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Democrats set up policy committee
Democrat Party's Korn Chatikavanij Monday revealed the setup of a policy committee, consisting of 15 members.
Among the members are former foreign minister Kasit Bhirom and Nipon Wongtrangan, a former president of the Thai rice Millers Association.
According to Korn, they will draw up strategies to address national problems in all front.
The strategies will deal with the problems in the short to long term. They will be completed in four months.
He said that the team would discuss with academics and other parties before drafting the strategies.
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I am a time traveler from the year 2020......
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all of you need to stop calling this guy a lunatic becuase we have absolutely no idea about alot of things. we have no idea what the government is experimenting with / or the technologies involved - case in point - he seattle lawyer who claims to be a time traveler as a child in US Military experiments, - claims that NIKOLA TESLA was working with the Military on time travel experiments and that FBI raided his apartment after his death to retrieve documents on said experiments. the point is that ALL WE HAVE IS RUMOR AND SUSPICION at this point. open your minds and the truth will FIND YOU.i have noticed with this forum that most know more about the real play than others. i wouldnt entirely discount it.. but seek out the proof behind it.
badkittie748 7067524
your gov actually got time travel technology, but this clown know nothing about the real deal.
or even if he's in the know, he's just psy-opsing.
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Bangalore Inc. gets baby-friendly, opens up to #MumsWithoutBabysitters
There's a 48% dropout rate in working women before they hit 30 years of age.
Bangalore gets its first premium lifestyle 'Quirk Card' for diners
With the kick-off in Bangalore, diners would be able to avail a flat 25 pe...
Mock drill at Delhi's IGI airport to deal with radioactive emergency
Security personnel participated in a mock drill to deal with radioactive...
You could soon be travelling from Chennai to Bangalore in just 30 mins with Hyperloop technology
Hyperloop Transportation Technologies, a US startup, is hoping to revolutionise travel in India based on a concept championed by Elon Musk.
Bangalore university split: Skill-based courses on offer at new varsities
The new university, along with its twin Bangalore Central University - also to be carved out of Bangalore University, will start functioning from next academic year.
Delhi HC deferrs order blocking Gennova's Biosimilar
Gennova's drug can't be approved as a biosimilar of tenecteplase as the original drug isn't prescribed for strokes, argued P Chidambaram, counsel for Deep Das
Delhi Assembly ratifies "big reform" GST bill
"We support it. We support tax reform. Delhi is a service state and it (the bill) is quite useful," Sisodia said in reply to a debate on the bill in Delhi assembly.
Delhi LG Jung felicitates veteran freedom fighters
In a ceremony held at Raj Niwas, Lieutenant-Governor Najeeb Jung interacted and felicitated veteran freedom fighters who played significant roles in the nation's freedom struggle. The event that was part of the Independence Day celebrations was titled 'Azadi 70- Yaad Karo Qurbani'.
Will fight for full statehood of Delhi: Kejriwal
Without making any direct reference to anyone or referring to the recent high court judgement, Delhi chief minister Arvind Kejriwal launched a scathing attack on the Central government saying that he and his government will fight for full statehood for Delhi and go to any extent to make it happen for the benefit of the people of Delhi.
No plan to ban alcohol in Delhi, clarifies Manish Sisodia
Deputy Chief Minister Manish Sisodia said the Delhi government has no plan to ban liquor in the city even as he maintained that the AAP dispensation does not want to run the city administration with money collected from sale of alcohol in the national.
Irrfan Khan to visit Bangalore college for 'Madaari' promotions
The subject intrigued Irrfan Khan so much that he even turned producer for 'Madaari'. The movie is all set to release on July 15.
Delhi Metro readies soundproof stretch
According to Delhi Metro officials, the elasticized mass spring system basically helps mitigate the vibration generated by a passing train at the source.
Delhi's IGI airport not passive to radioactive threat
This incident triggered a series of meetings and all authorities were roped in to fill in the gaps and ensure fool-proof operations in the future.
Airtel rolls out 4G network capacity in Bangalore
In November 2015, Airtel commenced the implementation of its network transformation program - Project Leap.
How much longer can Bangalore's tech giants hide?
The technological landscape is shifting dramatically. Companies could once draw clear distinctions between the core of their business and extraneous IT work that could be outsourced.
Speeding car mows down Delhi Police constable
A 54-year-old Delhi Police head constable was killed when a speeding car driven by an 18-year-old rammed into his motorcycle while he was on way to work, police said. The errant driver has been arrested.
Delhi: 5 criminals arrested after encounter in Rohini
An encounter broke out between police and criminals in Sector-24, Rohini. A policeman and two criminals have been injured. Five people have been arrested by the police.
Bangalore-based startup Altigreen has a low-cost solution to convert diesel cars into hybrid
The product will be eligible for excise cut and subsidy under the FAME Scheme from Govt of India. This will make the solution much more affordable and accessible to people.
Dipa Karmakar gets hero's welcome at Delhi airport
Gymnast Dipa Karmakar, who made India proud at the Rio Olympics 2016, was welcomed with great fanfare at the Delhi airport.
ACB knocks on Delhi Commission for Women doors
No FIR has been filed yet; the ACB sleuths intend to question DCW officials and examine recruitment documents before proceeding further.
Minimum wages hiked in Delhi despite protests
The minimum wage of unskilled labour has gone up from Rs 9,568 to Rs 14,052, for semi-skilled it has been revised from Rs 10,582 to Rs 15,471.
IIT Delhi launches WEE to strengthen the women ecosystem
The chief guest for this occasion was Deepa Malik, an Arjuna awardee and the only woman Para-athlete from India to represent India in RIO paralympics 2016.
Clean chit to DLF in Delhi's realty spat
India's largest real estate firm DLF has got clean chit in Delhi's property spat, said COMPAT.
Power failure hits Delhi Metro
Commuters said the trains ran at slow speed and stopped longer than normal at various stations during the disruption.
Chikungunya on the rise in Delhi, but under-reported
A typical chikungunya patient manifests high-grade fever, severe joint pain, headache, muscle pain, joint swelling, or rash.
Arvind Kejriwal reiterates demand for Delhi's statehood
The Aam Aadmi Party (AAP) leader quoted the late Brahm Prakash's son as saying that his father too fought doggedly to secure statehood for Delhi.
US Secretary of State John Kerry to travel to Dhaka and New Delhi
The US Secretary of State John Kerry would travel to New Delhi to attend the second India-US Strategic and Commercial Dialogue, the State Department announced.
Delhi High Court holds stay order on ITC suit against Britannia
A notification issued by Britannia to the stock exchanges said the court has fixed the next date of hearing on August 31, 2016.
On cam: Hit by tempo, man dies on Delhi road
A 40-year-old e-rickshaw driver was killed after being hit by a speeding tempo in west Delhi's Subhash Nagar. Police said the victim, identified as Matibool, a resident of West Bengal, lay bleeding on the road for close to 90 minutes before they reached the spot. No one had come to his aid in the meantime.
Bangalore Metro to invite startups to set up offices at its stations
Bangalore Metro Rail Corporation Ltd currently has 31 stations operational along 18 km from Baiyappanahalli to Mysuru Road and along 13 km from Nagasandra to Sampige Road.
Telcos to be asked to provide Mumbai with network connectivity at par with Delhi
Deepak said the department will also be discussing the possibility of erecting telecom infrastructure on the railway network, for the benefit of passengers.
Police say honking highest at traffic junctions in south, central Delhi
Police said incessant honking was the biggest source of noise pollution at those stretches. So they set up three-member teams to challan drivers honking too much.
Blame game over Chinese manja on first day of Delhi assembly session
The first day of the Delhi Assembly's four-day session saw heated exchanges with the AAP alleging a nexus between the Centre and the Chinese manja "mafia" behind the import of the glass and metal-coated thread that recently claimed three lives in the city.
Reliance pleads with Delhi HC to quash AAP's FIR against it
In the Delhi High Court, Reliance Industries counsel Harish Salve questioned the Delhi government's authority to lodge the FIR in the first place.
Centre preparing ground to impose President rule in Delhi: Manish Sisodia
Sisodia said that land, police and public order, the AAP government has power on all issues including services, ACB despite Delhi being not the full statehood.
Hotel Leelaventure seeks shareholder approval to sell prime Delhi, Chennai properties
Its total income from operation was up 7.82% to Rs 148.98 crore during the quarter under review as against Rs 138.17 crore in the corresponding quarter last fiscal.
Leela Hotel seeks shareholders' nod to sell Chennai,Delhi properties
Located at Adyar Sea Face in the city, the Leela Palace, Chennai has a capacity of 326 guest rooms while the Leela Palace, New Delhi has a capacity of 254 guest rooms.
Eleventh edition of MMMM 2016 to start on Wednesday in Delhi
MMMM 2016 offers a platform for industry professionals to establish JVs, partnerships and associations besides offering opportunities for sourcing, dealership.
Sakshi Malik to be awarded Rs 1 crore by Delhi government
Sisodia also announced a promotion for Sakshi's father, Sukhbir Malik, who works as a bus conductor in Delhi Transport Corporation (DTC).
Police constable shot dead by unidentified chain snatchers in Delhi
A police constable was shot dead by unidentified miscreants after he tried to catch the criminals who were escaping after snatching a woman's chain in Shahbad area of Delhi.
