Journal articles: 'Intrapartum care and postpartum care'

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Afriat, Cydney I. "Antenatal Care/Intrapartum Care/Postpartum Care." Journal of Perinatal & Neonatal Nursing 8, no. 1 (June 1994): 80–82. http://dx.doi.org/10.1097/00005237-199406000-00012.

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Yulia, A., and S. Mackenzie. "Intrapartum and postpartum bladder care." Archives of Disease in Childhood - Fetal and Neonatal Edition 96, Supplement 1 (June 1, 2011): Fa118. http://dx.doi.org/10.1136/adc.2011.300163.73.

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Gross, Mechthild, Claire Michelsen, Bernhard Vaske, and Sonja Helbig. "Intrapartum Care Working Patterns of Midwives: The Long Road to Models of Care in Germany." Zeitschrift für Geburtshilfe und Neonatologie 222, no. 02 (January 16, 2018): 72–81. http://dx.doi.org/10.1055/s-0043-122888.

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Abstract Introduction Midwifery models of care help to enhance perinatal health outcomes, women's satisfaction, and continuity of care. Despite the ubiquitous presence of certified midwives at births in Germany, no research has investigated the diversity of midwives’ practice patterns. Describing the variety of working patterns through which midwives provide intrapartum care may contribute to improving the organisation of midwifery services. Methods This cross-sectional survey took place in the region of Hannover and Hildesheim, Germany. Midwives attending births and practicing in hospitals and/or out-of-hospital were able to participate. Midwives who did not attend births were excluded. We assessed midwives' scope of services, practice locations, employment patterns, continuity of care, midwife-led births, and midwives' level of agreement with core values of midwifery care. The response rate of the survey was 32.7 % (69/211). Results We found that midwifery care services can be described according to midwives’ employment patterns. The majority of midwives were employed in a hospital to provide intrapartum care (74.2 %, n = 49), and most also independently offered one or more antenatal and/or postpartum service/s. Only 25.8 % (n = 17) of midwives offered their services independently (laborist model of care). Independent midwives attended births in all three possible settings: hospital, free-standing birth centres and home. Significantly more independent midwives than employed midwives offered antenatal care and lactation consulting. Compared to employed midwives, significantly more independent midwives provided antenatal, intrapartum, and postpartum care to the same women, were more likely to know women before labour, and to offer one-to-one care during labour. Discussion The most common practice pattern among surveyed midwives was ‘employment in a hospital’ for provision of intrapartum care with additional postpartum and few antenatal services provided on an independent basis. Midwives who worked solely independently reported more continuity and one-to-one intrapartum care with women. Most midwives did not work in patterns that offered continuity of care or consistently provide one-to-one care. Future research should assess whether women in Germany desire more services similar to caseload midwifery.

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Ahmed, Saifuddin, Swati Srivastava, Nicole Warren, Kaveri Mayra, Madhavi Misra, Tanmay Mahapatra, and K. D. Rao. "The impact of a nurse mentoring program on the quality of labour and delivery care at primary health care facilities in Bihar, India." BMJ Global Health 4, no. 6 (December 2019): e001767. http://dx.doi.org/10.1136/bmjgh-2019-001767.

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IntroductionAlthough the number of women who deliver with a skilled birth attendant in India has almost doubled between 2006 and 2016, the country still has the second highest number of maternal deaths and the highest number of neonatal deaths globally. This study examines the impact of a nurse mentoring programme intended to improve the quality of intrapartum care at primary healthcare centre (PHC) facilities in Bihar, India.MethodWe conducted an evaluation study in 319 public PHCs in Bihar, where nurses participated in a mentoring programme. Using a quasi-experimental trial design, we compared the intrapartum quality of care between the mentored (n=179) and non-mentored PHCs (n=80). Based on direct observation of 847 women, we examined percent differences in 39 labour, delivery and postpartum care-related recommended tasks on five domains: vital sign and labour progress monitoring after admission, second and third stages of labour management, postpartum counselling, infection prevention and essential newborn care practices.ResultsA significantly higher proportion of women at mentored PHCs received the recommended clinical care, compared with women at non-mentored PHCs. The overall total score of quality of care, expressed in percent of tasks performed, was 30.2% (95% CI: 28.3 to 32.2) in the control PHCs, suggesting that less than one-third of the expected tasks during labour and delivery were performed by nurses in these facilities; the score was 44.2% (95% CI: 42.1 to 46.4) among the facilities where the nurses were trained within last 3 months. The task completion score was slightly attenuated when observed 1 year after mentoring (score 39.1% [37.7–40.5]).ConclusionMentoring improved intrapartum care by nurses at PHCs in Bihar. However, less than half of the recommended normal delivery intrapartum tasks were completed by the nurse providers. This suggests the need for further improvement in the provision of quality of intrapartum care when risks to maternal and perinatal mortality are highest.

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Mortensen, Berit, Lien M. Diep, Mirjam Lukasse, Marit Lieng, Ibtesam Dwekat, Dalia Elias, and Erik Fosse. "Women’s satisfaction with midwife-led continuity of care: an observational study in Palestine." BMJ Open 9, no. 11 (November 2019): e030324. http://dx.doi.org/10.1136/bmjopen-2019-030324.

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ObjectivesA midwife-led continuity model of care had been implemented in the Palestinian governmental health system to improve maternal services in several rural areas. This study investigated if the model influenced women’s satisfaction with care, during antenatal, intrapartum and postnatal period.DesignAn observational case-control design was used to compare the midwife-led continuity model of care with regular maternity care.Participants and settingWomen with singleton pregnancies, who had registered for antenatal care at a rural governmental clinic in the West Bank, were between 1 to 6 months after birth invited to answer a questionnaire rating satisfaction with care in 7-point Likert scales.Primary outcomeThe mean sum-score of satisfaction with care through the continuum of antenatal, intrapartum and postnatal period, where mean sum-scores range from 1 (lowest) to 7 (highest).Secondary outcomeExclusive breastfeeding.ResultsTwo hundred women answered the questionnaire, 100 who received the midwife-led model and 100 who received regular care. The median time point of interview were 16 weeks postpartum in both groups. The midwife-led model was associated with a statistically significant higher satisfaction with care during antenatal, intrapartum and postnatal period, with a mean sum-score of 5.2 versus 4.8 in the group receiving regular care. The adjusted mean difference between the groups’ sum-score of satisfaction with care was 0.6 (95% CI 0.35 to 0.85), p<0.0001. A statistically significant higher proportion of women who received the midwife-led continuity model of care were still exclusively breastfeeding at the time point of interview, 67% versus 46% in the group receiving regular care, an adjusted OR of 2.56 (1.35 to 4.88) p=0.004.ConclusionsThere is an association between receiving midwife-led continuity of care and increased satisfaction with care through the continuum of pregnancy, intrapartum and postpartum period, and an increased duration of exclusive breastfeeding.Trial registration numberNCT03863600

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Minooee, Sonia, Masoumeh Simbar, Zohreh Sheikhan, and Hamid Alavi Majd. "Audit of Intrapartum Care Based on the National Guideline for Midwifery and Birth Services." Evaluation & the Health Professions 41, no. 3 (May 22, 2018): 415–29. http://dx.doi.org/10.1177/0163278718778095.

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Providing high-quality maternity care is a worldwide health concern that necessitates regular assessment of intrapartum practice. In an observational study, we aimed to audit intrapartum care based on the National Guideline for Midwifery and Birth Services. Using quota sampling, a total of 200 pregnant women, admitted for normal vaginal delivery, were recruited from four educational hospitals in Tehran, Iran. An observational checklist was developed based on the national guideline to assess the quality of provided care. Content and face validity of the tool were checked and confirmed. Reliability of the observational checklist and questionnaire was confirmed using concurrent observation (intrarater reliability; r = .93) and test–retest ( r = .9) methods, respectively. We found that the compatibility of intrapartum care and the national guideline in different domains were as follows: history taking 88.3%, vital sign measurement 64.6%, performing Leopold’s maneuver 38.5%, initial assessment 83.4%, labor care 22.5%, using pain relief methods 63.5%, labor progress assessment 71.5%, process of delivery 89.5%, and postpartum management 89.5%. The findings indicate that additional attention and monitoring are required to align current intrapartum care practices with the national guidelines.

