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The Diabetes and Antenatal Milk Expressing (DAME) randomised controlled trial (RCT) was conducted in 2011–2015, at six sites in Melbourne, Australia to explore the effect of advising women with diabetes in pregnancy to express breast milk from 36 weeks gestation. Infants whose mothers were randomised to express in pregnancy were more likely to be exclusively breast milk fed during their hospital stay, and there was no evidence of harm. This paper explores women's views and experiences of antenatal expressing. In this two‐arm RCT, 635 women with diabetes in pregnancy who were otherwise of low medical risk were randomised at 36–37 weeks gestation to usual care (not expressing, n = 316), or the intervention, where women were advised to hand express for 10 min twice daily until birth (n = 319). Semistructured face‐to‐face interviews were conducted with 10 women who expressed antenatally. They were asked about their experiences of antenatal expressing, including how they felt about the overall experience, the amount of breast milk they expressed, making time to express, and their experience of breastfeeding. Thematic analysis of the in‐depth interviews identified six themes: (1) learning and adapting expressing, (2) feelings and sensations associated with expressing, (3) support, (4) dis/empowerment, (5) health, and (6) the value of breast milk. Women had both positive and negative experiences of antenatal expressing. If health professionals are advising antenatal expressing to women, it is important they understand the range of outcomes and experiences. Key messages: Women's experiences of antenatal expressing were both positive and negative; it is important to understand the range of experiences.Women should be advised that some women express little or no breast milk antenatally and therefore be reassured if they are concerned.For women with diabetes in pregnancy, their diabetes management is a significant time burden, and should be considered when discussing antenatal expressing with women.Maternity care providers need to follow‐up with pregnant women advised to express, to provide education, reassurance, and reassess expressing techniques.Maternity care providers need to manage and prioritise the use of expressed breast milk. [ABSTRACT FROM AUTHOR]

Objective: To examine whether a method for raising women's awareness of fetal movements, Mindfetalness, can affect pregnancy outcomes.Design: Cluster-randomised controlled trial.Setting: Sixty-seven maternity clinics in Stockholm, Sweden.Population: Women with singleton pregnancy with birth from 32 weeks' gestation.Methods: Women registered at a clinic randomised to Mindfetalness were assigned to receive a leaflet about Mindfetalness (n = 19 639) in comparison with routine care (n = 20 226). Data were collected from a population-based register.Main Outcome Measures: Apgar score <7 at 5 minutes after birth, visit to healthcare due to decrease in fetal movements. Other outcomes: Apgar score <4 at 5 minutes after birth, small-for-gestational-age and mode of delivery.Results: No difference (1.1 versus 1.1%, relative risk [RR] 1.0; 95% CI 0.8-1.2) was found between the Mindfetalness group and the Routine care group for a 5-minute Apgar score <7. Women in the Mindfetalness group contacted healthcare more often due to decreased fetal movements (6.6 versus 3.8%, RR 1.72; 95% CI 1.57-1.87). Mindfetalness was associated with a reduction of babies born small-for-gestational-age (RR 0.95, 95% CI 0.90-1.00), babies born after gestational week 41+6 (RR 0.91, 95% CI 0.83-0.98) and caesarean sections (19.0 versus 20.0%, RR 0.95; 95% CI 0.91-0.99).Conclusions: Mindfetalness did not reduce the number of babies born with an Apgar score <7. However, Mindfetalness was associated with the health benefits of decreased incidence of caesarean section and fewer children born small-for-gestational-age.Tweetable Abstract: Introducing Mindfetalness in maternity care decreased caesarean sections but had no effect on the occurrence of Apgar scores <7. [ABSTRACT FROM AUTHOR]

This retrospective study assessed maternal and perinatal outcomes for women with rheumatic heart disease (RHD) admitted to the largest tertiary obstetric hospital in Western Australia from 2009 to 2016. Of 54 women identified, 75.9% were Indigenous, 59.3% lived in rural areas and 40.7% had severe RHD. Heart failure developed in 10% who gave birth. Indigenous women were younger, had higher gravidity (P = 0.0305), were more likely to receive secondary prophylaxis (P = 0.0041) and have sub‐optimal antenatal clinic attendance (P = 0.0078). There were no maternal deaths and two perinatal deaths (4.0%), reflecting vigilance in the obstetric management of women with RHD in Western Australia. [ABSTRACT FROM AUTHOR]

