Perinatal and Women's Health

Patients with multiple pregnancies are at greater risk of preterm labor and delivery which is associated with increased risk of perinatal morbidity and mortality. We report a case of delayed-interval delivery of a twin pregnancy with the survival of the second fetus. The patient was hospitalized at 24 weeks and 3 days gestational age (GA) due to premature rupture of the membrane of the first amniotic sac. At 26 weeks of GA, the first fetus was born vaginally and died due to prematurity. To keep the second fetus in utero and minimize the complications,  emergency  McDonald  cerclage  was  performed,  and tocolysis,  magnesium  sulfate,  betamethasone,  and  antibiotics  were administrated. Despite our treatment at 28 weeks and 2 days gestational age, the second fetus was born via cesarean section due to breech presentation. At 10 months of corrected age, she exhibited normal development. She is now 6 years old and  does not have sequel.

Due to the changes that occur to the immunity and physiological
state of women during pregnancy, they are at increased risk of
suffering issues with both their physical and mental health (Liu et
al., 2020). It is estimated that 1 in 5 women develop a mental health
problem in the perinatal period (Hahn-Holbrook et al., 2018; World
Health Organization, 2015), with depression and anxiety among the
most prevalent conditions (Shorey et al., 2018). Importantly, these
conditions have long lasting adverse effects on women and their
babies, and place a heavy burden on families and society as a whole
(Bauer et al., 2014; Gavin et al., 2005). Conditions such as extreme
stress, conflict situations, emergencies, and natural disasters can
increase the risk of developing specific mental illnesses (World
Health Organization, 2016).
The Coronavirus disease 2019 (COVID-19), declared a global
pandemic on March 11 by the World Health Organization, is currently
cited as a significant cause of stress and anxiety for pregnant and
postpartum women (PPW) around the world (Chen et al., 2020),
taking into account that these women constitute one of the most
vulnerable populations in the world.

Objective: The aim of this study is to adapt the Perinatal Post Traumatic Stress Disorder Questionnaire- II (PPQ-II) and determine the psychometric properties of this scale.
Method: The study was conducted with two different samples consisting of mothers who give full-term and preterm birth. To investigate the factor structure and conduct confirmatory factor analysis, the first sample was composed of 194 women between the ages of 18-43 (Mean=30.12, standard deviation [SD]=4.96). The second sample in which confirmatory factor analysis was conducted consisted of 238 women between the ages of 19-43 (Mean=30.33, SD=4.00). Depression Anxiety Stress Scale and Connor-Davidson Resilience Scale were used in this study as well as PPQ-II.
Results: The exploratory and confirmatory factor analysis revealed a two-factor structure named “Intrusive Thoughts and Avoidance” and “Hyperarousal and Numbness Responses”. The model obtained by confirmatory factor analysis demonstrated acceptable goodness of fit values and the questionnaire was found to have satisfactory reliability and validity values.
Conclusion: PPQ-II could be considered as a valid and reliable scale which could be used in maternal mental health studies conducted in Turkey.
Keywords: Factor analysis, perinatal trauma, PTSD, reliability, validity

Abstract: Triage in hospitals typically aim to categorize and prioritize pregnant women who present for emergent or urgent care before detailed evaluation and management. However, obstetric patients are best served if local emergency services develop protocols whereby they were taken to the most appropriate facility.
Aim of the study: this study aimed to assess the effect of nurse’s application of structure obstetrics triage guideline on pregnant women outcomes.
Design: A prospective quasi-experimental design (pre and post intervention) was utilized.
Setting: at obstetrics department in Prince Hussein Bin Abdullah (Amman, Jordan).
Sample: a convenience sample consists of all nurses (50) working in obstetric department at the time of data collection. Instruments: included a structured interview questionnaire consisting of two parts; “personal characteristics, and knowledge about obstetric Triage” and the performance assessment checklist through Maternal Fetal Triage Index (MFTI) adopted from AWHONN’s, (2016). Results: nurses were gain knowledge and practices for obstetric women triage as well as “Maternal Fetal Triage Index” after intervention than in before intervention with statistical significance difference p<0001 for all knowledge item about triage. In addition nurses after intervention increase their level of outcomes evaluation above the upper confidence level. An increases in nurses’ practicing in relation to improve maternal outcomes after intervention increase their level of outcomes evaluation “above the upper confidence levels”, than before intervention “below the confidence level”.
Conclusion: Nurses application improved in their proficiency after conducting Structured Obstetrics Triage Guideline for pregnant women outcomes on post intervention than on pre intervention. Recommendations: 1- theoretical and practical training of obstetric triage for nurses in hospitals as well as undergraduate curriculum.2-Continous educational training programs about obstetric triage for health team should be provided to increase their knowledge and skills 3-Simple manual guidelines for Triage and MFTI should be available at every obstetric unit to guide nurses to priories newly admitted cases according to severity of obstetric symptoms 4-Establish an emergency simulation scenarios with staff from multiple areas to help everyone involved to be better prepared when an actual emergency occurred. Keywords: Structured Obstetrics Triage, Guideline, pregnant Women Outcomes.

Background: Since 2000, the United Nations' Millennium Development Goals, which included a goal to improve maternal health by the end of 2015, has facilitated significant reductions in maternal morbidity and mortality worldwide. However, despite more focused efforts made especially by low-and middle-income countries, targets were largely unmet in sub-Saharan Africa, where women are plagued by many challenges in seeking obstetric care. The aim of this review was to synthesise literature on barriers to obstetric care at health institutions in sub-Saharan Africa. Methods: This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases were electronically searched to identify studies on barriers to health facility-based obstetric care in sub-Saharan Africa, in English, and dated between 2000 and 2015. Combinations of search terms 'obstetric care', 'access', 'barriers', 'developing countries' and 'sub-Saharan Africa' were used to locate articles. Quantitative, qualitative and mixed-methods studies were considered. A narrative synthesis approach was employed to synthesise the evidence and explore relationships between included studies.

