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Introduction: Nausea and Vomiting of Pregnancy (NVP) are common symptoms of pregnancy. Often, treatment is guided by subjective symptoms, leading to hospitalisation of these patients and unnecessary health costs. The 24-hour Pregnancy-Unique Quantification of Emesis (PUQE) index helps objectively quantify these symptoms and guide the management of these patients. Aim: To assess the association of the 24-hour PUQE index with the self-rated well-being score in evaluating the severity of NVP. Materials and Methods: In this cross-sectional study, a total of 207 women at 5 to 12 weeks of singleton pregnancy were recruited after obtaining informed consent. They were interviewed regarding their symptoms of nausea and vomiting based on a 24-hour PUQE index questionnaire, and a score was assigned to them. They were stratified as mild, moderate, or severe based on the score. The association of these symptoms with a self-rated well-being score and subjective symptoms such as the ability to take multivitamins, sleep pattern, liquid intake, and the need for hospitalisation was assessed. They were followed-up after four weeks, and a repeat score was obtained. Chi-square test was performed to compare the severity of PUQE-24. Results: The mean well-being score at the first visit was 3.381±1.650, and at the follow-up visit, it was 7±1.763. At the first visit, 46 out of 207 had a mild 24-hour PUQE score, 140 out of 207 had a moderate score, and 21 out of 207 had a severe score. During the follow-up visit, 123 out of 207 had a mild score, 77 out of 207 had a moderate score, and seven out of 207 had a severe score. There was a significant association between the mean self-rated well-being score and the 24-hour PUQE score at the first and follow-up visits (p-value=0.0001). Among the patients hospitalised at the first visit (21 out of 28), 75% belonged to the severe PUQE category. The mean liquid intake at the first visit was 24.363±10.357 mL/kg/hr, and at the follow-up visit was 29.972±10.691, showing a significant association with the severity of the 24-hour PUQE score (p-value=0.0001). A significant association was observed between the 24-hour PUQE scores of the first and follow-up visits (p-value=0.002). Conclusion: In this study, there was a significant association between the 24-hour PUQE score and the well-being score at both visits. Stratifying the severity of NVP objectively will guide us to choose the appropriate treatment and reduce the need for hospitalisation.

Abstract Background Timely, appropriate, and equitable access to quality healthcare during pregnancy is proven to contribute to better health outcomes of birthing individuals and infants following birth. Equity is conceptualized as the absence of differences in healthcare access and quality among population groups. Healthcare policies are guides for front-line practices, and despite merits of contemporary policies striving to foster equitable healthcare, inequities persist. The purpose of this umbrella review is to identify prenatal healthcare practices, summarize how equities/inequities are reported in relation to patient experiences or health outcomes when accessing or using services, and collate equity reporting characteristics. Methods For this umbrella review, six electronic databases were searched (Medline, EMBASE, APA PsychInfo, CINAHL, International Bibliography of the Social Sciences, and Cochrane Library). Included studies were extracted for publication and study characteristics, equity reporting, primary outcomes (prenatal care influenced by equity/inequity) and secondary outcomes (infant health influenced by equity/inequity during pregnancy). Data was analyzed deductively using the PROGRESS-Plus equity framework and by summative content analysis for equity reporting characteristics. The included articles were assessed for quality using the Risk of Bias Assessment Tool for Systematic Reviews. Results The search identified 8065 articles and 236 underwent full-text screening. Of the 236, 68 systematic reviews were included with first authors representing 20 different countries. The population focus of included studies ranged across prenatal only (n = 14), perinatal (n = 25), maternal (n = 2), maternal and child (n = 19), and a general population (n = 8). Barriers to equity in prenatal care included travel and financial burden, culturally insensitive practices that deterred care engagement and continuity, and discriminatory behaviour that reduced care access and satisfaction. Facilitators to achieve equity included innovations such as community health workers, home visitation programs, conditional cash transfer programs, virtual care, and cross-cultural training, to enhance patient experiences and increase their access to, and use of health services. There was overlap across PROGRESS-Plus factors. Conclusions This umbrella review collated inequities present in prenatal healthcare services, globally. Further, this synthesis contributes to future solution and action-oriented research and practice by assembling evidence-informed opportunities, innovations, and approaches that may foster equitable prenatal health services to all members of diverse communities.

Background: Depression during pregnancy is a significant health concern that can lead to a variety of short and long-term complications for mothers. Unfortunately, there is a lack of information available on the prevalence and predictors of prenatal depression in rural eastern Ethiopia. This study assessed prenatal depression and associated factors among pregnant women attending public health facilities in the Babile district, Eastern Ethiopia. Method: An institution-based cross-sectional study was conducted among 329 pregnant women attending Babile District Public Health Facilities from November 1 to December 30, 2021. Bivariable and multivariable logistic regression were used to identify factors associated with prenatal depression. The adjusted odds ratio (AOR) with a 95% confidence interval was used to report the association, and the significance was declared at a p-value < 0.05. Results: The prevalence of prenatal depression was 33.1% (95% CI = 28.0%, 38.2%). A lower income (AOR = 3.85, 95% CI = 2.08, 7.13), contraceptive use (AOR = 0.53, 95% CI = 0.28, 0.98), unintended pregnancy (AOR = 2.24, 95% CI = 1.27, 3.98), history of depression (AOR = 5.09, 95% CI = 2.77, 9.35), poor social support (AOR = 5.08, 95% CI = 2.15, 11.99), and dissatisfied marriage (AOR = 2.37, 95% CI = 1.30, 4.33) were the factors associated with increased prenatal depression among pregnant women. Conclusions: One in every three pregnant women in rural eastern Ethiopia had prenatal depression. Monthly income, contraceptive use, pregnancy intention, history of depression, social support, and marriage satisfaction status were the determinants of prenatal depression. Preventing unintended pregnancies by encouraging women to utilize modern contraceptive methods is essential for mitigating and controlling the risks and burdens of prenatal depression and its negative consequences. [ABSTRACT FROM AUTHOR]

Introduction: It is well known that preterm birth (PTB) contributes to perinatal mortality and long-term morbidity. Elevated serum ferritin levels have been frequently reported in PTB compared to term births; however, most studies had blood samples taken during the peripartum period. We aim to evaluate the relationship between antenatal serum ferritin levels and PTB. Methods: A retrospective study of pregnant women delivered at our hospital between January 2013 and December 2020 was conducted. Demographic data, medical history, gestation, and blood ferritin results were retrieved from the hospital and laboratory information system. Patients with maternal serum ferritin measured antenatally who were not documented to have chronic diseases, infection, iron disorders, multiple gestations, and uterine or cervical anomalies were included in the analysis. We compared the preterm and term groups' ferritin levels and other risk factors. Results: Among 202 recruited women, 27 (14.4%) had spontaneous PTB. Most ferritin measurements (80%) were taken during the third trimester. There was no significant difference in the median ferritin levels between PTBs (15.81µg/L, IQR 10.09 - 32.41 µg/L) and term births (16.11µg/L, IQR 9.09 - 34.38 µg/L), P=0.801. However, ferritin levels in the second trimester nearly doubled that in the first trimester in the PTB group. PTB was associated with more cases of preeclampsia (P=0.003), a history of antepartum haemorrhage (p=0.040) and premature rupture of membrane status (P<0.001). Conclusion: Despite the elevation of ferritin levels in the second trimester, there is no significant association between maternal antenatal ferritin levels and PTB. [ABSTRACT FROM AUTHOR]

BACKGROUND: Effective family support is essential for promoting the well-being of pregnant women and reducing the risk of adverse pregnancy outcomes. This study examined family support patterns and influencing factors among pregnant women attending antenatal clinics in Ile-Ife, Nigeria. METHODS: This descriptive cross-sectional study involved 384 pregnant women in a Local Government Area in southwestern Nigeria. Three healthcare facilities with the highest antenatal attendance were selected through purposive sampling. Data were collected using a tested and structured questionnaire, which was developed following a review of similar studies. The results were analyzed using SPSS version 20.0, employing Pearson Chi-square tests with a significance level set at p < 0.05. RESULTS: More than half of the respondents reported inadequate family support in various aspects including tangible/instrumental support (52.9%), emotional support (51.4%), and financial support (54.4%). However, the majority reported significant financial supports from their spouses (60.7%). Religion, educational qualification, and partner's occupation were found to significantly influence the likelihood of women receiving higher levels of social support. CONCLUSION: Many respondents lacked adequate support from spouses and families. Encouraging family involvement in antenatal care can improve understanding and support, benefiting maternal and child health. Hence, healthcare professionals and policymakers should consider the factors influencing family support options when designing focused interventions to strengthen maternal support systems and address the varied needs of pregnant women. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to determine the effectiveness of antenatal corticosteroid in reducing respiratory morbidity in babies born in the late preterm period. Methods: Two hundred and eighty-six pregnant women at risk of having a late preterm delivery were studied. One hundred and forty-three (143) served as the cases and were given 2 doses of 12 mg intramuscular dexamethasone 12 h apart, while 143 served as the controls and were given a similar quantity of placebo. The women were followed up prospectively and data were collected on the pregnant women and their newborns on a standardized form. The neonates were assessed for acute respiratory distress syndrome and transient tachypnea of the newborn based on clinical signs, symptoms, and chest x-ray results (when indicated). The primary outcome was the occurrence of neonatal respiratory morbidity. Results: The primary outcome occurred in 5 out of 130 infants (3.8%) in the dexamethasone group and 31 out of 122 (25.4%) in the placebo group (P value = 0.000003). Birth asphyxia, neonatal intensive care admission and need for active resuscitation at birth also occurred significantly less frequently in the dexamethasone group (P value 0.004, 0.009, 0.014 respectively). There were no significant group differences in the incidence of neonatal sepsis, neonatal jaundice, hypoglycemia and feeding difficulties. Conclusions: Administration of dexamethasone to women at risk for late preterm delivery significantly reduced the rate of neonatal respiratory complications, neonatal intensive care unit admission, and need for active resuscitation at birth. Trial registration: PACTR (www.pactr.org) Registration Number: PACTR202304579281358. The study was retrospectively registered on April 19, 2023. [ABSTRACT FROM AUTHOR]

