Evidenzlage des Anamnesekatalogs im deutschen Mutterpass

In the risk catalogue A of German maternal passes a large number of questions regarding the medical history of the patient and her family are listed. While there is no doubt that knowledge of the past medical history is of importance in obstetrics for many of the listed risk factors, scientific evidence is lacking for many of the points listed in the catalogue. Data from well performed, randomized studies only exist for a small number of these aspects of prenatal care. It is, however, of paramount importance that open questions about levels of evidence in antenatal management will be answered in the near future, which not only helps to optimize maternal and fetal outcome but to reduce unwarranted maternal fear and depression.     

Versorgung des Neugeborenen durch den Geburtshelfer

Care of the newborn is governed by law and the regulation on continuing education. The main responsibility always rests with the obstetrician. Interdisciplinary cooperation is ideal. Specialists ensure that risks are detected in good time already during pregnancy by following a staged concept. The basis for efficient care is expertise in selection of risk pregnancies and triage to determine the necessary intensity of care. Risks jeopardizing life can be recognized early enough with prenatal diagnostics and averted. Timely transfer, e.g., to a perinatal center, is important in problem cases. At the time of childbirth the duty roster should be scheduled to include at least one qualified physician for gynecology, for pediatrics, and for anesthesiology. Unforeseen problems can arise even in an assumed risk-free birth and a fully functional resuscitation unit is essential. In emergencies the physician most competent for the particular situation takes action.     

Coupe des trois vaisseaux et de la trachée en période prénatale : aspects anormaux

Good knowledge of normal characteristics of prenatal three vessels and trachea view allows not only to detect, but also to identify abnormalities such as normal variants and malformations of interest to main vessels (trunk of the pulmonary artery and its branches, the aorta and the superior vena cava) and various vascular structures in the anterior-superior mediastinum. These abnormalities may be isolated or associated with other anomalies of cardiac architecture.     

Improving Access to and Use of Prenatal Care

Inadequate prenatal care is one of the most perplexing problems in obstetrics. Many women do not seek prenatal care early, and some obtain no prenatal care. The history of prenatal care, the impact of inadequate prenatal care, and the many factors involved in access to and use of prenatal care are discussed. Nursing implications aimed at exploring ways of reducing these factors are examined.     

Preventing Low Birthweight: 25 years, prenatal risk, and the failure to reinvent prenatal care

In 2010, Preventing Low Birthweight celebrated it 25th anniversary. The report, one of the most influential policy statements ever issued regarding obstetric health care delivery, linked prenatal care to a reduction in low birthweight (LBW). Medicaid coverage for prenatal care services was subsequently expanded and resulted in increased prenatal care utilization. However, the rate of LBW failed to decrease. This well-intentioned expansion of prenatal care services did not change the structure of prenatal care. A single, standardized prenatal care model, largely ineffective in the prevention of LBW, was expanded to a heterogeneous group of patients with a variety of medical and psychosocial risk factors. Reinventing prenatal care as a flexible model, with content, frequency, and timing tailored to maternal and fetal risk, may improve adverse birth outcomes. Risk-appropriate prenatal care may improve the effectiveness of prenatal care for high-risk patients and the efficiency of prenatal care delivery for low-risk patients.     

孕妇X染色体异常对其外周血游离DNA产前筛查的影响

目的探讨孕妇X染色体异常对于其外周血游离DNA(cf-DNA)产前筛查的影响。方法收集2016年4月1日至2019年5月31日于中国医学科学院北京协和医院就诊且cf-DNA产前筛查提示胎儿性染色体非整倍体异常(SCA)高风险的孕妇共124例,遗传咨询后行侵入性产前诊断。对于侵入性产前诊断结果与cf-DNA产前筛查结果不相符者,取孕妇白细胞、提取孕妇DNA进行大规模平行测序,以检测孕妇X染色体是否存在数量异常或拷贝数变异。结果124例cf-DNA产前筛查提示胎儿SCA高风险的孕妇中,除9例拒绝诊断,余115例均行侵入性产前诊断,其中41例与cf-DNA产前筛查结果相符,74例不相符。在结果不相符的74例孕妇中,孕妇DNA大规模平行测序发现孕妇X染色体数目异常或携带拷贝数变异者19例,占SCA假阳性孕妇的比例为25.7%(19/74),占总SCA高风险病例的15.3%(19/124)。结论孕妇X染色体数目异常、嵌合或携带拷贝数变异会影响cf-DNA产前筛查的结果,导致假阳性或假阴性结果;对于cf-DNA产前筛查提示胎儿SCA高风险的孕妇,应强调该结果可能受孕妇X染色体异常的影响。对于侵入性产前诊断和cf-DNA产前筛查结果不一致的孕妇,推荐对孕妇染色体进行检测,以明确假阳性或假阴性的原因;而对已明确X染色体数目异常或携带拷贝数变异的孕妇,则不推荐进行cf-DNA产前筛查。     