The death of Joe “Sudharman” Fenton sparked competing narratives leaving some members of the family wondering who Joe Fenton was, the man who died as Sudharman.  During the night of July 4, 2010, Sudharman was murdered as he slept in his yoga studio in Union County, Pennsylvania.  Using a thematic analysis, this piece examines his death in order to examine how communication was used to describe Joe Fenton.  We used ethnographic methods to collect the media coverage of his death, the funeral remembrances, and blog posts as well as completed two in-depth interviews with family members in order to find out how others described Joe Fenton.  We analyzed how others described Fenton through the themes of dark and bright communication.  The analysis determined that. Dark communication described Fenton was being manipulative, deceitful, and, at times, emotionally abusive.  Fenton was seen in a spiritual/religious light, as he was described as god-like, a shining beacon and memorable

Antiviral Nutrition Update #1 for 2018:
Clinical Trial of Vitamin D3 against HVP/CIN1: The video of this presentation is archived at ichnfm.org/hpv1, and the transcript in PDF format—which is considered the final and citable version—is archived at academia.edu/35808436; any corrections or updates will be made to the PDF file. Observe that this video presentation is truly an *update* subsequent to previous publications and that therefore not all sources are cited; for citations, see the video, and for complete citations regarding the protocol in its entirety, see the book Antiviral Strategies and Immune Nutrition or the ebook version titled Antiviral Nutrition. Citation: Vasquez A. Antiviral Nutrition Update #2 for 2018. Video presentation (ichnfm.org/hpv2) and official transcript (academia.edu/35808436) 2018 January

Primary reference: Antiviral Strategies and Immune Nutrition https://www.amazon.com/dp/1502894890/ also published in digital ebook format as Antiviral Nutrition (Kindle ebook) https://www.amazon.com/dp/B00OPDQG4W. Also published in Inflammation Mastery, 4th Edition https://www.amazon.com/dp/B01KMZZLAQ/ and Textbook of Clinical Nutrition and Functional Medicine, vol. 1: Essential Knowledge for Safe Action and Effective Treatment https://www.amazon.com/dp/B01JDIOHR6/

The video of this presentation is archived at http://www.ichnfm.org/hpv2 and the transcript in PDF format—which is considered the final and citable version—is archived at academia.edu/35798286; any corrections or updates will be made to the PDF file. Observe that this video presentation is truly an *update* subsequent to previous publications and that therefore not all sources are cited; for citations, see the video, and for complete citations regarding the protocol in its entirety, see the book Antiviral Strategies and Immune Nutrition or the ebook version titled Antiviral Nutrition.

"Every NHS hospital should have a liaison psychiatry service as standard, according to a new report from Centre for Mental Health and the NHS Confederation Mental Health Network.
Liaison psychiatry services provide immediate access to specialist mental health support for people being treated for physical health problems, most often in general hospitals and in some cases in the community.
The report, Liaison Psychiatry in the Modern NHS, finds that liaison psychiatry services can save an average hospital £5 million a year by reducing the number and length of admissions to beds. It adds that even bigger savings could be achieved in future if liaison psychiatry services were extended to work in the community to prevent crises from happening at all.
People who have a long term physical health condition are more than twice as likely to have a mental health problem as the general population. This can have a huge effect on a patient's chances of recovery. For example, someone with chronic heart failure is eight times more likely to die within 30 months if they also have depression. Altogether, there are over 4.6 million people with a long term physical health condition and co-morbid mental health problem, all of whom would benefit from more integrated physical and mental health care.
Half of all hospital inpatients have mental health conditions such as depression and dementia. Identifying and managing these conditions quickly and effectively helps people to recover and reduces their length of stay in hospital.
There is a wide variation in the way liaison psychiatry services work and who they help. Many offer training and support to other clinical staff as well as providing mental health care themselves.
The report concludes that well run liaison psychiatry services can be highly cost-effective, saving more money than they cost. The greatest immediate impact can be achieved by supporting older patients in hospital but liaison psychiatry services also have the potential to offer better care at potentially lower cost to many other groups, both in hospital and in the community."

El embarazo y el parto son acontecimientos vitales de gran importancia en el desequilibrio emocional en algunos casos. Aunque el embarazo se ha considerado tradicionalmente como un periodo de relativo "bienestar" psíquico, sí parece de-mostrado que el puerperio es un período de especial incidencia de aparición de la patología psíquica. Así, aclaramos que el embarazo no es un estado protector para la salud mental de la mujer. está sujeto a cambios físicos, hormonales, emocionales y socioculturales que pue-den afectar a la dinámica familiar, al patrón de sueño y en consecuencia al estado-rrollar un trastorno mental en el postparto, conseguiríamos adelantar mucho en la prevención del desarrollo de patología psíquica perinatal tan sólo con prestar un mínimo seguimiento y atención a aquellas mujeres embarazadas que tengan ante-cedentes personales o familiares de problemas psiquiátricos, que carezcan de apo-yo psicosocial o que sobrelleven acontecimientos estresantes. Teniendo en cuenta que las patologías mentales son las enfermedades más frecuentes en esta etapa, un adecuado abordaje en el período perinatal podría causar un menor impacto nega-y disminuiría la morbilidad materna (1). La Psiquiatría Perinatal es un área nueva de conocimiento desarrollada en trastornos psiquiátricos durante el embarazo, la lactancia y el puerperio. Actual-mente la salud mental perinatal se puede decir que está ignorada en nuestro medio aunque presente elevada prevalencia y morbilidad además de riesgo de mortalidad como suicidio e infanticidio. Conocemos que el 20% de las mujeres embarazadas sufre alguna sintomatología emocional o trastorno psiquiátrico (2).

Classificazione, distribuzione geografica e conseguenze delle MGF La mutilazione genitale femminile comprende varie tipologie di pratiche escissorie dei genitali. Questa pratica prevalente in Africa sub-sahariana, presente anche nei paesi di religione islamica e di cui sono vittime donne e bambine, ha nefasti risvolti fisici e psicologici. Attualmente, le MGF rappresentano uno degli ambiti di azione su cui la Comunità internazionale si sta concentrando ormai da anni, al fine di divulgare informazioni sui problemi connessi a tale pratica e, sul fatto che essa è strettamente radicata ad una violenza costante e ad un controllo che un certo tipo di società tribale, ancora oggi, attua ed impone sul corpo della donna. La realtà nella quale le donne nascono, crescono e vivono, soprattutto in alcuni paesi come Nigeria, Egitto, Somalia, Etiopia, Eritrea, Afghanistan e Yemen, è caratterizzata sia dall'eventualità dell'essere sottoposte alla pratica mutilatoria genitale, sia dall'emarginazione e solitudine, violenze fisiche, matrimoni precoci, gravidanze ed aborti in età adolescenziale. Quando si parla di pratica mutilatoria genitale ci si riferisce alla parziale o totale eliminazione dell'apparato genitale, che causa una evidente modifica del profilo anatomico e di quello funzionale. Nello specifico, secondo l'Organizzazione Mondiale della Sanità (OMS), le donne che nel mondo sarebbero state vittime di una pratica così brutale, sono più di centotrenta milioni, considerando che è molto difficile stimare degli indicatori precisi, dato che le mutilazioni dei genitali vengono praticate nel segreto e nel non