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Sward, Lindsey B., and Sara G. Tariq. "Maternal-Fetal Physiology, Intrapartum Care, Postpartum Care: A Team-Based Learning Module for Normal Obstetrics." MedEdPORTAL 15, no. 1 (January 2019): 10856. http://dx.doi.org/10.15766/mep_2374-8265.10856.

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Waldenstrom, Ulla, Stephanie Brown, Helen McLachlan, Della Forster, and Shaun Brennecke. "Does Team Midwife Care Increase Satisfaction with Antenatal, Intrapartum, and Postpartum Care? A Randomized Controlled Trial." Birth 27, no. 3 (September 2000): 156–67. http://dx.doi.org/10.1046/j.1523-536x.2000.00156.x.

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Millogo, Tieba, Marie Laurette Agbre-Yace, Raissa K. Kourouma, W. Maurice E. Yaméogo, Akoua Tano-Kamelan, Fatou Bintou Sissoko, Aminata Soltié Koné-Coulibaly, Anna Thorson, and Seni Kouanda. "Quality of maternal and newborn care in limited-resource settings: a facility-based cross-sectional study in Burkina Faso and Côte d’Ivoire." BMJ Open 10, no. 6 (June 2020): e036121. http://dx.doi.org/10.1136/bmjopen-2019-036121.

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ObjectiveTo assess and compare the quality of intrapartum and immediate postpartum care across levels of healthcare in Burkina Faso and Côte d’Ivoire using validated process indicators.DesignHealth facility-based cross-sectional study with direct observation of healthcare workers’ practices while caring for mother–newborn pairs during intrapartum and immediate postpartum periods.SettingPrimary healthcare facilities and their corresponding referral hospitals in the Central-North region in Burkina Faso and the Agneby-Tiassa-Mé region in Côte d’Ivoire.ParticipantsHealthcare providers who care for mother–newborn pairs during intrapartum and immediate postpartum periods, the labouring women and their newborns after childbirth.Main outcome measure(s)Adherence to essential best practices (EBPs) at four pause points in each birth event and the overall quality score based on the level of adherence to the set of EBPs observed for a selected pause point.ResultsA total of 532 and 627 labouring women were included in Burkina Faso and Côte d’Ivoire, respectively. Overall, the compliance with EBPs was insufficient at all the four pause points, even though it varied widely from one EBP to another. The adherence was very low with respect to hand hygiene practices: the care provider wore sterile gloves for vaginal examination in only 7.96% cases (95% CI 5.66% to 11.06%) in Burkina Faso and the care provider washed hands before examination in 6.71% cases (95% CI 3.94% to 11.20%) in Côte d’Ivoire. The adherence was very high with respect to thermal management of newborns in both countries (>90%). The overall mean quality scores were consistently higher in referral hospitals in Burkina Faso at all pause points excluding immediate post partum.ConclusionsWomen delivering in healthcare facilities do not always receive proven EBPs needed to prevent poor childbirth outcomes. There is a need for quality improvement interventions.

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Markwei, Metabel, and Oluwatosin Goje. "Optimizing mother–baby wellness during the 2019 coronavirus disease pandemic: A case for telemedicine." Women's Health 17 (January 2021): 174550652110132. http://dx.doi.org/10.1177/17455065211013262.

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Background: The 2019 coronavirus disease pandemic poses unique challenges to healthcare delivery. To limit the exposure of providers and patients to severe acute respiratory syndrome coronavirus 2, the Centers for Disease Control and Prevention encourages providers to use telehealth platforms whenever possible. Given the maternal mortality crisis in the United States and the compounding 2019 coronavirus disease public health emergency, continued access to quality preconception, prenatal, intrapartum, and postpartum care are essential to the health and well-being of mother and baby. Objective: This commentary explores unique opportunities to optimize virtual obstetric care for low-risk and high-risk mothers at each stage of pregnancy. Methods: In this review paper, we present evidence-based literature and tools from first-hand experience implementing telemedicine in obstetric care clinics during the pandemic. Results: Using the best evidence-based practices with telemedicine, health care providers can deliver care in the safest, most respectful, and appropriate way possible while providing the critical support necessary in pregnancy. In reviewing the literature, several studies endorse the implementation of specific tools outlined in this article, to facilitate the implementation of telemedicine. From a quality improvement standpoint, evidence-based telemedicine provides a solution for overburdened healthcare systems, greater confidentiality for obstetric services, and a personalized avenue for health care providers to meet maternal health needs in the pandemic. Conclusion: During the COVID-19 pandemic, continued access to quality prenatal, intrapartum, and postpartum care are essential to the health and well-being of mother and baby.

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Albertsen, Peter C. "National Survey for Intrapartum and Postpartum Bladder Care: Assessing the Need for Guidelines." Journal of Urology 174, no. 1 (July 2005): 273. http://dx.doi.org/10.1097/01.ju.0000164459.72295.9c.

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Zaki, Mona M., Meghana Pandit, and Simon Jackson. "National survey for intrapartum and postpartum bladder care: assessing the need for guidelines." BJOG: An International Journal of Obstetrics and Gynaecology 111, no. 8 (August 2004): 874–76. http://dx.doi.org/10.1111/j.1471-0528.2004.00200.x.

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Wu, Y., E. McArthur, S. Dixon, J. S. Dirk, and B. K. Welk. "Association Between Intrapartum Epidural Use and Maternal Postpartum Depression Presenting for Medical Care." Obstetric Anesthesia Digest 39, no. 2 (June 2019): 103–4. http://dx.doi.org/10.1097/01.aoa.0000557692.14333.ac.

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Meherda, Kanti, and Shikha Mathur. "Comparative study of fetomaternal outcome in adolescent and young adult primigravidas." International Journal of Research in Medical Sciences 5, no. 3 (February 20, 2017): 912. http://dx.doi.org/10.18203/2320-6012.ijrms20170635.

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Background: Adolescent pregnancy is a worldwide public health problem. WHO has defined adolescence as the period from 10-19 years of age. Purpose of the study was to compare the fetomaternal outcome in adolescent and young adult primigravidas.Methods: The study was conducted at a tertiary care centre over a period of six months. 150 adolescent (in our study between 15-19 years of age) and 150 young adults (20-25 years) primigravidas who delivered at our institution were randomly selected for the study. All the data including age, booking status, educational and economic status and address were noted. All essential antepartum, intrapartum and postpartum data were collected for both the groups and compared using Chi square test.Results: In our study the incidence of antepartum, intrapartum and postpartum complications was 86%,36% and 10% respectively in the study group. But in the control group only 40% of the subjects had antepartum complications ,17.33% had intrapartum complications and the incidence of postpartum complications was only 4%. The difference is highly significant with a p value <0.001.Conclusions: Adolescent pregnancy is associated with adverse fetomaternal outcome and any effort to prevent it is worthwhile.

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Martín-Arribas, Anna, Rafael Vila-Candel, Rhona O’Connell, Martina Dillon, Inmaculada Vila-Bellido, M. Ángeles Beneyto, Inmaculada De Molina-Fernández, Nerea Rodríguez-Conesa, Cristina González-Blázquez, and Ramón Escuriet. "Transfers of Care between Healthcare Professionals in Obstetric Units of Different Sizes across Spain and in a Hospital in Ireland: The MidconBirth Study." International Journal of Environmental Research and Public Health 17, no. 22 (November 13, 2020): 8394. http://dx.doi.org/10.3390/ijerph17228394.