Now use your Delhi Metro card for DTC bus also
On Friday, DTC took the first step by using the Delhi Metro card on the electronic ticketing machines installed on its buses.
Caught on cam: Delhi cop beats up man at bus stop
A policeman was caught on camera thrashing a man on the allegation of theft at a bus stop in national capital.
Delhi government notifies implementation of 7th Pay panel recommendations
The hike in pensions and salaries will cost the exchequer around Rs 2,000 crore annually. The notification was issued after Lt Governor Najeeb Jung gave his approval for the same
GST bill will be placed in Delhi Assly during 4-day session
The AAP government has already made it clear that it is in favour of GST, which would subsume a number of indirect central and state levies.
The Urban Debate: Who is responsible for Delhi now?
In the latest episode of 'The Urban Debate', experts debate on the Delhi high court's ruling that Delhi is a Union territory despite presence of an elected government. The judgment also gave the LG final word as the administrator in charge of the city.
Startup Capital conferences planned for Delhi and Bangalore
Both the conferences will feature panel sessions on local startup ecosystems and what opportunities and challenges they face.
Delhi High Court asks Payal Abdullah to 'gracefully' vacate government bungalow
Payal, who has been residing at 7, Akbar Road bungalow since 1999, however, refused to move out and urged the court to pass an order.
Delhi shootout unravels Pak-Nepal-India weapons trail
After a late night shootout at Sarai Kale Khan, the Special Cell of Delhi Police arrested two gunrunners from UP with 10 sophisticated weapons.


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A wiser person than me once said, "Before you judge someone, walk a mile in their shoes... that way, when you do judge them... you're a mile away and you've got their fuckin' shoes!" I love to laugh, hopefully you do too. If you don't, you should probably kick rocks. I'm...
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Dear Abby: Should I thank guest who ruined reception?
Clinton aide Abedin dumps husband Weiner over new scandal
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Life hacks for living cheaper in the Bay Area
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Actor Gene Wilder, star of Mel Brooks movies, dies at 83
Ann Coulter Gets Burned at Rob Lowe's Comedy Central Roast
Posts filtered on Category
Keba Konte: Bringing color into the white world of third-wave coffee
By Tracey Taylor BERKELEYSIDE NOSH: Keba Konte would like to inject some diversity into the primarily white world of third-wave coffee. As he puts it: "The last brown person involved in your coffee is …
The mystery of the 'Berkeley boom'
By Emilie Raguso BERKELEYSIDE: Residents around Berkeley have wondered online for more than a month about a recurrent nighttime boom that has woken babies, freaked out pets and set off car alarms. The …
Downtown Berkeley worker assaults homeless man (video)
By Lance Knobel BERKELEYSIDE: A staffer for a downtown Berkeley business group assaulted a homeless man Friday in what appears to be violent incident that was captured on video. That homeless man and …
A thoughtful Berkeley note to a Wall Street Journal thief
BERKELEYSIDE: Here in Berkeley, when we scold our neighbors, we add a little extra flourish. Reader Marty Schiffenbauer shared the photograph above which he took a few days ago. The notice was posted …
Animal legs, dead birds wash up on Berkeley beach
By Emilie Raguso BERKELEYSIDE: A woman on a walk along a Berkeley beach Thursday with her dog stumbled on two decapitated chickens, two skinned mammal legs with cloven hooves, and several dead …
Man died after 23-minute delay for paramedics during Berkeley protests
By Emilie Raguso BERKELEYSIDE: They were just blocks away, but it took paramedics 27 minutes during the Berkeley protests in December to reach a man who later died, according to documents obtained by …
Comedian W. Kamau Bell victim of "textbook racism" at Berkeley café
By Tracey Taylor and Frances Dinkelspiel BERKELEYSIDE: Popular comedian W. Kamau Bell was told to "scram," or words to that effect, by an employee at the Elmwood Café in Berkeley as he was chatting to …
Pilot flew fighter jet low over Berkeley to say 'hi' to his Cal grad student brother
By Emilie Raguso BERKELEYSIDE: It has emerged that the fighter jet that flew low over the city of Berkeley on Tuesday, triggering car alarms as well as alarm among many local residents, was being …
Head trauma led to Cal student's death
By Emilie Raguso BERKELEYSIDE: The man who died in Berkeley's Southside neighborhood early Saturday was a 20-year-old from San Ramon pursuing a double major in mathematics and economics at UC …
Berkeley prepares new cell phone radiation safety law
By Emilie Raguso BERKELEYSIDE: The city of Berkeley is considering whether to require local retailers to give out radiation-related safety sheets to cell phone customers who make a purchase. Last …


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This book is perfect for those looking for something to bridge the gap between grades. Selected for the ABRSM Alto and Baritone Saxophone Examinations Grades 1 and 2.
Thirteen pieces covering the Baroque to the present day for saxophonists of grades 4-6 standard, selected and arranged by Ian Denley.
Three Piece Suite for alto saxophone and piano is a transcription made by the composer in 1996 of three movements from his Four Piece Suite for two pianos of 1974. For ABRSM examinations.
The Light Touch is a fabulous collection of graded pieces for Alto Saxophone and Piano. There are five glorious examples of Light saxophone music in various styles all of which are characterised by the light touch!


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It is often assumed that giving birth is both stressful and painful for the mother. This may be the case for humans but does it also apply to horses or are we transferring human experiences to the animals?
Scientists at the Vetmeduni Vienna have investigated the stress associated with birth in horses and other domestic animals. The findings show that contrary to expectations horse mares appear to be completely relaxed when foaling. The results are published in the Journal Theriogenology.
Foaling appears to cause the opposite of a stress response.
(Photo: Vetmeduni Vienna)
Foaling in horses is extremely fast. Labour and the active part of foaling, resulting in delivery of the foal, take 10 to 20 minutes and are considerably shorter than giving birth in humans or in cows. Is this brief period stressful for the animals or are horses more relaxed than humans when giving birth?
This issue has been addressed by Christina Nagel and colleagues, who closely observed 17 foalings at the Brandenburg State Stud in Neustadt (Dosse), Germany, as well as recording electrocardiograms before, during and after foaling. The researchers also took samples of saliva and blood and analysed the levels of stress hormones such as cortisol and epinephrine. As Nagel summarizes, "Normal foaling appears to cause just the opposite of a stress response".
Cardiac and circulatory demands remain at a low level
Surprisingly, during labour the heart rate of mares does not increase. On the contrary, the mares even miss some individual heart beats due to delayed stimulus conduction in the heart. In humans, such second-degree atriventricular (AV) blocks often require medical treatment but many healthy horses show AV blocks at rest. On physical activity, e.g. when the horse is ridden, the heart beat becomes regular and the beat frequency increases. The finding of AV blocks during foaling suggests that mares are strongly influenced by the parasympathetic nervous system, which usually causes a state of rest and relaxation. Its antagonist, the sympathetic nervous system, would prepare the organism for a stress response but does not seem to be active while the animals are giving birth.
No stress during foaling
The level of stress hormones remains low in foaling mares and the researchers did not find an adrenaline rush at any point. Foaling clearly does not evoke a stress response. The need to care for the newly born foal was also not perceived as stressful: contact between the mare and the foal was associated with a further state of relief and relaxation.
Horses thus experience giving birth very differently from human mothers. They need a safe environment to give birth: all the foals in the study were born at night, when the stable was quiet. As the Head of the Research Group, Christine Aurich, explains, "Parturition in horses requires a state of relaxation in the mare. This is an advantage in wild horses because mares can postpone labour until they perceive the environment as calm and safe. Once this is the case, foaling proceeds within a very short time."
The article "Parturition in horses is dominated by parasympathetic activity of the autonomous nervous system", by Christina Nagel, Regina Erber, Natascha Ille, Mareike von Lewinski, Jörg Aurich, Erich Möstl and Christine Aurich has just been published in the scientific journal Theriogenology.
The study was conducted at the Graf Lehndorff Institute for Equine Science, a joint research unit of the Vetmeduni Vienna and the Brandenburg State Stud at Neustadt (Dosse), Germany.
About the University of Veterinary Medicine, Vienna
The University of Veterinary Medicine, Vienna in Austria is one of the leading academic and research institutions in the field of Veterinary Sciences in Europe. About 1,200 employees and 2,300 students work on the campus in the north of Vienna which also houses five university clinics and various research sites. Outside of Vienna the university operates Teaching and Research Farms. http://www.vetmeduni.ac.at
Scientific Contact:
Dr. Christina Nagel
Clinical Unit of Obstetrics, Gynaecology and Andrology
University of Veterinary Medicine Vienna (Vetmeduni Vienna)
Released by:
Dr. Susanna Kautschitsch
Science Communication / Public Relations
University of Veterinary Medicine Vienna (Vetmeduni Vienna)
Dr. Susanna Kautschitsch | idw - Informationsdienst Wissenschaft
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text:
Dempsey Fight Bell
The Case:
July 4, 1919 marks the day America found its true calling in a national obsession. Icon Jack Dempsey became the world's first boxing superstar, and he did it with the clang of a bell.
Now, a contributor in Reno, Nevada wants to know: Is the bell he's toasted many a night on the wall of his favorite bar the one that was ringside at Dempsey's legendary world heavyweight championship match?
