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Clinical Applications of Fetal Cell-Free DNA: State of the Science. 无胎儿细胞 DNA 的临床应用:科学现状。
Pub Date : 2024-07-25 DOI: 10.1111/jmwh.13674
Julie Knutson, Kathryn Anthony, Melissa L Russo, Martha B Kole-White

Advances in technology have correlated with expanding prenatal genetic testing options for pregnant people. Leading medical organizations recommend cell-free DNA as the most sensitive screening test for trisomies 13, 18, and 21, as well as for fetal sex chromosome aneuploidies. The commercially available testing options go beyond these recommended tests, and prenatal care professionals should be familiar with the tests that their patients may choose despite being beyond the scope of current medical recommendations. This article explains updates in cell-free DNA technology and clinical considerations for prenatal care professionals, recognizing that this is a rapidly changing field of science and health care.

随着技术的进步,孕妇产前基因检测的选择范围也在不断扩大。领先的医学组织推荐无细胞 DNA 是筛查 13、18 和 21 三体以及胎儿性染色体非整倍体最灵敏的检测方法。商业化的检测方案超出了这些推荐的检测范围,产前保健专业人员应熟悉病人可能选择的检测方法,尽管这些方法超出了目前医学推荐的范围。本文介绍了无细胞 DNA 技术的最新进展以及产前护理专业人员的临床注意事项,并指出这是一个日新月异的科学和医疗保健领域。
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引用次数: 0
Disparities in Screening and Treatment Patterns for Depression and Anxiety During Pregnancy: An Integrative Review. 孕期抑郁和焦虑症筛查与治疗模式的差异:综合评述。
Pub Date : 2024-07-25 DOI: 10.1111/jmwh.13679
Rachel Eakley, Audrey Lyndon

Introduction: Symptoms of untreated depression and anxiety during pregnancy are associated with serious adverse effects for the pregnant person, birth outcomes, and child development. However, pregnant persons are less likely to be screened and treated compared with nonpregnant people. In this systematic review, we aimed to explore individual, provider, and systems factors that impact screening, identification, and treatment patterns for depression and anxiety during pregnancy.

Methods: Studies were eligible for inclusion if they were conducted within the United States and published in English between January 2012 and January 2023. Each study included analysis that compared rates of screening, identification, or treatment engagement and explicitly discussed disparities or health equity in marginalized groups. Fifteen articles met full inclusion criteria.

Results: Results demonstrated variation in the screening, identification, and treatment of depression and anxiety during pregnancy among diverse groups of patients. Screening rates ranged from 51.3% in Puerto Rico to 90.7% in Alaska. Among specific clinical populations, rates were as low as 2.0%. Fewer than half of patients were referred to treatment when indicated by screening or diagnoses. Patient characteristics such as age, race, ethnicity, socioeconomic and health factors, mental health history, and obesity were associated with variation in the rates of screening, diagnoses, or treatment engagement. Language factors were the most common factor associated with lower rates of screening and treatment access.

Discussion: Results suggest that many pregnant people are being overlooked and lack appropriate referrals or resources to access treatment. Results are consistent with previous findings that role confusion and lack of time, provider training, and interest contribute to low rates of screening and treatment. Future research must focus on system level factors to address perceived barriers to screening and treating depression and anxiety during pregnancy in a systematic and equitable way.

