Day 1 :
- Midwifery care
Midwives in Maternal Care
Physician, Israelita Albert Einstein Hospital, Brazil
Dr. Tomaz Crochemore is physician, a specialist in intensive care medicine, whose area of expertise is in Hemostasis and Thrombosis, with extensive experience in the study of rotational thromboelastometry. Doctor responsible for the Support Group in coagulation and hemostasis of the intensive care unit of the Hospital Israelita Albert Einstein, São Paulo - Brazil.
Introduction: Acute fatty liver of pregnancy (AFLP) is a rare but life-threatening disease. AFLP is characterized by liver failure with different degrees of coagulopathy. Outcome and survival can be dramatically improved with prompt recognition and treatment. Thromboelastometry has been considered a point of care for the management of bleeding patients. It could, therefore, be an alternative tool to treat the complex cases of AFLP involving liver failure and coagulopathy. Through this study, we present our successful experience of an AFLP case that was submitted to an emergency cesarean section in which blood transfusion was guided by thromboelastometry.
Case presentation: We report the case of a previously healthy 28-year-old woman, Afro-Brazilian, in her first pregnancy with no medical records until the 36th pregnancy week. She presented to our emergency department with an acute onset of abdominal pain, jaundice, nausea and vomiting. The laboratory examinations revealed metabolic acidosis, acute kidney injury (serum creatinine 3.4mg/dL), platelets 97 x 103/mm3, serum fibrinogen 98mg/dL and increased international nationalized ratio (INR 6.9) without acute bleeding. An emergency cesarean section was indicated. Based on the results of the thromboelastometric tests EXTEM and FIBTEM, prothrombin complex concentrate and fibrinogen concentrate were administered at the beginning of the cesarean section, which succeeded with no major bleeding and without need of further transfusion.
Conclusions:Thromboelastometry may be considered a useful, feasible and safe tool to monitor and manage coagulopathy in obstetric patients with acute fatty liver of pregnancy, with the potential advantage of helping avoid unnecessary transfusion in such patients.
Christina Spyropoulos is a French physiotherapist and fitness instructor based in Australia. She has with over thirty years’ experience, specialised in pelvic floor wellness, particularly for pregnant and post-partum women. She has developed her unique program of post-natal fitness during her years in private practice, her collaboration with renowned French experts, and has developed and taught courses in her methods to physiotherapists and midwives. She is a passionate advocate of a ‘whole wellness’ approach to health and fitness for pregnant women and new mothers. Christina also has complementary skills in sports injury, lymphatic drainage, massage, and beauty with natural and non-invasive therapies
Urinary incontinence affects around a third of all post-partum women; this figure is higher for those experiencing vaginal delivery. Further to that, a majority of women experience some level of urinary incontinence as they age. Almost half of women who practice an intense sport also suffer from some degree of stress urinary incontinence. This condition can have an overall negative impact on a woman’s health by making it more difficult and uncomfortable to lead an active and healthy lifestyle and therefore make a maximum contribution to family life. The midwife is uniquely positioned to educate women at a particularly vulnerable time in their lives to develop practices that will help to shield them from this embarrassing condition. It is well known that the post-partum healing process cannot be hurried, but beginning the right exercise regime as soon as possible after delivery is critically important to the new mother’s long-term pelvic health. This presentation outlines the major types of incorrect exercises and sports for the first six months to one year after childbirth, explaining the irreversible damage caused to the pelvic area and diastasis, with the resultant risk of ongoing urinary incontinence and prolapse. Further, it will outline in detail Christina’s unique “Five Star Exercise Program” for post-partum women: body posture, pelvic posture, pelvic floor muscles, correct abdominal muscles, and correct breathing. A major advantage of this easy and comfortable program is that women in any physical condition (including overweight and obese) can participate and benefit. .
