Postpartum consultation: Occurrence, requirements and expectations

<p>Abstract</p> <p>Background</p> <p>As a matter of routine, midwives in Sweden have spoken with women about their experiences of labour in a so-called 'postpartum consultation'. However, the possibility of offering women this kind of consultation today is reduced due to shortage of both time and resources. The aim of this study was to explore the occurrence, women's requirements of, and experiences of a postpartum consultation, and to identify expectations from women who wanted but did not have a consultation with the midwife assisting during labour.</p> <p>Methods</p> <p>All Swedish speaking women who gave birth to a live born child at a University Hospital in western Sweden were consecutively included for a phone interview over a three-week period. An additional phone interview was conducted with the women who did not have a postpartum consultation, but who wanted to talk with the midwife assisting during labour. Data from the interviews were analysed using qualitative content analysis.</p> <p>Results</p> <p>Of the 150 interviewed women, 56% (n = 84) had a postpartum consultation of which 61.9% (n = 52) had this with the midwife assisting during labour. Twenty of the 28 women who did not have a consultation with anyone still desired to talk with the midwife assisting during labour. Of these, 19 were interviewed. The content the women wanted to talk about was summarized in four categories: to understand the course of events during labour; to put into words, feelings about undignified management; to describe own behaviour and feelings, and to describe own fear.</p> <p>Conclusion</p> <p>The survey shows that the frequency of postpartum consultation is decreasing, that the majority of women who give birth today still require it, but only about half of them receive it. It is crucial to develop a plan for these consultations that meets both the women's needs and the organization within current maternity care.</p

Risk of Early-Onset Neonatal Group B Streptococcal Disease With Maternal Colonization Worldwide: Systematic Review and Meta-analyses.

Background: Early-onset group B streptococcal disease (EOGBS) occurs in neonates (days 0-6) born to pregnant women who are rectovaginally colonized with group B Streptococcus (GBS), but the risk of EOGBS from vertical transmission has not been systematically reviewed. This article, the seventh in a series on the burden of GBS disease, aims to estimate this risk and how it varies with coverage of intrapartum antibiotic prophylaxis (IAP), used to reduce the incidence of EOGBS. Methods: We conducted systematic reviews (Pubmed/Medline, Embase, Latin American and Caribbean Health Sciences Literature (LILACS), World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data from investigator groups on maternal GBS colonization and neonatal outcomes. We included articles with ≥200 GBS colonized pregnant women that reported IAP coverage. We did meta-analyses to determine pooled estimates of risk of EOGBS, and examined the association in risk of EOGBS with IAP coverage. Results: We identified 30 articles including 20328 GBS-colonized pregnant women for inclusion. The risk of EOGBS in settings without an IAP policy was 1.1% (95% confidence interval [CI], .6%-1.5%). As IAP increased, the risk of EOGBS decreased, with a linear association. Based on linear regression, the risk of EOGBS in settings with 80% IAP coverage was predicted to be 0.3% (95% CI, 0-.9). Conclusions: The risk of EOGBS among GBS-colonized pregnant women, from this first systematic review, is consistent with previous estimates from single studies (1%-2%). Increasing IAP coverage was linearly associated with decreased risk of EOGBS disease

Which method is best for the induction of labour?: A systematic review, network meta-analysis and cost-effectiveness analysis

Background: More than 150,000 pregnant women in England and Wales have their labour induced each year. Multiple pharmacological, mechanical and complementary methods are available to induce labour. Objective: To assess the relative effectiveness, safety and cost-effectiveness of labour induction methods and, data permitting, effects in different clinical subgroups. Methods: We carried out a systematic review using Cochrane methods. The Cochrane Pregnancy and Childbirth Group’s Trials Register was searched (March 2014). This contains over 22,000 reports of controlled trials (published from 1923 onwards) retrieved from weekly searches of OVID MEDLINE (1966 to current); Cochrane Central Register of Controlled Trials (The Cochrane Library); EMBASE (1982 to current); Cumulative Index to Nursing and Allied Health Literature (1984 to current); ClinicalTrials.gov; the World Health Organization International Clinical Trials Registry Portal; and hand-searching of relevant conference proceedings and journals. We included randomised controlled trials examining interventions to induce labour compared with placebo, no treatment or other interventions in women eligible for third-trimester induction. We included outcomes relating to efficacy, safety and acceptability to women. In addition, for the economic analysis we searched the Database of Abstracts of Reviews of Effects, and Economic Evaluations Databases, NHS Economic Evaluation Database and the Health Technology Assessment database. We carried out a network meta-analysis (NMA) using all of the available evidence, both direct and indirect, to produce estimates of the relative effects of each treatment compared with others in a network. We developed a de novo decision tree model to estimate the cost-effectiveness of various methods. The costs included were the intervention and other hospital costs incurred (price year 2012–13). We reviewed the literature to identify preference-based utilities for the health-related outcomes in the model. We calculated incremental cost-effectiveness ratios, expected costs, utilities and net benefit. We represent uncertainty in the optimal intervention using cost-effectiveness acceptability curves. Results: We identified 1190 studies; 611 were eligible for inclusion. The interventions most likely to achieve vaginal delivery (VD) within 24 hours were intravenous oxytocin with amniotomy [posterior rank 2; 95% credible intervals (CrIs) 1 to 9] and higher-dose (≥ 50 μg) vaginal misoprostol (rank 3; 95% CrI 1 to 6). Compared with placebo, several treatments reduced the odds of caesarean section, but we observed considerable uncertainty in treatment rankings. For uterine hyperstimulation, double-balloon catheter had the highest probability of being among the best three treatments, whereas vaginal misoprostol (≥ 50 μg) was most likely to increase the odds of excessive uterine activity. For other safety outcomes there were insufficient data or there was too much uncertainty to identify which treatments performed ‘best’. Few studies collected information on women’s views. Owing to incomplete reporting of the VD within 24 hours outcome, the cost-effectiveness analysis could compare only 20 interventions. The analysis suggested that most interventions have similar utility and differ mainly in cost. With a caveat of considerable uncertainty, titrated (low-dose) misoprostol solution and buccal/sublingual misoprostol had the highest likelihood of being cost-effective. Limitations: There was considerable uncertainty in findings and there were insufficient data for some planned subgroup analyses. Conclusions: Overall, misoprostol and oxytocin with amniotomy (for women with favourable cervix) is more successful than other agents in achieving VD within 24 hours. The ranking according to safety of different methods was less clear. The cost-effectiveness analysis suggested that titrated (low-dose) oral misoprostol solution resulted in the highest utility, whereas buccal/sublingual misoprostol had the lowest cost. There was a high degree of uncertainty as to the most cost-effective intervention

