Early labour : women’s expectations and experiences

Background: Early labour care is a major challenge for all involved. A women-centred approach that considers women’s needs requires more knowledge about their individual experiences. Therefore, this study aimed to generate in-depth knowledge of primiparous women’s preparation for early labor as well as their expectations and experiences of physical and emotional symptoms of onset of labor. Method and Material: We conducted four focus group discussions with n=18 women who had given birth to their first child in the previous six months. Two researchers coded and summarised the women's statements into themes. Qualitative content analysis was applied using Atlas.ti 9. Findings: Four themes emerged from women’s narratives: ‘Preparing for the unpredictable’, ‘Expectations and reality’, ‘Perception and wellbeing’ and ‘Experiencing the beginning of birth’. Many women could not distinguish the preparation for early labour from that for the whole birth. Relaxation techniques were very much appreciated as antenatal preparation. Not meeting expectations was a big challenge for many women. For instance, some participants were surprised about the intensity of contractions and others felt pleased how well they could cope with them. Physical and emotional symptoms of onset of labour differed greatly from woman to woman. Some parturients were positively excited, yet others were anxious about the unknown. Additionally, some women had great difficulties with sleep deprivation. Early labor at home was mostly experienced positively, whereas early labor at the hospital was sometimes difficult, because women felt neglected and being in the second rank. Conclusion: The individual character of experiencing onset of labour and early labour was striking which highlighted the great need of women-centred early labour care. Further research is needed to investigate how the findings of this study could be used to improve advising and caring for women during early labour

Entwicklung eines Fragebogens für die Beratung am Geburtsbeginn

Posterpreis: 2. PlatzDie Betreuung von Gebärenden am Geburtsbeginn ist eine ungelöste Herausforderung der klinischen Praxis. Bisher getestete Interventionen erhöhten zwar die Zufriedenheit mit der Betreuung, verbesserten jedoch die geburtshilflichen Outcomes nicht. Ein Scoping Review in der ersten Phase der GebStart-Studie unterstrich die sehr unterschiedlichen und auch gegensätzlichen Symptome des Geburtsbeginns sowie die individuellen Bedürfnisse von Gebärenden in der Latenzphase. Deshalb soll ein standardisierter Fragebogen für die frauenzentrierte Beratung entwickelt werden. Ziele: - Evidenzbasierte Entwicklung des Fragebogens - Multizentrische Anwendung in sechs Schweizer Spitälern für die Validierun

Selbstmanagement und Betreuungsbedarf von Erstgebärenden während der Latenzphase

Posterprei

Symptoms of onset of labour and early labour : a scoping review

Background: Early labour care often insufficiently addresses the individual needs of pregnant women leading to great dissatisfaction. In-depth knowledge about symptoms of onset of labour and early labour is necessary to develop women-centred interventions. Question or aim: To provide an overview on the current evidence about pregnant women’s symptoms of onset of labour and early labour. Methods: We conducted a scoping review in the five databases PubMed, Web of Science, CINHAL Complete, PsychInfo and MIDIRS in May 2021 and August 2022 using a sensitive search strategy. A total of 2861 titles and abstracts and 290 full texts were screened independently by two researchers using Covidence. For this article, data was extracted from 91 articles and summarised descriptively and narratively. Findings: The most frequently mentioned symptoms were ‘Contractions, labour pain’ (n =78, 85.7 %), ‘Details about the contractions’ (n =51 articles, 56.0 %), ‘Positive and negative emotions’ (n =50, 54.9 %) and ‘Fear and worries’ (n =48 articles, 52.7 %). Details about the contractions ranged from a slight pulling to unbearable pain and the emotional condition varied from joy to great fear, showing an extraordinary diversity of symptoms highlighting the very individual character of early labour. Discussion: A comprehensive picture of varying and contradicting symptoms of onset of labour and early labour was drawn. Different experiences indicate different needs. This knowledge builds a good basis to develop women-centred approaches to improve early labour care. Conclusion: Further research is necessary to design individualised early labour interventions and evaluate their effectiveness

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Physical and emotional symptoms of onset of labour