导言:孕期抑郁和焦虑症状如不及时治疗,会对孕妇、分娩结果和儿童发育造成严重不良影响。然而,与非孕妇相比,孕妇接受筛查和治疗的可能性较低。在本系统综述中,我们旨在探讨影响孕期抑郁和焦虑筛查、识别和治疗模式的个人、提供者和系统因素:2012年1月至2023年1月期间,在美国境内进行的、以英语发表的研究均符合纳入条件。每项研究都包含对筛查、识别或治疗参与率进行比较的分析,并明确讨论了边缘化群体的差异或健康公平问题。有 15 篇文章符合全部纳入标准:结果显示,不同患者群体在筛查、识别和治疗孕期抑郁和焦虑方面存在差异。筛查率从波多黎各的 51.3% 到阿拉斯加的 90.7% 不等。在特定的临床人群中,筛查率低至 2.0%。根据筛查或诊断结果转诊治疗的患者不到一半。年龄、种族、民族、社会经济和健康因素、精神健康史和肥胖等患者特征与筛查、诊断或治疗参与率的差异有关。语言因素是导致筛查率和治疗率较低的最常见因素:讨论:结果表明,许多孕妇被忽视,缺乏适当的转诊或治疗资源。结果与之前的研究结果一致,即角色混乱、缺乏时间、提供者培训和兴趣导致筛查和治疗率较低。未来的研究必须关注系统层面的因素,以系统、公平的方式解决筛查和治疗孕期抑郁和焦虑症的障碍。
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引用次数: 0
Oral Health Care Among Women in Perimenopause or Menopause: An Integrative Review. 围绝经期或更年期妇女的口腔保健:综合评述。
Pub Date : 2024-07-24 DOI: 10.1111/jmwh.13668
Namitha Thomas, Kath Peters, Kate O' Reilly, Mariana S Sousa, Ajesh George

Introduction: Women in menopause are at a higher risk of developing oral health problems, affecting their overall quality of life. Several studies have identified the role of health care providers in addressing women's oral health needs across various phases of their lives, yet a review in the area of perimenopause and menopause has not been undertaken. Therefore, the aim of this review was to explore current evidence regarding the oral health knowledge, attitudes, and practices of women in perimenopause or menopause and their health care providers. Additionally, guidelines and recommendations to inform strategies for oral health promotion are included.

Methods: A systematic search was carried out across 5 databases. Inclusion criteria included articles published in English that examined at least one study outcome: oral health knowledge, attitudes, and practices of either women in perimenopause or menopause or of health care providers or guidelines around oral health care. Qualitative, quantitative, mixed-methods, and experimental studies with survey components were included with no restrictions on publication period, quality, or setting.

Results: A total of 12 articles met the inclusion criteria, with a majority being of poor quality and mostly from low-income and middle-income countries. Overall findings indicated that there was a lack of knowledge and limited practices in maintaining oral hygiene and visiting the dentist among women in perimenopause or menopause. Health care providers exhibited poor attitudes in advising the importance of periodic dental check-ups and informing oral health changes during this period. There were also insufficient guidelines to adopt care for women and guide health care providers in their practice.

Discussion: Women in perimenopause or menopause have limited oral health knowledge and unmet oral health needs. Appropriate guidelines and supportive strategies are required to assist health care providers in providing comprehensive care and encouragement to women in perimenopause or menopause to improve their oral health.

简介更年期妇女出现口腔健康问题的风险较高,会影响她们的整体生活质量。有几项研究已经确定了医疗保健提供者在满足妇女一生中不同阶段的口腔健康需求方面所扮演的角色,但尚未对围绝经期和更年期领域进行综述。因此,本综述旨在探索围绝经期或更年期女性及其医疗服务提供者在口腔健康知识、态度和实践方面的现有证据。此外,该综述还包括了有关口腔健康促进策略的指南和建议:方法:在 5 个数据库中进行了系统检索。纳入标准包括用英语发表的文章,这些文章至少研究了一项研究结果:围绝经期或更年期女性或医疗服务提供者的口腔健康知识、态度和实践,或口腔健康护理指南。这些研究包括定性研究、定量研究、混合方法研究以及包含调查内容的实验研究,对发表时间、质量或环境没有限制:共有 12 篇文章符合纳入标准,其中大部分文章质量较差,且大多来自低收入和中等收入国家。总体研究结果表明,围绝经期或更年期妇女在保持口腔卫生和看牙医方面知识匮乏,实践有限。医疗服务提供者在告知定期牙科检查的重要性和告知这一时期口腔健康变化方面的态度不佳。此外,也没有足够的指南来对妇女进行护理并指导医疗服务提供者的实践:讨论:围绝经期或更年期妇女的口腔健康知识有限,口腔健康需求得不到满足。需要适当的指南和支持策略,以协助医疗服务提供者为围绝经期或更年期妇女提供全面的护理,并鼓励她们改善口腔健康。
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引用次数: 0
Altered Abdominal Muscle Recruitment and Declined Physical Function in Postpartum Individuals With Pregnancy-Related Pelvic Girdle Pain: A Matched Case-Control Study. 与妊娠相关的骨盆腰部疼痛的产后患者腹肌募集改变和身体功能下降:一项匹配病例对照研究。
Pub Date : 2024-07-23 DOI: 10.1111/jmwh.13673
Sze Chee Chua, Meng-Hsing Wu, Yi-Liang Kuo, Kuan-Yin Lin, Yi-Ju Tsai