Queensland University of Technology, Australia
Shonel Hall has her expertise in Advanced Care Paramedic. She is Associate Lecturer in Queensland University of Technology, Australia
Statement of Problem: General obstetrics training is core to paramedic curriculum and targets normal deliveries as well as key emergency procedures for complicated deliveries. However training is generally quite limited and is frequently taught by paramedic educators and academics whose clinical birthing experience may be limited. Procedural training is limited to simulation models and few undergraduate Paramedic programs contain any obstetric clinical placement. Despite this limited training, paramedics are expected to be able to manage complicated birth, diagnose and treat a wide array of obstetric emergencies as soon as they enter the workforce. We sought to determine whether there is any peer reviewed evidence of a direct correlation between obstetric capability/confidence and educator type for paramedics
Poltekkes Kemenkes Riau, Indonesia
Rully Hevrialni has her expertise in Midwifery. She is from Department of Midwifery at Poltekkes Kemenkes Riau, Indonesia
Background.The quality of midwifery clinical education in the province of Riau Indonesia has a good reputation in the model of care. However, only the Poltekkes Kemenkes Riau is implementing care continuity of midwifery care from 17 other institutions. The purpose of this study is to explore the needs and feelings of the client, who was accompanied by students from 28 weeks to decide to become acceptors.
Methods.Longitudinal studies in 34 clients with the concept of OSOC conducted advocacy on mothers since pregnancy is 28 weeks with home visits, help birth mothers working area midwife practice where the mother stays, visits during childbirth, the care of the baby at home or in midwife practices and family planning counseling to the mother to be acceptors.
Result. Almost 75% of women feel safe accompanied by students, more students feel closer to the patient, waking interpersonal communication and good trust and behavioral changes in the mother and family. In addition the incidence of complications in pregnancy and childbirth can be prevented.
Conclusion.Continuity of care to the client given by students is very important applied in clinical education in midwifery institution of Indonesia. This care offers a great opportunity for the mother to give birth normally and avoid complications during pregnancy, childbirth, postpartum and infant. Mother strongly feel ready to face the delivery. Poltekkes Kemenkes Riau shifting patterns of clinical education with more attention to the values of the philosophy of midwifery care with an approach centered on women and sustainable concept OSOC.
University of Health Sciences, Switzerland
Claire de Labrusse is a midwife and a lecturer in the Midwifery School of the University of Health Sciences in Western Switzerland (Lausanne). Her research area is on expert skills in midwifery and patient-centred care in maternity services. Working as a midwife, and research fellow in several countries in Europe, Asia, central Asia enabled her to develop a reflexive approach to the diversity of maternity services and of midwifery from the different settings where she worked. She has published on midwifery expert skills, validation in French of a satisfaction scale, evaluation of maternity care in Swiss hospitals and about patient-centred approach and interventions in maternity; using a range of methodological approaches: mix methods, but as well hermeneutics and regression modelling
Providing patient-centred care (PCC) is one of the six goals described by the Institute of Medicine (2001) to deliver quality of care. Several interventions have targeted organisational and system levels, but it remains unclear how to design and implement interventions for patients. What is needed to improve the quality of care in maternity services is an evaluation of interventions that support PCC including healthcare providers (HCPs) and women’s perceptions. This study aimed to evaluate the extent to which: The Scottish Woman-Held Maternity Record in Scotland and the Prenatal Consultation with a Midwife Counsellor in Switzerland support PCC. This presentation will specifically focus on women’s perceptions of these interventions. As Scotland and Switzerland present major differences, a multiple case study approach with two cases was chosen. A mix method approach was favoured with policy review (n=20), medical record review (n=500), longitudinal interviews with women (antenatal and postnatal; n=58), and interviews with HCPs (n=32). Descriptive and framework analysis were used. Some of the key findings were: Scottish women addressed the need to have emotional continuity of care with their lead midwife, especially when complications arise. In complicated cases, continuity of care with the lead midwife was not specified in national policies. In Switzerland, women are looking to have some handheld information, especially about maternity pathways of care; with Non-Swiss women were less likely to seek an appointment with the midwife counsellor than other women, which raises the question of access to care for vulnerable women. Therefore, this study raised the importance to have individualised and timely information on options that would enable women to make decisions. Importantly, provision of care to socially-deprived women needed to be considered. This could be supported by having a clearer definition of the midwife role, and to fulfil the need elicited by women to have a continuity of emotional care with the lead midwife