The question goes beyond a single fight. Dempsey's bout ushered in the Roaring 20's, America's fascination with celebrity and the golden age of championship sports.
History Detectives sorts truth from myth to determine which clues ring true.
Season 5, Episode 3
Season 6, Episode 5
Tukufu Zuberi Location:
Reno, Nevada and New York City
Related Content
Related Links
- Also with Tukufu Zuberi Whaling Ship Might a ship docked in Mystic Seaport, hold secrets to the Underground Railroad?
- Related Investigation Coca Cola Trade Card Could this card be a unique piece of early Coca-Cola advertising?
- Also in Emerging Modern America: 1890-1930 Shippen Golf Club Was this the golf club used by John Shippen when he made sporting history in the 1896 U.S. Open?
- Also in Emerging Modern America: 1890-1930 PsychoPhone Did Thomas Edison make a machine to unlock the secrets of the dead?
- Also with Tukufu Zuberi Civil War Sabotage? The steamship Sultana exploded one night in 1865, killing more than 1,800 people. Was the disaster a result of Civil War sabotage?
- Also in Emerging Modern America: 1890-1930 Crazy Horse Photo Is this the only photograph of a Native American legend?
This is a place for opinions, comments, questions and discussion; a place where viewers of History Detectives can express their points of view and connect with others who value history. We ask that posters be polite and respectful of all opinions. History Detectives reserves the right to delete comments that don't conform to this conduct. We will not respond to every post, but will do our best to answer specific questions, or address an error.


text:
Format Films, Videos
Results: 1-2 of 2 | Refined by: Original Format: Film, Video Remove Subject: Drama Remove Subject: Courtship Remove Location: California Remove
Film, Video
The Rose of San Juan / Catalog Record Only
Ben Cameron (Sidney Ayres), a young Virginian, arrives in California to homestead on government land. He meets a starving youth along the way and returns him to his mother (Louise Lester). He then meets Inez, the most beautiful girl in San Juan, and they fall in love. Later, at a dance, they meet again and Cameron beats a drunken Spaniard (Jack Richardson) who forces ...
- Date: 1913
Film, Video
M'liss / Catalog Record Only
A comedy-melodrama set in the mining town, Red Gulch, Calif., about the untamed daughter (Mary Pickford) of the town drunk (Theodore Roberts) who falls in love with the new schoolteacher (Thomas Meighan) who is accused of murdering her father and the situations that occur during his murder trial.
- Date: 1918


text:
Huckabee Pimps Book About Putting Christ Back in Christmas (Like That'll Ever Happen)
Mike Huckabee, the former Arkansas governor who presumably did not have his way with Monica Lewinsky, signs books at the Borders book store in Tustin Saturday.
The onetime and possibly future presidential contender is scheduled to appear at 4:30 p.m. to sign his new book A Simple Christmas.
The former pastor claims God never intended on Christmas becoming synonymous with shopping, overindulging, competition, and stress--leading to the natural question: Then why did the all-knowing, all-seeing, all-being One let it happen?
It's unclear whether Huckabee goes into that (so let's ask him!), but he does go into his desire that Christmas again be about simple things like faith, love, family, hope and zzzzzzz . . .
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Christ, no wonder this loser lost. Daddy needs a new flatscreen!
Anyway, the Huckster pontificates the early evening away at 2493 Park Ave., Tustin.
Make sure to ask him about his secret gastric bypass surgery!
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Lyrics Depot is your source of lyrics to You Can Have Her by Kenny Price. Please check back for more Kenny Price lyrics.
You Can Have Her Lyrics
Artist: Kenny Price
Album: 30 California Women
Well you can have her I don't want her she didn't love me anyway
She only wanted someone to play with but all I wanted was love to stay
The girl I love she upped and left me she ran away with my best friend
Comes home at night for just one hour when daylight comes she's gone again
Well you can have he...
When you're stuck with the wrong woman there ain't that much that you can do
If you get the wrong woman there's only one thing you can do
You just dig a hole and crawl right in it then you pull the ground right over you
Well you can have her...
Life without love is mighty empty but confession is good for your soul
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BMC Pregnancy and Childbirth (1374)
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Women and healthcare providers' perceptions of a midwife-led unit in a Swiss university hospital: a qualitative study
Maillefer, Françoise
de Labrusse, Claire
Cardia-Vonèche, Laura
Hohlfeld, Patrick
Stoll, Beat
BMC Pregnancy and Childbirth
The development of medical-led care in obstetrics over the past decades has contributed to improving outcomes for both mother and child. Although efficiency has improved in complex situations, unnecessary interventions are still practiced in low-risk pregnancies, contrary to international recommendations. A shift to a less interventionist model of care has encouraged many countries to review their policies on maternal health care and develop models such as the "midwife-led unit" (MLU) where the midwife plays a predominant role with a minimum of routine intervention. Existing research has provided convincing evidence that MLUs lead to better maternal and neonatal outcomes when compared to traditional models. They not only improve the level of satisfaction amongst women, but are also associated with reduced healthcare costs. This study aimed to explore the perceptions of women and healthcare providers regarding the creation of an MLU in a Swiss university hospital.
A descriptive research study using qualitative methods was conducted among pregnant women and new mothers in a Swiss maternity unit, including also midwives and medical staff. Data collection was carried out through one-to-one interviews, focus groups, and telephone interviews (n = 63). After transcription, thematic analysis was performed.
The triangulation of perceptions of women and healthcare providers indicated support for the implementation of an MLU to promote physiological delivery. Most women welcomed the idea of an MLU, in particular how it could help in offering continuity of care. Healthcare providers were optimistic about the implementation of an MLU and recognised the need for some women to have access to a less interventionist approach. From the women's perspective, barriers concerned the lack of awareness of midwives' full scope of practice, while barriers for midwives and obstetricians were related to the challenge to develop a good interprofessional collaboration.
Alternative models to provide maternity care for low-risk women have been developed and evaluated widely in several countries outside Switzerland. This study showed that women and healthcare providers were favourable towards the development of a new care model, while taking into account the specific expectations and barriers raised by participants.
Midwife-led unit; Maternity services care model; Midwifery; Continuity of care; Physiological childbirth; Qualitative research
Related Articles
Effects of preconception counseling on maternal health care of migrant women in China: a community-based, cross-sectional survey
You, Xiaofang
Tan, Hui
Hu, Shiyun
Wu, Jianmei
Jiang, Hong
Peng, Aiping
Dai, Yue
Wang, Ling
Guo, Sufang
Qian, Xu
BMC Pregnancy and Childbirth
Migrants have long been a disadvantaged group in China's health care system, especially in terms of maternal health care. Many studies have explored the factors associated with a lack of maternal health care and found many determinants, including social, economic, behavioral, and environmental factors. However, studies focusing on factors associated with maternal health care have rarely examined preconception counseling (PCC). This study explored factors related to PCC uptake among migrant women, and investigated the association between PCC and maternal health care in migrant women.
A community-based cross-sectional study was conducted from July to December 2011, in Nanhai, Guangdong Province, and Pinghu, Zhejiang Province, China. A total of 1,012 migrant women who had their most recent pregnancy within 1 year of the survey answered a standardized interviewer-administered questionnaire about maternal health care. Descriptive statistics and multivariable logistic regression were used to analyze the data.
Only 208 (20.6%, 95% confidence interval [CI]: 18.1–23.1%) of 1,012 migrant women had received PCC. Younger age, having more than one child, lack of knowledge of maternal health care and inter-province migration were predictors of a lack of PCC. PCC was associated with higher consumption of folic acid supplements during the preconception period (adjusted odds ratio [AOR] = 2.65, 95% CI: 1.66–4.23). Among migrants who were resident in Nanhai or Pinghu for less than 5 years, PCC was related to better quality prenatal care (AOR = 3.07, 95% CI: 1.79–5.24).
The prevalence of PCC among migrant women was low (20.6%, 95% CI: 18.1–23.1%). Positive associations were found between the receipt of PCC and preconception folic acid supplements and quality prenatal care. Future studies focusing on maternal health care should pay attention to PCC and explore the effects of PCC on maternal health care through intervention studies. Continued efforts to increase PCC in migrants should target specific age groups (20–24 years), families with more than one child, and women who have migrated between provinces, as well as provide in-depth knowledge of maternal health care.
Maternal health care; Preconception counseling; Quality prenatal care; Folic acid supplements; Migrant
Related Articles
Increasing uptake of influenza vaccine by pregnant women post H1N1 pandemic: a longitudinal study in Melbourne, Australia, 2010 to 2014
McCarthy, Elizabeth Anne
Pollock, Wendy Elizabeth
Tapper, Lauren
Sommerville, Maree
McDonald, Susan
BMC Pregnancy and Childbirth
A Melbourne (Australia) university affiliated, tertiary obstetric hospital provides lay and professional education about influenza vaccine in pregnancy annually each March, early in the local influenza season. Responding to a 2011 survey of new mothers' opinions, the hospital made influenza vaccine freely available in antenatal clinics from 2012. We wished to determine influenza vaccination uptake during pregnancy with these strategies 5 years after 2009 H1N1.
Face to face interviews based on US Center for Disease Control and Prevention Pregnancy Risk Assessment Monitoring System with new mothers in postnatal wards each July, 2010 to 2014. We calculated recalled influenza vaccine uptake each year and assessed trends with chi square tests, and logistic regression.
