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International audience; Cesarean deliveries are widely used in many high- and middle-income countries. This overuse both increases costs and lowers quality of care and is thus a major concern in the healthcare industry. The study first examines the impact of prenatal care utilization on cesarean delivery rates. It then determines whether socioeconomic status affects the use of prenatal care and thereby influences the cesarean delivery decision. Using exclusive French delivery data over the 2008–2014 period, with multilevel logit models, and controlling for relevant patient and hospital characteristics, we show that women who do not participate in prenatal education have an increased probability of a cesarean delivery compared to those who do. The study further indicates that attendance at prenatal education varies according to socioeconomic status. Low socioeconomic women are more likely to have cesarean deliveries and less likely to participate in prenatal education. This result emphasizes the importance of focusing on pregnancy health education, particularly for low-income women, as a potential way to limit unnecessary cesarean deliveries. Future studies would ideally investigate the effect of interventions promoting such as care participation on cesarean delivery rates.

INTRODUCTION: The clinical practice guidelines on pregnancy care have been developed to provide reliable and standardised guidance for health professionals providing antenatal care in Australia. They were originally released as the Clinical Practice Guidelines: Antenatal Care in two separate editions (modules 1 and 2) in 2012 and 2014. These modules have now been combined and updated to form a single set of consolidated guidelines that were publicly released in February 2018 as the Clinical Practice Guidelines: Pregnancy Care. Eleven topics have been updated and new guidance on substance use in pregnancy has been added. Main recommendations: The updated guidelines include the following key changes to practice: recommend routine testing for hepatitis C at the first antenatal visit; recommend against routine testing for vitamin D status in the absence of a specific indication; recommend discussing weight change, diet and physical activity with all pregnant women; and recommend offering pregnant women the opportunity to be weighed at every antenatal visit and encouraging women to self-monitor weight gain. Changes in management as a result of the guidelines: The guidelines will enable pregnant women diagnosed with hepatitis C to be identified and thus avoid invasive procedures that increase the risk of mother-to-baby transmission. Women can be treated postpartum, reducing the risk of liver disease and removing the risk of perinatal infection for subsequent pregnancies. Routine testing of all pregnant women for vitamin D status and subsequent vitamin D supplementation is not supported by evidence and should cease as the benefits and harms of vitamin D supplementation remain unclear. The recommendation for health professionals to provide advice to pregnant women about weight, diet and physical activity, and the opportunity to be weighed will help women to make changes leading to better health outcomes for themselves and their babies.

BACKGROUND Pregnant women at risk for hypertensive complications need frequent monitoring in the outpatient clinics. These recurrent visits interfere with daily life and can a burden for both patients and perinatal care resources. Telemonitoring has the potential to complement or replace standard pathways in prenatal care with self-measurements, integrated in a monitoring dashboard for in-hospital obstetric care professionals. OBJECTIVE In this feasibility study of a telemonitoring platform in antenatal care, we examined the patient engagement and compliance, accuracy of the alert system and the participants’ experiences. METHODS We developed a telemonitoring platform, consisting of an app and secured web portal, wireless blood pressure monitor and an in-app 10-symptom checklist. In this prospective observational study, 14 participating women with low-risk pregnancies were asked to submit blood pressure (BP) measurements and symptom checklists once daily during 15 consecutive weekdays. Values exceeding the preset threshold values led to alerts on the monitoring dashboard for health care providers and were reviewed daily in our outpatient clinic. Patient engagement was measured by evaluating the number of entered values. The accuracy of the automatic alerts was checked by comparing all the entered values with the threshold values. The usability and patient satisfaction were measured using questionnaires. RESULTS Compliance rates for blood pressure and symptom checklist were 93% and 86% respectively during the 15 telemonitoring days. No false positive or missing alerts have been found. The telemonitoring system alarmed 7 times for BP thresholds (3.8% of all received BP values), of which 4 alerts for an exceeded upper limit. These 4 alerts came from one participant, who was diagnosed with chronic hypertension and received further evaluation and treatment outside the study protocol. Of all 167 returned symptom checklists, 73 reported one or more symptoms (43.7%). In five cases (3.0%), symptoms gave reason for further analysis in the outpatient clinic. Other symptom alarms could be handled with expectant management, e.g. because of normal blood pressure. The majority of participants was satisfied with the use and convenience of the app and the automatic blood pressure monitor. CONCLUSIONS This feasibility study of a telemonitoring platform for blood pressure and symptom measurements in women with an uncomplicated pregnancy showed that remote monitoring with an app and alert system can be used in antenatal care and holds the promise of improving outpatient care for women at risk of hypertensive pregnancy disorders.