Andaman Nicobar Islands Institute of Medical Sciences, Port Blair, India
Dr (Brigadier) Sukesh Kumar Kathpalia, superannuated after 37 years of service in Armed Forces and took over the present appointment. He graduated from AFMC Pune, did his PG from the same institute. He has presented papers at both national and international level. His paper was adjudged the best paper at 43rd AICOG Agra and was awarded CS Dawn prize. He has conducted many lectures and workshops on ‘Declining Sex Ratio’ and ‘Gender Sensitization’ He has been awarded an international prize in painting. His areas of interest are Perinatal Transmission of HIV, Social Obstetrics, Ethical issues in Medical Research and Contraception
In spite of many available contraceptives numerous unwanted and unplanned pregnancies occur. Though the couples desire contraception but are not able to accept it due to their ignorance and misconceptions. Intrauterine Contraceptive Device (IUCD); an effective contraceptive is usually inserted six weeks after delivery. It can be inserted within 48 h of delivery called postpartum insertion for which government has started the program in many states. The study was undertaken to find out the choices about contraception after delivery and awareness about postpartum insertion.
The present observational study was conducted in one of the zonal service hospitals. 500 antenatal cases were included in the study. Their choice of contraception after delivery and awareness was determined through a questionnaire. Reasons for refusal of postpartum insertion were recorded. A small sample of staff also was included in the study.
500 cases were included in the study, a large number had decided about contraception; mainly breast feeding supplemented by barrier contraceptive. 94 of 500 were willing for insertion of contraceptive device but not immediately after delivery due to apprehension in general and fear of side effects. Staff's awareness about postpartum insertion was poor.
Knowledge and acceptance of postpartum insertion is very low among antenatal women; probably because the concept is new in the community. There is a strong need to increase the knowledge and awareness about this by health education and counseling.
Institute Of Kidney Disease And Research Centre, India
Sumesh Choudhary, after serving for 22 years in Armed Forces , is working as an assistant professor in department of Obstetrics & Gynecology in IKDRC, Ahmedabad, India. He has an experience of about 4 years in management of high risk pregnancies in renal disease patients. He has three articles under his name about pregnancy in renal disease patient and renal transplant recipient. He has presented a paper on renal disease in pregnancy in national conference. He has a special interest in fetomaternal medicine and infertility.
Pregnancy in renal transplant recipient is a high risk pregnancy associated with increased risk of graft rejection and other complications. These patients require close monitoring during their antenatal and postpartum period. This is a retrospective study conducted at tertiary health center in Ahmedabad, from 2004 to 2016. Renal transplant recipients in reproductive age group (20-40 years of age) were included in this study and were followed up in gynecology outdoor patient department. There were 220 female renal transplant recipients, out of which 19 (8.63 %) patients have conceived, as 113 (51.36%) patients had complete family, 3 (1.36%) patients were infertile, 33 (15%) patients were lost to follow up and remaining 46 (20.91%) did not try for pregnancy. Unmarried patients, divorced and widow patients were excluded. Maternal and fetal outcomes were studied.There were 19 patients who conceived, out of which 8 patients had abortions, 2 patients had preterm delivery and 9 patients had full term deliveries. Out of 19 patients, 12 patients were chronic hypertensive. Six patients with chronic hypertension had missed abortion, whereas 2 patients delivered till term being mild hypertensive throughout pregnancy and one developed preeclampsia superimposed on chronic hypertension. Two patients developed newly diagnosed gestational hypertension from 20 weeks of gestation, out of which 1 patient developed preeclampsia at 8 months of amenorrhea. One patient had graft rejection 2 months post abortion and one had cholestasis of pregnancy from 7 months of gestation. On follow up, one patient expired following 1 year after abortion due to tuberculosis meningitis and one patient was on intermittent hemodialysis for 3 months, after 1.5 years of renal transplant. Renal transplant recipients are at risks for many complications during pregnancy, out of which graft rejection is the most grievous one. But with proper peri transplant and peri conceptional counselling regarding optimal time for pregnancy, these patients can have good pregnancy outcome.