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Background: In Europe, the majority of healthy women give birth at conventional obstetric units with the assistance of registered midwives. This study examines the relationships between the intrapartum transfer of care (TOC) from midwife to obstetrician-led maternity care, obstetric unit size (OUS) with different degrees of midwifery autonomy, intrapartum interventions and birth outcomes. Methods: A prospective, multicentre, cross-sectional study promoted by the COST Action IS1405 was carried out at eight public hospitals in Spain and Ireland between 2016–2019. The primary outcome was TOC. The secondary outcomes included type of onset of labour, oxytocin stimulation, epidural analgesia, type of birth, episiotomy/perineal injury, postpartum haemorrhage, early initiation of breastfeeding and early skin-to-skin contact. A logistic regression was performed to ascertain the effects of studied co-variables on the likelihood that participants had a TOC; Results: Out of a total of 2,126 low-risk women, those whose intrapartum care was initiated by a midwife (1772) were selected. There were statistically significant differences between TOC and OUS (S1 = 29.0%, S2 = 44.0%, S3 = 52.9%, S4 = 30.2%, p < 0.001). Statistically differences between OUS and onset of labour, oxytocin stimulation, type of birth and episiotomy or perineal injury were observed (p = 0.009, p < 0.001, p < 0.001, p < 0.001 respectively); Conclusions: Findings suggest that the model of care and OUS have a significant effect on the prevalence of intrapartum TOC and the birth outcomes. Future research should examine how models of care differ as a function of the OUS in a hospital, as well as the cost-effectiveness for the health care system.

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Niznik, Charlotte, Emily Szmuilowicz, Alan Peaceman, Lynn Yee, and Annie Dude. "Management of Diabetes in the Intrapartum and Postpartum Patient." American Journal of Perinatology 35, no. 11 (March 13, 2018): 1119–26. http://dx.doi.org/10.1055/s-0038-1629903.

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AbstractAchieving maternal euglycemia in women with pregestational and gestational diabetes mellitus is critical to decreasing the risk of neonatal hypoglycemia, as maternal blood glucose levels around the time of delivery are directly related to the risk of hypoglycemia in the neonate. Many institutions use continuous insulin and glucose infusions during the intrapartum period, although practices are widely variable. At Northwestern Memorial Hospital, the “Management of the Perinatal Patient with Diabetes” policy and protocol was developed to improve consistency of management while also allowing individualization appropriate for the patient's specific diabetic needs. This protocol introduced standardized algorithms based on maternal insulin requirements to drive real-time maternal glucose control during labor as well as provided guidelines for postpartum glycemic control. This manuscript describes the development and implementation of this protocol to encourage other institutions to adopt a standardized protocol that allows highly individualized intrapartum care to women with diabetes.

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Sablok, Aanchal, Taru Gupta, Sangeeta Gupta, R. K. Duggal, and Amrita Tiwari. "Postpartum atypical haemolytic uremic syndrome: a rare clinical entity." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 8 (July 26, 2019): 3409. http://dx.doi.org/10.18203/2320-1770.ijrcog20193576.

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P-aHUS has incidence of 1 in 25000 pregnancies. It’s characterized by microangiopathic haemolytic anemia, thrombocytopenia and renal failure. Mrs X, 26 year old lady, G2 P1L1 with 39 weeks POG came to emergency of a tertiary care hospital. She underwent LSCS in view of previous caesarean section not willing for trial of labour. Antenatal, intrapartum and immediate post operative period were uneventful. However, she became anuric 36 hours post operatively. Laboratory investigations suggested hemolysis. Complement system evaluation showed decreased complement levels. Diagnosis of p-aHUS was made by taking multidisciplinary approach and renal biopsy. Patient received 4 sessions of plasmapheresis and symptomatic treatment. Gradually her urine output increased and she was discharged with the baby on post operative day 19. Diagnosis of p-aHUS is tricky owing to similar clinical features with many other pregnancy associated conditions. Timely management and diagnosis are imperative to save the mother’s life.

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-, IRUM, SAMINA KAUSAR, ROBINA ALI, and Shazia Shaheen. "RISKY GRAND MULTIPARAS." Professional Medical Journal 20, no. 03 (March 25, 2013): 416–21. http://dx.doi.org/10.29309/tpmj/2013.20.03.694.

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Grandmultiparity has long been classified as constituting a high risk factor in pregnancy. The complications associatedwith grandmultiparity have been divided into ante-partum, intra-partum and the postpartum. Intrapartum complications most commonlythought to be associated with grandmultiparity are malpresentations, placental disorders, postpartum hemorrhage and uterine rupture.Concerted effort should be instituted for effective family planning initiatives and specialized antepartum and intrapartum management.Objective: To determine the frequency of intrapartum complications and mode of delivery in grandmultipara. Material and Methods: Itis descriptive case series study conducted in department of obstetrics and gynaecology, Punjab Medical College and affiliated hospitals,Faisalabad from March 11, 2010 to September 10, 2010. Results: Grandmultipara women who fulfilled the inclusion criteria werestudied for intrapartum complications and mode of deliveries. One hundred and thirty nine patients were included in my study. Mean ageof the patients was 32.38 years. Mean gestational age for delivery was 37.06 weeks. Grandmultiparas had more intrapartumcomplications including malpresentation (19.4%), placental abruption (5.8%), placenta previa (8.6%), postpartum hemorrhage (6.5%)and ruptured uterus (1.4%). Mode of delivery was also assessed and 59%, 7.9 %, 31.7% of patients had normal vaginal delivery,instrumental vaginal delivery and cesarean section respectively. Conclusions: It is concluded that in the developing countries theincidence of grandmultiparity is still high with a significantly increased risk of complications. Grandmultiparity should be considered highrisk and needs active intervention by improving literacy, health care facilities, provision of safe and effective contraception andreproductive health status.

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ROOKS, J., N. WEATHERBY, and E. ERNST. "The National Birth Center Study Part II—Intrapartum and immediate postpartum and neonatal care." Journal of Nurse-Midwifery 37, no. 5 (September 1992): 301–30. http://dx.doi.org/10.1016/0091-2182(92)90239-y.

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Miller, Emily M. S., Allie Sakowicz, Elise Leger, Elizabeth Lange, and Lynn M. Yee. "Association between Receipt of Intrapartum Magnesium Sulfate and Postpartum Hemorrhage." American Journal of Perinatology Reports 11, no. 01 (January 2021): e21-e25. http://dx.doi.org/10.1055/s-0040-1721671.

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Abstract Objective The aim of the study is to investigate the association between intrapartum administration of magnesium sulfate in women with hypertensive disorders of pregnancy and postpartum hemorrhage. Study Design This was a retrospective cohort study of women diagnosed with a hypertensive disorder of pregnancy who delivered singleton gestations >32 weeks at a single, large volume tertiary care center between January 2006 and February 2015. Women who received intrapartum magnesium sulfate for seizure prophylaxis were compared with women who did not receive intrapartum magnesium sulfate. The primary outcome was frequency of postpartum hemorrhage. Secondary outcomes included estimated blood loss, uterine atony, and transfusion of packed red blood cells. Bivariable analyses were used to compare the frequencies of each outcome. Multivariable logistic regression models examined the independent associations of magnesium sulfate with outcomes. Results Of 2,970 women who met inclusion criteria, 1,072 (36%) received intrapartum magnesium sulfate. Women who received magnesium sulfate were more likely to be nulliparous, publicly insured, of minority race or ethnicity, earlier gestational age at delivery, and undergo labor induction. The frequency of postpartum hemorrhage was significantly higher among women who received magnesium sulfate compared with those who did not (12.4 vs. 9.3%, p = 0.008), which persisted after controlling for potential confounders. Of secondary outcomes, there was no difference in estimated blood loss between women who did and did not receive magnesium sulfate (250 mL [interquartile range 250–750] vs. 250 mL [interquartile range 250–750], p = 0.446). However, compared with women who did not receive magnesium sulfate, women who received magnesium sulfate had a greater frequency of uterine atony (8.9 vs 4.9%, p < 0.001) and transfusion of packed red blood cells (2.0 vs. 0.8%, p = 0.008). These differences persisted after controlling for potential confounders. Conclusion Intrapartum magnesium sulfate administration to women with hypertensive disorders of pregnancy is associated with increased odds of postpartum hemorrhage, uterine atony, and red blood cell transfusion.

