http://www.biomedcentral.com/bmcpregnancychildbirth/ The latest research articles published by BMC Pregnancy and Childbirth 2012-05-30T00:00:00Z Background: Pregnant women with prior venous thromboembolism (VTE) are at risk of recurrence. Lowmolecular weight heparin (LWMH) reduces the risk of pregnancy-related VTE. LMWHprophylaxis is, however, inconvenient, uncomfortable, costly, medicalizes pregnancy, andmay be associated with increased risks of obstetrical bleeding. Further, there is uncertainty inthe estimates of both the baseline risk of pregnancy-related recurrent VTE and the effects ofantepartum LMWH prophylaxis. The values and treatment preferences of pregnant women,crucial when making recommendations for prophylaxis, are currently unknown. Theobjective of this study is to address this gap in knowledge. Methods: We will perform a multi-center cross-sectional interview study in Canada (2 sites), USA,Norway and Finland. The study population will consist of 100 women with a history of lowerextremity deep vein thrombosis (DVT) or pulmonary embolism (PE), and who are eitherpregnant, planning pregnancy, or may in the future consider pregnancy (women between 18and 45 years). We will exclude individuals who are on full dose anticoagulation orthromboprophylaxis, who have undergone surgical sterilization, or whose partners haveundergone vasectomy. We will determine each participant's willingness to receive LMWHprophylaxis during pregnancy through direct choice exercises based on real life andhypothetical scenarios, preference-elicitation using a visual analog scale ("feelingthermometer"), and a probability trade-off exercise. The primary outcome will be theminimum reduction (threshold) in VTE risk at which women change from declining toaccepting LMWH prophylaxis. We will explore possible determinants of this choice,including educational attainment, the characteristics of the women's prior VTE, and priorexperience with LMWH. We will determine the utilities that women place on the burden ofLMWH prophylaxis, pregnancy-related DVT, pregnancy-related PE and pregnancy-relatedhemorrhage. We will generate a "personalized decision analysis" using participants' utilitiesand their personalized risk of recurrent VTE as inputs to a decision analytic model. We willcompare the personalized decision analysis to the participant's stated choice.DiscussionThe preferences of pregnant women at risk of VTE with respect to the use of antithrombotictherapy remain unexplored. This research will provide explicit, quantitative expressions ofwomen's valuations of health states related to recurrent VTE and its prevention with LMWH.This information will be crucial for both guideline developers and for clinicians. http://www.biomedcentral.com/1471-2393/12/40 Pablo Alonso-Coello Shanil Ebrahim Gordon Guyatt Kari Tikkinen Mark Eckman Ignacio Neumann Sarah McDonald Elie Akl Shannon Bates BMC Pregnancy and Childbirth 2012, null:40 2012-05-30T00:00:00Z doi:10.1186/1471-2393-12-40 /content/figures/1471-2393-12-40-toc.gif BMC Pregnancy and Childbirth 1471-2393 ${item.volume} 40 2012-05-30T00:00:00Z PDF Background: Three million babies are stillborn each year and 3.6 million die in the first month of life. InIndia, early neonatal deaths make up four-fifths of neonatal deaths and infant mortality threequartersof under-five mortality. Information is scarce on cause-specific perinatal andneonatal mortality in urban settings in low-income countries. We conducted verbal autopsiesfor stillbirths and neonatal deaths in Mumbai slum settlements. Our objectives were toclassify deaths according to international cause-specific criteria and to identify major causesof delay in seeking and receiving health care for maternal and newborn health problems. Methods: Over two years, 2005-2007, births and newborn deaths in 48 slum areas were identifiedprospectively by local informants. Verbal autopsies were collected by trained fieldresearchers, cause of death was classified by clinicians, and family narratives were analysedto investigate delays on the pathway to mortality. Results: Of 105 stillbirths, 65 were fresh (62%) and obstetric complications dominated the causeclassification. Of 116 neonatal deaths, 87 were early and the major causes were intrapartumrelated(28%), prematurity (23%), and severe infection (22%). Bereavement was associatedwith socioeconomic quintile, previous stillbirth, and number of antenatal care visits. Weidentified 201 individual delays in 121/187 birth narratives (65%). Overall, delays inreceiving care after arrival at a health facility dominated and were mostly the result of referralfrom one institution to another. Most delays in seeking care were attributed to a failure torecognise symptoms of complications