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PubMed1991

[A program to lower perinatal morbidity and mortality in women with multiple pregnancies].

A total of 511 females with multiple pregnancy (486 with twins and 25 with triplets) were examined for the nature of fetal development, and management of pregnancy, labor and postpartum period. An early diagnosis was found to play a decisive role in the implementation of therapeutical and preventive measures. A classification of the prenatal development of monozygotic twins was presented. It was shown that the optimal management of pregnancy in multiple-pregnant females was effective in relation to the time of employing the basic components of the program. It was demonstrated that the active management of labour was important in multiple pregnancy; the results of clinical trials of this procedure were also provided. In terms of the risk for perinatal morbidity and mortality, three groups were identified, these may include females with multiple pregnancy. Implementing the proposed treatment-and-prevention measures showed that perinatal morbidity and mortality rates in multiple pregnancy might be substantially reduced.

Female↗
PubMed2006

Universal perinatal depression screening in an Academic Medical Center.

OBJECTIVE: To develop a department-based program to identify and treat women at risk for perinatal depression. METHODS: Private and employed physician groups were engaged to conduct antepartum maternal depression screening using the Edinburgh Postnatal Depression Scale. A comprehensive program was established to ensure that patients identified as being at risk would receive appropriate care. The program 1) developed a network of existing community mental health providers to accommodate screen-positive referrals, 2) created a 24/7 hotline staffed by mental health workers to respond to urgent/emergent patient needs, 3) provided nursing and physician education via a comprehensive curriculum on perinatal depression, and 4) facilitated outpatient depression screening that included a centralized scoring and referral system. RESULTS: A total of 4,322 women completed 4,558 screens during the initial 24 months (June 2003-May 2005). Although initial uptake of the screening program was gradual, all 20 departmental obstetric practices were screening their patients at the end of the first year. Depression screening was accomplished between 28-32 weeks of gestation, and postpartum screening (during the 6-week postpartum visit) was subsequently added. Overall, 11.1% of women screened positive in the antenatal period, and 7.3% screened positive in the postnatal period. Three hundred three women were referred for evaluation and care. CONCLUSION: Department-based, perinatal depression screening was feasible when individual physician practices were not required to develop the infrastructure necessary to respond to at-risk patients. We believe that the provision of clinical safety nets (mental health provider network and the hotline) were essential to the universal acceptance of this program by practitioners. LEVEL OF EVIDENCE: III.

Adult↗
PubMed1996

Timing of weight gain during pregnancy: promoting fetal growth and minimizing maternal weight retention.

OBJECTIVE: To examine the association of the extent and timing of pregnancy weight gain with infant birth weight (IBW) and postpartum weight retention (PPWR). DESIGN: Retrospective cohort study of pregnant women followed through 6 weeks postpartum. MEASUREMENTS: Birth weight and maternal weight gain before 20 weeks, 21-30 weeks, 31 weeks to term and postpartum weight retention were measured. SUBJECTS: A total of 371 healthy white nonsmoking pregnant women followed by the Prenatal Nutrition Counselling Program of the Department of Health and Social Services of the province of Prince Edward Island, Canada, between 1979 and 1989 who had uncomplicated pregnancies resulting in full term singleton infants. RESULTS: Weight gain during pregnancy (> 12 kg) was associated with PPWR (> 2.5 kg) in underweight, normal and overweight women. Pregnancy weight gain explained 65.2% of the variability in PPWR, but very little of the variability (4.7%) in IBW. Predictors of IBW (gestational age, pregravid weight and infant gender) were not related to PPWR. Early maternal weight gain (< or = 20 weeks) was a strong predictor of PPWR. Comparisons of mothers with PPWR above and below the median of the group indicated important differences in early weight gain (< or = 20 weeks) for underweight (3.3 kg), normal weight (3.3 kg), and overweight (6.2 kg) mothers. CONCLUSION: The results emphasize the importance of the timing of gestational weight gain and show an advantage in deferring a larger portion of required weight gain to late pregnancy (particularly in well-nourished overweight women) in order to promote fetal growth while reducing the risk of high weight retention and its potential adverse health consequences.