Variation in stillbirth rates across high-income countries and large equity gaps within high-income countries persist. If all high-income countries achieved stillbirth rates equal to the best performing countries, 19 439 late gestation (28 weeks or more) stillbirths could have been avoided in 2015. The proportion of unexplained stillbirths is high and can be addressed through improvements in data collection, investigation, and classification, and with a better understanding of causal pathways. Substandard care contributes to 20–30% of all stillbirths and the contribution is even higher for late gestation intrapartum stillbirths. National perinatal mortality audit programmes need to be implemented in all high-income countries. The need to reduce stigma and fatalism related to stillbirth and to improve bereavement care are also clear, persisting priorities for action. In high-income countries, a woman living under adverse socioeconomic circumstances has twice the risk of having a stillborn child when compared to her more advantaged counterparts. Programmes at community and country level need to improve health in disadvantaged families to address these inequities.

Objective: To propose a phylogenetic significance to the Moro reflex which remains unexplained since its publication in 1918 because both hands are free at the end of the gesture. Method: Among the 75 videos of healthy term newborns we have filmed in a research project on antenatal education to parenthood, we describe a sequence that clearly showed the successive movements of the Moro reflex and we report the occurrence of this reflex in the videos that were recorded from Time 0 of birth defined as the moment that lies between the birth of the thorax and the pelvis of the infant. Results: The selected sequence showed the following succession of the newborn's actions: quick extension-adduction of both arms, the orientation of the body, head and eyes towards a human person, and full extension-abduction of both arms with spreading of the fingers, crying and a distressed face. There were 13 Moro reflexes between 2 and 14 s from Time 0 of birth. We found a significant association between the occurrence of the Moro reflex and the placement of the newborn at birth in supine position on the mother's abdomen (p = 0.002). Discussion: The quick extension-adduction of both arms which started the sequence may be considered as a startle reflex controlled by the neural fear system and the arm extension-adduction which followed as a Moro reflex. The characteristics of all Moro reflexes were those of ritualization: amplitude, duration, stereotype of the gestures. This evolutionary process turns a physiological behavior, grasping in this case, to a non-verbal communicative behavior whose meaning is a request to be picked up in the arms. The gestures associated with the Moro reflex: crying and orientation of the body, head, and eyes towards a human person, are gestures of intention to communicate which support our hypothesis. The neural mechanism of the Moro reaction probably involves both the fear and the separation-distress systems. Conclusion: This paper proposes for the first time a phylogenetic significance to the Moro reflex: a ritualized behavior of nonverbal communication. Professionals should avoid stimulating the newborns' fear system by unnecessarily triggering Moro reflexes. Antenatal education should teach parents to respond to the Moro reflexes of their newborn infant by picking her up in their arms with mother talk.

Postmortem photography is a widespread practice in perinatal bereavement care, yet few studies have explored how it affects bereaved parents, or how it might be received by parents of older children. This study is an examination of the meaning, utility, and social context of postmortem photography in a sample of 181 bereaved parents. Data were subjected to both quantitative and qualitative analysis. Photographs were positively regarded by most parents after perinatal death and several parents of older children. Other parents rejected postmortem photography for aesthetic, personal, or cultural reasons. Brief recommendations are offered for healthcare providers.

In this article, I examine the ways in which risk is constructed and managed by those involved in the pregnancy and childbirth of women who use drugs, including the women themselves. I discuss how constructions of risk influence maternal care outcomes and the understanding of choice, often in the form of stigmatisation. In this article, I draw on data from a qualitative research study that I conducted in 2011 in a western Canada city in which I interviewed 13 pregnant and parenting women who had used drugs during their pregnancy. In this article, I show how the everyday risk construction of pregnancy, labour and delivery is compounded significantly by drug use and the stigmatisation associated with this perceived risk-taking behaviour. The participants in the study often internalised this understanding of risk and this manifested itself in delays in accessing maternal health and social care services. The women in the study had different understandings of risk and these were structured by the women’s own understanding of general risk factors during their pregnancy, as well as their experiences of the constructions of risk and risk management by health and social care professionals. While structural life chances can constrain women’s feelings of self-efficacy, services that promote clients’ ability to make choices can facilitate reduced stigmatisation and facilitate the development of more compassionate and autonomous approaches to risk management.

Although pregnancy and childbirth have significant identity and health implications for all women, perinatal research has focused primarily on non-disabled women. In this article, I provide a review of literature regarding the perinatal care experiences of women with physical disabilities. I found that many women with physical disabilities encounter attitudinal, informational, physical, and financial barriers during the perinatal period, which contribute to poor care experiences and may subsequently affect health outcomes. In an effort to improve perinatal care experiences and outcomes, I offer recommendations to address the barriers identified in the literature, including increased disability content in medical school curricula.

OBJECTIVE: To systematically map data availability for stillbirths from all countries with Demographic and Health Surveys (DHS) surveys to outline the limitations and challenges with using the data for understanding the determinants and causes of stillbirths, and for cross-country comparisons.

METHODS: We assessed data sources from the DHS programme website, including published DHS reports and their associated questionnaires for surveys completed between 2005 and 2015.

RESULTS: Between 2005 and 2015, the DHS programme completed 114 surveys across 70 low- and middle-income countries. Ninety-eight (86.0%) surveys from 66 countries collected stillbirth data adequately to calculate a stillbirth rate, while 16 surveys from 12 countries did not. The method used to count stillbirths varied; 96 (84.2%) surveys used a live birth history with a reproductive calendar, while 16 (14.0%) surveys from 12 countries did a full pregnancy history. Based on assessment of questionnaires, antenatal and delivery care information for stillbirths was only available in 15 surveys (13.2%) from 12 countries (17.1%). Data on maternal conditions/complications were captured in 17 surveys (16.0%), but only in six could these be linked to stillbirths. Data on other recognised risk factors were scarce, varying considerably across surveys. Upon further examination of data sets from surveys with maternity care data on non-live births, we found incomplete capture of these data; only two surveys had adequately and completely collected these for stillbirths.