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MATTHEWS, ZOË, JAYASHREE RAMAKRISHNA, SHANTI MAHENDRA, ASHA KILARU, and SARASWATHY GANAPATHY. "BIRTH RIGHTS AND RITUALS IN RURAL SOUTH INDIA: CARE SEEKING IN THE INTRAPARTUM PERIOD." Journal of Biosocial Science 37, no. 4 (January 17, 2005): 385–411. http://dx.doi.org/10.1017/s0021932004006911.

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Maternal morbidity and mortality are high in the Indian context, but the majority of maternal deaths could be avoided by prompt and effective access to intrapartum care (WHO, 1999). Understanding the care seeking responses to intrapartum morbidities is crucial if maternal health is to be effectively improved, and maternal mortality reduced. This paper presents the results of a prospective study of 388 women followed through delivery and traditional postpartum in rural Karnataka in southern India. In this setting, few women use the existing health facilities and most deliveries occur at home. The analysis uses quantitative data, collected via questionnaires administered to women both during pregnancy and immediately after delivery. By virtue of its prospective design, the study gives a unique insight into intentions for intrapartum care during pregnancy as well as events following morbidities during labour. Routine care in the intrapartum period, both within institutions and at home, and impediments to appropriate care are also examined. The study was designed to collect information about health seeking decisions made by women and their families as pregnancies unfolded, rather than trying to capture women’s experience from a retrospective instrument. The data set is therefore a rich source of quantitative information, which incorporates details of event sequences and health service utilization not previously collected in a Safe Motherhood study. Additional qualitative information was also available from concurrent in-depth interviews with pregnant women, their families, health care providers and other key informants in the area. The level of unplanned institutional care seeking during the intrapartum period within the study area was very high, increasing from 11% planning deliveries at a facility to an eventual 35% actually delivering in hospitals. In addition there was a significant move away from planned deliveries with the auxiliary nurse midwive (ANM), to births with a lay attendant or dai. The proportion of women who planned for an ANM to assist was 49%, as compared with the actual occurrence, which was less than half of this proportion. Perceived quality of care was found to be an important factor in health seeking behaviour, as was wealth, caste, education and experience of previous problems in pregnancy. Actual care given by a range of practitioners was found to contain both beneficial and undesirable elements. As a response to serious morbidities experienced within the study period, many women were able to seek care although sometimes after a long delay. Those women who experienced inadequate progression of labour pains were most likely to proceed unexpectedly to a hospital delivery.

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Acquaye, Stephanie N., and Diane L. Spatz. "An Integrative Review: The Role of the Doula in Breastfeeding Initiation and Duration." Journal of Perinatal Education 30, no. 1 (January 1, 2021): 29–47. http://dx.doi.org/10.1891/j-pe-d-20-00037.

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The objective of this integrative review was to assess birth and postpartum doulas' roles in supporting breastfeeding initiation and duration. The electronic databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, PubMed, and Scopus were searched using the key terms doula and breastfeeding. Fourteen articles met inclusion criteria. Six key themes were identified. Doulas may acquire only modest amounts of lactation-specific education; however, doula care still enhances the breastfeeding care provided by health-care professionals. Doulas offer prenatal and intrapartum support that encourages breastfeeding initiation in the hospital, as well as providing breastfeeding support in the community and home settings. This reinforces the unique role of the doula in bolstering maternal–infant health. The effect of doulas on breastfeeding duration is less clear.

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Sivarajah, Kenga, Sophie Relph, Radha Sabaratnam, and Spyros Bakalis. "Spina bifida in pregnancy: A review of the evidence for preconception, antenatal, intrapartum and postpartum care." Obstetric Medicine 12, no. 1 (May 17, 2018): 14–21. http://dx.doi.org/10.1177/1753495x18769221.

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Women with spina bifida in pregnancy require complex multi-disciplinary management. Most women have uncomplicated pregnancies; however, complications are more frequent than in ‘low risk’ pregnancies. Careful antenatal planning and management of the complications can optimise outcome. There are currently no guidelines on the management of pregnant women with spina bifida, but there is a growing body of evidence from case reports and series examining the antenatal and postnatal course of these women. In this review, we examine the available literature and provide a framework on the prenatal counselling, antenatal, intrapartum and postnatal management of pregnant women with spina bifida.

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Waldenström, Ulla, Ann Rudman, and Ingegerd Hildingsson. "Intrapartum and postpartum care in Sweden: women's opinions and risk factors for not being satisfied." Acta Obstetricia et Gynecologica Scandinavica 85, no. 5 (January 2006): 551–60. http://dx.doi.org/10.1080/00016340500345378.

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Bano, Saadia, Tasneem Azhar, and Iram Aslam. "GRANDMULTIPARAS." Professional Medical Journal 22, no. 04 (April 10, 2015): 395–400. http://dx.doi.org/10.29309/tpmj/2015.22.04.1314.

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Intrapartum complications that are classically associated with grandmultiparasinclude fetal malpresentation, dysfunctional labour, chronic hypertension, abruptio placentae,postpartum haemorrhage and macrosomic babies. Excellent maternal and fetal outcome ispossible in grandmultiparas with improvement in health care system and free provision of healthfacilities to all pregnant women. Objectives: The objective of the study was: to find the frequencyof hypertension, placental abruption and primary postpartum hemorrhage in grandmultiparas.Study Design: It was a prospective study with descriptive pattern. Setting: Gynaecologyand Obstetric unit-I of Allied Hospital, Punjab Medical College Faisalabad. Period: January toJune 2006. Methods: Eighty patients were included in the study. Eighty grandmultiparas wererandomly selected for the study. Detailed evaluation of all patients was done by thorough history,examination and investigation. Patients were analyzed for complications during pregnancy,labour and delivery, especially hypertension, placental abruption and primary post partumhaemorrhage. Results: Hypertensive disorders found to be in 32 (33.8%), placental abruptionin 7(8.8%) and postpartum hemorrhage in 19( 23.8%) of grandmultiparas. Conclusions: It wasconcluded from the result of my study that grandmultiparity is still a major obstetric hazard indeveloping countries like Pakistan with higher incidence of complications. Safe maternal andperinatal outcome is possible in grandmultiparas with improvement in health care system andfree provision of health care facilities to all pregnant women.

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Patel, Shivani, Aldeboran N. Rodriguez, Devin A. Macias, Jamie Morgan, Alexandria Kraus, and Catherine Y. Spong. "A Gap in Care? Postpartum Women Presenting to the Emergency Room and Getting Readmitted." American Journal of Perinatology 37, no. 14 (May 30, 2020): 1385–92. http://dx.doi.org/10.1055/s-0040-1712170.

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Abstract Objective Emergent postpartum hospital encounters in the first 42 days after birth are estimated to complicate 5 to 12% of births. Approximately 2% of these visits result in admission. Data on emergent visits and admissions are critically needed to address the current maternal morbidity crisis. Our objective is to characterize trends in emergent postpartum hospital encounters and readmissions through chief complaints and admission diagnoses over a 4.5-year period. Study Design All postpartum hospital encounters within 42 days of delivery at our institution from 2015 to 2019 were included. We reviewed demographic information, antepartum, intrapartum, and postpartum care and postpartum hospital encounters. Trends in hospital presentation and admission over the study period were analyzed. Comparisons between women who were admitted to those managed outpatient were performed. Statistical analysis included Chi-square, student's t-test, and Mantel–Haenszel test for trend and ANOVA, as appropriate. A p-value <0.05 considered significant. Results Among 8,589 deliveries, 491 (5.7%) presented emergently to the hospital within 42 days of delivery, resulting in 576 hospital encounters. From 2015 to 2019, annual rates of presentation were stable, ranging from 5.0 to 6.4% (p = 0.09). Of the 576 hospital encounters, 224 (38.9%) resulted in an admission with increasing rates from 2.0% in 2015 to 3.4% in 2019 (p = 0.005). Primiparous women with higher body mass index, cesarean delivery, and blood loss ≥1, 000 mL during delivery were significantly more likely to be admitted to the hospital. Women with psychiatric illnesses increasingly utilized the emergency room in the postpartum period (6.7–17.2%, p = 0.03). The most common presenting complaints were fever, abdominal pain, headache, vaginal bleeding, wound concerns, and high blood pressure. Admitting diagnoses were predominantly hypertensive disorder (22.9%), wound complications (12.8%), endometritis (9.6%), headache (6.9%), and delayed postpartum hemorrhage (5.6%). Conclusion The average proportion of women presenting for an emergent hospital encounter in the immediate 42-day postpartum period is 5.7%. Nearly 40% of emergent hospital encounters resulted in admission and the rate increased from to 2.0 to 3.4% over the study period. The most common reasons for presentation were fever, abdominal pain, headache, vaginal bleeding, wound concerns, and hypertension. Hypertension, wound complications, and endometritis accounted for the top three admission diagnoses.

