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Maternal critical care

Mary D Brantley, Nicole L Davis, David A Goodman, William M Callaghan, Wanda D Barfield
BACKGROUND: Perinatal services exist today as a dyad of maternal and neonatal care. When perinatal care is fragmented or unavailable, excess morbidity and mortality may occur in pregnant women and newborns. OBJECTIVE: Describe spatial relationships between women of reproductive age, individual perinatal subspecialists (Maternal Fetal Medicine and Neonatology), and obstetric and neonatal critical care facilities in the United States to identify gaps in health care access...
October 20, 2016: American Journal of Obstetrics and Gynecology
Richard Kalisa, Stephen Rulisa, Thomas van den Akker, Jos van Roosmalen
BACKGROUND: The WHO Maternal Near Miss (MNM) approach was developed to evaluate and improve quality of obstetric care worldwide. This study aimed to study the incidence of MNM and quality of care at a district hospital in rural Rwanda by applying this approach. METHODS: A facility based, prospective cohort study conducted at a district hospital in rural Rwanda between June 2013 and December 2014. Subjects were followed from time of admission to discharge or death...
October 21, 2016: BMC Pregnancy and Childbirth
Sarah Verbiest, Erin Bonzon, Arden Handler
Introduction The first 3 months after giving birth can be a challenging time for many women. The Postpartum Health and Wellness special issue explores this period, one that is often overlooked and under-researched. Methods This issue is designed to bring greater focus to the need for woman-centered care during the postpartum period. Articles in this issue focus on four key areas: (1) the postpartum visit and access to care, (2) the content of postpartum care and postpartum health concerns, (3) interconception care including contraception, and (4) policy, systems, and measurement...
October 19, 2016: Maternal and Child Health Journal
Angel Paternina-Caicedo, Jezid Miranda, Ghada Bourjeily, Andrew Levinson, Carmelo Dueñas, Camilo Bello Muñoz, José A Rojas-Suarez
BACKGROUND: Every day, about 830 women die worldwide from preventable causes related to pregnancy and childbirth. Obstetric early-warning scores have been proposed as a potential tool to reduce maternal morbidity and mortality, based upon the identification of predetermined abnormal values in the vital signs or laboratory parameters, to generate a rapid and effective medical response. Several early-warning scores have been developed for obstetrical patients, but the majority are the result of a clinical consensus rather than statistical analyses of clinical outcome measures (i...
October 14, 2016: American Journal of Obstetrics and Gynecology
Jianli Wang, Chaobao Liu, Yongping Ma
Parents-offspring bonding is critical for development of offspring in mammals. While it is known that pups stimuli provide rewarding effects on their parents, few studies have assessed whether parental stimuli serve as a reinforcing agent to their pups, and what the neural mechanisms underlying this reward process may be. In addition to maternal care, male ICR mice display pairmate-dependent parental behavior. Using the conditioned place preference (CPP) paradigm, we examined the effects of maternal and paternal conditioning on the postnatal day 17-21 female ICR mice pups, and compared the expression of oxytocin (OT)- and tyrosine hydroxylase (TH)- immunoreactive (IR) neurons...
October 13, 2016: Behavioural Brain Research
Gifty Apiung Aninanya, Natasha Howard, John E Williams, Benjamin Apam, Helen Prytherch, Svetla Loukanova, Eunice Karanja Kamara, Easmon Otupiri
BACKGROUND: Lack of an adequate and well-performing health workforce has emerged as the biggest barrier to scaling up health services provision in sub-Saharan Africa. As the global community commits to the Sustainable Development Goals and universal health coverage, health workforce challenges are critical. In northern Ghana, performance-based incentives (PBIs) were introduced to improve health worker motivation and service quality. OBJECTIVE: The goal of this study was to determine the impact of PBIs on maternal health worker motivation in two districts in northern Ghana...
2016: Global Health Action
Joan Garvan
BACKGROUND: Changes to gendered norms have been the single most significant development in the second part of the twentieth century; practices within families have mirrored these changes. Many, however, are falling by the wayside after the birth of an infant, with high rates of marital breakdown, high rates of anxiety and depression, and significant issues related to identity. OBJECTIVES/AIMS: The aim of this research was to gauge how a sample of Australian women were travelling through the Transition to Parenthood, particularly in terms of their relationships; sharing the care and housework; their life course; and their sense of self...