Background: Iron and folic acid (IFA) supplements are currently provided to Cambodian women during pregnancy. However, recent research has found benefits of a multiple micronutrient supplement (MMS) over just IFA alone on several outcomes of perinatal and infant health. The Ministry of Health in Cambodia has proposed a transition from IFA to MMS but to effectively guide this transition requires implementation research on the acceptability and adherence to MMS (over IFA). Methods: This non-inferiority trial aims to assess the adherence and acceptability of IFA (60 mg elemental iron and 400 μg folic acid) compared to MMS (standard UNIMMAP formulation including 15 micronutrients) during antenatal care in Cambodia. A prospective cohort of 1545 pregnant women will be assigned to one of three trial arms: (1) IFA for 90 days [IFA-90]; (2) MMS for 180 days with two distributions of 90-count tablet bottles [MMS-90]; or (3) MMS for 180 days with one 180-count tablet bottle [MMS-180]. Each arm will enroll 515 women across 48 health centers (clusters) in Kampong Thom Province in Cambodia. The primary outcome is the non-inferiority of adherence rates of MMS-180 compared to IFA-90, as assessed by tablet counts. Mixed-effects logistic and linear regression models will be used to estimate the difference in the adherence rate between the two groups, with an 'a priori' determined non-inferiority margin of 15%. Acceptability of MMS and IFA will be measured using a quantitative survey conducted with enrolled pregnant women at 30-day, 90-day, and 180-day time-points. Discussion: Findings from this study will guide an effective and feasible MMS scale-up strategy for Cambodia. Additionally, the findings will be shared globally with other stakeholders planning to scale up MMS in other countries. Trial registration: NCT05867836 (ClinicalTrials.gov, registered May 18, 2023). [ABSTRACT FROM AUTHOR]

Background: Maternal and neonatal mortality remains high in sub-Saharan Africa (SSA) with women having 1 in 36 lifetime risk. The WHO launched the new comprehensive recommendations/guidelines on antenatal care (ANC) in 2016, which stresses the essence of quality antenatal care. Consequently, the objective of this cross-sectional study is to investigate the quality of ANC in 13 SSA countries. Methods: This is a cross-sectional study that is premised on pre-existing secondary data, spanning 2015 to 2021. Data for the study was obtained from the Measure DHS Programme and included a total of 79,725 women aged 15–49 were included. The outcome variable was quality ANC and it was derived as a composite variable from four main ANC services: blood pressure taken, urine taken, receipt of iron supplementation and blood sample taken. Thirteen independent variables were included and broadly categorised into individual and community-level characteristics. Descriptive statistics were used to present the proportion of women who had quality ANC across the respective countries. A two-level multilevel regression analysis was conducted to ascertain the direction of association between quality ANC and the independent variables. Results: The overall average of women who had quality ANC was 53.8% [CI = 51.2,57.5] spanning from 82.3% [CI = 80.6,85.3] in Cameroon to 11% [CI = 10.0, 11.4] in Burundi. Women with secondary/higher education had higher odds of obtaining quality ANC compared with those without formal education [aOR = 1.23, Credible Interval [Crl] = 1.10,1.37]. Poorest women were more likely to have quality ANC relative to the richest women [aOR = 1.21, Crl = 1.14,1.27]. Married women were more likely to receive quality ANC relative to those cohabiting [aOR = 2.04, Crl = 1.94,3.05]. Women who had four or more ANC visits had higher odds of quality ANC [aOR = 2.21, Crl = 2.04,2.38]. Variation existed in receipt of quality ANC at the community-level [σ2 = 0.29, Crl = 0.24,0.33]. The findings also indicated that a 36.2% variation in quality ANC is attributable to community-level factors. Conclusion: To achieve significant improvement in the coverage of quality ANC, the focus of maternal health interventions ought to prioritise uneducated women, those cohabiting, and those who are unable to have at least four ANCs. Further, ample recognition should be accorded to the existing and potential facilitators and barriers to quality ANC across and within countries. [ABSTRACT FROM AUTHOR]

Objectives: Cartoons, comics, and caricatures have been incorporated in health education. This trial aimed to evaluate the effectiveness of caricature‑based breastfeeding education at improving breastfeeding knowledge, attitudes, self‑efficacy, and practice among pregnant women. Materials and Methods: A randomized controlled clinical trial was carried out at Riyadh First Health Cluster in Saudi Arabia. A total of 85 pregnant women were randomly assigned to the intervention group (n = 41) or the control group (n = 44). The intervention was two caricature-based versus one standard online lecture in breastfeeding. The participants were followed up for 3 months postpartum. The primary outcome was full breastfeeding (predominant and exclusive breastfeeding) by the time infants were 3 months old. The secondary outcomes were prenatal and postnatal breastfeeding self‑efficacy, Iowa Infant Feeding Attitude Scale (IIFAS) scores, and satisfaction with the education. Results: The participants were mostly Saudi (97.6% vs. 90.9%) and housewives (79% vs. 86.4%) for the intervention and control groups, respectively. The full breastfeeding rate at 3 months postpartum was 32.5% for the intervention and 31.6% for the control (P = 0.808; 95% confidence interval 0.539–1.965; relative risk = 1.029). Prenatal breastfeeding, postnatal self‑efficacy, and IIFAS scores were compared between the intervention and control groups; no statistically significant difference was found (P > 0.05). In both arms of the study, participants’ experiences with the health education were satisfactory. Conclusion: Caricature use in antenatal breastfeeding education was a pleasant experience, but its effect on self‑efficacy, attitudes, and behavior could not be determined from this trial. Large‑scale, multi‑center, multi‑component research is recommended. [ABSTRACT FROM AUTHOR]

Background: Maternal healthcare service utilization is a pivotal indicator of a nation's progress in safeguarding the health and well-being of its women and children. In this context, women's empowerment emerges as a critical determinant influencing the utilization of maternal healthcare services. The study aims to assess the relationship between women's level of empowerment and utilization of maternal healthcare services among currently married women in India. Data and Methods: The study uses data from the fifth round of the National Family Health Survey conducted in 2019–2021 and analyzed 26,552 (15–49 aged) currently married women who had a live birth in the last 5 years preceding the survey. Additionally, univariate and bivariate analyses, multivariate logistic regression, and the SWPER index were used for the analysis. Results: Over the years, utilization of antenatal care, skilled birth attainment, and postnatal care has increased extensively in India. However, the study found that utilization of services was higher among empowered women, and it varies across the state with the extent of empowerment. State-level analysis shows that the extent of women empowerment was higher in Goa, followed by Tamil Nadu and Kerala, and lower in Jharkhand, followed by Tripura, so as the utilization of maternal and health care services. The extent of empowerment and utilization of services also varies by level of educational attainment, employment, and socio-economic status. Conclusion: There is a need for comprehensive strategies to enhance women's empowerment through education, employment, political participation, self-awareness, and reduction in gender-based violence and child marriages, which may improve awareness demand for better public health structure, and may ensure higher utilization of maternal healthcare services. Ultimately, these strategies may converse the higher maternal death and child mortality. Significance: What is already known about this subject? Existing literature in India mostly highlights a clear connection between women's autonomy and maternal healthcare services utilization. Women with higher autonomy, decision-making power, and mobility are more likely to use these services. However, in exploring the link between women's empowerment and maternal healthcare, some studies focus on education, employment, and media access among Indian mothers, sidelining broader empowerment dimensions. What this study adds? This study is likely the first to investigate the relationship between women's empowerment and the level of maternal healthcare service utilization in India. It covers key dimensions of women's empowerment, including Attitude to Violence, Social Independence, and Decision-making Power. Moreover, it is possibly the first Indian research paper to employ a survey-based women's empowerment index in this context. Notably, the assessment highlights Social Independence as a significant dimension. [ABSTRACT FROM AUTHOR]

Maternal Mortality refers to any death of a woman due to complications from pregnancy or deaths within 42 days after childbirth, while Maternal Mortality Rate is the ratio of Maternal Mortality per 100,000 childbirths. Hence, this study investigated the Prevalence Rate of Maternal Mortality in Adamawa State, Nigeria. The study used Ex post facto design with quantitative approach. A Secondary data between the year 2011 and 2022 was obtained using a purposive sampling technique from some Health Services Providing Centres across Adamawa State. A Statistical Package for Social Science (SPSS) Version 25 software was used for data diagnostic tests and analysis. Based on the findings, the prevalence rate of the maternal mortality fluctuated within the study period recording the lowest and highest in 2017 and 2021 with 284 and 605 mortalities per 100,000 childbirths respectively. The study concluded that the average Maternal Mortality rate in Adamawa state, Nigeria for the period under review is 439 per 100,000 childbirths. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to investigate the prevalence, severity, and factors associated with antenatal depression among women receiving antenatal care at Mubende Regional Referral Hospital (MRRH) in Uganda. Antenatal depression is a critical concern for maternal and child well-being, as it is associated with adverse outcomes such as preterm birth, abortion, low birth weight, and impaired maternal-infant bonding. Despite several international guidelines recommending routine screening for antenatal depression, local Ugandan guidelines often overlook this essential aspect of maternal care. Methods: A cross-sectional study involving 353 pregnant women utilized the Patient Health Questionnaire 9 (PHQ-9) to assess antenatal depression. Participants were categorized as having antenatal depression if their total PHQ-9 score was ≥ 5 and met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for either major or minor depression. Psychosocial demographic and obstetric characteristics were recorded. Logistic regression analysis identified factors linked to antenatal depression. Results: The burden of antenatal depression was notably high, affecting 37.68% of the participants. Among those with antenatal depression, the majority exhibited mild symptoms 94 (70.68%). The significant factors associated with antenatal depression, revealed by multivariate analysis, included younger age (≤ 20 years), older age (≥ 35 years), history of domestic violence, alcohol use, gestational age, history of abortion, history of preeclampsia, and unplanned pregnancies. Conclusion: This study revealed a significantly high prevalence of antenatal depression, emphasizing its public health importance. Most cases were classified as mild, emphasizing the importance of timely interventions to prevent escalation. The identified risk factors included age, history of domestic violence, alcohol use, first-trimester pregnancy, abortion history, previous preeclampsia, and unplanned pregnancy. [ABSTRACT FROM AUTHOR]

