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PubMed2005

Factors associated with low immunity to rubella infection on antenatal screening.

BACKGROUND: Rubella infection during the first trimester results in congenital rubella syndrome. There has been little recent published evidence identifying those at-risk of infection in the first trimester of pregnancy. This study examined the level of rubella immunity in pregnant women in a part of Sydney and risk factors for non-immunity. METHODS: We looked at data on all confinements at two maternity hospitals in Sydney in the 2-year period between July 1999 and June 2001. Variables included in our data set included mother's country of birth, mother's date of birth, hospital status (public or private patient), parity, rubella status and postpartum rubella vaccination. RESULTS: Of the 8096 confinements, the mother was documented as being non-immune to rubella in 567 cases (7%) of cases. Of the 567 confinements where rubella status was documented as non-immune, Asian-born women comprised of 65% (366) of non-immune women while 13% (73) were Australian-born. Country of birth remained a strong predictor of immunity, even after controlling for age, parity and hospital status. Maternal age > 35 years and nulliparity were also significant risk factors for non-immunity. CONCLUSION: Programs targeting underimmunised populations for rubella vaccination should focus on overseas-born women, particularly those born in Asia, nulliparous women and also women > 35 years of age.

Adult↗
PubMed1989

Is there a greater incidence of abdominal pregnancy in developing countries? Report of four cases.

Early ectopic pregnancies often are unrecognized in rural areas of Papua New Guinea. Some of these untreated tubal pregnancies abort into the peritoneal cavity and continue as advanced abdominal pregnancies. Of 72 ectopic pregnancies that were treated surgically over a 67-month period, four fetuses were found to be implanted in the abdomen. Two of these pregnancies proceeded to term and viable normal infants were delivered. One in 18 ectopic pregnancies were of advanced gestation in the abdomen. This incidence is higher than has been reported previously and is related to the poor utilization of medical care by pregnant women in rural areas of Papua New Guinea.

Adult↗
PubMed1987

The medical and psychosocial impact of comprehensive care on adolescent pregnancy and parenthood.

To assess the medical and psychosocial effects of services provided by a comprehensive adolescent pregnancy and parenthood program, 125 adolescents who received care from a comprehensive program were compared with 135 adolescents who received care from community health providers. Few differences were found in pregnancy outcome measures. At 12 and 26 months after delivery, however, the intervention group scored significantly better on composite measures encompassing medical, psychosocial, and parenting events than did the comparison group, even after accounting for possible confounding factors. This suggests that comprehensive care has little effect on pregnancy outcomes for those adolescents who are already receiving prenatal and nutritional services, but does have a significant effect on events occurring during the first and second postpartum years.

Adolescent↗
PubMed1993

Medicaid program; exemption of poverty level pregnant women from the cooperation requirements of establishing paternity and obtaining medical support and payments as a condition of eligibility; technical correction--HCFA. Final rule with comment period.

In general, as a condition of eligibility for Medicaid coverage, each legally able applicant and recipient is required by section 1912(a) of the Social Security Act (the Act) to cooperate with the State in establishing the paternity of any eligible child born out of wedlock and in obtaining medical support and payments. The condition is required to be met unless the individual establishes good cause of not cooperating. Section 4606 of the Omnibus Budget Reconciliation Act of 1990, (OBRA '90), Public Law 101-508, provides an exemption to this requirement for certain pregnant women and women in the postpartum period, as described in section 1902(l)(1)(A) of the Act. We have identified this group as "poverty level pregnant women". This final rule with comment period modifies our regulations to incorporate and interpret this exemption.

Eligibility Determination↗
PubMed1989

A prenatal diagnostic center's first-year experience with the California alpha-Fetoprotein Screening Program.

The University of California Davis Medical Center has offered secondary and tertiary care to pregnant patients with abnormal maternal serum alpha-fetoprotein levels since the start of the California alpha-Fetoprotein Screening Program in April 1986. In our first year of involvement with this method of prenatal screening, 452 patients were referred to our center for further evaluation and follow-up of either high or low maternal serum alpha-fetoprotein levels, as determined by the standard multiple of the median adjusted for maternal weight, race, and presence of insulin-dependent diabetes mellitus. This article presents the first-year results of our clinical experience. Information is presented concerning medical complications, screening and diagnostic test results and their confirmation, clinical procedures performed, and postpartum follow-up reports. Findings of pregnancy outcomes associated with low and high alpha-fetoprotein levels are presented and discussed.

Adult↗
PubMed2006

The effects of smoking cessation counseling by midwives on Dutch pregnant women and their partners.

