Maternal Health

Maternal Health

  • Judy Slome Cohain added an answer:
    Is there a test that can detect the chance of developing pre eclampsia early on during the pregnancy?

    .

    Judy Slome Cohain · All the way home birth service

    I would like you to explain why you ask this question.  I think the desire to 

    predict  the chance of developing pre eclampsia early on during the pregnancy is equivalent to predicting whether your child will learn to ride a bicycle.  What is the relevance of this question?   We know what prevents preeclampsia-  adequate nutrition of protein and micronutrients.    if there is a lack of adequate protein and micronutrients, the risk of preeclampsia, while small increases.   

    It seems there continues to be a desire to define more and more women at risk of some horrible , albeit rare disease of pregnancy, rather than focusing on educating women on how to prevent those same diseases.

    If a woman has a green shake every morning, made up of every kind of green leafy vegetable , with 2 brazil nuts and some pecans,  and then for lunch eats brown rice and lentils with salad, and takes some B12, and for dinner, vary her diet depending on protein needs for that stage of pregnancy,  and that is her diet every day, she will not suffer preeclampsia.   It is bewildering to me that despite the fact that we know exactly how to eliminate preeclampsia , the focus is rather on developing ultrasound or other technology , that will not eliminate it, but rather detect a prediction of the degree of risk someone has to develop preeclampsia.

  • Maria Chifuniro Chikalipo added an answer:
    Does anyone know any contacts for population council on antenatal education services?

    I am looking for information on male involvement in antenatal education and my interest is to have information on what was delivered to men during the health talks. These projects were done in Kenya by ICAP in 2012/2013, South africa in Durban by Population Council in 2004 and another one in Nepal in 2005/2006. I know in High income countries they have organized sessions for couples and it will be good to learn as well what is in their curriculum for couple counseling. I will appreciate if I get the information or the contacts of these organizations so that I can access the information.

    Maria Chifuniro Chikalipo · University of Malawi

    Thank you Ian

    Kind regards

  • Elizabeth Skinner added an answer:
    Do we have a booklet containing antenatal education for childbearing women at ministerial level as a standard to be used in our clinics?

    I am asking this because I feel there is no such document and I am interested in designing one for childbearing women. Please midwives, obstetricians help.

    Elizabeth Skinner · University of Sydney

    Our research is observing that women are not given accurate and consistent information during the antenatal period and  significantly informed consent regarding  operative intrapartum procedures is totally neglected. Analysis so far suggests that they are often traumatized by lack of knowledge. I would be keen to see any of these documents.

     Warm regards

     Liz Skinner

    Sydney University

  • Ehsan Saboory added an answer:
    What are the 5 most important chemical or hormonal indicators of preeclampsia in human and/or rat?

    We are studying the effect of major life stressors on preeclampsia in rat and human. What must be measured in pregnant subjects to better illustrate the situation?

    Ehsan Saboory · Urmia University of Medical Sciences

    Dear Colleagues

    I appreciate all your valuable comments and suggestions.

    sincerely

    Ehsan Saboory

  • Cheryl Nikodem added an answer:
    Is the maneuver Fundal pressure - vis a tergo - expressio fetus a safe maneuver?

    I'm very interested in this maneuver because it is common practice though there is little evidence on it.

    who has interesting research ideas on this topic? who has already useful protocols and instruction tools for this maneuver?

    Cheryl Nikodem · Fort Hare University

    Fundal pressure during the second stage of labour
    RHL Summary
    30 June 2014
    Lieve Blancquaert
    Findings of the review: Fundal pressure is a widely used practice which involves the use of manual or instrumental pressure on maternal abdomen in the direction of the birth canal with the purpose of accelerating the second stage of labour. While it is used routinely in many settings, it is also considered obsolete in many countries and there is some concern about its effectiveness as well as its potential adverse consequences. The aim of this review was to determine the benefits and adverse effects (for both the mother and her baby) of fundal pressure in the second stage of labour. Only one trial, judged by the authors to be of good methodological quality, was included in this review. That trial involved 500 nulliparous women (who had received epidural analgesia) compared fundal pressure by insufflatable belt with no fundal pressure. No significant differences were found in the duration of the second stage of labour, mode of delivery, five-minute Apgar scores, neonatal arterial cord pH and admission to neonatal intensive care unit. In the intervention group there was an increase in intact perineum but also an increase in anal sphincter tears. The lack of blinding may have influenced these two opposite results, although a possible association with the intervention cannot be ruled out.

