Exploring the focus of prenatal information offered to pregnant mothers regarding newborn care in rural Uganda

Background: Neonatal death accounts for one fifth of all under-five mortality in Uganda. Suboptimal newborn care practices resulting from hypothermia, poor hygiene and delayed initiation of breastfeeding are leading predisposing factors. Evidence suggests focused educational prenatal care messages to mitigate these problems. However, there is a paucity of data on the interaction between the service provider and the prenatal service user. This study aims to understand the scope of educational information and current practices on newborn care from the perspectives of prenatal mothers and health workers. Methods: A qualitative descriptive methodology was used. In-depth interviews were conducted with lactating mothers (n = 31) of babies younger than five months old across Masindi in western Uganda. Additional interviews with health workers (n = 17) and their employers or trainers (n = 5) were conducted to strengthen our findings. Data were audio-taped and transcribed verbatim. A thematic content analysis was performed using NVivo 8. Results: Vertical programmes received more attention than education for newborn care during prenatal sessions. In addition, attitudinal and communication problems existed among health workers thereby largely ignoring the fundamental principles of patient autonomy and patient-centred care. The current newborn care practices were largely influenced by relatives' cultural beliefs rather than by information provided during prenatal sessions. There is a variation in the training curriculum for health workers deployed to offer recommended prenatal and immediate newborn care in the different tiers of health care. Conclusions: Findings revealed serious deficiencies in prenatal care organisations in Masindi. Pregnant mothers remain inadequately prepared for childbirth and newborn care, despite their initiative to follow prenatal sessions. These findings call for realignment of prenatal care by integrating education on newborn care practices into routine antenatal care services and be based on principles of patient-centred care

The Safety Appliance Act and the FELA: A Plea for Clarification

The aim of this thesis is to analyse and examine the debate on prenatal testing in Western countries, with a special focus on my own country, Sweden. In the near future it might be possible for a pregnant woman to profile the DNA of her foetus with a simple blood test early in pregnancy. This method of prenatal testing – Non Invasive Prenatal Diagnosis (NIPD) – could potentially detect the genetic causes of almost every disease. I will argue that prenatal testing should be offered by society to all pregnant women, not only to those at highest risk of giving birth to children with severe conditions. I will do that from a perspective of reproductive freedom. Furthermore, I will argue that offering prenatal testing for some conditions (such as Downs’s syndrome) and not for others, is conflicting with the autonomous choice of the pregnant woman

Prenatal ultrasound screening for fetal anomalies and outcomes in high-risk pregnancies due to maternal HIV infection : a retrospective study

Objective: To assess the prevalence of prenatal screening and of adverse outcome in high-risk pregnancies due to maternal HIV infection. Study design: The prevalence of prenatal screening in 330 pregnancies of HIV-positive women attending the department for prenatal screening and/or during labour between January 1, 2002 and December 31, 2012, was recorded. Screening results were compared with the postnatal outcome and maternal morbidity, and mother-to-child transmission (MTCT) was evaluated. Results: One hundred of 330 women (30.5%) had an early anomaly scan, 252 (74.5%) had a detailed scan at 20–22 weeks, 18 (5.5%) had a detailed scan prior to birth, and three (0.9%) had an amniocentesis. In seven cases (2.12%), a fetal anomaly was detected prenatally and confirmed postnatally, while in eight (2.42%) an anomaly was only detected postnatally, even though a prenatal scan was performed. There were no anomalies in the unscreened group. MTCT occurred in three cases (0.9%) and seven fetal and neonatal deaths (2.1%) were reported. Conclusion: The overall prevalence of prenatal ultrasound screening in our cohort is 74.5%, but often the opportunity for prenatal ultrasonography in the first trimester is missed. In general, the aim should be to offer prenatal ultrasonography in the first trimester in all pregnancies. This allows early reassurance or if fetal disease is suspected, further steps can be taken

Establishing a pediatric prenatal visit at The Health Center (THC) in Plainfield, VT

The AAP has long recommended a prenatal visit as part of the continuum of well-child care. However, this visit is underutilized by new families. Most prenatal education focuses on labor and childbirth with little to no information about parenting and the postpartum period. The PRAMS VT Survey 2012-2014 identified “a class for new parents (parenting, not childbirth)” as a requested resource by respondents. The pediatric prenatal visit provides infant care guidance and can connect families with community organizations that provide postpartum education. The Health Center (THC) does not currently have an established pediatric prenatal visit for expecting parents.https://scholarworks.uvm.edu/fmclerk/1461/thumbnail.jp

Defending biomedical authority and regulating the womb as social space. Prenatal testing in the Polish press

The issue of abortion has been the topic of heated and frequent debate in post-Communist Poland. Parliamentary debate in 1998—9 centred around a legislative attempt to restrict prenatal testing, specifically amniocentesis, in order to further reduce the numbers of abortions carried out, as it was argued to inevitably result in the termination of pregnancy. Medical professionals are rarely visible as subjects of and authorities on the abortion debate in the Polish context. However, in this debate around prenatal testing, the medical community appear as key commentators and meaning-makers. This article asks the following questions: What role do the medical profession and biomedical knowledge play in the debate around prenatal testing, when abortion is highly politicized? Second, what social meanings and consequences are attributed to prenatal testing? How do these construct the relationship between foetus, pregnant woman and doctor, and what agency and 'rights' are attributed to women in the process of prenatal testing