Adolescent↗
PubMedDate not supplied

Development of a breastfeeding support program at Naval Hospital Sigonella, Italy.

The Naval Hospital (NH) Sigonella, which contains a level one nursery, cares for prenatal patients in an isolated military community. Many of the traditional support systems available to breastfeeding mothers in the United States, such as Le Leche League, are unavailable in this setting. Some prenatal patients in this setting who have had the desire to breastfeed have failed to do so because they were not offered a structured educational support system that encouraged and monitored their breastfeeding efforts. This prompted the pediatric nurse, functioning as breastfeeding counselor nurse at NH Sigonella, to develop a breastfeeding support program. The goal of the program is to educate new mothers about breastfeeding and to encourage them to initiate and continue breastfeeding for at least 5 to 6 months. These goals are in line with the Healthy People 2000 (1990) objectives, which are to increase to at least 75% the proportion of mothers who breastfeed their babies in the early postpartum period and to at least 50% the proportion of those who continue breastfeeding until their babies are 5 to 6 months old. At delivery, the breastfeeding counselor meets individually with each new mother who expresses the desire to breastfeed. During this visit, she observes and evaluates each mother's breastfeeding technique. Discharge follow-up via telephone is conducted weekly for 4 weeks and at 3 and 6 months postpartum. Data collection after 6 months revealed that 86.7% of all new mothers initiated breastfeeding and 51.4% of those mothers continued breastfeeding for 5 to 6 months. The Breastfeeding Counseling Support Program will enhance NH Sigonella's efforts in continuing to meeting the objectives of Healthy People 2000 and the Breast Feeding Hospital Initiative while providing the benefits of breastfeeding to mother and infant.

Adult↗
PubMed2003

Pattern and manipulation of follicular development in Bos indicus cattle.

Bos indicus cattle are widespread in tropical regions due to their adaptation to these environments. Although data on reproductive performance have indicated both inferior and superior results for B. indicus cattle, there is little doubt that B. indicus cattle are superior than Bos taurus cattle when they are both kept in tropical or subtropical environments, where stressors like hot temperatures, humidity, ectoparasites and low quality forages are greater. Reproductive endocrinology and oestrus behaviour of the B. indicus cattle have been studied for over 30 years; however, the application of technologies such as real time ultrasonography and Heat-Watch systems has expanded our knowledge on the ovarian follicular-wave dynamics during the oestrous cycle and the time of ovulation. Ovarian follicular dynamics in B. indicus cattle is characterised by the occurrence of two, three or sometimes four waves of follicular development. While dominance is similar to that in B. taurus cattle, maximum diameters of the dominant follicle and CL are smaller than those reported in B. taurus and are probably due to a lower capacity for LH secretion than in B. taurus. Duration of oestrus is approximately 10 h and the interval from oestrus to ovulation is about 27 h. However, the variability in response to prostaglandin F2alpha (PGF) treatments and the difficulty for oestrus detection in B. indicus cattle have limited the widespread application of artificial insemination (AI) and emphasizes the need for treatments that control follicular development and ovulation. Follicular-wave development in B. indicus cattle can be controlled mechanically by ultrasound-guided follicle ablation, or hormonally by treatments with GnRH or oestradiol and progestogen/progesterone in combination. Treatments with GnRH plus PGF and a second GnRH (synchronization protocol known as Ovsynch) or oestradiol benzoate (known as GPE) have resulted in acceptable pregnancy rates after fixed-time AI (FTAI) in cycling cows, but results were lower in heifers and cows in postpartum anoestrus. Alternatively, treatments with oestradiol and progestogen/progesterone releasing devices resulted in synchronous emergence of a new follicular wave, and a second oestradiol or GnRH treatment after device removal resulted in synchronous ovulation and acceptable pregnancy rates to FTAI. Furthermore, oestradiol and progesterone treatments combined with eCG (given at the time of device removal) increased pregnancy rates in suckled B. indicus cows and may be useful for the treatment of cows in postpartum anoestrus. In summary, exogenous control of luteal and follicular development facilitates the application of assisted reproductive technologies in B. indicus cattle by offering the possibility of planning AI programs without the necessity of oestrus detection and without sacrificing the overall results.