Background: Longitudinal cohort studies gather large amounts of data over time, often without direct benefit to participants. A positive experience may encourage retention in the study, and participants may benefit in unanticipated ways. Objective: To explore first‐time mothers' experiences of taking part in a longitudinal cohort study and completing self‐administered surveys during pregnancy and at 3, 6, 9 and 12 months' postpartum. Design: Content analysis of comments written by participants in the Maternal health And Maternal Morbidity in Ireland study's five self‐completion surveys, a multisite cohort study exploring women's health and health problems during and after pregnancy. This paper focuses on what women wrote about taking part in the research. Ethical approval was granted by the site hospitals and university. Setting and participants: A total of 2174 women were recruited from two maternity hospitals in Ireland between 2012 and 2015. Findings: A total of 1000 comments were made in the five surveys. Antenatally, barriers related to surveys being long and questions being intimate. Postpartum, barriers related to being busy with life as first‐time mothers. Benefits gained included gaining access to information, taking time to reflect, stopping to think and being prompted to seek help. Survey questions alone were described as valuable sources of information. Discussion and conclusions: Findings suggest that survey research can "give back" to women by being a source of information and a trigger to seek professional help, even while asking sensitive questions. Understanding this can help researchers construct surveys to maximize benefits, real and potential, for participants. [ABSTRACT FROM AUTHOR]

Objective: To assess antenatal care (ANC) coverage and analyse constraining factors for service delivery to rural settled and mobile populations in two districts in Chad.Method: Data from cross-sectional household and health facility surveys in the two Chadian rural health districts were analysed. First, contact coverage of ANC services in the study area was estimated from household data as the proportion of women who visited health facilities to obtain ANC during their last pregnancy. Second, bottlenecks in the provision of this service were explored by calibrating a multiplicative model of ANC contact coverage to household and health facility data. The model allowed quantification of the magnitude by which coverage decreased as it progressed through the health system. Sensitivity analysis was applied to account for uncertainty around the estimated coverage factors.Results: Direct estimates revealed that ANC contact coverage decreased as the number of required visits increased: 79% of rural settled mothers and 46% of mobile pastoralist mothers visited a health facility to obtain ANC at least once (ANC 1). Among mobile pastoralists, only 20% of pregnant women attended ANC at least three times compared to 63% of rural settled women. Availability, accessibility, affordability and acceptability contributed to reductions in service coverage in both populations. For mobile pastoralists, acceptability was clearly the most important factor. ANC 1 contact coverage resulting from the model is 50% for rural settled and 30% for mobile pastoralists.Conclusion: Antenatal care coverage was low in rural districts of Chad, particularly for mobile pastoralists. Acceptability largely explained the prevailing difference between the two population groups. [ABSTRACT FROM AUTHOR]

Introduction: Progesterone is becoming universally accepted for preventing recurrent spontaneous preterm delivery. There is, however, poor consensus on the effective types and doses of progesterone to be used. Despite the encouraging available research, the role of oral micronized progesterone has not yet been thoroughly investigated.Material and Methods: We randomized 212 singleton pregnancies with past history of spontaneous preterm delivery at <37 weeks, into a progesterone group (receiving 100 mg oral micronized progesterone, six-hourly, starting at 14-18 weeks until 37 weeks or delivery) and an identical placebo group. The rate of spontaneous preterm delivery was the primary outcome. Secondary outcomes included gestational age at birth and admission to neonatal intensive care units.Results: The progesterone group delivered at a later gestational age, and needed longer tocolysis-to-delivery intervals (35.4 weeks vs. 33.9 weeks, p = 0.01, and 87 days vs. 36 days, p < 0.001, respectively). The relative risk of spontaneous preterm delivery was 0.7 (95% confidence interval 0.54-0.92, p = 0.01), and the number needed-to-treat to prevent one case of spontaneous preterm delivery was 5 (95% confidence interval 3-20). The two groups had similar rates of operative delivery and postpartum complications. Progesterone was associated with mild maternal dizziness (29.1% vs. 9.8%, p = 0.002), somnolence (41.6% vs. 19.7%, p = 0.002), and vaginal dryness (20.8% vs. 8.7%, p = 0.03), lower neonatal mortality rates (7.3% vs. 25.2%, p < 0.001), and shorter neonatal intensive care unit admissions (p = 0.008).Conclusion: Oral micronized progesterone is effective in preventing spontaneous preterm delivery. The additional advantages of oral administration, affordability, and high safety profile make it worth recommending, at least for further research. [ABSTRACT FROM AUTHOR]

