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Background: As a quality service improvement response since elexacaftor/ tezacaftor/ivacaftor (ELX/TEZ/IVA) became available and the yearly average number of cystic fibrosis (CF) pregnancies (n = 7 pre-2020, n = 33 in 2021) increased significantly at an adult CF center (~600 people with CF), a monthly multidisciplinary CF-maternal health virtual clinic was established with antenatal virtual CF exercise classes dedicated to providing adaptive, specialist support to this cohort, aswell as outreach guidance and education to local obstetric teams. Method(s): This was a single-center retrospective reviewof Royal Brompton Hospital CF-Maternal Health multidisciplinary team clinic records and a patient survey from March 2020 to March 2022. Result(s): Of 47 pregnancies in 41 women (median age 30;) eligible for ELX/ TEZ/IVA at start of pregnancy, 40% (n = 19) were unplanned, and 19% (n = 9) used assisted conception. Three women with a history of infertility conceived naturally, having required assisted conception for previous pregnancies, and five women had multiple pregnancies during the study period. ELX/TEZ/IVA was continued in 60% (n = 28), delayed in 28% (n = 13), and stopped in 13% (n = 6) of pregnancies through maternal choice and careful clinical counselling. Pre-pregnancy pulmonary status was poorer in women who continued than in those who delayed or stopped (Table 1). Of those who stopped, 85% (n = 5) restarted because of pulmonary deterioration by the third trimester. Prenatal CF complications included at least one episode of minor hemoptysis in 21% (n = 9/41) of women, at least one infective exacerbation in 55% of pregnancies (n = 26/47), and noninvasive ventilation in one woman. Other pregnancy-associated complications included one case of ovarian hyperstimulation syndrome, one case of sub-segmental pulmonary embolism, and two cases of pregnancy-induced hypertension. Excluding 10 first trimester terminations, 10 current pregnancies, and one patient relocation, obstetric outcomes available for 26 pregnancies confirmed a live birth rate of 85% (n = 22/26) and a 15% first-trimester miscarriage rate (n = 4). Obstetric complications included preterm delivery rate of 23% (n = 6/26), including two cases of COVID infection resulting in two neonatal intensive care unit admissions, one case of endometritis after cesarean section, and a fourthdegree perineal tear. There were no ectopic pregnancies, maternal or neonatal deaths, or reports of infant cataracts or congenital malformations. Median gestational age was 37/40 weeks (range 29-40). Mode of delivery was via cesarean section in 45% (n = 10/22, of which twowere emergency) and vaginal in 55% (n = 12/22), of which 83% (n = 10/12) were via induction of labor for diabetes (CF or gestational) indication. Deliveries were supported and occurred equally at local obstetric units and in tertiarycare obstetric hospital settings (50%, n = 11/22). Patient-experience survey responses cited high levels of confidence in health optimization and prioritization during pregnancy and praised excellent inter-health care provider communication and peer-to-peer emotional support provided among expectant mothers in the virtual prenatal exercise groups. Table 1. Baseline demographic and clinical characteristics of elexacaftor/tezacaftor/ivacaftoreligible expectant mothers according to therapeutic decision (Table Presented) Conclusion(s): In the absence of clinical trial safety data, the novel approach of a dedicated CF-maternal health multidisciplinary team clinic with local obstetric outreach support has ensured regular specialist clinical and emotional peer-to-peer support for this cohort of women eligible for ELX/ TEZ/IVA to ensure optimal outcomes and experiences of their pregnancies, where appropriate, close to home.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved
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Background: Reflection is important in the professional practice of medicine, and analyses of trainees' reflection papers have been utilized to evaluate training outcomes. This study was to determine the degree of reflection of residents completing the developmental-behavioral pediatrics (DBP) rotation, which provides a high degree of interprofessional and family-centered experiences. We sought to explore whether level of reflection was correlated with timing of the rotation [earlier or later in training year, before or since the coronavirus disease 2019 (COVID-19) pandemic]. Method(s): This retrospective study included deidentified reflection statements of Pediatrics (Peds) and Medicine-Pediatrics (Med-Peds) residents after their DBP rotation from 2017-2021. Level of reflection for each of four categories of prompts, leadership, interdisciplinary, family-centered, and equity (LIFE), which codifies 12 Maternal Child Health (MCH) competencies, and ideally reflect the principles of the DBP rotation. The prompts were coded using a five-point Castleberry rating. Result(s): Thirty-six residents completed reflections, 58% completed the rotation prior to the COVID-19 pandemic, and 44% completed the rotation early in their academic year. Mean Castleberry ratings were 3.2 [standard deviation (SD) =0.7], 2.7 (SD =0.8), 2.6 (SD =1.0), and 2.6 (SD =0.8) for LIFE, respectively. Wilcoxon rank-sum tests tested differences in Castleberry ratings for each facet of the LIFE framework by timing of rotation vis-a-vis the COVID-19 pandemic and early or late in the training year. We found statistically significant lower results for interdisciplinary (I) facet of the LIFE framework in those who completed the rotation late in the training year (W=214.50;P=0.02). Conclusion(s): Peds and Med-Peds residents reflect moderately on their DBP rotation, and more on leadership than other aspects integral to DBP practice. Future research is needed to compare reflections on the LIFE framework across different rotations, and thematic/sentiment analysis can reveal opportunities for guiding residents on the reflection process.Copyright © Pediatric Medicine. All rights reserved.
