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INTRODUCTION: Synthetic oxytocin is one of the most regularly administered medications to facilitate labor induction and augmentation. The present study examined the associations between oxytocin administration during childbirth and postpartum posttraumatic stress symptoms (PTSS). MATERIALS AND METHODS: In a multicenter longitudinal study, women completed questionnaires during pregnancy and at 2 months postpartum (N = 386). PTSS were assessed with the Impact of Event Scale. Logistic regression was used to examine the difference in PTSS at Time 2 between women who received oxytocin and women who did not. RESULTS: In comparison with women who did not receive oxytocin, women who received oxytocin induction were 3.20 times as likely to report substantial PTSS (P = .036, 95% confidence interval: 1.08-9.52), and women who received oxytocin augmentation were 3.29 times as likely to report substantial PTSS (P = .036, 95% confidence interval: 1.08-10.03), after controlling for being primiparous, preeclampsia, prior mental health diagnosis, mode of birth, postpartum hemorrhage, and satisfaction with staff. DISCUSSION: Oxytocin administration was associated with a 3-fold increased risk of PTSS. The findings may reflect biological and psychological mechanisms related to postpartum mental health and call for future research to establish the causation of this relationship.
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BACKGROUND AND AIM: Studies have shown that increased maternal cortisol level is associated with child adverse health outcomes. Hair cortisol (HC) is suitable for assessing long-term circulating cortisol concentration. Only two previous studies reported beneficial associations between cortisol and residential greenness during pregnancy and no study focused on the first trimester. Our aim was to evaluate the association between residential greenness and first trimester HC levels among pregnant women in Israel. METHODS: Women were recruited during second and third trimesters. Hair samples were collected from the scalp and retrospective HC levels during the first trimester were quantified for 217 women. HC levels were natural log transformed and outliers were excluded. Based on geocoded birth address, small area sociodemographic status (SES) and mean residential surrounding greenness were calculated using high-resolution satellite-based Normalised Difference Vegetation Index (NDVI) data at 100, 300 and 500-m buffers in a cross-sectional approach. In addition, longitudinal exposure to mean greenness during a week preconception and during the first trimester were calculated. Missing covariates were imputed and linearity of the associations were evaluated. Generalized linear models were used to estimate the crude and adjusted associations controlled for the relevant covariates. RESULTS: After exclusion of outliers, for 211 women, crude and adjusted beneficial associations between exposure to higher mean NDVI and HC levels were observed for all the exposure measures. An increase in 1 interquartile range of greenness (100 m buffer) was associated with a statistically significant lower estimated natural log mean HC level (-0.27 95% CI: -0.44; -0.11). The associations were robust to adjustment for covariates. The findings were consistent for different buffers, for the longitudinal approach, when all observations were included in the analysis and slightly stronger associations were observed for women with addresses geocoded at the home or street level. For most of the exposure measures, stronger associations were observed among those of lower sociodemographic status. CONCLUSION: Our findings that more greenness associated with reduced maternal cortisol levels measured in the hair during the first trimester, could have substantial implications for urban planners and public health professional. If our observations will be replicated, it may present a useful avenue for public-health intervention to promote health through the provision of greenness exposure during early pregnancy, specifically to disadvantage populations.