The Predictive Value of Routine Urine Drug Screening in a High-Risk Obstetric Population

This study assesses the incidence of drug usage in our high-risk obstetrical population and correlates these findings to patient history, pregnancy complications, and routine prenatal drug screens. Intrapartum drug screens for cocaine and marijuana metabolites were performed on 466 patients. Prenatal drug screens were available on 269 of these women. Positive cocaine and marijuana screens occurred in 9.6% and 3.6% of intrapartum screens and in 8.6% and 7.4% of prenatal screens, respectively. Positive marijuana screens were not associated with any prenatal risk factor or adverse pregnancy outcome. Intrapartum cocaine use was associated with an increased incidence of absent/poor prenatal care, sexually transmitted disease, preterm rupture of membranes, abruption, and low birth weight. Antenatal cocaine or marijuana use was significantly associated only with low birth weight. A positive prenatal drug screen was associated with a high incidence of a positive intrapartum screen. A majority of complications occurred in patients without prenatal care regardless of drug use. Routine prenatal drug screening may identify women who use cocaine and marijuana, but does not have a significant effect on perinatal morbidity or mortality as those at highest risk often do not present for prenatal care or have negative prenatal screens.     

A study to determine the incidence and prevalence of newly discovered human immunodeficiency virus infection during the prenatal care period

OBJECTIVES: This study asked the following questions: 1) Does HIV testing in pregnancy identify women who previously were not known to be HIV positive? 2) When in pregnancy are women identified as HIV infected? 3) Does HIV seroconversion occur during the prenatal care period? METHODS: Medical records of 97 women from two primarily indigent care hospitals in Houston, TX who were found to be HIV positive at delivery were reviewed to determine if they had tested positive during the prenatal care period. Demographics and time of gestation of the prenatal testing also were recorded. The outcome measures were: 1) number of women found positive during prenatal care; 2) week of gestation at discovery of HIV positivity; and 3) number of women seroconverting between the initiation of prenatal care and delivery. RESULTS: Thirty women were known to be HIV positive prior to pregnancy. Fifty-six women were found to be positive during prenatal care and the seropositivity of 44 was discovered before the 34th week of pregnancy. Ten women were found to be positive at their first prenatal visit, which occurred after the 34th week. Date of testing was unknown for two women. Eleven women who received no prenatal care were found to be HIV positive at delivery. There were no seroconversions while women were under prenatal care. CONCLUSIONS: HIV testing at delivery did not find any HIV-positive women who had tested negative during prenatal care. Testing is very important for women who do not receive prenatal care. Making certain that high-risk women get into prenatal care also is very important.     

NURSE-MIDWIFERY PRACTICE: A Descriptive Study of Prenatal Care*

Since 1925, nurse-midwives in the United States have provided prenatal care to an essentially normal population and have contributed to decreased maternal and infant mortality and morbidity. The purpose of this investigation was to identify and describe the components of prenatal care provided by certified nurse-midwives. The components of prenatal care were defined as content (the services provided, the physical examination, and the subjects discussed) and process (approaches, attitudes, and the amount of talking). Data were collected by audio tape recordings of 40 prenatal visits between 23 certified nurse-midwives and their clients. Quantification of the components of prenatal care was accomplished by measuring the frequency and/or duration of events. The average return prenatal visit lasted 23.7 min. Aspects of nurse-midwifery practice were defined and measured. Analysis using the Pearson product moment correlation confirmed the presence of relationships between a portion of the components of prenatal care.     

Lack of prenatal care in a traditional society. Is it an obstetric hazard?

OBJECTIVE: To examine the association between lack of prenatal care (fewer than three visits at any prenatal care facility) and perinatal complications in the Bedouin parturient population where lack of prenatal care is not associated with absence of prenatal services, substance abuse or marital status. STUDY DESIGN: The study population consisted of all Bedouin women lacking prenatal care (n = 7,601) who gave birth between the years 1990-1997 in the Soroka University Medical Center. The analysis consisted of a comparison of labor and delivery outcomes in women without prenatal care to outcomes in women who had some prenatal care. RESULTS: During the years 1990-1997 there were 36,281 singleton deliveries to Bedouin women at our institution. Of those, 20.9% did not receive prenatal care. Mothers in the no-prenatal-care group tended to be in the extremes of their reproductive cycles (< 18 years, > 35 years) and were of higher parity (P < .001) than those receiving prenatal care. There were more deliveries prior to 32 weeks of gestation in the no-prenatal-care group (2.8%) in comparison to the prenatal care group (1.5%, P < .001) and fewer postterm deliveries (> 42 weeks, P < .01). The incidence of low birth weight (< 2,500 g) in the no-prenatal-care group was higher than in the prenatal-care group (11.2% vs. 8.4%, P < .001). Women who did not receive adequate prenatal care had statistically significantly higher rates of antepartum fetal death (OR = 1.8, 95% CI 1.4-2.3, P < .001), intrapartum fetal death (OR = 2.38, 95% CI 1.2-4.5, P < .03) and postpartum fetal death (OR = 1.60, 95% CI 1.2-2.1, P < .001). Multiple logistic regression models were used to analyze the independent contribution of lack of prenatal care to perinatal mortality and to very-low-birth-weight newborns. In both models lack of prenatal care was an independent contributing factor. CONCLUSION: Lack of prenatal care is an independent contributor to perinatal mortality and low birth weight in a traditional society. In light of the high percentage of lack of prenatal care in Bedouin society, special attempts should be made to encourage women to use the available prenatal services.     

