Background: While COVID‑19 spreads rapidly around the world, innovative means to provide continuing prenatal care are being developed to monitor maternal and fetal health while minimizing disease transmission. Telemedicine is one platform by which patients are provided the necessary prenatal and postpartum care safely as the pandemic rages Aims and Objectives: To evaluate the acceptability of telemedicine in the delivery of prenatal and postnatal care in the setting of the COVID‑19 pandemic Materials and Methods: A cross‑sectional study was conducted in a tertiary hospital in Manila. A structured Likert scale‑based survey consisting of a model measuring telemedicine perception was utilized. This was a predeveloped model by Lin in 2017.[1] Descriptive statistical analysis and Chi‑square tests were done to evaluate the data Results: A total of 193 pregnant and postpartum patients participated in the study. Majority of the respondents were between 25 and 34 years old, living within Metro Manila, and normal obstetric patients who were previously seen at the outpatient department. Most of the participants considered telemedicine to be cost‑effective, reliable, easy to use, and useful Conclusion We conclude that telemedicine is an acceptable means of providing prenatal and postnatal care among pregnant patients because it allowed the necessary interaction between patient and doctor and these “users” kept on using the system. There was no association between telemedicine perceptions and patient age, place of residence, type of patient encounter, disease, and treatment. In the setting of the COVID‑19 pandemic, telemedicine is an acceptable means of providing prenatal and postnatal care regardless of patient characteristics
COVID‑19 ; Pandemics ; Postnatal Care ; Prenatal Care ; Telemedicine

BACKGROUND: In ensuring access to maternal health services, various strategies toward safer health practices and improved health service delivery are important ingredients to eliminate avoidable maternal deaths. A recent household survey showed that access to antenatal care (ANC) (89%) and facility-based delivery (FBD) (82.4%) in the Eastern Visayas region is significantly high, despite the extensive damage to over 500 health facilities caused by Typhoon Haiyan in November 2013. Postpartum care (PPC), however, was relatively low (37.4%). As these findings needed further elaboration, a qualitative study using focus groups was conducted. METHOD: The focus groups method was utilized to elicit responses from the mothers, BHWs, and midwives to explain what contributed to the high ANC visits, high FBD, and low PPC. Sixteen focus groups were conducted in the local dialect (Waray and Cebuano), and all discussions were audio recorded. Focus groups data were transcribed and subsequently translated to English text, then reviewed and validated by socio-linguistic academics from the region. Other data sources included debriefing session reports and expanded field notes. Nvivo 10 software was used in the coding process and data management. The data analysis referred to the principles of thematic analysis. RESULTS: The findings showed that incentives in the form of free maternal services and cash grants drive mothers to go to the health facility for antenatal care and facility-based deliveries. The free services were provided by PhilHealth (the country's social health insurance), while cash grants were awarded through the government's conditional cash transfer program and other community partners. Mothers were provided with some financial risk protection through these financial incentives. The disincentives came in the form of local ordinances, which prohibited home births. Penalties included fines for both mother and birth attendant when the mother was found to deliver outside the health facility. The unintended stigma, shame, and fear that developed in response to these ordinances also deterred home births. The significantly low use of PPC services in the health facility was attributed to the lack of advices given to mothers regarding the need for follow up care after delivery. It is also noted that there are no incentives for PPC, which may contribute to its low rates. The role of the community health workers and midwives were to inform and educate the mothers on these incentives and disincentives. However, these incentives and disincentives are extrinsic motivators and are deemed insufficient to provide long-term impact. CONCLUSION AND RECOMMENDATIONS. The implementation of the incentives and disincentives in Eastern Visayas has increased rates of ANC and FBD. The presence of these in the current environment has initially facilitated behavior change, shifting home births to facility births. However, we argue that financial incentives, with a lack of intrinsic motivation, may be insufficient to sustain long-term impact. Disincentives, in the form of local ordinances, forced mothers instead to seek care in facilities. Such an approach may eventually become less effective over time. Incentives and disincentives are both demand-side factors, and to sustain change, concurrent improvements in the supply end need to be implemented. The capacity of facilities to absorb the increased demand should be in place to provide positive experiences for mothers in the health facilities.
Pregnancy ; Female ; Prenatal Care ; Postnatal Care ; Postpartum Period