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Ambiente , Cabello , Hidrocortisona , Primer Trimestre del Embarazo , Entorno Construido/psicología , Niño , Femenino , Cabello/química , Promoción de la Salud , Humanos , Hidrocortisona/análisis , Israel , Embarazo , Primer Trimestre del Embarazo/fisiología , Primer Trimestre del Embarazo/psicología , Estudios RetrospectivosRESUMEN
Background: Mobile medical devices for self-patient use are a rapidly evolving section of telehealth. We examined the INSTINCT® ultrasound system, a portable, self-operated ultrasound device attached to a commercial smartphone for remote fetal assessment. We aimed to evaluate whether it is feasible to use remote fetal assessment during pregnancy. Materials and Methods: This is an observational noninterventional trial. We included women with a singleton fetus at 14 + 0 to 39 + 6 gestational weeks. Each participant received the device for a self-use period of 7-14 days and was instructed to perform one to three scans a day. Participants completed a self-assessment questionnaire to evaluate safety and usability (i.e., user experience and satisfaction). Each scan was evaluated for fetal heart activity, amniotic fluid volume, fetal tone, fetal body, and breathing movements. Results: One hundred women, completing 1,360 self scans, used the device for 8.1 ± 1.5 days, performing an average of 13.6 ± 6.2 scans each. There were no device-related serious adverse events. Success in detection was 95.3% for fetal heart activity, 88.3% for body movements, 69.4% for tone, 92.2% for normal amniotic fluid volume, and 23.8% for breathing movements. Interobserver agreement was 94.4% for fetal heart rate activity, 85.9% for body movements, 69.5% for fetal tone, 86.9% for amniotic fluid volume, and 94.0% for breathing movements. Self-assessed user experience was rated at 4.4/5, whereas device satisfaction was rated at 3.9/5. Conclusion: The INSTINCT ultrasound system is a feasible solution for remote sonographic fetal assessment. Further studies are needed to assess its role and impact in telehealth antenatal care and fetal surveillance.
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Frecuencia Cardíaca Fetal , Telemedicina , Líquido Amniótico , Femenino , Humanos , Embarazo , Atención Prenatal , UltrasonografíaRESUMEN
INTRODUCTION: Various biopsychosocial factors affect women's preferences with respect to mode of birth, but they are usually not examined simultaneously and prospectively. In the current study, we assessed the contribution of personal characteristics of first-time mothers, their prior prenatal perceptions, events during birth, and subjective birth experiences, on their preference about mode of second birth. METHODS: This was a secondary analysis of two prospective birth cohort studies. Participants included 832 primiparous women recruited mostly from women's health centers in Israel, and through natural birth communities and cesarean birth websites. Women completed questionnaires prenatally and were followed up at 6-8 weeks postpartum to understand their preferences for a second birth. RESULTS: Regression models indicated that after vaginal first birth, being less religious, believing that birth is a medical process, and having a negative experience increased the odds of preferring primary cesarean for the second birth. After cesarean birth, being more religious, having higher education, conceiving spontaneously, having a more negative birth experience, and perceiving better treatment from the staff during birth contributed to preferring vaginal birth for the second birth. CONCLUSIONS: Religiosity is central to women's preferences, probably because of its association with the desire to have many children. Modifiable factors, such as women's beliefs about the nature of birth, their overall birth experience, and their perceived treatment from the staff, could influence the uptake of having vaginal births. Intrapartum care that is empathic and encouraging, along with education about modes of birth, could help decrease cesarean birth rates.
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Cesárea/psicología , Conducta de Elección , Parto , Prioridad del Paciente , Adulto , Cesárea/estadística & datos numéricos , Cesárea Repetida/psicología , Femenino , Humanos , Israel , Embarazo , Estudios Prospectivos , Análisis de Regresión , Religión , Encuestas y Cuestionarios , Parto Vaginal Después de Cesárea/psicologíaRESUMEN
PROBLEM: Birth preferences, such as mode and place of birth and other birth options, have important individual and societal implications, yet few studies have investigated the mechanism which predicts a wide range of childbirth options simultaneously. BACKGROUND: Basic beliefs about birth as a natural and as a medical process are both predictive factors for childbirth preferences. Studies investigating birth beliefs, preferences, and actual birth are rare. AIM: To test a predictive model of how these beliefs translate into birth preferences and into actual birth related-options. METHODS: Longitudinal observational study including 342 first-time expectant mothers recruited at women's health centres and natural birth communities in Israel. All women filled out questionnaires including basic birth beliefs and preferred birth options. Two months postpartum, they filled out a questionnaire including detailed questions regarding actual birth. FINDINGS: Stronger beliefs about birth being natural were related to preferring a more natural place and mode of birth and preferring more natural birth-related options. Stronger beliefs about birth being medical were associated with opposite options. The preferences mediated the association between the birth beliefs and actual birth. The beliefs predicted the preferences better than they predicted actual birth. DISCUSSION: Birth beliefs are pivotal in the decision-making process regarding preferred and actual birth options. In a medicalized obstetric system, where natural birth is something women need to actively seek out and insist on, the predictive powers of beliefs and of preferences decrease. CONCLUSION: Women's beliefs should be recognized and birth preferences respected.
