Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Postpartum Programs”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 811 records · Page 45Linked to original sources
PubMed1995

An integrated village maternity service to improve referral patterns in a rural area in West-Java.

The Regionalization of Perinatal Care, an intervention study carried out in Tanjungsari, a subdistrict in rural West Java, aimed to develop a comprehensive maternal health program to improve maternal and perinatal health outcomes. The main inputs included training at all levels of the health care system (informal and formal) and the establishment of birthing homes in villages to make services more accessible. Special attention was given to referral, transportation, communication and appropriate case management, A social marketing program was conducted to inform people of the accessible birthing homes for clean delivery, located near the women, and with better transportation and communications to referral facilities should complications arise. The study design was longitudinal, following all pregnant women from early pregnancy until 42 days postpartum in an intervention and a comparison area. The population was +/- 90,000 in the intervention area and 40,000 in the comparison area. Inclusion criteria were all mother and infant units delivered between June 1st, 1992 and May 31st, 1993. Analysis showed the following results: Most women sought antenatal care (> 95%). In Tanjungsari, nearly 90% sought such care from professional providers as versus 75% in the control area of Cisalak. Most women with bleeding or bleeding and edema during pregnancy sought professional assistance in both the study and control areas. However, fever for more than 3 days received more attention in the study area versus control area (93 vs. 69%). Greater than 85% of deliveries in both areas were conducted by TBAs. However, in the study area, nearly one-third of those with intrapartum complications (17%) delivered in a health facility compared to one-tenth in the control area. This meant a hospital delivery, primarily with assistance of a doctor or doctor/midwife combination. Overall referral rates by TBAs were low -13% of women with complications in Tanjungsari and 6% in Cisalak. More women with intrapartum complications were referred in the study area than in the control, and more complied when referred. Women who suffered intrapartum complications were more likely to have a perinatal death. Perinatal deaths declined in Tanjungsari, but not significantly. However, the trend over the period of the intervention shows an improvement in the deliveries managed by TBAs with more deaths resulting in the hands of professionals. Either women were arriving too late or the quality of care could not meet the needs. There was no change in the levels or place of perinatal deaths in Cisalak.

Adult↗
PubMed1991

Thyroid disease and pregnancy.

Thyroid disease is common in younger women and may be a factor in reproductive dysfunction. This probably only applies to severe cases of hyper- or hypothyroidism. Once adequately treated, neither of these disorders significantly impacts on fertility. The key is to recognize and to treat thyroid disorders in the reproductive-age woman before conception. Thyroxine therapy and even antithyroid drug therapy should be continued during pregnancy as necessary. Pregnancy is a euthyroid state that is normally maintained by complex changes in thyroid physiology. The fetal and neonatal hypothalamic-pituitary-thyroid system develops independently, but it may be influenced by thyroid disease in the mother. Early pregnancy is characterized by an increase in maternal T4 secretion stimulated by hCG and an increase in TBG, resulting in the elevated total serum T4 in pregnancy. The debate continues as to whether maternal T4 is important in early or late fetal brain development. If so, the physiologic changes in thyroid hormone secretion and transport in early pregnancy would help to ensure that a sufficient amount of thyroid hormone was available. There is new evidence in human subjects that substantial maternal T4 can cross the placenta during pregnancy, and this may be particularly important when fetal thyroid function is compromised as a result of congenital hypothyroidism. Maternal and fetal/neonatal outcomes in pregnancy are adversely affected if severe hypothyroidism is undiagnosed or inadequately treated. Thyroid function tests should be obtained during gestation in women taking T4 and appropriate dose adjustments should be made for TSH levels outside a normal range. The TSH-receptor blocking antibodies from the mother are a recognized cause of congenital hypothyroidism in the fetus and neonate that can be permanent or transient. If neonatal hypothyroidism is detected through neonatal screening programs, and prompt and adequate T4 replacement therapy is instituted as soon as possible following delivery, subsequent growth and development are usually normal. Paradoxically, pregnancy often has a favorable effect on the course of maternal Hashimoto's disease, although there is the risk of relapse postpartum. Pathophysiologic conditions of hCG secretion such as gestational trophoblastic disease and hyperemesis gravidarum may present as thyrotoxicosis in pregnancy, but the main cause of this syndrome is Graves' disease. The mainstay of treatment is antithyroid drugs and either propylthiouracil or methimazole may be used safely. Subtotal thyroidectomy, after medical control, is the alternative treatment, but radioiodine ablation is contraindicated.(ABSTRACT TRUNCATED AT 400 WORDS)

