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Antenatal Clinics (antenatal + clinic)
Selected AbstractsEffects of vitamin A deficiency during pregnancy on maternal and child healthBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2002M.S. Radhika Objective To examine the association between biochemical vitamin A deficiency in pregnancy and maternal and fetal health. Design A cross sectional clinical study. Setting Antenatal clinic of nutrition unit of Niloufer Hospital catering for a low socio-economic population, and a private nursing home (Swapna nursing home) catering for a high socio-economic population. Population 736 pregnant women in their third trimester of pregnancy belonging to low (n= 522) and high socio-economic groups (n= 214). Methods All the women were subjected to a detailed clinical, anthropometric and obstetric examination. Night blindness was assessed by administering the standard WHO questionnaire. Birthweight and gestational age of the infants, maternal anaemia and development of pregnancy-induced hypertension in the mother were recorded. Haemoglobin and serum retinol were estimated at the time of recruitment to the study. Main outcome measures Serum retinol levels, anaemia, pregnancy-induced hypertension, birthweight and gestational age of the infant. Results Night blindness was observed in 2.9% of the women and subclincal vitamin A deficiency (serum retinol <20 ,g/dL with no clinical signs) in 27% of the women. Moderate to severe anaemia was observed in 41.2% of the women, and 15.8% of the women developed pregnancy-induced hypertension. Sixty-one (9.4%) women delivered preterm. Univariate analysis identified a significant association between serum retinol <20 ,g/dL and preterm delivery (OR = 1.74, 95% CI 1.03,2.96), maternal anaemia (OR = 1.82, 95% CI 1.28,2.60) and pregnancy-induced hypertension (OR = 1.56, 95% CI 1.02,2.83). After adjusting for the confounding variables (body mass index, parity, age and socio-economic status) in a multivariate analysis, the significant associations between serum retinol <20 ,g/dL and preterm delivery (P= 0.02) and anaemia (P= 0.003) persisted, while that for pregnancy-induced hypertension disappeared (P= 0.71). Conclusion The study suggests that subclinical vitamin A deficiency is a problem during the third trimester of pregnancy. Serum concentration of retinol <20 ,g/dL appears to indicate a deficient status, and is associated with an increased risk of preterm delivery and maternal anaemia. [source] Does stage-based smoking cessation advice in pregnancy result in long-term quitters?ADDICTION, Issue 1 200518-month postpartum follow-up of a randomized controlled trial ABSTRACT Aims To evaluate the effect on quitting smoking at 18 months postpartum of smoking cessation interventions based on the Transtheoretical Model (TTM) delivered in pregnancy compared to current standard care. It has been claimed that TTM-based interventions will continue to create quitters after the end of the intervention period. Design Cluster randomized trial. Setting Antenatal clinics in general practices in the West Midlands, UK. Participants A total of 918 pregnant smokers originally enrolled in the trial, of which 393 women were followed-up at 18 months postpartum. Interventions One hundred general practices were randomized into the three trial arms. Midwives in these practices delivered three interventions: A (standard care), B (TTM-based self-help manuals) and C (TTM-based self-help manuals plus sessions with an interactive computer program giving individualized smoking cessation advice). Measurements Self-reported continuous and point prevalence abstinence since pregnancy. Findings When combined together, there was a slight and not significant benefit for both TTM arms compared to the control, with an odds ratio (OR) 95% confidence interval (CI) of 1.20 (0.29,4.88) for continuous abstinence. For point prevalence abstinence, the OR (95%CI) was 1.15 (0.66,2.03). Seven of the 54 (13%) women who had quit at the end of pregnancy were still quit 18 months later, and there was no evidence that the TTM-based interventions were superior in preventing relapse. Conclusions The TTM-based interventions may have shown some evidence of a short-term benefit for quitting in pregnancy but no benefit relative to standard care when followed-up in the longer-term. [source] Assessment of risk for the development of pre-eclampsia by maternal characteristics and uterine artery DopplerBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2005Aris T. Papageorghiou Objective To develop a method for the estimation of patient-specific risk for the development of pre-eclampsia by combining maternal history and uterine artery Doppler. Design Prospective multicentre observational study. Setting Antenatal clinics in seven hospitals in the UK and three overseas centres. Population Unselected women with singleton pregnancies attending for routine antenatal care. Methods Doppler studies of the uterine arteries were performed using colour flow mapping and pulsed wave Doppler at 23 weeks of gestation. The mean pulsatility index (PI) of the two uterine arteries was calculated. Doppler and maternal history variables were combined to develop a model for risk assessment. The incidence of pre-eclampsia was used to derive the prior risk for this complication. The posterior risk was derived by multiplying the prior odds with likelihood ratios (LRs) derived from independent risk factors identified from the maternal history, and the LR estimated from the heights of the frequency distributions of mean PI in affected and unaffected pregnancies. Main outcome measure Pre-eclampsia. Results There were 17,480 women recruited to the study, in which 17,319 (99.1%) of these Doppler examination of both uterine arteries were completed, and outcome data were available in 16,806 (97.0%). Pre-eclampsia occurred in 369 (2.20%) cases. Significant independent prediction of pre-eclampsia was provided by mean PI, ethnic origin, body mass index (BMI), parity, cigarette smoking, history of hypertension and family or personal history of pre-eclampsia. Models were derived allowing calculation of patient-specific risk for development of pre-eclampsia. For a false-positive rate of 25%, the detection rate of pre-eclampsia by screening using maternal history was 45.3%, with uterine artery Doppler it was 63.1% and with combined assessment it was 67.5%. Conclusions Combining risk factors in the mother's history with Doppler of the uterine arteries allows calculation of patient-specific risk for the development of pre-eclampsia. [source] Maternal serum activin, inhibin, human chorionic gonadotrophin and ,-fetoprotein as second trimester predictors of pre-eclampsiaBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 