Reduced length of hospital stay after caesarean section: A systematic review examining women's experiences and psychosocial outcomes

The Effect of Nursing Interventions in Women With Gestational Hypertension: A Systematic Review and Meta-Analysis

Pregnancy-related hypertensive disorders are significant global causes of maternal morbidity and mortality. Quality nursing care is essential for pregnant women with hypertension to ensure a healthy pregnancy and delivery. This study aimed to systematically synthesize evidence on the effectiveness of nursing interventions for women with gestational hypertension. A systematic review and meta-analysis were conducted following PRISMA guidelines. Literature was searched across seven electronic databases from August 1 to September 27, 2023. Thirteen studies, encompassing 1458 women with gestational hypertension, were included. Quality assessment indicated that 10 randomized controlled trials were rated as good, one as fair, and all quasi-experimental studies as good quality. Various nursing interventions were analyzed, including training programs, home-based comprehensive nursing, case management, vascular symptom management, music therapy, and clinical nursing pathways. Meta-analysis results revealed that nursing interventions significantly reduced systolic and diastolic blood pressure, anxiety, depression, and hospital length of stay. These findings suggest that nursing interventions can effectively improve health outcomes for women with gestational hypertension, positively impacting at least one outcome in all included studies. PROSPERO REGISTRATION NUMBER: CRD42023444829.

Healthcare Providers' Experiences With and Perspective on Delivering the Enhanced Recovery After Elective Caesarean Birth Pathway With Next-Day Discharge: Qualitative Analysis

AIMS

To understand the perspectives and experiences of healthcare providers who have experience working with an enhanced recovery care after elective caesarean birth pathway with next-day discharge and home midwifery.

DESIGN

This study applies a qualitative study design with a pragmatic realist approach. The realist framework was used while also taking a post-positivist philosophy.

METHODS

The work was conducted in South Australia, Australia between May and October 2019. Twenty-three semi-structured interviews were completed with 5 doctors and 18 midwives who had occupational experience working with the pathway. Interviews were analysed using following the six-phase qualitative thematic analysis process outlined by Braun and Clarke. COREQ guidelines were followed.

RESULTS

Four main themes and 11 sub-themes were identified. Main themes identified were as follows: The pathway is more than just early discharge; experiences with the process; staff engagement with the pathway; and the impact of the pathway within the health system.

CONCLUSION

Healthcare providers generally accepted the pathway and found enhanced recovery care to be a positive and beneficial model of care. Staff identified five main challenges with implementing the pathway: early discharge; eligible women's automatic inclusion on the pathway; engaging women; change for staff and organisational constraints and procedures. Elements that support integration include the following: education for women; reassurance and communication with women and families; prepared care and supports including home midwifery; staff education and communication of the evidence; clear guidelines and protocols; defined staff roles; enough clinical time and clinical flexibility.

IMPACT

Knowledge from staff in this study would be useful for other health services to consider when looking to deliver similar models of care.

PATIENT OR PUBLIC CONTRIBUTION

The health service and health providers were involved with the initiation and development of the research aims and design.

A mixed methods study of the postnatal care journey from birth to discharge in a maternity service in New South Wales, Australia

BACKGROUND

Service gaps continue in hospital and community-based postnatal care despite a high prevalence of physical and mental health concerns reported by women following birth. The aim of this study was to describe the postnatal journey and the care provided to women and their babies who were at low risk for health complications from birth to discharge from the maternity service.

METHODS

A mixed methods design was used to map the postnatal journey, for the woman and baby, from birth to discharge from the maternity service. Data were collected through activity diaries completed by 15 women and telephone interviews with the women two weeks after birth.

RESULTS

The average hospital postnatal stay was 70 h and, in this time, the women received on average, a total of 3 h of direct care from a health professional. That is, 4.3% of the in-hospital postnatal stay was spent interacting with a health professional. Approximately 53 min of care in the postnatal unit was directed at the mother's health, 50 min on the baby's health needs, 43 min supporting breastfeeding and 20 min on discharge information. Most reported that hospital based postnatal care was helpful, although they reported that staff on the postnatal unit were rushed and mostly the midwife caring for them was unfamiliar to them. Breastfeeding support in the first 12-24 h was limited, with women wanting more one-on-one access to midwives. Some women received home-based midwifery care, and on average each home visit by a midwife was 29 min. Women who received home-based midwifery care reported that this care was very helpful. Women reported that home-based midwives were more likely to engage women in conversations about their social and emotional needs than hospital-based midwives. All mothers were offered a home visit from a child and family health nurse and most visited a general practitioner in the first week.

