Practice advisory: interim guidance for care of obstetric patients during a zika virus outbreak

Zika during pregnancy has been associated with birth defects, specifically significant microcephaly. Transmission of Zika to the fetus has been documented in all trimesters; Zika virus RNA has been detected in fetal tissue from early missed abortions, amniotic fluid, term neonates and the placenta. However, much is not yet known about Zika virus in pregnancy. Uncertainties include the incidence of Zika virus infection among pregnant women in areas of Zika virus transmission, the rate of vertical transmission and the rate with which infected fetuses manifest complications such as microcephaly or demise. The absence of this important information makes management and decision making in the setting of potential Zika virus exposure (i.e. travel to endemic areas) or maternal infection, difficult. Currently, there is no vaccine or treatment for this infection

Characteristics of fetal heart rate tracings prior to uterine rupture

Objective: To identify the fetal heart rate patterns that occurred in a 2‐h period of time preceding uterine rupture. Methods: The fetal monitor strips and the medical records of patients with a confirmed diagnosis of uterine rupture were reviewed. These patients delivered at the University of Michigan Hospital from January 1, 1985 to December 31, 1999 and were ≥28 weeks gestational age. Asymptomatic uterine scar dehiscences were excluded. The weeks of gestation, the number of cesarean sections, the surgical findings, and the maternal complications were obtained from the review of the maternal records. The fetal monitor strips for the 2 h preceding the uterine rupture were analyzed, and the fetal heart rate patterns were classified. Results: During the study period, there were 11 patients identified with uterine rupture. Seven of the 11 (64%) had operative or post‐operative complications. There were no maternal deaths. Review of the eight fetal heart rate tracings available revealed 7/8 (87.5%) with recurrent late decelerations and 4/8 (50%) with terminal bradycardia. All four of the patients with fetal bradycardia were preceded by recurrent late decelerations (100%). Conclusions: The most common fetal heart rate abnormalities that occurred prior to uterine rupture were recurrent late decelerations and bradycardia. The appearance of recurrent late decelerations may be an early sign of impending uterine rupture.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135337/1/ijgo235.pd

The History of Preconception Care: Evolving Guidelines and Standards

This article explores the history of the preconception movement in the United States and the current status of professional practice guidelines and standards. Professionals with varying backgrounds (nurses, nurse practitioners, family practice physicians, pediatricians, nurse midwives, obstetricians/gynecologists) are in a position to provide preconception health services; standards and guidelines for numerous professional organizations, therefore, are explored. The professional nursing organization with the most highly developed preconception health standards is the American Academy of Nurse Midwives (ACNM); for physicians, it is the American College of Obstetricians and Gynecologists (ACOG). These guidelines and standards are discussed in detail

Best Practices in Second Stage Labor Care: Maternal Bearing Down and Positioning

Despite evidence of adverse fetal and maternal outcomes from the use of sustained Valsalva bearing down efforts, current second-stage care practices are still characterized by uniform directions to “push” forcefully upon complete dilatation of the cervix while the woman is in a supine position. Directed pushing might slightly shorten the duration of second stage labor, but can also contribute to deoxygenation of the fetus; cause damage to urinary, pelvic, and perineal structures; and challenge a woman’s confidence in her body. Research on the second stage of labor care is reviewed, with a focus on recent literature on maternal bearing down efforts, the “laboring down” approach to care, second-stage duration, and maternal position. Clinicians can apply the scientific evidence regarding the detrimental effects of sustained Valsalva bearing down efforts and supine positioning by individualizing second stage labor care and supporting women’s involuntary bearing down sensations that can serve to guide her behaviors

Validity and Reliability of the Perceived Readiness for Discharge After Birth Scale

Objective: To assess the psychometric properties of a scale measuring mothers’ perceptions of readiness for discharge after birth. Design: Psychometric analyses including construct validity using factor analysis and known groups comparisons, predictive validity, and reliability. Data were collected at discharge and 6 weeks postdischarge. Setting: Tertiary-level perinatal center in the Midwestern United States. Participants: 1,462 postpartum mothers. Intervention: None. Main Outcome Measures: Perceived Readiness for Discharge After Birth Scale scores; subscale scores for personal status and knowledge factors.\u27 Results: Exploratory and confirmatory factor analyses indicated that the scale contained two factors. Perceived Readiness for Discharge After Birth Scale scores were lower for mothers who were breast-feeding, married, primiparous, and had a short hospital stay (less than 30 hours) than for their comparison groups. The Perceived Readiness for Discharge After Birth Scale personal status factor was predictive of self-reported physical and psychosocial problems and unscheduled utilization of health services in the first 6 weeks postpartum. The knowledge factor was predictive of postdischarge telephone calls to the pediatric provider. Reliability estimates ranged from 0.83 to 0.89 for the total scale and subscales. Conclusions: The Perceived Readiness for Discharge After Birth Scale performed well in psychometric testing. Assessing mothers’perceptions of readiness for discharge is important for measuring outcomes of hospitalization and for identifying mothers at risk for postdischarge problems