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Co-designed health initiatives are gaining popularity in Aotearoa (New Zealand). However, emerging research identifies potential pitfalls for Indigenous populations, particularly Māori (Indigenous Peoples of Aotearoa), when Kaupapa Māori principles are ignored. Using the Indigenous He Pikinga Waiora Implementation (HPW) framework as a guide, this paper provides an autoethnographic reflective account of the co-design process that led to the development and implementation of the Whirihia holistic assessment tool for the Kaupapa Māori antenatal wānanga (workshop) Whirihia Te Korowai Aroha. The co-design process resulted in a culturally appropriate and responsive holistic assessment tool that provided a quality health needs assessment pathway for māmā hapū (pregnant women) and their whānau (family). This reflective account provides examples of key considerations that align to the HPW framework in the hope that it will afford some guidance for fellow emerging researchers who wish to undertake ethical co-designed health research with Māori (and non-Māori) communities and organisations. Glossary of Māori words: Aotearoa: New Zealand; hapū: sub-tribes; hapūtanga: pregnancy; hui: meeting; ipu: clay pot; iwi: tribe; Kaupapa Māori: Māori ideology incorporating the knowledge, skills, attitudes and values of Māori society; māmā: mothers; māmā hapū: pregnant women; Māori: Indigenous people of Aotearoa; Pākehā: non-Māori (most often New Zealand European); pēpi: infant; pono: true, valid, honest, genuine; pōwhiri: welcome ceremony; te ao Māori: Māori world view; te reo Māori: Māori language; tika: correct, accurate, appropriate; tikanga: values and beliefs; wahakura: woven flax basket that can be used in the parental bed; waiata: song; wānanga: workshop; whakawhānau: birth; whakawhanaungatanga: relationship/connections; whānau family; whenua: afterbirth; land. [ABSTRACT FROM AUTHOR]

AbstractIn Oman, the risk of maternal depression is not routinely screened for during pregnancy or after childbirth. This study aimed therefore to explore the prevalence of and the association between the risk of antenatal and postnatal depression among Omani mothers, as well as the sociodemographic characteristics of women with increased risk of antenatal depression. A longitudinal study was conducted among 263 Omani pregnant women who were screened for risk of antenatal and postnatal depression, using the Edinburg Postnatal Depression Scale (EPDS). A considerable rate of women had an increased risk of antenatal depression (22.4%), which slightly increased after childbirth. The majority of mothers who had increased risk of depression were housewives (61.0%), had low monthly income (62.7%), had higher education (54.2%), were living in simple family construction (55.9%), were physically inactive (86.4%), and were not using contraception before the current pregnancy (55.9%). Increased risk of antenatal depression was significantly and positively associated with risk of postnatal depression (P < 0.001). The findings of this study highlight the urgent need for standardization of depression screening of all pregnant women in the Sultanate. It also calls for a population-based study to investigate the prevalence of depression in pregnant women and the first year following childbirth. [ABSTRACT FROM AUTHOR]

Medical imaging in pregnancy (antenatal imaging) is routine. However, the effect of seeing fetal images on the parent–fetal relationship is not well understood, particularly for fathers or partners, or when using advanced imaging technologies. This review aimed to explore how parent experience and prenatal attachment is impacted by antenatal imaging. Database searches were performed between September 2020 and April 2021 Inclusion criteria were English language primary research studies published since 2000, describing or reporting measures of attachment after antenatal imaging in expectant parents. The Pillar Integration Process was used for integrative synthesis. Twenty-three studies were included. Six pillar themes were developed: 1) the scan experience begins before the scan appointment; 2) the scan as a pregnancy ritual; 3) feeling actively involved in the scan; 4) parents' priorities for knowledge and understanding of the scan change during pregnancy; 5) the importance of the parent–sonographer partnership during scanning; and 6) scans help to create a social identity for the unborn baby. Antenatal imaging can enhance prenatal attachment. Parents value working collaboratively with sonographers to be actively involved in the experience. Sonographers can help facilitate attachment by delivering parent-centred care tailored to parents' emotional and knowledge needs. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Women in the postpartum period come under multi-level pressure to return to pre-pregnancy body shape and size. This pressure can lead to reduced body image satisfaction, self-esteem, and mood. In this systematic review we explored the influences and outcomes of body dissatisfaction during the postpartum period.Four databases were searched using keywords: postpart* OR postnatal OR peripart* OR ‘new mother’ OR ‘breast feed*’ AND ‘body image’ OR ‘body dissatisf*’ OR ‘body satisf*’ OR ‘body attitude’ OR ‘body shape’.The influences and outcomes of body image dis/satisfaction in the postpartum period from 55 international studies were found to align within four of the five factors of the socioecological model. Intrapersonal factors: weight and body shape concerns, mental health and stressors, attitudes and behaviours, and protective coping skills and interventions. Interpersonal factors: social support (partner, family, and friends) and sexual functioning. Institutional factors: experiences with the healthcare system and returning to work. Societal factors: culture and ethnicity, media influences and social norms such as the thin ideal.A focus on intrapersonal factors alone is insufficient to understand women’s experiences of body dis/satisfaction during the postpartum period. This suggests a need for better education and policy practices in pre-natal and postpartum care directed at body image and education to dispel societal norms such as the thin ideal. Doing so shifts the focus to include interpersonal, institutional, and societal influences alongside intrapersonal experiences. Research is needed to explore the utility and efficacy of broader approaches for women during this vulnerable life period. [ABSTRACT FROM AUTHOR]

To report on the rates of misinterpretation, confusion, and attribution of the anhedonia question in the PHQ-4 and Whooley questions by pregnant women. The NICE Perinatal Mental Health guidelines recommend the use of the anhedonia question for depression screening, yet evidence suggests it may be misinterpreted or not be related to mood. Women attending a public hospital's antenatal clinic, communicating in English as their language of choice, completed either the PHQ-4 or the Whooley questions. Following comments to general evaluation questions in the first sample, women were asked a targeted anhedonia interpretation question, an anhedonia attribution question, and an ease of understanding question (PHQ-4: N = 37–119; Whooley: N = 31–100). Across the PHQ-4 and Whooley formats around 15% of participants completely misinterpreted the anhedonia question, with a further 17% finding it difficult to understand. Around two-thirds of those experiencing the symptom said it was due to normal symptoms of pregnancy, and not related to their mood. In the PHQ-4 format, which included all three questions, 48% of the women had one or more of these issues. While CALD women appear to have greater difficulty understanding the question, there were no meaningful associations with whether English was spoken at home. Almost half of the women incorrectly interpreted the anhedonia question, or said that it was confusing, or that it did not reflect low mood. These data indicate that the anhedonia question should not be used in screening women in the antenatal period, whether in the PHQ-4 or Whooley formats. [ABSTRACT FROM AUTHOR]