Prelabour rupture of the membranes at or near term. Clinical and epidemiological studies

Objectives: To study: (1) the risks and benefits for women with prelabourrupture of the membranes (PROM) after 34 weeks of gestation managed withdifferent expectant periods from 24 to 72 hours; (2) perinatal infectiousmorbidity in the different groups and the association between demographic,intrapartum and postpartum variables and neonatal sepsis; (3) theinfluence of bath on infectious morbidity in mothers and neonates in womenwith PROM; (4) the false negative rate using a sterile speculum examination for thediagnosis of rupture of the membranes (ROM) compared to Diamine oxidase(DAO); (5) possible risks for the mother and the baby when the women wereallowed to return home without further controls if amniotic fluid was notvisible at the speculum examination; (6) the prevalence and risk factorsfor PROM in an urban Swedish population.Material and methods: Studies I-III were based on a randomised studycomparing two different regimens in women with PROM. Women withoutcontractions within two hours (n=1012) were randomised to induction thefollowing morning after PROM ("early induction group") or induction twodays later ("late induction group"). Digital examination of the cervix wasavoided until onset of active labour. Labour was induced with oxytocin ifno spontaneous contractions occurred or if chorioamnionitis or fetaldistress was detected.Study IV was based on women admitted for suspected rupture of themembranes after 34 weeks of gestation in which no amniotic fluid wasvisible at the sterile speculum examination. A test for DAO was performed.No further controls were performed if amniotic fluid was not visible atthe speculum examination. Neonatal and obstetric outcome was recordedprospectively. Study V was based on a sample of 2880 women randomlyselected from the national population register. They had delivered 2270times at hospitals in the Göteborg area and 2242 of these case recordswere found. The case records were systematically analysed for theoccurrence of PROM and potential risk factors for PROM. Two thousand twohundred and eight of these deliveries occurred after 34 weeks ofgestation. The analyses were based on these 2208 deliveries.Results: There were no differences in the frequency of neonatal ormaternal infections if the mother were randomised to early or lateinduction. No differences were found in the frequency of caesareansections between the randomised groups. In nulliparous women ventouseextraction was more often used in the "early induction group" compared tothe "late induction group", 14% and 7% respectively (p&lt;0.05). There was nodifference in the incidence of neonatal infections between the groups.Clinical neonatal sepsis was associated with time from PROM to deliveryover 32 hours, caesarean section, parous women and gestational age between34 and 36 weeks. The false negative rate of a speculum examination of thediagnosis of rupture of the membranes in women without amniotic fluidvisible at a speculum examination was 12%. This study did not show anyfalse negative speculum examination. The prevalence of PROM after 34 weeksstepwise regression analysis risk factors for PROM were age at delivery"35 years, primiparity, premature contractions, PROM in a previouspregnancy and bleeding in the first trimester

The effect of twin-to-twin delivery time intervals on neonatal outcome for second twins

Abstract Background The objective was to examine the effect of twin-to-twin delivery intervals on neonatal outcome for second twins. Methods This was a retrospective, hospital-based study, performed at a university teaching hospital in Western Sweden. Twin deliveries between 2008 and 2014 at ≥32 + 0 weeks of gestation, where the first twin was delivered vaginally, were included. Primary outcome was a composite outcome of metabolic acidosis, Apgar   30 min (p <  0.0001). Conclusions An association, but not necessarily a causality, between twin-to-twin delivery interval and primary outcome was seen. An upper time limit on twin-to-twin delivery time intervals may be justified. However, the optimal time interval needs further studies