OBJECTIVE: Smoking during pregnancy is an important problem in the Netherlands. We tested the effectiveness of a health counseling method by midwives using a RCT. METHODS: Four provinces with 42 practices including 118 midwives were randomly assigned to the experimental or control condition. Midwives in the experimental group provided brief health counseling, self-help materials on smoking cessation during pregnancy and early postpartum, and a partner booklet. Controls received routine care. The main outcome measures were 7-day abstinence, continuous abstinence, and partner smoking at 6 weeks post-intervention (T1) and 6 weeks postpartum (T2). RESULTS: Multi-level analysis revealed significant differences between both conditions at T1 and T2 using intention-to-treat analysis. Nineteen percent of the experimental group reported 7-day abstinence compared to 7% of the control group at T1, and 21 and 12%, respectively, at T2. For continuous abstinence these percentages were 12% in the experimental group and 3% in the control group. The partner intervention was not successful. CONCLUSION: The intervention resulted in significant effects on smoking behavior for pregnant women, but not for partner smoking. PRACTICE IMPLICATIONS: The program realized short-term effects. An important precondition is that midwives need a proper training.

Adult↗
PubMed1975

Current aspects of sterilization. The selection and application of various surgical methods of sterilization.

A partial analysis of 4,270 female sterilizations performed during a 7 year time period was described as related to changing patterns of application according to a sterilization program. Special attention was given to such factors as type of procedure, reasons for selection of procedures, ancillary conditions, mortality rate, and follow-up. A plea is made for accuracy when a sterilization is truly used as the primary indication for surgery and for flexibility and individualization in the application of sterilization techniques.

Culdoscopy↗
PubMedDate not supplied

Social and professional support for pregnant and parenting women.

PURPOSE: A literature review to contrast the role of social and professional support in improving maternal and infant outcomes in pregnant and parenting women. In addition, recommendations are made for future research and policy and program development concerning support needed by pregnant and parenting women. DATA SOURCES: Data were limited to published studies. Searches of computerized databases, hand searches of journals, and backward searches from reference lists of studies were conducted. Nursing, medicine, psychology, public health, sociology, and social work literatures were searched (CINAHL, Medline, PsychLit, Social Sciences Abstracts, Social Sciences Citation, and Social Work Abstracts). STUDY SELECTION: The studies focused on outcomes of social support and professional support to pregnant and parenting women. The samples of the studies included pregnant women and parenting women up to 2 years postpartum. Studies reviewed were conducted in the United States or Canada and included maternal and/or infant outcomes. All ages and races of pregnant and parenting women were considered. DATA EXTRACTION: Data were extracted from each study concerning the theoretical framework, variables, sample, design, measuring instruments, interventions, and outcomes. DATA SYNTHESIS: Social support outcomes were summarized in paragraphs while a table was used to summarize professional support intervention outcomes. CONCLUSIONS: Outcomes associated with specific support interventions should be clearly identified, informed by theory, and include assisting the pregnant and parenting woman to improve her social support.

Clinical Competence↗
PubMed1995

Pregnancy in women 50 or more years of age: outcomes of 22 consecutively established pregnancies from oocyte donation.

OBJECTIVE: To describe the reproductive and obstetric outcomes of women > or = 50 years attempting pregnancy using donor oocytes. SETTING: The IVF program at the University of Southern California. PATIENTS: Thirty-six postmenopausal women aged 50 to 59 years, mean 52.3 +/- 2.6 years (mean +/- SD) were screened medically, reproductively, and psychologically and enrolled in a trial of oocyte donation. INTERVENTIONS: Recipients underwent hormone replacement therapy using oral micronized E2 and IM administered P. Oocytes were provided by designated gamete donors (mean age 30.5 +/- 4.4 years). Embryos (4.3 +/- 1.2) were transferred transcervically. MAIN OUTCOME MEASURES: Rates for embryo implantation, spontaneous abortion, ongoing and delivered pregnancies, as well as the gestational age at delivery, birthweights, complications, and postpartum outcomes. RESULTS: Forty-five aspirations resulted in 22 pregnancies (48.9%): 3 preclinical, 2 ending in spontaneous abortion, and 17 viable pregnancies (37.8%). The embryo implantation rate was 20.6%. Nine of 17 pregnancies (52.9%) were multiple gestations (6 twins; 1 triplet; and 2 quadruplets, selectively terminated to twins). All pregnancies delivered beyond 32 weeks: mean gestational age for singletons was 38.4 +/- 1.9 weeks (range 35 to 41 weeks); mean gestational age for twins was 36.3 +/- 1.4 weeks (range 34 to 38 weeks); the triplet pregnancy delivered at 32 weeks. Complications occurred in eight patients; gestational hypertension (n = 7), preterm labor (n = 3), gestational diabetes (n = 2), and pre-eclampsia (n = 1). One infant was trisomy-21. CONCLUSION: Patients > or = 50 years experience similar pregnancy rates after oocyte donation as younger women and are at equal risk for multiple gestation. Antenatal complications were experienced by the majority of patients, underscoring the importance of high risk obstetric surveillance and care.