1 2003Emma J. Davidson Objective To compare the serum levels of human chorionic gonadotrophin (hCG), ,-fetoprotein, activin A, inhibin A and inhibin isoforms containing pro and ,C in the second trimester serum of women who subsequently developed hypertensive disorders of pregnancy with those who remained normotensive throughout pregnancy. Design Retrospective case,control study of 15,20 week serum samples matched for duration of storage at ,20°C. Setting Antenatal clinics at a teaching hospital in Scotland. Sample Second trimester serum samples of 39 women who subsequently developed pre-eclampsia, 31 who subsequently developed pregnancy-induced hypertension and 155 women who remained normotensive throughout pregnancy. Main outcome measures hCG, ,-fetoprotein, activin A, inhibin A and inhibin pro,,C serum levels. Results Activin A levels in serum were significantly elevated in women who later developed pregnancy-induced hypertension (26% increase compared with controls) and hCG levels were significantly elevated in women who later developed pre-eclampsia (24% increase compared with controls). ,-Fetoprotein, inhibin A and inhibin pro,,C levels were not significantly elevated in the patient groups compared with their controls. Conclusions A combination of analyses including second trimester serum activin A and hCG may yet prove to be helpful predictors of women at risk of hypertensive disorders of pregnancy. While the results proved significant, the effects reported in this study are too modest compared with natural variability to be useful as screening tools on their own. [source] First trimester maternal serum free , human chorionic gonadotrophin and pregnancy associated plasma protein A as predictors of pregnancy complicationsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 10 2000Charas Y. T. Ong Research Fellow (Fetal Medicine) Objective To examine the value of first trimester maternal serum free , human chorionic gonadotrophin (, hCG) and pregnancy associated plasma protein A (PAPP-A) as predictors of pregnancy complications. Design Screening study. Setting Antenatal clinics. Population Singleton pregnancies at 10,14 weeks of gestation. Methods Maternal serum free , hCG and PAPP-A were measured at 10,14 weeks of gestation in 5584 singleton pregnancies. In the 5297 (94.9%) pregnancies with complete follow up free , hCG and PAPP-A were compared between those with normal outcome and those resulting in miscarriage, spontaneous preterm delivery, pregnancy induced hypertension or fetal growth restriction and in those with pre-existing or gestational diabetes. Results Maternal serum PAPP-A increased and , hCG decreased with gestation. The multiple of median maternal serum PAPP-A was significantly lower in those pregnancies resulting in miscarriage, pregnancy induced hypertension, growth restriction and in those with pre-existing or gestational diabetes mellitus, but not in those complicated by spontaneous preterm delivery. The level was < 10th centile of the reference range in about 20% of the pregnancies that subsequently resulted in miscarriage or developed pregnancy induced hypertension or growth restriction, and in 27% of those that developed gestational diabetes. Maternal serum free , hCG was < 10th centile of the reference range in about 15% of the pregnancies that subsequently resulted in miscarriage or developed pregnancy induced hypertension or growth restriction, and in 20% of those that developed gestational diabetes. Conclusion Low maternal serum PAPP-A or , hCG at 10,14 weeks of gestation are associated with subsequent development of pregnancy complications. [source] Lipid peroxidation and vitamin E status in gestational diabetes mellitusJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2003Debjyoti Santra Abstract Aim: To investigate any correlation between plasma levels of lipid peroxides, antioxidant nutrient (,-tocopherol) and oxidized high-density lipoprotein (HDL) in patients with gestational diabetes and those with a normal pregnancy and the incidence of pre-eclampsia. Methods: Sixty pregnant women attending an antenatal clinic were recruited for the study and were divided into two groups. Thirty women with gestational diabetes mellitus were recruited in the study group. The glucose-tolerance-test criteria, using 100 g of glucose taken orally, as laid down by the American College of Obstetricians and Gynecologists (1994) for diagnosis of gestational diabetes mellitus was used. Thirty gestation-matched pregnant women with normal glucose tolerance test results were recruited as controls. A 10 mL venous blood sample was collected from each subject at the time of recruitment and thereafter at 4 week intervals until the time of delivery. Samples were analyzed for malondialdehyde thiobarbituric acid reactive, oxidized HDL-cholesterol and ,,tocopherol. The incidence of pre-eclampsia and its correlation with antioxidant and lipid peroxide levels were compared in both the groups. Results: Ten subjects out of 30 in the study group and three subjects out of 30 in the control group developed pre-eclampsia. The incidence of preterm labor in both the groups was same (16.66%). The mean lipid peroxide level was lower in the study group at recruitment and later the levels kept falling, whereas levels of ,,tocopherol and oxidized-HDL were higher in the study group and kept on rising at follow up. Conclusion: Gestational diabetes is not associated with increased levels of lipid peroxides and decreased levels of ,-tocopherol. [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] Peri-conceptual folic acid supplementation in type 1 diabetesPRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 4 2001C.J. Wills Specialist Registrar in Diabetes, Endocrinology Abstract Aim To document peri-conceptual folic acid supplementation in women with type 1 diabetes mellitus (DM) attending the diabetic ante-natal clinic of a university teaching hospital. Methods Women with pre-existing type 1 DM who booked at the diabetes antenatal clinic at University Hospital, Nottingham over 3 years (1996,98) took part in a telephone survey about folic acid supplements. Results Data was available on 50 women, 65 pregnancies. Folic acid supplements were used before 50.7% (33) pregnancies, all planned, and started on confirmation of pregnancy in 34% (22), at a mean gestation of 5.8 weeks. No folic acid was used before or during 10 (15.4%) pregnancies. 75.4% (49) pregnancies were planned. 24 planned pregnancies were in women who had never had pre-pregnancy counselling. 