The Age at Which a Woman Becomes a Mother and Her Satisfaction with the Process of Pregnancy, Childbirth and the Puerperium.

This study assessed the effect of maternal age on satisfaction at each stage of pregnancy, childbirth and puerperium, and globally. An observational study was carried out in five hospitals of the Andalusian public health system with older primiparous women, from May 2016 to May 2018. Using a pre-piloted questionnaire, information was collected on pregnancy, childbirth, puerperium, newborn variables and degree of satisfaction with the care received. Crude and adjusted mean differences and the standard error of the mean were calculated. A total of 373 women participated. In total, 43.0% of the sample were very satisfied with the care received during pregnancy, and 74.2% with the care received during childbirth. During the puerperium, the highest percentage (60.4%) was found among the women who reported being quite satisfied, although the results were not significant in any of these stages (p > 0.05). No significant differences were established between women's different age strata and maternal satisfaction. However, the average given by women regarding their satisfaction with the process, on a scale from 0 to 4, was: 3.5 ± 0.5 in general, 3.2 ± 0.8 regarding pregnancy, 3.7 ± 0.5 in childbirth and 3.1 ± 0.6 in the postpartum period. The woman's satisfaction with the follow up and health care received during pregnancy, childbirth and puerperium is independent of the mother's age.

Continuous versus discontinuous suture in perineal injuries produced during delivery in primiparous women: a randomized controlled trial.

BACKGROUND: The technique used in the repair of a perineal injury resulting from childbirth could avoid discomfort and morbidity during the postpartum period. Recent studies show inconsistent results and support the need for new research with the inclusion of new health parameters not yet studied. Therefore, this study aims to evaluate if the suture technique (continuous or interrupted) has an effect on pain and other postpartum problems, incidence of incontinence (urinary and/or fecal), and the restart of sexual relations. METHODS: A single-blind randomized clinical trial was conducted in five hospitals in south-east Spain. The participants were primiparous women who had experienced a perineal injury during delivery (second-degree tear or episiotomy). Data was collected on sociodemographic variables, variables associated with pregnancy, labor and delivery, and the postpartum period, and outcomes during the 3 months after delivery: pain, incontinence, and restart of sexual relations. Odds ratios (OR) were calculated by binary logistic regression to assess the influence of the suture type on binary outcomes and t-test used for comparing continuous outcomes. Multivariate analyses (using logistic regression -adjusted (aOR)- and analysis of covariance) were carried out to adjust for unbalanced variables after randomization. RESULTS: A total of 70 women were included in the intervention group (continuous suture) and 64 in the reference group (interrupted sutures). A negative association was observed (aOR = 0.39; 95% CI = 0.18-0.86) between a continuous suture and the need for analgesia at 24 h postpartum. Pain experienced by the women at 24 h postpartum was assessed as 4.4 ± 0.3 compared with a score of 3.4 ± 0.3 in the group with continuous sutures (p = 0.011). At 15 days postpartum, women in the intervention group experienced less pain (aOR = 0.38; 95% CI = 0.18-0.80) (p = 0.019). Urinary sphincter incontinence was also evaluated at 15 days, with 4.3% (n = 3) of the women in the intervention group presenting with urinary incontinence compared with 18.8% (n = 12) in the control group (aOR = 0.11; 95% CI = 0.03-0.47) (P = 0.003). CONCLUSIONS: The women who had a continuous suture repair showed lower levels of pain from delivery to 3 months after delivery and had a lower incidence of urinary incontinence at 15 days postpartum. TRIAL REGISTRATION: ClinicalTrials.gov NCT03825211 posted January 31, 2019 (retrospectively registered).

The delay of motherhood: Reasons, determinants, time used to achieve pregnancy, and maternal anxiety level.

