Influence of perinatal factors on full-term low-birth-weight infants and construction of a predictive model

BACKGROUND Being too light at birth can increase the risk of various diseases during infancy.AIM To explore the effect of perinatal factors on term low-birth-weight(LBW)infants and build a predictive model.This model aims to guide the clinical management of pregnant women’s healthcare during pregnancy and support the healthy growth of newborns.METHODS A retrospective analysis was conducted on data from 1794 single full-term pregnant women who gave birth.Newborns were grouped based on birth weight:Those with birth weight<2.5 kg were classified as the low-weight group,and those with birth weight between 2.5 kg and 4 kg were included in the normal group.Multiple logistic regression analysis was used to identify the factors influencing the occurrence of full-term LBW.A risk prediction model was established based on the analysis results.The effectiveness of the model was analyzed using the Hosmer–Leme show test and receiver operating characteristic(ROC)curve to verify the accuracy of the predictions.RESULTS Among the 1794 pregnant women,there were 62 cases of neonatal weight<2.5 kg,resulting in an LBW incidence rate of 3.46%.The factors influencing full-term LBW included low maternal education level[odds ratio(OR)=1.416],fewer prenatal examinations(OR=2.907),insufficient weight gain during pregnancy(OR=3.695),irregular calcium supplementation during pregnancy(OR=1.756),and pregnancy hypertension syndrome(OR=2.192).The prediction model equation was obtained as follows:Logit(P)=0.348×maternal education level+1.067×number of prenatal examinations+1.307×insufficient weight gain during pregnancy+0.563×irregular calcium supplementation during pregnancy+0.785×pregnancy hypertension syndrome−29.164.The area under the ROC curve for this model was 0.853,with a sensitivity of 0.852 and a specificity of 0.821.The Hosmer–Leme show test yieldedχ^(2)=2.185,P=0.449,indicating a good fit.The overall accuracy of the clinical validation model was 81.67%.CONCLUSION The occurrence of full-term LBW is related to maternal education,the number of prenatal examinations,weight gain during pregnancy,calcium supplementation during pregnancy,and pregnancy-induced hypertension.The constructed predictive model can effectively predict the risk of full-term LBW.

Child Abuse during the Pandemic and Trauma-Informed Care: A Review of Evidence-Based Literature

Abuse of infants and children is a public health problem that warrants immediate attention. It is estimated that over 7 million children are affected by child abuse yearly, with the highest rate of abuse in those less than one year of age. Approximately 60% of child abuse victims are children under the age of three years, making infants and young children a particularly vulnerable population. Interventions targeting the perinatal period can be effective in mitigating child abuse, including parent education programs and trauma-informed care services. This paper provides an overview of the current evidence base related to child abuse following the COVID-19 pandemic, with a focus on prevention and intervention strategies that can be utilized to increase caregiver support and reduce child abuse rates during the perinatal period.

Experiences and Countermeasures of a Perinatal Ward Nursing Manager Dealing with Family Members’ Problematic Behaviors

Background: When family members and/or patients behave in a problematic way, this hinders the provision of safe and secure medical care. During the perinatal period, a family’s relationships and functions change significantly, and each family member is prone to experiencing stress. As such, conflict arises easily between family members and medical staff. Aims: Therefore, we conducted this study to shed light on the following phenomena: 1) family members’ problematic behaviors;2) the concerns of a perinatal ward nurse manager (hereafter referred to as the manager) and ward nurses;and 3) countermeasures carried out by the manager, together with the ward nurses, based on the manager’s experiences. Methods: We conducted an 80-minute, semi-structured interview with the manager, following which we analyzed the content of her narrated accounts. Results: According to the findings, 1) family members’ problematic actions include verbal abuse;arrogance, unreasonableness, and selfish behaviors;and violent conduct;2) the manager’s and ward nurses’ fears and worries about family members’ problematic behaviors;responses to gradually becoming involved with family members;and resistance to staying involved with family members following patient discharge. In addition, we examined 3) countermeasures carried out by the manager together with the ward nurses: resolute and consistent responses to family members’ problematic behaviors;attempted enforcement measures taken to deal with family members who exhibit problematic behaviors;engagement while trying to avoid conflict with family members;preparation that anticipates the occurrence of problematic conduct;cooperation with the medical team;cooperation with the hospital organization;cooperation with social resources outside the hospital;and patient protection. Conclusions: With awareness of cooperation with the medical team toward family members who engage in problematic actions, the medical staff members try to unify their response and share their feelings of hardship with each other.

Pelvic floor muscle training as a persistent nursing intervention: Effect on delivery outcome and pelvic floor myodynamia

