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Aim Background Method Results Implications for nursing/midwifery and health policy To determine the experiences of nurses and midwives providing perinatal care in an earthquake area.On February 6, 2023, two earthquakes measuring 7.8 and 7.6 magnitudes struck Turkey, affecting a large area. It is crucial for perinatal care to be rapidly organized, provided under the most suitable conditions, and delivered by qualified health professionals. Understanding the post‐disaster experiences of nurses and midwives is crucial to addressing this issue.This is a qualitative study using phenomenological methodology with 8 nurses and 12 midwives in the earthquake‐affected area. Personal information and semistructured interview forms were used for data collection. Content analysis was used for data analysis.Participants had a mean age of 33.75 years. The experiences of nurses and midwives were grouped into five themes: emotions experienced, challenges encountered, problems in perinatal services, coping mechanisms, and recommendations. The emotions experienced theme encompasses both positive and negative emotions. The challenges encountered theme includes challenging environmental conditions, organizational issues, problems with medical supplies and drugs, and being a victim of the earthquake. The problems in perinatal services theme includes pregnancy, childbirth, and postpartum services. The coping mechanism's theme encompasses problem‐focused and emotion‐focused coping strategies. The recommendations theme includes education and awareness, preparedness for disasters, and sustainable services.Nurses and midwives working in the earthquake‐affected area experienced numerous physical and psychological challenges and encountered difficulties in delivering health services. A disaster education course including simulated disaster drills and practice can be integrated into the education system. Strengthening healthcare facilities against disasters and raising awareness among the community are crucial. [ABSTRACT FROM AUTHOR]

Introduction: Screening for substance use during pregnancy is critical for enhancing maternal health and perinatal outcomes. However, disparities persist in screening and intervention rates within maternity services. This retrospective case note review explored contemporaneous practices around screening and interventions for substance use among pregnant women during routine antenatal care. Methods: A random sample of 100 sets of maternity records were reviewed. Eligible cases included any woman attending initial pregnancy assessments at one of two South Australian metropolitan Hospital‐based antenatal clinics, from July 2019–September 2020. Screening rates for past and current alcohol, tobacco and other substance use were identified and compared with data from a subset of a nationally representative survey. Intervention details and referral pathways were also assessed. Results: The final sample of eligible cases (n = 93) demonstrated prioritisation of screening for current use, over past use, across all substances (p < 0.001). Screening was most likely for tobacco and least likely for e‐cigarettes (p < 0.001). Significant underreporting of past use compared with the benchmark was identified for all substances (except tobacco, p = 0.224). Interventions typically involved written resources, which were usually declined by clients. Discussion and Conclusions: Despite longstanding recommendations, screening and intervention practices for substance use appear inconsistent. With the recent emergence of vaping, no evidence of updated approaches to identifying e‐cigarette consumption in pregnant women was found. Several opportunities for enhancing routine screening and intervention practices within antenatal clinics were identified, and will inform the development of policy directives, targeted training modules, and other resources for health professionals working in these services. [ABSTRACT FROM AUTHOR]

Objective: To assess the uptake of a multidisciplinary team approach in obstetric disseminated intravascular coagulopathy (DIC) management in a low‐ to middle‐income country. Methods: A cross‐sectional observational study, in which a semi‐structured and pre‐tested questionnaire was used to collect data on the uptake by Nigerian obstetricians of the multidisciplinary team approach to obstetric DIC management. Results: A total of 171 obstetricians responded, 82 (48.0%) were consultants and 89 (52.0%) were specialist registrars. Most (165; 96.5%) practiced in tertiary healthcare facilities and the multidisciplinary team approach was the most preferred (162; 94.7%) management approach. In all, 142 (83.0%) supported the invitation of hematologists always in the management whereas 115 (67.3%) participants recommended that involvement of specialists in the treatment should be when clinical presentation was suggestive of DIC. No significant association existed between years of obstetric practice and adoption of a multidisciplinary team‐based approach (χ2 = 9.590; P = 0.252). Conclusion: A multidisciplinary approach is widely adopted in the management of obstetric DIC, with hematologists being a key member of the team. Synopsis: A multidisciplinary management team approach to DIC is preferable with hematologists as key members. Literature on a team‐based approach to obstetric DIC care is sparse. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Design Setting Sample Methods Main Outcome Measures Results Conclusions Deaf and hard of hearing (DHH) women experience higher rates of reproductive healthcare barriers and adverse birth outcomes compared to their hearing peers. This study explores the pregnancy experiences of DHH women who do not sign to better understand their barriers and facilitators to optimal perinatal health care.Qualitative study using thematic analysis.Semi‐structured, individual remote, or in‐person interviews in the United States.Twenty‐two DHH English speakers (non‐signers) who gave birth in the United States within the past 5 years.Semi‐structured interviews explored how DHH women experienced pregnancy and birth, including access to perinatal information and resources, relationships with healthcare providers, communication access, and their involvement with the healthcare system throughout pregnancy. A thematic analysis was conducted.The barriers and facilitators related to a positive perinatal care experience among DHH women.Five key themes emerged. For barriers, healthcare communication breakdowns and loss of patient autonomy highlighted DHH women's struggle with perinatal health care. In contrast, DHH participants outlined the importance of accessible health communication practices and accommodations, use of patient advocacy or self‐advocacy, and assistive technologies for DHH parents for more positive perinatal care experiences.Perinatal healthcare providers and staff should routinely inquire about ways to ensure an inclusive and accessible healthcare experience for their DHH patients and provide communication accommodations for optimal care. Additionally, healthcare providers should be more aware of the unique parenting needs and resources of their DHH patients. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Sickle cell disease (SCD) is associated with complications during pregnancy and can negatively influence maternal outcomes. Our study aimed to determine the prevalence and predictors of maternal morbidity among participants enrolled in an eight‐site SCD Implementation Consortium (SCDIC) registry.We conducted a cross‐sectional analysis of female registry participants, aged 15–45 years, with a confirmed diagnosis of SCD. Participants completed a survey of self‐reported pregnancies and outcomes.Seven hundred and thirty‐eight individuals had at least one pregnancy event, with 1076 live births. Twenty percent reported a pregnancy loss or fetal demise. Of the 1076 live births, 75% involved at least one complication. The most prevalent complications were pain crises (61.1%) and pregnancy requiring blood transfusion(s) (33.0%).Multiparous individuals with a prior occurrence of a complication in a previous pregnancy had higher odds of recurrence of the same complication in subsequent pregnancies (i.e., previous acute crisis was associated with subsequent acute pain events odds ratio [OR]: 3.13; 95% confidence interval [CI]: 2.06–4.76) and prior transfusion requiring another transfusion (OR: 3.22; 95% CI: 2.01–5.16).Individuals reported a high prevalence of pregnancy loss and maternal complications. Our findings underscore the importance of preconception counseling and early initiation of perinatal care in SCD. [ABSTRACT FROM AUTHOR]