Introduction: Pregnant women experience onset of labour with various physical and emotional symptoms and cope with them differently. More knowledge about the symptoms of onset of labour is necessary to improve care at the beginning of birth. Methods: In preparation for the development of a standardised questionnaire we conducted an extensive scoping review and four focus group discussions to inform the decision whether primiparous women should be admitted or not to the hospital. We applied a sensitive literature search strategy including the search components ‘pregnant women/parturients’, ‘physical and/or emotional symptoms’, ‘care/support needs’ and ‘onset of labour’. Women who had given birth to their first child during the last six months could participate in the focus group discussions. Interviews were transcribed verbatim and analysed using qualitative content analysis. Outcome: Preliminary results showed that regular and irregular contractions were the most frequent physical symptoms of onset of labour. Further physical signs such as watery, mucous and bloody discharges as well as gastro-intestinal discomfort and sleep alterations were observed. Emotional symptoms of onset of labour covered a wide spectrum from joy and happiness to worries and fears. Women in the focus group discussions described emotional changes from restlessness to joy once labour started, but also from worries to anxiety. Great uncertainty prevented women at the beginning of birth from staying at home. Conclusion: The various symptoms of onset of labour showed its individual character. The correct assessment of these signs, especially the emotional ones, is crucial to individualise care and meet women’s needs

Betreuungsbedarf von gebärenden Frauen in der Latenzphase

Hintergrund: Der Umgang mit der Latenzphase stellt sowohl für gebärende Frauen als auch für Hebammen eine grosse Herausforderung dar. Um Frauen vor unnötigen Interventionen während der Latenzphase zu bewahren, wird der Spitaleintritt möglichst hinausgezögert. Damit aber eine individuelle Betreuung der Gebärenden gewährleistet werden kann, ist es wichtig, den Betreuungsbedarf von Frauen in einer solch vulnerablen Phase zu kennen. Ziel: Die Studie ermittelt den Betreuungsbedarf von Frauen in der Latenzphase. Methoden: Es wurde ein Scoping Review mit einer umfassenden Suchstrategie in fünf verschiedenen Datenbanken durchgeführt, die "schwangere Frauen" als Population, "Betreuungsbedarf" als Konzept und "Latenzphase" als Kontext einschloss. Berücksichtigt wurden Artikel aller wissenschaftlicher Methodiken. Die gefundenen Studien wurden von zwei unabhängigen Forscherinnen gescreent und diskutiert, bis ein Konsens gefunden wurde. Die Ergebnisse wurden deskriptiv analysiert. Ergebnisse: Es wurden 52Artikel in die Auswertung eingeschlossen. Ein Hauptbedürfnis von Frauen in den Latenzphase war es, Sicherheit und Beruhigung zu erlangen und Rat und professionelle Unterstützung zu bekommen, wie sie mit dieser Phase umgehen können. Für die Frauen war es wichtig, dass sie auf eine freundliche und respektvolle Weise behandelt werden. Außerdem kamen viele Studien zu dem Schluss, dass Frauen die Aufnahme im Krankenhaus präferierten, da dies als sicherer Ort empfunden wurde. Die Gebärenden wünschten Informationen über den Geburtsfortschritt durch vaginale Untersuchungen zu erhalten und den Gesundheitszustand des Kindes beurteilen zu lassen. Zudem waren gutes Schmerzmanagement wie auch die Möglichkeit zu haben, wehenhemmende oder wehenfördernde Massnahmen zu erhalten, weitere Bedürfnisse von Frauen während der Latenzphase. Diskussion: Der individuelle Charakter des Betreuungsbedarfs von Frauen während der Latenzphase muss berücksichtigt werden, um eine optimale Qualität der Betreuung zu fördern. Ein ständiger Austausch mit einer Hebamme in dieser Geburtsphase ist von grosser Bedeutung, um die Frauen im Umgang mit der Latenzphase zu unterstützen. Ein Aufschieben der Krankenhausaufnahme sollte gut überlegt sein, da der Schutz der Frauen vor Interventionen nicht unbedingt den Bedürfnissen aller Frauen entspricht

Beratung und Betreuung von Erstgebärenden in der Latenzphase : ein hebammenwissenschaftliches Forschungsprojekt

Schwangere Frauen erleben den Geburtsbeginn und die erste Phase der Geburt, die Latenzphase, sehr unterschiedlich und mit verschiedenen körperlichen und emotionalen Symptomen. Ein früher Spitaleintritt ist mit vermehrten Interventionen und einer erhöhten Kaiserschnittrate assoziiert. Erstgebärende melden sich jedoch häufig im Spital bevor die Geburt voranschreitet, weil einige Frauen Mühe haben, im häuslichen Umfeld mit dem Wehenschmerz umzugehen. Ein wissenschaftliches Forschungsprojekt der ZHAW befasst sich mit diesem Thema. Frau Prof. Grylka wird die bisherige wissenschaftliche Arbeit und das aktuelle Forschungsprojekt vorstellen