Neural correlates of prenatal stress in young women.

open5noBACKGROUND: Prenatal stress is hypothesized to have a disruptive impact on neurodevelopmental trajectories, but few human studies have been conducted on the long-term neural correlates of prenatal exposure to stress. The aim of this study was to explore the relationship between prenatal stress exposure and gray-matter volume and resting-state functional connectivity in a sample of 35 healthy women aged 14-40 years. METHOD: Voxel-based morphometry and functional connectivity analyses were performed on the whole brain and in specific regions of interest (hippocampus and amygdala). Data about prenatal/postnatal stress and obstetric complications were obtained by interviewing participants and their mothers, and reviewing obstetric records. RESULTS: Higher prenatal stress was associated with decreased gray-matter volume in the left medial temporal lobe (MTL) and both amygdalae, but not the hippocampus. Variance in gray-matter volume of these brain areas significantly correlated with depressive symptoms, after statistically adjusting for the effects of age, postnatal stress and obstetric complications. Prenatal stress showed a positive linear relationship with functional connectivity between the left MTL and the pregenual cortex. Moreover, connectivity between the left MTL and the left medial-orbitofrontal cortex partially explained variance in the depressive symptoms of offspring. CONCLUSIONS: In young women, exposure to prenatal stress showed a relationship with the morphometry and functional connectivity of brain areas involved in the pathophysiology of depressive disorders. These data provide evidence in favor of the hypothesis that early exposure to stress affects brain development and identified the MTL and amygdalae as possible targets of such exposure.openFavaro, Angela; Tenconi, Elena; Degortes, Daniela; Manara, R; Santonastaso, PaoloFavaro, Angela; Tenconi, Elena; Degortes, Daniela; Manara, R; Santonastaso, Paol

Analyzing the impact of prenatal care on infant health: do we have useful input and output measures?

Recent work raises questions about the input and output measures typically used to estimate the impact of prenatal care on infant health: self-reported prenatal care may generate biased estimates of the impact of prenatal care on infant health, and birthweight may be a narrow measure of infant health that leads to underestimation of the impact of prenatal care on delivery outcomes. We link data from a prenatal care clinic, the associated hospital and the relevant birth certificate records to analyze these measurement issues. We conclude that low birthweight is not meaningful measure of infant health for the purpose of estimating the relation between prenatal care and delivery outcomes. In addition, the discrepancy between provider-reported and self-reported care is substantial, the correlation between these two measures is low, and the estimated relationship between prenatal care and infant health is not robust with respect to reliance on self-reported vs. provider-reported care.

Prenatal Screening and Genetics

Although the term 'genetic screening' has been used for decades, this paper discusses how, in its most precise meaning, genetic screening has not yet been widely introduced. 'Prenatal screening' is often confused with 'genetic screening'. As we show, these terms have different meanings, and we examine definitions of the relevant concepts in order to illustrate this point. The concepts are i) prenatal, ii) genetic screening, iii) screening, scanning and testing, iv) maternal and foetal tests, v) test techniques and vi) genetic conditions. So far, prenatal screening has little connection with precisely defined genetics. There are benefits but also disadvantages in overstating current links between them in the term genetic screening. Policy making and professional and public understandings about screening could be clarified if the distinct meanings of prenatal screening and genetic screening were more precisely observed

Results of Universal Prenatal Screening for Hepatitis C Infection in a Remote American Indian Primary Care Population

BACKGROUND: Although chronic liver disease remains a major area of health disparity for American Indian (AI) people, the epidemiology of hepatitis C virus (HCV) infection among AI people is poorly documented. Because of suspected high local prevalence, two remote AI clinics in the Northern Plains implemented universal prenatal HCV screening in 2005. When this screening program reported an unexpectedly high prenatal anti-HCV (anti-HCV antibody) positivity rate, we conducted a case-control study to determine risks for infection and opportunities for community intervention. MAIN FINDINGS: The clinics screened a total of 205 pregnant women (median age, 22 years). Of these 205 women, a total of 13 (6.3%; 95% confidence interval, 3.4–10.6) had anti-HCV confirmed. Of the anti-HCV-positive women, 10 (76.9%) were aged 15–24 years. We included 10 cases and 40 anti-HCV-negative prenatal controls in a case-control study. On multivariate analysis, only injection-drug use (IDU) remained associated with HCV seropositivity. CONCLUSIONS: Universal prenatal screening revealed a high prevalence of anti-HCV at these remote AI clinics. This population has not been previously described at being at elevated risk for HCV infection. In order to reduce health disparities, young, rural AI populations seeking prenatal care need to be included in interventions to reduce HCV transmission