Background: Ultrasound technology is indispensable in perinatal care due to its non-invasive and painless nature, offering vital insights into foetal development and childbirth. With the academisation of midwifery in Germany, there is a growing necessity to incorporate ultrasound training into midwifery education. This paper discusses the development and implementation of an introductory obstetric ultrasound curriculum tailored for midwifery students, focusing on fundamental ultrasound techniques in obstetrics. Materials and methods: We used Kern's six-step approach of curricular development comprising [1] problem identification and general needs assessment [2], needs assessment of the targeted learners [3], goals and objectives [4], educational strategies [5], implementation, and [6] evaluation and feedback. The individual components of the curriculum were meticulously designed based on comprehensive literature reviews, thorough consultations with experienced ultrasound experts and evaluated needs of participants prior to the course instruction. Results: Twenty-seven ultrasound-naive midwifery students participated in the newly developed obstetric ultrasound course. Structured as a modular and integrated framework, the course aimed to provide theoretical and practical instruction in basic obstetric ultrasound, with intrapartum sonography and focused assessment with abdominal sonography for trauma (FAST) as key supplementary specialisations. The results demonstrated a significant increase in the students' overall knowledge and practical skills, as evidenced by the median post-course total score rising from 20 to 60 out of 75 (p < 0.001) in the objective structured clinical examination (OSCE) and from 9 to 19 out of 20 (p = 0.001) in the knowledge test. Additionally, students reported high satisfaction with the course and noted substantial personal benefits. Conclusion: The integration of basic obstetric ultrasound training within the midwifery curriculum is feasible and effective to teach fundamental knowledge and skills of obstetric ultrasound examinations to midwifery students. Expansion, standardisation and regulatory structures are critical components for a continued improvement and realistic integration into midwifery educational frameworks and thus the further development of the midwifery profession. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To evaluate maternal and obstetric risk factors associated with retained placenta following singleton live vaginal births.We conducted a retrospective cohort study of women diagnosed with retained placenta after singleton live vaginal birth at or after 24 weeks of gestation, compared in a 1:2 ratio with women who had uncomplicated vaginal deliveries. The study and control groups were matched for maternal age, gestational age, and parity. Multivariate regression analysis assessed potential risk factors related to retained placenta.In all, 15,260 women who delivered at our medical center(both vaginal and non‐vaginal)between 2015 and 2022, 170 (1.1%) were diagnosed with retained placenta. Ninety‐nine women (0.65%) who met the inclusion criteria were matched with 198 controls (1.3%). Multivariate logistic regression identified potential risk factors not previously described for retained placenta, including in vitro fertilization (OR 3.8, 95% CI 1.3–11.7, P = 00.018), large‐for‐gestational‐age fetuses (OR 28.2, 95% CI 5.4–148.5, P = 00.029), and endometriosis (OR 8.2, 95% CI 0.92–20, P = 00.024). Additional risk factors included pre‐eclampsia, labor induction, vacuum‐assisted delivery, and prolonged second‐stage labor.This study identifies critical risk factors for retained placenta, highlighting the importance of early identification to improve maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Background: Midwives and perinatal nurses play a crucial role in responding to intimate partner violence (IPV) against pregnant women; however, these roles are often not performed adequately. This study aimed to identify provider-related, healthcare system, and social barriers and facilitators to IPV response from the perspective of midwives and perinatal nurses. Methods: This qualitative descriptive study used semi-structured interviews with five midwives and a nurse from perinatal care facilities in Tokyo, Japan. A framework approach was employed to analyze the interview transcripts. Results: Barriers included inadequate knowledge about IPV and reluctance to provide support by healthcare providers. Barriers in the healthcare system included the absence of structural infrastructure for IPV response. This involved the lack of screening tool adoption, the partner's presence during interviews, and time constraints. Additionally, there was insufficient systematic and collaborative coordination within and outside the team. Another barrier was the lack of in-service training to develop IPV-related knowledge and skills. Finally, there was uncertainty about how the support at healthcare facilities impacts women's lives. Further barriers in the social system included the absence of additional reimbursement for IPV response. There was also a lack of a comprehensive approach to IPV that provides for the rehabilitation of perpetrators and care for the children of victims and a culture that discourages separation from the perpetrator. Conversely, facilitators included healthcare providers recognizing the perinatal period as an opportunity to address IPV. They also acknowledged IPV as a prevalent issue, practiced conscious self-care, and systematically collaborated within the healthcare team. Conclusion: This study emphasized the need for routine IPV screening in perinatal care and the importance of team-based educational interventions for healthcare providers to facilitate implementation. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Methods Results Conclusion Legalization in many jurisdictions has increased the prevalence of cannabis use, including during pregnancy and lactation. Accordingly, clinicians providing perinatal and infant care are increasingly required to counsel about this topic, even if they do not feel comfortable or prepared for this conversation. The aim of this research was to explore how prenatal clinicians and pregnant and lactating women interact with cannabis consumption.Using qualitative description, we conducted semi‐structured interviews with 75 individuals in Canada: 23 clinicians who provide pregnancy and lactation care, and 52 individuals who made cannabis consumption decisions during pregnancy and/or lactation. Data were analyzed using inductive content analysis.Three phases of the clinical encounter influenced decision‐making about cannabis consumption: initiation of a discussion about cannabis, sense‐making, and the outcome of the encounter. Patients and clinicians described similar ideals for a counseling encounter about cannabis consumption during pregnancy or lactation: open, patient‐centered conversation grounded in an informed decision‐making model to explore the benefits, risks, and alternatives to cannabis. While clinicians described these values as reflecting real clinical interactions, patients reported that in their experience, actual interactions did not live up to these ideals.Clinicians and pregnant and lactating people report desiring the same things from a counseling interaction about cannabis: sharing of information, identification of values, and facilitation of a decision. Both groups endorse an open, nonjudgemental counseling approach that explores the reasons why a patient is considering cannabis consumption and reflects these reasons against available evidence and alternatives known to be safe. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions This study aims to test and adapt the Turkish psychometric properties of the preventive health management self‐efficacy related to premature labor (PHMSE‐PL) scale for women of reproductive age.The study follows a methodological approach. The original scale comprises 34 items distributed across 5 subscales and is structured on a five‐point Likert scale. The study sample consisted of 351 women aged 19 to 49, all without any physical or mental disabilities, irrespective of marital status or pregnancy status. Exclusion criteria encompassed women engaged in healthcare professions such as medical faculty, nursing, or midwifery, as well as those with a history of preterm birth during pregnancy.During the validity assessment of the scale, language, content, and construct validity were scrutinized. In the reliability phase, internal consistency and stability over time ‐analyses were conducted. Following confirmation of language validity, all items achieved a content validity index value exceeding 0.80. Exploratory and confirmatory factor analyses were employed to assess structural validity, revealing that the scale retained its original grouping into five sub‐factors. These factors collectively accounted for 81.5% of the variance. The Cronbach's alpha coefficient for the entire scale reached 0.98, indicating high internal consistency. Test–retest analyses yielded a correlation coefficient of 0.99 between overall scale scores, demonstrating excellent consistency between the two measurement measurements.The PHMSE‐PL scale adapted to Turkish culture demonstrated high levels of validity and reliability. [ABSTRACT FROM AUTHOR]

Purpose: Prenatal and perinatal experiences of the mother are known to influence infant development. Maternal exposure to coronavirus disease 2019 (COVID-19) during pregnancy has been associated with increased morbidity and mother-baby separation. However, the developmental outcomes of infants born to COVID-19-positive mothers remain unclear. This study represents an initial exploratory effort to assess the developmental risks faced by infants born to mothers who tested positive for COVID-19. Methods: This cross-sectional study involved telephonic interviews and developmental screenings of 45 infants, aged 9 to 15 months, who were born to perinatal COVID-19-positive mothers between July 2020 and May 2021. The Ages & Stages Questionnaire was used for the developmental assessment. The impacts of maternal, infant and separation-related factors on development were analyzed. Results: Within the study population, 28.8% (13 of 45 infants) presented with a risk of developmental delay. The gross motor and problem-solving domains were the most frequently impacted. Among the factors studied, prolonged separation period (exceeding 7 days), advanced maternal age, and gestational age (preterm birth) were associated with higher proportions of infants at risk of developmental delay; however, these associations were not statistically significant. Conclusion: This study suggests that infants born to mothers who tested positive for COVID-19 during the perinatal period face a risk of developmental delay. Factors such as maternal age, gestational age at birth, metabolic disease during pregnancy, and infant-mother separation could exacerbate this risk. Future research should prioritize objective assessments of development and long-term follow-up to monitor developmental outcomes in this population. [ABSTRACT FROM AUTHOR]

Issue Addressed: Engagement with health supports benefits the whole family, yet few health services report successful engagement of fathers. Our aim was to describe available evidence on barriers and opportunities relevant to health system access for fathers. Methods: Scoping reviews were conducted seeking empirical evidence from (1) Australian studies and (2) international literature reviews. Results: A total of 52 Australian studies and 44 international reviews were included. The most commonly reported barriers were at the health service level, related to an exclusionary health service focus on mothers. These included both 'surface' factors (e.g., appointment times limited to traditional employment hours) and 'deep' factors, in which health service policies perpetuate traditional gender norms of mothers as 'caregivers' and fathers as 'supporters' or 'providers'. Such barriers were reported consistently, including but not limited to fathers from First Nations or culturally diverse backgrounds, those at risk of poor mental health, experiencing perinatal loss or other adverse pregnancy and birth events, and caring for children with illness, neurodevelopmental or behavioural problems. Opportunities for father engagement include offering father‐specific resources and support, facilitating health professionals' confidence and training in working with fathers, and 'gateway consultations', including engaging fathers via appointments for mothers or infants. Ideally, top‐down policies should support fathers as infant caregivers in a family‐based approach. Conclusions: Although barriers and opportunities exist at individual and cultural levels, health services hold the key to improved engagement of fathers. So What?: Evidence‐based, innovative strategies, informed by fathers' needs and healthy masculinities, are needed to engage fathers in health services. [ABSTRACT FROM AUTHOR]

Perinatal care provides important health care opportunities for many individuals at risk for cervical cancer. Pregnancy does not alter cervical cancer screening regimens. ASCCP risk-based management has a colposcopy threshold of a 4% immediate risk of cervical intraepithelial neoplasia (CIN) 3 or cancer, but the actual risk can be considerably higher based on current and past screening results. Improving cervical cancer outcomes with diagnosis during pregnancy rather than postpartum and facilitating further evaluation and treatment postpartum for lesser lesions are the perinatal management goals. Although colposcopy indications are unchanged in pregnancy, some individuals with lower risk of CIN 2-3 and reliable access to postpartum evaluation may defer colposcopy until after delivery. Cervical intraepithelial neoplasia diagnosed in pregnancy tends to be stable, with frequent regression postpartum, though this is not universal. Colposcopic inspection during pregnancy can be challenging. Although biopsies in pregnancy are subjectively associated with increased bleeding, they do not increase complications. Endocervical curettage and expedited treatment are unacceptable. Treatment of CIN 2-3 in pregnancy is not recommended. Excisional biopsies in pregnancy are reserved for suspicion of malignancy that cannot be confirmed by colposcopic biopsy and when excisional biopsy results would alter oncologic or pregnancy care. Surveillance of high-grade lesions in pregnancy uses human papillomavirus-based testing, cytology, and colposcopy, with biopsy of worsening lesions every 12-24 weeks from diagnosis until postpartum evaluation. Mode of delivery does not definitively affect persistence of CIN postpartum. Postpartum care may involve a full colposcopic evaluation or expedited excisional procedure if indicated. [ABSTRACT FROM AUTHOR]

