Objective Postpartum hemorrhage (PPH) is a major cause of maternal mortality world-wide; misoprostol is a relatively cheap, easily administered, and an efficient medication to be given after the delivery of the baby to prevent PPH, thus posing it as a first choice in resource-poor communities. The aim of this study is to answer questions regarding the most appropriate dose (400 µg versus 600 µg), effect of labour settings (community or clinical), and management of labour on misoprostol effectiveness and safety in preventing PPH. Methods We developed a search strategy and conducted a search within five key databases. Two reviewers screened the articles for predefined inclusion/exclusion criteria, quality, and performed data extraction. Discrepancy was dealt with by reaching consensus. In article 1, we only included randomized controlled trials, we performed a random-effects Bayesian network meta-analysis comparing 400 µg to 600 µg misoprostol over five outcomes of interest: blood loss ≥500 ml, blood loss ≥1000 ml, using additional uterotonics, shivering, and pyrexia. In article 2, we included any experimental trial, we performed a random effects model meta-analysis, pooling the incidence of PPH from each misoprostol arm. Subsequently, a meta-regression model was performed on identified potential effect-modifiers, including clinical settings and labour management. Results Of 444 identified records, 46 trials met the inclusion/exclusion criteria in article 1, and 56 trials in article 2. The odds ratio (OR) of misoprostol 400 µg vs. 600 µg for bleeding ≥ 500 ml is 0.86 [95% Credible Intervals: 0.46 − 1.54], for bleeding ≥ 1000 ml the OR is 0.83 [95% CrI 0.54 – 1.26], for additional uterotonics is 0.75 [95% CrI 0.40 – 1.40], for pyrexia and shivering an OR of 0.57 [95% CrI 0.15 – 2.18] and 0.63 [95% CrI 0.29 – 1.31] respectively. The overall incidence of PPH was 6.62 per 100 pregnancies (95%CI 4.71 per 100 – 8.53 per 100). Labour settings and other aspects of active management of labour had no statistically significant effect on the incidence of post-partum hemorrhage. Conclusion We found no difference between the administration of misoprostol 400 µg or 600 µg for the prevention of PPH and side effects of misoprostol, as well as no effect of labour settings and management of labour on misoprostol effectiveness.

No description available.

Abstract Background Regular physical activity is an important part of a woman’s health. There are no Swedish guidelines regarding physical activity during the postpartum period which leads to limited knowledge in healthcare. This lack of knowledge shows a need to examine postpartum women´s personal experience of information regarding physical activity and exercise after childbirth.   Objectives To investigate postpartum women’s experience of information regarding physical activity and exercise after childbirth.    Method A quality descriptive study design was used. Six semi-structured interviews with postpartum women were conducted and analysed with a quality content analysis.    Results The analysis revealed six categories and nine subcategories regarding the informants’ experiences. The informants experienced insufficient information regarding physical activity and exercise after childbirth. All the informants described the information as general and desired to obtain personalized advice regarding physical activity and exercise.   Conclusion Women experience lack of information after childbirth. There is no guidance on how physical activity and exercise should be performed. Individualized information regarding physical activity and exercise could contribute to better health for the postpartum woman. / Sammanfattning Bakgrund Regelbunden fysisk aktivitet är en viktig del av livet för kvinnors hälsa. Kunskapen hos vården är begränsad då det inte finns några svenska riktlinjer för fysisk aktivitet och träning efter förlossning. Kunskapsbristen hos vården visar ett behov av att undersöka nyförlösta kvinnors egna upplevelser av information angående fysisk aktivitet och träning efter förlossning.    Syfte Att undersöka nyförlösta kvinnors upplevelser av den information som givits angående fysisk aktivitet och träning efter förlossning.    Metod En kvalitativ deskriptiv design användes. Semistrukturerade intervjuer genomfördes med sex nyförlösta kvinnor och materialet bearbetades genom en kvalitativ innehållsanalys.   Resultat Genom analysen framkom sex kategorier och nio subkategorier gällande informanternas upplevelser. Informanterna upplevde att de fått otillräcklig information angående fysisk aktivitet och träning efter förlossning. Samtliga informanter beskrev informationen som generell och önskade erhålla individanpassade råd angående hur de skulle träna efter förlossning.   Konklusion Kvinnor upplever att informationen som erhålls efter förlossning är bristande. Det saknas vägledning i hur fysisk aktivitet och träning bör utföras. Individanpassad information angående fysisk aktivitet och träning skulle kunna bidra till bättre hälsa för den nyförlösta kvinnan.