Prematurity represents the determinant cause of infant mortality. This serious public health problem is directly related to the assistance provided during pregnancy and childbirth. Hence, this paper proposes the use of leading machine learning techniques capable of supporting health experts in pattern recognition in the prediction of high-risk situations for the fetus. The proposed model creates an ensemble of nearest-neighbor classifiers using the random subspace algorithm, reaching an overall accuracy of 0.937 and area under the curve of 0.721, in predicting the Apgar score, and 0.829 and 0.669 in predicting if the newborn will be small for gestational age, respectively. These results show the model effectiveness in reducing severe pregnancy related-problems.

Caring for the obstetric patient with significant medical problems can be complex. Neurologic diseases in pregnancy can range in severity and therefore vary in the amount of care planning that is required. Certain diseases will require more coordination of care with multidisciplinary teams than others. In these cases, the use of care maps or guidelines can assist practitioners with providing comprehensive care. This chapter will serve as an overview of pregnancy-specific considerations that will be reviewed in subsequent chapters throughout this book. Overall, by focusing attention to the specific needs of the complex obstetric neurologic patient, practitioners can help to optimize outcomes for these women and their pregnancies.

Background: Gestational diabetes is a common pregnancy disorder that affects the mother’s and neonate’s health. The present study was conducted to investigate the effect of a health literacy approach to counselling on the lifestyle of women with gestational diabetes. The present randomized controlled clinical trial was conducted in 2017 using a parallel design. The subjects included 84 eligible women presenting to Alborz and Kamali Hospitals, Karaj, Iran. Methods: Convenience sampling was first used to select the subjects. They were then assigned to an intervention or control group based on randomized blocks of four. Both groups attended counselling sessions. The mothers in the intervention group attended six sessions of counselling with a health literacy approach in addition to counselling on routine pregnancy care. The control group attended counselling sessions on safe pregnancy care and received a training package containing all the subjects discussed in the intervention group. The Lifestyle Questionnaire and the Iranian Health Literacy Questionnaire were completed by the mothers at the beginning and at the end of the sessions as well as three weeks after the sessions. The data obtained were analyzed in SPSS-19. Results: According to the study findings, the scores of lifestyle (P=0.8) and health literacy (P=0.423) showed no significant differences between the intervention and control groups before the intervention. Significant differences were, however, observed in the mean scores of lifestyle and health literacy between the two groups immediately and three weeks after the intervention. Comparing the means showed a higher increase in the mean scores in the intervention group (P Conclusions: Providing counselling services by midwives can significantly help modify mothers’ unhealthy lifestyle choices and increase their health literacy; therefore, reducing maternal and neonatal consequences, especially in high-risk pregnancies. Trial registration number: IRCT2017021427728N3 Trial registry: Iranian Registry of Clinical Trials Trial registration date: 5th April 2017

At the time of networked care organizations, especially during the existence of vulnerabilities identified such as the existence of maternal or parental psychiatric disorders more broadly, the pediatrician is part of the actors of pregnancy care, anticipation of birth and postnatal support.

Cases in which patients hold idiosyncratic beliefs that are at odds with the beliefs and practices of the health care provider are often challenging. Getting help from another perspective is useful...

Lorretta F Ntoimo,1,2 Friday E Okonofua,1,3,4 Rosemary N Ogu,1,3,5 Hadiza S Galadanci,6 Mohammed Gana,7 Ola N Okike,8 Kingsley N Agholor,9 Rukiyat A Abdus-Salam,10 Adetoye Durodola,11 Eghe Abe,12 Abdullahi J Randawa13 On behalf of the WHARC WHO FMOH MNCH Implementation Research Study Team 1WHO Implementation Research Group, The Women’s Health and Action Research Centre, Benin City, Edo State, 2Department of Demography and Social Statistics, Federal University Oye-Ekiti, Ekiti State, 3Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Edo State, 4Vice Chancellors Office, University of Medical Sciences, Ondo City, Ondo State, 5Department of Obstetrics and Gynaecology, University of Port Harcourt, Port Harcourt, Rivers State, 6Aminu Kano Teaching Hospital, Kano, Kano State, 7General Hospital, Minna, Niger State, 8Karshi General Hospital, Federal Capital Territory, Abuja, 9Central Hospital, Warri, Delta State, 10Adeoyo Maternity Hospital, Ibadan, Oyo State, 11General Hospital, Ijaye, Abeokuta, Ogun State, 12Central Hospital, Benin City, Edo State, 13Department of Obstetrics and Gynaecology, Ahmadu Bello University, Zaria, Kaduna State, Nigeria Introduction: While reports from individual hospitals have helped to provide insights into the causes of maternal mortality in low-income countries, they are often limited for policymaking at national and subnational levels. This multisite study was designed to determine maternal mortality ratios (MMRs) and identify the risk factors for maternal deaths in referral health facilities in Nigeria.Methods: A pretested study protocol was used over a 6-month period (January1–June 30, 2014) to obtain clinical data on pregnancies, births, and maternal deaths in eight referral hospitals across eight states and four geopolitical zones of Nigeria. Data were analyzed centrally using univariate, bivariate, and multivariate statistics.Results: The results show an MMR of 2,085 per 100,000 live births in the hospitals (range: 877–4,210 per 100,000 births). Several covariates were identified as increasing the odds for maternal mortality; however, after adjustment for confounding, five factors remained significant in the logistic regression model. These include delivery in a secondary health facility as opposed to delivery in a tertiary hospital, non-booking for antenatal and delivery care, referral as obstetric emergency from nonhospital sources of care, previous experience by women of early pregnancy complications, and grandmultiparity.Conclusion: MMR remains high in referral health facilities in Nigeria due to institutional and patient-related factors. Efforts to reduce MMR in these health facilities should include the improvement of emergency obstetric care, public health education so that women can seek appropriate and immediate evidence-based pregnancy care, the socioeconomic empowerment of women, and the strengthening of the health care system. Keywords: maternal death, maternal mortality ratio, emergency obstetric care, pregnancy care, tertiary hospital