Background: Timely, appropriate, and equitable access to quality healthcare during pregnancy is proven to contribute to better health outcomes of birthing individuals and infants following birth. Equity is conceptualized as the absence of differences in healthcare access and quality among population groups. Healthcare policies are guides for front-line practices, and despite merits of contemporary policies striving to foster equitable healthcare, inequities persist. The purpose of this umbrella review is to identify prenatal healthcare practices, summarize how equities/inequities are reported in relation to patient experiences or health outcomes when accessing or using services, and collate equity reporting characteristics. Methods: For this umbrella review, six electronic databases were searched (Medline, EMBASE, APA PsychInfo, CINAHL, International Bibliography of the Social Sciences, and Cochrane Library). Included studies were extracted for publication and study characteristics, equity reporting, primary outcomes (prenatal care influenced by equity/inequity) and secondary outcomes (infant health influenced by equity/inequity during pregnancy). Data was analyzed deductively using the PROGRESS-Plus equity framework and by summative content analysis for equity reporting characteristics. The included articles were assessed for quality using the Risk of Bias Assessment Tool for Systematic Reviews. Results: The search identified 8065 articles and 236 underwent full-text screening. Of the 236, 68 systematic reviews were included with first authors representing 20 different countries. The population focus of included studies ranged across prenatal only (n = 14), perinatal (n = 25), maternal (n = 2), maternal and child (n = 19), and a general population (n = 8). Barriers to equity in prenatal care included travel and financial burden, culturally insensitive practices that deterred care engagement and continuity, and discriminatory behaviour that reduced care access and satisfaction. Facilitators to achieve equity included innovations such as community health workers, home visitation programs, conditional cash transfer programs, virtual care, and cross-cultural training, to enhance patient experiences and increase their access to, and use of health services. There was overlap across PROGRESS-Plus factors. Conclusions: This umbrella review collated inequities present in prenatal healthcare services, globally. Further, this synthesis contributes to future solution and action-oriented research and practice by assembling evidence-informed opportunities, innovations, and approaches that may foster equitable prenatal health services to all members of diverse communities. [ABSTRACT FROM AUTHOR]

Obstetric research in sub-Saharan Africa largely focuses on the material, physical, and psychosocial aspects of pregnancy and childbirth in relation to mothers. This research aimed to address a research gap in terms of fathers' experiences of pregnancy and childbirth, particularly in the context of a medically high-risk pregnancy. Specifically, this article focuses on fathers' interactions with the healthcare system and healthcare professionals throughout the antenatal and neonatal periods. This study was exploratory and qualitative in nature. Eight fathers whose partners had experienced at least one medically high-risk pregnancy participated in semi-structured interviews that were examined using interpretive phenomenological analysis. The findings indicate that fathers' experiences vacillated between healthcare providers being supportive and informative versus them being uncompassionate and not conveying adequate information. Importantly, the distinctions were largely attributed to the type of healthcare facility (i.e. public or private) that was attended. This research offers recommendations to healthcare workers to enhance fathers' experiences during pregnancy and childbirth, especially in potentially traumatic situations. [ABSTRACT FROM AUTHOR]

Background: Antenatal depression is common and has significant consequences. The literature suggests that antibiotic exposure may be associated with depression. Many individuals are exposed to antibiotics during pregnancy. Further investigation of the association between antenatal antibiotic use and the development of depression during pregnancy is needed. Methods: A national prospective observational cohort study of pregnant individuals was undertaken using an online survey, completed during the third trimester. Antenatal depressive symptoms (ADSs) were defined as having an Edinburgh Postnatal Depression Scale score of ≥13 and/or receiving a clinical diagnosis of depression. Results: One in six individuals (16.5%, n = 977) experienced ADSs during their pregnancy, of whom 37.9% received a depression diagnosis. There was no relationship between antibiotic use and the development of ADSs. Four factors were identified as significant independent predictors of ADSs: personal history of depression, severe nausea and vomiting causing an inability to eat, emotional abuse from an intimate partner within the prior 12 months, and not having a university degree. Conclusions: Antenatal antibiotic use was not associated with the development of ADSs. Given the high incidence of undiagnosed depression, new strategies and models of care that prioritise individuals with risk factors may be required to optimise antenatal care. [ABSTRACT FROM AUTHOR]

Introduction: Nausea and Vomiting of Pregnancy (NVP) are common symptoms of pregnancy. Often, treatment is guided by subjective symptoms, leading to hospitalisation of these patients and unnecessary health costs. The 24-hour Pregnancy-Unique Quantification of Emesis (PUQE) index helps objectively quantify these symptoms and guide the management of these patients. Aim: To assess the association of the 24-hour PUQE index with the self-rated well-being score in evaluating the severity of NVP. Materials and Methods: In this cross-sectional study, a total of 207 women at 5 to 12 weeks of singleton pregnancy were recruited after obtaining informed consent. They were interviewed regarding their symptoms of nausea and vomiting based on a 24-hour PUQE index questionnaire, and a score was assigned to them. They were stratified as mild, moderate, or severe based on the score. The association of these symptoms with a selfrated well-being score and subjective symptoms such as the ability to take multivitamins, sleep pattern, liquid intake, and the need for hospitalisation was assessed. They were followed-up after four weeks, and a repeat score was obtained. Chi-square test was performed to compare the severity of PUQE-24. Results: The mean well-being score at the first visit was 3.381±1.650, and at the follow-up visit, it was 7±1.763. At the first visit, 46 out of 207 had a mild 24-hour PUQE score, 140 out of 207 had a moderate score, and 21 out of 207 had a severe score. During the follow-up visit, 123 out of 207 had a mild score, 77 out of 207 had a moderate score, and seven out of 207 had a severe score. There was a significant association between the mean self-rated well-being score and the 24-hour PUQE score at the first and follow-up visits (p-value=0.0001). Among the patients hospitalised at the first visit (21 out of 28), 75% belonged to the severe PUQE category. The mean liquid intake at the first visit was 24.363±10.357 mL/kg/hr, and at the followup visit was 29.972±10.691, showing a significant association with the severity of the 24-hour PUQE score (p-value=0.0001). A significant association was observed between the 24-hour PUQE scores of the first and follow-up visits (p-value=0.002). Conclusion: In this study, there was a significant association between the 24-hour PUQE score and the well-being score at both visits. Stratifying the severity of NVP objectively will guide us to choose the appropriate treatment and reduce the need for hospitalisation. [ABSTRACT FROM AUTHOR]

This mixed-methods study investigated the barriers and enablers to breastfeeding for women with high prepregnancy BMI from the perspectives of women and midwives, compared to women with normal BMI. Women recruited from a public Australian health service completed a survey in pregnancy (n=67) and postnatally (n=43) about breastfeeding intentions, barriers, enablers and support preferences. Midwives (n=13) employed at the health service participated in a focus group. There were no significant differences in infant feeding intentions, initiation and duration by BMI group. Women with high BMI were significantly more likely than women with normal BMI to report barriers to breastfeeding, including difficulties breastfeeding while in paid employment (high BMI: 76.3% vs normal BMI: 50.0%, p=0.029), and breastfeeding complications such as their baby being unable to latch to the breast (high BMI: 48.1% vs normal BMI: 11.1%; p=0.048). The midwives perceived that women with high BMI often have unrealistic breastfeeding expectations. Women with high BMI would benefit from further breastfeeding support and education. [ABSTRACT FROM AUTHOR]

Exposure to secondhand smoke (SHS) during fetal development results in negative postnatal effects, including altered organ development, changes in metabolism, and increased risk of respiratory illness. Previously, we found the induction of intrauterine growth restriction (IUGR) dependent on the expression of the receptor for advanced glycation end-products (RAGE) in mice treated with SHS. Furthermore, antenatal SHS exposure increases RAGE expression in the fetal lung. Our objective was to determine the postnatal effects of antenatal SHS treatment in 4- and 12-week-old offspring. Pregnant animals were treated with SHS via a nose-only delivery system (Scireq Scientific, Montreal, Canada) for 4 days (embryonic day 14.5 through 18.5), and offspring were evaluated at 4 or 12 weeks of age. Animal and organ weights were measured, and lungs were histologically characterized. Blood pressure and heart rates were obtained, and RAGE protein expression was determined in the lungs of control and treated animals. We observed the following: (1) significant decreases in animal, liver, and heart weights at 4 weeks of age; (2) increased blood pressure in 4-week-old animals; and (3) increased RAGE expression in the lungs of the 4-week-old animals. Our results suggest an improvement in these metrics by 12 weeks postnatally such that measures were not different regardless of RA or SHS exposure. Increased RAGE expression in lungs from 4-week-old mice antenatally treated with SHS suggests a possible role for this important smoke-mediated receptor in establishing adult disease following IUGR pregnancies. [ABSTRACT FROM AUTHOR]

Background: Non-psychotic mental disorders are common during the perinatal period. In South Africa, there are few studies on antenatal anxiety and these results vary. Antenatal anxiety does not only add to the burden of perinatal co-morbidity but has subsequent immediate and long-term effects on the mother, birth outcomes and her offspring. Aim: The aim of this study was to determine the prevalence of anxiety symptoms in pregnant women during the antenatal period and to determine associated factors. Setting: The study was conducted at an antenatal clinic located in Chris Hani Baragwanath Academic Hospital (CHBAH), Soweto, Johannesburg. Data were collected from March to December 2022. Methods: This was a prospective, cross-sectional study in which 200 pregnant women were interviewed. A biographical questionnaire and the generalised anxiety disorder questionnaire (GAD-7) were administered. Results: The prevalence of anxiety symptoms in pregnant women attending the antenatal clinic was 33%. Participants with anxiety were younger, employed and had lower perceived social support. Women with planned and wanted pregnancies had a lower prevalence of anxiety. Conclusion: One-third of the pregnant women screened positive for anxiety symptoms on the GAD-7. This is significantly higher compared to other studies carried out in the same facility previously. High-risk groups should be screened for anxiety. Contribution: This study prompts further studies and guiding policies on routine screening of pregnant women for anxiety and other mental illnesses during pregnancy.