Objectives: This study was aimed to report the prevalence-pattern of hereditary and congenital anomalies (CA) in general population of Balochistan province of Pakistan, and to elucidate the familial/sporadic presentations and parental consanguinity of CA. Methods: In a multi-center cross-sectional study, patients with CA were ascertained from various district hospitals and public places throughout Balochistan from 2019 to 2023. Online Mendelian Inheritance in Man (OMIM) and International Classification of Diseases (ICD-10) databases were utilized for uniformity in classification. Descriptive statistics was employed. Results: A cohort of 1185 independent patients diagnosed with CA was recruited and the index males were 71%. The CA were classified into nine major and 118 minor entities. In the major categories, neurological disorders had the highest prevalence (n=317; 27%), followed by limb defects (n=161; 14%), blood-heart defects (n=159; 13%), neuromuscular anomalies (n=156; 13%), sensorineural/ear defects (n=140; 12%), eye/visual impairments (n=90; 8%), musculoskeletal defects (n=83; 7%), ectodermal defects (n=31; 3%), and others (48; 4%). Sixty one percent CA were sporadic in nature and 39% were familial; and parental consanguinity was observed in 51% cases. Several rare CA were witnessed. Conclusions: High preponderance of sporadic presentations in neuromuscular anomalies and musculoskeletal defects and low incidence of parental consanguinity in ectodermal defects and musculoskeletal defects may depict a significant etiological role of non-genetic/environmental factors such as prenatal exposures and maternal conditions. In this context, it is important to increase health education, enhance antenatal and perinatal care, and strengthen the health-care system in Balochistan to reduce the burden of CA. [ABSTRACT FROM AUTHOR]

Aim: This cross‐sectional multicentre study aimed to determine the effect of interventions during vaginal birth for fear of childbirth. Methods: In this cross‐sectional and analytical study, 852 women who had a vaginal birth between 2019 and 2020 were enrolled. Data were collected using the Descriptive Questionnaire and Wijma Birth Expectation/Experience Scale Version B. Results: The mean total Wijma Birth Expectation/Experience Scale Version B score of the women was 97.00 ± 24.24, indicating severe and clinical levels of fear of childbirth. Moreover, 69.4% of the women had clinical, 18.6% had severe and 12% had moderate levels of fear of childbirth. During birth, women who had close supporters, who were allowed to move and who did not undergo amniotomy, enema, perineal shaving and electronic foetal monitoring had a low level of fear of childbirth. As the number of pregnant women in the labour room, frequency of vaginal examinations, duration of delivery/hour, severity of labour pain and negative perception of the approach of health professionals increased, the women's fear of childbirth increased. Fear of childbirth decreased as the frequency of antenatal follow‐ups, number of births and satisfaction levels of the women increased (p < 0.05). Low income perception, irregular prenatal follow‐up, severe labour pain and a long duration of labour were strong predictors of increased fear of childbirth. Increasing number of births, high birth satisfaction level and positive perception of the approach of health professionals were strong predictors of reduced fear of childbirth. Conclusions: The reduction of interventions in vaginal delivery and support from health care providers during delivery can be effective in reducing fear of childbirth. Summary statement: What is already known about this topic? Fear of childbirth (FOC) is a problem experienced by most women.Sociodemographic characteristics and past experiences can increase FOC.Birth interventions are common as the majority of births in Turkey take place in health institutions. What does this paper add? Women who have vaginal births appear to have severe and clinical levels of fear of childbirth. Multiparity, mobilization, high birth satisfaction and positive approaches by health care providers are strong predictors of reduced FOC.Enema, amniotomy and fundal pressure application, high‐intensity labour pain and a long duration of labour are strong predictors of increased FOC. The implications of this study: Many current routine interventions during childbirth should be avoided.The reduction of interventions in vaginal birth and support from health professionals during labour can be effective in reducing fear of childbirth and negative consequences related to FOC, as well as helping to achieve non‐invasive vaginal deliveries.It is recommended that hospitals be organized in line with the criteria of mother‐friendly hospitals, health professionals be trained and the environments in which women give birth be improved. [ABSTRACT FROM AUTHOR]

Objective: The study aims to examine maternal care among Hispanic birthing people by primary language and state policy environment. Data Sources and Study Setting: Pooled data from 2016 to 2020 Pregnancy Risk Assessment Monitoring System surveys from 44 states and two jurisdictions. Study Design: Using multivariable logistic regression, we calculated adjusted predicted probabilities of maternal care utilization (visit attendance, timeliness, adequacy) and quality (receipt of guideline‐recommended care components). We examined outcomes by primary language (Spanish, English) and two binary measures of state policy environment: (1) expanded Medicaid eligibility to those <133% Federal Poverty Level, (2) waived five‐year waiting period for pregnant immigrants to access Medicaid. Data Collection/Extraction Methods: Survey responses from 35,779 postpartum individuals with self‐reported Hispanic ethnicity who gave birth during 2016–2020. Principal Findings: Compared to English‐speaking Hispanic people, Spanish‐speaking individuals reported lower preconception care attendance and worse timeliness and adequacy of prenatal care. In states without Medicaid expansion and immigrant Medicaid coverage, Hispanic birthing people had, respectively, 2.3 (95% CI:0.6, 3.9) and 3.1 (95% CI:1.6, 4.6) percentage‐point lower postpartum care attendance and 4.2 (95% CI:2.1, 6.3) and 9.2 (95% CI:7.2, 11.2) percentage‐point lower prenatal care quality than people in states with these policies. In states with these policies, Spanish‐speaking Hispanic people had 3.3 (95% CI:1.3, 5.4) and 3.0 (95% CI:0.9, 5.1) percentage‐point lower prenatal care adequacy, but 1.3 (95% CI:−1.1, 3.6) and 2.7 (95% CI:0.2, 5.1) percentage‐point higher postpartum care quality than English‐speaking Hispanic people. In states without these policies, those same comparisons were 7.3 (95% CI:3.8, 10.8) and 7.9 (95% CI:4.6, 11.1) percentage‐points lower and 9.6 (95% CI:5.5, 13.7) and 5.3 (95% CI:1.8, 8.9) percentage‐points higher. Conclusions: Perinatal care utilization and quality vary among Hispanic birthing people by primary language and state policy environment. States with Medicaid expansion and immigrant Medicaid coverage had greater equity between Spanish‐speaking and English‐speaking Hispanic people in adequate prenatal care and postpartum care quality among those who gave birth. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Supported by remote signal processing techniques and wireless communication technology, remote electronic fetal monitoring (REFM) has emerged as a promising alternative to traditional electronic fetal monitoring (TEFM) in clinical practice. The aim of this study was to evaluate the comparability, accessibility, and clinical utility of REFM in contrast to TEFM.This was a multicenter prospective cohort study. A cohort of 2900 pregnant women were enrolled from three medical centers between June 1, 2021 and June 31, 2022. Among them, 800 utilized REFM, with 760 of them completing the self‐rating anxiety scale (SAS) and self‐rating depression scale (SDS) assessments using the devices for 1 month. The control group comprised 2100 pregnant women who did not use REFM. Additionally, 80 pregnant women concurrently employed both REFM and TEFM, and their respective curve coincidence rates were determined through curve fitting. Primary outcomes encompassed pregnancy outcomes in both groups, average curve coincidence rates between REFM and TEFM, as well as SDS and SAS scores.Among the 760 pregnant women who completed SAS and SDS assessments, their average SAS scores before and after 1 month of REFM usage were 43.09 ± 8.04 and 41.58 ± 6.59, respectively. Concurrently, the average SDS scores before and after 1 month of REFM usage were 45.45 ± 9.60 and 44.80 ± 9.17, respectively. A statistically significant decrease was observed in SAS scores (P = 0.005), whereas no significant difference was noted in SDS scores (P = 0.340). Furthermore, a statistically significant difference in the rate of adverse pregnancy outcomes (neonatal asphyxia) emerged between the two groups, those who employed REFM and those who did not (P = 0.021). In the subset of 80 pregnant women employing both REFM and TEFM, all 80 results showed precise congruence between the two methods. The average coincidence rate was determined to be 79.45% ± 12.64%.REFM contributes to improved pregnancy outcomes and exhibits a high level of concordance with TEFM, thereby accurately reflecting the quality of fetal heart monitoring. Additionally, REFM effectively mitigates pregnant women's anxiety. Thus, REFM demonstrates comparability, accessibility, and clinical utility. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Discussion Weight bias toward individuals with higher body weights in healthcare settings is associated with adverse health behaviors, reduced healthcare utilization, and poor health outcomes. The purpose of this integrative review was to explore: (1) What has been measured and described regarding perinatal care providers' and students' weight bias toward pregnant, birthing, and postpartum individuals with higher body weights? (2) What has been measured and described regarding pregnant, birthing, and postpartum individuals' experiences of weight bias? (3) What is the association of experiences of weight bias with perinatal and mental health outcomes among pregnant, birthing, and postpartum individuals?We conducted a systematic search in CINAHL, PubMed, and PsycINFO databases to identify relevant research publications related to the Medical Subject Headings (MeSH) terms weight prejudice (and related terms) and pregnancy (and related terms). The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA), Johns Hopkins Nursing Evidence‐Based Practice model for study quality determination, and the Whittemore and Knafl integrative review framework for data extraction and analyses.Twenty‐two publications met inclusion criteria, representing six countries and varying study designs. This review found pervasive sources of explicit weight bias in the perinatal period, including care providers and close relationships. Experiences of weight bias among pregnant and postpartum individuals are associated with adverse perinatal and mental health outcomes.The findings address a knowledge gap regarding a summary of literature on weight bias in the perinatal period and elucidate its prevalence as well as its negative influence on perinatal and mental health outcomes. Future research efforts on this topic must examine the nature and extent of perinatal care providers' weight bias by demographic factors and explore its association with clinical decision‐making and perinatal and mental health outcomes. [ABSTRACT FROM AUTHOR]