Introduction: The influence of pregnancy-related pelvic girdle pain (PPGP) on lumbopelvic muscles has not been comprehensively examined in postpartum individuals. Previous research also presented self-reported activity limitations without objective measures.

Methods: Thirty postpartum individuals with PPGP (PPGP group) and 30 age-, parity-, and postpartum duration-matched asymptomatic individuals (healthy group) were recruited. Transabdominal ultrasonography was used to measure muscle thickness or activation changes of the external oblique (EO), internal oblique (IO), transverse abdominals, lumbar multifidus, and pelvic floor muscles (PFMs) during rest and while performing the active straight leg raise (ASLR). Muscle changes were compared separately in the painful and nonpainful sides between the PPGP and health control group. Physical function was assessed using the ASLR fatigue (ASLRF), timed up-and-go, and 6-m walking (6MW) tests.

Results: The PPGP group had greater thickening changes in the bilateral IO during ASLR compared with the healthy group (nonpainful side, 16.34 vs 3.52 mm; P = .010; painful side, 18.83 vs 6.60 mm; P = .02) but became thinner in the EO (nonpainful side, -2.19 vs 19.97 mm; P < .001; painful side, -5.97 vs 21.43 mm; P < .001). Thicker IO and EO on the nonpainful side (IO, 6.60 vs 5.78 mm; P = .004; EO, 5.37 vs 4.54 mm; P = .011) and a lower bladder base (indication of PFMs) (91.87 vs 78.61 mm; P = .002) during rest were also observed in the PPGP group. Furthermore, the performance of the ASLRF and 6MW tests was poorer in the PPGP than in the healthy group (ASLRF nonpainful side, 82.36 vs 59.09 sec; P = .01; painful side, 75.73 vs 59.26 sec; P = .04; 6MW, 3.48 vs 3.17 sec; P = .02).

Discussion: Postpartum individuals with PPGP demonstrated altered abdominal muscle recruitment strategies during loading tasks, with objectively impaired physical functions. These findings are critical for developing effective muscle training interventions for PPGP.

简介:与妊娠相关的骨盆腰部疼痛(PPGP)对产后患者腰椎骨盆肌肉的影响尚未得到全面研究。以前的研究也只提供了自我报告的活动限制,而没有客观的测量方法:方法:招募了 30 名患有 PPGP 的产后患者(PPGP 组)和 30 名年龄、胎次和产后持续时间匹配的无症状患者(健康组)。采用经腹超声波检查法测量患者在休息时和进行主动直腿抬高(ASLR)时腹外斜肌(EO)、腹内斜肌(IO)、腹横肌、腰多裂肌和骨盆底肌(PFMs)的肌肉厚度或激活变化。分别比较了 PPGP 组和健康对照组疼痛侧和非疼痛侧的肌肉变化。身体功能通过 ASLR 疲劳(ASLRF)、定时起立行走和 6 米步行(6MW)测试进行评估:结果:与健康组相比,PPGP 组在 ASLR 期间双侧 IO 的增厚变化更大(非疼痛侧,16.34 vs 3.52 mm;P = .010;疼痛侧,18.83 vs 6.60 mm;P = .02),但 EO 变薄(非疼痛侧,-2.19 vs 19.97 mm;P 讨论:产后 PPGP 患者在完成负荷任务时腹部肌肉募集策略发生了改变,客观上损害了身体功能。这些发现对于制定有效的 PPGP 肌肉训练干预措施至关重要。
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引用次数: 0
The Availability of Midwifery Care in Rural United States Communities. 美国农村社区助产护理的可用性。
Pub Date : 2024-07-23 DOI: 10.1111/jmwh.13676
Emily C Sheffield, Alyssa H Fritz, Julia D Interrante, Katy Backes Kozhimannil

Introduction: Access to pregnancy-related and childbirth-related health care for rural residents is limited by health workforce shortages in the United States. Although midwives are key pregnancy and childbirth care providers, the current landscape of the rural midwifery workforce is not well understood. The goal of this analysis was to describe the availability of local midwifery care in rural US communities.