Background Health economic assessments are used to determine whether the resources needed to generate net benefit from an antenatal or newborn screening programme, driven by multiple benefits and harms, are justifiable. It is not known what benefits and harms have been adopted by economic evaluations assessing these programmes and whether they omit benefits and harms considered important to relevant stakeholders. Objectives (1) To identify the benefits and harms adopted by health economic assessments in this area, and to assess how they have been measured and valued; (2) to identify attributes or relevance to stakeholders that ought to be considered in future economic assessments; and (3) to make recommendations about the benefits and harms that should be considered by these studies. Design Mixed methods combining systematic review and qualitative work. Systematic review methods We searched the published and grey literature from January 2000 to January 2021 using all major electronic databases. Economic evaluations of an antenatal or newborn screening programme in one or more Organisation for Economic Co-operation and Development countries were considered eligible. Reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. We identified benefits and harms using an integrative descriptive analysis and constructed a thematic framework. Qualitative methods We conducted a meta-ethnography of the existing literature on newborn screening experiences, a secondary analysis of existing individual interviews related to antenatal or newborn screening or living with screened-for conditions, and a thematic analysis of primary data collected with stakeholders about their experiences with screening. Results The literature searches identified 52,244 articles and reports, and 336 unique studies were included. Thematic framework resulted in seven themes: (1) diagnosis of screened for condition, (2) life-years and health status adjustments, (3) treatment, (4) long-term costs, (5) overdiagnosis, (6) pregnancy loss and (7) spillover effects on family members. Diagnosis of screened-for condition (115, 47.5%), life-years and health status adjustments (90, 37.2%) and treatment (88, 36.4%) accounted for most of the benefits and harms evaluating antenatal screening. The same themes accounted for most of the benefits and harms included in studies assessing newborn screening. Long-term costs, overdiagnosis and spillover effects tended to be ignored. The wide-reaching family implications of screening were considered important to stakeholders. We observed good overlap between the thematic framework and the qualitative evidence. Limitations Dual data extraction within the systematic literature review was not feasible due to the large number of studies included. It was difficult to recruit healthcare professionals in the stakeholder’s interviews. Conclusions There is no consistency in the selection of benefits and harms used in health economic assessments in this area, suggesting that additional methods guidance is needed. Our proposed thematic framework can be used to guide the development of future health economic assessments evaluating antenatal and newborn screening programmes. Study registration This study is registered as PROSPERO CRD42020165236. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR127489) and is published in full in Health Technology Assessment; Vol. 28, No. 25. See the NIHR Funding and Awards website for further award information. Plain language summary Every year the NHS offers pregnant women screening tests to assess the chances of them or their unborn baby having or developing a health condition. It also offers screening tests for newborn babies to look for a range of health conditions. The implementation of screening programmes and the care for women and babies require many resources and funding for the NHS, so it is important that screening programmes represent good value for money. This means that the amount of money the NHS spends on a programme is justified by the amount of benefit that the programme gives. We wanted to see whether researchers consider all the important benefits and harms associated with screening of pregnant women and newborn babies when calculating value for money. To do this, we searched all studies available in developed countries to identify what benefits and harms they considered. We also considered the views of parents and healthcare professionals on the benefits and harms screening that creates for families and wider society. We found that the identification of benefits and harms of screening is complex because screening results affect a range of people (mother–baby, parents, extended family and wider society). Researchers calculating the value for money of screening programmes have, to date, concentrated on a narrow range of benefits and harms and ignored many factors that are important to people affected by screening results. From our discussions with parents and healthcare professionals, we found that wider impacts on families are an important consideration. Only one study we looked at considered wider impacts on families. Our work also found that parent’s ability to recognise, absorb and apply new information to understand their child’s screening results or condition is important. Healthcare professionals involve in screening should consider this when supporting families of children with a condition. We have created a list for researchers to identify the benefits and harms that are important to include in future studies. We have also identified different ways researchers can value these benefits and harms, so they are incorporated into their studies in a meaningful way. Scientific summary Background National population screening programmes are implemented in the NHS on the advice of the United Kingdom National Screening Committee (UK NSC), which makes independent, evidence-based recommendations to ministers in the four countries of the UK. The recommendation to adopt a screening programme on a national scale is based on the premise that the benefits associated with the programme outweigh the harms to all relevant stakeholders. Screening committees require up-to-date evidence of these benefits and harms, as well as data demonstrating that the screening programme represents value for money. The latter is determined using a health economic assessment confirming that the additional costs to the NHS of implementing the programme and any unavoidable harms associated with it are justified by the benefits achieved, which are usually evaluated through outcome measures such as the incremental cost per quality-adjusted life-year (QALY) gained metric. Although there is established guidance on best practice for economic assessments of screening programmes in general (such as economic modelling), such guidance does not address the challenge of how the full range of potentially relevant benefits and harms can be incorporated into a single assessment, nor does it specifically focus on antenatal and newborn screening. Guidance in this area, therefore, remains limited. Objectives The overall objectives of this programme of work were to: enhance knowledge about methods for the identification and valuation of benefits and harms within economic assessments of antenatal and newborn screening identify attributes of relevance to stakeholders (parents/carers, health professionals, other relevant stakeholders) that should be considered for incorporation into future economic assessments using a range of qualitative research methods make recommendations about the benefits and harms that should be considered by economic evaluations and the health economic tools that could be employed for this purpose. Methods Systematic review and development of thematic framework of benefits and harms to use in future health economic assessments A systematic review of the published and grey literature of articles and reports published after January 2000 was conducted to identify health economic assessments evaluating antenatal and newborn screening programmes in one or more of the Organisation for Economic Co-operation and Development (OECD) countries (see Chapter 3). A protocol for this review was registered with PROSPERO (CRD42020165236) and published in January 2020. The Population, Intervention, Comparator, Outcome and Study design (PICOS) framework was used to develop the study eligibility criteria and applied to the literature searches. No language restrictions were imposed. The published literature was searched using a comprehensive selection of electronic bibliographic databases. The academic electronic database search was supplemented by manual reference searching of bibliographies, contacts with experts in the field and author searching. The list of sources of grey literature searched was informed by a recent systematic review of national policy recommendations on newborn screening. Two independent reviewers assessed the suitability for inclusion of outputs identified in the published and grey literature. A data extraction sheet was created including: (1) items from the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist, and (2) a bespoke form created by the research team to extract benefits and harms adopted by economic assessments evaluating antenatal and newborn screening programmes. The information captured in the bespoke form was used to develop a framework of benefits and harms adopted by health economic assessments using a number of themes grouped into categories based on an integrative descriptive analysis (see Chapter 4). Benefits and harms reported by articles and reports were categorised into themes and subtheme(s) according to the condition and screening type, using this thematic framework. Qualitative component We conducted a qualitative study using multiple methods to capture stakeholders’ views about the benefits and harms of antenatal and newborn screening that should be incorporated into future economic assessments. The qualitative study included: a meta-ethnography of the existing literature on newborn screening experiences (see Chapter 5) secondary analysis of existing individual interviews related to antenatal screening, newborn screening and living with screened-for conditions (see Chapter 6) thematic analysis of primary data collected with stakeholders about their experiences with antenatal and newborn screening (see Chapter 7). We conducted a meta-ethnography to better understand what was known about the experiences of newborn bloodspot screening. The experiences of antenatal screening have been extensively investigated, but newborn screening experiences remained underexplored. In our secondary analysis, the goal was to bring together, examine and interpret the findings from disparate qualitative research studies and produce a richer and broader understanding than would be possible by looking at the studies individually. We drew on a large body of existing interview data reflecting a range of screening experiences, to better understand how individuals affected by screening discussed their experiences. What emerged was a complex web of individuals, organisations, technologies and discourses that shape the screening landscape. Finally, we conducted a thematic analysis of evidence generated from primary research with three groups of stakeholders (individuals, charity and policy professionals, and healthcare providers) to understand how these groups conceptualised the benefits and harms of screening. This primary data collection amplified concepts from our meta-ethnography and secondary analysis. By using a range of qualitative methods, we identified well-informed conclusions about not only the benefits and harms of screening as understood by a variety of stakeholders, but also concepts which do not fit neatly into that framework. We present the methods and findings for each of these pieces of work in individual chapters before summarising critical findings from across components of the qualitative study (see Chapter 8). Blending benefits and harms taxonomy with qualitative evidence A mapping exercise was carried out to identify levels of overlap between the outcomes of the systematic review and the qualitative component of the study. The aim of this exercise was to identify whether health economics assessments miss the adoption of key benefits and harms when evaluating antenatal and newborn screening programmes. We mapped the qualitative data (see Chapters 5–7) onto the completed thematic framework. In some cases, the qualitative data collected did not cover subcategories of the framework, and we noted the absence. There were also themes from the qualitative data that could not be easily mapped onto the thematic framework. Stakeholder workshops A scoping review of alternative methods to value benefits and harms associated with screening scenarios was conducted. The aim of this exercise was to clarify which valuation methods should be implemented to value antenatal and newborn benefits and harms in future studies. The final selected alternatives were presented to our parent and public involvement (PPI) members to understand the feasibility of administering these valuation methods to relevant participants in future studies. This was supplemented by a separate workshop held with a broad set of stakeholders to review the findings of the VALENTIA research programme and contribute to a set of recommendations about approaches for the measurement and valuation of outcomes that should be considered by future economic assessments of antenatal and newborn screening, and to highlight areas for future methodological enquiry. The session was attended by healthcare professionals, representatives from relevant academic disciplines, representatives from charities, outreach services and support groups, and representatives from policy-making bodies. Results Systematic review and development of taxonomy of benefits and harms to use in future health economic assessments We identified 52,244 articles and reports from the searches of the published and grey literature and included 336 records in the data extraction. The majority of the records were journal articles, with almost half conducted in the USA or UK. Genetic conditions and infectious diseases were the main areas covered by the articles and reports assessing antenatal screening, while metabolic and structural conditions were the main areas covered in the evaluations of newborn screening programmes. Decision-analytical models were employed in 272 (81.0%) of the articles and reports, while 117 (43.0%) used a lifetime time horizon. Almost half of the studies conducted a cost–utility analysis reporting incremental cost per QALY values (167, 49.4%). The costing perspective adopted was not stated in 117 (33.7%) articles and reports. Reporting quality assessed using the CHEERS checklist was heterogeneous. The top five items not satisfied among the studies for antenatal screening programmes were ‘Abstract’ (160, 88.4%), ‘Time horizon’ (153, 84.5%), ‘Choice of model’ (153, 84.5%), ‘Discount rate’ (130, 71.8%) and ‘Study funding, limitation, generalisability and current knowledge’ (123, 68.0%). The top six items not satisfied among newborn screening programme studies were ‘Abstract’ (69, 83.1%), ‘Time horizon’ (67, 80.7%), ‘Study funding, limitation, generalisability and current knowledge’ (59, 71.1%), ‘Choice of model’ (55, 66.3%), ‘Discount rate’ (53, 63.9%) and ‘Setting and location’ (53, 63.9%). The top five items satisfied among the studies for both antenatal and newborn screening programmes were ‘Background and objectives’ (264, 100%), ‘Target population and subgroups’ (264, 100%), ‘Choice of health outcomes’ (263, 99.6%), ‘Measurement of effectiveness’ (260, 98.5%) and ‘Estimate resources and cost’ (247, 93.6%). We identified 86 unique descriptions of consequences associated with benefits and harms across all articles and reports. Our thematic analysis resulted in seven core themes of benefits and harms: (1) diagnosis of screened for condition, (2) life-years and health status adjustments, (3) treatment, (4) long-term costs, (5) overdiagnosis, (6) pregnancy loss and (7) spillover effects on family members. Diagnosis of screened-for condition (115, 47.5%), life-years and health status adjustments (90, 37.2%) and treatment (88, 36.4%) accounted for most of the benefits and harms evaluating antenatal screening. The same themes accounted for most of the benefits and harms included in studies assessing newborn screening. Overdiagnosis and spillover effects tended to be ignored. Only 10 out of the 242 (4.1%) antenatal screening evaluations adopted benefits and harms from all of themes 1–4, whereas only 9 out of the 95 (9.5%) newborn screening evaluations adopted benefits and harms from all of themes 1–4. Qualitative component By looking across a range of moments, outcomes and conditions across international contexts, our meta-ethnography identified that newborn screening experiences vary widely across families. We developed the concept of absorptive capacity – the ability to recognise, assimilate and apply new information – to capture the abilities of parents, and crucially also the limits of those abilities, to comprehend their child’s screening results or condition. We explain the various ways that parents experience the expansion and compression of time throughout and beyond the screening pathway, demonstrating the far-reaching implications of screening across time, as well as to wider family and kin. Our secondary analysis brought together a large, rich data set and yielded a situational map. This map demonstrates that conversations about antenatal and newborn screening involve a complicated weaving of individuals, organisations, materials and discourses. We identified elements that may (or may not) be involved in an individual’s situation and consider implicated environments that shape the landscape of screening. We generated a list of stakeholders that are central to screening conversations and uncovered temporal, spatial, economic and societal issues shaping screening experiences and debates. We conducted in-depth interviews and focus groups with people who had recently made decisions about screening, charity and professional stakeholders and healthcare providers. While different stakeholders named different benefits and harms, there was a substantial amount of overlap between groups. Consistently named benefits included screening’s ability to get information, prevent harm and provide reassurance. Consistently named harms included possible pressure to have termination of pregnancy, lack of preparation for unexpected results, emotional distress and a lack of understanding of the purposes and potential implications of screening tests. Blending benefits and harms from the thematic framework with qualitative evidence Our mapping exercise resulted in an overall good overlap between the quantitative and qualitative evidence, with elements of the qualitative evidence relevant to specific themes on the thematic framework identified. There was no suggestion that our thematic framework of benefits and harms excluded any important themes. Elements of the qualitative evidence not present in the thematic framework were also identified. For most of these elements, it was clear that they were not relevant for the development of health economic assessments (e.g. challenge of information provision to make sure choice is ‘informed’). However, the area of wide-reaching family implications of screening was considered important to our stakeholders in the qualitative work but often overlooked by developers of health economic assessments evaluating antenatal and newborn screening programmes. Stakeholder workshops In the first workshop, concerns around the practicality of the number of valuation techniques that could be applied within the online workshops led to a focus on best–worst scaling and discrete choice experiments as the primary valuation techniques. The workshops highlighted a number of factors that can inform the design of future preference elicitation studies in this area. In the second workshop, we reviewed the findings of the VALENTIA research programme and informed the final set of recommendations about approaches for the measurement and valuation of outcomes that should be considered by future economic assessments of antenatal and newborn screening, and highlighted areas for future methodological enquiry. Conclusions Benefits and harms of antenatal and newborn screening are complex and multidimensional, and they have generally been incorporated in a haphazard manner into economic evaluations. Our work suggests that there is an immediate need to provide methods guidance for researchers conducting these types of studies in future work. Our proposed framework of benefits and harms can be used as a starting point to guide the development of health economic assessments evaluating antenatal and newborn screening for specific conditions and to prevent exclusion of important harms. It is important that future economic evaluations in this area incorporate benefits and harms of spillover effects to family members, as this was considered very important to the stakeholders consulted during the study. The QALY remains a common approach for capturing the benefits and harms associated with antenatal and newborn screening programmes. This study identifies a range of benefits and harms that should be considered for inclusion within future economic assessments and provides preliminary evidence of the feasibility of applying alternative economic valuation methods in this area. Study registration This study is registered as PROSPERO CRD42020165236. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR127489) and is published in full in Health Technology Assessment; Vol. 28, No. 25. See the NIHR Funding and Awards website for further award information.