Antenatal fetal heart rate (FHR) monitoring is currently limited by hospital-based accessibility as well as the availability of relevant equipment and expertise required to position device electrodes. Ambulatory FHR monitoring in the form of noninvasive fetal electrocardiography (NIFECG) is currently an area of research interest, particularly during the era of the COVID-19 pandemic, and the potential to improve maternity care and reduce hospital attendances need to be evaluated. To assess the feasibility, acceptability, and signal success of ambulatory NIFECG monitoring and identify research areas required to facilitate clinical utilization of this method of monitoring. Medline, EMBASE, and PubMed databases were searched from January 2005 to April 2021 using terms relevant to antenatal ambulatory or home NIFECG. The search was compliant with PRISMA guidelines, and was registered with the PROSPERO database (CRD42020195809). All studies reporting the clinical utilization of NIFECG inclusive of its use in the ambulatory setting performed in the antenatal period, human studies, and those in the English language were included. Those reporting novel technological methods and electrophysiological algorithms, satisfaction surveys, intrapartum studies, case reports and reviews, and animal studies were excluded. Study screening and data extraction were conducted in duplicate. Risk of bias was appraised using the Modified Downs and Black tool. Due to the heterogeneity of the reported findings, a meta-analysis was not feasible. The search identified 193 citations, where 11 studies were deemed eligible for inclusion. All studies used a single NIFECG system with a duration of monitoring ranging from 5.6 to 21.4 h. Predefined signal acceptance threshold ranged from 34.0-80.0%. Signal success in the study populations was 48.6–95.0% and was not affected by maternal BMI. Good signals were achieved in the 2nd trimester, but less so in the early 3rd trimester. NIFECG was a well-accepted method of FHR monitoring, with up to 90.0% of women's satisfaction levels when worn during outpatient induction of labor. Placement of the acquisition device needed input from healthcare staff in every report. Although there is evidence for the clinical feasibility of ambulatory NIFECG, the disparity in the literature limits the ability to draw firm conclusions. Further studies to establish repeatability and device validity, whilst developing standardized FHR parameters and set evidence-based standards for signal success for NIFECG are required to ascertain the clinical benefit and potential limitations of ambulatory outpatient FHR monitoring. [ABSTRACT FROM AUTHOR]

Summary of recommendations Corticosteroids should be administered to women at a gestational age between 24+0 and 33+6 weeks, when preterm birth is anticipated in the next seven days, as these have been consistently shown to reduce neonatal mortality and morbidity. (Strong-quality evidence; strong recommendation). In selected cases, extension of this period up to 34+6 weeks may be considered (Expert opinion). Optimal benefits are found in infants delivered within 7 days of corticosteroid administration. Even a single-dose administration should be given to women with imminent preterm birth, as this is likely to improve neurodevelopmental outcome (Moderate-quality evidence; conditional recommendation). Either betamethasone (12 mg administered intramuscularly twice, 24-hours apart) or dexamethasone (6 mg administered intramuscularly in four doses, 12-hours apart, or 12 mg administered intramuscularly twice, 24-hours apart), may be used (Moderate-quality evidence; Strong recommendation). Administration of two "all" doses is named a "course of corticosteroids". Administration between 22+0 and 23+6 weeks should be considered when preterm birth is anticipated in the next seven days and active newborn life-support is indicated, taking into account parental wishes. Clear survival benefit has been observed in these cases, but the impact on short-term neurological and respiratory function, as well as long-term neurodevelopmental outcome is still unclear (Low/moderate-quality evidence; Weak recommendation). Administration between 34 + 0 and 34 + 6 weeks should only be offered to a few selected cases (Expert opinion). Administration between 35+0 and 36+6 weeks should be restricted to prospective randomized trials. Current evidence suggests that although corticosteroids reduce the incidence of transient tachypnea of the newborn, they do not affect the incidence of respiratory distress syndrome, and they increase neonatal hypoglycemia. Long-term safety data are lacking (Moderate quality evidence; Conditional recommendation). Administration in pregnancies beyond 37+0 weeks is not indicated, even for scheduled cesarean delivery, as current evidence does not suggest benefit and the long-term effects remain unknown (Low-quality evidence; Conditional recommendation). Administration should be given in twin pregnancies, with the same indication and doses as for singletons. However, existing evidence suggests that it should be reserved for pregnancies at high-risk of delivering within a 7-day interval (Low-quality evidence; Conditional recommendation). Maternal diabetes mellitus is not a contraindication to the use of antenatal corticosteroids (Moderate quality evidence; Strong recommendation). A single repeat course of corticosteroids can be considered in pregnancies at less than 34+0 weeks gestation, if the previous course was completed more than seven days earlier, and there is a renewed risk of imminent delivery (Low-quality evidence; Conditional recommendation). [ABSTRACT FROM AUTHOR]

There is limited access to life-saving antenatal ultrasound in rural and low-resource settings largely due to shortages in skilled staff. Studies have shown healthcare practitioners can be upskilled in PoCUS through focused training, offering a viable solution to this deficit. However, standards for training and competency assessment are unclear and regulation surrounding practice is lacking. We aimed to review published literature examining antenatal PoCUS training programs, comparing teaching approaches and study methodologies. A search of electronic databases EMBASE, MEDLINE and Google Scholar was conducted. Original research articles evaluating antenatal PoCUS training of healthcare professionals worldwide were identified for analysis. Articles with limited detail on the PoCUS training intervention and those describing comprehensive diagnostic training programs were excluded. Evaluations were compared against the Kirkpatrick Evaluation Framework (KEF). Twenty-seven studies were included from an initial search result of 484 articles. There was considerable heterogeneity between the PoCUS training programs described. Course duration ranged from 3 hours to 2 years, with 11 of the 27 studies delivering obstetric-exclusive content. 44% trained multidisciplinary groups of health professionals. Long-term follow-up training and skills assessments were lacking in over half of the reviewed studies. Study quality and reporting detail varied, but overall beneficial outcomes were reported with 3/4s of the studies reaching upper KEF levels 3 and 4. PoCUS performed by upskilled healthcare professionals offers an attractive solution to the problem of inequitable access to antenatal ultrasound. A review of available literature highlighted a paucity of comparable high-quality studies needed to establish a stronger evidence base for antenatal PoCUS, and a need to standardise training and competency assessment. This review may inform educators, researchers and policy-makers on existing training formats and methodologies to assist in establishing best practice antenatal PoCUS training methods for safe service delivery by remote healthcare professionals. [ABSTRACT FROM AUTHOR]

In this study, we aimed to assess the determining role of foetal fibronectin (FFN) and plasminogen activator inhibitor type (PAI-1) levels in the antenatal prediction of placenta accreta spectrum in cases with risk factors for placenta accreta spectrum. Singleton live pregnancies with placenta previa or low-lying placenta within 32–34 weeks of gestation were included in the study. The cases were divided into two groups after delivery as those with PAS and those with normal placentation. 54 cases diagnosed with placenta previa or low-lying placenta were included in the study. 17 of the cases underwent peripartum hysterectomy due to placenta accreta spectrum. 37 cases with normal placentation underwent caesarean delivery. Foetal fibronectin (p:.03) and PAI-1 (p:.02) levels were determined to be significantly different between cases with placenta accreta spectrum and cases with normal placentation. AUC for foetal FFN was calculated to be 0.69, while the AUC for, PAI-1was 0.66. Results for both FFN and PAI-1 were not found useful enough for the diagnosis of PAS. What is already known on this subject? We lack biomarkers which can identify placenta accreta spectrum. What do the results of this study add? Maternal plasma levels of FFN and PAI-1 significantly altered in PAS What are the implications of these findings for clinical practice and/or future research? If multiple of median values of FFN and PAI-1 levels in maternal blood are determined in future studies, it can be used in the antenatal diagnosis of PAS cases. [ABSTRACT FROM AUTHOR]