We recorded 1086 interviews. Influenza vaccination during pregnancy increased by 6% per year (95% confidence interval 4 to 8%): from 29.6% in 2010 to 51.3% in 2014 (p < 0.001). Lack of discussion from maternity caregivers was a persistent reason for non-vaccination, recalled by 1 in 2 non-vaccinated women. Survey respondents preferred face to face consultations with doctors and midwives, internet and text messaging as information sources about influenza vaccination. Survey responses indicate messages about vaccine safety in pregnancy and infant benefits are increasingly being heeded. However, there was progressively lower awareness of maternal benefits of influenza vaccination, especially for women with risk factors for severe disease.
We observed improving influenza vaccination during pregnancy. There is potential to integrate technology such as text message or internet with antenatal consultations to increase vaccination coverage further.
Electronic supplementary material
The online version of this article (doi:10.1186/s12884-015-0486-3) contains supplementary material, which is available to authorized users.
Pregnancy complications; Infectious/prevention & control; Influenza vaccines/immunology; Trivalent
Related Articles
Evaluation of the quality of guidelines for the management of reduced fetal movements in UK maternity units
Jokhan, Stephanie
Whitworth, Melissa K
Jones, Felicity
Saunders, Ashleigh
Heazell, Alexander E P
BMC Pregnancy and Childbirth
The development of evidence-based guidelines is a key step in ensuring that maternity care is of a universally high standard. To influence patient care national and international guidelines need to be interpreted and implemented locally. In 2011, the Royal College of Obstetricians and Gynaecologists published guidelines for the management of reduced fetal movements (RFM), which can be an important symptom of fetal compromise. Following dissemination it was anticipated that this guidance would be implemented in UK maternity units. This study aimed to assess the quality of local guidelines for the management of RFM in comparison to published national standards.
Cross-sectional survey of maternity unit guidelines for RFM. The guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Tool and scored by two independent investigators. Two national guidelines were used as standards to evaluate unit guidelines.
Responses were received from 98 units (42%); 12 units had no guideline. National guidelines scored highly using the AGREE II tool but there was wide variation in the quality of individual maternity unit guidelines, which were frequently of low quality. No guidelines incorporated all the recommendations from the national guideline. Maternity unit guidelines performed well for clarity and presentation but had low scores for stakeholder involvement, rigour of development and applicability.
In contrast to national evidence based guidance the quality of maternity unit guidelines for RFM is variable and frequently of low quality. To increase quality, guidelines need to include up to date evidence and audit standards which could be taken directly from national evidence-based guidance. Barriers to local implementation and resource implications need to be taken into consideration. Training may also improve the implementation of the guideline. Research is needed to inform strategies to realize the benefits of clinical guidance in practice.
Reduced fetal movements; Management; Stillbirth; Stillbirth prevention; Risk management
Related Articles
Change in level of physical activity during pregnancy in obese women: findings from the UPBEAT pilot trial
Hayes, Louise
Mcparlin, Catherine
Kinnunen, Tarja I
Poston, Lucilla
Robson, Stephen C
Bell, Ruth
BMC Pregnancy and Childbirth
Maternal obesity is associated with an increased risk of pregnancy complications, including gestational diabetes. Physical activity (PA) might improve glucose metabolism and reduce the incidence of gestational diabetes. The purpose of this study was to explore patterns of PA and factors associated with change in PA in obese pregnant women.
PA was assessed objectively by accelerometer at 16 – 18 weeks' (T0), 27 – 28 weeks' (T1) and 35 – 36 weeks' gestation (T2) in 183 obese pregnant women recruited to a pilot randomised trial of a combined diet and PA intervention (the UPBEAT study).
Valid PA data were available for 140 (77%), 76 (42%) and 54 (30%) women at T0, T1 and T2 respectively. Moderate and vigorous physical activity as a proportion of accelerometer wear time declined with gestation from a median of 4.8% at T0 to 3% at T2 (p < 0.05). Total activity as a proportion of accelerometer wear time did not change. Being more active in early pregnancy was associated with a higher level of PA later in pregnancy. The intervention had no effect on PA.
PA in early pregnancy was the factor most strongly associated with PA at later gestations. Women should be encouraged to participate in PA before becoming pregnant and to maintain their activity levels during pregnancy. There is a need for effective interventions, tailored to the needs of individuals and delivered early in pregnancy to support obese women to be sufficiently active during pregnancy.
Trial registration
Current Controlled Trials ISRCTN89971375 (Registered 28/11/2008).
Maternal obesity; Accelerometer; MVPA; Socio-demographic factors
Related Articles
Successful five-item triage for the broad spectrum of mental disorders in pregnancy – a validation study
Quispel, Chantal
Schneider, Tom AJ
Hoogendijk, Witte JG
Bonsel, Gouke J
Lambregtse-van den Berg, Mijke P
BMC Pregnancy and Childbirth
Mental disorders are prevalent during pregnancy, affecting 10% of women worldwide. To improve triage of a broad spectrum of mental disorders, we investigated the decision impact validity of: 1) a short set of currently used psychiatric triage items, 2) this set with the inclusion of some more specific psychiatric items (intermediate set), 3) this new set with the addition of the 10-item Edinburgh Depression Scale (extended set), and 4) the final set with the addition of common psychosocial co-predictors (comprehensive set).
This was a validation study including 330 urban pregnant women. Women completed a questionnaire including 20 psychiatric and 10 psychosocial items. Psychiatric diagnosis (gold standard) was obtained through Structured Clinical Interviews of DSM-IV axis I and II disorders (SCID-I and II). The outcome measure of our analysis was presence (yes/no) of any current mental disorder.
The performance of the short, intermediate, extended, and comprehensive triage models was evaluated by multiple logistic regression analysis, by analysis of the area under the ROC curve (AUC) and through associated performance measures, including, for example, sensitivity, specificity and the number of missed cases.
Diagnostic performance of the short triage model (1) was acceptable (Nagelkerke's R2=0.276, AUC=0.740, 48 out of 131 cases were missed). The intermediate model (2) performed better (R2=0.547, AUC=0.883, 22 cases were missed) including the five items: ever experienced a traumatic event, ever had feelings of a depressed mood, ever had a panic attack, current psychiatric symptoms and current severe depressive or anxious symptoms. Addition of the 10-item Edinburgh Depression Scale or the three psychosocial items unplanned pregnancy, alcohol consumption and sexual/physical abuse (models 3 and 4) further increased R2 and AUC (>0.900), with 23 cases missed. Missed cases included pregnant women with a current eating disorder, psychotic disorder and the first onset of anxiety disorders.
For a valid detection of the full spectrum of common mental disorders during pregnancy, at least the intermediate set of five psychiatric items should be implemented in routine obstetric care. For a brief yet comprehensive triage, three high impact psychosocial items should be added as independent contributors.
Electronic supplementary material
The online version of this article (doi:10.1186/s12884-015-0480-9) contains supplementary material, which is available to authorized users.
Mental disorders; Personality disorders; Pregnancy; Psychosocial problems; Triage; Validation
Related Articles
Preferences for infant delivery site among pregnant women and new mothers in Northern Karnataka, India
Bruce, Sharon G
Blanchard, Andrea K
Gurav, Kaveri
Roy, Anuradha
Jayanna, Krishnamurthy
Mohan, Haranahalli L
Ramesh, Banadakoppa M
Blanchard, James F
Moses, Stephen
Avery, Lisa
BMC Pregnancy and Childbirth
The National Rural Health Mission (NRHM) of India aims to increase the uptake of safe and institutional delivery among rural communities to improve maternal, neonatal and child health (MNCH) outcomes. Previous studies in India have found that while there have been increasing numbers of institutional deliveries there are still considerable barriers to utilization and quality of services, particularly in rural areas, that may mitigate improvements achieved by MNCH interventions. This paper aims to explore the factors influencing preference for home, public or private hospital delivery among rural pregnant and new mothers in three northern districts of Karnataka state, South India.
In-depth qualitative interviews were conducted in 2010 among 110 pregnant women, new mothers (infants born within past 3 months), their husbands and mothers-in-law. Interviews were conducted in the local language (Kannada) and then translated to English for analysis. The interviews of pregnant women and new mothers were used for analysis to ultimately develop broader themes around definitions of quality care from the perspective of service users, and the influence this had on their delivery site preferences.
Geographical and financial access were important barriers to accessing institutional delivery services in all districts, and among those both above and below the poverty line. Access issues of greatest concern were high costs at private institutions, continuing fees at public hospitals and the inconsistent receipt of government incentives. However, views on quality of care that shaped delivery site preferences were deeply rooted in socio-cultural expectations for comfortable, respectful and safe care that must ultimately be addressed to change negative perceptions about institutional, and particularly public hospital, care at delivery.
In the literature, quality of care beyond access has largely been overlooked in favour of support for incentives on the demand side, and more trained doctors, facilities and equipment on the supply side. Taking a comprehensive approach to quality of care in line with cultural values and community needs is imperative for improving experiences, utilization, and ultimately maternal and neonatal health outcomes at the time of delivery.