Female↗
PubMed1998

Evaluation of timed insemination during summer heat stress in lactating dairy cattle.

We wished to compare the effect of summer heat stress on pregnancy rate in cows that were inseminated at a set interval associated with a synchronized ovulation vs those inseminated upon routine estrus detection. The study was carried out on a commercial dairy farm in Florida from May to September 1995. Lactating dairy cows were given PGF2 alpha (25 mg i.m.) at 30 + 3 d postpartum and randomly assigned to be inseminated at a set time (Timed group) or when estrus was detected (Control group). Cows in the Timed group were synchronized by sequential administration of Buserelin (8 micrograms i.m.) on Day 0 at 1600 h, PGF2 alpha (25 mg i.m.) on Day 7 at 1600 h and Buserelin (8 micrograms i.m.) on Day 9 at 1600 h. They were inseminated on Day 10 between 0800 and 0900 h (Day 9 + 16 h). Cows in the Control group were given PGF2 alpha at 57 + 3 d postpartum and inseminated when detected in estrus. Estrus detection or insemination rate for control insemination cows was 18.1 +/- 2.5% versus 100% for time inseminated cows (P < 0.01). Mean interval from PGF2 alpha to insemination was shorter for time inseminated cows (3 +/- 2.1 d < 35.5 +/- 1.9 d; P < 0.01). Pregnancy rate was greater for time inseminated cows (13.9 +/- 2.6 > 4.8 +/- 2.5%; P < 0.01) as was overall pregnancy rate by 120 d postpartum (27.0 +/- 3.6 > 16.5 +/- 3.5%; P < 0.05). Number of days open for cows conceiving by 120 d postpartum was less for time inseminated cows (77.6 +/- 3.8 < 90.0 +/- 4.2 d; P < 0.05), as was interval to first service (58.7 +/- 2.1 < 91.0 +/- 1.9 d; P < 0.01). Services per conception were greater for time inseminated cows (1.63 +/- 0.10 > 1.27 +/- 0.11; P < 0.05). The timed insemination program did improve group reproductive performance. However, the timed insemination program will not protect the embryo from temperature-induced embryonic mortality, but management limitations induced by heat stress on estrus detection are eliminated. An economical evaluation of the timed insemination program indicates an increase in net revenue per cow with implementation of timed insemination for first service during the summer months.

Animals↗
PubMed1996

Enhanced reproductive responses to melatonin in juvenile Siberian hamsters.

Reproductive responses to melatonin (Mel) exposure were assessed in male Siberian hamsters gestated in long (16 h light/day; 16L) or short (8 h light/day; 8L) day lengths (DLs). Hamsters were maintained in constant light beginning at 14 days of age (day 14) and were infused for 3 successive days beginning on day 18, 25, or 32 with long (12 h/day) or short (6 h/day) durations of Mel or saline. Two weeks later, testis and body weights were determined. Responsiveness to Mel was enhanced in hamsters beginning shortly after weaning and was influenced by photoperiodic history. Gonadal growth in 16L hamsters was inhibited by 12-h Mel infusions initiated on day 18 or day 25, but infusions initiated on day 32 were ineffective. Hamsters gestated in 8L were not responsive to Mel treatments initiated on day 18, but discriminated 12-h from 6-h infusions at day 25 and manifested reduced gonadal growth after 12-h Mel infusions on day 32. Hamsters born in 8L to dams judged as photoinsensitive to short DLs did not respond to 12-h infusions on day 32 as inhibitory signals. We propose that maternal Mel secretion provides juvenile males with a photoperiodic history, which allows them to compare gestational with early postweaning Mel signals and thereby program seasonally appropriate developmental trajectories.

