Evaluation of the Effectiveness of Behavioral Change Strategies on Choosing Delivery Method in Nulliparous Pregnant Women

Abstract Background Pregnant women with active perianal Crohn’s disease (CD), have an indication for a caesarean section according to the current ECCO guidelines. This advice is based on the assumption that vaginal delivery leads to exacerbation of perianal disease and to worsening of faecal continence. However, there is no strong evidence to support this. This study aims to examine the effects of delivery method on perianal disease progression and faecal incontinence in women with perianal CD Methods In this retrospective cohort study, 209 women were selected from a large IBD database within a tertiary hospital in the Netherlands. All women are aged >18 years, have perianal CD, and have at least one child. In addition, 102 women of this cohort completed a questionnaire. Faecal continence was scored using the Vaizey-score. Descriptive analysis using SPSS and linear regression analysis were performed. The outcome was corrected for the years after delivery (median 15, range 0-55). p-values <0,05 were considered statistically significant. Results The caesarean section rate within this cohort was 27,8%, which is high when compared the general Dutch population (14%). Within the group of women who delivered at least one child vaginally (n=84), 25,5% reported an alteration of faecal continence, compared to 18,8% of the women who never had a vaginal delivery (n=18). No significant relation between mode of delivery and faecal continence was found (B 0,97 [-1,19-3,14] p 0,375). The average Vaizey-score within this cohort in women who delivered solely through caesarean section had a median Vaizey-score of 5 (range 0-12). Women who had at least one vaginal delivery had an median Vaizey-score of 7 (range 0-20). In a large study amongst the general Dutch population (n=1259) a median Vaizey-score of 11 (range 0-17) was reported. Conclusion Faecal incontinence after vaginal delivery in CD women with perianal fistula is not significantly increased. Therefore the current guideline to advice a caesarean section should be adjusted and other factors such as the location of the fistula should be taken into account. To draw solid conclusions, better registration of fistula location and objective documentation of fistula activity (using PDAI-score) and stool consistency is needed.

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Diagnósticos, resultados e intervenções de enfermagem no parto cesáreo

Revista de Enfermagem UFPE on line ◽

10.5205/1981-8963-v12i12a237549p3221-3230-2018 ◽

2018 ◽

Vol 12 (12) ◽

pp. 3221

Author(s):

Myria Ribeiro da Silva ◽

Dejeane De Oliveira Silva ◽

Nayara Mary Andrade Teles Monteiro ◽

Ricardo Matos Santana ◽

Talita Hevilyn Ramos da Cruz Almeida ◽

...

Keyword(s):