To develop and evaluate Baby CHAT, a single-session psychoeducational intervention for expectant parents. Baby CHAT aims to improve parental reflective functioning (RF) and bonding. The early years of a child's life, including pregnancy, are vital for healthy physical and emotional development. Caregivers who provide responsive parenting, enhanced through strong bonds and good RF, can aid healthy development.. However, limited interventions exist to enhance RF and bonding in expectant parents. Feasibility of Baby CHAT was assessed using a mixed methods randomised controlled trial design. It evaluated uptake and retention of participants, effect size calculations, and acceptability and satisfaction with Baby CHAT. Participants (N = 20) were aged 30–39 years (n = 17) in their third trimester of pregnancy (n = 12). Nine males and 11 females were recruited. Content analysis of qualitative feedback after the intervention resulted in four themes; positive group aspects, group improvements, 4D scan footage and relating content to my baby. Baby CHAT can help expectant parents think about their baby as a separate person and has potential to improve prenatal RF and bonding. However, further research is required to assess the effectiveness of Baby CHAT to improve bonding and RF. [ABSTRACT FROM AUTHOR]

Protecting an unborn baby from abuse and neglect presents particular challenges for professionals due to the uncertainties about appraising future harm and functioning of family relationships. This systematic narrative review synthesises studies of professional decision making by health and social care professionals regarding child protection of an unborn baby. Five bibliographic databases (ASSIA, CINAHL Plus, Ovid MEDLINE, PsycINFO, Social Care Online) were searched using an explicit and robust search; papers identified as relevant were appraised for quality and combined using a narrative synthesis based on the main themes in the papers. Ten papers met the inclusion criteria, including qualitative studies, surveys and randomised trials of the effectiveness of decision support tools. The papers identified the following case risk factors relating to risks to an unborn baby: alcohol abuse; ante-natal care; previous children in care; domestic violence; drug abuse; lack of education; employment issues; unrealistic expectations of the baby; housing issues; learning disability; feelings about pregnancy; low socio-economic status; mental illness; mother's childhood experiences; lack of parenting capacity; physical disability. There were several papers on developing risk assessment tools. A few papers focused on risk assessment and decision processes including engagement with pregnant women. There was some discussion of psychosocial supports for risks in pregnancy. There is useful published material on the range of risk factors, and more limited material on the development of assessment tools and on decision processes. The psychosocial supports that might be provided to the pregnant woman as decision options is an area for future research. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether evaluations of antenatal umbilical coiling index (aUCI) could predict postnatal umbilical coiling index (UCI) (pUCI) in people with gestational diabetes mellitus (GDM) compared with normal pregnancy independent of maternal demographic and reproductive characteristics.Method: In this prospective study, 105 women with normal pregnancy, and 117 women with pregnancy complicated by GDM were recruited. Ultrasound scan of umbilical cord was performed at 18-23 and 37-41 weeks of gestation (WG). Evaluation of pUCI, as the reference standard, was performed within 24 hours after delivery.Findings: There was no significant relationship between aUCI and maternal demographic and reproductive characteristics. The mean for pUCI was 0.21 ± 0.12 in the GDM group, and 0.21 ± 0.09 in the normal pregnancy (p = .61). In the GDM group, a significant association was found between aUCI and pUCI categories (p = .004). The area under curve (AUC) was less than 0.5 for hypocoiling in both groups. For hypercoiling it was 0.84 ± 0.04 in the GDM group and 0.75 ± 0.06 in the normal pregnancy group (18-23 WG). In the GDM group the cutoff points that predict hypercoiling were 0.28 (18-23WG), and 0.21 (37-41WG). These were 0.35 (18-23WG), and 0.33 (37-41WG) in the normal pregnancy group. Diagnostic accuracy analysis revealed that in the GDM group, the sensitivity and specificity of hypercoiling for prediction of pUCI were 0.94 and 0.70 respectively at 18-23 WG.Conclusions: Antenatal hypercoiling at the second trimester of pregnancy strongly predict postnatal hypercoiling in pregnancies complicated by GDM. [ABSTRACT FROM AUTHOR]

Breastfeeding rates in the UK remain persistently low, with a rapid fall off during the first 6–8 weeks. The work of healthcare and public health practitioners impacts on mothers' experiences of infant feeding. Support, promotion and protection of breastfeeding are a national priority. Semi-structured qualitative interviews were undertaken with mothers who had experience of breastfeeding. Participants were engaged with a local Children's Centre (indicating engagement with public health provision) and their babies were up to 6-month old (to increase recall of early experiences). Twenty-four participants were recruited and interviews thematically analysed. Mothers identified matters significant in relation to public health provision for breastfeeding, including three stages of time of significance for breastfeeding impact. These interlinked critical stages impact on a mother's experiences. Joined up public health practice providing breastfeeding support and information before birth, around the time of the birth, and once home is significant in mother's accounts. Breastfeeding support, in both healthcare and public health contexts, needs to be highly attuned to different stages in the experiences of mothers. Breastfeeding continuation is influenced by support experienced antenatally, perinatally, and in early weeks. To enhance the initiation and retention of breastfeeding, public health practice must pay attention to these stages. Breastfeeding support needs to begin prior to birth and be given throughout the postnatal period and beyond. [ABSTRACT FROM AUTHOR]

In this article we contribute to critical risk approaches to studying pregnancy and childbirth in the global South. Following Sarah Rudrum's work, our approach focusses on sociocultural inequalities amid the regulation of individuals. We draw on data from our Foucauldian-inspired ethnography of two antenatal clinics in an under-resourced area of South Africa to illustrate how multi-layered risk management operates in these spaces. These data were collected over a period of six months in the form of semi-structured interviews, observations of consultations and waiting room interactions, documents used in the clinic, and posters appearing on the clinic walls. Our findings show how a scientific-bureaucratic approach to pregnancy risk management, as encoded in international, national and institutional guidelines, is well known, highly visible, and practised through surveillance and reporting mechanisms in clinics. This approach incites healthcare practitioners to achieve particular performance standards and to monitor their professional agency. Managing pregnancy risk thus entails regulating the healthcare practitioners themselves. In implementing approved pregnancy risk management strategies in an over-subscribed and under-resourced public healthcare setting, however, healthcare practitioners face potential risk to their professional reputation and integrity. In managing this risk, they resist the scientific-bureaucratic approach through: depicting themselves as victims of unfair institutional arrangements or unreasonable patients; instituting street-level bureaucracy to control access to the clinics; and controlling patients' actions in authoritarian ways. Our research shows that without engagement with the on-the-ground realities of the antenatal clinic in resource-poor environments, a scientific-bureaucratic approach to pregnancy risk management is inevitably limited in its effectiveness. [ABSTRACT FROM AUTHOR]