or their severity. Conclusions: In Mumbai's slum settlements, early neonatal deaths made up 75% of neonatal deaths andintrapartum-related complications were the greatest cause of mortality. Delays wereidentified in two-thirds of narratives, were predominantly related to the provision of care, andwere often attributable to referrals between health providers. There is a need for clearprotocols for care and transfer at each level of the health system, and an emphasis on rapididentification of problems and communication between health facilities.Trial registrationISRCTN96256793 http://www.biomedcentral.com/1471-2393/12/39 Ujwala Bapat Glyn Alcock Neena Shah More Sushmita Das Wasundhara Joshi David Osrin BMC Pregnancy and Childbirth 2012, null:39 2012-05-30T00:00:00Z doi:10.1186/1471-2393-12-39 /content/figures/1471-2393-12-39-toc.gif BMC Pregnancy and Childbirth 1471-2393 ${item.volume} 39 2012-05-30T00:00:00Z PDF Background: First trimester growth restriction is associated with an increased risk of adverse birthoutcomes (preterm birth, low birth weight and small for gestational age at birth). Thedifferences between normal and abnormal growth in early pregnancy are small if the fetalsize is measured by the crown-rump-length. Three-dimensional ultrasound volumemeasurements might give more information about fetal development than two-dimensionalultrasound measurements. Detection of the fetus with a small fetal volume might result inearlier detection of high risk pregnancies and a better selection of high risk pregnancies. Methods: A prospective cohort study, performed at the Maxima Medical Centre, in Eindhoven-Veldhoven, the Netherlands. During the routine first trimester scan with nuchal translucencymeasurement 500 fetal volumes will be obtained. The gestational age is based on the first dayof the last menstrual period in a regular menstrual cycle and by the crown-rump-length. Theacquired datasets are collected and stored on a hard disk for offline processing and volumecalculation. The investigator who performs the volume measurements is blinded for theresults of the first trimester scan. The manual mode will be used to outline the Region OfInterest, the fetal head and rump, in all cross sections. The fetal volumes are calculated with arotational step of 9degrees.First, the relation between fetal volume and gestational age, for a set of participants withnormal pregnancies (training set), will be assessed. This model will then be used to determineexpected values of fetal volume for a normal pregnancy, which will be referred to as expectednormal values. Secondly, for a new set of participants with normal pregnancies and a set ofparticipants with complicated pregnancies (together defined as validation set), the observedfetal volumes (FVobserved) are compared with their expected normal values (FVexpected) andexpressed as a percentage of the expected normal value. The mean difference in percentageerror between the set of normal versus complicated pregnancies will then be compared usingthe independent-samples t-test. Finally, logistic regression analysis will be applied to thevalidation set of participants to analyze the possibility of predicting the pregnancy outcomeafter fetal volume calculation in the first trimester, using this percentage error.DiscussionAfter this study it is clear whether FV measurement in the first trimester can detect high riskpregnancies. If it is possible to detect these pregnancies, more intensive follow up in thesepregnancies might result in fewer complicated pregnancies and fewer fetal morbidities. http://www.biomedcentral.com/1471-2393/12/38 Nicol Smeets Marc Prudon Bjorn Winkens S Guid Oei BMC Pregnancy and Childbirth 2012, null:38 2012-05-28T00:00:00Z doi:10.1186/1471-2393-12-38 /content/figures/1471-2393-12-38-toc.gif BMC Pregnancy and Childbirth 1471-2393 ${item.volume} 38 2012-05-28T00:00:00Z PDF The initial sample size calculation in our protocol (Hegeman et al, BMC Pregnancy Childbirth, 2009, 9:44) was based on the expected proportion of 'bad neonatal outcome' in the intervention group (3.9%) and control group (7.2%) and accounts for the fact that the outcomes in children form multiple pregnancies are non-independent using an intra class correlation of 0.6. As the intervention is performed on the mother, analysis should be done on the maternal level. This adjustment was made during recruitment and approved by the medical ethics committee of the Academic Medical Centre in Amsterdam (ref. No. MEC 09/107). The sample size is calculated based on the primary outcome 'bad neonatal outcome'. http://www.biomedcentral.com/1471-2393/12/37 Sophie Liem Dick Bekedam Kitty Bloemenkamp Anneke Kwee Dimitri Papatsonis Joris van der Post Arianne Lim Hubertina