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Sample records for hospitals maternity

  1. [Proximity and breastfeeding at the maternity hospital].

    PubMed

    Fradin-Charrier, Anne-Claire

    2015-01-01

    The establishment of breastfeeding, as well as its duration, are facilitated through the proximity of the mother with her new baby. However, in maternity hospitals, breastfeeding mothers very often leave their baby in the nursery at night time. A study carried out in 2014 in several maternity hospitals put forward suggestions and highlighted areas to improve in everyday practice.

  2. Measures of performance in Scottish maternity hospitals.

    PubMed Central

    Leyland, A H; Pritchard, C W; McLoone, P; Boddy, F A

    1991-01-01

    OBJECTIVE--To develop measures of hospital performance over time with particular reference to maternal and neonatal care by controlling for case mix. DESIGN--Analysis of computerised records of births. SETTING--Scotland, 1980-7. SUBJECTS--Over half a million singleton live births and stillbirths. MAIN OUTCOME MEASURES--Numbers of perinatal deaths and caesarean sections. RESULTS--Scottish maternity hospitals perform more or less equally with regard to perinatal mortality. When caesarean sections are considered, there is evidence that hospitals differ in their treatment of different groups of women; in two examples one hospital had an increased rate among women of parity 2 or more and another had a reduced rate of repeat caesarean section. CONCLUSIONS--Developing measures of performance over time by controlling for case mix is a valid system for monitoring hospital outcomes and activity, and allows comparison either between hospitals or with data for all Scottish maternity hospitals. Hospital profiles permit identification of differences for particular patient groups after allowance is made for other case mix variables. PMID:1912806

  3. Influence of the support offered to breastfeeding by maternity hospitals

    PubMed Central

    Passanha, Adriana; Benício, Maria Helena D’Aquino; Venâncio, Sônia Isoyama; dos Reis, Márcia Cristina Guerreiro

    2015-01-01

    ABSTRACT OBJECTIVE To evaluate whether the support offered by maternity hospitals is associated with higher prevalences of exclusive and predominant breastfeeding. METHODS This is a cross-sectional study including a representative sample of 916 infants less than six months who were born in maternity hospitals, in Ribeirao Preto, Sao Paulo, Southeastern Brazil, 2011. The maternity hospitals were evaluated in relation to their fulfillment of the Ten Steps to Successful Breastfeeding. Data were collected regarding breastfeeding patterns, the birth hospital and other characteristics. The individualized effect of the study factor on exclusive and predominant breastfeeding was analyzed using Poisson multiple regression with robust variance. RESULTS Predominant breastfeeding tended to be more prevalent when the number of fulfilled steps was higher (p of linear trend = 0.057). The step related to not offering artificial teats or pacifiers to breastfed infants and that related to encouraging the establishment of breastfeeding support groups were associated, respectively, to a higher prevalence of exclusive (PR = 1.26; 95%CI 1.04;1.54) and predominant breastfeeding (PR = 1.55; 95%CI 1.01;2.39), after an adjustment was performed for confounding variables. CONCLUSIONS We observed a positive association between support offered by maternity hospitals and prevalences of exclusive and predominant breastfeeding. These results can be useful to other locations with similar characteristics (cities with hospitals that fulfill the Ten Steps to Successful Breastfeeding) to provide incentive to breastfeeding, by means of promoting, protecting and supporting breastfeeding in maternity hospitals. PMID:26759966

  4. The relationship between maternal self-esteem and maternal attachment in mothers of hospitalized premature infants.

    PubMed

    Chen, C W; Conrad, B

    2001-09-01

    The purpose of this study was to examine the relationship between maternal self-esteem and maternal attachment in mothers of hospitalized premature infants. The research instruments administered included: a demographic sheet, the Maternal Self-Report Inventory (MSRI), Rosenberg Self-Esteem Scale, and Leifer's How I Feel About My Baby Now Scale. Thirty-two mothers whose premature infants were medically stable and hospitalized in the NICU were studied. Two hypotheses on the positive relationships between maternal self-esteem and maternal attachment, and global self-esteem and maternal attachment could not be tested by correlational analyses due to the inadequate internal consistency of the How I Feel About My Baby Now Scale. A significant correlation was found between maternal self-esteem and global self-esteem. Thus, maternal role influenced general self-concept in mothers. In addition, it was found that there were no significant correlations between the MSRI and demographic variables, such as: maternal age, marital status, income, and educational level. Another result indicated that increased global self-esteem was correlated (p < .05) with maternal age, income, and educational level. The results of this study provide clinical nurses to pay attention not only to caregiving skills but also to the mother's appraisal of herself as a mother and attachment behaviors.

  5. Birthing Centers and Hospital Maternity Services

    MedlinePlus

    ... who go on to receive further training in high-risk pregnancies are called maternal-fetal specialists or perinatologists. If ... certain medical conditions (such as gestational diabetes or high blood pressure), or ... early in pregnancy and given prenatal care at the birth center ...

  6. Facility-based maternal death reviews: effects on maternal mortality in a district hospital in Senegal.

    PubMed Central

    Dumont, Alexandre; Gaye, Alioune; de Bernis, Luc; Chaillet, Nils; Landry, Anne; Delage, Joanne; Bouvier-Colle, Marie-Hélène

    2006-01-01

    OBJECTIVE: The improvement of obstetric services is one of the key components of the Safe Motherhood Programme. Reviewing maternal deaths and complications is one method that may make pregnancy safer, but there is no evidence about the effectiveness of this strategy. The objective of our before and after study is to assess the effect of facility-based maternal deaths reviews (MDR) on maternal mortality rates in a district hospital in Senegal that provides primary and referral maternity services. METHODS: We included all women who were admitted to the maternity unit for childbirth, or within 24 hours of delivery. We recorded maternal mortality during a 1-year baseline period from January to December 1997, and during a 3-year period from January 1998 to December 2000 after MDR had been implemented. Effects of MDR on organization of care were qualitatively evaluated. FINDINGS: The MDR strategy led to changes in organizational structure that improved life-saving interventions with a relatively large financial contribution from the community. Overall mortality significantly decreased from 0.83 (95% CI (confidence interval) = 0.60 -1.06) in baseline period to 0.41 (95% CI = 0.25 -0.56) per 100 women 3 years later. CONCLUSION: MDR had a marked effect on resources, management and maternal outcomes in this facility. However, given the design of our study and the local specific context, further research is needed to confirm the feasibility of MDR in other settings and to confirm the benefits of this approach for maternal health in developing countries. PMID:16583081

  7. Maternal mortality in Cameroon: a university teaching hospital report.

    PubMed

    Tebeu, Pierre-Marie; Pierre-Marie, Tebeu; Halle-Ekane, Gregory; Gregory, Halle-Ekane; Da Itambi, Maxwell; Maxwell, Da Itambi; Enow Mbu, Robinson; Robinson, Enow Mbu; Mawamba, Yvette; Yvette, Mawamba; Fomulu, Joseph Nelson; Nelson, Fomulu Joseph

    2015-01-01

    More than 550,000 women die yearly from pregnancy-related causes. Fifty percent (50%) of the world estimate of maternal deaths occur in sub-Saharan Africa alone. There is insufficient information on the risk factors of maternal mortality in Cameroon. This study aimed at establishing causes and risk factors of maternal mortality. This was a case-control study from 1st January, 2006 to 31st December, 2010 after National Ethical Committee Approval. Cases were maternal deaths; controls were women who delivered normally. Maternal deaths were obtained from the delivery room registers and in-patient registers. Controls for each case were two normal deliveries following identified maternal deaths on the same day. Variables considered were socio-demographic and reproductive health characteristics. Epi Info 3.5.1 was used for analysis. The mean MMR was 287.5/100,000 live births. Causes of deaths were: postpartum hemorrhage (229.2%), unsafe abortion (25%), ectopic pregnancy (12.5%), hypertension in pregnancy (8.3%), malaria (8.3%), anemia (8.3%), heart disease (4.2%), and pneumonia (4.2%), and placenta praevia (4.2%). Ages ranged from 18 to 41 years, with a mean of 27.7 ± 5.14 years. Lack of antenatal care was a risk factor for maternal death (OR=78.33; CI: (8.66- 1802.51)). The mean MMR from 2006 to 2010 was 287.5/100,000 live births. Most of the causes of maternal deaths were preventable. Lack of antenatal care was a risk factor for maternal mortality. Key words: Maternal mortality, causes, risk factors, Cameroon.

  8. Maternal mortality in Cameroon: a university teaching hospital report

    PubMed Central

    Tebeu, Pierre-Marie; Halle-Ekane, Gregory; Da Itambi, Maxwell; Mbu, Robinson Enow; Mawamba, Yvette; Fomulu, Joseph Nelson

    2015-01-01

    More than 550,000 women die yearly from pregnancy-related causes. Fifty percent (50%) of the world estimate of maternal deaths occur in sub-Saharan Africa alone. There is insufficient information on the risk factors of maternal mortality in Cameroon. This study aimed at establishing causes and risk factors of maternal mortality. This was a case-control study from 1st January, 2006 to 31st December, 2010 after National Ethical Committee Approval. Cases were maternal deaths; controls were women who delivered normally. Maternal deaths were obtained from the delivery room registers and in-patient registers. Controls for each case were two normal deliveries following identified maternal deaths on the same day. Variables considered were socio-demographic and reproductive health characteristics. Epi Info 3.5.1 was used for analysis. The mean MMR was 287.5/100,000 live births. Causes of deaths were: postpartum hemorrhage (229.2%), unsafe abortion (25%), ectopic pregnancy (12.5%), hypertension in pregnancy (8.3%), malaria (8.3%), anemia (8.3%), heart disease (4.2%), and pneumonia (4.2%), and placenta praevia (4.2%). Ages ranged from 18 to 41 years, with a mean of 27.7 ± 5.14 years. Lack of antenatal care was a risk factor for maternal death (OR=78.33; CI: (8.66- 1802.51)). The mean MMR from 2006 to 2010 was 287.5/100,000 live births. Most of the causes of maternal deaths were preventable. Lack of antenatal care was a risk factor for maternal mortality. Key words: Maternal mortality, causes, risk factors, Cameroon. PMID:26401210

  9. Evaluation of maternal and neonatal hospital care: quality index of completeness

    PubMed Central

    da Silva, Ana Lúcia Andrade; Mendes, Antonio da Cruz Gouveia; Miranda, Gabriella Morais Duarte; de Sá, Domicio Aurélio; de Souza, Wayner Vieira; Lyra, Tereza Maciel

    2014-01-01

    OBJECTIVE Develop an index to evaluate the maternal and neonatal hospital care of the Brazilian Unified Health System. METHODS This descriptive cross-sectional study of national scope was based on the structure-process-outcome framework proposed by Donabedian and on comprehensive health care. Data from the Hospital Information System and the National Registry of Health Establishments were used. The maternal and neonatal network of Brazilian Unified Health System consisted of 3,400 hospitals that performed at least 12 deliveries in 2009 or whose number of deliveries represented 10.0% or more of the total admissions in 2009. Relevance and reliability were defined as criteria for the selection of variables. Simple and composite indicators and the index of completeness were constructed and evaluated, and the distribution of maternal and neonatal hospital care was assessed in different regions of the country. RESULTS A total of 40 variables were selected, from which 27 single indicators, five composite indicators, and the index of completeness of care were built. Composite indicators were constructed by grouping simple indicators and included the following variables: hospital size, level of complexity, delivery care practice, recommended hospital practice, and epidemiological practice. The index of completeness of care grouped the five variables and classified them in ascending order, thereby yielding five levels of completeness of maternal and neonatal hospital care: very low, low, intermediate, high, and very high. The hospital network was predominantly of small size and low complexity, with inadequate child delivery care and poor development of recommended and epidemiological practices. The index showed that more than 80.0% hospitals had a low index of completeness of care and that most qualified heath care services were concentrated in the more developed regions of the country. CONCLUSIONS The index of completeness proved to be of great value for monitoring the

  10. Maternal Infection Requiring Hospitalization during Pregnancy and Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Atladottir, Hjordis O.; Thorsen, Poul; Ostergaard, Lars; Schendel, Diana E.; Lemcke, Sanne; Abdallah, Morsi; Parner, Erik T.

    2010-01-01

    Exposure to prenatal infection has been suggested to cause deficiencies in fetal neurodevelopment. In this study we included all children born in Denmark from 1980, through 2005. Diagnoses of autism spectrum disorders (ASDs) and maternal infection were obtained through nationwide registers. Data was analyzed using Cox proportional hazards…

  11. [Importance of sanitary-antiepidemic measures in preventing staphylococcal infections in maternity hospitals].

    PubMed

    Kitel', V S; Chumalo, P G; Gorbatiuk, K P

    1980-01-01

    The results of the realization of antistaphylococcal measures in maternity hospitals, carried out under the guidance and control of the sanitary and epidemiological service, are presented. The sanitary and epidemiological station registered each case of staphylococcal infection in nursing mothers and infants and investigated its epidemiological aspects. The exposure of the causes responsible for the disease allowed to take up the necessary antiepidemic measures in due direction, thus preventing the spread of hospital infections.

  12. Maternal Mortality in the Main Referral Hospital in Angola, 2010-2014: Understanding the Context for Maternal Deaths Amidst Poor Documentation

    PubMed Central

    Umar, Abubakar Sadiq; Kabamba, Lusamba

    2016-01-01

    Background: Increasing global health efforts have focused on preventing pregnancy-related maternal deaths, but the factors that contribute to maternal deaths in specific high-burden nations are poorly understood. The aim of this study was to identify factors that influence the occurrence of maternal deaths in a regional maternity hospital in Kuando Kubango province of Angola. Methods: The study was a retrospective cross-sectional analysis of case notes of all maternal deaths and deliveries that were recorded from 2010 to 2014. The information collected included data on pregnancy, labor and post-natal period retrieved from case notes and the delivery register. Results: During the period under study, a total of 7,158 live births were conducted out of which 131 resulted in maternal death with an overall maternal mortality ratio of 1,830 per 100,000 live births. The causes of death and their importance was relatively similar over the period reviewed. The direct obstetric causes accounted for 51% of all deaths. The major causes were hemorrhage (15%), puerperal sepsis (13%), eclampsia (11%) and ruptured uterus (10%). In addition, indirect non-obstetric medical causes such as Malaria, Anemia, hepatitis, AIDs and cardiovascular diseases accounted for 49% of all maternal deaths. There is poor documentation of personal data and clinical case management of cases. The factors of mutual instability of statistical significance associated with maternal death are: place of domicile (P=0.0001) and distance to the hospital (P=0.0001). Conclusion and Global Health Implication: The study demonstrated that the MMR in maternity hospital is very high and is higher than the WHO 2014 estimates and the province is yet to achieve the desired MDG 5 target by the end of 2015. A reversal of the present state requires data driven planning in order to improve access and use of Maternal Health Services (MHS) and ultimately lower the number of pregnancy-related maternal deaths. PMID:28058194

  13. Use of clinical guidelines: perspectives from clinicians in paediatric and maternity hospitals in Kabul, Afghanistan.

    PubMed

    Graham, H; Tokhi, M; Edward, A; Salehi, A S; Turkmani, S; Duke, T; Bartlett, L

    2015-04-02

    This study explored the perceived value, role and reported use of clinical guidelines by clinicians in urban paediatric and maternity hospital settings, and the effect of current implementation strategies on clinician attitudes, knowledge and behaviour. A total of 63 clinicians from 7 paediatric and maternity hospitals in Kabul, Afghanistan participated in structured focus groups; content analysis methodology was used for identification and analysis of key themes. Seven sets of guidelines, protocols or standards were identified (including 5 WHO-endorsed guidelines). However, most are failing to achieve high levels of use. Factors associated with guideline use included: clinician involvement in guideline development; multidisciplinary training; demonstrable results; and positive clinician perceptions regarding guideline quality and contextual appropriateness. Implementation activities should fulfil 3 major objectives: promote guideline awareness and access; stimulate motivation among clinical guideline users; and actively facilitate adherence to guidelines.

  14. Incidence and causes of maternal mortality in five Kampala hospitals, 1980-1986.

    PubMed

    Kampikaho, A; Irwig, L M

    1991-08-01

    This report presents results of a descriptive study to estimate the mortality rate, identify the type and the causes of maternal deaths. The study was conducted in 1987 in Kampala hospitals for a period covering seven years from 1st January 1980 to 31st December, 1986. The non abortion maternal mortality rate (NAMMR) was 2.65 per 1000 deliveries while the abortion related maternal mortality rate (ARMMR) was 3.58 per 1000 abortions. There was a statistically significant increase in NAMMR while the increase in ARMMR was almost significant over the seven year period. Of all maternal deaths, 80 per cent were non abortion while 20 per cent were abortion related. The commonest immediate causes of death, in order of importance, were sepsis, haemorrhage, ruptured uterus, anaesthesia and anaemia. The commonest patient management factors which contributed to death, in order of importance, were lack of blood for transfusion, lack of drugs and intravenous fluids, theatre problems and doctor related factors. We feel that a lot happens to the pregnant mother before she finally reaches a health unit for delivery and that there is a great need to improve on the community's gynaecological and obstetrical services as well as ambulance and emergency services. We also feel that maternal mortality in developing countries could be reduced if the health workers were imaginative in respect to each patient, tried not to operate as though they were working in a developed country, and created relevant solutions for the local problems.(ABSTRACT TRUNCATED AT 250 WORDS)

  15. Increased frequency of neonatal jaundice in a maternity hospital.

    PubMed

    Campbell, N; Harvey, D; Norman, A P

    1975-06-07

    The frequency of "significant" jaundice of the newborn at this hospital increased from 8-1% of all live births in 1971 to 12-1% in 1972 and 15-4% in 1973. This coincided with an increased use of oxytocic agents and epidural anaesthetics in labour, and a change in the artificial feed given to normal infants. A retrospective study of jaundiced infants born in 1972 failed to explain the increase in jaundice. Though the use of oxytocic agents was not the direct cause, since their use results in the delivery of more infants before 40 weeks of gestation it may be a contributory factor. The use of epidural anaesthetics was sastically related to the development of jaundice but the nature of the association was not clear. Mothers of infants who became jaundiced has a significantly higher frequency of poor past obstetric histories, but once again the association was not clear. The change in artificial feeds was excluded as a possible cause.

  16. Care in movement: Health psychology in the Sofia Feldman Maternity Hospital in Belo Horizonte, Brazil.

    PubMed

    Spink, Peter Kevin; Horta, Julia C A; Brigagão, Jacqueline M; Menegon, Vera M; Spink, Mary-Jane P

    2016-03-01

    Psychologists in hospital settings are part of a complex network of professional relationships in constant negotiation. In addition, psychologists have skills that enable them to work with social phenomena and to act strategically within them. This is especially important in inter-disciplinary team work where professional boundaries can generate barriers to change. This article shows how psychologists of a maternity hospital in a working-class district of a large Brazilian city adapted to an integral approach to health care in a way that helped other professionals to rethink practices.

  17. Postpartum maternal morbidity requiring hospital admission in Lusaka, Zambia – a descriptive study

    PubMed Central

    Vallely, Lisa; Ahmed, Yusuf; Murray, Susan F

    2005-01-01

    Background Information on the extent of postpartum maternal morbidity in developing countries is extremely limited. In many settings, data from hospital-based studies is hard to interpret because of the small proportion of women that have access to medical care. However, in those areas with good uptake of health care, the measurement of the type and incidence of complications severe enough to require hospitalisation may provide useful baseline information on the acute and severe morbidity that women experience in the early weeks following childbirth. An analysis of health services data from Lusaka, Zambia, is presented. Methods Six-month retrospective review of hospital registers and 4-week cross-sectional study with prospective identification of postpartum admissions. Results Both parts of the study identified puerperal sepsis and malaria as, respectively, the leading direct and indirect causes of postpartum morbidity requiring hospital admission. Puerperal sepsis accounted for 34.8% of 365 postpartum admissions in the 6-month period. Malaria and pneumonia together accounted for one-fifth of all postpartum admissions (14.5% & 6% respectively). At least 1.7% of the postpartum population in Lusaka will require hospital-level care for a maternal morbidity. Conclusions In developing country urban settings with high public health care usage, meticulous review of hospital registers can provide baseline information on the burden of moderate-to-severe postpartum morbidity. PMID:15686592

  18. [Analysis of abortions at a community maternity hospital in Bangui].

    PubMed

    Sepou, A; Ngbale, R; Yanza, M C; Domande-Modanga, Z; Nguembi, E

    2004-01-01

    Abortion, i.e., early termination of pregnancy, has few complications when it occurs spontaneously. However self-inflicted abortion (SIA) often leads to more or less serious complications. In view of the increasing number of abortion cases in our department, we undertook this yearlong transversal study to evaluate the incidence of SIA in the department, determine the demographic characteristics of the women that practiced SIA, and identify the complications of SIA. Only ongoing or incomplete abortions were studied. Amenorrhea not related to pregnancy or associated with ectopic pregnancy was excluded from study. Clinical and demographic data were noted on forms specially designed by the research team. Data analysis yielded the following findings. Abortion accounted for 719 of the 5292 hospitalizations (13.6%) in gynecology unit, including 43.4% of SIA. Mean patient age was 24.7 years (range, 13 to 39). Spontaneous abortion was more likely to be observed in married women than in students who usually presented SIA. Wanted pregnancy was more likely to be reported by married women than by single woman who posed the problem of unwanted pregnancy. Students had more SIA. The main reasons for practicing SIA were financial (61.5%). The most common methods used for SIA were drug combinations (39.1%) and mechanical tools (26.0%). All severe complications such as infection and death were observed in women who practiced SIA. The high incidence of SIA in the department was especially disturbing due to the young age of the women involved and the severity of the complications. More action is needed to spread information on contraceptive methods in schools and universities to avoid unintended pregnancies that drive young people to practice SIA.

  19. Reliability of Reported Maternal Smoking: Comparing the Birth Certificate to Maternal Worksheets and Prenatal and Hospital Medical Records, New York City and Vermont, 2009.

    PubMed

    Howland, Renata E; Mulready-Ward, Candace; Madsen, Ann M; Sackoff, Judith; Nyland-Funke, Michael; Bombard, Jennifer M; Tong, Van T

    2015-09-01

    Maternal smoking is captured on the 2003 US Standard Birth Certificate based on self-reported tobacco use before and during pregnancy collected on post-delivery maternal worksheets. Study objectives were to compare smoking reported on the birth certificate to maternal worksheets and prenatal and hospital medical records. The authors analyzed a sample of New York City (NYC) and Vermont women (n = 1,037) with a live birth from January to August 2009 whose responses to the Pregnancy Risk Assessment Monitoring System survey were linked with birth certificates and abstracted medical records and maternal worksheets. We calculated smoking prevalence and agreement (kappa) between sources overall and by maternal and hospital characteristics. Smoking before and during pregnancy was 13.7 and 10.4% using birth certificates, 15.2 and 10.7% using maternal worksheets, 18.1 and 14.1% using medical records, and 20.5 and 15.0% using either maternal worksheets or medical records. Birth certificates had "almost perfect" agreement with maternal worksheets for smoking before and during pregnancy (κ = 0.92 and 0.89) and "substantial" agreement with medical records (κ = 0.70 and 0.74), with variation by education, insurance, and parity. Smoking information on NYC and Vermont birth certificates closely agreed with maternal worksheets but was underestimated compared with medical records, with variation by select maternal characteristics. Opportunities exist to improve birth certificate smoking data, such as reducing the stigma of smoking, and improving the collection, transcription, and source of information.

  20. [Hospital readmission after postpartum discharge of term newborns in two maternity wards in Stockholm and Marseille].

    PubMed

    Boubred, F; Herlenius, E; Andres, V; des Robert, C; Marchini, G

    2016-03-01

    The consequences of early postpartum discharge (EPPD, within 2 days after birth) on newborn health remain debated. Early discharge has been associated with increased neonatal morbidity. However, neonatal re-hospitalization can be prevented by careful follow-up during the 1st week after birth. We compared the early neonatal hospitalization of term newborns over 2 years in two hospitals: Karolinska University Hospital in Stockholm (n=7300 births), which allowed early discharge from 6h after birth with specific neonatal follow-up, and Marseille University Hospital (AP-HM) (n=4385) where postpartum discharge was more conventional after 72 h. During the study period, the EPPD rate was 41% vs. 2% in Stockholm and Marseille, respectively (P<0.001). Hospital readmission was comparable (5.6‰ vs. 7‰, P=0.2). The leading cause associated with hospitalization was icterus in Stockholm (76% vs. 26%, P<0.001) and feeding difficulties in Marseille (17% vs. 48%, P<0.001). In conclusion, close neonatal follow-up during the 1st week of life associated with restricted maternal and neonatal eligibility criteria for EPPD are required to prevent early neonatal re-hospitalization.

  1. The prevalence of maternal medical conditions during pregnancy and a validation of their reporting in hospital discharge data.

    PubMed

    Hadfield, Ruth M; Lain, Samantha J; Cameron, Carolyn A; Bell, Jane C; Morris, Jonathan M; Roberts, Christine L

    2008-02-01

    Population health datasets are a valuable resource for studying maternal and obstetric health outcomes. However, their validity has not been thoroughly examined. We compared medical records from a random selection of New South Wales (NSW) women who gave birth in a NSW hospital in 2002 with coded hospital discharge records. We estimated the population prevalence of maternal medical conditions during pregnancy and found a tendency towards underreporting although specificities were high, indicating that false positives were uncommon.

  2. Relationship between maternal hypoglycaemia and small-for-gestational-age infants according to maternal weight status: a retrospective cohort study in two hospitals

    PubMed Central

    Shinohara, Satoshi; Uchida, Yuzo; Hirai, Mitsuo; Hirata, Shuji; Suzuki, Kohta

    2016-01-01

    Objective The relationship between pre-pregnancy body mass index (BMI) and low glucose challenge test (GCT) results by maternal weight status has not been examined. This study aimed to clarify the relationship between a low GCT result and small for gestational age (SGA) by maternal weight status. Design A retrospective cohort study in 2 hospitals. Setting This study evaluated the obstetric records of women who delivered in a general community hospital and a tertiary perinatal care centre. Participants The number of women who delivered in both hospitals between January 2012 and December 2013 and underwent GCT between 24 and 28 weeks of gestation was 2140. Participants with gestational diabetes mellitus or diabetes during pregnancy, and GCT results of ≥140 mg/dL were excluded. Finally, 1860 women were included in the study. Primary and secondary outcome measures The participants were divided into low-GCT (≤90 mg/dL) and non-low-GCT groups (91–139 mg/dL). The χ2 tests and multivariate logistic regression analyses were conducted to investigate the association between low GCT results and SGA by maternal weight status. Results The incidence of SGA was 11.4% (212/1860), and 17.7% (330/1860) of the women showed low GCT results. The patients were divided into 3 groups according to their BMI (underweight, normal weight and obese). When the patients were analysed separately by their weight status after controlling for maternal age, pre-pregnancy maternal weight, maternal weight gain during pregnancy, pregnancy-induced hypertension, thyroid disease and difference in hospital, low GCT results were significantly associated with SGA (OR 2.10; 95% CI 1.14 to 3.89; p=0.02) in the underweight group. Conclusions Low GCT result was associated with SGA at birth among underweight women. Examination of maternal glucose tolerance and fetal growth is necessary in future investigations. PMID:27913562

  3. Scheduled cesarean delivery: maternal and neonatal risks in primiparous women in a community hospital setting.

    PubMed

    Quiroz, Lieschen H; Chang, Howard; Blomquist, Joan L; Okoh, Yvonne K; Handa, Victoria L

    2009-04-01

    We compared the short-term maternal and neonatal outcomes of women who deliver by cesarean without labor compared with women who deliver by cesarean after labor or by vaginal birth. This was a retrospective cohort study of women delivering a first baby from 1998 to 2002. Hospital discharge diagnostic coding identified unlabored cesarean deliveries (UCDs), labored cesarean deliveries (LCDs), and vaginal births (VBs). Medical records were abstracted and mode of delivery confirmed. The three outcomes of interest were maternal bleeding complications, maternal febrile morbidity, and neonatal respiratory complications. Using logistic regression for each outcome, we investigated whether mode of delivery was associated with the outcome, independent of other factors. The study groups included 513 UCDs, 261 LCDs, and 251 VBs. Compared with the UCD group, the adjusted odds of bleeding complications was higher in the LCD comparison group (odds ratio [OR] 2.3; 95% confidence interval [CI] 1.21, 4.53) and the VB comparison group (OR 1.96; 95% CI 0.95, 4.02). The incidence of febrile morbidity was similar for both cesarean groups but lower in the VB group. Both comparison groups had lower odds of neonatal complications than the UCD group (OR for LCD comparison group 0.52; 95% CI 0.27, 0.95 and OR for VB comparison group 0.26; 95% CI 0.098, 0.59). Scheduled cesarean is associated with increased odds of neonatal respiratory complications but decreased odds of maternal bleeding complications.

  4. Maternal mortality and its relationship to emergency obstetric care (EmOC) in a tertiary care hospital in South India

    PubMed Central

    2015-01-01

    Objective: To determine the trends in maternal mortality ratio over 5 years at JIPMER Hospital and to find out the proportion of maternal deaths in relation to emergency admissions. Methods: A retrospective analysis of maternal deaths from 2008 to 2012 with respect to type of admission, referral and ICU care and cause of death according to WHO classification of maternal deaths. Results: Of the 104 maternal deaths 90% were emergency admissions and 59% of them were referrals. Thirty two percent of them died within 24 hours of admission. Forty four percent could be admitted to ICU and few patients could not get ICU bed. The trend in cause of death was increasing proportion of indirect causes from 2008 to 2012. Conclusion: The trend in MMR was increasing proportion of indirect deaths. Ninety percent of maternal deaths were emergency admissions with complications requiring ICU care. Hence comprehensive EmOC facilities should incorporate Obstetric ICU care. PMID:27512460

  5. Poor standards of care in small, private hospitals in Maharashtra, India: implications for public-private partnerships for maternity care.

    PubMed

    Bhate-Deosthali, Padma; Khatri, Ritu; Wagle, Suchitra

    2011-05-01

    The private health sector in India is generally unregulated. Maharashtra is among the few states which require registration of private hospitals. This paper reports on a study of standards of care in small, private hospitals (less than 30 beds) in Maharashtra state, India, with a focus on maternity care, based on interviews with the hospitals' owners or senior staff, and observation. In the absence of reliable information on the number of private hospitals in the state, a physical listing was carried out in 11 districts and an estimate drawn up; 10% of hospitals found in each location were included in the study sample. We found poor standards of care in many cases, and few or no qualified nurses or a duty medical officer in attendance. Of the 261 hospitals visited, 146 provided maternity services yet 137 did not have a qualified midwife, and though most claimed they provided emergency care, including caesarean section, only three had a blood bank and eight had an ambulance. Government plans to promote public-private partnerships with such hospitals, including for maternity services, create concern, given our findings. The need to enforce existing regulations and collect information on health outcomes and quality of care before the state involves these hospitals further in provision of maternity care is called for.

  6. Major clonal lineages in impetigo Staphylococcus aureus strains isolated in Czech and Slovak maternity hospitals.

    PubMed

    Růžičková, Vladislava; Pantůček, Roman; Petráš, Petr; Machová, Ivana; Kostýlková, Karla; Doškař, Jiří

    2012-11-01

    One hundred and twenty-seven exfoliative toxin-producing (ET-positive) strains of Staphylococcus aureus collected in 23 Czech and one Slovak maternity hospitals from 1998 to 2011 were genotypically characterized by multilocus sequence typing (MLST), pulsed-field gel electrophoresis (PFGE) profiling, spa gene polymorphism analysis, and ETA-converting prophage carriage, which resulted in the identification of 21 genotypes grouped into 4 clonal complexes (CC). Ninety-one isolates carried the eta gene alone whilst 12 isolates harboured only the etb gene. Two new, to date not defined, spa types (t6644 and t6645) and 2 novel sequence types (ST2194 and ST2195) were identified in the set of strains under study. The predominant CC121 occurred in 13 Czech hospitals. CC15, CC9, and ST88 (CC88) exclusively included eta gene-positive strains while the strains belonging to ST121 harboured the eta and/or etb genes. This study highlights not only significant genomic diversity among impetigo strains and the distribution of major genotypes disseminated in the Czech and Slovak maternity hospitals, but also reveals their impact in epidermolytic infections.

  7. Effect of time of birth on maternal morbidity during childbirth hospitalization in California

    PubMed Central

    Lyndon, Audrey; Lee, Henry C.; Gay, Caryl; Gilbert, William M.; Gould, Jeffrey B.; Lee, Kathryn A.

    2015-01-01

    Objectives This observational study aimed to determine the relationship between time of birth and maternal morbidity during childbirth hospitalization. Study Design Composite maternal morbidities were determined using ICD9-CM and vital records codes, using linked hospital discharge and vital records data for 1,475,593 singleton births in California from 2005-2007. Time of birth, day of week, sociodemographic, obstetric, and hospital volume risk factors were estimated using mixed effects logistic regression models. Results The odds for pelvic morbidity were lowest between 11PM and 7AM compared to other time periods and the reference value of 7AM-11 AM. The odds for pelvic morbidity peaked between 11AM and 7PM [Adjusted Odds Ratio (AOR) 1101-1500=1.07 (1.06, 1.09); 1501-1900=1.08 (1.06, 1.10)]. Odds for severe morbidity were higher between 11PM and 7AM [AOR 2301-0300=1.31 (1.21, 1.41); 0300-0700=1.30 (1.20-1.41)] compared to other time periods. The adjusted odds were not statistically significant for weekend birth on pelvic morbidity [AOR Saturday=1.00 (0.98, 1.02); Sunday=1.01 (0.99, 1.03)] or severe morbidity [AOR Saturday=1.09 (1.00, 1.18); Sunday=1.03 (0.94, 1.13)]. Cesarean birth, hypertensive disorders, birthweight, and sociodemographic factors that include age, race, ethnicity, and insurance status, were also significantly associated with severe morbidity. Conclusions Even after controlling for sociodemographic factors and known risks such as cesarean birth and pregnancy complications like hypertensive disorders, birth between 11PM and 7AM is a significant independent risk factor for severe maternal morbidity. PMID:26196454

  8. Fetal outcome in emergency versus elective cesarean sections at Souissi Maternity Hospital, Rabat, Morocco

    PubMed Central

    Benzouina, Soukayna; Boubkraoui, Mohamed El-mahdi; Mrabet, Mustapha; Chahid, Naima; Kharbach, Aicha; El-hassani, Amine; Barkat, Amina

    2016-01-01

    Introduction Perinatal mortality rates have come down in cesarean sections, but fetal morbidity is still high in comparison to vaginal delivery and the complications are more commonly seen in emergency than in elective cesarean sections. The objective of the study was to compare the fetal outcome and the indications in elective versus emergency cesarean section performed in a tertiary maternity hospital. Methods This comparative cross-sectional prospective study of all the cases undergoing elective and emergency cesarean section for any indication at Souissi maternity hospital of Rabat, Morocco, was carried from January 1, to February 28, 2014. Data were analyzed with emphasis on fetal outcome and cesarean sections indications. Mothers who had definite antenatal complications that would adversely affect fetal outcome were excluded from the study. Results There was 588 (17.83%) cesarean sections among 3297 births of which emergency cesarean section accounted for 446 (75.85%) and elective cesarean section for 142 cases (24.15%). Of the various factors analyzed in relation to the two types of cesarean sections, statistically significant associations were found between emergency cesarean section and younger mothers (P < 0.001), maternal illiteracy (P = 0.049), primiparity (P = 0.005), insufficient prenatal care (P < 0.001), referral from other institution for pregnancy complications or delivery (P < 0.001), cesarean section performed under general anesthesia (P < 0.001), lower birth weight (P < 0.016), neonatal morbidity and early mortality (P < 0.001), and admission in neonatal intensive care unit (P = 0.024). The commonest indication of emergency cesarean section was fetal distress (30.49%), while the most frequent indication in elective cesarean section was previous cesarean delivery (47.18%). Conclusion The overall fetal complications rate was higher in emergency cesarean section than in elective cesarean section. Early recognition and referral of mothers who are

  9. [Women hospitalized due to abortion in a maternity teaching hospital in Recife, Brazil].

    PubMed

    da Ramos, Karla Silva; Ferreira, Ana Laura Carneiro Gomes; de Souza, Ariani Impieri

    2010-09-01

    This cross-sectional study was performed with 160 women between 2005-2006. The objective was to describe the social-demographic and reproductive characteristics of women hospitalized due to abortions, and their knowledge about contraceptive methods and abortion induction. In order to determine the association between the abortion classification and social-demographic variables, Pearson's chi-square test was used, with a significance level of 5%. A frequency of 56.3% was found for probably induced abortions. Most cases of abortion occurred before 12 weeks (55.7%). As for the women's profiles: 48.9% were between 20-29 years old, 72.0% had eight years or more of schooling, 90.1% had a partner, 52.0% had 1-3 children, 100% knew about oral contraceptives and condoms and 80.0% had heard about misoprostol. The social-demographic and reproductive profile of women hospitalized at the referred service due to abortion did not change over the last years. Misoprostol remains the most known method for abortion induction.

  10. Severe maternal morbidity in the intensive care unit of a havana teaching hospital,1998 to 2004.

    PubMed

    Pérez, Albadio; Bacallao, Jorge; Alcina, Serafín; Gómez, Yamilka

    2008-07-01

    Introduction In recent years, several reports have appeared in the international literature concerning evolution and prognosis for obstetric patients whose illnesses have led to admission to intensive care units (ICUs). The term severe maternal morbidity has been proposed to refer to life-threatening complications that occur during pregnancy, delivery or postpartum. Objective Characterize severe maternal morbidity in obstetric patients admitted to the ICU of the Enrique Cabrera General Teaching Hospital in Havana from 1998 to 2004. Methods From 1998 to 2004, we conducted a prospective, descriptive, and observational study of 312 patients admitted to the ICU of the Enrique Cabrera General Teaching Hospital in Havana, Cuba. Patients were included whose length of stay was >24 hours, and whose family members provided written informed consent. A data collection form was developed to record general characteristics, personal and family medical history, cause of ICU admission, diagnosis, obstetric condition at the onset of illness and at admission, pregnancy outcome, surgeries performed and patient's ICU discharge status (survivor or non-survivor), the latter a dependent variable. An Excel database was compiled and processed using SPSS 13.0. Percentages were used to summarize qualitative variables. A Chi-square test was used for univariate analysis between these qualitative variables and patient discharge status; t-test was used for quantitative analyses. Results Overall mortality in the cohort was 7.4% (23 patients), greater among women aged <20 years, those with a history of previous illnesses, and those subjected to several surgical interventions. Obstetric hemorrhage, pre-eclampsia/eclampsia, and postpartum sepsis were the most commonly diagnosed obstetric disorders. Non-obstetric disorders diagnosed included severe asthma, pneumonia and peritonitis. Amniotic fluid embolism, postpartum sepsis, early postpartum hemorrhage and pre-eclampsia/eclampsia were associated with

  11. Complications of childbirth and maternal deaths in Kinshasa hospitals: testimonies from women and their families

    PubMed Central

    2011-01-01

    Background Maternal mortality in Kinshasa is high despite near universal availability of antenatal care and hospital delivery. Possible explanations are poor-quality care and by delays in the uptake of care. There is, however, little information on the circumstances surrounding maternal deaths. This study describes and compares the circumstances of survivors and non survivors of severe obstetric complications. Method Semi structured interviews with 208 women who survived their obstetric complication and with the families of 110 women who died were conducted at home by three experienced nurses under the supervision of EK. All the cases were identified from twelve referral hospitals in Kinshasa after admission for a serious acute obstetric complication. Transcriptions of interviews were analysed with N-Vivo 2.0 and some categories were exported to SPSS 14.0 for further quantitative analysis. Results Testimonies showed that despite attendance at antenatal care, some women were not aware of or minimized danger signs and did not seek appropriate care. Cost was a problem; 5 deceased and 4 surviving women tried to avoid an expensive caesarean section by delivering in a health centre, although they knew the risk. The majority of surviving mothers (for whom the length of stay was known) had the caesarean section on the day of admission while only about a third of those who died did so. Ten women died before the required caesarean section or blood transfusion could take place because they did not bring the money in time. Negligence and lack of staff competence contributed to the poor quality of care. Interviews revealed that patients and their families were aware of the problem, but often powerless to do anything about it. Conclusion Our findings suggest that women with serious obstetric complications have a greater chance of survival in Kinshasa if they have cash, go directly to a functioning referral hospital and have some leverage when dealing with health care staff PMID

  12. ‘Because of Poverty brought into Hospital: . . .’A Casenote-Based Analysis of the Changing Role of the Edinburgh Royal Maternity Hospital, 1850-1912

    PubMed Central

    Nuttall, Alison

    2008-01-01

    Summary Although the shift from a social to a medical function which occurred in nineteenth-century general hospitals has been explored, the occurrence of such a change in maternity hospitals has not been considered. Recent analyses of such institutions have examined particular aspects only, and thus give a somewhat static picture. This paper uses analysis of patient records (themselves an under-exploited resource) to explore the changing function of the Edinburgh Royal Maternity Hospital from a provider of shelter during childbirth to the destitute to a source of skilled medical care. It concludes that, although the Hospital had adopted the outward features of a medical institution by 1890, its casebooks suggest that its purpose only truly changed in the early twentieth century, and thus can perhaps be more appropriately linked with national anxiety regarding the health of babies and their mothers. PMID:18605328

  13. Nursing and midwife staffing needs in maternity wards in Burkina Faso referral hospitals

    PubMed Central

    2014-01-01

    Background In 2006, Burkina Faso set up a policy to subsidize the cost of obstetric and neonatal emergency care. This policy has undoubtedly increased attendance at all levels of the health pyramid. The aim of this study was to measure the capacity of referral hospitals’ maternity services to cope with the demand for health services after the implementation of this policy. Methods This study was conducted in three referral health centres (CMAs, CHRs, and CHUs). The CHU Yalgado Ouédraogo (tertiary level) and the CMA in Sector 30 (primary level) were selected as health facilities in the capital, along with the Kaya CHR (secondary level). At each health facility, the study included official maternity ward staff only. We combined the two occupational categories (nurses and midwives) because they perform the same activities in these health facilities. We used the WISN method recommended by WHO to assess the availability of nurses and midwives. Results Nurses and midwives represented 38% of staff at the University Hospital, 65% in the CHR and 80% in the CMA. The number of nurses and midwives needed for carrying out the activities in the maternity ward in the University Hospital and the CMA is greater than the current workforce, with WISN ratio of 0.68 and 0.79 respectively. In the CHR, the current workforce is greater than the number required (WISN ratio = 2). This medical centre is known for performing a high number curative and preventive activities compared to the Kaya CHR. Like the CHU, the delivery room is a very busy unit. This activity requires more time and more staff compared to other activities. Conclusion This study showed a shortage of nurses and midwives in two health facilities in Ouagadougou, which confirms that there is considerable demand. At the Kaya CHR, there is currently enough staff to handle the workload in the maternity ward, which may indicate a need to expand the analysis to other health facilities to determine whether a redistribution of

  14. [Normative prenatal evaluation at a philanthropic maternity hospital in São Paulo].

    PubMed

    Corrêa, Claudia Regina Hostim; Bonadio, Isabel Cristina; Tsunechiro, Maria Alice

    2011-12-01

    This cross-sectional study counted with the participation of 301 pregnant women seen in 2009 at a philanthropic maternity hospital in the city of São Paulo (a prenatal support program named Pré-Natal do Amparo Maternal - PN-AM). The objectives of this study were to evaluate the prenatal care according to the initial gestational age, the number of appointments that were held, the continuity of the assistance, and relate the appropriateness with the socio-demographic, obstetric and local variables of the initial prenatal care. The analysis criteria used was initiating prenatal care before 120 days of gestation and attending at least six appointments. The relationship between the variables was analyzed using the Chi-Square Test. Results showed that 41.5% of the pregnant women initiated prenatal care at another health care service and transferred spontaneously to the PN-AM; 74.1% initiated the prenatal care early and 80.4% attended at least six appointments; 63.1% met both criteria simultaneously. Appropriate prenatal care showed a statistically significant difference for mother's age, steady partner, employment, place of residence, having a companion during the appointment and place where prenatal care was initiated.

  15. Assessment of client satisfaction in labor and delivery services at a maternity referral hospital in Ethiopia

    PubMed Central

    Melese, Tadele; Gebrehiwot, Yirgu; Bisetegne, Daniel; Habte, Dereje

    2014-01-01

    Introduction Patients perception about service quality shapes their confidence with regard to use of the available health care facility. This study is aimed to assess the client`s satisfaction in a maternal health care setting. Methods This is an institution based cross sectional descriptive study. A total of 423 postpartum women were interviewed. Data was analyzed using SPSS version 20 statistical package. Results The proportion of mothers who are completely satisfied with health care ranges between 2.4 to 21%. Pain control was the poorest source of satisfaction with 82% reporting dissatisfaction. Provider's communication with clients yielded complete satisfaction rates ranging between 0.7 to 26%. Inadequate information about the drug prescribed and explanation of procedures to be done to the client were found to be major causes of dissatisfaction. The complete satisfaction rate with environmental factor of the hospital was between 3.3 to 40.2%. Age of the client, educational status, income of the client and client's address away from Addis Ababa were found to be the predictors of client satisfaction. Provider's attitude and communication, as well as longer duration of stay in the ward were independent predictors of client satisfaction. Conclusion Pain management, client privacy and client provider communication need to be addressed to ensure the satisfaction of maternity clients. The clients need to be involved in the management of their own health problems. PMID:25018826

  16. Accuracy of reporting maternal in-hospital diagnoses and intrapartum procedures in Washington State linked birth records.

    PubMed

    Lydon-Rochelle, Mona T; Holt, Victoria L; Nelson, Jennifer C; Cárdenas, Vicky; Gardella, Carolyn; Easterling, Thomas R; Callaghan, William M

    2005-11-01

    While the impact of maternal morbidities and intrapartum procedures is a common topic in perinatal outcomes research, the accuracy of the reporting of these variables in the large administrative databases (birth certificates, hospital discharges) often utilised for such research is largely unknown. We conducted this study to compare maternal diagnoses and procedures listed on birth certificates, hospital discharge data, and birth certificate and hospital discharge data combined, with those documented in a stratified random sample of hospital medical records of 4541 women delivering liveborn infants in Washington State in 2000. We found that birth certificate and hospital discharge data combined had substantially higher true positive fractions (TPF, proportion of women with a positive medical record assessment who were positive using the administrative databases) than did birth certificate data alone for labour induction (86% vs. 52%), cephalopelvic disproportion (83% vs. 35%), abruptio placentae (85% vs. 68%), and forceps-assisted delivery (89% vs. 55%). For procedures available only in hospital discharge data, TPFs were generally high: episiotomy (85%) and third and fourth degree vaginal lacerations (91%). Except for repeat caesarean section without labour (TPF, 81%), delivery procedures available only in birth certificate data had low TPFs, including augmentation (34%), repeat caesarean section with labour (61%), and vaginal birth after caesarean section (62%). Our data suggest that researchers conducting perinatal epidemiological studies should not rely solely on birth certificate data to detect maternal diagnoses and intrapartum procedures accurately.

  17. Regionalization and Local Hospital Closure in Norwegian Maternity Care—The Effect on Neonatal and Infant Mortality

    PubMed Central

    Grytten, Jostein; Monkerud, Lars; Skau, Irene; Sørensen, Rune

    2014-01-01

    Objective To study whether neonatal and infant mortality, after adjustments for differences in case mix, were independent of the type of hospital in which the delivery was carried out. Data The Medical Birth Registry of Norway provided detailed medical information for all births in Norway. Study Design Hospitals were classified into two groups: local hospitals/maternity clinics versus central/regional hospitals. Outcomes were neonatal and infant mortality. The data were analyzed using propensity score weighting to make adjustments for differences in case mix between the two groups of hospitals. This analysis was supplemented with analyses of 13 local hospitals that were closed. Using a difference-in-difference approach, the effects that these closures had on neonatal and infant mortality were estimated. Principal Finding Neonatal and infant mortality were not affected by the type of hospital where the delivery took place. Conclusion A regionalized maternity service does not lead to increased neonatal and infant mortality. This is mainly because high-risk deliveries were identified well in advance of the birth, and referred to a larger hospital with sufficient perinatal resources to deal with these deliveries. PMID:24476021

  18. High rates of burnout among maternal health staff at a referral hospital in Malawi: A cross-sectional study

    PubMed Central

    2011-01-01

    Background Burnout among maternal healthcare workers in sub-Saharan Africa may have a negative effect on services provided and efforts to mitigate high maternal mortality rates. In Malawi, research on burnout is limited and no empirical research has been conducted specifically among maternal health staff. Therefore, the aims of the study were to examine the prevalence and degree of burnout reported by healthcare workers who provide antenatal, intrapartum, and postnatal services in a district referral hospital in Malawi; and, to explore factors that may influence the level of burnout healthcare workers experience. Methods In the current cross-sectional study, levels of burnout among staff working in obstetrics and gynaecology at a referral hospital in Malawi were examined, in addition to individual and job characteristics that may be associated with burnout. Results In terms of the three dimensions of burnout, of the 101 participants, nearly three quarters (72%) reported emotional exhaustion, over one third (43%) reported depersonalization while almost three quarters (74%) experienced reduced personal accomplishment. Conclusions Based on these findings, burnout appears to be common among participating maternal health staff and they experienced more burnout than their colleagues working in other medical settings and countries. Further research is needed to identify factors specific to Malawi that contribute to burnout in order to inform the development of prevention and treatment within the maternal health setting. PMID:21605379

  19. Placenta previa and pre-eclampsia: analyses of 1645 cases at medani maternity hospital, Sudan.

    PubMed

    Adam, Ishag; Haggaz, Abdelrahium D; Mirghani, Omer A; Elhassan, Elhassan M

    2013-01-01

    A retrospective case-control study was conducted to investigate the risk factors for pre-eclampsia - including the protective effect of placenta previa - at Medani Maternity Hospital, Sudan. Medical files of the patients during the period 2003-2010 were reviewed for age, parity, education level, prenatal care, placenta previa, and hemoglobin level. Women with pre-eclampsia were the cases, and women with normal pregnancy were the controls. There were 54,339 singleton deliveries and 1765 women with pre-eclampsia in the hospital, giving the incidence of pre-eclampsia of 3.2%. The risk factors for pre-eclampsia were; women with age >35 years (OR = 1.4, 95% CI: 1.1-1.8), primiparity (OR = 3.3, 95% CI: 2.7-4.0), para >5 (OR = 3.1, 95% CI: 2.4-4.0), and anemia (OR = 3.3, 95% CI: 2.8-3.9). The risk of pre-eclampsia was inversely increased with education level and prenatal care attendance. The prevalence of placenta previa was 0 (0%) and 55 (3.3%), P < 0.001 in pre-eclamptic and control women, respectively. Placenta previa was a significant protective factor of pre-eclampsia (OR = 0.3, 95% CI: 0.1-0.7). Although, the socio-demographic risk factors for pre-eclampsia observed among women at Medani hospital were similar to those found in other settings; placenta previa was associated with decreased incidence of pre-eclampsia.

  20. A retrospective review of maternal and child health services at the Albert Schweitzer Hospital in rural Haiti.

    PubMed

    Wallace, C E; Marshall, F N; Robinson, C

    1982-01-01

    For the past 25 years the Albert Schweitzer Hospital in Deschapelles, Haiti has been providing a wide range of maternal and child health services to the people of its rural district. Numerous special services for mothers and children have been added over the years, but these began to realize considerably greater potential with the creation of the hospital's Community Health Department in 1967. This department has carried out numerous preventive health programs and services designed to accommodate these groups' special health needs. Attention is directed to neonatal tetanus control; surveillance, treatment, and prevention of malnutrition; and other maternal and child health services (school programs, immunization activities, prenatal and postnatal care, family planning, the midwives' program, the "cord-cut" unit, the low birth weight project, and dispensaries and health agents). In 1967 the hospital began to develop programs especially designed to control neonatal tetanus. Communities were immunized systematically. By establishing outdoor immunization clinics at the hospital and at major marketplaces in the district and by working with traditional midwives, these programs were responsible for a sharp decline in the incidence of neonatal tetanus. Malnutrition has remained the most frequently occurring health problem among children in the hospital district. Several services and programs have been established throughout the years to meet the identified needs. These include the following which are described: the nutrition clinic; courtyard education; "weigh-ins;" nutrition recovery centers; the 3-day center at Deschapelles; nutrition intervention and case follow-up program; and malnutrition treatment. The hospital's family planning program has gradually increased its use of community education to reach the population and to try to gain acceptance of the need to space and limit births. This community education has been disseminated by dispensaries, mobile health team

  1. The Kangaroo Program at a Brazilian maternity hospital: the preterm/low-weight babies' health-care under examination.

    PubMed

    Véras, Renata Meira; Traverso-Yépez, Martha

    2011-03-01

    The Kangaroo Program, originally developed in Colombia, was adopted as a public policy by the Brazilian Unified Health System (SUS) in 2000, in an effort to improve maternal and infant health in the country. This article aims to examine the Kangaroo Program as it is practiced and carried out at a maternity hospital in the northeastern Brazilian region. Through an institutional ethnographic approach, research demonstrates that the Kangaroo Program has been effective in saving lives and improving some of the infants' health outcomes. However, research also demonstrates that: (i) the socioeconomic profile of mothers in the Kangaroo Program, (ii) conflicting relationships between healthcare workers and users, and (iii) lack of socioeconomic and emotional support are impairing the adequate implementation of the program. Due to the low literacy level of most of these mothers, institutional power is used as a form of social control to keep mothers uninformed about the possibility of leaving the maternity wards. In a two-tier health system, this controlling behavior is part of existing social inequities, as the Kangaroo Program is a choice in the private health system but tends to be mandatory at SUS maternity hospitals across Brazil.

  2. Profile of maternal and foetal complications during labour and delivery among women giving birth in hospitals in Matlab and Chandpur, Bangladesh.

    PubMed

    Huda, Fauzia Akhter; Ahmed, Anisuddin; Dasgupta, Sushil Kanta; Jahan, Musharrat; Ferdous, Jannatul; Koblinsky, Marge; Ronsmans, Carine; Chowdhury, Mahbub Elahi

    2012-06-01

    Worldwide, for an estimated 358,000 women, pregnancy and childbirth end in death and mourning, and beyond these maternal deaths, 9-10% of pregnant women or about 14 million women per year suffer from acute maternal complications. This paper documents the types and severity of maternal and foetal complications among women who gave birth in hospitals in Matlab and Chandpur, Bangladesh, during 2007-2008. The Community Health Research Workers (CHRWs) of the icddr,b service area in Matlab prospectively collected data for the study from 4,817 women on their places of delivery and pregnancy outcomes. Of them, 3,010 (62.5%) gave birth in different hospitals in Matlab and/or Chandpur and beyond. Review of hospital-records was attempted for 2,102 women who gave birth only in the Matlab Hospital of icddr,b and in other public and private hospitals in the Matlab and Chandpur area. Among those, 1,927 (91.7%) records were found and reviewed by a physician. By reviewing the hospital-records, 7.3% of the women (n=1,927) who gave birth in the local hospitals were diagnosed with a severe maternal complication, and 16.1% with a less-severe maternal complication. Abortion cases--either spontaneous or induced--were excluded from the analysis. Over 12% of all births were delivered by caesarean section (CS). For a substantial proportion (12.5%) of CS, no clear medical indication was recorded in the hospital-register. Twelve maternal deaths occurred during the study period; most (83%) of them had been in contact with a hospital before death. Recommendations include standardization of the hospital record-keeping system, proper monitoring of indications of CS, and introduction of maternal death audit for further improvement of the quality of care in public and private hospitals in rural Bangladesh.

  3. Maternal and foetal outcome of 206 high risk pregnancy cases in border guard hospital, dhaka.

    PubMed

    Shapla, N R; Islam, M A; Shahida, S M; Parveen, Z; Lipe, Y S

    2015-04-01

    This observational study was carried out to identify the various types of high risk pregnancy and to determine the maternal and foetal outcome. The study was carried out on 206 pregnant high risk women in the Gynecology and Obstetrics department of Border Guard Hospital, Dhaka from January 2012 to December 2012. During mentioned period among 598 pregnant women 206 high risk pregnancy cases were randomly selected. Pregnant women (gestational age from 34 weeks upto 40 weeks) having medical condition and pregnancy related high risk factors were included and uncomplicated pregnancy, pregnancy before 37 weeks, post dated pregnancy were excluded from this study. Data was collected from semi structured history sheet and data analysis done by percentage. High risk pregnant women were grouped into three. Group A and Group B includes pregnant women having medical condition before and during pregnancy respectively. Group C consists of pregnant women had pregnancy related high risk issues. Among 206 high risk pregnancy cases majority 47.57% women had medical condition during pregnancy, 31.55% patient had medical condition before pregnancy. Among them majority 30.58% of the patient suffered from pregnancy induced hypertension, 15.04% patients suffered from gestational Diabetes Mellitus and premature rupture of membranes were 12.13%. In this study majority 43.68% of high risk pregnant patients were in age group of 30-35 years, 19.90% pregnant women were in age group of >35 years and 19.40% were in age group of upto 20 years. Among study groups maximum 65.04% of the patients were multiparous. Among 206 study population 60.19% high risk pregnant women were at term at the time of delivery and 39.8% women delivered their babies preterm. Caesarean section was done in 69.41% of high risk pregnant women. After delivery majority 77.66% women had no complication, only 10.19%, 8.25%, 2.91% and 0.97% high risk pregnant women suffered from fever, UTI, abdominal wound infection and post

  4. Prenatal lead exposure and relationship with maternal exposure determinants in a public maternity hospital of La Plata, Argentina.

    PubMed

    Martins, Enrique; Varea, Ana; Apezteguía, María; González, Horacio F; Girardelli, Ana; Caro, Laura Sanchez; Lobisuto, Mario; Delgado, Griselda; Disalvo, Liliana

    2014-03-01

    Prenatal lead exposure is a health hazard that may cause cognitive development impairments and other adverse effects in children. We conducted a cross sectional study analyzing cord blood lead levels (CBLL) of newborns and their relationship with maternal determinants of lead exposure. Mothers answered a questionnaire about socio-demographic, lifestyle habits and environmental characteristics. We used Mann-Whitney's test to compare CBLL geometrical means (GM) corresponding to the presence or absence of each lead exposure determinant, and Chi square test to study the relationship between CBLL and maternal lead exposure determinants. A total of 159 newborns participated in the study. CBLL GM was 2.1 μg/dL; and 25% of the participants had a measurable CBLL (LOQ=3.3 μg/dl). Although the participants had several determinants of lead exposure, we only found a significant relationship with inside household determinants, such as presence of lead piping (p=0.026), unplastered walls (p=0.046) and peeling paint (p=0.048). Our results show that CBLL GM was similar to that reported in several studies conducted around the world. However, 25% of the participants might have some degree of risk for lead poisoning.

  5. Nutritional anemia in pregnancy: a study at the maternity hospital, Kuala Lumpur.

    PubMed

    Tee E Siong; Kandiah, M; Ali, J; Kandiah, V; Zahari, M R; Kuladevan, R; Hamzah, Z

    1984-06-01

    The study presents recent data on the prevalence and pattern of nutritional anemia in the Maternity Hospital, Kuala Lumpur. A total of 309 pregnant women in their 3rd trimester, of Malay, Chinese and Indian origin from the lower socio-economic strata were randomly selected for the study. Hematological indices (including Hb, PCV, MCHC, and TRBC), serum iron, transferrin saturation and ferritin, serum folate as well as protein and albumin were determined. Based on Hb and PCV values, 30-40% of the women could be considered anemic; approximately 50% of them presented with unsatisfactory serum iron, transferrin saturation and ferritin values; 60.9% had low serum folate levels; and about 30% may be considered to be of poor protein nutriture. Anemia in the study population was seen to be related mostly to iron and to a lesser extent, folate deficiency. Hematological, iron, folate and protein status was observed to be the poorest amongst the Indian women, better in the Malay group and generally the best amongst the Chinese women. Birth records of 169 of these women revealed that all of them had live births. Nearly all the infants were delivered by normal vaginal delivery (NVD). The mean gestational age was 38.6 weeks. One of the infants had a birth weight of 2.0 kg; incidence of low birth weight, 2.5 kg, was 8.3%. Although there was a trend of deteriorating hematological, iron and protein status of women from the 0, 1-3 and 4 parity groups, these differences were not statistically significant.

  6. An IBCLC in the Maternity Ward of a Mother and Child Hospital: A Pre- and Post-Intervention Study

    PubMed Central

    Chiurco, Antonella; Montico, Marcella; Brovedani, Pierpaolo; Monasta, Lorenzo; Davanzo, Riccardo

    2015-01-01

    Published evidence on the impact of the integration of International Board Certified Lactation Consultants (IBCLCs) for breastfeeding promotion is growing, but still relatively limited. Our study aims at evaluating the effects of adding an IBCLC for breastfeeding support in a mother and child hospital environment. We conducted a prospective study in the maternity ward of our maternal and child health Institute, recruiting 402 mothers of healthy term newborns soon after birth. The 18-month intervention of the IBCLC (Phase II) was preceded (Phase I) by data collection on breastfeeding rates and factors related to breastfeeding, both at hospital discharge and two weeks later. Data collection was replicated just before the end of the intervention (Phase III). In Phase III, a significantly higher percentage of mothers: (a) received help to breastfeed, and also received correct information on breastfeeding and community support, (b) started breastfeeding within two hours from delivery, (c) reported a good experience with the hospital staff. Moreover, the frequency of sore and/or cracked nipples was significantly lower in Phase III. However, no difference was found in exclusive breastfeeding rates at hospital discharge or at two weeks after birth. PMID:26308018

  7. Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care

    PubMed Central

    Jacobs, Lee D; Judd, Thomas M; Bhutta, Zulfiqar A

    2016-01-01

    The neonatal, infant, child, and maternal mortality rates in Haiti are the highest in the Western Hemisphere, with rates similar to those found in Afghanistan and several African countries. We identify several factors that have perpetuated this health care crisis and summarize the literature highlighting the most cost-effective, evidence-based interventions proved to decrease these mortality rates in low- and middle-income countries. To create a major change in Haiti’s health care infrastructure, we are implementing two strategies that are unique for low-income countries: development of a countrywide network of geographic “community care grids” to facilitate implementation of frontline interventions, and the construction of a centrally located referral and teaching hospital to provide specialty care for communities throughout the country. This hospital strategy will leverage the proximity of Haiti to North America by mobilizing large numbers of North American medical volunteers to provide one-on-one mentoring for the Haitian medical staff. The first phase of this strategy will address the child and maternal health crisis. We have begun implementation of these evidence-based strategies that we believe will fast-track improvement in the child and maternal mortality rates throughout the country. We anticipate that, as we partner with private and public groups already working in Haiti, one day Haiti’s health care system will be among the leaders in that region. PMID:26934625

  8. Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care.

    PubMed

    Jacobs, Lee D; Judd, Thomas M; Bhutta, Zulfiqar A

    2016-01-01

    The neonatal, infant, child, and maternal mortality rates in Haiti are the highest in the Western Hemisphere, with rates similar to those found in Afghanistan and several African countries. We identify several factors that have perpetuated this health care crisis and summarize the literature highlighting the most cost-effective, evidence-based interventions proved to decrease these mortality rates in low- and middle-income countries.To create a major change in Haiti's health care infrastructure, we are implementing two strategies that are unique for low-income countries: development of a countrywide network of geographic "community care grids" to facilitate implementation of frontline interventions, and the construction of a centrally located referral and teaching hospital to provide specialty care for communities throughout the country. This hospital strategy will leverage the proximity of Haiti to North America by mobilizing large numbers of North American medical volunteers to provide one-on-one mentoring for the Haitian medical staff. The first phase of this strategy will address the child and maternal health crisis.We have begun implementation of these evidence-based strategies that we believe will fast-track improvement in the child and maternal mortality rates throughout the country. We anticipate that, as we partner with private and public groups already working in Haiti, one day Haiti's health care system will be among the leaders in that region.

  9. Understanding Afghan healthcare providers: a qualitative study of the culture of care in a Kabul maternity hospital

    PubMed Central

    Arnold, R; van Teijlingen, E; Ryan, K; Holloway, I

    2015-01-01

    Objective To analyse the culture of a Kabul maternity hospital to understand the perspectives of healthcare providers on their roles, experiences, values and motivations and the impact of these determinants on the care of perinatal women and their babies. Design Qualitative ethnographic study. Setting A maternity hospital, Afghanistan. Population Doctors, midwives and care assistants. Methods Six weeks of observation followed by 22 semi-structured interviews and four informal group discussions with staff, two focus group discussions with women and 41 background interviews with Afghan and non-Afghan medical and cultural experts. Main outcome measures The culture of care in an Afghan maternity hospital. Results A large workload, high proportion of complicated cases and poor staff organisation affected the quality of care. Cultural values, social and family pressures influenced the motivation and priorities of healthcare providers. Nepotism and cronyism created inequality in clinical training and support and undermined the authority of management to improve standards of care. Staff without powerful connections were vulnerable in a punitive inequitable environment—fearing humiliation, blame and the loss of employment. Conclusions Suboptimal care put the lives of women and babies at risk and was, in part, the result of conflicting priorities. The underlying motivation of staff appeared to be the socio-economic survival of their own families. The hospital culture closely mirrored the culture and core values of Afghan society. In setting priorities for women's health post-2015 Millennium Development Goals, understanding the context-specific pressures on staff is key to more effective programme interventions and sustainability. PMID:25394518

  10. The dilemma of a practice: experiences of abortion in a public maternity hospital in the city of Salvador, Bahia.

    PubMed

    McCallum, Cecilia; Menezes, Greice; Reis, Ana Paula Dos

    2016-01-01

    The article discusses abortion and miscarriage from the perspective of women admitted to a public maternity hospital in Salvador (BA), Brazil. Based on qualitative and quantitative research, it draws on participant observation of everyday hospital life. Taking an ethnographic approach, it addresses the hospital experiences of women who had miscarriages or induced abortions, also presenting the views of health professionals. It argues that the way the institution structures care for abortion and miscarriage involves symbolic processes that profoundly affect women's experiences. The discrimination against women who have had abortions/miscarriages is an integral part of the structure, organization and culture of these institutions, and does not derive solely from the individual actions of healthcare personnel.

  11. [The Hospital Information System of the Brazilian Unified National Health System: a performance evaluation for auditing maternal near miss].

    PubMed

    Nakamura-Pereira, Marcos; Mendes-Silva, Wallace; Dias, Marcos Augusto Bastos; Reichenheim, Michael E; Lobato, Gustavo

    2013-07-01

    This study aimed to investigate the performance of the Hospital Information System of the Brazilian Unified National Health System (SIH-SUS) in identifying cases of maternal near miss in a hospital in Rio de Janeiro, Brazil, in 2008. Cases were identified by reviewing medical records of pregnant and postpartum women admitted to the hospital. The search for potential near miss events in the SIH-SUS database relied on a list of procedures and codes from the International Classification of Diseases, 10th revision (ICD-10) that were consistent with this diagnosis. The patient chart review identified 27 cases, while 70 potential occurrences of near miss were detected in the SIH-SUS database. However, only 5 of 70 were "true cases" of near miss according to the chart review, which corresponds to a sensitivity of 18.5% (95%CI: 6.3-38.1), specificity of 94.3% (95%CI: 92.8-95.6), area under the ROC of 0.56 (95%CI: 0.48-0.63), and positive predictive value of 10.1% (IC95%: 4.7-20.3). These findings suggest that SIH-SUS does not appear appropriate for monitoring maternal near miss.

  12. Maternal Chlamydia trachomatis Infections and Preterm Births in a University Hospital in Vitoria, Brazil

    PubMed Central

    Schmidt, Renylena; Muniz, Renan Rosetti; Cola, Elizandra; Stauffert, Dulce; Silveira, Mariangela Freitas; Miranda, Angelica E.

    2015-01-01

    Background Preterm birth (PTB) is a major determinant of neonatal morbimortality with adverse consequences for health. The causes are multifactorial, with intrauterine infection probably explaining most of these outcomes. It is believed that infection with Chlamydia trachomatis (CT) is also involved in PTB and premature rupture of membranes. Objetives To evaluate the prevalence of and associated factors for CT among cases of PTB attended at a University Hospital in Vitoria, Brazil. Methods A cross-sectional study performed among parturient who had preterm birth from June 2012 to August 2013 in Vitoria, Brazil. Participants answered a questionnaire including demographic, behavioral, and clinical data. A sample of urine was collected and screened for CT using polymerase chain reaction. Chi-square tests were used for proportion differences and Student’s-t tests and variance analysis were used for testing differences between mean values. Odds ratio was used as a measure of association with a 95% confidence interval. Results The prevalence of PTB during the period of the study was 26% and the prevalence of CT among them was 13.9%. A total of 31.6% pregnant women were younger than 25 years old and women infected by CT were even younger than women not infected by CT (p = 0.022). Most of them (76.2%) were married or had a living partner, and CT infection was more frequent among the single ones (p = 0.018); 16.7% of women reported their first sexual intercourse under 14 years old. The causes of prematurity were maternal-fetal in 40.9%; rupture of the membranes in 29.7% and premature labor in 29.4%. In multivariate analysis, being married was a protective factor for infection [OR = 0.48 (95%CI:0.24–0.97)]. None of the other characteristics were associated with CT infection. Conclusions This study shows a high prevalence of CT infection among parturient who have preterm birth. This high prevalence highlight the need for defining screening strategies focused on young

  13. Can managers empower nurse-midwives to improve maternal health care? A comparison of two resource-poor hospitals in Tanzania.

    PubMed

    Tibandebage, Paula; Kida, Tausi; Mackintosh, Maureen; Ikingura, Joyce

    2016-10-01

    Maternal mortality is very high in Tanzania. Competent hospital care is key to improving maternal outcomes, but there is a crisis of availability and performance of health workers in maternal care. This article uses interviews with managers, nurse-midwives, and women who had given birth in two hospitals providing virtually all the emergency maternal care in one Tanzania city. It contrasts women's experience in the two hospitals, and analyses interconnections with nurse-midwives' and managers' experiences of working conditions. The conceptual literature on nurse empowerment identifies some key explanatory variables for these contrasts. Staff experienced less frustration and constraint in one of the hospitals; had more access to structurally empowering resources; and experienced greater congruence between job commitment and working culture, resulting in better work engagement. Conversely, nurse-midwives in the other hospital were constrained by supply shortages and recurrent lack of support. Contrasting management styles and their impacts demonstrate that even in severely resource-constrained environments, there is room for management to empower staff to improve maternal care. Empowering management practices include participatory management, supportive supervision, better incentives, and clear leadership concerning ward culture. Structural constraints beyond the capacity of health facility managers must however also be addressed. © 2015 The Authors. International Journal of Health Planning and Management published by John Wiley & Sons, Ltd.