CONCLUSION: Substantial variation exists in DHS surveys in the measurement of stillbirths, with limited scope to examine risk factors or causes. Without immediate improvements, our understanding of country-specific trends and determinants for stillbirths will remain hampered, limiting the development and prioritisation of programmatic interventions to prevent these deaths.

Objective: To identify the causes and categories of stillbirth using the Application of ICD-10 to Deaths during the Perinatal Period (ICD-PM).

Methods: Prospective, observational study in 12 hospitals across Kenya, Malawi, Sierra Leone and Zimbabwe. Healthcare providers (HCPs) assigned cause of stillbirth following perinatal death audit. Cause of death was classified using the ICD-PM classification system.

Findings: 1267 stillbirths met the inclusion criteria. The stillbirth rate (per 1000 births) was 20.3 in Malawi (95% CI: 15.0-42.8), 34.7 in Zimbabwe (95% CI: 31.8-39.2), 38.8 in Kenya (95% CI: 33.9-43.3) and 118.1 in Sierra Leone (95% CI: 115.0-121.2). Of the included cases, 532 (42.0%) were antepartum deaths, 643 (50.7%) were intrapartum deaths and 92 cases (7.3%) could not be categorised by time of death. Overall, only 16% of stillbirths could be classified by fetal cause of death. Infection (A2 category) was the most commonly identified cause for antepartum stillbirths (8.6%). Acute intrapartum events (I3) accounted for the largest proportion of intrapartum deaths (31.3%). In contrast, for 76% of stillbirths, an associated maternal condition could be identified. The M1 category (complications of placenta, cord and membranes) was the most common category assigned for antepartum deaths (31.1%), while complications of labour and delivery (M3) accounted for the highest proportion of intra-partum deaths (38.4%). Overall, the proportion of cases for which no fetal or maternal cause could be identified was 32.6% for antepartum deaths, 8.1% for intrapartum deaths and 17.4% for cases with unknown time of death.

Conclusion: Clinical care and documentation of this care require strengthening. Diagnostic protocols and guidelines should be introduced more widely to obtain better data on cause of death, especially antepartum stillbirths. Revision of ICD-PM should consider an additional category to help accommodate stillbirths with unknown time of death.

Background: While more women with physical disabilities are becoming mothers, many encounter barriers to perinatal care and experience poor outcomes. Little is known about the perinatal care experiences and outcomes of women with physical disabilities in Canada. Objective: This qualitative study sought to understand the perinatal care experiences and outcomes of women with physical disabilities in one Canadian province, with an emphasis on identifying barriers to care. Methods: In-depth interviews were conducted with 13 women with physical disabilities who had given birth in the last 5 years. Follow-up interviews were conducted with 10 of the 13 participants. All interviews were audio-recorded and transcribed verbatim. Data analysis was informed by a constructivist grounded theory approach. Results: Based on analysis of participants' interviews, five themes regarding barriers to care were identified: (1) Inaccessible care settings, (2) Negative attitudes, (3) Lack of knowledge and experience, (4) Lack of communication and collaboration among providers, and (5) Misunderstandings of disability and disability-related needs. Conclusions: Study findings reveal that the perinatal care system is not set up with women with physical disabilities in mind and that barriers to perinatal care may contribute to poor outcomes. More research and training are needed to address barriers to perinatal care for women with physical disabilities. Collaboration among perinatal and disability-related providers and meaningful inclusion of women with physical disabilities in educational initiatives and care plans are vital to improve care experiences and outcomes.

Non invasive prenatal Testing (NIPT) is changing the practice of prenatal diagnosis worldwide. It provides high sensitivity and specificity in screening for common aneuploidies. As a result, it has reduced the number of invasive procedures, thereby reducing their associated risk of pregnancy miscarriage. NIPT is based on the detection and analysis of cell free fetal DNA (cffDNA) that is obtained from a maternal peripheral blood sample. Advanced laboratory detection and purification technology has improved the performance of NIPT and allowed the introduction of new applications in recent years. The introduction of Next Generation Sequencing (NSG) into clinical practice has rendered NIPT to have high sensitivity in the screening of aneuploidy. It has also allowed detecting and investigating the fetal genome from maternal plasma. Fetal Whole Exome Sequencing (WES) provides non invasive prenatal diagnosis of inherited monogenic disorders and can also offer a diagnosis of an underlying cause of fetal anomalies that have a normal karyotype. The following will review the current and potential future applications of NIPT and discuss the advantages and disadvantages of the various NIPT techniques. The role of public healthcare system plays in the provision of the test, and the psychological impact of NIPT on the end-users will also be highlighted.

RESUMEN El objetivo del presente trabajo consiste en reconocer las prácticas de cuidado y atención de los agentes del sistema médico tradicio-nal responsables de la salud reproductiva femenina en el sur de la Amazonia colombiana. Para ello, se realizaron entrevistas a profundidad, grupos focales y observación etnográfica con agentes locales de salud de cinco comunidades rurales y cascos urbanos de los municipios de Leticia y Puerto Nariño. Los resultados mostraron que la formación de personas, sus cuerpos y el buen trato, media-dos por un constante control de las relaciones entre humanos y no humanos, se establecen como los determinantes de las prácticas de cuidado y atención a la salud reproductiva femenina. Igualmente, se evidencia un profundo respeto por las decisiones de la madre durante su proceso procreativo, lo que coincide con las recientes disposiciones internacionales. Estos datos sirven como base para la comprensión de la cultura médica local y su incorporación en los procesos terapéuticos de salud en un marco de interculturalidad. Palabras clave: medicina tradicional, partería, plantas medicinales, región amazónica, salud materno-perinatal.

Objective: the purpose of this study was to explore the perceptions and experiences of perinatal women who have availed of midwifery led model of care (MLC) at secondary care settings in Karachi, Pakistan.

Design: a qualitative descriptive exploratory approach using semi-structured interviews.

Participants: a purposive sample of 10 women who had used MLC was enrolled from each site.