Aging↗
PubMed1995

Integrating smoking cessation into routine public prenatal care: the Smoking Cessation in Pregnancy project.

OBJECTIVES: In 1986, the state health departments of Colorado, Maryland, and Missouri conducted a federally-funded demonstration project to increase smoking cessation among pregnant women receiving prenatal care and services from the Women, Infants, and Children (WIC) program in public clinics. METHODS: Low-intensity interventions were designed to be integrated into routine prenatal care. Clinics were randomly assigned to intervention or control status; pregnant smokers filled out questionnaires and gave urine specimens at enrollment, in the eighth month of pregnancy, and postpartum. Urine cotinine concentrations were determined at CDC by enzyme-linked immunosorbent assay and were used to verify self-reported smoking status. RESULTS: At the eighth month of pregnancy, self-reported quitting was higher for intervention clinics than control clinics in all three states. However, the cotinine-verified quit rates were not significantly different. CONCLUSIONS: Biochemical verification of self-reported quitting is essential to the evaluation of smoking cessation interventions. Achieving changes in smoking behavior in pregnant women with low-intensity interventions is difficult.

Adult↗
PubMed1990

Bacteriuria in the puerperium. Risk factors, screening procedures, and treatment programs.

Screening for bacteriuria by culture of voided midstream urine was done in 6803 puerperal women; significant growth was found in 8.1%. The urine was recollected by suprapubic aspiration and bacteriuria was confirmed in 52%, corresponding to an incidence of bladder bacteriuria of 3.7%. A history of past urinary tract infection, bacteriuria in pregnancy, operative delivery, epidural anesthesia, and bladder catheterization increased the risk of postpartum urinary tract infection. Only 21% of the women complained of dysuria; this symptom occurred significantly more often after operative delivery and in patients with previous urinary tract infection. Two hundred fifty-one women with bladder bacteriuria were subjected to different treatments by randomized allocation: 153 patients with amoxicillin-susceptible bacterias were selected for amoxicillin treatment of 1, 3, and 10 days' duration. The cure rates were 84%, 94%, and 98%, respectively; the single-dose therapy was significantly less effective than 10 days' treatment (p less than 0.05). Forty-six women with amoxicillin-resistant bacterial infections received cephalexin or nitrofurantoin therapy of 7 days' duration; the cure rate was 91%. Fifty-two women served as control subjects and received no treatment. Ten weeks later 27% still had persistent bacteriuria in their suprapubic aspiration control specimens. All therapeutic regimens except the single-dose method showed a cure rate that was significantly higher than the spontaneous cure rate (p less than 0.05). Multiparity seemed to be a predisposing factor for persistence of bacteriuria. The study indicates that puerperal patients with positive midstream urine specimens should not be automatically treated, but more thoroughly examined. In cases of confirmed bladder bacteriuria, treatment should be recommended; 3 days' therapy appears to be sufficient.

Anti-Bacterial Agents↗
PubMed2000

Goitrogenesis during pregnancy and neonatal hypothyroxinaemia in a borderline iodine sufficient area.