Objective: Pregnancy‐related anxiety has been identified as a distinct anxiety associated with adverse outcomes. This partial replication of the seminal study which demonstrated pregnancy‐related anxiety and measures of state/trait anxiety and depression shared little variance, provides additional empirical support for this anxiety type. In addition, the Perinatal Anxiety Screening Scale (PASS) was examined together with the contributing role of neuroticism. Method: Pregnant women were recruited online (n = 202, Mage = 25.0, SD = 4.9), and completed the Pregnancy‐Related Anxiety Questionnaire‐Revised (PRAQ‐R2), PASS, Edinburgh Depression Scale, State Trait Anxiety Inventory, and the International Personality Item Pool Neuroticism scale. Results: There were small to very large correlations between all main variables. Large correlations between the predictors (anxiety, depression, neuroticism) indicated multicollinearity resulting in the exclusion of neuroticism. Multiple regression confirmed that the PRAQ‐R2 shared little variance with measures of anxiety and depression. By contrast, the PASS shared large proportions of variance with measures of anxiety. Conclusions: The findings in relation to the PRAQ‐R2 support the proposition that pregnancy‐related anxiety is a distinct anxiety type. However, given the significant proportion of variance the PASS shares with anxiety/depression, the PASS is better suited for screening anxiety disorder symptomology but less suitable as a measure of pregnancy‐related anxiety. Limitations included a sample size that was not sufficient to enable stratification. Further, given that the PRAQ‐R2 assesses only some of the core pregnancy‐related anxieties, use of a more comprehensive scale of pregnancy‐related anxiety is needed for an accurate assessment. Clinical implications include the possibility that some women with elevated pregnancy‐related anxiety may be overlooked using existing measures. Given the reported prevalence and adverse outcomes, a psychometrically sound measure for pregnancy‐related anxiety may afford valuable intervention opportunities. [ABSTRACT FROM AUTHOR]

Objective: Pregnancy‐related anxiety has been identified as a distinct anxiety associated with adverse outcomes. This partial replication of the seminal study which demonstrated pregnancy‐related anxiety and measures of state/trait anxiety and depression shared little variance, provides additional empirical support for this anxiety type. In addition, the Perinatal Anxiety Screening Scale (PASS) was examined together with the contributing role of neuroticism. Method: Pregnant women were recruited online (n = 202, Mage = 25.0, SD = 4.9), and completed the Pregnancy‐Related Anxiety Questionnaire‐Revised (PRAQ‐R2), PASS, Edinburgh Depression Scale, State Trait Anxiety Inventory, and the International Personality Item Pool Neuroticism scale. Results: There were small to very large correlations between all main variables. Large correlations between the predictors (anxiety, depression, neuroticism) indicated multicollinearity resulting in the exclusion of neuroticism. Multiple regression confirmed that the PRAQ‐R2 shared little variance with measures of anxiety and depression. By contrast, the PASS shared large proportions of variance with measures of anxiety. Conclusions: The findings in relation to the PRAQ‐R2 support the proposition that pregnancy‐related anxiety is a distinct anxiety type. However, given the significant proportion of variance the PASS shares with anxiety/depression, the PASS is better suited for screening anxiety disorder symptomology but less suitable as a measure of pregnancy‐related anxiety. Limitations included a sample size that was not sufficient to enable stratification. Further, given that the PRAQ‐R2 assesses only some of the core pregnancy‐related anxieties, use of a more comprehensive scale of pregnancy‐related anxiety is needed for an accurate assessment. Clinical implications include the possibility that some women with elevated pregnancy‐related anxiety may be overlooked using existing measures. Given the reported prevalence and adverse outcomes, a psychometrically sound measure for pregnancy‐related anxiety may afford valuable intervention opportunities. [ABSTRACT FROM AUTHOR]

Purpose: Bisphenol A is a chemical compound related to adverse maternal and neonatal outcomes. The purpose of the present systematic review is to summarize the current knowledge in the field. Materials and methods: We systematically searched the Medline (1966-2017), Scopus (2004-2017), Clinicaltrials.gov (2008-2017), Cochrane Central Register of Controlled Trials CENTRAL (1999-2017) databases. Results: Thirty-five studies were included in the present systematic review. According to our findings, BPA has a direct negative impact on maternal, fetal, and neonatal outcomes, including birthweight, rates of preterm birth, developmental defects, and recurrent miscarriage. Data in the field of preeclampsia and gestational diabetes mellitus remain inconclusive because current research is very limited. Conclusions: BPA exposure during pregnancy can result in significant antenatal pathology; hence, occupational exposure should be at least discouraged during this period. However, cross-sectional studies in the field that would assess the levels of exposure at timely intervals are still lacking, therefore, the actual impact of BPA remains unclear. [ABSTRACT FROM AUTHOR]

Objective:To assess the relation between antenatal mother–infant bonding scores and maternal reports of infant crying behaviour. Background:Crying is normal behaviour and it is important for parent–infant bonding. Even though bonding starts antenatally, the relation between antenatal bonding scores and infant crying behaviour has never been studied. Method:A secondary analysis was performed on data that were gathered in a large prospective study within our region. Bonding was assessed using an antenatal bonding questionnaire at 32 weeks gestational age. The crying behaviour of infants was assessed with three questions at six weeks postpartum. Crying was termed excessive (EC+) when mothers perceived the crying to be ‘every day’, ‘often’ or ‘very often’, and with ‘crying episodes lasting more than 30 minutes’; in other words, when mothers scored high on all three questions. The relation between bonding and crying was examined using a multiple logistic regression analysis, including adjustment for relevant variables, especially maternal depression as measured with the Edinburgh Depression Scale. Results:In total, 894 women were included of whom 47 reported EC+ infants (5.3%). Antenatal bonding scores were significantly related to the reporting of crying behaviour, even after adjustment for relevant variables (p= 0.02). Each extra point on the bonding scale reduced the EC+ risk with 14% (OR = 0.86, 95% CI [0.76–0.97]). Conclusion:Mothers with lower antenatal bonding scores were more likely to report an EC+ infant. Future research should further explore the concept of antenatal bonding, its relation with EC and risks associated with EC. [ABSTRACT FROM PUBLISHER]

This article suggests that transactional analysis can be an effective treatment approach for women suffering from mental health conditions and the emotional and life disturbances that may occur during the perinatal period. It offers a brief introduction to perinatal psychological distress followed by a description of the use of transactional analysis psychotherapy for this condition. The article outlines a new model for a research project that aims to ascertain women's views on the helpfulness of the treatment and to gain a better understanding of the stigma often associated with perinatal mental health issues. The author argues for the necessity of qualitative research to assess the efficacy of transactional-analysis-based treatment and to increase our knowledge about the change process in transactional analysis psychotherapy with this client population as well as to inform future transactional analysis treatment protocols. [ABSTRACT FROM AUTHOR]