70.8%(17) of these were in multiparous women, and folic acid was taken before 41.1% (seven) of such pregnancies. Lack of awareness was the predominant reason for failure to take folic acid supplements in all groups. Conclusions Folic acid was taken before conception in only half of the pregnancies in the survey, due to lack of awareness of its importance. Three-quarters of pregnancies were planned but a disappointing number of women had pre-pregnancy counselling, probably due to poor advertising and the assumption that women who had been pregnant before did not need such a session. Women with DM should be informed about folic acid and offered pre-pregnancy counselling. It should not be assumed that women who have had a pregnancy know about folic acid. Copyright © 2001 John Wiley & Sons, Ltd. Key Points Folic acid supplementation prior to conception and in the first trimester helps to prevent neural tube defects. Almost half of the women in this survey failed to take folic acid prior to conception. Women who did not take folic acid were unaware of its importance. We need to ensure that women with diabetes understand the importance of folic acid. [source] Assessment of the effect of psychosocial support during childbirth in Ibadan, south-west Nigeria: A randomised controlled trialAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2009Imran O. MORHASON-BELLO Objective: To assess the effect of psychosocial support on labour outcomes. Methodology: A randomised control trial conducted at the University College Hospital Ibadan, Nigeria, from November 2006 to 30 March 2007. Women with anticipated vaginal delivery were recruited and randomised at the antenatal clinic. The experimental group had companionship in addition to routine care throughout labour until two hours after delivery, while the controls had only routine care. The primary outcome measure was caesarean section rate. Others included duration of active phase, pain score, time of breast-feeding initiation and description of labour experience. Multivariable analyses were used to adjust for potential confounders. The level of statistical significance was set at 5%. Results: Of the 632 recruited, 585 were eventually studied: 293 and 292 were in experimental and control groups, respectively. Husbands constituted about two-thirds of the companions. Women in the control group were about five times more likely to deliver by caesarean section (95% confidence interval (CI) 1.98,12.05), had significantly longer duration of active phase (P < 0.001), higher pain scores (P = 0.011) and longer interval between delivery and initiation of breast-feeding (P < 0.001). However, those in experimental group had a more satisfying labour experience (odds ratio 3.3 95% CI 2.15,5.04). Conclusion: Women with companionship had better labour outcomes compared to those without. It is desirable to adopt this practice in our health-care settings as an alternative strategy to provide comparable quality services to would-be mothers in labour. [source] Body fat composition and weight changes during pregnancy and 6,8 months post-partum in primiparous and multiparous womenAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2009William W. K. TO Objective:, To compare changes in maternal weight and body fat composition from early to late pregnancy and 6,8 months postnatally between primiparous and multiparous patients Methods:, Maternal weight and body fat percentage were assessed in a cohort of low-risk uncomplicated women in a general antenatal clinic at 14,20 weeks gestation, after 36 weeks, and around six to eight months after delivery using a Tanita TBF 105 Fat Analyser. Maternal epidemiological and anthropometric data, as well as pregnancy characteristics and perinatal outcome, were derived from standard antenatal records after delivery. The cohort was stratified into primiparous and multiparous women for comparison. Results:, In a cohort of 104 women, 55 (52.8%) were primiparous and 49 (47.1%) were multiparous. A relatively good overall correlation between body fat percentage gain and weight gain was observed (correlation coefficient 0.33) from early to late pregnancy. Primiparous women had higher weight gain (12 kg) and higher body fat gain (7.7%) during the pregnancy compared to multiparous women (10.8 kg and 6%, respectively), and they also retained more of the fat accumulated during pregnancy (1.92% vs , 0.44%, P < 0.001) when assessed over six months after their delivery. Conclusion:, The findings could represent more exaggerated physiological responses to the pregnant state in the primiparous woman as compared to multiparous women. [source] Pregnant smokers are receptive to smoking cessation advice and use of nicotine replacement therapyAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2008Karen BEDFORD Pregnant women who identified themselves as smokers were surveyed to ascertain their attitudes towards and likelihood of using nicotine replacement therapy (NRT) if it were to be provided free of charge at antenatal clinics. Smokers were asked to participate in a brief anonymous survey to identify current levels of smoking, nicotine dependence, attitudes towards cessation, use of cessation aids and whether they would use free NRT if it were provided with support at antenatal clinics. The majority of women were supportive of NRT being offered to pregnant smokers (87%), and 64% reported they would be very likely to use NRT if it were offered free from the antenatal clinic. These results provide strong support for a comprehensive cessation strategy implemented in antenatal clinics. [source] Ascertaining women's choice of title during pregnancy and childbirthAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2002Angela S Denning ABSTRACT Methods A questionnaire was administered to 958 women attending the antenatal clinic at Mercy Hospital for Women, Melbourne, to ascertain their choice of title during pregnancy. Midwifery, nursing and medical staff (376 in total) were also invited to respond to a similar questionnaire. Results The response rate was 73.6% from the survey of all women who were overwhelmingly in favour of being called ,patient' as their first choice (34%), followed by ,other' (20%) and then ,mother' (19%). Virtually all women requesting ,other' wished to be called by their name. Women wishing to be called ,patient' for first choice did not significantly differ from the remainder of the study group in age, gestation, number of previous pregnancies, or number of children. When women from the Family Birth Centre (FBC) were analysed as a separate group, they had a clear preference to be called ,other' (unanimously, by their name) than the general antenatal population (odds ratio (OR) 5.1; 95% confidence interval (CI) 3.1, 8.3; p < 0.0001). The staff survey, with a response rate of 84%, also demonstrated that ,patient' was the most popular first choice for patient title. Medical staff were significantly more likely to choose ,patient' (OR 4.2, 95% CI 2.3, 7.7; p < 0.0001), though