Methods: We developed and conducted a national survey of rural US hospitals with current or recently closed childbirth services. Maternity unit managers or administrators at 292 rural hospitals were surveyed from March to August 2021, with 133 hospitals responding (response rate 46%; 93 currently offering childbirth services, 40 recently closed childbirth services). This cross-sectional analysis describes whether rural hospitals with current or prior childbirth services had midwifery care with certified nurse-midwives available locally and whether rural communities with and without midwifery care differed by hospital-level and county-level characteristics.

Results: Among hospitals surveyed, 55% of those with current and 75% of those with prior childbirth services reported no locally available midwifery care. Of the 93 rural communities with current hospital-based childbirth services, those without midwifery care were more likely to have lower populations (37% vs 33%); majority populations that were Black, Indigenous, and people of color (24% vs 10%); and hospitals where at least 50% of births were Medicaid funded (77% vs 64%), compared with communities with midwifery care. Conversely, communities with midwifery care more often had greater than 30% of patients traveling more than 30 miles for hospital-based childbirth services (38% vs 28%).

Discussion: More than half of rural hospitals surveyed reported no locally available midwifery care, and availability differed by hospital-level and county-level characteristics. Efforts to ensure pregnancy and childbirth care access for rural birthing people should include attention to the availability of local midwifery care.

导言:在美国,农村居民获得与妊娠和分娩相关的医疗保健服务受到了医疗卫生劳动力短缺的限制。虽然助产士是怀孕和分娩护理的主要提供者,但人们对农村助产士队伍的现状并不十分了解。这项分析的目的是描述美国农村社区当地助产护理的可用性:方法:我们对目前或最近关闭了分娩服务的美国农村医院进行了一项全国性调查。2021 年 3 月至 8 月,我们对 292 家农村医院的产科经理或管理人员进行了调查,其中 133 家医院做出了回应(回应率为 46%;93 家医院目前提供分娩服务,40 家医院最近关闭了分娩服务)。这项横断面分析描述了目前或之前提供分娩服务的农村医院是否在当地配备了助产士,以及有助产士和没有助产士的农村社区在医院层面和县级层面的特征是否存在差异:在接受调查的医院中,55%的现有医院和 75% 的曾有过分娩服务的医院表示当地没有提供助产护理。在 93 个目前有医院分娩服务的农村社区中,与有助产护理的社区相比,没有助产护理的社区更有可能人口较少(37% 对 33%);大多数人口为黑人、土著人和有色人种(24% 对 10%);至少 50%的分娩由医疗补助资助的医院(77% 对 64%)。相反,在提供助产护理的社区中,有超过 30% 的患者需要前往 30 英里以外的医院接受分娩服务(38% 对 28%):讨论:在接受调查的农村医院中,有一半以上的医院表示当地没有助产护理服务,而且医院和县级医院的助产护理服务情况也不尽相同。确保农村分娩者获得怀孕和分娩护理的努力应包括关注当地助产护理的可用性。
{"title":"The Availability of Midwifery Care in Rural United States Communities.","authors":"Emily C Sheffield, Alyssa H Fritz, Julia D Interrante, Katy Backes Kozhimannil","doi":"10.1111/jmwh.13676","DOIUrl":"https://doi.org/10.1111/jmwh.13676","url":null,"abstract":"<p><strong>Introduction: </strong>Access to pregnancy-related and childbirth-related health care for rural residents is limited by health workforce shortages in the United States. Although midwives are key pregnancy and childbirth care providers, the current landscape of the rural midwifery workforce is not well understood. The goal of this analysis was to describe the availability of local midwifery care in rural US communities.</p><p><strong>Methods: </strong>We developed and conducted a national survey of rural US hospitals with current or recently closed childbirth services. Maternity unit managers or administrators at 292 rural hospitals were surveyed from March to August 2021, with 133 hospitals responding (response rate 46%; 93 currently offering childbirth services, 40 recently closed childbirth services). This cross-sectional analysis describes whether rural hospitals with current or prior childbirth services had midwifery care with certified nurse-midwives available locally and whether rural communities with and without midwifery care differed by hospital-level and county-level characteristics.</p><p><strong>Results: </strong>Among hospitals surveyed, 55% of those with current and 75% of those with prior childbirth services reported no locally available midwifery care. Of the 93 rural communities with current hospital-based childbirth services, those without midwifery care were more likely to have lower populations (37% vs 33%); majority populations that were Black, Indigenous, and people of color (24% vs 10%); and hospitals where at least 50% of births were Medicaid funded (77% vs 64%), compared with communities with midwifery care. Conversely, communities with midwifery care more often had greater than 30% of patients traveling more than 30 miles for hospital-based childbirth services (38% vs 28%).</p><p><strong>Discussion: </strong>More than half of rural hospitals surveyed reported no locally available midwifery care, and availability differed by hospital-level and county-level characteristics. Efforts to ensure pregnancy and childbirth care access for rural birthing people should include attention to the availability of local midwifery care.</p>","PeriodicalId":94094,"journal":{"name":"Journal of midwifery & women's health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
An Integrative Review Exploring Womens' Experiences of Retraumatization Within Perinatal Services. 在围产期服务中探索妇女再创伤经历的综合评论。
Pub Date : 2024-07-22 DOI: 10.1111/jmwh.13662
Jennifer Gordon, Andrew Hunter, Fiona Callanan, Clare Kiely, Annmarie Grealish