  14. Frequency and risk factors for the birth of small-for-gestational-age newborns in a public maternity hospital

    PubMed Central

    Teixeira, Marina Parca Cavelagna; Queiroga, Tatiana Peloso Reis; Mesquita, Maria dos Anjos

    2016-01-01

    ABSTRACT Objective: To determine the frequency and risk factors of small-for-gestational-age newborns in a high-risk maternity. Methods: This is an observational, cross-sectional, and case-control study, conducted in a public tertiary care maternity hospital. Data from 998 newborns and their mothers were collected through interviews and review of medical records and prenatal care cards. Some placentas underwent histopathological analysis. The variables of small-for-gestational-age and non-small-for-gestational-age newborns and of their mothers were statistically compared by means of Student's t test, Fisher's exact test, and odds ratio. The significance level used was 0.050. Results: There was a 17.9% frequency of small-for-gestational-age newborns. The statistically significant factors associated with the birth of these babies were female sex (p=0.012); positive history of another small-for-gestational-age child (p=0.006); inadequate prenatal care (p=0.019); smoking (p=0.003); hypertensive disorders of pregnancy (p=0.007); placental bleeding (p=0.009) and infarction (p=0.001). Conclusion: In the population studied, the frequency of small-for-gestational-age newborns was high and associated with sex, inappropriate prenatal care, presence of maternal diseases and addictions, and placental abnormalities. PMID:27759818

  15. [Voluntary abortion and domestic violence among women attended at a public maternity hospital of Salvador-BA].

    PubMed

    Diniz, Normélia Maria Freire; Gesteira, Solange Maria Dos Anjos; Lopes, Regina Lúcia Mendonça; Santos Mota, Rosana; Pérez, Bárbara Angélica Gómez; Gomes, Nadirlene Pereira

    2011-01-01

    Quantitative study in order to study domestic violence in women with induced abortion. Interviews were conducted with 147 women hospitalized for induced abortion in a public maternity hospital in Salvador, Bahia. The subjects are characterized by mostly women, black, poorly educated, economically dependent on spouses, experienced psychological abuse, physical and sexual abuse committed by their spouses. Almost half of the women were victims of domestic violence during the current pregnancy, and that was the reason for inducing abortion for 67% of them. The study reveals an association between experience of domestic violence and induced abortion. As mental health consequences, they developed symptoms of post trauma stress disorder. It is necessary that the health professionals consider the cues to identify domestic violence as a health problem associated with induced abortion, which requires a transformation on the training model, including domestic violence as a health issue.

  16. An analysis of variations of indications and maternal-fetal prognosis for caesarean section in a tertiary hospital of Beijing

    PubMed Central

    Liu, Yajun; Wang, Xin; Zou, Liying; Ruan, Yan; Zhang, Weiyuan

    2017-01-01

    Abstract In recent decades, we have observed a remarkable increase in the rate of caesarean section (CS) in both developed and developing countries, especially in China. According to the World Health Organization (WHO) systematic review, if the increase in CS rate was between 10% and 15%, the maternal and neonatal mortality was decreased. However, above this level, increasing the rate of CS is no longer associated with reduced mortality. To date, no consensus has been reached on the main factors driving the cesarean epidemic. To reduce the progressively increasing rate of CS, we should find indications for the increasing CS rate. The aim of our study was to estimate the change of CS rate of Beijing Obstetrics and Gynecology Hospital and to find the variation of the indications. From January 1995 to December 2014, the CS rate of Beijing Obstetrics and Gynecology Hospital was analyzed. For our analysis, we selected 14,642 and 16,335 deliveries respectively that occurred during the year 2011 and 2014, to analyze the difference of indications, excluding incomplete data and miscarriages or termination of pregnancy before 28 weeks of gestation because of fatal malformations, intrauterine death, or other reasons. The average CS rate during the past 20 years was 51.15%. The highest caesarean delivery rate was 60.69% in 2002; however, the caesarean delivery rate declined to 34.53% in 2014. The obviously different indications were caesarean delivery on maternal request and previous CS delivery. The rate of CS due to maternal request in 2014 was decreased by 8.16% compared with the year 2011. However, the percentage of pregnancy women with a previous CS delivery increased from 9.61% to 20.42% in 3 years. Along with the decline of CS rate, the perinatal mortality and the rate of neonatal asphyxia decreased in 2014 compared with that in 2011. After a series of measures, the CS rate declined indeed. Compared with 2011, the perinatal mortality and the rate of neonatal asphyxia

  17. Maternal and foetal risk factor and complication with immediate outcome during hospital stay of very low birth weight babies.

    PubMed

    Mannan, M A; Jahan, N; Dey, S K; Uddin, M F; Ahmed, S

    2012-10-01

    This prospective study was done to find out the maternal and foetal risk factors and complications during hospital stay. It was conducted in Special Care Neonatal Unit (SCANU), Department of Child Health, Bangabandhu Memorial Hospital (BBMH), University of Science and Technology Chittagong (USTC) from1st October 2001 to 30th March 2002 and cases were 35 very low birth weight (VLBW) newborns. Common complications of VLBW babies of this series were frequent apnea (40%), Septicemia (25.71%), Hypothermia (17.14%), NEC (14.28%), Convulsion (11.43%), Hyper-bilirubinaemia (8.57%), Anemia (5.71%), IVH (5.71%), RDS (2.86%), HDN (2.86%), CCF (2.86%), ARF (2.86%), either alone or in combination with other clinical conditions. Newborns 62.86% male, 37.14% female & their mortality rate were 40.91% & 38.46% respectively; Preterm 88.57% & their mortality (41.93%) were higher than term babies (25.00%); AGA 62.86%, SGA 37.14% & mortality rate of AGA babies (45.46%) were higher than of SGA (30.77%) babies. The mortality rate of VLBW infants of teen age (≤ 18 years) mothers (57.14%) & high (≥ 30 years) aged mothers (50.00%) were higher than average (19-26 yrs) maternal age mothers (33.33%). Mortality rate was higher among the babies of primi (41.67%) than multiparous (36.36%), poor socioeconomic group (53.33%) than middle class (30.00%) & mothers on irregular ANC (47.83%) than regular ANC (25.00%). It has been also noted the mortality rate of home delivered babies (50.00%) higher than institutional delivered (34.78%) babies; higher in LUCS babies (46.15%) than normal vaginal delivered babies (31.58%); higher in the babies who had antenatal maternal problem (48.15%) than no maternal problems babies (12.50%); higher in the babies who had fetal distress (50.00%) and twin (46.67%) than no foetal risk factors (28.57%) during intrauterine life; higher in the babies who had problems at admission (46.67%) than no problems (35.00%); and mortality higher in twin (46.67%) than singleton

  18. Characteristics of RSV-Specific Maternal Antibodies in Plasma of Hospitalized, Acute RSV Patients under Three Months of Age

    PubMed Central

    Widjaja, Ivy; Ahout, Inge M. L.; de Groot, Ronald; Guichelaar, Teun; Luytjes, Willem; de Jonge, Marien I.; de Haan, Cornelis A. M.; Ferwerda, Gerben

    2017-01-01

    Respiratory syncytial virus (RSV) is the leading cause for respiratory illness that requires hospitalization in infancy. High levels of maternal antibodies can protect against RSV infection. However, RSV-infected infants can suffer from severe disease symptoms even in the presence of high levels of RSV-specific antibodies. This study analyzes several serological characteristics to explore potential deficiencies or surpluses of antibodies that could relate to severe disease symptoms. We compare serum antibodies from hospitalized patients who suffered severe symptoms as well as uninfected infants. Disease severity markers were oxygen therapy, tachypnea, oxygen saturation, admission to the intensive care unit and duration of hospitalization. Antibodies against RSV G protein and a prefusion F epitope correlated with in vitro neutralization. Avidity of RSV-specific IgG antibodies was lower in RSV-infected infants compared to uninfected controls. Severe disease symptoms were unrelated to RSV-specific IgG antibody titers, avidity of RSV-IgG, virus neutralization capacity or titers against pre- and postfusion F or G protein ectodomains and the prefusion F antigenic site Ø. In conclusion, the detailed serological characterization did not indicate dysfunctional or epitope-skewed composition of serum antibodies in hospitalized RSV-infected infants suffering from severe disease symptoms. It remains unclear, whether specific antibody fractions could diminish disease symptoms. PMID:28135305

  19. Afraid of Delivering at the Hospital or Afraid of Delivering at Home: A Qualitative Study of Thai Hmong Families' Decision-Making About Maternity Services.

    PubMed

    Culhane-Pera, Kathleen A; Sriphetcharawut, Sarinya; Thawsirichuchai, Rasamee; Yangyuenkun, Wirachon; Kunstadter, Peter

    2015-11-01

    Thailand has high rates of maternity services; both antenatal care (ANC) and hospital delivery are widely used by its citizens. A recent Northern Thailand survey showed that Hmong women used maternity services at lower rates. Our objectives were to identify Hmong families' socio-cultural reasons for using and not using maternity services, and suggest ways to improve Hmong women's use of maternity services. In one Hmong village, we classified all 98 pregnancies in the previous 5 years into four categories: no ANC/home birth, ANC/home, no ANC/hospital, ANC/hospital. We conducted life-history case studies of 4 women from each category plus their 12 husbands, and 17 elders. We used grounded theory to guide qualitative analysis. Families not using maternity services considered pregnancy a normal process that only needed traditional home support. In addition, they disliked institutional processes that interfered with cultural birth practices, distrusted discriminatory personnel, and detested invasive, involuntary hospital procedures. Families using services perceived physical needs or potential delivery risks that could benefit from obstetrical assistance not available at home. While they disliked aspects of hospital births, they tolerated these conditions for access to obstetrical care they might need. Families also considered cost, travel distance, and time as structural issues. The families ultimately balanced their fear of delivering at home with their fear of delivering at the hospital. Providing health education about pregnancy risks, and changing healthcare practices to accommodate Hmong people's desires for culturally-appropriate family-centered care, which are consistent with evidence-based obstetrics, might improve Hmong women's use of maternity services.

  20. Patient assessments of hospital maternity care: a useful tool for consumers?

    PubMed Central

    Finkelstein, B S; Harper, D L; Rosenthal, G E

    1999-01-01

    OBJECTIVE: To examine three issues related to using patient assessments of care as a means to select hospitals and foster consumer choice-specifically, whether patient assessments (1) vary across hospitals, (2) are reproducible over time, and (3) are biased by case-mix differences. DATA SOURCES/STUDY SETTING: Surveys that were mailed to 27,674 randomly selected patients admitted to 18 hospitals in a large metropolitan region (Northeast Ohio) for labor and delivery in 1992-1994. We received completed surveys from 16,051 patients (58 percent response rate). STUDY DESIGN: Design was a repeated cross-sectional study. DATA COLLECTION: Surveys were mailed approximately 8 to 12 weeks after discharge. We used three previously validated scales evaluating patients' global assessments of care (three items)as well as assessments of physician (six items) and nursing (five items) care. Each scale had a possible range of 0 (poor care) to 100 (excellent care). PRINCIPAL FINDINGS: Patient assessments varied (p<.001) across hospitals for each scale. Mean hospital scores were higher or lower (p<.01) than the sample mean for seven or more hospitals during each year of data collection. However, within individual hospitals, mean scores were reproducible over the three years. In addition, relative hospital rankings were stable; Spearman correlation coefficients ranged from 0.85 to 0.96 when rankings during individual years were compared. Patient characteristics (age, race, education, insurance status, health status, type of delivery) explained only 2-3 percent of the variance in patient assessments, and adjusting scores for these factors had little effect on hospitals' scores. CONCLUSIONS: The findings indicate that patient assessments of care may be a sensitive measure for discriminating among hospitals. In addition, hospital scores are reproducible and not substantially affected by case-mix differences. If our findings regarding patient assessments are generalizable to other patient

  1. [Presence of the rotavirus antigen in newborn infants at maternity hospitals in Moldavia].

    PubMed

    Avram, G; Constantiniu, S; Combiescu, A A; Perşu, A; Mihai, A; Alexandru, D; Macovei, V; Zavate, O

    1988-01-01

    Studies conducted on 417 feces samples collected from newborn infants from seven maternity homes revealed the presence of rotavirus in 1.2 to 9.5% of the subjects. The infants get infection during the first 24 to 48 hours of life (1.8%) and the positivity rate reaches a peak the 7th day (9.7%). Enteroviruses were found in 3.4% and enterobacteria in 11.8% of the samples.

  2. Evaluation of Maternal Complications in Severe Preeclampsia in a University Hospital in Tirana

    PubMed Central

    Ndoni, Eriseida; Hoxhallari, Redi; Bimbashi, Astrit

    2016-01-01

    BACKGROUND: Preeclampsia is a hypertensive multisystem disorder of pregnancy that complicates up to 10% of pregnancies worldwide and is one of the leading causes of maternal and perinatal morbidity and mortality. AIM: To evaluate maternal complications associated with severe preeclampsia. METHODS: This is a retrospective cross-sectional study conducted in the UHOG “Koço Gliozheni”, in Tirana. Primary outcomes evaluated: maternal death, eclampsia, stroke, HELLP syndrome, and pulmonary edema. Secondary outcomes: renal failure, admission in ICU, caesarean section, placental abruption, and postpartum hemorrhage. Fisher’s exact test and Chi-squared test were used as statistical methods. RESULTS: In women with severe preeclampsia we found higher rates of complications comparing to the group with preeclampsia. Eclampsia (1.5% vs. 7.1%, P < 0.001), HELLP syndrome (2.4% vs. 11.0%; P < 0.001), stroke (0.5% vs 1.9%, P = 0.105) pulmonary edema (0.25% vs. 1.3%, P = 0.0035), renal failure (0.9% vs. 2.6%, P = 0.107), admission in ICU (19.5% vs. 71.4%, P = 0.007), caesarean section rates (55.5% vs. 77%, P = 0.508), placental abruption (4.3% vs. 7.8%, P = 0.103) and severe postpartum hemorrhage (3.2% vs. 3.9%, P = 0.628). CONCLUSION: Severe preeclampsia is associated with high rates of maternal severe morbidity and early diagnosis and timely intervention can prevent life treating complications. PMID:27275340

  3. Social psychological predictors of satisfaction with intrapartum and postpartum care – what matters to women in Czech maternity hospitals?

    PubMed Central

    Seidlerová, Jitka Mlíková; Šulová, Lenka; Hoskovcová, Simona Horáková

    2015-01-01

    Objective To identify the social psychological factors affecting women’s evaluation of care provided in Czech maternity hospitals using following criteria: satisfaction with intrapartum and postpartum care, willingness to return to a given hospital and to recommend the hospital to others. Methods 762 women completed a 71-item original Czech questionnaire KLI-P designed to measure the psychosocial climate in both delivery and after-birth unit on six scales. The sample was representative of the Czech parturients population. Multivariate logistic regression was used to investigate the predictive value of the questionnaire scales for maternal satisfaction, willingness to return to and to recommend a given hospital. Results For delivery unit, the satisfaction predictors were: helpfulness and empathy of midwives (Χ2=48.9), communication of information and availability of caregivers (Χ2=16.6), helpfulness and empathy of physicians (Χ2=10.9), symmetrical and respectful attitude of staff members (Χ2=9.7) and physical comfort and services (Χ2=7.6). The predictors of satisfaction with after-birth unit included helpfulness and empathy of the staff (Χ2≥42.1), communication of information and availability of caregivers (Χ2=52.5), physical comfort and services (Χ2=30.6), control and involvement in decision-making (Χ2=6.6) and parity (Χ2=8.6). The factors influencing women’s willingness to return to and to recommend a hospital differed from the predictors of general satisfaction. Conclusions The satisfaction factors revealed in this research correspond predominantly to the results of studies conducted in other countries (warm, non-formal and supportive approach, sufficient and well-timed provision of information and explanation, availability of caregivers, physical environment). However, participation in decision making, which has been repeatedly shown to be among the strongest predictors of childbirth satisfaction, was not important for the Czech parturients

  4. Bacteriological profile and associated risk factors of neonatal sepsis in Paropakar Maternity and Women's Hospital Thapathali, Kathmandu.

    PubMed

    Adhikari, N; Shah, P K; Acharya, G; Vaidya, K M

    2014-12-01

    Neonatal Sepsis is one of the most common reasons for admission to neonatal units in developing countries. It is also a major cause of mortality in both developed and developing countries. Identification of the common bacteria and risk factors causing such infections and their susceptibility patterns will provide necessary information for timely intervention. This study was carried out to determine the bacteriological profile and associated risk factors of neonatal sepsis in Paropakar Maternity and Women's hospital. A cross-sectional prospective study was conducted among neonates suspected of neonatal sepsis. Blood culture was performed and organisms were identified and antibiotic susceptibility was carried out with standard microbiological methods. Data were analysed by using SPSS. Ver. 16 software. The positive yield of blood culture was 21%. The most common isolates were Staphylococcus epidermidis, E. coli, Staphylococcus aureus, Klebsiella pneumoniae and Pseudomonas spp. In Antibiotic susceptibility pattern Gentamycin showed the highest sensitivity to all types of isolated organisms. Vancomycin sensitivity was highest for Gram positive organism and Ciprofloxacin was most effective for Gram negative organisms isolated. Ampicillin and Amoxycillin were the least effective drug. Multiple drug resistance was observed in 77.15% of isolates. Prematurity, low birth weight and maternal pyrexia before delivery were found to be strongly associated with neonatal sepsis. Gram positive organisms were more prevalent than gram negative organisms.

  5. Serum Retinol Concentrations in Mothers and Newborns at Delivery in a Public Maternity Hospital in Recife, Northeast Brazil

    PubMed Central

    Andreto, Luciana Marques; Vieira, Carmina Silva dos Santos; de Arruda, Ilma Kruze Grande; Diniz, Alcides da Silva

    2014-01-01

    Serum retinol concentrations were compared in a consecutive series of 65 mother-newborn pairs at delivery in a public maternity hospital in Recife, Brazil, from January to August 2008 and examined their association with biological, socioeconomic, environmental and obstetrical characteristics. Serum retinol concentrations of the newborns (umbilical cord) and mothers (brachial venipuncture) were analyzed by high-performance liquid chromatography. Prevalence of low (<0.70 µmol/L) and inadequate (<1.05 µmol/L) serum retinol concentrations were observed in 23.1% (95% CI 13.9-35.5) and 23.0% (95% CI 13.5-35.8) among newborns and mothers respectively. The serum retinol distribution was lower in male than female infants (-0.4 µmol/L, p=0.01) and, across both sexes, concentrations in paired newborn and mother were correlated (r=0.27, p=0.04). Further, maternal status explains only 7% of the variance in retinol concentrations in newborn's cord plasma. Among mothers delivering in public facilities in Recife, hypovitaminosis may exist. PMID:24847590

  6. Feto-Maternal Outcome of Jaundice in Pregnancy in a Tertiary Care Hospital.

    PubMed

    Parveen, T; Begum, F; Akhter, N

    2015-07-01

    Acute viral hepatitis is the most common cause of jaundice in pregnancy. Amongst hepatitis E bears a deadly combination with pregnancy, leading to loss of very young lives. There is almost no data available in this aspect documenting prevalence, profile and effect of jaundice on outcome of pregnancy in Bangladesh. This observational study was done to determine and analyze the frequency, cause and outcome of jaundice in pregnancy among the admitted patients in the feto-maternal medicine wing of Bangabandhu Sheikh Mujib Medical University, for a 2 years period from August 2009 to July 2011. Management was done in collaboration with the hepatologists, hematologists and intensive care unit specialist. Outcome was noted in terms of the mode of delivery, maternal complications, need of blood transfusion and fresh frozen plasma and maternal end result. Fetal outcome was assessed by birth weight, Apgar score, neonatal admission, and perinatal mortality. Prevalence of jaundice was found 2.5% among all high risk and 1.3% among all obstetric admissions. Hepatitis E was the commonest cause and responsible for 80.4% cases of jaundice and next was cholestatic jaundice. Almost half of the patients (43.4%) faced complications like post partum haemorrhage (15.3%), hepatic encephalopathy (10.8%), ante partum hemorrhage (6.5%). Preterm delivery was noted in 71.1% cases. Out of 46 patients with jaundice four (4) mothers died due to hepatic encephalopathy in hepatitis E group. Regarding perinatal outcome 55.8% were of low birth weight, 35.3% had low Apgar score and perinatal mortality was 6.4%.

  7. Loneliness and pregnancy in an urban Latino community: associations with maternal age and unscheduled hospital utilization.

    PubMed

    Geller, Jeffrey S

    2004-01-01

    The objective is to compare loneliness in a pregnant population to a non-pregnant control group, and to evaluate loneliness and unscheduled hospital visits during pregnancy. A prospective cohort study in a Latino urban community including 53 consecutive pregnant women in their first trimester, and 61 non-pregnant women as a control. The UCLA Loneliness Scale version 3, and demographic information was collected. A chart review after delivery determined total number of unscheduled pregnancy related hospital visits. Appropriate data analysis using t-test and regression analysis was used. Forty-eight women continued to delivery. There was no difference in mean loneliness scores between pregnant (41) and non-pregnant groups (43), or that of normal populations (41). There was a significant association between UCLA loneliness scores and total pregnancy related unscheduled hospital visits p = 0.042, beta = 0.06, r= 0.29. There was a significant association between increasing age and increasing loneliness during pregnancy p = 0.007, beta = 0.21, r= 0.36, not seen in the non-pregnant group p = 0.98. Loneliness, when controlling for age, yielded a stronger association with unscheduled hospital visits p = 0.018, beta = 0.076, and r = 0.40. The findings were that increased loneliness is associated with increased unscheduled pregnancy related hospital utilization during pregnancy. Older pregnant women had higher loneliness scores. Loneliness was more significant than age in predicting higher unscheduled hospital visits. The combination of increased loneliness and younger age predicted the highest number of unscheduled hospital visits.

  8. Maternal asthma, diabetes, and high blood pressure are associated with low birth weight and increased hospital birth and delivery charges; Hawai'i hospital discharge data 2003-2008.

    PubMed

    Hayes, Donald K; Feigal, David W; Smith, Ruben A; Fuddy, Loretta J

    2014-02-01

    Asthma, diabetes, and high blood pressure are common maternal conditions that can impact birth outcomes. Data from hospital discharges in Hawai'i were analyzed for 107,034 singleton births from 2003-2008. Categories were determined using the International Statistical Classification of Diseases, ninth revision (ICD-9) from linked delivery records of mother and infant. Prevalence estimates of asthma (ICD-9: 493), diabetes (ICD-9: 250,648.0, 648.8), high blood pressure (ICD-9: 401-405,642) as coded on the delivery record, low birth weight (<2500 grams), high birth weight (>4500 grams), Cesarean delivery, and median hospital charges were calculated. Median regression analysis assessed total hospital charges adjusting for maternal age, maternal race, insurance, and Cesarean delivery. Maternal asthma was present in 4.3% (95% confidence interval=4.1-4.4%), maternal diabetes was present in 7.7% (95% CI=7.6-7.9%), and maternal high blood pressure was present in 9.2% (95% CI=9.0-9.3%) of births. In the adjusted median regression analysis, mothers with asthma had $999 (95% CI: $886 to $1,112) higher hospital charges compared to those without; mothers with diabetes had $743 (95% CI: $636 to $850) higher charges compared to those without; and mothers with high blood pressure had $2,314 (95% CI: $2,194 to $2,434) higher charges compared to those without. Asthma, diabetes, and high blood pressure are associated with higher hospital delivery charges and low birth weight. Diabetes and high blood pressure were also associated with Cesarean delivery. An increased awareness of the impact of these conditions on both adverse birth outcomes and the development of chronic disease is needed.

  9. Maternal and Umbilical Cord Blood Levels of Zinc and Copper in Active Labor Versus Elective Caesarean Delivery at Khartoum Hospital, Sudan.

    PubMed

    Elhadi, Alaeldin; Rayis, Duria A; Abdullahi, Hala; Elbashir, Leana M; Ali, Naji I; Adam, Ishag

    2016-01-01

    A case-control study was conducted in Khartoum Hospital Sudan to determine maternal and umbilical cord blood levels of zinc and copper in active labor versus elective cesarean delivery. Cases were women delivered vaginally and controls were women delivered by elective cesarean (before initiation of labor). Paired maternal and cord zinc and copper were measured using atomic absorption spectrophotometry. The two groups (52 paired maternal and cord in each arm) were well matched in their basic characteristics. In comparison with cesarean delivery, the median (interquartile range) of both maternal [87.0 (76.1-111.4) vs. 76.1 (65.2-88.3) μg/dL, P = 0.004] and cord zinc [97.8 (87.0-114.1) vs. 81.5(65.2-110.2) μg/dL P = 0.034] levels were significantly higher in the vaginal delivery. While there was no significant difference in the maternal copper [78.8 (48.1-106.1) vs. 92.4 (51.9-114.9) μg/dL, P = 0.759], the cord copper [43.5(29.9-76.1) vs. 32.2(21.7-49.6) μg/dL, P = 0.019] level was significantly higher in vaginal delivery. There was no significant correlation between zinc (both maternal and cord) and copper. While the cord zinc was significantly correlated with maternal zinc, there was no significant correlation between maternal and cord copper. The current study showed significantly higher levels of maternal and cord zinc and cord copper in women who delivered vaginally compared with caesarean delivery.

  10. [Introduction of the psychoprophylactic method and its influence on the prenatal care program for institutional parturition in Japan: the practice in the Central Hospital of Maternity of the Japanese Red Cross Society and Oomori Red Cross Hospital, 1953-1964].

    PubMed

    Fujihara, Satoko; Tsukisawa, Miyoko

    2014-03-01

    The psychoprophylactic method is one of the methods for providing 'painless childbirth without drugs' and was invented by applying I. Pavlov's theory of higher nervous activity. In 1951, it was adopted as a national policy in the Union of Soviet Socialist Republics. This method was then introduced in the People's Republic of China in 1952. In 1953, it was brought to Japan by Masatomo SUGAI, an obstetrician, and was introduced into the Central Hospital of Maternity of the Japanese Red Cross Society with the support of the director, Naotarou KUJI. The practice of this method by the research team, which consisted of the obstetricians and midwives of the Central Hospital of Maternity of the Japanese Red Cross Society and Oomori Red Cross Hospital, resulted in the initiation and characterization of the prenatal care program to encourage the autonomy of the pregnant women for normal parturition in the institutions of Japan.

  11. [Healthcare and maternal morbidity and mortality: a hospital-based case-control study in two regions of Colombia (Bogotá and Antioquia), 2009-2011].

    PubMed

    Yepes, Francisco J; Gómez, Joaquin G; Zuleta, John Jairo; Londoño, Juan Luis; Acosta-Reyes, Jorge Luis; Sánchez-Gómez, Luz Helena; Ramírez, Marta L

    2016-11-01

    The study aimed to identify whether payment forms and insurance schemes are associated with severe obstetric complications and maternal mortality. A hospital-based case-control study was conducted in two regions of Colombia, 2009-2011. Data were obtained from each woman's clinical history. Unconditional logistic regression was used. The sample included 1,011 patients: 337 cases and 674 controls. No quality component was statistically significant in either region. In Bogotá, the risk of obstetric complications was significantly higher in the contributive insurance scheme than in subsidized coverage or uninsured; Antioquia showed similar associations, but not statistically significant. Differences in maternal morbidity according to payment scheme were not statistically significant in either Antioquia or Bogotá. Factors associated with maternal morbidity and mortality differed according to the study population, suggesting the need for local studies to identify determinants and make appropriate decisions.

  12. [Maternal mortality rate in the Aurelio Valdivieso General Hospital: a ten years follow up].

    PubMed

    Noguera-Sánchez, Marcelo Fidias; Arenas-Gómez, Susana; Rabadán-Martínez, Cesar Esli; Antonio-Sánchez, Pedro

    2013-01-01

    Antecedentes: en México, la mortalidad materna ha disminuido en las últimas décadas. En Oaxaca esto no se ha manifestado porque se incrementó la tasa de mortalidad materna. Este estado se ubica entre las entidades con más muertes maternas. Objetivo: analizar 10 años de mortalidad materna en el Hospital General Dr. Aurelio Valdivieso de los Servicios de Salud de Oaxaca, para conocer el comportamiento epidemiológico y caracterización de los decesos. Material y métodos: estudio retrospectivo, transversal y descriptivo efectuado mediante la revisión de expedientes clínicos de mortalidad materna en la División de Gineco-Obstetricia. Se consideraron variables sociales, obstétricas y circunstanciales y las comprobaciones se efectuaron con estadística general y descriptiva. Resultados: entre el 1 de enero de 2000 y el 31 de diciembre de 2009 se registraron 109 muertes maternas, excluidas dos que no fueron obstétricas; es decir, que hubo 107 muertes maternas: 75 directas y 32 indirectas. La tasa de mortalidad materna fue de 172.14 × 100,000 nacidos vivos. De las muertes maternas revisadas 89 pudieron evitarse (83%) y 18 no (17%), esto con base en el dictamen del Comité ad hoc del Hospital General Dr. Aurelio Valdivieso. La enfermedad hipertensiva aguda del embarazo fue la de mayor mortalidad; la escolaridad y el puerperio ueron el mayor riesgo. Conclusiones: las variables atribuibles a bajo índice de desarrollo humano, como: baja escolaridad y paridad elevada incrementaron el riesgo de mortalidad materna, que fue intrahospitalaria y durante el puerperio. La tasa de mortalidad materna fue la mayor encontrada en publicaciones nacionales con respecto a este referente.

  13. Racial/ethnic disparities in maternal morbidities: a statewide study of labor and delivery hospitalizations in Wisconsin.

    PubMed

    Cabacungan, Erwin T; Ngui, Emmanuel M; McGinley, Emily L

    2012-10-01

    We examined racial/ethnic disparities in maternal morbidities (MM) and the number of MM during labor and delivery among hospital discharges in Wisconsin. We conducted a retrospective cohort study of hospital discharge data for 206,428 pregnant women aged 13-53 years using 2005-2007 Healthcare Cost and Utilization Project State Inpatient Dataset (HCUP-SID) for Wisconsin. After adjustments for covariates, MM (preterm labor, antepartum and postpartum hemorrhage, hypertension in pregnancy, gestational diabetes, membrane-related disorders, infections and 3rd and 4th perineal lacerations) were examined using logistic regression models, and number of MM (0, 1, 2, >2 MM) were examined using multivariable ordered logistic regressions with partial proportional odds models. African-Americans had significantly higher likelihood of infections (OR = 1.74; 95% CI 1.60-1.89), preterm labor (OR = 1.42; 1.33-1.50), antepartum hemorrhage (OR = 1.63; 1.44-1.83), and hypertension complicating pregnancy (OR = 1.39; 1.31-1.48) compared to Whites. Hispanics, Asian/Pacific Islanders, and Native Americans had significantly higher likelihood of infections, postpartum hemorrhage, and gestational diabetes than Whites. Major perineal lacerations were significantly higher among Asian/Pacific Islanders (OR = 1.53; 1.34-1.75). All minority racial/ethnic groups, except Asians, had significantly higher likelihood of having 0 versus 1, 2 or >2 MM, 0 or 1 versus 2 or >2 MM, and 0, 1 or 2 versus >2 MM than white women. Findings show significant racial/ethnic disparities in MM, and suggest the need for better screening, management, and timely referral of these conditions, particularly among racial/ethnic women. Disparities in MM may be contributing to the high infant mortality and adverse birth outcomes among different racial/ethnic groups in Wisconsin.

  14. Sociodemographic predictors of acceptance of voluntary HIV testing among pregnant women in a large maternity hospital, Omdurman, Sudan.

    PubMed

    Idris, A K M; Elsamani, E Z; Elnasri, A E A

    2015-06-09

    This study aimed to determine the sociodemographic predictors of willingness of pregnant women in Sudan to accept HIV testing. A random sample of 500 pregnant women attending antenatal care clinics in Omdurman maternity hospital in 2010 were interviewed. Significant predictors of women's tendency to accept HIV testing were: age < 30 years (OR 3.5, 95% CI: 2.2-5.8), primigravida (OR 1.5, 95% CI: 1.0-2.3), better education level (OR 3.4, 95% CI: 1.7-6.7), owning a radio (OR 2.1, 95% CI: 1.3-3.4), in employment (OR 2.5, 95% CI: 1.2-5.0) and ≥ 2 antenatal care visits (OR 1.9, 95% CI: 1.2-2.9). Husband's age ≥ 35 years (OR 3.2, 95% CI: 2.0-5.2) and Christian faith (OR 3.8, 95% CI: 1.4-10.7) were significant variables, although with a wide margin of confidence. These predictors should be considered in strategies to increase the acceptance and use of HIV testing and counselling services.

  15. Reasons for routine episiotomy: A mixed-methods study in a large maternity hospital in Phnom Penh, Cambodia.

    PubMed

    Schantz, Clémence; Sim, Kruy Leang; Ly, Ek Meng; Barennes, Hubert; Sudaroth, So; Goyet, Sophie

    2015-05-01

    First documented in 1741, the practice of episiotomy substantially increased worldwide during the 20th century. However, research shows that episiotomy is not effective in reducing severe perineal trauma and may be harmful. Using a mixed-methods approach, we conducted a study in 2013-14 on why obstetricians and midwives in a large maternity hospital in Phnom Penh, Cambodia, still do routine episiotomies. The study included the extent of the practice, based on medical records; a retrospective analysis of the delivery notes of a random sample of 365 patients; and 22 in-depth interviews with obstetricians, midwives and recently delivered women. Of the 365 women, 345 (94.5%, 95% CI: 91.7-96.6) had had an episiotomy. Univariate analysis showed that nulliparous women underwent episiotomy more frequently than multiparous women (OR 7.1, 95% CI 2.0-24.7). The reasons given for this practice by midwives and obstetricians were: fear of perineal tears, the strong belief that Asian women have a shorter and harder perineum than others, lack of time in overcrowded delivery rooms, and the belief that Cambodian women would be able to have a tighter and prettier vagina through this practice. A restrictive episiotomy policy and information for pregnant women about birthing practices through antenatal classes should be implemented as soon as possible.

  16. Improving obstetric care in low-resource settings: implementation of facility-based maternal death reviews in five pilot hospitals in Senegal

    PubMed Central

    Dumont, Alexandre; Tourigny, Caroline; Fournier, Pierre

    2009-01-01

    Background In sub-Saharan Africa, maternal and perinatal mortality and morbidity are major problems. Service availability and quality of care in health facilities are heterogeneous and most often inadequate. In resource-poor settings, the facility-based maternal death review or audit is one of the most promising strategies to improve health service performance. We aim to explore and describe health workers' perceptions of facility-based maternal death reviews and to identify barriers to and facilitators of the implementation of this approach in pilot health facilities of Senegal. Methods This study was conducted in five reference hospitals in Senegal with different characteristics. Data were collected from focus group discussions, participant observations of audit meetings, audit documents and interviews with the staff of the maternity unit. Data were analysed by means of both quantitative and qualitative approaches. Results Health professionals and service administrators were receptive and adhered relatively well to the process and the results of the audits, although some considered the situation destabilizing or even threatening. The main barriers to the implementation of maternal deaths reviews were: (1) bad quality of information in medical files; (2) non-participation of the head of department in the audit meetings; (3) lack of feedback to the staff who did not attend the audit meetings. The main facilitators were: (1) high level of professional qualifications or experience of the data collector; (2) involvement of the head of the maternity unit, acting as a moderator during the audit meetings; (3) participation of managers in the audit session to plan appropriate and realistic actions to prevent other maternal deaths. Conclusion The identification of the barriers to and the facilitators of the implementation of maternal death reviews is an essential step for the future adaptation of this method in countries with few resources. We recommend for future

  17. Microbial flora of the lower genital tract of women in labour at Harare Maternity Hospital. The Puerperal Sepsis Study Group.

    PubMed

    Mason, P R; Katzenstein, D A; Chimbira, T H; Mtimavalye, L

    1989-03-01

    The vaginal flora of 214 women who had been referred, in labour, to Harare Maternity Hospital was investigated by examination of vaginal washings and of cervical and urethral swabs taken before and/or after delivery. Four groups of patients were studied: women who had a normal vaginal delivery (NVD), women who were referred because of meconium stained liquor (MSL), women with a history of prolonged rupture of membranes (PROM), and women who were delivered by cesarean section (CS). The first three groups had received no antibiotics during the 7 days preceding specimen collection, while specimens were collected from CS patients only after at least 48 hr of i.v. penicillin and chloramphenicol. T. vaginalis was identified in 19 percent of women, but was not associated with any specific patient group. Chlamydial antigen was detected in 13 percent of patients, but in only one patient (2 percent) in the MSL group. N. gonorrhoeae were isolated from 7 percent of women overall and 25 percent of the strains were penicillinase-producing. Gonococci were recovered significantly more frequently from the PROM patients than from NVD patients as were Group B streptococci and pigment-producing Bacteroides species. Lactobacilli were isolated from only 20 percent of women, despite the use of specific transport and isolation media for these organisms. Specimens from CS patients were taken after these had received parenteral penicillin and chloramphenicol and it was therefore not surprising to find major differences in their vaginal flora with a virtual absence of Gram-positive bacteria, and a high-rate of carriage of multi-resistant coliforms.(ABSTRACT TRUNCATED AT 250 WORDS)

  18. Mode of birth and social inequalities in health: the effect of maternal education and access to hospital care on cesarean delivery.

    PubMed

    Kottwitz, Anita

    2014-05-01

    Access to health care is an important factor in explaining health inequalities. This study focuses on the issue of access to health care as a driving force behind the social discrepancies in cesarean delivery using data from 707 newborn children in the 2006-2011 birth cohorts of the German Socio-Economic Panel Study (SOEP). Data on individual birth outcomes are linked to hospital data using extracts of the quality assessment reports of nearly all German hospitals. Geographic Information Systems (GIS) are used to assess hospital service clusters within a 20-km radius buffer around mother׳s homes. Logistic regression models adjusting for maternal characteristics indicate that the likelihood to deliver by a cesarean section increases for the least educated women when they face constraints with regard to access to hospital care. No differences between the education groups are observed when access to obstetric care is high, thus a high access to hospital care seems to balance out health inequalities that are related to differences in education. The results emphasize the importance of focusing on unequal access to hospital care in explaining differences in birth outcomes.

  19. Are Women of East Kazakhstan Satisfied with the Quality of Maternity Care? Implementing the WHO Tool to Assess the Quality of Hospital Services

    PubMed Central

    DAULETYAROVA, Marzhan; SEMENOVA, Yuliya; KAYLUBAEVA, Galiya; MANABAEVA, Gulshat; KHISMETOVA, Zayituna; AKILZHANOVA, Zhansulu; TUSSUPKALIEV, Akylbek; ORAZGALIYEVA, Zhazira

    2016-01-01

    Background: To evaluate the satisfaction of mothers with the quality of care provided by maternity institutions in East Kazakhstan on the basis of the “Quality of hospital Care for mothers and newborn babies, assessment tool” (WHO, 2009). Methods: This cross-sectional study took place in 2013 and covered five maternity hospitals in East Kazakhstan (one referral, two urban and two rural). To obtain information, interviews with 872 patients were conducted. The standard tool covered 12 areas ranging from pregnancy to childcare. A score was assigned to each area of care (from 0 to 3). The assessment provided the semi-quantitative data on the quality of hospital care for women and newborns from the perception of mothers. Results: The average satisfaction score was 2.48 with a range from 2.2 to 2.7. The mean age of women was 27.4 yr. Forty-two percent were primiparas. Mean birth weight was 3455.4 g. All infants had ‘skin to skin’ contact with their mothers immediately after birth. Mean number of antenatal visits to family clinics was 8.6. Only 42.1% of the respondents used contraceptives while the rest were not aware of contraception, never applied it and could not distinguish between different methods and devices. Conclusion: The quality of care was substandard in all institutions. To improve the quality of care, WHO technologies in perinatal care could be applied. PMID:27648415

  20. Syphilis serology in pregnancy: an eight-year study (2005-2012) in a large teaching maternity hospital in Dublin, Ireland.

    PubMed

    McGettrick, Padraig; Ferguson, Wendy; Jackson, Valerie; Eogan, Maeve; Lawless, Mairead; Ciprike, Vaneta; Varughese, Alan; Coulter-Smith, Sam; Lambert, John S

    2016-03-01

    All cases of positive syphilis serology detected in antenatal and peripartum screening in a large teaching maternity hospital in inner city Dublin, Ireland over an eight-year period (2005-2012 inclusive) were reviewed and included in our study. Demographic, antenatal registration, laboratory (including co-infections), partner serology, treatment and delivery data were recorded in our database. Infant follow-up, treatment and outcome data were also collected. During this period, 194 women had positive syphilis serology, of which 182 completed their pregnancies at the institution. This accounts for 0.28% of the total number of women completing their pregnancies during this time (N = 66038); 79 had no previous diagnosis of infection. There was one case of re-infection during pregnancy. Thirty-two women were co-infected with human immunodeficiency virus, hepatitis B or hepatitis C. There was one case suggestive of congenital syphilis infection. Our study is a comprehensive analysis of the diagnosis, management and clinical outcomes of women testing positive for syphilis infection in pregnancy. It reveals the relatively high prevalence of syphilis infection in the population utilising the maternity services in north inner-city Dublin. It re-enforces the importance of continued active surveillance to prevent morbidity and mortality associated with maternal syphilis infection. It also highlights the importance of strategies such as re-testing high-risk groups and definitive screening of spouse serology.

  1. Association between maternal exposure to housing renovation and offspring with congenital heart disease: a multi-hospital case–control study

    PubMed Central

    2013-01-01

    Background Congenital heart disease (CHD) is one of the most prevalent birth defects. Housing renovations are a newly recognized source of indoor environmental pollution that is detrimental to health. A growing body of research suggests that maternal occupational exposure to renovation materials may be associated with an increased risk of giving birth to fetuses with CHD. However, the effect of indoor housing renovation exposure on CHD occurrence has not been reported. Methods A multi-hospital case–control study was designed to investigate the association between maternal periconceptional housing renovation exposure and the risk of CHD for offspring. In total, 346 cases and 408 controls were enrolled in this study from four hospitals in China. Exposure information was based on a questionnaire given to women during pregnancy. The association between housing renovation exposure and CHD occurrence was assessed by estimating odds ratios (OR) with logistic regression models adjusted for potential confounders. Results The risk for CHD in offspring was significantly associated with maternal exposure to housing renovations (AOR: 1.89, 95% CI: 1.29-2.77). There were similar risks for cardiac defects with or without extra-cardiac malformation (AOR of 2.65 and 1.76, respectively). Maternal housing renovation exposure may increase the fetus’ risk of suffering from conotruncal defect or anomalous venous return. There were significant risks for cardiac defects if the pregnant woman moved into a new house within one month after decoration at either 3 months before pregnancy (AOR: 2.38, 95% CI: 1.03 to 5.48) or during first trimester (AOR: 4.00, 95% CI: 1.62 to 9.86). Conclusions Maternal exposure to housing renovations may have an increased risk of giving birth to fetuses with some selected types of CHD. This relationship was stronger for women who moved into a newly decorated house. However, considering the limited number of subjects and the problem of multiple exposures

  2. A 10-year appraisal of cesarean delivery and the associated fetal and maternal outcomes at a teaching hospital in southeast Nigeria

    PubMed Central

    Onoh, Robinson Chukwudi; Eze, Justus Ndulue; Ezeonu, Paul Olisaemeka; Lawani, Lucky Osaheni; Iyoke, Chukwuemeka Anthony; Nkwo, Peter Onubiwe

    2015-01-01

    Background The global rise in cesarean delivery rate has been a major source of public health concern. Aim To appraise the cesarean deliveries and the associated fetal and maternal outcomes. Materials and methods The study was a case series with data collected retrospectively from the records of patients delivered by cesarean section at the Ebonyi State University Teaching Hospital, Abakaliki over a 10-year period, from January 2002 to December 2011. Ethical approval was obtained. Results Of 14,198 deliveries, 2,323/14,198 (16.4%) were by cesarean deliveries. The overall increase of cesarean delivery was 11.1/10 (1.1%) per annum from 184/1,512 (12.2%) in 2002 to 230/986 (23.3%) in 2011. Of 2,097 case folders studied, 1,742/2,097 (83.1%) were delivered at term, and in 1,576/2,097 (75.2%), the cesarean deliveries were emergencies. The common indications for cesarean delivery were previous cesarean scars 417/2,097 (19.9%) and obstructed labor 331/2,097 (15.8%). There were 296 perinatal deaths, giving a perinatal mortality rate of (296/2,197) 134.7/1,000 births. Also, 129/2,097 (6.1%) maternal case fatalities occurred, giving a maternal mortality rate of 908.6/100,000 total births. Hemorrhage 57/129 (44.2%) and sepsis 41/129 (32.6%) were the major causes. Conclusion The study recorded a significant increase in cesarean delivery rate. Previous cesarean scars and obstructed labors were the main indications. Perinatal and maternal case fatalities were huge. Hence, there is need for continued community education for its reduction. PMID:25999769

  3. [Women's complaint leadership in the Causa Kleinwächter. A contribution to patient history of the Innsbruck maternity hospital].

    PubMed

    Hilber, Marina

    On the basis of the Innsbruck Maternity Clinic this paper deals with the individual and collective worlds of experience of obstetric patients. However, not only the patient's view on the proceedings in this specific medical space is being reconstructed, also the prevailing conventions surrounding the treatment of pregnant, parturient and puerperal patients serving as clinical material in obstetric research and education are critically scrutinised. At the centre of this paper stands Dr. Ludwig Kleinwächter's period of duty, who acted as professor for obstetrics and gynaecology in Innsbruck between 1877 and 1881. During this period numerous conflicts regarding the treatment of patients are documented. Concerned about the good reputation of the Maternity Clinic, the Tyrolean State Committee, as the Clinic's provider, tried to solve the crisis. The existing letters of complaint and protocols do not only give a voice to the women concerned, but also to the medical professions as well as the local political representatives involved.

  4. A longitudinal study to determine association of various maternal factors with neonatal birth weight at a tertiary care hospital

    PubMed Central

    Misra, Akshay; Ray, Sougat; Patrikar, Seema

    2015-01-01

    Background Neonatal birth weight is a powerful predictor of infant growth and survival and maternal factors like poor knowledge and insufficient dietary intake are significant risk factors. Other preventable determinants like pre pregnant BMI <18.5, low gestational weight gain (GWG) and anemia are also associated with low birth weight. This study was carried out to identify the impact of these maternal factors with risk of low birth weight (LBW). Methods A longitudinal study was carried out on 124 booked antenatal cases at a tertiary care center. A validated protocol containing socio demography, food frequency and anthropometry was administered at the 3rd trimester. Birth weight of the newborn was noted after delivery. Results 26.28% children had low birth weight (<2500 g), 14.6% mothers were thin (BMI < 18.5), 55.3% mothers had a weight gain of less than 9 kgs and 45.5% were anemic. 81.81% mothers with BMI >18.5 and 28.92% women who were educated till high school had a baby with LBW. Most mothers consumed milk and vegetables daily and a few consumed non vegetarian foods but quality and quantity of food were grossly inadequate. GWG levels and Hb levels were significantly different in different birth weight groups and also were significantly associated with low birth weight. Conclusion Quality and quantity of maternal dietary intake during pregnancy, even in normal weight mothers (BMI > 18.5), are important determinants of birth weight. Nutritional counseling for mothers during the antenatal period is the cornerstone for healthy mother and healthy child. PMID:26288495

  5. Community-Academic Partnership to Investigate Low Birth Weight Deliveries and Improve Maternal and Infant Outcomes at a Baltimore City Hospital.

    PubMed

    Harvey, Elizabeth M; Strobino, Donna; Sherrod, Leslie; Webb, Mary Catherine; Anderson, Caroline; White, Jennifer Arice; Atlas, Robert

    2017-02-01

    Purpose Mercy Medical Center (MMC), a community hospital in Baltimore Maryland, has undertaken a community initiative to reduce low birth weight (LBW) deliveries by 10 % in 3 years. MMC partnered with a School of Public Health to evaluate characteristics associated with LBW deliveries and formulate collaborations with obstetricians and community services to improve birth outcomes. Description As part of the initiative, a case control study of LBW was undertaken of all newborns weighing <2500 grams during June 2010-June 2011 matched 2:1 with newborns ≥2500 grams (n = 862). Assessment Logistic regression models including maternal characteristics prior to and during pregnancy showed an increased odds of LBW among women with a previous preterm birth (aOR 2.48; 95 % CI: 1.49-4.13), chronic hypertension (aOR: 2.53; 95 % CI: 1.25-5.10), hospitalization during pregnancy (aOR: 2.27; 95 % CI:1.52-3.40), multiple gestation (aOR:12.33; 95 % CI:5.49-27.73) and gestational hypertension (aOR: 2.81; 95 % CI: 1.79-4.41). Given that both maternal pre-existing conditions and those occurring during pregnancy were found to be associated with LBW, one strategy to address pregnant women at risk of LBW infants is to improve the intake and referral system to better triage women to appropriate services in the community. Meetings were held with community organizations and feedback was operationalized into collaboration strategies which can be jointly implemented. Conclusion Education sessions with providers about the referral system are one ongoing strategy to improve birth outcomes in Baltimore City, as well as provision of timely home visits by nurses to high-risk women.

  6. Maternal and perinatal outcomes of eclampsia with and without HELLP syndrome in a teaching hospital in western Turkey.

    PubMed

    Asıcıoglu, O; Güngördük, K; Yildirim, G; Aslan, H; Günay, T

    2014-05-01

    In this study, we compared the perinatal and maternal outcomes of women with eclampsia with and without HELLP syndrome. A total of 219 pregnancies complicated by eclampsia with and without HELLP syndrome managed between January 2002 and December 2011, were reviewed. The incidence of eclampsia was 1.7/1,000 deliveries. Among 219 patients with eclampsia, 141 (64.4%) did not develop HELLP syndrome and 78 (35.6%) did develop HELLP syndrome. Maternal age and the rates of nulliparity were similar in both groups. Interval time from eclamptic seizure to delivery was significantly longer in the without-HELLP syndrome group (0.92 ± 0.29 weeks vs 0.16 ± 0.12 weeks, p = 0.028). Furthermore, overall perinatal mortality (particularly after gestational week 32) was significantly higher in the with-HELLP syndrome group (20.5% vs 9.9%, p = 0.029). In conclusion, patients with HELLP syndrome had significantly higher perinatal mortality than those with eclampsia without HELLP syndrome and no regular prenatal care.

  7. [Use of rehabilitation services by technology-dependent children and adolescents in a maternal and child hospital in Rio de Janeiro, Brazil].

    PubMed

    Gavazza, Cláudia Zornoff; Fonseca, Vânia Matos; da Silva, Kátia Silveira; Cunha, Sueli Rezende

    2008-05-01

    The objective of this study was to describe the dependence on technology and use of rehabilitation services by children and adolescents in a maternal and child hospital in Rio de Janeiro, Brazil. Using a cross-sectional design, the following variables were analyzed: gender and age of the children and adolescents, socioeconomic characteristics of the family, technology dependence, and use of rehabilitation services. The majority of the study population consisted of preschoolers (56.3%), boys (58.3%), residing in Greater Metropolitan Rio de Janeiro (89.3%), from low-income families (70.9%), and cared for mainly by their mothers (93.8%), who in turn have low schooling (54.2%) and are unemployed (89.6%). Of the entire study population, 22.9% were dependent on more than three different technologies, with medication as the most prevalent. Government and nonprofit institutions fund the rehabilitation, and physical therapists are the most widely used health professionals during treatment (60.4%). The target hospital provides all of the specialized medical treatment and most of the rehabilitation.

  8. The Google news effect: did the tainted milk scandal in China temporarily impact newborn feeding patterns in a maternity hospital?

    PubMed

    Seror, Jeremy; Amar, Audrey; Braz, Leslie; Rouzier, Roman

    2010-06-01

    Many factors influence a mother's decision to breastfeed. We investigated whether the melamine scandal involving infant formula influenced the decision to breastfeed. News of the melamine scandal was revealed in September 2008 and rapidly spread via the Internet. We illustrate that this scandal significantly and rapidly impacted the pattern of newborn feeding among Chinese women who delivered at a hospital in the eastern district of Paris. This area is home to one of the largest groups of Chinese people in France. The breastfeeding rate increased sharply in September 2008 from 14% to a peak of 31% (p = 0.014) before decreasing over a 6-month period at a rate slower than the diminishing media frenzy. The effect of the melamine news coverage on the Internet was temporary and strongly associated to ethnicity and language (p = 0.015, p = 0.004, respectively). Numerous patients utilize the Internet to access medical information, and these findings highlight the Internet's role in the healthcare equation.

  9. [Maternity blues].

    PubMed

    Gonidakis, F

    2007-04-01

    Maternity blues is a transient change of mood that occurs mainly between the 1st and 10th day of puerpartum and is characterized by bursts of tears, mild depressive mood, anxiety and liability of mood. The frequency of maternity blues varies in different studies form 4% to 80%. A number of biological and psychosocial parameters have been studied in order to determine their correlation with maternity blues. The most well studied biological parameters are progesterone and cortizol although their relation with maternity blues has not yet been clearly defined. Stress and the emotional state of the woman during pregnancy as well as history of mood disorders or maternity blues in a previous birth are the psychosocial parameters that are more likely to correlate with the occurrence of maternity blues. Most of the authors suggest that information on maternity blues and reassurance of the woman are the best way to deal with maternity blues both on preventive and therapeutical basis.

  10. Maternal understanding of infective endocarditis after hospitalization: assessing the knowledge of mothers of children with congenital heart disease and the practical implications.

    PubMed

    Knöchelmann, Anja; Geyer, Siegfried; Grosser, Urte

    2014-02-01

    This study aimed to examine the knowledge of mothers of children with congenital heart disease as well as the association of cardiological factors and maternal characteristics with maternal understanding. Mothers of 135 children (≤2 years old) were interviewed to assess maternal knowledge of infective endocarditis (IE) using the Hannover Inventory of Parental Knowledge of Congenital Heart Disease. Two subscales, endocarditis and risk factors, were used. Cardiological data as well as maternal characteristics were collected. Two-thirds of the mothers achieved only low scores, answering 0-20 % of the questions correctly (endocarditis = 64.4 %; risk factors = 71.1 %). Mothers with higher education recalled the correct definition of IE (P = 0.001) and the importance of dental hygiene (P = 0.004) more often. Mothers with only one child were more likely to know the most typical symptom (P = 0.007). The severity of the heart disease and the requirement of endocarditis prophylaxis did not influence maternal understanding. Yet, mothers assessing the heart disease as severe showed better knowledge (typical symptom P = 0.021; importance of dental hygiene P = 0.007). If mothers learned the diagnosis before their child's birth, they remembered relevant information more often. Mothers receiving information by the medical staff and from the Internet showed better knowledge (definition P = 0.014; importance of dental hygiene P = 0.001). Due to low levels of knowledge, more efforts must be put into the education of mothers. Educational programs should take maternal characteristics into account, providing written material and thereby keeping the instruction of lower-educated persons in mind. Furthermore, education should be focused on mothers of children requiring IE prophylaxis.

  11. [Maternal phenylketonuria].

    PubMed

    Bókay, János; Kiss, Erika; Simon, Erika; Szőnyi, László

    2013-05-05

    Elevated maternal phenylalanine levels during pregnancy are teratogenic, and may result in embryo-foetopathy, which could lead to stillbirth, significant psychomotor handicaps and birth defects. This foetal damage is known as maternal phenylketonuria. Women of childbearing age with all forms of phenylketonuria, including mild variants such as hyperphenylalaninaemia, should receive detailed counselling regarding their risks for adverse foetal effects, optimally before contemplating pregnancy. The most assured way to prevent maternal phenylketonuria is to maintain the maternal phenylalanine levels within the optimal range already before conception and throughout the whole pregnancy. Authors review the comprehensive programme for prevention of maternal phenylketonuria at the Metabolic Center of Budapest, they survey the practical approach of the continuous maternal metabolic control and delineate the outcome of pregnancies of mothers with phenylketonuria from the introduction of newborn screening until most recently.

  12. 'I Used to Fight with Them but Now I Have Stopped!': Conflict and Doctor-Nurse-Anaesthetists' Motivation in Maternal and Neonatal Care Provision in a Specialist Referral Hospital

    PubMed Central

    Aberese-Ako, Matilda; Agyepong, Irene Akua; Gerrits, Trudie; Van Dijk, Han

    2015-01-01

    Background and Objectives This paper analyses why and how conflicts occur and their influence on doctors and nurse-anaesthetists' motivation in the provision of maternal and neonatal health care in a specialist hospital. Methodology The study used ethnographic methods including participant observation, conversation and in-depth interviews over eleven months in a specialist referral hospital in Ghana. Qualitative analysis software Nvivo 8 was used for coding and analysis of data. Main themes identified in the analysis form the basis for interpreting and reporting study findings. Ethics Statement Ethical clearance was obtained from the Ghana Health Service Ethics Review board (approval number GHS-ERC:06/01/12) and from the University of Wageningen. Written consent was obtained from interview participants, while verbal consent was obtained for conversations. To protect the identity of the hospital and research participants pseudonyms are used in the article and the part of Ghana in which the study was conducted is not mentioned. Results Individual characteristics, interpersonal and organisational factors contributed to conflicts. Unequal power relations and distrust relations among doctors and nurse-anaesthetists affected how they responded to conflicts. Responses to conflicts including forcing, avoiding, accommodating and compromising contributed to persistent conflicts, which frustrated and demotivated doctors and nurse-anaesthetists. Demotivated workers exhibited poor attitudes in collaborating with co-workers in the provision of maternal and neonatal care, which sometimes led to poor health worker response to client care, consequently compromising the hospital's goal of providing quality health care to clients. Conclusion To improve health care delivery in health facilities in Ghana, health managers and supervisors need to identify conflicts as an important phenomenon that should be addressed whenever they occur. Effective mechanisms including training managers

  13. [Precautionary maternity leave in Tirol].

    PubMed

    Ludescher, K; Baumgartner, E; Roner, A; Brezinka, C

    1998-01-01

    Under Austrian law, precautionary maternity leave is a decree issued by the district public health physician. It forbids a pregnant woman to work and mandates immediate maternity leave. Regular maternity leave for all women employed in all jobs begins at 32 weeks of gestation. Women who work in workplaces deemed dangerous and women with a history of obstetric problems such as premature or growth-retarded babies from previous pregnancies are regularly 'sent' into precautionary maternity leave. The public health physicians of Tirol's nine administrative districts were interviewed and supplied data on precautionary maternity leave from their districts. In 100 women who attended the clinic for pregnancies at risk of the Obstetrics/Gynecology Department of Innsbruck University Hospital and who had already obtained precautionary maternity leave, the medical/administrative procedure was studied in each case and correlated with pregnancy outcome. The town district of Innsbruck and the district that comprises the suburbs of the provincial capital had the highest rates of precautionary maternity leave. The town district of Innsbruck had a rate of 24.3% of all pregnant women (employed and not employed) in precautionary maternity leave in 1997, whereas the whole province of Tirol had 13.4%. More than 80% of decrees for precautionary maternity leave are issued by district public health physicians on the basis of written recommendations from gynecologists. One third of women who are sent into precautionary maternity leave are issued the decree prior to 12 weeks of gestation - mostly cases of multiple pregnancies and women with previous miscarriages. The present system of precautionary maternity leave appears to work in the sense that most working pregnant women with risk factors are correctly identified - with most errors on the side of caution. As the system also helps employers - the employee's pay is paid from the federal family support fund and state insurance once she is in

  14. Maternal Immunization

    PubMed Central

    Chu, Helen Y.; Englund, Janet A.

    2014-01-01

    Maternal immunization has the potential to protect the pregnant woman, fetus, and infant from vaccine-preventable diseases. Maternal immunoglobulin G is actively transported across the placenta, providing passive immunity to the neonate and infant prior to the infant's ability to respond to vaccines. Currently inactivated influenza, tetanus toxoid, and acellular pertussis vaccines are recommended during pregnancy. Several other vaccines have been studied in pregnancy and found to be safe and immunogenic and to provide antibody to infants. These include pneumococcus, group B Streptococcus, Haemophilus influenzae type b, and meningococcus vaccines. Other vaccines in development for potential maternal immunization include respiratory syncytial virus, herpes simplex virus, and cytomegalovirus vaccines. PMID:24799324

  15. Alternative Maternity Services in Washington State.

    ERIC Educational Resources Information Center

    Starzyk, Patricia M.

    The nature of maternity services has changed in the past 20 years, with a movement away from traditional (physician delivery in a hospital) towards other alternative services. This study examined alternative maternity services in Washington State, which ranks eighth in the country in the use of such services. Data were collected from birth and…

  16. Phenylketonuria and maternal phenylketonuria.

    PubMed

    Purnell, H

    2001-07-01

    Phenylketonuria is a genetic disease affecting 1:10,000 to 14,000 live births. In NSW there is an average of nine cases diagnosed each year (Dietitians Working Party 1996). This paper discusses the management of phenylketonuria, and in particular the value of breastfeeding, complemented with a low phenylalanine infant formula, in facilitating easier maintenance of satisfactory phenylalanine blood levels. The 'diet for life' approach to managing phenylketonuria is to avoid long-term neurological deficits and, in particular, the risk that maternal PKU, which is not under strict dietary control, will have adverse effects on infants born of mothers with the disease. There have been 31 successful pregnancies to 1997 managed by the Nutrition and Dietetics Department of The Children's Hospital at Westmead, Sydney. The Maternal PKU diet is presented with the case of a client with phenylketonuria who has achieved two normal pregnancies and breastfed her second child for six months.

  17. [A case-control study of factors associated with repeat teen pregnancy based on a sample from a university maternity hospital].

    PubMed

    Silva, Andréa de Albuquerque Arruda; Coutinho, Isabela C; Katz, Leila; Souza, Alex Sandro Rolland

    2013-03-01

    Repeat teen pregnancy is a frequent issue and is considered an aggravating factor for increased maternal and fetal morbidity and social problems. The aim of the study was to identify factors associated with repeat teen pregnancy. A case-control study was conducted in 90 postpartum adolescents with more than one pregnancy (cases) and 90 adult women with a history of only one pregnancy during adolescence (controls). Statistical analysis used hierarchical logistic regression with 5% significance. Early sexual initiation (< 15 years), early age at first pregnancy (< 16 years), not raising the children themselves, and low family income (< one minimum wage) were associated with repeat teenage pregnancy, while partner change was inversely associated. Repeat teen pregnancy was mainly associated with reproductive and socioeconomic factors. Partner change appeared as a protective factor. Measures should be adopted during the postpartum period of teenage mothers in order to avoid repeat pregnancy.

  18. [Maternal and foetal prognostic during severe toxemia].

    PubMed

    Rachdi, Radhouane; Kaabi, Mehdi; Zayene, Houssine; Basly, Mohamed; Messaoudi, Fathi; Messaoudi, Lotfi; Chibani, Mounir

    2005-02-01

    Severe gravidic toxemia gives heavy maternal and foetal morbidity and mortality. The purpose of our study is to loosen the factors of bad maternal and foetal prognostic. It's a retrospective study about 100 cases of severe and complicated gravidic toxemia repertorieted in the maternity of Military Hospital of Tunis. Maternal morbidity is dominated by the complications of hypertension and a blood disorders. We raised 4 cases of eclampsia, 9 cases of retro placental hematome and 5 cases of HELLP syndrome. We don't deplore any maternal death. Perinatal mortality is 28.8%. The rate of delay intra-uterine growth was 43.8% and the prematurity 65.9%. More toxemia appears early during pregnancy more maternal and foetal prognostic is compromised.

  19. Maternal Depression and Parent Management Training Outcomes.

    PubMed

    Dempsey, Jack; McQuillin, Samuel; Butler, Ashley M; Axelrad, Marni E

    2016-09-01

    This study examines the impact of maternal depression on reductions in children's behavior problems severity following implementation of the Brief Behavioral Intervention-a brief, manualized parent management training treatment. The parents of 87 children aged 2-6 years of age received parent management training at a metropolitan hospital. Parents of participants completed measures of externalizing behavior and maternal depression. The association between pre-post treatment change in externalizing behavior and maternal depression was examined using an autoregressive cross-lagged model. Results showed that self-reported maternal depressive symptoms at pre-treatment negatively influenced the overall magnitude of reduction of reported externalizing behaviors in children following treatment. Results indicate that aspects of family functioning not specifically targeted by parent management training, such as maternal depression, significantly affect treatment outcomes. Clinicians providing parent management training may benefit from assessing for maternal depression and modifying treatment as indicated.

  20. [The incidence of a neonatal bacterial infection syndrome with maternofetal transmission in the Neonatal Department of the Baia Mare District Maternity Hospital in 1983-1987].

    PubMed

    Pohl, A; Radu, I; Mesaroş, M; Surianu, E; Bancoş, T

    1991-01-01

    In a retrospective study extending on a 5-year period, authors have analysed the incidence of the bacterial infectious syndrome with maternofetal transmission in the newborns admitted to the above-mentioned department. Among 20,674 live-born infants, 241 cases (1.16%) with diseases of an infectious character with vertical transmission were recorded. The incidence of the neonatal infectious syndrome was marked by a yearly increase, from 0.86% in the first year of the study to 1.24% in the last year, with a peak of 1.43% in 1986. The infection risk by maternofetal transmission was more than 10 times higher in the group of premature children. During the study period, of the total of 128 deaths, 31 (24.22%) were due to the neonatal infectious syndrome; of these 31 deaths, 21 occurred in premature children, hence 2/3 of all the failures were recorded in premature infants. Authors conclude that the prevention of the neonatal bacterial infectious syndrome could surely exert a favorable influence on the course of perinatal mortality and on the incidence of premature births in maternities.

  1. The WHO Maternal Near-Miss Approach and the Maternal Severity Index Model (MSI): Tools for Assessing the Management of Severe Maternal Morbidity

    PubMed Central

    Souza, Joao Paulo; Cecatti, Jose Guilherme; Haddad, Samira M.; Parpinelli, Mary Angela; Costa, Maria Laura; Katz, Leila; Say, Lale; Almeida, Elson J; Amaral, Eliana M; Amorim, Melania M; Andreucci, Carla B; Aquino, Márcia M; Bahamondes, Maria V; Lima, Antonio C Barbosa; Barroso, Frederico; Bione, Adriana; Brum, Ione R; Calderon, Iracema M; Camargo, Rodrigo S; Campanharo, Felipe F; Carvalho, Luiz E; Carvalho, Simone A; Cecatti, José G; Chaves, George N; Cordioli, Eduardo; Costa, Maria L; Costa, Roberto A; Costa, Sergio M; Feitosa, Francisco E; Freire, Djacyr M; Gonçalves, Simone P; Guanabara, Everardo M; Guimarães, Daniela; Gurgel, Lúcio T; Haddad, Samira M; Katz, Leila; Leite, Debora; Lima, Moises D; Lobato, Gustavo; Lotufo, Fátima A; Luz, Adriana G; Filho, Nelson L Maia; Martins, Marilia G; Matias, Jacinta P; Mattar, Rosiane; Menezes, Carlos A; Moises, Elaine C; Filho, Olímpio B Moraes; Moreira, Joaquim L; Nakamura-Pereira, Marcos; Nascimento, Denis J; Ohnuma, Maria H; Oliveira, Fernando C; Pacagnella, Rodolfo C; Paiva, Cláudio S; Parpinelli, Mary A; Pattinson, Robert C; Paula, Liv B; Peraçoli, Jose C; Peret, Frederico A; Perez, Cynthia D; Pessoni, Cleire; Peterossi, Alessandra; Pfitscher, Lucia C; Silva, João L Pinto e; Quintana, Silvana M; Radaci, Ivelyne; Filho, Edilberto A Rocha; Rodrigues, Simone M; Rohloff, Roger D; Rudge, Marilza V; Saint'ynes, Gloria C; Santana, Danielly S; Santos, Patricia N; Say, Lale; Schmaltz, Luiza E; Sousa, Maria H; Sousa, Maria R; Souza, Joäo P; Surita, Fernanda G; Zanette, Elvira A; Zotareli, Vilma

    2012-01-01

    Objectives To validate the WHO maternal near-miss criteria and develop a benchmark tool for severe maternal morbidity assessments. Methods In a multicenter cross-sectional study implemented in 27 referral maternity hospitals in Brazil, a one-year prospective surveillance on severe maternal morbidity and data collection was carried out. Diagnostic accuracy tests were used to assess the validity of the WHO maternal near-miss criteria. Binary logistic regression was used to model the death probability among women with severe maternal complications and benchmark the management of severe maternal morbidity. Results Of the 82,388 women having deliveries in the participating health facilities, 9,555 women presented pregnancy-related complications, including 140 maternal deaths and 770 maternal near misses. The WHO maternal near-miss criteria were found to be accurate and highly associated with maternal deaths (Positive likelihood ratio 106.8 (95% CI 99.56–114.6)). The maternal severity index (MSI) model was developed and found to able to describe the relationship between life-threatening conditions and mortality (Area under the ROC curve: 0.951 (95% CI 0.909–0.993)). Conclusion The identification of maternal near-miss cases using the WHO list of pregnancy-related life-threatening conditions was validated. The MSI model can be used as a tool for benchmarking the performance of health services managing women with severe maternal complications and provide case-mix adjustment. PMID:22952897

  2. Wāhine hauora: linking local hospital and national health information datasets to explore maternal risk factors and obstetric outcomes of New Zealand Māori and non-Māori women in relation to infant respiratory admissions and timely immunisations

    PubMed Central

    2013-01-01

    Background Significant health inequities exist around maternal and infant health for Māori, the indigenous people of New Zealand. The infants of Māori are more likely to die in their first year of life and also have higher rates of hospital admission for respiratory illnesses, with the greatest burden of morbidity being due to bronchiolitis in those under one year of age. Timely immunisations can prevent some respiratory related hospitalisations, although for Māori, the proportion of infants with age appropriate immunisations are lower than for non-Māori. This paper describes the protocol for a retrospective cohort study that linked local hospital and national health information datasets to explore maternal risk factors and obstetric outcomes in relation to respiratory admissions and timely immunisations for infants of Māori and non-Māori women. Methods/Design The study population included pregnant women who gave birth in hospital in one region of New Zealand between 1995 and 2009. Routinely collected local hospital data were linked via a unique identifier (National Health Index number) to national health information databases to assess rates of post-natal admissions and access to health services for Māori and non-Māori mothers and infants. The two primary outcomes for the study are: 1. The rates of respiratory hospitalisations of infants (≤ 1 yr of age) calculated for infants of both Māori and non-Māori women (for mothers under 20 years of age, and overall) accounting for relationship to parity, maternal age, socioeconomic deprivation index, maternal smoking status. 2. The proportion of infants with age appropriate immunisations at six and 12 months, calculated for both infants born to Māori women and infants born to non-Māori women, accounting for relationship to parity, maternal age, socioeconomic deprivation index, smoking status, and other risk factors. Discussion Analysis of a wide range of routinely collected health information in which

  3. Post Discharge Formula Fortification of Maternal Human Milk of Very Low Birth Weight Preterm Infants: An Introduction of a Feeding Protocol in a University Hospital

    PubMed Central

    El Sakka, Abeer; El Shimi, Mohamed Sami; Salama, Kareem; Fayez, Hend

    2016-01-01

    The objective of this study is to determine the growth parameters and nutritional biochemical markers and complications of fortification of human milk by post discharge formula of preterm very low birth weight newborns (VLBW). Fifty preterm infants less than 37 weeks with weight less than 1500 g were enrolled in the study. They received parental nutrition and feeding according to our protocol. When enteral feeding reached 100 cc/kg/day, infants were randomized into two groups: group I, Cases, n=25, where post discharge formula (PDF) was used for fortification, group II, Controls, n=25 with no fortification. Infants of both groups were given 50% of required enteral feeding as premature formula. This protocol was used until infants’ weight reached 1800 g. Daily weight, weekly length and head circumference were recorded. Hemoglobin, albumin (Alb), electrolytes, blood urea nitrogen (BUN) and clinical complications were documented. Human milk fortification with PDF resulted in better growth with increase in weight 16.8 and 13.78 g/kg/day (P=0.0430), length 0.76 and 0.58 cm/week (P=0.0027), and head circumference of 0.59 and 0.5 cm/week (P=0.0217) in cases and controls respectively. Duration of hospital stay was less in cases (22.76 versus 28.52 days in Controls), P=0.02. No significant changes were found in serum electrolytes, BUN, or Alb between both groups. Hemoglobin was significantly higher in Cases, P=0.04. There were no significant clinical complications. Our feeding protocol of fortification of human milk with PDF in preterm very low birth weight newborns resulted in better growth and decrease in length of hospital stay. The use of PDF could be an alternative option for fortification of mothers’ milk for preterm VLBW infants in developing countries with low resources. PMID:27777705

  4. Midwives’ knowledge and attitudes when encountering Gender-Based Violence in their practice at a maternity-hospital in Kingston, Jamaica

    PubMed Central

    Pitter, Cynthia Pearl

    2016-01-01

    Introduction Gender-based violence (GBV) can have devastating consequences for pregnancy because both mother and child are at risk. Midwives are in a strategic position to identify and empower pregnant women experiencing GBV; however, currently midwives in Jamaica are not required to screen for GBV, neither are they prepared to do so. Aim This study forms the baseline of a larger study designed to improve the capacity of midwives to identify and treat pregnant women experiencing GBV in Jamaica. This specific component assessed midwives’ knowledge and attitudes when encountering GBV in their practice in Kingston, Jamaica. Methods A qualitative study design was used. Six practicing midwives were purposely selected to participate in a focus group discussion at the antenatal clinic of a hospital in Kingston, Jamaica. Results All six respondents said it was very important to screen for GBV among pregnant women in their care. The findings from their report revolved around six themes, namely midwives have suboptimal knowledge, are exposed to women experiencing GBV in pregnancy, lack professional preparedness, report gaps in the institutional framework to guide their practice, are concerned for their safety and security, and are willing to intervene. Conclusion This study confirmed that midwives are aware of the problem and are willing to intervene but are faced with lack of formal procedures to detect and treat pregnant women who are experiencing GBV. Findings could be used to inform a protocol which is being developed to guide midwives’ practice. Findings could also be incorporated in the national strategy to eliminate GBV. PMID:26894744

  5. Praying until Death: Apostolicism, Delays and Maternal Mortality in Zimbabwe

    PubMed Central

    2016-01-01

    Religion affects people’s daily lives by solving social problems, although it creates others. Female sexual and reproductive health are among the issues most affected by religion. Apostolic sect members in Zimbabwe have been associated with higher maternal mortality. We explored apostolic beliefs and practices on maternal health using 15 key informant interviews in 5 purposively selected districts of Zimbabwe. Results show that apostolicism promotes high fertility, early marriage, non-use of contraceptives and low or non-use of hospital care. It causes delays in recognizing danger signs, deciding to seek care, reaching and receiving appropriate health care. The existence of a customized spiritual maternal health system demonstrates a huge desire for positive maternal health outcomes among apostolics. We conclude that apostolic beliefs and practices exacerbate delays between onset of maternal complications and receiving help, thus increasing maternal risk. We recommend complementary and adaptive approaches that address the maternal health needs of apostolics in a religiously sensitive manner. PMID:27509018

  6. Birthing Centers and Hospital Maternity Services

    MedlinePlus

    ... use a certified nurse-midwife (CNM) . CNMs are registered nurses who have a graduate degree in midwifery, meaning ... home births. In addition to obstetricians and CNMs, registered nurses (RNs) attend births to take care of the ...