the term ,patient' was the preferred choice of all staff. [source] Team Midwifery Care in a Tertiary Level Obstetric Service: A Randomized Controlled TrialBIRTH, Issue 3 2000Mary Anne Biró RN Background:In 1996 a new model of maternity care characterized by continuity of midwifery care from early pregnancy through to the postpartum period was implemented for women attending Monash Medical Centre, a tertiary level obstetric service, in Melbourne, Australia. The objective of this study was to compare the new model of care with standard maternity care.Methods:In a randomized controlled trial, 1000 women who booked at the antenatal clinic and met the eligibility criteria were randomly allocated to receive continuity of midwifery care (team care) from a group of seven midwives in collaboration with obstetric staff, or care from a variety of midwives and obstetric staff (standard care). The primary outcome measures were procedures in labor, maternal outcomes, neonatal outcomes, and length of hospital stay.Results:Women assigned to the team care group experienced less augmentation of labor, less electronic fetal monitoring, less use of narcotic and epidural analgesia, and fewer episiotomies but more unsutured tears. Team care women stayed in hospital 7 hours less than women in standard care. More babies of standard care mothers were admitted to the special care nurseries for more than 5 days because of preterm birth, and more babies of team care mothers were admitted to the nurseries for more than 5 days with intrauterine growth retardation. No differences occurred in perinatal mortality between the two groups.Conclusions:Continuity of midwifery care was associated with a reduction in medical procedures in labor and a shorter length of stay without compromising maternal and perinatal safety. Continuity of midwifery care is realistically achievable in a tertiary obstetric referral service. [source] Continuity of Caregivers for Care During Pregnancy and ChildbirthBIRTH, Issue 3 2000E.D. Hodnett A substantive amendment to this systematic review was last made on 04 March 1998. Cochrane reviews are regularly checked and updated if necessary. ABSTRACT Background: Care is often provided by multiple caregivers, many of whom work only in the antenatal clinic, labour ward, or postnatal unit. However, continuity of care is provided by the same caregiver or a small group from pregnancy through the postnatal period. Objectives: The objective of this review was to assess continuity of care during pregnancy and childbirth and the puerperium with usual care by multiple caregivers. Search strategy: The Cochrane Pregnancy and Childbirth Group trials register was searched. Selection criteria: Controlled trials comparing continuity of care with usual care during pregnancy, childbirth and the postnatal period. Data collection and analysis: Trial quality was assessed. Study authors were contacted for additional information. Main results: Two studies involving 1815 women were included. Both trials compared continuity of care by midwives with non-continuity of care by a combination of physicians and midwives. The trials were of good quality. Compared to usual care, women who had continuity of care from a team of midwives were less likely to be admitted to hospital antenatally (odds ratio 0.79, 95% confidence interval 0.64,0.97) and more likely to attend antenatal education programs (odds ratio 0.58, 95% confidence interval 0.41,0.81). They were also less likely to have drugs for pain relief during labour (odds ratio 0.53, 95% confidence interval 0.44,0.64), and their newborns were less likely to require resuscitation (odds ratio 0.66, 95% confidence interval 0.52,0.83). No differences were detected in Apgar scores, low birthweight, and stillbirths or neonatal deaths. While they were less likely to have an episiotomy (odds ratio 0.75, 95% confidence interval 0.60,0.94), women receiving continuity of care were more likely to have either a vaginal or perineal tear (odds ratio 1.28, 95% confidence interval 1.05, 1.56). They were more likely to be pleased with their antenatal, intrapartum, and postnatal care. Reviewers' conclusions: Studies of continuity of care show beneficial effects. It is not clear whether these are due to greater continuity of care, or to midwifery care. Citation: Hodnett ED. Continuity of caregivers for care during pregnancy and childbirth (Cochrane Review). In: The Cochrane Library, Issue 2, 2000. Oxford: Update Software. The preceding reports are abstracts of regularly updated, systematic reviews prepared and maintained by the Cochrane Collaboration. The full texts of the reviews are available in The Cochrane Library (ISSN 1464-780X). Seehttp://www.update-software.com/cochrane.htmor contact Update Software,info@update.co.uk, for information on subscribing to The Cochrane Library in your area. Update Software Ltd, Summertown Pavilion, Middle Way, Oxford OX2 7LG, United Kingdom (Tel.: +44 1865 513902; Fax: +44 1865 516918). [source] Women's attitudes to HIV screening in pregnancy in an area of low prevalenceBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2 2003Swati Jha Objectives To identify factors that influence acceptance of the human immunodeficiency virus (HIV) screening test by pregnant women. Design Prospective survey using questionnaires. Setting An antenatal clinic at a tertiary referral hospital. Population 200 pregnant women of multiethic origin residing in a low prevalence area. Methods Two hundred consecutive women attending the antenatal booking clinic were interviewed. We collected data on reasons for opting in or out and factors that could influence the rate of acceptance, such as ethnicity, age, parity, level of education, first language and marital or relationship status. Main outcome measure Attitudes of pregnant women to HIV screening. Results The rate of acceptance of HIV screening was 160/200(80%). The most frequent reasons for opting in were the perceived benefits of screening (92/160, 58%) and the fact that the test is now routinely offered (87/160, 54%). The most frequent reason for refusal of screening was perceived low risk of HIV (27/40, 68%). Logistic regression analysis showed that ethnicity, age, parity and level of formal education did not play a role in influencing uptake of the test. However, women whose first language was English were more likely to opt in compared with those whose first language was not English (P= 0.016) and those who were married or in a stable relationship were more likely to opt in than those who were not (P < 0.001). Conclusion We have not reached the national target of 90% in our region. This appears to be due to a combination of factors, the main one being a perception of low risk. Greater knowledge of the ease of transmission of