A Qualitative Study to Explore the Barriers for Nonadherence to Referral to Hospital Births by Women with High-Risk Pregnancies in Nepal

Maternal and neonatal morbidity and mortality tend to decrease if referral advice during pregnancy is utilized appropriately. This study explores the reasons for nonadherence to referral advice among high-risk pregnant women. A qualitative study was conducted in Morang District, Nepal. A phenomenological inquiry was used. Fourteen participants were interviewed in-depth. High-risk women who did not comply with the referral to have a hospital birth were the study participants. Participants were chosen purposively until data saturation was achieved. The data were generated using thematic analysis. Preference of homebirth, women’s diminished autonomy and financial dependence, conditional factors, and sociocultural factors were the four major themes that hindered hospital births. Women used antenatal check-ups to reaffirm normalcy in their current pregnancies to practice homebirth. For newly-wed young women, information barriers such as not knowing where to seek healthcare existed. The poorest segments and marginalized women did not adhere to referral hospital birth advice even when present with high-risk factors in pregnancy. Multiple factors, including socioeconomic and sociocultural factors, affect women’s decision to give birth in the referral hospital. Targeted interventions for underprivileged communities and policies to increase facility-based birth rates are recommended.

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Perceptions and Practice of Preconception Care by Healthcare Workers and High-Risk Women in South Africa: A Qualitative Study

Healthcare ◽

10.3390/healthcare9111552 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1552

Author(s):

Winifred Chinyere Ukoha ◽

Ntombifikile Gloria Mtshali

Keyword(s):

South Africa ◽

High Risk ◽

Qualitative Study ◽

Pregnancy Outcomes ◽

Healthcare Workers ◽

Preconception Care ◽

Adverse Pregnancy Outcomes ◽

High Risk Women ◽

Reproductive Life ◽

Adverse Pregnancy

Preconception care is biomedical, behavioural, and social health interventions provided to women and couples before conception. This service is sometimes prioritised for women at high risk for adverse pregnancy outcomes. Evidence revealed that only very few women in Africa with severe chronic conditions receive or seek preconception care advice and assessment for future pregnancy. Thus, this study aimed to explore the perceptions and practice of preconception care by healthcare workers and high-risk women in Kwa-Zulu-Natal, South Africa. This exploratory, descriptive qualitative study utilised individual in-depth interviews to collect data from 24 women at high risk of adverse pregnancy outcomes and five healthcare workers. Thematic analysis was conducted using Nvivo version 12. Five main themes that emerged from the study include participants’ views, patients’ access to information, practices, and perceived benefits of preconception care. The healthcare workers were well acquainted with the preconception care concept, but the women had inconsistent acquaintance. Both groups acknowledge the role preconception care can play in the reduction of maternal and child mortality. A recommendation is made for the healthcare workers to use the ‘One key’ reproductive life plan question as an entry point for the provision of preconception care.

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Vaccination against COVID-19 infection: the need of evidence for diabetic and obese pregnant women

Acta Diabetologica ◽

10.1007/s00592-021-01764-0 ◽

2021 ◽

Author(s):

A. Lapolla ◽

M. G. Dalfrà ◽

S. Burlina

Keyword(s):

High Risk ◽

Pregnant Women ◽

Neonatal Morbidity ◽

Published Data ◽

International Debate ◽

Lactating Women ◽

High Risk Women ◽

Pregnancy And Lactation ◽

Potential Benefits ◽

Diabetes And Obesity

Abstract Aim The recent availability of vaccines against COVID-19 has sparked national and international debate on the feasibility of administering them to pregnant and lactating women, given that these vaccines have not been tested to assess their safety and efficacy in such women. As concerns the risks of COVID-induced disease, published data show that pregnant women who develop COVID-19 have fewer symptoms than patients who are not pregnant, but they are more likely to need hospitalization in intensive care, and neonatal morbidity. Aim of the present perspective paper is to analyze the current literature regarding the use of the vaccine against COVID-19 infection, in terms of safety and protection, in high risk pregnant women as those affected by diabetes and obesity. Methods Analysis of literature about vaccination against COVID-19 infection in pregnancy. Results The main health organizations and international scientific societies, emphasize that—although data regarding the use of COVID vaccines during pregnancy and lactation are still lacking—vaccination should not be contraindicated. It should be considered for pregnant women at high risk of exposure to COVID-19. For such women, the potential benefits and risks should be assessed by the healthcare professionals caring for them. A recent prospective study to test the immunogenicity and reactogenicity of vaccination with COVID-19 mRNA in pregnant and lactating women, has showed that SARS-CoV-2 mRNA vaccination triggers a robust humoral immunity in pregnant and lactating women; there was also evidence of an immune transfer to their newborn. Conclusions We urgently need data on the effect of COVID-19 vaccination, in terms of maternal and fetal outcomes and vaccine related symptoms in high risk women during pregnancy and breastfeeding. It is important to run campaigns to promote vaccination, in particular in pregnant women at high risk to have severe COVID infection as those diabetics and/or obese.

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A qualitative study of the information needs of high-risk women undergoing prophylactic oophorectomy

Psycho-Oncology ◽

10.1002/1099-1611(200011/12)9:6<486::aid-pon478>3.0.co;2-y ◽

2000 ◽

Vol 9 (6) ◽

pp. 486-495 ◽

Cited By ~ 34

Author(s):

N. Hallowell

Keyword(s):

High Risk ◽

Qualitative Study ◽

Information Needs ◽

Prophylactic Oophorectomy ◽

High Risk Women

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Public Health Messaging and Strategies to Promote “SWIFT” Lung Cancer Detection: a Qualitative Study Among High-Risk Individuals

Journal of Cancer Education ◽

10.1007/s13187-020-01916-w ◽

2020 ◽

Author(s):

Mohamad M. Saab ◽

Caroline Kilty ◽

Brendan Noonan ◽

Serena FitzGerald ◽

Abigail Collins ◽

...