    Implementation: There is no evidence to either support or discourage the use of manual fundal pressure during the second stage of labour. Further research is needed to evaluate the effectiveness and safety of manual pressure or use of an insufflatable belt for fundal pressure during the second stage of labour.


    Cochrane review


    Citation: Verheijen EC, Raven JH, Hofmeyr GJ. Fundal pressure during the second stage of labour. Cochrane Database of Systematic Review 2009, Issue 4. Art. No.: CD006067. DOI: 10.1002/14651858.CD006067.pub2.


    Abstract
    Background
    Fundal pressure during the second stage of labour involves application of manual pressure to the uppermost part of the uterus directed towards the birth canal in an attempt to assist spontaneous vaginal delivery and avoid prolonged second stage or the need for operative delivery. Fundal pressure has also been applied using an inflatable girdle. A survey in the United States found that 84% of the respondents used fundal pressure in their obstetric centres.There is little evidence to demonstrate that the use of fundal pressure is effective to improve maternal and/or neonatal outcomes. Several anecdotal reports suggest that fundal pressure is associated with maternal and neonatal complications: for example, uterine rupture, neonatal fractures and brain damage. There is a need for objective evaluation of the effectiveness and safety of fundal pressure in the second stage of labour.

    Objectives
    To determine the benefits and adverse effects of fundal pressure in the second stage of labour.

    Search methods
    We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2008).

    Selection criteria
    Randomised and quasi-randomised controlled trials of fundal pressure versus no fundal pressure in women in the second stage of labour with singleton cephalic presentation.

    Data collection and analysis
    Three review authors independently assessed for inclusion all the potential studies. We extracted the data using a pre-designed form. We entered data into Review Manager software and checked for accuracy.

    Main results
    We excluded two of three identified trials from the analyses for methodological reasons. This left no studies on manual fundal pressure. We included one study (500 women) of fundal pressure by means of an inflatable belt versus no fundal pressure to reduce operative delivery rates. The methodological quality of the included study was good.

    Use of the inflatable belt did not change the rate of operative deliveries (RR 0.94, 95% CI 0.80 to 1.11). Fetal outcomes in terms of five-minute Apgar scores below seven (RR 4.62, 95% CI 0.22 to 95.68), low arterial cord pH (RR 0.47, 95% CI 0.09 to 2.55) and admission to the neonatal unit (RR 1.48, 95% CI 0.49 to 4.45) were also not different between the groups. There was no severe neonatal or maternal mortality or morbidity. There was an increase in intact perineum (RR 1.73, 95% CI 1.07 to 2.77), as well as anal sphincter tears (RR 15.69, 95% CI 2.10 to 117.02) in the belt group. There were no data on long-term outcomes.

    Authors' conclusions
    There is no evidence available to conclude on beneficial or harmful effects of manual fundal pressure. Good quality randomised controlled trials are needed to study the effect of manual fundal pressure. Fundal pressure by an insufflatable belt during the second stage of labour does not appear to increase the rate of spontaneous vaginal births in women with epidural analgesia. There is insufficient evidence regarding safety for the baby. The effects on the maternal perineum are inconclusive.

  • Marie-Celine Farver added an answer:
    Can anyone suggest a possible method to prevent meconium aspiration in the presence of thick or thin meconium?
    http://www.youtube.com/watch?v=O-OqnqfHQ2Q

    https://www.youtube.com/watch?v=Bk0nLRlFbrQ

    As explained in these youtubes, I have been preventing all meconium aspiration by delivery on hands and knees, and waiting a minute or more between delivery of head and body. This gives a minute for meconium and vernix to drain from the lungs, trachea and nose. By the time the body is delivered, the lungs and trachea are clear of all meconium.
    Marie-Celine Farver · Sutter Davis Hospital

    As you stated above, we are only intervening if the baby is nonvigorous. Then we do not stimulate, but entubate and suction. If the cords are clear, there is no suctioning. If the baby is not vigorous after suctioning, we follow AAP NRP guidelines (http://www2.aap.org/nrp/) and then dry, stimulate, and provide ventilation as needed.