HIV may alter this perception, which may improve acceptance of the test. [source] Implementation of the ,Fresh Start' smoking cessation programme to 23 antenatal clinics: a randomized controlled trial investigating two methods of disseminationDRUG AND ALCOHOL REVIEW, Issue 1 2001MARGARET COOKE Abstract The aim of the research was to investigate the effect of two methods of dissemination on the implementation of a smoking cessation programme and use of smoking cessation interventions in antenatal clinics. A repeated-measures randomized design was used. Hospital antenatal clinics (n = 23) were randomized to simple or intensive dissemination groups. All clinics in NSW with > 500 births were asked to participate. A survey of all clinical staff (n = 323) in 23 antenatal clinics was carried out prior to programme dissemination and 18 months after dissemination (n = 283). The response rate was 63% at baseline and 64% at follow-up. Smoking cessation intervention significantly increased after dissemination. (F (18,1) = 49.26, p < 0.001). The average number of smoking cessation interventions provided by clinics after programme dissemination increased from 4.5 to 7. 48 (mean difference 2.98, t(19) 7.08, n < 0.001, 95% CI (2.1,3.86). Type of dissemination did not influence the number of programme components used or the number of smoking cessation interventions offered. Also, the estimated proportion of clients offered intervention by clinicians did not vary due to type of dissemination. A simple mail-out of a smoking cessation programme to antenatal clinics for use during pregnancy can increase clinician intervention for smoking. When more intensive methods of dissemination are used, the quality of the interventions implemented by clinicians improves. More research on dissemination methods are required as both methods of dissemination did not produce systematic or sustained use of the programme. [source] Opportunistic screening for Chlamydia in general practice: the experience of health professionalsHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2003Elizabeth Perkins Abstract Chlamydia trachomatis is the most common curable bacterial sexually transmitted infection in the UK. The infection is asymptomatic in up to 70% of women, and if untreated, can lead to pelvic inflammatory disease, ectopic pregnancy and infertility. Chlamydial infection can be diagnosed using urine testing and is easily treated with antibiotics. In 1999, the UK Department of Health funded a pilot opportunistic Chlamydia screening programme in two health authorities. All sexually active women between the ages of 16 and 24 years attending general practices and other healthcare settings, such as family planning clinics, antenatal clinics and genito-urinary medicine services, were offered the opportunity to be screened for Chlamydia, regardless of the purpose of their visit. This evaluation was funded to assess the feasibility and acceptability of opportunistic screening. The evaluation was conducted using both qualitative and quantitative methods. The present paper describes findings from the qualitative evaluation study arising from the health professionals' experience of opportunistic screening in general practice. Receptionists were central to the opportunistic screening model in general practice and it was this aspect of the model that raised most concerns. Whilst general practitioners reported that the involvement of receptionists saved them time, the receptionists themselves were sometimes drawn into discussions for which they felt ill equipped and unsuitably located. This research suggests that a call,recall national screening programme would provide a better model to undertake Chlamydia screening in general practice. The advantages of this model are threefold. First, each individual within the target age range can receive information about Chlamydia through the post. Secondly, the test and more detailed information can be managed by a practice nurse in a private and confidential setting. Thirdly, individuals are not repeatedly offered the test when visiting the surgery. [source] Acceptability of willingness to pay techniques to consumersHEALTH EXPECTATIONS, Issue 4 2002Susan J. Taylor PhD Abstract Objective The purpose of this study was to assess and compare the proportion of usable responses and protest votes obtained with two willingness to pay (WTP) techniques, contingent valuation (CV) and discrete choice experiment (DCE) and to assess the acceptability of the techniques to respondents. Setting and participants Pregnant women attending the public antenatal clinics of a Sydney teaching hospital were surveyed. Main variables studied Preference for either Treatment A (artificial rupture of the membranes followed by intravenous oxytocin) or Treatment B (prostaglandin E2 gel followed by oxytocin if necessary) was assessed. Then WTP for the preferred treatments was assessed using CV and WTP for specific attributes of the treatments in the DCE. In addition, the acceptability of the two techniques was compared in terms of responses deemed to be valid according to defined criteria, protest votes and comments recorded by consumers. Results With the CV, 74% of respondents chose gel and their maximum WTP was Aus$178 compared with $133 for the alternative. A total of 68% of responses were deemed to be valid including 5% who may have been expressing a protest vote. With the DCE, respondents were WTP $55 for every 1 h reduction in the length of time from induction to delivery. A total of 72% of responses were deemed valid and only two of these 258 women were considered to have expressed a protest vote. Conclusions Only a small number of women expressed objections to the use of WTP questions in health-care and the majority of women completed both questions successfully. [source] Food consumption patterns, dietary quality and health status of expectant mothers: case studies in suburban and rural communities in GhanaINTERNATIONAL JOURNAL OF CONSUMER STUDIES, Issue 1 2002Christina A. Nti Abstract The study was conducted to determine the food consumption patterns, dietary quality and health status of expectant women and also to assess their level of awareness of nutritional requirements during pregnancy. Food beliefs, taboos and superstitions held by the women were also investigated. Using the purposive sampling technique, 30 pregnant women attending the Maternal and Child Health Clinic at Dodowa (rural) and University Hospital, Legon (suburban), were selected for the study. A structured questionnaire was used to collect information on the respondents' nutritional knowledge, beliefs, taboos and superstitions and health status. A food frequency questionnaire and the 24-h dietary recall method were used to obtain information on food