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Magistrado, Leila, Mary C. Tolcher, Anju Suhag, Sonal Zambare, and Kjersti M. Aagaard. "Pregnancy and Lactation in a 67-Year-Old Elderly Gravida following Donor Oocyte In Vitro Fertilization." Case Reports in Obstetrics and Gynecology 2020 (September 14, 2020): 1–6. http://dx.doi.org/10.1155/2020/9801565.

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There is limited data on the anticipated perinatal course among gravidae in their sixth and seventh decades. Our objective was to describe the relatively uncomplicated prenatal, intrapartum, and postpartum course of a 67-year-old essential primigravida. Briefly, our patient conceived a singleton pregnancy via IVF with donor oocytes, then presented at 13 6/7 weeks of gestation to initiate prenatal care. Her medical history was significant for chronic hypertension, hyperlipidemia, and obesity. Her cardiac function was monitored throughout pregnancy, and she delivered at 36 1/7 weeks by cesarean for a decline in left ventricular function with mitral regurgitation. Her intrapartum and postpartum course was uncomplicated, and she was able to successfully breastfeed for six months and resume prepregnancy activity. For comparison, we analyzed deliveries among gravidae>45 years of age from our institutional obstetrical database (2011-2018). This case represents the eldest gravidae identified in the literature and illustrates the potential for a relatively uncomplicated perinatal course with successful lactation. This case may enable other providers to counsel elderly patients on anticipated outcomes inclusive of ability to breastfeed.

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Quevedo, Shany, Caroline Bekele, Patrice D. Thompson, Megan Philkhana, Sana Virani, Andrea Consuegra, Paul Douglass, and Alida M. Gertz. "Peripartum cardiomyopathy and HELLP syndrome in a previously healthy multiparous woman: A case report." SAGE Open Medical Case Reports 8 (January 2020): 2050313X2097928. http://dx.doi.org/10.1177/2050313x20979288.

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Peripartum cardiomyopathy is a type of dilated cardiomyopathy in which the exact etiology is uncertain. HELLP syndrome is characterized by a constellation of different clinical and laboratory findings, including hemolysis, elevated liver enzymes, and low platelets. Few case reports exist detailing successful diagnosis and management of postpartum HELLP syndrome, peripartum cardiomyopathy, and multisystem organ failure in a previously healthy woman. We herein report the case of a 39-year-old multiparous female with mild gestational hypertension, who presented in the third trimester with vaginal bleeding and was subsequently suspected to have intrapartum placental abruption leading to immediate Cesarean section, complicated by massive postpartum hemorrhage, necessitating care in the intensive care unit. HELLP syndrome, disseminated intravascular coagulation, and acute kidney injury requiring hemodialysis subsequently developed along with respiratory failure and peripartum cardiomyopathy. After diagnosis and proper management, the patient made a full recovery. Peripartum cardiomyopathy should remain on the differential for women with heart failure symptoms.

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Okafor, U. V., and R. E. Efetie. "Critical care management of eclamptics: challenges in an African setting." Tropical Doctor 38, no. 1 (January 2008): 11–13. http://dx.doi.org/10.1258/td.2007.053260.

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We conducted a retrospective study of the management and outcome for eclampsia patients in the intensive care unit (ICU) of National hospital, Abuja between November 2001 and April 2005 (42 months). The patients’ case files and ICU records were used to extract the necessary data. During the study period, there were a total of 4857 deliveries, with 5051 total births (including multiple births) and 4854 live births. Forty eclamptics were admitted to the ICU, giving an ICU admission rate of 8.2/1000 live births. The records of two patients were incomplete. The average age of the patients was 28.4 years (range 17–4 years). Six patients (15.8%) were booked and 32 (84.2%) were not. The average duration of stay in ICU was 5 days. Twenty patients (52.6%) had antepartum eclampsia, 12 (31.6%) had postpartum eclampsia and six (15.8%) presented with intrapartum eclampsia. Twenty-nine (76.3%) gave birth via caesarean section and nine (23.7%) delivered per vagina augmented by oxytocin infusion. Seventeen (45%) received mechanical ventilation; 20 (53%) received oxygen via nasal prongs, nasal catheters or variable performance facemask. One patient (2%) did not receive oxygen therapy. All the patients were admitted postpartum. There were 11 maternal deaths, giving a case fatality rate of 29%. There were five (45.4%) deaths due to haemolysis, elevated liver enzymes and low platelet count syndrome and two (18.2%) due to disseminated intravascular coagulation. The remaining deaths were due to cerebrovascular accident (9.1%), lobar pneumonia (9.1%), acute renal failure (9.1%) and multiple organ failure (9.1%). All patients were admitted postpartum. This fatality rate is higher than that detailed in the reports reviewed in this study. Early referral of eclamptics or at risk patients to a tertiary care institution may help reduce morbidity and mortality. In addition, early referral to a facility providing basic essential obstetric care or comprehensive essential obstetric care is also important. Another important factor is the correct diagnosis of pre-eclampsia during antenatal and postpartum care by screening, noting blood pressure levels, performing urinalysis for protein and asking about warning signs such as headache, blurred vision, epigastric pain, etc.

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Dhanapal, Mohana, Subha Sivagami Sengodan, and Praveena Murugesan. "Eclampsia: a retrospective study in a tertiary care centre." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 8 (July 26, 2017): 3604. http://dx.doi.org/10.18203/2320-1770.ijrcog20173493.

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Background: This study was done to analyse the maternal mortality, morbidity and fetal outcome in eclampsia complicating pregnancy.Methods: This study was conducted in Government Mohan Kumaramangalam Medical College and Hospital, Salem. It was a retrospective study from May 2016 to May 2017.Results: Majority were referral 82.8%. 78.8% were in the age group of 20-30 years. Primi gravida was the commonest sufferer. In our study 67.02% had antepartum eclampsia and 31.2% had postpartum eclampsia. Only 1.8% patients had intrapartum eclampsia. While taking gestational age majority were preterm. Regarding mode of delivery 61.3% were delivered by LSCS. 29.2% of patients had pulmonary edema which was the commonest complication followed by Hellp syndrome (17.7%), Acute renal failure (10.6%), Cardiovascular accident (8.8%). There were 9 maternal deaths due to eclampsia (8.3%). Preterm delivery and Low birth weight were higher in eclamptic patients. Preterm birth occurred in 67.17% of patients. Intrauterine death occurred in 8 patients. Still birth occurred in 10.6% of patients.Conclusions: High maternal morbidity and mortality has been attributed to the late referral, delay in the timely management of preeclampsia. So coordinated efforts of medical and paramedical staffs and health education is needed to fight against eclampsia.

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Molokwu, Jennifer. "Obstetrics and Gynecology Ultrasound Topics in Family Medicine Resident Training." Donald School Journal of Ultrasound in Obstetrics and Gynecology 8, no. 1 (2014): 31–34. http://dx.doi.org/10.5005/jp-journals-10009-1331.