OBJECTIVE: Severe iodine deficiency disorders (IDDs) may have been eradicated in many parts of the world, but milder forms still exist and may escape detection. We evaluated the impact of pregnancy on the maternal and fetal thyroid axis in Hong Kong, a coastal city in southern China with borderline iodine intake. DESIGN: A prospective study performed in a maternity hospital. PATIENTS: Two hundred and thirty pregnant women were prospectively studied and their neonates assessed at birth. MEASUREMENTS: Urine iodine concentration, thyroid function tests and thyroid volume (TV) by ultrasound were determined in the mothers during pregnancy and up to 3 months postpartum and in the neonates. RESULTS: Increased urinary iodine concentration was seen from first trimester onwards and the proportion of women having urine iodine concentration of < 0.4 micromol/l decreased from 11.3% in the first trimester to 4.7% in the third trimester. There was progressive reduction in circulating fT4 and fT3 concentrations and free thyroxine index (FTI) with increasing gestation and the percentage of women having subnormal levels at term were 53.2%, 61.1% and 4.8%, respectively. The serum TSH concentration during pregnancy doubled towards term. In the first trimester, multiparous women had significantly larger TV than the nulliparous women (P < 0.001). By the third trimester, TV had increased by 30% (range 3-230%) so that the goitre incidence was 14.1%, 21.8%, 25.9% during the three trimesters of pregnancy, and 24.3% and 21.9% at 6 weeks and 3 months postpartum (ANOVA, P < 0.05). The change in thyroid volume during pregnancy correlated positively with the change in thyroglobulin (r = 0.225, P < 0.002) and negatively with urinary iodine concentration (r = - 0.149, P < 0.02). Fourteen women with excessive thyroidal stimulation in the second trimester (defined as those with thyroglobulin (Tg) concentrations in the highest tertile and FTI in the lowest tertile) were found to have lower urine iodine concentrations and larger TV (both P < 0.005) throughout pregnancy, and their neonates had higher cord TSH (P < 0.05), Tg (P < 0.05) and slightly larger TV (P = 0.06) as compared to the findings in 216 pregnant women without evidence of thyroid stimulation. Seven neonates (50%) born to these women had subnormal fT4 levels at birth. CONCLUSION: In a borderline iodine sufficient area, pregnancy posed an important stress resulting in higher rates of maternal goitrogenesis as well as neonatal hypothyroxinaemia and hyperthyro- trophinaemia. An adequate iodization program is necessary to eliminate iodine deficiency disorders during pregnancy.

Analysis of Variance↗
PubMed2005

Does stage-based smoking cessation advice in pregnancy result in long-term quitters? 18-month postpartum follow-up of a randomized controlled trial.

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.

Adult↗
PubMed1994

Rapid screening for early detection of mother-to-child transmission of human immunodeficiency virus type 1.

The testing of dried blood spots (DBSs) for the presence of human immunodeficiency type 1 (HIV-1) proviral DNA by PCR was first described in 1991. The technology has proven to be particularly valuable for resolving the infection status in HIV-1-indeterminate infants born to HIV-1-seropositive mothers. To broaden the applicability of DBS PCR, we adapted it to a standardized, commercially available microwell plate amplification and detection kit, Amplicor HIV-1, produced by Roche Diagnostic Systems. The microwell assay is rapid and easy to perform and uses equipment that is readily available in routine diagnostic laboratories. The high level of performance of the assay was demonstrated in 1,168 duplicate tests performed on 584 DBSs from 178 uninfected and 100 HIV-1-infected individuals, including 56 children with perinatally acquired HIV-1. Of 12 infants who were followed prospectively from birth, 3 (25%) were infected in utero (PCR positive at birth) and 9 (75%) were infected intrapartum (PCR negative, culture negative at birth). Overall, HIV-1 DNA was identified in 3 of 11 (27.3%) DBSs collected from infected infants during the first 4 days of life, 8 of 9 (88.9%) DBSs collected between 10 and 15 days postpartum, and 166 of 167 (99.4%) DBSs collected after 15 days of age. All 320 DBSs from uninfected children were PCR DNA negative. These findings indicate that use of the Roche microwell DBS PCR assay provides a powerful new approach for large-scale perinatal screening programs and population-based studies of vertical transmission.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Influences on breastfeeding rates in low income communities in Ontario.