Delivery sites; Rural India; Quality of care; Qualitative; Reproductive health
Related Articles
Person-centred care in interventions to limit weight gain in pregnant women with obesity - a systematic review
Olander, Ellinor K
Berg, Marie
McCourt, Christine
Carlström, Eric
Dencker, Anna
BMC Pregnancy and Childbirth
Person-centred care, asserting that individuals are partners in their care, has been associated with care satisfaction but the value of using it to support women with obesity during pregnancy is unknown. Excessive gestational weight gain is associated with increased risks for both mother and baby and weight gain therefore is an important intervention target. The aims of this review was to 1) explore to what extent and in what manner interventions assessing weight in pregnant women with obesity use person-centred care and 2) assess if interventions including aspects of person-centred care are more effective at limiting weight gain than interventions not employing person-centred care.
Ten databases were systematically searched in January 2014. Studies had to report an intervention offered to pregnant women with obesity and measure gestational weight gain to be included. All included studies were independently double coded to identify to what extent they included three defined aspects of person-centred care: 1) "initiate a partnership" including identifying the person's circumstances and motivation; 2) "working the partnership" through sharing the decision-making regarding the planned action and 3) "safeguarding the partnership through documentation" of care preferences. Information on gestational weight gain, study quality and characteristics were also extracted.
Ten studies were included in the review, of which five were randomised controlled trials (RCT), and the remaining observational studies. Four interventions included aspects of person-centred care; two observational studies included both "initiating the partnership", and "working the partnership". One observational study included "initiating the partnership" and one RCT included "working the partnership". No interventions included "safeguarding the partnership through documentation". Whilst all studies with person-centred care aspects showed promising findings regarding limiting gestational weight gain, so did the interventions not including person-centred care aspects.
The use of an identified person-centred care approach is presently limited in interventions targeting gestational weight gain in pregnant women with obesity. Hence to what extent person-centred care may improve health outcomes and care satisfaction in this population is currently unknown and more research is needed. That said, our findings suggest that use of routines incorporating person-centredness are feasible to include within these interventions.
Electronic supplementary material
The online version of this article (doi:10.1186/s12884-015-0463-x) contains supplementary material, which is available to authorized users.
Person-centred care; Maternal obesity; Gestational weight gain; Intervention; Systematic review
Related Articles
Successful prevention of exacerbation of thrombocytopenia in a pregnant patient with idiopathic thrombocytopenic purpura by anticoagulation treatment
Hisano, Michi
Tsukada, Nobuhiro
Sago, Haruhiko
Yamaguchi, Koushi
BMC Pregnancy and Childbirth
Corticosteroid or intravenous immunoglobulin is used in the management of idiopathic thrombocytopenic purpura during pregnancy.
Case presentation
A patient with idiopathic thrombocytopenic purpura had a previous history of interrupted pregnancy due to severe thrombocytopenia, and was unresponsive to high doses of corticosteroids and intravenous immunoglobulin. Immediately following pregnancy, our patient had a marked elevation in plasma levels of fibrinogen degradation products, D-dimer, and platelet factor 4, with a decrease in platelets, suggesting platelet activation and thrombogenesis. Combined treatment with an anticoagulant agent could prevent exacerbation of thrombocytopenia throughout pregnancy. Although the underlying causes leading to the series in her pregnancy course were uncertain, there were notable serological abnormalities, such as weakly positive antinuclear antibody and anti-U1-RNP antibody.
When thrombocytopenia rapidly develops in patients with idiopathic thrombocytopenic purpura immediately following pregnancy, the possibility of a thrombogenic state and differential diagnosis, including antiphospholipid syndrome and collagen vascular disease, should be considered. Treatment with an anticoagulant agent might then be appropriate.
Idiopathic thrombocytopenic purpura; Pregnancy; Thrombocytopenia; Anticoagulation
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A qualitative study on barriers in the prevention of anaemia during pregnancy in public health centres: perceptions of Indonesian nurse-midwives
Widyawati, Widyawati
Jans, Suze
Utomo, Sutarti
van Dillen, Jeroen
Janssen, ALM Lagro
BMC Pregnancy and Childbirth
Anemia in pregnancy remains a major problem in Indonesia over the past decade. Early detection of anaemia in pregnancy is one of the components which is unsuccessfully implemented by nurse-midwives. This study aims to explore nurse-midwives' experiences in managing pregnant women with anaemia in Public Health Centres.
We conducted a qualitative study with semi-structured face to face interviews from November 2011 to February 2012 with 23 nurse-midwives in five districts in Yogyakarta Special Province. Data analysis was thematic, using the constant comparison method, making comparison between participants and supported by ATLAS.ti software.
Twelve nurse-midwives included in the interviews had less than or equal to 10 years' working experience (junior nurse-midwives) and 11 nurse-midwives had more than 10 years' working experience (senior nurse-midwives) in Public Health Centres. The senior nurse-midwives mostly worked as coordinators in Public Health Centres. Three main themes emerged: 1) the lack of competence and clinical skill; 2) cultural beliefs and low participation of family in antenatal care programme; 3) insufficient facilities and skilled support staff in Public Health Centres. The nurse-midwives realized that they need to improve their communication and clinical skills to manage pregnant women with anaemia. The husband and family involvement in antenatal care was constrained by the strength of cultural beliefs and lack of health information. Moreover, unfavourable work environment of the Public Health Centres made it difficult to apply antenatal care the pregnant womens' need.
The availability of facilities and skilled staffs in Public Health Centre as well as pregnant women's husbands or family members contribute to the success of managing anaemia in pregnancy. Nurse-midwives and pregnant women need to be empowered to achieve the optimum result of anaemia management. We recommend a more comprehensive approach in managing pregnant women with anaemia, which synergizes the available resources and empowers nurse-midwives and pregnant women.
Nurse-midwives; Competences; Anaemia; Pregnant women; Antenatal care; Comprehensive approach
Related Articles
A community-based assessment of correlates of facility delivery among HIV-infected women in western Kenya
Kinuthia, John
Kohler, Pamela
Okanda, John
Otieno, George
Odhiambo, Frank
John-Stewart, Grace
BMC Pregnancy and Childbirth
Childbirth at health facilities is an important strategy to reduce maternal morbidity and mortality, improve fetal outcomes, and reduce mother-to-child transmission of HIV. Although access to antenatal care in Kenya is high (>90%), less than half of births occur at health facilities. This analysis aims to assess correlates of facility delivery among recently pregnant HIV-infected women participating in a community-based survey, and to determine whether these correlates were unique when compared to HIV-uninfected women from the same region.
Women residing in the Kenya Medical Research Institute/Centers for Disease Control and Prevention Health and Demographic Surveillance System, and who had delivered an infant in the previous year were visited at home in 2011. Consenting mothers answered a questionnaire assessing demographics, place of delivery, utilization of prevention of mother-to-child HIV transmission (PMTCT) services, and stigma indicators. Known HIV-positive women were purposively oversampled. Chi-square tests of proportions and multivariate logistic regression, stratified by HIV status, were performed to assess correlates of facility delivery.
Overall, 101 (46.8%) HIV-infected and 127 (39.9%) HIV-uninfected women delivered at health facilities. Among HIV-infected women, cost (42.8%), distance (18.8%) and fear of harsh treatment (15.2%) were primary disincentives for facility delivery; 2.9% noted fear of HIV testing was a disincentive. HIV-infected women who delivered at facilities had higher education (p = 0.04) and socioeconomic status (p < 0.005), initiated antenatal care (ANC) earlier (4.9 vs. 5.4 months, p = 0.016), were more likely to know partner's HIV status (p = 0.016), report satisfaction with delivery care (p = 0.001) and use antiretrovirals (87.1% vs. 77.4%, p = 0.063) compared to those with non-facility delivery. Stigma indicators were not associated with delivery location. Similar cofactors of facility delivery were noted among uninfected women.
Utilization of facility delivery remains low in Kenya and poses a challenge to elimination of infant HIV and reduction of peripartum mortality. Cost, distance, and harsh treatment were cited as barriers and these need to be addressed programmatically. HIV-infected women with lower socioeconomic status and those who present late to ANC should be prioritized for interventions to increase facility delivery. Partner involvement may increase use of maternity services and could be enhanced by couples counseling.
HIV; Facility delivery; Infant; Partner; Antiretroviral
Related Articles
Effect of external airflow resistive load on postural and exercise-associated cardiovascular and pulmonary responses in pregnancy: a case control study
Kim, Jung-Hyun
Roberge, Raymond J
Powell, Jeffrey B
BMC Pregnancy and Childbirth
Facial coverings (e.g., balaclavas, niqabs, medical/surgical masks, respirators, etc.), that impose low levels of airflow resistive loads, are worn by millions of pregnant women worldwide, but little data exist addressing their impact on pregnancy-associated cardiovascular and pulmonary responses.
16 pregnant and 16 non-pregnant women were monitored physiologically (heart rate, blood pressure, mean arterial pressure, total peripheral resistance, stroke volume, cardiac output, oxygen saturation, transcutaneous carbon dioxide, fetal heart rate) and subjectively (exertion) for 1 h of mixed sedentary postural activity (sitting, standing) and moderate exercise (bicycle ergometer) with and without wearing N95 filtering facepiece respirators with filter resistive loads of 94.1 Pa (9.6 mm H2O) – 119.6 Pa (12.2 mm H2O) pressure.