Objective: To explore women’s experience of anxiety in pregnancy and views on the use of anxiety instruments in antenatal care. Background:Anxiety in pregnancy is associated with adverse birth outcomes, developmental and behavioural problems in infants and postnatal depression. Despite recommendations for routine psychological assessment in pregnancy, the optimal methods to identify anxiety in pregnancy have not been confirmed. Methods:A qualitative study using two focus group discussions was undertaken. Focus group one included women in a community setting and focus group two included women in a hospital clinic setting who had received additional support for anxiety in pregnancy. Participants were women who had given birth within the past nine months and considered themselves to have been anxious during their pregnancy. Results:Three main themes were identified using template analysis: sources of support, administration of anxiety instruments and the use of instruments to prompt discussion. Women stated that anxiety instruments could help them to identify their anxious feelings and prompt a discussion around those feelings. However, they expressed concerns surrounding the administration of anxiety instruments and questioned how useful they would be in helping women access help and support. Conclusions:The introduction of anxiety instruments in antenatal care may present an opportunity to discuss women’s emotional health and anxieties. Providing women with sufficient time to discuss their anxious feelings, identified by such instruments, could facilitate access to additional support. [ABSTRACT FROM AUTHOR]

Objective:The project aimed to test of the quality and acceptability of researcher-developed Short Message Service (SMS) messages designed to support fathers of infants aged 12 months or less.Background:The findings of previous studies suggest antenatal and postnatal depression among fathers’ impacts negatively on the health of family members.Method:Draft messages were first modified based on expert review. In a second phase, parents (mothersn = 56; fathersn = 46; unknownn = 4) were recruited through two early childhood parenting services to rate the clarity, usefulness and relevance of the 70 SMS messages using a paper-based survey. In a third phase, 15 fathers were recruited to receive texts at different times over three weeks.Results:Findings suggest that SMS items were easily understood by the majority of parents, with only 3% of responses indicating an item was ‘not easily understood’. Feedback from parents indicated that negatively rated SMS messages were considered as either poorly phrased, lacking enough information or as not offering sufficient support. The majority (88%) of the SMS items were also rated as ‘useful’ by the parents.Conclusion:Fathers’ responses indicated that receiving the texts at different times was acceptable and that message content was relevant to their fathering. The study has produced a set of brief text messages suitable and acceptable to new fathers and their partners. [ABSTRACT FROM PUBLISHER]

Objective: To report on clinical and socio-demographic factors of a one-year caseload of women attended by a statewide ambulance service in Australia, who presented during pregnancy, prior to the commencement of labor. Methods: Retrospective clinical data collected via in-field electronic patient care record (VACIS®) by paramedics during clinical management was provided by Ambulance Victoria. Cases were electronically extracted from the Ambulance Victoria Clinical Data Warehouse via comprehensive filtering followed by case review. Results: Over a 12-month period, paramedics were called to 2,098 women with pregnancy as a primary or non-primary clinical consideration. Women's ages ranged from 14 to 48 years. The majority were multigravidas (86%). There was a greater chance that ambulance services would be required during business hours than any other time of the day. Paramedics noted pregnant women required ambulance services for a range of primary presenting symptoms both obstetric (n = 1137) and non-obstetric (n = 961). Some women had pre-existing conditions including asthma, hypertension, and diabetes potentially complicating their pregnancies. Paramedics administered analgesia to one third of the women. Paired t-tests revealed significant improvement in the pain relief and overall vital signs of the women encountered. Less than half the women (n = 986, 47%) required interventions. Conclusions: This is a unique population wide analysis of ambulance service resource use exploring the clinical profile of pregnant women requiring ambulance services in one calendar year. To manage obstetric and non-obstetric complications in this population safely and effectively, paramedics require an understanding of the unique physiological adaptions during pregnancy. This study therefore has both educational and practice implications. [ABSTRACT FROM AUTHOR]

Objective: Previous studies demonstrated that magnesium sulfate is associated with better neurological outcome and decreased cerebral palsy rates in preterm newborns. The aim of this study is to assess the effects of antenatal magnesium sulfate on neurodevelopmental outcomes of preterm infants.Methods: Preterm newborns with a gestational age of <32 weeks whose mothers were diagnosed with preeclampsia were extracted from the hospital records and files retrospectively. The neurodevelopmental assessment was performed at 2 years of age by developmental pediatrician. The results of the infants exposed to antenatal magnesium sulfate were compared with the control group.Results: Between the years 2010 and 2012, 387 preterm babies were born to preeclamptic mothers. Fifty-nine (15.2%) of them were exposed to antenatal magnesium sulfate. The main clinical characteristics did not differ between the groups. On the other hand, cerebral palsy was significantly lower in preterm infants exposed to magnesium sulfate compared to the control group (3.3% and 12.2%, respectively, p = 0.004). On multinominal logistic regression analysis, magnesium sulfate was not an independent significant factor to reduce CP on its own.Conclusion: Antenatal magnesium sulfate can be used as a neuroprotective strategy especially for the prevention of cerebral palsy in preterm infants. Future studies should be designed to support the positive effect of antenatal magnesium sulfate on neurologic development. [ABSTRACT FROM AUTHOR]

Background: The prevalence of HIV among antenatal clients in South Africa has remained at a very high rate of about 29% despite substantial decline in several sub-Saharan countries. There is a paucity of data on risk factors for incident HIV infection among antenatal mothers and women within the reproductive age bracket in local settings in the Eastern Cape, South Africa. Objective: To establish the risk factors for incident HIV infection among antenatal clients aged 18-49 years attending public antenatal clinics in rural Eastern Cape, South Africa. Design: This was an unmatched case-control study carried out in public health antenatal clinics of King Sabata District Municipality between January and March 2014. The cases comprised 100 clients with recent HIV infection; the controls were 200 HIV-negative antenatal clients. Socio-demographic, sexual, and behavioral data were collected using interviewer-administered questionnaires adapted from the standard DHS5 women's questionnaire. Multivariate logistic regression models were used to identify the independent risk factors for HIV infection. A p < 0.05 was considered statistically significant. Results: The independent risk factors for incident HIV infection were economic dependence on the partner, having older male partners especially among women aged ≤ 20 years, and sex under the influence of alcohol. Conclusions: Therefore, effective prevention of HIV among antenatal mothers in KSDM must target the improvement of the economic status of women, thereby reducing economic dependence on their sexual partners; address the prevalent phenomenon of cross-generation sex among women aged <20 years; and regulate the brewing, marketing, and consumption of alcohol. [ABSTRACT FROM AUTHOR]

Objective:The aim of this study was to examine whether depressive symptoms predict anxiety and stress or whether anxiety and stress precede depressive symptoms in fathers during the antenatal period.Background:The findings of previous studies suggest that there is an association between paternal depression, anxiety and stress during the antenatal period. However, the temporal inter-relationship between these variables has yet to be investigated.Method:Data were collected from 150 expectant couples at approximately 18, 25 and 33 weeks’ gestation.Results:After accounting for the relative stability of depression, anxiety and stress over time, for men higher levels of anxiety earlier in pregnancy predicted higher levels of depression and stress in middle pregnancy, which predicted higher depression during late pregnancy. A similar relationship remained after partialling out the effects of partner’s depression, perceived social support and sleep quality. Further analyses also revealed significant differences in the manifestation of distress symptoms between men and women, but not between first-time and non-first-time fathers.Conclusion:Our findings indicated a possible inter-relationship between depression, anxiety and stress for men antenatally. Our findings also showed that men who reported elevated depression, anxiety and stress earlier in the antenatal period also reported elevated symptomology at later time points. Finally, the current findings revealed that antenatal paternal stress may play a key role in the development of depression and anxiety later in pregnancy. Therefore, it may be important to screen for early levels of antenatal stress in men, as well as depression and anxiety. [ABSTRACT FROM PUBLISHER]

