Journal of Pregnancy最新文献

Grief does not only affect human emotions but also impacts their physical health. Understanding physical grief of people can bring to bear the grip of its daunting nature, a situation where routines become challenging. A qualitative explorative descriptive research method was used. A purposive sample of 18 ward supervisors and 39 ward midwives was used to ascertain the physical effects of maternal deaths on these caregivers in the Ashanti Region of Ghana. Data were collected through semistructured and focus group discussions. Data analysis was done parallel with data collection till saturation was reached. Ethics was obtained from the University of the Western Cape, South Africa, and Ghana Health Service. The findings indicated that generally, as a result of grieving over the deaths of their patients, midwives experienced physical health sufferings. Therefore, reported depression is expressed as insomnia, appetite loss, exhaustion, and social isolation. There is the need to reduce the physical effects of patients' death on caregivers in Ghana and therefore, the study recommends that all hospitals in Ghana utilize employee assistance programmes, a workplace intervention programme designed for such purposes.

Methods: A community-based cross-sectional study was employed among 686 mothers in Burie District from March 16 to March 25, 2017. A multistage sampling technique was used to select the study participants. Data were collected using face to face interviewer administered structured questionnaires. Then, the collected data was entered, coded, and cleaned into EPI Data version 3.1 and exported to SPSS version 20.0 for data analysis. Bivariate and multivariate logistic regression was done to assess the association of factors with postpartum modern contraceptive use. Adjusted odds ratios with 95% confidence intervals were calculated, and p values <0.05 were considered to indicate statistical significance.

Result: This study revealed that postpartum modern contraceptive use was found to be 20.7%. Postpartum modern contraceptive use was significantly associated with women's level of education (AOR = 0.15, 95% CI (0.03-0.71)), discussing FP methods with partner (AOR = 0.60, 95% CI (0.40-0.90)), knowing menses return after birth (AOR = 0.39, 95% CI (0.25-0.59)), ever heard about modern FP methods (AOR = 0.06, 95% CI (0.01-0.43)), and contacting health professionals (AOR = 1.85, 95% CI (1.19-2.88)). Conclusion and Recommendations. Postpartum modern contraceptive use was found to be low. Therefore, health professionals should work on improvements in women's educational status, making awareness of the women and counseling of their husbands about the use of postpartum contraception, when fertility returned and risky timing for becoming pregnant.

Background: One of the major aims of marriage is to procreate or give birth to a child. Childbirth is so crucial in marriage that it often determines the happiness of the couple. Too much delay in childbirth after marriage or the likelihood that one cannot give birth after marriage can lead to divorce. However, causes of delay in childbirth are often difficult to detect by both the Gynaecologist and the couple involved. This makes proposing solutions to issues related to childbirth usually unsuccessful.

Methods: It is against this background that we conducted this study to identify factors that determine childbirth within 10 months or after 10 months of marriage (birth length) among women in Ghana. This was achieved by using a logistic regression model for the dichotomous birth length variable, adjusting for risk factors/predictors of birth length. The data used for the study were obtained from the 2014 Ghana Demographic and Health Survey, consisting 6,525 complete cases with 18 predictor variables. Statistical analyses were carried out using STATA version 14.1.

Results: The results show that respondents who have ever terminated pregnancy are more likely (OR = 0.178, 95%CI = 0.044, 0.312) to deliver after 10 months, wives whose husbands have higher education are less likely (OR = -0.162, 95%CI = -0.236, -0.088) to give birth after 10 months of marriage, wives who reported that beating is justified if she goes out without her husband's notice are more likely (OR = 0.466, 95%CI = 0.305, 0.628) to give birth after 10 months, wives who reported that beating is justified if she neglects the child are more likely (OR = -0.305, 95%CI = -0.461, -0.149) to give birth within 10 months, and wives who reported that beating is justified when she argues with her husband are less likely (OR = -0.301, 95%CI = -0.451, -0.152) to give birth after 10 months of marriage. Every unit increase in the age of the respondent at marriage increases the likelihood of giving birth after 10 months of marriage, and a unit increase in the age of the respondent at first sex decreases the likelihood of giving birth after 10 months in marriage.