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ABSTRACT Access to timely and appropriate prenatal and maternity care is widely known to be an important factor in improving birth outcomes. Family physicians make a significant contribution to the provision of prenatal care in the United States. The amount of exposure to maternity care and prenatal procedures in residency increase likelihood of incorporation of prenatal care in future practice. The use of prenatal ultrasounds has become standard in the management of pregnancy. Ultrasonography has wide application in obstetric care and is being used in screening and diagnosis during antenatal, intrapartum and postpartum periods. Family physicians that provide obstetric care should be trained to carry out basic obstetric ultrasound scans. In our paper, we have outlined an approach to the incorporation of ultrasound training into Family Medicine residency education. We have also explored the use of simulation as an adjunct to scanning live patients in a training curriculum. How to cite this article Molokwu J. Obstetrics and Gynecology Ultrasound Topics in Family Medicine Resident Training. Donald School J Ultrasound Obstet Gynecol 2014;8(1):31-34.

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Chitnis, Swati, and Padmaja Samant. "Physical disabilities in pregnant women: impact on care and pregnancy outcome." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 4 (March 30, 2017): 1306. http://dx.doi.org/10.18203/2320-1770.ijrcog20171383.

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Background: Health care providers are often insensitive to and unfamiliar with the needs of pregnant women with disability. Medical services are many times not tailored to the needs of the disabled. This study analyzes the impact of disabilities on pregnancy in women delivering in a tertiary care hospital in India.Methods: Prospective study of total of 50 pregnant women with various disabilities was conducted in a tertiary care hospital in Mumbai, India. Each patient’s antepartum, intrapartum and postpartum course were noted. Patients were also interviewed with help of a structured questionnaire for difficulties accessing services, and impact on their daily life, pain.Results: Rate of cesarean deliveries due to pelvic problems, and complications like urinary tract infections which arise due to mobility issues were significantly higher in patients with physical disabilities. 30% participants found examination tables unsuitable and 20% found it difficult access toilets. Over all patients were satisfied with skills of health workers.Conclusions: Healthcare facilities have to be equipped for receiving patients with disabilities and should train health workers in management of these clients. They require pre-conceptional counseling and planning.

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Khakwani, Sadia, Claire Winton, Nosheen Aslam, and Suzanne Taylor. "Platelet storage pool disorder: multidisciplinary planning in pregnancy." BMJ Case Reports 14, no. 5 (May 2021): e239321. http://dx.doi.org/10.1136/bcr-2020-239321.

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A 32-year old primigravida woman presented for antenatal care giving a history that her mother had platelet storage pool disorder (PSPD). The patient was subsequently diagnosed with PSPD during her pregnancy and had a caesarean delivery for breech presentation at 39 weeks. In this paper, we discuss the basic science, inheritance pattern, symptoms and management of this condition, alongside the antenatal and intrapartum and postnatal management specific to it, highlighting the need for a multidisciplinary approach to care. PSPD refers to a group of rare conditions involving defects in platelet granule storage or secretion, which leads to abnormal aggregation and activation of platelets. There are both genetic and acquired forms of the condition. It is a functional platelet disorder, meaning platelet counts will usually remain in the normal range. The diagnosis may be suspected due to characteristic signs and symptoms, but patients may also be asymptomatic. There have been only a few documented cases of pregnant women with PSPD; therefore, management is not clear. Vaginal delivery is not contraindicated, however, postpartum haemorrhage should be anticipated and planned for the use of deamino D-arginine vasopressin (DDAVP), tranexamic acid, prophylactic oxytocics and prompt access to blood products, including platelets, if required. This case highlights the need for effective multidisciplinary teamwork between obstetricians, anaesthetists and haematologists to ensure high-quality care and enable careful intrapartum management planning.

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Tiruneh, Gizachew Tadele, Meaza Demissie, Alemayehu Worku, and Yemane Berhane. "Community’s experience and perceptions of maternal health services across the continuum of care in Ethiopia: A qualitative study." PLOS ONE 16, no. 8 (August 4, 2021): e0255404. http://dx.doi.org/10.1371/journal.pone.0255404.

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Background Continuum of care is an effective strategy to ensure that every woman receives a series of maternal health services continuously from early pregnancy to postpartum stages. The community perceptions regarding the use of maternal services across the continuum of care are essential for utilization of care in low-income settings but information in that regard is scanty. This study explored the community perceptions on the continuum of care for maternal health services in Ethiopia. Methods This study employed a phenomenological qualitative research approach. Four focus group discussions involving 26 participants and eight in-depth interviews were conducted with women who recently delivered, community health workers, and community leaders that were purposively selected for the study in West Gojjam zone, Amhara region. All the interviews and discussions were audio-taped; the records were transcribed verbatim. Data were coded and analyzed thematically using ATLAS.ti software. Results We identified three primary themes: practice of maternal health services; factors influencing the decision to use maternal health services; and reasons for discontinuation across the continuum of maternal health services. The study showed that women faced multiple challenges to continuously uptake maternal health services. Late antenatal care booking was the main reasons for discontinuation of maternal health services across the continuum at the antepartum stage. Women’s negative experiences during care including poor quality of care, incompetent and unfriendly health providers, disrespectful care, high opportunity costs, difficulties in getting transportation, and timely referrals at healthcare facilities, particularly at health centers affect utilization of maternal health services across the continuum of care. In addition to the reverberation effect of the intrapartum care factors, the major reasons mentioned for discontinuation at the postpartum stage were lack of awareness about postnatal care and service delivery modality where women are not scheduled for postpartum consultations. Conclusion This study showed that rural mothers still face multiple challenges to utilize maternal health services as recommended by the national guidelines. Negative experiences women encountered in health facilities, community perceptions about postnatal care services as well as challenges related to service access and opportunity costs remained fundamental to be reasons for discontinuation across the continuum pathways.

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Ur Rehman, Bilal, and Hiba Gul. "Indication and complication of caesarean section at tertiary care hospital: a retrospective study." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 4 (March 26, 2019): 1646. http://dx.doi.org/10.18203/2320-1770.ijrcog20191235.

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Background: The incidence of cesarean section is steadily rising. Cesarean delivery has played a major role in lowering both maternal and perinatal morbidity and mortality rates. There are various factors involved in the rise of rate of cesarean section like rising incidence of primary cesarean delivery, identification of high-risk pregnancy, wider use of repeat cesarean section, rising rates of induction of labor and failure of induction, no reassuring fetal status etc.Methods: A retrospective cross-sectional study was conducted. Data was collected from patient records of the hospital during 1st January 2018 to 30th June 2018. All patients (N= 602) who had delivered their baby by caesarean section were included in the study. Data were analyzed by help of SPSS version 21 after proper compilation.Results: Among all women who underwent cesarean section, majority were age group between 21 and 30 years (67.1%). Repeat cesarean section (48.5%), followed by fetal distress (18.9%), oligohydramnias (6.6%) and cephalopelvic disproportion (6.5%) were most common among all major indication of cesarean section. Intrapartum complication (2.0%) includes postpartum hemorrhage (1.2%), CS hysterectomy (0.5%), bladder injury (0.3%) and postpartum complication (2.3%) including UTI (0.8), wound infection (0.5%), sepsis (0.5%), lactation failure (0.5%) were major maternal complication of cesarean section.Conclusions: Reduction of number of primary cesarean section, successful VBAC, individualization of the indication and careful evaluation, following standardized guidelines can help to keep rate of cesarean section to the possible minimum level.

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Goodman, Daisy. "Buprenorphine for the Treatment of Perinatal Opioid Dependence: Pharmacology and Implications for Antepartum, Intrapartum, and Postpartum Care." Journal of Midwifery & Women's Health 56, no. 3 (April 28, 2011): 240–47. http://dx.doi.org/10.1111/j.1542-2011.2011.00049.x.

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Sonawane, Pundalik K., and Deep M. Bhadra. "Comparative study of maternal and perinatal outcome in pregnancies with and without umbilical cord around foetal neck." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 3 (February 26, 2019): 1096. http://dx.doi.org/10.18203/2320-1770.ijrcog20190886.