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Objectives: to assess the effect-related inflammatory and coagulation biomarkers in pregnancy and their connection with the coronavirus disease of 2019 (COVID-19). Method(s): A prospective case-control study was carried out among normal third-trimester pregnant women admitted to the labor room of Dr. Soetomo General Academic Hospital between January until June 2021. Two classified groups of patients were established in accordance with the result of the RT-PCR test. Demographic, clinical and laboratory results data of the two groups were collected and compared. Result(s): Platelet-to-lymphocyte ratio (PLR) was shown to be the only significant biomarkers found in the expectant with COVID-19, which was 35.8% higher compared to the ones free of COVID-19 [212.25 (157.57-269.37) vs 156.29 (128.55-195.3), p=0.048]. Logistic regression analysis of PLR between groups showed that the level of PLR was an independent factor in pregnant women with COVID-19 (OR 4.483, 95%CI 1.262-15.926). The ROC analysis showed that the PLR cut-off among the expectant was 171.335, with both sensitivity and specificity were 66.7% (p=0.021). The result shows no significant differences in leukocyte count, absolute neutrophils - lymphocyte count and percentage, neutrophil-to-lymphocyte ratio (NLR) and D-Dimer level between pregnant women infected with COVID-19 and free of the virus (p>0.05). Conclusion(s): Intriguingly, physiological adaptation during the course of the third trimester of pregnancy found no difference in most inflammation and coagulation markers, both in the condition of infected COVID-19 or not. The evidence from this single-centre study supports the viewpoint that elevated PLR was associated with independent biomarkers and thereby might be helpful to detect expectant with COVID-19. Copyright © 2022, Yerevan State Medical University. All rights reserved.
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BACKGROUND: In the COVID-19 pandemic situation, there are almost all routine services including maternal and newborn health services. For example, pregnant women are reluctant to go to the community health center or other facilities for fear of being infected and services delay pregnancy checks and classes for pregnant women. This causes maternal and newborn health services to be one of the services affected, both in terms of access and quality. Therefore, in improving maternal health, literacy about COVID-19 and Antenatal Care (ANC) services are needed during the adaptation period of the COVID-19 period. The general purpose of the study was to determine the effectiveness of providing literacy about COVID-19 on the compliance of pregnant women in conducting ANC in Pematangsiantar City. AIM: The specific objectives of the study were to determine the level of health literacy about COVID-19 in pregnant women, to know the coverage of ANC during the COVID-19 pandemic, and to analyze the effectiveness of providing literacy about COVID-19 on the compliance of pregnant women with ANC in Pematangsiantar City. METHODS: This research used a quasi-experimental design by providing literacy about COVID-19 and ANC to pregnant women. Literacy ability was assessed using a 16-item S-HLS-EU-Q questionnaire with a Likert scale. The number of samples in this study was 33 for the intervention group and 33 for the control group. Consecutive sampling and data analysis using the Chi-square test using the Statistical Package and Service Solutions version 25.0 application. RESULTS: The results of the study were 33 respondents in the intervention group, all of whom had high literacy about the health-care domain. While in the control group, only 75.8% had high literacy. The results of Fisher’s test showed p = 0.005. In the intervention group, 97% of the disease prevention domain had high literacy, and in the control group, there were 84.8% who had high literacy. The results of Fisher’s test showed p = 0.197. In the intervention group, the domain of health promotion overall had high literacy, and in the control group, there were 84.8% who had high literacy. Fisher’s test results show p = 0.053. CONCLUSION: The results, based on research, need to be made efforts to overcome the compliance of pregnant women in implementing an ANC.