Keyword(s):

Public Health ◽

Lung Cancer ◽

High Risk ◽

Qualitative Study ◽

Early Detection ◽

Life Course Perspective ◽

Policy Network ◽

Early Presentation ◽

Targeted Interventions ◽

High Incidence

Abstract Lung cancer (LC) is the most common cancer and the leading cause of cancer mortality globally. A positive association between LC incidence and socioeconomic deprivation exists. High-risk individuals are less likely to be aware of LC and to correctly appraise LC symptoms and seek medical help accordingly. This qualitative study explored strategies to promote early detection of LC among at-risk individuals living in high-incidence areas in Ireland. Five semi-structured focus groups were conducted with 46 individuals. Data were collected face-to-face in community centres and organisations in high-incidence areas in two Irish counties and analysed using inductive qualitative content analysis. Participants believed that there was insufficient information regarding LC and recommended promoting LC awareness at a young rather than old age. They favoured public health messages that are Simple, clear, and honest; Worded positively; Incorporating a shock element; Featuring a celebrity, healthcare professional, or survivor; and Targeted (SWIFT). Most participants reported becoming immune to messages on cigarette packaging and recommended using a combination of broadcast and print media within national government-run campaigns to promote LC awareness and early detection. Study findings suggest that promoting LC awareness, help-seeking, early presentation, and diagnosis can be achieved by developing and testing targeted interventions. Promoting LC awareness requires a multi-sectoral policy network, or a whole systems approach. Such approaches ought to consider the multifactorial drivers of LC risk behaviours; involve coordinated, collective actions across various stakeholders; operate across multiple agencies; and take a life course perspective.

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Early Pregnancy Screening for Women at High-Risk of GDM Results in Reduced Neonatal Morbidity and Similar Maternal Outcomes to Routine Screening

Journal of Pregnancy ◽

10.1155/2020/9083264 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Erin Clarke ◽

Thomas J. Cade ◽

Shaun Brennecke

Keyword(s):

High Risk ◽

Early Pregnancy ◽

International Association ◽

Neonatal Morbidity ◽

Study Groups ◽

High Risk Group ◽

Adverse Outcomes ◽

Study Objective ◽

High Risk Women ◽

Retrospective Audit

The Australasian Diabetes in Pregnancy Society recommends screening high-risk women for gestational diabetes mellitus (GDM) before 24 weeks gestation, under the assumption that an earlier diagnosis and opportunity to achieve normoglycemia will minimize adverse outcomes. However, little evidence exists for this recommendation. The study objective was to compare the pregnancy outcomes of high-risk women diagnosed with GDM before 24 weeks gestation and routinely diagnosed women after 24 weeks gestation. A retrospective audit was conducted of all pregnancies diagnosed with GDM using International Association of Diabetes and Pregnancy Study Groups criteria over 12 months at a tertiary Australian hospital. Adverse perinatal outcomes were compared between “Early GDM” diagnosed before 24 weeks (n=133) and “Late GDM” diagnosed from 24 weeks (n=636). Early GDM had a significantly lower newborn composite outcome frequency (hypoglycemia, birth trauma, NICU/SCN admission, stillbirth, neonatal death, respiratory distress, and phototherapy) compared to Late GDM (20.3% vs. 30.0%, p=0.02). Primary cesarean, hypertensive disorders, postpartum hemorrhage, birthweight >90th percentile, macrosomia, and preterm birth frequencies were not significantly different between groups. Therefore, high-risk women diagnosed with GDM in early pregnancy were not more likely to have an adverse outcome compared to routinely diagnosed women. As they are a high-risk group, this may indicate a possible benefit to the early diagnosis of GDM.

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Professionally responsible counseling about birth location during the COVID-19 pandemic

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0183 ◽

2020 ◽

Vol 48 (5) ◽

pp. 450-452 ◽

Cited By ~ 2

Author(s):

Amos Grünebaum ◽

Laurence B. McCullough ◽

Eran Bornstein ◽

Risa Klein ◽

Joachim W. Dudenhausen ◽

...

Keyword(s):

Home Birth ◽

Neonatal Morbidity ◽

The United States ◽

Adverse Outcomes ◽

Hospital Birth ◽

Informed Decisions ◽

Difficult Time ◽

Control And Prevention ◽

Obstetric Emergencies ◽

Hospital Births

AbstractIf the worries about the coronavirus disease 2019 (COVID-19) pandemic are not already enough, some pregnant women have been questioning whether the hospital is a safe or safe enough place to deliver their babies and therefore whether they should deliver out-of-hospital during the pandemic. In the United States, planned out-of-hospital births are associated with significantly increased risks of neonatal morbidity and death. In addition, there are obstetric emergencies during out-of-hospital births that can lead to adverse outcomes, partly because of the delay in transporting the woman to the hospital. In other countries with well-integrated obstetric services and well-trained midwives, the differences in outcomes of planned hospital birth and planned home birth are smaller. Women are empowered to make informed decisions when the obstetrician makes ethically justified recommendations, which is known as directive counseling. Recommendations are ethically justified when the outcomes of one form of management is clinically superior to another. The outcomes of morbidity and mortality and of infection control and prevention of planned hospital birth are clinically superior to those of out-of-hospital birth. The obstetrician therefore should recommend planned hospital birth and recommend against planned out-of-hospital birth during the COVID-19 pandemic. The COVID-19 pandemic has increased stress levels for all patients and even more so for pregnant patients and their families. The response in this difficult time should be to mitigate this stress and empower women to make informed decisions by routinely providing counseling that is evidence-based and directive.

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