consumption patterns and dietary quality. The study revealed that, although the majority of the respondents (83.3%) had some knowledge of nutrition, not all were applying it in their feeding practices because of financial constraints. With regard to consumption patterns, most of the women (83.3%) were having three meals a day, while the rest either ate twice a day or anytime they were hungry. Seventy-three per cent of the respondents also increased their food intake during pregnancy. Foods eaten were based mainly on starchy roots and tubers, cereals and vegetables. Legumes, oilseeds and fruits were often lacking in the main meals of respondents. Although animal products were consumed daily, the quantities taken were very small to provide for adequate protein, especially in the rural area. Various types of food were avoided by some of the expectant mothers for reasons such as nausea, loss of appetite, taboos and superstition. With regard to dietary quality, respondents from the rural area had diets of poorer quality in terms of nutrient intake compared with those from the suburban area. In both communities, iron contents of diets were quite low. Forty-seven per cent of the women interviewed were anaemic, with a higher prevalence of anaemia being observed in the rural community. Common ailments reported by the women were dizziness, headache, waist pains and malaria. Based on the results of the study, it was recommended that nutrition education for pregnant women should be stepped up at antenatal clinics especially in rural areas. [source] Influence of Social Support, Work Overload, and Parity on Pregnant Career Women's Psychological Well-BeingJOURNAL OF APPLIED BIOBEHAVIORAL RESEARCH, Issue 4 2008Adebayo O. Adejumo The influence of social support, work overload, and parity on psychological well-being of pregnant career women was investigated. Women executives (N200) attending antenatal clinics were selected. A 2 × 2 × 2 analysis of variance (ANOVA) revealed significant independent influence of social support (F(1, 199) = 26.51, p < 0.05) and work overload (F(1, 199) = 461.76, p < 0.05), and significant joint effect of social support and work overload. There was no significant effect of parity (F(1, 199) = 0.72, p > 0.05). Combinations of parity, social support, and work overload were also not significant (F(1, 199) = 0.80, p > 0.05). Social support and appropriate work incentives are helpful in assisting pregnant women executives in coping with psychological changes during pregnancy. [source] HIV epidemic in central african republic: High prevalence rates in both rural and urban areasJOURNAL OF MEDICAL VIROLOGY, Issue 3 2004Marcelle Diane Matsika-Claquin Abstract A sentinel serosurveillance study was conducted in Central African Republic to estimate the prevalence of HIV seropositivity in the general adult population in each province so that the public health authorities can target HIV prevention programmes to the priority areas. Blood samples were collected from women attending 48 antenatal clinics in urban and rural areas of the Central African Republic. These samples were tested for HIV antibodies in an anonymous and unlinked manner using strategy II recommended by WHO. The data were extrapolated to all women of reproductive age in Central African Republic by use of a parity-based adjustment involving the application of correction factors to the observed prevalence rates. A total of 9,305 pregnant women were recruited from November 2001 to October 2002. HIV seroprevalence was high in all age groups (12% in the less than 20 year age group to 17% in the 25,29 year age group). The median prevalence of HIV in antenatal clinics was similar for rural areas, for Bangui and for other urban areas (16.5, 15.0, and 12.5% respectively). Adjustment for parity and fertility pattern increased the prevalence of HIV in all antenatal clinics except in Bangui. This first national study of HIV prevalence in Central African Republic revealed that the HIV epidemic is continuing to spread in both urban and rural areas. Thus, efforts to reduce transmission should be made in every part of the country. J. Med. Virol. 72:358,362, 2004. © 2004 Wiley-Liss, Inc. [source] Does continuous use of metformin throughout pregnancy improve pregnancy outcomes in women with polycystic ovarian syndrome?JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2008Fauzia Haq Nawaz Abstract Aim:, Polycystic ovarian syndrome (PCOS) is one of the most common endocrinopathies in women of reproductive age. It is associated with hyperinsulinemia and insulin resistance which is further aggravated during pregnancy. This mechanism has a pivotal role in the development of various complications during pregnancy. In the past few years, metformin, an insulin sensitizer, has been extensively evaluated for induction of ovulation. Its therapeutic use during pregnancy is, however, a recent strategy and is a debatable issue. At present, evidence is inadequate to support the long-term use of insulin-sensitizing agents during pregnancy. It is a challenge for both clinicians and researchers to provide good evidence of the safety of metformin for long-term use and during pregnancy. This study aimed to evaluate pregnancy outcomes in women with PCOS who conceived while on metformin treatment, and continued the medication for a variable length of time during pregnancy. Methods:, This case-control study was conducted from January 2005 to December 2006 at the antenatal clinics of the Department of Obstetrics and Gynecology, Aga Khan University, Karachi, Pakistan. The sample included 137 infertile women with PCOS; of these, 105 conceived while taking metformin (cases), while 32 conceived spontaneously without metformin (controls). Outcomes were measured in three groups of cases which were formed according to the duration of use of metformin during pregnancy. Comparison was made between these groups and women with PCOS who conceived spontaneously. Results:, All 137 women in this study had a confirmed diagnosis of PCOS (Rotterdam criteria). These women were followed up during their course of pregnancy; data forms were completed once they had delivered. Cases were divided into three groups: group A, 40 women who stopped metformin between 4,16 weeks of pregnancy; group B, 20 women who received metformin up until 32 weeks of gestation; and group C; 45 women who continued metformin throughout pregnancy. All the groups were matched by age, height and weight. Comparison was in terms of early and late pregnancy complications, intrauterine growth restriction and live birth rates. In groups A, B and C the rate of pregnancy-induced hypertension/pre-eclampsia was 43.7%, 33% and 13.9% respectively (P < 0.020). Rates of gestational diabetes requiring insulin treatment in groups