Hepatitis b virus infection presents major threat to public health throughout endemic countries of tropical and sub-Saharan Africa. There is a scarcity of data on HBV in Adamawa State, Nigeria. Hence, the objectives of this paper is to evaluate the epidemiology of hepatitis B infection among pregnant women in Yola North Local Government Area, Adamawa State Nigeria using Structured questionnaire to collect information from 1,254 pregnant women who come for antenatal clinic (ANC) for the first visit. Five (5) mL of blood samples were drown from each consented pregnant women for serological analysis by using rapid diagnostic test/ELISA. A pooled prevalence of 4.1% was recorded for HBV. Of all the sociodemographic characteristics studied, only occupation recorded a significant association with HBV (P=0.023) with highest prevalence among house wives (2.2%) and lowest among civil servants (0.6%). Also, considering the eight attitudes-related questions used to assess the participants, a good attitude of 73.9% toward HBV was reported. Three factors that recorded significant association with hepatitis b infection were; ever screened for HBV (AOR=0.349; 95% CI= 0.121-1.007; P=0.052), can be infected with HBV (AOR=0.107; 95% C.I =0.017-0.660; P=0.016) and people with HBV are discriminated in the society (AOR=3.071; 95% CI= 1.508-6.253; P=0.002). Therefore, awareness on modes of transmission, early detection and screening of HBV for all pregnant women attending ANC must be strengthened to minimize and control vertical transmission of the infections.

This case report discusses the rare occurrence of pericarditis with preeclampsia in the antepartum through to postpartum state. A woman in her 30s presented four days postnatally with positional central chest pain, elevated blood pressure and newly deranged liver function tests. Echocardiogram demonstrated new pleural effusion and she was diagnosed with preeclampsia and superimposed pericarditis. Her blood pressure was stabilised with a combination treatment regime of labetalol, enalapril and frusemide, whilst her pericarditis responded well to colchicine and ibuprofen. She was eventually discharge on enalapril and colchicine. By her 6-week follow-up she had made a full recovery and she had reported no recurrence of symptoms at the time of writing.

BACKGROUND: For the management of hemolytic disease of the fetus and newborn (HDFN), it is important to detect unexpected red cell antibody in pregnant women. We assessed the prevalence of unexpected red cell antibodies in consecutive pregnant women attending antenatal clinic (ANC). More importantly, cases with unexpected antibody causing severe anemia were followed-up for intervention (Intra-uterine transfusion {IUT}) and outcome of pregnancy (still-birth/live-healthy). AIMS AND OBJECTIVES: The study was conducted with an objective to find the prevalence of unexpected RBC antibodies in pregnant women, their specificity and to do the follow-up for IUT and outcome of pregnancy (still-birth, live-birth) in antibody positive women. MATERIALS AND METHODS: This was a prospective study from January 2021 to May 2022 at two tertiary care centres. All antenatal samples received by the laboratory were screened for unexpected red cell antibody. Whenever antibody screen was positive, antibody identification was performed. Patients, positive for unexpected antibody and anemia were followed up for any transfusion-based intervention and outcome of pregnancy. RESULTS: A total of 539 consecutive samples were worked up and among these, 10 samples (1.85%) were found to be antibody positive. The antibodies identified were Anti-D (n=6), anti-Leb (n=1), anti-M (n=1), anti-C (n=1) and anti-E (n=1).The prevalence of unexpected antibodies in Rh positive and Rh negative pregnant women was 0.83% and 10.9% respectively. Follow-up was done for all 10 cases with unexpected antibody and anemia was monitored by MCA PSV (middle cerebral artery peak systolic velocity).Two women developed severe anemia thus requiring single intrauterine transfusion (at 26 weeks and 28 weeks respectively) each, for correction of anemia. In both these cases, healthy male child was delivered. At 3-month follow-up both children were alive and healthy. CONCLUSION: The study found prevalence of unexpected RBC antibodies in pregnant women as 1.85%. The study also underlined importance of transfusion-based interventions contributing to successful outcome in couple of cases with severe anemia.

Objectives: Cartoons, comics, and caricatures have been incorporated in health education. This trial aimed to evaluate the effectiveness of caricature-based breastfeeding education at improving breastfeeding knowledge, attitudes, self-efficacy, and practice among pregnant women. Materials and Methods: A randomized controlled clinical trial was carried out at Riyadh First Health Cluster in Saudi Arabia. A total of 85 pregnant women were randomly assigned to the intervention group (n = 41) or the control group (n = 44). The intervention was two caricature-based versus one standard online lecture in breastfeeding. The participants were followed up for 3 months postpartum. The primary outcome was full breastfeeding (predominant and exclusive breastfeeding) by the time infants were 3 months old. The secondary outcomes were prenatal and postnatal breastfeeding self-efficacy, Iowa Infant Feeding Attitude Scale (IIFAS) scores, and satisfaction with the education. Results: The participants were mostly Saudi (97.6% vs. 90.9%) and housewives (79% vs. 86.4%) for the intervention and control groups, respectively. The full breastfeeding rate at 3 months postpartum was 32.5% for the intervention and 31.6% for the control (P = 0.808; 95% confidence interval 0.539–1.965; relative risk = 1.029). Prenatal breastfeeding, postnatal self-efficacy, and IIFAS scores were compared between the intervention and control groups; no statistically significant difference was found (P > 0.05). In both arms of the study, participants' experiences with the health education were satisfactory. Conclusion: Caricature use in antenatal breastfeeding education was a pleasant experience, but its effect on self-efficacy, attitudes, and behavior could not be determined from this trial. Large-scale, multi-center, multi-component research is recommended.