Animals↗
PubMed2005

The influence of in-pregnancy smoking cessation programmes on partner quitting and women's social support mobilization: a randomized controlled trial [ISRCTN89131885].

BACKGROUND: Smoking cessation interventions in pregnancy could influence a woman's social behaviour and her partner's smoking behaviour, but this has not been examined in any published randomized trials. METHOD: 918 women smoking at booking for antenatal care were enrolled in a cluster-randomized trial of three interventions: standard care, self-help manual and enhanced stage-based counselling, or self-help manual, enhanced stage-based counselling and use of an interactive computer program. The outcomes were change in social support received by women between booking for maternity care and 30 weeks gestation and 10 days postpartum and reported cessation in the woman's partner at these times. RESULTS: Few pregnant women's partners stopped smoking (4.1% at 30 weeks of gestation and 5.8% at 10 days postpartum) and the probability of quitting did not differ significantly by trial arm. Women's scores on the Inventory of Socially Supportive Behaviors showed a slight decline from booking to 30 weeks gestation, and a slight increase to 10 days postpartum, but these changes did not differ significantly by trial arm. CONCLUSION: The stage-based interventions tested in this trial aimed partly to influence women's mobilization of support and might have influenced partners' quitting, but there was no evidence that they did so. Given that women and their partners often stopped smoking together, future interventions to prevent smoking in pregnant women could encourage both partners to quit together.

Adolescent↗
PubMed2001

WHO principles of perinatal care: the essential antenatal, perinatal, and postpartum care course.

World Health Organization (WHO) recommendations and meta-analyses of controlled trials have concluded that inappropriate perinatal care and technology continue to be practiced widely throughout the world, despite the acceptance of evidence-based principles and care. The WHO Regional Office for Europe, in consultation with policy makers and reproductive health experts recently proposed ten "Principles of Perinatal Care," which have been endorsed by the reproductive health units of most member states. A comprehensive training program, based on the principles, is now being offered throughout the European region. This paper describes the development of the WHO principles and the WHO training course "Essential Antenatal, Perinatal and Postpartum Care." Together they provide an innovative model of evidence-based and psychosocially sensitive care for the future guidance of perinatal policy makers and caregivers worldwide.

Female↗
PubMed1999

Improving the detection of postnatal depression.

Women are at risk of developing mental health problems in the postnatal period. Health visitors play an important role in the detection of postnatal depression. The Edinburgh Postnatal Depression Scale can be used to screen all new mothers.

Algorithms↗
PubMed1990

[Prevention and treatment of complications in twin gestation].

From Sept. 1987 to Oct. 1988, a collaborative program of preventing and treating the common complications of nulliparous twin gestations, namely pregnancy induced hypertension, anemia, premature labour and postpartum hemorrhage was carried out in nine hospitals according to the same plan. There were 91 subjects who met the above criteria (treated group) and 99 cases not included in the plan (control group). The incidence of pregnancy induced hypertension was 33%, anemia 13.2%, postpartum hemorrhage 6.6%, and perinatal mortality 22%, in the treated group. The mean duration of pregnancy was 38.38 weeks (268.7 days) and the mean neonatal birth weight was 2725.8 g. The rate of maternal and fetal complications and prenatal mortality in the treated group were significantly lower than those of the control group.

Anemia↗
PubMed1998

Out of the darkness and into the light: women's experiences with depression after childbirth.

While becoming a mother can be a fulfilling and joyful experience, 10-28% of women are affected by an intense emotional response commonly called postpartum depression. This phenomenon is distinguishable from the "transitory baby blues" and is often characterized by crying, confusion, fatigue, depression, insomnia, difficulty caring for the baby and self, and suicidal thoughts. Research on postpartum depression has largely concentrated on investigating its possible causes and predictors utilizing quantitative methodology. Women are the experts of their own lives, yet their voices are missing in the existing body of knowledge about depression after childbirth. In this exploratory qualitative study, I used a feminist perspective to explore the experiences of eight women who had recovered from postpartum depression. A three-stage model emerged that demonstrated how women made sense of that time in their lives. The findings of this study provide a contextual picture of women's experiences with depression after childbirth. The knowledge created has important implications for informing the practice of professionals and the implementation of policy and programs that meet the needs of new mothers and their families.