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Background: Umbilical cord around neck of the foetus is called the nuchal cord. The aims and objectives are to find out the incidence of nuchal cord around foetal neck at delivery, and to compare and evaluate intrapartum and postpartum maternal and foetal outcome in those with or without nuchal cord at delivery.Methods: It is a prospective cross-sectional study conducted at tertiary care hospital for period of 12 months. Of 1380 patients, 934 patients were enrolled in present study after meeting the inclusion and exclusion criteria of which 150 patients were included in study group who delivered with nuchal cord and 784 patients in control group who delivered without nuchal cord.Results: Present study showed 18.84% incidence of nuchal cord at delivery. Duration of labour was 6.51hrs in study group and 6.15hrs in control group and the difference was statistically significant. Rest of the intrapartum and postpartum events were statistically not significant. Mean length of cord was more in patients delivered with loop of cord around foetal neck as compared to another group and it is statistically significant.Conclusions: Nuchal cord is a common finding at the time of delivery. However, it is per-se not an indication of LSCS and it only increases the operative morbidity.

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Monnier, Dale M., and Cynthia Chester. "CODE PINK PACIFIER©: Developing the Postpartum, Intrapartum, Newborn Kits (Pink) for Practicing Acute Care Intrapartum Facts Important for Everyone to Have Right (Pacifier) Program." Journal of Obstetric, Gynecologic & Neonatal Nursing 40 (June 2011): S65. http://dx.doi.org/10.1111/j.1552-6909.2011.01242_90.x.

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Jabeen, Nadia, Fareeha Zaheer, Kinza Ali, Amna Faruqi, Irfan Afzal Mughal, and Asma Irfan. "Impact of COVID-19 on Antenatal, Natal, and Postnatal Care of pregnant females at Akbar Niazi Teaching Hospital." Journal of Rawalpindi Medical College 25, no. 1 (March 30, 2021): 60–65. http://dx.doi.org/10.37939/jrmc.v25i1.1471.

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Objective: To determine the perception of pregnant patients regarding the COVID pandemic, preventive measures taken by the patients during the pandemic, and the impact of COVID on their Natal, Intrapartum, and Postpartum Care.Materials and Methods: This study included 850 patients presenting in the Obstetrics and Gynaecology department for antenatal care, inpatient care (delivery and caesarean section), and postpartum complications. Percentages were calculated for descriptive variables like demographic factors, source of information, and opinion of patients about COVID-19, preventive measures are taken by the patients, their Antenatal, Natal, and Postnatal fears. An independent t-test was applied and a p-value of ˂0.05 was taken as statistically significant.Results: We enrolled 850 patients in this study with a mean age of +28 years,mean gravidity of +3, 50% were matriculated and 75% of our patients belonged to middle-class families.. Among our patients, 96% were in fear of getting infected along with their fetus, if they visited the hospital for antenatal care, which is why a majority of them did not visit the hospital for antenatal care and a statistically significant percentage (80%) of them missed antenatal care for 5 months. While the same number of patients (96%, p-value ˂0.05) shared their fear regarding contracting the infection from the hospital during delivery and postnatal care in the hospital, and the same percentage were of the opinion that the baby would get infected during and after delivery in a hospital.Conclusion: Antenatal care is a basic right of every pregnant female. During emergencies like pandemics ways and means should be devised, not only to provide care but, also, to address the fears of pregnant females to prevent complications during this important phase of life.

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Purohit, Neha. "Utilization of delivery and postnatal health services by indigenous women of a hilly, remote district in India: a struggle for safe motherhood." International Journal Of Community Medicine And Public Health 8, no. 2 (January 27, 2021): 694. http://dx.doi.org/10.18203/2394-6040.ijcmph20210223.

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Background: Maternal and new-born health remains issue of critical concern for the developing world. The day of Delivery and immediate postpartum period poses the greatest risk of survival for the mother as well as the child. The indigenous women in rural, remote areas face various geographical, climatic, socio-economic inequities, which further amplify health risks associated with delivery. The study aimed to identify the pattern of utilization of intrapartum and postpartum health services by indigenous women in rural, remote area and understand the challenges faced by them to access care. Methods: A community based descriptive, cross-sectional study was carried out in 41 far-flung villages of Lahaul and Spiti district in Himachal Pradesh, India, using a mixed-method approach of data collection. 103 females who had experienced delivery in past 2 years and were residents of Lahaul for minimum of 3 years, were interviewed using a semi-structured questionnaire. The quantitative data was analysed by SPSS-20. The qualitative data was transcribed and analysed thematically. Results: The study highlighted the significant physical, psychological, financial and socio-cultural risks borne by the women of Lahaul in order to access biomedical care during maternity care. The prime cause of the grave situation was inadequacy of appropriate care in the health facilities of the district, which forced the women to migrate to areas with better healthcare facilities.Conclusions: The study stressed the need to establish comprehensive emergency, obstetric and new born care in the tribal area to reverse the disparities in the region and improve health outcomes.

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O'Sullivan, O. E., D. Crosby, B. Byrne, and C. Regan. "Pregnancy Complicated by Portal Hypertension Secondary to Biliary Atresia." Case Reports in Obstetrics and Gynecology 2013 (2013): 1–4. http://dx.doi.org/10.1155/2013/421386.

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Biliary atresia is a rare idiopathic neonatal cholestatic disease characterized by the destruction of both the intra- and extrahepatic biliary ducts. As the disease is progressive all cases will develop portal fibrosis, cirrhosis, and portal hypertension with the sequelae of varices, jaundice, and eventually liver failure requiring a transplant. Survival rates have improved considerably with many females living well in to be childbearing age. Due to the complexity of the disease these pregnancies are considered, high risk. We report the antenatal, intrapartum, and postpartum managements of a pregnancy complicated by biliary atresia. Furthermore, we highlight the importance of a multidisciplinary team approach in optimizing obstetric care for this high risk group.

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Kozuki, Naoko, Lolade Oseni, Angella Mtimuni, Reena Sethi, Tambudzai Rashidi, Fannie Kachale, Barbara Rawlins, and Shivam Gupta. "Health facility service availability and readiness for intrapartum and immediate postpartum care in Malawi: A cross-sectional survey." PLOS ONE 12, no. 3 (March 16, 2017): e0172492. http://dx.doi.org/10.1371/journal.pone.0172492.

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Gaddam, Swetha Gulabi, and Vijithra Thangamani. "Maternal and Fetal Outcome in Antepartum Haemorrhage of Unknown Origin in Chennai, India." Journal of Evolution of Medical and Dental Sciences 10, no. 31 (August 2, 2021): 2481–84. http://dx.doi.org/10.14260/jemds/2021/507.

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BACKGROUND Antepartum haemorrhage of unknown origin (APHUO) being a diagnosis of exclusion, is a rare condition which poses dilemma in the management of pregnancy in terms of timing and mode of delivery. The purpose of this study was to evaluate antenatal factors associated with APHUO, clinical presentation and analyse its impact on pregnancy and its outcome. METHODS This is a retrospective study conducted over a period of two years in a tertiary care hospital. Pregnancy outcomes were compared between 41 cases who had APHUO versus 39 controls who never had history of bleeding in their antepartum period. Bleeding pattern, incidence of preterm labour, intra partum and postpartum complications, mode of delivery, birth weight, APGAR (appearance, pulse, grimace, activity, and respiration) score of the baby and neo-natal intensive care unit (NICU) admission were analysed. RESULTS Patients with APHUO had subclinical abruption and increased risk of preterm delivery. Intrapartum and postpartum complications were similar among both the groups. The average birth weight was much lesser in the study group, but the cause was attributed to prematurity. These findings were consistent with the previous studies. CONCLUSIONS APHUO is associated with subclinical abruption and increased risk of preterm labour. Hence the patient should be counselled for delivery at a tertiary care center with adequate neonatal care. Greater incidence of NICU admission and low birth weight were attributed to prematurity among the study group. Induction of labour at term in this group is of questionable value unless there is an associated obstetric indication. KEY WORDS APHUO, Preterm Labour, Sub Clinical Abruption, Low Birth Weight

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Se Homer, Caroline. "Private health insurance uptake and the impact on normal birth and costs: a hypothetical model." Australian Health Review 25, no. 2 (2002): 32. http://dx.doi.org/10.1071/ah020032.