CONCLUSIONS

Women often experience limited time in direct interaction with midwives in the postnatal unit in hospital. Those who received midwifery care at home were more satisfied with this care, Women are requesting more support from professionals in the early postnatal period.

Quality of birth care and risk factors of length of stay after birth: A machine learning approach

AIM

Length of stay (LOS) is an outcome measure and is assumed to be related to quality. The objective of this study is to examine the quality of birth care and risk factors associated with LOS after birth.

METHODS

A nationwide population-based Turkish Demographic and Health Survey (TDHS) was used for the year 2018. A total of 1849 women ages 15-49 were included. Explanatory factor analysis and machine learning predictors such as Random Forest, Support Vector Machine, Neural Network, k-Nearest Neighbor, and Naïve Bayes were used to identify the quality of birth care and risk factors associated with LOS after birth.

RESULTS

As a result of the explanatory factor analysis, factor structures of quality of birth care, antenatal check-ups and supplements, and risk factors associated with birth were obtained using the Categorical Component Analysis method. The type of delivery, place of delivery, age, and type of place, which are under the quality of birth care, and risk factors associated with birth factors were found to be the variables that had the highest impact on LOS estimation. Random forest (Accuracy = 0.5789), support vector machine (radial) (Accuracy = 0.5766), and neural network (Accuracy = 0.5750) models outperformed, respectively.

CONCLUSION

Type of delivery which is an indicator of quality of birth care is a strong predictor of LOS after birth according to the Random Forest model. We demonstrated that machine learning techniques offer precise LOS prediction after birth. Further studies assessing the effect of quality of birth care on predicting LOS at birth would be beneficial.

Effects of digital parenting interventions on self-efficacy, social support, and depressive symptoms in the transition to parenthood: A systematic review and meta-analysis

BACKGROUND

Parenting self-efficacy is essential for the transition to parenthood. As digital parenting educational interventions are rapidly being developed, their effects have not been examined by pooling available randomized controlled trials (RCTs).

OBJECTIVES

To comprehensively investigate the effects of digital educational interventions on parents' self-efficacy, social support, and depressive symptoms in the first year after childbirth and identify the significant associated factors.

METHODS

This study searched six electronic databases for relevant RCTs examining the efficacy of digital parenting interventions from inception to September 2022. The studied outcomes included changes in parent's self-efficacy, social support, and depressive symptoms observed after participating in a digital parenting program. The random-effects model was used to pool results. Subgroup and moderator analyses were performed.

RESULTS

In total, seven RCTs enrolling 1342 participants were included. The parents who received digital parenting interventions had higher parenting self-efficacy (standardized mean difference [SMD]: 1.06, 95 % confidence interval [CI]: 0.40-1.71, p =.002) and social support (SMD: 2.72, 95 % CI: 0.38-5.07, p =.02) and decreased depressive symptoms at 3 months postpartum (SMD: -0.39, 95 % CI: -0.73 to - 0.04, p =.03). Providing the interventions for ≥ 6 weeks (SMD: 1.62, 95 % CI: 1.18-2.06, p <.001), providing in-person orientation (SMD: 1.88, 95 % CI: 1.32-2.44, p <.001), including a guided curriculum (SMD: 2.00, 95 % CI: 1.78-2.22, p <.001), and conducting interventions in Organisation for Economic Co-operation and Development countries (SMD: 1.98, 95 % CI: 1.78-2.19, p <.001) were identified as significant moderators.

CONCLUSIONS

Digital parenting interventions significantly increase parenting self-efficacy and social support as well as alleviate depressive symptoms for parents during their first year after childbirth. Such interventions can be beneficial for parents who prefer online education. Future studies investigating the long-term effects of these interventions are warranted.