We report a study to design and evaluate an app to support pregnancy information provided to women through an Australian health service. As part of a larger project to provide prenatal resources for culturally and linguistically diverse groups, this study focused on the design and reception of an app with the local Vietnamese community and health professionals of a particular hospital. Our study had three stages: an initial design workshop with the hospital; prototype design and development; prototype-based interviews with health professionals and focus groups with Vietnamese women. We explore how an app of this sort must be designed for a range of different use scenarios, considering its use by consumers with a multiplicity of differing viewpoints about its nature and purpose in relation to pregnancy care.

BACKGROUND: Preconception care is a set of interventions that aim to identify and repair the factors that can affect the outcome of pregnancy. The aim of this study was to determine the prevalence of receiving preconception care, its relation with recipients’ individuality, fertility, and determining the reason for lack of checkup. MATERIALS AND METHODS: This was a descriptive cross-sectional study that was conducted based on simple stratified random quota sampling on 702 women who gave birth in hospitals of Isfahan (Iran) from April to June in 2016. The tool of collecting data was researcher-made questionnaire. The data were analyzed by the SPSS software version 18 using the mean, standard deviation, relativity, and independent Chi-square tests. RESULTS: The results showed that 47.7% of participants had received preconception care. There was a significant relationship between educational levels, income, wanted pregnancy, number of pregnancies, and previous individual delivery with preconception care (P < 0/05). The main reason for the lack of preconception care was unplanned pregnancy. CONCLUSIONS: Results of this study indicated that the quantity of preconception care is not desirable. Therefore, notifying and sensitizing women of childbearing age is essential to refer to service centers and receiving preconception care and planning to present it to all eligible women before pregnancy care. The main causes of the lack of preconception care can be adjusted through health programs.

The maternal mortality rate (MMR) in developing countries is still a major health problem, including in Indonesia. Antenatal Care (ANC), delivery with skilled birth attendance (SBA) at the time of delivery and delivery in institutional are universally considered important for reducing maternal mortality. Husbands can play a crucial role in pregnancy and childbirth. Therefore, the aim of this study was analyze the indicators of husband's role in pregnancy and maternity care which were suspected as one of the determinants of ANC and SBA use in Polewali Mandar Regency. The population of this prospective cohort study was all married and pregnant woman, before using contraceptives and contraceptive failure or not using contraception and pregnancy is planned, unplanned pregnancy or mistimed pregnancy in Polewali Mandar 2015 (Size of sample = 100). Samples were randomly selected from participants of screening in 12 sub-districts in Polewali Mandar. Data about husband's role in pregnancy and maternity care was obtained through interviews using a structured questionnaire data processing by using SMART-PLS. The result of data analysis suggested that the coefficient value that has been standardized from each indicator were as follows: accessibility = 0.944 and engagement = 0.954, dan responsibility = 0.968. Indicators of organizational support in implementing Maternal and Child Health Information System at Polewali Mandar Regency, respectively from the most important are: responsibility, engagement, and accessibility. Full Text: PDF DOI: http://dx.doi.org/10.11591/ijphs.v6i2.6181

Reproductive rights are essential to the recognition/treatment of women as full-fledged human beings/citizens. Barriers to reproductive rights pose a grave danger to women's well-being. This article explores the origins of these barriers, their nature, and their impact on mental health. The most controversial relationship is between induced abortion and mental health. Barriers, misinformation, and coercion affecting contraceptive, abortion, and pregnancy care are an ongoing danger to women's mental health and the well-being of their families. Mental health professionals are best qualified, and have an obligation, to know the facts, apply them, and provide accurate information to protect women's health.