Nursing program of Medical college, Nepal
Nirsuba Gurung is a B.Sc Nurse having experience of working in working in labor room of Teaching hospital of Kathmandu and as assistant lecturer in nursing programme of medical college in Pokhara. Currently studying masters in nursing in women health and development. Researcher is also involved in many health camps and community awareness programme.And had sound knowledge of computer ,SPSS and epidata
Mothering issue remains a focus of public concern because of their impact on both maternal and child health. Mothers do not naturally adapt to their maternal role performance during early postpartum period but they need to learn and adjust continuously. They must use their potential and strength to adapt with changing role. Mother who are able to cope successfully in transition to motherhood will gain mastery in their maternal role performance including role competence in infant care, relation with infant and satisfaction in their maternal role. The investigator conducted this study that would be helpful in determining the factors related to maternal role competence during the transition to motherhood and its effect on infant outcome
A descriptive cross sectional research design was used to conduct the study aimed to find our perceived maternal role competence among mothers of infant residing in Pokhara. A total 185 mothers of infant were selected by simple Random sampling technique. Standard tool “Parenting sense of competence” was used to assess perceived maternal role competence. The data were analyzed with descriptive and inferential statistics at 0.05 level of significance.
The mean score of perceived maternal role competence obtained by respondents was 72.48±8.33. The mean score of satisfaction and efficacy domain were 32.61±5.76 and 34.34±4.45 respectively. There was significant association of perceived maternal competence and age of the mother (p<0.022), educational status (p=0.011), employment status(p=0.019) and readiness for pregnancy (p=0.022). The study findings revealed positive correlation in between perceived maternal role competence and age of respondents (r=0.202, p=.006) and age at marriage (r=0.159, p=0.030)
There is need to support young mother to adjust in a new role of the mother. Higher education, along with better job opportunities and planned pregnancy are essential for proper infant care. Education and support by the nurses and family members is of utmost importance to boost up self esteem and increase competence in maternal role
Kilimanjaro Christian Medical University College, Tanzania
He was trained at Sokoine University of Agriculture (Tanzania), Master of Public Health from Kilimanjaro Christian Medical University College (Tanzania) and PhD in epidemiology and applied biostatistics from University of Bergen (Norway).
He began working at Kilimanjaro Christian Medical University College in 2007 as an assistant lecturer after completing his Masters in 2005, teaching Epidemiology and Biostatistics for undergraduate medical students. Currently is a working as a senior lecturer & head (Department of Epidemiology & Biostatistics), teaching Epidemiology, Biostatistics and Research Methodology for both undergraduate and postgraduate students as well as student supervision of their projects. He has a worth of experience from training and community oriented projects which equipped him with skills and competence in data management and analysis for large projects as well as research methods. His main research area is in Maternal New born and Reproductive Health particularly; pregnancy complications and perinatal outcomes, HIV/AIDS and Family Planning
Tanzania is one among the sub-Saharan Africa countries with high fertility rate and fast population growth rate. Despite these facts, the prevalence of modern contraceptive use and unmet need for family planning among women of reproductive age is still unacceptable (24%. vs 25.1%, respectively). Family planning is a crucial strategy to control population growth, reduce child mortality and improve maternal health. This study aimed to assess the prevalence and determinants of modern contraceptive use among women of reproductive age group (15-49 years).
University of Peradeniya, Sri Lanka
Malshani is a Nursing Educator at Faculty of Allied Health Sciences, University of Peradeniya, Sri Lanka. She has Bachelor degree (in Nursing) and Master degree (in Bio Statistics) from University of Peradeniya and currently reading for doctoral degree in Maternity Nursing at Niigata University, Japan. Her research interests are low birth weight, maternal nutrition and breast feeding.