  7. Community level risk factors for maternal mortality in Madagascar.

    PubMed

    Hernandez, Julio C; Moser, Christine M

    2013-12-01

    This paper explores the effect of risk and socioeconomic factors on maternal mortality at the community level in Madagascar using a unique, nationwide panel of communes (i.e., counties). Previous work in this area uses individual or cross-country data to study maternal mortality, however, studying maternal mortality at the community level is imperative because this is the level at which most policy is implemented. The results show that longer travel time from the community to the hospital leads to a high level of maternal mortality. The findings suggest that improvement to transportation systems and access to hospitals with surgery rooms are needed to deal with obstetric complications and reduce maternal mortality.

  8. Maternal anxiety, maternal sensitivity, and attachment.

    PubMed

    Stevenson-Hinde, Joan; Chicot, Rebecca; Shouldice, Anne; Hinde, Camilla A

    2013-01-01

    Previous research has related maternal anxiety to insecurity of attachment. Here we ask whether different aspects of maternal sensitivity mediate this link. From a community sample of intact families with 1-3 children, mothers with 4.5-year-olds were selected for low, medium, or high anxiety levels (N = 98). Following Mary Ainsworth's lead, our maternal sensitivity measures were primarily based on ratings of direct observations. Six sets of measures were obtained: positive maternal style at home (a mean of four different ratings); providing a sensitive framework, limit setting, allowing autonomy, criticizing/cutting in (each a mean over two laboratory joint tasks); and tension-making (a mean of three different ratings in a fear-inducing task). Regression analyses showed firstly that maternal anxiety rather than behavioral inhibition or sex of child was the significant predictor of each maternal sensitivity measure; and secondly that these measures rather than maternal anxiety or sex were the significant predictors of security of attachment. Finally, ANOVA's indicated which sets of maternal ratings were associated with each pattern of attachment (Avoidant, Secure, Ambivalent, or Controlling).

  9. Effects of twin gestation on maternal morbidity.

    PubMed

    Young, Brett C; Wylie, Blair J

    2012-06-01

    As the incidence of twin gestation increases, it is important to consider the maternal risks associated with carrying multiples. Compared with singleton gestation, there are increased risks to the mother during the antepartum, intrapartum, and postpartum periods. Certain pregnancy complications are more likely to occur during a twin gestation, including preeclampsia and other hypertensive disorders, antepartum hospitalization for preterm labor or abnormal bleeding, nutritional deficiencies, cesarean delivery, and postpartum hemorrhage. Women carrying twins may benefit from early education regarding these issues, close maternal monitoring as well as physical therapy sessions, and nutrition counseling during their pregnancies.

  10. Maternal food restrictions during breastfeeding

    PubMed Central

    Jeong, Goun; Park, Sung Won; Lee, Yeon Kyung; Ko, Sun Young

    2017-01-01

    Purpose This study investigated self-food restriction during breastfeeding, reviewed the literature showing the effect of maternal diet on the health of breast-fed infants, and explored the validity of dietary restrictions. Methods Questionnaire data were collected from breastfeeding Korean mothers who visited the pediatric clinic of Cheil General Hospital & Women's Healthcare Center from July 2015 through August 2015. The survey included items assessing maternal age, number of children, maternal educational attainment, household income, degree of difficulty with self-food restriction, types of self-restricted foods, dietary customs during breastfeeding, and sources of information about breastfeeding. Results The questionnaire was completed by 145 mothers. More than a third (n=56, 39%) had discomfort from and usually avoided 4–5 types of food (mean, 4.92). Mothers younger than 40 years had more discomfort (odds ratio [OR], 12.762; P=0.017). Primiparas felt less discomfort than multiparas (OR, 0.436; P=0.036). Dietary practices were not influenced by maternal educational attainment or household income. The most common self-restricted foods were caffeine (n=131, 90.3%), spicy foods (n=124, 85.5%), raw foods (n=109, 75.2%), cold foods (n=100, 69%), and sikhye (traditional sweet Korean rice beverage) (n=100, 69%). Most mothers (n=122, 84.1%) avoided foods for vague reasons. Conclusion Most mothers restricted certain foods unnecessarily. Literature review identified no foods that mothers should absolutely avoid during breastfeeding unless the infant reacts negatively to the food. PMID:28392822

  11. [Maternal mortality and perinatal mortality].

    PubMed

    Boutaleb, Y; Mesbahi, M; Lahlou, D; Aderdour, M

    1982-01-01

    94 maternal deaths and 1546 fetal and neonatal deaths were registered among 28,706 births at the CHU Averroes in Casablanca between 1978-80. 45% of women who deliver at the clinic are very poor and only 10% are relatively well off. Obstetrical antecedents were noted in 27% of the fetal deaths. 70% of the maternal deaths occurred in women aged 20-34. 32 maternal deaths occurred among 16,232 women with 1-2 children, 30 among 6514 women with 3-5 children, and 32 among 5960 women with 6-14 children. 11,027 of the 28,706 were primaparas. Perinatal mortality was 4.46% among primaparas, 8.24% among grand multiparas, and 4.1% among secondiparas. In 58 of the 94 cases of maternal mortality the woman was hospitalized after attempting delivery at home or in a village clinic. Among women with 1 or 2 children, hemorrhage was the cause of death in 8 cases, infection in 7 cases, eclampsia in 3 cases, thromboembolism in 2 cases, uterine inversion in 2 cases, pulmonary tuberculosis in 1 case, embolism in 5 cases, and other causes 1 case each. Among women with 3-5 children hemorrhage was the cause of death in 10 cases, septicemia in 3 cases, uterine rupture in 3 cases, eclampsia in 3 cases, uterine inversion in 2 cases, viral hepatitis in 2 cases, emboli in 2 cases, and other reasons 1 case each. Among grand multiparas hemorrhage was the cause of death in 11 cases, uterine rupture in 12 cases, peritonitis in 2 cases, eclampsia in 2 cases, emboli in 2 cases, and other causes 1 case each. 19 of the maternal deaths were judged to have been avoidable with better management. Prematurity and birth weight of 1000-2500 g associated or not with other pathology were found in 714 of 1546 perinatal deaths. Of 390 cases of death in utero with retention and maceration, 68 were caused by reno-vascular syndromes, 76 by maternal infections, 33 by maternal syphilis, 26 by fetal malformation, 18 by maternal diabetes, 10 by Rh incompatability, and 159 by indeterminate causes. In 795 cases of

  12. Maternal intake of antioxidant vitamins in pregnancy in relation to maternal and fetal plasma levels at delivery.

    PubMed

    Scaife, Alison R; McNeill, Geraldine; Campbell, Doris M; Martindale, Sheelagh; Devereux, Graham; Seaton, Anthony

    2006-04-01

    The aim of the present study was to test the hypothesis that maternal intake of antioxidant vitamins is associated with maternal and cord plasma levels at delivery. Women were recruited in early pregnancy in Aberdeen Maternity Hospital and habitual diet during pregnancy was assessed by a food-frequency questionnaire mailed at 34 weeks gestation. Blood samples were taken at recruitment (n 1149) and maternal (n 1149) and cord blood samples (n 747) taken at delivery for analyses of vitamins A, C, E and beta-carotene. Maternal plasma levels of vitamin E and beta-carotene at delivery were significantly higher than levels in early pregnancy while levels of vitamins A and C were significantly lower. Positive correlations were observed for maternal levels of all the vitamins between early pregnancy and delivery. At delivery, maternal plasma concentrations of vitamins A, E and beta-carotene were significantly higher than cord levels, while maternal levels of vitamin C were significantly lower. There were significant correlations between maternal and cord plasma concentrations for beta-carotene and vitamin C but not for vitamins A or E. Maternal dietary intakes were positively correlated with maternal plasma levels of vitamins C, E and beta-carotene in early pregnancy, with maternal plasma levels of beta-carotene and vitamin C at delivery and with cord plasma levels of beta-carotene and vitamin C. The results from the present study show that, in this population, maternal diet influences cord plasma levels of beta-carotene and vitamin C, but not vitamins A and E.

  13. Australian primary maternity units: past, present and future.

    PubMed

    Monk, Amy R; Tracy, Sally; Foureur, Maralyn; Barclay, Lesley

    2013-09-01

    Primary maternity units are commonly those run by midwives who provide care to women with low-risk pregnancies with no obstetric, anaesthetic, laboratory or paediatric support available on-site. In some other countries, primary level maternity units play an important role in offering equitable and accessible maternity care to women with low-risk pregnancies, particularly in rural and remote areas. However there are very few primary maternity units in Australia, largely due to the fact that over the past 200 years, the concept of safety has become inherently linked with the immediate on-site availability of specialist medical support. The purpose if this paper is to explore the various drivers and barriers to the sustainability of primary maternity units in Australia. It firstly looks at the historical antecedents that shaped primary level maternity services in Australia, from the time of colonisation to now. During this period the space and management of childbirth moved from home and midwifery-led settings to obstetric-led hospitals. Following on from this an analysis of recent political events shows how Australian government policy both supports and undermines the potential of primary maternity units. It is important that researchers, clinicians and policy makers understand the past in order to manage the challenges facing the development and maintenance of midwifery-led maternity services, in particular primary maternity units, in Australia today.

  14. The Role of Obstetrics/Gynecology Hospitalists in Reducing Maternal Mortality.

    PubMed

    Stevens, Tobey A; Swaim, Laurie S; Clark, Steven L

    2015-09-01

    The United States experienced a 6.1% annual increase in the maternal death rate from 2000 to 2013. Maternal deaths from hemorrhage and complications of preeclampsia are significant contributors to the maternal death rate. Many of these deaths are preventable. By virtue of their continuous care of laboring patients, active involvement in hospital safety initiatives, and immediate availability, obstetric hospitalists are uniquely positioned to evaluate patients, initiate care, and coordinate a multidisciplinary effort. In cases of significant maternal hemorrhage, hypertensive crisis, and acute pulmonary edema, the availability of an obstetrics hospitalist may facilitate improved patient safety and fewer maternal deaths.

  15. "I was on the way to the hospital but delivered in the bush": Maternal health in Ghana's Upper West Region in the context of a traditional birth attendants' ban.

    PubMed

    Rishworth, Andrea; Dixon, Jenna; Luginaah, Isaac; Mkandawire, Paul; Tampah Prince, Caesar

    2016-01-01

    This study examines perceptions and experiences of mothers, traditional birth attendants (TBA), and skilled birth attendants (SBA) regarding Ghana's recent policy that forbids TBAs from undertaking deliveries and restricts their role to referrals. In the larger context of Ghana's highly underdeveloped and geographically uneven health care system, this study draws on the political ecology of health framework to explore the ways global safe motherhood policy discourses intersect with local socio-cultural and political environments of Ghana's Upper West Region (UWR). This study reveals that futile improvements in maternal health and the continued reliance on TBAs illustrate the government's inability to understand local realities marked by poor access to SBAs or modern health care services. Using focus group discussions (FGDs) (n = 10) and in-depth interviews (IDIs) (n = 48) conducted in Ghana's UWR, the findings suggest that mothers generally perceive TBAs as better placed to conduct deliveries in rural isolated communities, where in most cases no SBAs are present or easily accessible. The results indicate that by adhering to the World Health Organization's guidelines, the local government may be imposing detrimental, unintended consequences on maternal and child health in remote rural locations. In addition, the findings suggest that the new policy has resulted in considerable confusion among TBAs, many of whom remain oblivious or have not been officially notified about the new policy. Furthermore, participant accounts suggest that the new policy is seen as contributing to worsening relations and tensions between TBAs and SBAs, a situation that undermines the delivery of maternal health services in the region. The study concludes by suggesting relevant policy recommendations.

  16. Caregivers' role in maternal-fetal conflict.

    PubMed

    Avci, Ercan

    2015-01-01

    The case, which occurred in a public hospital in Turkey in 2005, exhibits a striking dilemma between a mother's and her fetus' interests. For a number of reasons, the mother refused to cooperate with the midwives and obstetrician in the process of giving birth, and wanted to leave the hospital. The care providers evaluated the case as a matter of maternal autonomy and asked the mother to give her consent to be discharged from the hospital, which she did despite the fact that her cervix was fully open. She left the hospital and gave birth shortly thereafter. Subsequently, the baby died two days later. In light of the contemporary ethical principles, the mother's competency could be debatable due to the physical and psychological conditions the mother confronted. Furthermore, protection of the fetus' life should have been taken into account by the caregivers when making a decision concerning discharging of the mother.

  17. Severe maternal morbidity in Canada, 1991–2001

    PubMed Central

    Wen, Shi Wu; Huang, Ling; Liston, Robert; Heaman, Maureen; Baskett, Tom; Rusen, I.D.; Joseph, K.S.; for, Michael S. Kramer

    2005-01-01

    Background Although death rates are often used to monitor the quality of health care, in industrialized countries maternal deaths have become rare. Severe maternal morbidity has therefore been proposed as a supplementary indicator for surveillance of the quality of maternity care. Our purpose in this study was to describe severe maternal morbidity in Canada over a 10-year period, among women with or without major pre-existing conditions. Methods We carried out a retrospective cohort study of severe maternal morbidity involving 2 548 824 women who gave birth in Canadian hospitals between 1991 and 2000. Thirteen conditions that may threaten the life of the mother (e.g., eclampsia) and 11 major pre-existing chronic conditions (e.g., diabetes) that could be identified from diagnostic codes were noted. Results The overall rate of severe maternal morbidity was 4.38 per 1000 deliveries. The fatality rate among these women was 158 times that of the entire sample. Rates of venous thromboembolism, uterine rupture, adult respiratory distress syndrome, pulmonary edema, myocardial infarction, severe postpartum hemorrhage requiring hysterectomy, and assisted ventilation increased substantially from 1991 to 2000. The presence of major pre-existing conditions increased the risk of severe maternal morbidity to 6-fold. Interpretation Severe maternal morbidity occurs in about 1 of 250 deliveries in Canada, with marked recent increases in certain morbid conditions such as pulmonary edema, myocardial infarction, hemorrhage requiring hysterectomy, and the use of assisted ventilation. PMID:16186582

  18. [Maternal mortality and referral maternities in Morocco: how to (re)motivate professionals?].

    PubMed

    Péchevis, M; Fernandez, H; Cook, J; Bensalah, A; Aouraghe, M; Benbaha, A

    1999-06-01

    The very high rates of maternal mortality and perinatal mortality, as well as the deficiencies and dysfunctions observed in maternity hospitals, which play the role of referential maternity wards, led the Moroccan Minister of Public Health to implement a project in order to improve the quality of care of parturient women and new-borns. This project included 8 provinces in the country. The strategy chosen was "the team approach to resolving health problems", which is a learning process which leads local teams to implement and evaluate projects they have developed themselves. This pedagogical approach, which is carried out over a period of more than a year, proved itself to be very motivating and mobilising for the professionals included, despite the obstacles that were encountered. It also contributed to creating a true team spirit. Most activities planned within these projects were carried out and many indicators improved.

  19. Mother-baby friendly hospital.

    PubMed

    Aragon-choudhury, P

    1996-01-01

    In Manila, the Philippines, the Dr. Jose Fabella Memorial Hospital has been a maternity hospital for 75 years. It averages 90 deliveries a day. Its fees are P200-P500 for a normal delivery and P800-P2000 for a cesarean section. Patients pay what they can and pay the balance when they can. The hospital provides a safe motherhood package that encompasses teaching responsible parenthood, prenatal care, labor, delivery, postpartum care, breast feeding, family planning, and child survival. In 1986, the hospital introduced innovative policies and procedures that promote, protect, and support breast feeding. It has a rooming-in policy that has saved the hospital P6.5 million so far. In the prenatal stage, hospital staff inform pregnant women that colostrum protects the newborn against infections, that suckling stimulates milk production, and that there is no basis to the claim of having insufficient breast milk. Sales representatives of milk substitutes are banned from the hospital. Staff confiscate milk bottles or formula. A lactation management team demonstrates breast feeding procedures. Mothers also receive support on the correct way of breast feeding from hospital staff, volunteers from the Catholic Women's League, consumer groups, and women lawyers. The hospital's policy is no breast milk, no discharge. This encourages mothers to motivate each other to express milk immediately after birth. The hospital has received numerous awards for its breast feeding promotion efforts. UNICEF has designated Fabella Hospital as a model of the Baby-Friendly Hospital Initiative. The hospital serves as the National Lactation Management Education Training Center. People from other developing countries have received training in lactation management here. The First Lady of the Philippines, the First Lady of the US, and the Queen of Spain have all visited the hospital. The hospital has also integrated its existing services into a women's health care center.

  20. Norovirus - hospital

    MedlinePlus

    Gastroenteritis - norovirus; Colitis - norovirus; Hospital acquired infection - norovirus ... fluids ( dehydration ). Anyone can become infected with norovirus. Hospital patients who are very old, very young, or ...

  1. Lost opportunities for effective management of obstetric conditions to reduce maternal mortality and severe maternal morbidity in Argentina and Uruguay

    PubMed Central

    Karolinski, Ariel; Mazzoni, Agustina; Belizán, José M; Althabe, Fernando; Bergel, Eduardo; Buekens, Pierre

    2010-01-01

    Objective To review the use of evidence-based practices in the care of mothers who died or had severe morbidity attending public hospitals in two Latin American countries. Methods This study is part of a multicenter intervention to increase the use of evidence-based obstetric practice. Data on maternal deaths and women admitted to intensive care units whose deliveries occurred in 24 hospitals in Argentina and Uruguay were analyzed. Primary outcomes were use rates of effective interventions to reduce maternal mortality (MM) and severe maternal morbidity (SMM). Results A total of 106 women were included: 26 maternal deaths and 80 women with SMM. Some effective interventions for severe acute hemorrhage had a high use rate, such as blood transfusion (91%) and timely cesarean delivery (75%), while active management of the third stage of labor (25%) showed a lower rate. The overall use rate of effective interventions was 58% (95% CI, 49%–67%). This implies that 42% of the women did not receive one of the effective interventions to reduce MM and SMM. Conclusion This study shows a low use of effective interventions to reduce MM and SMM in public hospitals in Argentina and Uruguay. Dissemination and implementation of evidence-based practices must be guaranteed to effectively achieve progress on maternal health. PMID:20605151

  2. Maternal mortality in Benghazi: a clinicoepidemiological study.

    PubMed

    Legnain, M; Singh, R; Busarira, M O

    2000-01-01

    We conducted a clinicoepidemiological study of 14 maternal deaths out of 79,981 live births at Al-Jamahiriya Hospital, Benghazi between 1993 and 1997. The maternal mortality rate per 100,000 live births was 17.5. The reproductive profile of these women was: mean age 31.5 +/- 6.9 years, mean parity 4.5, mean birth interval 14.6 +/- 7.0 months, mean gestation 27.7 +/- 14.6 weeks and mean haemoglobin 9.3 +/- 2.1 g/dL. None of the women had prebooked their delivery, 50% had preconceptional medical or obstetric risk factors, around 70% were anaemic, almost all were admitted with serious medical conditions and > 50% required surgical intervention. The main underlying medical causes of death were: hypertensive disease of pregnancy (28.6%), haemorrhage (14.3%), pulmonary embolism (14.3%) and brain tumour (14.3%).

  3. Why did maternal mortality decline in Matlab?

    PubMed

    Maine, D; Akalin, M Z; Chakraborty, J; de Francisco, A; Strong, M

    1996-01-01

    In 1991, an article on the Maternity Care Program in Matlab, Bangladesh, reported a substantial decline in direct obstetric deaths in the intervention area, but not in the control area. The decline was attributed primarily to the posting of midwives at the village level. In this article, data are presented from the same period and area on a variety of intermediate events. They indicate that the decline in deaths was probably due to the combined efforts of community midwives and the physicians at the Matlab maternity clinic. Their ability to refer patients to higher levels of care was important. The data further indicate that the decline in deaths depended upon the functioning of the government hospital in Chandpur, where cesarean sections and blood transfusions were available. Midwives might also have made a special contribution by providing early termination of pregnancy, which is legal in Bangladesh.

  4. Maternal near miss and death among women with severe hypertensive disorders: a Brazilian multicenter surveillance study

    PubMed Central

    2014-01-01

    Background Hypertensive disorders represent the major cause of maternal morbidity in middle income countries. The main objective of this study was to identify the prevalence and factors associated with severe maternal outcomes in women with severe hypertensive disorders. Methods This was a cross-sectional, multicenter study, including 6706 women with severe hypertensive disorder from 27 maternity hospitals in Brazil. A prospective surveillance of severe maternal morbidity with data collected from medical charts and entered into OpenClinica®, an online system, over a one-year period (2009 to 2010). Women with severe preeclampsia, severe hypertension, eclampsia and HELLP syndrome were included in the study. They were grouped according to outcome in near miss, maternal death and potentially life-threatening condition. Prevalence ratios and 95% confidence intervals adjusted for cluster effect for maternal and perinatal variables and delays in receiving obstetric care were calculated as risk estimates of maternal complications having a severe maternal outcome (near miss or death). Poisson multiple regression analysis was also performed. Results Severe hypertensive disorders were the main cause of severe maternal morbidity (6706/9555); the prevalence of near miss was 4.2 cases per 1000 live births, there were 8.3 cases of Near Miss to 1 Maternal Death and the mortality index was 10.7% (case fatality). Early onset of the disease and postpartum hemorrhage were independent variables associated with severe maternal outcomes, in addition to acute pulmonary edema, previous heart disease and delays in receiving secondary and tertiary care. Conclusions In women with severe hypertensive disorders, the current study identified situations independently associated with a severe maternal outcome, which could be modified by interventions in obstetric care and in the healthcare system. Furthermore, the study showed the feasibility of a hospital system for surveillance of severe

  5. Maternal Competition in Women.

    PubMed

    Linney, Catherine; Korologou-Linden, Laurel; Campbell, Anne

    2017-03-01

    We examined maternal competition, an unexplored form of competition between women. Given women's high investment in offspring and mothers' key role in shaping their reproductive, social, and cultural success as adults, we might expect to see maternal competition between women as well as mate competition. Predictions about the effect of maternal characteristics (age, relationship status, educational background, number of children, investment in the mothering role) and child variables (age, sex) were drawn from evolutionary theory and sociological research. Mothers of primary school children (in two samples: N = 210 and 169) completed a series of questionnaires. A novel nine-item measure of maternal competitive behavior (MCQ) and two subscales assessing Covert (MCQ-C) and Face-to-Face (MCQ-FF) forms of competition were developed using confirmatory factor analysis. Competitiveness (MCQ score) was predicted by maternal investment, single motherhood, fewer children, and (marginally) child's older age. The effect of single motherhood (but not other predictors) was partially mediated by greater maternal investment. In response to a scenario of their child underperforming relative to their peers, a mother's competitive distress was a positive function of the importance she ascribed to their success and her estimation of her child's ability. Her competitive distress was highly correlated with the distress she attributed to a female friend, hinting at bidirectional dyadic effects. Qualitative responses indicated that nonspecific bragging and boasting about academic achievements were the most common irritants. Although 40% of women were angered or annoyed by such comments, less than 5% endorsed a direct hostile response. Instead, competitive mothers were conversationally shunned and rejected as friends. We suggest that the interdependence of mothers based on reciprocal childcare has supported a culture of egalitarianism that is violated by explicit competitiveness.

  6. Qualitative study on maternal referrals in rural Tanzania: decision making and acceptance of referral advice.

    PubMed

    Pembe, Andrea B; Urassa, David P; Darj, Elisabeth; Carlsted, Anders; Olsson, Pia

    2008-08-01

    The aim of this study was to describe perceptions of maternal referrals in a rural district in Tanzania. Focus group discussions (FGDs) with health workers and community members, stratified by age and gender, were conducted. The FGDs revealed that husbands and relatives are the decision makers in maternal referrals, whereas the women had limited influence, especially on emergency referrals. The process in deciding to seek referral care is envisaged within community perception of seriousness of the condition, difficulty to access and cost involved in transport, living expenses at the hospital, and perceived quality of care at facility level. The hospitals were seen as providing acceptable quality of care, whereas, the health centres had lower quality than expected. To improve maternal referral compliance and reduce perinatal and maternal morbidity and mortality, community views of existing referral guidelines, poverty reduction, women's empowerment and male involvement in maternal care are necessary.

  7. Salmonella isolation from hospital areas.

    PubMed Central

    Harvey, R. W.; Price, T. H.; Joynson, D. H.

    1979-01-01

    Evidence of the presence of salmonellas in a paediatric ward, a special care baby unit, a maternity unit and a hospital kitchen was obtained by culture of sewer swabs, faeces and food samples. The survey was designed to cause as little administrative interference as possible. The technical aspects of the survey did not strain laboratory facilities. Minimal secondary spread of salmonella infection was experienced. PMID:390044

  8. Inter-Pregnancy Intervals and Maternal Morbidity: New Evidence from Rwanda.

    PubMed

    Habimana-Kabano, Ignace; Broekhuis, Annelet; Hooimeijer, Pieter

    2015-09-01

    The effects of short and long pregnancy intervals on maternal morbidity have hardly been investigated. This research analyses these effects using logistic regression in two steps. First, data from the Rwanda Demographic and Health Survey 2010 are used to study delivery referrals to District hospitals. Second, Kibagabaga District Hospital's maternity records are used to study the effect of inter-pregnancy intervals on maternal morbidity. The results show that both short and long intervals lead to higher odds of being referred because of pregnancy or delivery complications. Once admitted, short intervals were not associated with higher levels of maternal morbidity. Long intervals are associated with higher risks of third trimester bleeding, premature rupture of membrane and lower limb edema, while a higher age at conception is associated with lower risks. Poor women from rural areas and with limited health insurance are less often admitted to a hospital, which might bias the results.

  9. Maternal Attitudes. Progress Report.

    ERIC Educational Resources Information Center

    Harnischfeger, Annegret; Wiley, David E.

    This paper discusses ways in which maternal attitudes may serve as mediating variables linking social class characteristics of the family to the socialization of children. Reference is made to the Family Problem Scale (Ernhart and Loevinger) which provides a psychological characterization of social class levels on five dimensions or subscales:…

  10. Maternity Leave in Taiwan

    ERIC Educational Resources Information Center

    Feng, Joyce Yen; Han, Wen-Jui

    2010-01-01

    Using the first nationally representative birth cohort study in Taiwan, this paper examines the role that maternity leave policy in Taiwan plays in the timing of mothers returning to work after giving birth, as well as the extent to which this timing is linked to the amount of time mothers spend with their children and their use of breast milk…

  11. Maternal Sexuality and Breastfeeding

    ERIC Educational Resources Information Center

    Bartlett, Alison

    2005-01-01

    In this paper I consider the ways in which lactation has been discussed as a form of maternal sexuality, and the implications this carries for our understanding of breastfeeding practices and sexuality. Drawing on knowledge constructed in the western world during the last half of the twentieth century, the paper identifies a shift between the…

  12. The Impact of Cardiac Diseases during Pregnancy on Severe Maternal Morbidity and Mortality in Brazil

    PubMed Central

    Campanharo, Felipe F.; Cecatti, Jose G.; Haddad, Samira M.; Parpinelli, Mary A.; Born, Daniel; Costa, Maria L.; Mattar, Rosiane

    2015-01-01

    Background To evaluate maternal heart disease as a cause or complicating factor for severe morbidity in the setting of the Brazilian Network for Surveillance of Severe Maternal Morbidity. Methods and Findings Secondary data analysis of this multicenter cross-sectional study was implemented in 27 referral obstetric units in Brazil. From July 2009 to June 2010, a prospective surveillance was conducted among all delivery hospitalizations to identify cases of severe maternal morbidity (SMM), including Potentially Life-Threatening Conditions (PLTC) and Maternal Near Miss (MNM), using the new criteria established by the WHO. The variables studied included: sociodemographic characteristics, clinical and obstetric history of the women; perinatal outcome and the occurrence of maternal outcomes (PLTC, MNM, MD) between groups of cardiac and non-cardiac patients. Only heart conditions with hemodynamic impact characterizing severity of maternal morbidity were considered. 9555 women were included in the Network with severe pregnancy-related complications: 770 maternal near miss cases and 140 maternal death cases. A total of 293 (3.6%) cases were related to heart disease and the condition was known before pregnancy in 82.6% of cases. Maternal near miss occurred in 15% of cardiac disease patients (most due to clinical-surgical causes, p<0.001) and 7.7% of non-cardiac patients (hemorrhagic and hypertensive causes, p<0.001). Maternal death occurred in 4.8% of cardiac patients and in 1.2% of non-cardiac patients, respectively. Conclusions In this study, heart disease was significantly associated with a higher occurrence of severe maternal outcomes, including maternal death and maternal near miss, among women presenting with any severe maternal morbidity. PMID:26650684

  13. [Obstetric analgesia in Norwegian hospitals].

    PubMed

    Dahl, V; Hagen, I E; Raeder, J C

    1998-04-30

    We report the results of a questionnaire sent to anaesthetists and midwives on the use of obstetric analgesia and anaesthesia in Norwegian hospitals in 1996. 95% of the 49 hospitals involved responded to the questionnaire, representing a total of 56,884 births. The use of epidural analgesia in labour varied from 0 to 25% in the different hospitals with a mean value of 15%. Epidural analgesia was much more widely used in university and regional hospitals than in local hospitals (p < 0.001). Five of the local hospitals did not offer epidural analgesia during labour at all. The combination of low-dose local anaesthetic and an opioid (either sufentanil or fentanyl) had not been introduced in nine of the hospitals (20%). The optimal use of epidural analgesia to relieve labour pain was judged to be more frequent by the anaesthetists than by the midwives (19% versus 11%, p < 0.01). In response to what factors limited the frequency of epidural analgesia, the anaesthetists specified factors related to the attitude of the midwife, and the midwives specified factors related to the anaesthetist. Only five of the hospitals provided written information on the various analgesic methods that could be employed during labour. The majority of midwives considered the analgesic methods employed on their maternity ward to be good or excellent. The frequency of Caesarean section was 12%; spinal anaesthesia was used in 55%, epidural anaesthesia in 17%, and general anaesthesia in 28% of the cases.

  14. Understanding hospitality.

    PubMed

    Patten, C S

    1994-03-01

    Bridging patient/"customer" issues and business aspects can be aided through developing a specific nursing basis for hospitality. The ancient practice of hospitality has evolved into three distinct levels: public, personal and therapeutic. Understanding these levels is helpful in integrating various dimensions of guest relations programs in hospitals into a more comprehensive vision. Hospitality issues must become a greater part of today's nursing management.

  15. Neuroendocrine regulation of maternal behavior.

    PubMed

    Bridges, Robert S

    2015-01-01

    The expression of maternal behavior in mammals is regulated by the developmental and experiential events over a female's lifetime. In this review the relationships between the endocrine and neural systems that play key roles in these developmental and experiential processes that affect both the establishment and maintenance of maternal care are presented. The involvement of the hormones estrogen, progesterone, and lactogens are discussed in the context of ligand, receptor, and gene activity in rodents and to a lesser extent in higher mammals. The roles of neuroendocrine factors, including oxytocin, vasopressin, classical neurotransmitters, and other neural gene products that regulate aspects of maternal care are set forth, and the interactions of hormones with central nervous system mediators of maternal behavior are discussed. The impact of prior developmental factors, including epigenetic events, and maternal experience on subsequent maternal care are assessed over the course of the female's lifespan. It is proposed that common neuroendocrine mechanisms underlie the regulation of maternal care in mammals.

  16. [Social inequalities in maternal health].

    PubMed

    Azria, E; Stewart, Z; Gonthier, C; Estellat, C; Deneux-Tharaux, C

    2015-10-01

    Although medical literature on social inequalities in perinatal health is qualitatively heterogeneous, it is quantitatively important and reveals the existence of a social gradient in terms of perinatal risk. However, published data regarding maternal health, if also qualitatively heterogeneous, are relatively less numerous. Nevertheless, it appears that social inequalities also exist concerning severe maternal morbidity as well as maternal mortality. Analyses are still insufficient to understand the mechanisms involved and explain how the various dimensions of the women social condition interact with maternal health indicators. Inadequate prenatal care and suboptimal obstetric care may be intermediary factors, as they are related to both social status and maternal outcomes, in terms of maternal morbidity, its worsening or progression, and maternal mortality.

  17. Maternal Deaths Databases Analysis: Ecuador 2003-2013.

    PubMed

    Pino, Antonio; Albán, María; Rivas, Alejandra; Rodríguez, Erika

    2016-08-19

    Background: Maternal mortality ratio in Ecuador is the only millennium goal on which national agencies are still making strong efforts to reach 2015 target. The purpose of the study was to process national maternal death databases to identify a specific association pattern of variable included in the death certificate. Design and methods: The study processed mortality databases published yearly by the National Census and Statistics Institute (INEC). Data analysed were exclusively maternal deaths. Data corresponds to the 2003-2013 period, accessible through INEC's website. Comparisons are based on number of deaths and use an ecological approach for geographical coincidences. Results: The study identified variable association into the maternal mortality national databases showing that to die at home or in a different place than a hospital is closely related to women's socioeconomic characteristics; there was an association with the absence of a public health facility. Also, to die in a different place than the usual residence could mean that women and families are searching for or were referred to a higher level of attention when they face complications. Conclusions: Ecuadorian maternal deaths showed Patterns of inequity in health status, health care provision and health risks. A predominant factor seems unclear to explain the variable association found processing national databases; perhaps every pattern of health systems development played a role in maternal mortality or factors different from those registered by the statistics system may remain hidden. Some random influences might not be even considered in an explanatory model yet.

  18. Rural maternity care: can we learn from Wal-Mart?

    PubMed

    van Teijlingen, E R; Pitchforth, E

    2010-03-01

    In many countries rural maternity care is under threat. Consequently rural pregnant women will have to travel further to attend larger maternity units to receive care and deliver their babies. This trend is not dissimilar from the disappearance of other rural services, such as village shops, banks, post offices and bus services. We use a comparative approach to draw an analogy with large-scale supermarkets, such as the Wal-Mart and Tesco and their effect on the viability of smaller rural shops, depersonalisation of service and the wider community. The closure of a community-maternity unit leads to women attending a different type of hospital with a different approach to maternity care. Thus small community-midwifery units are being replaced, not by a very similar unit that happens to be further away, but by a larger obstetric unit that operates on different models, philosophy and notions of risk. Comparative analysis allows a fresh perspective on the provision of rural maternity services. We argue that previous discussions focusing on medicalisation and change in maternity services can be enhanced by drawing on experience in other sectors and taking a wider societal lens.

  19. [Maternal anaemia: effect on the newborn].

    PubMed

    Toure-Fall, A O; Gadji, M; Diop, S; Dieye, T; Thiam, D; Diakhate, L

    2004-01-01

    Pregnancy increases considerably iron needs in mother and her foetus. The purpose of our study is to measure the effect of maternal anaemia on the foetus and the effect of iron supplementation on the maternal and foetal reserves. Therefore, we conducted a three-month cross sectional study at the gynaecological and obstetrics clinics of Aristide Le Dantec Hospital. Ninety-five women aged 16 to 43 years old and having an haemoglobin rate < 11 g/dl were recruited. Most of them were primipares. Among them 69 had a low ferritinemia (< 50 ng/ml), 36, a ferritinemia collapsed (< 30 ng/ml) and 13 virtually non-existent reserves (< 12 ng/ml). All newborns were born in terms with an apgar score >/= in 93 of them. Among them 24 had anemia (rate of haemoglobin < 14 g/dl) and 54.7% a low ferritinemia. There is no relationship between the maternal and foetal rates of haemoglobin; 74% of newborn had a normal rate of haemoglobin. Among 36 women with low ferritinemia only two gave birth to a newborn without iron reserves. In our study, among 68 women who received iron regularly, 41 had normal reserves and 43 gave birth to a newborn with high ferritinemia. There is significant difference between the women having received iron during their pregnancy and those not supplemented as regards the effect on newborn (p = 0.00001). The prevention of iron deficiency and anaemia can be done by the iron systematic and premat supplementation.

  20. Maternal serum screening.

    PubMed Central

    Carroll, J. C.

    1994-01-01

    Maternal serum screening (MSS) measures three serum markers: alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol, from which the risk of fetal Down syndrome or open neural tube defect is calculated. Initially, 8% of women will have positive results. I present a protocol for investigating these women. Family physicians should be informed about MSS so they can give their patients information and guidance. PMID:7524838

  1. Are Free Maternity Services Completely Free of Costs?

    PubMed Central

    Acharya, Jeevan

    2015-01-01

    Objectives The Government of Nepal revised free maternity health services, “Aama Surakshya Karyakram”, beginning at the start of Fiscal Year 2012/13, which specifies the services to be funded, the tariffs for reimbursement, and the system for claiming and reporting on free deliveries each month. This study was designed to investigate the amount of monetary expenditure incurred by families using apparently free maternity services. Methods Between August 2014 and December 2014, a hospital-based cross-sectional study was conducted at Manipal Teaching Hospital and Western Regional Hospital. Nepalese women were not involved with family finances and had very little knowledge of income or expenditures. Therefore, face-to-face interviews with 384 postpartum mothers with their husbands or the head of the family household were conducted at the time of discharge by using a pre-tested semi-structural questionnaire. Results The average monthly family income was 19,272.4 NRs (189.01 US$), the median duration of hospital stay was 4 days (range, 2−19 days), and the median patient expenditure was equivalent to 13% of annual family income. The average total visible cost was 3,887.07 NRs (38.1 US$). When the average total hidden cost of 27,288.5 NRs (267.6 US$) was added, then the average total maternity care expenditure was 31,175.6 NRs (305.76 US$), with an average cost per day of 7,167.5 NRs (70.29 US$). The mean patient expenditure on food and drink, clothes, transport, and medicine was equivalent to 53.07%, 9.8%. 7.3%, and 5.6% of the mean total maternity care expenditure, respectively. The earnings lost by respondent women, husbands, and heads of household were 5,963.7 NRs (58.4 US$), 7,429.3 NRs (72.9 US$), and 6,175.9 NRs (60.6 US$), respectively. Conclusion The free maternity service in Nepal has high out-of-pocket expenditures, and did not represent a system completely free of costs. Therefore, arrangements should be made by hospitals free of cost to provide

  2. Relationship between maternal pelvis height and other anthropometric measurements in a multisite cohort of Ugandan mothers

    PubMed Central

    Munabi, Ian Guyton; Byamugisha, Josaphat; Luboobi, Livingstone; Luboga, Samuel Abilemech; Mirembe, Florence

    2016-01-01

    Introduction In sub Saharan Africa, childbirth remains a challenge that creates the need for additional screening tools. Maternal pelvis height, which is currently in use by automotive engineers has previously been shown to have significant associations with various childbirth related outcomes and events. This study set out to determine the associations between maternal: Age, height, weight and number of pregnancies with maternal pelvis height in Ugandan mothers. Methods This was a secondary analysis of maternal birth records from nine Ugandan hospitals, of mothers with singleton pregnancies. Data was analyzed using multilevel regression with respect to maternal pelvis height and additional analysis for tribe and site of childbirth intraclass correlations (ICCs). Results The mean maternal pelvis height was 7.30cm for the 2068 records. Maternal pelvis height was associated with: a 0.01cm reduction per centimeter of maternal height (P=0.02), 0.01cm increase per kg of maternal weight (P<0.01), 0.04cm increase for each additional pregnancy (P=0.03) and 0.03cm increase with respect to tribe of mother (P=0.27), for a constant of 7.97cm (P<0.01). The ICC for tribe was 0.20 (SE=0.08) and 0.37 (SE=0.11) for site. Conclusion Maternal pelvis height was associated with maternal height, maternal weight and number of pregnancies. The site of childbirth had a moderate effect on the above associations with maternal pelvis height. More study on the public health screening value of these measurements in these settings is required. PMID:27800110

  3. Maternally acquired runt disease.

    PubMed

    Beer, A E; Billingham, R E

    1973-01-19

    Without altering the structural integrity of the placenta by irradiation or drugs, we have shown that it is possible to immunize females both adoptively and actively against the paternally inherited transplantation antigens of their fetuses. Such immunization causes a high incidence of runt disease among the litters. Although the putative chimeric status of the affected offspring has yet to be confirmed, the results of our experiments support the thesis that runt disease is caused by the activities of "unwanted" immigrant lymphocytes from the maternal circulation. Our results suggest that immunologically activated cells are more likely to cross the placenta than normal cells and that this greater mobility may not be related to the immunologic specificity of the activated cells. Two factors may have contributed to the apparent failure of numerous previous attempts to demonstrate the capacity of transplantation immunity to affect the well-being of a fetus or, more correctly, its placenta, in the way that might be expected of a homograft. (i) Investigators were preoccupied with obtaining a classic type of rejection, in utero, analogous to the rejection of an orthotopic skin homograft. The birth of consistently healthy-looking litters, interpreted as a failure of the experiment, convinced the investigators of the efficacy of nature's solution of the homograft problem and there was no reason for them to suspect its possible limitations. Observation of the litters for several weeks might have uncovered the phenomenon of maternally induced runt disease. (ii) Most investigators resorted to hyperimmunization of the mothers. This would have facilitated the synthesis of protective isoantibodies capable of interfering with the expression of the potentially harmful cellular immune response (6). Ever since the abnormalities of runt disease were first described they have repeatedly been compared to those observed in patients with certain lymphomas (17). Various theories have been

  4. Planning Nurses in Maternity Care: a Stochastic Assignment Problem

    NASA Astrophysics Data System (ADS)

    Phillipson, Frank

    2015-05-01

    With 23 percent of all births taking place at home, The Netherlands have the highest rate of home births in the world. Also if the birth did not take place at home, it is not unusual for the mother and child to be out of hospital in a few hours after the baby was born. The explanation for both is the very well organised maternity care system. However, getting the right maternity care nurse available on time introduces a complex planning issue that can be recognized as a Stochastic Assignment Problem. In this paper an expert rule based approach is combined with scenario analysis to support the planner of the maternity care agency in his work.

  5. To Assess the Effect of Maternal BMI on Obstetrical Outcome

    NASA Astrophysics Data System (ADS)

    Lakhanpal, Shuchi; Aggarwal, Asha; Kaur, Gurcharan

    2012-06-01

    AIMS: To assess the effect of maternal BMI on complications in pregnancy, mode of delivery, complications of labour and delivery.METHODS:A crossectional study was carried out in the Obst and Gynae department, Kasturba Hospital, Delhi. The study enrolled 100 pregnant women. They were divided into 2 groups based on their BMI, more than or equal to 30.0 kg/m2 were categorized as obese and less than 30 kg/m2 as non obese respectively. Maternal complications in both types of patients were studied.RESULTS:CONCLUSION: As the obstetrical outcome is significantly altered due to obesity, we can improve maternal outcome by overcoming obesity. As obesity is a modifiable risk factor, preconception counseling creating awareness regarding health risk associated with obesity should be encouraged and obstetrical complications reduced.

  6. Postpartum early discharge: impact on maternal fatigue and functional ability.

    PubMed

    Smith-Hanrahan, C; Deblois, D

    1995-02-01

    The purpose of this study was to determine the impact of a postpartum early discharge program, with home follow-up by hospital nursing staff, on the maternal fatigue and functional ability of low-risk mothers with healthy neonates. A quasi-experimental design was used. Subjects were randomly assigned to one of two groups receiving the early-discharge program (hospital stay less than 60 hours plus home follow-up by hospital-based nurses; n = 35) or traditional hospital care (hospital stay more than 60 hours and no home follow-up by hospital staff; n = 17). A third group emerged from those originally assigned to traditional care but later transferred to early discharge due to bed shortages (n = 29). The Rhoten Fatigue Scale and the Inventory of Functional Status After Childbirth were used to collect the data at discharge and 1 and 6 weeks postpartum period. No significant differences between groups were found, suggesting that early discharge with adequate home follow-up does not affect the low-risk mother's fatigue and functional ability to any significantly greater extent than traditional care. It was also noted that, regardless of type of care, the proportion of subjects reporting severe fatigue was relatively large (25%, 31%, and 19% at discharge, 1 and 6 weeks postpartum period), highlighting the need for further study of maternal fatigue in the postpartum period.

  7. Maternal mortality and accessibility to health services by means of transit-network estimated traveled distances.

    PubMed

    Simões, Patricia Passos; Almeida, Renan Moritz V R

    2014-08-01

    This study analyzed the relationship between maternal mortality and variables related to the use of health services (especially residence-hospital traveled distances estimated through transit networks). Deaths were identified for Rio de Janeiro and adjacent cities, from 2000 to 2002, and were matched by age and socio-economic level to birth admissions without maternal deaths (1 case to 3 controls). The variables used were: type of hospital (general × specialized maternity services), number of hospital beds, nature of hospital ownership (public × private-associated), main admission diagnostic, residence-hospital distance, age, income, and education. Distances were estimated by a geographic information system, and were based on most probable itineraries through the urban transit networks. The probability of death was estimated by conditional logistic regression models. 226 maternal deaths were studied, and another 10 were excluded due to incompleteness of information. The ROC area for the final model was 0.89 [95% CI (0.87-0.92)]. This model retained statistical significance for the variables admission diagnostic, type of hospital and residence-hospital distance. The death odds ratio for women who traveled 5-10 km (reference category: <5 km) was 3.84 [95% CI (1.96-7.55)]. The traveled distance measured through transit networks was an important risk factor for death in the studied population.

  8. National survey of hospital patients.

    PubMed Central

    Bruster, S.; Jarman, B.; Bosanquet, N.; Weston, D.; Erens, R.; Delbanco, T. L.

    1994-01-01

    OBJECTIVE--To survey patients' opinions of their experiences in hospital in order to produce data that can help managers and doctors to identify and solve problems. DESIGN--Random sample of 36 NHS hospitals, stratified by size of hospital (number of beds), area (north, midlands, south east, south west), and type of hospital (teaching or non-teaching, trust or directly managed). From each hospital a random sample of, on average, 143 patients was interviewed at home or the place of discharge two to four weeks after discharge by means of a structured questionnaire about their treatment in hospital. SUBJECTS--5150 randomly chosen NHS patients recently discharged from acute hospitals in England. Subjects had been patients on medical and surgical wards apart from paediatric, maternity, psychiatric, and geriatric wards. MAIN OUTCOME MEASURES--Patients' responses to direct questions about preadmission procedures, admission, communication with staff, physical care, tests and operations, help from staff, pain management, and discharge planning. Patients' responses to general questions about their degree of satisfaction in hospitals. RESULTS--Problems were reported by patients, particularly with regard to communication with staff (56% (2824/5020) had not been given written or printed information); pain management (33% (1042/3162) of those suffering pain were in pain all or most of the time); and discharge planning (70% (3599/5124) had not been told about warning signs and 62% (3177/5119) had not been told when to resume normal activities). Hospitals failed to reach the standards of the Patient's Charter--for example, in explaining the treatment proposed and giving patients the option of not taking part in student training. Answers to questions about patient satisfaction were, however, highly positive but of little use to managers. CONCLUSIONS--This survey has highlighted several problems with treatment in NHS hospitals. Asking patients direct questions about what happened

  9. The Relationship between Maternal Plasma Leptin and Adiponectin Concentrations and Newborn Adiposity

    PubMed Central

    Castro, Natália P.; Euclydes, Verônica V.; Simões, Fernanda A.; Vaz-de-Lima, Lourdes R. A.; De Brito, Cyro A.; Luzia, Liania A.; Devakumar, Delan; Rondó, Patrícia H. C.

    2017-01-01

    Increased maternal blood concentrations of leptin and decreased adiponectin levels, which are common disturbances in obesity, may be involved in offspring adiposity by programming fetal adipose tissue development. The aim of this study was to assess the relationship between maternal leptin and adiponectin concentrations and newborn adiposity. This was a cross-sectional study involving 210 healthy mother-newborn pairs from a public maternity hospital in São Paulo, Brazil. Maternal blood samples were collected after delivery and leptin and adiponectin concentrations were measured by enzyme-linked immunosorbent assay. Newborn body composition was estimated by air displacement plethysmography. The association between maternal leptin and adiponectin concentrations and newborn adiposity (fat mass percentage, FM%) was evaluated by multiple linear regression, controlling for maternal age, socioeconomic status, parity, pre-pregnancy body mass index (BMI), weight gain, gestational age, and newborn age at the time of measurement. No relationship was found between maternal leptin and FM% of male or female newborn infants. Maternal adiponectin (p = 0.001) and pre-pregnancy BMI (p < 0.001; adj. R2 = 0.19) were positively associated with FM% of newborn males, indicating that maternal adiponectin is involved in fetal fat deposition in a sex-specific manner. Large-scale epidemiological, longitudinal studies are necessary to confirm our results. PMID:28241462

  10. Maternal Depression, Maternal Expressed Emotion, and Youth Psychopathology

    ERIC Educational Resources Information Center

    Tompson, Martha C.; Pierre, Claudette B.; Boger, Kathryn Dingman; McKowen, James W.; Chan, Priscilla T.; Freed, Rachel D.

    2010-01-01

    Across development, maternal depression has been found to be a risk factor for youth psychopathology generally and youth depression specifically. Maternal Expressed Emotion (EE) has been examined as a predictor of outcome among youth with depression. The present study explored the associations between youth psychopathology and two…

  11. Child Health, Maternal Marital and Socioeconomic Factors, and Maternal Health

    ERIC Educational Resources Information Center

    Garbarski, Dana; Witt, Whitney P.

    2013-01-01

    Although maternal socioeconomic status and health predict in part children's future health and socioeconomic prospects, it is possible that the intergenerational association flows in the other direction such that child health affects maternal outcomes. Previous research demonstrates that poor child health increases the risk of adverse maternal…

  12. Maternal ethanol ingestion: effect on maternal and neonatal glucose balance

    SciTech Connect

    Witek-Janusek, L.

    1986-08-01

    Liver glycogen availability in the newborn is of major importance for the maintenance of postnatal blood glucose levels. This study examined the effect of maternal ethanol ingestion on maternal and neonatal glucose balance in the rate. Female rats were placed on 1) the Lieber-DeCarli liquid ethanol diet, 2) an isocaloric liquid pair-diet, or 3) an ad libitum rat chow diet at 3 wk before mating and throughout gestation. Blood and livers were obtained from dams and rat pups on gestational days 21 and 22. The pups were studied up to 6 h in the fasted state and up to 24 h in the fed state. Maternal ethanol ingestion significantly decreased litter size, birth weight, and growth. A significantly higher mortality during the early postnatal period was seen in the prenatal ethanol exposed pups. Ethanol significantly decreased fed maternal liver glycogen stores but not maternal plasma glucose levels. The newborn rats from ethanol ingesting dams also had significantly decreased liver glycogen stores. Despite mobilizing their available glycogen, these prenatal ethanol exposed pups became hypoglycemic by 6 h postnatal. This was more marked in the fasted pups. Ethanol did not affect maternal nor neonatal plasma insulin levels. Thus maternal ethanol ingestion reduces maternal and neonatal liver glycogen stores and leads to postnatal hypoglycemia in the newborn rat.

  13. Maternal mortality in New York--Looking back, looking forward.

    PubMed

    Chazotte, Cynthia; D'Alton, Mary E

    2016-03-01

    New York City was ahead of its time in recognizing the issue of maternal death and the need for proper statistics. New York has also documented since the 1950s the enormous public health challenge of racial disparities in maternal mortality. This paper addresses the history of the first Safe Motherhood Initiative (SMI), a voluntary program in New York State to review reported cases of maternal deaths in hospitals. Review teams found that timely recognition and intervention in patients with serious morbidity could have prevented many of the deaths reviewed. Unfortunately the program was defunded by New York State. The paper then focuses on the revitalization of the SMI in 2013 to establish three safety bundles across the state to be used in the recognition and treatment of obstetric hemorrhage, severe hypertension in pregnancy, and the prevention of venous thromboembolism; and their introduction into 118 hospitals across the state. The paper concludes with a look to the future of the coordinated efforts needed by various organizations involved in women's healthcare in New York City and State to achieve the goal of a review of all maternal deaths in the state by a multidisciplinary team in a timely manner so that appropriate feedback to the clinical team can be given and care can be modified and improved as needed. It is the authors' opinion that we owe this type of review to the women of New York who entrust their care to us.

  14. Family Centered Maternity Care

    PubMed Central

    Enkin, Murray W.

    1973-01-01

    Current practices of obstetrical care tend to hinder rather than facilitate family development and maturation. A program of family centred maternity care is described. Husbands are invited to prenatal visits, and are involved in intensive preparation for labor and delivery. Their presence and active participation in labor, delivery, and postpartum course are encouraged. This, along with a rooming-in policy for the baby, and the utilization of the postpartum period for an intensive training in parenthood, appears to produce a safe and satisfying obstetrical experience for the family. PMID:20468914

  15. Polybrominated diphenyl ethers in maternal and fetal blood samples.

    PubMed Central

    Mazdai, Anita; Dodder, Nathan G; Abernathy, Mary Pell; Hites, Ronald A; Bigsby, Robert M

    2003-01-01

    Polybrominated diphenyl ethers (PBDEs) are widely used as flame retardants in consumer goods, such as plastics, electronics, textiles, and construction material. PBDEs have been found in human milk, fat, and blood samples. Rodent studies indicate that PBDEs may be detrimental to neurodevelopment, possibly by lowering thyroid hormone concentrations in blood. In the present study, we determined concentrations of PBDEs and thyroid hormones in human fetal and maternal serum. Patients presenting in labor to Indiana University and Wishard Memorial County hospitals in Indianapolis, who were older than 18 years, were recruited to participate. Twelve paired samples of maternal and cord blood were obtained and analyzed using gas chromatographic mass spectrometry; thyroid hormone concentrations were determined by radioimmunoassay. Six congeners of PBDE were measured in maternal and fetal serum samples. The concentrations of total PBDEs found in maternal sera ranged from 15 to 580 ng/g lipid, and the concentrations found in fetal samples ranged from 14 to 460 ng/g lipid. Individual fetal blood concentrations did not differ from the corresponding maternal concentrations, indicating that measurement of maternal PBDE blood levels is useful in predicting fetal exposure; similarly, other reports have shown a high correlation between PBDE in mother's milk and fetal exposure. In accord with reports on other biologic samples, the tetrabrominated PBDE congener BDE-47 accounted for 53-64% of total PBDEs in the serum. The concentrations of PBDEs found in maternal and fetal serum samples were 20-106-fold higher than the levels reported previously in a similar population of Swedish mothers and infants. In this small sample, there was no apparent correlation between serum PBDEs and thyroid hormone concentrations. Our study shows that human fetuses in the United States may be exposed to relatively high levels of PBDEs. Further investigation is required to determine if these levels are

  16. Decline in maternal mortality in Matlab, Bangladesh: a cautionary tale.

    PubMed

    Ronsmans, C; Vanneste, A M; Chakraborty, J; van Ginneken, J

    This study examines the impact of the Maternal-Child Health and Family Planning (MCH-FP) program in the Matlab, Bangladesh. Data were obtained from the Matlab surveillance system for treatment and comparison areas. This study reports the trends in maternal mortality since 1976. The MCH-FP area received extensive services in health and family planning since 1977. Services included trained traditional birth attendants and essential obstetric care from government district hospitals and a large number of private clinics. Geographic ease of access to essential obstetric care varied across the study area. Access was most difficult in the northern sector of the MCH-FP area. Contraception was made available through family welfare centers. Tetanus immunization was introduced in 1979. Door-to-door contraceptive services were provided by 80 female community health workers on a twice-monthly basis. In 1987, a community-based maternity care program was added to existing MCH-FP services in the northern treatment area. The demographic surveillance system began collecting data in 1966. During 1976-93 there were 624 maternal deaths among women aged 15-44 years in Matlab (510/100,000 live births). 72.8% of deaths were due to direct obstetric causes: postpartum hemorrhage, induced abortion, eclampsia, dystocia, and postpartum sepsis. Maternal mortality declined in a fluctuating fashion in both treatment and comparison areas. Direct obstetric mortality declined at about 3% per year. After 1987, direct obstetric mortality declined in the north by almost 50%. After the 1990 program expansion in the south, maternal mortality declined, though not significantly, in the south. Maternal mortality declined in the south comparison area during 1987-89 and stabilized. The comparison area of the north showed no decline.

  17. Prenatal Maternal Smoking and Tourette Syndrome: A Nationwide Register Study.

    PubMed

    Leivonen, Susanna; Chudal, Roshan; Joelsson, Petteri; Ekblad, Mikael; Suominen, Auli; Brown, Alan S; Gissler, Mika; Voutilainen, Arja; Sourander, Andre

    2016-02-01

    This is the first nationwide register-based study to examine the relationship between prenatal maternal smoking and Tourette syndrome. A total of 767 children diagnosed with Tourette syndrome were identified from the Finnish Hospital Discharge Register. Each case was matched to four controls. Information on maternal smoking during pregnancy was obtained from the Finnish Medical Birth Register. Conditional logistic regression models were used for statistical analyses. Prenatal maternal smoking was associated with Tourette syndrome when comorbid with ADHD (OR 4.0, 95 % CI 1.2-13.5, p = 0.027 for exposure during first trimester, OR 1.7, 95 % CI, 1.05-2.7, p = 0.031 for exposure for the whole pregnancy). There was no association between maternal smoking during pregnancy and Tourette syndrome without comorbid ADHD (OR 0.5, 95 % CI 0.2-1.3, p = 0.166, OR 0.9, 95 % CI 0.7-1.3, p = 0.567). Further research is needed to elucidate the mechanisms behind the association between prenatal maternal smoking and Tourette syndrome with comorbid ADHD.

  18. Maternal Deaths Databases Analysis: Ecuador 2003-2013

    PubMed Central

    Pino, Antonio; Albán, María; Rivas, Alejandra; Rodríguez, Erika

    2016-01-01

    Background: Maternal mortality ratio in Ecuador is the only millennium goal on which national agencies are still making strong efforts to reach 2015 target. The purpose of the study was to process national maternal death databases to identify a specific association pattern of variable included in the death certificate. Design and methods: The study processed mortality databases published yearly by the National Census and Statistics Institute (INEC). Data analysed were exclusively maternal deaths. Data corresponds to the 2003-2013 period, accessible through INEC’s website. Comparisons are based on number of deaths and use an ecological approach for geographical coincidences. Results: The study identified variable association into the maternal mortality national databases showing that to die at home or in a different place than a hospital is closely related to women’s socioeconomic characteristics; there was an association with the absence of a public health facility. Also, to die in a different place than the usual residence could mean that women and families are searching for or were referred to a higher level of attention when they face complications. Conclusions: Ecuadorian maternal deaths showed Patterns of inequity in health status, health care provision and health risks. A predominant factor seems unclear to explain the variable association found processing national databases; perhaps every pattern of health systems development played a role in maternal mortality or factors different from those registered by the statistics system may remain hidden. Some random influences might not be even considered in an explanatory model yet. Significance for public health General agreement on maternal mortality reduction suggests that to reach the millennium target a health system must to be able to provide essential, and emergency obstetric care in a well allocate, geographic, ethnic, and socioeconomic distribution of resources. Patterns of inequity in health status

  19. Maternal Employment and Adolescent Development.

    ERIC Educational Resources Information Center

    Montemayor, Raymond; Clayton, Mark D.

    1983-01-01

    The relationship between maternal employment and adolescent development is enormously complex, and no simple generalizations are possible. Many intervening variables alter the impact that maternal employment has on adolescent development. There is an urgent need to discover what impact this arrangement has on adolescent development. (CJ)

  20. Evolution of maternal effect senescence

    PubMed Central

    Moorad, Jacob A.; Nussey, Daniel H.

    2016-01-01

    Increased maternal age at reproduction is often associated with decreased offspring performance in numerous species of plants and animals (including humans). Current evolutionary theory considers such maternal effect senescence as part of a unified process of reproductive senescence, which is under identical age-specific selective pressures to fertility. We offer a novel theoretical perspective by combining William Hamilton’s evolutionary model for aging with a quantitative genetic model of indirect genetic effects. We demonstrate that fertility and maternal effect senescence are likely to experience different patterns of age-specific selection and thus can evolve to take divergent forms. Applied to neonatal survival, we find that selection for maternal effects is the product of age-specific fertility and Hamilton’s age-specific force of selection for fertility. Population genetic models show that senescence for these maternal effects can evolve in the absence of reproductive or actuarial senescence; this implies that maternal effect aging is a fundamentally distinct demographic manifestation of the evolution of aging. However, brief periods of increasingly beneficial maternal effects can evolve when fertility increases with age faster than cumulative survival declines. This is most likely to occur early in life. Our integration of theory provides a general framework with which to model, measure, and compare the evolutionary determinants of the social manifestations of aging. Extension of our maternal effects model to other ecological and social contexts could provide important insights into the drivers of the astonishing diversity of lifespans and aging patterns observed among species. PMID:26715745

  1. Towards elimination of maternal deaths: maternal deaths surveillance and response.

    PubMed

    Hounton, Sennen; De Bernis, Luc; Hussein, Julia; Graham, Wendy J; Danel, Isabella; Byass, Peter; Mason, Elizabeth M

    2013-01-02

    Current methods for estimating maternal mortality lack precision, and are not suitable for monitoring progress in the short run. In addition, national maternal mortality ratios (MMRs) alone do not provide useful information on where the greatest burden of mortality is located, who is concerned, what are the causes, and more importantly what sub-national variations occur. This paper discusses a maternal death surveillance and response (MDSR) system. MDSR systems are not yet established in most countries and have potential added value for policy making and accountability and can build on existing efforts to conduct maternal death reviews, verbal autopsies and confidential enquiries. Accountability at national and sub-national levels cannot rely on global, regional and national retrospective estimates periodically generated from academia or United Nations organizations but on routine counting, investigation, sub national data analysis, long term investments in vital registration and national health information systems. Establishing effective maternal death surveillance and response will help achieve MDG 5, improve quality of maternity care and eliminate maternal mortality (MMR ≤ 30 per 100,000 by 2030).

  2. Towards elimination of maternal deaths: maternal deaths surveillance and response

    PubMed Central

    2013-01-01

    Current methods for estimating maternal mortality lack precision, and are not suitable for monitoring progress in the short run. In addition, national maternal mortality ratios (MMRs) alone do not provide useful information on where the greatest burden of mortality is located, who is concerned, what are the causes, and more importantly what sub-national variations occur. This paper discusses a maternal death surveillance and response (MDSR) system. MDSR systems are not yet established in most countries and have potential added value for policy making and accountability and can build on existing efforts to conduct maternal death reviews, verbal autopsies and confidential enquiries. Accountability at national and sub-national levels cannot rely on global, regional and national retrospective estimates periodically generated from academia or United Nations organizations but on routine counting, investigation, sub national data analysis, long term investments in vital registration and national health information systems. Establishing effective maternal death surveillance and response will help achieve MDG 5, improve quality of maternity care and eliminate maternal mortality (MMR ≤ 30 per 100,000 by 2030). PMID:23279882

  3. Maternal Deaths Due to Sepsis in the State of Michigan, 1999–2006

    PubMed Central

    Bauer, Melissa E.; Lorenz, Robert P.; Bauer, Samuel T.; Rao, Krishna; Anderson, Frank W.J.

    2015-01-01

    Objective To identify maternal deaths due to sepsis in the state of Michigan, review the events leading to diagnosis, and evaluate treatment to identify areas for improvement. Methods A case series was collected for maternal deaths due to sepsis from a cohort of maternal deaths in the state of Michigan. The study period was 1999–2006 and included deaths during pregnancy and up to 42 days postpartum. Cases were identified using Maternal Mortality Surveillance records from the Michigan Department of Community Health. Each case was reviewed by all authors. Results Maternal sepsis was the cause of death in 14.6% (22/151) of pregnancy-related deaths. Of 22 deaths, 13 women presented to the hospital with sepsis, two developed sepsis during hospitalization, and seven developed sepsis at home without admission to the hospital for care. Review of available hospital records (n=15) revealed delays in initial appropriate antibiotic treatment occurred in 73% (11/15) of patients. Delay in escalation of care also occurred and was identified in 53% (8/15) of patients. Conclusion Common elements in these deaths illustrate three key delays that may have contributed to the deaths: in recognition of sepsis, in administration of appropriate antibiotics, and in escalation of care. PMID:26348189

  4. Hospital marketing.

    PubMed

    Carter, Tony

    2003-01-01

    This article looks at a prescribed academic framework for various criteria that serve as a checklist for marketing performance that can be applied to hospital marketing organizations. These guidelines are drawn from some of Dr. Noel Capon of Columbia University's book Marketing Management in the 21st Century and applied to actual practices of hospital marketing organizations. In many ways this checklist can act as a "marketing" balanced scorecard to verify performance effectiveness and develop opportunities for innovation.

  5. Hospital philanthropy.

    PubMed

    Smith, Dean G; Clement, Jan P

    2013-01-01

    It remains an open question whether hospital spending on fundraising efforts to garner philanthropy is a good use of funds. Research and industry reports provide conflicting results. We describe the accounting and data challenges in analysis of hospital philanthropy, which include measurement of donations, measurement of fundraising expenses, and finding the relationships among organizations where these cash flows occur. With these challenges, finding conflicting results is not a surprise.

  6. Maternal Risk Factors for Neonatal Necrotizing Enterocolitis

    PubMed Central

    March, Melissa I.; Gupta, Munish; Modest, Anna M.; Wu, Lily; Hacker, Michele R.; Martin, Camilia R.; Rana, Sarosh

    2015-01-01

    Objective This study aimed to investigate the relationship between maternal hypertensive disease and other risk factors and the neonatal development of necrotizing enterocolitis (NEC). Methods This was a retrospective case control study of infants with NEC from 2008 to 2012. The primary exposure of interest was maternal hypertensive disease, which has been hypothesized to put infants at risk for NEC. Other variables collected included demographics, pregnancy complications, medications, and neonatal hospital course. Data was abstracted from medical records. Results 28 cases of singleton neonates with NEC and 81 matched controls were identified and analyzed. There was no significant difference in the primary outcome. Fetuses with an antenatal diagnosis of growth restriction were more likely to develop NEC (p=0.008). Infants with NEC had lower median birth weight than infants without NEC (p=0.009). Infants with NEC had more late-onset sepsis (p=0.01) and mortality before discharge (p=0.001). Conclusions The factors identified by this case-control study that increased the risk of neonatal NEC included intrauterine growth restriction and lower neonatal birth weight. The primary exposure, hypertensive disease, did not show a significantly increased risk of neonatal NEC, however there was a nearly two-fold difference observed. Our study was underpowered to detect the observed difference. PMID:25162307

  7. Neurocysticercosis in pregnancy: maternal and fetal outcomes

    PubMed Central

    D'Cruz, Rebecca F.; Ng, Sher M.; Dassan, Pooja

    2016-01-01

    Neurocysticercosis (NCC) is a parasitic infection with the larvae of Taenia solium from contaminated pork. It is a leading cause of seizures in the developing world. Symptoms may be secondary to live or degenerating cysts, or previous infection causing calcification or gliosis. Diagnosis is based on clinical presentation, radiological confirmation of intracranial lesions and immunological testing. Management involves symptom control with antiepileptics and antiparasitic agents. Few cases have been described of maternal NCC during pregnancy. We describe a 25-year-old female presenting to a London hospital with secondary generalized seizures. MRI of the brain confirmed a calcified lesion in the right parietal lobe, and she gave a corroborative history of NCC during her childhood in India. She was stabilized initially on antiepileptics, but during her pregnancy presented with breakthrough seizures and radiological evidence of NCC reactivation. She was managed symptomatically with antiepileptics and completed the pregnancy to term with no fetal complications. PMID:27471595

  8. Fetal growth and birth size is associated with maternal anthropometry and body composition.

    PubMed

    Thame, Minerva; Osmond, Clive; Trotman, Helen

    2015-10-01

    The objective was to investigate the association of maternal weight, height and body composition with fetal growth. We recruited 425 women at the University Hospital of the West Indies, Jamaica, who had singleton pregnancies, were less than 15 weeks gestation and had no systemic illness. Maternal weight, height and skinfold thicknesses were measured at the first antenatal visit and lean mass was calculated. Sonographic measurements of the fetus were made at 15, 25 and 35 weeks gestation. Weight, crown-heel length and head circumference were measured at birth. Analyses were confined to 360 (85%) women; 65 women did not complete the study. Maternal height was positively associated with femoral length at 25 and 35 weeks gestation and with head circumference at 35 weeks (all P < 0.02). Maternal weight was positively associated with abdominal circumference and femoral length at 25 weeks, and with larger head and abdominal circumference and longer femur at 35 weeks (all P < 0.02). Maternal lean mass had similar associations to maternal weight and they were both positively associated with estimated fetal weight (all P < 0.02). All three maternal measurements were positively associated with birthweight, length and head circumference. Maternal size was associated with fetal size as early as 25 weeks gestation, with height strongly associated with femoral length, and with weight and lean mass strongly associated with abdominal circumference.

