The sustained adverse impact of COVID-19 pandemic on mental health among pregnant women in Sri Lanka: a reassessment during the second wave

Objective To study the change in trend of antenatal mental health and associated factors among a cohort of pregnant women during the second wave of COVID-19 using Hospital Anxiety and Depression Scale (HADS). Previous study using the same scale, during the first wave reported a higher prevalence of anxiety and depression. Results A descriptive cross-sectional study was carried out at the two large maternity hospitals in Colombo, Sri Lanka: Castle Street Hospital for Women (CSHW) and De Soysa Hospital for Women (DSHW). Consecutively recruited 311 women were studied. Out of which, 272 (87.5%) were having uncomplicated pregnancies at the time of the survey and 106 (34.1%) were either anxious, depressed, or both. Prevalence of anxiety was 17.0% and depression 27.0%. Overall, continuing COVID-19 pandemic increased antenatal anxiety and depression. The trend was to aggravate depression more intensively compared to anxiety in this cohort of women studied. Special support is needed for pregnant mothers during infectious epidemics taking more attention to antenatal depression.

Frequency and Determinants of Breastfeeding in Greece: A Prospective Cohort Study during the COVID-19 Pandemic

Breastfeeding is considered to be the cornerstone of child health. In Europe however, overall breastfeeding rates remain low. The present study aimed at estimating the frequency of breastfeeding in Greece during the COVID-19 pandemic period and comparing findings with the latest national study in order to identify a potential impact of the pandemic. Additionally, possible correlations of socio-cultural and demographic characteristics with breastfeeding indicators were investigated. This prospective cohort study included 847 women from five tertiary maternity hospitals, between January and December 2020. Data were collected by a structured questionnaire via interview during hospitalization and via telephone in the first, third and sixth month postpartum. Results showed that all breastfeeding indicators improved over the last three years. Full breastfeeding reached 7.2%, contrary to 0.78% of the latest national study at six months postpartum. Employment, marital status, educational level, mode of delivery, type of maternity hospital, body mass index before pregnancy, previous breastfeeding experience of the mother and infant’s birth weight correlated significantly with breastfeeding indicators at different time periods. The COVID-19 pandemic seems to have favorably influenced breastfeeding initiation and duration in Greece due to lockdowns, home confinement and teleworking.

Humanized childbirth: the values of health professionals in daily obstetric care

ABSTRACT Objective: To understand health professionals' values in the process of thinking and feeling about obstetric care, based on their experienced needs in the care process. Methods: Phenomenological study based on the Schelerian framework, with 48 health professionals from four maternity hospitals within the Metropolitan Region II of the state of Rio de Janeiro. Data collection was done through a phenomenological interview; and the analysis, with the Ricoeurian methodological framework. Results: The vital value was signified in care centered on physiological processes, for an individualized and safe monitoring. The ethical value was signified in the attitudes that provide women with autonomy in their way of giving birth, and recognize dialogue as a process of sympathy, affection, and bonding. Conclusion: The resignification of obstetric practice, articulated with public policies in the field of delivery and birth, supported by a vital ethical value, positively contributes to the humanization of care for women.

Neuropsychomotor development in children born preterm at 6 and 12 months of corrected gestational age

ABSTRACT Objective: To assess the incidence of neuropsychomotor developmental delay at 6 and 12 months of corrected gestational age in children born at 32 gestational weeks or less. Methods: A descriptive and prospective study was carried out at two public maternity hospitals. Between April 2017 and January 2019, we assessed 133 children without any known risk factors for neuropsychomotor developmental delay. The Bayley III scale was used to evaluate cognitive and motor development. The p value of the numerical variables was calculated using the Mann-Whitney test, whereas proportions of categorical variables were compared using the Z-test. Results: The mean maternal age was 26±6.9 years,78.8% were from middle and lower economic classes, and 57.1% of the analyzed children were female. Children presented with a higher incidence of delay at 12 months than at 6 months (10.3 and 2.3% at 12 and 6 months, respectively, for the cognitive score; 22.7 and 12% at 12 and 6 months, respectively, for the composite motor score; and 24.7 and 8.4% at 12 and 6 months, respectively, for the fine motor score). Conclusions: Cognitive and motor developmental delays were significant, with the highest incidence at 12 months. The results of this study encourage further research on this topic, since the exclusion criteria were comprehensive and the delays in neuropsychomotor development were significant.