Objective: To compare severe maternal complications (potentially life-threatening conditions [PLTCs], maternal near miss [MNM], and maternal death) and perinatal outcomes between multiple and singleton pregnancies.Methods: A secondary analysis was undertaken using data from the Brazilian Network for Surveillance of Severe Maternal Morbidity (prospective surveillance of morbidities in 27 Brazilian obstetric units between July 2009 and June 2010). Health indicators and criteria used for PLTCs and MNM were assessed. Adjusted prevalence ratios (PRadj ) with 95% confidence intervals (CIs) were calculated for perinatal outcomes.Results: Among 267 multiple pregnancies, 235 (88.0%) were affected by PLTCs, 25 (9.4%) by MNM, and 7 (2.6%) by maternal death; these prevalences did not differ from singleton pregnancies (n=7986). Management criteria for MNM were used almost twice as much in multiple pregnancies (PRadj 1.85, 95% CI 1.41-2.42). Preterm birth (PRadj 1.62, 95% CI 1.41-1.86), low birthweight (PRadj 1.73, 95% CI 1.45-2.06 for the first-born vs singleton), any adverse perinatal outcome (PRadj 1.12, 95% CI 1.03-1.22 for the second- vs first-born), and neonatal near miss (PRadj 1.37, 95% CI 1.13-1.67 for the second-born vs singleton) were significantly associated with multiple pregnancy.Conclusion: Among cases of severe maternal morbidity, perinatal but not maternal outcomes were poorer for multiple pregnancies than for singletons. Differentiated care is needed during pregnancy and childbirth. [ABSTRACT FROM AUTHOR]

Background: The Winnunga Nimmityjah Aboriginal Health Service Aboriginal Midwifery Access Program (AMAP) was established in 2001 to provide antenatal care, birth support and postnatal care to clients in the Australian Capital Territory (ACT). Aim: To describe the uptake and impact of AMAP services on access to antenatal care, behavioural risk factors and pregnancy outcomes and to compare the characteristics of AMAP clients with other women giving birth in the ACT. Methods: A descriptive study of medical records for AMAP clients who gave birth in 2004-2008. Outcome measures: maternal and baby characteristics, antenatal visits, behavioural risk factors and complications. Characteristics of AMAP clients were compared with the ACT Maternal and Perinatal Collection. Results: Of 187 women, 11.2% were aged <20 years, 50.3% presented in the first trimester and 94.7% attended five or more antenatal visits. Of 193 babies, 17.1% were born preterm and 18.1% had low birthweight. Compared with the ACT Maternal and Perinatal Collection, Aboriginal and Torres Strait Islander AMAP clients had a higher smoking rate (63.8 vs 49.0%), a lower caesarean delivery rate (20.0 vs 27.6%), a slightly lower proportion of preterm babies (18.8 vs 21.6%) and a slightly lower proportion of low-birthweight babies (18.8 vs 21.0%). Conclusions: Aboriginal Midwifery Access Program provides high-quality antenatal care in a trusted environment. The high rate of smoking in pregnancy needs to be addressed. [ABSTRACT FROM AUTHOR]