OBJECTIVE: This study estimated the effects of weekend and off-hour childbirth and the size of perinatal medical care center on the incidence of cerebral palsy. METHODS: The cases were all children with severe cerebral palsy born in Japan from 2009 to 2012 whose data were stored at the Japan Obstetric Compensation System for Cerebral Palsy database, a nationally representative database. The inclusion criteria were the following: neonates born between January 2009 and December 2012 who had a birth weight of at least 2000 g and gestational age of at least 33 weeks and who had severe disability resulting from cerebral palsy independent of congenital causes or factors during the neonatal period or thereafter. Study participants were restricted to singletons and controls without report of death, scheduled cesarean section, or ambulance transportation. The controls were newborns, randomly selected by year and type of delivery (normal spontaneous delivery without cesarean section and emergency cesarean section) using a 1:10 case to control ratio sampled from the nationwide Japan Society of Obstetrics and Gynecology database. RESULTS: A total of 90 cerebral palsy cases and 900 controls having normal spontaneous delivery without cesarean section were selected, as were 92 cerebral palsy cases and 920 controls with emergent cesarean section. A significantly higher risk for cerebral palsy was found among cases that underwent emergent cesarean section on weekends (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.06-2.81) and during the night shift (OR 2.29, 95% CI 1.30-4.02). No significant risk was found among normal spontaneous deliveries on weekends (OR 1.63, 95% CI 0.97-2.73) or during the quasi-night shift (OR 1.26, 95% CI 0.70-2.27). Regional perinatal care centers showed significantly higher risk for cerebral palsy in both emergent cesarean section (OR 2.35, 95% CI 1.47-3.77) and normal spontaneous delivery (OR 2.92, 95% CI 1.76-4.84). CONCLUSION Labor on weekends, during the night shift, and at regional perinatal medical care centers was associated with significantly elevated risk for cerebral palsy in emergency cesarean section.
Case-Control Studies ; Cerebral Palsy ; epidemiology ; etiology ; Delivery, Obstetric ; statistics & numerical data ; Health Facilities ; statistics & numerical data ; Humans ; Incidence ; Infant, Newborn ; Japan ; epidemiology ; Parturition ; Perinatal Care ; statistics & numerical data ; Retrospective Studies ; Time Factors

PURPOSE: This study aimed to investigate the effects of a reinforcement program for behavioral skills in postpartum care for couples with their first baby. METHODS: The study used a non-equivalent control group and pretest-posttest design. It was conducted from January 14 to April 10, 2016 at a postpartum care center in D city. It analyzed 43 couples (22 in the experimental group and 21 in the control group.) For data analysis, descriptive statistics, test of homogeneity in pretest, independent t-tests, and repeated measures ANOVA were used. RESULTS: For maternal fulfillment of postpartum care and postpartum fatigue, there was no significant difference in the interaction between group and time. In terms of parent-newborns attachment, the interaction between group and time showed a significant difference for mothers (F=13.63, p=.001) and fathers (F=6.51, p=.001). In marital intimacy, the interaction between group and time showed a significant difference for mothers (F=14.40, p<.001) and fathers (F=9.46, p=.004). In parenting stress, the interaction between group and time showed a significant difference for mothers (F=31.8, p<.001) and fathers (F=11.69, p=.001). A significant difference was found for the mothers' postpartum sleeping hours (F=0.14 p=.004). CONCLUSION: This program for behavioral skills in postpartum care, which is based on the information-motivation-behavioral skills model, improves postpartum care, parent-newborn attachment, marital intimacy, parenting stress, and maternal postpartum sleeping, by reinforcing behavioral skills required for postpartum care.
Child ; Child Care ; Family Characteristics ; Fathers ; Fatigue ; Humans ; Mothers ; Parenting ; Parents ; Parturition ; Postnatal Care ; Postpartum Period ; Statistics as Topic

PURPOSE: This study was done to assess development and postnatal care interventions in postnatal care intervention records for maternity ward nurses in tertiary hospitals and women's hospitals in South Korea. METHODS: This mixed-method research was a Time-Motion (TM) study. Data were collected through external observation of 12 nurses in 4 wards over 24 hours. Mann-Whitney U test and independent t-test were employed for the analysis of frequency and provision time of direct/indirect care activity. χ² (Fisher's exact test) was utilized to determine the difference in frequency between two groups. IBM SPSS 22.0 statistical program was employed for calculation. All statistical significance levels were at α= .05. RESULTS: According to the KPCS-1 (Korean Patient Classification System-1), women's hospitals are group 3 and tertiary hospitals, group 4. With respect to time difference in direct care, tertiary hospitals showed 791 minutes and women's hospitals, 399 a difference of 392 minutes. For time difference in indirect care, women's hospitals had 2,415 minutes while tertiary hospitals, 2,080, a difference of 335 minutes for women's hospitals. No difference was found in the average total care workload between the two institutions. Individual time also showed no difference (p>.05). CONCLUSION: High-risk maternal care strength in tertiary hospitals and breast-feeding strength in women's hospitals need to be benchmarked with each other.
Benchmarking ; Classification ; Humans ; Korea ; Nursing ; Postnatal Care ; Postpartum Period ; Tertiary Care Centers ; Tertiary Healthcare