Findings: content analysis highlighted that ‘women’s satisfaction with MLC’ emerged as the main theme and, under this theme, the six categories that emerged were: (1) the admired capability and maturity of midwives, (2) the affordability of midwifery services, (3) a personalized relationship, (4) the empowerment of women to make decisions, (5) presence, and (6) a voiced concern regarding lack of marketing of MLC.

Key conclusions: the study findings revealed that women had an overall feeling of satisfaction with the maternity care provided by the midwives. Mostly, women appreciated the midwives' expertise in providing maternity care. Majority of the women acknowledged the continuous presence of the midwives during child birth and the women shared that they were empowered to make decisions related to their care. Most of the women indicated that marketing for MLC is scarce and insufficient. Majority of the women are even not aware of this model; therefore, it is imperative to create awareness and to provide MLC access to women through robust marketing.

Implications for practice: the findings of this study may help to advocate and provide women friendly maternity care, by giving choice and control to women during child birth, providing comfort to women by using fewer medical interventions, and promoting normality by attending spontaneous vaginal child- births.

Perinatal period is one of the most crucial period in the field of Family Mental Health and Behavioral Sciences. During this period, women undergo changes which affects their biological and psychological functioning, the spouses have an increased responsibility affecting their social and psychological functioning. These cumulative changes may affect the entire family, thereby having an affect on the biological and psychosocial etiology which may affect the whole family. Psychosocial aspects may trigger the illness and act as risk and maintaining factors. Social workers need to intervene in this context for optimal functioning of women with perinatal mental health issues and her family. A biopsychosocial framework may be adopted for social work assessment and intervention. Individual, familial, group, and community level intervention is required to address this complex issue, along with other mental health clinicians.

Background. Evidence recommends encouraging expectant mothers to adopt birthing positions that will assist them in having a normal physiological birth. Upright birthing positions have been shown to have good birth outcomes and assist women to give birth normally. However, adopting the lithotomy position with legs flexed and supported with hands has become an entrenched clinical birthing practice in Nigeria and is associated with an increased risk of a routinely performed episiotomy. Hospital protocols have supported this medicalised approach to how women give birth, with little regard to woman-centred care. Nevertheless, Nigerian obstetricians' perceptions and experiences on birthing position and perineal trauma have received minimal recognition and research. Aim. To explore the perceptions and experiences of Nigerian obstetricians' regarding maternal birthing position and perineal trauma following childbirth, and to gain insights as to whether obstetricians clinical decisions and practice were influenced by research evidence. Methods. A descriptive qualitative study was conducted involving a purposive sample of eight obstetricians recruited from two referral hospitals in the Niger Delta region of Nigeria during November 2014. Data were collected using an interview schedule and a thematic analysis was undertaken. Data analysis was guided by Braun and Clarke's (2006) six-stage thematic framework. Interviews were transcribed in full and categorisation of the data achieved with several in-depth readings of the transcripts. Data saturation was reached with the facilitation of the second focus group interview as no more emerging themes were identified. The study obtained ethical approval from the health and social research ethics committee at the University of Chester in the UK, and also from the study hospitals in the Niger Delta region in Nigeria. Results. Six participants were doctors undertaking obstetric specialist training and two were consultant obstetricians. The following core themes emerged: entrenched practice, lack of insight for evidence, embracing woman-centred care and professional dominance. An overall finding demonstrated a willingness to support mothers in their choices of birthing position and involved reflections on the indications for an episiotomy and incidences of perineal injuries. The findings also indicated that the obstetricians were prepared to consider woman-centred care in relation to birthing position and perineal trauma. Conclusions. This study has enabled some Nigerian obstetricians to reflect upon their perceptions and experiences of their clinical decisions and practices concerning birthing position and perineal trauma. Their current practice was frequently not supported by evidence. However, it emerged that there was a willingness to listen to women and adopt clinical birthing practices and perineal care that would respect choices based on contemporary evidence. Adopting a woman-centred approach would also enable Nigerian midwives working in the two study hospitals to support women to give birth in a position of their choosing and reduce the risk of a routinely performed episiotomy.

Abstract:: The aim of this paper is introduce the premier research of two baby skeleton found in the 3 area of Monte Bernorio oppidum. The finds of children was contemporary with a later occupation of the hillfort just before this destruction in the latest decades of the last century b.C. and was a funerary practice completely different than the use for adults in Iron Age. This rite is very common in the north of Spain and indicates of a pass rite from babies to childhood.

KEY WORDS: Monte Bernorio Hillfort, perinatals, funerary rite, pass rite, Iron Age.

Text in Spanish with abstract and keywords in English and Euskera (Vasque Language)

Objective: To explore how perinatal care practice may influence labor outcomes among circumcised women. Study design: In-depth interviews were conducted with 23 Somali immigrants and 36 Norwegian health care professionals about their experiences from antenatal care, delivery and the management of circumcision. Results: Circumcision was not recognized as an important delivery issue among Norwegian health care professionals and generally the topic was not addressed antenatally. The Somalis feared lack of experience and sub-optimal treatment at delivery. All of the women expressed a strong fear of cesarean section. Health care professionals were uncertain about delivery procedures for infibulated women and occasionally cesarean sections were performed in place of defibulation. Conclusion: We hypothesize that neglect of circumcision may lead to adverse birth outcomes including unnecessary cesarean sections, prolonged second stage of labor and low Apgar scores. We suggest that infibulated women need a carefully planned delivery, correctly performed defibulation and adequate pain relief.