Prenatal and postpartum care are important for reducing maternal and infant morbidity. Racial and ethnic disparities are prevalent in maternal peripartum health and infant birth outcomes as well as peripartum care access and utilization. They highlight the need to identify and better understand correlates of poor prenatal and postpartum care compliance. While risk factors for low adherence to peripartum care have been identified, no studies have looked specifically at predictors of prenatal and postpartum care attendance in an at-risk sample of African American pregnant women. Using existing data from an RCT targeting maternal and infant health disparities and comparing a patient navigation/behavioral incentive intervention to treatment as usual, the present study sought to identify predictors of prenatal and postpartum care attendance. Participants were African American women at risk for poor prenatal care compliance, who participated in the RCT and had a documented live birth (n=123). Using hierarchical linear and logistic regression, the study identified predictors of prenatal and postpartum care attendance, respectively. The study found high-risk pregnancy (p < .001) and fewer barriers to care (p = .013) significantly predicted better prenatal care attendance. Less than adequate prenatal care attendance significantly predicted postpartum visit nonattendance (p < .001). In addition, given that study participants were limited to women who provided informed consent to RCT participation, the present study also examined representativeness of the clinical trial sample. Specifically, women who consented to the RCT (consenters; n=149) were compared to those who did not (non-consenters; n=122) on a variety of demographic and psychosocial variables using chi-square for categorical variables and t-tests for continuous variables. Consenters and non-consenters differed only on education level, with consenters more likely to have at least a high school education than non-consenters. The present study provides benchmark data on sample representativeness and predictors of peripartum care in a clinical trial of strategies to improve prenatal care compliance. These findings could have important implications for healthcare system changes and treatment interventions among this population.

No description available.

No description available.

Postpartum hemorrhage (PPH) is the leading direct cause of maternal mortality worldwide, with the majority of deaths taking place in the least developed countries of the world. Low- and middle-income countries (LMICs) have increased rates of PPH due to lack of access to healthcare, inadequate number of care providers and availability of interventions and resources needed. PPH has four main etiologies: uterine atony, trauma, retained placenta and coagulopathy. The most common and challenging to treat is uterine atony, where a lack of uterine contractility leads to massive hemorrhage postpartum. Specific risk factors have been identified that increase a woman’s risk of developing PPH. Risk factors of PPH can be categorized as biological, demographical and social risk factors. Many people in LMICs experience a lot of the social risk factors like lack of providers, skilled facilities and resources available to them in case of an obstetric emergency. Home births are also a common practice in many LMICs, placing a woman further from any resources she may have had access to if she was at a health facility. PPH can also occur in women without risk factors and requires that providers always be prepared to treat it. Interventions to treat PPH are well known and encompass both pharmacological and non-pharmacological interventions that are usually tried in a least to most invasive order. The first line of intervention is often to administer a uterotonic drug, preferably oxytocin. This poses a challenge to LMICs because oxytocin requires a cold-chain storage, which many LMICs countries lack. Therefore, uterotonics and non-pharmacologic interventions have increasingly been used in these regions. The final and ultimate life saving measure to stop bleeding is a hysterectomy, which is often not available in these rural places where home births take place, and has led to higher mortality rates. Prevention measures of PPH include increasing antenatal care (ANC) use and practicing active management of the third stage of labor (AMTSL) with all pregnancies. Use of ANC and ultrasound technology can help identify the biological risk factors that make a woman more likely to experience PPH. Solutions to lowering the occurrence of PPH in LMICs involve increasing resources and access to healthcare. An important part to increasing access is increasing the number of skilled health facilities and health providers. Community health workers (CHW) and skilled birth attendants (SBA) are vital to increasing the amount and acceptability of care in these regions. These workers are trusted members of the community that can help educate and bring resources to women, as well as women to the resources. Solutions to stopping PPH need to consider the affordability, acceptability and accessibility in order to reach people in remote areas with limited resources. Both immediate short-term interventions and long-term, longitudinal healthcare reform are necessary to save mothers in LMICs.