Background: The Elders Mentoring Program (EMP) is part of a strengths-based community-based participatory research partnership with the Cree communities of Maskwacîs, Alberta, Canada. The EMP objective is to promote maternal and child health through traditional Cree teachings and support from community Elders to pregnant women and their partners. During the COVID-19 pandemic, the Elders decided to shift the program to an online format in early 2021. The Elders continued to offer mentorship to program participants virtually by Zoom and telephone, and online workshops. The objective of this study was to qualitatively explore the experiences of women that took part in the virtual EMP. Methods: We utilized qualitative description as our method, informed by our overarching community-led research partnership. Semi-structured phone interviews were conducted by Maskwacîs research assistants (RAs) with 11 women who participated in the virtual program. Interviews were conducted between December 2021 and June 2022. The participants were asked about their perceptions of the program and its benefits. The interviews were recorded, transcribed, and coded by four RAs using thematic analysis. Results: Although cultural teachings are traditionally offered in person, the shift to the virtual platform was greatly appreciated by all the women. Technology can be a useful tool for cultural teachings and language to be shared among community members when they cannot be physically together. Four main themes emerged from the data, representing the participants' experiences, and learning through their interactions with the Elders from the EMP. The themes are: Ohpikihâwasowin (grounding and guiding on the path to be a healthy parent); Indigenous ways of healing; On the path of cultural learning; and Identity for self and baby. Conclusion: The virtual adaptation of the EMP allowed a space for Elders to offer support to women living in and out of the community to provide guidance with their pregnancies and into motherhood. The workshops and one-on-one calls allowed for cultural revitalization which is critical for Indigenous well-being. All the participants found that the teachings and interactions positively impacted their pregnancy and parenthood. Overall, the virtual program demonstrated a venue for intergenerational healing and resilience. [ABSTRACT FROM AUTHOR]

Objective The perinatal period represents a critical juncture in a woman's life marked by profound emotional, social, and physical changes. During this phase, there is a propensity for the exacerbation of pre-existing psychiatric symptoms or the emergence of new ones. Notably, there is often an uptick in psychiatric emergencies and presentations to emergency psychiat-ric departments among women in the perinatal period. This study aimed to retrospectively evaluate women accessing emergency psychiatric departments during pregnancy and the postpartum period, focusing on their presenting complaints, diagnoses, clinical trajectory, and factors influencing the decision for inpatient treatment. Material and Method A retrospective review was conducted on the records of 11,419 women aged 18 to 45 who sought care at the Psychiatric Emergency Department of Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital between July 2015 and July 2016. Results Among them, the records of 163 women who were either pregnant or within one year postpartum were analyzed. Of the women accessing services during the perinatal period, 46% were pregnant, while 54% were in the postpartum phase. Additionally, 38.7% of these women presented to the psychiatric department for the first time. Distress and anxiety emerged as the most common reasons for seeking help. Interestingly, no significant differences were observed between the pregnancy and postpartum periods regarding presenting complaints and clinical progression. However, the incidence of psychotic disorders was notably higher during the postpartum period compared to pregnancy. Through logistic regression analysis involving pregnancy status, presenting complaints, and diagnoses, it was determined that the nature of the presenting complaint significantly influenced the decision for inpatient treatment. Notably, scepticism, agitation, and suicidal ideation were identified as the most prevalent complaints among women who required inpatient care. Conclusion Mental health challenges during the perinatal period not only jeopardize the well-being of the woman but also impact the health of the infant. Detecting and addressing emergent psychiatric issues during this phase are pivotal for timely intervention and preventive measures. [ABSTRACT FROM AUTHOR]

Aim: This qualitative study aimed to explore nurses' perspectives regarding the challenges of providing perinatal/neonatal end-of-life care in a regional hospital. Methods: This exploratory qualitative study was conducted with 20 nurses working in Turkey. Study data were collected through in-depth and semi-structured individual interviews. The interviews were then submitted to thematic analysis. Results: Three themes emerged from analyses of the interviews: (1) inadequate support for delivery of palliative care, (2) perceptions of family readiness, and (3) providing information/education to the family. The most prominent difficulties experienced by nurses were inadequacy of unit and equipment and lack of trained personnel. Another important issue that stood out was families' not accepting the end-of-life care decision for the fetus or the neonate and their having unrealistic expectations. Conclusion: Study results have provided important considerations for regional isolated neonatal and perinatal units, and they will be used to inform clinical practice improvements, staff education support, policies/procedures, family support, and further research relating to end-of-life care provision for the most vulnerable babies and their families. [ABSTRACT FROM AUTHOR]

This article provides an account of using reflexive participatory methods including study advisory group membership to evaluate a perinatal wellbeing service in an economically deprived area of Scotland. There is little qualitative research that explores the experiences of women accessing perinatal mental health services. This article draws on feminist values and narrative theory to explore the practice, process and ethics of using participatory methods with women in the perinatal period. We explore the blurring of intervention and research group boundaries to consider the service and study advisory group as a space which provided the conditions for collective care and re-storying the self. We explore the study advisory group as an extension of the intervention itself, highlighting the role of community in research practices and in interventions, for women who experience perinatal mental health difficulties. We reflect on the 'sticky' practice of navigating epistemic and decision-making power in participatory research, including the dual positionalities of being two academic researchers who come to research with therapeutic training in counselling, psychotherapy and social work. We call for reflexive, community-oriented and flexible approaches when using participatory methods with populations that might be considered vulnerable, marginalised or stigmatised. [ABSTRACT FROM AUTHOR]

The research is limited to the role of African American (AA) fathers in maternal health. African American fathers are largely not included in perinatal care, and their contribution may be essential in addressing the Black maternal health disparity crisis. The purpose of this conceptual paper is to examine the evidence of African American fathers involvement in supporting maternal health during the perinatal period. This conceptual paper will summarize research findings and will focus on 1) the evolution of the concept of fatherhood and the role of African American fathers; 2) the extent of African American fathers engagement during the perinatal period; and 3) the potential for African American fathers to play a key role in improving maternal health. Findings from this paper will enhance the evidence base on fathers' involvement in maternal health, highlight the research gaps, and opportunities to focus on African American fathers in addressing maternal morbidity and mortality among African American women. [ABSTRACT FROM AUTHOR]

To synthesize evidence regarding the association between interpregnancy weight change (IPWC) in consecutive pregnancies and neonatal or infant outcomes in the subsequent pregnancy. Search strategy was implemented in MEDLINE, EMBASE, Web of Science, Scopus and Cochrane Library from their inception to 13 November 2023. The most adjusted odds ratio (OR) or risk ratio estimates provided by original studies were used to calculate pooled risk ratios and their corresponding 95 % confidence intervals (CI) with the DerSimonian and Laird random effects method. Publication bias was assessed by funnel plots and Egger's method, and risk of bias was assessed with The Newcastle Ottawa Quality Assessment Scale. Thirty-seven observational studies were included. Interpregnancy weight loss or gain were associated with large for gestational age (OR: 0.89; 95 % CI: 0.84–0.94; I2 = 83.6 % and OR: 1.33; 95 % CI:1.26–1.40; I2 = 98.9 %), and stillbirth risk (OR: 1.10; 95 % CI: 1.01–1.18; I2 = 0.0 % and OR: 1.21; 95 % CI: 1.09–1.33; I2 = 60.2 %,). Findings highlight the importance of managing weight between interpregnancy periods, although these findings should be interpreted cautiously because of the possible influence of social determinants of health and other factors. • Interpregnancy weight change is linked to risks of large and small for gestational age and stillbirth in the next pregnancy. • For women with BMI < 25 kg/m2 interpregnancy weight loss and gain are related to preterm birth risk in the next pregnancy. • Individualized manage of weight in interpregnancy periods could improve neonatal or infant outcomes. [ABSTRACT FROM AUTHOR]