Abstract:  Background:  Falling consent rates for postmortems, regardless of age of death, have been widely reported in recent years. The aim of this study was to explore parental attitudes to, and decision-making about, a perinatal postmortem after termination for fetal abnormality, late miscarriage, or stillbirth.Methods:  A prospective self-completion questionnaire was given to 35 women and their partners. The participants had experienced second or third trimester pregnancy loss in a single fetal medicine and delivery unit in the United Kingdom and were making decisions about having a postmortem. They were asked to complete a questionnaire about their attitudes to, and expectations of, a perinatal postmortem.Results:  Thirty-one questionnaires were received from parents of 17 babies (49% of those asked; 16 from mothers, 15 from fathers). Parents of nine babies (53%) said they would agree to a full postmortem, of three babies to a limited postmortem, and of four babies to an external examination only; one couple were undecided. The most important issues for the parents in this study that related to their decisions about a postmortem centered on the need for information, both for future planning and about what had happened. Moderately important issues related to altruism, which is, improving medical knowledge and helping other parents experiencing similar bereavement. Among the lowest scoring issues were potential barriers, such as concerns about cultural or religious acceptability of a postmortem, funeral delays, and what would happen to the baby’s body.Conclusions:  Bereaved parents who participated in this study, where postmortem consent rates were relatively high, thought that their need for knowledge eclipsed assumed barriers when deciding whether or not to have a postmortem for their baby. (BIRTH 39:1 March 2012)

This article analyzes two perinatal health practices – feeding practices and post-partum rest – of mothers of Chinese origin in Paris, who navigate between different registers of care and medical and paramedical standards. Through a qualitative study carried out between 2016 and 2018 among some thirty women of Chinese origin, and in some cases also among their family circle (spouses and parents), the article highlights the logic underlying their perinatal health practices which are based on Chinese medicine in a migratory context. The empirical material shows that the use of medical pluralism in the French context, during the perinatal period, can be understood by these women as a way of emancipation, at least in a punctual and limited manner, on the one hand from the domination of Western clinical norms and institutional violence ; and on the other hand, from power relations within the home and the extended family.

Résumé

Cet article analyse deux pratiques de santé périnatale – le régime alimentaire et le repos post-partum – de mères d’origine chinoise à Paris, qui naviguent entre différents registres de soins et de normes médicales et paramédicales. À travers une enquête qualitative menée entre 2016 et 2018 auprès d’une trentaine de femmes d’origine chinoise, et dans certains cas également auprès de leur entourage familial (conjoints et parents), l’article met en relief les logiques sous-tendant leurs pratiques de santé périnatale qui relèvent de la médecine chinoise en contexte migratoire. Les matériaux empiriques montrent que les recours à un pluralisme médical dans le contexte français, pendant la période périnatale, peuvent être appréhendés par ces femmes comme une façon de s’émanciper, au moins de manière ponctuelle et limitée, de la domination des normes cliniques occidentales et des violences institutionnelles d’une part, et des rapports de force à l’intérieur du foyer et de la famille élargie d’autre part.

In Cape Town where cesarian rates range from 70 percent to 30 percent, birth practitioners and pregnant women in Cape Town use tranquility to sustain spontaneous vaginal birth. Tranquil birth methods involve psychological as well as physical preparation for labor, but even more importantly peaceful, private low-light settings for labor. For respondents in my ethnographic study from 2014 to 2017, in the highly emergency-conscious sociality of post-apartheid Cape Town, non-institutional settings and non-hospital birth practitioners are less risky for medically unnecessary, expensive, potentially dangerous and invasive birth interventions (such as pharmaceutical inductions and cesarians). Women in my study were typically not informed of reasonable birthing alternatives, or were otherwise coerced. Tragically, where most pregnancies are understood as risky, and where infrastructure is limited, facilities for surgical and pharmaceutical intervention may not be available for genuine emergencies.

Kristie Holmes, PhD, LCSW
University of Southern California
USC Suzanne Dworak-Peck School of Social Work
323-459-5685

Cardiac issues will end our lives as females 33% of the time- more than breast cancer ever will, despite incredible awareness campaigns that have convinced us otherwise. Symptoms like fatigue, frequent urination, shortness of breath and headaches are easily ignored by patients as well as providers.

Educational objectives:
1. Increase knowledge of cardiac issues pre, during, and post birth.
2. Increase knowledge of signs and symptoms to refer immediately as a mental health provider, including "impending doom".
3. Increase knowledge of clear action items to raise awareness in participant's network that will save lives.
4. Increase knowledge of maternal mortality rate in the US as compared to other countries in the world and how California has reversed the national trend.

Introduction: perinatal mortality is the result of the maternal health status, the interaction of bio-psychosocial
factors during pregnancy, and the quality characteristics of the healthcare provided to both the mother
and the fetus. Objective: to analyze the perinatal mortality in the 2012 and 2013 cohorts at the Colombia
University Clinic. Methodology: descriptive, retrospective study with data collected by the perinatal
mortality surveillance sub-system of the Colombia University Clinic. Provide complementary information
based on the review of medical records and death certificates. The analysis of the data was done using
the BABIES Matrix and the Delays Model. Results: in 2012 there were 72 perinatal death events of which
77.7% were associated with maternal risk factors, with pre-eclampsia as the major morbidity associated.
The rate for that year was 23.6 per 1,000 life births. In 2013 there were 68 events, 64.1% of which were
associated with maternal health risks. Based on the Delays Model, Delays I, II, and III play a relevant role in
both years. Conclusions: the perinatal mortality at the Colombia University Clinic has a behavior similar to
that described in the literature. There is a need to develop actions leading to an improved knowledge about
the bio-psychosocial risks of pregnant women, ensuring the respect for sexual and reproductive human
rights, and the knowledge of warning signs and signals, in addition to developing skilled human resources.
Keywords: perinatal mortality, infant mortality.

Endometriosis presents a diagnostic challenge as clinical
symptoms do not correlate well with the extent of disease [1].
Cramer, et al. [2] found that menstrual cycle length shorter than 27
days, menses longer than 7 days and severe cramping dysmenorrhea
were predictive of endometriosis with relative risks of 2.1 (95%CI
1.5-2.9), 2.4 (95%CI 1.4-4.0) and 6.7(95%CI 4.4-10.2) respectively.
The study compared 268 women with infertility and laparoscopically
confirmed endometriosis with 3794 women admitted for delivery
(controls) using a retrospective questionnaire. The study was
limited by recall bias and the criteria for laparoscopic diagnosis
were not clearly defined. No significant correlation was found with
chronic pelvic pain. The issue has been studied prospectively [3,4]
in 134 women scheduled for laparoscopy for chronic pelvic pain
(CPP). Dyschezia, dyspareunia, and non-menstrual pain were all
identified as predictors of deep infiltrating endometriosis (DIE)
with odds ratios of 3.9 (95%CI 1.7-8.9), 4.6 (95%CI 1.5-14.2) and
2.5 (95%CI 1.1-5.6) respectively. Mrs. SF presented with all of these
symptoms to a greater or lesser extent. One criticism of Chapron’s
study is that the diagnosis was made on laparoscopic appearance
without histological confirmation. Visualization alone has been
shown to have a positive predictive value (PPV) for endometriosis
of 45% and up to 36% of lesions were down staged on histology

Objective: About 15% of clinically recognized pregnancies result in spontaneous abortion in the first trimester and the vast majority of these are the result of chromosome abnormalities. Studies of chromosomal constitutions of first trimester spontaneous abortions have revealed that at least 50% of the abortions have an abnormal karyotype. In this study we aimed to report the single centre experience of anomalies detected in spontaneous abortions.