We present the experience of a tertiary referral hospital in Greece, evaluating obstetric and perinatal outcomes among teenage and average maternal age (AMA) women. We retrospectively assessed all singleton pregnancies during a twelve-month period (January–December 2012). A total of 1,704 cases were reviewed and divided into two groups: one of AMA mothers (20–34 years old) (1,460 women) and the other of teenage mothers (12–19 years old) (244 women). We observed significantly higher incidence rates of preterm births (p< 0.001), preterm premature rupture of the membranes (p< 0.001), gestational hypertension (p< 0.001), preeclampsia (p= 0.043) and Apgar scores < 7 at 5 min (p= 0.015) among teenage mothers. Antenatal surveillance was decreased among teenage mothers (p< 0.001), while rates of anaemia were higher (p< 0.001). Teenage pregnancy is accompanied by significant antenatal and perinatal complications that need specific obstetrical attention. Obstetricians should be aware of these complications in order to ameliorate the antenatal outcome of childbearing teenagers. [ABSTRACT FROM PUBLISHER]

Objective:To develop a grounded theory model of first-time mothers’ experiences of postnatal posttraumatic stress, with the aim of aiding understanding, formulation and treatment of new mothers.Background:Research into postnatal posttraumatic stress is growing, yet evidence-based treatment models have yet to be fully developed. It is unknown whether existing models of posttraumatic stress are directly applicable to postnatal posttraumatic stress, or whether other factors are particularly relevant for symptoms occurring in this context.Methods:A qualitative design explored first-time mothers’ experiences of pregnancy, labour, birth and the postpartum, following a subjectively identified traumatic labour and/ or childbirth. Eleven mothers were interviewed individually, either reporting full symptoms of posttraumatic stress (n= 6), or partial symptoms (n= 5). Grounded theory methodology was used to code the data and develop a theoretical model of maternal postnatal posttraumatic stress based on these accounts.Results:Factors emerged specific to postnatal experiences, including: antenatal expectations and anxieties, constructions of the experience, perceptions of other people’s views, social support (from specific sources) and adaptive and maladaptive coping strategies.Limitations:The study was based on a small sample of first-time mothers’ accounts, and therefore may not be applicable to mothers with previous children, or a wider maternal population.Conclusions:The new model highlights important areas for development in clinical practice at various stages of maternal healthcare provision: in the antenatal period, during labour and birth, and into the postpartum. The model can inform formulation and treatment of mothers experiencing postnatal trauma symptoms, providing specific areas of focus for intervention. [ABSTRACT FROM PUBLISHER]

Objective: Evaluate the outcome of prenatally diagnosed nuchal cord. Methods: A retrospective study on all cases of prenatally diagnosed nuchal cord. Study end points were gestational age at delivery, intrapartum fetal heart rate (FHR) abnormalities, mode of delivery, intrauterine fetal growth retardation (IUGR), intrauterine fetal demise (IUFD), and the rate of labor induction. Results: This study included 44 cases; 86% were diagnosed at second trimester scan, confirmed by Color Doppler and 3D ultrasound. Mean gestational age at delivery was 39 weeks.18/44 cases (41%) underwent labor induction mostly as a result of parental anxiety. Primary cesarean rate was 34% (15/44), and 16% (7/44) had intrapartum FHR abnormalities with no impact for induction of labor. Instrumental vaginal delivery was used in 5 cases. IUGR was present in 7% (3/44), and none had IUFD. Nuchal cord was confirmed at birth in all cases. Correct prenatal diagnosis was in only one case of the 5/44 (11%) with multiple loops. Conclusion: Prenatal diagnosis of nuchal cord is feasible with difficulty in determining multiple loops. Outcome is favorable, but parental anxiety is common and may increase induction rates, without leading to difference in cesarean rates or FHR abnormalities. [ABSTRACT FROM PUBLISHER]

Objective To determine the influence of multiple contraceptive counselling sessions during antenatal care on use of modern postpartum contraception. Method A total of 216 eligible pregnant women were randomised into antenatal and postnatal counselling groups. The 'Antenatal group' received one-to-one antenatal contraceptive counselling on several occasions while the 'Postnatal group' received a single one-to-one contraceptive counselling session at the sixth week postnatal check, as is routinely practised. All participants were contacted six months postpartum by telephone or personal visit, and questioned about their contraceptive use, if any. Results More women who had multiple antenatal contraceptive counselling sessions used modern contraceptive methods than those who had a single postnatal counselling session (57% vs. 35%; p = 0.002). There was also a significantly more frequent use of contraception among previously undecided patients in the Antenatal group ( p = 0.014). Conclusion Multiple antenatal contraceptive counselling sessions improve the use of modern postpartum contraception. [ABSTRACT FROM AUTHOR]

Abstracts from the conference "Effects of Traumatic Stress: Molecular and Hormonal Mechanism," held in New York, September 11–14, 2012 are presented.

Objective. To describe the characteristics and outcome of fetuses with Turner syndrome reported to a national congenital anomalies register. Methods. All cases with a diagnosis of Turner syndrome reported to Congenital Anomaly Register and Information Service for Wales (CARIS) between 1 January 1998 and 31 December 2007 were included. The cases were grouped in five categories based on their outcomes: fetal loss (FL), termination of pregnancy (TOP), live birth (LB), and postnatal (PN) detection and comparison was undertaken between the groups. Results. One hundred twenty-four cases were reported during the study period. The prevalence of Turner syndrome was 1 in 4901 live female births. Seventy-four percent had 45 X karyotype while the rest had some form of Mosaic Turner karyotype. Pregnancy was terminated in 66%% of antenatally diagnosed cases. FL and TOP groups had 92%% and 87%%, respectively, of 45 X karyotype - far greater than in the LB and PN groups. Increased nuchal thickness was the commonest anomaly noted in antenatal ultrasound and was a predictor for 45 X karyotype, FL, and termination. Conclusion. Termination was the most common outcome of fetuses diagnosed antenatally with Turner syndrome. This has modified the natural history of Turner syndrome particularly in cases with Mosaic karyotype. [ABSTRACT FROM AUTHOR]

Objective: To determine the lipid levels in early pregnancy and the risk for pre-eclampsia in a Trinidad population. Methods: Prospective cohort study comprised 156 pregnant women attending antenatal clinic visits prior to 20 weeks at an average of 14 weeks. Blood samples were analysed for lipid levels. Of which 102 participants were followed until delivery and were monitored for pre-eclampsia. Data was analysed using univariate linear and stepwise logistic regression analysis. Results: In the study 11 women developed pre-eclampsia and 91 remained normal. Mean triglyceride levels were found significantly higher in the pre-eclampsia group ( p == 0.001). Mean HDL levels were low and LDL/HDL ratios were high in pre-eclampsia group. Women with triglycerides above 130 mg/dL had increased risk of pre-eclampsia (adjusted OR 14.046; 95% CI 1.254-157.334) compared with those with triglycerides levels 91 mg/dL or less. Conclusion: Increased serum triglyceride levels in early pregnancy before 20 weeks are associated with pre-eclampsia. [ABSTRACT FROM AUTHOR]