Medical assistance, maternal and child welfare service of the Udmurt ASSR during the post-war period (1945–1950)

Introduction. The article examines the state of protection of mothers and children in the Udmurt Autonomous Soviet Socialist Republic in the post-war period of 1945–1950. The article analyzes the quality of medical care and services for the protection of mothers and children, the equipment of medical institutions with medical personnel and the staffing of departments with beds and the necessary equipment for providing medical care to children and mothers. Materials and Methods. The work used the data from the central Republican archive of the Udmurt ASSR. It carried out a market analysis on the state and development of the network of obstetric and gynecological care. The materials contained in research that give an idea of the problem under consideration, as well as legal documents have been investigated and summarized. Results and Discussion. In this period under review, a network of antenatal clinics, maternity hospitals, obstetric and gynecological departments is being created. The number of beds for pregnant women and women in labor increased. A specialized department of pregnancy pathology was organized. The rates of maternal mortality, stillbirth and neonatal mortality have dropped significantly. An exchange card has been introduced in hospitals. With the creation of a methodological office, work began on the development of programs for preschool education, cluster and regional conferences began to be held. The conferences dealt with deaths, with special attention paid to issues of late hospitalization. Since 1949, the method of serving children according to the “single pediatrician” system were practiced. Conclusion. Protecting the interests of mother and child, the Udmurt Autonomous Soviet Socialist Republic in the postwar years provided great assistance to pregnant women and mothers, fulfilling the Decree of the Presidium of the Supreme Council of July 8, 1944. Employees of the Childhood Department, doctors of Izhevsk and employees of the department childhood diseases of the Izhevsk Medical Institute traveled to the regions of the Republic to provide practical assistance and control the work on childhood in the field.

OVERVIEW OF IMMEDIATE NEW-BORN CHECK-UP

There's proof from maternity hospital-based settings in developing countries that newborn resuscitation education of the staff diminishes new-born deaths from inborn associated events, such as neonatal asphyxia (by 30%), with potential saving 93,700 neonates globally per year by investigating missed attendance of birth clinics or maternity hospitals, together with (up to 192,000) new-born at 90% scope, as it was considering the impact on intrapartum-related neonatal passings. In an arrangement to realize a higher reduction in intrapartum-related newborn passing's, preterm delivery and intrapartum death, a compelling obstetric plan is considered as the most vital intercession and this ought to be complemented with prompt infant care and resuscitation. There is expanding venture in obstetric care, yet to be coordinated by viable execution and supportability of quick infant care and essential newborn resuscitation. Within the private settings, prompt basic care at birth is essential and accessible, even though evaluated by specialists to be of low effects (10% on before delivery and on stillbirths associated with newborn passings). private hospital settingsbased newborn revival may minimise all the reasons of newborn and before delivery deaths, but available information is critical and controversial to directly gauge an effect size from the prove. Future researches ought to endeavour to address impediments distinguished here especially in terms of intercession definitions, plan, comparative control group, outcome identification and subdivision of reasons of stillbirths and neonatal passings. Whereas the available types of evidence for incitement at delivery and neonatal revival are low, mostly since they are regarded as a plan of care, there is adequate and consistent prove of effect. However, such fundamental care stays irregular particularly for the global 60 million home births. Disentangled preparing plan, and effective protocol, low price hardware are presently ac

Brazilian network of COVID-19 during pregnancy (REBRACO: a multicentre study protocol)

IntroductionThe aim of this study was to evaluate the clinical, epidemiological and laboratory aspects of SARS-CoV-2 infection during pregnancy and postpartum in 16 maternity hospitals.Methods and analysisA prospective multicentre study, with five axes. First, the prevalence of SARS-CoV-2 infection among women admitted for childbirth will be described in a cross-sectional study. Second, maternal and perinatal outcomes will be assessed in a prospective cohort study including pregnant or postpartum women with suspected COVID-19. Third, a cohort of positive COVID-19 cases with sampling of a variety of biological material. Histopathological and viral analysis of biological maternal and neonatal samples will be performed, and the assessment of nutritional variables to evaluate the association between vitamin D and severity of infection. Fourth, a monitoring and evaluation committee to collect relevant healthcare information and plan actions in centres facing the pandemic. Furthermore, qualitative studies will be performed to study pregnant women, their families and health professionals. Fifth, an ecological study will monitor the number of live births, stillbirths and other outcomes to explore any trend among the periods before, during and after the pandemic. Data will systematically be collected in an electronic platform following standardised operational procedures. For quantitative study components, an appropriate statistical approach will be used for each analysis. For qualitative data, in-depth interviews recorded in audio will be transcribed, checking the text obtained with the recording. Subsequently, thematic analysis with the aid of the NVivo programme will be performed.Ethics and disseminationEthical approval was obtained (letters of approval numbers 4.047.168, 4.179.679 and 4.083.988). All women will be fully informed to sign the consent form before enrolment in the study. Findings will be disseminated through peer-reviewed journals and scientific conferences.