Adaptation, Psychological↗
PubMed1988

Outcome of pregnancy in relation to maternal serum alpha-fetoprotein levels in the second trimester. An evaluation of a screening program and a longitudinal follow-up.

120 women with elevated alpha-fetoprotein (AFP) in pregnancy week 16-17 were subsequently supervised every 4th week until a few days postpartum. A group of 102 women with normal (n = 78) or low (n = 24) serum AFP concentrations in pregnancy week 16-17 were studied in the same way. In the last week before parturition the AFP serum level declined and the decrease was more pronounced with increasing gestational duration up to pregnancy week 41. The AFP level relationship between the women was stable on average throughout the pregnancies. Smoking was found to be related to elevated maternal serum AFP levels in pregnancy week 16-17. Among mothers younger than 25 years, 72% of those with high or very high AFP serum levels in pregnancy week 16-17 were smokers. Among women with elevated or much elevated maternal serum AFP levels in pregnancy week 16-17, male fetuses predominated. But only those carrying female fetuses gave premature birth to small-for-date children. Further analysis of the data revealed that if such a woman was a multipara, there was a 54% risk of a small-for-date premature female baby. Other data indicate that this risk may be increased by smoking and maternal age. It is recommended that this category of mothers with elevated AFP in pregnancy week 16-17 is continuously supervised during pregnancy.

Adult↗
PubMedDate not supplied

[Detection, prevention and treatment of postpartum depression: a controlled study of 859 patients].

This study evaluated the clinical effectiveness of a programme aimed at detecting, preventing and treating postpartum depression. The French version of the EPDS was used to measure the intensity of postpartum blues on a sample of 859 women, during their stay at the obstetrical clinic. Subjects under treatment for psychological problems were excluded from the study. Mothers scoring 9 or above on the EPDS, which is predictive of pospartum depression, were randomly assigned to a prevention and a control group. Written informed consent was obtained from the subjects after the study procedure had been explained. The prevention group received a counselling session integrating supportive, educational and cognitive-behavioral components. Therapists included five female Master's Degree level students in psychology. All therapists participated in didactic and clinical training as wells as weekly supervision from the first author. All subjects were given a second EPDS with written instructions to complete the questionnaire during the period 4 to 6 weeks postpartum and return it for analysis. At four to 6 weeks, women in the prevention group had significant reductions in the frequency of probable depression, as defined by a score of 11 or above on the EPDS (30.2% vs 48.2%, chi 2 = 7.36, dl = 1, p = 0.0067) and in the intensity of depressive symptoms measured by the mean score on the EPDS (8.5, SD = 4 vs 10.3, SD = 4.4, t = 3.06, dl = 209, p = 0.0024). Mothers with a probable depression were interviewed at home and assessed using the MINI (Mini Neuropsychiatric Interview, Lecrubier et al., 1997) to diagnose major depressive episode, the SIGH-D (Structured Interview Guide for the Hamilton Depression Rating Scale, Williams, 1988) and the BDI (Beck Depression Inventory, Beck et al., 1988). The baseline depression rating scores, EPDS (mean = 13.6, SD = 4), BDI (mean = 15.7, SD = 5.9), HDRS (mean = 14.8, SD = 6), were consistent with moderate depression. No significant differences in baseline scores were observed between the two groups on all the rating scales (p < 0.001). Mothers with probable depression in the prevention group were offered a program of 5 to 8 home visits. Most of the mothers in the prevention group (72%) agreed to participate in the program. On the contrary, most of the mothers (83.3%) who scored below 9 on the first EPDS and 11 or above on the second, who so did not received the preventive counselling session, declined to participate. This suggests the importance of the preventive session in establishing therapeutic alliance. The home visits program integrated four components, supportive, educational, cognitive-behavioral and psychodynamic centred on the mother-infant relationship in terms of the mother's personal history. Therapist participated in clinical training and weekly supervision. Fifteen women (71.4%) in the study group demonstrated complete symptom remission, as defined by HDRS score below 7 after the intervention, compared with 4 women (10.5%) in the control group (chi 2 = 23, p < 0.0001). A clearly therapeutic response to treatment was observed in the treated group with a mean reduction in HDRS score of 9.5 (DS = 6.7) from baseline. The improvement in the women in the treated group, as measured by the mean HDRS scores was statistically greater than that in the control group (m = 5.35, SD = 3.5 vs m = 15.8, SD = 4.6, t = 8.24, dl = 52, p < 0.0001). Our results indicate that a program based on an intervention at obstetrical clinics and on home visits is efficacious and well accepted for prevention, detection and treatment of postpartum depression.