A and B were 18.7% and 33.3% compared to 2.5% in group C (P < 0.004). The rate of intrauterine growth restriction was significantly low in group C: 2.5% compared to 19.2% and 16.6% in groups A and B respectively (P < 0.046). Frequency of preterm labor and live birth rate was significantly better in group C compared to groups A and B. Overall rate of miscarriages was 7.8%. Controls were comparable to group A in terms of early and late pregnancy complications. Conclusion:, In women with PCOS, continuous use of metformin during pregnancy significantly reduced the rate of miscarriage, gestational diabetes requiring insulin treatment and fetal growth restriction. No congenital anomaly, intrauterine death or stillbirth was reported in this study. [source] The prediction of disruptive behaviour disorders in an urban community sample: the contribution of person-centred analysesTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 6 2004Keith B. Burt Background:, Variable- and person-centred analyses were used to examine prediction of middle childhood behaviour problems from earlier child and family measures. Method:, A community sample of 164 families, initially recruited at antenatal clinics at two South London practices, was assessed for children's behaviour problems and cognitive ability, maternal mental health, and the family environment when the children were 4 years old. At age 11, children, mothers, and teachers reported the child's disruptive behaviour, and mothers and children were interviewed to identify cases of disruptive behaviour disorders (DBD). Results:, Neither social class nor ethnicity predicted the child's disruptive behaviour at age 11. Rather, path analyses and logistic regression analyses drew attention to early behavioural problems, maternal mental health and the child's cognitive ability at 4 as predictors of disruptive behaviour at age 11. Cluster analysis extended these findings by identifying two distinct pathways to disruptive symptoms and disorder. In one subgroup children who showed intellectual difficulties at 4 had become disruptive by 11. In a second subgroup mothers and children both showed psychological problems when the child was 4, and the children were disruptive at age 11. The person-centred approach also revealed a high-functioning group of cognitively able 4-year-olds in supportive environments, at especially low risk for DBD. Conclusions:, Combining variable- and person-centred analytic approaches can aid prediction of children's problems, draw attention to pertinent developmental pathways, and help integrate data from multiple informants. [source] Original Article: Maternal sleep deprivation, sedentary lifestyle and cooking smoke: Risk factors for miscarriage: A case control studyAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2010Yasindu SAMARAWEERA Aims:, To determine risk factors for miscarriage. Methods:, A case control study was carried out at the gynaecological wards and antenatal clinics of the De Soysa Maternity Hospital in Sri Lanka. A case was defined as that of mothers with a confirmed diagnosis of partial or full expulsion of the fetus during the first 28 weeks of gestation. Controls comprised ante-natal clinic attendees whose period of gestation was <28 weeks and carrying a viable fetus. Two hundred and thirty cases and 504 controls were selected. A pre-tested interviewer-administered questionnaire and modified life events inventory were used to gather data. Multivariate logistic regression was applied separately for first and second trimester miscarriages and the results were expressed as odds ratios (OR) and as 95% confidence intervals (95%CI). Results:, Sleeping ,8 h/day (OR:3.80, 95%CI:1.01,14.3) was found to be a risk factor for first trimester miscarriage controlling for the effect of period of gestation. Sleeping ,8 h/day (OR:2.04, 95%CI:1.24,3.37), standing ,3 h/day (OR:1.83, 95%CI:1.08,3.10), exposure to cooking smoke (OR:3.83, 95%CI:1.50,9.90) and physical trauma during the pregnancy (OR:43.2, 95%CI:4.55,411.4) were found to be risk factors for second trimester miscarriage controlling for the effect of period of gestation. Conclusions:, Sleep deprivation, a sedentary lifestyle, exposure to cooking smoke and physical trauma during pregnancy were risk factors for miscarriage. Most of the risk factors are therefore modifiable. [source] Castor oil for induction of labour: Not harmful, not helpfulAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2009Machteld Elisabeth BOEL Background:, Castor oil is one of the most popular drugs for induction of labour in a non-medical setting; however, published data on safety and effectiveness of this compound to induce labour remain sparse. Aim:, To assess the safety and effectiveness of castor oil for induction of labour in pregnancies with an ultrasound estimated gestational at birth of more than 40 weeks. Methods:, Data were extracted from hospital-based records of all pregnant women who attended antenatal clinics on the Thai,Burmese border and who were more than 40 weeks pregnant. The effectiveness of castor oil to induce labour was expressed as time to birth and analysed with a Cox proportional hazards regression model. Measures associated with safety were fetal distress, meconium-stained amniotic fluid, tachysystole of the uterus, uterine rupture, abnormal maternal blood pressure during labour, Apgar scores, neonatal resuscitation, stillbirth, post-partum haemorrhage, severe diarrhoea and maternal death. Proportions were compared using Fisher's exact test. Results:, Of 612 women with a gestation of more than 40 weeks, 205 received castor oil for induction and 407 did not. The time to birth was not significantly different between the two groups (hazard ratio 0.99 (95% confidence interval: 0.81 to 1.20; n = 509)). Castor oil use was not associated with any harmful effects on the mother or fetus. Conclusions:, Castor oil for induction of labour had no effect on time to birth nor were there any harmful effects observed in this large series. Our findings leave no justification for recommending castor oil for this purpose. [source] Pregnant smokers are receptive to smoking cessation advice and use of nicotine replacement therapyAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2008Karen BEDFORD Pregnant women who identified themselves as smokers were surveyed to ascertain their attitudes towards and likelihood of using nicotine replacement therapy (NRT) if it were to be provided free of charge at antenatal clinics. Smokers were asked to participate in a brief anonymous survey to identify current levels of smoking, nicotine dependence, attitudes towards cessation, use of cessation aids and whether they would use free NRT if it were provided with support at antenatal clinics. The