Background: Shared decision making in pregnancy, labour, and birth is vital to woman-centred care and despite strong evidence for the effectiveness of shared decision making in pregnancy care, practical uptake has been slow. Design and Aim: This scoping review aimed to identify and describe effective and appropriate shared decision aids designed to be provided to women in the antenatal period to assist them in making informed decisions for both pregnancy and birth. Two questions guided the enquiry: (i) what shared decision aids for pregnancy and perinatal care are of appropriate quality and feasibility for application in Australia? (ii) which of these decision aids have been shown to be effective and appropriate for Aboriginal and Torres Strait Islander peoples, culturally diverse women, or those with low literacy? Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR) was used to conduct the review. Five key databases and selected grey literature sources were examined. English language evidence from Australia, Europe, Canada, United Kingdom, New Zealand, and United States of America produced from 2009 was eligible for inclusion, checked against apriori inclusion criteria, and assessed for quality and usability using the International Patient Decision Aid Standards. Results: From a total of 5,209 search results, 35 sources of evidence reporting on 27 decision aids were included following title/abstract and full-text review. Most of the decision aids concerned decisions around birth (52%, n = 14) or antenatal screening 37% (n = 10). The quality of the decision aids was moderate to high, with most communicating risks, benefits, and choice pathways via a mix of Likert-style scales, quizzes, and pictures or graphs. Use of decision aids resulted in significant reductions in decisional conflict and increased knowledge. The format of decision aids appeared to have no effect on these outcomes, indicating that paper-based are as effective as video- or audio-based decision aids. Eleven decision aids were suitable for low literacy or low health literacy women, and six were either developed for culturally diverse groups or have been translated into other languages. No decision aids found were specific to Aboriginal and Torres Strait Islander peoples. Conclusions and implications for practice: The 27 decision aids are readily adoptable into westernised healthcare settings and can be used by midwives or multidisciplinary teams in conjunction with women. Decision aids are designed to support women, and families to arrive at informed choices and supplement the decision-making process rather than to replace consumer-healthcare professional interaction. If given before an appointment, high quality decision aids can increase a woman's familiarity with medical terminology, options for care, and an insight into personal values, thereby decreasing decisional conflict and increasing knowledge. Refereed/Peer-reviewed

We conducted a focused ethnography with 12 First Nations women who had had diabetes in pregnancy to understand their real-life experiences and find ways to improve care for those with diabetes in pregnancy. We carried out unstructured interviews that were recorded, transcribed, and subject to qualitative content analysis. The experience of diabetes in pregnancy is one wrought with difficulties but balanced to some degree by positive lifestyle changes. Having a strong support system (family, health care, cultural/community, and internal support) and the necessary resources (primarily awareness/education) allows women to take some control of their health. Efforts to improve pregnancy care for First Nations women should take a more patient-centered care approach and strive to enhance the support systems of these women, increase their sense of autonomy, and raise awareness of diabetes in pregnancy and its accompanying challenges.

We evaluated the trends of the last decades in maternal mortality in Hungary and compared Hungarian results with those of other European countries.Cases of maternal death in Hungary during the study period from calendar year 1978 to 2010 were analyzed in a retrospective manner to characterize mortality distribution and to identify potential clinical or demographic predictors. Data in all cases were extracted both from the national Obstetric Registry operated by the National Institute of Gynecology and Obstetrics, from the Hungarian Central Bureau of Statistics and from the National Public Health and Medical Officer Service. Detailed clinical data were obtained based on obligatory reporting by individual clinical institutions.The annual maternal mortality rate (MMR) was 26.7 per 100,000 live births in the period 1978-1987 and declined significantly to 10.9 per 100,000 live births in the period 1997-2010. In the period 1988-1996 (with missing associated clinical and demographic data) the MMR was 16.4 per 100,000 live births. The proportion of delivery-associated causes of death increased significantly between the two study periods from 49.4% to 62.9% (p0.05). Among obstetric causes of death, the rate of thromboembolism showed a significant increase, while there was a trend toward a decline in rate of maternal deaths attributable to hemorrhagic shock. Among medical causes of death not directly attributable to obstetric complications, the rate of renal and gastrointestinal etiologies declined significantly throughout the study periods.We observed a marked decline in maternal mortality during the last few decades in Hungary. Recent changes in mortality distribution highlight current characteristics of pregnancy care in Hungary and may help identify strategies for future improvement.