  • Manoj Suva added an answer:
    What dose of metformin do you use in women with PCOS (with and without prediabetes) who wish to conceive?
    What is your experience with efficacy of metformin in achieving ovulatory cycles?
    Manoj Suva

    Respected sir,

    If possible provide the reference for the myo inositol dosage for PCOS

  • Joshua Sumankuuro added an answer:
    Can anyone provide information on the current statistics for maternal mortality rate in Africa and Kenya?

    In line with achieving the MDG 5.

    Joshua Sumankuuro · Youth Alive

    thisa link will also be useful to you: http://data.unicef.org/maternal-health/maternal-mortality

  • Kuczyński Jarosław added an answer:
    What is the role of bearing microparticles of obstetric complications STBM in: preeclampsia, amniotic-fluid embolism, placental abruption?

    new experiences  .....cooperation.

    Kuczyński Jarosław · Państwowa Wyższa Szkoła Zawodowa

    STBM microparticles released from the maternal part of the bearing with the development of the fetus. In a normal pregnancy the placenta is the most-developed at 36-40 weeks. In addition, they circulate in the blood to the collapse of the spleen. In most of the microparticles is emerging STBM and pregnancy complicated: preeclamsia. In IUGR bearing is failing is probably STBM microparticle concentration in the blood is lower

  • Gerald Chinedu Nkwocha added an answer:
    How I can attain permission to use the labour agency scale (LAS) as soon as possible?

    This scale is used to describe the extent to which women feel in control during childbirth.

    Gerald Chinedu Nkwocha · University of Ibadan

    This scale is not yet in use in Nigeria. Could you please throw more light on its relevance either in research or enhancement in practice of Obstetrics

  • Alessandra Diehl added an answer:
    The abortion from a male Perspective?

    Someone could help with paper indication or reports of studies (prevalence and or qualitative) that had  evaluated somehow the abortion from a male perspective?

    Alessandra Diehl · Universidade Federal de São Paulo

    Thank you Dr. Emmanuel !

  • Forough Mortazavi added an answer:
    What are effects of early supplementation with formula or water based fluids on breastfeeding?

    Is there any reference indicate that the early supplementation may decrease milk production due to less frequent breastfeeding, developing breastfeeding difficulties, reduced maternal breastfeeding confidence, and perceived insufficient milk supply?

    Forough Mortazavi · Sabzevar University of Medical Sciences

    Thank you Genevieve

    I requested the full text.

  • Joan Rosen Bloch added an answer:
    Does anyone know the research gold standard of measuring telemere length to capture a biological measure of weathering in mothers?

    This is important to move forward health and social equity research.

    Joan Rosen Bloch · Drexel University

    Stacey,

     Thank you very much for the information.

    Joan

  • Elizabeth Skinner added an answer:
    Does anyone have a good indicator scale or tool for PTSD?

    I am researching the psychological effects of birth trauma to women and an emerging theme of 40 interviews appears to be PTSD. However, it would be beneficial to examine the accuracy of this theme.

    Elizabeth Skinner · University of Sydney

    Dear Beatrice and Daniel

     Thank you so much for this great information - I will also  share this with Prof Hans Peter Dietz - the head of this research team re levator ani/ OASIS birth injuries.

  • Patricia D Ndhlovu added an answer:
    Should you treat Schistosomiasis during pregnancy?
    Schistosomiasis morbidity has been reported to be associated with adverse pregnancy outcomes like low birth weight, prenatal death and maternal death. The most implicating risk factor is anaemia. Recent studies have also stressed the poor immunogenicity of vaccine in neonates of untreated infected mothers and there have been reports on the occurrence of proinflammatory cytokines associated with Schistosoma fibrosis in neonates of infected mothers suggesting a possibility of congenital transmission and adverse effects in neonates. While the WHO has recommended the administration of praziquantel to infected mothers during pregnancy (though without many randomized control trials as at the time of the recommendation), recent evidences have however shown beneficial effects as regards non-treatment during pregnancy. In one study, the children of treated women were reported to show high prevalence of eczema! Furthermore, the most acclaimed risk factor of infection (anaemia) which is the major cause of LBW, prenatal death etc was reported not to be associated with schistosomiasis ruling out coinfection with hookworm and Plasmodium falciparum. Infact another observation showed no association between mother's infection and response to vaccination in children. I want your opinion in this regards as Schistosoma researcher. If you have done something related to this subject matter, I would love to know your findings.
    Patricia D Ndhlovu · Imperial College London

    No you can not treat pregnant women with praziquantel.