Conclusions: For conception within 1 month of marriage, wives and husbands should/are encouraged to have frequent sex, any negative social behaviour or policies must be discouraged, experts' advice on contraceptive use must be sought, and women are encouraged to desist from termination of pregnancy at any time of their life. Husbands should openly express their desire and love for their children since this increases the likelihood of wives' desire to give birth. This leads to frequent sex, which then reduces conception time, and hence childbirth within the shortest possible time.

Background: A pregnancy is described unintended if it is either unwanted or mistimed. The former occurs when no child or no more children are desired, and the latter is when the conception occurs earlier than the desired time, but wanted later. Unwanted pregnancy causes a serious health, economic, and social problem to the woman and her family. In the study area, there is limited data on unintended pregnancy. Therefore, this study fills this gap by studying the magnitude of unintended pregnancy and its associated factors among pregnant women attending antenatal care in the study area.

Methods: A facility-based cross-sectional study was done from 1 March to 1 April 2019, among 612 randomly selected pregnant women attending antenatal care at Bako Tibe district public health facility. The data were collected via interview using a structured and pretested questionnaire. They were entered into EpiData Version 3.1 and SPSS Version 23 for cleaning and analyses. The variables, which were significant at P ≤ 0.2 in the bivariate logistic regression, were included in the multivariable analysis. The direction and strength of statistical association were measured by an odds ratio with 95% CI. A variable with a P value < 0.05 was considered a significantly associated factor with the outcome one.

Results: In this study, the prevalence of unintended pregnancy was 33.3%, at 95% CI (29.8, 37.3). The factors that had significant association with unintended pregnancy were family size ≥ 6 (AOR = 8.0, 95% CI: 1.38-46.66), women who did not communicate about family planning with their husbands (AOR = 2.8, 95% CI: 1.50-5.20), and parity ≥ 5 (AOR = 3.0, 95% CI: 1.34-6.8).

Conclusion: About one-third of the pregnant women reported that their pregnancy was unintended. Parity, family size, and lack of spousal communication showed a significant association with the problem. To decrease the current level of unintended pregnancy in the area, the Bako Tibe District Health Bureau and the health workers should work harder to scale up spousal communication on family planning.

Hypertensive disorders of pregnancy (HDP) are the most common cardiometabolic complications of pregnancy, affecting nearly 10% of US pregnancies and contributing substantially to maternal and infant morbidity and mortality. In the US, women of African American race are at increased risk for HDP. Early biomarkers that reliably identify women at risk for HDP remain elusive, yet are essential for the early identification and targeting of interventions to improve maternal and infant outcomes. We employed high-resolution metabolomics (HRM) to identify metabolites and metabolic pathways that were altered in early (8-14 weeks) gestation serum samples of pregnant African American women who developed HDP after 20 weeks' gestation (n = 20)-either preeclampsia (PE; n = 11) or gestational hypertension (gHTN; n = 9)-compared to those who delivered full term without complications (n = 80). We found four metabolic pathways that were significantly (p < 0.05) altered in women who developed PE and five pathways that were significantly (p < 0.05) altered in women who developed gHTN compared to women who delivered full term without complications. We also found that four specific metabolites (p < 0.05) were distinctly upregulated (retinoate, kynurenine) or downregulated (SN-glycero-3-phosphocholine, 2'4'-dihydroxyacetophenone) in women who developed PE compared to gHTN. These findings support that there are systemic metabolic disruptions that are detectable in early pregnancy (8-14 weeks of gestation) among pregnant African American women who develop PE and gHTN. Furthermore, the early pregnancy metabolic disruptions associated with PE and gHTN are distinct, implying they are unique entities rather than conditions along a spectrum of the same disease process despite the common clinical feature of high blood pressure.