BACKGROUND: The postpartum period has been advocated as a way to improve the survival of mothers and newborns. However, the status of the recommended number of postnatal care (PNC) services has not been well studied. The purpose of this study was to assess the level of full PNC visits and factors associated with it among mothers. METHODS: A community-based cross-sectional study was performed among 1,109 women from March to April 29, 2017. Data were collected via face-to-face interviews, recorded using EPI INFO ver. 7.0 (Centers for Disease Control and Prevention, Atlanta, GA, USA) and analyzed by STATA ver. 12.0 (Stata Corp., College Station, TX, USA). Multivariate logistic regression was applied to assess the predictors of the recommended frequency of PNC services. Adjusted odds ratios (aORs) at 95% confidence interval (CIs) were performed. P-values <0.05 were declared statistically significant. RESULTS: Status of compliance with the use of full PNC services was found to be 16.1%. Women who had antenatal care follow-up (aOR, 5.60; 95% CI, 2.50 to 12.55) and women who delivered at health institutions (aOR, 3.66; 95% CI, 1.74 to 7.70) were more likely to have full PNC visits. Proximity of women to health facilities was found to lower the odds of complete PNC visits (aOR, 0.24; 95% CI, 0.10 to 0.56). Moreover, district of residence remains a predictor of service use. CONCLUSION: The percentage of women with full PNC visits was found to be low. Therefore, to achieve the recommended frequency of PNC in the study area, the results of this study suggest a need to strengthen the uptake of ANC and institutional delivery services.
Compliance ; Cross-Sectional Studies ; Ethiopia ; Female ; Follow-Up Studies ; Health Facilities ; Humans ; Infant, Newborn ; Logistic Models ; Mothers ; Odds Ratio ; Postnatal Care ; Postpartum Period ; World Health Organization

PURPOSE: Recently, the number of late preterm infants are increasing, and they are prone to have many clinical problems. The purpose of this study is to emphasize the importance of perinatal care for the late preterm infants and their mothers. METHODS: Total admitted numbers of late preterm infants were 547 (from 464 mothers) and of term infants were 1,514 (from 1,470 mothers) in NICU, at Chonnam National University Hospital January 2014~December 2015. Maternal and neonatal mortality rate were calculated in the total admitted numbers. Exclusion criteria were death or transfer during admission, congenital anomaly, and etc. The enrolled numbers of late preterm infants were 493 (from 418 mothers) and of term infants were 1,167 (from 1,123 mothers). Retrospective chart review was conducted. In mothers, demographics, underlying illness, and obstetric complication, and in newborns, demographics, hospital days and morbidity were compared between late preterm group and term group. RESULTS: Maternal mortality rate was not different. However, neonatal mortality rate was higher in late preterm infants. In mothers of late preterm group, there was no difference in demographic characteristics, but the rates of autoimmune disease and obstetric complication were higher. In infants of late preterm group, body size was smaller, artificial conception and C-section rate were higher, and one and five-minute Apgar scores were lower, and hospital duration was longer. And the incidence of respiratory distress, transient tachypena of newborn, intraventricular hemorrhage and metabolic abnormalities were higher, but the incidence of meconium aspiration syndrome was lower compare to the term infant group. CONCLUSIONS: Maternal mortality was not different. However, neonatal mortality was higher in late preterm infants. In late preterm group, the mothers had higher rate of autoimmune disease and obstetric complication, and the infants had higher morbidity compare to the term group. When the obstetrician decides on delivery time in high risk pregnancy, maternal medical condition and neonatal outcome should be considered.
Autoimmune Diseases ; Body Size ; Demography ; Fertilization ; Hemorrhage ; Humans ; Incidence ; Infant ; Infant Mortality ; Infant, Newborn ; Infant, Premature ; Jeollanam-do ; Maternal Mortality ; Meconium Aspiration Syndrome ; Mortality ; Mothers ; Perinatal Care ; Pregnancy, High-Risk ; Premature Birth ; Retrospective Studies