Exposure to secondhand smoke (SHS) during fetal development results in negative postnatal effects, including altered organ development, changes in metabolism, and increased risk of respiratory illness. Previously, we found the induction of intrauterine growth restriction (IUGR) dependent on the expression of the receptor for advanced glycation end-products (RAGE) in mice treated with SHS. Furthermore, antenatal SHS exposure increases RAGE expression in the fetal lung. Our objective was to determine the postnatal effects of antenatal SHS treatment in 4- and 12-week-old offspring. Pregnant animals were treated with SHS via a nose-only delivery system (Scireq Scientific, Montreal, Canada) for 4 days (embryonic day 14.5 through 18.5), and offspring were evaluated at 4 or 12 weeks of age. Animal and organ weights were measured, and lungs were histologically characterized. Blood pressure and heart rates were obtained, and RAGE protein expression was determined in the lungs of control and treated animals. We observed the following: (1) significant decreases in animal, liver, and heart weights at 4 weeks of age; (2) increased blood pressure in 4-week-old animals; and (3) increased RAGE expression in the lungs of the 4-week-old animals. Our results suggest an improvement in these metrics by 12 weeks postnatally such that measures were not different regardless of RA or SHS exposure. Increased RAGE expression in lungs from 4-week-old mice antenatally treated with SHS suggests a possible role for this important smoke-mediated receptor in establishing adult disease following IUGR pregnancies.

A 23 yr old primigravida reported for a 1st-trimester antenatal scan at 12 weeks of gestation. Sonography revealed findings consistent with Cystic Hygroma with Hydrops fetalis. The case merits discussion to reflect upon the findings of these rare co-existing grave medical conditions in the fetus and emphasize the relevance of timely antenatal diagnosis of Cystic Hygroma with concomitant hydrops, the condition known to have a very high rate of fetal mortality. The relevant review of literature and findings of the case are discussed thence. [ABSTRACT FROM AUTHOR]

Abstract Background The COVID-19 pandemic caused various disruptions to NHS maternity services in England. Changes were made to antenatal and postnatal care and the way that information was shared with maternity service users during these times. Fewer face-to-face appointments, increased virtual appointments and changes in guidance about the suitability of the COVID-19 vaccine without appropriate information sharing and evidence caused concern. Methods This study took a blended inductive-deductive approach to secondary data analysis using a population subset of 16 from a wider study that sought to understand the impact of COVID-19 on maternity services in England. Participants of this study were aged 28–44 and gave birth using NHS maternity services in England. The data were collected and coded using Rapid Analysis Procedure sheets, which generated key themes, which are used here to structure the results. Results Four main themes were generated from the analysis: 1) service restrictions to antenatal and postnatal appointments 2) access to information and changes to antenatal and postnatal care 3) inconsistencies in the implementation of government and NHS policy and 4) limited information about COVID-19 vaccine provided by NHS trusts and hesitancy in vaccine acceptance. Conclusion Participants experienced poor communication that affected their understanding of maternity service changes and there was limited general and maternal health information provided. Vaccine information was also inadequate, and participants expressed a desire for clearer guidance. The UK Government, Royal College of Obstetricians and Gynaecologists, and NHS must collaborate with maternity service users to ensure that there are evidence-based guidelines and policies that can be understood and standardised across all NHS maternity trusts.

Abstract Background Antenatal Education equips parents with knowledge for safe maternal health and infant care. It also reduces fear and anxiety during childbirth. ANE curriculum can vary according to country and institute. It can include classes focusing on childbirth, pain relief techniques, mode of birth, parenting, breastfeeding, breathing techniques, etc. Although ANE is widely practiced in developed countries, there is no standard program in developing countries like Pakistan. This study aims to improve antenatal education at a tertiary care hospital in Karachi, Pakistan potentially proposing an upgraded curriculum as a national standard. Methods This multiphase study used mix-method design was conducted in the Obstetrics and Gynaecology Department of a tertiary care hospital of Karachi, Pakistan from 2019 to 2021. Phase 1 of the study included reviewing and comparing the hospital’s antenatal curriculum with existing literature, followed by Phase 2, which was a desk review of attendance and patient feedback. The 3rd phase involved IDIs (in depth interviews) from health care workers (Obstetrics experts) to understand their perspectives regarding the ANE and the conducted classes. For phase one, gaps were identified and reported theoretically. For phase two, the annual attendance was recorded and participants’ satisfaction with the classes assessed. Qualitative data from phase 2 and 3 was converted into themes and sub-themes. Results The audit showed a decline in the attendance of antenatal classes due to the pandemic and consequent shift to online sessions. The low attendance in online courses could be attributed to various factors. Patient feedback was generally positive, with a majority expressing high satisfaction levels. Expert feedback highlighted the need for additional topics such as mental health and COVID in pregnancy, as well as fathers' involvement. The curriculum was updated to include these topics and made more interactive with printed handouts for parents. Conclusion A standardized antenatal education covering various topics surrounding pregnancy, childbirth, and postnatal care must be available to parents nationwide.

Background: Antenatal depression is a significant concern worldwide, particularly in low- and middle-income countries where prevalence rates vary widely. Understanding the socio-demographic and medical factors associated with antenatal depression is crucial for effective intervention and management. This study aims to assess the prevalence of antenatal depression and its relationship with various demographic, obstetric, and medical factors among pregnant women attending a tertiary healthcare hospital in Bhopal, India. Methods: An observational cross-sectional study was conducted over 18 months, involving 500 pregnant women attending antenatal clinics. Participants were assessed using a structured questionnaire covering demographic, obstetric, and medical factors. Antenatal depression was measured using the Edinburgh Postnatal Depression Scale (EPDS). Data analysis was performed to determine associations between depression and various factors. Results: The prevalence of antenatal depression was found to be 28.4%. Significant associations were observed between depression and socio-demographic factors such as younger age, lower education levels, lower socio-economic status, and belonging to extended or joint families. Medical factors such as stage of pregnancy, parity, marital conflict, unplanned pregnancy, preference for a male child, and past history of abortion were also significantly associated with antenatal depression. Conclusion: This study highlights the high prevalence of antenatal depression among pregnant women and identifies several socio-demographic and medical factors associated with its occurrence. Effective screening and management of antenatal depression, particularly among women with lower education levels, poorer socio-economic status, and limited family support, are essential for improving maternal and child health outcomes. [ABSTRACT FROM AUTHOR]

Pregnancy is an important period for a woman. During this period, women experience many physical and emotional changes that require special attention and care. Antenatal health education is an effort to provide knowledge and information to pregnant women about pregnancy, childbirth and postpartum health. The aim of this research is to determine the impact of antenatal health education on healthy pregnancies and safe births. This study used qualitative research methods. Research data was obtained through literature study and in)depth interviews with 10 pregnant women who had attended antenatal health education. The data that has been collected is then analyzed in three stages, namely data reduction, data presentation and drawing conclusions. The research results show that antenatal health education has a positive impact on healthy pregnancies and safe births. Pregnant women who take part in antenatal health education have better knowledge about pregnancy, childbirth and postpartum health. This knowledge helps pregnant women to take better care of themselves and their fetus' health, make the right decisions regarding pregnancy and childbirth, prepare themselves physically and mentally for labor and postpartum, and face pregnancy and childbirth complications more calmly. [ABSTRACT FROM AUTHOR]

Introduction: neonatal mortality rate (NMR) is defined as the probability of dying during the first 28 days of life expressed per 1,000 live births. The death of neonates without risk factors at the end of pregnancy could be an indicator of sub-optimal quality care during labor and care of sick neonates. Therefore, this study aimed to determine the factors associated with neonatal deaths happening without detected risks during prenatal period. Methods: a cross-sectional study was conducted from 2017 to 2021. The recruited pregnant women were those who had a live, term, single-intrauterine pregnancy without detectable fetal abnormality at the time of starting labor. The data were collected through open data kit (ODK) forms that were customized in kobo tool in the tablets. The data analysis was performed using STATA statistical software. The factors associated with neonatal mortality were analyzed in a multiple logistic regression and considered significant if p < 0.05. Results: among the 4401 enrolled mothers, neonatal deaths were 361 (8.2%). The factors associated with death of neonates without risk factors during prenatal period were low Apgar score [AOR = 4.38: 95%CI (2.33-7.72)], male sex [AOR=2.25: 95%CI (1.12-3.81)], gestational age above 40 weeks [AOR=4.79: (2.50-7.61)] and assisted vaginal delivery [AOR = 2.55: 95%CI (1.12-4.96)]. Conclusion: the increased number of neonatal deaths are associated with sex of neonates, low Apgar score, post maturity and assisted vaginal delivery. The hospital-based studies should be done to address the preventable neonatal deaths with no detected risk factors before birth. [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/Aims: Routine antenatal medications are essential drugs used during pregnancy to improve maternal and fetal outcomes and prevent complications. These include iron, folic acid and sulfadoxine–pyrimethamine. This study evaluated pregnant women's knowledge of and compliance with these medications in selected antenatal care centres in Lagos, Nigeria. Methods: A descriptive cross-sectional study was conducted among 356 pregnant women. Multistage random sampling was used to select the study population and structured questionnaires were administered. Data were analysed using descriptive statistics and hypotheses were tested using a Chi-squared test. Results: The majority (63.7%) of participants had adequate knowledge of routine antenatal medications. There was high compliance with folic acid (64.0%), iron (71.5%) and sulfadoxine-pyrimethamine (56.5%), with overall 64.9% showing high compliance with routine antenatal medications. Conclusions: Participants demonstrated high knowledge of and compliance with routine antenatal medications, which is vital to improving maternal health and preventing complications. [ABSTRACT FROM AUTHOR]