Providing in-utero treatments to target specific conditions in the fetus is a relatively new approach in perinatal care, with the vast majority of these treatments being used off-label. The high degree of off-label medication use in the perinatal and neonatal settings raises concern for the safety of both the fetuses and expectant mothers. This report presents two examples of intra-amniotic drug administration based on reported clinical cases. From the ethical framework of medical principlism, we examine the competing ethical duties of autonomy, beneficence, and non-maleficence in this setting. We then lay out three fundamental ethical principles for obtaining informed consent and maximizing clinical benefit. [ABSTRACT FROM AUTHOR]

Aim: Sudden unexpected postnatal collapse is a life‐threatening event and may occur in any newborn infant. Safe skin‐to‐skin contact, and awareness of sudden unexpected postnatal collapse are key to its prevention. The aim of this study was to survey the presence of skin‐to‐skin contact and/or sudden unexpected postnatal collapse protocols in the 70 perinatal centres in the Netherlands. Methods: We performed a survey among Dutch paediatricians to examine the safe skin‐to‐skin contact and sudden unexpected postnatal collapse protocols. Results: We received data from 59/70 (85%) perinatal centres. At least one case of sudden unexpected postnatal collapse was reported in 35/59 (59%) of these centres. Nearly half the centres had safe skin‐to‐skin contact and/or sudden unexpected postnatal collapse protocols. Ultimately, 16 protocols were available for analysis. They showed considerable differences in the type of perinatal care provided. Most protocols lacked recently published insights on safe skin‐to‐skin contact. Besides, protocols failed to incorporate awareness of and knowledge on how to prevent sudden unexpected postnatal collapse. Conclusion: This study underlines the importance of drawing up uniform, multidisciplinary guidelines containing recommendations for the prevention of sudden unexpected postnatal collapse in the Netherlands. [ABSTRACT FROM AUTHOR]

Caring for persons with mental health diagnoses can be daunting, especially when the conditions are rare, and there is little evidence to guide nursing practice. There Is minimal information about caring for persons with dissociative disorders beyond the behavioral health literature, much less as in obstetric context. Women are more likely to experience dissociative disorders and post-traumatic stress disorders than men. Severe maternal morbidity is significantly more common in women with a history of stress and trauma-related conditions, highlighting the importance of providing guidance for clinicians caring for them. It is imperative that nurses caring for women who may dissociate understand the complexities of the disorders and advocate for early, interdisciplinary care. Dissociative disorders, including dissociative identity disorder, post-traumatic stress disorder with dissociation, dissociative amnesia, depersonalization-derealization disorder, other specified dissociative disorders, and the care of pregnant persons with these conditions are presented. [ABSTRACT FROM AUTHOR]

Introduction: There are striking disparities in perinatal health outcomes for Black women in the United States. Although the causes are multifactorial, research findings have increasingly identified social and structural determinants of health as contributors to perinatal disparities. Maltreatment during perinatal care, which is disproportionately experienced by Black women, may be one such contributor. Qualitative researchers have explored Black women's perinatal care experiences, but childbirth experience data has yet to be analyzed in‐depth across studies. The aim of this meta‐synthesis was to explore the birthing experience of Black women in the United States. Methods: PubMed, Embase, PsycINFO, and CINAHL databases were searched. Inclusion criteria were qualitative research studies that included birth experience data shared by self‐identified Black or African American women who had given birth in the United States. Exclusion criteria were reports that did not include rich qualitative data or only included experience data that did not specify the race of the participant (eg, data pooled for women of color). The search began February 2022 and ended June 2022. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was used to appraise the research. Results were synthesized using content analysis. Results: Fifteen studies met inclusion criteria. Main themes included (1) trust: being known and seen; (2) how race influences care; (3) preserving autonomy; and (4) birth as trauma. Discussion: Fragmented care resulted in reports of poor birth experiences in several studies. Open communication and feeling known by perinatal care providers was influential in improving childbirth experiences among Black women; these themes are consistent with existing research. Further prospective research exploring relationships among these themes and perinatal outcomes is needed. Limitations of this report include the use of content analysis and meta‐synthesis which may lose the granularity of the original reports; however, the aggregation of voices may provide valuable, transferable, actionable insight that can inform future supportive care interventions. [ABSTRACT FROM AUTHOR]

Introduction: Empathy plays an important role in midwifery care, not only for the women but also for midwives. The Midwifery Empathy Scale (MES) was developed to assess the empathy levels of midwives and midwifery students. The purpose of this study was the translation and validation of the MES for an Austrian sample. Methods: A total of 277 midwives working in Austria completed the questionnaire of the MES. The psychometric measurements that were performed included explanatory factor analysis using a varimax rotation and principal components analysis. Moreover, the internal consistency of the MES was assessed with reliability coefficients. The Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and a Bartlett's test of sphericity were carried out. Results: Principal components analysis showed seven orthogonal factors. KMO measure of sample adequacy = 0.724 and Bartlett's test of sphericity = 1058.904 (df=231, p<0.0001). The MES showed an acceptable overall internal consistency: Cronbach's alpha was found to be 0.721 and the Guttman split-half coefficient was 0.611. The findings of our study confirm the multidimensionality of MES, demonstrating a seven-factor structure which contained subscales reflecting empathy and emotional connection. The mean total score of Austrian midwives' responses to the MES was 44.80 with scores ranging from 24 to 81. Conclusions: This study shows that the German version of the Midwifery Empathy Scale is a reliable instrument for evaluating the empathy levels of midwives and midwifery students in Austria. The German MES could be used in the selection and education of future midwives as well as in connection with empathy trainings of midwives. [ABSTRACT FROM AUTHOR]

Maternal feminist theory and normative motherhood are influenced by a repronormativity that assumes all birthing people will breastfeed or chestfeed their infants. However, there is a predominant absence of a critical analysis of breast and chestfeeding from maternal theory and normative motherhood. Many new parents— for example, trans parents who have had chest masculinization surgery and parents who have had double mastectomies—do not have the privilege or ability to breast or chestfeed. For these breastless parents, the dilemma they face is intensified by normative motherhood discourses that essentialize good parenting as hetero-normative and repronormative, along with “breast is best” propaganda espousing erroneous health benefits. In this article, I argue that breastfeeding mandates are ubiquitous and misguided, in part due to an unspoken and assumed aspect of normative mothering, which has diluted the way health and perinatal care systems support breastless parents. This article centres repronormativity and transnormativity, ideologies entrenching the gender binary into its most rigid form, as intrinsic structures to normative motherhood. Understanding these concepts illustrates the harm inflicted on gender-nonconforming (or maternal nonconforming) identities embodying parenting. To combat this embodied shame and discrimination, I outline a conceptual framework for transnormative parenthood delineated by queer, intersectional, and ambivalent dictates. [ABSTRACT FROM AUTHOR]

Abstract Background Midwives and perinatal nurses play a crucial role in responding to intimate partner violence (IPV) against pregnant women; however, these roles are often not performed adequately. This study aimed to identify provider-related, healthcare system, and social barriers and facilitators to IPV response from the perspective of midwives and perinatal nurses. Methods This qualitative descriptive study used semi-structured interviews with five midwives and a nurse from perinatal care facilities in Tokyo, Japan. A framework approach was employed to analyze the interview transcripts. Results Barriers included inadequate knowledge about IPV and reluctance to provide support by healthcare providers. Barriers in the healthcare system included the absence of structural infrastructure for IPV response. This involved the lack of screening tool adoption, the partner’s presence during interviews, and time constraints. Additionally, there was insufficient systematic and collaborative coordination within and outside the team. Another barrier was the lack of in-service training to develop IPV-related knowledge and skills. Finally, there was uncertainty about how the support at healthcare facilities impacts women’s lives. Further barriers in the social system included the absence of additional reimbursement for IPV response. There was also a lack of a comprehensive approach to IPV that provides for the rehabilitation of perpetrators and care for the children of victims and a culture that discourages separation from the perpetrator. Conversely, facilitators included healthcare providers recognizing the perinatal period as an opportunity to address IPV. They also acknowledged IPV as a prevalent issue, practiced conscious self-care, and systematically collaborated within the healthcare team. Conclusion This study emphasized the need for routine IPV screening in perinatal care and the importance of team-based educational interventions for healthcare providers to facilitate implementation.

Background The umbilical cord forms the connection between the fetus and the placenta at the feto-maternal interface and normally comprises two umbilical arteries and one umbilical vein. In some cases, only a single umbilical artery (SUA) is present. This study was conducted to evaluate associations between SUA and other congenital malformations discovered in perinatal autopsies and to ascertain the existence of preferential associations between SUA and certain anomalies. Methods We evaluated records of all fetuses sent for autopsy to the Department of Pathology during the 10-year period from 2013 through 2022 (n = 1,277). The data were obtained from the hospital’s pathology laboratory records. The congenital anomalies were grouped by organ or system for analysis and included cardiovascular, urinary tract, nervous system, gastrointestinal tract, musculoskeletal, and lung anomalies. Results A SUA was present in 8.61% of the autopsies. The gestational age of the affected fetuses ranged between 13 to 40 weeks. An SUA presented as an isolated single anomaly in 44 cases (3.4%). Of the 110 SUA cases, 60% had other congenital anomalies. There was a significant association between birth defects and SUAs (p < .001). Strong associations between SUA and urinary tract, lung, and musculoskeletal anomalies were observed. Conclusions A SUA is usually seen in association with other congenital malformations rather than as an isolated defect. Therefore, examination for associated anomalies when an SUA is detected either antenatally or postnatally is imperative. The findings of this study should be helpful in counseling expectant mothers and their families in cases of SUA.