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Introduction/ Background: Known for their weakness, health systems in West Africa have been the subject of pessimistic predictions. We were interested in understanding how the Senegalese, Gambian and Burkinabe health systems have coped with the shock of the pandemic. Methods: We conducted interviews with 75 doctors, nurses, midwives, and other medical personnel working in four selected healthcare institutions per country. We also interviewed six healthcare managers in charge of coordinating COVID-19 activities in each of the three countries, including a nation-wide COVID-19 decision-maker, a COVID-19 treatment centre coordinator and a COVID-19 testing laboratory manager. We used the theory of resilient health systems (Fridell et al., 2020) to analyse our data. Results: Health professionals reported leadership support. Solidarity between colleagues improves the working environment although the working conditions are difficult. To cope with the lack of training, health professionals go to colleagues or to the Internet. The availability and quality of Personal protective equipments varies between countries and services. COVID-19 treatment centre and laboratory staff felt more protected within their department than outside it, whereas maternal health workers.. About delivery services, the first patients were taken care of with a lot of pressure because of providers lack's of experience. In addition, health professionals find themselves playing the role of carer in their absence. Impact: This study shows that health systems in West Africa, although weak and often under-resourced, have a workforce capable of using the resources available to deal with the shock of a pandemic. Conclusion: Human resources of health are strong and committed, despite difficult working conditions with insufficient preparation, providers have drawn on their own resources to train themselves to the point of taking over the role of the carer.
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Background: Perinatal depression is a common and undertreated pregnancy complication. Beginning in January 2020, we implemented “Reach Out, Stay Strong, Essentials for New Moms,” (ROSE) an empirically validated 5-session intervention recommended by the U.S. Preventive Services Task Force to prevent perinatal depression (PPD). Methods: Our integrated evaluation framework helped us to understand the virtual program delivery adapted due to the COVID-19 pandemic. This included semi-structured provider interviews and surveys, patient questionnaires, and a COVID-19 stressor screen. Two controls matched on maternal age, race, delivery date, zip-code, and infant gender were selected per ROSE participant on a quarterly basis, and maternal and infant outcomes were assessed at nine months post-delivery. Results: To date, 68 highrisk pregnant women have been referred, and 57 enrolled in the ROSE program (84% retention, Figure 1). Eight ROSE infants and 16 controls have reached nine months of age and were eligible for review. ROSE participants and controls had similar rates of attendance at a six-week PPD follow-up visit. Participants and controls also attended on average a similar number of well-child visits, had similar rates of screening for PPD at attended visits, and had similar cumulative incidence of positive screens for PPD. ROSE participants and controls had similar rates of initiating breastfeeding. Of those who initiated breastfeeding, ROSE participants had, on average, a longer duration of breastfeeding. Rate of completion of infant vaccination schedules was similar between ROSES participants and controls, with a trend toward reduced vaccination refusal in the ROSE group. Provider stakeholders surveyed feel that the ROSE program is addressing a gap in care by flexibly providing additional mental health services, improving continuity of care through a dedicated program coordinator, and increasing partner engagement. Participants sought out an additional 103 contacts beyond those required by the five sessions of the program. Conclusion: Analysis of preliminary data shows trends toward increased duration of breastfeeding and decreased vaccine hesitancy in the ROSE study population. The majority of records reviewed to date are from initial enrollment, which began in a clinic for pregnant mothers with substance use disorder. Stakeholders feel that ROSE is addressing key care needs, particularly in this clinic population, and participants continue to seek engagement with the program outside of required sessions. Our data suggests that ROSE supports high-risk mothers in caring for themselves and their infants after birth. We will continue to review additional infant and maternal health metrics (Figure 2) as enrollment expands and more of our study population reaches nine months post-delivery.
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Purpose of Study Birth asphyxia is a major cause of neonatal mortality in low- and middle-income countries (LMIC). A Blended Learning Program was set up by Georgetown University (GU) faculty for quality improvement (QI) activities in several district hospitals in Ghana (funded by GU Global Health Initiative). Birth asphyxia was selected as the top priority by the Ghana staff, specially focusing on resuscitation at birth. The in- country workshop was cancelled due to the COVID pandemic. However, facilitation of QI activities was carried out using digital technology. We share the impact of this program in one Ghana regional hospital. Methods Used Hospital staff had received in-country training in AAP-Helping Babies Breathe (HBB) course earlier. Using Zoom and WhatsApp, the GU faculty worked with health care providers to facilitate QI activities to improve resuscitation at birth. This included setting up a QI team, correct documentation of Apgar scores, refresher courses, practices on a manikin, promoting having at least two persons at each birth and ensuring appropriate equipment being kept in readiness. Monthly changes in proportion of babies ≥ 34 wks. gestational age whose Apgar score rose from £ 6 at 1 min. to ≥ 7 at 5 min of age were monitored. Pre-and post-intervention periods were Oct-Dec 2019 and Jan 2020 to Mar 2021. The program was considered exempt from review by the GU IRB. Summary of Results Figure 1 indicates the proportion of babies in whom the Apgar score rose from £ 3 at 1 min to > 4 at 5 min and those in whom the score rose from 4-6 at 1 min to ≥ 7 at 5 min. No significant difference was noted between the pre and post intervention periods. Table 1 shows that among 112 newborns with a 1minute Apgar score of £ 3, the scores remained at £ 3 at 5 minutes in about 50% of babies despite resuscitation attempts until the 4th quarter;17 (37%) of these infants died. Table 2 shows that in 639 infants with Apgar scores of 4-6, the scores did not improve to > 7 in 75 babies (11.7%);there were 5 deaths (0.8%) attributed to birth asphyxia in this group. Conclusions The improvement in Apgar scores showed that HBB had a positive effect. However, to have the full desired impact on outcome in newborns with birth asphyxia, it is essential to go beyond 'HBB' to a more comprehensive 'Mother-Baby Approach' where management addresses prevention and treatment. This includes (a) Counseling in the antenatal period promoting mothers to reach the facility at the appropriate time in labor (b) 'Helping Mothers Deliver' through capacity building of the maternal health staff for competency in optimal management of labor and delivery (c) 'HBB' to improve competence related to neonatal resuscitation (d) Better communication and coordination between maternal and newborn health staff and (e) Post resuscitation care of the baby. (Table Presented).