BACKGROUND: Women use various coping strategies to deal with stress and depression. These strategies are shaped by social contexts over the life course and may attenuate and/or exacerbate the physiologic effects of depression. AIMS: The purpose of this study was to determine whether coping strategies (active, disengaged, or social support coping) moderate depression-related diurnal cortisol dysregulation and to explore how social context influences women's use of coping. METHODS: This was a mixed-methods study of pregnant women (N = 65) during mid-pregnancy. Cortisol was measured in saliva collected during the waking hours of the day. Participants completed the Edinburgh Depression Scale and the Brief COPE. A subset of the sample participated in semistructured qualitative interviews (n = 20). RESULTS: Social support coping, but not active or disengaged coping, moderated end-of-day cortisol levels. Among depressed women, higher use of social support was associated with lower and more dynamic (i.e., less flat) diurnal cortisol rhythms. The qualitative findings revealed how complex social dynamics related to financial insecurity, lack of mutuality, and social identity affected women's use of and access to social support. CONCLUSION: These findings support theories of the stress-buffering effects of social support. Future research is needed to examine how social determinants affect access to social support, and how early life social experiences condition women's adaptive formation of social support coping strategies over the life course. Clinically, these findings underscore the value of relationship-centered nursing care for depressed women. [ABSTRACT FROM AUTHOR]

Background: Sample self-collection for reproductive tract infection diagnosis has been found to offer greater convenience, privacy, autonomy, and expanded access to testing in non-pregnant adults. This review aimed to determine whether sample self-collection is as accurate as provider-collection for detection of group B streptococcus colonisation in pregnancy and whether a strategy of self-collection compared to provider-collection might improve maternal and neonatal health outcomes. Methods: We searched CINAHL Plus, Medline, EMBASE, Maternity and Infant Care Database, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews in June 2022. Eligible studies compared self-collected and provider-collected samples taken from the same participants or participants randomised to either self-collection or provider-collection for reproductive tract infection testing using the same test and testing method in pregnant individuals. We included trials and observational studies. Reviewers assessed risk of bias using the QUADAS-2 checklist and independently extracted data. Sensitivity and specificity for group B streptococcus colonisation of self-collected compared to provider-collected samples were pooled using a bivariate, random-effects, meta-analytic model. This review was registered with PROSPERO (CRD42023396573). Results: The search identified 5909 references, of which eleven diagnostic accuracy group B streptococcus studies were included (n = 3269 participants). No studies assessed the effects of self-collection in pregnancy on health outcomes. All studies had high or unclear risk of bias. Pooled sensitivities of self-collected samples for group B streptococcus detection were 82% (95% CI: 66–91%; I2 = 68.85%) in four trials (n = 1226) and 91% (95% CI: 83–96%; I2 = 37.38%) in seven non-randomised studies (n = 2043). Pooled specificities were 99% (95% CI: 98–99%; I2 = 12.08%) and 97% (95% CI: 94–99%; I2 = 72.50%), respectively. Conclusions: Self-collected samples for group B streptococcus detection in pregnancy had high specificity compared to provider-collection, but lower sensitivity, particularly for included trials. Studies investigating the effect of self-collection on health outcomes, and further higher quality trials comparing accuracy of self-collection to provider-collection, are required. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic caused various disruptions to NHS maternity services in England. Changes were made to antenatal and postnatal care and the way that information was shared with maternity service users during these times. Fewer face-to-face appointments, increased virtual appointments and changes in guidance about the suitability of the COVID-19 vaccine without appropriate information sharing and evidence caused concern. Methods: This study took a blended inductive-deductive approach to secondary data analysis using a population subset of 16 from a wider study that sought to understand the impact of COVID-19 on maternity services in England. Participants of this study were aged 28–44 and gave birth using NHS maternity services in England. The data were collected and coded using Rapid Analysis Procedure sheets, which generated key themes, which are used here to structure the results. Results: Four main themes were generated from the analysis: 1) service restrictions to antenatal and postnatal appointments 2) access to information and changes to antenatal and postnatal care 3) inconsistencies in the implementation of government and NHS policy and 4) limited information about COVID-19 vaccine provided by NHS trusts and hesitancy in vaccine acceptance. Conclusion: Participants experienced poor communication that affected their understanding of maternity service changes and there was limited general and maternal health information provided. Vaccine information was also inadequate, and participants expressed a desire for clearer guidance. The UK Government, Royal College of Obstetricians and Gynaecologists, and NHS must collaborate with maternity service users to ensure that there are evidence-based guidelines and policies that can be understood and standardised across all NHS maternity trusts. [ABSTRACT FROM AUTHOR]

Background: Antenatal Education equips parents with knowledge for safe maternal health and infant care. It also reduces fear and anxiety during childbirth. ANE curriculum can vary according to country and institute. It can include classes focusing on childbirth, pain relief techniques, mode of birth, parenting, breastfeeding, breathing techniques, etc. Although ANE is widely practiced in developed countries, there is no standard program in developing countries like Pakistan. This study aims to improve antenatal education at a tertiary care hospital in Karachi, Pakistan potentially proposing an upgraded curriculum as a national standard. Methods: This multiphase study used mix-method design was conducted in the Obstetrics and Gynaecology Department of a tertiary care hospital of Karachi, Pakistan from 2019 to 2021. Phase 1 of the study included reviewing and comparing the hospital's antenatal curriculum with existing literature, followed by Phase 2, which was a desk review of attendance and patient feedback. The 3rd phase involved IDIs (in depth interviews) from health care workers (Obstetrics experts) to understand their perspectives regarding the ANE and the conducted classes. For phase one, gaps were identified and reported theoretically. For phase two, the annual attendance was recorded and participants' satisfaction with the classes assessed. Qualitative data from phase 2 and 3 was converted into themes and sub-themes. Results: The audit showed a decline in the attendance of antenatal classes due to the pandemic and consequent shift to online sessions. The low attendance in online courses could be attributed to various factors. Patient feedback was generally positive, with a majority expressing high satisfaction levels. Expert feedback highlighted the need for additional topics such as mental health and COVID in pregnancy, as well as fathers' involvement. The curriculum was updated to include these topics and made more interactive with printed handouts for parents. Conclusion: A standardized antenatal education covering various topics surrounding pregnancy, childbirth, and postnatal care must be available to parents nationwide. [ABSTRACT FROM AUTHOR]

Background/Aims: Although maternity care in developed countries is safe, fear of childbirth is a common problem. There is limited research in this area on nulliparous and multiparous women. The aim of this study was to compare fear of childbirth, its risk factors and birth outcomes between Australian nulliparous and multiparous women. Methods: In this prospective cohort study, 141 nulliparous women and 212 multiparous women were recruited from antenatal clinics. Data were collected using standardised questionnaires and analysed. Results: A third of nulliparous (33%) and multiparous women (31%) feared childbirth. Nulliparous women with high–severe fear were more likely to have a lower family income, attend antenatal education classes, undergo assisted conception and report higher levels of depression, anxiety and stress. They also had greater odds of prelabour cervical ripening, oxytocin for induction or augmentation of labour, instrumental birth, episiotomy and greater volume of blood loss during birth than multiparous women. Conclusions: To empower and support women with fear of childbirth, their unique needs must be recognised. A assistance in coping with fear and anxiety must be made available to contribute to a positive pregnancy experience and birth outcome. [ABSTRACT FROM AUTHOR]

We present a summary of the European Consensus guidelines on management of respiratory distress syndrome, which were released in 2022, and compare these with the current National Neonatology Forum of India guidelines, and discuss the feasibility of their application in the Indian settings. [ABSTRACT FROM AUTHOR]

Antenatal depression and maternal nutrition can influence infant temperament. Although broad-spectrum-micronutrients (BSM: vitamins and minerals) given above Recommended Dietary Allowances during pregnancy can mitigate symptoms of antenatal depression, their associated effects on infant temperament are unknown. One hundred and fourteen New Zealand mother-infant dyads (45 infants exposed to BSM during pregnancy (range of exposure during pregnancy: 12–182 days) to treat antenatal depressive symptoms (measured by Edinburgh Postnatal Depression Scale) and 69 non-exposed infants) were followed antenatally and for 12 months postpartum to determine the influence of in utero BSM exposure on infant temperament. The Infant Behavior Questionnaire–Revised: Very Short-Form assessed temperament at 4 (T1), 6 (T2) and 12 (T3) months postpartum via online questionnaire. Latent growth curve modeling showed BSM exposure, antenatal depression and infant sex did not statistically significantly predict initial levels or longitudinal changes in orienting/regulatory capacity (ORC), positive affectivity/surgency (PAS) or negative affectivity (NEG). Higher gestational age was positively associated with initial PAS, and smaller increases between T1 and T3. Breastfeeding occurrence was positively associated with initial NEG. Although not significant, BSM exposure exerted small, positive effects on initial NEG (β = −0.116) and longitudinal changes in ORC (β = 0.266) and NEG (β = −0.235). While BSM exposure did not significantly predict infant temperament, it may mitigate risks associated with antenatal depression. BSM-exposed infants displayed temperamental characteristics on par with typical pregnancies, supporting the safety of BSM treatment for antenatal depression.

Abstract Background Perinatal palliative care is an emerging branch of children’s palliative care. This study sought to better understand the pattern of antenatal referrals and the role of a specialist paediatric palliative care (PPC) team in supporting families throughout the antenatal period. Methods A single-centre retrospective chart review of all antenatal referrals to a quaternary children’s palliative care service over a 14-year period from 2007 to 2021. Results One hundred fifty-nine antenatal referrals were made to the PPC team over a 14-year period, with increasing referrals over time. Referrals were made for a broad spectrum of diagnoses with cardiac conditions (29% of referrals) and Trisomy 18 (28% of referrals) being the most prevalent. 129 referrals had contact with the PPC team prior to birth and 60 had a personalised symptom management plan prepared for the baby prior to birth. Approximately one third (48/159) died in utero or were stillborn. Only a small number of babies died at home (n = 10) or in a hospice (n = 6) and the largest number died in hospital (n = 72). 30 (19% of all referrals) were still alive at the time of the study aged between 8 months and 8 years. Conclusions Specialist PPC teams can play an important role in supporting families during the antenatal period following a diagnosis of a life-limiting fetal condition and demand for this service is increasing. A large proportion of the cases referred will not survive to the point of delivery and a number of babies may survive much longer than predicted. PPC teams can be particularly helpful navigating the uncertainty that exists in the antenatal period and ensuring that plans are made for the full spectrum of possible outcomes.