  • Masako Fujita asked a question:
    Does anyone know the serum FOLR1 concentration equivalent to serum folate conc of 8 ug/L?

    We would like to determine the prevalence of folate deficiency in our serum samples using FOLR1 ELISA. We found the deficiency cutoff for serum folate, but no luck finding the one using FOLR1. Thank you!

  • Olga Lebedeva added an answer:
    Can anybody suggest any correlation between expression of antimicrobial peptides in cervix uteri and endometrium?

    Please, advise me any publications in this topic would also be helpful. 

    Olga Lebedeva · Belgorod State University

    Thank you very much for your answer, Maria! Yes, there are some publications separately about endometrial cells or about cervix uteri, but not about interrelations between both sites. 

  • Zelalem Tafese Wondimagegne added an answer:
    Is there any association between incidence of eclamsia and the nutritional status and or the nutrient profile of a woman in developing countries?

    Eclamsia is a major cause of maternal mortality, morbidity and adverse fetal and neonatal outcome. There are research attempts to investigate the factors associated with eclamsia; but is there any recent finding that suggests the association of eclamsia with specific nutrient deficiency in developing countries.

    Zelalem Tafese Wondimagegne · Hawassa College of Health Sciences

    Thank you for all who respond to my question.

  • Kalkidan Hassen Abate added an answer:
    Does anyone know what the terms "redlive", "benworn" and 'dimifew" may have to do with maternal health or calcium supplementation?

    Working on a maternal health project

    Kalkidan Hassen Abate · Jimma University

    O' lord i barely speak English.

  • Christopher C Rout added an answer:
    Does anyone have experience with the assessment of maternal cardiac output?

    How can I manage a decrease of maternal CO during Cesarean section ?

    Christopher C Rout · University of KwaZulu-Natal

     Can you provide a few more specifics? For example preoperative morbidity - has she valvular heart disease, a cardiomyopathy or what? Also, what sort of anaesthetic are you using and are you measuring cardiac output? What is causing the decrease in cardiac output?

    The simplistic (and not very helpful) answer to your question is to increase it. But depending on cause and amount by which the CO is decreased there are a number of possible options including nothing at all (i.e. watch and wait), but we need more details.

  • Arthur Fougner added an answer:
    What are the possible differential diagnostics for multilocular ovarian cyst with multifocal dermoid cysts?

    For a case of unilateral serous multilocular ovarian cyst with multifocal dermoid cysts incorporated in the wall of the cyst in a 29 years old female with 2 living children?

    what about differential diagnosis and possible ones ?

    Arthur Fougner · Hofstra North Shore-LIJ School of Medicine

    Check out the lectures on sonoworld.com - registration is free.

    http://sonoworld.com/LectureDetails/LectureDetails.aspx?Id=1052&Sequence=5

    http://sonoworld.com/LectureDetails/Sonographic_Evaluation_of_the_Ovary__To_Worry_or_not_to_Worry_.aspx?Id=822&Sequence=1

    These two would be a good start.

    Art

  • Jennifer L Barkin added an answer:
    Other than the Edinburgh Postnatal Depression Scale and PDSS, what other assessments measure postpartum risk?
    I am researching whether postpartum risk assessment scales are adequately measuring all risk variables that contribute to crimes of maternal infanticide.
    Jennifer L Barkin · Mercer University

    Sorry, this one  - the Barkin Index of Maternal Functioning

  • Clara Isaza added an answer:
    Would Histopaque 1077 interact with cell free DNA?

    We have plasma, that we kept from a previous experiment, that was obtained after separating blood using Histopaque 1077. Now we would like to use that plasma to extract cell free DNA. Would you expect to be able to recover cell free DNA from that plasma? Or would the histopaque 1077 interact with the cfDNA during the blood separation and possible deplete plasma of it?

    Clara Isaza · Ponce School of Medicine and Health Sciences

    Dear Dr. Mishra,

    Thank you very much for your answer.

    Clara

  • Prabhat Chandra Mondal added an answer:
    How can severe postcesarean hypertension be managed?