Birth Rate↗
PubMed1987

Maternal mortality--a twelve-year survey at the University of Ilorin Teaching Hospital (U.I.T.H.) Ilorin, Nigeria.

This paper concerns an analysis of maternal death at the University of Ilorin Teaching Hospital (U.I.T.H.) Ilorin over a 12-year period (1972-1983). There were 138,577 births and 624 deaths making a maternal mortality rate of 4.50 per 1000 births. Hemorrhage, ruptured uterus and obstructed labor were the major direct obstetric causes of death. The most important indirect causes were cerebrospinal meningitis, pulmonary infections and fulminating hepatitis. The main avoidable factors were ineffective and cumbersome blood transfusion services; poor management of the third stage of labor; large number of unbooked patients and poor delivery room structure encouraging sepsis. Suggestions are made for a more integrated type of maternity services in our hospital, health education programs for the public and particularly the expectant women and availability of an effective blood bank service within the maternity hospital premises for prompt treatment of patients requiring emergency blood transfusion. The analysis underlines the great problem of maternal mortality in the developing world.

Adult↗
PubMed2006

Postnatal pelvic floor muscle training for preventing and treating urinary incontinence: where do we stand?

PURPOSE OF REVIEW: Postnatal pelvic floor muscle training aims to rehabilitate the pelvic floor muscles. To be effective, a certain exercise dosage must be respected. Recent trials evaluated the effect of different programs on prevention/treatment of urinary incontinence immediately after delivery and in treatment of persistent incontinence. RECENT FINDINGS: Only three systematic reviews, six trials, and four follow-up studies have been published in the past two decades. High heterogeneity in postnatal pelvic floor muscle training programs is observed throughout the literature, making comparisons difficult. In the prevention/treatment of postnatal urinary incontinence immediately after delivery and in persistent incontinence, supervised intensive programs prove more effective than standard postnatal care. Longer-term results have yet to show advantages for postnatal training programs. SUMMARY: Although a certain exercise dosage must be respected for a postnatal pelvic floor muscle training program to be effective, a few randomized controlled trials present such dosage. Randomized controlled trials should study the effect of supervised, intensive training protocols with adherence aids. As standard care does not seem to reduce the prevalence of postnatal urinary incontinence, obstetrics services must address delivery of postnatal pelvic floor muscle training.

Female↗
PubMedDate not supplied

The experience of seeking help for postnatal depression.

This qualitative study sought to explore women's experiences of support and treatment for postnatal depression. In-depth interviews from seven women were analysed using the phenomenological method described by Creswell (1998). Findings indicate that partners provided women the most support. The women did not know where to seek professional help, often being identified and helped by the maternal health nurse who monitors and guides the progress of their babies' development. Hospital programs were criticised for not informing and involving family. The women were dissatisfied with hospital doctors and their GPs claiming they had limited time for counselling, preferring to prescribe medication that alleviated symptoms but reinforced feelings of inadequacy. Recommendations are made to involve families and to use the unique position of the maternal health nurse in assessing new mothers.

Adult↗
PubMed1995

Impact of health education during pregnancy on behavior and utilization of health resources. Latin American Network for Perinatal and Reproductive Research.

OBJECTIVE: Our purpose was to assess whether an intervention in the education of the mother and the support person involves a change in health-related behavior and use of health facilities. STUDY DESIGN: A randomized, controlled trial was conducted in four cities of Latin America on pregnant women at risk. Half of them (n = 1115) received a home intervention of four to six visits dealing with psychosocial support and education about health-related habits, alarm signs, hospital facilities, antismoking and antialcohol programs, and a reinforcement of adequate health services utilization for the pregnant woman and a support person. The control group (n = 1120) received routine prenatal care. RESULTS: The distribution of risk factors and demographic, obstetric, and psychologic characteristics at baseline was similar in both groups. Women in the intervention group showed a statistically significant better knowledge of seven of the nine alarm signs considered and of two of the three labor-onset signs required. No differences between groups were observed in improvement on diet, cigarette and alcohol consumption, maternal physical strain, lactation at 40 days postpartum, and utilization of health facilities. CONCLUSIONS: An intervention of psychosocial support and health education during pregnancy failed to show any benefit on perinatal outcome, health-related behavior, or utilization of health facilities.

Alcohol Drinking↗
PubMed1975

Contraceptive practice required to meet a prescribed crude birth rate target: a proposed macro-model (TABRAP) and hypothetical illustrations.