Purpose:To evaluate the effect of pelvic floor muscle training as a nursing intervention on delivery outcomes and postpartum pelvic floor myodynamia.Methods:In total,106 nulliparas were randomised into an intervention group and control group.All nulliparas participated in a pelvic floor training programme led by a midwife.A pelvic floor physical therapist measured the women’s pelvic floor myodynamia and taught them how to correctly perform pelvic muscle contractions before the intervention.A registered nurse monitored the intervention group via twice-weekly telephone checkups.The control group did not receive individual direction.Results:There were no differences in the rate of Caesarean section or elective Caesarean section between the two groups(χ^(2)=3.446,p=0.076 and χ^(2)=2.343,p=0.185,respectively).There was a difference in the timing of the second stage of labour between the two groups(t=2.101,p=0.040);no difference was observed in the timing of the other two stages of labour(t=1.771,p=0.081 and t=1.142,p=0.263,respectively).In addition,no differences were observed in the gestational weight gain(t=0.196,p=0.845),neonatal weight(t=0.113,p=0.911),rate of episiotomy(χ^(2)=0.932,p=0.351)or rate of perineal laceration(χ^(2)=0.022,p=0.982)between the two groups.The pelvic floor myodynamia of the intervention group had improved to a greater degree than that in the control group at 6 weeks and 3 months after delivery(p<0.005).Conclusion:Persistent nursing intervention for pregnant/postpartum women helped to shorten the second stage of labour and contributed to the recovery of postpartum pelvic floor myodynamia.The influence of this intervention on the delivery mode,and rates of episiotomy and perineal laceration remains unknown.Medical staff should strengthen health education programmes that involve pelvic floor functional rehabilitation.

Therapeutic termination of pregnancy and women’s mental health:Determinants and consequences

The therapeutic termination of pregnancy(TToP)is an induced abortion following a diagnosis of medical necessity.TToP is applied to avoid the risk of substantial harm to the mother or in cases of fetal unviability.This type of induced abortion is provided after the second semester of gestation if fetal illness or the pregnancy cause physical danger or pathological mental distress to the mother.Sociocultural and economic determinants could influence the desire for children and family planning in couples,as well as the use of effective contraception and the choice to perform an induced abortion.Also,pre-existing mental health problems could affect the decision between carrying on a problematic pregnancy or having TToP.Furthermore,the TToP is a reproductive event with an important traumatic burden,but also with an intrinsic therapeutic effect and it can produce different psychological and psychopathological effects on women and couples.The aim of this review is to evaluate what demographic,reproductive and psychopathological determinants are involved in the choice of undergoing a TToP in women.Also,we will examine both positive and negative consequences of this procedure on women’s mental health,underlying which factors are related to a worse outcome in order to provide the best clinical support to vulnerable groups.

Ethnic disparities: Genetics vs(social) environment

To define "ethnicity" in the context of perinatal care is a tough job. The word makes us think: "racial, social, cultural, national…". An ethnic group is generally considered a group of people with a common history, usually(but not always) a common religion and language, sharing aspects of culture such as nutrition and traditions concerning pregnancy, childbirth, the way they care for children. As procreation occurs mostly ingroup, every ethnic group will demonstrate a higher prevalence of, more or less well-known, genes and their connected diseases. For some populations, such as Ashkenazi Jewish people, the prevalence and associated risks of these autosomal diseases are well known, as in the case of "Jewish genetic disease", and specific screening programs are available.

Factors Associated with Umbilical Cord Stump Healing Practices: Literature Review

Objective: To analyze the evidence in the evolution of scientific production on the factors associated with curative practices of the umbilical stump. Materials and Methods: The study data collection took place in April 2017. The electronic databases used to search the articles were: PubMed (National Library of Medicine and National Institutes of Health) and VHL (Virtual Health Library). We used the keywords “perinatal care”, “umbilical cord”, “patient care team”, “neonatology”, “newborn”, in the Portuguese, English and Spanish languages, accompanied by the expression AND and selected through DeCS (Descriptors in Health Sciences). Results: A final sample of 9 articles was obtained from the PubMed and VHL databases, which met the inclusions criteria. It has been found that traditional umbilical stump care practices are still present in many communities, however, have been replaced by appropriate practices, the most recommended being: chlorhexidine 4% sanitation, soap and water and alcohol antisepsis 70%. Conclusions: There is a need for multi-professional involvement, approaching these women since pregnancy, with detailed information and accessible language about proper care with the newborn and the umbilical stump.

Scientific Evidence about the Assistance Provided to the Newborn with Meconium Elimination:Integrative Literature Review

The Meconial Aspiration Syndrome (MAS) is a complication caused by the presence of meconium amniotic fluid with consequent aspiration, being responsible for important rates of perinatal morbidity and mortality. This study aims to analyze the bibliographical production on newborn care with meconium elimination in the delivery room. It was a literature integrative review electronically based. Most of the studies referred to tracheal intubation and exogenous surfactant ministration as main care methods. The Meconium Aspiration Syndrome is presented as main theme. It is understood that health care professionals must develop knowledge, skills and actions, showing conduct based on scientific, critical and reflexive knowledge with purposeful interventions directed to the patient’s needs.

Perinatal Management and Outcomes of Pregnancy Following Sheehan Syndrome: A Case Report and Literature Review

Pregnancy is rare and difficult in Sheehan syndrome patients.With the help of assisted reproductive technology,the patients even with panhypopituitarism can get pregnant again.Moreover,women with hypopituitarism have increased risk of pregnancy complications.Here we report a patient who suffered acute and severe Sheehan syndrome with panhypopituitarism and central diabetes insipidus got pregnant again by in vitro fertilization and embryo transfer.A regular and careful antenatal care was given by the cooperation between obstetricians and endocrinologists.Finally,she delivered a healthy female baby at 37+6 weeks of gestation with Apgar scores of 10 and 10 at 1 and 5 minutes,respectively.The patient and her baby were doing well at postpartum follow-up.The related articles were also reviewed.This case report is aimed to help clinical practitioners to make better decisions on the management of Sheehan syndrome or other type of hypopituitarism during pregnancy.