Background. Women living with HIV in sub-Saharan Africa face significant challenges in accessing HIV care and adhering to antiretroviral therapy. Most reports have focused on issues relating to long-term adherence such as those surrounding stigma and disclosure, hunger, cultural factors, lack of accurate health information, lack of social support, medication side effects and overcrowded health systems. Information related to the challenges facing pregnant women when taking antiretrovirals for prophylactic purposes is limited. The 'Kesho Bora Study' is a multicentre prevention of mother-to-child transmission (PMTCT) trial in sub-Saharan Africa evaluating the PMTCT efficacy of triple therapy until cessation of breast feeding compared to short course zidovudine monotherapy in a predominantly breast feeding population. Following unexplained discrepancies during objective adherence assessments, a sub-study was conducted at one site to examine the underlying adherence issues. Methods. The counselling and clinical notes of all 100 enrolled Zulu women were examined. Extracted information was supplemented by unstructured, free-ranging interviews conducted by trained adherence counsellors on 43 consecutive women attending the trial clinic over a two-week period. Adherence was defined as good (>95% adherence), or poor (<95% adherence). Results. Reasons provided for sub-optimal adherence included therapy misconceptions/misunderstandings, antiretroviral use by relatives, domestic violence, poverty and issues relating to disclosure and stigma. About 61% (57/94) of antenatal women had good adherence with their PMTCT prophylaxis, with no significant difference shown between those taking the long and short course. Conclusion. Antenatal women in northern rural KwaZulu-Natal face significant challenges in taking antiretroviral PMTCT prophylaxis. [ABSTRACT FROM AUTHOR]

Some pregnant women do book concurrently with multiple antenatal care providers. Structured questionnaires were administered to women attending antenatal clinics in 12 facilities in Enugu, Nigeria. A total of 535 women responded: 372 (69.5%) were booked into more than one facility and 163 (30.5%) were booked into a single facility; 280 (52.3%) booked into the two Teaching Hospitals and 91 (12.5%) booked with a traditional birth attendant. Reasons for multiple bookings included selecting a facility with affordable prices (43.9%); selecting a facility promising vaginal delivery (35.3%); avoiding HIV testing (17.9%); avoiding caesarean section (10.8%); avoiding being regarded as unbooked (10.1%) and booking into a facility where they were not known. Possible disadvantages were confusion in deciding where to deliver (53.1%); default on expert advice (27.5%); mismanagement (18.7%); delays, complications and death (12.5%). Multiple bookings were common in this study. Disadvantages of this practice, including risk of death, were identified by the women. [ABSTRACT FROM AUTHOR]

This evaluative study measured self-reported changes in abuse-related measures six months after routine screening for intimate partner violence. Participants were 122 women who disclosed abuse and 241 who did not report abuse, screened in antenatal, substance abuse, and mental health services according to an existing standardized protocol used in New South Wales, Australia. Six months after initial screening, abused women were more likely to report increased agreement with a number of attitudes relating to abuse, in particular that being hurt by a partner affects a woman's health and that health services should ask about abuse. The proportion reporting current abuse was significantly lower after six months. While 6% (7/119) reported negative emotional reactions, 34% (41/120) reported useful effects—most frequently re-evaluating their situation and reducing isolation. Women who had experienced abuse, but elected not to disclose it reported similar effects. The results of this study lend support to the use of protocols for asking about abuse and responding to disclosures of abuse. [ABSTRACT FROM AUTHOR]

We report a case of spondyloepiphyseal dysplasia congenita (SED congenita), diagnosed at autopsy of a term infant. Prenatal ultrasound at 20 weeks of gestation had shown shortening of all the fetal long bones, with bowing of the femora and humeri, clubfeet, and small thoracic cage. We discuss the diagnostic features of SED and the main differential diagnoses. [ABSTRACT FROM AUTHOR]

Heteromorphisms of chromosome 9 are among the most common variations in the human karyotype. The pericentromeric polymorphisms of chromosome 9 include variations in the size of q-arm heterochromatin, pericentric inversions, and rarely, additional C-band-negative, G-band-positive material. The finding of a polymorphic variant, either in prenatal screening or in chromosomal analysis for phenotypic abnormalities, may cause parental anxiety and initiate genetic counselling. We report a case of a 39-year-old primigravida with unremarkable pregnancy, who had amniocentesis due to advanced maternal age. Chromosomal analysis demonstrated a long arm (q) variant of chromosome 9 with an enlarged heteromorphic area, approximately three times longer than known reported variants. Prenatal analysis demonstated an identical variant in the probands phenotypically normal father, uncle, and paternal grandmother, confirming an apparently “normal” variant. [ABSTRACT FROM AUTHOR]

Teratoma is the leading neoplasm diagnosed in neonates and infants. Although over 99% of teratomas found in the fetus and newborn are histologically benign, those tumors may cause death if vital structures are involved or if the airway is compromised. We review the literature on antenatal intrapericardial teratomas and report a case of intrapericardial teratoma, with massive pericardial effusion and fetal hydrops, diagnosed on antenatal ultrasound at 21 weeks of gestation. Pericardioamniotic shunt was placed at 22 weeks and 6 days gestational age. In spite of successful drainage of the pericardial effusion, fetal demise was documented 8 days later, likely due to tumor compression of the heart. [ABSTRACT FROM AUTHOR]

Objective. To determine the antenatal detection rate in Northern Ireland (NI) for major congenital heart disease (CHD) between 1st January 2002 and 31st December 2006. To compare characteristics and prognosis of antenatal versus postnatal groups. Methods. Data were obtained from fetal, neonatal and post-mortem records. Variables recorded: antenatal diagnosis, karyotype, referral indication, type of defect and neonatal outcome. Results. Twenty-seven per cent (73/272) of patients with major CHD were diagnosed antenatally. Forty-one per cent (30/73) of these died before 28 days. Eighty-two per cent (60/73) of the antenatal diagnosis group were referred with suspected cardiac abnormality on obstetric screening. There were more lethal trisomies amongst the antenatal diagnosis group (15%, 11/73) than the postnatal diagnosis group (2%, 4/191) p < 0.001. Significantly more of the antenatal group had functionally univentricular hearts than the postnatal/post-mortem group (47%vs. 7%). Eighty-nine per cent (65/73) of defects diagnosed antenatally were 'four chamber view' defects. 11% (8/73) were 'outflow tract view' defects. Conclusions. Antenatal detection in NI is around the European average. Those with an antenatal diagnosis have more complex CHD, higher risk of karyotype abnormality and poorer neonatal outcomes. Screening is responsible for the majority of antenatal diagnoses of major CHD. A regional training programme for obstetric sonographers has now been delivered. [ABSTRACT FROM AUTHOR]