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INTRODUCTION: Insufficient milk production is a major problem for mothers who have just given birth and affects the health condition of postpartum mothers. One of the actions that can be taken to increase milk production and improve the health of postpartum mothers is to consume foods that can increase breast milk production, namely ingredients that contain galactagogue substances. Several types of herbal plants that are often consumed by postpartum mothers after giving birth to increase breast milk in North Sumatra, especially the city of Medan, are making vegetables from the bangun-bangun leaves. Bangun-bangun leaves contain the main ingredients, namely carvakrol, thymol, humulene, undecanal, terpinene, cymene, caryophyllene oxide, terpineol, and salinene whose nutritional content and composition help to stimulate breast milk production. AIM: The purpose of this study was to determine the effectiveness of the intervention of the leaves of the wake on the milk production of postpartum mothers and the health condition of postpartum mothers during the COVID 19 pandemic. METHOD: The intervention was carried out by giving 100 g of bangun-bangun leaves and consumed three times a day starting from the time the mother gave birth until 7 days. Breast milk production was assessed from the time the first breast milk was released and the health condition of the postpartum mother was assessed by measuring vital signs and assessing health conditions while still adhering to health protocols. The study was conducted in Medan Johor, North Sumatra Province and the sample in this study consisted of 60 people consisting of 30 intervention groups and 30 control groups according to the inclusion criteria. Collecting data using a questionnaire consisting of demographic data, data on the 1st day of breastfeeding, and data on health conditions in postpartum mothers before and after the intervention. Data analysis was carried out using dependent and independent t-tests. RESULTS: The results of the study showed that there was an effect of the intervention on the consumption of bangun-bangun leaves on breast milk production using an independent t-test with a p = 0.010 and intervention for consumption of bangun-bangun leaves with postpartum mother’s health condition with a p = 0.001. CONCLUSION: The results of this study are expected to be a solution and intervention in the care of postpartum mothers who have problems in spending milk production and can improve health conditions, especially during the COVID 19 pandemic.
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Objective: Pandemic-related changes produced a major shift for parental roles, responsibilities, and expectations. Our objective was to identify parenting challenges experienced by low-income postpartum mothers during a global pandemic lockdown. Study Design: In this qualitative investigation, we conducted semi-structured interviews with 40 postpartum individuals who gave birth in a single center in Chicago in the first three months of the COVID-19 pandemic (January-March 2020). Interviews addressed issues related to maternal health and well-being, including parental stress, limited access to essential goods, and COVID-related barriers to providing for children. All interviews were conducted via phone, transcribed, and analyzed using the constant comparative method. Results: Of the 40 participants, 50% (n=20) identified as non-Hispanic Black and 38% (n=15) as Hispanic;75% (n=30) were parents of multiple children. The primary parenting-related themes included challenges of parenting multiple children, barriers to self-care, and novel barriers to providing for children (Table). Subthemes within challenges of parenting multiple children include new role as an educator, struggle with entertaining, and time allocation. The barriers to self-care subthemes included lack of free time, changes in self-care and coping strategies, and effects on maternal mental health. The novel barriers to providing for children subthemes included lack of communal support, financial stress, and difficulty obtaining essential needs. Conclusion: Obstetric providers are often a first-line point of contact for postpartum individuals and may benefit from understanding how psychosocial stressors experienced during the pandemic may negatively affect maternal health. Our findings suggest new psychosocial burdens were introduced by the pandemic that challenged individual health and wellbeing during the postpartum period. Findings can inform interventions, which may include enhanced support from the clinical team or connections to community resources, to alleviate postpartum challenges for mothers and their families. [Formula presented]