‘What is could indeed be better’—Swedish women’s perceptions of early postnatal care

Background

studies have shown that women are more likely to be satisfied with intrapartum rather than postpartum care. The structure and organisation of care seems to be a barrier to good-quality postpartum treatment

Objective

to explore the perceived reality and the subjective importance of early postnatal care provided in hospital, and to study women’s satisfaction with different models of early postnatal care and the factors that are most strongly associated with being ‘very satisfied’ with the postnatal care received.

Method

a regional survey was conducted with 1240 women recruited in mid-pregnancy and followed-up two months after childbirth.

Results

a statistically significant difference existed between the subjective importance and the perceived reality for all studied variables, with a greater subjective importance than perceived reality for all statements. The length of postnatal stay and the content of care were related to satisfaction, while the model of postnatal care was not. The most important variables for being ‘very satisfied’ with postnatal care were that the infant received the best possible check-ups/medical care, and that the woman received sufficient support from staff.

Conclusion

further studies are needed to assess the best model of postnatal care that gives the best opportunities to provide satisfactory care for women and their families.     

Oral nutrition in labour: ‘Whose choice is it anyway?’ A review of the literature

Objective

to identify factors affecting women’s oral nutrition in labour.

Design

literature review (1988–2009).

Setting

Westernised maternity care settings.

Participants

women, midwives, obstetricians, anaesthetists and hospitals.

Measurements and findings

when addressing labour stages, the risk categorisation of women and maternal/fetal birthing outcomes, there was a lack of consistent evidence identifying adverse outcomes for mothers/infants when oral nutrition in labour had occurred.

Key conclusions

little evidence exists to support the continuance of restrictive practices around oral nutrition in labour for all women. Women’s choice is impacted by health practitioners’ opinions, experience and practice methods and policy (or lack thereof). Policies are not reflective of current evidence.

Implications for practice

women’s choices and desires regarding oral nutrition in labour need to be addressed. Clear guidelines/policies need to be established based on current evidence. Midwives need greater exposure to research, as well as involvement in policy development and implementation.     

Attitudes of nearly 7000 health professionals,genomic researchers and publics toward the return of incidental results from sequencing research

Genome-wide sequencing in a research setting has the potential to reveal health-related information of personal or clinical utility for the study participant. There is increasing pressure to return research findings to participants that may not be related to the project aims, particularly when these could be used to prevent disease. Such secondary, unsolicited or ''incidental findings'' (IFs) may be discovered unintentionally when interpreting sequence data, or as the result of a deliberate opportunistic screen. This cross-sectional, web-based survey investigated attitudes of 6944 individuals from 75 countries towards returning IFs from genome research. Participants included four relevant stakeholder groups: 4961 members of the public, 533 genetic health professionals, 843 non-genetic health professionals and 607 genomic researchers who were invited via traditional media, social media and professional e-mail list-serve. Treatability and perceived utility of incidental results were deemed important with 98% of stakeholders personally interested in learning about preventable life-threatening conditions. Although there was a generic interest in receiving genomic information, stakeholders did not expect researchers to opportunistically screen for IFs in a research setting. On many items, genetic health professionals had significantly more conservative views compared with other stakeholders. This finding demonstrates a disconnect between the views of those handling the findings of research and those participating in research. Exploring, evaluating and ultimately addressing this disconnect should form a priority for researchers and clinicians alike. This social sciences study offers the largest dataset, published to date, of attitudes towards issues surrounding the return of IFs from sequencing research.     

The TWIST gene, although not disrupted in Saethre-Chotzen patients with apparently balanced translocations of 7p21, is mutated in familial and sporadic cases

The TWIST gene maps to 7p21 and mutations in the gene have been reported in the Saethre-Chotzen form of craniosynostosis. The position of the Saethre-Chotzen gene has previously been refined by FISH analysis of four patients carrying balanced translocations involving 7p21 which suggested that it was located between D7S488 and D7S503. We report here that the breakpoints in four translocation patients do not interrupt the coding sequence of the TWIST gene and thus most likely act through a positional effect. Twelve Saethre-Chotzen cases were found to have TWIST mutations. Four of these families had been used as part of the linkage study of the Saethre-Chotzen locus. The mutations detected included missense and nonsense mutations and three cases of a 21 bp duplication. Although phenotypically diagnosed as having Saethre- Chotzen syndrome, three families were found to have a pro250arg mutation of FGFR3.      

Extracellular matrix improves survival of both stored and fresh human primordial and primary ovarian follicles in long-term culture

Ovarian cortical tissue was obtained during gynaecological operations by biopsy or after oophorectomy from 20 women aged 25-42 years. It was placed in organ culture, either fresh or following thawing after cryopreservation, for 1-4 months. The tissue was cut in slices 0.1-0.3 mm in diameter and transferred to 12 mm inserts in 24-well culture plates. These slices were cultured for 4-21 days in either alpha minimum essential medium (alpha-MEM) or Earle's balanced salt solution with added pyruvate. Both media were supplemented with 10% human serum, insulin, gonadotrophins and antibiotics. Half of the inserts were precoated with extracellular matrix (Matrigel). Histological samples revealed that there were viable, non-atretic, primordial, primary and secondary follicles in all the cultures. Mitoses were seen in the granulosa cells of the secondary follicles. Although the proportion of atretic follicles increased during culture, non-atretic follicles were still present after 21 days. After 4-11 days the proportion of viable follicles was significantly higher when cultured in Earle's solution supplemented with pyruvate, than when cultured in MEM (77 versus 38%, P < 0.001). In cultures with extracellular matrix the proportion of viable follicles was significantly higher after 10-15 days than it was without matrix (85 versus 19%, P < 0.001). Culture after thawing frozen ovarian tissue did not affect the density or the proportion of the viable follicles. Two-thirds of follicles in cryopreserved tissue were viable after 10-15 days in culture. The results indicate that it is possible to culture human primary and primordial follicles in vitro, and follicles in cryopreserved tissue are viable.      

Comparison of two ventilator circuits for Dräger Babylog high-frequency ventilation

Aim: The Dräger Babylog 8000plus ventilator (Dräger Medical Systems, Lübeck, Germany) can provide both conventional and high‐frequency ventilation (HFV). Dräger recommends specific circuits for each of these modes. We investigated the performance of the Babylog ventilator in HFV mode when used with the recommended circuits for both conventional and HFV. Methods: The Fisher and Paykel RT235 (conventional; Fisher and Paykel Healthcare, Auckland, New Zealand) and Hytrel (HFV; Fisher and Paykel Healthcare) circuits were studied using a 50‐mL test lung. Tidal volume, high‐frequency minute volume and ventilator alarms were compared at 100 combinations of mean airway pressures (10–16 cm H₂O), frequencies (6–14 Hz) and amplitudes (20–60%). Results: Tidal volume with the two circuits differed by <5% for tidal volumes ≤2.5 mL. Above this, tidal volumes delivered with the HFV circuit were up to 15% more than that obtained with the conventional ventilation circuit, and high‐frequency minute volume differed by up to 30%. With the exception of the highest tidal/minute volumes, the tidal volume delivered using the HFV circuit could also be achieved with adjusted frequency or amplitude when using the conventional circuit. More ‘pressure measurement out of range’ alarms were noted with the conventional ventilation circuit, particularly at mean airway pressure ≥14 cm H₂O and frequency ≤10 Hz. Conclusions: The conventional ventilation circuit may allow delivery of adequate tidal volume for some infants. Where requirements are higher, the HFV circuit allows the Babylog to deliver higher tidal volumes and higher minute volume, and reduce alarms.