majority of women were supportive of NRT being offered to pregnant smokers (87%), and 64% reported they would be very likely to use NRT if it were offered free from the antenatal clinic. These results provide strong support for a comprehensive cessation strategy implemented in antenatal clinics. [source] Social influences for smoking in pregnancy in south western Sydney antenatal clinic attendeesAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2007Mohammed MOHSIN Abstract This study examined the needs of and barriers to smoking cessation of 677 women who attended antenatal clinics in south-west Sydney. More than a quarter (26.3%) of the mothers reported smoking at their first antenatal visit. Smokers were more likely to be teenagers, single mothers and less likely to have formal education or employment. They were less aware of the potential health risks of smoking in pregnancy (SIP). High levels of SIP remain a public health problem, and effective interventions are needed. [source] Prevalence of health behaviours in pregnancy at service entry in a Queensland health service districtAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2009Shelley A. Wilkinson Abstract Objective: Limited prevalence data for unhealthy pregnancy health behaviours make it difficult to prioritise primary prevention efforts for maternal and infant health. This study's objective was to establish the prevalence of cigarette smoking, sufficient fruit and vegetable intake and sufficient physical activity among women accessing antenatal clinics in a Queensland (Australia) health service district. Method: Cross-sectional self-reported smoking status, daily fruit and vegetable intake, weekly physical activity and a range of socio-demographic variables were obtained from women recruited at their initial antenatal clinic visit, over a three-month recruitment phase during 2007. Results: Analyses were based on 262 pregnant women. The study sample was broadly representative of women giving birth in the district and state, with higher representation of women with low levels of education and high income. More than one quarter of women were smoking. Few women met the guidelines for sufficient fruit (9.2%), vegetables (2.7%) or physical activity (32.8%) during pregnancy. Conclusions: There were low levels of adherence to health behaviour recommendations for pregnancy in this sample. Implications: There is a clear need to develop and evaluate effective pregnancy behaviour interventions to improve primary prevention in maternal and infant health. Brief minimal contact interventions that can be delivered through primary care to create a greater primary prevention focus for maternal and infant health would be worth exploring. [source] Maternal complications and pregnancy outcome in women with mechanical prosthetic heart valves treated with enoxaparinBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2009C McLintock Objective, To determine maternal and fetal outcomes in women with mechanical heart valves managed with therapeutic dose enoxaparin during pregnancy. Design, Retrospective audit. Setting, Hospital-based high-risk antenatal clinics. Population, Pregnant women with mechanical heart valves attending high-risk antenatal clinics, treated with enoxaparin (1 mg/kg twice daily) during pregnancy. Methods, Women with mechanical heart valves treated with enoxaparin at any stage during pregnancy (1997,2008) identified using a database of women with mechanical heart valves attending the high-risk clinics and a prospective database of women prescribed enoxaparin for any indication during pregnancy. Main outcome measures, Maternal outcomes included thromboembolic and haemorrhagic complications. Pregnancy and fetal outcomes included miscarriage, stillbirth, baby death and live birth, small-for-gestational-age infants, warfarin embryopathy and warfarin-related fetal loss. Results, Thirty-one women underwent 47 pregnancies. In 34 pregnancies (72.3%), anticoagulation was with predominantly enoxaparin and 13 (27.7%) pregnancies women received mainly warfarin, with enoxaparin given in the first trimester and/or peri-delivery. Seven (14.9%) thrombotic complications occurred, of which five (10.6%) were associated with enoxaparin treatment. Non-compliance or sub-therapeutic anti-Xa levels contributed in each case. Antenatal and postpartum haemorrhagic complications occurred in eight (17%) and 15 (32%) pregnancies respectively. Of 35 pregnancies continuing after 20 weeks' gestation, 96% (22/23) of women taking predominantly enoxaparin had a surviving infant compared with 75% (9/12) in women taking primarily warfarin. Four perinatal deaths occurred, three attributable to warfarin. Conclusions, Compliance with therapeutic dose enoxaparin and aspirin during pregnancy in women with mechanical heart valves is associated with a low risk of valve thrombosis and good fetal outcomes, but close monitoring is essential. [source] The effect of cigarette or sheesha smoking on first-trimester markers of Down syndromeBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 11 2007MSM Ardawi Objective, To investigate the influence of cigarette or sheesha smoking on first-trimester markers of Down syndrome. Design, A prospective observational study. Setting, Primary care centres and antenatal clinics of Maternity and Children Hospital, King Abdulaziz University Hospital and New Jeddah Clinic Hospital, Jeddah, Saudi Arabia. Population, Women with a singleton pregnancy who were either nonsmokers (n= 1736) or cigarette smokers (n= 420) or sheesha smokers (n= 181). Methods, Fetal nuchal translucency thickness (fetal NT), maternal serum free beta-human chorionic gonadotrophin (free ,-hCG) and pregnancy-associated plasma protein-A (PAPP-A) were measured at 11 weeks 0 days to 13 weeks 6 days of gestation in all women. Women were grouped according to smoking status, confirmed by maternal serum cotinine measurements, and analyte levels between groups were compared. Main outcome measures, Fetal NT, maternal serum free ,-hCG, PAPP-A and cotinine measurements. Results, Compared with nonsmoking women, fetal NT was significantly increased and free ,-hCG and PAPP-A levels were significantly decreased in both cigarette and sheesha smokers. There were significant relationships between all three markers and the number of sheeshas consumed per day. Conclusions, Cigarette and sheesha smoking significantly affect first-trimester markers of Down syndrome (fetal NT, free ,-hCG and PAPP-A). Correction for this effect in women who smoke might improve the effectiveness of first-trimester screening for Down syndrome in these women. The underlying mechanism(s) relating smoking to the changes in first-trimester markers require further studies. [source] | |||||||||||||||||||||||||||||||