Adult↗
PubMed2000

Evaluating WIC.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has enjoyed extraordinary bipartisan support stemming from the widespread belief that research studies have proven that WIC "works." Although some studies suggest real dietary and health improvements, the greatest benefits only apply to WIC's prenatal program (just a small part of the total program). Even here, weaknesses in the research render the findings highly uncertain. The three most significant weaknesses are (1) selection bias, (2) simultaneity bias, and (3) lack of generalizeability. The resulting uncertainty places WIC's possible impacts on infant mortality, prematurity, and birthweight on a range from zero to substantial. For infants, children, and postpartum and breastfeeding mothers, the only impacts seem to be small to modest effects on anemia and nutrient intake. This paper does not argue that WIC's weaknesses justify abandoning or even cutting the program. On the contrary, there should be a sustained effort to make the program more effective. This effort should start with a policy debate about WIC's role and impacts, coupled with a grant of greater flexibility to state and local WIC agencies to open the program to innovation and experimentation. To increase WIC's positive impacts, we propose a series of possible reforms, each to be thoroughly evaluated.

Child, Preschool↗
PubMedDate not supplied

Comparative analysis of the performance of the Postpartum Depression Screening Scale with two other depression instruments.

BACKGROUND: Postpartum depression affects approximately 13% of mothers but up to 50% of all cases of this tragic illness can go undetected. OBJECTIVE: The purpose of this study was to compare the performance of a newly created instrument, the Postpartum Depression Screening Scale (PDSS), with the Edinburgh Postnatal Depression Scale (EPDS) and a general depression scale, the Beck Depression Inventory-II (BDI-II). METHOD: In this methodological design a total of 150 new mothers completed these three instruments in random order, followed immediately by a DSM-IV diagnostic interview. Using the LABROC I program, the areas under each of the instrument's Receiver Operator Characteristic (ROC) curves were compared to determine if they were significantly different. RESULTS: Eighteen (12%) of the women were diagnosed with major postpartum depression, 28 women (19%) with minor postpartum depression, and 104 women (69%) with no depression. Compared to the EPDS, the PDSS had a significantly larger area under the ROC curve when screening for major or minor postpartum depression. When using the published recommended cut-off scores for major depression for the three instruments, the PDSS achieved the highest combination of sensitivity, 94%, and specificity, 98%. When detecting women with major or minor postpartum depression, the PDSS again yielded the highest combination of sensitivity (91%) and specificity (72%) of the three instruments. The PDSS identified 17 (94%) of the women diagnosed with major postpartum depression, the EPDS identified 14 of these women (78%), and the BDI-II identified 10 of the 18 women (56%). CONCLUSION: If mothers identified as "most depressed" are substantially determined by the instrument used, the implications for both research and clinical practice are significant. Researchers and clinicians need to be aware of the differential sensitivity of depression instruments which, while supposedly measuring the same construct, are focused on different components of this mood disorder.

Adolescent↗
PubMed1995

Effect of group teaching projects on women's stress during postpartum hospitalization.