  9. Association of maternal age with child health: A Japanese longitudinal study

    PubMed Central

    2017-01-01

    Average maternal age at birth has been rising steadily in Western and some Asian countries. Older maternal age has been associated with adverse pregnancy and birth outcomes; however, studies on the relationship between maternal age and young children’s health remain scarce. Therefore, we sought to investigate the association of maternal age with child health outcomes in the Japanese population. We analyzed data from two birth cohorts of the nationwide Japanese Longitudinal Survey of Babies in 21st Century (n2001 = 47,715 and n2010 = 38,554). We estimated risks of unintentional injuries and hospital admissions at 18 and 66 months according to maternal age, controlling for the following potential confounders: parental education; maternal parity, smoking status, and employment status; household income; paternal age, and sex of the child. We also included the following as potential mediators: preterm births and birthweight. We observed a decreasing trend in the risks of children’s unintentional injuries and hospital admissions at 18 months according to maternal age in both cohorts. In the 2001 cohort, compared to mothers <25 years, odds ratios of hospital admission at 18 months were 0.97 [95% CI: 0.86, 1.09], 0.92 [0.81, 1.05], 0.76 [0.65, 0.90], and 0.71 [0.51, 0.98] for mothers aged 25.0–29.9, 30.0–34.9, 35.0–39.9, and >40.0 years, respectively, controlling for confounders. Our findings were in line with previous findings from population-based studies conducted in the United Kingdom and Canada suggesting that older maternal age may be beneficial for early child health. PMID:28234951

  10. In utero pesticide exposure, maternal paraoxonase activity, and head circumference.

    PubMed

    Berkowitz, Gertrud S; Wetmur, James G; Birman-Deych, Elena; Obel, Josephine; Lapinski, Robert H; Godbold, James H; Holzman, Ian R; Wolff, Mary S

    2004-03-01

    Although the use of pesticides in inner-city homes of the United States is of considerable magnitude, little is known about the potentially adverse health effects of such exposure. Recent animal data suggest that exposure to pesticides during pregnancy and early life may impair growth and neurodevelopment in the offspring. To investigate the relationship among prenatal pesticide exposure, paraoxonase (PON1) polymorphisms and enzyme activity, and infant growth and neurodevelopment, we are conducting a prospective, multiethnic cohort study of mothers and infants delivered at Mount Sinai Hospital in New York City. In this report we evaluate the effects of pesticide exposure on birth weight, length, head circumference, and gestational age among 404 births between May 1998 and May 2002. Pesticide exposure was assessed by a prenatal questionnaire administered to the mothers during the early third trimester as well as by analysis of maternal urinary pentachlorophenol levels and maternal metabolites of chlorpyrifos and pyrethroids. Neither the questionnaire data nor the pesticide metabolite levels were associated with any of the fetal growth indices or gestational age. However, when the level of maternal PON1 activity was taken into account, maternal levels of chlorpyrifos above the limit of detection coupled with low maternal PON1 activity were associated with a significant but small reduction in head circumference. In addition, maternal PON1 levels alone, but not PON1 genetic polymorphisms, were associated with reduced head size. Because small head size has been found to be predictive of subsequent cognitive ability, these data suggest that chlorpyrifos may have a detrimental effect on fetal neurodevelopment among mothers who exhibit low PON1 activity.

  11. Partnership Transitions and Maternal Parenting

    PubMed Central

    Beck, Audrey N.; Cooper, Carey E.; McLanahan, Sara; Brooks-Gunn, Jeanne

    2011-01-01

    We use data from the Fragile Families and Child Wellbeing Study (N = 1,975) to examine the association between mothers’ partnership changes and parenting behavior during the first five years of their children’s lives. We compare coresidential with dating transitions, and recent with more distal transitions. We also examine interactions between transitions and race/ethnicity, maternal education and family structure at birth. Findings indicate that both coresidential and dating transitions were associated with higher levels of maternal stress and harsh parenting; recent transitions had stronger associations than distal transitions. Maternal education significantly moderates these associations, with less educated mothers responding more negatively to instability in terms of maternal stress, and more educated mothers responding more negatively in terms of literacy activities. PMID:21423848

  12. Maternal health in Third World.

    PubMed

    Rosenfield, A; Maine, D

    1987-03-21

    The authors are responding to a LANCET editorial that asserted that female education, rather than family planning, should be advocated for prevention of maternal deaths in sub-Saharan Africa. Family planning can prevent maternal deaths in 2 ways. The 1st is prevention of pregnancy among women at high risk of complicated pregnancy and delivery, including illegal abortion. The 2nd is simply prevention of pregnancy and, thus, exposure to complications. If only women who say they want no more children had no further births, an estimated 33% of maternal deaths in developing countries would be prevented. In reality, the effect of family planning might well be greater, since it plays an essential part in reducing mortality from illicitly induced abortion. Although improvement of education for Third World women will improve the quality of their lives, it is not likely to reduce maternal mortality. Once pregnant, 10-15% of women will have serious complicatons of pregnancy or delivery, no matter what the setting. The primary responsibility of health professionals is not socioeconomic development but prevention of maternal deaths resulting from lack of effective medical care. Interest in the issue is growing. In February, 1987, the World Bank, with the World Health Organization and the UN Fund for Population Activities, sponsored a meeting in Nairobi to launch the "Safe Motherhood Initiative." This initiative will contain a variety of activities. The authors hope that foremost will be those that act directly to prvent maternal deaths--prevention of unwanted pregnancies and early treatment of complications.

  13. Maternal immune transfer in mollusc.

    PubMed

    Wang, Lingling; Yue, Feng; Song, Xiaorui; Song, Linsheng

    2015-02-01

    Maternal immunity refers to the immunity transferred from mother to offspring via egg, playing an important role in protecting the offspring at early life stages and contributing a trans-generational effect on offspring's phenotype. Because fertilization is external in most of the molluscs, oocytes and early embryos are directly exposed to pathogens in the seawater, and thus maternal immunity could provide a better protection before full maturation of their immunological systems. Several innate immune factors including pattern recognition receptors (PRRs) like lectins, and immune effectors like lysozyme, lipopolysaccharide binding protein/bacterial permeability-increasing proteins (LBP/BPI) and antioxidant enzymes have been identified as maternally derived immune factors in mollusc eggs. Among these immune factors, some maternally derived lectins and antibacterial factors have been proved to endue mollusc eggs with effective defense ability against pathogen infection, while the roles of other factors still remain untested. The physiological condition of mollusc broodstock has a profound effect on their offspring fitness. Many other factors such as nutrients, pathogens, environment conditions and pollutants could exert considerable influence on the maternal transfer of immunity. The parent molluscs which have encountered an immune stimulation endow their offspring with a trans-generational immune capability to protect them against infections effectively. The knowledge on maternal transfer of immunity and the trans-generational immune effect could provide us with an ideal management strategy of mollusc broodstock to improve the immunity of offspring and to establish a disease-resistant family for a long-term improvement of cultured stocks.

  14. Trends in maternal mortality in resident vs. migrant women in Shanghai, China, 2000-2009: a register-based analysis.

    PubMed

    Du, Li; Qin, Min; Zhang, Lei; Xu, Houqin; Zhu, Liping

    2012-06-01

    Although Shanghai has good maternal health indicators, it also has a large in-migrating population, which has made control of maternal mortality a major challenge. This study analyzed maternal mortality and causes of death in pregnant women in Shanghai in the ten years from 2000 to 2009, comparing resident and migrant women. All live births were registered and every maternal death audited. The number of live births rose from 84,898 in 2000 to 187,335 in 2009. The number of migrants increased 4.6 times, while the proportion of live births to migrant women increased from 27% to 55%. There were 262 maternal deaths, 55 in Shanghai residents and 207 in migrant women (78.9% of the total). Most deaths in migrant women were due to illegal delivery. Three policy changes focusing on maternal health greatly reduced deaths: low-cost delivery services were established for migrant women in maternity hospitals, five obstetric emergency care and referral centres were created in general hospitals, and training for health professionals and health education for women were instituted. Maternal mortality in Shanghai decreased steadily from 2000 to 2009, reaching 10 per 100,000 live births in 2009. Among Shanghai permanent residents the ratio was below ten in most of those years, while among migrant women it declined sharply from 58 to 12 per 100,000 live births.

  15. Maternity Leave in Taiwan

    PubMed Central

    Feng, Joyce Yen; Han, Wen-Jui

    2011-01-01

    Using the first nationally representative birth cohort study in Taiwan, this paper examines the role that maternity leave policy in Taiwan plays in the timing of mothers returning to work after giving birth, as well as the extent to which this timing is linked to the amount of time mothers spend with their children and their use of breast milk versus formula. We found that the time when mothers returned to work coincided with the duration of guaranteed leave. In particular, mothers with a labor pension plan resumed work significantly earlier than mothers with no pension plan, and mothers with no pension plan returned to work significantly later than those with pension plans. The short leave of absence guaranteed under existing policies translated into mothers spending less time with their children and being more likely to exclusively use formula by 6 months after birth. In contrast, mothers who resumed work later than 6 months after birth were more likely to have not worked before birth or to have quit their jobs during pregnancy. Implications and recommendations for parental leave policy in Taiwan are discussed. PMID:21603074

  16. Hospitality Management.

    ERIC Educational Resources Information Center

    College of the Canyons, Valencia, CA.

    A project was conducted at College of the Canyons (Valencia, California) to initiate a new 2-year hospitality program with career options in hotel or restaurant management. A mail and telephone survey of area employers in the restaurant and hotel field demonstrated a need for, interest in, and willingness to provide internships for such a program.…

  17. Hospital finance.

    PubMed

    Herman, M J

    1998-01-01

    This article summarizes key areas of focus for the analysis of risk in the hospital segment of the health care industry. The article is written from a commercial bank lending perspective. Both for-profit (C-corporations) and 501 (c)(3) not-for-profit segments are addressed.

  18. Academic Hospitality

    ERIC Educational Resources Information Center

    Phipps, Alison; Barnett, Ronald

    2007-01-01

    Academic hospitality is a feature of academic life. It takes many forms. It takes material form in the hosting of academics giving papers. It takes epistemological form in the welcome of new ideas. It takes linguistic form in the translation of academic work into other languages, and it takes touristic form through the welcome and generosity with…

  19. Operationalising the Lean principles in maternity service design using 3P methodology.

    PubMed

    Smith, Iain

    2016-01-01

    The last half century has seen significant changes to Maternity services in England. Though rates of maternal and infant mortality have fallen to very low levels, this has been achieved largely through hospital admission. It has been argued that maternity services may have become over-medicalised and service users have expressed a preference for more personalised care. NHS England's national strategy sets out a vision for a modern maternity service that continues to deliver safe care whilst also adopting the principles of personalisation. Therefore, there is a need to develop maternity services that balance safety with personal choice. To address this challenge, a maternity unit in North East England considered improving their service through refurbishment or building new facilities. Using a design process known as the production preparation process (or 3P), the Lean principles of understanding user value, mapping value-streams, creating flow, developing pull processes and continuous improvement were applied to the design of a new maternity department. Multiple stakeholders were engaged in the design through participation in a time-out (3P) workshop in which an innovative pathway and facility for maternity services were co-designed. The team created a hybrid model that they described as "wrap around care" in which the Lean concept of pull was applied to create a service and facility design in which expectant mothers were put at the centre of care with clinicians, skills, equipment and supplies drawn towards them in line with acuity changes as needed. Applying the Lean principles using the 3P method helped stakeholders to create an innovative design in line with the aspirations and objectives of the National Maternity Review. The case provides a practical example of stakeholders applying the Lean principles to maternity services and demonstrates the potential applicability of the Lean 3P approach to design healthcare services in line with policy requirements.

  20. Operationalising the Lean principles in maternity service design using 3P methodology

    PubMed Central

    Smith, Iain

    2016-01-01

    The last half century has seen significant changes to Maternity services in England. Though rates of maternal and infant mortality have fallen to very low levels, this has been achieved largely through hospital admission. It has been argued that maternity services may have become over-medicalised and service users have expressed a preference for more personalised care. NHS England's national strategy sets out a vision for a modern maternity service that continues to deliver safe care whilst also adopting the principles of personalisation. Therefore, there is a need to develop maternity services that balance safety with personal choice. To address this challenge, a maternity unit in North East England considered improving their service through refurbishment or building new facilities. Using a design process known as the production preparation process (or 3P), the Lean principles of understanding user value, mapping value-streams, creating flow, developing pull processes and continuous improvement were applied to the design of a new maternity department. Multiple stakeholders were engaged in the design through participation in a time-out (3P) workshop in which an innovative pathway and facility for maternity services were co-designed. The team created a hybrid model that they described as “wrap around care” in which the Lean concept of pull was applied to create a service and facility design in which expectant mothers were put at the centre of care with clinicians, skills, equipment and supplies drawn towards them in line with acuity changes as needed. Applying the Lean principles using the 3P method helped stakeholders to create an innovative design in line with the aspirations and objectives of the National Maternity Review. The case provides a practical example of stakeholders applying the Lean principles to maternity services and demonstrates the potential applicability of the Lean 3P approach to design healthcare services in line with policy requirements

  1. Maternal outcomes of cesarean sections

    PubMed Central

    Aubrey-Bassler, Kris; Newbery, Sarah; Kelly, Len; Weaver, Bruce; Wilson, Scott

    2007-01-01

    OBJECTIVE To compare maternal outcomes of cesarean sections performed by GPs with the outcomes of those performed by specialists. DESIGN Retrospective, comorbidity-adjusted study. SETTING Mostly small isolated rural hospitals in Ontario, British Columbia, Alberta, and Saskatchewan compared with all levels of specialist obstetric programs offered in Canada. PARTICIPANTS Fifteen GPs with less than 1 year of surgical training who performed cesarean sections. METHOD Using data from the Canadian Institute for Health Information’s Discharge Abstracts Database for the years 1990 to 2001, we matched each of 1448 cesarean section cases managed by these GPs to 3 cases managed by specialists and looked for comorbidity. In total, we analyzed the outcomes of 5792 cesarean sections. MAIN OUTCOME MEASURES Composites of major morbidity possibly attributable to surgery:death, sepsis, cardiac arrest, shock, hypotension, ileus or bowel obstruction,major puerperal infection, septic or fat embolism, postpartum hemorrhage requiring hysterectomy, need for cardiopulmonary resuscitation, or another operation; and all major morbidity: major surgical morbidity, acute coronary syndrome, endocarditis, pulmonary edema, cerebrovascular disorder, pneumothorax, respiratory failure, amniotic fluid embolism, complications of anesthesia, deep vein thrombosis, pulmonary embolism, acute renal failure, and need for mechanical ventilation. RESULTS The rate of all major morbidity was higher among GPs’ patients than among specialists’ patients (3.1% vs 1.9%, odds ratio [OR] 1.6, 95% confidence interval [CI] 1.1 to2.3, P = .009) as was the rate of major surgical morbidity (2.5% vs 1.6%, OR 1.6, 95% CI 1.1 to 2.4, P = .024). Differences in major morbidity variables were not significant if major postpartum infection was excluded (all major morbidity 1.5% vs 1.1%, major surgical morbidity 1.0% vs 0.8%). Secondary outcomes included rate of transfer to acute care institutions (6.0% vs 1.5%, OR 4.6, 95% CI

  2. Adoption, ART, and a re-conception of the maternal body: toward embodied maternity.

    PubMed

    Brakman, Sarah-Vaughan; Scholz, Sally J

    2006-01-01

    We criticize a view of maternity that equates the natural with the genetic and biological and show how such a practice overdetermines the maternal body and the maternal experience for women who are mothers through adoption and ART (Assisted Reproductive Technologies). As an alternative, we propose a new framework designed to rethink maternal bodies through the lens of feminist embodiment. Feminist embodied maternity, as we call it, stresses the particularity of experience through subjective embodiment. A feminist embodied maternity emphasizes the physical relations of the subjective lived-body rather than the genetic or biological connections. Instead of universalizing claims about the maternal body, embodied maternity looks to communicable experiences and empathetic understanding.

  3. Delegation of responsibility in maternity care in Karawa rural health zone, Zaire.

    PubMed

    Duale, S

    1992-06-01

    Karawa Health Zone (KHZ) located in northwestern Zaire, comprises 19,000 km2 with about 340,000 inhabitants. As part of an expanding primary health care program, KHZ officials instituted an extensive outreach program to increase access of women to maternity care. General practitioner (GP) doctors, nurses, midwives, auxiliaries, and traditional birth attendants share responsibilities in delivering maternity care services. Nurses and midwives perform most of the obstetric functions at the Karawa Hospital Maternity Center. Data from 1988 to 1990 show that nurses and midwives attended 98% of normal deliveries and 81% of the complicated ones. Selected nurses performed cesarean section routinely. There was no significant difference in maternal and neonatal outcomes for cesarean section performed by nurses and GPs. Physicians on staff provided support through monitoring, supervision, training, and care for the most complicated cases.

  4. The impact of integrated obstetric and neonatal services on utilization of postpartum maternal health care services

    PubMed Central

    Vural, Fisun; Yildirim, Filiz; Vural, Birol

    2015-01-01

    OBJECTIVE: Postnatal care is an important issue in maintaining and promoting maternal and neonatal health. However, utilization of postpartum maternal health care services is at a low rate in many countries. This study was aimed to investigate the impact of integrated obstetric and neonatal services on utilization rates of postnatal health care service among mothers. METHODS: This study was performed among a total of 4193 mothers who gave birth at Maternity Unit of Golcuk Necati Celik State Hospital of Kocaeli Province between 2010 and 2013. All mothers were called back to postnatal care clinic (PNC) for newborn hearing test (NHT) screenings, neonatal and maternal care within two weeks after delivery. The deliveries after, (n=3093) and before (n=1100) utilization of integrated services were compared as for postnatal service utilization rates. RESULTS: Utilization rates of neonatal health care, NHT and postpartum maternal health care services significantly increased after implementation of integrated services (p<0.0001). Especially maternal service utilization rates increased from 34% to 99 percent. CONCLUSION: Integration of newborn and maternal health care services as a unit increases the utilization of PNC services. PMID:28058353

  5. The Relationship between Maternal Vitamin D Deficiency and Low Birth Weight Neonates

    PubMed Central

    Khalessi, Nasrin; Kalani, Majid; Araghi, Mehdi; Farahani, Zahra

    2015-01-01

    Objective: Maternal hypovitaminosis D may impair fetal growth and cause adverse pregnancy outcomes including intrauterine growth restriction and neonatal low birth weight. The aim of this study is to evaluate the relationship between maternal vitamin D status and neonate’s birth weight. Materials and methods: A cross-sectional, descriptive analytical study was carried out in the nursery ward of 2 hospitals (Tehran-Iran) during one year (January 2011- January 2012). One hundred and two neonates were categorized into two groups, neonates with birth weight< 2500 gr (n=52) and neonates with birth weight>2500 gr (n = 50). Data regarding medical history, physical examination and anthropometric measurements of neonates were noted in a questionnaire. Birth time blood samples of their mothers were analyzed for serum 25-(OH)-vitamin D by ELISA method. Maternal vitamin D status was compared in two groups. Results: Mean maternal vitamin D (vit D) level was 31.46 nmol/L. Forty eight percent of mothers had vitamin D deficiency, 27.5% had vit D insufficiency and 24.5% were normal. Mean maternal vitamin D level of LBW neonates was lower than other group; 25.05 vs. 38.13 (p = 0.001). All mothers of neonates with head circumference ≤ 33 cm also had vitamin D deficiency (p = 0.007). Conclusion: Maternal Vitamin D deficiency may increase the risk of low birth weight neonate and modifying maternal nutrition behavior and their vit D level could be beneficial on pregnancy outcome. PMID:26622309

  6. Using survival analysis to determine association between maternal pelvis height and antenatal fetal head descent in Ugandan mothers

    PubMed Central

    Munabi, Ian Guyton; Luboga, Samuel Abilemech; Mirembe, Florence

    2015-01-01

    Introduction Fetal head descent is used to demonstrate the maternal pelvis capacity to accommodate the fetal head. This is especially important in low resource settings that have high rates of childbirth related maternal deaths and morbidity. This study looked at maternal height and an additional measure, maternal pelvis height, from automotive engineering. The objective of the study was to determine the associations between maternal: height and pelvis height with the rate of fetal head descent in expectant Ugandan mothers. Methods This was a cross sectional study on 1265 singleton mothers attending antenatal clinics at five hospitals in various parts of Uganda. In addition to the routine antenatal examination, each mother had their pelvis height recorded following informed consent. Survival analysis was done using STATA 12. Results It was found that 27% of mothers had fetal head descent with an incident rate of 0.028 per week after the 25th week of pregnancy. Significant associations were observed between the rate of fetal head descent with: maternal height (Adj Haz ratio 0.93 P < 0.01) and maternal pelvis height (Adj Haz ratio 1.15 P < 0.01). Conclusion The significant associations observed between maternal: height and pelvis height with rate of fetal head descent, demonstrate a need for further study of maternal pelvis height as an additional decision support tool for screening mothers in low resource settings. PMID:26918071

  7. Understanding maternal mental illness: psychiatric autopsy of a maternal death.

    PubMed

    Chen, Helen

    2012-05-01

    Maternal mental illness is a significant public health concern, with established adverse outcomes on both mother and infant, such as impaired mother-infant bonding and infant cognitive and emotional development. In severe cases, maternal mortality and infanticide can tragically occur. This is a report on the suicide of a mother who jumped to her death at three months postpartum. She suffered from puerperal psychosis with bipolar features, with onset at six weeks postpartum. The case highlights the burden of maternal mental illness in our community as well as the need for resources and services to care well for mothers. With a better understanding of its presentation and risk factors, early identification and intervention can reduce morbidity and mortality.

  8. The importance of cardiovascular pathology contributing to maternal death: Confidential Enquiry into Maternal Deaths in South Africa, 2011–2013

    PubMed Central

    Soma-Pillay, Priya; Seabe, Joseph; Soma-Pillay, Priya; Seabe, Joseph; Sliwa, Karen

    2016-01-01

    Summary Aims Cardiac disease is emerging as an important contributor to maternal deaths in both lower-to-middle and higher-income countries. There has been a steady increase in the overall institutional maternal mortality rate in South Africa over the last decade. The objectives of this study were to determine the cardiovascular causes and contributing factors of maternal death in South Africa, and identify avoidable factors, and thus improve the quality of care provided. Methods Data collected via the South African National Confidential Enquiry into Maternal Deaths (NCCEMD) for the period 2011–2013 for cardiovascular disease (CVD) reported as the primary pathology was analysed. Only data for maternal deaths within 42 days post-delivery were recorded, as per statutory requirement. One hundred and sixty-nine cases were reported for this period, with 118 complete hospital case files available for assessment and data analysis. Results Peripartum cardiomyopathy (PPCM) (34%) and complications of rheumatic heart disease (RHD) (25.3%) were the most important causes of maternal death. Hypertensive disorders of pregnancy, HIV disease infection and anaemia were important contributing factors identified in women who died of peripartum cardiomyopathy. Mitral stenosis was the most important contributor to death in RHD cases. Of children born alive, 71.8% were born preterm and 64.5% had low birth weight. Seventy-eight per cent of patients received antenatal care, however only 33.7% had a specialist as an antenatal care provider. Avoidable factors contributing to death included delay in patients seeking help (41.5%), lack of expertise of medical staff managing the case (29.7%), delay in referral to the appropriate level of care (26.3%), and delay in appropriate action (36.4%). Conclusion The pattern of CVD contributing to maternal death in South Africa was dominated by PPCM and complications of RHD, which could, to a large extent, have been avoided. It is likely that there were

  9. Tender Beginnings program: an educational continuum for the maternity patient.

    PubMed

    Brown, Susan E H

    2006-01-01

    The Tender Beginnings program demonstrates a comprehensive educational plan for maternity patients that can be extended throughout pregnancy, the birth process, and into the postpartum period. In today's healthcare environment, where the maternity patient continues to experience a shortened stay structure, the hurried learning process that is absorbed over a 48-hour stay is often ineffectual. This program provides a strategy and framework for effective teaching that can be successfully implemented all through the peripartum period. Budgetary constraints have given way to an innovative approach and opportunity for the healthcare specialist to explore an entrepreneurial relationship within the structure of the program. The Tender Beginnings program has proven to be a true integration of community educational outreach, nurse entrepreneurship, hospital-based education, and postpartum/neonatal follow-up.

  10. Development of the breastfeeding quality improvement in hospitals learning collaborative in New York state.

    PubMed

    Fitzpatrick, Eileen; Dennison, Barbara A; Welge, Sara Bonam; Hisgen, Stephanie; Boyce, Patricia Simino; Waniewski, Patricia A

    2013-06-01

    Exclusive breastfeeding is a public health priority. A strong body of evidence links maternity care practices, based on the Ten Steps to Successful Breastfeeding, to increased breastfeeding initiation, duration and exclusivity. Despite having written breastfeeding policies, New York (NY) hospitals vary widely in reported maternity care practices and in prevalence rates of breastfeeding, especially exclusive breastfeeding, during the birth hospitalization. To improve hospital maternity care practices, breastfeeding support, and the percentage of infants exclusively breastfeeding, the NY State Department of Health developed the Breastfeeding Quality Improvement in Hospitals (BQIH) Learning Collaborative. The BQIH Learning Collaborative was the first to use the Institute for Health Care Improvement's Breakthrough Series methodology to specifically focus on increasing hospital breastfeeding support. The evidence-based maternity care practices from the Ten Steps to Successful Breastfeeding provided the basis for the Change Package and Data Measurement Plan. The present article describes the development of the BQIH Learning Collaborative. The engagement of breastfeeding experts, partners, and stakeholders in refining the Learning Collaborative design and content, in defining the strategies and interventions (Change Package) that drive hospital systems change, and in developing the Data Measurement Plan to assess progress in meeting the Learning Collaborative goals and hospital aims is illustrated. The BQIH Learning Collaborative is a model program that was implemented in a group of NY hospitals with plans to spread to additional hospitals in NY and across the country.

  11. Improved Maternal and Child Health Care Access in a Rural Community.

    ERIC Educational Resources Information Center

    Carcillo, Joseph A.; And Others

    1995-01-01

    Describes an underserved rural community in which health care initiatives increased access to comprehensive care. Over a 3-year period, increased accessibility to maternal and child health care also increased use of preventive services, thus decreasing emergency room visits and hospitalizations as well as low birth weight, risk of congenital…

  12. Associations of Psychosocial Factors with Maternal Confidence among Japanese and Vietnamese Mothers

    ERIC Educational Resources Information Center

    Goto, Aya; Nguyen, Quang Vinh; Nguyen, Thi Tu Van; Pham, Nghiem Minh; Chung, Thi Mong Thuy; Trinh, Huu Phuc; Yabe, Junko; Sasaki, Hitomi; Yasumura, Seiji

    2010-01-01

    We conducted this cross-sectional study among 392 Japanese and 294 Vietnamese mothers who attended routine child health visits in a Japanese city and at a tertiary hospital in Vietnam, in order to investigate the prevalence and associated sociodemographic, parenting, and psychological characteristics of low maternal confidence in child rearing…

  13. Impact of specialization in gynecology and obstetrics departments on pregnant women's choice of maternity institutions.

    PubMed

    Adachi, Yoshimi; Iso, Hiroyasu; Shen, Junyi; Ban, Kanami; Fukui, On; Hashimoto, Hiroyuki; Nakashima, Takako; Morishige, Kenichiro; Saijo, Tatuyoshi

    2013-12-23

    In April 2008, specialization in gynecology and obstetrics departments was introduced in the Sennan area of Osaka prefecture in Japan that aimed at solving the problems of regional provisions of obstetrics services (e.g., shortage of obstetricians, overworking of obstetricians, and provision of specialist maternity services for high-risk pregnancies). Under this specialization, the gynecology and obstetrics departments in two city hospitals were combined and reconstructed into two centers, i.e., the gynecological care center in Kaizuka City Hospital and the prenatal care center in Izumisano City Hospital. This paper investigates to what extent and how this specialization affected pregnant women's choices of the prenatal care center and other maternity institutions. We used birth certificate data of 15,927 newborns from the Sennan area between April 1, 2007 and March 30, 2010, for Before and After Analysis to examine changes in pregnant women's choices of maternity institutions before and after the specialization was instituted. Our results indicated that this specialization scheme was, to some extent, successful on the basis of providing maternity services for high-risk pregnancies at the prenatal care center (i.e., Izumisano City Hospital) and having created a positive effect by pregnant women to other facilities in the nearby area.

  14. Intimate Partner Violence During Pregnancy: Maternal and Neonatal Outcomes

    PubMed Central

    Ray, Ellen; Sharps, Phyllis; Bullock, Linda

    2015-01-01

    Abstract The effects of intimate partner violence (IPV) on maternal and neonatal outcomes are multifaceted and largely preventable. During pregnancy, there are many opportunities within the current health care system for screening and early intervention during routine prenatal care or during episodic care in a hospital setting. This article describes the effects of IPV on maternal health (e.g., insufficient or inconsistent prenatal care, poor nutrition, inadequate weight gain, substance use, increased prevalence of depression), as well as adverse neonatal outcomes (e.g., low birth weight [LBW]), preterm birth [PTB], and small for gestational age [SGA]) and maternal and neonatal death. Discussion of the mechanisms of action are explored and include: maternal engagement in health behaviors that are considered “risky,” including smoking and alcohol and substance use, and new evidence regarding the alteration of the hypothalamic-pituitary-adrenal axis and resulting changes in hormones that may affect LBW and SGA infants and PTB. Clinical recommendations include a commitment for routine screening of IPV in all pregnant women who present for care using validated screening instruments. In addition, the provision of readily accessible prenatal care and the development of a trusting patient–provider relationship are first steps in addressing the problem of IPV in pregnancy. Early trials of targeted interventions such as a nurse-led home visitation program and the Domestic Violence Enhanced Home Visitation Program show promising results. Brief psychobehavioral interventions are also being explored. The approach of universal screening, patient engagement in prenatal care, and targeted individualized interventions has the ability to reduce the adverse effects of IPV and highlight the importance of this complex social disorder as a top priority in maternal and neonatal health. PMID:25265285

  15. Maternal Health Phone Line: Saving Women in Papua New Guinea

    PubMed Central

    Watson, Amanda H.A.; Sabumei, Gaius; Mola, Glen; Iedema, Rick

    2015-01-01

    This paper presents the findings of a research project which has involved the establishment of a maternal health phone line in Milne Bay Province of Papua New Guinea (PNG). Mobile phones and landline phones are key information and communication technologies (ICTs). This research study uses the “ICTs for healthcare development” model to ascertain benefits and barriers to the successful implementation of the Childbirth Emergency Phone. PNG has a very high maternal mortality rate. The “three stages of delay” typology was developed by Thaddeus and Maine to determine factors that might delay provision of appropriate medical treatment and hence increase risk of maternal death. The “three stages of delay” typology has been utilised in various developing countries and also in the present study. Research undertaken has involved semi-structured interviews with health workers, both in rural settings and in the labour ward in Alotau. Additional data has been gathered through focus groups with health workers, analysis of notes made during phone calls, interviews with women and community leaders, observations and field visits. One hundred percent of interviewees (n = 42) said the project helped to solve communication barriers between rural health workers and Alotau Provincial Hospital. Specific examples in which the phone line has helped to create positive health outcomes will be outlined in the paper, drawn from research interviews. The Childbirth Emergency Phone project has shown itself to play a critical role in enabling healthcare workers to address life-threatening childbirth complications. The project shows potential for rollout across PNG; potentially reducing maternal morbidity and maternal mortality rates by overcoming communication challenges. PMID:25923199

  16. Frequency of Maternal and Newborn Birth Outcomes, Lima, Peru, 2013

    PubMed Central

    Wynn, Adriane; Cabeza, Jeanne; Adachi, Kristina; Needleman, Jack; Garcia, Patricia J.; Klausner, Jeffrey D.

    2015-01-01

    Objective This study describes the pregnancy and birth outcomes at two hospitals in Lima, Peru. The data collection and analysis is intended to inform patients, providers, and policy makers on Peru’s progress toward achieving the Millennium Development Goals and to help set priorities for action and further research. Methods Data were collected retrospectively from a sample of 237 women who delivered between December 2012 and September 2013 at the Instituto Nacional Materno Perinatal or the Hospital Nacional Arzobispo Loayza. The outcomes were recorded by a trained mid-wife through telephone interviews with patients and by review of hospital records. Associations between participant demographic characteristics and pregnancy outcomes were tested with Chi-squared, Fisher’s exact, or Student’s t-test. Results Over 37% of women experienced at least one maternal or perinatal complication, and the most frequent were hypertension/preeclampsia and macrosomia. The women in our sample had a cesarean section rate of 50.2%. Conclusion Maternal and perinatal complications are not uncommon among women in the lower socioeconomic strata of Lima. Also, the high cesarean rate underpins the need for a more comprehensive understanding of the indications for cesarean section deliveries, which could help reduce the number of unnecessary procedures and preventable complications. PMID:25806522

  17. Outcome of ruptured uterus at University Teaching Hospital Aleppo, Syria.

    PubMed

    Bakour, S; Nassif, B; Nwosu, E C

    1998-09-01

    A 10-year review of ruptured gravid uterus at the University Teaching Hospital, Aleppo, Syria showed an incidence of one ruptured uterus in 565 deliveries. This is an average figure compared with published studies but is still high compared with developed countries. Sixty-four per cent of the cases of ruptured uterus had no antenatal care. It is no surprise therefore that maternal and fetal mortality was highest amongst the unbooked labouring women. In survivors the morbidity was also higher. Ruptured uterus is therefore a major cause of maternal and perinatal mortality and morbidity in Syria. The overall hospital maternal and perinatal mortalities for the period under review were 4.3% and 2.6% respectively. The main risk factor identified is scarring from previous caesarean sections. Other risk factors are discussed.

  18. Where does distance matter? Distance to the closest maternity unit and risk of foetal and neonatal mortality in France

    PubMed Central

    Blondel, Béatrice; Drewniak, Nicolas; Zeitlin, Jennifer

    2014-01-01

    Background: The number of maternity units has declined in France, raising concerns about the possible impact of increasing travel distances on perinatal health outcomes. We investigated impact of distance to closest maternity unit on perinatal mortality. Methods: Data from the French National Vital Statistics Registry were used to construct foetal and neonatal mortality rates over 2001–08 by distance from mother’s municipality of residence and the closest municipality with a maternity unit. Data from French neonatal mortality certificates were used to compute neonatal death rates after out-of-hospital birth. Relative risks by distance were estimated, adjusting for individual and municipal-level characteristics. Results: Seven percent of births occurred to women residing at ≥30 km from a maternity unit and 1% at ≥45 km. Foetal and neonatal mortality rates were highest for women living at <5 km from a maternity unit. For foetal mortality, rates increased at ≥45 km compared with 5–45 km. In adjusted models, long distance to a maternity unit had no impact on overall mortality but women living closer to a maternity unit had a higher risk of neonatal mortality. Neonatal deaths associated with out-of-hospital birth were rare but more frequent at longer distances. At the municipal-level, higher percentages of unemployment and foreign-born residents were associated with increased mortality. Conclusion: Overall mortality was not associated with living far from a maternity unit. Mortality was elevated in municipalities with social risk factors and located closest to a maternity unit, reflecting the location of maternity units in deprived areas with risk factors for poor outcome. PMID:24390464

  19. Maternal death audit in Rwanda 2009–2013: a nationwide facility-based retrospective cohort study

    PubMed Central

    Sayinzoga, Felix; Bijlmakers, Leon; van Dillen, Jeroen; Mivumbi, Victor; Ngabo, Fidèle; van der Velden, Koos

    2016-01-01

    Objective Presenting the results of 5 years of implementing health facility-based maternal death audits in Rwanda, showing maternal death classification, identification of substandard (care) factors that have contributed to death, and conclusive recommendations for quality improvements in maternal and obstetric care. Design Nationwide facility-based retrospective cohort study. Settings All cases of maternal death audited by district hospital-based audit teams between January 2009 and December 2013 were reviewed. Maternal deaths that were not subjected to a local audit are not part of the cohort. Population 987 audited cases of maternal death. Main outcome measures Characteristics of deceased women, timing of onset of complications, place of death, parity, gravida, antenatal clinic attendance, reported cause of death, service factors and individual factors identified by committees as having contributed to death, and recommendations made by audit teams. Results 987 cases were audited, representing 93.1% of all maternal deaths reported through the national health management information system over the 5-year period. Almost 3 quarters of the deaths (71.6%) occurred at district hospitals. In 44.9% of these cases, death occurred in the post-partum period. Seventy per cent were due to direct causes, with post-partum haemorrhage as the leading cause (22.7%), followed by obstructed labour (12.3%). Indirect causes accounted for 25.7% of maternal deaths, with malaria as the leading cause (7.5%). Health system failures were identified as the main responsible factor for the majority of cases (61.0%); in 30.3% of the cases, the main factor was patient or community related. Conclusions The facility-based maternal death audit approach has helped hospital teams to identify direct and indirect causes of death, and their contributing factors, and to make recommendations for actions that would reduce the risk of reoccurrence. Rwanda can complement maternal death audits with other

  20. Prenatal Maternal Stress Programs Infant Stress Regulation

    ERIC Educational Resources Information Center

    Davis, Elysia Poggi; Glynn, Laura M.; Waffarn, Feizal; Sandman, Curt A.

    2011-01-01

    Objective: Prenatal exposure to inappropriate levels of glucocorticoids (GCs) and maternal stress are putative mechanisms for the fetal programming of later health outcomes. The current investigation examined the influence of prenatal maternal cortisol and maternal psychosocial stress on infant physiological and behavioral responses to stress.…

  1. [Experience of the Baby Friendly Hospital initiative].

    PubMed

    Lamounier, J A

    1998-01-01

    In the study is analyzed and described the initiative called "Initiative Baby Friendly Hospitals", a program which started in Brazil, 1992. This initiative intends to support, to protect and to promote the breastfeeding as proposed in a meeting in 1990 in Florence, Italy, which was promoted by WHO and UNICEF. The basic goal of this initiative is to mobilize health professionals and hospital or maternity workers for changing their routines and conducts aiming to prevent the early wean. The health establishments are evaluated based on the "ten steps for success of breastfeeding, a group of goals created in the same meeting. In Brazil, the evaluation is coordinated by the Federal Government through the PNIAM (Programa Nacional de Incentivo ao Aleitamento Materno). A baby friendly hospital, if approved, receives from the Minister of Health, a Federal Governmental Agency (SUS) a differential payment for childbirth assistance and prenatal accompaniment, 10% and 40%, more respectively. Until 1998 year there were 103 baby friendly hospitals in Brazil, with the majority of them located in the northeast area (68.1%). However, taking in accounting the number of 5650 hospitals linked to SUS in the country, less than 2.0% are baby friendly hospitals. On the basis of the experience and according with PNIAM data the implementation of the ten steps and the incentive to breastfeeding through baby friendly hospitals have resulted in a significant increase of breastfeeding incidence and duration in Brazil.

  2. Oxytocin and Maternal Brain Plasticity

    ERIC Educational Resources Information Center

    Kim, Sohye; Strathearn, Lane

    2016-01-01

    Although dramatic postnatal changes in maternal behavior have long been noted, we are only now beginning to understand the neurobiological mechanisms that support this transition. The present paper synthesizes growing insights from both animal and human research to provide an overview of the plasticity of the mother's brain, with a particular…

  3. Multigenerational effects of maternal undernutrition.

    PubMed

    Einstein, Francine H

    2014-06-03

    Intrauterine exposure to reduced nutrient availability can have major effects in determining susceptibility to chronic disease later in life. Martínez et al. (2014) demonstrate multigenerational effects of poor maternal nutrition and evidence of germline transmission through alterations in DNA methylation.

  4. Predicting Breastfeeding Duration Related to Maternal Attitudes in a Taiwanese Sample

    PubMed Central

    Ho, Yen-Ju; McGrath, Jacqueline M.

    2011-01-01

    The purpose of this study was to examine maternal attitudes and sociodemographic variables associated with Taiwanese mothers’ continuation of breastfeeding at 6 weeks postpartum. A sample of 140 in-hospital breastfeeding mothers was recruited in Taiwan. Participants completed the Iowa Infant Feeding Attitude Scale (IIFAS) in the hospital prior to discharge. Postdischarge participants were contacted by telephone at 3 and 6 weeks postpartum to obtain information regarding their feeding method and duration. Findings revealed that in-hospital maternal breastfeeding attitudes are predictive of breastfeeding duration. Insufficient milk supply was the reason most often given for discontinuing breastfeeding. Women’s husband/partner was found to be the main source of breastfeeding support. We recommend health-care professionals add the IIFAS to their assessment to identify mothers at high risk for discontinuing breastfeeding and to develop and better evaluate breastfeeding promotion programs. PMID:22942621

  5. [Obstetric care during childbirth in Rio de Janeiro: hospital practices and user access].

    PubMed

    Campos, T P; Carvalho, M S

    2000-01-01

    The purpose of this paper is to identify and describe Rio de Janeiro maternity hospital profiles and the route between the mother's place of residence and the hospital. Data sources were: the State Live Birth Information System (1995) and the National Survey on Medical Care (1992). Two groups of maternity hospitals were identified using multivariate cluster analysis. Group A had an extremely high cesarean rate (81%), with mothers and neonates presenting good health conditions. Cesarean rates were lower in Group B, although still high (32%), and other variables reflected worse neonatal conditions. Cesarean rate was the indicator which best discriminated between the groups, followed by proportion of adolescent mothers and mothers with a high school education. The uneven spatial distribution of maternity hospitals, which were concentrated in the richest area of the city, was a factor in the long routes used by women to reach medical care for childbirth.

  6. Systematic review of the magnitude and case fatality ratio for severe maternal morbidity in sub-Saharan Africa between 1995 and 2010

    PubMed Central

    2011-01-01

    Background Analysis of severe maternal morbidity (maternal near misses) provides information on the quality of care. We assessed the prevalence/incidence of maternal near miss, maternal mortality and case fatality ratio through systematic review of studies on severe maternal morbidity in sub-Saharan Africa. Methods We examined studies that reported prevalence/incidence of severe maternal morbidity (maternal near misses) during pregnancy, childbirth and postpartum period between 1996 and 2010. We evaluated the quality of studies (objectives, study design, population studied, setting and context, definition of severe acute obstetric morbidity and data collection instruments). We extracted data, using a pre-defined protocol and criteria, and estimated the prevalence or incidence of maternal near miss. The case-fatality ratios for reported maternal complications were estimated. Results We identified 12 studies: six were cross-sectional, five were prospective and one was a retrospective review of medical records. There was variation in the setting: while some studies were health facility-based (at the national referral hospital, regional hospital or various district hospitals), others were community-based studies. The sample size varied from 557 women to 23,026. Different definitions and terminologies for maternal near miss included acute obstetric complications, severe life threatening obstetric complications and severe obstetric complications. The incidence/prevalence ratio and case-fatality ratio for maternal near misses ranged from 1.1%-10.1% and 3.1%-37.4% respectively. Ruptured uterus, sepsis, obstructed labor and hemorrhage were the commonest morbidities that were analyzed. The incidence/prevalence ratio of hemorrhage ranged from 0.06% to 3.05%, while the case fatality ratio for hemorrhage ranged from 2.8% to 27.3%. The prevalence/incidence ratio for sepsis ranged from 0.03% to 0.7%, while the case fatality ratio ranged from 0.0% to 72.7%. Conclusion The

  7. Links between maternal health and NCDs.

    PubMed

    Kapur, Anil

    2015-01-01

    Non-communicable diseases (NCDs) and maternal health are closely linked. NCDs such as diabetes, obesity and hypertension have a significant adverse impact on maternal health and pregnancy outcomes, and through the mechanism of intrauterine programming maternal health impacts the burden of NCDs in future generations. The cycle of vulnerability to NCDs is repeated with increasing risk accumulation in subsequent generations. This article discusses the impact, interlinkages and advocates for integration of services for maternal and child health, NCD care and prevention and health promotion to sustainably improve maternal health as well address the rising burden of NCDs.

  8. Maternal weight gain, smoking and other factors in pregnancy as predictors of infant birth-weight in Sydney women.

    PubMed

    Ash, S; Fisher, C C; Truswell, A S; Allen, J R; Irwig, L

    1989-08-01

    Two hundred and four (204) women attending a Sydney maternity hospital and their babies were followed throughout pregnancy in a study, which aimed: 1) to describe the distribution of maternal weight gain in present day Australian women and 2) to determine the effect of weight gain and other factors on birth-weight. Maternal weights and skinfold thicknesses were measured serially to give an indication of weight gain. Mean weight gain from conception to term was 14.2kg and mean birth-weight was 3,442g. Maternal predictors of birth-weight such as maternal weight gain, parity, age, education, height, public or private booking status, smoking, prepregnancy weight, and sex of the infant and gestational age were explored using simple and multiple regression analysis. Weight gain was predictive of birth-weight, each kg increase in total weight gain resulting in about a 30g increase in birthweight. Other strong predictors were gestational age, maternal smoking, sex of the infant and maternal parity. Maternal height was less strongly predictive and age and prepregnant weight were not predictive. Smoking mothers had infants who were 268g lighter than those of nonsmoking mothers. However, smokers were also younger, shorter, had less education and were more likely to book as public patients than nonsmokers. After adjusting for all other predictors, the birth-weight of infants whose mothers smoked, was still 224g less than that for nonsmoking mothers.

  9. Awareness about a Life-Threatening Condition: Ectopic Pregnancy in a Network for Surveillance of Severe Maternal Morbidity in Brazil

    PubMed Central

    Filho, Edilberto Alves Rocha; Santana, Danielly Scaranello; Costa, Maria Laura; Haddad, Samira Maerrawe; Parpinelli, Mary Angela; Sousa, Maria Helena; Camargo, Rodrigo Soares; Pacagnella, Rodolfo Carvalho; Surita, Fernanda Garanhani; Pinto e Silva, Joao Luiz

    2014-01-01

    Objective. To assess occurrence of severe maternal complications associated with ectopic pregnancy (EP). Method. A multicenter cross-sectional study was conducted, with prospective surveillance of potentially life-threatening conditions (PLTC), maternal near miss (MNM), and maternal death (MD). EP complications, patient sociodemographic/obstetric characteristics, and conditions of severity management were assessed, estimating prevalence ratios with respective 95% CI. Factors independently associated with greater severity were identified using multiple regression analysis. Results. Of the 9.555 severe maternal morbidity patients, 312 women (3.3%) had complications after EP: 286 (91.7%) PLTC, 25 (8.0%) MNM, and 1 (0.3%) MD. Severe maternal outcome ratio (SMOR) was 0.3/1000 LB among EP cases and 10.8/1000 LB among other causes. Complicated EP patients faced a higher risk of blood transfusion, laparotomy, and lower risk of ICU admission and prolonged hospitalization than women developing complications resulting from other causes. Substandard care was the most common in more severe maternal morbidity and EP cases (22.7% MNM and MD versus 15% PLTC), although not significant. Conclusion. Increased maternal morbidity due to EP raised awareness about the condition and its impact on female reproductive life. No important risk factors for greater severity were identified. Care providers should develop specific guidelines and interventions to prevent severe maternal morbidity. PMID:24772441

  10. Relationship between Hospital Policies for Labor Induction and Cesarean Delivery and Perinatal Care Quality among Rural U.S. Hospitals.

    PubMed

    Kozhimannil, Katy B; Hung, Peiyin; Casey, Michelle M; Henning-Smith, Carrie; Prasad, Shailendra; Moscovice, Ira S

    2016-01-01

    Many hospitals are adopting quality improvement strategies in obstetrics. This study characterized rural U.S. hospitals based on their hospital staffing and clinical management policies for labor induction and cesarean delivery, and assessed the relationship between policies and performance on maternity care quality. We surveyed all 306 rural maternity hospitals in nine states and used data from the Healthcare Cost and Utilization Project Statewide Inpatient Database hospital discharge database. We found staffing policies were more prevalent at lower-volume hospitals (92% vs. 86% for cesarean and 82% vs. 79%, both p < .01). Using multivariable logistic regression, we found hospitals with policies for cesarean delivery had up to 24% lower odds of low-risk cesarean (adjusted odds ratio = 0.76; 95% confidence interval=[0.67-0.86]) and non-indicated cesarean (0.78 [0.70-0.88]), with variability across birth volume. Clinical management and staffing policies are common, but not universal, among rural U.S. hospitals providing obstetric services and are generally positively associated with quality.

  11. Maternal responsiveness and maternal selectivity in domestic sheep and goats: the two facets of maternal attachment.

    PubMed

    Poindron, Pascal; Lévy, Frédéric; Keller, Matthieu

    2007-01-01

    Sheep and goats rapidly establish an exclusive relationship with their neonate following contact with it during a sensitive period of maternal responsiveness induced by the physiological events occurring at parturition. The data concerning the sensory, physiological, and neurobiological factors involved in the activation of both maternal responsiveness and the establishment of selective nursing indicates that these processes are activated simultaneously by the combined action of two main factors, the prepartum rise in circulating estrogen and the vaginocervical stimulation (VCS) caused by fetus expulsion. On the one hand, these two factors act on a neural network including the main olfactory system (MOB), the medial preoptic area (MPOA), and the paraventricular nucleus of the hypothalamus (PVN) to induce maternal responsiveness towards any neonate. The intracerebral release of oxytocin (OT) from the PVN, and the triggering of olfactory attraction for amniotic fluid (AF) are key elements in this process. On the other hand, VCS at birth also sets the MOB ready to memorize the individual odor of the neonate, through the release of peptides and neurotransmitters (noradrenaline and acetylcholine). In addition to the MOB, the network involved in recognition mainly includes the medial and cortical amygdala. Across consolidation processes, reorganization occurs in the network engaged in lamb recognition. Whether this memorization may be potentiated by other sensory cues is not known. The identification of the chemosensory compounds involved in the attraction for AF and in the recognition of the neonate is important for understanding the mechanisms of maternal attachment.

  12. Maternal control of early embryogenesis in mammals

    PubMed Central

    Zhang, Kun; Smith, George W.

    2015-01-01

    Oocyte quality is a critical factor limiting the efficiency of assisted reproductive technologies (ART) and pregnancy success in farm animals and humans. ART success is diminished with increased maternal age, suggesting a close link between poor oocyte quality and ovarian-aging. However, the regulation of oocyte quality remains poorly understood. Oocyte quality is functionally linked to ART success because the maternal-to-embryonic transition is dependent on stored maternal factors, which are accumulated in oocytes during oocyte development and growth. The maternal-to-embryonic transition consists of critical developmental processes including maternal RNA depletion and embryonic genome activation. In recent years, key maternal proteins encoded by maternal-effect genes have been determined, primarily using genetically modified mouse models. These proteins are implicated in various aspects of early embryonic development including maternal mRNA degradation, epigenetic reprogramming, signal transduction, protein translation and initiation of embryonic genome activation. Species differences exist in number of cell divisions encompassing the maternal-to-embryonic transition and maternal-effect genes controlling this developmental window. Perturbations of maternal control result in decreased oocyte quality, some of which are associated with ovarian aging. PMID:25695370

  13. Fetal and perinatal consequences of maternal obesity.

    PubMed

    Vasudevan, Chakrapani; Renfrew, Mary; McGuire, William

    2011-09-01

    In many industrialised countries, one in five women booking for antenatal care is obese. As well as affecting maternal health, maternal obesity may have important adverse consequences for fetal, neonatal and long-term health and well-being. Maternal obesity is associated with a higher risk of stillbirth, elective preterm birth and perinatal mortality. The incidence of severe birth defects, particularly neural tube and structural cardiac defects, appears to be higher in infants of obese mothers. Fetal macrosomia associated with maternal obesity and gestational diabetes predisposes infants to birth injuries, perinatal asphyxia and transitional problems such as neonatal respiratory distress and metabolic instability. Maternal obesity may also result in long-term health problems for offspring secondary to perinatal problems and to intrauterine and postnatal programming effects. Currently, the available interventions to prevent and treat maternal obesity are of limited proven utility and further research is needed to define the effects of maternal weight management interventions on fetal and neonatal outcomes.

  14. Maternal phobic anxiety and child anxiety.

    PubMed

    Bernstein, Gail A; Layne, Ann E; Egan, Elizabeth A; Nelson, Lara P

    2005-01-01

    The present study examined the relation between maternal anxiety symptoms and child anxiety symptoms and evaluated whether a reporting bias is associated with maternal anxiety. Fifty-seven mother-child pairs participated. All children had features or diagnoses of separation anxiety disorder (SAD), generalized anxiety disorder, and/or social phobia. Measures of maternal symptomatology and child anxiety were administered. Higher levels of maternal phobic anxiety on the Brief Symptom Inventory were significantly associated with higher levels of separation anxiety in children. After controlling for clinician rating of SAD severity, maternal phobic anxiety emerged as a significant predictor of maternal ratings of child separation anxiety, accounting for 19% of the variance. Phobic mothers endorsed levels of separation anxiety in their children that exceeded levels endorsed by clinicians, suggesting maternal overreporting.

  15. Maternal Characteristics Predicting Young Girls’ Disruptive Behavior

    PubMed Central

    van der Molen, Elsa; Hipwell, Alison E.; Vermeiren, Robert; Loeber, Rolf

    2011-01-01

    Little is known about the relative predictive utility of maternal characteristics and parenting skills on the development of girls’ disruptive behavior. The current study used five waves of parent and child-report data from the ongoing Pittsburgh Girls Study to examine these relationships in a sample of 1,942 girls from age 7 to 12 years. Multivariate Generalized Estimating Equation (GEE) analyses indicated that European American race, mother’s prenatal nicotine use, maternal depression, maternal conduct problems prior to age 15, and low maternal warmth explained unique variance. Maladaptive parenting partly mediated the effects of maternal depression and maternal conduct problems. Both current and early maternal risk factors have an impact on young girls’ disruptive behavior, providing support for the timing and focus of the prevention of girls’ disruptive behavior. PMID:21391016

  16. Triclosan/triclocarban levels in maternal and umbilical blood samples and their association with fetal malformation.

    PubMed

    Wei, Ling; Qiao, Pengyun; Shi, Ying; Ruan, Yan; Yin, Jie; Wu, Qingqing; Shao, Bing

    2017-03-01

    Triclosan (TCS) and triclocarban (TCC) are widely used as antimicrobial compounds in consumer products. TCS and TCC are frequently found in waste water and sewage. In this study, we investigate the potential impact of exposure to triclosan (TCS) and triclocarban (TCC) on fetal abnormalities. We measured TCS and TCC levels in maternal and umbilical cord blood samples from 39 pregnant women diagnosed with fetal or post-birth abnormalities at Beijing Obstetrics and Gynecology Hospital. 52 pregnant women who gave birth to healthy neonates during the same period of time were included as controls. Applying ultra-performance liquid chromatography-tandem mass spectrometry, TCS and TCC concentrations were measured in maternal and fetal sera. Significantly increased levels of TCS were detected in maternal sera from mothers with abnormal births. Similar levels of TCS or TCC were found in maternal and cord sera in control group. The concentrations of TCS or TCC in maternal sera correlated with those in umbilical cord sera (r=0.649, P<0.01). These observations suggest that maternal blood test could be a useful assay for detecting fetal exposure to TCS and TCC, and high exposure to TCS may be potentially associated with increased risk for fetal malformations.

  17. [Application study of droplet digital PCR to detect maternal cell contamination in prenatal diagnosis].

    PubMed

    Geng, J; Liu, C; Zhou, X C; Ma, J; Du, L; Lu, J; Zhou, W N; Hu, T T; Lyu, L J; Yin, A H

    2017-02-25

    Objective: To develop a new method based on droplet digital PCR (DD-PCR) for detection and quantification of maternal cell contamination in prenatal diagnosis. Methods: Invasive prenatal samples from 40 couples of β(IVS-Ⅱ-654)/β(N) thalassemia gene carriers who accepted prenatal diagnosis in Affiliated Women and Children's Hospital of Guangzhou Medical University from October 2015 to December 2016 were analyzed retrospectively. Specific primers and probes were designed. The concentration gradient were 50%, 25%, 12.5%, 6.25%, 3.125%, 1.562 5%. There were 40 groups of prenatal diagnostic samples. Comparing DD-PCR with quantitative fluorescent-PCR (QF-PCR) based on the short tandem repeats for assement of the sensitivity and accuracy of maternal cell contamination, respectively. Results: DD-PCR could quantify the maternal cell contamination as low as 1.562 5%. The result was proportional to the dilution titers. In the 40 prenatal samples, 6 cases (15%, 6/40) of maternal cell contamination were detected by DD-PCR, while the QF-PCR based on short tandem repeat showed 3 cases (7.5%, 3/40) with maternal cell contamination, DD-PCR was more accurate (P=0.002) . Conclusion: DD-PCR is a precise and sensitive method in the detection of maternal cell contamintation. It could be useful in clinical application.

  18. Cost estimate of hospital stays for premature newborns in a public tertiary hospital in Brazil

    PubMed Central

    Desgualdo, Claudia Maria; Riera, Rachel; Zucchi, Paola

    2011-01-01

    OBJECTIVES: To estimate the direct costs of hospital stays for premature newborns in the Interlagos Hospital and Maternity Center in São Paulo, Brazil and to assess the difference between the amount reimbursed to the hospital by the Unified Health System and the real cost of care for each premature newborn. METHODS: A cost-estimate study in which hospital and professional costs were estimated for premature infants born at 22 to 36 weeks gestation during the calendar year of 2004 and surviving beyond one hour of age. Direct costs included hospital services, professional care, diagnoses and therapy, orthotics, prosthetics, special materials, and blood products. Costs were estimated using tables published by the Unified Health System and the Brasíndice as well as the list of medical procedures provided by the Brazilian Classification of Medical Procedures. RESULTS: The average direct cost of care for initial hospitalization of a premature newborn in 2004 was $2,386 USD. Total hospital expenses and professional services for all premature infants in this hospital were $227,000 and $69,500 USD, respectively. The costs for diagnostic testing and blood products for all premature infants totaled $22,440 and $1,833 USD. The daily average cost of a premature newborn weighing less than 1,000 g was $115 USD, and the daily average cost of a premature newborn weighing more than 2,500 g was $89 USD. Amounts reimbursed to the hospital by the Unified Health System corresponded to only 27.42% of the real cost of care. CONCLUSIONS: The cost of hospital stays for premature newborns was much greater than the amount reimbursed to the hospital by the Unified Health System. The highest costs corresponded to newborns with lower birth weight. Hospital costs progressively and discretely decreased as the newborns' weight increased. PMID:22012050

  19. Maternal age and risk of labor and delivery complications.

    PubMed

    Cavazos-Rehg, Patricia A; Krauss, Melissa J; Spitznagel, Edward L; Bommarito, Kerry; Madden, Tessa; Olsen, Margaret A; Subramaniam, Harini; Peipert, Jeffrey F; Bierut, Laura Jean

    2015-06-01

    We utilized an updated nationally representative database to examine associations between maternal age and prevalence of maternal morbidity during complications of labor and delivery. We used hospital inpatient billing data from the 2009 United States Nationwide Inpatient Sample, part of the Healthcare Cost and Utilization Project. To determine whether the likelihood that maternal morbidity during complications of labor and delivery differed among age groups, separate logistic regression models were run for each complication. Age was the main independent variable of interest. In analyses that controlled for demographics and clinical confounders, we found that complications with the highest odds among women, 11-18 years of age, compared to 25-29 year old women, included preterm delivery, chorioamnionitis, endometritis, and mild preeclampsia. Pregnant women who were 15-19 years old had greater odds for severe preeclampsia, eclampsia, postpartum hemorrhage, poor fetal growth, and fetal distress. Pregnant women who were ≥35 years old had greater odds for preterm delivery, hypertension, superimposed preeclampsia, severe preeclampsia, and decreased risk for chorioamnionitis. Older women (≥40 years old) had increased odds for mild preeclampsia, fetal distress, and poor fetal growth. Our findings underscore the need for pregnant women to be aware of the risks associated with extremes of age so that they can watch for signs and symptoms of such complications.

  20. Factors associated with maternal death in an intensive care unit

    PubMed Central

    Saintrain, Suzanne Vieira; de Oliveira, Juliana Gomes Ramalho; Saintrain, Maria Vieira de Lima; Bruno, Zenilda Vieira; Borges, Juliana Lima Nogueira; Daher, Elizabeth De Francesco; da Silva Jr, Geraldo Bezerra

    2016-01-01

    Objective To identify factors associated with maternal death in patients admitted to an intensive care unit. Methods A cross-sectional study was conducted in a maternal intensive care unit. All medical records of patients admitted from January 2012 to December 2014 were reviewed. Pregnant and puerperal women were included; those with diagnoses of hydatidiform mole, ectopic pregnancy, or anembryonic pregnancy were excluded, as were patients admitted for non-obstetrical reasons. Death and hospital discharge were the outcomes subjected to comparative analysis. Results A total of 373 patients aged 13 to 45 years were included. The causes for admission to the intensive care unit were hypertensive disorders of pregnancy, followed by heart disease, respiratory failure, and sepsis; complications included acute kidney injury (24.1%), hypotension (15.5%), bleeding (10.2%), and sepsis (6.7%). A total of 28 patients died (7.5%). Causes of death were hemorrhagic shock, multiple organ failure, respiratory failure, and sepsis. The independent risk factors associated with death were acute kidney injury (odds ratio [OR] = 6.77), hypotension (OR = 15.08), and respiratory failure (OR = 3.65). Conclusion The frequency of deaths was low. Acute kidney injury, hypotension, and respiratory insufficiency were independent risk factors for maternal death. PMID:28099637

  1. The Evolution of Multivariate Maternal Effects

    PubMed Central

    Kuijper, Bram; Johnstone, Rufus A.; Townley, Stuart

    2014-01-01

    There is a growing interest in predicting the social and ecological contexts that favor the evolution of maternal effects. Most predictions focus, however, on maternal effects that affect only a single character, whereas the evolution of maternal effects is poorly understood in the presence of suites of interacting traits. To overcome this, we simulate the evolution of multivariate maternal effects (captured by the matrix M) in a fluctuating environment. We find that the rate of environmental fluctuations has a substantial effect on the properties of M: in slowly changing environments, offspring are selected to have a multivariate phenotype roughly similar to the maternal phenotype, so that M is characterized by positive dominant eigenvalues; by contrast, rapidly changing environments favor Ms with dominant eigenvalues that are negative, as offspring favor a phenotype which substantially differs from the maternal phenotype. Moreover, when fluctuating selection on one maternal character is temporally delayed relative to selection on other traits, we find a striking pattern of cross-trait maternal effects in which maternal characters influence not only the same character in offspring, but also other offspring characters. Additionally, when selection on one character contains more stochastic noise relative to selection on other traits, large cross-trait maternal effects evolve from those maternal traits that experience the smallest amounts of noise. The presence of these cross-trait maternal effects shows that individual maternal effects cannot be studied in isolation, and that their study in a multivariate context may provide important insights about the nature of past selection. Our results call for more studies that measure multivariate maternal effects in wild populations. PMID:24722346

  2. Current Concepts of Maternal Nutrition

    PubMed Central

    Lowensohn, Richard I.; Stadler, Diane D.; Naze, Christie

    2016-01-01

    Background A nutrient-rich maternal diet before and during pregnancy is associated with improved fetal health, more appropriate birth weight, and increased rates of maternal and infant survival. Physicians need a better understanding of the role of diet in shaping fetal outcomes. Given this background, we reviewed and summarized articles on maternal nutrition found in MEDLINE since 1981, written in English, and limited to human subjects. For the Offspring Maternal diets high in sugar and fat lead to an increased incidence of metabolic syndrome, diabetes, and cardiovascular disease later in life. Folic acid should be supplemented prior to conception and continued through at least the first 28 days of fetal life to prevent neural tube defects, and vitamin C should be given to women who smoke to lower the incidence of asthma and wheezing in the children. Iodine deficiency is increasing, and iodine should be included in prenatal supplements. If the maternal hemoglobin is 7 g/dL or more, there is no evidence that iron supplementation is needed. Fish intake during pregnancy is protective against atopic outcomes, whereas high-meat diets contribute to elevated adult blood pressure and hypersecretion of cortisol. For the Mother Calcium supplementation lowers the risk of preeclampsia and hypertensive disease in pregnancy. Conclusions Given the limits of our current knowledge, a diet rich in whole grains, fruits, vegetables, and selected fish is desirable for the best outcomes. Diets high in sugar and fat lead to higher rates of diabetes, metabolic syndrome, and cardiovascular disease. Folic acid, iodine, and calcium in all pregnant women and vitamin C in smokers are the only supplements so far shown to be of value for routine use. The physician treating a pregnant woman should be ready to advise a healthy diet for the benefit of the fetus. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives After participating in this activity, the

  3. Hidden Costs of Hospital Based Delivery from Two Tertiary Hospitals in Western Nepal

    PubMed Central

    Acharya, Jeevan; Kaehler, Nils; Marahatta, Sujan Babu; Mishra, Shiva Raj; Subedi, Sudarshan

    2016-01-01

    Introduction Hospital based delivery has been an expensive experience for poor households because of hidden costs which are usually unaccounted in hospital costs. The main aim of this study was to estimate the hidden costs of hospital based delivery and determine the factors associated with the hidden costs. Methods A hospital based cross-sectional study was conducted among 384 post-partum mothers with their husbands/house heads during the discharge time in Manipal Teaching Hospital and Western Regional Hospital, Pokhara, Nepal. A face to face interview with each respondent was conducted using a structured questionnaire. Hidden costs were calculated based on the price rate of the market during the time of the study. Results The total hidden costs for normal delivery and C-section delivery were 243.4 USD (US Dollar) and 321.6 USD respectively. Of the total maternity care expenditures; higher mean expenditures were found for food & drinking (53.07%), clothes (9.8%) and transport (7.3%). For postpartum women with their husband or house head, the total mean opportunity cost of “days of work loss” were 84.1 USD and 81.9 USD for normal delivery and C-section respectively. Factors such as literate mother (p = 0.007), employed house head (p = 0.011), monthly family income more than 25,000 NRs (Nepalese Rupees) (p = 0.014), private hospital as a place of delivery (p = 0.0001), C-section as a mode of delivery (p = 0.0001), longer duration (>5days) of stay in hospital (p = 0.0001), longer distance (>15km) from house to hospital (p = 0.0001) and longer travel time (>240 minutes) from house to hospital (p = 0.007) showed a significant association with the higher hidden costs (>25000 NRs). Conclusion Experiences of hidden costs on hospital based delivery and opportunity costs of days of work loss were found high. Several socio-demographic factors, delivery related factors (place and mode of delivery, length of stay, distance from hospital and travel time) were associated

  4. Anthropometry of fetal growth in rural Malawi in relation to maternal malaria and HIV status

    PubMed Central

    Kalanda, B; van Buuren, S; Verhoeff, F; Brabin, B

    2005-01-01

    Objective: To describe fetal growth centiles in relation to maternal malaria and HIV status, using cross sectional measurements at birth. Design: A cross sectional study of pregnant women and their babies. Data on maternal socioeconomic status and current pregnancy, including HIV status and newborn anthropometry, were collected. Malaria parasitaemia was assessed in maternal peripheral and placental blood, fetal haemoglobin was measured in cord blood, and maternal HIV status was determined. Setting: Two district hospitals in rural southern Malawi, between March 1993 and July 1994. Outcome variables: Newborn weight, length, Rohrer's ponderal index. Results: Maternal HIV (adjusted odds ratio (AOR) 1.76 (95% confidence interval 1.04 to 2.98)) and first pregnancy (AOR 1.83 (1.10 to 3.05)) were independently associated with low weight for age. Placental or peripheral parasitaemia at delivery (AOR 1.73 (1.02 to 2.88)) and primigravidae (AOR 2.13 (1.27 to 3.59)) were independently associated with low length for age. Maternal malaria at delivery and primiparity were associated with reduced newborn weight and length but not with disproportionate growth. Maternal HIV infection was associated only with reduced birth weight. The malaria and parity effect occurred throughout gestational weeks 30–40, but the HIV effect primarily after 38 weeks gestation. Conclusion: Fetal growth retardation in weight and length commonly occurs in this highly malarious area and is present from 30 weeks gestation. A maternal HIV effect on fetal weight occurred after 38 weeks gestation. PMID:15724042

  5. Incorporating immunizations into routine obstetric care to facilitate Health Care Practitioners in implementing maternal immunization recommendations

    PubMed Central

    Webb, Heather; Street, Jackie; Marshall, Helen

    2014-01-01

    Immunization against pertussis, influenza, and rubella reduces morbidity and mortality in pregnant women and their offspring. Health care professionals (HCPs) caring for women perinatally are uniquely placed to reduce maternal vaccine preventable diseases (VPDs). Despite guidelines recommending immunization during the perinatal period, maternal vaccine uptake remains low. This qualitative study explored the role of obstetricians, general practitioners, and midwives in maternal vaccine uptake. Semi-structured interviews (n = 15) were conducted with perinatal HCPs at a tertiary maternity hospital in South Australia. HCPs were asked to reflect on their knowledge, beliefs, and practice relating to immunization advice and vaccine provision. Interviews were transcribed and coded using thematic analysis. Data collection and analysis was an iterative process, with collection ceasing with theoretical saturation. Participants unanimously supported maternal vaccination as an effective way of reducing risk of disease in this vulnerable population, however only rubella immunity detection and immunization is embedded in routine care. Among these professionals, delegation of responsibility for maternal immunization was unclear and knowledge about maternal immunization was variable. Influenza and pertussis vaccine prevention measures were not included in standard pregnancy record documentation, information provision to patients was “ad hoc” and vaccinations not offered on-site. The key finding was that the incorporation of maternal vaccinations into standard care through a structured process is an important facilitator for immunization uptake. Incorporating vaccine preventable disease management measures into routine obstetric care including incorporation into the Pregnancy Record would facilitate HCPs in implementing recommendations. Rubella prevention provides a useful “template” for other vaccines. PMID:24509790

  6. Impact of maternal vitamin D status during pregnancy on neonatal vitamin D status.

    PubMed

    El Koumi, Mohamed A; Ali, Yasser F; Abd El Rahman, Rehab N

    2013-01-01

    Maternal vitamin D deficiency is not uncommon. The lack of vitamin D during pregnancy may result in poor fetal growth and altered neonatal development that may persist into later life. Recognition of risk factors and early detection of vitamin D deficiency during pregnancy are important in order to prevent neonatal vitamin D deficiency and related complications. The aim of the current study was to assess the effect of maternal vitamin D status on the neonatal vitamin D stores. A total of 92 pregnant women at the end of the 3rd trimester and their newborns were recruited from Zagazig University Maternity and Children's Hospital, Egypt during the year 2011. Maternal and cord blood samples were taken at the beginning of the third trimester for determination of serum levels of circulating 25-hydroxyvitamin D3 (25(OH) D3) concentration, serum calcium (Ca++), phosphorus (PO4), and alkaline phosphatase (ALP). Compared with pregnant women with adequate vitamin D levels, women deficient in vitamin D had infants with vitamin D deficiency (X±SD 33.44±18.33 nmol/L vs. 55.39±17.37 nmol/L, p=0.01). Maternal and neonatal serum 25(OH)D3 levels showed a positive correlation with serum Ca++ and negative correlation with serum PO4 and ALP. Neonatal 25(OH) D3 was related to maternal third trimester levels (r=0.89, p=0.01). The newborn serum 25(OH)D3 concentrations are reliant on maternal vitamin D status, and the poor maternal vitamin D status may adversely affect neonatal vitamin D status and consequently Ca++ homeostasis.