Introduction: Evidence indicates that retraumatization has a detrimental effect for those women who are accessing perinatal services. One in five women worldwide has a history of childhood adversity. Between 18% and 34% of women experience trauma, which is a well-known risk factor for the onset of chronic mental health disorders. There is a lack of evidence on women's experiences on retraumatization in perinatal care settings and how to prevent retraumatization from occurring. The purpose of this study was to conduct an integrative review on women experiences of retraumatization to determine preventive measures within perinatal services.

Methods: This integrative review followed Whittemore and Knafl's 5-stage framework as it allows for the inclusion and integration of diverse research methodologies into an overall synthesis of the evidence. A systematic search of 5 databases was conducted (Web of Science, MEDLINE, CINAHL, ASSIA, and PsychINFO) with no date, language, or geographical limits set due to the paucity of research published in this subject area. This review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: Fifteen studies met the inclusion criteria and were included in the thematic synthesis. The review identified that participants across the studies had a history of child sexual abuse, sexual abuse, and rape. Three main themes plus subthemes were identified: (1) activating (subthemes: positions in labor, intimate procedures, communications with health care professionals, loss of control); (2) outcomes (subtheme: emotional responses); and (3) interventions reducing or preventing retraumatization (subthemes: role of the health care professional, screening for abuse and history of trauma).

Discussion: Our findings demonstrate that women are experiencing retraumatization in perinatal services, and there is evidence of formalized approaches being applied in clinical settings to prevent retraumatization from occurring. This study is the first to examine the factors that contribute to retraumatization in perinatal services and make recommendations to reduce the harmful practices in place in perinatal care settings.

