of urban Indigenous women. Strategies addressing potentially modifiable risk factors should be an important focus of antenatal care delivery to Indigenous women and may represent an opportunity to improve perinatal outcome in Indigenous communities in Australia. [source] CONTINUUM OF CARE AND THE ANTENATAL RECORD IN RURAL NEW SOUTH WALESAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 3 2003Karen Patterson ABSTRACT Objective: The aim of the study was to determine the effect of the woman held antenatal record card (PNC2) on the continuity of maternity care received when presenting to the acute rural setting for clinical assessment. Design: Qualitative, open-ended questionnaires. Setting: Rural New South Wales public hospital. Subjects: Maternity consumers, 50 women who were inpatients receiving antenatal or postnatal care between August and October 1998. A stratified sample of healthcare professionals employed by the service, 12 midwives and 13 general practitioners. Main outcome measure: The self reported use of the antenatal card and the viewed effects of the card on the continuity of healthcare received. Results: The study identified a significant difference between the responding professionals (93%) positive perception of the effect of the PNC2 on the women's pregnancy continuum of care and the maternity consumer (36%), who felt it bore little impact on their care. The study findings suggested a lack of compliance and standardisation in usage of the antenatal card negated any flow on effects for the women. Conclusions: The intended purposes of the PNC2 were compromised in this rural setting. The study recommends that stakeholders in rural maternity care be accountable for examining the benefits and barriers of their antenatal practices, that the rural community's expectations of ,continuity of maternity care' are sought and that there should be a review of the available models of rural antenatal care. [source] THE MATERNITY EXPERIENCES OF INDIGENOUS WOMEN ADMITTED TO AN ACUTE CARE SETTINGAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 3 2002Jennifer Watson ABSTRACT: This is the report of stage two of a three-stage project. The aim of the project is to develop educational resources through information and experiences provided by Aboriginal and Torres Strait Islander women and health care professionals. The objectives were to optimise collaboration and participation by Indigenous and Torres Strait Islander women in sharing their maternity experiences about the birthing of their babies either in hospital, or out of hospital before arrival. The descriptive research of stage two explores issues that existed for twelve Indigenous women during and after their birthing experiences in an acute care setting. The results will inform patient and professional educational programs and policy in order to enhance the experiences for Indigenous women admitted to the acute care setting before or following birth. The results show broad variation in responses related to antenatal care, preparation for hospital and for birth, coming into town, accommodation, family support, experiences while in hospital, relationship with hospital staff and being away from home. Miscommunication and lack of cultural and spiritual understanding by health care professionals generally is a constant theme. The need for preparation of Indigenous women generally, prior to admission to an acute care setting, is confirmed. [source] | |||||||||||||||||||||||||||||||||||||