BACKGROUND: Fertility in recent decades in European countries such as Norway, Spain or United Kingdom has declined, while in others such as Portugal, it has remained relatively constant, and in others such as Germany fertility rated have risen. The determinants of this change in reproductive pattern can be explained by the cultural, social, and economic changes that took place in our society. Objective: to identify the principal reasons and independent determinants associated with the postponement of motherhood and document any association between the time taken to achieve successful pregnancy and maternal age, as well as the level of anxiety of these women. METHODS: An observational study, including 326 women, was conducted in Spain with primiparous women, in which data was collected on sociodemographic, health, and pregnancy-related factors. Comparison of means (t-test or analysis of variance) and the analysis of covariance was used to estimate adjusted means for potential confounders. RESULTS: Women in stable relationships became mothers at older ages (31.83±0.29) than those who were not (28.75±0.78) (p<0.001). Women who delayed motherhood for medical reasons had a mean age of 34.15 ± 0.88 years, compared to a mean of 30.52±0.36 years for personal reasons, and 27.51±1.39 years for other reasons. Mothers with an older age had a higher level of anxiety (p<0.05). The average time required to achieve pregnancy increased as maternal age increased, with an average time of 24 months for women with a mean age of 35.23±0.71 years compared to <3 months for women with a mean age of 29.44±0.39 years. Women ≥ 35 years were more likely to need medical assistance to achieve pregnancy (aOR = 12.07, 95% CI: 1.50-97.05; p = 0.019). CONCLUSIONS: Medical reasons were among those cited for delaying motherhood. The postponement of motherhood was associated with difficulty to achieve a successful pregnancy and a higher level of anxiety.

Newborn Health Indicators Associated with Maternal Age during First Pregnancy.

Delaying motherhood is becoming increasingly common, raising questions of the possible influence that maternal age may have on newborn health. Therefore, the objective of this study was to determine the association between maternal age and different newborn health parameters. An observational study was conducted in Spain on primiparous women and their infants. Data were collected on newborn health variables, breastfeeding, and different clinical practices that are beneficial for child health and development. Crude and adjusted mean differences were calculated along with the standard error of the mean. A total of 373 women and their children participated. In terms of early commencement skin-to-skin contact, the mean age of women that did skin-to-skin contact was 29.95 ± 0.31 years compared to 31.49 ± 0.66 years in those that did not (p = 0.042). In terms of other newborn parameters, such as preterm birth, health problems or complications, or the need for hospital admission, these were more frequent in the oldest group of mothers, but the differences found were not significant (p > 0.05). Hence, indicators of newborn morbidity were not found to be significantly associated with maternal age; however, beneficial practices such as early commencement skin-to-skin contact were found to be significantly associated with maternal age.

Maternal Age and Pregnancy, Childbirth and the Puerperium: Obstetric Results.

Delaying maternity is becoming more common, resulting in questions regarding the influence age may have on obstetric results. Therefore, we proposed the objective to determine the association between maternal age and different health variables during pregnancy, childbirth and the puerperium. We conducted an observational study in Spain with primiparous women in which data was collected on sociodemographic, health and obstetric variables. Crude and adjusted mean differences were calculated with their corresponding 95% confidence intervals. The study included a final sample of 373 women. The mean age of women presenting with hypertension during pregnancy was 34.54 years (95% CI: 31.80-37.27) compared with a mean of 30.11 (95% CI: 29.56-30.66) in women that did not (p = 0.002). Women who had a eutocic delivery were also younger: 29.17 years (95% CI: 28.48-29.86) compared with 31.90 years (95% CI: 31.05-32.74; p < 0.001) for those that had a dystocic delivery. The duration of dilatation was longer in those ≥35 years (p = 0.001). In conclusion, an advanced maternal age is associated with a higher incidence of pathology during pregnancy and dystocic labor.