引言有证据表明,再次创伤会对接受围产期服务的妇女产生不利影响。全世界每五名妇女中就有一名有童年逆境史。18%到 34% 的妇女经历过心理创伤,而心理创伤是众所周知的慢性精神疾病发病的风险因素。关于妇女在围产期护理环境中的再创伤经历以及如何预防再创伤的发生,目前还缺乏相关证据。本研究旨在对妇女的再创伤经历进行综合回顾,以确定围产期服务中的预防措施:本综合综述遵循 Whittemore 和 Knafl 的 5 阶段框架,因为该框架允许将不同的研究方法纳入并整合到证据的总体综合中。我们对 5 个数据库(Web of Science、MEDLINE、CINAHL、ASSIA 和 PsychINFO)进行了系统检索,由于该主题领域发表的研究较少,因此没有设定日期、语言或地域限制。本综述根据《系统综述和元分析首选报告项目》指南进行编写和报告:结果:15 项研究符合纳入标准,并被纳入专题综合。综述发现,所有研究的参与者都有儿童性虐待、性虐待和强奸史。确定了三个主要主题和次主题:(1)激活(次主题:分娩姿势、亲密程序、与医护人员的沟通、失控);(2)结果(次主题:情绪反应);以及(3)减少或预防再创伤的干预措施(次主题:医护人员的角色、筛查虐待和创伤史):讨论:我们的研究结果表明,妇女在围产期服务中正在经历再创伤,有证据表明,临床环境中正在采用正式的方法来防止再创伤的发生。本研究首次探讨了围产期服务中造成再创伤的因素,并提出了减少围产期护理环境中有害做法的建议。
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引用次数: 0
Presentation and Management of Postpartum Granulation Tissue: A Single-Institution Retrospective Study. 产后肉芽组织的表现和处理:单机构回顾性研究
Pub Date : 2024-07-22 DOI: 10.1111/jmwh.13669
Bethany Kette, Allison Kumnick, Serenity Budd, Neha Gaddam, Nicholas Hazen

Introduction: Although the development of postpartum granulation tissue (PPGT) is an expected phase of healing of perineal and vaginal lacerations, the persistence of this tissue can result in delayed wound healing, pain, bleeding, and discharge. There is a paucity of information on the efficacy of the treatments used for pathologic PPGT. The objective of this study was to describe characteristics associated with the development of PPGT and the treatment methods currently used for management.

Methods: This was a retrospective cohort study of 140 patients diagnosed with PPGT within one year of birth from 2012 through 2022 within a single health care system. Patients were identified by International Classification of Diseases and Current Procedural Terminology codes. Demographics, birth characteristics, symptoms, and treatment information were obtained and assessed in frequencies and means. Treatments were compared with 95% CIs and P values. Time to resolution was assessed by the number of weeks and the number of visits.

Results: It was the first vaginal birth for 129 (92%) patients in the study cohort. The majority (84.3%) of patients presented with pain. Almost half of all patients (45%) were diagnosed after 6 weeks postpartum. 30.0% of patients were initially treated conservatively. 76.4% of patients were treated with silver nitrate, and 33.6% had an excisional procedure. Successful conservative management had the lowest average number of visits to resolution with 1.39 visits (95% CI, 1.15-1.69), followed by silver nitrate alone with 1.95 visits (95% CI, 1.73-2.19), and excision with or without silver nitrate with 2.40 visits (95% CI, 2.07-2.78). Conservative management was unsuccessful 45% of the time, requiring additional treatment with silver nitrate or excision. 30% of patients treated with silver nitrate or excision continued to report pain even after the resolution of granulation tissue upon examination.

Conclusion: PPGT is commonly associated with first vaginal births, often presents beyond 6 weeks postpartum, and frequently requires treatment.