The external airflow resistive loads were associated with increases in diastolic pressure (p = 0.004), mean arterial pressure (p = 0.01), and subjective exertion score (p < 0.001) of all study subjects. No significant differences were noted with the external resistive loads between the pregnant and non-pregnant groups for any cardiovascular, pulmonary and subjective variable over 1 h.
Low external airflow resistive loads, during combined sedentary postural activity and moderate exercise over 1 h, were associated with increases in the diastolic and mean arterial pressures of all study subjects, but pregnancy itself was not associated with any significant differences in physiologic or subjective responses to the external airway resistive loads utilized in the study.
Pregnancy; External airflow resistive loads; Effects; Cardiovascular; Pulmonary
Related Articles
Sexuality among fathers of newborns in Jamaica
Gray, Peter B
Reece, Jody-Ann
Coore-Desai, Charlene
Dinnall-Johnson, Twana
Pellington, Sydonnie
Samms-Vaughan, Maureen
BMC Pregnancy and Childbirth
While a growing body of research has addressed pregnancy and postpartum impacts on female sexuality, relatively little work has been focused upon men. A few studies suggest that a fraction of men report decreases in libido during a partner's pregnancy and/or postpartum, with alterations in men's sexual behavior also commonly aligning with those of a partner. Here, we investigate sexuality among fathers of newborn children in Jamaica. In Jamaica, as elsewhere in the Caribbean, relationship dynamics can be fluid, contributing to variable paternal roles and care, as well as a high fraction of children born into visiting relationships in which parents live apart from each other.
During July-September, 2011, 3410 fathers of newborns with an average age of 31 (SD = 8) years participated in the fatherhood arm of a national birth cohort study (JAKids). These fathers answered questions about sociodemographic background, relationship quality and sexuality (e.g., various components of sexual function such as sex drive and sexual satisfaction as well as number of sexual partners the previous 12 months and sexual intercourse the previous week) during a visit to a hospital or birth center within a day or two of their child being born.
Showed that sex drive was more variable than other components (erections, ejaculation, problem assessment) of sexual function, though sexual satisfaction was generally high. Thirty percent of men reported two or more sexual partners the previous 12 months. Nearly half of men indicated not engaging in sexual intercourse the past week. Multivariate analyses showed that relationship status was related to various aspects of men's sexuality, such as men in visiting relationships reporting more sexual partners and more openness to casual sex. Relationship quality was the most consistent predictor of men's sexuality, with men in higher quality relationships reporting higher sexual satisfaction, fewer sexual partners, and higher frequency of sex, among other findings.
These results provide an unusually large, quantitative look at men's sexuality during the transition to fatherhood in Jamaica, offering helpful insight to would-be parents, clinicians or others seeking to anticipate the effects of a partner's pregnancy on men's sexuality.
Fatherhood; Men; Parents; Caribbean; Sexual function; Sexual relationship
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Regional differences in severe postpartum hemorrhage: a nationwide comparative study of 1.6 million deliveries
Prick, Babette W
auf Altenstadt, Joost F von Schmidt
Hukkelhoven, Chantal WPM
Bonsel, Gouke J
Steegers, Eric AP
Mol, Ben W
Schutte, Joke M
Bloemenkamp, Kitty WM
Duvekot, Johannes J
BMC Pregnancy and Childbirth
The incidence of severe postpartum hemorrhage (PPH) is increasing. Regional variation may be attributed to variation in provision of care, and as such contribute to this increasing incidence. We assessed reasons for regional variation in severe PPH in the Netherlands.
We used the Netherlands Perinatal Registry and the Dutch Maternal Mortality Committee to study severe PPH incidences (defined as blood loss ≥ 1000 mL) across both regions and neighborhoods of cities among all deliveries between 2000 and 2008. We first calculated crude incidences. We then used logistic multilevel regression analyses, with hospital or midwife practice as second level to explore further reasons for the regional variation.
We analyzed 1599867 deliveries in which the incidence of severe PPH was 4.5%. Crude incidences of severe PPH varied with factor three between regions while between neighborhoods variation was even larger. We could not explain regional variation by maternal characteristics (age, parity, ethnicity, socioeconomic status), pregnancy characteristics (singleton, gestational age, birth weight, pre-eclampsia, perinatal death), medical interventions (induction of labor, mode of delivery, perineal laceration, placental removal) and health care setting.
In a nationwide study in The Netherlands, we observed wide practice variation in PPH. This variation could not be explained by maternal characteristics, pregnancy characteristics, medical interventions or health care setting. Regional variation is either unavoidable or subsequent to regional variation of a yet unregistered variable.
Electronic supplementary material
The online version of this article (doi:10.1186/s12884-015-0473-8) contains supplementary material, which is available to authorized users.
Cohort study; Postpartum hemorrhage; Geographic distribution; Epidemiology; Maternal mortality
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Variation in referrals to secondary obstetrician-led care among primary midwifery care practices in the Netherlands: a nationwide cohort study
Offerhaus, Pien M
Geerts, Caroline
de Jonge, Ank
Hukkelhoven, Chantal WPM
Twisk, Jos WR
Lagro-Janssen, Antoine LM
BMC Pregnancy and Childbirth
The primary aim of this study was to describe the variation in intrapartum referral rates in midwifery practices in the Netherlands. Secondly, we wanted to explore the association between the practice referral rate and a woman's chance of an instrumental birth (caesarean section or vaginal instrumental birth).
We performed an observational study, using the Dutch national perinatal database. Low risk births in all primary care midwifery practices over the period 2008–2010 were selected. Intrapartum referral rates were calculated. The referral rate among nulliparous women was used to divide the practices in three tertile groups. In a multilevel logistic regression analysis the association between the referral rate and the chance of an instrumental birth was examined.
The intrapartum referral rate varied from 9.7 to 63.7 percent (mean 37.8; SD 7.0), and for nulliparous women from 13.8 to 78.1 percent (mean 56.8; SD 8.4). The variation occurred predominantly in non-urgent referrals in the first stage of labour. In the practices in the lowest tertile group more nulliparous women had a spontaneous vaginal birth compared to the middle and highest tertile group (T1: 77.3%, T2:73.5%, T3: 72.0%). For multiparous women the spontaneous vaginal birth rate was 97%. Compared to the lowest tertile group the odds ratios for nulliparous women for an instrumental birth were 1.22 (CI 1.16-1.31) and 1.33 (CI 1.25-1.41) in the middle and high tertile groups. This association was no longer significant after controlling for obstetric interventions (pain relief or augmentation).
The wide variation between referral rates may not be explained by medical factors or client characteristics alone. A high intrapartum referral rate in a midwifery practice is associated with an increased chance of an instrumental birth for nulliparous women, which is mediated by the increased use of obstetric interventions. Midwives should critically evaluate their referral behaviour. A high referral rate may indicate that more interventions are applied than necessary. This may lead to a lower chance of a spontaneous vaginal birth and a higher risk on a PPH. However, a low referral rate should not be achieved at the cost of perinatal safety.
Midwifery; Referral; Instrumental birth
Related Articles
Obstetric care providers are able to assess psychosocial risks, identify and refer high-risk pregnant women: validation of a short assessment tool – the KINDEX Greek version
Spyridou, Andria
Schauer, Maggie
Ruf-Leuschner, Martina
BMC Pregnancy and Childbirth
Prenatal assessment for psychosocial risk factors and prevention and intervention is scarce and, in most cases, nonexistent in obstetrical care. In this study we aimed to evaluate if the KINDEX, a short instrument developed in Germany, is a useful tool in the hands of non-trained medical staff, in order to identify and refer women in psychosocial risk to the adequate mental health and social services. We also examined the criterion-related concurrent validity of the tool through a validation interview carried out by an expert clinical psychologist. Our final objective was to achieve the cultural adaptation of the KINDEX Greek Version and to offer a valid tool for the psychosocial risk assessment to the obstetric care providers.
Two obstetricians and five midwives carried out 93 KINDEX interviews (duration 20 minutes) with pregnant women to assess psychosocial risk factors present during pregnancy. Afterwards they referred women who they identified having two or more psychosocial risk factors to the mental health attention unit of the hospital. During the validation procedure an expert clinical psychologist carried out diagnostic interviews with a randomized subsample of 50 pregnant women based on established diagnostic instruments for stress and psychopathology, like the PSS-14, ESI, PDS, HSCL-25.
Significant correlations between the results obtained through the assessment using the KINDEX and the risk areas of stress, psychopathology and trauma load assessed in the validation interview demonstrate the criterion-related concurrent validity of the KINDEX. The referral accuracy of the medical staff is confirmed through comparisons between pregnant women who have and have not been referred to the mental health attention unit.
Prenatal screenings for psychosocial risks like the KINDEX are feasible in public health settings in Greece. In addition, validity was confirmed in high correlations between the KINDEX results and the results of the validation interviews. The KINDEX Greek version can be considered a valid tool, which can be used by non-trained medical staff providing obstetrical care to identify high-risk women and refer them to adequate mental health and social services. These kind of assessments are indispensable for the promotion of a healthy family environment and child development.