Prenatal care: limitations and opportunities

Prenatal care is a venerable tradition in the U.S. health care system and one that deserves critical examination. Inordinate amounts of public and personal resources are expended on a tradition of care that has not proven itself equal to current perinatal prevention challenges. In this article, the evolution of prenatal care is reviewed, its efficacy is critiqued, and efforts at restructuring the content and processes of care are examined. Three promising alternatives to the dominant medical model are described: the comprehensive prenatal care approach illustrated by many publicly funded prenatal clinics, the prenatal empowerment model as exemplified by midwifery care, and the prenatal group model as illustrated by CenteringPregnancy. Nurses are called upon to champion prenatal options for women.     

Hispanic Women's Perceptions of Patient‐Centeredness During Prenatal Care: A Mixed‐Method Studya

ABSTRACT: Background: Assessing the quality of prenatal care received by Hispanic women is particularly important, given the rapidly growing Hispanic population in the United States. The purpose of this study was threefold: to assess the prevalence of Hispanic mothers who perceived their prenatal care to be patient‐centered, to determine whether Hispanic mothers were less likely to perceive their prenatal care to be patient‐centered than non‐Hispanic mothers, and to better understand Hispanic women's perceptions of the patient‐centeredness of their prenatal care. Methods: Semistructured interviews were conducted with a proportionate, stratified random sample of 359 women initiating prenatal care in their first trimester and 68 women initiating prenatal care in their third trimester who delivered at 10 Palm Beach County, Florida, maternity hospitals between May and December 2003. Interviews assessed three aspects of patient‐centered prenatal care using quantitative and qualitative methods. Results: Hispanic mothers were less likely than non‐Hispanic mothers to perceive that doctors and nurses treated them with respect during their prenatal care appointments (adjusted OR, 0.29; 95% CI, 0.10–0.86), and to perceive that office staff treated them with respect during their prenatal care appointments (adjusted OR, 0.29; 95% CI, 0.12–0.73). Hispanic mothers were more likely to experience language or communication problems than non‐Hispanic mothers (adjusted OR, 3.30; 95% CI, 1.40–7.76). Qualitative analyses found that lack of patient‐centered care limited Hispanic mothers’ ability to understand information given during prenatal visits, ability to ask questions about their prenatal care, and desire to return for subsequent appointments. Conclusions: Hispanic women could benefit from prenatal care that is more culturally and linguistically competent as well as care that is responsive to the group's cultural norms. One recommendation is the use of group prenatal care, which encourages groups of women with similar gestational ages to articulate and discuss cultural norms and attitudes about pregnancy during structured prenatal care sessions. (BIRTH 32:4 December 2005)     

A Review of Prenatal Home‐Visiting Effectiveness for Improving Birth Outcomes

ObjectiveTo determine the effectiveness of prenatal home visiting for improving prenatal care utilization and preventing preterm birth and low birth weight.Data SourcesMedline, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Social Work Abstract databases were searched for articles that examined prenatal home‐visiting and prenatal care utilization or neonatal outcomes, with additional ascendancy and descendancy searches. Listservs were also used to identify unpublished evaluations.Study SelectionQuantitative studies meeting the following criteria were included in the analyses: published between 1985 and 2009, published in English, reported providing prenatal home visiting, and reported on prenatal care utilization or a neonatal outcome.Data ExtractionStudy characteristics and findings related to prenatal care utilization, gestational age, and birth weight were abstracted independently by at least two authors. Study quality was assessed across five domains.Data SynthesisThe search yielded 28 studies comparing outcomes for women who did and did not receive prenatal home visiting, with 14 (59%) using an RCT design. Five (17%) studies reporting on prenatal care utilization found a statistically significant improvement in use of prenatal care for women with home visiting. Of 24 studies reporting an effect on birth outcomes, five (21%) found a significant positive effect on gestational age, and seven of 17 (41%) found a significant positive effect on birth weight.ConclusionsMore evidence suggests that prenatal home visiting may improve the use of prenatal care, whereas less evidence exists that it improves neonatal birth weight or gestational age. These findings have implications for implementing Title II of the Affordable Care Act.     