导言:虽然产后肉芽组织(PPGT)的形成是会阴和阴道裂伤愈合的一个预期阶段,但这种组织的持续存在会导致伤口愈合延迟、疼痛、出血和分泌物增多。目前有关病理性 PPGT 治疗效果的信息还很少。本研究旨在描述与 PPGT 发生相关的特征以及目前用于治疗的方法:这是一项回顾性队列研究,研究对象是一个医疗保健系统中从 2012 年到 2022 年出生后一年内被诊断为 PPGT 的 140 名患者。根据国际疾病分类和当前程序术语代码确定患者身份。研究人员获取了人口统计学、出生特征、症状和治疗信息,并对其频率和均值进行了评估。通过 95% CI 和 P 值对治疗方法进行比较。根据周数和就诊次数评估解决问题的时间:研究队列中有 129 名患者(92%)是首次经阴道分娩。大多数患者(84.3%)伴有疼痛。近一半的患者(45%)在产后 6 周后被确诊。30.0%的患者最初接受保守治疗。76.4%的患者接受了硝酸银治疗,33.6%的患者接受了切除手术。保守治疗成功的患者平均就诊次数最少,为 1.39 次(95% CI,1.15-1.69 次),其次是单纯硝酸银治疗,为 1.95 次(95% CI,1.73-2.19 次),有硝酸银或无硝酸银的切除术为 2.40 次(95% CI,2.07-2.78 次)。45%的保守治疗不成功,需要使用硝酸银或切除术进行额外治疗。在接受硝酸银或切除术治疗的患者中,30%的患者在检查肉芽组织消退后仍报告疼痛:结论:PPGT 常见于经阴道分娩的初产妇,通常在产后 6 周后出现,并且经常需要治疗。
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引用次数: 0
Gender and Sex Inclusive Approaches for Discussing Predicted Fetal Sex: A Call for Reflection and Research. 讨论预测胎儿性别的性别和性别包容方法:呼吁反思与研究。
Pub Date : 2024-07-18 DOI: 10.1111/jmwh.13663
Hannah Llorin, Tiffany Lundeen, Elizabeth Collins, Claudia Geist, Kyl Myers, Susanna R Cohen, Kimberly Zayhowski
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引用次数: 0
Antenatal Care Visits, Institutional Births, and Associated Risk Factors in Afghanistan: Insights from the Multiple Indicator Cluster Survey 2022-2023. 阿富汗的产前护理就诊率、住院分娩率及相关风险因素:2022-2023 年多指标类集调查的启示》。
Pub Date : 2024-07-12 DOI: 10.1111/jmwh.13666
Jahar Bhowmik, Lakma Gunarathne, Sunil Bhar, Udayan Bhowmik, Raaj Kishore Biswas

Introduction: Insufficient use of antenatal care (ANC) services and institutional births services can elevate the maternal mortality risk in limited resource settings. Hence, the key objective of this study was to evaluate the potential association between the frequency of ANC visits and institutional birth services in Afghanistan, while also identifying other sociodemographic factors that may exert influence. Furthermore, we explored factors associated with the attendance of women at ANC visits during their pregnancy.

Methods: We employed data from the most recent Multiple Indicator Cluster Survey conducted in Afghanistan in 2022 to 2023 with a total of 8096 women aged 15 to 49. A complex survey weight-adjusted logistic regression model was used to examine factors related to institutional births, and a multinomial logistic regression model was fitted to assess the relationships between sociodemographic factors and ANC visits, adjusting for survey weights, cluster effects, and strata.

Results: Approximately 40% of the sample (n = 3247) had undergone 4 or more ANC visits, and 74.4% (n = 6,022) had opted for institutional birth. Women's higher education was found to be associated with ANC visits. The area of residence, wealth index, education levels of women, ownership of mobile phones, number of children, and number of ANC visits were associated with institutional births. Compared with women with no or one ANC visit, those with more than 3 visits had 31% higher odds (adjusted odds ratio, 1.31; 95% CI, 1.10-1.57) of accessing institutional births.

Discussion: Our findings indicate a significant association between ANC visits and use of institutional birth care. These findings carry implications for advancing safe motherhood and childbirth by enhancing women's social status.

导言:在资源有限的情况下,产前检查(ANC)服务和住院分娩服务使用不足会增加孕产妇死亡风险。因此,本研究的主要目的是评估阿富汗产前检查频率与住院分娩服务之间的潜在关联,同时确定可能产生影响的其他社会人口因素。此外,我们还探讨了妇女在怀孕期间接受产前检查的相关因素:我们采用了 2022 年至 2023 年在阿富汗进行的最新多指标类集调查的数据,共调查了 8096 名 15 至 49 岁的妇女。我们采用了一个复杂的调查权重调整逻辑回归模型来研究住院分娩的相关因素,并拟合了一个多叉逻辑回归模型来评估社会人口学因素与产前保健就诊之间的关系,同时对调查权重、集群效应和分层进行了调整:约 40% 的样本(n = 3247)接受过 4 次或更多次产前检查,74.4% 的样本(n = 6022)选择了住院分娩。研究发现,妇女接受高等教育与产前检查次数有关。居住地区、财富指数、妇女教育水平、手机拥有量、子女数量和产前检查次数与住院分娩有关。与未接受过产前检查或仅接受过一次产前检查的妇女相比,接受过 3 次以上产前检查的妇女接受住院分娩的几率要高出 31%(调整后的几率比为 1.31;95% CI 为 1.10-1.57):讨论:我们的研究结果表明,产前检查次数与使用住院分娩护理之间存在重大关联。这些发现对通过提高妇女的社会地位来促进安全孕产具有重要意义。
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引用次数: 0
Midwives' and Obstetric Physicians' Practices Related to Pregnancy Nutrition Counseling: A Scoping Review. 助产士和产科医生的孕期营养咨询实践:范围审查。
Pub Date : 2024-07-10 DOI: 10.1111/jmwh.13661
Katherine Erbe, Kylea Liese, Lisa Tussing-Humphreys, Elizabeth Lerner Papautsky, Julienne Rutherford, Mary Dawn Koenig