Data Collection ◽

Pregnant Women ◽

Clinical Examination ◽

Nursing Care ◽

Exploratory Study ◽

Scientific Method ◽

Delivery Method ◽

Effective Care ◽

Las Mujeres ◽

Quantitative Descriptive

RESUMOObjetivo: descrever a Sistematização da Assistência de Enfermagem das parturientes admitidas no centro obstétrico para o parto cesáreo e o puerpério. Método: trata-se de um estudo quantitativo, descritivo, exploratório, realizado com 152 clientes em um hospital. Realizaram-se, para a coleta de dados, a anamnese e o exame clínico, e os resultados apresentam-se em forma de tabelas. Resultados: observa-se que os diagnósticos mais predominantes pertencem aos domínios Segurança e Proteção, Enfrentamento e Tolerância ao Estresse e Conforto. Conclusão: destacam-se as necessidades das mulheres admitidas, proporcionando o subsídio teórico e científico por meio da associação das classificações de Enfermagem. Evidencia-se, neste estudo, a relevância da sistematização da Enfermagem como um método científico seguro para uma assistência holística e mais eficaz. Descritores: Enfermagem; Obstetrícia; Assistência; Parto; Gestantes; Classificação.ABSTRACTObjective: to describe the Systematization of Nursing Care of parturients admitted to the obstetric center for cesarean and puerperium delivery. Method: this is a quantitative, descriptive, exploratory study of 152 clients in a hospital. Anamnesis and clinical examination were performed for data collection, and the results are presented in the form of tables. Results: it is observed that the most prevalent diagnoses belong to the domains Security and Protection, Confrontation and Tolerance to Stress and Comfort. Conclusion: the needs of women admitted are highlighted, providing the theoretical and scientific subsidy through the association of Nursing classifications. The relevance of Nursing systematization as a safe scientific method for holistic and more effective care is evidenced in this study. Descriptors: Nursing; Obstetrics; Assistance; Parurition; Pregnant Women; Classification.RESUMENObjetivo: describir la Sistematización de la Asistencia de Enfermería de las parturientas admitidas en el centro obstétrico para el parto por cesárea y el puerperio. Método: se trata de un estudio cuantitativo, descriptivo, exploratorio, realizado con 152 clientes en un hospital. Se realizaron, para la recolección de datos, la anamnesis y el examen clínico, y los resultados se presentan en forma de tablas. Resultados: se observa que los diagnósticos más predominantes pertenecen a los campos Seguridad y Protección, Enfrentamiento y Tolerancia al estrés y Confort. Conclusión: se destacan las necesidades de las mujeres admitidas, proporcionando el subsidio teórico y científico por medio de la asociación de las clasificaciones de Enfermería. Se evidencia, en este estudio, la relevancia de la sistematización de la Enfermería como un método científico seguro para una asistencia holística y más eficaz. Descriptores: Enfermería; Obstetricia; Asistencia; Parto; Mujeres Embarazadas; Classificación.

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The Iranian Version of Theory-Based Intention for Cesarean Section (IR-TBICS) Scale: Development and First Evaluation

10.21203/rs.2.14833/v1 ◽

2019 ◽

Author(s):

Seyed Abolhassan Naghibi ◽

Maryam Khazaee-Pool ◽

Mahmood Moosazadeh

Keyword(s):

Scale Development ◽

Cesarean Section ◽

Pregnant Women ◽

Content Validity ◽

Intraclass Correlation ◽

Factor Analyses ◽

Validity And Reliability ◽

Delivery Method ◽

Cross Sectional ◽

Confirmatory Factor Analyses

Abstract Background: The rate of mothers experiencing a cesarean section in the absence of medical signs is growing in the world. Women beliefs and intentions have an essential role in the request or choosing a delivery method. At present, there is no comprehensive, validated scale for assessing pregnant women' beliefs about cesarean section in the Iranian population. This study performed to develop and assess the validity and reliability of the belief-based cesarean section scale using the theory of reason action (TRA) constructs as a theoretical framework for measuring intention toward delivery method selection. Methods: In this cross-sectional validation study, 480 pregnant women were recruited of Sari, north of Iran, through a multi-stage random sampling approach. Content validity was examined using the content validity index (CVI) and content validity ratio (CVR). Furthermore, both exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) were applied to assess the construct validity of the developed scale. Reliability was measured by internal consistency and intraclass correlation coefficient (ICC). Results: Results obtained from factor analysis showed that the data were fit to the model (χ2= 2298.389, P<0.001) and TRA consisted of 24 items assessing five domains which describing 62.46% of the common variance. The CFA showed a model with suitable fitness for the data. Cronbach’s alpha coefficient for the domains of the scale ranged from .609 to .843, and the ICC value ranged from .71 to .84, which is within satisfactory ranges. Conclusion: The belief-based cesarean section scale is a reliable instrument and now is suitable and appropriate and can be applied in other researches. Keywords: Cesarean section, Intention, Scale development, Psychometrics, Pregnant women

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Self-Efficacy: The Power of Believing You Can

The Oxford Handbook of Positive Psychology ◽

10.1093/oxfordhb/9780195187243.013.0031 ◽

2009 ◽

pp. 334-344 ◽

Cited By ~ 14

Author(s):

James E. Maddux

Keyword(s):