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Parto Obstétrico/psicología , Medicalización , Parto/psicología , Adulto , Parto Obstétrico/métodos , Femenino , Humanos , Israel , Estudios Longitudinales , Madres/psicología , Prioridad del Paciente , Embarazo , Encuestas y CuestionariosRESUMEN
BACKGROUND: Several studies have shown inconsistent associations between anxiety during pregnancy and adverse pregnancy outcome. This inconsistency may be due to lack of controlling for the timing and type of maternal anxiety. We aimed to isolate a specific type of anxiety - maternal anxiety propensity, which is not directly related to pregnancy, and evaluate its association with adverse pregnancy outcome. METHODS: We conducted a prospective observational study of 512 pregnant women, followed to delivery. The trait anxiety scale of the State-Trait Anxiety Inventories was used in order to detect a propensity towards anxiety. The association between anxiety propensity (defined as trait-anxiety subscale score above 38) and adverse pregnancy outcome was evaluated. Primary outcome was a composite outcome including preterm birth prior to 37 gestational weeks, hypertensive disorders in pregnancy, small for gestational age newborn and gestational diabetes mellitus. Secondary outcomes were each one of the above mentioned gestational complications. RESULTS: There were no significant between-group differences in adverse pregnancy outcomes, including the rate of preterm birth, hypertensive disorders, small for gestational age, gestational diabetes or a composite outcome of them all. CONCLUSION: Anxiety propensity is not associated with adverse pregnancy outcome.
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Ansiedad , Diabetes Gestacional , Hipertensión Inducida en el Embarazo , Recién Nacido Pequeño para la Edad Gestacional , Complicaciones del Embarazo , Resultado del Embarazo , Mujeres Embarazadas/psicología , Adulto , Ansiedad/diagnóstico , Ansiedad/fisiopatología , Ansiedad/psicología , Correlación de Datos , Diabetes Gestacional/epidemiología , Diabetes Gestacional/psicología , Femenino , Humanos , Hipertensión Inducida en el Embarazo/epidemiología , Hipertensión Inducida en el Embarazo/psicología , Israel/epidemiología , Inventario de Personalidad , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/fisiopatología , Complicaciones del Embarazo/psicología , Resultado del Embarazo/epidemiología , Resultado del Embarazo/psicología , Puntaje de Propensión , Estudios ProspectivosRESUMEN
BACKGROUND: Women perceive what birth is even before they are pregnant for the first time. Part of this conceptualization is the basic belief about birth as a medical and natural process. These two separate beliefs are pivotal in the decision-making process about labor and birth. Adapting Engel's biopsychosocial framework, we explored the importance of a wide range of factors which may contribute to these beliefs among first-time mothers. METHOD: This observational study included 413 primiparae ≥24 weeks' gestation, recruited in medical centers and in natural birth communities in Israel. The women completed a questionnaire which included the Birth Beliefs Scale and a variety of biopsychosocial characteristics such as obstetric history, birth environment, optimism, health-related anxiety, and maternal expectations. RESULTS: Psychological dispositions were more related to the birth beliefs than the social or biomedical factors. Sociodemographic characteristics and birth environment were only marginally related to the birth beliefs. The basic belief that birth is a natural process was positively related to optimism and to conceiving spontaneously. Beliefs that birth is a medical process were related to pessimism, health-related anxiety, and to expectations that an infant's behavior reflects mothering. Expectations about motherhood as being naturally fulfilling were positively related to both beliefs. CONCLUSION: Psychological factors seem to be most influential in the conceptualization of the beliefs. It is important to recognize how women interpret the messages they receive about birth which, together with their obstetric experience, shape their beliefs. Future studies are recommended to understand the evolution of these beliefs, especially within diverse cultures.
