Maternal self-care in the early postpartum period: An integrative review

Contains fulltext : 229276.pdf (Publisher’s version ) (Closed access)OBJECTIVE: To clarify the concept of maternal self-care in the early postpartum period and to develop a conceptual framework of mothers' self-care needs. DESIGN: An integrative review concept analysis method was used as described by Whittemore and Knafl (2005). As part of this data analysis process, a matrix based on Orem's self-care theory was developed to facilitate a structured and systematic analysis of the data. DATA SOURCES: CINAHL, Embase, PubMed, and Web of Science. REVIEW METHODS: After systematic and rigorous literature searches, the title and abstract of 1535 studies were scanned while applying five exclusion criteria. This resulted in 29 studies for full text review. Eventually, nine studies were appraised by two quality assessment tools and selected for the analysis. RESULTS: Guided by Orem's self-care theory, we have built a conceptual framework that depicts maternal self-care in the early postpartum period. Mothers' self-care needs involve numerous and diverse activities, tasks, and emotions, which can be categorised into three themes: universal, developmental, and health self-care needs. Their ability to perform these needs is subjected to various internal and external factors as well as the societal context they live in. CONCLUSIONS: Our review indicated that maternal self-care needs, already in the first few days postpartum, go beyond mothers' physical health as it extends to their emotional well-being as well. Postpartum care is, however, generally centred around physical self-care needs putting mothers' emotional self-care needs at risk of neglection. Further research is needed to determine how individualised care innovations can promote maternal self-care

Inter- and intra-observer agreement of non-reassuring cardiotocography analysis and subsequent clinical management

Contains fulltext : 138324.pdf (publisher's version ) (Closed access)OBJECTIVE: To quantify inter- and intra-observer agreement of non-reassuring intrapartum cardiotocography (CTG) patterns and subsequent clinical management. DESIGN: Methodological study. SETTING: University Medical Center. POPULATION: CTG patterns of 79 women beyond 37 weeks of gestation with a singleton fetus in vertex position in first stage of labor in whom fetal blood sampling (FBS) had been performed. METHODS: Nine observers assessed CTG patterns, which were formerly clinically classified as non-reassuring and indicative for FBS, according to the guidelines of the International Federation of Gynecology and Obstetrics modified for ST analysis. They also proposed clinical management strategies without and with insight into clinical parameters. Weighted kappa values (kappaw ) and proportions of agreement (Pa ) were calculated. MAIN OUTCOME MEASURES: Agreement on CTG classification and clinical management. RESULTS: Inter-observer agreement on CTG classification and on clinical management were poor for most observer categories (kappaw range 0.31-0.50 and 0.20-0.45, respectively). Observers agreed best on abnormal CTG patterns (Pa range 0.28-0.36) and on the clinical management option "continue monitoring" (Pa range 0.32-0.40). Intra-observer agreement was fair to good for most observers (kappaw 0.33-0.70). Insight into clinical parameters resulted in similar inter- and intra-observer agreement. CONCLUSIONS: There was poor inter-observer agreement and fair to good intra-observer agreement on classification and clinical management of intrapartum CTG patterns, which had been classified as non-reassuring and indicative for FBS during birth

Shared agenda making for quality improvement; towards more synergy in maternity care

OBJECTIVES: Professionals in maternity care have started working in a network approach. To further enhance the efficacy of this multidisciplinary maternity network, the identification of priorities for improvement is warranted. The aim of this study was to create key recommendations for the improvement agenda, in co-production with patients and professionals. STUDY DESIGN: We conducted a Delphi study to inventory (round 1), prioritize (round 2) and eventually approve (round 3) the improvement agenda for the maternity network. Both patients and professionals joined this study. Initial input for the study consisted of experiences from 397 patients, collected using the ReproQ questionnaire. In round 1, the expert panel, gave improvement recommendations, based on the ReproQ results. This resulted in 11 recommendations. In the second round, the expert panel prioritised these recommendations. In the consensus meeting then finally the concrete improvement agenda was composed. RESULTS: Priority scores differed considerably between patients and professionals in seven items, while four items received similar priority scores from both groups. The four most important improvement activities were: Realise more single bedrooms in hospitals; Create more opportunities for the continued presence of the community midwife during labour; Initiate a digital patient record view system for the network with a view function for patients; and Introduce a case manager for pregnant woman. CONCLUSION: Based on patient experience and the active involvement of patients and professionals, we were able to compose the shared agenda for quality improvement in maternity care

Current and future expectations of mifepristone treatment in early pregnancy failure: a survey among Dutch gynaecologists

Contains fulltext : 207873.pdf (publisher's version ) (Closed access

Women desiring less care than recommended during childbirth: Three years of dedicated clinic

BACKGROUND: Some women decline recommended care during pregnancy and birth. This can cause friction between client and provider. METHODS: A designated outpatient clinic was started for women who decline recommended care in pregnancy. All women who attended were analyzed retrospectively. The clinic used a systematic multidisciplinary approach. During the first visit, women told their stories and explained the reasoning behind their birth plan. The second visit was used to present the evidence underpinning recommendations and attempt to reach a compromise if care within recommendations was still not acceptable to the woman. During the third visit, a final birth plan was decided on. RESULTS: From January 1, 2015, until December 31, 2017, 55 women were seen in the clinic, 29 of whom declined items of recommended care during birth and were included in the study. After discussions had been completed, 38% of birth plans were within recommendations, 38% were a compromise, in which both the woman and the care provider had made certain concessions, and 24% did not reach an agreement and delivered with another provider either at home or elsewhere. All maternal and perinatal outcomes were good. CONCLUSIONS: Using a respectful and systematic multidisciplinary approach, in which women feel heard and are invited to explain their motivations for their birth plans, we are able to arrive at a plan either compatible with or much closer to recommendations than the woman's initial intentions in most cases, thereby preventing negative choices

Sonography-based Automated Volume Count to estimate fetal urine production in twin-to-twin transfusion syndrome: comparison with Virtual Organ Computer-aided AnaLysis

Development and application of statistical models for medical scientific researc