The purpose of this paper was to identify factors associated with breastfeeding among mothers of children born in 1994 in five of the low income communities participating in the longitudinal prevention initiative "Better Beginnings, Better Futures." Household income was < or = poverty line for 76%, 63% had completed high school or beyond, and 29% were born outside of Canada. The breastfeeding initiation rate was 77% (380 of 493). Of the 270 women who initiated breastfeeding and were interviewed up to five months postpartum, 63% continued for at least three months. Women with higher education, married, not experiencing financial stress and who attended prenatal classes were more likely to initiate breastfeeding. Continuation of breastfeeding was associated with older age, higher education, not smoking, and participation in a home visitor program. Breastfeeding promotion strategies should include ongoing support as well as education components.

Breast Feeding↗
PubMed1982

Bovine cystic ovarian disease: hereditary relationships and case study.

Cystic ovarian disease (COD) was studied in a closed 300-cow dairy herd, using Dairy Herd Improvement Association and individual health records for a 7-year period (1974-1980). There were 2,112 calvings by 649 cows during the period. Cysts were found in 130 cows. Of the 649 cows that calved, 110 (16.9%) produced at least 1 daughter in which COD developed. Two bulls sired 17.6% of the daughters with COD, which was more than anticipated inasmuch as they sired only 11.6% of all daughters (P less than 0.05). These bulls were removed from the breeding program in an attempt to reduce code in the herd.

Animals↗
PubMedDate not supplied

Centering pregnancy. An interdisciplinary model of empowerment.

This is a time of change within the health care system. This has created a challenge for health care providers to develop creative new patterns that will provide quality service within a system that is mandating more economy and efficiency. The Centering Pregnancy program abolishes routine prenatal care by bringing women out of examination rooms and into groups for their care. The design incorporates the three components of prenatal care--risk assessment, education, and support--into one entity. Women are placed into groups of 8 to 12 based on estimated dates of delivery and meet for ten 90-minute prenatal or postpartum visits at regular intervals. At these visits, standard prenatal risk assessment is completed within the group setting, an educational format is followed that uses a didactic discussion format, and time is provided for women to talk and share with one another. By incorporating these three components into one whole, emphasis is placed on their collective importance. Women are encouraged to take responsibility for themselves; this leads to a shift in the client-provider power base. Evaluative data demonstrated that 96% of the women preferred receiving their prenatal care in groups. This model is interdisciplinary in design and demonstrates provider satisfaction, as well as efficiency in delivery of care. It is an excellent model for the care of teens and for midwives and nurse practitioners to lead. The combination of satisfaction, good outcomes, and effective delivery of care makes this an attractive model for agencies to implement.

Adolescent↗
PubMed1993

Developing skills for delivery and maternity care.

This issue of Safe Motherhood looks at training for safe motherhood, concentrating on how to ensure that birth attendants and health care providers have the necessary skills to save life and ensure safe delivery. WHO believes that to achieve safe motherhood, training programs for all those providing health services to women--from the obstetrician to the traditional birth attendant--should receive attention. In order to encourage new thinking on training for maternal health, WHO is involved in initiatives with both governments and key international associations and agencies in many countries. The Special Feature's Ideas for Change includes examples of some of the more inspirational training initiatives such as giving skills to Chinese village doctors to manage postpartum hemorrhage, the team approach to solving the problems of district maternal health care in Uganda, and the success of a project in Mozambique which trains surgical technicians to undertake cesarean sections.

Delivery of Health Care↗
PubMed1998

Effects of a smoking cessation program for pregnant women and their partners attending a public hospital antenatal clinic.