Background and purpose: Prematurity birth occurs when a newborn is born before the thirty seventh week of pregnancy. Preterm birth is the most expensive and the most common health problem. So, the aim of this study was to do epidemiological survey of prematurity in Gonbad-e Kavous in 2010. Materials and Methods: This sectional- descriptive study was carried out on 172 premature babies with census method. A questionnaire was made with α= 0.873 to collect the data. The data were analyzed with SPSS software, descriptive statistics and Poisson regression. Results: The incidence of prematurity was 41.04 at live births per 1,000 and the mortality rate of prematurity based on all births at live births per 1,000 was 7.78 in 2009. In 2007 and 2008, the mortality rate of prematurity based on all births at live births per 1000 was 10.74 and 7.08, respectively. The villages of Baghlimara, Gadomabad, Aghabad, Gharemohammadtapeh, Chaighoshan, Agribaghaz, Soltanali, Taghiabad, Gonbad1, Gonbad 6, Bibishirvan had the highest maturity rate in 2009-2010, respectively. The most focused was in the south and southeast villages and broader line villages had the lowest rate of prematurity. Conclusion: The majority of mothers who had preterm birth did not have appropriate nutrition, economic and social situations. In terms of education, 61% of them were at primary level that can have effect on their knowledge and practice. Therefore, increasing knowledge rate and changing diet in pregnancy care and paying more attention to related organizations in improving their livelihood are recommended.

Background Gestational diabetes mellitus (GDM) is defined as a glucose tolerance disorder that arises during pregnancy. Estimates of its prevalence vary widely because of varying threshold values. Screening of all pregnant women with a two-step test has been available in Germany since 2012. This study is the first population-based, nationwide analysis of the screening coverage and the resulting one-year prevalence. Methods Billing data from the outpatient sector were analyzed for all persons covered by statutory health insurance in the two-year period 2014-2015. A cohort of pregnant women, constructed by using pregnancy care billing data, was studied with respect to the screening coverage. The prevalence of GDM was determined from the use of the corresponding ICD-10-GM codes. Results 80.8% of 567 191 pregnant women were screened for GDM. Most of them (63.3%) received only the pre-test, and 12.7% received both the pre-test and the diagnostic test. 4.8% received only the diagnostic test. The overall prevalence of GDM was 13.2%. The prevalence rose with age, from 8% to 26% in women aged 45 or older. Younger women more commonly received only the pre-test; the frequency of receiving both tests rose with age. Conclusion Screening for GDM is comprehensively implemented. The analysis of billing data reveals a relatively high prevalence that accords with estimates in other countries, implying that earlier prevalence figures for Germany were probably underestimates.

The authors report a case of angular ectopic pregnancy interrupted at six weeks of amenorrhoea with the patients of 32 years old, with her 2nd pregnancy, nulliparous an antecedent of laparotomy for right ectopic pregnancy (EP). At the admission, the clinical examination and the ultrasound have permitted to make a diagnosis of an abdominal pregnancy. During the operation the diagnosis of a left retort ectopic pregnancy has been made. It has profited from a suture with a perfect haemostasis. The aftermaths of the operation have been simple and the patient has been recovered five days (5 days) after the operation.

BACKGROUND:The use of complementary and alternative medicine (CAM) to manage pregnancy-related conditions is becoming increasingly popular. This article draws on a qualitative study that aimed to explain the processes midwives engaged when determining the role of these therapies for pregnancy care.METHODOLOGY:Our study used grounded theory methodology. Twenty-five midwives, who were employed in metropolitan hospitals situated in Victoria, Australia, participated in the study. Data was collected from semistructured interviews and nonparticipant observation of a subgroup over an 18-month period.RESULTS:Midwives’ attitudes and behavior toward the CAM was influenced by their professional ideology and knowledge. When participants considered the role of these therapies, they employed various strategies including aligning CAM with midwifery philosophy, using the therapies to increase women’s options, valuing diverse ways of understanding and seeking out professional knowledge.CONCLUSIONS:Although midwives do not reject conventional medicine, many value the opportunity CAM offers to individualize care and promote natural childbearing.

Gross iron overload has long been known to result in diabetes mellitus. However, it is now thought that milder levels of iron overload, possibly within the normal range, also increase the risk of diabetes mellitus. The article by Rawal et al in this issue (Diabetologia doi: 10.1007/s00125-016-4149-3 ) provides further support for the relationship between mild degrees of iron overload and the risk of gestational diabetes. The purpose of this commentary is to briefly discuss the background of this relationship and the implications it may have for routine pregnancy care.