BACKGROUND: Management of pregnant women at high risk of pre-eclampsia (PE) requires frequent monitoring, with referral to specialized perinatal care centers. Reliable tests are necessary to improve prediction of PE and related complications and to assess disease severity and progression. An imbalance in two biomarkers, soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF), is involved in PE pathogenesis. The sFlt-1 to PlGF ratio is increased in pregnant women before the onset of PE. An elevated ratio is highly predictive of PE, whereas the diagnosis of PE can be ruled out within one week for low ratios. The main objective of this study was to assess whether a low sFlt-1/PlGF ratio, below a cutoff of 38, can predict the absence of PE within one week. METHODS: We performed a prospective, monocentric, observational study to evaluate serum sFlt-1/PlGF ratio (Roche Diagnostics Cobas e411 system) for predicting -PE in a group of 67 high-risk pregnant women (20–37 gestation weeks). RESULTS: Among the 67 patients included, 53 had a sFlt-1/PlGF ratio lower than 38; none developed subsequent PE leading to a negative predictive value of 100%. Eight patients developed clinical PE. The positive predictive value was 21% at one week and 18% at four weeks, in accordance with previous studies. CONCLUSIONS: The serum sFlt-1/PlGF ratio showed highly predictive performances for ruling out PE. Using these biomarkers in routine management of PE may improve clinical care and avoid inappropriate hospitalization, which has a significant economic impact.
Biomarkers ; Diagnosis ; Female ; Hospitalization ; Humans ; Observational Study ; Perinatal Care* ; Pre-Eclampsia* ; Pregnancy ; Pregnant Women ; Prospective Studies ; Referral and Consultation ; Vascular Endothelial Growth Factor Receptor-1

PURPOSE: We examined the effects of a community outreach program for maternal health in Tigray, Ethiopia, on women's knowledge about pregnancy, childbirth, postpartum care, and family planning, and assessed their participation in antenatal care, postpartum checkups, institutional childbirth, and contraceptive use. METHODS: We recruited Ethiopian women of reproductive age (15 to 49 years) in Tigray, Ethiopia. Two villages in Tigray, Kihen and Mesanu, which have similar population sizes and living environments, were chosen as the intervention and comparison groups, respectively. A two-group pretest-posttest design with cluster sampling was employed. We conducted self-report questionnaire surveys using face-to-face interviews. The 2.5-year community outreach program was developed based on Rogers' diffusion of innovation theory. It consisted of mass media use and health education for lay women in the community, along with training of health care providers, including nurses, midwives, and health extension workers, in maternal health care. RESULTS: The intervention group showed significant increases in knowledge and behaviors regarding maternal health and family planning compared to the comparison group (p < .001). In particular, there was a dramatic increase from 10.8% to 93.5% in the institutional birth rate in the intervention group. CONCLUSION: The community outreach program and health care professional training effectively improved knowledge and behaviors regarding maternal health in Ethiopian women. Mass media and interpersonal communication channels for health education may be useful health interventions in developing countries.
Birth Rate ; Community-Institutional Relations* ; Delivery of Health Care ; Developing Countries ; Diffusion of Innovation ; Ethiopia* ; Family Planning Services* ; Female ; Health Education ; Health Personnel ; Humans ; Mass Media ; Maternal Health* ; Midwifery ; Parturition ; Population Density ; Postnatal Care ; Pregnancy

OBJECTIVE: The objective of this study was to reinterpret the neurodevelopmental prognostic factors that are associated with birth head injury by performing a long-term follow-up. METHODS: Seventy-three neonates with head injuries were retrospectively analyzed after a duration of 10.0±7.3 years to determine the correlations between perinatal factors, including gender, head circumference, gestational age, body weight, and mode of delivery, and head injury factors from radiologic imaging with social, fine motor, language, and motor developmental quotients. RESULTS: There was a statistically significant difference between perinatal factors and head injury factors with respect to head circumference, body weight, gestational age, mode of delivery, Apgar scores at 1 min, cephalohematoma, subdural hemorrhage, subarachnoid hemorrhage, and hypoxic injury, but no direct correlation by regression analysis was observed between perinatal factors and developmental quotients. Of the head injury factors, falx hemorrhage showed a significant indirect relationship with the language and motor developmental quotients. Mode of delivery, subgaleal hematoma, cephalohematoma, greenstick skull fracture, epidural hemorrhage (EDH), tentorial hemorrhage, brain swelling, and hypoxic injury showed an indirect relationship with social development. CONCLUSION: In terms of perinatal factors and head injury factors, mode of delivery, subgaleal hematoma, cephalohematoma, greenstick skull fracture, EDH, tentorial hemorrhage, falx hemorrhage, brain swelling, and hypoxic injury displayed an indirect relationship with long-term development, and therefore these factors require particular attention for perinatal care.
Birth Injuries ; Body Weight ; Craniocerebral Trauma* ; Follow-Up Studies ; Gestational Age ; Head* ; Hematoma ; Hematoma, Subdural ; Hemorrhage ; Humans ; Infant, Newborn* ; Intracranial Hemorrhages ; Parturition* ; Perinatal Care ; Retrospective Studies ; Skull Fractures ; Social Change ; Subarachnoid Hemorrhage