Scheepers Christine Willekes Johannes Duvekot Marc Spaanderman Martina Porath Jim van Eyck Monique Haak Marielle van Pampus Hein Bruinse Ben Willem Mol Maud Hegeman BMC Pregnancy and Childbirth 2012, null:37 2012-05-23T00:00:00Z doi:10.1186/1471-2393-12-37 /content/figures/1471-2393-12-37-toc.gif BMC Pregnancy and Childbirth 1471-2393 ${item.volume} 37 2012-05-23T00:00:00Z PDF Background: Neonatal anxiety and depression and breastfeeding cessation are significant public healthproblems. There is an association between maternal symptoms of anxiety and depression andearly breastfeeding cessation. In earlier studies, the causality of this association wasinterpreted both ways; symptoms of anxiety and depression prepartum significantly impactsbreastfeeding, and breastfeeding cessation significantly impacts symptoms of anxiety anddepression.First, we aimed to investigate whether breastfeeding cessation is related to an increase insymptoms of anxiety and depression from pregnancy to six months postpartum. Second, wealso investigated whether the proposed symptom increase after breastfeeding cessation wasdisproportionately high for those women already suffering from high levels of anxiety anddepression during pregnancy. Methods: To answer these objectives, we examined data from 42 225 women in the Norwegian Motherand Child Cohort Study (MoBa). Subjects were recruited in relation to a routine ultra-soundexamination, and all pregnant women in Norway were eligible. We used data from theMedical Birth Registry of Norway and questionnaires both pre and post partum. Symptoms ofanxiety and depression at six months postpartum were predicted in a linear regressionanalysis by WHO-categories of breastfeeding, symptoms of anxiety and depressionprepartum (standardized score), and interaction terms between breastfeeding categories andprepartum symptoms of anxiety and depression. The results were adjusted for cesareansections, primiparity, plural births, preterm births, and maternal smoking. Results: First, prepartum levels of anxiety and depression were related to breastfeeding cessation (beta0.24; 95%CI 0.21-0.28), and breastfeeding cessation was predictive of an increase inpostpartum anxiety and depression (beta 0.11; 95%CI 0.09-0.14). Second, prepartum anxietyand depression interacted with the relation between breastfeeding cessation and postpartumanxiety and depression (beta 0.04; 95%CI 0.01-0.06). The associations could not be accountedfor by the adjusting variables. Conclusions: Breastfeeding cessation is a risk factor for increased anxiety and depression. Women withhigh levels of anxiety and depression during pregnancy who stop breastfeeding early are at anadditional multiplicative risk for postpartum anxiety and depression. http://www.biomedcentral.com/1471-2393/12/36 Eivind Ystrom BMC Pregnancy and Childbirth 2012, null:36 2012-05-23T00:00:00Z doi:10.1186/1471-2393-12-36 /content/figures/1471-2393-12-36-toc.gif BMC Pregnancy and Childbirth 1471-2393 ${item.volume} 36 2012-05-23T00:00:00Z PDF Background: A father's experience of the birth of his first child is important not only for their birth-givingpartner but also for the father himself, his relationship with the mother and the newborn. Novalidated questionnaire assessing first-time fathers' experiences during childbirth is currentlyavailable. Hence, the aim of this study was to develop and validate an instrument to assessfirst-time fathers' experiences of childbirth.MethodDomains and items were initially derived from interviews with first-time fathers, andsupplemented by a literature search and a focus group interview with midwives. Thecomprehensibility, comprehensiveness and relevance of the items were evaluated by fourpaternity research experts and a preliminary questionnaire was pilot tested in eight first-timefathers. A revised questionnaire was completed by 200 first- time fathers (response rate =81%) Exploratory factor analysis using principal component analysis with varimax rotationwas performed and multitrait scaling analysis was used to test scaling assumptions. Externalvalidity was assessed by means of known-groups analysis. Results: Factor analysis yielded four factors comprising 22 items and accounting 48% of the variance.The domains found were Worry, Information, Emotional support and Acceptance. Multitraitanalysis confirmed the convergent and discriminant validity of the domains; however,Cronbach's alpha did not meet conventional reliability standards in two domains. Thequestionnaire was sensitive to differences between groups of fathers hypothesized to differ onimportant socio demographic or clinical variables Conclusions: The questionnaire adequately measures important dimensions of first-time fathers' childbirthexperience