Abstract Background The Elders Mentoring Program (EMP) is part of a strengths-based community-based participatory research partnership with the Cree communities of Maskwacîs, Alberta, Canada. The EMP objective is to promote maternal and child health through traditional Cree teachings and support from community Elders to pregnant women and their partners. During the COVID-19 pandemic, the Elders decided to shift the program to an online format in early 2021. The Elders continued to offer mentorship to program participants virtually by Zoom and telephone, and online workshops. The objective of this study was to qualitatively explore the experiences of women that took part in the virtual EMP. Methods We utilized qualitative description as our method, informed by our overarching community-led research partnership. Semi-structured phone interviews were conducted by Maskwacîs research assistants (RAs) with 11 women who participated in the virtual program. Interviews were conducted between December 2021 and June 2022. The participants were asked about their perceptions of the program and its benefits. The interviews were recorded, transcribed, and coded by four RAs using thematic analysis. Results Although cultural teachings are traditionally offered in person, the shift to the virtual platform was greatly appreciated by all the women. Technology can be a useful tool for cultural teachings and language to be shared among community members when they cannot be physically together. Four main themes emerged from the data, representing the participants’ experiences, and learning through their interactions with the Elders from the EMP. The themes are: Ohpikihâwasowin (grounding and guiding on the path to be a healthy parent); Indigenous ways of healing; On the path of cultural learning; and Identity for self and baby. Conclusion The virtual adaptation of the EMP allowed a space for Elders to offer support to women living in and out of the community to provide guidance with their pregnancies and into motherhood. The workshops and one-on-one calls allowed for cultural revitalization which is critical for Indigenous well-being. All the participants found that the teachings and interactions positively impacted their pregnancy and parenthood. Overall, the virtual program demonstrated a venue for intergenerational healing and resilience.

Objective: Several observational studies have revealed a potential relationship between menstrual reproductive factors (MRF) and osteoarthritis (OA). However, the precise causal relationship remains elusive. This study performed Mendelian randomization (MR) to provide deeper insights into this relationship. Methods: Utilizing summary statistics of genome-wide association studies (GWAS), we conducted univariate MR to estimate 2 menstrual factors (Age at menarche, AAM; Age at menopause, AMP) and 5 reproductive factors (Age at first live birth, AFB; Age at last live birth, ALB; Number of live births, NLB; Age first had sexual intercourse, AFSI; Age started oral contraceptive pill, ASOC) on OA (overall OA, OOA; knee OA, KOA and hip OA, HOA). The sample size of MRF ranged from 123846 to 406457, and the OA sample size range from 393873 to 484598. Inverse variance weighted (IVW) method was used as the primary MR analysis methods, and MR Egger, weighted median was performed as supplements. Sensitivity analysis was employed to test for heterogeneity and horizontal pleiotropy. Finally, multivariable MR was utilized to adjust for the influence of BMI on OA. Results: After conducting multiple tests (P<0.0023) and adjusting for BMI, MR analysis indicated that a lower AFB will increase the risk of OOA (odds ratio [OR] = 0.97, 95% confidence interval [CI]: 0.95–0.99, P = 3.39×10−4) and KOA (OR = 0.60, 95% CI: 0.47–0.78, P = 1.07×10−4). ALB (OR = 0.61, 95% CI: 0.45–0.84, P = 2.06×10−3) and Age AFSI (OR = 0.66, 95% CI: 0.53–0.82, P = 2.42×10−4) were negatively associated with KOA. In addition, our results showed that earlier AMP adversely affected HOA (OR = 1.12, 95% CI: 1.01–1.23, P = 0.033), and earlier ASOC promote the development of OOA (OR = 0.97, 95% CI: 0.95–1.00, P = 0.032) and KOA (OR = 0.58, 95% CI: 0.40–0.84, P = 4.49×10−3). ALB (OR = 0.98, 95% CI: 0.96–1.00, P = 0.030) and AFSI (OR = 0.98, 95% CI: 0.97–0.99, P = 2.66×10−3) also showed a negative association with OOA but they all did not pass multiple tests. The effects of AAM and NLB on OA were insignificant after BMI correction. Conclusion: This research Certificates that Early AFB promotes the development of OOA, meanwhile early AFB, ALB, and AFSI are also risk factors of KOA. Reproductive factors, especially those related to birth, may have the greatest impact on KOA. It provides guidance for promoting women's appropriate age fertility and strengthening perinatal care. [ABSTRACT FROM AUTHOR]

Aim Design Methods Results Conclusions Implications for the Profession and/or Patient Care What Problem Did the Study Address? What Were the Main Findings? Where and on Whom Will the Research have an Impact? Reporting Method Patient or Public Contribution To explore the perceptions and experiences of midwives caring for couples who experience a stillbirth.Qualitative study based on Gadamer's hermeneutic phenomenology.This study was conducted with midwives (n = 18) at the birth unit of a third‐level public hospital in Jaén (Spain) in 2023. Personal semi‐structured interviews were recorded in audio for later transcription by two researchers following steps described by Fleming.Two themes were identified as important aspects of the practise of midwives in a situation of the birth of a stillborn child: (1) the importance of each action of the midwife, and (2) the availability of resources determines the care provided.Having a stillbirth is a very complex experience, in which the psychological support and human and material resources involved are the basic tool for the care of these families. Acknowledging limitations of the available resources, the assistance and care provided by midwives are in line with the clinical practice guidelines, which can have an emotional impact on them.The care to be provided in stillbirth requires appropriate human and material resources for these families. Midwifery and nursing professionals are in a unique position for acting in cases of families with a stillbirth, updated protocols and, in general, the coordination of the different agents involved within the healthcare system.The midwives´ experiences in cases which end with the delivery of a stillborn.Each action of the midwife is as important as the availability of resources to offer the most appropriate care.In each woman who receives the care of a midwife who attends the birth of a stillborn.COREQ checklist.No patient or public contribution occurred for this study as this research focused on exploring staffs' perspectives from the specific viewpoint of their personal experience. [ABSTRACT FROM AUTHOR]

Perinatal depression (PND) affects up to 20% of women and is associated with significant impairment and disability in affected women. In addition, perinatal depression is associated with broader public health and multigenerational consequences. Innovative approaches are needed to reduce the burden of perinatal depression through identification, tracking, and treatment of depressive symptoms during the perinatal period. This study is a randomized clinical trial comparing the relative efficacy of a multi-tiered system of care, Screening and Treatment of Anxiety and Depression (STAND) to perinatal care delivered by a reproductive psychiatrist in reducing symptoms of depression and anxiety. A sample of 167 individuals was randomized between week 28 of pregnancy and 6 months postpartum. A secondary aim compares the original online therapy intervention used in the first half of the study to a newer online therapy program used in the second half of the study for individuals assigned to the STAND treatment. The study measures, intervention groups, and analysis methods are described, as well as expected implications. The findings from this study may improve the methods for tracking symptom changes over time, monitoring treatment response, and providing personalized care for individuals with PND. As such, this study may improve the lives of patients with PND and their families and lower the related health care costs to society. Trial registration NCT: 9/24/2021 NCT direct link: https://www.clinicaltrials.gov/study/NCT05056454?term=NCT05056454&rank=1&a=1. [ABSTRACT FROM AUTHOR]

Tobacco retail outlet (TRO) density has been associated with increased cotinine levels in pregnant persons and their children. As such, the higher densities of TROs may represent higher levels of active smoking during pregnancy. The purpose of this study is to simulate the reduction in cotinine (a biomarker of smoke exposure) and health care utilization that could occur in pregnant persons under enactment of several candidate TRO reduction policy recommendations. Using existing retail outlet data from the state of North Carolina and from the Newborn Epigenetic Study (NEST), the present study created hypothetical policy-informed datasets of TROs that a) limited the number of TROs to the same density as the 2014 San Francisco (SF) policy (Policy 1), b) set the minimum distance to 500 feet between TROs from a school and from other TROs (Policy 2), c) restricted the types of TROs to exclude pharmacies (Policy 3), and d) a combination of Policies 1–3 (Policy 4). We estimated the effects of each policy individually and in a separate model with their combined effects in terms of the reduction on cotinine levels and health care utilization, as measured by number of visits to the emergency department (ED). We found that the hypothetical policies were likely to be effective in reducing maternal cotinine and ED visits, with the majority of the mothers in the dataset demonstrating reductions in these outcomes after implementation of the policies. We found that Policy 1 led to moderate reductions in TRO exposure for the majority of the sample as well as stratified by race/ethnicity. Additionally, Policy 4 had slightly larger estimated effects than Policy 1, but could be more onerous to implement in practice. Overall, we identified evidence supporting the efficacy of TRO reduction strategies that could impact smoke exposure during pregnancy in our diverse sample in North Carolina. [ABSTRACT FROM AUTHOR]

