SC PRAMS special delivery

This sheet discusses the sleeping positions of infants and the risks of sudden infant death syndrome

Intervention planning and modification of the BUMP intervention: a digital intervention for the early detection of raised blood pressure in pregnancy

Background: Hypertensive disorders in pregnancy, particularly pre-eclampsia, pose a substantial health risk for both maternal and foetal outcomes. The BUMP (Blood Pressure Self-Monitoring in Pregnancy) interventions are being tested in a trial. They aim to facilitate the early detection of raised blood pressure through self-monitoring. This article outlines how the self-monitoring interventions in the BUMP trial were developed and modified using the person-based approach to promote engagement and adherence. Methods: Key behavioural challenges associated with blood pressure self-monitoring in pregnancy were identified through synthesising qualitative pilot data and existing evidence, which informed guiding principles for the development process. Social cognitive theory was identified as an appropriate theoretical framework. A testable logic model was developed to illustrate the hypothesised processes of change associated with the intervention. Iterative qualitative feedback from women and staff informed modifications to the participant materials. Results: The evidence synthesis suggested women face challenges integrating self-monitoring into their lives and that adherence is challenging at certain time points in pregnancy (for example, starting maternity leave). Intervention modification included strategies to address adherence but also focussed on modifying outcome expectancies, by providing messages explaining pre-eclampsia and outlining the potential benefits of self-monitoring. Conclusions: With an in-depth understanding of the target population, several methods and approaches to plan and develop interventions specifically relevant to pregnant women were successfully integrated, to address barriers to behaviour change while ensuring they are easy to engage with, persuasive and acceptable

Effectiveness of a Natural Family Planning Service Program

Purpose: The aims of this study were to determine and compare extended use-effectiveness of an online nurse-managed fertility education service program among women (and subgroups of women) seeking to avoid pregnancy. Study Design and Methods: This was a 24-month prospective study of a university-based online Web site with 663 nonbreastfeeding women using an online charting system to avoid pregnancy. Participants tracked their fertility online with either cervical mucus monitoring, electronic hormonal fertility monitoring, or both fertility indicators. Unintended pregnancies were validated by professional nurses. Results: Participants had a mean age of 30.4 years (SD = 6.3) and mean 1.7 children (SD = 2.0). Among the 663 nonbreastfeeding participants there were 2 unintended pregnancies per 100 at 24 cycles of correct use and 15 pregnancies at 24 cycles of typical use. However, the 212 women using the electronic fertility monitor had a typical use unintended pregnancy rate of 6 at 24 cycles of use in comparison with the 118 women using cervical mucus monitoring that had a typical use pregnancy rate of 19 at 24 cycles and with the 333 women using both fertility indicators that had a pregnancy rate of 18 at 24 cycles of use. Clinical Implications: Use of the fertility monitor to estimate fertility among nonbreastfeeding women provides the most secure method of avoiding pregnancy

Influenza Vaccinations Among Pregnant Women in Georgia: The Provider Role

Georgia's data from the Pregnancy Risk Assessment Monitoring System (PRAMS) reveal several reasons why women do not receive influenza vaccinations during pregnancy. The majority of reasons could be addressed through patient education by the health care provider

A node-wise analysis of the uterine muscle networks for pregnancy monitoring

The recent past years have seen a noticeable increase of interest in the correlation analysis of electrohysterographic (EHG) signals in the perspective of improving the pregnancy monitoring. Here we propose a new approach based on the functional connectivity between multichannel (4x4 matrix) EHG signals recorded from the women abdomen. The proposed pipeline includes i) the computation of the statistical couplings between the multichannel EHG signals, ii) the characterization of the connectivity matrices, computed by using the imaginary part of the coherence, based on the graph-theory analysis and iii) the use of these measures for pregnancy monitoring. The method was evaluated on a dataset of EHGs, in order to track the correlation between EHGs collected by each electrode of the matrix (called node-wise analysis) and follow their evolution along weeks before labor. Results showed that the strength of each node significantly increases from pregnancy to labor. Electrodes located on the median vertical axis of the uterus seemed to be the more discriminant. We speculate that the network-based analysis can be a very promising tool to improve pregnancy monitoring.Comment: 4 pages, 3 figures, accepted in the IEEE EMBC conferanc