Impact of COVID-19 Lockdown on Preterm Births, Low Birthweights and Stillbirths: A Retrospective Cohort Study

Objective: The effect of lockdowns during the coronavirus (COVID-19) pandemic on pregnancy outcomes remains uncertain. We aimed to evaluate the association between the COVID-19-related lockdown and pregnancy outcomes in maternity hospitals in France. Study design: This was a retrospective cohort study from six tertiary referral hospitals in different regions of France. Three 55-day periods were compared: pre-lockdown from 22 January 2020, lockdown from 17 March 2020, and post-lockdown from 11 May 2020 to 4 July 2020. We included all women who delivered singleton or multiple pregnancies, who delivered at ≥24 weeks of gestation and with birthweights ≥500 g. We documented gestational ages at the delivery of liveborn and stillborn infants (‘stillbirths’). These were categorized as having a very low birthweight (VLBW, <1500 g), or a low birthweight (LBW, <2500 g). Adjustments were made for place of birth, maternal age, parity and diabetes, and hypertensive disorders, as well as for multiple pregnancies. Results: In total, 11,929 women delivered in the six selected centers. This figure is constituted of 4093, 3829, and 4007 deliveries in the pre-lockdown (1), peri-lockdown (2), and post-lockdown (3) periods, respectively. There were no differences in pregnancy outcomes between these three periods. Overall, birth rates <27+6 weeks, between weeks 28+0 and 31+6, and between 32+0 and weeks 36+6 were 1.0%, 1.9%, and 4.4%, respectively. After adjustment, these rates were stable between periods 1 and 2 (adjusted odds ratio, aOR 0.90; 95% confidence interval, CI 0.69–1.19) and between periods 2 and 3 (aOR 1.04; 95% CI 0.80–1.36). Although more VLBW neonates were born during lockdown (3.5% vs. 2.6%, p = 0.03), this difference did not persist after adjustment (aOR 0.84, CI 95% 0.64–1.10). The LBW rates were similar during the three periods at 12.5% overall. The stillbirth rate was unaffected by the lockdown. Conclusion: The pregnancy outcomes (preterm birth, LBW, VLBW, and stillbirth rates) were not modified by the COVID-19 lockdown in our cohort study in France. Considering the discrepancies in results and methodological issues in previous published studies, there is not sufficient evidence to conclude that such lockdowns have any impact on perinatal outcomes.

Clinical Handover Communication at Maternity Shift Changes and Women's Safety in Banjul, The Gambia: A Mixed-Methods Study

Background Clinical handover is a vital communication process for patient safety; transferring patient responsibility between healthcare professionals (HCPs). Exploring handover processes in maternity care is fundamental for service quality, addressing continuity of care and maternal mortality.MethodsThis mixed-methods study was conducted in all three maternity hospitals in Banjul, The Gambia. Shift-to-shift maternity handovers were observed and compared against a standard investigating content and environment. Semi-structured interviews and focus group discussions with doctors, midwives and nurses explored handover experience.Results110 nurse/midwife shift-to-shift handovers were observed across all shift times and maternity wards; only 666 of 845 women (79%) were handed over. Doctors had no scheduled handover. Shift-leads alone gave/received handover, delayed [median 35 minutes, IQR 24-45] 82% of the time; 96% of handovers were not confidential and 29% were disrupted. Standardised guidelines and training were lacking.A median 6 of 28 topics [IQR 5-9] were communicated per woman. Information varied significantly by time, high-risk classification and location. For women in labour, 10 [IQR 8-14] items were handed-over, 8 [IQR 5-11] for women classed ‘high-risk’, 5 [IQR 4-7] for ante/postnatal women (p<0.001); >50% had no care management plan communicated.21 interviews and two focus groups were conducted. Facilitators and barriers to effective handover surrounding three health service factors emerged; health systems, organisation culture and individual clinician factors.ConclusionMaternity handover was inconsistent, hindered by contextual barriers including lack of team communication and guidelines, delays, with some women omitted entirely. Findings alongside HCPs views demonstrate feasible opportunities for enhancing handover, thereby improving women's safety.

Knowledge on Newborn Life Support among the Healthcare Providers in a Tertiary Care Maternity Hospital in the Southern Province, Sri Lanka

Introduction. The newborn life support (NLS) is a set of educational guidelines established by the academies of Paediatrics that outline the proper procedures for resuscitation of a newborn. The objective of this study was to determine the knowledge on NLS among the healthcare providers (HCPs) in a tertiary care maternity hospital in the Southern Province, Sri Lanka. Methods. A hospital-based cross-sectional study was carried out among doctors, nurses, and midwives, using a self-administered questionnaire. Comparison of knowledge among different categories was made using the chi-square test. Total sample of 191 consisted of 118 (61.8%) nurses, 33 (17.3%) midwives, and 36 (18.8%) doctors. The majority of HCPs (76.7%) had good knowledge of NLS; however, following guidelines on NLS among HCPs was poor (33%). According to the category, 91% of doctors and 78% of nurses had good knowledge, whereas only 48% of midwives had good knowledge. The difference of knowledge on NLS among different categories of HCPs was statistically significant ( p < 0.001 ). Only 33% of HCPs had good knowledge of following NLS guidelines. Of them, 52% were doctors, 31% were nurses, and only 18% were midwives. The difference in adherence to NLS guidelines among different categories of HCPs was highly significant statistically ( p = 0.003 ). Conclusion. The majority of the healthcare providers had good knowledge of NLS. There was a significant difference in the level of knowledge on NLS among different categories of HCPs. Gaps in the knowledge in following guidelines of NLS were noted in the majority. Newborn resuscitation has to be included in nursing and midwifery curricula, and training on NLS is essential in the orientation programs for newly recruited HCPs in maternity hospitals.