Aim: Health-related quality of life(HRQoL) is essential for high-risk pregnant women and their spouses. This study aimed to explore the dyadic associations (including actor and partner effects) among self-efficacy, dyadic coping, and HRQoL of high-risk pregnant women and their spouses and examine the mediating effect of dyadic coping. Methods: This cross-sectional study recruited participants from two Grade A tertiary hospitals in China from October 2022 to September 2023. A questionnaire including the Chinese version of the General Self-Efficacy Scale, Dyadic Coping Inventory, and 12 Short Form Health Survey Scales was used for the survey. The actor-partner interdependence mediation model was constructed to test dyadic associations and mediating effects. Results: In the actor effects, self-efficacy was positively associated with dyadic coping and HRQoL (P < 0.05). Regarding partner effects, pregnant women's self-efficacy was positively associated with spouses' dyadic coping and physical health (P < 0.05). Dyadic coping partially mediated the relationship between self-efficacy and HRQoL for both groups(P < 0.05). Conclusion: The HRQoL of high-risk pregnant women and their spouses requires urgent attention. Enhancing self-efficacy and dyadic coping in these couples is related to their improved physical and mental health. Healthcare professionals should consider interactions between couples and include them together in perinatal care. Intervention programs for couples or families based on existing positive psychology and dyadic interventions may work together to improve the HRQoL of couples. Plain English summary: In the context of high-risk pregnancy, the physical and mental health of high-risk pregnant women and their spouses can be impacted. However prior studies and current prenatal care have focused less on the overall health of these couples, especially their spouses. This study overcame the drawback of focusing only on one party's health by involving both parties in a survey and evaluating their health-related quality of life(HRQoL).We explored the direct and indirect effects of personal psychological resources (self-efficacy) and coping behaviors (dyadic coping) on HRQoL. An analysis method suitable for paired data was used to validate the dyadic associations. We found that increasing self-efficacy and dyadic coping is crucial for improving HRQoL, whether for high-risk pregnant women, spouses, or both. Dyadic coping functions as an essential mediator that can provide new targets for interventions. Our findings confirmed the close correlation between high-risk pregnant women and their spouses, indicating that these couples should be intervened in perinatal care as a whole. The conclusions of this study also provide an important reference for the development of more comprehensive binary intervention programs. [ABSTRACT FROM AUTHOR]

History of childhood maltreatment (CM) is common and robustly associated with prenatal and postpartum (perinatal) depression. Given perinatal depression symptom heterogeneity, a transdiagnostic approach to measurement could enhance understanding of patterns between CM and perinatal depression. In two independently collected samples of women receiving care at perinatal psychiatry clinics (n = 523 and n = 134), we categorized longitudinal symptoms of perinatal depression, anxiety, stress, and sleep into transdiagnostic factors derived from the Research Domain Criteria and depression literatures. We split the perinatal period into four time points. We conducted a latent profile analysis of transdiagnostic factors in each period. We then used self-reported history of CM (total exposure and subtypes of abuse and neglect) to predict class membership. A three-class solution best fit our data. In relation to positive adaptive functioning, one class had relatively more positive symptoms (high adaptive), one class had average values (middle adaptive), and one class had fewer adaptive symptoms (low adaptive). More total CM and specific subtypes associated with threat/abuse increased an individual's likelihood of being in the Low Adaptive class in both samples (ORs: 0.90–0.97, p <.05). Generalizability of our results was curtailed by 1) limited racial/ethnic diversity and 2) missing data. Our results support taking a person-centered approach to characterize the relationship between perinatal depression and childhood maltreatment. Given evidence that increased exposure to childhood maltreatment is associated with worse overall symptoms, providers should consider incorporating preventative, transdiagnostic interventions for perinatal distress in individuals with a history of childhood maltreatment. • Women with a history of childhood maltreatment (CM) had worse transdiagnostic mood and anxiety symptoms. • The pattern of results was consistent across pregnancy and the first year postpartum. • Retrospective total CM and abuse (not neglect) increased a person's likelihood of displaying the maladptive symptom pattern. • Results replicated in two independently collected samples with varying clinical and demographic characteristics. [ABSTRACT FROM AUTHOR]

Over the past decades dozens of randomized trials have shown that psychological treatments are more effective than care-as-usual (CAU). It could be expected that these treatments are implemented in routine care and that the response rates in usual care improve over time. The aim of the current meta-analysis is to examine if response and remission rates in usual care have improved over time. We used an existing meta-analytic database of randomized controlled trials examining the effects of psychological treatments of depression and selected CAU control groups from these trials. We only included CAU conditions in primary care, specialized mental health care, perinatal care and general medical care. The response rate (50 % symptom reduction) was the primary outcome. We included 125 CAU control groups (8542 participants). The response rate for all CAU control groups was 0.22 (95 % CI: 0.19; 0.24) with high heterogeneity (I 2 = 83; 95 % CI: 80; 85), with somewhat higher rates in primary care (0.27; 95 % CI: 0.23; 0.31). We found hardly any indications that the outcomes have improved over the years. The meta-regression analysis with publication year as predictor in the full dataset resulted in a coefficient of 0.1 (SE = 0.01; p = 0.0.35). A series of sensitivity analyses supported the main findings. Remission rates and pre-post effect sizes also did not significantly improve over time. Response and remission rates in usual care are low, with the large majority of patients not responding or remitting, and the outcomes have probably not improved over time. • Response rates in usual mental health care have not improved over time. • Only about one in five patients in usual care respond. • Response rates are low in specialized mental health care, perinatal and general medical care. • Response rates are somewhat higher in primary care. [ABSTRACT FROM AUTHOR]

An arbitrary gestational age limit of viability cannot be set, and in clinical practice the focus should be on a periviability interval—the so‐called "gray zone" of prognostic uncertainty. For cases within this interval, the most appropriate decision‐making process remains debatable and periviability has emerged as one of the greatest challenges in bioethics. Universally recognized ethical principles may be interpreted differently due to socioeconomic, cultural, and religious aspects. In the case of periviability, there is considerable uncertainty over whether interventions result in a greater balance of clinical good over harm. Furthermore, the fetus or neonate is unable to exercise autonomy and the physicians and parents will act as patient surrogates. When parents and physicians disagree about the infant's best interest, a dialogue without paternalistic attitudes is essential, whereby physicians should only offer, but not recommend, perinatal interventions. Parental choice, based on thorough information, should be respected within the limits of what is medically feasible and appropriate. When disagreements between parents and physicians occur, how is consensus to be achieved? Professional guidelines can be helpful as a framework and starting point for discussion. In reality, however, guidelines only rarely draw categorical lines and in many cases remain vague and ambiguously worded. Local ethics committees can provide counseling and function as moderators during discussions, but ethics committees do not have decision precedence. Counseling assumes the most significant role in periviability discussions, taking into consideration the particular fetal and maternal characteristics, as well as parental values. Several caveats should be observed relative to counseling: message fragmentation or inconsistence should be minimized, prognosis should preferably be presented in a positive framing, and overreliance on statistics should be avoided. It is recommended that decisions regarding neonatal resuscitation in the periviability interval be made before birth and not conditional on the newborn's appearance at birth. Regardless of decision, it is important to assure pre‐ and postnatal coherence. The present article describes how individual physicians, centers, and countries differ in the approach to the decision to initiate or forgo intensive care in the periviability interval. It is impossible to provide a global consensus view and there can be no unifying ethical, moral, or practical strategy. Nevertheless, ethically justified, quality care comprises early involvement of the obstetric and neonatal team to enable a coherent, comprehensible, nonpaternalistic, and balanced plan of care. Ultimately, physicians will need to adjust the expectations to the local standards, local outcome data, and local neonatal support availability. Synopsis: Ethically justified, quality care comprises early involvement of the obstetric and neonatal team to enable a coherent, comprehensible, nonpaternalistic, and balanced plan of care. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine perinatal outcomes based on fasting bile acid concentrations in pregnant women diagnosed with intrahepatic cholestasis of pregnancy (ICP) and to assess pregnancy management according to fasting bile acid levels. Methods: This study is carried out with 160 patients who were diagnosed with Intrahepatic Cholestasis of Pregnancy and gave birth in the same clinic. The patients were divided into two groups based on their fasting bile acid concentrations: Group 1 (54 patients), with levels between 10 and 40 micromol/liter, defining mild ICP according to the literature, and Group 2 (106 patients), with levels above 40 micromol/liter, defining severe ICP. The birth weeks, delivery methods, indications for cesarean section if applicable, birth weights, 1st and 5th minute APGAR scores, neonatal intensive care unit admission, presence of meconium-stained amniotic fluid at birth, and fetal death data of both groups were recorded and compared. Results: Patients with severe ICP were found to have statistically higher ALT and total bilirubin values than patients with mild ICP. (p<0.001, p<0.001 respectively). The presence of meconium was significantly higher in group 2 patients compared to patients group 1 patients (26.4% and 9.3%, respectively; p=0.011). It was found that the weeks of diagnosis of cholestasis and weeks of labor were significantly greater in the patients with meconium in the amniotic fluid compared to the group without meconium (34,9±3,4; 33,0±3,5; p=0,002 ve 38,1±0,9; 36,9±1,5 respectively; p<0,001). Group 2 patients were found to have significantly higher incidence rates of ALT values above 75 and AST values above 130 compared to group 1 patients (p<0,001). Conclusion: Intrahepatic cholestasis of pregnancy causes unpredictable fetal complications. The patients with values of bile acid above 40 and ALT values above 75 and/or having meconium stained amniotic fluid during labor should evaluated carefully due to the association with poor perinatal outcomes. [ABSTRACT FROM AUTHOR]