Abstract Background Conjoined twin pregnancy is a rare variety, which occurs due to incomplete separation of the embryonic plate after 13 days. Each type of this entity is linked to distinct levels of organ sharing, structural abnormalities, complications, and difficulties concerning the potential for separation. So a comprehensive multidisciplinary prenatal assessment of conjoined twins is crucial for providing accurate parental counseling, effectively managing the pregnancy, and formulating an appropriate delivery strategy. The purpose of our study was to early diagnosis of conjoined twins using ultrasound, describing the various types of conjoined twins and the role of recent advances like 3D ultrasound in aiding their management. Case presentation Here, we are describing the case series of four conjoined twins, which were diagnosed antenatally by using ultrasound between the period of January 2019 and December 2019. Four cases of conjoined twins (two thoracopagus and two thoraco-omphalopagus) were accurately diagnosed on antenatal ultrasound. After detailed counseling of the parents regarding the risks and benefits of this complicated pregnancy and obtaining written consent, all four cases were terminated. Ultrasound plays a vital role in the early diagnosis and management of conjoined twins. Also, 3D ultrasound and MRI help in better characterization of fused body parts and connection between vital organs, thus it aids in the management. Conclusions It is important to detect these cases early as termination of pregnancy is less risky in the early stages as compared to the late stages for proper management.

Objectives: Telemedicine (TM) emergence has been profound in using technology to address the problems of obstetrics in remote and rural places, especially in low-risk pregnancy. Through this study, we made an effort to assess the satisfaction level and concerns of antenatal and postnatal patients who availed the telemedicine facility during the study period. We also made an effort to facilitate improved access to antenatal and postnatal care, especially the low-risk pregnancies through telemedicine for patients from remote areas of eastern India that do not have the availability of specialists. Materials and Methods: Primary data were collected by means of a telephonic survey of all the antenatal patients who used telemedicine services of AIIMS, Kalyani, based on a preformed questionnaire. Results: A total of 80 antenatal patients gave consent to participate in the study. Most of the patients were from the upper lower class [43.75%] followed by the lower middle class [35%]. The average gestational age of respondents was 23.95 weeks. Seventy-one out of 80 patients felt that the appointment was made within a reasonable time. Only 12 patients [15.3%] had waiting time greater than 10 min. The average waiting time was 6.93 min. 56.3% of respondents felt that the person who attended their call was very cooperative. 86.3% of respondents strongly agreed that the consultant was able to understand their health issues completely. Eighty percent of the respondents said that they would like to continue using telemedicine in the future. There is a significant difference between those preferring to use telemedicine in the future and those who do not prefer telemedicine in the future. Poor internet facility and privacy were prominent reasons for not opting for telemedicine in the future by some respondents. Conclusion: From this study, it was concluded that TM certainly has great potential to make health care accessible to people residing in rural and far-off places.

Abstract Background Ultrasound is the primary diagnostic tool in pregnancy, capable of identifying high-risk pregnancies and life-threatening conditions, allowing for appropriate management to prevent maternal and fetal morbidity and mortality. Women and babies from rural and remote Australia and low-resource areas worldwide experience poorer health outcomes and barriers to accessing antenatal care and imaging services. Healthcare clinicians working in these regions face significant challenges practising with limited resources and accessing training opportunities. Objective To perform an exploratory needs-analysis survey investigating the availability, accessibility and use of antenatal ultrasound in rural Australia, exploring rural clinicians’ interest in and access to ultrasound training opportunities. Methods The survey tool for this cross-sectional study was designed and distributed as an anonymous online questionnaire targeting healthcare clinicians (doctors, nurses, midwives, clinic managers, Aboriginal healthcare workers) providing antenatal care in rural regions. Descriptive analysis was applied to quantitative data and thematic analysis was used to explore qualitative components. Results A total of 114 valid survey responses were analysed. Overall, 39% (43/111) reported ultrasound was not used when providing antenatal care to patients at their clinic, stating ‘Lack of ultrasound equipment (73%,29/40) and inaccessibility of training opportunities (47%,19/40) as the main reasons. For those with ultrasound (61%,68/111), estimating due date (89%,57/64) was the main use, and limited training/skills to operate the equipment (59%,38/64) and inaccessibility/distance of training opportunities (45%,29/64) were the most commonly reported barriers. Clinicians described a lack of childcare options (73%,74/102), long distances to reach ultrasound services (64%,65/102), appointment (59%,60/102) and transport availability/times (46%,47/102) as the main obstacles to patient access. Increased attendance, compliance with care directives, parental bonding and improved lifestyle choices were described by respondents as positive outcomes of antenatal ultrasound use. Conclusions Future efforts to combat inequitable service access must adopt a coordinated approach to meet the needs of pregnant women in low-resource settings. Providing portable ultrasound equipment, training in antenatal Point-of-Care ultrasound (PoCUS) with ongoing support/mentoring and accreditation of health professionals could strengthen rural workforce capacity. This, along with addressing the complex economic, environmental and socio-cultural barriers faced by patients, could improve service access and pregnancy outcomes in rural and remote communities.

Abstract Background Antenatal corticosteroids are considered the standard of care for pregnant women at risk for preterm birth, but studies examining their potential risks are scarce. We aimed to estimate the associations of antenatal corticosteroids with three severe adverse events: sepsis, heart failure, and gastrointestinal bleeding, in pregnant women. Methods Of 2,157,321 pregnant women, 52,119 at 24 weeks 0/7 days to 36 weeks 6/7 days of gestation were included in this self-controlled case series study during the study period of 2009–2018. We estimated incidence rates of three severe adverse events: sepsis, heart failure, and gastrointestinal bleeding. Conditional Poisson regression was used to calculate incidence rate ratios (IRRs) for comparing incidence rates of the adverse events in each post-treatment period compared to those during the baseline period among pregnant women exposed to a single course of antenatal corticosteroid treatment. Results Among 52,119 eligible participants who received antenatal corticosteroid treatment, the estimated incidence rates per 1000 person-years were 0.76 (95% confidence interval (CI): 0.69–0.83) for sepsis, 0.31 (95% CI: 0.27–0.36) for heart failure, and 11.57 (95% CI: 11.27–11.87) for gastrointestinal bleeding. The IRRs at 5 ~ 60 days after administration of antenatal corticosteroids were 5.91 (95% CI: 3.10–11.30) for sepsis and 4.45 (95% CI: 2.63–7.55) for heart failure, and 1.26 (95% CI: 1.02–1.55) for gastrointestinal bleeding; and the IRRs for days 61 ~ 180 were 2.00 (95% CI: 1.01–3.96) for sepsis, 3.65 (95% CI: 2.14–6.22) for heart failure, and 1.81 (95% CI: 1.56–2.10) for gastrointestinal bleeding. Conclusions This nationwide population-based study suggests that a single course of antenatal corticosteroids is significantly associated with a 1.3- to 5.9-fold increased risk of sepsis, heart failure, and gastrointestinal bleeding in pregnant women. Maternal health considerations, including recommendations for adverse event monitoring, should be included in future guidelines for antenatal corticosteroid treatment.

Abstract Purpose Internationally, the COVID-19 pandemic impacted maternity services. In Australia, this included changes to antenatal appointments and the reduction of support people during labour and birth. For women pregnant during the pandemic there were increased stressors of infection in the community and in hospitals along with increased periods of isolation from friends and families during lockdown periods. The aim of this study was to explore the real-time experiences of women who were pregnant and had a baby during the first wave of the COVID-19 pandemic in Australia. Methods This study followed seven women throughout their pregnancy and early parenthood. Women created audio or video recordings in real time using the Voqual app and were followed up by in-depth interviews after they gave birth. Results Using narrative analysis their individual stories were compared and an overarching theme of ‘feeling anxious’ was found which was underpinned by the two themes ‘model of care’ and ‘environment’. Conclusions These findings highlight the protective impact midwifery continuity of care has on reducing anxiety in women during the pandemic, and that the home environment can either be secure and safe or a place of isolation.

BackgroundStructural and cultural barriers limit Indian women's access to adequate postnatal care and support despite their importance for maternal and neonatal health. Targeted postnatal education and support through a mobile health intervention may improve postnatal recovery, neonatal care practices, nutritional status, knowledge and care seeking, and mental health.ObjectiveWe sought to understand the feasibility and acceptability of our first pilot phase, a flexible 6-week postnatal mobile health intervention delivered to 3 groups of women in Punjab, India, and adapt our intervention for our next pilot phase, which will formally assess intervention feasibility, acceptability, and preliminary efficacy.MethodsOur intervention prototype was designed to deliver culturally tailored educational programming via a provider-moderated, voice- and text-based group approach to connect new mothers with a social support group of other new mothers, increase their health-related communication with providers, and refer them to care needed. We targeted deployment using feature phones to include participants from diverse socioeconomic groups. We held moderated group calls weekly, disseminated educational audios, and created SMS text messaging groups. We varied content delivery, group discussion participation, and chat moderation. Three groups of postpartum women from Punjab were recruited for the pilot through community health workers. Sociodemographic data were collected at baseline. Intervention feasibility and acceptability were assessed through weekly participant check-ins (N=29), weekly moderator reports, structured end-line in-depth interviews among a subgroup of participants (15/29, 52%), and back-end technology data.ResultsThe participants were aged 24 to 28 years and 1 to 3 months postpartum. Of the 29 participants, 17 (59%) had their own phones. Half of the participants (14/29, 48%) attended ≥3 of the 6 calls; the main barriers were childcare and household responsibilities and network or phone issues. Most participants were very satisfied with the intervention (16/19, 84%) and found the educational content (20/20, 100%) and group discussions (17/20, 85%) very useful. The participants used the SMS text messaging chat, particularly when facilitator-moderated. Sustaining participation and fostering group interactions was limited by technological and sociocultural challenges.ConclusionsThe intervention was considered generally feasible and acceptable, and protocol adjustments were identified to improve intervention delivery and engagement. To address technological issues, we engaged a cloud-based service provider for group calls and an interactive voice response service provider for educational recordings and developed a smartphone app for the participants. We seek to overcome sociocultural challenges through new strategies for increasing group engagement, including targeting midlevel female community health care providers as moderators. Our second pilot will assess intervention feasibility, acceptability, and preliminary effectiveness at 6 months. Ultimately, we seek to support the health and well-being of postpartum women and their infants in South Asia and beyond through the development of efficient, acceptable, and effective intervention strategies.