Inducción mecánica del parto: doble balón o sonda de Cook® / Mechanical induction of labour: double balloon or Cook® catheter

Los procedimientos mecánicos para la maduración de un cérvix desfavorable se están configurando como una alternativa eficaz frente a los farmacológicos, especialmente en los casos donde estos están contraindicados. En la actualidad se despierta el interés sobre el uso de estos métodos por tratarse en general de dispositivos que generan bajo coste, son seguros, simples, cómodos, reversibles, sin fármacos y, fundamentalmente, por sus pocos efectos adversos y repercusiones maternas y/o fetales. Con el objetivo de dar a conocer dicho método mecánico de inducción de parto, se realizó el seguimiento de una mujer gestante con patología asmática y con indicación de finalización del embarazo mediante doble balón de Cook®; este concluye con un parto eutócico y sin incidencias

Mechanical procedures for ripening an unfavourable cervix are positioning as an effective option vs. pharmacological methods, particularly in those cases where the latter are contraindicated. There is current interest about the use of these methods, as these are overall low-cost devices, simple, convenient, reversible, drug-free, and most of all, they cause few adverse effects and low impact on the mother and/or the foetus. With the objective to create awareness about said mechanical method for labour induction, follow-up was conducted for a pregnant woman with asthma and indication of end of pregnancy through Cook® double balloon, resulting in a normal delivery without incidences

Calidad del control del embarazo en Atención Primaria / Quality control of pregnancy in Primary Care

En Andalucía, la asistencia prenatal es prestada por enfermeras, matronas y médicos de familia de acuerdo a las pautas recogidas en el proceso asistencial integrado de embarazo, parto y puerperio de la Junta de Andalucía. Objetivos: determinar el estado del control del embarazo de bajo riesgo que se realiza en Atención Primaria, así como conocer la satisfacción de la usuaria y su valoración de los profesionales implicados. Método: se realizó un estudio observacional descriptivo durante el tercer trimestre del año 2010 en el área sanitaria del Complejo Hospitalario de Jaén con mujeres embarazadas de bajo riesgo que habían sido controladas en Atención Primaria. Se recogió información relativa a los datos demográficos, componentes de calidad de la atención prenatal (según los criterios establecidos por la Junta de Andalucía), satisfacción de la mujer, profesional mejor valorado y grado de cumplimentación del documento de salud de la embarazada. Resultados: la muestra estuvo compuesta por 117 mujeres, la media de edad fue de 29,38 ±5,015 (18-37) años. Asistieron a tres o más sesiones de educación maternal el 51,28% de las embarazadas; de los 24 componentes de la atención prenatal, 19 se habían cumplido en más del 80% de las mujeres atendidas. El 51,28% de las mujeres estaban bastante satisfechas con la atención prenatal recibida. Para el 74,36% de la muestra, el profesional implicado en la atención prenatal mejor valorado es la matrona. Conclusión: el control del embarazo es adecuado, aunque aspectos como la educación maternal deberían ser fomentados por los profesionales. La usuaria está satisfecha con el actual sistema de control y valora positivamente a los profesionales que lo desarrollan, especialmente a la matrona (AU)

In Andalusia, antenatal care is provided by nurses, midwives and family physicians according to the guidelines contained in the integrated care process of pregnancy, childbirth of the Junta de Andalucía (Andalusian local government). Objectives: To determine the monitoring status of low-risk pregnancy performed in primary care and to determine user satisfaction and her assessment of the professionals involved in her care. Method: A descriptive observational study was conducted during the third quarter of 2010 in the Hospital of Jaén health area on low-risk pregnant women who had been monitored in primary care. Information was collected on demographics, quality components of prenatal care (according to criteria established by the Junta de Andalucía), women satisfaction, best valued professional, and level of completion of the document on the health of pregnant woman. Results: The sample consisted of 117 women; mean age was 29.38 ±5,015 (18-37) years. Of these, 51.28% of pregnant women attended three or more sessions on maternal education; of the 24 components of prenatal care, 19 had been met in more than 80% of the women treated. The 51.28% of the women were quite satisfied with the prenatal care received. For 74.36% of the sample, the most valued professional involved in antenatal car e is the midwife. Conclusion: Pregnancy care is adequate, although issues such as maternal education should be encouraged by professionals. The user is satisfied with the current care system and values positively the professionals who deliver the care, especially the midwife (AU)