Evidence suggests that perinatal doula care can support maternal health and reduce racial inequities among low-income pregnant and postpartum people, prompting growing interest by state Medicaid agencies to reimburse for doula services. Emerging peer-reviewed and gray literature document factors facilitating or impeding that reimbursement. We conducted a scoping review of that literature (2012–2022) to distill key policy considerations for policymakers and advocates in the inclusion of doula care as a Medicaid-covered benefit. Fifty-three reports met the inclusion criteria. Most (53%) were published in 2021 or 2022. Their stated objectives were advocating for expanded access to doula care (17%), describing barriers to policy implementation, and/or offering recommendations to overcome the barriers (17%). A primary policy consideration among states was prioritizing partnership with doulas and doula advocates to inform robust and equitable policymaking to sustain the doula profession. [ABSTRACT FROM AUTHOR]

No consensus exists for the initial management of infants with gastroschisis. The American Pediatric Surgical Association (APSA) Outcomes and Evidenced-based Practice Committee (OEBPC) developed three a priori questions about gastroschisis for a qualitative systematic review. We reviewed English-language publications between January 1, 1970, and December 31, 2019. This project describes the findings of a systematic review of the three questions regarding: 1) optimal delivery timing, 2) antibiotic use, and 3) closure considerations. 1339 articles were screened for eligibility; 92 manuscripts were selected and reviewed. The included studies had a Level of Evidence that ranged from 2 to 4 and recommendation Grades B-D. Twenty-eight addressed optimal timing of delivery, 5 pertained to antibiotic use, and 59 discussed closure considerations (Figure 1). Delivery after 37 weeks post-conceptual age is considered optimal. Prophylactic antibiotics covering skin flora are adequate to reduce infection risk until definitive closure. Studies support primary fascial repair, without staged silo reduction, when abdominal domain and hemodynamics permit. A sutureless repair is safe, effective, and does not delay feeding or extend length of stay. Sedation and intubation are not routinely required for a sutureless closure. Despite the large number of studies addressing the above-mentioned facets of gastroschisis management, the data quality is poor. A wide variation in gastroschisis management was documented, indicating a need for high quality RCTs to provide an evidence-based approach when caring for these infants. Qualitative systematic review of Level 1–4 studies. [ABSTRACT FROM AUTHOR]

Women experiencing infertility tend to experience distinct emotions during pregnancy following infertility. Individuals in this population often struggle with psychological and social challenges during pregnancy. This qualitative phenomenological study determines how infertility experiences affect mothers' mental well-being during pregnancy as well as their experiences and emotions after becoming pregnant. A face-to-face, in-depth interview with 15 women with infertility was conducted between November 2022 and May 2023. The study adhered to ethical guidelines, with informed written consent obtained prior to interviews and voice recordings. The COREQ checklist is applied to follow the EQUATOR guidelines for reporting research and the data were coded using MAXQDA.20 software. A thematic analysis revealed four main themes and 15 codes. Main themes included "Over Emotional Burden," "Overprotection," "Overthinking," and "Social Activity Changes." Pregnancy after infertility is a unique and emotionally charged experience for women, encompassing a spectrum of feelings that can be difficult to express. The importance of caring for these women and receiving support from their partners, families, and healthcare providers should not be overstated. Healthcare providers should be aware of these emotional challenges so they can provide better support and counselling to improve women's overall pregnancy experience. It is believed that empathetic communication and tailored support can significantly improve the psychological well-being of this population. Psychologists, psychiatrists, and midwives should also be more attentive to mothers' emotional challenges and integrate comprehensive emotional support and provide coping mechanisms in perinatal care programs. [ABSTRACT FROM AUTHOR]

Background: In 2023, the World Health Organization (WHO) published a Global Position Paper on Kangaroo Mother Care (KMC), which is applicable to all countries worldwide: from the moment of birth, every “small and sick” newborn should remain with mother in immediate and continuous skin-to-skin contact (SSC), receiving all required clinical care in that place. This was prompted by the startling results of a randomized controlled trial published in 2021: in which 1,609 infants receiving immediate SSC were compared with 1,602 controls that were separated from their mothers but otherwise received identical conventional state-of-the-art care. The intervention infants showed a 25% reduction in mortality after 28  days. New perspectives: The new WHO guidelines are a significant change from earlier guidance and common clinical practice. The author presents that separating mothers and babies is assumed to be “normal” (a paradigm) but actually puts newborns at increased risk for morbidity and mortality. The author presents arguments and ethical perspectives for a new perspective on what is “normal,” keeping newborns with their mothers is the infant’s physiological expectation and critical requirement for healthy development. The author reviews the scientific rationale for changing the paradigm, based on synchronous interactions of oxytocin on both mother and infant. This follows a critique of the new policies that highlights the role of immediate SSC. Actionable recommendations: This critique strengthens the case for implementing the WHO guidelines on KMC for small and sick babies. System changes will be necessary in both obstetric and neonatal settings to ensure seamless perinatal care. Based on the role of oxytocin, the author identifies that many current routine care practices may actually contribute to stress and increased vulnerability to the newborn. WHO has actionable recommendations about family involvement and presence in newborn intensive care units. Discussion: The concepts of resilience and vulnerability have specific definitions well known in perinatal care: the key outcome of care should be resilience rather than merely the absence of vulnerability. Newborns in all settings and contexts need us to re-evaluate our paradigms and adopt and implement the new WHO guidelines on KMC in perinatal care. [ABSTRACT FROM AUTHOR]

Dysphoricmilk ejection reflex (D-MER) is characterized by a sudden onset of profoundly negative emotions that are temporally linked to milk letdown when breastfeeding or pumping breast milk. These affective experiences have no psychological precipitants and only last for minutes. D-MER is relatively underappreciated in the physician-oriented medical literature, although there are important clinical and public health consequences when a nursing parent experiences unwanted, negative emotions paired with breastfeeding. D-MER can undermine the parent's confidence and may affect bonding with their infant; it may also contribute to weaning earlier than planned. It is especially important for psychiatrists and other health care professionals who may be called upon to evaluate postpartum patients or nursing parents to be knowledgeable about D-MER. This perspective article aims to provide information about D-MER to the psychiatric and broader medical communities, and to underscore the need for additional research on this topic. Drawing on a literature search, the article first traces historical recognition of D-MER as a clinical entity, then summarizes the clinical characteristics of D-MER and recommends an assessment and management approach that emphasizes psychoeducation. The article also discusses factors that have contributed to the underappreciation of this condition, outlines gaps in our understanding, and suggests next steps for epidemiological and clinical research. D-MER is likely a neuroendocrine condition with psychiatric manifestations. Given that it is episodic but with predictable timing, this condition presents a unique opportunity for scientific investigation. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine the impact of the first year of COVID-19 pandemic on maternal and neonatal outcomes at a large military treatment facility in Southern California. Study Design and Methods: A retrospective review of maternal and neonatal medical records was conducted between January 1, 2019, and December 31,2020. Outcomes measured included necesstillbirth rate, neonatal intensive care unit admission, neonatal death, cesarean birth, and postpartum hemorrhage. Results: A total of 4,425 records were analyzed. Rates of stillbirth between the years did not vary. The neonatal death rate decreased more than 50% in 2020 (p = .149). Cesarean births rose by 2.7% in 2020 Cp = .046) Rates of postpartum hemorrhage did not vary between years. Clinical Implications: The impact of COVID-19 on maternal and neonatal outcomes at a military treatment facility in the first year of the COVID-19 pandemic provides guidance for optimizing perinatal health care. Vertical transmission of COVID-19 is low and routine testing of asymptomatic neonates of positive mothers may not be necesstillbirth sary. COVID-19 infections should not be an indication for cesarean birth and are not associated with neonatal deaths or NICU admission. [ABSTRACT FROM AUTHOR]

Globally, significant numbers of women report obstetric violence (OV) during childbirth. The United Nations has identified OV as gendered violence. OV can be perpetrated by any healthcare professional (HCP) and is impacted by systemic issues such as HCP education, staffing ratios, and lack of access to continuity of care. The current study explored the experiences of OV reported in a national survey in 2021 by Australian women who had a baby in the previous 5 years. A content analysis of 626 open text comments found three main categories: "I felt dehumanised," "I felt violated," and "I felt powerless." Women reported bullying, coercion, non-empathic care, and physical and sexual assault. Disrespect and abuse and non-consented vaginal examinations were the subcategories with the most comments. [ABSTRACT FROM AUTHOR]