Statement of the Problem: Many researchers revealed the association of smoking and low birth weight. The prevalence of low birth weight in Sri Lanka is quite high and it was 16.3% in 2012. The active smoking among Sri Lankan women is negligible, but almost all households use wood as the main cooking fuel. This study aimed to describe the patterns of second hand tobacco smoke exposure and wood fuel smoke exposure among Sri Lankan pregnant women and their effects on birth weight. Methodology & Theoretical Orientation: A prospective study was carried out in a tertiary-care hospital in Sri Lanka. Eighty seven pregnant women who visited the antenatal clinic at 30 weeks of gestation were asked to answer a questionnaire on passive smoking and kitchen wood fuel smoke exposure. Breath carbon monoxide concentration and percentage of blood carboxyhaemoglobin were measured using piCO+ Smokerlyzer® breath carbon monoxide monitor. Birth weight was obtained from the hospital records following deliveries. Findings: Second hand tobacco smoke exposure was found to be 34.48%. Women who exposed to daily tobacco smoke had delivered neonates with low mean birth weight (2727.5 ± 552.5 g) compared women who exposed about once a week (3056 ± 499.6) ( p<0.05). Inversely the percentage of blood carboxyhaemoglobin was significantly high in daily passive smokers (1.011 ± 0.273) compared to that of once a week (0.856 ± 0.113) (p<0.05). All most all women (96.55%) had exposed to wood fuel smoke. Of them only 85.71% women had a kitchen equipped with a chimney. The duration of cooking in a kitchen without a chimney showed strong positive correlation with percentage of blood carboxyhaemoglobin (r = 0.885; p = 0.003). Conclusion & Significance: Second hand tobacco smoke is associated with low mean birth weight. Long time excessive exposure to wood fuel smoke in a kitchen without a chimney can increase the risk of inhaling high concentrations of carbon monoxide and thereby may lead to adverse pregnancy outcomes like tobacco smoke
Bridge Consultants Foundation, Pakistan
Aamir Nadeem background includes business management and finance, but for the past few years he have been associated with public health and research. Currently Aamir Nadeem is working at Bridge Consultants Foundation, which is a non-governmental organization that works primarily on projects related to infectious diseases including tuberculosis, HIV, malaria and polio, in Pakistan. His present responsibilities include monitoring of activities in a research project on TB/HIV co-infection, in which he work as a field supervisor. Prior to this he also obtained some experience in a project titled ‘Community Home Based Care for people living with HIV (PLHIV)’. In that project they provide medical and social services to PLHIVs and also to their families
Statement of the Problem: Almost 30 years into the HIV epidemic, women account for nearly half of the 36.7 million people living with HIV worldwide, with an even higher proportion in developing countries. Apart of sub-Saharan Africa, women are at least twice more likely to acquire HIV from men during sexual intercourse than vice versa. The aim of the study was to identify the social determinants of HIV transmission among women in Karachi, Pakistan.
Data were obtained and analyzed from a community home based center (CHBC) site established in Karachi with support of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) to provide medical and social services to people living with HIV (PLHIV). These data included primary social determinants for acquiring HIV like age, sex, education level, income, social status, homelessness, access to healthcare and opportunities for HIV testing as women.
Between March 2012 and September 2016, we recruited 424 PLHIVs of whom 31 (7.3%) were women. Their mean age was 30.3 years and average years of education was 5 years. All 31 women were married and were economically dependent on their husbands. All 31 women were living with their husbands and children. Although all of them had access to healthcare, perceived stigma and discrimination led to difficulties in accessing needed facilities and voluntary HIV testing. None of the 31 PLHIV women knew HIV status of their spouses at the time of their own HIV testing. HIV-infected women registered at CHBC in Karachi were married and economically dependent, and poorly literate, presenting challenges in accessing care. The social determinants related to acquiring HIV among women include poor communication and gender-power relationships with spouses. Strategic interventions can be developed to empower Pakistani women for prevention, testing, and treatment access
Mohammad-Hossein Biglu is a clinical psychologist. His expertise is in evaluation, passion and improving the health and wellbeing of women.