Intestinal malrotation has an incidence of 1 per 6000 live births. The most serious consequence of malrotation is volvulus. Midgut volvulus is a rare condition in which the small bowel and proximal colon twist around the superior mesenteric artery, leading to a high-grade proximal bowel obstruction and vascular compromise of the intestine, thereby leading to infarction of the involved intestine. Midgut volvulus rarely occcurs antenatally and is usually not lethal in utero. There are only 7 cases of intrauterine fetal demise caused by midgut volvulus reported in the literature. We report a case of intrauterine fetal demise at 38 weeks of gestation, due to cardiovascular failure and shock from midgut volvulus. Non-specific abnormalities, including ascites and dilated bowel, had been seen on the antenatal ultrasound from the 15th week of gestation. In addition to the volvulus, the fetus had intestinal atresia and arthrogryphosis. [ABSTRACT FROM AUTHOR]

The aim was to discover how often women perform pelvic floor exercises (PFE) in the antenatal period and how they wished to be taught. We compared this with the opinions of the health professionals looking after them. A total of 54 women attending the antenatal day assessment unit completed questionnaires. A total of 21 obstetricians, 29 midwives and 25 GPs returned similar questionnaires. Most women think they should be performing PFE daily but only 15% do so. Some 57% of the women wanted to be taught in the antenatal period. Over 50% of the women/midwives believed that PFE should be taught in an individual basis. Obstetricians/GPs favoured classes. A total of 76% of the women want midwives to teach them PFE and 57% of midwives agree. Most health professionals felt that they had not received adequate training on PFE. The midwife is felt to be the best placed person to teach PFE. Health professionals give PFE low priority. [ABSTRACT FROM AUTHOR]

Antenatal smoking is a potentially preventable risk factor associated with pre-term birth and low birth weight. Rates of antenatal smoking, low birth weight, and infant mortality are all higher among the Indigenous populations than the non-Indigenous populations of Australia, Canada, New Zealand and the USA. Given this, it might be expected that publications examining smoking cessation efforts in Indigenous antenatal groups would be substantive. We examined the differences in the number and type of antenatal smoking publications for Indigenous and non-Indigenous populations across three time periods (1984 - 86, 1994 - 96 and 2004 - 06). Articles were classified as research studies (focusing on measurement, descriptive, or intervention studies), literature reviews, descriptions of programmes or research (with no data), or discussions. There was a significant increase in the number of publications relating to antenatal smoking among Indigenous populations in the time periods examined, but the total number of publications remained small. The number relating to general antenatal populations increased, but remained substantially lower than that relating to low birth weight. There was no increase in the proportional allocation of research articles to the intervention category in the later time period. The pattern of research output relating to antenatal smoking by mainstream or Indigenous populations is not optimal for advancement of knowledge in the field. There is a clear need for intervention-based research to allow the development of evidence-based practice for reducing the prevalence of antenatal smoking and associated health issues. [ABSTRACT FROM AUTHOR]

Objective. To assess the impact that education through participation in a depression screening program has on mental health literacy and help seeking behavior in perinatal women. Methods. Responses to a hypothetical case of depression, help seeking behavior, and screening levels for risk of depression using the Edinburgh Postnatal Depression Scale were compared between two groups of postnatal women; one group who had participated in a screening program and the other who had not. Those who participated in the screening program were also asked to evaluate the educational material they had received. Results. A total of 1309 women, broadly representative of postnatal women, answered one or more questionnaires. Those who had participated in the screening program were better able to recognize depression in a hypothetical case, and also assess their own mental state more appropriately. Those women who had been part of the program and did not score high on the EPDS were less likely to seek help, were more satisfied when they did and tended to benefit more from the educational booklet. Conclusions. Participation in a screening program with educational material had significant benefits for mental health literacy and the health service use for perinatal women at risk for depression. [ABSTRACT FROM AUTHOR]

Objective: To determine if one course of antenatal corticosteroids at 32 weeks produces maternal adrenal suppression at term. Methods: The adrenocorticotropic hormone (ACTH) stimulation test was administered at 38 weeks to 11 pregnant women who had received a single course of antenatal betamethasone prior to 33 weeks and to six control subjects. Results: There was no difference in basal cortisol levels (mean ± standard deviation) between the two groups: 41.6 ± 6.9 μg/dl for controls versus 36.0 ± 7.8 μg/dl for the steroid group, p  = 0.16. Peak cortisol levels at 45 min following ACTH stimulation were not different: 61.6 ± 3.5 μg/dl for controls versus 55.0 ± 2.6 μg/dl for the steroid group, p  = 0.16. The power of the study to detect a statistical difference in the observed peak cortisol levels was greater than 95%. None of the study subjects had laboratory criteria or clinical signs of adrenal suppression. Conclusions: A single course of betamethasone for women at risk for preterm delivery does not produce adrenal insufficiency at term and stress dose steroids are not recommended. [ABSTRACT FROM AUTHOR]

Objective: To determine the ability of early sonogram to predict the presentation of twin A at birth. Methods: A retrospective cohort study was conducted on all twin pregnancies evaluated at our Fetal Evaluation Unit from 2007 to 2009. Sonogram records were reviewed for the presentation of twin A at seven gestational age intervals and inpatient medical records were reviewed for the presentation of twin A at delivery. The positive predictive value, sensitivity, and specificity of presentation as determined by ultrasound, at each gestational age interval, for the same presentation at delivery were calculated. Results: Two hundred and thirty-eight twin pregnancies met inclusion criteria. A total of 896 ultrasounds were reviewed. The positive predictive value of cephalic presentation of twin A as determined by ultrasound for the persistence of cephalic presentation at delivery reached 95% after 28 weeks gestation. The positive predictive value for noncephalic presentation as established by sonogram for noncephalic at delivery was >90% after 32 weeks gestation. Conclusions: The presentation of the first twin at delivery can be determined by sonogram by the 32nd week of gestation in over 90% of twin pregnancies. [ABSTRACT FROM AUTHOR]

This cross-sectional study was designed to evaluate the knowledge, attitude and motivation of husbands of pregnant mothers towards antenatal blood donation. A total of 700 husbands of pregnant mothers in Abakaliki, south-east Nigeria were interviewed over a 1-year period using a questionnaire. A total of 640 respondents completed the questionnaires giving a response rate of 91%. They had a mean age of 26.2 ± 4 years with a range of 21 - 50 years. All the respondents had heard about blood donation but only 39% were well informed about it. One-third (33.1%) of respondents were willing to donate blood and the main motivating factor was their wives' previous experience with bleeding during pregnancy/delivery. Other motivating factors to blood donation included previous donation, information on blood donation and husband participation in antenatal programme. Two-thirds of respondents were unwilling to donate because of fear, misconception and availability of paid blood donors. Higher educational status was significantly associated with willingness to donate blood (p < 0.05). The willing blood donors showed a more positive attitude towards blood donation and were of the view that the donated blood if not used for their wives would benefit others. The non-donors on the other hand had a selfish attitude and would prefer to procure blood only when their wives needed blood transfusion. An intensive donor recruitment campaign, including mobilising husbands of pregnant mothers and providing information and education on all aspects of blood donation, will help correct some of the misconceptions about blood donation. This will increase the number of voluntary blood donors and thus increase available banked blood for pregnant women. [ABSTRACT FROM AUTHOR]