Related Articles
Designs of two randomized, community-based trials to assess the impact of influenza immunization during pregnancy on respiratory illness among pregnant women and their infants and reproductive outcomes in rural Nepal
Tielsch, James M
Steinhoff, Mark
Katz, Joanne
Englund, Janet A
Kuypers, Jane
Khatry, Subarna K
Shrestha, Laxman
LeClerq, Steven C
BMC Pregnancy and Childbirth
Among the most important causes of illness and death in both pregnant women and their newborn infants are respiratory infections including influenza. Pregnant women in North America have a 4 to 5 fold excess rate of hospitalization compared to non-pregnant women. Rates of infant hospitalization associated with influenza are much higher than in their mothers. Fully half of children hospitalized for influenza in the US are in the age group 0–5 months, a group where no vaccine is licensed. Data on influenza are much fewer in low income countries where the risks of serious morbidity and mortality are much higher. A recent trial in Bangladesh suggested that influenza immunization in pregnant women could have important protective effects against influenza in both mothers and their infants. These trials were designed to provide additional evidence about the effect of influenza vaccination in pregnancy in settings where influenza may circulate for up to ten months/year.
We conducted a consecutive pair of community-based, placebo-controlled, randomized trials of influenza vaccination of pregnant women in a rural district in southern Nepal. Two trials were conducted to insure, as much as possible, the match of circulating strains with those included in the vaccine. Eligible women included all who were or became pregnant over a one year period. Each trial included a one year cohort of pregnant women who were individually randomized to the influenza vaccine available at the time of their enrollment or placebo. Exclusions included a history of allergy to vaccine components, prior influenza vaccine receipt, and for the second trial, participation in the first trial. Morbidity was assessed on a weekly basis for women throughout pregnancy and through 180 days post-partum. Infants were followed weekly through 180 days. Primary outcomes included: 1) incidence of influenza like illness in women, 2) incidence of laboratory confirmed influenza illness in infants, and 3) birthweight among newborn infants.
We have presented the design and methods of two randomized trials of influenza immunization of pregnant women.
Trial registration
Clinicaltrials.gov: (NCT01034254).
Influenza vaccination; Pregnancy; Early infancy; Influenza like illness; Influenza illness; Birthweight
Related Articles
BMC Pregnancy and Childbirth reviewer acknowledgement 2014
Boodhun, Nawsheen
BMC Pregnancy and Childbirth
Contributing reviewers
The editors of BMC Pregnancy and Childbirth would like to thank all our reviewers who have contributed to the journal in Volume 14 (2014).
Related Articles
Triple return on investment: the cost and impact of 13 interventions that could prevent stillbirths and save the lives of mothers and babies in South Africa
Michalow, Julia
Chola, Lumbwe
McGee, Shelley
Tugendhaft, Aviva
Pattinson, Robert
Kerber, Kate
Hofman, Karen
BMC Pregnancy and Childbirth
The time of labor, birth and the first days of life are the most vulnerable period for mothers and children. Despite significant global advocacy, there is insufficient understanding of the investment required to save additional lives. In particular, stillbirths have been neglected. Over 20 000 stillbirths are recorded annually in South Africa, many of which could be averted. This analysis examines available South Africa specific stillbirth data and evaluates the impact and cost-effectiveness of 13 interventions acknowledged to prevent stillbirths and maternal and newborn mortality.
Multiple data sources were reviewed to evaluate changes in stillbirth rates since 2000. The intervention analysis used the Lives Saved tool (LiST) and the Family Planning module (FamPlan) in Spectrum. LiST was used to determine the number of stillbirths and maternal and neonatal deaths that could be averted by scaling up the interventions to full coverage (99%) in 2030. The impact of family planning was assessed by increasing FamPlan's default 70% coverage of modern contraception to 75% and 80% coverage. Total and incremental costs were determined in the LiST costing module. Cost-effectiveness measured incremental cost effectiveness ratios per potential life years gained.
Significant variability exists in national stillbirth data. Using the international stillbirth definition, the SBR was 17.6 per 1 000 births in 2013. Full coverage of the 13 interventions in 2030 could reduce the SBR by 30% to 12.4 per 1 000 births, leading to an MMR of 132 per 100 000 and an NMR of 7 per 1 000 live births. Increased family planning coverage reduces the number of deaths significantly. The full intervention package, with 80% family planning coverage in 2030, would require US$420 million (US$7.8 per capita) annually, which is less than baseline costs of US$550 million (US$10.2 per capita). All interventions were highly cost-effective.
This is the first analysis in South Africa to assess the impact of scaling up interventions to avert stillbirths. Improved coverage of 13 interventions that are already recommended could significantly impact the rates of stillbirth and maternal and neonatal mortality. Family planning should also be prioritized to reduce mortality and overall costs.
Stillbirths; Maternal health; Child health; Cost analysis; South Africa
Related Articles
Epigenetic regulation of lncRNA connects ubiquitin-proteasome system with infection-inflammation in preterm births and preterm premature rupture of membranes
Luo, Xiucui
Pan, Jing
Wang, Leilei
Wang, Peirong
Zhang, Meijiao
Liu, Meilin
Dong, Ziqing
Meng, Qian
Tao, Xuguang
Zhao, Xinliang
Zhong, Julia
Ju, Weina
Gu, Yang
Jenkins, Edmund C
Brown, W Ted
Shi, Qingxi
Zhong, Nanbert
BMC Pregnancy and Childbirth
Preterm premature rupture of membranes (PPROM) is responsible for one third of all preterm births (PTBs). We have recently demonstrated that long noncoding RNAs (lncRNAs) are differentially expressed in human placentas derived from PPROM, PTB, premature rupture of the membranes (PROM), and full-term birth (FTB), and determined the major biological pathways involved in PPROM.
Here, we further investigated the relationship of lncRNAs, which are differentially expressed in spontaneous PTB (sPTB) and PPROM placentas and are found to overlap a coding locus, with the differential expression of transcribed mRNAs at the same locus. Ten lncRNAs (five up-regulated and five down-regulated) and the lncRNA-associated 10 mRNAs (six up- and four down-regulated), which were identified by microarray in comparing PPROM vs. sPTB, were then validated by real-time quantitative PCR.
A total of 62 (38 up- and 24 down-regulated) and 1,923 (790 up- and 1,133 down-regulated) lncRNAs were identified from placentas of premature labor (sPTB + PPROM), as compared to those from full-term labor (FTB + PROM) and from premature rupture of membranes (PPROM + PROM), as compared to those from non-rupture of membranes (sPTB + FTB), respectively. We found that a correlation existed between differentially expressed lncRNAs and their associated mRNAs, which could be grouped into four categories based on the gene strand (sense or antisense) of lncRNA and its paired transcript. These findings suggest that lncRNA regulates mRNA transcription through differential mechanisms. Differential expression of the transcripts PPP2R5C, STAM, TACC2, EML4, PAM, PDE4B, STAM, PPP2R5C, PDE4B, and EGFR indicated a co-expression among these mRNAs, which are involved in the ubiquitine-proteasome system (UPS), in addition to signaling transduction and beta adrenergic signaling, suggesting that imbalanced regulation of UPS may present an additional mechanism underlying the premature rupture of membrane in PPROM.
Differentially expressed lncRNAs that were identified from the human placentas of sPTB and PPROM may regulate their associated mRNAs through differential mechanisms and connect the ubiquitin-proteasome system with infection-inflammation pathways. Although the detailed mechanisms by which lncRNAs regulate their associated mRNAs in sPTB and PPROM are yet to be clarified, our findings open a new approach to explore the pathogenesis of sPTB and PPROM.
Preterm birth (PTB); Preterm premature rupture of membrane (PPROM); Long non-coding RNA (lncRNA); mRNA; Pathogenic mechanism
Related Articles
Unsafe abortion in Kenya: a cross-sectional study of abortion complication severity and associated factors
Ziraba, Abdhalah Kasiira
Izugbara, Chimaraoke
Levandowski, Brooke A
Gebreselassie, Hailemichael
Mutua, Michael
Mohamed, Shukri F
Egesa, Caroline
Kimani-Murage, Elizabeth W
BMC Pregnancy and Childbirth
Complications due to unsafe abortion cause high maternal morbidity and mortality, especially in developing countries. This study describes post-abortion complication severity and associated factors in Kenya.
A nationally representative sample of 326 health facilities was included in the survey. All regional and national referral hospitals and a random sample of lower level facilities were selected. Data were collected from 2,625 women presenting with abortion complications. A complication severity indicator was developed as the main outcome variable for this paper and described by women's socio-demographic characteristics and other variables. Ordered logistic regression models were used for multivariable analyses.
Over three quarters of abortions clients presented with moderate or severe complications. About 65 % of abortion complications were managed by manual or electronic vacuum aspiration, 8% by dilation and curettage, 8% misoprostol and 19% by forceps and fingers. The odds of having moderate or severe complications for mistimed pregnancies were 43% higher than for wanted pregnancies (OR, 1.43; CI 1.01-2.03). For those who never wanted any more children the odds for having a severe complication was 2 times (CI 1.36-3.01) higher compared to those who wanted the pregnancy then. Women who reported inducing the abortion had 2.4 times higher odds of having a severe complication compared to those who reported that it was spontaneous (OR, 2.39; CI 1.72-3.34). Women who had a delay of more than 6 hours to get to a health facility had at least 2 times higher odds of having a moderate/severe complication compared to those who sought care within 6 hours from onset of complications. A delay of 7–48 hours was associated with OR, 2.12 (CI 1.42-3.17); a delay of 3–7 days OR, 2.01 (CI 1.34-2.99) and a delay of more than 7 days, OR 2.35 (CI 1.45-3.79).