Background: Listening to women as part of their antenatal care has been recognized as valuable in understanding the woman's needs. Conversations as part of routine antenatal interactions offer ideal opportunities for women to express themselves and for midwives to learn about the woman's issues and concerns. The antenatal visit and the convention of antenatal consultations for midwives have not been well explored or defined and much of what takes place replicate medical consultative processes. As a consequence, there is little to assist midwives construct woman-centred care consultations for their routine antenatal care practice. This study showed how some practices were better in promoting the woman's voice and woman-centred care in the hospital setting. Method: Contemporary focused ethnography using both interview and observations, explored how midwives from six different public antenatal clinics in South Australia organized their antenatal care consultations with pregnant women. Findings: Thematic analysis of the data provided insights into professional interpretation of woman-centred practice. How midwives interacted with women during routine antenatal care events demonstrated that some practices in a hospital setting could either support or undermine a woman-centred philosophy. Conclusion: Individual midwives adopted practices according to their own perceptions of actions and behaviors that were considered to be in accordance with the philosophy of woman-centred care. Information arising from this study has shown ways midwives may arrange antenatal care consultations to maximize women's participation. Refereed/Peer-reviewed

Background Severe fetal growth restriction (FGR) (

Parathyroid disease is not common during pregnancy but can be severe when it occurs. Hyperparathyroidism in eight of every 100,000 women of reproductive age are seen. Hypercalcemia may be masked during pregnancy due to Calcium passes through the placenta to the fetus but it can cause hypercalcemic crisis, acute pancreatitis, pathologic fractures and mortality in the postpartum period. As a result of the inhibition of fetal parathyroid hormone arises risks of hypocalcemia, tetany, abortion, intrauterine growth retardation, low birth weight, polyhydramnios and preterm labor. Karpopedal spazm trousseau and Chvostek signs are helpful in the diagnosi of hypoparathyroidisms. In these diseases can be seen fetal risks of abortion, rachitism, demineralization and intrauterine fractures. Therefore, newborns should be observed and screened for an autosomal recessive disease in the postpartum period. Also, Breastfeeding should be avoided due to calcium loss. As a result, Midwifery care for pregnant women to be given importance for parathyroid disease can threaten the lives of both mother and fetus although not very common in pregnancy, Paratiroid hastalıklar gebelik sırasında yaygın olmamakla birlikte meydana geldiğinde şiddetli sonuçlar gelişebilmektedir. Üreme çağındaki her 100.000 kadının sekizinde hiperparatiroidi görülmektedir. Gebelikte kalsiyum plasenta ile fetusa geçtiği için hiperkalsemi maskelenebilmektedir. Postpartum dönemde hiperkalsemik kriz, akut pankreatit, patolojik kırıklar ve mortaliteye neden olabilmektedir. Fetal parathormonun inhibisyonu sonucunda hipokalsemi, tetani, abortus, intrauterin gelişme geriliği, düşük doğum ağırlığı, polihidroamnios ve prematür eylem riski ortaya çıkmaktadır. Karpopedal spazm trousseau ve chvostek bulgusu hipoparatiroidizm tansını koymada yardımcıdır. Bu hastalıklarda abortus, raşitizm, demineralizasyon ve intrauterin kırık gibi fetal riskler görülebilir. Bu nedenle postpartum dönemde yenidoğan gözlenmeli ve otozomal resesif geçişli olabileceği için tarama yapılmalıdır. Bununla birlikte kalsiyum kaybından dolayı anne emzirmeden kaçınmalıdır. Sonuç olarak, paratiroid hastalıklar gebelikte çok sık görülmemesine rağmen hem anne hem de fetusun hayatını tehdit eden bir durum olabileceği için gebeye verilecek sağlık bakımı önem taşımaktadır.

Approximately 113,000 bariatric procedures are conducted yearly. From 1998 to 2005, 83% of those having bariatric surgery in the 18 to 45-year-old age group were women. Reproductive implications are ideally addressed when surgery is planned, including the possibility of increased fertility after surgery, appropriate contraception, and the interval from surgery to pregnancy. Maternal and neonatal outcomes post bariatric surgery have generally been found to be positive and are often improved over those seen in obese women without a history of bariatric procedures. However, surgical complications have been reported, as well as nutritional deficits. Some studies have suggested an increase in small for gestational age (SGA) newborns and increased cesarean section rates, while others have not found these relationships. Neonatal complications have also been reported. Pregnancy care for women with a history of bariatric surgery includes screening for and managing nutritional deficits, careful assessment to rule o...