and may be used to assess aspects of fathers' experiences during childbirth. Toobtain the FTFQ and permission for its use, please contact the corresponding author. http://www.biomedcentral.com/1471-2393/12/35 Åsa Premberg Charles Taft Anna-Lena Hellström Marie Berg BMC Pregnancy and Childbirth 2012, null:35 2012-05-17T00:00:00Z doi:10.1186/1471-2393-12-35 /content/figures/1471-2393-12-35-toc.gif BMC Pregnancy and Childbirth 1471-2393 ${item.volume} 35 2012-05-17T00:00:00Z PDF Background: Nearly half the world's babies are born at home. We sought to evaluate the training,knowledge, skills, and access to medical equipment and testing for home birth attendantsacross 7 international sites. Methods: Face-to-face interviews were done by trained interviewers to assess level of training,knowledge and practices regarding care during the antenatal, intrapartum and postpartumperiods. The survey was administered to a sample of birth attendants conducting home or outof-facility deliveries in 7 sites in 6 countries (India, Pakistan, Guatemala, DemocraticRepublic of the Congo, Kenya and Zambia). Results: A total of 1226 home birth attendants were surveyed. Less than half the birth attendants wereliterate. Eighty percent had one month or less of formal training. Most home birth attendantsdid not have basic equipment (e.g., blood pressure apparatus, stethoscope, infant bag andmask manual resuscitator). Reporting of births and maternal and neonatal deaths togovernment agencies was low. Indian auxilliary nurse midwives, who perform some homebut mainly clinic births, were far better trained and differed in many characteristics from thebirth attendants who only performed deliveries at home. Conclusions: Home birth attendants in low-income countries were often illiterate, could not read numbersand had little formal training. Most had few of the skills or access to tests, medications andequipment that are necessary to reduce maternal, fetal or neonatal mortality. http://www.biomedcentral.com/1471-2393/12/34 Ana Garces Elizabeth McClure Elwyn Chomba Archana Patel Omrana Pasha Antoinette Tshefu Fabian Esamai Shivaprasad Goudar Adrien Lokangaka K Michael Hamidge Linda Wright Marion Koso-Thomas Carl Bose Waldemar Carlo Edward Liechty Patricia Hibberd Sherri Bucher Ryan Whitworth Robert Goldenberg BMC Pregnancy and Childbirth 2012, null:34 2012-05-14T00:00:00Z doi:10.1186/1471-2393-12-34 Little formal training for HBAs Home birth attendants (HBAs) in low-resource countries are often illiterate, lack basic medical equipment, and have little formal training, indicating the need to provide greater training in safe birthing practices and the recognition of life-threatening complications. /content/figures/1471-2393-12-34-toc.gif BMC Pregnancy and Childbirth 1471-2393 ${item.volume} 34 2012-05-14T00:00:00Z PDF Background: 39% of neonatal deaths in India occur on the first day of life, and 57% during the first threedays of births. However, the association between postnatal care (PNC) for newborns andneonatal mortality has not hitherto been examined. The paper aims to examine the associationof PNC for newborns with neonatal mortality in India. Methods: Data from District Level Household Survey, waive three (DLHS-3) conducted in 2007-08 isutilized in the study. We used conditional logit regression models to examine the associationof PNC with neonatal mortality. The matching variables included birth order and the age ofthe mother at the birth of the newborn. Results: The findings suggest no association between check-up of newborns within 24 hours of birthand neonatal mortality. However, the place where the newborns were examined wassignificantly associated with neonatal mortality. Moreover, findings do reveal that children ofmothers who were advised on 'keeping baby warm (kangaroo care) after birth' during theirantenatal sessions were significantly less likely to die during the neonatal period compared tothose children whose mothers were not advised about the same. Conclusions: The findings are relevant because 'keeping baby warm' is one of the most cost-effective andeasiest interventions to save babies from dying during the neonatal period. Thoughrandomized controlled trials have already demonstrated the effectiveness of 'keeping babywarm', for the first time this has been found effective in a large-scale population-based study.The findings are of immense value for a country like India where the neonatal mortality ratesare unacceptably high. http://www.biomedcentral.com/1471-2393/12/33 Abhishek Singh Awadhesh Yadav Ashish Singh BMC Pregnancy and Childbirth 2012, null:33 2012-05-09T00:00:00Z doi:10.1186/1471-2393-12-33 /content/figures/1471-2393-12-33-toc.gif BMC Pregnancy and Childbirth 1471-2393 ${item.volume} 