TABRAP (TArget Birth Rate Acceptor Program) is a computer programmed model that provides a direct solution to the problem of determining the total annual numbers of contraceptive acceptors required to achieve a prescribed crude birth rate target path. Applied to an initial population for which age structure, the fertility schedule, and expected trends in life expectancy and age-specific proportions of females married are known, TABRAP incorporates the following factors: age at acceptance, with acceptors drawn from currently married nonusers; age-method-specific attrition rates of users; a potential fertility schedule of acceptors that allows for aging and sterility; and allowance both for postpartum anovulation and nine months for gestation to time properly the averted births. TABRAP generates annual data on acceptors, couple-years of use, births averted and age-specific fertility rates that meet the crude birth rate target. Resulting changes in population size, age structure and crude vital rates, also yielded, are invariant with respect to acceptor age and method mix. Assuming a target to reduce the crude birth rate from 45 to 30 in ten years, TABRAP is illustrated for seven mixes of acceptor age-method combinations applied to a population approximately that of Thailand, circa 1965.

Adolescent↗
PubMedDate not supplied

Update through 1985 on the incidence of toxic shock syndrome among members of a prepaid health plan.

Through hospital records of men and women aged 15-34 years who were members of the Northern California Kaiser-Permanente Medical Care Program, trends in the incidence of toxic shock syndrome (TSS) requiring hospitalization in 1984-1985 were examined, and the results were compared with those for the period 1972-1983. No definite or probable cases of TSS were found in men during either 1984 or 1985. A total of 16 cases of TSS (10 definite and six probable) were found in women in 1984-1985. Ten (71%) of 14 cases for which the menstrual status of the patient could be determined unambiguously from the medical record occurred during menstruation, and two of the four nonmenstrual cases occurred in postpartum women using barrier contraception. Of the 16 cases, 14 (88%) were diagnosed as TSS or probable TSS by the attending physician, although only nine (64%) of the 14 diagnosed cases were given the correct discharge code. While trends in the incidence of TSS requiring hospitalization in women 15-34 years of age generally paralleled changes in the absorbency of available tampons, the contribution of other factors (e.g., changes in the chemical composition of tampons, changes in patterns of tampon use) to these trends could not be assessed.

Adolescent↗
PubMedDate not supplied

Understanding newborn infant readmission: findings of the Ontario Mother and Infant Survey.

The Ontario Mother and Infant Survey examined health and social service utilization of postpartum women and newborn infants from five hospital sites. A cross-sectional multilanguage survey design with longitudinal follow-up was used: 1,250 eligible, consenting women completed a self-report questionnaire in hospital and 875 women participated in a structured telephone interview at four weeks post-discharge. Rates of newborn infant readmission ranged from 2.4% to 6.7%. The best predictors of readmission were: main source of household income was other than employment; maternal self-rating of health was poor; mother anticipated inadequate help and support at home following discharge; mother received help from friends/neighbours following discharge; and mother had concern about infant care and behaviour. Readmission was not associated with length of postpartum hospital stay. The study findings suggest that there is a complex relationship between infant health care needs, family resources and provider practices that produces clinically important, site-specific readmission patterns.

Female↗
PubMedDate not supplied

Immunizations in pregnancy. A public health perspective.

With the successful implementation of childhood immunization programs in the United States, an increasing percentage of vaccine-preventable infections now occur in adults. By providing primary care services to adult women, midwives are in a unique position to halt the spread of these infections. Immunizations are often avoided in pregnancy and the early post partum period, however, in the mistaken belief that vaccines are harmful to the fetus or neonate. This article, the first in a two-part series on immunizations, reviews the current epidemiology of vaccine-preventable diseases, discusses the indications and precautions for vaccine usage in pregnancy and the early postpartum period, and presents the current recommendations from the American Committee on Immunization Practices for the most commonly administered adult immunizations: tetanus-diphtheria, hepatitis B, influenza, pneumococcal, measles, mumps, rubella, and varicella.

Adult↗
PubMed1998

Breastfeeding among low-income women with and without peer support.

This research examined the effect of peer support on breastfeeding duration and exclusivity (breastfeeding without supplements) in a population of low-income women during the first 3 months postpartum. Participants in the peer counselor group (n = 18) exhibited higher rates of exclusive breastfeeding across time than those without a counselor (n = 18), and more exclusive breastfeeding was associated with long duration overall. Mother's career plans had the greatest effect on duration of breastfeeding. Women who intended to return to work, attend school, or both breastfed 6 to 9 weeks less than participants who intended to stay home. Attendance at a breastfeeding class and knowing someone who had breastfed was significantly correlated with a longer duration of breastfeeding. Nutritionists from the Women, Infants and Children (WIC) Program were the primary source of breastfeeding information. Two main factors discouraged women from breastfeeding: returning to work, school, or both and the perception of a diminished milk supply. Greater emphasis should be placed on prenatal breastfeeding education for low-income women, and their mothers and grandmothers should be included. Peer support is one important component of social support in the area of breastfeeding that community health nurses (CHNs) can utilize. CHNs are in a unique position to assist working mothers, provide support, and develop educational programs to enhance breastfeeding success in this population.

Adolescent↗