  7. Preterm Labor and Maternal Hypoxia in Patients With Community-Acquired Pneumonia

    PubMed Central

    Pinell, Phillip; Martens, Mark G.; Faro, Sebastian

    1996-01-01

    Objective: We sought to determine if preterm labor is associated with the degree of maternal hypoxia in pregnant women with community-acquired pneumonia but no other maternal diseases. Methods: We retrospectively reviewed the medical records of all antepartum patients admitted with a diagnosis of community-acquired pneumonia to an inner-city university hospital between 1983 and 1987. Included in this review were only the patients with radiologically confirmed diagnose of pneumonia and documented arterial blood gases on room air at the time of admission, but no other maternal diseases. Results: A total of 22 cases were identified. There was no maternal mortality, but there were 2 patients (9%) who developed respiratory failure requiring mechanical ventilation. Bacteremia with Streptococcus pneumoniae was documented in 1 patient (5%). Preterm labor complicated 5 cases (23%) and led to preterm delivery in 3 patients (14%). Terbutaline tocolysis was instituted in 3 patients, but was discontinued in 1 patient who was allowed to deliver because of her worsening condition. Preterm labor was associated with the WBC count on admission, usually > 18,000/mm3, but no statistically significant correlation with the severity of maternal hypoxia was noted. Five patients (23%) were incorrectly diagnosed at the time of admission, 4 with an initial diagnosis of pyelonephritis and 1 with an initial diagnosis of cholecystitis. Conclusions: Community-acquired pneumonia in the antepartum period is responsible for significant maternal and fetal complications even in the absence of other maternal diseases. Preterm labor and delivery remain frequent, and tocolysis should be used cautiously. At the time of admission, the diagnosis may be difficult. The degree of maternal hypoxia on admission does not correlate with the presence of preterm labor. PMID:18476096

  8. Infants delivered in maternity homes run by traditional birth attendants in urban Nigeria: a community-based study.

    PubMed

    Olusanya, Bolajoko O; Inem, Victor A; Abosede, Olayinka A

    2011-06-01

    We explored factors associated with traditional maternity/herbal homes (TMHs) run by traditional birth attendants (TBAs) compared with hospital or home delivery in Lagos, Nigeria, and found that infants delivered at TMHs were less likely to have severe hyperbilirubinemia compared with infants delivered in hospitals or residential homes. These infants were also less likely to be preterm compared with those delivered in hospitals or undernourished compared with infants delivered in residential homes. We concluded that infants delivered at TMHs who survive are unlikely to be at greater risks of some adverse perinatal outcomes than those delivered in hospitals or family homes.

  9. Prenatal Screening Using Maternal Markers

    PubMed Central

    Cuckle, Howard

    2014-01-01

    Maternal markers are widely used to screen for fetal neural tube defects (NTDs), chromosomal abnormalities and cardiac defects. Some are beginning to broaden prenatal screening to include pregnancy complications such as pre-eclampsia. The methods initially developed for NTDs using a single marker have since been built upon to develop high performance multi-maker tests for chromosomal abnormalities. Although cell-free DNA testing is still too expensive to be considered for routine application in public health settings, it can be cost-effective when used in combination with existing multi-maker marker tests. The established screening methods can be readily applied in the first trimester to identify pregnancies at high risk of pre-eclampsia and offer prevention though aspirin treatment. Prenatal screening for fragile X syndrome might be adopted more widely if the test was to be framed as a form of maternal marker screening. PMID:26237388

  10. Maternal obesity and prenatal programming.

    PubMed

    Elshenawy, Summer; Simmons, Rebecca

    2016-11-05

    Obesity is a significant and increasing public health concern in the United States and worldwide. Clinical and epidemiological evidence clearly shows that genetic and environmental factors contribute to the increased susceptibility of humans to obesity and its associated comorbidities; the interplay of these factors is explained by the concept of epigenetics. The impact of maternal obesity goes beyond the newborn period; fetal programming during the critical window of pregnancy, can have long term detrimental effects on the offspring as well as future generations. Emerging evidence is uncovering a link between the clinical and molecular findings in the offspring with epigenetic changes in the setting of maternal obesity. Research targeted towards reducing the transgenerational propagation and developmental programming of obesity is vital in reducing the increasing rates of disease.

  11. Maternal language and adverse birth outcomes in a statewide analysis.

    PubMed

    Sentell, Tetine; Chang, Ann; Ahn, Hyeong Jun; Miyamura, Jill

    2016-01-01

    Limited English proficiency is associated with disparities across diverse health outcomes. However, evidence regarding adverse birth outcomes across languages is limited, particularly among U.S. Asian and Pacific Islander populations. The study goal was to consider the relationship of maternal language to birth outcomes using statewide hospitalization data. Detailed discharge data from Hawaii childbirth hospitalizations from 2012 (n = 11,419) were compared by maternal language (English language or not) for adverse outcomes using descriptive and multivariable log-binomial regression models, controlling for race/ethnicity, age group, and payer. Ten percent of mothers spoke a language other than English; 93% of these spoke an Asian or Pacific Islander language. In multivariable models, compared to English speakers, non-English speakers had significantly higher risk (adjusted relative risk [ARR]: 2.02; 95% confidence interval [CI]: 1.34-3.04) of obstetric trauma in vaginal deliveries without instrumentation. Some significant variation was seen by language for other birth outcomes, including an increased rate of primary Caesarean sections and vaginal births after Caesarean, among non-English speakers. Non-English speakers had approximately two times higher risk of having an obstetric trauma during a vaginal birth when other factors, including race/ethnicity, were controlled. Non-English speakers also had higher rates of potentially high-risk deliveries.

  12. Maternal Language and Adverse Birth Outcomes in a Statewide Analysis

    PubMed Central

    Sentell, Tetine; Chang, Ann; Jun Ahn, Hyeong; Miyamura, Jill

    2016-01-01

    Background Limited English proficiency is associated with disparities across diverse health outcomes. However, evidence regarding adverse birth outcomes across languages is limited, particularly among US Asian and Pacific Islander populations. The study goal was to consider the relationship of maternal language to birth outcomes using statewide hospitalization data. Methods Detailed discharge data from Hawai‘i childbirth hospitalizations from 2012 (n=11,419) were compared by maternal language (English language or not) for adverse outcomes using descriptive and multivariable log-binomial regression models, controlling for race/ethnicity, age group, and payer. Results Ten percent of mothers spoke a language other than English; 93% of these spoke an Asian or Pacific Islander language. In multivariable models, compared to English speakers non-English speakers had significantly higher risk (adjusted relative risk [ARR]: 2.02; 95% Confidence Interval [CI]: 1.34–3.04) of obstetric trauma in vaginal deliveries without instrumentation. Some significant variation was seen by language for other birth outcomes, including an increased rate of primary Caesarean sections and vaginal births after Caesarean among non-English speakers. Conclusions Non-English speakers had approximately two times higher risk of having an obstetric trauma during a vaginal birth when other factors, including race/ethnicity, were controlled. Non-English speakers also had higher rates of potentially high-risk deliveries. PMID:26361937

  13. Prenatal drug exposure and maternal and infant feeding behaviour

    PubMed Central

    LaGasse, L; Messinger, D; Lester, B; Seifer, R; Tronick, E; Bauer, C; Shankaran, S; Bada, H; Wright, L; Smeriglio, V; Finnegan, L; Maza, P; Liu, J

    2003-01-01

    Objective: To evaluate feeding difficulties and maternal behaviour during a feeding session with 1 month old infants prenatally exposed to cocaine and/or opiates. Methods: The study is part of the maternal lifestyle study, which recruited 11 811 subjects at four urban hospitals, then followed 1388 from 1 to 36 months of age. Exposure to cocaine and opiates was determined by maternal interview and meconium assay. At the 1 month clinic visit, biological mothers were videotaped while bottle feeding their infants. This sample included 364 exposed to cocaine, 45 exposed to opiates, 31 exposed to both drugs, and 588 matched comparison infants. Mothers were mostly black, high school educated, and on public assistance. Videotapes were coded without knowledge of exposure status for frequency, duration and quality of infant sucking, arousal, feeding problems, and maternal feeding activity and interaction. Results: No cocaine effects were found on infant feeding measures, but cocaine-using mothers were less flexible (6.29 v 6.50), less engaged (5.77 v 6.22), and had shorter feeding sessions (638 v 683 seconds). Opiate exposed infants showed prolonged sucking bursts (29 v 20 seconds), fewer pauses (1.6 v 2.2 per minute), more feeding problems (0.55 v 0.38), and increased arousal (2.59 v 2.39). Their mothers showed increased activity (30 v 22), independent of their infants' feeding problems. Conclusions: Previous concerns about feeding behaviour in cocaine exposed infants may reflect the quality of the feeding interaction rather than infant feeding problems related to prenatal exposure. However, opiate exposed infants and their mothers both contributed to increased arousal and heightened feeding behaviour. PMID:12937043

  14. Maternity Care in Russia: Issues, Achievements, and Potential.

    PubMed

    Shuvalova, Marina P; Yarotskaya, Ekaterina L; Pismenskaya, Tatiana V; Dolgushina, Nataliya V; Baibarina, Elena N; Sukhikh, Gennady T

    2015-10-01

    In this review, we provide basic facts about maternity care services within the health care system in Russia. We give a short overview of such key aspects as the demographic situation, reproductive behaviour, regulatory framework for providing health care for women and children, maternal and perinatal mortality, and the availability of medical personnel. In 2012, Russia began registration of births in accordance with the WHO recommendations (births with weight ≥ 500 g at ≥ 22 weeks' gestation). Introduction of this new registration system increased the completeness and quality of the collected information and expanded possibilities for future international comparative assessments. A three-level system of specialized medical care has been introduced in Russia for women and newborns during pregnancy, childbirth, and the postpartum period. In 2014, the system included 1942 state (public) maternity hospitals providing 20 obstetric beds per 10 000 women aged 15 to 49 years. More than 100 perinatal centres (level III) are currently functioning in the country, with 32 new perinatal centres planned to open by 2016. The total number of obstetrician-gynaecologists in Russia is approximately 44 000, providing a ratio of 5.7 specialists per 10 000 women. The total number of midwives is 62 000, providing a ratio of 8.1 midwives per 10 000 women. In recent years we have succeeded in optimizing the maternity care system by increasing its accessibility and quality. This was achieved through qualitative and quantitative progress in the training of neonatologists, the development of intensive care technologies and neonatal critical care, capacity building of medical-genetic services and counselling, prenatal diagnosis, and the standardization of health care with data collection.

  15. Maternal Satisfaction with Administering Infant Interventions in the NICU

    PubMed Central

    Holditch-Davis, Diane; White-Traut, Rosemary; Levy, Janet; Williams, Kristi L.; Ryan, Donna; Vonderheid, Susan

    2015-01-01

    Objective To examine mothers’ satisfaction with administering interventions for their preterm infants and with the helpfulness of the study nurse by comparing the ATVV intervention (massage with auditory, tactile, visual, and vestibular stimulation), kangaroo care, and education about equipment needed at home. Secondarily, to explore whether mother and infant characteristics affected maternal satisfaction ratings. Design Three-group experimental design. Setting Four NICUs (two in North Carolina, two in Illinois). Participants 208 preterm infants and their mothers. Methods When the infant was no longer critically ill, mother-infant dyads were randomly assigned to ATVV, kangaroo care, or the education group, all taught by study nurses. At discharge and 2 months corrected age, mothers completed questionnaires. Results All groups were satisfied with the intervention and with nurse helpfulness, and the degree of satisfaction did not differ among them. Intervention satisfaction, but not nurse helpfulness, was related to recruitment site. Older, married, and minority mothers were less satisfied with the intervention but only at 2 months. Higher anxiety was related to lower intervention satisfaction at discharge and lower ratings of nurse helpfulness at discharge and 2 months. More depressive symptoms were related to lower nurse helpfulness ratings at 2 months. Conclusions Mothers were satisfied with providing interventions for their infants regardless of the intervention performed. Maternal satisfaction with the intervention was related to recruitment site, maternal demographic characteristics, and maternal psychological distress, especially at 2 months. Thus, nursing interventions that provide mothers with a role to play in the infant’s care during hospitalization are particularly likely to be appreciated by mothers. PMID:25803213

  16. Breech presentation: increasing maternal choice.

    PubMed

    Tiran, Denise

    2004-11-01

    Pregnant women with a third trimester breech presentation are almost invariably offered Caesarean section as the mode of delivery of first choice, especially when external version has failed to turn the fetus to cephalic. However, increasingly women are resorting to alternatives, to avoid either operative delivery or manipulative intervention in late pregnancy. This paper reviews some of the options for women with breech presentation, focusing especially on integrating these options into conventional maternity care.

  17. Trajectories of parenting behavior and maternal depression.

    PubMed

    Azak, Schale; Raeder, Sabine

    2013-06-01

    This study investigated trajectories of maternal parenting behavior across the infants' first 18 months of life in relation to maternal depression. Furthermore, predictors of the quality of the mother-infant relationship at 18 months were examined. Participants consisted of three types of mother-infant dyads: mothers with comorbid depression and anxiety (n=19), mothers with depression (n=7) and nondepressed mothers (n=24). Maternal behaviors and the quality of relationship were rated on a global scale (NICHD) from video-taped mother-infant interactions. Maternal behaviors rated at six, 12 and 18 months were collapsed into a composite variable maternal style. The quality of the relationship captured as dyadic mutuality was rated at 18 months. Comorbid and depressed mothers showed lower quality in maternal style compared with the nondepressed mothers at six months. Over the follow-up the comorbid mothers were lower in maternal style compared to the nondepressed mothers, but the comorbid mothers increased significantly in maternal style despite elevated depression symptoms. Mean maternal style and infant cognitive skills predicted the quality in relationship at 18 months suggesting that the mother-toddler relationship depends on contributions from the mother and the child. Higher growth in maternal style despite of depression symptoms among comorbid mothers was interpreted against the background that the majority of the comorbid mother-infant dyads received several treatments.

  18. Can hospitals compete on quality? Hospital competition.

    PubMed

    Sadat, Somayeh; Abouee-Mehrizi, Hossein; Carter, Michael W

    2015-09-01

    In this paper, we consider two hospitals with different perceived quality of care competing to capture a fraction of the total market demand. Patients select the hospital that provides the highest utility, which is a function of price and the patient's perceived quality of life during their life expectancy. We consider a market with a single class of patients and show that depending on the market demand and perceived quality of care of the hospitals, patients may enjoy a positive utility. Moreover, hospitals share the market demand based on their perceived quality of care and capacity. We also show that in a monopoly market (a market with a single hospital) the optimal demand captured by the hospital is independent of the perceived quality of care. We investigate the effects of different parameters including the market demand, hospitals' capacities, and perceived quality of care on the fraction of the demand that each hospital captures using some numerical examples.

  19. Changing hospital payments: implications for teaching hospitals.

    PubMed

    Bentley, J D

    1983-09-01

    Hospitals cannot continue to view themselves only as social institutions whose performance will be assessed on the good they do. Teaching hospitals, in particular, cannot view themselves simply as distinctive combinations of social and educational institutions. Under Medicare's prospective pricing system, the hospital's role as production system is enhanced, and all hospitals must learn to balance the new economic realities as they work with their medical staff to adapt to a changed future.

  20. Severe Maternal Morbidity and the Use of Assisted Reproductive Technology in Massachusetts

    PubMed Central

    Belanoff, Candice; Declercq, Eugene R.; Diop, Hafsatou; Gopal, Daksha; Kotelchuck, Milton; Luke, Barbara; Nguyen, Thien; Stern, Judy E.

    2016-01-01

    Objectives To assess whether risk of severe maternal morbidity at delivery differed for women who conceived using assisted reproductive technology (ART), those with indicators of subfertility but no ART (“subfertile”), and those who had neither ART nor subfertility (“fertile”). Methods This retrospective cohort study was part of the larger Massachusetts Outcomes Study of Assisted Reproductive Technology (MOSART). To construct the MOSART database and identify ART deliveries, we linked ART treatment records to birth certificates and maternal and infant hospitalization records occurring in Massachusetts between 2004 and 2010. An algorithm of ICD-9-CM diagnosis and procedure codes identified severe maternal morbidity. We used Logistic Generalized Estimating Equations to estimate odds of severe maternal morbidity associated with fertility status, adjusting for maternal demographic and health factors and gestational age, stratifying on plurality and method of delivery. Results The prevalence of severe maternal morbidity among this population (n = 458,918) was 1.16%. The overall, crude prevalences of severe maternal morbidity among fertile, subfertile and ART deliveries were 1.09%, 1.44% and 3.14%, respectively. The most common indicator of severe maternal morbidity was blood transfusion. In multivariable analyses, among singletons, ART was associated with increased odds of severe maternal morbidity compared to both fertile (Vaginal: aOR 2.27, 95% CI: 1.78 – 2.88; cesarean: aOR 1.67, 95% CI: 1.40 – 1.98, respectively) and subfertile (vaginal: aOR 1.97, 95% CI: 1.30 – 3.00; cesarean: aOR 1.75, 95% CI: 1.30 – 2.35, respectively) deliveries. Among twins, only cesarean ART deliveries had significantly greater severe maternal morbidity compared to cesarean fertile deliveries (aOR 1.48, 95% CI: 1.14, 1.93). Conclusions Women who conceive through ART may have elevated risk severe maternal morbidity at delivery, largely indicated by blood transfusion, even when

  1. Going to the Hospital

    MedlinePlus

    ... Happens in the Operating Room? Going to the Hospital KidsHealth > For Kids > Going to the Hospital Print ... you flowers, balloons, or other treats! previous continue Hospital People You'll meet lots of people in ...

  2. The role of the interpreter/doula in the maternity setting.

    PubMed

    Maher, Sandra; Crawford-Carr, Alison; Neidigh, Kimberly

    2012-12-01

    Health care organizations often struggle with issues related to communication with patients who have limited English proficiency. Providing quality interpreter services is necessary to comply with regulatory mandates and to provide safe, effective health care. Maternity care presents a unique situation due to the intimate and unpredictable nature of birth. A unique interpreter/doula program in which trained medical interpreters received additional education in labor and postpartum doula skills was tested at a large urban hospital maternity center with a large population of Spanish-speaking patients. Results showed that interpreter/doulas can offer timely, competent care in a variety of maternity situations. They also were cost-effective and associated with increased patient and staff satisfaction.

  3. Critical Access Hospitals (CAH)

    MedlinePlus

    ... use requirements for Critical Access Hospitals related to Electronic Health Records (EHRs)? Critical Access Hospital (CAH) are eligible for Electronic Health Record (EHR) incentive payments and can receive ...

  4. The Neuroendocrinology of Primate Maternal Behavior

    PubMed Central

    Saltzman, Wendy; Maestripieri, Dario

    2010-01-01

    In nonhuman primates and humans, similar to other mammals, hormones are not strictly necessary for the expression of maternal behavior, but nevertheless influence variation in maternal responsiveness and parental behavior both within and between individuals. A growing number of correlational and experimental studies have indicated that high circulating estrogen concentrations during pregnancy increase maternal motivation and responsiveness to infant stimuli, while effects of prepartum or postpartum estrogens and progestogens on maternal behavior are less clear. Prolactin is thought to play a role in promoting paternal and alloparental care in primates, but little is known about the relationship between this hormone and maternal behavior. High circulating cortisol levels appear to enhance arousal and responsiveness to infant stimuli in young, relatively inexperienced female primates, but interfere with the expression of maternal behavior in older and more experienced mothers. Among neuropeptides and neurotransmitters, preliminary evidence indicates that oxytocin and endogenous opioids affect maternal attachment to infants, including maintenance of contact, grooming, and responses to separation. Brain serotonin affects anxiety and impulsivity, which in turn may affect maternal behaviors such as infant retrieval or rejection of infants’ attempts to make contact with the mother. Although our understanding of the neuroendocrine correlates of primate maternal behavior has grown substantially in the last two decades, very little is known about the mechanisms underlying these effects, e.g., the extent to which these mechanisms may involve changes in perception, emotion, or cognition. PMID:20888383

  5. Evidence from Maternity Leave Expansions of the Impact of Maternal Care on Early Child Development

    ERIC Educational Resources Information Center

    Baker, Michael; Milligan, Kevin

    2010-01-01

    We study the impact of maternal care on early child development using an expansion in Canadian maternity leave entitlements. Following the leave expansion, mothers who took leave spent 48-58 percent more time not working in their children's first year of life. This extra maternal care primarily crowded out home-based care by unlicensed…

  6. Maternal and Child Anxiety: Do Attachment Beliefs or Children's Perceptions of Maternal Control Mediate Their Association?

    ERIC Educational Resources Information Center

    Costa, Natalie M.; Weems, Carl F.

    2005-01-01

    This study tested a model of the association between maternal and child anxiety that views mother and child attachment beliefs and children's perceptions of maternal control as mediators of the association. The study was conducted with mothers and their children aged 6 to 17 (N = 88). Maternal anxiety was significantly associated with child…

  7. Maternal and Adolescent Temperament as Predictors of Maternal Affective Behavior during Mother-Adolescent Interactions

    ERIC Educational Resources Information Center

    Davenport, Emily; Yap, Marie B. H.; Simmons, Julian G.; Sheeber, Lisa B.; Allen, Nicholas B.

    2011-01-01

    This study examined maternal and early adolescent temperament dimensions as predictors of maternal emotional behavior during mother-adolescent interactions. The sample comprised 151 early adolescents (aged 11-13) and their mothers (aged 29-57). Adolescent- and mother-reports of adolescent temperament and self-reports of maternal temperament were…

  8. Reshaping maternal services in Nigeria: any need for spiritual care?

    PubMed Central

    2014-01-01

    Background High maternal and perinatal mortalities occur from deliveries conducted in prayer houses in Nigeria. Although some regulatory efforts have been deployed to tackle this problem, less attention has been placed on the possible motivation for seeking prayer house intervention which could be hinged on the spiritual belief of patients about pregnancy and childbirth. This study therefore seeks to determine the perception of booked antenatal patients on spiritual care during pregnancy and their desire for such within hospital setting. Method A total of 397 antenatal attendees from two tertiary health institutions in southwest Nigeria were sampled. A pretested questionnaire was used to obtain information on socio-demographic features of respondents, perception of spiritual care during pregnancy and childbirth; and how they desire that their spiritual needs are addressed. Responses were subsequently collated and analyzed. Results Most of the women, 301 (75.8%), believe there is a need for spiritual help during pregnancy and childbirth. About half (48.5%) were currently seeking for help in prayer/mission houses while another 8.6% still intended to. Overwhelmingly, 281 (70.8%) felt it was needful for health professionals to consider their spiritual needs. Most respondents, 257 (64.7%), desired that their clergy is allowed to pray with them while in labour and sees such collaboration as incentive that will improve hospital patronage. There was association between high family income and desire for collaboration of healthcare providers with one’s clergy (OR 1.82; CI 1.03-3.21; p = 0.04). Conclusion Our women desire spiritual care during pregnancy and childbirth. Its incorporation into maternal health services will improve hospital delivery rates. PMID:24902710

  9. Marathon Maternity Oral History Project

    PubMed Central

    Orkin, Aaron; Newbery, Sarah

    2014-01-01

    Abstract Objective To explore how birthing and maternity care are understood and valued in a rural community. Design Oral history research. Setting The rural community of Marathon, Ont, with a population of approximately 3500. Participants A purposive selection of mothers, grandmothers, nurses, physicians, and community leaders in the Marathon medical catchment area. Methods Interviews were conducted with a purposive sample, employing an oral history research methodology. Interviews were conducted non-anonymously in order to preserve the identity and personhood of participants. Interview transcripts were edited into short narratives. Oral histories offer perspectives and information not revealed in other quantitative or qualitative research methodologies. Narratives re-personalize and humanize medical research by offering researchers and practitioners the opportunity to bear witness to the personal stories affected through medical decision making. Main findings Eleven stand-alone narratives, published in this issue of Canadian Family Physician, form the project’s findings. Similar to a literary text or short story, they are intended for personal reflection and interpretation by the reader. Presenting the results of these interviews as narratives requires the reader to participate in the research exercise and take part in listening to these women’s voices. The project’s narratives will be accessible to readers from academic and non-academic backgrounds and will interest readers in medicine and allied health professions, medical humanities, community development, gender studies, social anthropology and history, and literature. Conclusion Sharing personal birthing experiences might inspire others to reevaluate and reconsider birthing practices and services in other communities. Where local maternity services are under threat, Marathon’s stories might contribute to understanding the meaning and challenges of local birthing, and the implications of losing

  10. [Maternal mortality: levels, trends, and differentials].

    PubMed

    Langer, A; Lozano, R; Hernandez, B

    1993-01-01

    Maternal mortality in Mexico has declined significantly over the past half century. The maternal mortality rate was 53/10,000 live births in 1940 and 5.1 in 1990. The greatest and most rapid decline occurred in the 1940s. The maternal mortality rate is still too high, and in addition the differential between Mexican rates and those of the developed countries has increased. The average age at maternal death is 29 years, a full 40 years less than potential life expectancy. The risk of death from causes related to reproduction varies substantially by educational level. Of all maternal deaths between 1986 and 1991, 26% were in illiterate women, 33% in women with incomplete primary, and 24% in those with complete primary. In 1990, the average female school attainment was complete primary. The maternal mortality rate was eight times higher among illiterate women and five times higher in those not completing primary than in those finishing preparatory. Geographically, states with low maternal mortality rates of under 3.1 are mainly located in the north and those with high maternal mortality of over 6.0 are in the south. The central zone is an intermediate area. The 1991 maternal mortality rates of Oaxaca, Puebla, Tlaxcala, Veracruz, and the state of Mexico are similar to those of Nuevo Leon 30 years ago or Aguascalientes, Sonora, and Baja California 20 years ago. 72% of maternal deaths in the 1980s occurred in rural areas. The rates were 6.5/10,000 in rural areas and 4.1/10,000 in urban areas. The maternal mortality rate also increases with marginalization. An index of marginalization constructed with census data using multivariate techniques showed that fertile aged women in very marginalized municipios had maternal mortality rates of 11.5/10,000, or a risk of death three times greater than women in municipios scoring low for marginalization. Maternal mortality continues to be a priority public health problem in Mexico. Because so many maternal deaths are preventable

  11. Understanding Global Trends in Maternal Mortality

    PubMed Central

    Zureick-Brown, Sarah; Newby, Holly; Chou, Doris; Mizoguchi, Nobuko; Say, Lale; Suzuki, Emi; Wilmoth, John

    2013-01-01

    CONTEXT Despite the fact that most maternal deaths are preventable, maternal mortality remains high in many developing countries. Target A of Millennium Development Goal (MDG) 5 calls for a three-quarters reduction in the maternal mortality ratio (MMR) between 1990 and 2015. METHODS We derived estimates of maternal mortality for 172 countries over the period 1990–2008. Trends in maternal mortality were estimated either directly from vital registration data or from a hierarchical or multilevel model, depending on the data available for a particular country. RESULTS The annual number of maternal deaths worldwide declined by 34% between 1990 and 2008, from approximately 546,000 to 358,000 deaths. The estimated MMR for the world as a whole also declined by 34% over this period, falling from 400 to 260 maternal deaths per 100,000 live births. Between 1990 and 2008, the majority of the global burden of maternal deaths shifted from Asia to Sub-Saharan Africa. Differential trends in fertility, the HIV/ AIDS epidemic and access to reproductive health are associated with the shift in the burden of maternal deaths from Asia to Sub-Saharan Africa. CONCLUSIONS Although the estimated annual rate of decline in the global MMR in 1990–2008 (2.3%) fell short of the level needed to meet the MDG 5 target, it was much faster than had been thought previously. Targeted efforts to improve access to quality maternal health care, as well as efforts to decrease unintended pregnancies through family planning, are necessary to further reduce the global burden of maternal mortality. PMID:23584466

  12. Infant Arterial Stiffness and Maternal Iron Status in Pregnancy: A UK Birth Cohort (Baby VIP Study)

    PubMed Central

    Alwan, Nisreen A.; Cade, Janet E.; McArdle, Harry J.; Greenwood, Darren C.; Hayes, Helen E.; Ciantar, Etienne; Simpson, Nigel A.B.

    2015-01-01

    Background In animal studies, iron deficiency during pregnancy has been linked to increased offspring cardiovascular risk. No previous population studies have measured arterial stiffness early in life to examine its association with maternal iron status. Objective This study aimed to examine the association between maternal iron status in early pregnancy with infant brachio-femoral pulse wave velocity (PWV). Methods The Baby VIP (Baby's Vascular Health and Iron in Pregnancy) study is a UK-based birth cohort which recruited 362 women after delivery from the Leeds Teaching Hospitals postnatal wards. Ferritin and transferrin receptor levels were measured in maternal serum samples previously obtained in the first trimester. Infant brachio-femoral PWV was measured during a home visit at 2–6 weeks. Results Iron depletion (ferritin <15 µg/l) was detected in 79 (23%) women in early pregnancy. Infant PWV (mean = 6.7 m/s, SD = 1.3, n = 284) was neither associated with maternal ferritin (adjusted change per 10 µg/l = 0.02, 95% CI: −0.01, 0.1), nor with iron depletion (adjusted change = −0.2, 95% CI: −0.6, 0.2). No evidence of association was observed between maternal serum transferrin receptor level and its ratio to ferritin with infant PWV. Maternal anaemia (<11 g/dl) at <20 weeks’ gestation was associated with a 1.0-m/s increase in infant PWV (adjusted 95% CI: 0.1, 1.9). Conclusion This is the largest study to date which has assessed peripheral PWV as a measure of arterial stiffness in infants. There was no evidence of an association between markers of maternal iron status early in pregnancy and infant PWV. PMID:25790854

  13. Maternal deaths among rural–urban migrants in China: a case–control study

    PubMed Central

    2014-01-01

    Background Disparity in maternal mortality exists between rural–urban migrant and urban resident women in China, but little research has provided evidence for related policy development. The objective of this study was to identify associations with and risks for maternal death among rural–urban migrant women in order to improve health services for migrant women and reduce maternal mortality in China. Methods We conducted a prospective case–control study in urban areas of Guangdong, Zhejiang and Fujian provinces and Beijing municipality. In each, migrant women who died between July 1, 2010 and October 1, 2011 were identified through reports from China’s Maternal and Child Mortality Surveillance System. For each, four matched controls were selected from migrant women who delivered in local hospitals during the same period. We compared socio-demographic characteristics, health status and health service variables between cases and controls, and used bivariate and multivariate conditional logistic regression analyses to determine associations with and risk factors for maternal death. Results 109 cases and 436 controls were assessed. Family income <2000 yuan per month (OR = 4.5; 95% CI 1.7-11.7) and lack of health insurance (OR = 1.3; 95% CI 1.1-1.6) were more common amongst women who died, as were lack of antenatal care (ANC) (OR = 22.3; 95% CI 4.3-116.0) and attending ANC only 1–4 times (OR = 5.0; 95% CI 1.6-15.5). Knowledge of danger signs during delivery was less common in this group (OR = 0.3; 95% CI 0.1-0.8). Conclusion Differences existed between migrant women who died in pregnancy and surviving controls. The identified risk factors suggest strategies for health sector and community action on reducing maternal mortality among migrant women in China. A systematic approach to maternity care for rural–urban migrant women is recommended. PMID:24885480

  14. Finance and faith at the Catholic Maternity Institute, Santa Fe, New Mexico, 1944-1969.

    PubMed

    Cockerham, Anne Z; Keeling, Arlene W

    2010-01-01

    In 1944, the Medical Mission Sisters opened the Catholic Maternity Institute in Santa Fe, New Mexico, primarily to serve patients of Spanish American descent. The Maternity Institute offered nurse-midwifery care and functioned as a school to train nurse-midwifery students. Originally planned as a home birth service, the Catholic Maternity Institute soon evolved into a service in which patients chose whether to deliver in their own homes or in a small freestanding building called La Casita. In fact, despite their idealism about home birth and strong feelings that home birth was best, the sisters experienced significant ambivalence concerning La Casita. Births there met many of the institute's pragmatic needs for a larger number of student experiences, quick and safe transfers to a nearby hospital, and more efficient use of the midwives' time. Importantly, as the sisters realized that many of their patients preferred to deliver at La Casita, they came to see that this option permitted these impoverished patients an opportunity to exercise some choice. However, the choice of many patients to deliver at La Casita--which was significantly more expensive for the Maternity Institute than home birth--eventually led to the demise of the Maternity Institute.

  15. Challenges of maternal mortality reduction and opportunities under National Rural Health Mission--a critical appraisal.

    PubMed

    Kumar, Satish

    2005-01-01

    Maternal Mortality Ratio (MMR) continues to remain high in our country without showing any declining trend over a period of two decades. The proportions of maternal deaths contributed by direct obstetric causes have also remained more or less the same in rural areas. There is a strong need to improve coverage of antenatal care, promote institutional deliveries and provide emergency obstetric care. Delays occur in seeking care for obstetric complications and levels of 'met obstetric need' continue to be low in many parts of the country. Most of the First Referral Units (FRUs) and CHCs function at sub-optimal level in the country. National Rural Health Mission (NRHM) offers institutional mechanism and strategic options to reduce high MMR. 'Janani Suraksha Yojna', strengthening of CHCs (as per Indian Public Health standards) to offer 24 hours quality services including that of anesthetists and Accredited Social Health Activist (ASHA) are important proposals in this regard. District Health Mission can play an important role in monitoring maternal deaths occurring in hospitals or in community and thus create a social momentum to prevent and reduce maternal deaths. NRHM, however, depends largely on Panchayati Raj Institutions for effective implementation of proposed interventions and utilization of resources. In most parts of our country, State Governments have not empowered PRIs with real devolution of power. Therefore, much needs to be done locally to build the capacity of PRIs and develop state-specific guidelines in operational terms to implement interventions under NRHM for reducing maternal mortality ratio.

  16. Specialty hospitals: can general hospitals compete?

    PubMed

    Dummit, Laura A

    2005-07-13

    The rapid increase in specialty cardiac, surgical, and orthopedic hospitals has captured the attention of general hospitals and policymakers. Although the number of specialty hospitals remains small in absolute terms, their entry into certain health care markets has fueled arguments about the rules of "fair" competition among health care providers. To allow the smoke to clear, Congress effectively stalled the growth in new specialty hospitals by temporarily prohibiting physicians from referring Medicare or Medicaid patients to specialty hospitals in which they had an ownership interest. During this 18-month moratorium, which expired June 8, 2005, two mandated studies of specialty hospitals provided information to help assess their potential effect on health care delivery. This issue brief discusses the research on specialty hospitals, including their payments under Medicare's hospital inpatient payment system, the quality and cost of care they deliver, their effect on general hospitals and on overall health care delivery, and the regulatory and legal environment in which they have proliferated. It concludes with open issues concerning physician self-referral and the role of general hospitals in providing a range of health care services.

  17. Measuring Rural Hospital Quality

    ERIC Educational Resources Information Center

    Moscovice, Ira; Wholey, Douglas R.; Klingner, Jill; Knott, Astrid

    2004-01-01

    Increased interest in the measurement of hospital quality has been stimulated by accrediting bodies, purchaser coalitions, government agencies, and other entities. This paper examines quality measurement for hospitals in rural settings. We seek to identify rural hospital quality measures that reflect quality in all hospitals and that are sensitive…

  18. Hospital marketing revisited.

    PubMed

    Costello, M M

    1987-05-01

    With more hospitals embracing the marketing function in their organizational management over the past decade, hospital marketing can no longer be considered a fad. However, a review of hospital marketing efforts as reported in the professional literature indicates that hospitals must pay greater attention to the marketing mix elements of service, price and distribution channels as their programs mature.

  19. Evaluation of four maternal smoking questions.

    PubMed Central

    Kharrazi, M; Epstein, D; Hopkins, B; Kreutzer, R; Doebbert, G; Hiatt, R; Swan, S; Eskenazi, B; Pirkle, J L; Bernert, J T

    1999-01-01

    OBJECTIVE: The authors evaluated four questions about maternal smoking during pregnancy for use on birth certificates. METHODS: Question 1 (yes/no format) and Question 2 (trimester-specific design) were tested among 1171 women who delivered at two Kaiser Permanente medical centers in northern California. Responses to Questions 1 and 2 were compared with smoking information provided by participants in telephone interviews conducted during pregnancy. Question 3 (multiple choice format) and Question 4 (month- and grouped month-specific design) were tested among 900 women who enrolled in a statewide prenatal screening program and who delivered in 20 hospitals in four Central Valley counties. Responses to Questions 3 and 4 were compared with mid-pregnancy serum cotinine levels. The authors evaluated the four questions in terms of conciseness, response rate, data accuracy, and type of data requested. RESULTS: Questions 1 and 2 were the most concise. Response rates could not be calculated for Questions 1 and 2. Response rates were 86.0% for Question 3 and 74.2% for Question 4. Sensitivity was 47.3% for Question 1, 62.1% for Question 2, 83.8% for Question 3, and 86.7% for Question 4. The types of data requested by Questions 2 and 4 seem to best satisfy the needs of the broad audience of birth certificate users. CONCLUSIONS: No single question was clearly superior. The authors propose a combination of Questions 2 and 4, which asks about average number of cigarettes smoked per day in the three months before pregnancy and in each trimester of pregnancy. PMID:9925173

  20. Immigrants' experiences of maternity care in Japan.

    PubMed

    Igarashi, Yukari; Horiuchi, Shigeko; Porter, Sarah E

    2013-08-01

    Language and cultural differences can negatively impact immigrant women's birth experience. However, little is known about their experiences in Japan's highly homogenous culture. This cross-sectional study used survey data from a purposive sampling of immigrant women from 16 hospitals in several Japanese prefectures. Meeting the criteria and recruited to this study were 804 participants consisting of 236 immigrant women: Chinese (n = 83), Brazilian (n = 62), Filipino (n = 43), South Korean (n = 29) and from variety of English speaking nations (n = 19) and 568 Japanese women. The questionnaire was prepared in six languages: Japanese (kana syllables), Chinese, English, Korean, Portuguese, and Tagalog (Filipino). Associations among quality of maternity care, Japanese literacy level, loneliness and care satisfaction were explored using analysis of variance and multiple linear regression. The valid and reliable instruments used were Quality of Care for Pregnancy, Delivery and Postpartum Questionnaire, Rapid Estimate of Adult Literacy in Medicine Japanese version, the revised UCLA Loneliness Scale-Japanese version and Care satisfaction. Care was evaluated across prenatal, labor and delivery and post-partum periods. Immigrant women scored higher than Japanese women for both positive and negative aspects. When loneliness was strongly felt, care satisfaction was lower. Some competence of Japanese literacy was more likely to obstruct positive communication with healthcare providers, and was associated with loneliness. Immigrant women rated overall care as satisfactory. Japanese literacy decreased communication with healthcare providers, and was associated with loneliness presumably because some literacy unreasonably increased health care providers' expectations of a higher level of communication.

  1. Competition among hospitals.

    PubMed

    Noether, M

    1988-09-01

    The traditional view of hospital competition has posited that hospitals compete primarily along 'quality' dimensions, in the form of fancy equipment to attract admitting physicians and pleasant surroundings to entice patients. Price competition among hospitals is thought to be non-existent. This paper estimates the effects of various hospital market characteristics on hospital prices and expenses in an attempt to determine the form of hospital competition. The results suggest that both price and quality competition are greater in markets that are less concentrated, although the net effect of the two on prices is insignificant. It appears, therefore, that, despite important distortions, hospital markets are not immune to standard competitive forces.

  2. Pharmacogenomics of Maternal Tobacco Use

    PubMed Central

    Aagaard-Tillery, Kjersti; Spong, Catherine Y.; Thom, Elizabeth; Sibai, Baha; Wendel, George; Wenstrom, Katharine; Samuels, Philip; Simhan, Hyagriv; Sorokin, Yoram; Miodovnik, Menachem; Meis, Paul; O’Sullivan, Mary J.; Conway, Deborah; Wapner, Ronald J.

    2011-01-01

    OBJECTIVE To assess whether functional maternal or fetal genotypes along well-characterized metabolic pathways (ie, CYP1A1, GSTT1, and CYP2A6) may account for varying associations with adverse outcomes among pregnant women who smoke. METHODS DNA samples from 502 smokers and their conceptuses, alongside women in a control group, were genotyped for known functional allelic variants of CYP1A1 (Ile462Val AA>AG/GG), GSTT1(del), and CYP2A6 (Lys160His T>A). Modification of the association between smoking and outcome by genotype was evaluated. Outcomes included birth weight, pregnancy loss, preterm birth, small for gestational age, and a composite outcome composed of the latter four components plus abruption. RESULTS No interaction between maternal or fetal genotype of any of the polymorphisms and smoking could be demonstrated. In contrast, the association of smoking with gestational age–adjusted birth weight (birth weight ratio) was modified by fetal GSTT1 genotype (P for interaction=.02). Fetuses with GSTT1(del) had a mean birth weight reduction among smokers of 262 g (P=.01), whereas in fetuses without the GSTT1(del) the effect of tobacco exposure was nonsignificant (mean reduction 87 g, P=.16). After adjusting for confounding, results were similar. CONCLUSION Fetal GSTT1 deletion significantly and specifically modifies the effect of smoking on gestational age–corrected birth weight. PMID:20177288

  3. Maternal mortality and unsafe abortion.

    PubMed

    Fawcus, Susan R

    2008-06-01

    Unsafe abortions refer to terminations of unintended pregnancies by persons lacking the necessary skills, or in an environment lacking the minimum medical standards, or both. Globally, unsafe abortions account for 67,900 maternal deaths annually (13% of total maternal mortality) and contribute to significant morbidity among women, especially in under-resourced settings. The determinants of unsafe abortion include restrictive abortion legislation, lack of female empowerment, poor social support, inadequate contraceptive services and poor health-service infrastructure. Deaths from unsafe abortion are preventable by addressing the above determinants and by the provision of safe, accessible abortion care. This includes safe medical or surgical methods for termination of pregnancy and management of incomplete abortion by skilled personnel. The service must also include provision of emergency medical or surgical care in women with severe abortion complications. Developing appropriate services at the primary level of care with a functioning referral system and the inclusion of post abortion contraceptive care with counseling are essential facets of abortion care.

  4. Towards ending preventable maternal deaths by 2035.

    PubMed

    Bergevin, Yves; Fauveau, Vincent; McKinnon, Britt

    2015-01-01

    Maternal mortality has been reduced by half from 1990 to 2010, yet a woman in sub-Saharan Africa has a lifetime risk of maternal death of 1 in 39 compared with around 1 in 10,000 in industrialized countries. Annual rates of reduction of maternal mortality of over 10% have been achieved in several countries. Highly cost-effective interventions exist and are being scaled up, such as family planning, emergency obstetric and newborn care, quality service delivery, midwifery, maternal death surveillance and response, and girls' education; however, coverage still remains low. Maternal mortality reduction is now high on the global agenda. We examined scenarios of reduction of maternal mortality by 2035. Ending preventable maternal deaths could be achieved in nearly all countries by 2035 with challenging yet realistic efforts: (1) massive scaling-up and skilling up of human resources for family planning and maternal health; (2) reaching every village in every district and every urban slum toward universal health coverage; (3) enhanced financing; (4) knowledge for action: enhanced monitoring, accountability, evaluation, and R&D.

  5. Autism Symptom Topography and Maternal Socioemotional Functioning

    ERIC Educational Resources Information Center

    Ekas, Naomi; Whitman, Thomas L.

    2010-01-01

    Researchers examining the relationship of autism "symptomatology" and maternal stress have defined symptomatology in terms of level of severity, frequency of occurrence, or symptom type. In the present study, the relationship of maternal perceptions of these dimensions, along with a fourth, symptom diversity, and negative and positive indices of…

  6. Maternal Inattention and Impulsivity and Parenting Behaviors

    ERIC Educational Resources Information Center

    Chen, Mandy; Johnston, Charlotte

    2007-01-01

    This study extends previous research by examining whether maternal inattention, impulsivity, and hyperactivity are associated with different parenting behaviors. Ninety-six mother-son dyads participated in the study, and the boys ranged between 4 and 8 years of age. Maternal inattention was uniquely and positively associated with mothers' use of…

  7. Infant Communicative Behaviors and Maternal Responsiveness

    ERIC Educational Resources Information Center

    DiCarlo, Cynthia F.; Onwujuba, Chinwe; Baumgartner, Jennifer I.

    2014-01-01

    Background: This study applies attachment and transactional theories in evaluating the dyadic interactions observed between a mother and her infant. Infant communication and maternal responsivity are highlighted as the medium for positive interaction. Objective: The impact of individualized maternal training on mother infant communicative…

  8. Maternal Depression and Developmental Disability: Research Critique

    ERIC Educational Resources Information Center

    Bailey, Donald B., Jr.; Golden, Robert N.; Roberts, Jane; Ford, Amy

    2007-01-01

    Maternal depression in families having a child with a disability has been the subject of considerable research over the past 25 years. This review was designed to describe the literature on maternal depression, critique its research methodology, identify consensus findings across studies, and make recommendations for future research. A particular…

  9. Maternal vaccination: moving the science forward

    PubMed Central

    Faucette, Azure N.; Unger, Benjamin L.; Gonik, Bernard; Chen, Kang

    2015-01-01

    BACKGROUND Infections remain one of the leading causes of morbidity in pregnant women and newborns, with vaccine-preventable infections contributing significantly to the burden of disease. In the past decade, maternal vaccination has emerged as a promising public health strategy to prevent and combat maternal, fetal and neonatal infections. Despite a number of universally recommended maternal vaccines, the development and evaluation of safe and effective maternal vaccines and their wide acceptance are hampered by the lack of thorough understanding of the efficacy and safety in the pregnant women and the offspring. METHODS An outline was synthesized based on the current status and major gaps in the knowledge of maternal vaccination. A systematic literature search in PUBMED was undertaken using the key words in each section title of the outline to retrieve articles relevant to pregnancy. Articles cited were selected based on relevance and quality. On the basis of the reviewed information, a perspective on the future directions of maternal vaccination research was formulated. RESULTS Maternal vaccination can generate active immune protection in the mother and elicit systemic immunoglobulin G (IgG) and mucosal IgG, IgA and IgM responses to confer neonatal protection. The maternal immune system undergoes significant modulation during pregnancy, which influences responsiveness to vaccines. Significant gaps exist in our knowledge of the efficacy and safety of maternal vaccines, and no maternal vaccines against a large number of old and emerging pathogens are available. Public acceptance of maternal vaccination has been low. CONCLUSIONS To tackle the scientific challenges of maternal vaccination and to provide the public with informed vaccination choices, scientists and clinicians in different disciplines must work closely and have a mechanistic understanding of the systemic, reproductive and mammary mucosal immune responses to vaccines. The use of animal models should be

  10. A multidisciplinary program of preparation for childbirth and motherhood: maternal anxiety and perinatal outcomes

    PubMed Central

    2010-01-01

    Background To study maternal anxiety and perinatal outcomes in pregnant women submitted to a Multidisciplinary Program for Childbirth and Motherhood Preparation (MPCM). Methods This is a not randomized controlled trial on 67 nulliparous pregnant women divided into two groups according to participation (MPCM Group; n = 38) or not (Control Group; n = 29) in MPCM. The program consisted of 10 meetings (between the 18th and the 38th gestational week) during which educational, physiotherapeutic and interaction activities were developed. Anxiety was quantified at the beginning and at the end of the gestational period by the Trace-State Anxiety Inventory (STAI). Results Initial maternal anxiety was equivalent between the groups. At the end of the gestational period, it was observed that anxiety levels increased in the Control Group and were maintained in the MPCM Group. A higher occurrence of vaginal deliveries (83.8%) and hospital discharge of three-day-older newborns (81.6%) as a result of MPCM was also significant. Levels of state-anxiety at the end of pregnancy showed a negative correlation with vaginal delivery, gestational age, birth weight and Apgar index at the first minute and positive correlation with the hospital period remaining of the newborns. Conclusion In the study conditions, MPCM was associated with lower levels of maternal anxiety, a larger number of vaginal deliveries and shorter hospitalization time of newborns. It was not related to adverse perinatal outcomes. PMID:21034460

  11. Costs of maternal health care services in three anglophone African countries.

    PubMed

    Levin, Ann; Dmytraczenko, Tania; McEuen, Mark; Ssengooba, Freddie; Mangani, Ronald; Van Dyck, Gerry

    2003-01-01

    This paper is a synthesis of a case study of provider and consumer costs, along with selected quality indicators, for six maternal health services provided at one public hospital, one mission hospital, one public health centre and one mission centre, in Uganda, Malawi and Ghana. The study examines the costs of providing the services in a selected number of facilities in order to examine the reasons behind cost differences, assess the efficiency of service delivery, and determine whether management improvements might achieve cost savings without hurting quality. This assessment is important to African countries with ambitious goals for improving maternal health but scarce public health resources and limited government budgets. The study also evaluates the costs that consumers pay to use the maternal health services, along with the contribution that revenues from fees for services make to recovering health facility costs. The authors find that costs differ between hospitals and health centres as well as among mission and public facilities in the study sample. The variation is explained by differences in the role of the facility, use and availability of materials and equipment, number and level of personnel delivering services, and utilization levels of services. The report concludes with several policy implications for improvements in efficiency, financing options and consumer costs.

  12. The evolution of freestanding children’s hospitals in Canada

    PubMed Central

    Stang, Antonia S; Joshi, Arvind

    2006-01-01

    OBJECTIVE The purpose of the present article is to examine the evolution of freestanding children’s hospitals in Canada over the past century. The results include documentation of the number of freestanding children’s hospitals in Canada that have since closed, merged with other institutions or remained freestanding. Similar data are presented for the United States (US). Also included is an analysis of factors in the internal and external environment that contributed to the changing structure of children’s hospitals. METHODS Sources of information included a review of the literature, publicly available data and statistics on children’s hospitals in Canada and the US. RESULTS Nine of the 16 children’s hospitals in Canada were freestanding at one time. Today, only two remain freestanding. Three formerly freestanding children’s hospitals have merged with maternal health facilities and four formerly freestanding children’s hospitals have merged with adult institutions. Similar trends are seen in the US. CONCLUSIONS The structure of children’s hospitals in North America has changed significantly over the past century. This can be attributed to a number of factors, including the evolution of the health status of children due to medical advances, as well as external forces such as demographics and the rising cost of health care. The impact on the health of children and the mission of children’s hospitals in terms of patient care, teaching and research remains to be seen. PMID:19030317

  13. [Institutional iatrogeny and maternal death: Semmelweis and puerperal fever].

    PubMed

    Salaverry García, Oswaldo

    2013-07-01

    Puerperal fever is a disease that becomes epidemic in the eighteenth century as a result of two factors: the urban working masses generated by the industrial revolution and the progressive hegemonization and medicalization of birth care in large public hospitals. Institutionalized maternal death reached figures above 30%, while in the case of birth care provided by midwives, it was than 2%. Semmelweis, an Hungarian physician, sustained that physicians contaminated women in labor due to insufficient hygiene after performing necropsies and established prophylactic measures in the Vienna Hospital that reduced mortality dramatically. However, his ideas were rejected because they affected the institutionalization process of medicine, based on altruism and honor, which would make it impossible to cause harm to patients. He was forced to leave Vienna Hospital and he continued his struggle in Budapest, but the rejection and disagreement of his peers with his doctrine affected his mental health. He died in an asylum, a few years before Pasteur and Koch proved the existence of the bacteria that caused diseases such as puerperal fever.

  14. Guide to Choosing a Hospital

    MedlinePlus

    ... your condition? Should you consider a specialty hospital, teaching hospital (usually part of a university), community hospital, ... been approved by Medicare. Hospitals may choose either method of evaluation. You can check with a hospital ...

  15. Association between Maternal Mortality and Cesarean Section: Turkey Experience

    PubMed Central

    Uzuncakmak, Cihangir; Ozcam, Hasene

    2016-01-01

    Background To investigate the cesarean Section (C/S) rates and maternal mortality (MM) causes and its relation between 2002 and 2013. Methods Data were gathered from Turkish Ministry of Health and Istanbul Health Administration. The Annual Clinical Reports for 2002–2013 were reviewed and analyzed: C/Ss and maternal deaths in women who gave birth ≥20 weeks between January 1, 2002, and December 31, 2013, in any hospital in Turkey and Istanbul. Results The major causes of MM were hemorrhage (20%), hypertensive disorders (18.2%), embolism (10.3%), cardiovascular conditions (9%), infection (8.5%), and other causes (10.4%). Overall, the average annual CS delivery rate was 46.4% in Istanbul and 36.6% in Turkey. There was a significant increase in the CS rates in Istanbul and Turkey from 2008 to 2013 relative to those from 2002 to 2007 (p = 0.004). There was a statistically significant and inverse relationship (97.2%) between the MMR and CS rate from 2002 to 2013 in Turkey (p = 0.001). However, no significant relationship was detected between the MMR and CS rate from 2002 to 2013 in Istanbul (p > 0.05). There was a significant inverse correlation (66.3%) between the CS rate and peripartumhemorrhage in Turkey (p = 0.019) and there was a significant inverse correlation (66.5%) between the CS rate and peripartumhemorrhage(p = 0.018) in Istanbul between 2007 to 2013. There were no significant differences in ante-intrapartum haemorrhage bleeding (p > 0.05) or postpartum hemorrhage (p > 0.05) from 2007 to 2013. Conclusions This study demonstrates that there was a inverse correlation between increased CS and maternal mortality rates during the previous decade in Turkey. Although cesarean rates increase excessively, it appears that improved health care facilities have a positive effect on MMRs in Turkey. PMID:27880841

  16. Maternal attitudes to newborn screening for fragile X syndrome.

    PubMed

    Christie, Louise; Wotton, Tiffany; Bennetts, Bruce; Wiley, Veronica; Wilcken, Bridget; Rogers, Carolyn; Boyle, Jackie; Turner, Catherine; Hansen, Jessica; Hunter, Matthew; Goel, Himanshu; Field, Michael

    2013-02-01

    Although fragile X syndrome (FXS) is the commonest cause of inherited intellectual disability the mean age of diagnosis in Australia is 5.5 years. Newborn screening for FXS can provide an early diagnosis, preventing the "diagnostic odyssey", allowing access to early interventions, and providing reproductive information for parents. Parents of affected children support newborn screening, but few clinical studies have evaluated community attitudes. A pilot study in 2009-2010 was performed in a tertiary hospital to explore feasibility and maternal attitudes. FXS testing of male and female newborns was offered to mothers in addition to routine newborn screening. Mothers were provided with information about FXS, inheritance pattern, carrier status, and associated adult-onset disorders. One thousand nine hundred seventy-one of 2,094 mothers (94%) consented to testing of 2,000 newborns. 86% completed the attitudinal survey and 10% provided written comments. Almost all parents (99%) elected to be informed of both premutation and full mutation status and there was little concern about identification of carrier status or associated adult-onset disorders. Most mothers (96%) were comfortable being approached in the postnatal period and supported testing because no extra blood test was required. Mothers considered an early diagnosis beneficial to help prepare for a child with additional needs (93%) and for reproductive planning (64%). Some were anxious about the potential test results (10%) and others felt their feelings towards their newborn may change if diagnosed with FXS (16%). High participation rates and maternal attitudes indicate a high level of maternal acceptance and voluntary support for newborn screening for FXS.

  17. Maternally Administered Interventions for Preterm Infants in the NICU: Effects on Maternal Psychological Distress and Mother-Infant Relationship

    PubMed Central

    Holditch-Davis, Diane; White-Traut, Rosemary C.; Levy, Janet A.; O’Shea, T. Michael; Geraldo, Victoria; David, Richard J.

    2014-01-01

    Although studies have examined the effects of interventions focused on preterm infants, few studies have examined the effects on maternal distress (anxiety, depressive symptoms, post-traumatic stress symptoms, parenting stress) or parenting. This study examined the effects of the auditory-tactile-visual-vestibular (ATVV) intervention and kangaroo care (KC) on maternal distress and the mother-infant relationship compared to an attention control group. 240 mothers from four hospitals were randomly assigned to the three groups. Maternal characteristics in the three groups were similar: 64.1% of ATVV mothers, 64.2% of KC mothers, and 76.5% of control mothers were African American; maternal age averaged 26.3 years for ATVV mothers, 28.1 for KC mothers, and 26.6 for control mothers; and years of education averaged 13.6 for ATVV and KC mothers, and 13.1 for control mothers. Mothers only differed on parity: 68.4% of ATVV and 54.7% of KC mothers were first-time mothers as compared to 43.6% of control mothers. Their infants had a similar mean gestational ages (27.0 weeks for ATVV, 27.2 for KC, and 27.4 for control) and mean birthweights (993 grams for ATVV, 1022 for KC, and 1023 for control). Mothers completed questionnaires during hospitalization, and at 2, 6 and 12 months corrected age on demographic characteristics, depressive symptoms, state anxiety, post-traumatic stress symptoms, parenting stress, worry about child health, and child vulnerability (only at 12 months). At 2 and 6 months, 45-minute videotapes of mother-infant interactions were made, and the HOME Inventory was scored. Behaviors coded from the videotapes and a HOME subscale were combined into five interactive dimensions: maternal positive involvement and developmental stimulation and child social behaviors, developmental maturity, and irritability. Intervention effects were examined using general linear mixed models controlling for parity and recruitment site. The groups did not differ on any maternal

  18. Maternally administered interventions for preterm infants in the NICU: effects on maternal psychological distress and mother-infant relationship.

    PubMed

    Holditch-Davis, Diane; White-Traut, Rosemary C; Levy, Janet A; O'Shea, T Michael; Geraldo, Victoria; David, Richard J

    2014-11-01

    Although studies have examined the effects of interventions focused on preterm infants, few studies have examined the effects on maternal distress (anxiety, depressive symptoms, post-traumatic stress symptoms, parenting stress) or parenting. This study examined the effects of the auditory-tactile-visual-vestibular (ATVV) intervention and kangaroo care (KC) on maternal distress and the mother-infant relationship compared to an attention control group. 240 mothers from four hospitals were randomly assigned to the three groups. Maternal characteristics in the three groups were similar: 64.1% of ATVV mothers, 64.2% of KC mothers, and 76.5% of control mothers were African American; maternal age averaged 26.3 years for ATVV mothers, 28.1 for KC mothers, and 26.6 for control mothers; and years of education averaged 13.6 for ATVV and KC mothers, and 13.1 for control mothers. Mothers only differed on parity: 68.4% of ATVV and 54.7% of KC mothers were first-time mothers as compared to 43.6% of control mothers. Their infants had a similar mean gestational ages (27.0 weeks for ATVV, 27.2 for KC, and 27.4 for control) and mean birthweights (993 g for ATVV, 1022 for KC, and 1023 for control). Mothers completed questionnaires during hospitalization, and at 2, 6 and 12 months corrected age on demographic characteristics, depressive symptoms, state anxiety, post-traumatic stress symptoms, parenting stress, worry about child health, and child vulnerability (only at 12 months). At 2 and 6 months, 45-min videotapes of mother-infant interactions were made, and the HOME Inventory was scored. Behaviors coded from the videotapes and a HOME subscale were combined into five interactive dimensions: maternal positive involvement and developmental stimulation and child social behaviors, developmental maturity, and irritability. Intervention effects were examined using general linear mixed models controlling for parity and recruitment site. The groups did not differ on any maternal distress

  19. Maternal caloric restriction partially rescues the deleterious effects of advanced maternal age on offspring

    PubMed Central

    Gribble, Kristin E; Jarvis, George; Bock, Martha; Mark Welch, David B

    2014-01-01

    While many studies have focused on the detrimental effects of advanced maternal age and harmful prenatal environments on progeny, little is known about the role of beneficial non-Mendelian maternal inheritance on aging. Here, we report the effects of maternal age and maternal caloric restriction (CR) on the life span and health span of offspring for a clonal culture of the monogonont rotifer Brachionus manjavacas. Mothers on regimens of chronic CR (CCR) or intermittent fasting (IF) had increased life span compared with mothers fed ad libitum (AL). With increasing maternal age, life span and fecundity of female offspring of AL-fed mothers decreased significantly and life span of male offspring was unchanged, whereas body size of both male and female offspring increased. Maternal CR partially rescued these effects, increasing the mean life span of AL-fed female offspring but not male offspring and increasing the fecundity of AL-fed female offspring compared with offspring of mothers of the same age. Both maternal CR regimens decreased male offspring body size, but only maternal IF decreased body size of female offspring, whereas maternal CCR caused a slight increase. Understanding the genetic and biochemical basis of these different maternal effects on aging may guide effective interventions to improve health span and life span. PMID:24661622

  20. Association between Maternal Smoking during Pregnancy and Low Birthweight: Effects by Maternal Age

    PubMed Central

    Zheng, Wei; Suzuki, Kohta; Tanaka, Taichiro; Kohama, Moriyasu; Yamagata, Zentaro

    2016-01-01

    Background Maternal smoking during pregnancy has been consistently related to low birthweight. However, older mothers, who are already at risk of giving birth to low birthweight infants, might be even more susceptible to the effects of maternal smoking. Therefore, this study aimed to examine the modified association between maternal smoking and low birthweight by maternal age. Methods Data were obtained from a questionnaire survey of all mothers of children born between 2004 and 2010 in Okinawa, Japan who underwent medical check-ups at age 3 months. Variables assessed were maternal smoking during pregnancy, maternal age, gestational age, parity, birth year, and complications during pregnancy. Stratified analyses were performed using a logistic regression model. Results In total, 92641 participants provided complete information on all variables. Over the 7 years studied, the proportion of mothers smoking during pregnancy decreased from 10.6% to 5.0%, while the prevalence of low birthweight did not change remarkably (around 10%). Maternal smoking was significantly associated with low birthweight in all age groups. The strength of the association increased with maternal age, both in crude and adjusted models. Conclusions Consistent with previous studies conducted in Western countries, this study demonstrates that maternal age has a modifying effect on the association between maternal smoking and birthweight. This finding suggests that specific education and health care programs for older smoking mothers are important to improve their foetal growth. PMID:26795494

  1. Genetic Regulation of Maternal Oxytocin Response and Its Influences on Maternal Behavior

    PubMed Central

    Eapen, Valsamma; Kohlhoff, Jane; Mendoza Diaz, Antonio; Barnett, Bryanne; Silove, Derrick; Dadds, Mark R.

    2016-01-01

    We interrogated the genetic modulation of maternal oxytocin response and its association with maternal behavior using genetic risk scores within the oxytocin receptor (OXTR) gene. We identified a novel SNP, rs968389, to be significantly associated with maternal oxytocin response after a challenging mother-infant interaction task (Still Face Paradigm) and maternal separation anxiety from the infant. Performing a multiallelic analysis across OXTR by calculating a cumulative genetic risk score revealed a significant gene-by-environment (G × E) interaction, with OXTR genetic risk score interacting with adult separation anxiety to modulate levels of maternal sensitivity. Mothers with higher OXTR genetic risk score and adult separation anxiety showed significantly reduced levels of maternal sensitivity during free play with the infant. The same G × E interaction was also observed for the extended OXTR cumulative genetic risk score that included rs968389. Moreover, the extended cumulative OXTR genetic risk score itself was found to be significantly associated with maternal separation anxiety as it specifically relates to the infant. Our results suggest a complex montage of individual and synergistic genetic mediators of maternal behavior. These findings add to specific knowledge about genetic regulation of maternal oxytocin response in relation to maternal adjustment and infant bonding through the first few months of life. PMID:27872764

  2. Maternal and infant sleep postpartum.

    PubMed

    McGuire, Elizabeth

    2013-07-01

    New parents should be aware that infants' sleep is unlike that of adults and that meeting their infant's needs is likely to disrupt their own sleep. They will need to adjust their routine to manage their own sleep needs. Parental sleep patterns in the postpartum period are tied to the infant's development of a circadian sleep-wake rhythm, and the infant's feeds. Close contact with the mother and exposure to light/dark cues appear to assist in the development of the infant's circadian rhythm. The composition of breastmilk varies over the course of 24 hours and some components produced at night are likely to contribute to the infant's day/night entrainment. There is no clear evidence that using artificial feeds improves maternal sleep. Most infants need night feeds but requirements for nighttime feeds vary with the individual.

  3. The impact of maternal characteristics, infant temperament and contextual factors on maternal responsiveness to infant.

    PubMed

    Tester-Jones, Michelle; O'Mahen, Heather; Watkins, Edward; Karl, Anke

    2015-08-01

    Postnatal maternal depressive symptoms are consistently associated with impairments in maternal attunement (i.e., maternal responsiveness and bonding). There is a growing body of literature examining the impact of maternal cognitive factors (e.g., rumination) on maternal attunement and mood. However, little research has examined the role of infant temperament and maternal social support in this relationship. This study investigated the hypothesis that rumination would mediate (1) the relationship between depressive symptoms and attunement and (2) the relationship between social support and attunement. We further predicted that infant temperament would moderate these relationships, such that rumination would demonstrate mediating effects on attunement when infant difficult temperament was high, but not low. Two hundred and three mothers completed measures on rumination, depressive symptoms, attunement, perceived social support and infant temperament. Rumination mediated the effect of postnatal maternal depressive mood on maternal self-reported responsiveness to the infant when infants were low, but not high, in negative temperament. When infants had higher negative temperament, there were direct relationships between maternal depressive symptoms, social support and maternal self-reported responsiveness to the infant. This study is limited by its cross-sectional and correlational nature and the use of self-report measures to assess a mother's awareness of her infant needs and behaviours, rather than observational measures of maternal sensitivity. These findings suggest potentially different pathways to poor maternal responsiveness than those expected and provide new evidence about the contexts in which maternal cognitive factors, such as rumination, may impact on the mother-infant relationship.

  4. Maternal Age at Holocaust Exposure and Maternal PTSD Independently Influence Urinary Cortisol Levels in Adult Offspring

    PubMed Central

    Bader, Heather N.; Bierer, Linda M.; Lehrner, Amy; Makotkine, Iouri; Daskalakis, Nikolaos P.; Yehuda, Rachel

    2014-01-01

    Background: Parental traumatization has been associated with increased risk for the expression of psychopathology in offspring, and maternal posttraumatic stress disorder (PTSD) appears to increase the risk for the development of offspring PTSD. In this study, Holocaust-related maternal age of exposure and PTSD were evaluated for their association with offspring ambient cortisol and PTSD-associated symptom expression. Method: Ninety-five Holocaust offspring and Jewish comparison subjects received diagnostic and psychological evaluations, and 24 h urinary cortisol was assayed by RIA. Offspring completed the parental PTSD questionnaire to assess maternal PTSD status. Maternal Holocaust exposure was identified as having occurred in childhood, adolescence, or adulthood and examined in relation to offspring psychobiology. Results: Urinary cortisol levels did not differ for Holocaust offspring and comparison subjects but differed significantly in offspring based on maternal age of exposure and maternal PTSD status. Increased maternal age of exposure and maternal PTSD were each associated with lower urinary cortisol in offspring, but did not exhibit a significant interaction. In addition, offspring PTSD-associated symptom severity increased with maternal age at exposure and PTSD diagnosis. A regression analysis of correlates of offspring cortisol indicated that both maternal age of exposure and maternal PTSD were significant predictors of lower offspring urinary cortisol, whereas childhood adversity and offspring PTSD symptoms were not. Conclusion: Offspring low cortisol and PTSD-associated symptom expression are related to maternal age of exposure, with the greatest effects associated with increased age at exposure. These effects are relatively independent of the negative consequences of being raised by a trauma survivor. These observations highlight the importance of maternal age of exposure in determining a psychobiology in offspring that is consistent with increased

  5. The Impact of Maternal Obesity and Excessive Gestational Weight Gain on Maternal and Infant Outcomes in Maine: Analysis of Pregnancy Risk Assessment Monitoring System Results from 2000 to 2010

    PubMed Central

    Sarton, Cheryl; Lichter, Erika

    2016-01-01

    The objective of this study is to understand the relationships between prepregnancy obesity and excessive gestational weight gain (GWG) and adverse maternal and fetal outcomes. Pregnancy risk assessment monitoring system (PRAMS) data from Maine for 2000–2010 were used to determine associations between demographic, socioeconomic, and health behavioral variables and maternal and infant outcomes. Multivariate logistic regression analysis was performed on the independent variables of age, race, smoking, previous live births, marital status, education, BMI, income, rurality, alcohol use, and GWG. Dependent variables included maternal hypertension, premature birth, birth weight, infant admission to the intensive care unit (ICU), and length of hospital stay of the infant. Excessive prepregnancy BMI and excessive GWG independently predicted maternal hypertension. A high prepregnancy BMI increased the risk of the infant being born prematurely, having a longer hospital stay, and having an excessive birth weight. Excessive GWG predicted a longer infant hospital stay and excessive birth weight. A low pregnancy BMI and a lower than recommended GWG were also associated with poor outcomes: prematurity, low birth weight, and an increased risk of the infant admitted to ICU. These findings support the importance of preconception care that promotes achievement of a healthy weight to enhance optimal reproductive outcomes. PMID:27747104

  6. Rating maternal and neonatal health services in developing countries.

    PubMed Central

    Bulatao, Rodolfo A.; Ross, John A.

    2002-01-01

    OBJECTIVE: To assess maternal and neonatal health services in 49 developing countries. METHODS: The services were rated on a scale of 0 to 100 by 10 - 25 experts in each country. The ratings covered emergency and routine services, including family planning, at health centres and district hospitals, access to these services for both rural and urban women, the likelihood that women would receive particular forms of antenatal and delivery care, and supporting elements of programmes such as policy, resources, monitoring, health promotion and training. FINDINGS: The average rating was only 56, but countries varied widely, especially in access to services in rural areas. Comparatively good ratings were reported for immunization services, aspects of antenatal care and counselling on breast feeding. Ratings were particularly weak for emergency obstetric care in rural areas, safe abortion and HIV counselling. CONCLUSION: Maternal health programme effort in developing countries is seriously deficient, particularly in rural areas. Rural women are disadvantaged in many respects, but especially regarding the treatment of emergency obstetric conditions. Both rural and urban women receive inadequate HIV counselling and testing and have quite limited access to safe abortion. Improving services requires moving beyond policy reform to strengthening implementation of services and to better staff training and health promotion. Increased financing is only part of the solution. PMID:12378290

  7. Perimortem cesarean delivery: its role in maternal mortality.

    PubMed

    Katz, Vern L

    2012-02-01

    Since Roman times, physicians have been instructed to perform postmortem cesarean deliveries to aid in funeral rites, baptism, and in the very slim chance that a live fetus might still be within the deceased mother's womb. This procedure was disliked by physicians being called to a dying mother's bedside. As births moved to hospitals, and modern obstetrics evolved, the causes of maternal death changed from sepsis, hemorrhage, and dehydration to a greater incidence of sudden cardiac arrest from medication errors or embolism. Thus, the likelihood of delivering a viable neonate at the time of a mother's death increased. Additionally, as cardiopulmonary resuscitation (CPR) became widespread, physicians realized that during pregnancy, with the term gravid woman lying on her back, chest compressions cannot deliver sufficient cardiac output to accomplish resuscitation. Paradoxically, after a postmortem cesarean delivery is performed, effective CPR was seen to occur. Mothers were revived. Thus, the procedure was renamed the perimortem cesarean. Because brain damage begins at 5 minutes of anoxia, the procedure should be initiated at 4 minutes (the 4-minute rule) to deliver the healthiest fetus. If a mother has a resuscitatable cause of death, then her life may be saved as well by a prompt and timely cesarean delivery during CPR. Sadly, too often, we are paralyzed by the horror of the maternal cardiac arrest, and instinctively, we try CPR for too long before turning to the perimortem delivery. The quick procedure though may actually improve the situation for the mother, and certainly will save the child.