Violence against pregnant women with disabilities

Background Each year, violence is perpetrated against 1.5 million US women, of whom 324,000 are pregnant. Violence in pregnancy has adverse effects on maternal and infant health. Although there are 4.7 million childbearing age women with disabilities, and their pregnancy rates are growing, there is very little information about violence against pregnant women with disabilities. Objectives The study questions are: Are there differences in pre- and in-pregnancy violence experiences of women with and without disabilities? Is disability a significant predictor of pre- and in-pregnancy violence against women? Methods The study uses data from the 2009 Pregnancy Risk Assessment Monitoring System (PRAMS) from Massachusetts and Rhode Island. The study conducts χ 2 -tests and multivariate analyses of violence experiences. Results Pregnant women with disabilities experience more violence than those without. Disability is a significant violence predictor. The number and types of stress sources significantly affect the likelihood of violence. Poor health behaviors also contribute to the likelihood of violence. Conclusion There is a need to reduce violence against pregnant women particularly those with disabilities. Effective interventions require information about causality which can be established through analysis of primary data. Future studies should collect and analyze household level data. Care providers can contribute information by monitoring, recording, and reporting stress types, levels, and violence especially among pregnant women with disabilities

Pregnancy monitoring

International audienc

Randomized Comparison of Two Internet-Supported Natural Family Planning Methods (Preliminary Findings)

The aims of this study were to determine and compare efficacy, satisfaction, ease of use, and motivation in using an internet-based method of Natural Family Planning (NFP) that utilizes either electronic hormonal fertility monitoring (EHFM) or cervical-mucus monitoring (CMM). Four hundred fifty women (mean age 30.1) and their male partners (mean age 31.9) who sought to avoid pregnancy were randomized into either an EHFM (N=228) or CMM NFP group (N=222). Both groups utilized a Web site that provided NFP instructions, an electronic charting system, and support from professional nurses. Participants were assessed for satisfaction, ease of use, and motivation in use of their respective NFP method at 1, 3, and 6 months. Unintended pregnancies were validated by pregnancy evaluations and urine tests. Correct and total pregnancy rates were determined by survival analysis. Correct and total 12 month unintended pregnancy rates for the combined participants (N=450) were 1 and 9 per 100 couple users (Std. Error = .01 and .02) respectively. The EHFM participants (N=228), however, had a typical unintended pregnancy rate of 6 (Std. Error = .03) compared to the CMM group (N=222) pregnancy rate of 13 (Std. Error = .04) per 100 users over 12 months of use. The mean satisfaction/ease of use score for the EHFM group at 6 months of use was 46.1 compared to 42.9 for the CMM group (p \u3c .07). Motivation to avoid pregnancy was stronger for the CMM group compared to the EHFM group at 3 and 6 months of use (37.9 and 38.8 versus 33.7 and 33.4, p \u3c .01). Although both NFP methods were highly effective methods of family planning delivered through a nurse supported Web site, at this time, the unintended pregnancy rate was lower for the EHFM group and compared well with hormonal contraception. Although acceptability of the EHFM NFP was high, motivation to avoid pregnancy with that group decreased over time

Influenza Vaccination Coverage among Pregnant Women in Rhode Island: The Importance of the Prenatal Care Provider Role

Rhode Island's data from the Pregnancy Risk Assessment Monitoring System (PRAMS) demonstrate that health care providers play a critical role in the acceptance of influenza vaccine by pregnant women

An Approach to Monitor and Initiate Community Led Actions for Antenatal Care in Rural India – A Pilot Study

Background and Objective: Utilization of antenatal care in rural India is far from universal. It requires monitoring and identification of specific needs at field level for timely corrective actions. To pilot test the triangulation of rapid quantitative (Lot Quality Assurance Sampling) and qualitative (Focus Group Discussion) monitoring tools for ensuring antenatal care in a community based program. Methods: The present study was undertaken in surrounding 23 villages of Kasturba Rural Health Training Centre (KRHTC), Anji, which is also a field practice area of Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram. The monthly monitoring and action system of the study was based on the rapid quantitative monitoring tool (Lot Quality Assurance Sampling, LQAS)to find out poor performing supervision areas and overall antenatal service coverage and the qualitative methods (Focus group discussions (FGDs), and free listing) for exploring ongoing operational constraints in the processes for timely decision making at program and community level. A trained program supervisor paid house visit to 95 randomly selected pregnant women from 5 supervision areas by using pre-designed and pre-tested questionnaire. For poor performing indicators, semi structured FGDs and free listing exercise were undertaken to identify unmet service needs and reasons for its poor performance. Results: Registration of pregnancy within 12 weeks improved from 22.8% to 29.6%. The consumption of 100 or more IFA tablets during pregnancy significantly improved from 6.3% to 17.3%. There was significant improvement in awareness among pregnant women regarding danger signs and symptoms during pregnancy. Over three months period, the overall antenatal registration improved from 253 (67%) to 327 (86.7%). Conclusion: The present field based monitoring and action approach constructively identified the reasons for failures and directed specific collective actions to achieve the targets