Every year, about 85 percent of the approximately 5 million births in North America are evaluated with the electronic fetal monitoring (EFM). Clinicians use the EFM as a proxy to assess fetal oxygenation status, fetal well-being, and potential compromise. Despite the widespread use of this technology, neonatal hypoxia and acidosis continue to make up a high proportion of neonatal morbidity at term. Indeed, though the fetal heart rhythm is inextricably linked to fetal acid-base status, EFM has not been shown to reliably predict neonatal pH status nor has it reduced adverse maternal or neonatal outcomes. As a consequence, the high false-positive rate of EFM for predicting adverse neonatal outcomes has led to an increase in the rate of operative vaginal and cesarean delivery, with elevated rates of associated maternal and neonatal morbidity. This fact invariably leads to a paradox we have henceforth defined as the "obstetrical paradox." Herein, we explore the potential solutions to this paradox and introduce a novel noninvasive technique to assess fetal acid-base status in utero known as the "FETAL technique" (Fourier Evaluation of Tracings and Acidosis in Labour). The FETAL technique, currently under investigation, applies the discrete Fourier transformation to EFM tracings to determine the spectral frequency distribution of the fetal heart rate. These specific frequency distributions correlate with specific umbilical pH values and may provide the missing link between fetal heat rate patterns and acid-base status at birth. As we work toward realizing the full potential benefits of EFM, finding the best assessment strategies to evaluate fetal pH in real time remains a key goal in obstetrics.

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.

Background: Prenatal care refers to services a pregnant woman receives during pregnancy to ensure a healthy outcome for herself and her newborn. However, only limited studies have so far been done to assess the quality of prenatal care in the study area. Thus, this study is aimed at assessing the quality of prenatal care and associated factors at public health facilities in Wogera district, northwest Ethiopia.

Methods: An institution-based cross-sectional study was conducted in Wogera district from March to April 2019. A total of 465 pregnant women were interviewed using a semi-structured interviewer-administered questionnaire; consecutive sampling was used to select the participants. The binary logistic regression analysis model was fitted to identify the potential predictor variables. Variables with <0.2 p values were fitted into the multivariable logistic regression analysis model; <0.05 p values and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) were used to declare factors associated with the quality of prenatal care.

Results: The overall quality of prenatal care was 32.7% (95% CI: 28.1, 37.2). Four or more prenatal care visits (AOR = 2.3; 95% CI: 1.2, 4.7), high maternal education (AOR = 2.9; 95% CI: 1.03, 7.93), over USD 175.5 monthly household income (AOR = 2.8; 95% CI: 1.1, 7.8), and the availability of maternity waiting areas (AOR = 2.4; 95% CI: 1.2, 5.0) were positively associated with the quality of the care.

Conclusion: The overall quality of prenatal care in this study was low. Therefore, promoting focused prenatal care and increasing infrastructure, encouraging maternal education, and compensating for the healthcare costs for women with low household income might enhance the quality of the care.

Background: Evidence suggests that in patriarchal societies such as Ghana, access to and survival of maternal and child healthcare services require the active involvement of men. However, interventions to promote men's involvement in maternal and child health care are less likely to succeed if the views and concerns of women are not considered. This study provides an understanding of women's perspective on men's involvement in antenatal care, labour, and childbirth in the Northern Region of Ghana.

Methods: Data for this cross-sectional study were collected from 300 pregnant women using a structured questionnaire. Logistic regression models were then used to determine the socio-demographic factors associated with women's perspectives on men's involvement in antenatal care, labour, and childbirth.

Results: The mean age of the participants was 28 (SD = 5.21) years. More than four-fifths of the women in this study express the desire for male partner involment in natenatal care (ANC) services (n = 258, 86%) and as companions during labour and child birth (n = 254, 84.7%). We found that married women were 9.8 times more likely (95%CI 1.59, 60.81) to encourage male involvement in ANC compared to women who were unmarried. The probability of encouraging male involvement in ANC decreased with increased level of education among the women while support for male companionship during childbirth increased significantly with an increased level of education. After accounting for the effect of other significant covariates, there was good evidence to suggest that married women (p = 0.002), women with only primary/Junior High School education (p = 0.048) and those with two (p = 0.010), three (p =  0.008), or ≥4 (p = 0.044) previous pregnancies had a desire for male partner involvement in ANC while women who attained secondary (p = 0.004) or tertiary (p = 0.001) level education expressed the desire for male companionship in labour and childbirth in the adjusted model.

Conclusion: Male involvement in antenatal care, labour, and childbirth received overwhelming support from the women in this study.