Women health is one of the most important issue due to the main role of women in the society as mothers and wives. The physical and psychological status of women ply an impressive role in the families. Their psychosomatic situation influences on the well-being of all member in the family. The objective of current study was to investigate the effect of female circumcision on physical and mental health of circumcised women in comparison whit non-circumcised women in the same area.
Amirkabir University of Technology, Iran
Fatemeh Baghbani has a PhD in biomedical engineering-biomaterials from Amirkabir University of Technology. During her PhD, she was focused on development of ultrasound responsive polysaccharide stabilized perfluorocabon nanodroplets for the treatment of breast cancer and overian cancer and accomplished interesting results in vivo
Statement of the Problem: Development of multidrug resistance (MDR) mediated by overexpression of P-glycoproteins is one of the major obstacles to effective cancer chemotherapy. Ultrasound-responsive perfluorocarbon nanoemulsions are a class of new multifunctional smart nanocarriers which combine diagnostic properties with therapeutic properties and release their drug payload in a controlled manner in response to ultrasound. Therefore, combination therapy using chemoterapeutic and chemosensitizing agents co-entrapped in these nanocarriers seems beneficial for bypassing MDR in overian cancer.
Methodology &Theoretical Orientation: In the present study, multifunctional smart alginate/perfluorohexane nanodroplets were developed for co-delivery of doxorubicin and curcumin (a strong chemosensitizer). Findings: The nanodroplets with the average particle size of 55.1 nm were obtained via nanoemulsion process. The entrapment efficiency of doxorubicin was 92.3%. Ultrasound-mediated drug release kinetic was evaluated at two different frequencies of 28 kHz (low frequency) and 1 MHz (high frequency). Low frequency ultrasound resulted in higher triggered drug release from nanodroplets. The nanodroplets showed strong ultrasound contrast via droplet to bubble transition as confirmed via B-mode ultrasound imaging. Enhanced cytotoxicity in adriamycin-resistant A2780 ovarian cancer cells was observed for doxorubicin-curcumin loaded nanodroplets (Dox-Cur-NDs) compared to doxorubicin loaded nanodroplets (Dox-NDs) because of the synergistic effects of doxorubicin and curcumin. However, ultrasound irradiation significantly increased the cytotoxicity of Dox-Cur-NDs. Finally, in vivo ovarian cancer treatment using Dox-Cur-NDs combined with ultrasound irradiation resulted in efficient tumor regression. According to the present study, nanotherapy of multidrug resistant human ovarian cancer using ultrasound responsive doxorubicin-curcumin co-loaded alginate-shelled nanodroplets combined with ultrasound irradiation could be a promising modality for the future of cancer treatment
Hamadan University of Medical Sciences, Iran
Prisa Parsa has her expertise in mother and child health. She is teaching and administration in hospital and education institutions
Introduction: Improvement of maternal-fetal attachment can be used to the address of maternal psychological needs. The aim of this study was to determine the effect of consultation in the primi-parous mothers on Maternal-Fetal Attachment (MFA) in 1394 in Hamadan city.
Methods: This study was a quasi-experimental study. Subjects were 110 women in the 32-30 weeks gestational age . Participants were randomly assigned to two experimental and control groups (each group, n = 55). The data collected included demographic information, and standard Cranley questionnaire to measure the MFA. Before the consultation questionnaire was completed by both groups. The four weekly sessions during a month were conducted in case group. While the control group received only routine care. Two weeks after the consultation, the two groups were re-examined. Changes in maternal-fetal attachment between the two groups and within groups were compared.
Results: After consultation, there was a significant difference between case and control groups on the mean of MFA scores (P>0.01). The mean of MFA has increased significantly in case group (P<0.01). However, no a significant change was observed in the control group.
Conclusions: Consulting of MFA behavior can be used to promote mother-fetus relationship during prenatal care.