  8. Metabolic adjustments to moderate maternal nutrient restriction.

    PubMed

    Schlabritz-Loutsevitch, Natalia E; Dudley, Christopher J; Gomez, Jeremiah J; Nevill, C Heath; Smith, Bonnie K; Jenkins, Susan L; McDonald, Thomas J; Bartlett, Thad Q; Nathanielsz, Peter W; Nijland, Mark J

    2007-08-01

    Reduced food availability in pregnancy influences fetal growth, obstetric outcomes and offspring health in both developing and developed countries. The objective of the present study was to determine responses to moderate global maternal nutrient restriction (MNR) during pregnancy in baboons (Papio hamadryas) - an established non-human primate model for pregnancy-related research. Starting at 30 d gestation (dG), twelve pregnant baboons received 70 % of food (MNR group) consumed by twenty ad libitum-fed pregnant controls. Maternal body weight, BMI, food intake and physical activity were measured before pregnancy, at 90 dG and at 165 dG (full-term 180 dG). Fetal and placental weights were recorded at the time of Caesarean section (90 and 165 dG). Activity patterns were also evaluated in fourteen non-pregnant female baboons. Behavioural observations were made in five non-pregnant, six control and four MNR animals. Pregnant baboons decreased overall physical activity and energy-expensive behaviours compared with non-pregnant baboons. In the MNR group, maternal weight, weight gain and maternal physical activity were reduced compared with the control animals. MNR decreased placental weight and volume compared with control, while fetal weight and length were unaffected. We conclude that decreased physical activity and increased usage of maternal available body stores play an important role in the maternal response to pregnancy. Also, adaptations in maternal behaviour and energy utilisation protect fetal growth during moderate MNR.

  9. Maternal employment and childhood overweight in Germany.

    PubMed

    Meyer, Sophie-Charlotte

    2016-12-01

    A widespread finding among studies from the US and the UK is that maternal employment is correlated with an increased risk of child overweight, even in a causal manner, whereas studies from other countries obtain less conclusive results. As evidence for Germany is still scarce, the purpose of this study is to identify the effect of maternal employment on childhood overweight in Germany using two sets of representative micro data. We further explore potential underlying mechanisms that might explain this relationship. In order to address the selection into maternal full-time employment, we use an instrumental variable strategy exploiting the number of younger siblings in the household as an instrument. While the OLS models suggest that maternal full-time employment is related to a 5 percentage point higher probability of the child to be overweight, IV estimates indicate a 25 percentage points higher overweight probability due to maternal full-time employment. Exploring various possible pathways, we find that maternal full-time employment promotes unhealthy dietary and activity behavior which might explain the positive effect of maternal employment on child overweight to some extent. Although there are limitations to our IV approach, several sensitivity analyses confirm the robustness of our findings.

  10. Evidence from community level inputs to improve quality of care for maternal and newborn health: interventions and findings

    PubMed Central

    2014-01-01

    Annually around 40 million mothers give birth at home without any trained health worker. Consequently, most of the maternal and neonatal mortalities occur at the community level due to lack of good quality care during labour and birth. Interventions delivered at the community level have not only been advocated to improve access and coverage of essential interventions but also to reduce the existing disparities and reaching the hard to reach. In this paper, we have reviewed the effectiveness of care delivered through community level inputs for improving maternal and newborn health outcomes. We considered all available systematic reviews published before May 2013 on the pre-defined community level interventions and report findings from 43 systematic reviews. Findings suggest that home visitation significantly improved antenatal care, tetanus immunization coverage, referral and early initiation of breast feeding with reductions in antenatal hospital admission, cesarean-section rates birth, maternal morbidity, neonatal mortality and perinatal mortality. Task shifting to midwives and community health workers has shown to significantly improve immunization uptake and breast feeding initiation with reductions in antenatal hospitalization, episiotomy, instrumental delivery and hospital stay. Training of traditional birth attendants as a part of community based intervention package has significant impact on referrals, early breast feeding, maternal morbidity, neonatal mortality, and perinatal mortality. Formation of community based support groups decreased maternal morbidity, neonatal mortality, perinatal mortality with improved referrals and early breast feeding rates. At community level, home visitation, community mobilization and training of community health workers and traditional birth attendants have the maximum potential to improve a range of maternal and newborn health outcomes. There is lack of data to establish effectiveness of outreach services, mass media

  11. Antipsychotic Drugs on Maternal Behavior in Rats

    PubMed Central

    Li, Ming

    2015-01-01

    Rat maternal behavior is a complex social behavior. Many clinically used antipsychotic drugs, including the typical drug haloperidol and atypical drugs clozapine, risperidone, olanzapine, quetiapine, aripiprazole and amisulpride, all disrupt active maternal responses (e.g. pup retrieval, pup licking and nest building) to various extents. In this review, I present a summary of recent studies on the behavioral effects and neurobiological mechanisms of antipsychotic action on maternal behavior in rats. I argue that antipsychotic drugs at the clinical relevant doses disrupt active maternal responses primarily by suppressing maternal motivation. Atypical drug-induced sedation also contributes to their disruptive effects, especially that on pup nursing. Among many potential receptor mechanisms, dopamine D2 receptors and serotonin 5-HT2A/2C receptors are shown to be critically involved in the mediation of the maternal disruptive effects of antipsychotic drugs, with D2 receptors contributing more to typical antipsychotic-induced disruptions, while 5-HT2A/2C receptors contributing more to atypical drug-induced disruption. The nucleus accumbens shell-related reward circuitry is an essential neural network in the mediation of the behavioral effects of antipsychotic drugs on maternal behavior. This research not only helps to understand the extent and mechanisms of impacts of antipsychotic medications on human maternal care, but also is important for enhancing our understanding of the neurochemical basis of maternal behavior. It is also valuable for understanding the complete spectrum of therapeutic and side-effects of antipsychotic treatment. This knowledge may facilitate the development of effective intervening strategies to help patients coping with such undesirable effects. PMID:26221833

  12. Forecasting Epidemiological Consequences of Maternal Immunization

    PubMed Central

    Bento, Ana I.; Rohani, Pejman

    2016-01-01

    Background. The increase in the incidence of whooping cough (pertussis) in many countries with high vaccination coverage is alarming. Maternal pertussis immunization has been proposed as an effective means of protecting newborns during the interval between birth and the first routine dose. However, there are concerns regarding potential interference between maternal antibodies and the immune response elicited by the routine schedule, with possible long-term population-level effects. Methods. We formulated a transmission model comprising both primary routine and maternal immunization. This model was examined to evaluate the long-term epidemiological effects of routine and maternal immunization, together with consequences of potential immune interference scenarios. Results. Overall, our model demonstrates that maternal immunization is an effective strategy in reducing the incidence of pertussis in neonates prior to the onset of the primary schedule. However, if maternal antibodies lead to blunting, incidence increases among older age groups. For instance, our model predicts that with 60% routine and maternal immunization coverage and 30% blunting, the incidence among neonates (0–2 months) is reduced by 43%. Under the same scenario, we observe a 20% increase in incidence among children aged 5–10 years. However, the downstream increase in the older age groups occurs with a delay of approximately a decade or more. Conclusions. Maternal immunization has clear positive effects on infant burden of disease, lowering mean infant incidence. However, if maternally derived antibodies adversely affect the immunogenicity of the routine schedule, we predict eventual population-level repercussions that may lead to an overall increase in incidence in older age groups. PMID:27838674

  13. The application of hospitality elements in hospitals.

    PubMed

    Wu, Ziqi; Robson, Stephani; Hollis, Brooke

    2013-01-01

    In the last decade, many hospital designs have taken inspiration from hotels, spurred by factors such as increased patient and family expectations and regulatory or financial incentives. Increasingly, research evidence suggests the value of enhancing the physical environment to foster healing and drive consumer decisions and perceptions of service quality. Although interest is increasing in the broader applicability of numerous hospitality concepts to the healthcare field, the focus of this article is design innovations, and the services that such innovations support, from the hospitality industry. To identify physical hotel design elements and associated operational features that have been used in the healthcare arena, a series of interviews with hospital and hotel design experts were conducted. Current examples and suggestions for future hospitality elements were also sought from the experts, academic journals, and news articles. Hospitality elements applied in existing hospitals that are addressed in this article include hotel-like rooms and decor; actual hotels incorporated into medical centers; hotel-quality food, room service, and dining facilities for families; welcoming lobbies and common spaces; hospitality-oriented customer service training; enhanced service offerings, including concierges; spas or therapy centers; hotel-style signage and way-finding tools; and entertainment features. Selected elements that have potential for future incorporation include executive lounges and/or communal lobbies with complimentary wireless Internet and refreshments, centralized controls for patients, and flexible furniture. Although the findings from this study underscore the need for more hospitality-like environments in hospitals, the investment decisions made by healthcare executives must be balanced with cost-effectiveness and the assurance that clinical excellence remains the top priority.

  14. Maternal Obesity During Pregnancy Associates With Premature Mortality and Major Cardiovascular Events in Later Life.

    PubMed

    Lee, Kuan Ken; Raja, Edwin A; Lee, Amanda J; Bhattacharya, Sohinee; Bhattacharya, Siladitya; Norman, Jane E; Reynolds, Rebecca M

    2015-11-01

    One in 5 pregnant women is obese but the impact on later health is unknown. We aimed to determine whether maternal obesity during pregnancy associates with increased premature mortality and later life major cardiovascular events. Maternity records of women who gave birth to their first child between 1950 and 1976 (n=18 873) from the Aberdeen Maternity and Neonatal databank were linked to the National Register of Deaths, Scotland and Scottish Morbidity Record. The effect of maternal obesity at first antenatal visit on death and hospital admissions for cardiovascular events was tested using time-to-event analysis with Cox proportional hazard regression to compare outcomes of mothers in underweight, overweight, or obese body mass index (BMI) categories compared with normal BMI. Median follow-up was at 73 years. All-cause mortality was increased in women who were obese during pregnancy (BMI>30 kg/m(2)) versus normal BMI after adjustment for socioeconomic status, smoking, gestation at BMI measurement, preeclampsia, and low birth weight (hazard ratio, 1.35; 95% confidence interval, 1.02-1.77). In adjusted models, overweight and obese mothers had increased risk of hospital admission for a cardiovascular event (1.16; 1.06-1.27 and 1.26; 1.01-1.57) compared with normal BMI mothers. Adjustment for parity largely unchanged the hazard ratios (mortality: 1.43, 1.09-1.88; cardiovascular events overweight: 1.17, 1.07-1.29; and obese: 1.30, 1.04-1.62). In conclusion, maternal obesity is associated with increased risk of premature death and cardiovascular disease. Pregnancy and early postpartum could represent an opportunity for interventions to identify obesity and reduce its adverse consequences.

  15. Evaluation and Management of Maternal Cardiac Arrhythmias.

    PubMed

    Metz, Torri D; Khanna, Amber

    2016-12-01

    Pregnant women often complain of palpitations. The differential diagnosis for new-onset palpitations in pregnancy ranges from benign conditions to life-threatening arrhythmias. Maternal arrhythmias can occur in isolation or in the setting of underlying structural heart disease. Optimal management of maternal cardiac arrhythmias includes identification of the specific arrhythmia, diagnosis of comorbid conditions, and appropriate intervention. In general, management of maternal cardiac arrhythmias is similar to that of the general population. Special consideration must be given as to the effects of medications and procedures on both the mother and fetus to optimize outcomes. The importance of multidisciplinary care with cardiology, obstetrics, and anesthesia is emphasized.

  16. Modification of the association between maternal smoke exposure and congenital heart defects by polymorphisms in glutathione S-transferase genes

    PubMed Central

    Li, Xiaohong; Liu, Zhen; Deng, Ying; Li, Shengli; Mu, Dezhi; Tian, Xiaoxian; Lin, Yuan; Yang, Jiaxiang; Li, Jun; Li, Nana; Wang, Yanping; Chen, Xinlin; Deng, Kui; Zhu, Jun

    2015-01-01

    Congenital heart defects (CHDs) arise through various combinations of genetic and environmental factors. Our study explores how polymorphisms in the glutathione S-transferase (GST) genes affect the association between cigarette smoke exposure and CHDs. We analysed 299 mothers of children with CHDs and 284 mothers of children without any abnormalities who were recruited from six hospitals. The hair nicotine concentration (HNC) was used to quantify maternal smoke exposure, and the maternal GSTT1, and GSTM1 and GSTP1 genes were sequenced. We found a trend of higher adjusted odds ratios with higher maternal HNC levels, suggesting a dose-response relationship between maternal smoke exposure and CHDs. The lowest HNC range associated with an increased risk of CHDs was 0.213–0.319 ng/mg among the mothers with functional deletions of GSTM1 or GSTT1and 0.319–0.573 ng/mg among the mothers with normal copies of GSTM1 and GSTT1. In addition, the adjusted odds ratio for an HNC of >0.573 ng/mg was 38.53 among the mothers with the GSTP1 AG or GG genotype, which was 7.76 (χ2 = 6.702, p = 0.010) times greater than the AOR in the mothers with GSTP1 AA genotype. Our study suggests that polymorphisms of maternal GST genes may modify the association of maternal smoke exposure with CHDs. PMID:26456689

  17. Maternal anthropometric characteristics in pregnancy and blood pressure among adolescents: 1993 live birth cohort, Pelotas, southern Brazil

    PubMed Central

    2010-01-01

    Background We investigated the association between maternal anthropometric measurements in prepregnancy and at the end of pregnancy and their children's systolic (SBP) and diastolic (DBP) blood pressure at 11 years of age, in a prospective cohort study. Methods All hospital births which took place in 1993 in the city of Pelotas - Brazil, were identified (5,249 live births). In 2004, the overall proportion of follow-up was 85% and we obtained arterial blood pressure measurements of 4,452 adolescents. Results Independent variables analyzed included maternal prepregnancy weight and body mass index (BMI) and maternal weight, and height at the end of pregnancy. Multiple linear regression analysis controlling for the following confounders were carried out: adolescent's skin color, family income at birth, smoking, alcohol intake during pregnancy, and gestational arterial hypertension. Mean SBP and DBP were 101.9 mmHg (SD 12.3) and 63.4 mmHg (SD 9.9), respectively. Maternal prepregnancy weight and BMI, and weight at the end of pregnancy were positively associated with both SBP and DBP in adolescent subjects of both sexes; maternal height was positively associated with SBP only among males. Conclusions Adequate evaluation of maternal anthropometric characteristics during pregnancy may prevent high levels of blood pressure among adolescent children. PMID:20653949

  18. Modification of the association between maternal smoke exposure and congenital heart defects by polymorphisms in glutathione S-transferase genes.

    PubMed

    Li, Xiaohong; Liu, Zhen; Deng, Ying; Li, Shengli; Mu, Dezhi; Tian, Xiaoxian; Lin, Yuan; Yang, Jiaxiang; Li, Jun; Li, Nana; Wang, Yanping; Chen, Xinlin; Deng, Kui; Zhu, Jun

    2015-10-12

    Congenital heart defects (CHDs) arise through various combinations of genetic and environmental factors. Our study explores how polymorphisms in the glutathione S-transferase (GST) genes affect the association between cigarette smoke exposure and CHDs. We analysed 299 mothers of children with CHDs and 284 mothers of children without any abnormalities who were recruited from six hospitals. The hair nicotine concentration (HNC) was used to quantify maternal smoke exposure, and the maternal GSTT1, and GSTM1 and GSTP1 genes were sequenced. We found a trend of higher adjusted odds ratios with higher maternal HNC levels, suggesting a dose-response relationship between maternal smoke exposure and CHDs. The lowest HNC range associated with an increased risk of CHDs was 0.213-0.319 ng/mg among the mothers with functional deletions of GSTM1 or GSTT1and 0.319-0.573 ng/mg among the mothers with normal copies of GSTM1 and GSTT1. In addition, the adjusted odds ratio for an HNC of >0.573 ng/mg was 38.53 among the mothers with the GSTP1 AG or GG genotype, which was 7.76 (χ(2) = 6.702, p = 0.010) times greater than the AOR in the mothers with GSTP1 AA genotype. Our study suggests that polymorphisms of maternal GST genes may modify the association of maternal smoke exposure with CHDs.

  19. Plasticity of the Maternal Brain across the Lifespan

    ERIC Educational Resources Information Center

    Champagne, Frances A.; Curley, James P.

    2016-01-01

    Maternal behavior is dynamic and highly sensitive to experiential and contextual factors. In this review, this plasticity will be explored, with a focus on how experiences of females occurring from the time of fetal development through to adulthood impact maternal behavior and the maternal brain. Variation in postpartum maternal behavior is…

  20. The Relationship of Maternal Employment to Kindergarten Children's Adjustment.

    ERIC Educational Resources Information Center

    Wallace, Julia A. W.

    With increasing numbers of mothers entering the workforce, interest has focused on which elements and conditions of maternal employment have predictable effects on children. This investigation assessed the relationship of maternal employment factors and selected maternal attributes (career salience, maternal role investment, and maternal…

  1. The contributions of Maternal Sensitivity and Maternal Depressive Symptoms to Epigenetic Processes and Neuroendocrine Functioning

    PubMed Central

    Conradt, Elisabeth; Hawes, Katheleen; Guerin, Dylan; Armstrong, David A.; Marsit, Carmen J.; Tronick, Edward; Lester, Barry M.

    2015-01-01

    This study tested whether maternal responsiveness may buffer the child to the effects of maternal depressive symptoms on DNA methylation of NR3C1, 11β-HSD2, and neuroendocrine functioning. DNA was derived from buccal epithelial cells and pre-stress cortisol was obtained from the saliva of 128 infants. Mothers with depressive symptoms who were more responsive and who engaged in more appropriate touch during face-to-face play had infants with less DNA methylation of NR3C1 and 11β-HSD2 compared to mothers with depressive symptoms who were also insensitive. The combination of exposure to maternal depressive symptoms and maternal sensitivity was related to the highest pre-stress cortisol levels whereas exposure to maternal depressive symptoms and maternal insensitivity was related to the lowest pre-stress cortisol levels. PMID:26822444

  2. Postpartum Maternal Sleep, Maternal Depressive Symptoms and Self-Perceived Mother-Infant Emotional Relationship.

    PubMed

    Tikotzky, Liat

    2016-01-01

    This study examined the links between maternal sleep, maternal depressive symptoms, and mothers' perceptions of their emotional relationship with their infant in a self-recruited sample of mothers. Eighty mothers of infants 3-18 months old completed sleep diaries for 5 consecutive nights, and questionnaires assessing sleep (Insomnia Severity Index [ISI]), depressive symptom severity (Edinburgh Postnatal Depression Scale [EPDS]), and perceived mother-infant relationship (Postpartum Bonding Questionnaire [PBQ] and Maternal Postnatal Attachment Questionnaire [MPAQ]). Significant correlations, controlling for depression severity, were found between more disturbed maternal sleep and more negative maternal perceptions of the mother-infant relationship. Regression analyses revealed that EPDS showed the strongest association with PBQ, whereas ISI demonstrated the strongest association with MPAQ. The present study highlights the importance of deepening and expanding our understanding of the negative implications of maternal sleep problems.

  3. Help prevent hospital errors

    MedlinePlus

    ... www.ncbi.nlm.nih.gov/pubmed/23330698 . The Joint Commission. Hospital: 2014 National Patient Safety Goals. www.jointcommission. ... October 24, 2014. Accessed October 27, 2016. The Joint Commission. Hospital: 2016 National Patient Safety Goals. Updated January ...

  4. Hospitals as health educators

    MedlinePlus

    ... than your local hospital. From health videos to yoga classes, many hospitals offer information families need to ... care and breastfeeding Parenting Baby sign language Baby yoga or massage Babysitting courses for teens Exercise classes ...

  5. Surviving Your Child's Hospitalization.

    ERIC Educational Resources Information Center

    Cohen, David A.

    1988-01-01

    The parent of a young child who required major open heart surgery shares his suggestions for coping with a young child's hospitalization including parent visitation, relating to the hospital staff, getting answers to questions, and utilizing available services. (DB)

  6. Striving to promote male involvement in maternal health care in rural and urban settings in Malawi - a qualitative study

    PubMed Central

    2011-01-01

    Background Understanding the strategies that health care providers employ in order to invite men to participate in maternal health care is very vital especially in today's dynamic cultural environment. Effective utilization of such strategies is dependent on uncovering the salient issues that facilitate male participation in maternal health care. This paper examines and describes the strategies that were used by different health care facilities to invite husbands to participate in maternal health care in rural and urban settings of southern Malawi. Methods The data was collected through in-depth interviews from sixteen of the twenty health care providers from five different health facilities in rural and urban settings of Malawi. The health facilities comprised two health centres, one district hospital, one mission hospital, one private hospital and one central hospital. A semi-structured interview guide was used to collect data from health care providers with the aim of understanding strategies they used to invite men to participate in maternal health care. Results Four main strategies were used to invite men to participate in maternal health care. The strategies were; health care provider initiative, partner notification, couple initiative and community mobilization. The health care provider initiative and partner notification were at health facility level, while the couple initiative was at family level and community mobilization was at village (community) level. The community mobilization had three sub-themes namely; male peer initiative, use of incentives and community sensitization. The sustainability of each strategy to significantly influence behaviour change for male participation in maternal health care is discussed. Conclusion Strategies to invite men to participate in maternal health care were at health facility, family and community levels. The couple strategy was most appropriate but was mostly used by educated and city residents. The male peer

  7. Maternal nerve growth factor levels during pregnancy in women with preeclampsia: A longitudinal study.

    PubMed

    D'souza, Vandita; Kilari, Anitha; Pisal, Hemlata; Patil, Vidya; Mehendale, Savita; Wagh, Girija; Gupte, Sanjay; Joshi, Sadhana

    2015-12-01

    Preeclampsia (PE) is characterized by hypertension and proteinuria. Improper development of the placenta due to altered angiogenesis is the main culprit in PE. Nerve growth factor (NGF) is an angiogenic factor which is expressed and localized in the placenta. Our earlier cross sectional study has shown altered NGF levels at delivery in women with PE. However, there are no studies on NGF levels in PE early in pregnancy before manifestation of the disease. Thus, there is a need to examine the role of NGF in vascular development during different stages of gestation in PE. A longitudinal study was carried out where pregnant women were enrolled from two major hospitals from Pune, Bharati hospital and Gupte hospital. They were followed at three different time points [16-20 weeks (T1), 26-30 weeks (T2) and at delivery (T3)] during pregnancy and maternal blood at every time point and cord blood at delivery was collected and processed. This study included normotensive women (n=88) and women with PE (n=48). NGF levels were measured from maternal and cord plasma using the Emax Immuno Assay System (Promega). The data was analyzed using the SPSS/PC+ package (Version 20.0, Chicago, IL, USA). Maternal NGF levels did not change at all time points while cord NGF levels were higher (p<0.05) in women with PE. Further, maternal NGF levels were negatively associated with blood pressure while cord NGF levels were positively associated with baby head circumference. Our data suggests that there may possibly be a compensatory role for NGF in the foeto-placental circulation in PE.

  8. Maternal effects and maternal selection arising from variation in allocation of free amino acid to eggs

    PubMed Central

    Newcombe, Devi; Hunt, John; Mitchell, Christopher; Moore, Allen J

    2015-01-01

    Maternal provisioning can have profound effects on offspring phenotypes, or maternal effects, especially early in life. One ubiquitous form of provisioning is in the makeup of egg. However, only a few studies examine the role of specific egg constituents in maternal effects, especially as they relate to maternal selection (a standardized selection gradient reflecting the covariance between maternal traits and offspring fitness). Here, we report on the evolutionary consequences of differences in maternal acquisition and allocation of amino acids to eggs. We manipulated acquisition by varying maternal diet (milkweed or sunflower) in the large milkweed bug, Oncopeltus fasciatus. Variation in allocation was detected by examining two source populations with different evolutionary histories and life-history response to sunflower as food. We measured amino acids composition in eggs in this 2 × 2 design and found significant effects of source population and maternal diet on egg and nymph mass and of source population, maternal diet, and their interaction on amino acid composition of eggs. We measured significant linear and quadratic maternal selection on offspring mass associated with variation in amino acid allocation. Visualizing the performance surface along the major axes of nonlinear selection and plotting the mean amino acid profile of eggs from each treatment onto the surface revealed a saddle-shaped fitness surface. While maternal selection appears to have influenced how females allocate amino acids, this maternal effect did not evolve equally in the two populations. Furthermore, none of the population means coincided with peak performance. Thus, we found that the composition of free amino acids in eggs was due to variation in both acquisition and allocation, which had significant fitness effects and created selection. However, although there can be an evolutionary response to novel food resources, females may be constrained from reaching phenotypic optima with

  9. Maternal health literacy and late initiation of immunizations among an inner-city birth cohort.

    PubMed

    Pati, Susmita; Feemster, Kristen A; Mohamad, Zeinab; Fiks, Alex; Grundmeier, Robert; Cnaan, Avital

    2011-04-01

    To determine if maternal health literacy influences early infant immunization status. Longitudinal prospective cohort study of 506 Medicaid-eligible mother-infant dyads. Immunization status at age 3 and 7 months was assessed in relation to maternal health literacy measured at birth using the Test of Functional Health Literacy in Adults (short version). Multivariable logistic regression quantified the effect of maternal health literacy on immunization status adjusting for the relevant covariates. The cohort consists of primarily African-American (87%), single (87%) mothers (mean age 23.4 years). Health literacy was inadequate or marginal among 24% of mothers. Immunizations were up-to-date among 73% of infants at age 3 months and 43% at 7 months. Maternal health literacy was not significantly associated with immunization status at either 3 or 7 months. In multivariable analysis, compared to infants who had delayed immunizations at 3 months, infants with up-to-date immunizations at 3 months were 11.3 times (95%CI 6.0-21.3) more likely to be up-to-date at 7 months. The only strong predictors of up-to-date immunization status at 3 months were maternal education (high school graduate or beyond) and attending a hospital-affiliated clinic. Though maternal health literacy is not associated with immunization status in this cohort, later immunization status is most strongly predicted by immunization status at 3 months. These results further support the importance of intervening from an early age to ensure that infants are fully protected against vaccine preventable diseases.

  10. Maternal sounds elicit lower heart rate in preterm newborns in the first month of life

    PubMed Central

    Rand, Katherine; Lahav, Amir

    2015-01-01

    Background The preferential response to mother’s voice in the fetus and term newborn is well documented. However, the response of preterm neonates is not well understood and more difficult to interpret due to the intensive clinical care and range of medical complications. Aim This study examined the physiological response to maternal sounds and its sustainability in the first month of life in infants born very pretermaturely. Methods Heart rate changes were monitored in 20 hospitalized preterm infants born between 25 and 32 weeks of gestation during 30-minute exposure vs. non-exposure periods of recorded maternal sounds played inside the Neonatal incubator. A total of 13,680 min of HR data was sampled throughout the first month of life during gavage feeds Heart rate with and without exposure to maternal sounds. Results During exposure periods, infants had significantly lower heart rate compared to matched periods of care Auditory without exposure on the same day (p < .0001). This effect was observed in all infants, across the first month of life, irrespective of day of life, gestational age at birth, birth weight, age at testing, Apgar score, caffeine therapy, and requirement for respiratory support. No adverse effects were observed. Conclusion Preterm newborns responded to maternal sounds with decreased heart rate throughout the first month of life. It is possible that maternal sounds improve autonomic stability and provide a more relaxing environment for this population of newborns. Further studies are needed to determine the therapeutic implications of maternal sound exposure for optimizing care practices and developmental outcomes. PMID:25194837

  11. Cost-effectiveness of maternal influenza immunization in Bamako, Mali: A decision analysis

    PubMed Central

    Orenstein, Lauren A. V.; Diarra, Kounandji; Djiteye, Mahamane; Sidibé, Diakaridia; Haidara, Fadima C.; Doumbia, Moussa F.; Diallo, Fatoumata; Coulibaly, Flanon; Keita, Adama M.; Onwuchekwa, Uma; Teguete, Ibrahima; Tapia, Milagritos D.; Sow, Samba O.; Levine, Myron M.; Rheingans, Richard

    2017-01-01

    Background Maternal influenza immunization has gained traction as a strategy to diminish maternal and neonatal mortality. However, efforts to vaccinate pregnant women against influenza in developing countries will require substantial investment. We present cost-effectiveness estimates of maternal influenza immunization based on clinical trial data from Bamako, Mali. Methods We parameterized a decision-tree model using prospectively collected trial data on influenza incidence, vaccine efficacy, and direct and indirect influenza-related healthcare expenditures. Since clinical trial participants likely had better access to care than the general Malian population, we also simulated scenarios with poor access to care, including decreased healthcare resource utilization and worse influenza-related outcomes. Results Under base-case assumptions, a maternal influenza immunization program in Mali would cost $857 (95% UI: $188-$2358) per disability-adjusted life year (DALY) saved. Adjusting for poor access to care yielded a cost-effectiveness ratio of $486 (95% UI: $105-$1425) per DALY saved. Cost-effectiveness ratios were most sensitive to changes in the cost of a maternal vaccination program and to the proportion of laboratory-confirmed influenza among infants warranting hospitalization. Mean cost-effectiveness estimates fell below Mali’s GDP per capita when the cost per pregnant woman vaccinated was $1.00 or less with no adjustment for access to care or $1.67 for those with poor access to care. Healthcare expenditures for lab-confirmed influenza were not significantly different than the cost of influenza-like illness. Conclusions Maternal influenza immunization in Mali would be cost-effective in most settings if vaccine can be obtained, managed, and administered for ≤$1.00 per pregnant woman. PMID:28170416

  12. Reproduction at an advanced maternal age and maternal health.

    PubMed

    Sauer, Mark V

    2015-05-01

    Advanced age is a risk factor for female infertility, pregnancy loss, fetal anomalies, stillbirth, and obstetric complications. These concerns are based on centuries-old observations, yet women are delaying childbearing to pursue educational and career goals in greater numbers than ever before. As a result, reproductive medicine specialists are treating more patients with age-related infertility and recurrent pregnancy loss, while obstetricians are faced with managing pregnancies often complicated by both age and comorbidities. The media portrayal of a youthful but older woman, able to schedule her reproductive needs and balance family and job, has fueled the myth that "you can have it all," rarely characterizing the perils inherent to advanced-age reproduction. Reproductive medicine specialists and obstetrician/gynecologists should promote more realistic views of the evidence-based realities of advanced maternal age pregnancy, including its high-risk nature and often compromised outcomes. Doctors should also actively educate both patients and the public that there is a real danger of childlessness if individuals choose to delay reproduction.

  13. Hospital Dermatology, Introduction.

    PubMed

    Fox, Lindy P

    2017-03-01

    Inpatient dermatology is emerging as a distinct dermatology subspecialty where dermatologists specialize in caring for patients hospitalized with skin disease. While the main focus of inpatient dermatology is the delivery of top-quality and timely dermatologic care to patients in the hospital setting, the practice of hospital-based dermatology has many additional components that are critical to its success.

  14. Maternal characteristics and clinical diagnoses influence obstetrical outcomes in Indonesia.

    PubMed

    Adisasmita, Asri; Smith, Carl V; El-Mohandes, Ayman A E; Deviany, Poppy Elvira; Ryon, Judith J; Kiely, Michele; Rogers-Bloch, Quail; Gipson, Reginald F

    2015-07-01

    This Indonesian study evaluates associations between near-miss status/death with maternal demographic, health care characteristics, and obstetrical complications, comparing results using retrospective and prospective data. The main outcome measures were obstetric conditions and socio-economic factors to predict near-miss/death. We abstracted all obstetric admissions (1,358 retrospective and 1,240 prospective) from two district hospitals in East Java, Indonesia between 4/1/2009 and 5/15/2010. Prospective data added socio-economic status, access to care and referral patterns. Reduced logistic models were constructed, and multivariate analyses used to assess association of risk variables to outcome. Using multivariate analysis, variables associated with risk of near-miss/death include postpartum hemorrhage (retrospective AOR 5.41, 95 % CI 2.64-11.08; prospective AOR 10.45, 95 % CI 5.59-19.52) and severe preeclampsia/eclampsia (retrospective AOR 1.94, 95 % CI 1.05-3.57; prospective AOR 3.26, 95 % CI 1.79-5.94). Associations with near-miss/death were seen for antepartum hemorrhage in retrospective data (AOR 9.34, 95 % CI 4.34-20.13), and prospectively for poverty (AOR 2.17, 95 % CI 1.33-3.54) and delivering outside the hospital (AOR 2.04, 95 % CI 1.08-3.82). Postpartum hemorrhage and severe preeclampsia/eclampsia are leading causes of near-miss/death in Indonesia. Poverty and delivery outside the hospital are significant risk factors. Prompt recognition of complications, timely referrals, standardized care protocols, prompt hospital triage, and structured provider education may reduce obstetric mortality and morbidity. Retrospective data were reliable, but prospective data provided valuable information about barriers to care and referral patterns.

  15. Reflections on maternal health care within the Victorian Maternal and Child Health Service.

    PubMed

    Hooker, Leesa; Taft, Angela; Small, Rhonda

    2016-01-01

    Women suffer significant morbidity following childbirth and there is a lack of focussed, primary maternal health care to support them. Victorian Maternal and Child Health (MCH) nurses are ideally suited to provide additional care for women when caring for the family with a new baby. With additional training and support, MCH nurses could better fill this health demand and practice gap. This discussion paper reviews what we know about maternal morbidity, current postnatal services for women and the maternal healthcare gap, and makes recommendations for enhancing MCH nursing practice to address this deficit.

  16. Relations Among Maternal Racial Identity, Maternal Parenting Behavior, and Child Outcomes in Low-Income, Urban, Black Families

    ERIC Educational Resources Information Center

    Halgunseth, Linda C.; Ispa, Jean M.; Csizmadia, Annamaria; Thornburg, Kathy R.

    2005-01-01

    This study examined maternal racial identity and its relations to maternal depression, maternal age, maternal parenting behavior, and 5-year-old children's social and cognitive outcomes. Participants included 62 African American mother-child dyads enrolled in the Early Head Start Research and Evaluation Project. Mothers completed measures on their…

  17. A Multifaceted Approach to Revitalizing the Baby-Friendly Hospital Initiative in Croatia.

    PubMed

    Grgurić, Josip; Zakarija-Grković, Irena; Pavičić Bošnjak, Anita; Stanojević, Milan

    2016-08-01

    The Baby-Friendly Hospital Initiative (BFHI) was launched in Croatia in 1993. By 1998, 15 of 34 maternity facilities were designated "Baby-Friendly." Introduction of hospital bags, violating the International Code of the Marketing of Breastmilk Substitutes, led to a standstill in the BFHI. The aim of this article is to describe the successful reintroduction of the BFHI in Croatia between 2007 and 2015. After hospital bags were abolished in 2007, UNICEF Croatia undertook an assessment of BFHI implementation. All maternity facilities were invited by UNICEF and the Ministry of Health to join the renewed BFHI. UNICEF materials were translated and training for trainers, assessors, coordinators, and hospital staff held. By June 2015, 30 of 32 (94%) maternity facilities, providing care to 89% of newborns, were Baby-Friendly. Nine maternity hospitals have been renovated and 2 new hospitals have been built. Exclusive breastfeeding rates have risen 16% at 0 to 2 months (from 51% in 2007 to 67% in 2014) and 14% at 3 to 5 months (from 32% in 2007 to 46% in 2014). Fourteen "Breastfeeding-Friendly" primary care practices have been designated, 166 breastfeeding support groups are in operation, criteria for Mother-Friendly care are being piloted in 2 maternity facilities, and "Ten Steps in the Neonatal Intensive Care Unit" are being introduced. The BFHI provides an excellent opportunity for revitalizing breastfeeding protection, promotion, and support in all settings. Recognition and support of the BFHI by the Croatian government was crucial for implementing the BFHI, whereas the marketing practices of the breast milk substitutes industry are an ongoing challenge.

  18. Fetal-maternal erythrocyte distribution blood test

    MedlinePlus

    Kleihauer-Betke stain; Flow cytometry - fetal-maternal erythrocyte distribution; Rh incompatibility - erythrocyte distribution ... slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor ...

  19. A strategy for reducing maternal mortality.

    PubMed Central

    Suleiman, A. B.; Mathews, A.; Jegasothy, R.; Ali, R.; Kandiah, N.

    1999-01-01

    A confidential system of enquiry into maternal mortality was introduced in Malaysia in 1991. The methods used and the findings obtained up to 1994 are reported below and an outline is given of the resulting recommendations and actions. PMID:10083722

  20. Maternal and child health in China.

    PubMed Central

    Hesketh, T.; Zhu, W. X.

    1997-01-01

    China has made great progress in improving the health of women and children over the past two generations. The success has been attributed to improved living standards, public health measures, and good access to health services. Although overall infant and maternal mortality rates are relatively low there are large differences in patterns of mortality between urban and rural areas. The Chinese have developed a hierarchical network of maternal and child health services, with each level taking a supervisory and teaching role for the level below it. Maternal and child health in China came to international attention in 1995 with the promulgation of the maternal and child health law. In China this was seen as a means of prioritising resources and improving the quality of services, but in the West it was widely described as a law on eugenics. PMID:9224139

  1. Maternal Immunization: Opportunities for Scientific Advancement

    PubMed Central

    Beigi, Richard H.; Fortner, Kimberly B.; Munoz, Flor M.; Roberts, Jeff; Gordon, Jennifer L.; Han, Htay Htay; Glenn, Greg; Dormitzer, Philip R.; Gu, Xing Xing; Read, Jennifer S.; Edwards, Kathryn; Patel, Shital M.; Swamy, Geeta K.

    2014-01-01

    Maternal immunization is an effective strategy to prevent and/or minimize the severity of infectious diseases in pregnant women and their infants. Based on the success of vaccination programs to prevent maternal and neonatal tetanus, maternal immunization has been well received in the United States and globally as a promising strategy for the prevention of other vaccine-preventable diseases that threaten pregnant women and infants, such as influenza and pertussis. Given the promise for reducing the burden of infectious conditions of perinatal significance through the development of vaccines against relevant pathogens, the Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH) sponsored a series of meetings to foster progress toward clinical development of vaccines for use in pregnancy. A multidisciplinary group of stakeholders convened at the NIH in December 2013 to identify potential barriers and opportunities for scientific advancement in maternal immunization. PMID:25425719

  2. Clinical indications and determinants of the rise of cesarean section in three hospitals in rural China.

    PubMed

    Qin, Cheng; Zhou, Min; Callaghan, William M; Posner, Samuel F; Zhang, Jun; Berg, Cynthia J; Zhao, Gengli

    2012-10-01

    This study investigated changes in cesarean delivery rate and cesarean indications in 3 county-level hospitals in rural China. Hospital delivery records in 1997 and 2003 were used to examine the reasons behind the changes. In Chengde County Hospital, the cesarean delivery rate increased from 28% in 1997 to 54% in 2003. The rate increased from 43% in 1997 to 65% in 2003 in Anxian County Hospital and Anxian Maternal and Child Health Hospital. The dramatic increase in cesarean delivery in the study hospitals was associated with a shift from more severe to mild or no clinical indications. The ratio of mild to moderate to severe hypertension increased substantially. More than half of the cephalopelvic disproportion cases were diagnosed prior to labor. The majority of nuchal cord cases were diagnosed without fetal distress. Maternal/family request was the number one cesarean indication in Anxian County Hospital and Anxian MCH Hospital in 2003. Ultrasound evidence of nuchal cord moved from the ninth ranked indication in 1997 to the second in 2003 in Chengde County Hospital.

  3. Prenatal exposure to elevated maternal body temperature and risk of epilepsy in childhood: a population-based pregnancy cohort study.

    PubMed

    Sun, Yuelian; Vestergaard, Mogens; Christensen, Jakob; Olsen, Jørn

    2011-01-01

    Elevated maternal body temperature during pregnancy is of clinical concern as side effects have been reported. We estimated the association between maternal fever and sauna bathing during pregnancy and risk of epilepsy in the offspring. We identified 86,810 liveborn singletons from the Danish National Birth Cohort (DNBC) and followed them for up to 9 years of age. Information on fever including number, timing, level, duration, and symptoms of each fever episodes was collected in two computer-assisted telephone interviews around 17 and 32 gestational weeks; information on maternal use of a sauna was collected in the latter interview, and information on epilepsy was obtained from the Danish National Hospital Register. We applied Cox regression models to estimate the incidence rate ratios (IRR) of epilepsy for children exposed to maternal fever and sauna bathing during pregnancy. Maternal sauna bathing during pregnancy was not associated with an increased risk of epilepsy. Maternal fever during pregnancy in general was not associated with an increased risk of epilepsy in the offspring [IRR = 1.01, 95% confidence interval (CI) 0.85, 1.19], and no dose-response pattern was found according to number, level and duration of fever. However we did find an increased risk of epilepsy among children exposed to at least 3 fever episodes (IRR = 1.88, 95% CI 1.19, 2.98), to maternal fever with symptoms in the urinary system (IRR = 4.86, 95% CI 1.56, 15.17), and to one-day maternal fever of 39.0-39.4°C (IRR = 2.79, 95% CI 1.60, 4.84). Our findings do not support a strong association between hyperthermia and epilepsy but the associations between underlying causes of fever, especially prenatal infections, call for more research.

  4. Maternal carbohydrate intake and pregnancy outcome.

    PubMed

    Clapp, James F

    2002-02-01

    Experimental evidence indicates that the primary maternal environmental factor that regulates feto-placental growth is substrate delivery to the placental site, which is the product of maternal substrate levels and the rate of placental-bed blood flow. Thus, maternal factors which change either substrate level or flow alter feto-placental growth rate. The best-studied substrate in human pregnancy is glucose, and there is a direct relationship between maternal blood glucose levels and size at birth. Altering the type of carbohydrate eaten (high- v. low-glycaemic sources) changes postprandial glucose and insulin responses in both pregnant and non-pregnant women, and a consistent change in the type of carbohydrate eaten during pregnancy influences both the rate of feto-placental growth and maternal weight gain. Eating primarily high-glycaemic carbohydrate results in feto-placental overgrowth and excessive maternal weight gain, while intake of low-glycaemic carbohydrate produces infants with birth weights between the 25th and the 50th percentile and normal maternal weight gain. The calculated difference in energy retention with similar total energy intakes is of the order of 80,000 kJ. Preliminary information from subsequent metabolic studies indicates that the mechanisms involved include changes in: daily digestible energy requirements (i.e. metabolic efficiency), substrate utilization (glucose oxidation v. lipid oxidation), and insulin resistance and sensitivity. Thus, altering the source of maternal dietary carbohydrate may prove to be a valuable tool in the management of pregnancies at risk for anomalous feto-placental growth and for the prevention and/or treatment of obesity and insulin resistance in the non-pregnant state.

  5. Estimates of maternal mortality for 1995.

    PubMed Central

    Hill, K.; AbouZhar, C.; Wardlaw, T.

    2001-01-01

    OBJECTIVE: To present estimates of maternal mortality in 188 countries, areas, and territories for 1995 using methodologies that attempt to improve comparability. METHODS: For countries having data directly relevant to the measurement of maternal mortality, a variety of adjustment procedures can be applied depending on the nature of the data used. Estimates for countries lacking relevant data may be made using a statistical model fitted to the information from countries that have data judged to be of good quality. Rather than estimate the Maternal Mortality Ratio (MMRatio) directly, this model estimates the proportion of deaths of women of reproductive age that are due to maternal causes. Estimates of the number of maternal deaths are then obtained by applying this proportion to the best available figure of the total number of deaths among women of reproductive age. FINDINGS: On the basis of this exercise, we have obtained a global estimate of 515,000 maternal deaths in 1995, with a worldwide MMRatio of 397 per 100,000 live births. The differences, by region, were very great, with over half (273,000 maternal deaths) occurring in Africa (MMRatio: > 1000 per 100,000), compared with a total of only 2000 maternal deaths in Europe (MMRatio: 28 per 100,000). Lower and upper uncertainty bounds were also estimated, on the basis of which the global MMRatio was unlikely to be less than 234 or more than 635 per 100,000 live births. These uncertainty bounds and those of national estimates are so wide that comparisons between countries must be made with caution, and no valid conclusions can be drawn about trends over a period of time. CONCLUSION: The MMRatio is thus an imperfect indicator of reproductive health because it is hard to measure precisely. It is preferable to use process indicators for comparing reproductive health between countries or across time periods, and for monitoring and evaluation purposes. PMID:11285661

  6. It takes more than one for parenting: How do maternal temperament and child's conduct problems relate to maternal parenting behavior?

    PubMed

    Atzaba-Poria, Naama; Deater-Deckard, Kirby; Bell, Martha Ann

    2014-10-01

    The current study examined how individual differences in maternal temperament and child problem behaviors correlate with observed maternal positivity and negativity toward the child. The sample consisted of 153 mothers of 3-to-7 year old children. Mothers reported their own temperament (surgency, orienting sensitivity, effortful control and negative affect) and their children's problem behaviors. Maternal behavior was videotaped in a set of structured interaction tasks with the child during a lab visit. Results indicated that children's problem behaviors were related to less maternal positivity and more negativity. In addition, observed maternal negativity was associated with less maternal effortful control and more negative affect. In contrast, maternal temperament was unrelated to observed maternal positivity toward the child. Furthermore, maternal temperament was related to mothers' positivity and negativity but only for children high in problem behaviors. The findings implicate that child problem behaviors may interact with maternal temperament in explaining variance in caregiving positivity and negativity.

  7. It takes more than one for parenting: How do maternal temperament and child's conduct problems relate to maternal parenting behavior?

    PubMed Central

    Atzaba-Poria, Naama; Deater-Deckard, Kirby; Bell, Martha Ann

    2014-01-01

    The current study examined how individual differences in maternal temperament and child problem behaviors correlate with observed maternal positivity and negativity toward the child. The sample consisted of 153 mothers of 3-to-7 year old children. Mothers reported their own temperament (surgency, orienting sensitivity, effortful control and negative affect) and their children's problem behaviors. Maternal behavior was videotaped in a set of structured interaction tasks with the child during a lab visit. Results indicated that children's problem behaviors were related to less maternal positivity and more negativity. In addition, observed maternal negativity was associated with less maternal effortful control and more negative affect. In contrast, maternal temperament was unrelated to observed maternal positivity toward the child. Furthermore, maternal temperament was related to mothers' positivity and negativity but only for children high in problem behaviors. The findings implicate that child problem behaviors may interact with maternal temperament in explaining variance in caregiving positivity and negativity. PMID:25089066

  8. Serious maternal complications after early preterm delivery (24–33 weeks’gestation)

    PubMed Central

    Reddy, Uma M.; Rice, Madeline Murguia; Grobman, William A.; Bailit, Jennifer L.; Wapner, Ronald J.; Varner, Michael W.; Thorp, John M.; Leveno, Kenneth J.; Caritis, Steve N.; Prasad, Mona; Tita, Alan T. N.; Saade, George R.; Sorokin, Yoram; Rouse, Dwight J.; Blackwell, Sean C.; Tolosa, Jorge E.

    2015-01-01

    OBJECTIVE To describe the prevalence of serious maternal complications following early preterm birth by gestational age (GA), delivery route and type of cesarean incision. STUDY DESIGN Trained personnel abstracted data from maternal and neonatal charts for all deliveries on randomly selected days representing 1/3 of deliveries across 25 US hospitals over 3 years (n=115,502). All women delivering non-anomalous singletons between 23 and 33 weeks’ gestation were included. Women were excluded for antepartum stillbirth and highly morbid conditions for which route of delivery would not likely impact morbidity including non-reassuring fetal status, cord prolapse, placenta previa, placenta accreta, placental abruption, and severe, unstable maternal conditions (cardiopulmonary collapse, acute respiratory distress syndrome, seizures). Serious maternal complications were defined as: hemorrhage (blood loss ≥1500 mL, blood transfusion, or hysterectomy for hemorrhage); infection (endometritis, wound dehiscence, or wound infection requiring antibiotics, reopening or unexpected procedure); ICU admission; or death. Delivery route was categorized as classical cesarean delivery (CCD), low transverse cesarean delivery (LTCD), low vertical cesarean delivery (LVCD), and vaginal delivery (VD). Association of delivery route with complications was estimated using multivariable regression models yielding adjusted relative risks (aRR) controlling for maternal age, race, body mass index, hypertension, diabetes, preterm premature rupture of membranes, preterm labor, GA, and hospital of delivery. RESULTS Of 2659 women who met criteria for inclusion in this analysis, 8.6% of women experienced serious maternal complications. Complications were associated with GA and were highest between 23–27 weeks of gestation. The frequency of complications was associated with delivery route; compared with 3.5% of SVD, 23.0% of CCD (aRR 3.54, 95%CI 2.29–5.48), 12.1% of LTCD (aRR 2.59, 95%CI 1.77–3

  9. Emotions, stress, and maternal motivation in primates.

    PubMed

    Maestripieri, Dario

    2011-06-01

    Recent research conducted with nonhuman primates confirms that adaptive emotional processes, such as maternal attraction arousability and maternal anxiety arousability, enhance and sustain female motivation to interact with infants, invest in them, and protect them during the postpartum period. Changes in these emotional processes, and concomitant changes in maternal motivation, facilitate the reduction and eventual termination of maternal investment associated with infant weaning. Although laboratory studies of rodents and socially deprived rhesus monkeys have suggested that nulliparous females are neophobic and find infant stimuli aversive, recent primate research indicates that neophobia or aversion to infant stimuli do not occur in females with normal developmental experience. Furthermore, although some rodent and human studies have shown that lactation is accompanied by physiological hyporesponsiveness to stress, other studies of rodents, nonhuman primates, and humans indicate that mothers are highly vulnerable to stress and that stress-induced dysregulation of emotions can interfere with maternal motivation and parenting behavior. It is possible that some aspects of the emotional and experiential regulation of maternal motivation and parental behavior are different in different mammalian species. However, variation in the environments in which subjects are tested and in their developmental experience may also be responsible for the some discrepancies between the results of different studies.

  10. [Maternal breastfeeding: health factor. Historical memory].

    PubMed

    Barriuso, L; de Miguel, M; Sánchez, M

    2007-01-01

    Maternal breastfeeding is a habit that has been closely linked to the survival of the human species since time immemorial. Following a stage when it was massively abandoned in the mid-XX century, we are now witnessing a recovery of this habit, especially in the so-called "developed" world, promoted by the health institutions in light of the scientific evidence. The superiority of maternal breastfeeding over artificial feeding is beyond dispute as the scientific evidence makes clear. Maternal breastfeeding is a positive factor for the health of the mother and for the child. Hence the promotion and recovery of this habit is more than just a fashion or tendency: it is an incontrovertible factor in maternal-child health. Through the Foral Order of January 28th 2004, the government of Navarre has brought together the numerous administrative initiatives that are emerging in our province for the promotion of maternal breastfeeding by promoting a Technical Advisory Commission for the Promotion of Maternal Breastfeeding in Navarre.

  11. Positioning hospitals: a model for regional hospitals.

    PubMed

    Reddy, A C; Campbell, D P

    1993-01-01

    In an age of marketing warfare in the health care industry, hospitals need creative strategies to compete successfully. Lately, positioning concepts have been added to the health care marketer's arsenal of strategies. To blend theory with practice, the authors review basic positioning theory and present a framework for developing positioning strategies. They also evaluate the marketing strategies of a regional hospital to provide a case example.

  12. Maternal Obesity and Neck Circumference.

    PubMed

    Anglim, B; O'Higgins, A; Daly, N; Farren, M; Turner, M J

    2015-06-01

    Obese women are more likely to require general anaesthesia for an obstetric intervention than non-obese. Difficult tracheal intubation and oxygen desaturation is more common in pregnancy. Failed tracheal intubation has been associated with an increase in neck circumference (NC). We studied the relationship between maternal obesity and NC as pregnancy advanced in women attending a standard antenatal clinic. Of the 96 women recruited, 13.5% were obese. The mean NC was 36.8cm (SD 1.9) in the obese women compared with 31.5cm (SD 1.6) in women with a normal BMI (p < 0.001) at 18-22 weeks gestation. In the obese women it increased on average by 1.5cm by 36-40 weeks compared with an increase of 1.6 cm in women with a normal BMI. The antenatal measurement of NC is a simple, inexpensive tool that is potentially useful for screening obese women who may benefit from an antenatal anaesthetic assessment.

  13. Evolutionary genetics of maternal effects

    PubMed Central

    Wolf, Jason B.; Wade, Michael J.

    2016-01-01

    Maternal genetic effects (MGEs), where genes expressed by mothers affect the phenotype of their offspring, are important sources of phenotypic diversity in a myriad of organisms. We use a single‐locus model to examine how MGEs contribute patterns of heritable and nonheritable variation and influence evolutionary dynamics in randomly mating and inbreeding populations. We elucidate the influence of MGEs by examining the offspring genotype‐phenotype relationship, which determines how MGEs affect evolutionary dynamics in response to selection on offspring phenotypes. This approach reveals important results that are not apparent from classic quantitative genetic treatments of MGEs. We show that additive and dominance MGEs make different contributions to evolutionary dynamics and patterns of variation, which are differentially affected by inbreeding. Dominance MGEs make the offspring genotype‐phenotype relationship frequency dependent, resulting in the appearance of negative frequency‐dependent selection, while additive MGEs contribute a component of parent‐of‐origin dependent variation. Inbreeding amplifies the contribution of MGEs to the additive genetic variance and, therefore enhances their evolutionary response. Considering evolutionary dynamics of allele frequency change on an adaptive landscape, we show that this landscape differs from the mean fitness surface, and therefore, under some condition, fitness peaks can exist but not be “available” to the evolving population. PMID:26969266

  14. [Maternal cardiac arrhythmias in pregnancy].

    PubMed

    Facchini, M; Bauersfeld, U; Fasnacht, M; Candinas, R

    2000-12-23

    During pregnancy an increased incidence of maternal cardiac arrhythmias is observed. These include a wide spectrum, from clinically irrelevant isolated premature beats to debilitating supraventricular and ventricular tachycardias. In principle, management of arrhythmias during pregnancy is similar to that in non-pregnant patients. However, special consideration should be given to foetal age and potential teratogenic and haemodynamic adverse drug effects on the foetus. Therapeutic strategy should be guided by interdisciplinary consulting (i.e. cardiology, obstetrics, neonatology). Diagnostic evaluation must rule out underlying cardiovascular, pulmonary, endocrine or metabolic diseases. Additionally, precipitating factors such as excessive caffeine and/or alcohol ingestion and cigarette smoking should be avoided. For benign arrhythmias a conservative approach is appropriate. Antiarrhythmic drug selection depends on the specific arrhythmia being treated and the cardiac condition of the mother and the foetus. Some antiarrhythmic agents, such as propranolol, metoprolol, digoxin and quinidine, have been extensively tested during pregnancy and have proven to be safe; they should therefore, whenever possible, be used as firstline. For supraventricular tachycardia, intravenous adenosine may be used to terminate the arrhythmia if vagal manoeuvres fail. In emergency situations cardioversion may be performed with relative safety. Implantable cardioverter defibrillators as a preventive measure for life-threatening arrhythmias in pregnant patients do not seem to increase the risk of major complications.

  15. Maternal arrhythmia and perinatal outcomes

    PubMed Central

    Henry, Dana; Gonzalez, Juan M; Harris, Ian, S.; Sparks, Teresa; Killion, Molly; Thiet, Mari-Paule; Bianco, Katherine

    2016-01-01

    Objective To determine if arrhythmia in the setting of maternal cardiac disease (MCD) affects perinatal outcomes. Study Design This is a retrospective cohort study of pregnant women with MCD who delivered from 2008 to 2013. Perinatal outcomes among women with an arrhythmia were compared to those without. Result Among 143 women; 36 (25%) had an arrhythmia. Those with an arrhythmia were more likely to have a spontaneous vaginal delivery (64% vs. 43%, p < 0.05) and required fewer operative vaginal births (8% vs. 27%, p=0.02). Pregnancies were more likely to be complicated by IUGR (17% vs. 5%, p < 0.05) although there were no differences in the rate of small for gestational age. The risk of IUGR remained increased after controlling for confounding (aOR 6.98, 95% CI 1.59–30.79, p=0.01). Two cases of placental abruption were identified among mothers with arrhythmia while none were identified in the controls (p < 0.05) Conclusion Patients with arrhythmias were more likely to have a spontaneous vaginal delivery. Our data suggests that these pregnancies were an increased risk for IUGR. PMID:27309629

  16. Maternal contributions to preterm delivery.

    PubMed

    Boyd, Heather A; Poulsen, Gry; Wohlfahrt, Jan; Murray, Jeffrey C; Feenstra, Bjarke; Melbye, Mads

    2009-12-01

    Preterm delivery (PTD) is a complex trait with a significant familial component. However, no specific inheritance patterns have been established. The authors examined the contribution of PTDs in both the woman's family and her partner's family to her risk of PTD. The authors linked birth information from Danish national registers with pedigree information from the Danish Family Relations Database for 1,107,124 live singleton deliveries occurring from 1978 to 2004. Risk ratios were estimated comparing women with and without various PTD histories. Women with previous PTDs were at greatly increased risk of recurrent PTD (risk ratio = 5.6, 95% confidence interval: 5.5, 5.8); however, their PTD risk was unaffected by a partner's history of preterm children with other women. PTDs to a woman's mother, full sisters, or maternal half-sisters also increased her PTD risk (risk ratio = 1.6, 95% confidence interval: 1.5, 1.6), whereas PTDs in her paternal half-sisters, the female partners of her male relatives, or members of her partner's family did not affect her PTD risk. Inheritance patterns were similar for all gestational ages from very early through late PTD. The substantial portion of PTD risk explained by effects passed through the female line suggests a role for either imprinting or mitochondrial inheritance.

  17. Maternal obesity during pregnancy is negatively associated with maternal and neonatal iron status

    PubMed Central

    Jones, Andrew D.; Zhao, Gengli; Jiang, Ya-ping; Zhou, Min; Xu, Guobin; Kaciroti, Niko; Zhang, Zhixiang; Lozoff, Betsy

    2015-01-01

    Background/Objectives Obesity among pregnant women may adversely affect both maternal iron status throughout pregnancy and placental transfer of iron. The objective of this study was to determine the association of maternal body mass index (BMI) with 1) maternal iron status and inflammation in mid and late pregnancy, 2) the change in maternal iron status throughout pregnancy, and 3) neonatal iron status. Subjects/Methods We examined longitudinal data from 1,613 participants in a pregnancy iron supplementation trial in rural China. Women with uncomplicated singleton pregnancies were enrolled in the early second trimester of pregnancy and followed through parturition. Maternal blood samples obtained at enrollment and in the third trimester, and cord blood samples were analyzed for a range of hematological and iron biomarkers. Results There was a negative association between maternal BMI and iron status at enrollment (transferrin receptor (sTfR): r=0.20, P<0.001; body iron (BI): r=−0.05; P=0.03). This association was markedly stronger among obese women. Maternal BMI was positively associated with maternal inflammation (C-reactive protein: r=0.33, P<0.001). In multiple linear regression models, maternal BMI was negatively associated with neonatal iron status (cord serum ferritin: −0.01, P=0.008; BI: −0.06, P=0.006) and associated with a lower decrease in iron status throughout pregnancy (sTfR: −4.6, P<0.001; BI: 1.1, P=0.004). Conclusions Maternal obesity during pregnancy may adversely affect both maternal and neonatal iron status, potentially through inflammatory pathways. PMID:26813939

  18. Inpatient Obstetric Care at Irwin Army Community Hospital: A Study to Determine the Most Efficient Organization

    DTIC Science & Technology

    2001-03-01

    Reese’s new birthing suites may curb maternity malpractice suits. Modern Healthcare, 16 (11), 48. Clark, L., & Stewart, R. (1982). Nurse- midwifery ...practice in an in-hospital birthing center: 2050 births. Journal of Nurse- Midwifery , 27 (3), 21-26. Cooper, R. & Schindler, P. (1998a). Design Strategies. In

  19. Intraclass correlation coefficients in the Brazilian network for surveillance of severe maternal morbidity study

    PubMed Central

    2012-01-01

    Background The purpose of the study was to evaluate intraclass correlation coefficients (ICC) of variables concerning personal characteristics, structure, outcome and process in the Brazilian Network for Surveillance of Severe Maternal Morbidity study conducted to identify severe maternal morbidity/near miss cases using the World Health Organization criteria. Method It was a cross-sectional, multicenter study involving 27 hospitals providing care for pregnant women in Brazil. Cluster size and the mean size of the primary sampling unit were described. Estimated prevalence rates, ICC, their respective 95% confidence intervals, the design effect and the mean cluster size were presented for each variable. Results Overall, 9,555 cases of severe maternal morbidity (woman admitted with potentially life-threatening conditions, near miss events or death) were included in the study. ICC ranged from < 0.001 to 0.508, with a median of 0.035. ICC was < 0.1 for approximately 75% of the variables. For process-related variables, median ICC was 0.09, with 0.021 for those related to outcome. These findings confirm data from previous studies. Homogeneity may be considered minor, thus increasing reliability of these findings. Conclusions These results may be used to design new cluster trials in maternal and perinatal health and to help calculate sample sizes. PMID:22998520

  20. Discrepancies between national maternal mortality data and international estimates: the experience of Papua New Guinea.

    PubMed

    Mola, Glen; Kirby, Barry

    2013-11-01

    Over the past 30 years maternal mortality estimates for Papua New Guinea have varied widely. There is no mandatory vital registration in PNG, and 85% of the population live in rural areas with limited or no access to health services. Demographic Health Survey data for PNG estimates the maternal mortality ratio to be 370 deaths per 100,000 live births in 1996 and 733 in 2006, whereas estimates based upon mathematical models (as calculated by international bodies) gave figures of 930 for 1980 and 230 for 2010. This disparity has been a source of considerable confusion for health workers, policy makers and development partners. In this study, we compared 2009 facility-based survey data with figures from the national Health Information System records. The comparison revealed similar maternal mortality ratios: for provincial hospitals (245 and 295), government health centres (574 and 386), church agency health centres (624 and 624), and nationally (394 and 438). Synthesizing these estimates for supervised births in facilities and data on unsupervised births from a community-based survey in one province indicates a national MMR of about 500. Knowing the maternal mortality ratio is a necessary starting point for working out how to reduce it.

  1. IMPACT OF PRENATAL MATERNAL FACTORS AND BIRTH ORDER ON THE ANTHROPOMETRIC STATUS OF NEWBORNS IN IRAN.

    PubMed

    Kheirouri, Sorayya; Alizadeh, Mohammad

    2017-03-01

    This cross-sectional study was carried out to capture possible maternal factors affecting newborns' anthropometric measurements. Data were collected from eight public health centres and referral university hospital records in Tabriz and Heriss districts, north-west Iran, for 807 mother-neonate pairs delivering live singleton births and their offspring during the two years up to August 2014. The incidence of low birth weight (LBW) was 5.1%. A close correlation was found between maternal anthropometry and birth order with neonatal anthropometric data. Birth order and maternal height and body mass index (BMI) positively affected neonates' birth size (weight, length and head circumference). The rate of LBW was significantly higher for older (≥35 years), taller (≥170 cm), underweight (BMI<18.5) and non-iron-taking women and in the first-born babies. The odds of having LBW newborns in older, taller, underweight, obese and irregular iron-taking women were 3.82, 4.00, 9.07, 3.50 and 2.50 times those of mid-age group, middle-height, overweight and regular iron-taking women, respectively. First-born newborns were 5.97 times more likely to be LBW compared with second-birth neonates. The results indicate that maternal anthropometric indices, age, iron intake and birth order influence the risk of LBW in newborns.

  2. Maternal Ethnic Ancestry and Adverse Perinatal Outcomes in New York City

    PubMed Central

    Stein, Cheryl R.; Savitz, David A.; Janevic, Teresa; Ananth, Cande V.; Kaufman, Jay S.; Herring, Amy H.; Engel, Stephanie M.

    2009-01-01

    Objective To examine the association between narrowly defined subsets of maternal ethnicity and birth outcomes. Study Design Analysis of 1995-2003 New York City birth certificates linked to hospital discharge data for 949,210 singleton births to examine the multivariable associations between maternal ethnicity and preterm birth, subsets of spontaneous and medically indicated preterm birth, term small for gestational age (SGA), and term birthweight. Results Compared to non-Hispanic whites, Puerto Ricans had an elevated odds ratio (OR 1.9, 95% CI 1.9-2.0) for delivering at 32-36 weeks (adjusted for nativity, maternal age, parity, education, tobacco use, pre-pregnancy weight, birth year). We found an excess of adverse outcomes among most Latino groups. Outcomes also varied within regions, with North African infants nearly 100g (adjusted) heavier than sub-Saharan Africans. Conclusions The considerable heterogeneity in risk of adverse perinatal outcomes is obscured in broad categorizations of maternal race/ethnicity, and may help to formulate etiologic hypotheses. PMID:19729145

  3. The use of digital media by women using the maternity services in a developed country.

    PubMed

    O'Higgins, A; Murphy, O C; Egan, A; Mullaney, L; Sheehan, S; Turner, M J

    2014-01-01

    The provision of high quality healthcare information about pregnancy is important to women and to healthcare professionals and it is 1 driven, in part, by a desire to improve clinical outcomes,. The objective of this study was to examine the use of digital media by women' to access pregnancy information. A questionnaire was distributed to women attending a large maternity hospital. Of the 522 respondents, the mean age was 31.8 years, 45% (235/522) were nulliparous, 62% (324/522) lived in the capital city and 29% (150/522) attended the hospital as private patients. Overall 95% (498/522) used the internet for pregnancy information, 76% (399/522) had a smartphone and 59% (235/399) of smartphone owners had used a pregnancy smartapp. The nature of internet usage for pregnancy information included discussion forums (70%), social networks (67%), video media (48%), e-books (15%), blogs (13%), microblogs (9%) and podcasts (4%). Even women who were socially disadvantaged reported high levels of digital media usage. In contemporary maternity care women use digital media extensively for pregnancy information. All maternity services should have a digital media strategy.

  4. Neonatal family care for 24 hours per day: effects on maternal confidence and breast-feeding.

    PubMed

    Wataker, Heidi; Meberg, Alf; Nestaas, Eirik

    2012-01-01

    In family care (FC) program for neonatal intensive care units (NICUs), parents are encouraged to reside together with their infant for 24 hours a day to actively be involved in the care. The aim of this study was to assess the impact of FC on maternal confidence and breast-feeding. Maternal confidence and rate of breast-feeding were assessed in 31 mothers offered FC that included special family rooms in the NICU, and in 30 mothers from a comparable NICU providing traditional care without such facilities. One week prior to hospital discharge, mothers in the FC group felt better informed regarding nursing issues and had more confidence in interpretation of the infants regarding feeding issues and in caregiving without staff attendance (P < .05). They also reported a higher level of empowerment (P < .05). Three months after discharge, the mothers in the FC group had a higher self-reported skill level for interpretation of the infant's signals and knowledge about breast-feeding (P < .05). Despite similar rate of breast-feeding at discharge, more infants in the FC group were breastfed 3 months after discharge (P < .05). An FC program in the NICU promoted better maternal confidence during the hospital stay and 3 months after discharge compared with traditional care.

  5. Emotion Regulation in Preschoolers: The Roles of Behavioral Inhibition, Maternal Affective Behavior, and Maternal Depression

    ERIC Educational Resources Information Center

    Feng, Xin; Shaw, Daniel S.; Kovacs, Maria; Lane, Tonya; O'Rourke, Flannery E.; Alarcon, Joseph H.

    2008-01-01

    Background: This study examined preschoolers' emotion regulation (ER) strategies and the association with temperament, maternal interactive style, and maternal history of childhood-onset depression (COD). Methods: Participants were 62 children and their mothers, 37 of whom had mothers with COD. Children's ER was assessed using a disappointment…

  6. Current and Past Maternal Depression, Maternal Interaction Behaviors, and Children's Externalizing and Internalizing Symptoms

    ERIC Educational Resources Information Center

    Foster, Cynthia J. Ewell; Garber, Judy; Durlak, Joseph A.

    2008-01-01

    Relations among past maternal depressive disorder, current depressive symptoms, current maternal interaction behaviors, and children's adjustment were examined in a sample of 204 women and their young adolescent offspring (mean age = 11.86, SD = 0.55). Mothers either had (n = 157) or had not (n = 57) experienced at least one depressive disorder…

  7. Exploring the effects of maternal eating patterns on maternal feeding and child eating

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Recent research has demonstrated the importance of maternal feeding practices and children’s eating behavior in the development of childhood obesity. The purpose of this study was to examine the relations between maternal and child eating patterns, and to examine the degree to which these relationsh...

  8. Poverty and Maternal Responsiveness: The Role of Maternal Stress and Social Resources

    ERIC Educational Resources Information Center

    Evans, Gary W.; Boxhill, Louise; Pinkava, Michael

    2008-01-01

    One of the main reasons poverty is bad for children's development is because it reduces maternal responsiveness. This study addresses a heretofore unanswered question: why do low-income children experience diminished maternal responsiveness compared with their more affluent counterparts? In addition, we examine this question among a largely…

  9. Tightly Linked Systems: Reciprocal Relations Between Maternal Depressive Symptoms And Maternal Reports of Adolescent Externalizing Behavior

    PubMed Central

    Allen, Joseph P.; Manning, Nell; Meyer, Jess

    2010-01-01

    The frequently observed link between maternal depressive symptoms and heightened maternal reporting of adolescent externalizing behavior was examined from an integrative, systems perspective using a community sample of 180 adolescents, their mothers, fathers, and close peers, assessed twice over a three-year period. Consistent with this perspective, the maternal depression-adolescent externalizing link was found to reflect not simply maternal reporting biases, but heightened maternal sensitivity to independently observable teen misbehavior as well as long-term, predictive links between maternal symptoms and teen behavior. Maternal depressive symptoms predicted relative increases over time in teen externalizing behavior. Child effects were also found, however, in which teen externalizing behavior predicted future relative increases in maternal depressive symptoms. Findings are interpreted as revealing a tightly-linked behavioral-affective system in families with mothers experiencing depressive symptoms and teens engaged in externalizing behavior, and further suggest that research on depressive symptoms in women with adolescent offspring should now consider offspring externalizing behaviors as a significant risk factor. PMID:21090880

  10. MATERNAL SELF-REPORTED DEPRESSIVE SYMPTOMS AND MATERNAL CORTISOL LEVELS INTERACT TO PREDICT INFANT CORTISOL LEVELS.

    PubMed

    Khoury, Jennifer E; Gonzalez, Andrea; Levitan, Robert; Masellis, Mario; Basile, Vincenzo; Atkinson, Leslie

    2016-01-01

    Three basic findings have emerged from research on maternal depressive symptoms and offspring hypothalamic-pituitary-adrenal functioning: (a) Mothers' depressive symptoms are positively associated with their offsprings' cortisol stress response, (b) numerous individual and interpersonal maternal characteristics moderate this association, and (c) maternal and infant cortisol levels are highly correlated. In combination, these findings have suggested that maternal cortisol levels may moderate the relation between maternal depressive symptoms and infant cortisol responsivity; the current study assessed this hypothesis. Participants were 297 mother-infant dyads who were recruited from the community. Maternal depressive symptoms were assessed via self-report. Dyads participated in two differentially stressful infant challenges when infants were 16 and 17 months old. Mother and infant salivary cortisol was collected before and after challenges. Results indicate that maternal cortisol levels moderated associations between maternal depressive symptoms and infant cortisol levels across both challenges. Infants showed higher cortisol levels if their mothers had both higher depressive symptoms and higher cortisol levels, as compared to infants of mothers with higher depressive symptoms and lower cortisol, and to infants of mothers with lower depressive symptoms and either higher or lower cortisol levels. We discuss findings in relation to environmental and biological factors that may contribute to the intergenerational transmission of depressive symptoms.