October 14, 2016: Contemporary Nurse
Caroline Se Homer
There has been substantial reform in the past decade in the provision of maternal and child health services, and specifically regarding models of maternity care. Increasingly, midwives are working together in small groups to provide midwife-led continuity of care. This article reviews the current evidence for models of maternity care that provide midwifery continuity of care, in terms of their impact on clinical outcomes, the views of midwives and childbearing women, and health service costs. A systematic review of midwife-led continuity of care models identified benefits for women and babies, with no adverse effects...
October 17, 2016: Medical Journal of Australia
John J Mccarthy, Martin H Leamon, Loretta P Finnegan, Catherine Fassbender
Increase in the number of opioid dependent pregnant women delivering babies at risk for neonatal abstinence syndrome (NAS) prompted a General Accountability Office (GAO) report documenting deficits in research and provider knowledge about care of the maternal/fetal unit and the neonate. There are three general sources of dependence: untreated opioid use disorder (OUD), pain management, and medication assisted treatment with methadone or buprenorphine. A survey of methadone patients' experiences when telling a physician of their pregnancy and opioid dependence demonstrated physician confusion about proper care, frequent negative interactions with the mother, and failures to provide appropriate referral...
October 8, 2016: American Journal of Obstetrics and Gynecology
Naranpurev Mendsaikhan, Tsolmon Begzjav, Ganbold Lundeg, Martin W Dünser
CONTEXT: The epidemiology and outcome of critical illness in Mongolia remain undefined. AIM: The aim of this study was to evaluate the epidemiology and outcome of critical illness in Mongolia. SETTINGS AND DESIGN: This is a multicenter, prospective, observational cohort study including 19 Mongolian centers. MATERIALS AND METHODS: Demographic, clinical, and outcome data of patients >15 years admitted to the Intensive Care Units (ICUs) were collected during a 6-month period...
July 2016: International Journal of Critical Illness and Injury Science
Andrea Melberg, Abdoulaye Hama Diallo, Thorkild Tylleskär, Karen Marie Moland
BACKGROUND: Facility-based births have been promoted as the main strategy to reduce maternal and neonatal death risks at global scale. To improve birth outcomes, it is critical that health facilities provide quality care. Using a framework to assess quality of care, this paper examines health workers' perceptions about access to facility birth; the effectiveness of the care provided and obstacles to quality birth care in a rural area of Burkina Faso. METHODS: A qualitative study was conducted in 2011 in the Banfora Region, Burkina Faso...
September 29, 2016: BMC Pregnancy and Childbirth
L M Yee, A R Goldberger, P M Garcia, E S Miller
OBJECTIVE: To characterize pregnant patients' knowledge, attitudes and preferences regarding antenatal HIV testing for themselves and their sexual partners. STUDY DESIGN: Observational, mixed methods study of HIV-negative pregnant women from a university-based urban clinic. Participants completed an anonymous survey about HIV testing for themselves and their partners. Descriptive statistics, bivariable analyses, multivariable logistic regression and qualitative thematic analysis were utilized...
September 29, 2016: Journal of Perinatology: Official Journal of the California Perinatal Association
(no author information available yet)
Criticisms of the medicalisation of maternity care and unnecessary intervention in childbirth are fairly common, with the promotion of a more holistic approach to childbirth now reasonably well-established in the UK.
September 28, 2016: Nursing Standard
Joshua Amo-Adjei, Derek Anamaale Tuoyire
OBJECTIVES: We analysed the extent of planned, mistimed and unwanted pregnancies and how they predict optimal use of prenatal (timing and number of antenatal) care services in 30 African countries. METHODS: We pooled data from Demographic and Health Surveys conducted in 30 African countries between 2006 and 2015. We described the extent of mistimed and unwanted pregnancies and further used mixed effects logistic and Poisson regression estimation techniques to examine the impacts of planned, mistimed and unwanted pregnancies on the use of prenatal health services...