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Ansiedad/psicología , Toma de Decisiones , Trabajo de Parto/psicología , Parto/psicología , Adulto , Ansiedad/etiología , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Israel , Modelos Lineales , Embarazo , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To compare the performance of the 50 g glucose challenge test (GCT) and the 100 g oral glucose tolerance test (OGTT) in twin versus singleton pregnancies. METHODS: A retrospective study of all women who underwent a GCT (24-28 weeks) and delivered in a single tertiary medical center (2001-2012). The performance of the GCT and the OGTT tests were compared between twin and singleton pregnancies. RESULTS: The results of the GCT were available for 14 797 women, of whom 14 268 were singleton and 529 were twin pregnancies. Women in the twins group were characterized by a higher mean GCT result (104.7 ± 28 versus 98.5 ± 25, p < 0.001), a higher rate of GCT > 130 mg/dl (20.2% versus 11.8%, p < 0.001) or GCT >140 mg/dl (13.8% versus 9.6%, p = 0.001). The positive prediction value (PPV) for a GCT >140 mg/dl was significantly lower in the twins group for the prediction of either ≥1 abnormal values (21.1% versus 33.8%, p = 0.03) or ≥2 abnormal values (12.7% versus 23.0%, p = 0.04) in the OGTT. Twin pregnancy was independently associated with an increased risk for a GCT result >130 mg/dl [odds ratio (OR) = 2.2, 95% confidence interval (CI) 1.7-2.7] or >140 mg/dl (OR = 1.9, 95% CI 1.5-2.5) even after adjustment for maternal age, parity and fetal sex. CONCLUSION: The 50 g GCT appears to be associated with a higher false positive rate and a lower positive predictive value in twin compared with singleton pregnancies.
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Diabetes Gestacional/diagnóstico , Prueba de Tolerancia a la Glucosa/métodos , Embarazo Gemelar/sangre , Adulto , Diabetes Gestacional/sangre , Reacciones Falso Positivas , Femenino , Glucosa/administración & dosificación , Humanos , Análisis Multivariante , Valor Predictivo de las Pruebas , Embarazo , Estudios Retrospectivos , Edulcorantes/administración & dosificaciónRESUMEN
OBJECTIVE: To assess the incidence and risk factors for third- and fourth-degree perineal tears (34DPT), and to identify subgroups of women who are at especially high risk for 34DPT. METHODS: A cohort study of women who underwent vaginal delivery in a single tertiary medical center between 1999 and 2011, (58 937 deliveries). Women diagnosed with 34DPT following delivery were compared to control group. Multivariate logistic regression analysis and tree classification analysis were used to identify combinations of risk factors which were associated with considerable risk for 34DPT. RESULTS: Overall, 356 (0.6%) deliveries were complicated by 34DPT (340 (95.5%) third-degree tears and 16 (4.5%) fourth-degree tears). Independent predictors of 34DPT were: forceps delivery (odds ratio (OR) = 5.5, confidence interval (CI) 3.9-7.8), precipitate labor (OR = 5.2, CI 2.9-9.2), persistent occiput posterior position (OR = 2.6, CI 1.6-4.3), vacuum extraction (OR = 1.9, CI 1.4-2.6) as well as large for gestational age (LGA) infant and gestational age > 40 weeks. Fourth-degree tears were associated with forceps delivery (OR = 12.5, CI 2.3-66.2), precipitate labor (OR = 9.7, 95%-CI 1.2-75.4) and LGA infant (OR = 7.4, 95%-CI 1.7 -1.5). Overall, the predictability of 34DPT was limited (R(2 )= 0.4). In subgroups of women with certain combinations of risk factors the risk of 34DPT ranged from 10% to 25%. CONCLUSION: Despite the limited predictability of 34DPT by individual risk factors, the use of combinations of risk factors may assist obstetricians in identifying women who are at especially high risk for 34DPT.