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Recent Australian government policy has encouraged large numbers of women of childbearing age to enter private health insurance. This paper describes how increased uptake of private health insurance may impact on the rate of normal birth, caesarean section and the costs of providing maternity care in low risk primiparous women in New South Wales. A hypothetical model was developed using data from the NSW Midwives Data Collection. Costs were calculated usingdata established from previous research in NSW (Homer et al 2001). It suggests that, as the proportion of low risk primiparous women with private health insurance increases, the rate of normal birth may decrease with a subsequent increase in rate of caesarean section. As the rate of caesarean section rises, the cost of providing intrapartum and postpartum care may also increase. I argue that increased rates of private health insurance membership have the potential to increase the rate of caesarean section and the cost of providing maternity care to low risk women. It is evident that government policy can impact on the outcome of maternity care in Australia in ways that might not have been predicted. Paradoxically, the care ofhealthy childbearing women may cost the Australian government more to provide in the future.

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Parihar, Bharti C., Babli Yadav, and Jaya Patel. "Critical care management of eclampsia patients - one year study." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 9, no. 12 (November 26, 2020): 4850. http://dx.doi.org/10.18203/2320-1770.ijrcog20204945.

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Background: Critically ill eclampsia patients present a unique challenge to the obstetrician, anesthesiologist and intensivists. In developing countries, maternal mortality is still high due to lack of good maternal antenatal services and obstetric intensive care. This study aims to provide a comprehensive review for the management and outcome of critically ill eclampsia patients admitted in the obstetric intensive care unit (ICU), GMC, Bhopal.Methods: This study was a hospital based cross sectional study. The study included 145 eclampsia patients who were admitted in obstetric ICU for critical care management. For each eligible patient, sociodemograhic profile, indications of ICU admission, data on ICU interventions and maternal outcome were documented.Results: During study period, total obstetric admission were 19,815 and 14,731 live births. Out of 348 eclampsia patients, 145 patients were admitted to the obstetric ICU, giving an ICU admission rate of 9.8/1000 live births. 98.03% patients were unbooked referred obstetric emergencies.The average duration of stay in obstetric ICU was 5.4+3.1 days. 72.9% patients had antepartum eclampsia, 17.2% patients had postpartum eclampsia and 10.8% patients had intrapartum eclampsia. 41% patients received mechanical ventilation, 90% patients received oxygen and advanced monitoring, 48.6% patients received vasoactive drugs and 53.7% patients received blood transfusions. There were 26 maternal deaths giving a case fatality rate of 17.93%.Conclusions: Early referral of eclampsia patients or at risk patients to a tertiary care centre may help to reduce maternal morbidity and mortality. Early diagnosis and prompt treatment through a multidisciplinary team in an ICU setting can prevent complications and reduce morbidity and mortality.

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ROOKS, J., N. WEATHERBY, and E. ERNST. "The National Birth Center Study Part III—Intrapartum and immediate postpartum and neonatal complications and transfers, postpartum and neonatal care, outcomes, and client satisfaction." Journal of Nurse-Midwifery 37, no. 6 (November 1992): 361–97. http://dx.doi.org/10.1016/0091-2182(92)90122-j.

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K., Manjula S., Jasmine Deva Arul Selvi T., and Vishnu Priya K. M. N. "Maternal and perinatal outcome of Evan’s syndrome: a 5 years study in a tertiary care centre." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 6 (May 28, 2019): 2528. http://dx.doi.org/10.18203/2320-1770.ijrcog20192462.

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Background: Evans syndrome is a rare autoimmune disorder characterized by simultaneous or sequential presence of a positive antiglobulin test, autoimmune haemolytic anemia (AIHA), and immune thrombocytopenia (ITP). It is characterised by frequent exacerbations and remissions within a chronic course. It was first described by Robert Evans in 1951. Incidence of AIHA is 1 per 75 - 80,000 and ITP is 5.5 /100000 per general adult population. Incidence of Evans syndrome is 1.8% to 10% of patients with ITP. Objective was to study the maternal and perinatal outcome of women with Evans syndrome (E).Methods: About 4 antenatal mothers were identified with Evans syndrome at St. Johns medical college and hospital, Bengaluru during the study period of 5 years from July 2013-July 2017. They were followed up during their antenatal, intra natal and postnatal period and outcomes were studied. All patients included in the study fulfilled the criteria for Evans syndrome.Results: There were 4 cases of Evans syndrome, with a total number of deliveries of 11859, during this 5 year study. Incidence was 0.09 per 1000 births. All patients presented with bleeding manifestations ranging from mucosal haemorrhage to subarachnoid haemorrhage (SAH) at the time of diagnosis. All patients were on treatment with either 1st or 2nd line of management with corticosteroids/ azathioprine. None had bleeding during pregnancy after the initiation of treatment. Patients had antenatal complications like preeclampsia 25%, IUGR 25%, oligohydraminos 50%, IUD 25%. 2 patients received platelet transfusions intrapartum. None had intrapartum or postpartum haemorrhage. There were no maternal and neonatal mortality.Conclusions: Evans syndrome in pregnancy is a rare condition and requires multi disciplinary approach involving specialists from obstetrics, neonatology, and hematology. Close maternal and fetal surveillance and management during pregnancy is essential to increase the possibility of a favourable pregnancy outcome in these women.

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Asalkar, Mahesh, Bijal Kasar, Swapnil Dhakne, and Patit Paban Panigrahi. "Study of perinatal outcome in twin gestation in rural referral hospital in Maharashtra (India): a cross sectional study." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 11 (October 28, 2017): 5074. http://dx.doi.org/10.18203/2320-1770.ijrcog20175028.

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Background: Incidence of twin pregnancy is increasing all over the world. It can occur after Assisted Reproductive Technology (ART) or spontaneously and associated with increased maternal and neonatal complications both in the developed and developing countries.Methods: A descriptive (Cross sectional) study of 64 cases of twins was undertaken between January 2013 till December 2015. Data collection was done prospectively from the patients admitted to the hospital with twin gestation. Inclusion criteria: All pregnancy with twin gestation more than 28 weeks of gestation. Twin pregnancies with both fetuses alive are included. Exclusion criteria is multiple gestation other than twins, cases with congenital malformation and intrauterine death (in one or both twins) were excluded. Data included thorough antenatal history, demographic details and intrapartum and postpartum maternal and neonatal details.Results: Prevalence of twins in our study was 1.61% (95% CI 1.3-2%). Out of 69 cases of twin pregnancy 64 cases fulfilled the inclusion criteria. History of ovulation induction was associated with 23% cases. Commonest complications observed were preterm labour (56.5%) anaemia (43.4%) and PIH (22.3%). 30.2% cases delivered vaginally whereas 69.8% patients required c. section, malpresentation being commonest indication. No intrapartum still birth was recorded. Early neonatal death was seen in eight cases, causes were prematurity, hyaline membrane disease and neonatal jaundice. Diamnoitic-dichorionic twins were 90% and 3% cases were monoamniotic monochorionic. Zygosity was calculated by Weinbergs formula and 84% cases were dizygotic while 16% cases were monozygotic. No maternal mortality related to twin pregnancy was reported in present study.Conclusions: All twin pregnancy should be considered as high risk pregnancies and should have mandatory hospital delivery. Early diagnosis, adequate antenatal, intrapartum and postpartum care as well as good NICU back up are the key factors in reducing the complications and improving the perinatal outcome in twin pregnancies.

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Wu, Y. (Maria), E. McArthur, S. Dixon, J. S. Dirk, and B. K. Welk. "Association between intrapartum epidural use and maternal postpartum depression presenting for medical care: a population-based, matched cohort study." International Journal of Obstetric Anesthesia 35 (August 2018): 10–16. http://dx.doi.org/10.1016/j.ijoa.2018.04.005.

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Lundeen, Tiffany. "Intrapartum and Postpartum Transfers to a Tertiary Care Hospital from Out-of-Hospital Birth Settings: A Retrospective Case Series." Journal of Midwifery & Women's Health 61, no. 2 (March 2016): 242–48. http://dx.doi.org/10.1111/jmwh.12447.

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Journal articles on the topic 'Intrapartum care and postpartum care'

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