Prospects for fetal gene therapy

Advances in prenatal diagnosis and gene transfer technology have allowed consideration of prenatal gene therapy. A compelling argument can be made for this strategy in treating genetic diseases that are fatal in the prenatal or perinatal period. In other diseases, the fetal environment may offer unique biological advantages that favor a prenatal gene therapy strategy over treatment after birth. Although issues of safety and efficacy must be resolved before clinical application, the development of fetal gene therapy may become a new molecular therapeutic arm in the field of prenatal intervention.     

Uses of cell free fetal DNA in maternal circulation

For over a decade, researchers have focused their attention on the development of non-invasive prenatal diagnosis tests based on cell-free fetal DNA circulating in maternal blood. With the possibility of earlier and safer testing, non-invasive prenatal diagnosis has the potential to bring many positive benefits to prenatal diagnosis. Non-invasive prenatal diagnosis for fetal sex determination for women who are carriers of sex-linked conditions is now firmly established in clinical practice. Other non-invasive prenatal diagnosis-based tests are set to follow, as future applications, such?as the detection of single-gene disorders and chromosomal abnormalities, are now well within reach. Here, we review recent developments in non-invasive prenatal diagnosis for genetic conditions and chromosomal abnormalities, and provide an overview of research into ethical concerns, social issues and stakeholder view points.     

The Association of Inadequate and Intensive Prenatal Care With Maternal,Fetal, and Infant Outcomes: A Population-Based Study in Manitoba,Canada

ObjectiveLittle is known about how prenatal care influences health outcomes in Canada. The objective of this study was to examine the association of prenatal care utilization with maternal, fetal, and infant outcomes in Manitoba.MethodsThis retrospective cohort study conducted at the Manitoba Centre for Health Policy investigated all deliveries of singleton births from 2004-2005 to 2008-2009 (N = 67 076). The proportion of women receiving inadequate, intermediate/adequate, and intensive prenatal care was calculated. Multivariable logistic regression was used to examine the association of inadequate and intensive prenatal care with maternal and fetal-infant health outcomes, health care use, and maternal health-related behaviours.ResultsThe distribution of prenatal care utilization was 11.6% inadequate, 84.4% intermediate/adequate, and 4.0% intensive. After adjusting for sociodemographic factors and maternal health conditions, inadequate prenatal care was associated with increased odds of stillbirth, preterm birth, low birth weight, small for gestational age (SGA), admission to the NICU, postpartum depressive/anxiety disorders, and short interpregnancy interval to next birth. Women with inadequate prenatal care had reduced odds of initiating breastfeeding or having their infant immunized. Intensive prenatal care was associated with reduced odds of stillbirth, preterm birth, and low birth weight and increased odds of postpartum depressive/anxiety disorders, initiation of breastfeeding, and infant immunization.ConclusionInadequate prenatal care was associated with increased odds of several adverse pregnancy outcomes and lower likelihood of health-related behaviours, whereas intensive prenatal care was associated with reduced odds of some adverse pregnancy outcomes and higher likelihood of health-related behaviours. Ensuring women receive adequate prenatal care may improve pregnancy outcomes.     

高龄妊娠的孕期管理

高龄妊娠不但增加胎儿染色体疾病的发病,还可导致母胎不良事件的发生。本文介绍了关于高龄妊娠产前筛查、诊断的新进展及妊娠期相关并发症管理,供临床医师参考,以更好地降低不良妊娠结局的发生率。     

The relationship between utilization of prenatal care and Down syndrome live births.

OBJECTIVE: This study evaluated whether utilization of prenatal care, as measured by the Kessner index, affects the number of Down syndrome live births. METHODS: A retrospective analysis of birth certificate data of Down syndrome live births comparing 1989 to 2001 by year, maternal age, gestational age at first prenatal visit, and adequacy of prenatal care according to Kessner categories of adequacy of prenatal care. RESULTS: Down syndrome live births were inversely correlated with adequacy of prenatal care. Reductions in Down syndrome live births were seen in all categories of prenatal care in all age groups. In 2001 a minimum 30% reduction was seen in any category rising to a 58% reduction in women > or =35 years with adequate prenatal care. The largest reductions were seen in women > or =35 years of age. CONCLUSIONS: Reductions in Down syndrome live births occurred in all age groups between 1989 and 2001. Utilization of prenatal care as measured by the Kessner index was associated with reductions in Down syndrome live births, with a greater reduction in women > or =35 years of age.