33 2012-05-09T00:00:00Z PDF Background: When an ultrasound-based estimate of gestational age (GA) is less (greater) than an estimatebased on a definite last menstrual period, the fetus may grow slower (faster) than average.While the association between these discrepancies in GA estimates and adverse perinataloutcomes has been examined extensively, there is scant evidence about long-term effects,such as child neurodevelopment. Methods: Using data from a prospective cohort study titled, NICHD Study of Successive Small-for-Gestational Age Births, we examined if GA discrepancies in early second trimester ofpregnancy (17 weeks' gestation) are associated with: (1) impaired motor and mental functionat 13 months (measured using Bayley Scales of Infant Development (Bayley)), and (2)impaired cognitive development at five years (assessed by Wechsler Preschool and PrimaryScale of Intelligence - Revised Intelligence Quotient (WPPSI-R)) in the infant. The studypopulation consisted of 572 (30% of the overall sample of 1,945) women who presented forprenatal care in Norway and Sweden between 1986 and 1988. Results: Our results showed that GA discrepancies in early second trimester are significantlyassociated with birthweight. We found no significant relationship, however, with the Bayleydevelopment scores at 13 months and with the WPPSI-R IQ measures at five years. Conclusions: GA discrepancies at 17 weeks' gestation are not associated child neurodevelopment. Thesediscrepancies do, however, relate to birthweights, providing a basis for detecting fetal growthpatterns early in the second trimester of pregnancy. Our study, however, was unable toevaluate the impact of first-trimester discrepancies on impaired neurodevelopment in theinfant. http://www.biomedcentral.com/1471-2393/12/32 Jagteshwar Grewal Meghan Wernicke Jun Zhang BMC Pregnancy and Childbirth 2012, null:32 2012-04-30T00:00:00Z doi:10.1186/1471-2393-12-32 /content/figures/1471-2393-12-32-toc.gif BMC Pregnancy and Childbirth 1471-2393 ${item.volume} 32 2012-04-30T00:00:00Z PDF Background: Maternity services should take into account the needs of all women, including those related to disability. No reliable information, however, exists on the extent and characteristics of disability in this population in the UK. This brief report provides an overview of the prevalence of disability in women giving birth in the UK as measured by the presence of a limiting longstanding illness (LLI). The demographic, socio-economic, lifestyle and pregnancy related characteristics and child health outcomes are summarised to inform maternity and postnatal care service planning, and policy development. Methods: Secondary analysis of data on 18,231 mother-child pairs from the nationally representative UK Millennium Cohort Study. The baseline interviews with families were carried out in 2001-2002. The LLI prevalence in women who had recently delivered was estimated, and relevant characteristics and differences in outcomes compared using descriptive statistics taking into account the study design and non-response. Results: 9.4% (95% CI 8.7-10.0) of women who had recently given birth reported having an LLI. Musculoskeletal, respiratory and mental disorders accounted for most of the health problems. A significantly higher proportion of women with an LLI received means-tested financial benefits, had no educational qualifications and suffered from intimate partner violence compared to women who did not have an LLI (49.3% vs 35.3%, 20.4% vs 15.0%, 6.0% vs 3.3%, respectively). They were also more likely to smoke throughout pregnancy than women without an LLI (29.2% vs 20.8%), have a preterm birth (10.9% vs 6.8%) and be lone parents (19.5% vs 13.9%). Only 25.6% of children of mothers with an LLI were breastfed for more than three months compared to 33.4% of infants of mothers who did not have an LLI. At the age of seven years, 12.0% of children of mothers with an LLI had an activity limiting health problem themselves compared to 6.2% of children of mothers without an LLI. Conclusions: Disability in women who had recently delivered is relatively common. It is associated with social and economic inequalities and worse pregnancy and child related outcomes. Apart from condition-specific support during and after pregnancy, disabled women may require extra help from health professionals to quit smoking, continue breastfeeding, and reduce intimate partner violence. http://www.biomedcentral.com/1471-2393/12/31 Dana Šumilo Jennifer Kurinczuk Maggie Redshaw Ron Gray BMC Pregnancy and Childbirth 2012, null:31 2012-04-27T00:00:00Z doi:10.1186/1471-2393-12-31 /content/figures/1471-2393-12-31-toc.gif BMC Pregnancy and Childbirth 1471-2393 ${item.volume} 31 2012-04-27T00:00:00Z PDF