  11. Maternal Preconceptions About Parenting Predict Child Temperament, Maternal Sensitivity, and Children's Empathy

    ERIC Educational Resources Information Center

    Kiang, Lisa; Moreno, Amanda J.; Robinson, JoAnn L.

    2004-01-01

    This study examined the influence of maternal preconceptions on child difficult temperament at 6 months and maternal sensitivity at 12-15 months and whether all 3 variables predicted children's empathy at 21-24 months. Within a low-income, ethnically diverse sample of 175 mother-child dyads, path models were tested with 3 empathy indices…

  12. Maternal Attachment Representations, Maternal Sensitivity, and the Infant-Mother Attachment Relationship.

    ERIC Educational Resources Information Center

    Pederson, David R.; Gleason, Karin E.; Moran, Greg; Bento, Sandi

    1998-01-01

    Examined the mediating role of maternal sensitivity for the association between maternal attachment representations and the quality of infant-mother attachment. Found that autonomous mothers and mothers in secure relationships were more sensitive at home than nonautonomous mothers and mothers in nonsecure relationships, respectively. Infants in…

  13. Associations between Parents' Marital Functioning, Maternal Parenting Quality, Maternal Emotion and Child Cortisol Levels

    ERIC Educational Resources Information Center

    Pendry, Patricia; Adam, Emma K.

    2007-01-01

    Associations between family functioning and children's stress hormone levels are explored, by examining how aspects of the interparental relationship (parents' marital satisfaction and parent conflict styles), the mother-child relationship (maternal involvement and warmth) and maternal emotional functioning (depression, anxiety and self-esteem)…

  14. The Contributions of Maternal Sensitivity and Maternal Depressive Symptoms to Epigenetic Processes and Neuroendocrine Functioning

    ERIC Educational Resources Information Center

    Conradt, Elisabeth; Hawes, Katheleen; Guerin, Dylan; Armstrong, David A.; Marsit, Carmen J.; Tronick, Edward; Lester, Barry M.

    2016-01-01

    This study tested whether maternal responsiveness may buffer the child to the effects of maternal depressive symptoms on DNA methylation of "NR3C1," "11ß-HSD2," and neuroendocrine functioning. DNA was derived from buccal epithelial cells and prestress cortisol was obtained from the saliva of 128 infants. Mothers with depressive…

  15. Maternal Depressive Symptoms, Dysfunctional Cognitions, and Infant Night Waking: The Role of Maternal Nighttime Behavior

    ERIC Educational Resources Information Center

    Teti, Douglas M.; Crosby, Brian

    2012-01-01

    Mechanisms were examined to clarify relations between maternal depressive symptoms, dysfunctional cognitions, and infant night waking among 45 infants (1-24 months) and their mothers. A mother-driven mediational model was tested in which maternal depressive symptoms and dysfunctional cognitions about infant sleep predicted infant night waking via…

  16. Young Adults' Attachment: Does Maternal Employment Make a Difference? Attachments Correlates of Maternal Employment after Infancy.

    ERIC Educational Resources Information Center

    Domingo, Meera; Keppley, Sharon; Chambliss, Catherine

    As growing numbers of mothers enter the workforce, understanding the effects of maternal employment on children and adolescents has become increasingly important. The effects of maternal employment after infancy on adult attachment, and how these effects vary as a function of children's personality style are examined in this paper. It was…

  17. Maternal Psychopathology and Infant Development at 18 Months: The Impact of Maternal Personality Disorder and Depression

    ERIC Educational Resources Information Center

    Conroy, Susan; Pariante, Carmine M.; Marks, Maureen N.; Davies, Helen A.; Farrelly, Simone; Schacht, Robin; Moran, Paul

    2012-01-01

    Objective: No previous longitudinal study has examined the impact of comorbid maternal personality disorder (PD) and depression on child development. We set out to examine whether maternal PD and depression assessed at 2 months post partum would be independently associated with adverse developmental outcomes at 18 months of age. Method: Women were…

  18. The Relations among Maternal Depressive Disorder, Maternal Expressed Emotion, and Toddler Behavior Problems and Attachment

    ERIC Educational Resources Information Center

    Gravener, Julie A.; Rogosch, Fred A.; Oshri, Assaf; Narayan, Angela J.; Cicchetti, Dante; Toth, Sheree L.

    2012-01-01

    Direct and indirect relations among maternal depression, maternal Expressed Emotion (EE: Self- and Child-Criticism), child internalizing and externalizing symptoms, and child attachment were examined. Participants were mothers with depression (n = 130) and comparison mothers (n = 68) and their toddlers (M age = 20 mo.; 53% male). Assessments…

  19. Exploring the effects of maternal eating patterns on maternal feeding and child eating.

    PubMed

    Morrison, Halley; Power, Thomas G; Nicklas, Theresa; Hughes, Sheryl O

    2013-04-01

    Recent research has demonstrated the importance of maternal feeding practices and children's eating behavior in the development of childhood obesity. The purpose of this study was to examine the relations between maternal and child eating patterns, and to examine the degree to which these relationships were mediated through maternal feeding practices. Two hundred and twenty-two low-income mothers and their preschool children participated. About half of the families were African American and half were Latino. Mothers completed questionnaires assessing maternal eating patterns, maternal feeding practices, and children's eating patterns. Maternal external eating (eating in response to outside stimuli, not internal hunger/thirst cues) was positively correlated with two child eating scores: picky eating and desire to eat. Mediational analyses showed that external eating in mothers was related to picky eating in children through high maternal control in feeding; the relationship between mothers' external eating and desire to eat in children was not mediated through maternal control. Picky eating and desire to eat in children were related to emotional eating in mothers as well. The implications of these results for understanding the development of childhood obesity are considered.

  20. Relations among Intimate Partner Violence, Maternal Depressive Symptoms, and Maternal Parenting Behaviors

    ERIC Educational Resources Information Center

    Gustafsson, Hanna C.; Cox, Martha J.

    2012-01-01

    The authors examined the relations among intimate partner violence (IPV), maternal depressive symptoms, and maternal harsh intrusive parenting. Using a cross-lagged, autoregressive path model, they sought to clarify the directionality of the relations among these 3 variables over the first 2 years of the child's life. The results indicated that,…

  1. [Breast feeding and length of hospitalization].

    PubMed

    Díaz Gómez, M; Ramos Acosta, C L; Rico Sevillano, J; Robayna Curbelo, M; Alvarez Alvarez, J

    1997-11-01

    One of the important tasks for a nurse is to insure that the newborn receives all the nourishment that it needs. A well fed baby is healthier, experiences a shorter hospital stay and develops a stronger bond with its mother. To prove this point a study was performed on a group of low birth weight newborns (free of other pathological symptoms) to compare nutrition against hospitalization time. 85 children of both sexes were divided into 3 groups: premature but of normal gestational size, premature but small for gestational size, and full term but small for gestational size; all had a birth weight superior to 2 kilos and were examined postpartum on their first and third week. The groups were then subdivided into 2 groups: one received only artificial milk formula and the other group received their mothers' milk through a bottle. The children that drank the maternal milk required fewer days in the hospital (18 +/- 6 days versus 27 +/- 7 days for those drinking only formula) and had a smaller percentage of weight loss after birth (3.7 +/- 2.0% versus 5.2 +/- 2.9%), demonstrating a significant difference in their overall health.

  2. Health Extension Workers' and Mothers' Attitudes to Maternal Health Service Utilization and Acceptance in Adwa Woreda, Tigray Region, Ethiopia

    PubMed Central

    Jackson, Ruth; Tesfay, Fisaha Haile; Godefay, Hagos; Gebrehiwot, Tesfay Gebregzabher

    2016-01-01

    Background The maternal health system in Ethiopia links health posts in rural communities (kebeles) with district (woreda) health centres, and health centres with primary hospitals. At each health post two Health Extension Workers (HEWs) assist women with birth preparedness, complication readiness, and mobilize communities to facilitate timely referral to mid-level service providers. This study explored HEWs’ and mother’s attitudes to maternal health services in Adwa Woreda, Tigray Region. Methods In this qualitative study, we trained 16 HEWs to interview 45 women to gain a better understanding of the social context of maternal health related behaviours. Themes included barriers to health services; women’s social status and mobility; and women’s perceptions of skilled birth attendant’s care. All data were analyzed thematically. Findings There have been substantial efforts to improve maternal health and reduce maternal mortality in Adwa Woreda. Women identified barriers to healthcare including distance and lack of transportation due to geographical factors; the absence of many husbands due to off-woreda farming; traditional factors such as zwar (some pregnant women are afraid of meeting other pregnant women), and discouragement from mothers and mothers-in-law who delivered their children at home. Some women experienced disrespectful care at the hospital. Facilitators to skilled birth attendance included: identification of pregnant women through Women’s Development Groups (WDGs), and referral by ambulance to health facilities either before a woman’s Expected Due Date (EDD) or if labour started at home. Conclusion With the support of WDGs, HEWs have increased the rate of skilled birth attendance by calling ambulances to transfer women to health centres either before their EDD or when labour starts at home. These findings add to the growing body of evidence that health workers at the community level can work with women’s groups to improve maternal

  3. Enhancing Maternal and Perinatal Health in Under-Served Remote Areas in Sub-Saharan Africa: A Tanzanian Model

    PubMed Central

    Nyamtema, Angelo S.; Mwakatundu, Nguke; Dominico, Sunday; Mohamed, Hamed; Pemba, Senga; Rumanyika, Richard; Kairuki, Clementina; Kassiga, Irene; Shayo, Allan; Issa, Omary; Nzabuhakwa, Calist; Lyimo, Chagi; van Roosmalen, Jos

    2016-01-01

    Background In Tanzania, maternal mortality ratio (MMR), unmet need for emergency obstetric care and health inequities across the country are in a critical state, particularly in rural areas. This study was established to determine the feasibility and impact of decentralizing comprehensive emergency obstetric and neonatal care (CEmONC) services in underserved rural areas using associate clinicians. Methods Ten health centres (HCs) were upgraded by constructing and equipping maternity blocks, operating rooms, laboratories, staff houses and installing solar panels, standby generators and water supply systems. Twenty-three assistant medical officers (advanced level associate clinicians), and forty-four nurse-midwives and clinical officers (associate clinicians) were trained in CEmONC and anaesthesia respectively. CEmONC services were launched between 2009 and 2012. Monthly supportive supervision and clinical audits of adverse pregnancy outcomes were introduced in 2011 in these HCs and their respective district hospitals. Findings After launching CEmONC services from 2009 to 2014 institutional deliveries increased in all upgraded rural HCs. Mean numbers of monthly deliveries increased by 151% and obstetric referrals decreased from 9% to 3% (p = 0.03) in HCs. A total of 43,846 deliveries and 2,890 caesarean sections (CS) were performed in these HCs making the mean proportion of all births in EmONC facilities of 128% and mean population-based CS rate of 9%. There were 190 maternal deaths and 1,198 intrapartum and very early neonatal deaths (IVEND) in all health facilities. Generally, health centres had statistically significantly lower maternal mortality ratios and IVEND rates than district hospitals (p < 0.00 and < 0.02 respectively). Of all deaths (maternal and IVEND) 84% to 96% were considered avoidable. Conclusions These findings strongly indicate that remotely located health centres in resource limited settings hold a great potential to increase accessibility to CEm

  4. Externalizing behavior problems among polydrug cocaine-exposed children: Indirect pathways via maternal harshness and self-regulation in early childhood.

    PubMed

    Eiden, Rina D; Coles, Claire D; Schuetze, Pamela; Colder, Craig R

    2014-03-01

    This study examined direct and indirect associations between prenatal cocaine exposure (CE) and children's externalizing problems in kindergarten via higher maternal harshness and lower self-regulation in early childhood. Other environmental risk variables, such as child exposure to community violence and experience of hunger, were used as additional predictors. The sample consisted of 216 mother-infant dyads recruited at delivery from local area hospitals (116 cocaine-exposed, 100 nonexposed). Maternal harshness was coded from observations of mother-toddler interactions at 2 years of age, and children's self-regulation was measured at 3 years of age using several laboratory paradigms. Maternal reports of externalizing behavior problems were obtained at both time points and at kindergarten. Teacher reports were obtained and classroom observations of externalizing behaviors were conducted in the kindergarten classroom. Results indicated significant indirect associations between CE and maternal reports of externalizing problems via higher maternal harshness at 2 years and higher externalizing problems at 3 years of child age. A second indirect path from CE to externalizing problems in the school setting via higher maternal harshness at 2 years and lower self-regulation at 3 years was also significant. There were significant associations between community violence exposure and maternal reports of externalizing problems, and between hunger and externalizing problems in the school setting. Results highlight the role of parenting and self-regulation in early childhood as critical process variables in the indirect association between CE and externalizing behavior problems in kindergarten.

  5. Investigation of maternal environmental exposures in association with self-reported preterm birth.

    PubMed

    Patel, Chirag J; Yang, Ting; Hu, Zhongkai; Wen, Qiaojun; Sung, Joyce; El-Sayed, Yasser Y; Cohen, Harvey; Gould, Jeffrey; Stevenson, David K; Shaw, Gary M; Ling, Xuefeng Bruce; Butte, Atul J

    2014-06-01

    Identification of maternal environmental factors influencing preterm birth risks is important to understand the reasons for the increase in prematurity since 1990. Here, we utilized a health survey, the US National Health and Nutrition Examination Survey (NHANES) to search for personal environmental factors associated with preterm birth. 201 urine and blood markers of environmental factors, such as allergens, pollutants, and nutrients were assayed in mothers (range of N: 49-724) who answered questions about any children born preterm (delivery <37 weeks). We screened each of the 201 factors for association with any child born preterm adjusting by age, race/ethnicity, education, and household income. We attempted to verify the top finding, urinary bisphenol A, in an independent study of pregnant women attending Lucile Packard Children's Hospital. We conclude that the association between maternal urinary levels of bisphenol A and preterm birth should be evaluated in a larger epidemiological investigation.

  6. Maternal reports of behavior problems in preschool Hispanic children: an exploratory study in preventive pediatrics.

    PubMed Central

    Lequerica, M.; Hermosa, B.

    1995-01-01

    Maternal reports on the health, behavioral, and educational characteristics of Hispanic low-income preschoolers were gathered from a pediatric clinic to conduct appropriate consultation and teaching of behavioral issues to pediatric residents. Fifty-two Hispanic mothers attending an urban hospital clinic were given a questionnaire. Interviews provided data on family demographics, children's health status, behavior problems (65 items adapted from Achenbach's 1981 and 1987 Child Behavior Checklists [CBCL]), maternal depression, family life stressful events, and discipline methods. Thirteen externalizing and five internalizing high frequency behaviors were identified. Behavior problem scores were significantly related to the use of yelling and hitting/spanking as methods of discipline. Precarious health status and low enrollment in preschool programs also were reported. A broader preventive role for pediatricians in that pediatric setting was recommended and pursued. Results suggest a broad preventive role for pediatricians and pediatric clinics servicing low-income preschoolers. PMID:8558617

  7. Maternally Transmitted and Food-Derived Glycotoxins

    PubMed Central

    Mericq, Veronica; Piccardo, Cecilia; Cai, Weijing; Chen, Xue; Zhu, Li; Striker, Gary E.; Vlassara, Helen; Uribarri, Jaime

    2010-01-01

    OBJECTIVE Proinflammatory advanced glycation end products (AGEs) found in thermally processed foods correlate with serum AGEs (sAGEs) and promote type 1 and type 2 diabetes in mice. Herein we assess the relationship of maternal blood and food AGEs to circulating glycoxidants, inflammatory markers, and insulin levels in infants up to age 1 year. RESEARCH DESIGN AND METHODS AGEs (Nε-carboxymethyllysine [CML] and methylglyoxal derivatives) were tested in sera of healthy mothers in labor (n = 60), their infants, and infant foods. Plasma 8-isoprostane, fasting glucose, insulin, leptin, and adiponectin levels were assessed in 12-month-old infants. RESULTS Significant correlations were found between newborn and maternal serum CML (sCML) (r = 0.734, P = 0.001) serum methylglyoxal derivatives (sMGs) (r = 0.593, P = 0.001), and 8-isoprostanes (r = 0.644, P = 0.001). Infant adiponectin at 12 months negatively correlated with maternal sCML (r = −0.467, P = 0.011), whereas high maternal sMGs predicted higher infant insulin or homeostasis model assessment (P = 0.027). Infant sAGEs significantly increased with the initiation of processed infant food intake, raising daily AGE consumption by ∼7.5-fold in year 1. CONCLUSIONS Maternal blood and food-derived AGEs prematurely raise AGEs in children to adult norms, preconditioning them to abnormally high oxidant stress and inflammation and thus possibly to early onset of disease, such as diabetes. PMID:20628088

  8. Central line infections - hospitals

    MedlinePlus

    ... infection; CVC - infection; Central venous device - infection; Infection control - central line infection; Nosocomial infection - central line infection; Hospital acquired infection - central line infection; Patient safety - central ...

  9. Measuring hospital competition.

    PubMed

    White, S L; Chirikos, T N

    1988-03-01

    This paper appraises the use of the Herfindahl market share index as an exogenous competition variable in empirical studies of the hospital sector. An analysis of cross-sectional Florida data shows that this index itself is significantly influenced by the demand and supply factors commonly included in econometric models of hospital performance. The analysis then illustrates that biased inferences about the effects of market competition on the costs of hospital care may result unless the values of the Herfindahl Index are treated endogenously in hospital cost models.

  10. Costs, effects and cost-effectiveness analysis of a mobile maternal health care service in West Kiang, The Gambia.

    PubMed

    Fox-Rushby, J A; Foord, F

    1996-02-01

    The costs, effects and cost-effectiveness of a new mobile maternal care service offered in The Gambia at a government-run health centre in Karantaba were compared with the usual pattern of maternal care offered (at Ngayen Sanjal). Routinely collected data were supplemented by research on time allocation of staff by activity, use of drugs, medical consumables and vehicles, out-of-pocket payments by patients and a range of effectiveness indicators. To account for a differential effect on hospital referrals, maternity care at the main referral hospital was assessed. In 1991, the annual total cost of maternity care at Karantaba was US$64 800 compared with US$25 300 at Ngayen Sanjal. The largest proportion of this difference was attributed to training. Whilst average cost/attendance was higher at Karantaba, the marginal cost of expanding the service to other villages was lower than the marginal cost at Ngayen Sanjal. Incremental cost-effectiveness of the mobile service at Karantaba was calculated according to best and worst case scenarios which showed that the extra cost/extra death averted per year ranged between US$459 and US$2134. Using discounted life years gained reduced the figures to US$42.9 and US$206.3. Various suggestions are offered for reducing the cost of the new service, and a number of methodological points are raised for discussion.

  11. [Accidental out-of-hospital deliveries].

    PubMed

    Bouet, P-E; Chabernaud, J-L; Duc, F; Khouri, T; Leboucher, B; Riethmuller, D; Descamps, P; Sentilhes, L

    2014-03-01

    Unexpected out-of-hospital delivery accounts for 0.5% of the total number of delivery in France. The parturient is placed under constant multiparametric monitoring. Fetus heart rate is monitored thanks to fetal doppler. A high concentration mask containing a 50-to-50 percent mix of O(2) and NO performs analgesia. Assistance of mobile pediatric service can be required under certain circumstances such as premature birth, gemellary pregnancy, maternal illness or fetal heart rate impairment. Maternal efforts should start only when head reaches the pelvic floor, only if the rupture of the membranes is done and the dilation is completed. The expulsion should not exceed 30 min. Episiotomy should not be systematically performed. A systematic active management of third stage of labour is recommended. Routine care such as warming and soft drying can be performed when the following conditions are fulfilled: clear amniotic liquid, normal breathing, crying and a good tonus. Every 30 seconds assessment of heart rate, breathing quality and muscular tonus then guide the care. The redaction of birth certificate is a legal obligation and rests with the attending doctor.

  12. Maternal anxiety and infants' hippocampal development: timing matters.

    PubMed

    Qiu, A; Rifkin-Graboi, A; Chen, H; Chong, Y-S; Kwek, K; Gluckman, P D; Fortier, M V; Meaney, M J

    2013-09-24

    Exposure to maternal anxiety predicts offspring brain development. However, because children's brains are commonly assessed years after birth, the timing of such maternal influences in humans is unclear. This study aimed to examine the consequences of antenatal and postnatal exposure to maternal anxiety upon early infant development of the hippocampus, a key structure for stress regulation. A total of 175 neonates underwent magnetic resonance imaging (MRI) at birth and among them 35 had repeated scans at 6 months of age. Maternal anxiety was assessed using the State-Trait Anxiety Inventory (STAI) at week 26 of pregnancy and 3 months after delivery. Regression analyses showed that antenatal maternal anxiety did not influence bilateral hippocampal volume at birth. However, children of mothers reporting increased anxiety during pregnancy showed slower growth of both the left and right hippocampus over the first 6 months of life. This effect of antenatal maternal anxiety upon right hippocampal growth became statistically stronger when controlling for postnatal maternal anxiety. Furthermore, a strong positive association between postnatal maternal anxiety and right hippocampal growth was detected, whereas a strong negative association between postnatal maternal anxiety and the left hippocampal volume at 6 months of life was found. Hence, the postnatal growth of bilateral hippocampi shows distinct responses to postnatal maternal anxiety. The size of the left hippocampus during early development is likely to reflect the influence of the exposure to perinatal maternal anxiety, whereas right hippocampal growth is constrained by antenatal maternal anxiety, but enhanced in response to increased postnatal maternal anxiety.

  13. Maternal anxiety and infants' hippocampal development: timing matters

    PubMed Central

    Qiu, A; Rifkin-Graboi, A; Chen, H; Chong, Y-S; Kwek, K; Gluckman, P D; Fortier, M V; Meaney, M J

    2013-01-01

    Exposure to maternal anxiety predicts offspring brain development. However, because children's brains are commonly assessed years after birth, the timing of such maternal influences in humans is unclear. This study aimed to examine the consequences of antenatal and postnatal exposure to maternal anxiety upon early infant development of the hippocampus, a key structure for stress regulation. A total of 175 neonates underwent magnetic resonance imaging (MRI) at birth and among them 35 had repeated scans at 6 months of age. Maternal anxiety was assessed using the State-Trait Anxiety Inventory (STAI) at week 26 of pregnancy and 3 months after delivery. Regression analyses showed that antenatal maternal anxiety did not influence bilateral hippocampal volume at birth. However, children of mothers reporting increased anxiety during pregnancy showed slower growth of both the left and right hippocampus over the first 6 months of life. This effect of antenatal maternal anxiety upon right hippocampal growth became statistically stronger when controlling for postnatal maternal anxiety. Furthermore, a strong positive association between postnatal maternal anxiety and right hippocampal growth was detected, whereas a strong negative association between postnatal maternal anxiety and the left hippocampal volume at 6 months of life was found. Hence, the postnatal growth of bilateral hippocampi shows distinct responses to postnatal maternal anxiety. The size of the left hippocampus during early development is likely to reflect the influence of the exposure to perinatal maternal anxiety, whereas right hippocampal growth is constrained by antenatal maternal anxiety, but enhanced in response to increased postnatal maternal anxiety. PMID:24064710

  14. Birth choices in Timor-Leste: a framework for understanding the use of maternal health services in low resource settings.

    PubMed

    Wild, Kayli; Barclay, Lesley; Kelly, Paul; Martins, Nelson

    2010-12-01

    The high rate of maternal mortality in Timor-Leste is a persistent problem which has been exacerbated by the long history of military occupation and ongoing political crises since independence in 1999. It is similar to other developing countries where there have been slow declines in maternal mortality despite 20 years of Safe Motherhood interventions. The national Ministry of Health, United Nations (UN) agencies and non-government organisations (NGOs) have attempted to reduce maternal mortality by enacting policies and interventions to increase the number of births in health centres and hospitals. Despite considerable effort in promoting facility-based delivery, most Timorese women birth at home and the lack of midwives means few women have access to a skilled birth attendant. This paper investigates factors influencing access to and use of maternal health services in rural areas of Timor-Leste. It draws on 21 interviews and 11 group discussions with Timorese women and their families collected over two periods of fieldwork, one month in September 2006 and five months from July to December 2007. Theoretical concepts from anthropology and health social science are used to explore individual, social, political and health system issues which affect the way in which maternal health services are utilised. In drawing together a range of theories this paper aims to extend explanations around access to maternal health services in developing countries. An empirically informed framework is proposed which illustrates the complex factors that influence women's birth choices. This framework can be used by policy-makers, practitioners, donors and researchers to think critically about policy decisions and where investments can have the most impact for improving maternal health in Timor-Leste and elsewhere.

  15. Comparisons of polybrominated diphenyl ethers levels in paired South Korean cord blood, maternal blood, and breast milk samples.

    PubMed

    Kim, Tae Hyung; Bang, Du Yeon; Lim, Hyun Jung; Won, A Jin; Ahn, Mee Young; Patra, Nabanita; Chung, Ki Kyung; Kwack, Seung Jun; Park, Kui Lea; Han, Soon Young; Choi, Wahn Soo; Han, Jung Yeol; Lee, Byung Mu; Oh, Jeong-Eun; Yoon, Jeong-Hyun; Lee, Jaewon; Kim, Hyung Sik

    2012-03-01

    Polybrominated diphenyl ethers (PBDEs), commonly used flame retardants, have been reported as potential endocrine disruptor and neurodevelopmental toxicants, thus giving rise to the public health concern. The goal of this study was to investigate the relationship between umbilical cord blood, maternal blood, and breast milk concentrations of PBDEs in South Korean. We assessed PBDE levels in paired samples of umbilical cord blood, maternal blood, and breast milk. The levels of seven PBDE congeners were measured in 21 paired samples collected from the Cheil Woman's Hospital (Seoul, Korea) in 2008. We also measured thyroid hormones levels in maternal and cord blood to assess the association between PBDEs exposure and thyroid hormone levels. However, there was no correlation between serum thyroxin (T4) and total PBDEs concentrations. The total PBDEs concentrations in the umbilical cord blood, maternal blood, and breast milk were 10.7±5.1 ng g(-1) lipid, 7.7±4.2 ng g(-1) lipid, and 3.0±1.8 ng g(-1) lipid, respectively. The ranges of total PBDE concentrations observed were 2.28-30.94 ng g(-1) lipid in umbilical cord blood, 1.8-17.66 ng g(-1) lipid in maternal blood, and 1.08-8.66 ng g(-1) lipid in breast milk. BDE-47 (45-73% of total PBDEs) was observed to be present dominantly in all samples, followed by BDE-153. A strong correlation was found for major BDE-congeners between breast milk and cord blood or maternal blood and cord blood samples. The measurement of PBDEs concentrations in maternal blood or breast milk may help to determine the concentration of PBDEs in infant.

  16. Maternal transmission, sex ratio distortion, and mitochondria.

    PubMed

    Perlman, Steve J; Hodson, Christina N; Hamilton, Phineas T; Opit, George P; Gowen, Brent E

    2015-08-18

    In virtually all multicellular eukaryotes, mitochondria are transmitted exclusively through one parent, usually the mother. In this short review, we discuss some of the major consequences of uniparental transmission of mitochondria, including deleterious effects in males and selection for increased transmission through females. Many of these consequences, particularly sex ratio distortion, have well-studied parallels in other maternally transmitted genetic elements, such as bacterial endosymbionts of arthropods. We also discuss the consequences of linkage between mitochondria and other maternally transmitted genetic elements, including the role of cytonuclear incompatibilities in maintaining polymorphism. Finally, as a case study, we discuss a recently discovered maternally transmitted sex ratio distortion in an insect that is associated with extraordinarily divergent mitochondria.

  17. Interrupting Intergenerational Cycles of Maternal Obesity.

    PubMed

    Gillman, Matthew W

    2016-01-01

    Factors operating in the preconception and prenatal periods, such as maternal obesity, excessive gestational weight gain and gestational diabetes, predict a substantial fraction of childhood obesity as well as lifelong adverse health consequences in the mother. These periods may lend themselves to successful intervention to reduce such risk factors because parents may be especially willing to change behavior if it confers health advantages to their children. If effective interventions started before or during pregnancy can be maintained after birth, they have the potential to lower the risk of both maternal obesity in the next pregnancy and obesity in the growing child, thus helping to interrupt maternal and child intergenerational vicious cycles of obesity, diabetes and related cardiometabolic health consequences. While this paradigm is appealing, challenges include determining the magnitude, causality and modifiability of these risk factors, and quantifying any adverse consequences of intervention.

  18. Maternal Dietary Patterns and Pregnancy Outcome

    PubMed Central

    Chen, Xuyang; Zhao, Diqi; Mao, Xun; Xia, Yinyin; Baker, Philip N.; Zhang, Hua

    2016-01-01

    Maternal nutritional status during pregnancy will affect the outcomes for the mother and the baby. Many analyses of the relationship between diet and outcome are often based on a single or a few food items or nutrients. However, foods are not consumed in isolation and dietary patterns can be used to assess the whole diet consumed. The use of dietary pattern analysis to understand nutritional intake and pregnancy outcome is becoming more and more popular. Many published studies have showed the association between maternal dietary patterns and pregnancy outcome. This review examined articles about the relationship between maternal dietary patterns and pregnancy outcome. As a modifiable factor, dietary patterns may be more applicable to clinical and pregnant health interventions. PMID:27338455

  19. Maternal Education and Investments in Children's Health.

    PubMed

    Prickett, Kate C; Augustine, Jennifer M

    2016-02-01

    Maternal education differences in children's academic skills have been strongly linked to parental investment behaviors. This study extended this line of research to investigate whether these same maternal education patterns in parenting are observed among a set of parenting behaviors that are linked to young children's health. Drawing on data from the Early Childhood Longitudinal Study, Birth Cohort (n = 5,000) and longitudinal models incorporating random effects, the authors found that higher levels of maternal education were associated with more advantageous health investment behaviors at each phase of early development (9 months, 2 years, 4 years, 5 years). Moreover, these disparities were typically largest at the developmental stage when it was potentially most sensitive for children's long-term health and development. These findings provide further evidence of a developmental gradient associated with mothers' education and new insight into the salience of mothers' education for the short- and long-term health and well-being of their children.

  20. A boost for maternal health in Indonesia.

    PubMed

    Kennedy, L

    1998-01-01

    High maternal mortality has long been a major problem in Indonesia. Complications of abortion, such as hemorrhage and infection, account for 15-30% of maternal mortality in the country. The manager of AVSC's program in Indonesia expects the situation to worsen in the context of recent domestic economic and political crises. The current shortage of contraceptives will result in more unintended pregnancies and may increase the incidence of induced abortion. Because abortion is illegal in Indonesia, it is often performed under unsafe conditions, increasing the risk of complications and maternal death. To help reduce the consequences of unsafe abortion, AVSC launched a postabortion care (PAC) program in Indonesia in September 1997. Its goal is to improve the quality and availability of emergency services for managing postabortion complications, postabortion family planning counseling and services, and referrals for other reproductive health services. Implementing strategies to avoid treatment delays is part of the goal of AVSC's PAC program.

  1. Vascular effects of maternal alcohol consumption

    PubMed Central

    Magness, Ronald R.

    2012-01-01

    Maternal alcohol consumption during pregnancy is a significant field of scientific exploration primarily because of its negative effects on the developing fetus, which is specifically defined as fetal alcohol spectrum disorders. Though the effects on the mother are less explored compared with those on the fetus, alcohol produces multiple effects on the maternal vascular system. Alcohol has major effects on systemic hemodynamic variables, endocrine axes, and paracrine factors regulating vascular resistance, as well as vascular reactivity. Alcohol is also reported to have significant effects on the reproductive vasculature including alterations in blood flow, vessel remodeling, and angiogenesis. Data presented in this review will illustrate the importance of the maternal vasculature in the pathogenesis of fetal alcohol spectrum disorders and that more studies are warranted in this field. PMID:22730388

  2. Collaboration in maternity care: possibilities and challenges.

    PubMed

    Waldman, Richard; Kennedy, Holly Powell; Kendig, Susan

    2012-09-01

    The United States is about to face a maternity workforce crisis in the next decade because the number of medical students choosing obstetrics and gynecology is stagnant, the number of patients requiring care is increasing and many in the current workforce of obstetricians/gynecologists and midwives are ready to retire. There are not enough maternity providers to meet the future needs of women. Creative strategies must be explored to address these concerns. Collaborative practice among different types of maternity providers requires commitment, interpersonal skills, and teamwork. This article explores these issues and provides practical tips and a case study of the process in action between the American College of Obstetricians and Gynecologists and the American College of Nurse-Midwives.

  3. Maternal obesity, inflammation, and developmental programming.

    PubMed

    Segovia, Stephanie A; Vickers, Mark H; Gray, Clint; Reynolds, Clare M

    2014-01-01

    The prevalence of obesity, especially in women of child-bearing age, is a global health concern. In addition to increasing the immediate risk of gestational complications, there is accumulating evidence that maternal obesity also has long-term consequences for the offspring. The concept of developmental programming describes the process in which an environmental stimulus, including altered nutrition, during critical periods of development can program alterations in organogenesis, tissue development, and metabolism, predisposing offspring to obesity and metabolic and cardiovascular disorders in later life. Although the mechanisms underpinning programming of metabolic disorders remain poorly defined, it has become increasingly clear that low-grade inflammation is associated with obesity and its comorbidities. This review will discuss maternal metainflammation as a mediator of programming in insulin sensitive tissues in offspring. Use of nutritional anti-inflammatories in pregnancy including omega 3 fatty acids, resveratrol, curcumin, and taurine may provide beneficial intervention strategies to ameliorate maternal obesity-induced programming.

  4. Gestational age, sex and maternal parity correlate with bone turnover in premature infants.

    PubMed

    Aly, Hany; Moustafa, Mohamed F; Amer, Hanna A; Hassanein, Sahar; Keeves, Christine; Patel, Kantilal

    2005-05-01

    Factors affecting bone turnover in premature infants are not entirely clear but certainly are different from those influencing bones of adults and children. To identify fetal and maternal factors that might influence bone turnover, we prospectively studied 50 infants (30 preterm and 20 full-term) born at Ain Shams University Obstetric Hospital in Cairo, Egypt. Maternal parity and medical history and infant's weight, gestational age, gender and anthropometrical measurements were recorded. Cord blood samples were collected and serum type I collagen C-terminal propeptide (PICP) was assessed as a marker for fetal bone formation. First morning urine samples were collected and pyridinoline cross-links of collagen (Pyd) were measured as an index for bone resorption. Serum PICP was higher in premature infants when compared with full-term infants (73.30 +/- 15.1 versus 64.3 +/- 14.7, p = 0.022) and was higher in male premature infants when compared with females (81.64 +/- 9.06 versus 66.0 +/- 15.7, p = 0.018). In a multiple regression model using PICP as the dependent variable and controlling for different infant and maternal conditions, PICP significantly correlated with infant gender (r = 8.26 +/- 4.1, p = 0.05) maternal parity (r = -2.106 +/- 0.99, p = 0.041) and diabetes (r = 22.488 +/- 8.73, p = 0.041). Urine Pyd tended to increase in premature infants (612 +/- 308 versus 434 +/- 146, p = 0.057) and correlated significantly with gestational age (r = -63.93 +/- 19.55, p = 0.002). Therefore, bone formation (PICP) is influenced by fetal age and gender, as well as maternal parity and diabetes. Bone resorption (Pyd) is mostly dependent on gestational age only. Further in-depth studies are needed to enrich management of this vulnerable population.

  5. Maternal near miss in the intensive care unit: clinical and epidemiological aspects

    PubMed Central

    Oliveira, Leonam Costa; da Costa, Aurélio Antônio Ribeiro

    2015-01-01

    Objective To analyze the epidemiological clinical profile of women with maternal near miss according to the new World Health Organization criteria. Methods A descriptive crosssectional study was conducted, in which the records of patients admitted to the obstetric intensive care unit of a tertiary hospital in Recife (Brazil) over a period of four years were analyzed. Women who presented at least one near miss criterion were included. The variables studied were age, race/color, civil status, education, place of origin, number of pregnancies and prenatal consultations, complications and procedures performed, mode of delivery, gestational age at delivery, and maternal near miss criteria. The descriptive analysis was performed using the program Epi-Info 3.5.1. Results Two hundred fifty-five cases of maternal near miss were identified, with an overall ratio of maternal near miss of 12.8/1,000 live births. Among these cases, 43.2% of the women had incomplete primary education, 44.7% were primiparous, and 20.5% had undergone a previous cesarean section. Regarding specific diagnoses, there was a predominance of hypertensive disorders (62.7%), many of which were complicated by HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome (41.2%). The laboratory near miss criteria were the most often observed (59.6%), due mainly to the high frequency of acute thrombocytopenia (32.5%). Conclusions A high frequency of women who had a low level of education and who were primiparous was observed. According to the new criteria proposed by the World Health Organization, hypertensive pregnancy disorders are still the most common among maternal near miss cases. The high frequency of HELLP syndrome was also striking, which contributed to acute thrombocytopenia being the most frequent near miss criterion. PMID:26270856

  6. Randomized controlled trial of music during kangaroo care on maternal state anxiety and preterm infants' responses.

    PubMed

    Lai, Hui-Ling; Chen, Chia-Jung; Peng, Tai-Chu; Chang, Fwu-Mei; Hsieh, Mei-Lin; Huang, Hsiao-Yen; Chang, Shu-Chuan

    2006-02-01

    The purpose of this randomized controlled trial was to investigate the influences of music during kangaroo care (KC) on maternal anxiety and preterm infants' responses. There are no experimental studies that explore the influences of combination of music and KC on psychophysiological responses in mother-infant dyads. Purposive sampling was used to recruit 30 hospitalized preterm infants body weight 1500 gm and over, gestational age 37 weeks and lower from two NICUs. Mother-infant dyads were randomly assigned to the treatment and the control group using permuted block randomization stratified on gender. There were 15 mother-infant dyads in each group. Subjects in the treatment dyads listened to their choice of a lullaby music during KC for 60 min/section/day for three consecutive days. Control dyads received routine incubator care. Using a repeated measures design with a pretest and three posttests, the responses of treatment dyads including maternal anxiety and infants' physiologic responses (heart rate, respiratory rate, and O2 saturation) as well as behavioural state were measured. The results revealed that there were no significant differences between the two groups on infants' physiologic responses and the values were all in the normal range. However, infants in the treatment group had more occurrence of quiet sleep states and less crying (p<0.05-0.01). Music during KC also resulted in significantly lower maternal anxiety in the treatment group (p<0.01). Maternal state anxiety improved daily, indicating a cumulative dose effect. The findings provide evidence for the use of music during KC as an empirically-based intervention for bahavioural state stability and maternal anxiety in mother-infant dyads.

  7. Effective strategies for reducing maternal mortality in Isfahan University of Medical Sciences, 2014

    PubMed Central

    Nosraty, Somaye; Rahimi, Mojtaba; Kohan, Shahnaz; Beigei, Margan

    2016-01-01

    Background: Maternal mortality rate is among the most important health indicators. This indicator is a function of factors that are related to pregnant women; these factors include economic status, social and family life of the pregnant woman, human resources, structure of the hospitals and health centers, and management factors. Strategic planning, with a comprehensive analysis and coverage of all causes of maternal mortality, can be helpful in improving this indicator. Materials and Methods: This research is a descriptive exploratory study. After needs assessment and review of the current situation through eight expert panel meetings and evaluating the organization's internal and external environment, the strengths, weaknesses, threats, and opportunities of maternal mortality reduction were determined. Then, through mutual comparison of strengths/opportunities, strengths/threats, weaknesses/opportunities, and weaknesses/threats, WT, WO, ST, and SO strategies and suggested activities of the researchers for reducing maternal mortality were developed and dedicated to the areas of education, research, treatment, and health, as well as food and drug administration to be implemented. Results: In the expert panel meetings, seven opportunity and strength strategies, eight strength and threat strategies, five weakness and threat strategies, and seven weakness and opportunity strategies were determined and a strategic plan was developed. Conclusions: Dedication of the developed strategies to the areas of education, research, treatment, and health, as well as food and drug administration has coordinated these areas to develop Ministry of Health indicators. In particular, it emphasizes the key role of university management in improving the processes related to maternal health. PMID:27186210

  8. Maternal anti-HLA class I antibodies are associated with reduced birth weight in thrombocytopenic neonates.

    PubMed

    Dahl, J; Husebekk, A; Acharya, G; Flo, K; Stuge, T B; Skogen, B; Straume, B; Tiller, H

    2016-02-01

    In this comparative cross-sectional study, possible associations between maternal anti-HLA class I antibodies and birth weight in neonatal thrombocytopenia are explored. Although commonly detected in pregnancies and generally regarded as harmless, it has been suggested that such antibodies might be associated with fetal and neonatal alloimmune thrombocytopenia (FNAIT). As a link between FNAIT due to human platelet antigen 1a-specific antibodies and reduced birth weight in boys has previously been demonstrated, we wanted to explore whether maternal anti-HLA class I antibodies might also affect birth weight. To examine this, suspected cases of FNAIT referred to the Norwegian National Unit for Platelet Immunology during the period 1998-2009 were identified. Pregnancies where the only finding was maternal anti-HLA class I antibodies were included. An unselected group of pregnant women participating in a prospective study investigating maternal-fetal hemodynamics at the University Hospital North Norway during the years 2006-2010 served as controls. Twenty-nine percent of controls had anti-HLA class I antibodies. The thrombocytopenic neonates had a significantly lower adjusted birth weight (linear regression, P=0.036) and significantly higher odds of being small for gestational age (OR=6.72, P<0.001) compared with controls. Increasing anti-HLA class I antibody levels in the mother were significantly associated with lower birth weight and placental weight among thrombocytopenic neonates, but not among controls. These results indicate that maternal anti-HLA class I antibodies in thrombocytopenic neonates are associated with reduced fetal growth. Further studies are needed to test if placental function is affected.

  9. Maternal History of Parentification, Maternal Warm Responsiveness, and Children’s Externalizing Behavior

    PubMed Central

    Nuttall, Amy K.; Valentino, Kristin; Borkowski, John G.

    2012-01-01

    Destructive parentification occurs when children are expected to provide instrumental or emotional caregiving within the family system that overtaxes their developmental capacity. According to parentification theory, destructive parentification in family of origin poses a risk to child development in subsequent generations; however, there is a paucity of empirical research examining the impact of a maternal history of destructive parentification on parenting quality and child outcomes in subsequent generations. The present study examined the potential risk of maternal history of parentification on child adjustment by hypothesizing that a maternal history of parentification in family of origin would have a negative impact on quality of maternal warm responsiveness at 18 months of age which would, in turn, be associated with increased children’s externalizing symptoms at 36 months. Results indicated that there was a significant indirect effect of maternal history of destructive parentification in family of origin on child externalizing behavior in the next generation through maternal warm responsiveness, supporting the hypothesized model. This finding suggests that facilitating the development of maternal contingent responsiveness among mothers with a history of destructive parentification may promote more adaptive child development in the next generation. PMID:22888779

  10. Outbreaks of salmonella infection in hospitals in England and Wales 1978-87.

    PubMed Central

    Joseph, C. A.; Palmer, S. R.

    1989-01-01

    A total of 248 outbreaks of salmonella infection in hospital affecting over 3000 patients and 110 associated deaths were ascertained in England and Wales in 1978-87, compared with 522 outbreaks of salmonella in 1968-77. The largest reduction was found in outbreaks from children's units and maternity units. Fifty seven (24%) outbreaks were considered to be due to foodborne salmonellosis, and 70 (30%) were reported as person to person spread of the infection. The psychiatric hospital was the type of hospital in which foodborne outbreaks most often occurred, but the risk of being affected in an outbreak not due to food seemed to be highest in maternity units. Better control of infection and better surveillance should lead to earlier investigation and control of outbreaks. Images p1164-a PMID:2500174

  11. Care around birth, infant and mother health and maternal health investments - Evidence from a nurse strike.

    PubMed

    Kronborg, Hanne; Sievertsen, Hans Henrik; Wüst, Miriam

    2016-02-01

    Care around birth may impact child and mother health and parental health investments. We exploit the 2008 national strike among Danish nurses to identify the effects of care around birth on infant and mother health (proxied by health care usage) and maternal investments in the health of their newborns. We use administrative data from the population register on 39,810 Danish births in the years 2007-2010 and complementary survey and municipal administrative data on 8288 births in the years 2007-2009 in a differences-in-differences framework. We show that the strike reduced the number of mothers' prenatal midwife consultations, their length of hospital stay at birth, and the number of home visits by trained nurses after hospital discharge. We find that this reduction in care around birth increased the number of child and mother general practitioner (GP) contacts in the first month. As we do not find strong effects of strike exposure on infant and mother GP contacts in the longer run, this result suggests that parents substitute one type of care for another. While we lack power to identify the effects of care around birth on hospital readmissions and diagnoses, our results for maternal health investments indicate that strike-exposed mothers-especially those who lacked postnatal early home visits-are less likely to exclusively breastfeed their child at four months. Thus reduced care around birth may have persistent effects on treated children through its impact on parental investments.

  12. Maternal mortality in Malawi, 1977–2012

    PubMed Central

    Colbourn, Tim; Lewycka, Sonia; Nambiar, Bejoy; Anwar, Iqbal; Phoya, Ann; Mhango, Chisale

    2013-01-01

    Background Millennium Development Goal 5 (MDG 5) targets a 75% reduction in maternal mortality from 1990 to 2015, yet accurate information on trends in maternal mortality and what drives them is sparse. We aimed to fill this gap for Malawi, a country in sub-Saharan Africa with high maternal mortality. Methods We reviewed the literature for population-based studies that provide estimates of the maternal mortality ratio (MMR) in Malawi, and for studies that list and justify variables potentially associated with trends in MMR. We used all population-based estimates of MMR representative of the whole of Malawi to construct a best-fit trend-line for the range of years with available data, calculated the proportion attributable to HIV and qualitatively analysed trends and evidence related to other covariates to logically assess likely candidate drivers of the observed trend in MMR. Results 14 suitable estimates of MMR were found, covering the years 1977–2010. The resulting best-fit line predicted MMR in Malawi to have increased from 317 maternal deaths/100 000 live-births in 1980 to 748 in 1990, before peaking at 971 in 1999, and falling to 846 in 2005 and 484 in 2010. Concurrent deteriorations and improvements in HIV and health system investment and provisions are the most plausible explanations for the trend. Female literacy and education, family planning and poverty reduction could play more of a role if thresholds are passed in the coming years. Conclusions The decrease in MMR in Malawi is encouraging as it appears that recent efforts to control HIV and improve the health system are bearing fruit. Sustained efforts to prevent and treat maternal complications are required if Malawi is to attain the MDG 5 target and save the lives of more of its mothers in years to come. PMID:24353257

  13. Cues of Maternal Condition Influence Offspring Selfishness

    PubMed Central

    Wong, Janine W. Y.; Lucas, Christophe; Kölliker, Mathias

    2014-01-01

    The evolution of parent-offspring communication was mostly studied from the perspective of parents responding to begging signals conveying information about offspring condition. Parents should respond to begging because of the differential fitness returns obtained from their investment in offspring that differ in condition. For analogous reasons, offspring should adjust their behavior to cues/signals of parental condition: parents that differ in condition pay differential costs of care and, hence, should provide different amounts of food. In this study, we experimentally tested in the European earwig (Forficula auricularia) if cues of maternal condition affect offspring behavior in terms of sibling cannibalism. We experimentally manipulated female condition by providing them with different amounts of food, kept nymph condition constant, allowed for nymph exposure to chemical maternal cues over extended time, quantified nymph survival (deaths being due to cannibalism) and extracted and analyzed the females’ cuticular hydrocarbons (CHC). Nymph survival was significantly affected by chemical cues of maternal condition, and this effect depended on the timing of breeding. Cues of poor maternal condition enhanced nymph survival in early broods, but reduced nymph survival in late broods, and vice versa for cues of good condition. Furthermore, female condition affected the quantitative composition of their CHC profile which in turn predicted nymph survival patterns. Thus, earwig offspring are sensitive to chemical cues of maternal condition and nymphs from early and late broods show opposite reactions to the same chemical cues. Together with former evidence on maternal sensitivities to condition-dependent nymph chemical cues, our study shows context-dependent reciprocal information exchange about condition between earwig mothers and their offspring, potentially mediated by cuticular hydrocarbons. PMID:24498046

  14. Relationship between maternal dietary patterns and hypospadias.

    PubMed

    de Kort, Christianne A R; Nieuwenhuijsen, Mark J; Mendez, Michelle A

    2011-05-01

    Little is known about the role of maternal nutrition in the development of hypospadias, which is the most common urogenital congenital anomaly. This study investigated the relationship between maternal nutrition and the risk of hypospadias, particularly focusing on maternal food patterns. We compared 471 hypospadias cases with 490 controls in the United Kingdom. A questionnaire including information on life style, occupation, usual maternal diet and dietary supplements was administered using telephone interviews. Cases and controls were compared for individual food item intake and food patterns derived by cluster analysis. Multivariable logistic regression analysis adjusted for income, maternal age, low birthweight, smoking and folic acid supplement use was used to assess the relationship between maternal nutrition and hypospadias. Three food patterns were created with the labels 'health conscious', 'mixed' and 'non-health conscious'. 'Non-health conscious' subjects (low frequency of consumption of yoghurt, cheese, eggs, fruit and vegetables, fish, beans and pulses, olive oil and organic food) had a higher risk of hypospadias (odds ratio 1.54; 95% confidence interval 1.06, 2.26) compared with 'health conscious' subjects (high frequency of consumption of fresh fruit and vegetables, dried fruit, fresh or frozen fish, beans, pulses, soya products, olive oil and organic food), after adjustment for potential confounders. Intakes of individual foods were not strongly associated with hypospadias. We could not exclude the possibility of residual confounding, and this needs to be further investigated. We found an association between food pattern and hypospadias, with those with less health conscious food patterns having a higher risk. Further study is needed to confirm this association.

  15. Maternal glucocorticoids and prenatal programming of hypertension.

    PubMed

    Woods, Lori L

    2006-10-01

    Maternal glucocorticoids have been postulated to play an important role in prenatal programming for adult hypertension in the offspring. However, we have shown previously that offspring hypertension caused by maternal dexamethasone subcutaneous administration at 100 microg x kg(-1) x day(-1) can be accounted for by the corresponding reduction in food intake that these mothers experience. The present studies were designed to determine whether there is a lower dose of dexamethasone that does not reduce maternal food intake yet still causes hypertension in the adult offspring. Pregnant rats were treated with subcutaneous dexamethasone at 50 (D50) or 25 (D25) microg x kg(-1) x day(-1) on days 15-20 of pregnancy. An additional group was untreated or received vehicle injections (control). D25 and D50 dams reduced their food intake by 17% during and after treatment and gained 31% less weight than control over the course of gestation. In adulthood ( approximately 21 wk), chronically instrumented male offspring of D50 and D25 had normal blood pressures (D50: 131 +/- 2 mmHg and D25: 127 +/- 3 mmHg vs. 127 +/- 2 mmHg in control). Qualitatively similar results were found in female offspring. Thus neither dexamethasone per se at these doses nor the accompanying modest reductions in maternal food intake and weight gain have blood pressure programming effects. As far as has been tested, there does not appear to be a dose of dexamethasone that, given over this time period in the rat, programs offspring hypertension without reducing maternal food intake and weight gain. These data do not support the hypothesis that maternal glucocorticoids program offspring hypertension directly.

  16. Are species differences in maternal effects arising from maternal care adaptive?

    PubMed

    Benowitz, K M; Moody, K J; Moore, A J

    2015-02-01

    Parental care benefits offspring through maternal effects influencing their development, growth and survival. However, although parental care in general is likely the result of adaptive evolution, it does not follow that specific differences in the maternal effects that arise from care are also adaptive. Here, we used an interspecific cross-fostering design in the burying beetle species Nicrophorus orbicollis and N. vespilloides, both of which have elaborate parental care involving direct feeding of regurgitated food to offspring, to test whether maternal effects are optimized within a species and therefore adaptive. Using a full-factorial design, we first demonstrated that N. orbicollis care for offspring longer regardless of recipient species. We then examined offspring development and mass in offspring reared by hetero- or conspecific parents. As expected, there were species-specific direct effects independent of the maternal effects, as N. orbicollis larvae were larger and took longer to develop than N. vespilloides regardless of caregiver. We also found significant differences in maternal effects: N. vespilloides maternal care caused more rapid development of offspring of either species. Contrary to expectations if maternal effects were species-specific, there were no significant interactions between caretaker and recipient species for either development time or mass, suggesting that these maternal effects are general rather than optimized within species. We suggest that rather than coadaptation between parents and offspring performance, the species differences in maternal effects may be correlated with direct effects, and that their evolution is driven by selection on those direct effects.

  17. Organochlorine pesticide gradient levels among maternal adipose tissue, maternal blood serum and umbilical blood serum.

    PubMed

    Herrero-Mercado, Margarita; Waliszewski, S M; Caba, M; Martínez-Valenzuela, C; Gómez Arroyo, S; Villalobos Pietrini, R; Cantú Martínez, P C; Hernández-Chalate, F

    2011-03-01

    The objective of the present study was to determine levels and calculate ratios of copartition coefficients among organochlorine pesticides β-HCH, pp'DDE, op'DDT and pp'DDT in maternal adipose tissue, maternal blood serum and umbilical blood serum of mother-infant pairs from Veracruz, Mexico. Organochlorine pesticides were analyzed in 70 binomials: maternal adipose tissue, maternal serum and umbilical cord serum samples, using gas chromatography with electron capture detection (GC-ECD). The results were expressed as mg/kg on fat basis. p,p'-DDE was the major organochlorine component, detected in every maternal adipose tissue (0.770 mg/kg), maternal serum sample (5.8 mg/kg on fat basis) and umbilical cord blood sample (6.9 mg/kg on fat basis). p,p'-DDT was detected at 0.101 mg/kg, 2.2 mg/kg and 5.9 mg/kg respectively, according to the order given above. β-HCH was detected at 0.027 mg/kg, 4.2 mg/kg and 28.0 mg/kg respectively. op'DDT was detected only in maternal adipose tissue at 0.011 mg/kg. The copartition coefficients among samples identify significant increases in concentrations from adipose tissue to maternal blood serum and to umbilical blood serum. The increase indicated that maternal adipose tissue released organochlorine pesticides to blood serum and that they are carried over to umbilical cord blood.

  18. Fetal, Infant and Maternal Outcomes among Women with Prolapsed Membranes Admitted before 29 Weeks Gestation

    PubMed Central

    Robertson, Julie E.; Lisonkova, Sarka; Lee, Tang; De Silva, Dane A.; von Dadelszen, Peter; Synnes, Anne R.; Joseph, K. S.; Liston, Robert M.; Magee, Laura A.

    2016-01-01

    Background Few studies have examined fetal, infant and maternal mortality and morbidity among pregnant women at very early gestation with an open cervix and prolapsed membranes. We carried out a study describing the outcomes of women hospitalized with prolapsed membranes at 22–28 weeks’ gestation. Methods We prospectively recruited women with singleton pregnancies admitted at 22–28 weeks’ gestation to tertiary hospitals of the Canadian Perinatal Network between 2005 and 2009. Time-to-delivery, perinatal death, neonatal intensive care unit (NICU) admission, severe neonatal morbidity and severe maternal morbidity were compared between women admitted at 22–25 vs. 26–28 weeks gestation. Logistic regression was used to estimate adjusted odds ratios (AOR) and 95% confidence intervals. Results 129 women at 22–25 weeks gestation and 65 women at 26–28 weeks gestation were admitted to hospital and the median time-to-delivery was 4 days in both groups. Stillbirth rates were 12.4% vs 4.6% among women admitted at earlier vs later gestation (AOR 2.8, 95% CI 0.5–14.8), while perinatal death rates were 38.0% vs 6.1% (AOR 14.1, 95% CI 3.5–59.0), respectively. There were no significant differences in NICU admission and severe morbidity among live-born infants; 89.4% and 82.3% died or were admitted to NICU, (P value 0.18), and 53.9% vs 44.0% of NICU infants had severe neonatal morbidity (P value 0.28). Antibiotics, tocolysis and cerclage did not have a significant effect on perinatal death. Maternal death or severe maternal morbidity occurred in 8.5% and 6.2% of women admitted at 22–25 vs 26–28 weeks (AOR 1.2, 95% CI 0.4–4.2). Conclusion Perinatal mortality among women with prolapsed membranes at very early gestation is high, although significantly lower among those admitted at a relatively later gestational age. Rates of adverse maternal outcomes are also high. This information can be used to counsel women with prolapsed membranes at 22 to 28 weeks

  19. Hospitality Occupations. Curriculum Guide.

    ERIC Educational Resources Information Center

    California State Dept. of Education, Sacramento. Bureau of Homemaking Education.

    This curriculum guide on the hospitality occupations was developed to help secondary and postsecondary home economics teachers prepare individuals for entry-level jobs in the hospitality industry. The content is in seven sections. The first section presents organizational charts of a medium-size hotel, food and beverage division, housekeeping and…

  20. Hospitality, Tourism, and Recreation.

    ERIC Educational Resources Information Center

    Novachek, James

    The Northern Arizona Hospitality Education Program is an exemplary three-year project designed to help students, mainly Indian, obtain job skills and attitudes necessary for successful employment in the hospitality industry. Nine high schools from Apache, Coconino, and Navajo Counties participated in the project. Objectives included providing an…

  1. Handbook on Hospital Television.

    ERIC Educational Resources Information Center

    Prynne, T. A.

    Designed for both hospital personnel interested in television and audiovisual personnel entering the medical field, this handbook is a verbal and pictorial survey of what is being done with TV within the medical profession. After an introduction which answers technical questions about medical TV posed during the American Hospital Association's…

  2. Hospitality Services. Curriculum Guide.

    ERIC Educational Resources Information Center

    Texas Tech Univ., Lubbock. Home Economics Curriculum Center.

    This guide, which was developed as part of Texas' home economics education program, is intended to assist teachers of a hospitality services course focusing on the food and lodging segments of the hospitality and tourism industry. The first 40% of the approximately 600-page guide consists of strategies for teaching each of 29 essential…

  3. Hospitality Services Reference Book.

    ERIC Educational Resources Information Center

    Texas Tech Univ., Lubbock. Home Economics Curriculum Center.

    This reference book provides information needed by employees in hospitality services occupations. It includes 29 chapters that cover the following topics: the hospitality services industry; professional ethics; organization and management structures; safety practices and emergency procedures; technology; property maintenance and repair; purchasing…

  4. Virtual Pediatric Hospital

    MedlinePlus

    ... Thoracopaedia - An Imaging Encyclopedia of Pediatric Thoracic Disease Virtual Pediatric Hospital is the Apprentice's Assistant™ Last revised ... pediatric resources: GeneralPediatrics.com | PediatricEducation.org | SearchingPediatrics.com Virtual Pediatric Hospital is curated by Donna M. D' ...

  5. Hospital benefit segmentation.

    PubMed

    Finn, D W; Lamb, C W

    1986-12-01

    Market segmentation is an important topic to both health care practitioners and researchers. The authors explore the relative importance that health care consumers attach to various benefits available in a major metropolitan area hospital. The purposes of the study are to test, and provide data to illustrate, the efficacy of one approach to hospital benefit segmentation analysis.

  6. Leading a hospital closure.

    PubMed

    Lucey, Paula A

    2002-01-01

    Hospital closures have become more common. The challenges facing a nursing leader in this situation are complex and difficult. This author suggests that looking for new beginnings rather than focusing on endings created an approach to closing a public hospital. The article includes approaches to employee morale, staffing, and patient care.

  7. Maternal physiology and complications of multiple pregnancy.

    PubMed

    Norwitz, Errol R; Edusa, Valentine; Park, Joong Shin

    2005-10-01

    Approximately 1% to 3% of all pregnancies in the United States are multiple gestations. The vast majority (97-98%) are twin pregnancies. Multiple pregnancies constitute significant risk to both mother and fetuses. Antepartum complications-including preterm labor, preterm premature rupture of the membranes, intrauterine growth restriction, intrauterine fetal demise, gestational diabetes, and preeclampsia-develop in over 80% of multiple pregnancies as compared with approximately 25% of singleton gestations. This article reviews in detail the maternal physiologic adaptations required to support a multiple pregnancy and the maternal complications that develop when these systems fail or are overwhelmed.

  8. Neonatal thyrotoxicosis caused by maternal autoimmune hyperthyroidism

    PubMed Central

    Correia, Miguel Fragata; Maria, Ana Teresa; Prado, Sara; Limbert, Catarina

    2015-01-01

    Neonatal immune hyperthyroidism is a rare but potentially fatal condition. It occurs in 1–5% of infants born to women with Graves’ disease (GD). In most of the cases it is due to maternal antibodies transferred from the mother into the fetal compartment, stimulating the fetal thyroid by binding thyrotropin (thyroid-stimulating hormone, TSH) receptor. We present a case of neonatal thyrotoxicosis due to maternal GD detected at 25 days of age and discuss the potential pitfalls in the diagnosis. PMID:25750228

  9. Putting the "M" back in maternal-fetal medicine.

    PubMed

    D'Alton, Mary E; Bonanno, Clarissa A; Berkowitz, Richard L; Brown, Haywood L; Copel, Joshua A; Cunningham, F Gary; Garite, Thomas J; Gilstrap, Larry C; Grobman, William A; Hankins, Gary D V; Hauth, John C; Iriye, Brian K; Macones, George A; Martin, James N; Martin, Stephanie R; Menard, M Kathryn; O'Keefe, Daniel F; Pacheco, Luis D; Riley, Laura E; Saade, George R; Spong, Catherine Y

    2013-06-01

    Although maternal death remains rare in the United States, the rate has not decreased for 3 decades. The rate of severe maternal morbidity, a more prevalent problem, is also rising. Rise in maternal age, in rates of obesity, and in cesarean deliveries as well as more pregnant women with chronic medical conditions all contribute to maternal mortality and morbidity in the United States. We believe it is the responsibility of maternal-fetal medicine (MFM) subspecialists to lead a national effort to decrease maternal mortality and morbidity. In doing so, we hope to reestablish the vital role of MFM subspecialists to take the lead in the performance and coordination of care in complicated obstetrical cases. This article will summarize our initial recommendations to enhance MFM education and training, to establish national standards to improve maternal care and management, and to address critical research gaps in maternal medicine.

  10. The Physiological and Evolutionary Background of Maternal Responsiveness.

    ERIC Educational Resources Information Center

    Rosenblatt, Jay S.

    1989-01-01

    Examines the influence of hormonal factors during pregnancy on maternal responsiveness in infrahuman animals and human beings. Argues that it is likely that maternal behavior in humans has a physiological basis. (PCB)

  11. Competition among hospitals.

    PubMed

    Gaynor, Martin; Vogt, William B

    2003-01-01

    We examine competition in the hospital industry, in particular the effect of ownership type (for-profit, not-for-profit, government). We estimate a structural model of demand and pricing in the hospital industry in California, then use the estimates to simulate the effect of a merger. California hospitals in 1995 face an average price elasticity of demand of -4.85. Not-for-profit hospitals face less elastic demand and act as if they have lower marginal costs. Their prices are lower than those of for-profits, but markups are higher. We simulate the effects of the 1997 merger of two hospital chains. In San Luis Obispo County, where the merger creates a near monopoly, prices rise by up to 53%, and the predicted price increase would not be substantially smaller were the chains not-for-profit.

  12. [Use of maternal health services in rural Mexico].

    PubMed

    Potter, J E

    1988-01-01

    availability of different types of health services in the community was not a significant predictor of utilization of prenatal services, but existence of a good road was associated with a 30% increase in probability of using medical services and presence in the community of persons speaking only an indigenous language was associated with a 57% decline in probability. Use of prenatal services and hospital delivery were also associated with maternal educational level and housing characteristics. The results appear to indicate the isolation, poverty, and lack of familiarity with western culture constitute important barriers to use of modern maternal health services. The analysis suggests that the policy of providing medical facilities at the community level has had little effect on the extremely disparate use of prenatal care and hospital delivery in rural Mexico.

  13. Maternal hair--an appropriate matrix for detecting maternal exposure to pesticides during pregnancy.

    PubMed

    Ostrea, Enrique M; Villanueva-Uy, Esterlita; Bielawski, Dawn M; Posecion, Norberto C; Corrion, Melissa L; Jin, Yan; Janisse, James J; Ager, Joel W

    2006-07-01

    The detection of exposure of pregnant women to toxicants in the environment is important because these compounds can be harmful to the health of the woman and her fetus. The aim of this study was to analyze for pesticides/herbicides in paired maternal hair and blood samples to determine the most appropriate matrix for detecting maternal exposure to these compounds. A total of 449 pregnant women were prospectively recruited at midgestation from an agricultural site in the Philippines where a preliminary survey indicated significant use at home and on the farm of the following compounds: propoxur, cyfluthrin, chlorpyrifos, cypermethrin, pretilachlor, bioallethrin, malathion, diazinon, and transfluthrin. Paired maternal hair and blood samples were obtained from each subject upon recruitment into the study (midgestation) and at birth and were analyzed for the above compounds, as well as lindane and DDT [1,1,1-trichloro-2-2-bis(p-chlorophenyl) ethane], and some of their known metabolites by gas chromatography/mass spectrometry. The highest exposure rate was seen for propoxur and bioallethrin and maternal hair analysis provided the highest detection rate for these two compounds, compared to blood, at both time periods: (1) At midgestation, 10.5% positive for propoxur in hair compared to 0.7% in blood (P<0.001) and for bioallethrin, 11.9% positive in hair compared to 0% in blood (P < or = 0.001), and (2) at birth, 11.8% positive for propoxur in hair compared to 4% in blood (P < or = 0.001) and for bioallethrin, 7.8% in hair compared to 0% in blood (P < or = 0.001). A small number of maternal hair samples were also positive for malathion, chlorpyrifos, pretilachlor, and DDT. Only a few of the pesticide metabolites were detected, principally 3-phenoxybenzoic acid, malathion monocarboxylic acid, and DDE [1,1,dichloro-2-2-bis(p-chlorophenyl)ethylene], and they were mostly found in maternal blood. There was a significant association between the use of the home spray pesticide

  14. [Postpartum contraceptive practice in hospitals of the Federal District].

    PubMed

    Morán, C; Fuentes, G; Amado, F; Higareda, H; Bailón, R; Zárate, A

    1992-01-01

    For many women living in developing areas, childbirth is the only time when they receive medical care in a clinical setting. These women may not return until they are ready to deliver their next baby. Without access to family planning counseling and effective contraceptive methods, they are likely to become pregnant again within a year or two. Where contraceptive information and services are available to women receiving maternity care, many choose to begin using contraception in the postpartum period. Some elect to have an IUD inserted immediately after delivery or to undergo sterilization while still in the hospital. Under a postpartum contraceptive program administered by the IMSS in one hospital and the same program established in another hospital of the SSA, more than half of postpartum and postabortion women began using contraception or underwent sterilization before they left the hospital. In contrast, the other hospitals under the analysis showed a wide range of contraception coverage from 7 to 55 percent. A formal postpartum contraception program is necessary to establish in all the hospitals in order to improve coverage. Counseling is an important component for all women who must have adequate information before they choose a contraceptive method.

  15. Maternity patients' access to their electronic medical records: use and perspectives of a patient portal.

    PubMed

    Megan Forster, Megan; Dennison, Kerrie; Callen, Joanne; Andrew, Andrew; Westbrook, Johanna I

    2015-01-01

    Patients have been able to access clinical information from their paper-based health records for a number of years. With the advent of Electronic Medical Records (EMRs) access to this information can now be achieved online using a secure electronic patient portal. The purpose of this study was to investigate maternity patients' use and perceptions of a patient portal developed at the Mater Mothers' Hospital in Brisbane, Australia. A web-based patient portal, one of the first developed and deployed in Australia, was introduced on 26 June 2012. The portal was designed for maternity patients booked at Mater Mothers' Hospital, as an alternative to the paper-based Pregnancy Health Record. Through the portal, maternity patients are able to complete their hospital registration form online and obtain current health information about their pregnancy (via their EMR), as well as access a variety of support tools to use during their pregnancy such as tailored public health advice. A retrospective cross-sectional study design was employed. Usage statistics were extracted from the system for a one year period (1 July 2012 to 30 June 2013). Patients' perceptions of the portal were obtained using an online survey, accessible by maternity patients for two weeks in February 2013 (n=80). Descriptive statistics were employed to analyse the data. Between July 2012 and June 2013, 10,892 maternity patients were offered a patient portal account and access to their EMR. Of those 6,518 created one (60%; 6,518/10,892) and 3,104 went on to request access to their EMR (48%; 3,104/6,518). Of these, 1,751 had their access application granted by 30 June 2013. The majority of maternity patients submitted registration forms online via the patient portal (56.7%). Patients could view their EMR multiple times: there were 671 views of the EMR, 2,781 views of appointment schedules and 135 birth preferences submitted via the EMR. Eighty survey responses were received from EMR account holders, (response

  16. Improving Maternal and Child Health: A Legislator's Guide.

    ERIC Educational Resources Information Center

    Bruner, Charles

    This legislators' guide outlines state maternal health programs and strategies and offers states options for improving their maternal and child health services. The introductory chapter 1 is followed by an overview of maternal and child health status in the United States in chapter 2. Costs associated with the failure to provide adequate prenatal…

  17. Maternal oxytocin response predicts mother-to-infant gaze

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The neuropeptide oxytocin is importantly implicated in the emergence and maintenance of maternal behavior that forms the basis of the mother–infant bond. However, no research has yet examined the specific association between maternal oxytocin and maternal gaze, a key modality through which the mothe...

  18. Physiological Reactivity to Infant Crying and Observed Maternal Sensitivity

    ERIC Educational Resources Information Center

    Joosen, Katharina J.; Mesman, Judi; Bakermans-Kranenburg, Marian J.; Pieper, Suzanne; Zeskind, Philip S.; van IJzendoorn, Marinus H.

    2013-01-01

    Relations between maternal sensitivity and physiological reactivity to infant crying were examined using measures of heart rate (HR) and respiratory sinus arrhythmia (RSA) in 49 mothers of second-born infants. Using the Ainsworth Sensitivity Scale, an independent assessment of maternal sensitivity was made during maternal free play and bathing of…

  19. How Does Maternal Employment Affect Children's Socioemotional Functioning?

    ERIC Educational Resources Information Center

    Lam, Gigi

    2015-01-01

    The maternal employment becomes an irreversible trend across the globe. The effect of maternal employment on children's socioemotional functioning is so pervasive that it warrants special attention to investigate into the issue. A trajectory of analytical framework of how maternal employment affects children's socioemotional functioning originates…

  20. Mediating Links between Maternal Childhood Trauma and Preadolescent Behavioral Adjustment

    ERIC Educational Resources Information Center

    Min, Meeyoung O.; Singer, Lynn T.; Minnes, Sonia; Kim, Hyunsoo; Short, Elizabeth

    2013-01-01

    Structural equation modeling was used to simultaneously examine maternal psychological distress and social support as mediators linking maternal childhood trauma (MCT) to both maternal and child-reported behavior at 9 years of age in 231 birth mother-child dyads, who were primarily poor, urban, and African American. One half of the mothers…

  1. Maternal Smoking in Pregnancy, Child Behavior Problems, and Adolescent Smoking.

    ERIC Educational Resources Information Center

    Griesler, Pamela C.; Kandel, Denise B.; Davies, Mark

    1998-01-01

    Used longitudinal sample of 187 mother-child dyads to examine the role of child behavior problems in explaining the effect of maternal prenatal smoking on adolescent daughters' smoking. Found that maternal prenatal smoking retained a unique effect on girls' current smoking with controls for current maternal smoking, child behavior problems, and…

  2. Mentors Offering Maternal Support (M.O.M.S.)

    DTIC Science & Technology

    2011-08-02

    prenatal visit and of the length of gestation (Lederman, Weis, Camune, & Mian, 2002). Both maternal and paternal happiness about pregnancy also are...relationship satisfaction, communication, and interpersonal processes) are more likely to remain involved in co- parenting (versus paternal disengagement... adolescents . The theoretical framework for the project was based on maternal role theory. Importantly, the conceptual definition for maternal role

  3. Brief and long periods of maternal separation affect maternal behavior and offspring behavioral development in C57BL/6 mice.

