Capacity building to reduce maternal and neonatal morbidity and mortality

In sub-Saharan Africa midwifery educators are in short supply and opportunities to pursue advanced education are severely restricted. Postgraduate programmes that encourage critical thinking and strategic planning in midwifery education, practice, management and research are required to empower midwives to lead their profession. A unique user-led distance learning programme was developed by adopting a participatory approach to developing a curriculum for a Masters in Midwifery and Women's Health. Midwives from the East Central and South Africa (ECSA) region and the UK participated along with a representative from the Commonwealth Secretariat and International Confederation of Midwives (ICM). The curriculum was based on shared goals but adaptable to cultural and local context. Brainstorming sessions, informal workshops and formal consensus methods were used to reach decisions regarding modules and subsequent content. This article describes the process of developing a shared curriculum, the challenges faced in working across and within regions, and participants’ views of contributing to the end product. </jats:p

Women's perceptions of being pregnant and having pregestational diabetes

Objective: to explore the experiences of White British and South East Asian women with type 1 and type 2 diabetes, and the perceived impact of diabetes on their reproductive health. Design: a hermeneutic phenomenological approach was used to explore the perceptions of women with diabetes from two different cultural backgrounds with varied reproductive health experiences. Focus groups and one-to-one interviews were used to elicit women's experiences. An interpretive analytical approach was conducted by two researchers. Setting: obstetric and diabetes clinics in three hospital sites in the North West of England. Participants: a purposive sample of 22 women with type 1 or type 2 diabetes of different parity and ethnicity. Findings: the main themes were relinquishing personal control, pregnancy overshadowed by diabetes and haphazard preconception care. Key conclusions: strategies should be developed to ensure that whilst safety is maintained, the pregnancy focus is not lost. Women should be supported to optimise their experience as well as clinical outcomes. The convergence of professional roles needs consideration; individual members of multidisciplinary diabetes teams should provide a unique and complementary contribution to care. Preconception care needs to be accessible and responsive to women; this should include recognition of socio-cultural differences

Getreideumsatz, Getreide- und Brotpreise in Köln, 1368–1797. Part II: Brotgewichte find Brotpreise: Wochen-, Monats- und Jahrestabelle, Graphiken: Edited by Dietrich Ebeling and Franz Irsigler. Cologne, Vienna: Böhlau-Verlag, 1977. Pp. lii, 270, plus 86 graphs.

OBJECTIVE: To evaluate the feasibility of continuous telemetric trans-abdominal fetal electrocardiogram (a-fECG) in women undergoing labour induction at home. STUDY DESIGN: Low risk women with singleton term pregnancy undergoing labour induction with retrievable, slow-release dinoprostone pessaries (n = 70) were allowed home for up to 24 hours, while a-fECG and uterine activity were monitored in hospital via wireless technology. Semi-structured diaries were analysed using a combined descriptive and interpretive approach. RESULTS: 62/70 women (89%) had successful home monitoring; 8 women (11%) were recalled because of signal loss. Home monitoring lasted between 2–22 hours (median 10 hours). Good quality signal was achieved most of the time (86%, SD 10%). 3 women were recalled back to hospital for suspicious a-fECG. In 2 cases suspicious a-fECG persisted, requiring Caesarean section after recall to hospital. 48/51 women who returned the diary coped well (94%); 46/51 were satisfied with home monitoring (90%). CONCLUSIONS: Continuous telemetric trans-abdominal fetal ECG monitoring of ambulatory women undergoing labour induction is feasible and acceptable to women

Outcome of home monitoring.

a<p>Median (range).</p>b<p>Overall monitoring success rate - mean (SD).</p

Fetal ECG monitoring device (MONICA AN24).

<p>Copyright and courtesy of Monica healthcare limited. Portable trans-abdominal fetal ECG monitoring device with 5 electrodes attached to the maternal abdomen.</p

Demographic and clinical characteristics of women who were monitored at home (n = 70).

a<p>Mean (standard deviation).</p>b<p>Median (range).</p>c<p>Cord pHs - normal for these 3 cases.</p

Monitoring display.

<p>Continuous monitoring display from the MONICA AN24 device of fetal and maternal heart rate, uterine contractions and maternal movements. (Fetal heart rate – black line (top); maternal heart rate – green line (middle); Uterine contractions – black line (bottom); maternal movements – orange bars).</p