Objective: To explore maternal healthcare utilization in rural western China, and to analyze the socioeconomic and demographic determinants associated with use of maternal health services.Methods: Between July and August 2005, 14112 women from 45 counties in 10 western provinces of China were enrolled in a cross-sectional study by a multi-stage probability sampling method. The women completed a structured questionnaire, and a 2-level logistic regression model was used to examine the data.Results: The proportion of women who had prenatal care was 95%. The average number of prenatal visits was 4.94. The proportion of women who had more than 4 prenatal visits was 52.9%, and 66.9% of these had their first prenatal visit within 12 weeks of gestation. The hospital delivery rate was 86.3%. The frequency of postnatal visits was 84.8%, and the average number of postnatal visits was 2.19. Han ethnicity, higher education, lower parity, higher wealth index, and lower altitude of county had a higher odds ratio for more than 4 prenatal visits, hospital delivery, and postnatal visits.Conclusion: Maternal healthcare utilization seems to be associated with socio-economic and regional factors. The Chinese government should focus on the supply, funding, and quality of maternity services in rural areas. [ABSTRACT FROM AUTHOR]

Objective: We assessed the effect of prenatal and peripartum antibiotics on maternal morbidity and mortality among HIV-infected and uninfected women.Methods: A multicenter trial was conducted at clinical sites in 4 Sub-Saharan African cities: Blantyre and Lilongwe, Malawi; Dar es Salaam, Tanzania; and Lusaka, Zambia. A total of 1558 HIV-infected and 271 uninfected pregnant women who were eligible to receive both the prenatal and peripartum antibiotic/placebo regimens were enrolled. Pregnant women were interviewed at 20-24 weeks of gestation and a physical examination was performed. Women were randomized to receive either antibiotics or placebo. At the 26-30 week visit, participants were given antibiotics or placebo to be taken every 4 hours beginning at the onset of labor and continuing after delivery 3 times a day until a 1-week course was completed. Logistic regression and Cox proportional hazards models were used.Results: There were no significant differences between the antibiotic and placebo groups for medical conditions, obstetric complications, physical examination findings, puerperal sepsis, and death in either the HIV-infected or the uninfected cohort.Conclusion: Administration of study antibiotics during pregnancy had no effect on maternal morbidity and mortality among HIV-infected and uninfected pregnant women. [ABSTRACT FROM AUTHOR]

Objective: To obtain descriptive measures of maternal and perinatal health in the Ba Men Region of Inner Mongolia, China.Methods: Data collected from the Examination Chart for Pregnant Women for approximately 22,000 pregnancies in a three-county area of Inner Mongolia, China from December 1, 1996 through December 31, 1999 were analyzed for maternal, perinatal, and neonatal outcomes.Results: Compared to selected developing countries, a higher percentage of women (99%) in this region received at least one prenatal care visit. This region was also characterized by a low percentage of low birthweight (<2.5 kg) infants (1%) and neonatal mortality rate (5 deaths per 1000 live births).Conclusions: Maternal and neonatal health outcomes in this region of Inner Mongolia were better than those in selected developing countries. [ABSTRACT FROM AUTHOR]

Objective: To improve the quality of clinical care for women with severe pre-eclampsia.Methods: A criteria-based audit was conducted in a large government hospital in Uganda. Management practices were evaluated against standards developed by an expert panel by retrospectively evaluating 43 case files. Results of the audit were presented, and recommendations developed and implemented. A re-audit was conducted 6 months later.Results: The initial audit showed that most standards were rarely achieved. Reasons were discussed. Guidelines were produced, additional supplies were purchased following a fundraising effort, labor ward procedures were streamlined, and staffing was increased. In the re-audit there were significant improvements in diagnosis, monitoring, and treatment.Conclusion: Criteria-based audit can improve the quality of maternity care in countries with limited resources. [ABSTRACT FROM AUTHOR]