Introduction: Dietary intake during pregnancy impacts short- and long-term maternal and fetal health outcomes. Dietary habits are highly individualized and influenced by contextual factors and social determinants of health within each person's lived environment. Midwives and other health care providers are well positioned to facilitate nutrition conversations and interventions with patients related to recommendations and modifications before and during pregnancy. This scoping review synthesizes the literature on perinatal care providers' attitudes and practices related to antenatal nutrition counseling.

Methods: An electronic database literature search was conducted in March 2023 using the following inclusion criteria: English language, published between 1990 and 2023, completed in high-income countries, and evaluated provider practices related to educating pregnancy patients on nutrition. Exclusion criteria included comparison or interventional studies as well as those focused on patient perspectives, specialty diets, comorbidities, or pregnancy complications. Thematic analysis was completed to identify common themes and subthemes across studies related to perinatal care providers' perspectives of pregnancy nutrition.

Results: Thirty-six articles were included in the final review. Although providers acknowledged the importance of nutrition for pregnancy outcomes, few reported being able to cover the topic in-depth during antenatal visits. Counseling was usually generalized, limited in scope, and lacked consideration of patient-specific contextual factors such as dietary restrictions, preferences, or access to resources needed to follow recommendations. Provider barriers to comprehensive nutrition counseling included lack of training and time during clinic visits and limited availability of guidelines.

Discussion: Multiple gaps in current pregnancy nutrition counseling practices exist. Despite nutrition being viewed by perinatal care providers as an important part of pregnancy, multiple barriers lead to it being overlooked during patient-provider interactions. Contextual factors for both providers and patients contribute to failure of current interventions to consistently and significantly impact dietary habits of pregnant people.

导言:怀孕期间的饮食摄入会影响孕产妇和胎儿的短期和长期健康结果。饮食习惯是高度个性化的,受到每个人生活环境中的环境因素和决定健康的社会因素的影响。助产士和其他医疗服务提供者能够很好地促进与患者的营养对话,并就孕前和孕期的建议和调整进行干预。本综述综述了围产期保健提供者对产前营养咨询的态度和做法的相关文献:于 2023 年 3 月进行了电子数据库文献检索,纳入标准如下:英语,发表于 1990 年至 2023 年之间,在高收入国家完成,评估了医疗服务提供者对孕期患者进行营养教育的相关实践。排除标准包括对比研究或干预研究,以及关注患者观点、特殊饮食、合并症或妊娠并发症的研究。研究人员完成了主题分析,以确定与围产期保健提供者对孕期营养的看法有关的各项研究的共同主题和次主题:结果:36 篇文章被纳入最终综述。尽管医疗服务提供者承认营养对妊娠结果的重要性,但很少有人报告说他们能够在产前检查中深入探讨这一主题。咨询通常是泛泛而谈,范围有限,没有考虑到患者的具体情况,如饮食限制、偏好或获得遵循建议所需的资源。提供者进行全面营养咨询的障碍包括缺乏培训和门诊时间,以及指南的可获得性有限:讨论:目前的孕期营养咨询实践存在多种缺陷。尽管围产期保健提供者认为营养是孕期的重要组成部分,但多种障碍导致营养问题在患者与提供者的互动中被忽视。服务提供者和患者的环境因素导致目前的干预措施无法持续、显著地影响孕妇的饮食习惯。
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引用次数: 0
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Journal of midwifery & women's health
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