In view of the trend toward early hospital discharge and an acute nursing shortage in Taiwan, the effectiveness of postpartum teaching in meeting a mother's immediate need for task performance should be evaluated. The purpose of this study was to identify and document the effectiveness of group teaching programs conducted as a collaborative effort by nursing teachers and student nurses during the practicum period. A quasi-experimental study was conducted with data collected from 230 women (control group was 119 women; experimental group was 111 women, including three subgroups: subgroup 1 received "maternal care" classes; subgroup 2 received "infant feeding" classes; and subgroup 3 received "newborn care" classes) at one medical center in southern Taiwan. The Postpartum Stress Inventory and a Social Support Scale were used to obtain postpartum stress and social support ratings for both groups. The t-test was used to compare the differences between groups of mean scores for postpartum stress and social support. Findings show that the mother-related stress of the experimental subgroup 1 was significantly less than in the control group, and the friend support in experimental subgroup 3 was significantly greater than in the control. Therefore, group teaching related to maternal care was found to be effective in lowering stress and classes related to newborn care resulted in increased friend support for the mother. More evidence concerning the effectiveness of such teaching in economic terms and in terms of human welfare is urgently needed.

Adult↗
PubMed2005

Funding priorities in animal reproduction at the United States Department of Agriculture's Cooperative State Research, Education, and Extension Service.

The National Research Initiative (NRI) Competitive Grants Program is the U.S. Department of Agriculture's major competitive grants program and is administered by the Cooperative State Research, Education, and Extension Service (CSREES). Since its inception in 1991, the NRI has funded competitive grants in the discipline of animal reproduction. Previously, this program provided funding for a broad range of projects encompassing almost every subdiscipline in reproductive biology of farm animals, including aquatic species important to the aquaculture industry. During fiscal year 2004, the NRI Animal Reproduction Program narrowed the focus of funding priorities to the topics of infertility, basic mechanisms regulating fertility, cryopreservation of gametes, reducing the postpartum interval to conception, and sterilization methods or development of monosex populations. In response to a directive to further narrow the focus of funding priorities for fiscal year 2005 and beyond, CSREES conducted a Stakeholder Workshop on Funding Priorities in Animal Reproduction at the 37th Annual Meeting of the Society for the Study of Reproduction in Vancouver, Canada. More than 75 stakeholder scientists from a cross section of federal, public, and private institutions from across the United States participated in the workshop and provided recommendations to CSREES for future NRI-funding priorities in Animal Reproduction. The recommendations provided by stakeholders included continuing efforts to focus funding priorities into fewer high-impact areas relevant to animal agriculture and aquaculture. Recommendations also included movement back toward subdisciplines of animal reproduction that cut across all applicable species. The three funding priorities that consistently emerged as recommendations from the workshop participants were 1) gonadal function and production of gametes, 2) pituitary-hypothalamic function, and 3) embryo and conceptus development, including interaction between the conceptus and uterus. These funding priorities were considered when preparing the fiscal year 2006 NRI Request for Applications.

Animal Husbandry↗
PubMed2006

Coverage of antenatal syphilis screening and predictors for not being screened in Ulaanbaatar, Mongolia.

OBJECTIVES: To measure the coverage of antenatal syphilis screening and identify factors related to women not being screened. GOAL: To assess the syphilis control program in Mongolia. STUDY DESIGN: Antenatal care records of women in 16 antenatal care clinics of 6 districts were reviewed. Additionally, postpartum women were interviewed to identify potential factors for not being screened. RESULTS: Among 3,519 antenatal records, the coverage of syphilis screening was 77.7%. Of 2,735 screened women, 54 (2.0%) had reactive serological results and subsequently received treatment. Four late antenatal care comers delivered infants with congenital syphilis. Being unscreened was significantly associated with late antenatal care (odds ratio OR=2.6), lack of knowledge (OR=5.5), history of previous sexually transmitted infection (OR=3.7), and living far from screening services (OR=4.9). CONCLUSIONS: The coverage of antenatal syphilis screening is still low, with poor contact tracing. More efforts are needed to promote early antenatal care visit and improve syphilis screening systems.

Adolescent↗