Introduction: The clinical application of genetic advances has the potential to transform preconception and pregnancy care and improve pregnancy outcomes. The study aim was to evaluate the level of importance and level of confidence that midwives in the United States attach to using genetics in practice. Methods: The study was a descriptive, cross-sectional, online survey with a convenience sample of certified nurse-midwives who were active members of the American College of Nurse-Midwives (ACNM) and provided midwifery care in the United States. The survey contained genetic case studies and questions related to genetic activities that occur in clinical practice. Participants were asked to rate how important each genetic activity is to midwifery practice generally and their personal level of confidence in carrying out the stated activity at the present time; questions were rated on a Likert-type scale of 1 (not at all important, not at all confident) to 4 (essential, confident to teach). Results: There were 612 survey responses from among the 4244 active members of ACNM (14.42%). Most midwives believed that genetics-related activities were very important or essential to their clinical practices, but they were only moderately confident in their abilities to perform these activities. The average importance survey score was 88%, and the average confidence survey score was 70%. Some midwives (17.5%) thought that taking a 3-generation family history was essential, and some midwives (20.9%) were extremely confident in their abilities to perform this activity. Almost all midwives (98.5%) indicated that they wanted to learn more about genetics and genomics. Discussion: Genetics education programs need to be developed and made available to midwives to increase their confidence levels in using genetics in clinical practice.

Although dramatic improvements in pregnancy care and in general population health facilitated a dramatic decline in maternal mortality in the United States during the 20th century, women still die from complications of pregnancy. Moreover, rates appear to have increased during the early 21st century. This overview will provide context for understanding the problem of maternal mortality in the United States by outlining how maternal mortality rates are reported from National Vital Statistics data, and how pregnancy-related mortality ratios are reported from a national surveillance system. Trends and patterns in these deaths as well as emerging issues concerning causes of maternal deaths and the difficulty with interpreting trend data will be discussed.

Background: Cesarean delivery on maternal request is a worldwide growing phenomenon. The goal of this study was to describe young nulliparous women’s attitudes about cesarean delivery on maternal request. Methods: A total of 140 nulliparous women in Canada aged between 18 and 24 years and attending school from the vocational (n = 53), college (n = 61), and university (n = 18) levels (n = 8 other) participated in the survey. The self-administered questionnaire consisted of 23 open-ended questions. The outcome measure was the participant’s attitude toward cesarean delivery on maternal request. Descriptive, bivariate, and multiple regression analyses were performed. Results: Many of the respondents (63%) had previously heard about cesarean delivery on maternal request, and of these women 28.6 percent had a favorable attitude toward the procedure. Sociodemographic variables were not associated with participants’ attitudes toward cesarean delivery on maternal request except for place of residence and type of professional preferred for pregnancy care. Thinking that vaginal birth was more painful than cesarean delivery (p = 0.012) and had more consequences for the mother (p

Wie kein anderer Bereich in der Medizin ist die Geburtshilfe in den vergangenen Jahrzehnten durch die Pranatalmedizin beeinflusst worden. Sie hat entscheidend dazu beigetragen, dass sich das vorgeburtliche Problemspektrum ganzlich gewandelt hat und viele der fruheren Herausforderungen gelost sind. Stellten fruher noch das Erkennen von Mehrlingen oder die Bestimmung des Gestationsalters zentrale Probleme dar, konnen diese heute durch den Ultraschall als gelost betrachtet werden. Dagegen sind neue Fragestellungen entstanden, die risikostratifiziert erortert werden. Einen masgeblichen Einfluss auf die Reduktion der postpartalen Mortalitat und Morbiditat hat die pranatale Diagnose fetaler Fehlbildungen.

Unwanted pregnancy was a global social and health challenge. Worldwide 38% of pregnancies were undesirable pregnancies of 80 million pregnancies per year (WHO, 2013). The number of unintended pregnancies in Indonesia was difficult to know and has never been studied in depth either the reason or the attempts made to end the pregnancy. An unwanted pregnancy would have an impact on pregnancy and baby care. Purposes of the study were to determine the effect of unwanted pregnancy on the treatment of pregnancy and infant. The dependent variable of this research was pregnancy and infant care, whereas unwanted pregnancy was an independent variable. This study was a qualitative type of phenomenological study. Data collection used in-depth interview techniques with a reason to get more in-depth information about something that was related to the impact of unwanted pregnancy. The number of respondents based on adequacy and suitability of data. Data analysis techniques were used core analysis. The number of informants in this study was 8 people. The impact of unwanted pregnancy on pregnancy care in this study identified three themes: Themes 1. Psychosocial Problems The Impact of Unwanted Pregnancy, Theme 2 Rejection of Pregnancy and theme 3 Lack of Pregnancy Treatment. While the impact of unwanted pregnancy on infant care identified 1 theme: Need Time to Receive Baby. Hospitals/ Public Health Centres should conduct intensive counseling on mothers with unwanted pregnancies, that is a Family support coaching program.