    PubMed

    Bailoo, Jeremy D; Jordan, Richard L; Garza, Xavier J; Tyler, Amber N

    2014-05-01

    For rats, maternal mediation of brief and longer term dam-pup separations were thought to account for pup differences in adult "emotionality." In this study, early handling (EH), maternal separation (MS), and maternal peer separation (MPS) groups were compared to an animal facility reared (AFR) group for maternal behavior and offspring adult open-field behavior in C57BL/6 mice. Although MS and MPS dams displayed higher levels of maternal behavior upon reunion, these group differences did not predict offspring open-field behavior. However, when offspring behavior was analyzed as a function of specific aspects of maternal behavior, irrespective of treatment group, pups that received high levels of quiescent nursing and activity, but not licking, were less "emotional." Individual differences in maternal licking of pups predicted variability of "emotional" behavior for AFR and EH pups. Thus, for this strain of mouse, individual and not treatment differences in maternal care predict offspring "emotional" development.

  4. Costs of vaginal delivery and Caesarean section at a tertiary level public hospital in Islamabad, Pakistan

    PubMed Central

    2010-01-01

    Background Public hospitals in developing countries, rather than the preventive and primary healthcare sectors, are the major consumers of healthcare resources. Imbalances in rational, equitable and efficient allocation of scarce resources lie in the scarcity of research & information on economic aspects of health care. The objective of this study was to determine the average cost of a spontaneous vaginal delivery and Caesarean section in a tertiary level government hospital in Islamabad, Pakistan and to estimate the out of pocket expenditures to households using these services. Methods This hospital based cost accounting cross sectional study determines the average cost of vaginal delivery and Caesarean section from two perspectives, the patient's and the hospital. From the patient's perspective direct and indirect expenditures of 133 post-partum mothers (65 delivered by Caesarean section & 68 by spontaneous vaginal delivery) admitted in the maternity general ward were determined. From the hospital perspective the step down methodology was adopted, capital and recurrent costs were determined from inputs and cost centers. Results The average cost for a spontaneous vaginal delivery from the hospital's side was 40 US$ (2688 rupees) and from the patient's perspective was 79 US$ (5278 rupees). The average cost for a Caesarean section from the hospital side was 162 US$ (10868 rupees) and 204 US$ (13678 rupees) from the patient's side. Average monthly household income was 141 ± 87 US$ for spontaneous vaginal delivery and 168 ± 97 US$ for Caesarean section. Three fourth (74%) of households had a monthly income of less than 149 US$ (10000 rupees). Conclusion The apparently "free" maternity care at government hospitals involves substantial hidden and unpredicted costs. The anticipated fear of these unpredicted costs may be major factor for many poor households to seek cheaper alternate maternity healthcare. PMID:20085662

  5. Maternal smoking, social class and outcomes of pregnancy.

    PubMed

    Villalbí, Joan R; Salvador, Joaquin; Cano-Serral, Gemma; Rodríguez-Sanz, Maica C; Borrell, Carme

    2007-09-01

    Exposure to tobacco during pregnancy is an important risk factor for infant health. Recently the prevalence of smoking during pregnancy has declined in our area. The objective of this study was to analyse the association between several social variables and the fetal exposure to smoking, as well as the association between maternal smoking and some adverse gestational outcomes. Data collection was cross-sectional. The study population were women in the city of Barcelona (Catalonia, Spain) delivering a child without birth defects. The sample corresponded to the controls of the Birth Defects Registry of Barcelona, 2% of all pregnancy deliveries in the city from 1994 to 2003 (n = 2297). Information sources were hospital records and a personal interview of mothers. The analysis measured first the association between independent variables (instruction level, social class, occupation, nationality, planned pregnancy, parity, hospital funding and smoking status of the mother's partner) with two dependent variables: smoking at the initiation of pregnancy and quitting during pregnancy. Second, the persistence of smoking over pregnancy and all independent variables were studied with three variables indicating adverse outcomes of pregnancy: low gestation, low birthweight and intrauterine growth restriction (IUGR). Finally, the joint association between the persistence of smoking over pregnancy and social class taken as independent variables was determined with the three variables indicating adverse outcomes of pregnancy. Logistic regression models were fitted, adjusting for maternal age. Results are presented as odds ratios with their 95% confidence intervals. The prevalence of smoking at the onset of gestation was 41%, and 40% of these women quit during pregnancy, so that 25% delivered as active smokers. Fewer women with higher educational levels and from families with non-manual jobs smoked, as did immigrants, those planning pregnancy and women whose partner did not smoke

  6. Screening, testing, and reporting for drug and alcohol use on labor and delivery: a survey of Maryland birthing hospitals.

    PubMed

    Miller, Catherine; Lanham, Amy; Welsh, Christopher; Ramanadhan, Shaalini; Terplan, Mishka

    2014-01-01

    Recent amendments to the Child Abuse Prevention and Treatment Act tie the receipt of federal block grants to mandatory reporting of substance-exposed newborns. To determine rates of screening, testing, and reporting of drug and alcohol use at the time of delivery, we administered a telephone survey of nursing managers and perinatal social workers at Maryland birthing hospitals. Of the 34 hospitals, 31 responded (response rate 91%). Although 97% of hospitals reported universal screening, only 6% used a validated instrument. Testing was reported by 94% with 45% reporting universal maternal testing and 7% universal newborn testing. Only 32% reported obtaining maternal consent prior to testing. There is significant heterogeneity in screening and testing for substance use in birthing hospitals. Given federal reporting mandates, state-level practices need to be standardized.

  7. The mediated effects of maternal depression and infant temperament on maternal role.

    PubMed

    Rode, Jennifer L; Kiel, Elizabeth J

    2016-02-01

    We examined prenatal depression, postpartum depression, and infant temperament, respectively, in a mediated process model to predict maternal role. Using a prospective, observational design, we surveyed 168 women during pregnancy and then in postpartum. Data analyses supported the contribution of each variable in an ascending fashion (ab = -0.01, SE = 0.004, 95 % CI [-0.021, -0.004]), such that infant temperament had the strongest effects (sr(2) = .124, p < .001). Further, postpartum depression was found to influence maternal role with both direct effects and indirect effects via infant temperament. These results highlighted the significant impact postpartum depression may have on maternal role. Future interventions targeting mothers experiencing or who are at risk for depression may consider tools to improve mother-baby interactions. The effects of such intervention may subsequently improve both infant temperament and maternal role evaluation.

  8. How did Nepal reduce the maternal mortality? A result from analysing the determinants of maternal mortality.

    PubMed

    Karkee, R

    2012-01-01

    Nepal reportedly reduced the maternal mortality ratio by 48% within one decade between 1996-2005 and received the Millennium development goal award for this. However, there is debate regarding the accuracy of this figure. On the basis of framework of determinants of maternal mortality proposed by McCarthy and Maine in 1992 and successive data from Nepal demographic health survey of 1996, 2001 and 2006, a literature analysis was done to identify the important factors behind this decline. Although facility delivery and skilled birth attendants are acclaimed as best strategy of reducing maternal mortality, a proportionate increase in these factors was not found to account the maternal mortality rate reduction in Nepal. Alternatively, intermediate factors particularly women awareness, family planning and safe abortion might have played a significant role. Hence, Nepal as well as similar other developing countries should pay equal attention to such intermediate factors while concentrating on biomedical care strategy.

  9. Effect of maternal fasting on ovine fetal and maternal branched-chain amino acid transaminase activities.

    PubMed

    Liechty, E A; Barone, S; Nutt, M

    1987-01-01

    Activities of branched-chain amino acid transaminase were assayed in maternal skeletal muscle, liver and fetal skeletal muscle, cardiac muscle, liver, kidney and placenta obtained from fed and 5-day-fasted late gestation ewes. Very high activities were found in placenta; fetal skeletal muscle also had high activity. Fetal brain had intermediate activity, followed by cardiac muscle and kidney. Fetal liver possessed negligible activity. Activities were low in both maternal liver and skeletal muscle. Trends were seen for fasting to increase activities in fetal placenta, skeletal muscle, brain, kidney, heart and maternal liver, but these changes were statistically significant only for fetal brain and placental tissue. Fetal skeletal muscle activity was 100 times that of maternal skeletal muscle. These data imply differences in the metabolism of the branched-chain amino acids by fetal and adult ruminants and expand the thesis that branched-chain amino acids are important to the metabolism of the ovine fetus.

  10. The Maternal Description of Child (MDoC): A New Audiotaped Measure of Maternal Affect

    PubMed Central

    Martin, Anne; Razza, Rachel A.; Brooks-Gunn, Jeanne

    2015-01-01

    We report on a new measure of maternal affect from an ongoing multi-site birth cohort study with primarily low-income families, the Fragile Families and Child Wellbeing Study. At child age of 5 years, mothers were asked to describe their child in a short, semi-structured home interview. One innovation of this measure – called the Maternal Description of Child (MDoC) – is that it captured maternal affect via audiotape rather than videotape. Based on mothers’ talk about their child, coders scored mothers on Positive Affect, Negative Affect, and Detachment. Evidence is presented to support the convergent and predictive validity of these scales. Given that objective measures of parenting are generally preferable to self-reported measures, further research should determine whether the MDoC can be successfully administered by phone. If it can, the MDoC would allow large-scale phone surveys to measure maternal affect for the first time. PMID:27042164

  11. Hospitals' Internal Accountability

    PubMed Central

    Kraetschmer, Nancy; Jass, Janak; Woodman, Cheryl; Koo, Irene; Kromm, Seija K.; Deber, Raisa B.

    2014-01-01

    This study aimed to enhance understanding of the dimensions of accountability captured and not captured in acute care hospitals in Ontario, Canada. Based on an Ontario-wide survey and follow-up interviews with three acute care hospitals in the Greater Toronto Area, we found that the two dominant dimensions of hospital accountability being reported are financial and quality performance. These two dimensions drove both internal and external reporting. Hospitals' internal reports typically included performance measures that were required or mandated in external reports. Although respondents saw reporting as a valuable mechanism for hospitals and the health system to monitor and track progress against desired outcomes, multiple challenges with current reporting requirements were communicated, including the following: 58% of survey respondents indicated that performance-reporting resources were insufficient; manual data capture and performance reporting were prevalent, with the majority of hospitals lacking sophisticated tools or technology to effectively capture, analyze and report performance data; hospitals tended to focus on those processes and outcomes with high measurability; and 53% of respondents indicated that valuable cross-system accountability, performance measures or both were not captured by current reporting requirements. PMID:25305387

  12. Maternal Depression and Childhood Health Inequalities

    ERIC Educational Resources Information Center

    Turney, Kristin

    2011-01-01

    An increasing body of literature documents considerable inequalities in the health of young children in the United States, though maternal depression is one important, yet often overlooked, determinant of children's health. In this article, the author uses data from the Fragile Families and Child Wellbeing Study (N = 4,048) and finds that maternal…

  13. Early Environmental Correlates of Maternal Emotion Talk

    PubMed Central

    Garrett-Peters, Patricia; Mills-Koonce, Roger; Adkins, Daniel; Vernon-Feagans, Lynne; Cox, Martha

    2009-01-01

    SYNOPSIS Objective The primary goal of this study was to examine contextual, child, and maternal factors that are associated with mothers’ early emotion talk in an ethnically diverse, low-income sample. Design Emotion talk (positive and negative labels) was coded for 1111 mothers while engaged with their 7-month-olds in viewing an emotion-faces picture book. Infant attention during the interaction was also coded. Mothers’ parenting style (positive engagement and negative intrusiveness) was coded during a dyadic free-play interaction. Demographic information was obtained, as well as maternal ratings of child temperament and mother’s knowledge of infant development. Results Hierarchical regression analyses revealed that social context and maternal qualities are significant predictors of mothers’ early positive and negative emotion talk. In particular, mothers who were African American, had higher income, and who showed more positive engagement when interacting with their infants demonstrated increased rates of positive and negative emotion talk with their infants. For negative emotion talk, social context variables moderated other predictors. Specifically, infant attention was positively associated with negative emotion talk only for African American mothers, and knowledge of infant development was positively associated with negative emotion talk only for non-African American mothers. The positive association between maternal positive engagement and negative emotion talk was greater for lower-income families than for higher-income families. Conclusions Mothers’ emotion language with infants is not sensitive to child factors but is associated with social contextual factors and characteristics of the mothers themselves. PMID:19946464

  14. Maternal religious attendance and low birth weight.

    PubMed

    Burdette, Amy M; Weeks, Janet; Hill, Terrence D; Eberstein, Isaac W

    2012-06-01

    We use data from the U.S. Fragile Families and Child Wellbeing study to test whether maternal religious attendance is protective against low birth weight. Building on previous research, we also consider the mediating influence of mental health, cigarette use, alcohol use, illicit drug use, poor nutrition, and prenatal care. Our results indicate that maternal religious attendance is protective against low birth weight. In fact, each unit increase in the frequency of religious attendance reduces the odds of low birth weight by 15%. Religious attendance is also associated with lower odds of cigarette use and poor nutrition, but is unrelated to mental health, alcohol use, illicit drug use, and prenatal care. Although lower rates of cigarette use help to mediate or explain 11% of the association between maternal religious attendance and low birth weight, we find no evidence to substantiate the mediating influence of mental health, alcohol use, illicit drug use, poor nutrition, or prenatal care. Our results suggest that the health benefits of religious involvement may extend across generations (from mother to child); however, additional research is needed to fully explain the association between maternal religious attendance and low birth weight. It is also important for future research to consider the extent to which the apparent health advantages of religious adults might be attributed to health advantages in early life, especially those related to healthy birth weight.

  15. Effects of Maternal Depression on Youth Adjustment.

    ERIC Educational Resources Information Center

    Alexander, Jennifer

    Depressive disorders are chronic illnesses affecting women and their families for extended periods of time. This paper summarizes research related to the effects of maternal depression on children's short and long term adjustment. Children of depressed mothers are at risk for internalizing and externalizing disorders. Genetics account for a small…

  16. Maternal depression and perception of teratogenic risk.

    PubMed

    Koren, Gideon

    2014-01-01

    Depression in pregnancy is characterized by unrealistically heightened perception of teratogenic risk. Appropriate counseling regarding the exposure at hand can assist in reducing maternal concerns. Addressing depression during pregnancy and, in parallel, providing evidence based counseling and reassurance regarding different antidepressants in pregnancy may avert major health risks.

  17. Maternal Responsiveness and Subsequent Child Compliance.

    ERIC Educational Resources Information Center

    Parpal, Mary; Maccoby, Eleanor E.

    1985-01-01

    Contrasts effects of three modes of mother/child interaction on children's subsequent compliance with maternal directives. Subjects were 39 children from lower-middle-class families, ranging in age from approximately three to four-and-a-half. Responsive play and noninteractive conditions produced higher levels of compliance than the untrained free…

  18. Excessive Interviews: Listening to Maternal Subjectivity

    ERIC Educational Resources Information Center

    Willink, Kate

    2010-01-01

    In this article, the author revisits an interview with Ava Montalvo--a mother of two living in Albuquerque, New Mexico--which initially confounded her interpretive resources. This reflexive, performative article examines the role of excess as an analytical lens through which to understand maternal subjectivity and elaborates the methodological…

  19. Parity Effects on Maternal Attitudes During Pregnancy.

    ERIC Educational Resources Information Center

    Fuchs, Karen D.; Self, Patricia A.

    In this study, which investigates the association of parity and maternal attitudes during pregnancy, a 30-item questionnaire was completed by 17 primiparous and 33 multiparous mothers in their 8th month of pregnancy at the Obstetrics-Gynocology Clinic at a university medical center. Measures were obtained on five scales: quality of available…

  20. Maternal Work Conditions and Child Development

    ERIC Educational Resources Information Center

    Felfe, Christina; Hsin, Amy

    2012-01-01

    How do maternal work conditions, such as psychological stress and physical hazards, affect children's development? Combining data from the Child Development Supplement of the Panel Study of Income Dynamics and the Occupational Information Network allows us to shed some light on this question. We employ various techniques including OLS with…

  1. Family Structure Transitions and Maternal Parenting Stress

    ERIC Educational Resources Information Center

    Cooper, Carey E.; McLanahan, Sara S.; Meadows, Sarah O.; Brooks-Gunn, Jeanne

    2009-01-01

    Data from the Fragile Families and Child Wellbeing Study (N = 4,176) are used to examine family structure transitions and maternal parenting stress. Using multilevel modeling, we found that mothers who exit coresidential relationships with biological fathers or enter coresidential relationships with nonbiological fathers reported higher levels of…

  2. Update in Maternal and Infant Nutrition.

    ERIC Educational Resources Information Center

    Johnston, Elizabeth M.

    1989-01-01

    This review emphasizes research that confirms or questions established practices regarding maternal and infant nutrition. Controversial issues include weight gain and use of vitamins and mineral supplements during pregnancy and the effects of second-hand smoke. Infant nutrition topics include use of unmodified cow's milk, level of fat, and…

  3. Women's Decisions about Breastfeeding and Maternal Employment.

    ERIC Educational Resources Information Center

    Lindberg, Laura Duberstein

    1996-01-01

    Extends the concept of role incompatibility to examine potential incompatibilities between breastfeeding and maternal employment. Hypothesizes women may face both structural and attitudinal conflicts between these behaviors. Found significantly more women employed part-time are likely to breastfeed and for longer durations than women employed…

  4. Maternal Anxiety and Lead Levels in Children.

    ERIC Educational Resources Information Center

    Chaiklin, Harris; Mosher, Barbara

    There is a relationship between maternal anxiety and lead levels in children. Data were collected from the mothers of 15 children with "normal" lead levels and 15 children with elevated blood levels. Anxiety was measured by the Taylor Manifest Anxiety Scale. All families lived in areas with poor housing. Treatment of lead poisoning tends…

  5. Maternal Characteristics Predicting Young Girls' Disruptive Behavior

    ERIC Educational Resources Information Center

    van der Molen, Elsa; Hipwell, Alison E.; Vermeiren, Robert; Loeber, Rolf

    2011-01-01

    Little is known about the relative predictive utility of maternal characteristics and parenting skills on the development of girls' disruptive behavior. The current study used five waves of parent- and child-report data from the ongoing Pittsburgh Girls Study to examine these relationships in a sample of 1,942 girls from age 7 to 12 years.…

  6. Costs and Benefits of Treating Maternal Depression

    ERIC Educational Resources Information Center

    Sontag-Padilla, Lisa; Lavelle, Tara; Schultz, Dana

    2014-01-01

    An estimated 15 million mothers with young children in the U.S. suffer from depression. Untreated maternal depression has serious consequences for the mother's long-term health and for her child's development and functioning. it can also be costly, driving up health care use, reducing employment, and creating the need for early childhood…

  7. Maternal depression and developmental disability: research critique.

    PubMed

    Bailey, Donald B; Golden, Robert N; Roberts, Jane; Ford, Amy

    2007-01-01

    Maternal depression in families having a child with a disability has been the subject of considerable research over the past 25 years. This review was designed to describe the literature on maternal depression, critique its research methodology, identify consensus findings across studies, and make recommendations for future research. A particular emphasis is on the distinction between exhibiting depressive symptoms and meeting clinical criteria for a depressive disorder, how or whether research studies made this distinction, and implications for our understanding of maternal adaptation to disability in a family member. Of the 42 articles reviewed, only eight were clinically diagnosed depression; most of them used a scale rating depressive symptoms. Across the studies, mothers of children with disabilities generally exhibited a higher than average rate of depressive symptoms and are more at risk for clinical depression, but the incidence may be lower than reported in previous literature. Child behavior problems, maternal stress, coping style, and support were consistently associated with depressive symptoms. We conclude that we know relatively little about clinical depression in mothers of children with disabilities. The distinction between clinical depression and depressive symptoms may be important in conceptualizing how a child with a disability can influence family members and the nature of support that may need to be provided. Future research should incorporate gold standard diagnostic tools and assess history, severity, and type of depression. Research is also needed to study treatments to reduce the occurrence of both depressive symptoms and clinical depression.

  8. The Corporate Perspective on Maternal & Child Health.

    ERIC Educational Resources Information Center

    Cronin, Carol; Hartman, Rebecca

    This report considers the National Commission to Prevent Infant Mortality's recommendations for ways for the private sector to become more involved in promoting maternal and child health. The first chapter presents demographic data on changes affecting the workforce, including statistics on women in the workforce, changing family lifestyles,…

  9. Food availability and maternal immunization affect transfer and persistence of maternal antibodies in nestling pigeons.

    PubMed

    Ismail, Ahmad; Jacquin, Lisa; Haussy, Claudy; Legoupi, Julie; Perret, Samuel; Gasparini, Julien

    2013-01-01

    The ability of mothers to transfer antibodies (Abs) to their young and the temporal persistence of maternal Abs in offspring constitute important life-history traits that can impact the evolution of host-parasite interactions. Here, we examined the effects of food availability and parental immunization on the transfer and persistence of maternal antibodies in nestling pigeons (Columba livia). This species can transmit maternal Abs to offspring before hatching through the egg yolk and potentially after hatching through crop milk. However, the role of this postnatal substance in immunity remains elusive. We used a full cross-fostering design to disentangle the effects of food limitation and parental immunization both before and after hatching on the levels and persistence of maternal Abs in chicks. Parents were immunized via injection with keyhole limpet hemocyanin antigens. Using an immunoassay that specifically detected the IgY antibodies that are known to be transmitted via the yolk, we found that the levels of anti-KLH Abs in newly hatched chicks were positively correlated with the levels of anti-KLH Abs in the blood of their biological mothers. However, this correlation was not present between chicks and their foster parents, suggesting limited IgY transfer via crop milk to the chick's bloodstream. Interestingly, biological mothers subjected to food limitation during egg laying transferred significantly fewer specific maternal Abs, which suggests that the transfer of antibodies might be costly for them. In addition, the persistence of maternal Abs in a chick's bloodstream was not affected by food limitation or the foster parents' anti-KLH Ab levels; it was only affected by the initial level of maternal anti-KLH Abs that were present in newly hatched chicks. These results suggest that the maternal transfer of Abs could be costly but that their persistence in an offspring's bloodstream may not necessarily be affected by environmental conditions.

  10. Hospital service recovery.

    PubMed

    Gutbezahl, Cary; Haan, Perry

    2006-01-01

    An organization's ability to correct service errors is an important factor in achieving success in today's service economy. This paper examines service recovery in hospitals in the U.S. First is a general review of service recovery theories. Next is a discussion of specific service issues related to the hospital environment. The literature on service recovery is used to make specific recommendations to hospitals for ways to improve their ability to remedy service errors when they occur. Suggestions for future research in the field of service recovery are also made.

  11. Predicting hospital accounting costs

    PubMed Central

    Newhouse, Joseph P.; Cretin, Shan; Witsberger, Christina J.

    1989-01-01

    Two alternative methods to Medicare Cost Reports that provide information about hospital costs more promptly but less accurately are investigated. Both employ utilization data from current-year bills. The first attaches costs to utilization data using cost-charge ratios from the previous year's cost report; the second uses charges from current year's bills. The first method is the more accurate of the two, but even using it, only 40 percent of hospitals had predicted costs within plus or minus 5 percent of actual costs. The feasibility and cost of obtaining cost reports from a small, fast-track sample of hospitals should be investigated. PMID:10313352

  12. Risk of Adverse Infant Outcomes Associated with Maternal Tuberculosis in a Low Burden Setting: A Population-Based Retrospective Cohort Study

    PubMed Central

    LaCourse, Sylvia M.; Greene, Sharon A.; Dawson-Hahn, Elizabeth E.; Hawes, Stephen E.

    2016-01-01

    Background. Maternal tuberculosis (TB) may be associated with increased risk of adverse infant outcomes. Study Design. We examined the risk of low birth weight (LBW), small for gestational age (SGA), and preterm birth (<37 weeks) associated with maternal TB in a retrospective population-based Washington State cohort using linked infant birth certificate and maternal delivery hospitalization discharge records. We identified 134 women with births between 1987 and 2012 with TB-associated ICD-9 diagnosis codes at hospital delivery discharge and 536 randomly selected women without TB, frequency matched 4 : 1 on delivery year. Multinomial logistic regression analyses were performed to compare the risk of LBW, SGA, and preterm birth between infants born to mothers with and without TB. Results. Infants born to women with TB were 3.74 (aRR 95% CI 1.40–10.00) times as likely to be LBW and 1.96 (aRR 95% CI 0.91–4.22) as likely to be SGA compared to infants born to mothers without TB. Risk of prematurity was similar (aRR 1.01 95% CI 0.39–2.58). Conclusion. Maternal TB is associated with poor infant outcomes even in a low burden setting. A better understanding of the adverse infant outcomes associated with maternal TB, reflecting recent trends in US TB epidemiology, may inform potential targeted interventions in other low prevalence settings. PMID:26989338

  13. Maternal self-confidence postpartum and at pre-school age: the role of depression, anxiety disorders, maternal attachment insecurity.

    PubMed

    Zietlow, Anna-Lena; Schlüter, Myriam Kim; Nonnenmacher, Nora; Müller, Mitho; Reck, Corinna

    2014-10-01

    The aim of this study was to analyze the impact of maternal postpartum depression and/or anxiety disorders according to DMS-IV on maternal self-confidence throughout infancy and early childhood. Exploratively, associations between maternal attachment insecurity and maternal self-confidence at pre-school age were examined. The sample (N = 54) of this prospective longitudinal study was comprised of n = 27 women with postpartum depression and/or anxiety disorders according to DSM-IV criteria and n = 27 healthy women without present or history of mental health disorders or psychotherapy. Data was collected in the postpartum period (M = 60.08 days) and at pre-school age (M = 4.7 years). Subjects were recruited between 2004 and 2011 in South Germany. Data revealed a significant difference in maternal self-confidence between clinical and control group at child's pre-school age: Women with postpartum depression and/or anxiety disorder scored lower on maternal self-confidence than healthy controls, but only if they had current SCID-diagnoses or partly remitted symptoms. According to explorative analyses maternal attachment insecurity turned out to be the strongest predictor of maternal self-confidence at pre-school age besides maternal mental health status. The results emphasize the impact of attachment insecurity and maternal mental health regarding maternal self-confidence leading to potential adverse long-term consequences for the mother-child relationship. Attachment based interventions taking maternal self-confidence into account are needed.

  14. Social Support and Maternal Depression from Pregnancy to Postpartum: The Association with Positive Maternal Behaviours among Brazilian Adolescent Mothers

    ERIC Educational Resources Information Center

    Diniz, Eva; Koller, Sílvia H.; Volling, Brenda L.

    2015-01-01

    Adolescent motherhood is a risky situation related to poorer quality of infant caregiving. The lack of social support and increased odds for maternal depression are the main concerns. This study aimed to investigate whether maternal-foetal attachment, social support and maternal depression measured during pregnancy and after birth were associated…

  15. Maternal Eating Disorders and Infant Feeding Difficulties: Maternal and Child Mediators in a Longitudinal General Population Study

    ERIC Educational Resources Information Center

    Micali, Nadia; Simonoff, Emily; Stahl, Daniel; Treasure, Janet

    2011-01-01

    Background: Maternal eating disorders (ED) have been shown to increase the risk of feeding difficulties in the offspring. Very few studies, however, have investigated whether the effect of a maternal ED on childhood feeding is a direct effect or whether it can be ascribed to other child or maternal factors. We aimed to determine the role of…

  16. The hidden maternal-fetal interface: events involving the lymphoid organs in maternal-fetal tolerance

    PubMed Central

    Taglauer, Elizabeth S.; Adams Waldorf, Kristina M.; Petroff, Margaret G.

    2010-01-01

    The genetic disparity between the mother and fetus has long enticed immunologists to search for mechanisms of maternal tolerance to fetal antigens. The study of antigen-specific tolerance in murine and human pregnancy has gained new momentum in recent years through the focus on antigen-presenting cells, uterine lymphatics and fetal antigen-specific maternal T cell responses. In mice, we now know that these responses occur within the secondary lymphoid structures as they can be conveniently tracked through the use of defined, often transgenic fetal antigens and maternal T cell receptors. Although the secondary lymphoid organs are sites of both immunization and tolerization to antigens, the immunological processes that occur in response to fetal antigens during the healthy pregnancy must invariably lead to tolerance. The molecular properties of these maternal-fetal tolerogenic interactions are still being unraveled, and are likely to be greatly influenced by tissue-specific microenvironments and the hormonal milieu of pregnancy. In this article, we discuss the events leading to antigen-specific maternal tolerance, including the trafficking of fetal antigens to secondary lymphoid organs, the properties of the antigen-presenting cells that display them to maternal T lymphocytes, and the nature of the ensuing tolerogenic response. Experimental data generated from human biological specimens as well as murine transgenic models are considered. PMID:19876825

  17. Influence of paced maternal breathing on fetal–maternal heart rate coordination

    PubMed Central

    Van Leeuwen, P.; Geue, D.; Thiel, M.; Cysarz, D.; Lange, S.; Romano, M. C.; Wessel, N.; Kurths, J.; Grönemeyer, D. H.

    2009-01-01

    Pregnant mothers often report a special awareness of and bonding with their unborn child. Little is known about this relationship although it may offer potential for the assessment of the fetal condition. Recently we found evidence of short epochs of fetal–maternal heart rate synchronization under uncontrolled conditions with spontaneous maternal breathing. Here, we examine whether the occurrence of such epochs can be influenced by maternal respiratory arrhythmia induced by paced breathing at several different rates (10, 12, 15, and 20 cycles per minute). To test for such weak and nonstationary synchronizations among the fetal–maternal subsystems, we apply a multivariate synchronization analysis technique and test statistics based on twin surrogates. We find a clear increase in synchronization epochs mostly at high maternal respiratory rates in the original but not in the surrogate data. On the other hand, fewer epochs are found at low respiratory rates both in original and surrogate data. The results suggest that the fetal cardiac system seems to possess the capability to adjust its rate of activation in response to external—i.e., maternal—stimulation. Hence, the pregnant mothers' special awareness to the unborn child may also be reflected by fetal–maternal interaction of cardiac activity. Our approach opens up the chance to examine this interaction between independent but closely linked physiological systems. PMID:19597150

  18. Influences of Maternal Care on Chicken Welfare

    PubMed Central

    Edgar, Joanne; Held, Suzanne; Jones, Charlotte; Troisi, Camille

    2016-01-01

    Simple Summary For a domestic chick, the mother hen is an important role model; chicks learn a great deal from their mother about what to peck, when to rest and how to behave when there is a threat. However, in large farms, natural brooding is not commercially viable and so chicks are hatched in large incubators and reared artificially. Chicks reared without a mother in this way are more fearful and more likely to develop behavioural problems, such as feather pecking. We discuss the important features of maternal care in chickens, the behavioural consequences of deprivation, and the welfare implications on commercial farms. We finish by suggesting ways to simulate natural maternal care to improve commercial chick rearing practice. Abstract In domestic chickens, the provision of maternal care strongly influences the behavioural development of chicks. Mother hens play an important role in directing their chicks’ behaviour and are able to buffer their chicks’ response to stressors. Chicks imprint upon their mother, who is key in directing the chicks’ behaviour and in allowing them to develop food preferences. Chicks reared by a mother hen are less fearful and show higher levels of behavioural synchronisation than chicks reared artificially. In a commercial setting, more fearful chicks with unsynchronised behaviour are more likely to develop behavioural problems, such as feather pecking. As well as being an inherent welfare problem, fear can also lead to panic responses, smothering, and fractured bones. Despite the beneficial effects of brooding, it is not commercially viable to allow natural brooding on farms and so chicks are hatched in large incubators and reared artificially, without a mother hen. In this review we cover the literature demonstrating the important features of maternal care in domestic chickens, the behavioural consequences of deprivation and the welfare implications on commercial farms. We finish by suggesting ways to use research in natural

  19. Maternal diet programs embryonic kidney gene expression.

    PubMed

    Welham, Simon J M; Riley, Paul R; Wade, Angie; Hubank, Mike; Woolf, Adrian S

    2005-06-16

    Human epidemiological data associating birth weight with adult disease suggest that organogenesis is "programmed" by maternal diet. In rats, protein restriction in pregnancy produces offspring with fewer renal glomeruli and higher systemic blood pressures than controls. We tested the hypothesis that maternal diet alters gene expression in the metanephros, the precursor of the definitive mammalian kidney. We demonstrated that maternal low-protein diet initiated when pregnancy starts and maintained to embryonic day 13, when the metanephros consists of mesenchyme surrounding a once-branched ureteric bud, is sufficient to significantly reduce glomerular numbers in offspring by about 20%. As assessed by representational difference analyses and real-time quantitative polymerase chain reactions, low-protein diet modulated gene expression in embryonic day 13 metanephroi. In particular, levels of prox-1, the ortholog of Drosophila transcription factor prospero, and cofilin-1, a regulator of the actin cytoskeleton, were reduced. During normal metanephrogenesis, prox-1 protein was first detected in mesenchymal cells around the ureteric tree and thereafter in nascent nephron epithelia, whereas cofilin-1 immunolocalized to bud derivatives and condensing mesenchyme. Previously, we reported that low-protein diets increased mesenchymal apoptosis cells when metanephrogenesis began and thereafter reduced numbers of precursor cells. Collectively, these studies prove that the maternal diet programs the embryonic kidney, altering cell turnover and gene expression at a time when nephrons and glomeruli have yet to form. The human implication is that the maternal diet ingested between conception and 5- 6-wk gestation contributes to the variation in glomerular numbers that are known to occur between healthy and hypertensive populations.

  20. The Effect of Maternal Obesity on the Offspring

    PubMed Central

    Williams, Christine B.; Mackenzie, Kusaynyonon C.; Gahagan, Sheila

    2016-01-01

    Maternal obesity is inextricably linked to adverse health outcomes for the mother and her children. The peripartum period is a critical period of risk. In this chapter, we examine the importance of maternal pre-pregnancy weight status, gestational weight gain, breastfeeding, and postpartum weight loss in relation to subsequent risk for maternal obesity and obesity in the offspring. Promoting optimal maternal weight during the preconception, pregnancy and postpartum periods will provide lifelong benefits for maternal health and the health of her progeny. PMID:24936914

  1. Hospital-acquired thrombocytopenia.

    PubMed

    McMahon, Christine M; Cuker, Adam

    2014-10-01

    The development of thrombocytopenia is common in hospitalized patients and is associated with increased mortality. Frequent and important causes of thrombocytopenia in hospitalized patients include etiologies related to the underlying illness for which the patient is admitted, such as infection and disseminated intravascular coagulation, and iatrogenic etiologies such as drug-induced immune thrombocytopenia, heparin-induced thrombocytopenia, posttransfusion purpura, hemodilution, major surgery, and extracorporeal circuitry. This review presents a brief discussion of the pathophysiology, distinguishing clinical features, and management of these etiologies, and provides a diagnostic approach to hospital-acquired thrombocytopenia that considers the timing and severity of the platelet count fall, the presence of hemorrhage or thrombosis, the clinical context, and the peripheral blood smear. This approach may offer guidance to clinicians in distinguishing among the various causes of hospital-acquired thrombocytopenia and providing management appropriate to the etiology.

  2. Surgery, Hospitals, and Medications

    MedlinePlus

    ... products that are not commonly stocked in hospital pharmacies. Examples include: Salagen ® , Evoxac ® , and Restasis ® Eye drops, ... prescription and OTC medications/products in their labeled pharmacy container or packaging. This is important in case ...

  3. Home versus hospital confinement

    PubMed Central

    Barry, C. N.

    1980-01-01

    The case for hospital rather than home delivery has been powerfully argued, especially in and since the Report of the Peel Committee. Nevertheless, evidence of comparison with other countries, notably the Netherlands, suggests the choice is not necessarily simple. Some general practitioner units are now reporting perinatal mortality rates which are consistently lower than those of specialist units, and recent statistical analyses suggest that the presence of more high risk cases in consultant units does not explain this. The only big controlled home-versus-hospital trial did not lead to a significantly lower perinatal mortality rate in the hospital group. The onus of proof now seems to lie with those who advocate 100 per cent hospital confinement. PMID:7373581

  4. Objections to hospital philosophers.

    PubMed Central

    Ruddick, W; Finn, W

    1985-01-01

    Like morally sensitive hospital staff, philosophers resist routine simplification of morally complex cases. Like hospital clergy, they favour reflective and principled decision-making. Like hospital lawyers, they refine and extend the language we use to formulate and defend our complex decisions. But hospital philosophers are not redundant: they have a wider range of principles and categories and a sharper eye for self-serving presuppositions and implicit contradictions within our practices. As semi-outsiders, they are often best able to take an 'external point of view,' unburdened by routine, details, and departmental loyalties. Their clarifications can temporarily disrupt routine, but can eventually improve staff morale, hence team practice and patient welfare. PMID:3981573

  5. Hospital free cash flow.

    PubMed

    Kauer, R T; Silvers, J B

    1991-01-01

    Hospital managers may find it difficult to admit their investments have been suboptimal, but such investments often lead to poor returns and less future cash. Inappropriate use of free cash flow produces large transaction costs of exit. The relative efficiency of investor-owned and tax-exempt hospitals in the product market for hospital services is examined as the free cash flow theory is used to explore capital-market conditions of hospitals. Hypotheses concerning the current competitive conditions in the industry are set forth, and the implications of free cash flow for risk, capital-market efficiency, and the cost of capital to tax-exempt institution is compared to capital-market norms.

  6. American Hospital Association

    MedlinePlus

    ... Hospitals & Health Networks H & HN Daily Trustee Research & Trends AHA Policy Research Health Research & Educational Trust AHA ... Associations unless otherwise indicated. AHA does not claim ownership of any content, including content incorporated by permission ...

  7. Hospital Ship Replacement

    DTIC Science & Technology

    2011-08-01

    designed to operate primarily when anchored to reduce the effects of roll. Quantum markets two separate zero speed active roll fin models for small ...ships. Feasibility of scaling fins to the size of the hospital ship requires validation. 3.12 Lifeboats and Liferafts The safety appliances designated ...for Innovation in Ship Design Technical Report Hospital Ship Replacement By Hannah Allison, Christopher Mehrvarzi, Rebecca Piks, Beau Lovdahl

  8. Fast tracking hospital construction.

    PubMed

    Quirk, Andrew

    2013-03-01

    Hospital leaders should consider four factors in determining whether to fast track a hospital construction project: Expectations of project length, quality, and cost. Whether decisions can be made quickly as issues arise. Their own time commitment to the project, as well as that of architects, engineers, construction managers, and others. The extent to which they are willing to share with the design and construction teams how and why decisions are being made.

  9. Who are the Gatekeepers? Predictors of Maternal Gatekeeping

    PubMed Central

    Schoppe-Sullivan, Sarah J.; Altenburger, Lauren E.; Lee, Meghan A.; Bower, Daniel J.; Kamp Dush, Claire M.

    2016-01-01

    SYNOPSIS Objective The goal of this study was to identify determinants of maternal gatekeeping at the transition to parenthood. Design Participants included 182 different-gender dual-earner couples. During pregnancy, expectant parents completed questionnaires regarding their psychological functioning, attitudes, and expectations, and at 3 months postpartum questionnaires regarding maternal gatekeeping behavior and gate closing attitudes. Results SEM analyses revealed that mothers were more likely to close the gate to fathers when mothers held greater perfectionistic expectations for fathers’ parenting, had poorer psychological functioning, perceived their romantic relationship as less stable, and had higher levels of parenting self-efficacy. In contrast, fathers with lower parenting self-efficacy appeared to elicit greater maternal gate closing behavior. Mothers who engaged in greater gate opening behavior were more religious. Conclusions Maternal gatekeeping may be more strongly associated with maternal expectations and psychological functioning than with maternal traditional gender attitudes. Fathers’ characteristics are less predictive of maternal gatekeeping than mothers’ characteristics. PMID:27366115

  10. Maternal trait anxiety, emotional distress, and salivary cortisol in pregnancy.

    PubMed

    Pluess, Michael; Bolten, Margarete; Pirke, Karl-Martin; Hellhammer, Dirk

    2010-03-01

    Animal models suggest that stress-induced hormonal changes in the mother during pregnancy lead to enduring changes in the fetus and empirical links between prenatal maternal stress and negative child development have been discerned repeatedly in human studies. But the role of heritable personality traits has received little attention in the latter work. The goal of the current study was to investigate the relationship between maternal personality, psychological measures of maternal distress and maternal salivary cortisol during pregnancy. Maternal reports of personality (16 PF) and stress-related psychological measures (depression, pregnancy-related anxiety, perceived stress, negative life events) as well as salivary cortisol samples of 66 healthy pregnant women were collected in early and late pregnancy. Maternal trait anxiety proved related to all stress-related psychological measures and high anxiety predicted low baseline cortisol awakening levels in early pregnancy. Maternal trait anxiety is related to both psychological and biological stress measures during pregnancy.

  11. Maternal warming affects early life stages of an invasive thistle.

    PubMed

    Zhang, R; Gallagher, R S; Shea, K

    2012-09-01

    Maternal environment can influence plant offspring performance. Understanding maternal environmental effects will help to bridge a key gap in the knowledge of plant life cycles, and provide important insights for species' responses under climate change. Here we show that maternal warming significantly affected the early life stages of an invasive thistle, Carduus nutans. Seeds produced by plants grown in warmed conditions had higher germination percentages and shorter mean germination times than those produced by plants under ambient conditions; this difference was most evident at suboptimal germination temperatures. Subsequent seedling emergence was also faster with maternal warming, with no cost to seedling emergence percentage and seedling growth. Our results suggest that maternal warming may accelerate the life cycle of this species via enhanced early life-history stages. These maternal effects on offspring performance, together with the positive responses of the maternal generation, may exacerbate invasions of this species under climate change.

  12. Frequency of Maternal Mortality in Urban and Rural Areas of Iranshahr County (Southeast of Iran) in 2009-2013: A Retrospective Study

    PubMed Central

    Zareban, Iraj; Jamalzae, Abdul-Qaffar; Darban, Fatemeh; Bakhshani, Khadejeh Dehghan; Balouchi, Abbas

    2016-01-01

    Introduction Maternal mortality is one of the threatening factors of human life and the overall status index of women’s health in any society. Death of a mother causes irreversible damage to a family and a society. This study aims at examining the causes of maternal mortality in urban and rural areas. Aim The purpose of this study was to determine the frequney and causes of maternal mortality in urban and rural areas in southeast of Iran in 2009-2013. Materials and Methods This was a retrospective descriptive study and its research population includes the entire pregnant woman who died in Iranshahr County between April 2009 and March 2013. An eight-section questionnaire was used for collecting data. The first section was based on the hospital records of pregnant woman including mother’s demographic data and the following sections were completed based on their health records. Results The frequency of maternal mortality during birth in the study period was 34 (of 4857). The study individuals were between 13 and 40-year-old with the mean age of 30±6.4. Maximum maternal mortality occurred in 2012. Haemorrhage was the most common cause of maternal death (38.2%). Conclusion As haemorrhage was the most common cause of death of pregnant women in this study, it seems necessary to improve care for woman and reduce haemorrhage and its complications during pregnancy period. PMID:27656510

  13. Applying the Maternal Near Miss Approach for the Evaluation of Quality of Obstetric Care: A Worked Example from a Multicenter Surveillance Study

    PubMed Central

    Haddad, Samira Maerrawi; Souza, Joao Paulo; Sousa, Maria Helena; Parpinelli, Mary Angela; Costa, Maria Laura; Pacagnella, Rodolfo C.; Brum, Ione R.; Moraes Filho, Olímpio B.; Feitosa, Francisco E.; Menezes, Carlos A.; Guanabara, Everardo M.; Moreira, Joaquim L.; Peret, Frederico A.; Schmaltz, Luiza E.; Katz, Leila; Lima, Antonio C. Barbosa; Amorim, Melania M.; Martins, Marilia G.; Nascimento, Denis J.; Paiva, Cláudio S.; Rohloff, Roger D.; Costa, Sergio M.; Luz, Adriana G.; Lobato, Gustavo; Cordioli, Eduardo; Peraçoli, Jose C.; Maia Filho, Nelson L.; Quintana, Silvana M.; Lotufo, Fátima A.; Aquino, Márcia M.; Mattar, Rosiane

    2014-01-01

    Objective. To assess quality of care of women with severe maternal morbidity and to identify associated factors. Method. This is a national multicenter cross-sectional study performing surveillance for severe maternal morbidity, using the World Health Organization criteria. The expected number of maternal deaths was calculated with the maternal severity index (MSI) based on the severity of complication, and the standardized mortality ratio (SMR) for each center was estimated. Analyses on the adequacy of care were performed. Results. 17 hospitals were classified as providing adequate and 10 as nonadequate care. Besides almost twofold increase in maternal mortality ratio, the main factors associated with nonadequate performance were geographic difficulty in accessing health services (P < 0.001), delays related to quality of medical care (P = 0.012), absence of blood derivatives (P = 0.013), difficulties of communication between health services (P = 0.004), and any delay during the whole process (P = 0.039). Conclusions. This is an example of how evaluation of the performance of health services is possible, using a benchmarking tool specific to Obstetrics. In this study the MSI was a useful tool for identifying differences in maternal mortality ratios and factors associated with nonadequate performance of care. PMID:25147830

  14. Breastfeeding and the use of maternal health services in Sarawak.

    PubMed

    Kwa, S K

    1993-06-01

    In Malaysia, a demographer analyzed data on 1583 children born to 1047 15-49 year old mothers in the 5 years before the 1989 Population and Family Survey was conducted in all districts of Sarawak, except Belaga. She examined the relationship between use of maternal health services, including contraception, and the breast feeding pattern. Most women used prenatal care and postnatal care services (98.2% and 82.6%, respectively). The mean duration of breast feeding was only 6.13 months while the median duration was even shorter (3 months). Mothers who received prenatal care were more likely to initiate breast feeding than those who received no prenatal care (84.1% vs. 75%), but their duration of breast feeding was much shorter (median, 5 vs. 14.3 months). Women who delivered at a private hospital compared to those who delivered elsewhere were less likely to initiate breast feeding (70.6% vs. 84.6-88.9%) and breast feed for a shorter period of time (median, 2.36 vs. 4.41-13.56 months). Nurses in private hospitals care for newborns in a separate room and give prelacteal feeds, particularly commercial infant formula, which jeopardizes mothers' initiation of breast feeding. Women who were assisted by a physician had the lowest rate of initiation of breast feeding (70.5% vs. 86.2-92.4%) and the shortest duration of breast feeding (2.68 vs. 4.67-14.55 months). Women who had ever used contraception compared to those who had never used contraception were somewhat less likely to initiate breast feeding (83.2% vs. 87.5%) and breast feed for a shorter time (4.29 vs. 12.82 months). These results suggest that the government needs to change its policies on health services to promote breast feeding. It should target health personnel and clients in the private sector and family planning workers.

  15. Improving reporting of infant deaths, maternal deaths and stillbirths in Haryana, India

    PubMed Central

    Neogi, Sutapa B; Chopra, Sapna; Phogat, Amit; Sahota, Rupinder; Gupta, Ravikant; Gupta, Rakesh; Zodpey, Sanjay

    2016-01-01

    Abstract Underreporting hampers the accurate estimation of the numbers of infant and maternal deaths and stillbirths in India. In Haryana state, a surveillance-based model – the Maternal Infant Death Review System – was launched in 2013 to try to resolve this issue. The system is a mixture of routine passive data collection and active surveillance by specially recruited and trained field volunteers. The volunteers gather the relevant data from child day-care centres, community health centres, cremation grounds, hospitals, the municipal corporation’s offices and primary health centres and regularly visit health subcentres. The collected data are triangulated against the standard death registers and discussions with relevant community members. The details of any unregistered death are rapidly uploaded on the system’s web-based platform. In April 2014, we made field observations, reviewed records and conducted in-depth interviews with the key stakeholders to see if the system’s performance matched the state government’s planned objectives. The data collected indicate that implementation of the system has led to quantitative and qualitative improvements in reporting of infant and maternal deaths and stillbirths. Completeness and consistency in the reporting of deaths are essential for focused policy and programmatic interventions and there remains scope for improvement in Haryana via further reform and changes in policy. The model in its current form is potentially sustainable and scalable in similar settings elsewhere. PMID:27147767

  16. Newborns' temperature submitted to radiant heat and to the Top Maternal device at birth

    PubMed Central

    de Albuquerque, Rosemeire Sartori; Mariani, Corintio; Bersusa, Ana Aparecida Sanches; Dias, Vanessa Macedo; da Silva, Maria Izabel Mota

    2016-01-01

    ABSTRACT Objective: to compare the axillar temperatures of newborns that are put immediately after birth in skin-to-skin contact under the Top Maternal device, as compared to those in a radiant heat crib. Methods: comparatives observational study of the case-control type about temperature of 60 babies born at the Obstetric Center and Normal Delivery Center of a public hospital of the municipality of Sao Paulo, being them: 29 receiving assistance in heated crib and 31 in skin-to skin contact, shielded by a cotton tissue placed on mother's thorax, called Top Maternal. Results: the temperature of the babies of the skin-to-skin contact group presented higher values in a larger share of the time measures verified, as compared to those that were placed in radiant heat crib, independently from the place of birth. Differences between the two groups were not statistically significant. Conclusion: the study contributes to generate new knowledge, supporting the idea of keeping babies with their mothers immediately after birth protected with the Maternal Top, without harming their wellbeing, as it keeps the axillar temperature in recommendable levels. PMID:27508912

  17. Improving reporting of infant deaths, maternal deaths and stillbirths in Haryana, India.

    PubMed

    Negandhi, Preeti H; Neogi, Sutapa B; Chopra, Sapna; Phogat, Amit; Sahota, Rupinder; Gupta, Ravikant; Gupta, Rakesh; Zodpey, Sanjay

    2016-05-01

    Underreporting hampers the accurate estimation of the numbers of infant and maternal deaths and stillbirths in India. In Haryana state, a surveillance-based model - the Maternal Infant Death Review System - was launched in 2013 to try to resolve this issue. The system is a mixture of routine passive data collection and active surveillance by specially recruited and trained field volunteers. The volunteers gather the relevant data from child day-care centres, community health centres, cremation grounds, hospitals, the municipal corporation's offices and primary health centres and regularly visit health subcentres. The collected data are triangulated against the standard death registers and discussions with relevant community members. The details of any unregistered death are rapidly uploaded on the system's web-based platform. In April 2014, we made field observations, reviewed records and conducted in-depth interviews with the key stakeholders to see if the system's performance matched the state government's planned objectives. The data collected indicate that implementation of the system has led to quantitative and qualitative improvements in reporting of infant and maternal deaths and stillbirths. Completeness and consistency in the reporting of deaths are essential for focused policy and programmatic interventions and there remains scope for improvement in Haryana via further reform and changes in policy. The model in its current form is potentially sustainable and scalable in similar settings elsewhere.

  18. Cytomegalovirus-associated acute hydramnios treated by amniocentesis and maternal indomethacin.

    PubMed

    Suzumori, Nobuhiro; Hattori, Yukio; Kaneko, Saori; Suzuki, Yoshikatsu; Sugiura-Ogasawara, Mayumi

    2009-12-01

    A 22-year-old pregnant woman noticed a rapid increase of abdominal growth, uterine tenderness and irregular contraction, for which she hospitalized at 25 weeks of gestation. An ultrasound examination demonstrated a single fetus with normal anatomy and massive hydramnios. Serial therapeutic amniocentesis was performed for relief of maternal symptoms and indomethacin compress was initiated. Both the maternal and amniotic fluid IgM were positive for cytomegalovirus (CMV). Maternal compress indomethacin was discontinued at 32 weeks. Cesarean section was performed due to fetal distress at 34 weeks of gestation. A female infant was delivered and the neonatal examination was within normal limits with urine culture positive for CMV. At 1 year of age the child was developing normally with normal hearing and no clinical sequelae of intrauterine CMV infection. We postulate that serial and large volume reduction of amniotic fluid by amniocentesis and compress indomethacin in our case interrupted the natural course and provided sufficient time for the fetus to recover from the acute phase of viral infection.

  19. French retrospective multicentric study of neonatal hemochromatosis: importance of autopsy and autoimmune maternal manifestations.

    PubMed

    Collardeau-Frachon, Sophie; Heissat, Sophie; Bouvier, Raymonde; Fabre, Monique; Baruteau, Julien; Broue, Pierre; Cordier, Marie-Pierre; Debray, Dominique; Debiec, Hanna; Ronco, Pierre; Guigonis, Vincent

    2012-01-01

    Neonatal hemochromatosis is a rare disease that causes fetal loss and neonatal death in the 1st weeks of life and is one of the most common causes of liver failure in the neonate. The diagnosis is mostly made retrospectively, based on histopathologic features of severe liver fibrosis associated with hepatic and extrahepatic siderosis. Several etiologies may underlie this phenotype, including a recently hypothesized gestational alloimmune disease. Fifty-one cases of liver failure with intrahepatic siderosis in fetuses and neonates were analyzed retrospectively. Maternal and infant data were collected from hospitalization and autopsy reports. All available slides were reviewed independently by 3 pathologists. Immunologic studies were performed on maternal sera collected immediately after delivery. The diagnosis of neonatal haemochromatosis was retained in 33 cases, including 1 case with Down syndrome and 1 case with myofibromas. Liver siderosis was inversely proportional to fibrosis progression. In fetuses, iron storage was more frequent in the thyroid than in the pancreas. Perls staining in labial salivary glands was positive in 1 of 5 cases. Abnormal low signal intensity by magnetic resonance imaging was detected in the pancreas in 2 of 7 cases. Renal tubular dysgenesis was observed in 7 of 23 autopsy cases. Chronic villitis was seen in 7 of 15 placentas. Half of the mothers presented with an autoimmune background and/or autoantibodies in their sera. Our work highlights the importance of autopsy in cases of neonatal hemochromatosis and marshals additional data in support of the hypothesis that neonatal hemochromatosis could reflect maternal immune system dysregulation.

  20. [Nursing practice in maternity intensive care units. Severe pre-eclampsia in a primigravida].

    PubMed

    Carmona-Guirado, A J; Escaño-Cardona, V; García-Cañedo, F J

    2015-01-01

    39 year old woman, pregnant for 31+5 weeks, who came to our intensive care unit (ICU) referred from the emergency department of the hospital, having swollen ankles, headache and fatigue at moderate effort. We proceeded to take blood pressure (158/96 mmHg) and assess lower limb edema. The fetal heart rate monitoring was normal. Knowledgeable and user of healthy guidelines during her pregnancy, she did not follow any treatment. Single mother, she worried about her fetus (achieved through in vitro fertilization), her mother offered to help for any mishap. We developed an Individualized Care Plan. For data collection we used: Rating 14 Virginia Henderson Needs and diagnostic taxonomy NANDA, NOC, NIC. Nursing diagnoses of "fluid volume excess" and "risk of impaired maternal-fetal dyad" were detected, as well as potential complications such as eclampsia and fetal prematurity. Our overall objectives (NOC) were to integrate the woman in the process she faced and that she knew how to recognize the risk factors inherent in her illness. Nursing interventions (NIC) contemplated the awareness and treatment of her illness and the creation of new healthy habits. The work of nursing Maternal ICU allowed women to help maintain maximum maternal and fetal well-being by satisfying any of her needs. Mishandling of the situation leads into a framework of high morbidity and mortality in our units.

  1. Can Caesarean section improve child and maternal health? The case of breech babies.

    PubMed

    Jensen, Vibeke Myrup; Wüst, Miriam

    2015-01-01

    This paper examines the health effects of Caesarean section (CS) for children and their mothers. We use exogenous variation in the probability of CS in a fuzzy regression discontinuity design. Using administrative Danish data, we exploit an information shock for obstetricians that sharply altered CS rates for breech babies. We find that CS decreases the child's probability of having a low APGAR score and the number of family doctor visits in the first year of life. We find no significant effects for severe neonatal morbidity or hospitalizations. While mothers are hospitalized longer after birth, we find no effects of CS for maternal post-birth complications or infections. Although the change in mode of delivery for the marginal breech babies increases direct costs, the health benefits show that CS is the safest option for these children.

  2. Occurrence and determinants of postpartum maternal morbidities and disabilities among women in Matlab, Bangladesh.

    PubMed

    Ferdous, J; Ahmed, A; Dasgupta, S K; Jahan, M; Huda, F A; Ronsmans, C; Koblinsky, M; Chowdhury, M E

    2012-06-01

    The burden of maternal ill-health includes not only the levels of maternal mortality and complications during pregnancy and around the time of delivery but also extends to the standard postpartum period of 42 days with consequences of obstetric complications and poor management at delivery. There is a dearth of reliable data on these postpartum maternal morbidities and disabilities in developing countries, and more research is warranted to investigate these and further strengthen the existing safe motherhood programmes to respond to these conditions. This study aims at identifying the consequences of pregnancy and delivery in the postpartum period, their association with acute obstetric complications, the sociodemographic characteristics of women, mode and place of delivery, nutritional status of the mother, and outcomes of birth. From among women who delivered between 2007 and 2008 in the icddr,b service area in Matlab, we prospectively recruited all women identified with complicated births (n=295); a perinatal mortality (n=182); and caesarean-section delivery without any maternal indication (n=147). A random sample of 538 women with uncomplicated births, who delivered at home or in a facility, was taken as the control. All subjects were clinically examined at 6-9 weeks for postpartum morbidities and disabilities. Postpartum women who had suffered obstetric complications during birth and delivered in a hospital were more likely to suffer from hypertension [adjusted odds ratio (AOR)=3.44; 95% confidence interval (CI)=1.14-10.36], haemorrhoids (AOR=1.73; 95% CI=1.11-3.09), and moderate to severe anaemia (AOR=7.11; 95% CI=2.03-4.88) than women with uncomplicated normal deliveries. Yet, women who had complicated births were less likely to have perineal tears (AOR=0.05; 95% CI=0.02-0.14) and genital prolapse (AOR=0.22; 95% CI=0.06-0.76) than those with uncomplicated normal deliveries. Genital infections were more common amongst women experiencing a perinatal death than

  3. Maternal expressed emotion and treatment compliance of children with epilepsy.

    PubMed

    Otero, S; Hodes, M

    2000-09-01

    This study investigated the association between family relationships and compliance in the treatment of childhood epilepsy. It was a prospective study of 21 families with a child who had epilepsy attending Central Middlesex Hospital, London. There were 13 boys and eight girls, with a mean age of 12.0 years (SD 2.9) at initial assessment. Mothers were interviewed for assessment of expressed emotion as a measure of parent-child relationships. Assessment of the mothers' adjustment using the General Health Questionnaire (Goldberg 1978), and psychological adjustment of the children using the Rutter Scales (Rutter et al. 1970a), were completed by mothers and teachers. Reassessment was 3 to 4 years after initial contact, including a paediatric case-note review to assess clinic attendance and overall treatment compliance. Significantly more of the group who had a good level of compliance had recovered from epilepsy at follow-up. Good treatment compliance was found to be associated with less maternal hostility and criticism. Children and mothers in the good compliance group had fewer psychiatric symptoms. Poor treatment compliance and the associated psychological disturbances suggest that assertive paediatric and psychosocial intervention may be needed for some children with epilepsy.

  4. [On the groups of maternal support of breast feeding].

    PubMed

    Abol'ian, L V; Loranskiĭ, D N; Kazakova, L V; Koniaeva, N A; Barabash, N A; Zubkova, N Z

    2010-01-01

    The article deals with the data related to the establishment in Russia of public associations of maternal support of breast feeding initiated by the WHO/UNISEF international initiative "Baby friendly hospital". The breast feeding is mostly a concern of medicine and medical institutions of obstetrics and pediatrics and corresponding specialists such as obstetrician-gynecologist, neonatologist and pediatrician. Hence the issue of appropriateness of existence of such groups, their competence and relationship with medical personnel and forms of activity has to be considered From historical point of view, in Soviet health care accumulated very rich experience of effective cooperation of public activists of Russian Red Cross with public health bodies in implementation of preventive and health improving activities, including health education of population groups. The conclusion is made that to provide effective activities of voluntary mothers? Associations to support breast feeding their interaction is needed with medical personnel, the development of scientific-grounded programs of training of mothers-consultants and informational methodical and health education materials.

  5. The Feto-Maternal Outcome of Preeclampsia with Severe Features and Eclampsia in Abakaliki, South-East Nigeria

    PubMed Central

    Ozonu, Nelson Chukwudi; Ezeonu, Paul Olisaemeka; Lawani, Lucky Osaheni; Obuna, Johnson Akuma; Onwe, Emeka Ogah

    2016-01-01

    Introduction Preeclampsia with severe features and eclampsia has remained a serious challenge in tropical obstetric practice. It is a major cause of maternal and perinatal morbidity and mortality in Nigeria. Aim This study was aimed at determining the prevalence, the risk factors and feto-maternal outcome of preeclampsia with severe features and eclampsia in Abakaliki. Materials and Methods This was a 5-year retrospective case-control study of preeclampsia with severe features and eclampsia at the Federal Teaching Hospital, Abakaliki. Case notes of preeclampsia with severe features and eclampsia between January 2008 and December, 2012 were retrieved. Similarly, the case file of next parturient that did not have any medical disease was included in the study. The cases and controls were selected at the ratio of 1:1. The data assessed were information on maternal age, parity, booking status, diagnosis, mode of delivery, complications, maternal and perinatal outcomes. Results A total of 13,750 deliveries were recorded within the study period. The prevalence of preeclampsia with severe features and eclampsia were 136(0.99%) and 104(0.76%) respectively. Preeclampsia with severe features and eclampsia was more common among adolescents, rural dwellers, poorly educated, unemployed, unbooked and nulliparous women. It was more associated with preterm delivery, caesarean section, low birth weight babies, maternal and perinatal mortality. Conclusion Preeclampsia with severe features and eclampsia is common among the adolescents, unbooked, rural, and low socio-economic group of women in this study. It has also contributed to high maternal and perinatal morbidity and mortality. There is need for policy makers to formulate policies toward female education, women empowerment and provision of social amenities in rural areas. These policies may reverse the current ugly trend in this environment. PMID:27790527

  6. Hospitals look to hospitality service firms to meet TQM goals.

    PubMed

    Hard, R

    1992-05-20

    Hospitals that hire contract service firms to manage one or all aspects of their hospitality service departments increasingly expect those firms to help meet total quality management goals as well as offer the more traditional cost reduction, quality improvement and specialized expertise, finds the 1992 Hospital Contract Services Survey conducted by Hospitals.

  7. 3. Hospital Point, general view toward Portsmouth Naval Hospital Building ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    3. Hospital Point, general view toward Portsmouth Naval Hospital Building showing cannon (at left) and Saunders Monument (at right in distance), view to southwest - Portsmouth Naval Hospital, Bounded by Elizabeth River, Crawford Street, Portsmouth General Hospital, Parkview Avenue, & Scotts Creek, Portsmouth, Portsmouth, VA

  8. Maternal and congenital syphilis in Bolivia, 1996: prevalence and risk factors.

    PubMed Central

    Southwick, K. L.; Blanco, S.; Santander, A.; Estenssoro, M.; Torrico, F.; Seoane, G.; Brady, W.; Fears, M.; Lewis, J.; Pope, V.; Guarner, J.; Levine, W. C.

    2001-01-01

    OBJECTIVES: The present study was carried out in seven maternity hospitals to determine the prevalence of maternal syphilis at the time of delivery and the associated risk factors, to conduct a pilot project of rapid syphilis testing in hospital laboratories, to assure the quality of syphilis testing, and to determine the rate of congenital syphilis in infants born to women with syphilis at the time of delivery--all of which would provide baseline data for a national prevention programme in Bolivia. METHODS: All women delivering either live-born or stillborn infants in the seven participating hospitals in and around La Paz, El Alto, and Cochabamba between June and November 1996 were eligible for enrolment in the study. FINDINGS: A total of 61 out of 1428 mothers (4.3%) of live-born infants and 11 out of 43 mothers (26%) of stillborn infants were found to have syphilis at delivery. Multivariate analysis showed that women with live-born infants who had less than secondary-level education, who did not watch television during the week before delivery (this was used as an indicator of socioeconomic status), who had a previous history of syphilis, or who had more than one partner during the pregnancy were at increased risk of syphilis. While 76% of the study population had received prenatal care, only 17% had syphilis testing carried out during the pregnancy; 91% of serum samples that were reactive to rapid plasma reagin (RPR) tests were also reactive to fluorescent treponemal antibody-absorption (FTA-ABS) testing. There was 96% agreement between the results from local hospital laboratories and national reference laboratories in their testing of RPR reactivity of serum samples. Congenital syphilis infection was confirmed by laboratory tests in 15% of 66 infants born to women with positive RPR and FTA-ABS testing. CONCLUSION: These results indicate that a congenital syphilis prevention programme in Bolivia could substantially reduce adverse infant outcomes due to this

  9. The impact of hospital discharge on inappropriate hospital stay.

    PubMed

    Panis, Lambert J G G; Verheggen, Frank W S M; Pop, Peter; Prins, Martin H

    2004-01-01

    Appropriate hospital stay should be effective, efficient and tailored to patient needs. Previous studies have found that on average 20 per cent of hospital stay is inappropriate. Within obstetrics, inappropriate hospital stay consists mostly of delays in hospital discharge. The specific goals of this study were to reduce inappropriate hospital stay by fine-tuning patient logistics, increasing efficiency and providing more comfortable surroundings. New policies using strict discharge criteria were implemented. Total inappropriate hospital stay decreased from 13.3 to 7.2 per cent. The delay in discharge procedures halved. P-charts showed a decrease in inappropriate hospital stay, indicating the current process to be stable. Concludes that a significant reduction in inappropriate hospital stay was found following the implementation of innovative hospital discharge policies, indicating greater efficiency and accessibility of hospital services.

  10. Maternal intake of vitamins A, E and K in pregnancy and child allergic disease: a longitudinal study from the Danish National Birth Cohort.

    PubMed

    Maslova, Ekaterina; Hansen, Susanne; Strøm, Marin; Halldorsson, Thorhallur I; Olsen, Sjurdur F

    2014-03-28

    Fat-soluble vitamins A, E and K have been shown to play roles in immunity and inflammation, but studies on child allergic disease have been few and inconsistent. The aim of the present study was to examine the relationship between maternal intake of vitamins A, E and K in mid-pregnancy and child asthma and allergic rhinitis. We used data on 44 594 mother-child pairs from the Danish National Birth Cohort. Maternal intake of fat-soluble vitamins was calculated based on the information from a validated FFQ completed in mid-pregnancy. At 18 months, interviews with the mothers were conducted to evaluate doctor-diagnosed child asthma. At age 7 years, we assessed child asthma and allergic rhinitis using questions from the International Study of Asthma and Allergies in Childhood questionnaire and by national registries on hospital contacts and medication use. Current asthma was defined as asthma diagnosis and wheeze in the past 12 months by maternal report. We calculated multivariable risk ratios and 95 % CI by comparing the highest v. lowest quintile (Q) of maternal vitamin A, E and K intake in relation to child allergic disease outcomes. Maternal total vitamin K intake was directly associated with ever admitted asthma (Q5 v. Q1: 1·23, 95 % CI 1·01, 1·50) and current asthma at 7 years (Q5 v. Q1: 1·30, 95 % CI 0·99, 1·70). Weak inverse associations were present for maternal vitamin A and E intake during pregnancy with child allergic rhinitis. Maternal vitamin K intake during pregnancy may increase the risk of child asthma, and should be explored further on a mechanistic level. Conversely, maternal vitamin A and E intake may protect against child allergic rhinitis.

  11. Maternal positioning to correct occipito-posterior fetal position in labour: a randomised controlled trial

    PubMed Central

    2014-01-01

    Background The occipito-posterior (OP) fetal head position during the first stage of labour occurs in 10-34% of cephalic presentations. Most will spontaneous rotate in anterior position before delivery, but 5-8% of all births will persist in OP position for the third stage of labour. Previous observations have shown that this can lead to an increase of complications, such as an abnormally long labour, maternal and fetal exhaustion, instrumental delivery, severe perineal tears, and emergency caesarean section. Usual care in the case of diagnosis of OP position is an expectant management. However, maternal postural techniques have been reported to promote the anterior position of the fetal head for delivery. A Cochrane review reported that these maternal positions are well accepted by women and reduce back pain. However, the low sample size of included studies did not allow concluding on their efficacy on delivery outcomes, particularly those related to persistent OP position. Our objective is to evaluate the efficacy of maternal position in the management of OP position during the first stage of labour. Methods/design A randomised clinical trial is ongoing in the maternity unit of the Geneva University Hospitals, Geneva, Switzerland. The unit is the largest in Switzerland with 4,000 births/year. The trial will involve 438 women with a fetus in OP position, confirmed by sonography, during the first stage of the labour. The main outcome measure is the position of the fetal head, diagnosed by ultrasound one hour after randomisation. Discussion It is important to evaluate the efficacy of maternal position to correct fetal OP position during the first stage of the labour. Although these positions seem to be well accepted by women and appear easy to implement in the delivery room, the sample size of the last randomised clinical trial published in 2005 to evaluate this intervention had insufficient power to demonstrate clear evidence of effectiveness. If the technique

  12. Maternal work conditions and child development

    PubMed Central

    Felfe, Christina; Hsin, Amy

    2016-01-01

    How do maternal work conditions, such as psychological stress and physical hazards, affect children's development? Combining data from the Child Development Supplement of the Panel Study of Income Dynamics and the Occupational Information Network allows us to shed some light on this question. We employ various techniques including OLS with extensive controls, a value added approach and individual fixed effects in order to address potential endogeneity problems. Our results reveal that mothers’ exposure to work-related hazards negatively affects children's cognitive development and to work-related stress negatively affects children's behavioral development. While maternal time investments play a small but significant role in mediating these negative associations, paternal time investments neither reinforce nor compensate these associations. PMID:27642208

  13. Breast-feeding and maternal cardiovascular function.

    PubMed

    Mezzacappa, E S; Kelsey, R M; Myers, M M; Katkin, E S

    2001-11-01

    Two studies examined the effects of breast-feeding on maternal cardiovascular function. In the first experiment, groups of breast-feeding and bottle-feeding women were compared on preejection period (PEP), heart rate (HR), cardiac output (CO), and total peripheral resistance (TPR) recorded for 1-min periods before and during standard laboratory stressors. Compared with bottle-feeders, breast-feeders had higher CO throughout the session, and greater decreases in CO and increases in TPR during cold pressor. In the second experiment, HR and blood pressure (BP) were compared before and after one breast-feeding and one bottle-feeding session in a within-subjects design. Both feeding methods increased BP but decreased HR, and systolic BP was higher for the breast-feeding than the bottle-feeding condition. Both studies support the notion that breast-feeding alters maternal cardiovascular function, possibly through the actions of oxytocin.

  14. Maternal Regulation of Estrogen Receptor α Methylation

    PubMed Central

    Champagne,