Estetrol (E4) is a recently described natural estrogen with four hydroxyl-groups that is synthesized exclusively during pregnancy by the human fetal liver. It has important antioxidative activity. The aim of the present study was to define the importance of E4 in the attenuation of neonatal hypoxic-ischemic encephalopathy. Antioxidative effect of 650 μM, 3.25 mM and 6.5 mM E4 on primary hippocampal cell cultures was studied before/after H202-induced oxidative stress. To examine oxidative stress and cell viability, lactate dehydrogenase activity and cell proliferation colorimetric assays were performed. To study the neuroprotective and therapeutic effects of E4 in vivo neonatal hypoxic-ischemic encephalopathy model of 7-day-old newborn rat pups was used. The neuroprotective and therapeutic effects of estetrol before/after hypoxicischemic insult was studied in 1 mg/kg/day, 5 mg/kg/day, 10 mg/kg/day, 50 mg/kg/day E4 pretreated/treated groups and compared with the sham and the vehicle treated groups. The body temperature of the rat pups was examined along with their body and brain weights. Brains were studied at the level of the hippocampus and cortex. Intact cell counting and expressions of microtubule-associated protein-2, doublecortin and vascular-endothelial growth factor were evaluated by histo-and immunohistochemistry. ELISAs were performed on blood samples to detect concentrations of S100B and glial fibrillary acidic protein as brain damage markers. This work reveals for the first time that E4 significantly decreases LDH activity and enhances cell proliferation in primary hippocampal neuronal cell cultures in vitro, and decreases the early gray matter loss and promotes neuro-and angiogenesis in vivo.

Bu makalede bir kadın hastanın iki yıl içinde üst üste üç hamileliğinde yaşadığı ka-yıplar ve hastanın ruhsal işleyişi projektif testlerle incelenecektir. Hastanın ruhsal işleyişi ile gebelikleri, düşükleri psikanalitik perinatalite kuramı çerçevesinde anlaşıl-maya çalışılacak ve tartışılacaktır. Vaka Öyküsü Bayan A. 31 yaşında yükseköğrenim mezunudur ve yönetici olarak çalışmaktadır. Eşiyle severek evlenmiştir. İki yıl içinde ikisi ilk üç ayda, sonuncu gebeliği ise altıncı ayda ani biçimde sonlanmıştır. Gebeliklerin sonlanma nedeni olarak fetüsün kalbinin durduğunu söyleyen Bayan A. tekrar gebe kalmayı istediğini ancak tekrar aynı şeyleri yaşamaktan korktuğunu söylemektedir. Terapiye başlama nedeni olarak son düşüğü yaşadıktan sonra kendini iyi hissedemediğini ifade etmiş; "Kendime bir yıl vermiştim ama hâlâ düşündüğümde sinirlerim bozuluyor. İlki normaldi ama ikinci-sinde daha çok yara aldım. İkinciyi hemen birincinin yerine koydum. Kayıp, üzüldüm tabii. İşe verdim kendimi, düşünmemeye çalıştım. Sinirlerim bozuluyor. Bir yıl zaman verdim ama atlatamadım. Gene aynı şey olur. Bu travmayı atlatmam lazım." demiş-tir. Onu terapiye yaşadığı zorlukların getirdiğini ve artık bunların kendi başına üstesinden gelemediğini eklemiştir. Düşük öncelikle bir kayıp deneyimidir. Bu kayıpla birlikte doğal bir tepki olarak ortaya çıkan keder ve yas yaşanamadığında öznenin ruhsal dengesi ciddi anlamda sarsılabilir. Üzerinden zaman geçse de yıldönümlerinde üzüntü ve keder tepkilerinin verildiği bilinmektedir. Bayan A.'nın anlatımına bakıldığında çoklu kayıpları olmasına rağmen bu kayıplarının yasının tutulmasının hasta için ne kadar güç olduğu görülmek-tedir. Hastanın duygusal olarak kayıplarının etkisinde olduğu, kayıp sonrası yas süreci-ne dair güçlükleri olmakla birlikte terapiye başlamaya dair arzusu, yardım alma ve onarma arzusunun varlığına işaret etmektedir. Gebeliklerini görüldüğü üzere fiziksel ve

This paper introduces the design explorations of a multi-sensorial environment focused on emotional pregnancy. We define emotional pregnancy as the psychological and mental reactions to the transitional experiences towards motherhood/becoming a parent. We draw from insights into pregnant women's experiences and expert knowledge shared by midwives and doula to develop a sensorial experience and toolkit that combine affirmations, light, sound, movements and journaling. This is deployed within the context of a prenatal yoga setting with three women at different stages in their pregnancy. We offer insights into how a multi-sensorial approach to designing for the wholeness of pregnancy can support and empower women in their experiences of pregnancy, expand on societal understandings and foster the value of emotions during this time.

Rationale: Mifepristone was approved in 2000 by the FDA as an alternative to surgical abortion. In the predominant two drug abortion regimen, mife-pristone is followed by misoprostol after one to two days. Little has been published on the survival of living embryos after exposure to mifepristone alone. This review of the literature is undertaken to summarize available studies that define embryo survival after mifepristone. This review defines baseline continuing pregnancy rates after mifepristone, to aid in determining the therapeutic value of supplemental progesterone for women desiring to continue their pregnancy. Methods: PubMed and the Cochrane Database were searched through March, 2016 for articles that depicted embryo survival after ingestion of mifepri-stone as a single agent. Further studies were found in the reference lists of relevant articles and review articles. The relevant studies that verified embryo survival utilized ultrasound as a criterion for continuing pregnancy. Results: Of 1855 studies found, 30 studies using mifepristone as a single agent were selected for review. 18 met criteria describing embryo survival. Mifepristone was lethal over a wide range of doses and gestational ages; surviving embryos were present over a similar range. Survival rates using total doses of 200-300 mg ranged from 10-23.3%. In the one study using

Community-based, integrated, primary care maternity programs for pregnant women affected by problematic substance use are emerging as effective models for engaging women affected by multiple health and social issues. Although addictions services have historically been evaluated by individual achievement of abstinence, new definitions of program success are required as addiction comes to be viewed as a chronic illness. We conducted a mixed-methods study to follow the formative development stages of a community-based program, identifying key evaluation indicators and processes related to this program, program team members, and women and families served. As this program
model develops, it is critical that providers, community partners, and health system leaders collaborate to frame definitions of success in ways helpful for guiding program development.