    Severe hypertension 

    Prabhat Chandra Mondal · Bankura Sammilani Medical College

    Dear Sir,

           I am working in a warm country. It is my experience and observation that is very interesting. During winter season when suddenly temperature falls, we get more eclamptic mothers from rural area.  when there is heavy rainfall, we get more eclamptic mothers. There are some research articles describing this. This could be due to vasospasm  or water restriction.  In western country this has been explained as less sunlight exposure. 

  • Shahnawaz Khan added an answer:
    How does paid maternal leave influence well being?
    Most countries, other than the USA, have some sort of social support to assist new parents. The duration or paid leave is varied, as is the percentage of salary that mothers receives. What are the goals of maternal paid leave in each country? Do countries evaluate the efficacy of the program? Are there long-term impacts that have been researched?
    Shahnawaz Khan
    In a developing country like India paid maternal leaves are a mandatory process for the working women because women have to manage professional matters as well as family because education of child fully depends on the mother's input in their basic as well higher education along with physical growth by breast-feeding and feeding from other sources etc., if a mother has not been given paid maternity leaves how she will manage their family, this factor directly suffer their family and child basic education, personality and physical growth. In other words if a brain is not satisfied with the physical things of world, how that brain works better. It is suggested that for a healthy world it should be necessary to run a policy for paid maternity leaves for working women and welfare of human being.
  • Therese H Doan added an answer:
    Why is there lactation suppression following delivery in cases of Gestational Diabetes Mellitus?
    Gestational Diabetes Mellitus and Lactation suppression
    Therese H Doan · San Francisco State University
    Hi All,
    I agree with Megan. Effective lactation support and management in this case is most important. Gestational diabetes, in effect, resolves itself after the birth of baby (and the placenta). These GDM mothers may need more help with breastfeeding, specifically latching on technique, to ensure effective suckling, mother-baby interaction, and of course, let-down reflex. The article by Arthur et al. (1994) suggested a delay in increase of lactose in breast milk of women with insulin dependent diabetic mothers, not GDM mothers.
  • Igor Lakhno added an answer:
    What is the best way to analyze periodic changes in the maternal heart rate under resting conditions in late pregnancy but before the onset of labour?
    We captured the raw data of the maternal heart rate as part of another study, but would like to analyze it later to determine possible associations with pregnancy outcome.
    Igor Lakhno · V. N. Karazin Kharkiv National University
    Maternal HRV is a convinient instrument to evaluate regulatory balance that could promote control of hemodynamics. Variability (oscillations) of maternal hemodynamic processes spreads its influence through placental barrier and provide fetomaternal cooperation. Maternal sinus respiratory arrhythmia is the most valuable oscillator in the system of "mother-placenta-fetus".
  • Fernando Neuspiller added an answer:
    If the previous cesarean scar on skin is a verical midline, where to put incision next time for the cesarean section?
    Vertical or Transverse
    Fernando Neuspiller · Instituto Valenciano de Infertilidad IVI
    Vertical, and remove de previous scar
  • Helen Muscat added an answer:
    What should be the correct birthing position?
    Most places women give birth in un-natural position like lithotomy position leading to more tears of perineum and also difficult last phase of delivery
    Helen Muscat · Canterbury Christ Church University
    It is interesting that some of the comments include the "operator" or those "conducting" the delivery. It is worth considering that the woman will birth the baby and have some instinct as to the best position. This said the medicalisation of birth often means that women conform to recumbent position which suits the medical model. Even when there is intervention such as CTG etc a more woman centred approach can be considered.
  • Genevieve Ellen Becker added an answer:
    Does anyone known about the mechanisms of breast milk production?
    I'm doing an epidemiological major and I am still creating my thesis. So if we give a supplementation for breastfeeding to women how long will the composition of milk be changed? Please share.
    Genevieve Ellen Becker · BEST Services
    I agree with earlier responses, it depends what the supplement is. Some will have an effect on the amount of the supplement (if any) that reaches the milk ( a complex biochemical process). Or a supplement may affect the mother in some way. For example, if the mother is deficient in iron and is given an iron supplement the amount of iron in her milk will not change but she may feel better and feed the baby more effectively - thus the iron supplement could contribute to increased milk intake by the baby.
    I suggest you read some of the basic lactation textbooks on how milk is made as a first step.

About Maternal Health

Maternal health refers to the health of women during pregnancy, childbirth, and the postpartum period. It encompasses the health care dimensions of family planning, preconception, prenatal, and postnatal care in order to reduce maternal morbidity and mortality.

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