This article examines decision making in prenatal consultations, how obstetricians (OBs) and midwives differ, and the role of uncertainty in these processes. Using participant-observation, comparative case-study methodology, pregnant women were observed and audio-recorded in their pre- and postnatal appointments, and in-depth, semistructured interviews were conducted with mothers and providers. Although decision-making processes appear similar between the OBs and midwives, closer analysis, employing problematic integration theory, reveals marked differences in providers' probabilistic and evaluative orientations that carry clear implications for both mothers and providers during pregnancy care.

Diabetes mellitus is a chronic illness which affects a significant number of childbearing women. Despite the potential for adverse consequences for both maternal and fetal wellbeing, few women with diabetes plan their pregnancies to ensure that they enter pregnancy in optimal health. Furthermore, while adverse pregnancy outcomes are well documented for women with type I diabetes, it is now apparent that an increasing number of women with type II diabetes are becoming pregnant with similar adverse associated risk. There is an increasing recognition that significant adverse pregnancy outcomes are determined before a woman initiates pregnancy care, many of which could be minimized with the introduction of preconception care. As formalized preconception care clinics remain scant across the UK, there is an urgent need to increase the opportunities for the provision of preconception care and advice to women with diabetes. Midwives are ideally placed to provide preconception advice to women and could provide the missing link in terms of preconception advice for women with diabetes.

Background The United States is moving toward active drug safety surveillance using sources such as administrative claims and electronic medical records, but use of these data for studying teratogenicity has been challenging, as they typically do not allow for the easy identification of pregnancies. Our goal was to develop and validate an algorithm for the identification of pregnancies in the general practice research database (GPRD) that could be used to study pregnancy outcomes. Methods The algorithm identified pregnancies in women 15–45-year-old that were pregnant between 1 January 1987 and 31 December 2006. We identified live births, stillbirths, and spontaneous and elective terminations within a woman's record. We validated the algorithm using the additional clinical details maternity (ACDM) file and de-identified free-text records. Results We analyzed 16 035 394 records from 3 093 927 individuals and identified 383 184 women who had a total of 580 356 pregnancies. There were 415 221 full-term live births, 3080 pre- or post-term births, 1834 multi-fetus deliveries, 86 408 spontaneous abortions or miscarriages, 72 164 elective terminations, and 1649 stillbirths or fetal deaths. A marker of pregnancy care was identifiable for 86.3% of the 580 356 pregnancies. The internal validation steps indicated that the algorithm produced consistent results with the ACDM file. Conclusions We were successful in identifying a large number of pregnancies in the GPRD. Our use of a hierarchical approach to identify pregnancy outcomes builds upon the methods suggested in previous work, while implementing additional steps to minimize potential misclassification of pregnancy outcomes. Copyright © 2009 John Wiley & Sons, Ltd.

Experience with sonographic pregnancy care have demonstrated the necessity of quality control. Before a person is licensed to take account for sonography he should prove, that he has performed a certain number of examinations and that he is holding a file of documents on these examinations. This certificate should ensure that the fundamental knowledge of foetal sonographic anatomy and biometry as well as of possible signs of foetal malformations have been correctly acquired. As a provisional arrangement until sonography is fully integrated into gynaecological education, an examination by a board would appear to be desirable.

This study aims to determine (1) Learning Laboratory Practice Pregnancy Care Prodi D-III Midwifery STIKES Husada Jombang include (a) Laboratory Practice Learning Process; (B) Laboratory Learning Methods; (C) Schedule Settings; (D) Infrastructures; (E) Evaluation and Achievement System. (2) Constraints and How to Resolve. This study used descriptive qualitative approach to explore as much as possible the facts in accordance with the focus of research. Techniques of collecting data through interviews, observation and documentation involving program managers, coaches and student education level II Prodi D- III Midwifery STIKES Husada Jombang. Data were analyzed using constant comparison method. The validity of the data obtained by the extension of research time, perseverance observation, continuous engagement, triangulation and reviews of key informants. Triangulation used include triangulation of sources, methods and timing. The results of the study explained that the lesson preparation of midwifery laboratory practice about pregnancy care in Prodi D-III Midwifery STIKES Husada Jombang do several steps: (a) Preparation of schedule based on the syllabus (b) Strategies and Learning Methods using laboratory methods together (d) Evaluation study with response , assessment of affective, cognitive assessment and psychomotor assessment using the checklist. conclusion; In practice assessment, the aspects that include skills, attitudes and mastery of the material to assess indicators of the activities carried out in the laboratory based on the existing competence in the form of a checklist.

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