Moderate and severe post-abortion complications are common in Kenya and a sizeable proportion of these are not properly managed. Factors such as delay in seeking care, interference with pregnancy, and unwanted pregnancies are important determinants of complication severity and fortunately these are amenable to targeted interventions.
Unsafe abortion; Kenya; Maternal mortality; Complication; Severity; Termination of pregnancy
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Causes of perinatal mortality and associated maternal complications in a South African province: challenges in predicting poor outcomes
Allanson, Emma R
Muller, Mari
Pattinson, Robert C
BMC Pregnancy and Childbirth
Reviews of perinatal deaths are mostly facility based. Given the number of women who, globally, deliver outside of facilities, this data may be biased against total population data. We aimed to analyse population based perinatal mortality data from a LMIC setting (Mpumalanga, South Africa) to determine the causes of perinatal death and the rate of maternal complications in the setting of a perinatal death.
A secondary analysis of the South African Perinatal Problems Identification Program (PPIP) database for the Province of Mpumalanga was undertaken for the period October 2013 to January 2014, inclusive. Data on each individual late perinatal death was reviewed. We examined the frequencies of maternal and fetal or neonatal characteristics in late fetal deaths and analysed the relationships between maternal condition and fetal and/or neonatal outcomes. IBM SPSS Statistics 22.0 was used for data analysis.
There were 23503 births and 687 late perinatal deaths (stillbirths of ≥ 1000gr or ≥ 28 weeks gestation and early neonatal deaths up to day 7 of neonatal life) in the study period. The rate of maternal complication in macerated stillbirths, fresh stillbirths and early neonatal deaths was 50.4%, 50.7% and 25.8% respectively. Mothers in the other late perinatal deaths were healthy. Maternal hypertension and obstetric haemorrhage were more likely in stillbirths (p = <0.01 for both conditions), whereas ENNDs were more likely to have a healthy mother (p < 0.01). The main causes of neonatal death were related to immaturity (48.7%) and hypoxia (40.6%). 173 (25.2%) of all late perinatal deaths had a birth weight less than the 10th centile for gestational age.
A significant proportion of women have no recognisable obstetric or medical condition at the time of a late perinatal death; we may be limited in our ability to predict poor perinatal outcome if emphasis is put on detecting maternal complications prior to a perinatal death. Intrapartum care and hypertensive disease remain high priority areas for addressing perinatal mortality. Consideration needs to be given to novel ways of detecting growth restriction in a LMIC setting.
Perinatal mortality; Maternal complication; Growth restriction; Hypertension; Intrapartum care
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Adherence, tolerance and effectiveness of two different pelvic support belts as a treatment for pregnancy-related symphyseal pain - a pilot randomized trial
Flack, Natasha AMS
Hay-Smith, E Jean C
Stringer, Mark D
Gray, Andrew R
Woodley, Stephanie J
BMC Pregnancy and Childbirth
Pregnancy-related pubic symphysis pain is relatively common and can significantly interfere with daily activities. Physiotherapist-prescribed pelvic support belts are a treatment option, but little evidence exists to support their use. This pilot compared two pelvic belts to determine effectiveness (symptomatic relief), tolerance (comfort) and adherence (frequency, duration of use).
Unblinded, 2-arm, single-center, randomized (1:1) parallel-group trial. Twenty pregnant women recruited from the community (Dunedin, New Zealand), with physiotherapist-diagnosed symphyseal pain, were randomly allocated to wear either a flexible or rigid belt for three weeks. One author, not involved in data collection, randomized the allocation to trial group. The unblinded primary outcome was the Patient Specific Functional Scale (PSFS). Secondary outcomes were pain intensity during the preceding 24 hours and preceding week (visual analogue scale [VAS]), and disability (Modified Oswestry Disability Questionnaire [MODQ]). Duration of use (hours) was recorded daily by text messaging. Participants were assessed at baseline, by weekly phone interviews and at intervention completion (three weeks). To assess comfort, women wore the alternate belt in the fourth week.
Twenty pregnant women (mean ± SD age, 29.4 ± 6.5 years; mean gestation at baseline, 30.8 ± 5.2 weeks) were randomized to treatment groups (flexible = 10, rigid =10) and all were included in analysis. When adjusted for baseline, PSFS scores were not significantly different between groups at follow up (mean difference −0.1; 95% CI: −2.5 to 2.3; p =0.94). Pain in the preceding 24 hours reached statistical significance in favor of the flexible belt (VAS, p = 0.049). Combining both groups' data, function and pain were significantly improved at three weeks (mean difference −2.3; 95% CI: 1.2 to 3.5; p< 0.001). Belts were worn for an average of 4.9 ± 2.9 hours per day; women preferred the flexible belt. No adverse events were reported.
These preliminary results suggest the flexible pelvic support belt may be more effective in reducing pain and is potentially better tolerated than a rigid belt. Based on these data, a larger trial is both feasible and clinically useful.
Trial registration
Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12614000898651, 25th August, 2014.
Electronic supplementary material
The online version of this article (doi:10.1186/s12884-015-0468-5) contains supplementary material, which is available to authorized users.
Pubic symphysis pain; Pelvic support belts; Pain; Function; Disability; Tolerance; Effectiveness; Adherence
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The influence of preferred place of birth on the course of pregnancy and labor among healthy nulliparous women: a prospective cohort study
van Haaren-ten Haken, Tamar M
Hendrix, Marijke
Smits, Luc J
Nieuwenhuijze, Marianne J
Severens, Johan L
de Vries, Raymond G
Nijhuis, Jan G
BMC Pregnancy and Childbirth
Most studies on birth settings investigate the association between planned place of birth at the start of labor and birth outcomes and intervention rates. To optimize maternity care it also is important to pay attention to the entire process of pregnancy and childbirth. This study explores the association between the initial preferred place of birth and model of care, and the course of pregnancy and labor in low-risk nulliparous women in the Netherlands.
As part of a Dutch prospective cohort study (2007–2011), we compared medical indications during pregnancy and birth outcomes of 576 women who initially preferred a home birth (n = 226), a midwife-led hospital birth (n = 168) or an obstetrician-led hospital birth (n = 182). Data were obtained by a questionnaire before 20 weeks of gestation and by medical records. Analyses were performed according to the initial preferred place of birth.
Low-risk nulliparous women who preferred a home birth with midwife-led care were less likely to be diagnosed with a medical indication during pregnancy compared to women who preferred a birth with obstetrician-led care (OR 0.41 95% CI 0.25-0.66). Preferring a birth with midwife-led care – both at home and in hospital - was associated with lower odds of induced labor (OR 0.51 95% CI 0.28-0.95 respectively OR 0.42 95% CI 0.21-0.85) and epidural analgesia (OR 0.32 95% CI 0.18-0.56 respectively OR 0.34 95% CI 0.19-0.62) compared to preferring a birth with obstetrician-led care. In addition, women who preferred a home birth were less likely to experience augmentation of labor (OR 0.54 95% CI 0.32-0.93) and narcotic analgesia (OR 0.41 95% CI 0.21-0.79) compared to women who preferred a birth with obstetrician-led care. We observed no significant association between preferred place of birth and mode of birth.
Nulliparous women who initially preferred a home birth were less likely to be diagnosed with a medical indication during pregnancy. Women who initially preferred a birth with midwife-led care – both at home and in hospital – experienced lower rates of interventions during labor. Although some differences can be attributed to the model of care, we suggest that characteristics and attitudes of women themselves also play an important role.
Models of maternity care; Place of birth; Course of pregnancy; Birth outcomes
Related Articles
Uterine artery Doppler in the management of early pregnancy loss: a prospective, longitudinal study
Guedes-Martins, Luís
Saraiva, Joaquim P
Gaio, Ana R
Reynolds, Ana
Macedo, Filipe
Almeida, Henrique
BMC Pregnancy and Childbirth
The pharmacological management of early pregnancy loss reduced substantially the need for dilation and curettage. However, prognostic markers of successful outcome were not established. Thus the major purpose of this study was to determine the sensitivity and specificity of the uterine artery pulsatility (PI) and resistance (RI) indices to detect early pregnancy loss patients requiring dilation and curettage after unsuccessful management.
A cohort prospective observational study was undertaken to include women with early pregnancy loss, ≤ 12 weeks of gestation, managed with mifepristone (200 mg) and misoprostol (1600 μg) followed by PI and RI evaluation of both uterine arteries 2 weeks after. At this time, in 173/315 patients, incomplete miscarriage was diagnosed. Among them, 32 underwent uterine dilatation and curettage at 8 weeks of follow-up.
The cut-off points for the uterine artery PI and RI, leading to the maximum values of sensitivity (69.5%, CI95%: 61.5%-76.5% and 75.0%, CI95%: 57.9%-86.8%, respectively) and specificity (75.0%, CI95%: 57.9%-86.8% and 65.6%, CI95%: 48.3%-79.6%, respectively), for the discrimination between the women who needed curettage from those who resolved spontaneously were 2.8 and 1, respectively.
The potential usefulness of uterine artery Doppler evaluation to predict the need for uterine curettage in patients submitted to medical treatment for early pregnancy loss was demonstrated.
Early pregnancy loss; Incomplete miscarriage; Uterine artery Doppler
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