September 27, 2016: Tropical Medicine & International Health: TM & IH
Arden Handler, Kay Johnson
Objectives The broad maternal and child health community has witnessed increased attention to the entire continuum of reproductive and perinatal health concerns over the past few years. However, both recent discouraging trends in prenatal care access and utilization and a renewed understanding of prenatal care as a critical anchor of the reproductive/perinatal health continuum for women who do get pregnant demand a new effort to focus on the prenatal period as a gateway for maternal and infant health. Methods This commentary: describes the Medicaid expansions and the momentum for universal access to prenatal care of the 1980-1990s; examines the pivot away from this goal and its aftermath; provides a rationale for why renewed attention to prenatal care and the prenatal period is essential; and, explores the potential focus of an updated prenatal care agenda...
September 23, 2016: Maternal and Child Health Journal
V Mishra Vineet, A Goyal Preeti, S Aggarwal Rohina, S Choudhary, Tanvir Tanvir, D Dharaiya Nisarg, A Gaddagi Rashmi
BACKGROUND: Acute kidney injury (AKI) is a clinical syndrome characterized by a sudden decline in glomerular filtration rate leading to decreased excretion of nitrogenous waste products. It continues to be a common problem in developing countries. AIMS: The aim of this study was to understand AKI characteristics in pregnancy and identify the factors related to its unfavorable outcome. STUDY DESIGN: A prospective cross-sectional study. METHODS: This prospective study was conducted between January 2013 and May 2014...
October 2016: Journal of Obstetrics and Gynaecology of India
Aruna Kumar, Neha Agrawal
PURPOSE: Maternal brought in dead are the patient who dies in the need of adequate medical care. These deaths are often not analyzed sincerely as they are not institutional deaths. Our aim is to find out actual life threatening cause of delay leading to death. METHOD: Patients brought dead to casualty were seen by the doctors on duty in Department of Obstetrics and Gynaecology,Gandhi Medical College, Bhopal round the clock. Cause of death was analyzed by verbal autopsy of attendants and referral letter from the institute...
October 2016: Journal of Obstetrics and Gynaecology of India
Franz Castro, Julio Zúñiga, Gladys Higuera, María Carrión Donderis, Beatriz Gómez, Jorge Motta
BACKGROUND: This is the first study in Panama and Central America that has included indigenous populations in an assessment of the association between socioeconomic variables with delayed diagnosis and mortality due to congenital heart defects (CHD). METHODS: A retrospective observational study was conducted. A sample calculation was performed and 954 infants born from 2010 to 2014 were randomly selected from clinical records of all Panamanian public health institutions with paediatric cardiologists...
2016: PloS One
Mary E D'Alton, Alexander M Friedman, Richard M Smiley, Douglas M Montgomery, Michael J Paidas, Robyn D'Oria, Jennifer L Frost, Afshan B Hameed, Deborah Karsnitz, Barbara S Levy, Steven L Clark
Obstetric venous thromboembolism is a leading cause of severe maternal morbidity and mortality. Maternal death from thromboembolism is amenable to prevention, and thromboprophylaxis is the most readily implementable means of systematically reducing the maternal death rate. Observational data support the benefit of risk-factor-based prophylaxis in reducing obstetric thromboembolism. This bundle, developed by a multidisciplinary working group and published by the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care, supports routine thromboembolism risk assessment for obstetric patients, with appropriate use of pharmacologic and mechanical thromboprophylaxis...
October 2016: Anesthesia and Analgesia
Neha S Singh, Luis Huicho, Hoviyeh Afnan-Holmes, Theopista John, Allisyn C Moran, Tim Colbourn, Chris Grundy, Zoe Matthews, Blerta Maliqi, Matthews Mathai, Bernadette Daelmans, Jennifer Requejo, Joy E Lawn
BACKGROUND: Evaluating health systems and policy (HSP) change and implementation is critical in understanding reproductive, maternal, newborn and child health (RMNCH) progress within and across countries. Whilst data for health outcomes, coverage and equity have advanced in the last decade, comparable analyses of HSP changes are lacking. We present a set of novel tools developed by Countdown to 2015 (Countdown) to systematically analyse and describe HSP change for RMNCH indicators, enabling multi-country comparisons...
2016: BMC Public Health
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