Objective: To compare the course and outcome of triplet gestations under a preventive care strategy that includes hospitalization, surveillance, bed rest, and daily specialized care from the beginning of the second trimester, with pregnancies managed according to the Croatian standard outpatient care protocol for multiplets. Methods: A retrospective study of 79 triplet pregnancies. Preventive hospitalization from the beginning of the second trimester, with complete bed rest and all necessary interventions, was chosen by 55 women (Group I). The remaining 24 women (Group II) elected the standard outpatient protocol for multiple pregnancies. Outpatient management with prophylactic bed rest was initiated at home as soon as the multiple pregnancy was diagnosed. After 28 weeks of gestation, all outpatients were hospitalized until delivery irrespective of symptoms. Results: There was no difference between the groups regarding maternal age, race, pre-pregnancy weight and height, weight gain during the first 24 weeks of pregnancy, or the proportion of pregnancies achieved with assisted reproductive technology. Four out of 55 women (7.2%) from Group I and 4 out of 24 women (12.5%) from Group II had monochorionic triplet pregnancies (P=n.s.). Nulliparity was more frequent in Group I than in Group II (P=0.006). Elective cesarean delivery was significantly more frequent in Group I (46 out of 55 gestations, 72.7%) than in Group II (9 out of 24 gestations, 37.5%), P=0.024. Gestational age at delivery and mean birth weight were significantly higher in Group I than in Group II (P<0.001). Deliveries up to 28 weeks of pregnancy were infrequent in Group I (P=0.02). Thirty-three gestations in Group I (60%) and 6 (25%) in Group II had a duration of 33–36 weeks (P<0.001). Two out of 55 triplet gestations in Group I (3.6%) and 4 out of 24 in Group II (16.7%) ended in spontaneous abortion (P=0.053). The survival of the three triplets was more frequent in Group I than in Group II (P=0.048). For gestations reaching 24 weeks or more, the fetal and perinatal death rate was significantly lower in Group I (P<0.001). In Group I the intrauterine death rate for fetuses weighing 1500 g or less was also significantly lower (P=0.007), and the early neonatal death rate was almost half (15.8 vs. 28.9%, P=0.157). There were no differences in other pregnancy complications between the two groups except significantly more frequent preterm premature rupture of membranes and preterm labor requiring parenteral tocolysis in Group II (P=0.042 and 0.036, respectively), and significantly more frequent fetal growth retardation in Group I (P<0.001). Conclusion: Preventive hospitalization offers a better outcome for triplets even though prolonged hospitalization and all other procedures necessary to achieve optimal pregnancy outcome are also offered in the Croatian standard outpatient care protocol for multiplet pregnancies. [Copyright &y& Elsevier]

Aim: Australian data on the prevalence and distribution of antenatal risk factors are scarce. This study aimed to investigate (i) the feasibility and acceptability of an antenatal risk factor survey collected in public settings and (ii) whether the survey risk factors co-occur with more sensitive risk factors that are privately asked by clinicians.Methods: Design and setting: study-designed survey linked with clinician-collected risk factors.Participants: pregnant women attending antenatal clinics at two Victorian hospitals.Measures: (i) study-designed survey: young pregnancy, no support, poor/fair/good general health, anxious mood, not finishing high school, no income, long-term illness, living without another adult, not employed, never had a job and proxy poverty measures; (ii) Clinician-collected data: smoking, alcohol/marijuana/drug use, domestic violence, social issues, history of mental health problems and depression symptoms.Analyses: (i) feasibility and acceptability were assessed through survey completion. Each item was assessed for whether they discriminated risk; dichotomised into risk versus no risk; with a total count calculated. (ii) Co-occurrence was assessed by examining how the risk factor count agreed with clinician-collected items.Results: One hundred and sixty-six of 186 (89%) eligible women completed the survey; 139 of 166 (84%) consented to linking clinician-collected data. The high response and zero missing data demonstrated feasibility and acceptability. Of women with linked data, 92 of 139 (66%) had ≥1 survey risk factor and 30 of 139 (22%) had ≥3; 36 of 139 (26%) had at least one co-occurring clinician-collected risk factor.Conclusions: This survey provides a simple, rapid approach to gathering antenatal risk data publicly. It may be a helpful addition to clinicians' standard history collection. [ABSTRACT FROM AUTHOR]