This study aimed to assess the effect of a hospital-based smoking cessation intervention delivered by midwives during routine antenatal and postnatal care on the smoking habits of pregnant women and their partners. At the first antenatal visit, women in the intervention group (n = 110) were given a demonstration of the immediate effects of smoking on foetal heart rate, brief smoking cessation advice and smoking cessation booklets for themselves and their partners; at delivery, they were given brief advice and a booklet about postpartum cessation. Compared with an historical control group who received usual care (n = 110) and assuming those lost to follow-up continued to smoke, biochemically-verified maternal cessation sustained from at least 24 weeks gestation to late pregnancy was 6.4% in the intervention group and 1.8% in the comparison group. However, there was no difference between maternal quit rates at six months postpartum. Partners were more likely to try to quit in the intervention group, but quit rates did not differ. Exposure to the intervention was not associated with increased levels of psychological distress, as measured by the 12-item General Health Questionnaire. We conclude that this type of intervention, when implemented by staff during routine care, is probably associated with a small improvement in maternal cessation in pregnancy, similar to that produced by minimal advice to quit smoking.

Adult↗
PubMed1999

Is knowledge about signs and symptoms of preterm labor related to low birth weight?

The intent of this study was to explore the relationship of patient knowledge about the signs and symptoms of preterm labor and low birth weight. To this end, 538 women were interviewed in the postpartum period. Five aspects of preterm labor knowledge (abdominal tightness, vaginal discharge, cramping, diarrhea, and bleeding) were sought, along with standard demographic information. Data were analyzed as dichotomous variables and compared using odds ratios. Logistic regression was chosen to calculate adjusted odds ratios, including only those factors found to be associated with low birth weight. Patient knowledge of each varied from 46 to 87% for the five items. Only one third knew all five areas. Knowledge of the importance of abdominal tightness, vaginal discharge, and cramping were associated with a reduction in low birth weight, as was knowledge of all five aspects. However, regression analysis failed to support a significant association with any of the five areas alone or when considered as a group. The low sensitivity of the relationship between patient knowledge and low birth weight and the lack of correlation after regression suggest that programs focusing on enhanced patient education may have limited benefits.

Abdomen↗
PubMedDate not supplied

The effect of exercise on the circumvaginal muscles in postpartum women.

The effect of exercise on pressure developed by the circumvaginal muscles (CVM) in postpartum women was studied. The CVM assessment system described earlier by Dougherty, Abrams, and McKey used an intravaginal balloon device (IVBD) developed from an impression and model of the vagina. The system (IVBD, pressure transducer and strip chart recorder) provided permanent CVM pressure tracings with high test-re-test reliability (n = 16; r = .85) for maximum pressure (MP). The hypothesis in the research reported here was that exercise with and without an IVBD, when compared to no exercise, would result in significantly higher MP and pressure over time (POT). Forty-five healthy PP volunteers were randomly assigned to a 10-minute per day home training program, for six weeks. The baseline and six-week assessments consisted of CVM pressure tracings during contraction. Dependent variables were MP (highest pressure attained) and POT (area under the pressure curve). Although no significant differences were found between the home training groups, greater improvement was found in the exercise groups. Variability within subjects partly accounts for the results. Pressure changes before and after pregnancy and before and after CVM exercise are demonstrated in a case study. The findings support the use of CVM exercise in the postpartum.

Exercise↗
PubMed1999

Anal incontinence after obstetric third- /fourth-degree laceration. One-year follow-up after pelvic floor exercises.

The study was a 1-year follow-up of 48 women with obstetric third- /fourth-degree perineal laceration. After primary surgical repair the symptomatic patients were treated with pelvic floor exercises with or without transanal electrical stimulation. Various methods for assessing anal sphincter function were also evaluated. One month postpartum 10 women (21%) complained of anal incontinence, 8 for flatus only; 1 patient was reoperated on. After 1 year none complained of fecal incontinence, and 3 (7%) complained of flatus incontinence. We found relatively few women with anal incontinence after third- /fourth-degree laceration. The pelvic floor training program was effective, but electrical stimulation was abandoned because of anal pain. Grade IIIb lesion, dilution of the sphincter at anal ultrasonography, and sphincter weakness at palpation were significantly related to symptoms of anal incontinence. For routine follow-up after third- /fourth-degree laceration, palpation of the anal sphincter and pelvic floor seems sufficient as first-line assessment.

Adult↗