Postpartum depression affects between 10 - 15% of all mothers within the first year after giving birth (Dietz, 2007; Epperson, 1999).  Studies that have focused on women's experiences of postpartum depression have found similar in experience of contrast between women's expectations of motherhood, and their actual experiences (Beck, 2002; Knudson-Martin & Silverstein, 2009; Mauthner, 1999).  Using a phenomenological approach, this study sought to explore women's experiences of contrast, understand how this experience contributed to their social construction of what motherhood meant, and ask if and how women might change the messages that they receive regarding being a mother. Seven women were recruited from a postpartum depression support group and interviewed in a focus-group setting.  Respondents noted that they experienced a great contrast between their expectations of motherhood and what they actually experienced.  These expectations, however, seemed ambiguous and generic.  Women reported that they were surprised by the amount of judgment and pressure they felt surrounding being a mother.  Participants seemed to challenge their preconceptions about being a mother by focusing on making choices that were best for them and their children and by allowing unhappy feelings to be compatible with their definition of a good mother.  Women in the study described wanting to hear messages that were honest and open about the realities of motherhood, both from the media and in their interactions with other women and loved ones.  Participants also seemed to feel strongly that more efforts should be made to reach out to new mothers. / Master of Science

Thesis (M.S.C.E.) / OBJECTIVES: Half of all U. S. pregnancies are unintended, and of these, about 6 out of 10 are carried to term. These are known as “unintended births,” and they are at elevated risk for adverse social, economic and health outcomes. The goal of this study was to examine, using the latest data from the National Survey of Family Growth (2006-2010), whether women with unintended births were more likely than their counterparts to use effective postpartum contraception. METHODS: In this retrospective cohort study of U.S. women ages 15-44, all births within three years of the study interview were classified as intended or unintended, and the method and timing of postpartum contraception were ascertained. Our primary outcome was time to initiation of a highly effective postpartum contraceptive method during the first postpartum year. Highly effective contraception was defined as a method with less than one pregnancy per 100 woman-years of typical use. Secondary outcomes included time to initiation of any contraceptive use over the first postpartum year, and postpartum contraceptive non-use. RESULTS: Complete data was available for 2,691 births. Young, black, undereducated, unmarried, and poor women, as well as those who paid for their delivery with Medicaid were more likely than their counterparts to have unintended births (p<0.0001). After adjustment for confounders, women with unintended births were 1.4 (95% CI: 1.2-1.6) times as likely to use highly effective postpartum contraception compared to women with intended births. During the first month postpartum, women with unintended pregnancies were 0.8 times as likely to use no contraceptive method as women with intended births (95% CI 0.7-0.9, p=0.0046); there were no differences between groups for the rest of the first postpartum year. Married women, white women, women with college degrees, and women with who were giving birth for the first time were somewhat more likely than others to initiate effective contraception after an unwanted pregnancy. CONCLUSION: A relatively small difference in time to initiation of highly effective postpartum contraception, along with an almost 1 in 5 prevalence of postpartum contraceptive nonuse for the entire first postpartum year, indicates that women in this study sample are not well-prepared to prevent recurrence of unintended birth. These results add to the body of data supporting effective postpartum contraception as a public health priority.

Objective To reduce prevalence of anaemia in low-income postpartum women.Design A randomised, non-blind clinical trial was conducted among 959 low-income, postpartum women in eleven clinics in Mississippi. The clinics were randomised to one of three treatment groups: (i) selective anaemia screening of high-risk women as recommended currently (control); (ii) universal anaemia screening and treatment of anaemic women (group I); and (iii) universal Fe supplementation of 65 mg/d for two months to all low-income women (group II). All study participants within each clinic received the same treatment. Women were followed up at 6 months after delivery. Hb was measured at baseline and at follow-up. The primary outcome variable was the proportion of women with anaemia after treatment.Setting Eleven health clinics in Mississippi.Subjects Low-income, postpartum women.Results Baseline characteristics of the three study groups were compared using one-way ANOVA and an appropriate post hoc test for continuous variables and the χ 2 test for categorical variables. Fifty-two per cent of postpartum women were anaemic (Hb < 12.0 g/dl) and the rate decreased to 33 % at 6 months after the intervention. Group II women, who received universal Fe supplementation, improved their Hb status significantly (P < 0.001) at 6 months postpartum compared with the other groups. Prevalence of anaemia was also significantly lower among group II women (22.5 %) compared with controls (34 %) and group I women (43 %; P < 0.001).Conclusions A universal Fe supplementation strategy was effective in reducing the prevalence of anaemia among low-income postpartum women.