Collective Efficacy ◽

Psychological Adjustment ◽

Behavioral Change ◽

Self Efficacy ◽

Crucial Role ◽

Efficacy Beliefs ◽

Change Strategies ◽

Basic Premise ◽

The Face ◽

Group Members

The basic premise of self-efficacy theory is that “people's beliefs in their capabilities to produce desired effects by their own actions” (Bandura, 1997, p. vii) are the most important determinants of the behaviors people choose to engage in and how much they persevere in their efforts in the face of obstacles and challenges. Self-efficacy theory also maintains that these efficacy beliefs play a crucial role in psychological adjustment, psychological problems, physical health, as well as professionally guided and self-guided behavioral change strategies. This chapter provides an overview of self-efficacy theory and research by addressing three basic questions: (a) What is self-efficacy? (b) Where do self-efficacy beliefs come from? (c) Why is self-efficacy important? The chapter also discusses “collective efficacy”—group members' beliefs in their ability to collectively accomplish shared goals.

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P14.51 Can patients with a suspected high-grade glioma receive tumor treatment during pregnancy safely?

Neuro-Oncology ◽

10.1093/neuonc/noab180.163 ◽

2021 ◽

Vol 23 (Supplement_2) ◽

pp. ii47-ii47

Author(s):

A N van der Vegt ◽

R de Vries ◽

J Osinga ◽

N Grun ◽

T J Postma ◽

...

Keyword(s):

North America ◽

Pregnant Women ◽

Fetal Death ◽

High Grade Glioma ◽

Caesarian Section ◽

Intrauterine Fetal Death ◽

High Grade ◽

Tumor Surgery ◽

Tumor Treatment ◽

Delivery Method

Abstract BACKGROUND Diagnosis of a glioma during pregnancy has ethical and medical dilemmas; treatment of the mother may harm the unborn child, but a too conservative approach towards tumor treatment can compromise the survival of the mother. In patients with a suspected high-grade glioma, postponing tumor treatment is undesirable. We collected published cases to describe the given treatments during pregnancy and the outcomes for mother and child. METHODS From Pubmed, Embase and Web of Science, 122 cases were extracted from 65 reports published between 1999 and 2020. We added 7 cases from our center. Cases came from: North-America (54/129), Europe (47/129), Asia (13/129), Middle-East (3/129) and one from Oceania and Africa each; 10 cases were from an unspecified country. The data were analysed with descriptive statistics. RESULTS The median age of the pregnant women was 30 (range 17–48) years; at the time of publication 42% of mothers had deceased. Most frequent symptoms at presentation were high intracranial pressure (35%), seizures (30%) or focal deficits (19%). Patients were diagnosed in each phase of the pregnancy - 30% in the first, 35% in the second and 35% in the last trimester. Twenty-two women decided to terminate the pregnancy (North America 9; Europe 9; international unspecified, Africa, Asia and Middle-East each one case). In sixty-seven percent of women, tumors were operated while pregnant, 70% of those were planned surgery, while in 30% surgery was in performed in an emergency setting. Most women received a resection. In 6 patients tumor surgery was combined with a caesarian section. Histological diagnosis of the tumor was available in 112 patients: anaplastic oligodendroglioma (n=10), anaplastic astrocytoma (n=30), glioblastoma (n=66) or high-grade glioma NOS (n=6). In 10 patients there was a suspected high grade glioma based on MRI imaging. Only 20 patients were treated after surgery whilst still pregnant with either radiotherapy (15/20, 75%), chemotherapy (2/20, 10%) or a combination of radiotherapy and chemotherapy (3/20, 15%) Other patients received additional treatment after delivery (109/129; 84%). Delivery method was a caesarian section in 60% and vaginal delivery in 21%- in 19% delivery method was not described. In 63% of cesarean sections were brought forward either because of rapid maternal deterioration or to enable maternal treatment after delivery. In 92% a healthy child was born, 7% had a intrauterine fetal death and 1% the child was stillborn. None of the patients who experienced intrauterine fetal death had received radio- or chemotherapy during pregnancy. CONCLUSIONS The majority of pregnant women continue their pregnancy when facing a diagnosis of a high grade glioma. Tumor surgery seemed safe during pregnancy. No adverse events were reported in the limited patients who received radiotherapy (n=15) during pregnancy. For chemotherapy we could not draw any conclusions.

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