Preeclampsia (PE) is a leading cause of perinatal morbidity and mortality. Our aim of the study was to evaluate the association of oxidative stress and antioxidant defence systems with preeclampsia during pregnancy and after delivery. The study comprises a total of 52 subjects including PE women (n=27) and uncomplicated pregnant women (n=25) matched by age. Serummalondialdehyde (MDA), phospholipid hydroperoxide (PHP), superoxide dismutase (SOD), vitamin C and total antioxidant status (TAS) were estimated by spectrophotometric methods. Serum levels of MDA and PHP were significantly higher (p<0.001, respectively) while SOD, vitamin C and TAS were significantly lower (p<0.001, respectively) in patients both during and after delivery. The systolic and diastolic blood pressure significantly decreased among patients after delivery. On the other hand, the MDA and PHP concentrations non-significantly decreased in PE women after delivery whereas the antioxidant system non-significantly increased. Our results suggested that the raise in oxidative stress and reduction in antioxidant defence systems persisted after delivery for 1 to 3 days. Therefore, evaluation of oxidative status and antioxidant defence systems may be a useful tool for diagnosis and treatment of preeclampsia during and after pregnancy.

The past decades have seen a drastic increase in the medicalization of childbirth,
evidenced by increasing Caesarean section rates in many Western countries. In a
rare moment of congruence, alternative health-care providers, feminist advocates for
women’s health and, most recently, mainstream medical service providers have all
expressed serious concerns about the rise in Caesarean section rates and women’s
roles in medicalization. These concerns stem from divergent philosophical positions as
well as differing assumptions about the causes for increasing medicalization. Drawing
on this debate, and using a feminist and governmentality framing of the problem, we
interviewed 22 women who have recently had children about their birthing choices,
their expectations and their birth experiences. The women’s narratives revealed a
disjuncture between their expectations of choosing, planning and achieving as natural a
birth as possible, and their lived experiences of births that did not typically go to plan.
They also reveal the disciplining qualities of both natural and medical discourses about
birth and choice. Furthermore, their narratives counter assumptions that women, as
ideal patient consumers, are driving medicalization.

Adequate supply of dietary protein in regular diet is an important element of a proper nutritional status as it functions in the regulation of metabolic profiles signaling the reproductive axis. Reports have highlighted the association of the amount of protein in the diet to the functioning of hypothalamic-pituitary-testis axis, however its intragenerational effects are yet to be adequately explored. The study aims to analyze the effect of protein deficient diet on parameters associated with male infertility from one generation to another. Female rats in four (4) groups (n=10) were fed different ration of protein in their diet (PD) as formulated: 21%PD, 10%PD, 5%PD and control diet (rat chow), through gestation and lactation to first and second generations, while the male offspring sustained on the maternal diet after weaning were used for analysis. Sperm morphology and motility were evaluated using a light microscope and a computer-assisted semen analysis. The percentage of motile spermatozoa, morphological characteristics and histology in the deficient groups (5%, 10%PD) appeared normal as compared to control in the first generation, showing an adaptive response while second generation was presented with significantly altered fertility parameters of the male offspring. It is suggested that in a deficiency status especially at the critical phase of development, certain deleterious effects which may be adaptive or phenotypic can serve to reduce the fertility efficiency in the male offspring at both F1 and F2-generation.

Background: Women with disabilities are increasingly becoming pregnant, and growing evidence suggests maternal disability may be associated with increased risk for perinatal complications.

Objective: A systematic review and meta-analysis were undertaken to examine the association between maternal disabilities and risk for perinatal complications.

Study design: Medline, CINAHL, EMBASE, and PsycINFO were searched from inception to July 2018 for full-text publications in English on pregnancy, delivery, and postpartum complications in women with any disability and those with physical, sensory, and intellectual and developmental disabilities specifically. Searches were limited to quantitative studies with a comparison group of women without disabilities. Reviewers used standardized instruments to extract data from and assess the quality of included studies. Pooled odds ratios and 95% confidence intervals were generated using DerSimonian and Laird random effects models for outcomes with data available from ≥3 studies.

Results: The review included 23 studies, representing 8,514,356 women in 19 cohorts. Women with sensory (pooled unadjusted odds ratio, 2.85, 95% confidence interval, 0.79-10.31) and intellectual and developmental disabilities (pooled unadjusted odds ratio, 1.10, 95% confidence interval, 0.76-1.58) had elevated but not statistically significant risk for gestational diabetes. Women with any disability (pooled unadjusted odds ratio, 1.45, 95% confidence interval, 1.16-1.82) and intellectual and developmental disabilities (pooled unadjusted odds ratio, 1.77, 95% confidence interval, 1.21-2.60) had increased risk for hypertensive disorders of pregnancy; risk was elevated but not statistically significant for women with sensory disabilities (pooled unadjusted odds ratio, 2.84, 95% confidence interval, 0.85-9.43). Women with any (pooled unadjusted odds ratio, 1.31, 95% confidence interval, 1.02-1.68), physical (pooled unadjusted odds ratio, 1.60, 95% confidence interval, 1.21-2.13), and intellectual and developmental disabilities (pooled unadjusted odds ratio, 1.29, 95% confidence interval, 1.02-1.63) had increased risk for cesarean delivery; risk among women with sensory disabilities was elevated but not statistically significant (pooled unadjusted odds ratio, 1.28, 95% confidence interval, 0.84-1.93). There was heterogeneity in all analyses, and 13 studies had weak-quality ratings, with lack of control for confounding being the most common limitation.

Conclusion: Evidence that maternal disability is associated with increased risk for perinatal complications demonstrates that more high-quality research is needed to examine the reasons for this risk and to determine what interventions could be implemented to support women with disabilities during the perinatal period.