REGISTRATION

The protocol for this systematic review and meta-analysis is registered in PROSPERO (registration number: CRD42021243641).

Multiple Cesarean Section Outcomes and Complications: A Retrospective Study in Jazan, Saudi Arabia

BACKGROUND

Given the increase in the rate of cesarean sections (CSs) globally and in Saudi Arabia, this study was conducted to assess the maternal and perinatal complications after repeat cesarean sections in the studied population.

METHODS

This retrospective study was conducted by reviewing the records of all women who underwent CSs between January and July 2023 in three hospitals in the Jazan region of Saudi Arabia.

RESULTS

Of the 268 women studied, 195 (72.7%) had a CS for the first or second time and 73 (27.3%) had two, three, or four previous CSs (repeat CS). The most common maternal intra-operative complications reported by the repeat CS group were intra-peritoneal adhesions (7.5%) and fused abdominal layers (7.1%) while the most common postoperative complications were the need for blood transfusion (22%) and UTIs (3%). The most common neonatal complications were a low Apgar score (19%), needing neonatal resuscitation (2.6%), and intensive care admission. In addition, 3.7% of mothers failed to initiate breastfeeding in the first 24 h.

CONCLUSIONS

The frequent complications were intra-peritoneal adhesions, fused abdominal wall layers, blood transfusion, and postoperative infections which were overcome by the optimal hospital care. However, the frequent neonatal complications were a low Apgar score, needing neonatal resuscitation, and intensive care admission.

Medical expenditure of women during pregnancy, childbirth and puerperium at the beginning of China's universal two-child policy enactment: a population-based retrospective study

OBJECTIVES

To describe and explore women's medical expenditures during pregnancy, childbirth and puerperium at the beginning of the universal two-child policy enactment in China.

DESIGN

Population-based retrospective study.

SETTING

Dalian, China.

PARTICIPANTS

Under the System of Health Accounts 2011 framework, the macroscopic dataset was obtained from the annual report at the provincial and municipal levels in China. The research sample incorporated 65 535 inpatient and outpatient records matching International Classification of Diseases, 10th Revision codes O00-O99 in Dalian city from 2015 through 2017.

PRIMARY AND SECONDARY OUTCOME MEASURES

The study delineates women's current curative expenditure (CCE) during pregnancy, childbirth and puerperium at the beginning of the universal two-child policy in China. The temporal changes of medical expenditure of women during pregnancy, childbirth and puerperium at the beginning of China's universal two-child policy enactment were assessed. The generalised linear model and structural equation model were used to test the association between medical expenditure and study variables.

RESULTS

Unlike the inverted V-shaped trend in the number of live newborns in Dalian over the 3 studied years, CCE on pregnancy, childbirth and puerperium dipped slightly in 2016 (¥260.29 million) from 2015 (¥263.28 million) and saw a surge in 2017 (¥288.65 million). The ratio of out-of-pocket payment/CCE reduced year by year. There was a rapid increase in CCE in women older than 35 years since 2016. Length of stay mediated the relationship between hospital level, year, age, reimbursement ratio and medical expenditure.

CONCLUSIONS

The rise in CCE on pregnancy, delivery and puerperium lagged 1 year behind the surge of newborns at the beginning of China's universal two-child policy. Length of stay acted as a crucial mediator driving up maternal medical expenditure. Reducing medical expenditure by shortening the length of stay could be a feasible way to effectively address the issue of cost in women during pregnancy, childbirth and puerperium.

Effects of Spironolactone on Hypoxia-Inducible Factor-1α in the Patients Receiving Coronary Artery Bypass Grafting

ABSTRACT

We explored the protective effect of spironolactone on cardiac function in the patients undergoing coronary artery bypass grafting (CABG) by determining serum hypoxia-inducible factor-1α (HIF-1α) before and after CABG. We used the propensity score matching method retrospectively to select 174 patients undergoing CABG in our hospital from March 2018 to December 2019. Of the 174 patients, 87 patients taking spironolactone for more than 3 months before CABG were used as a test group and other 87 patients who were not taking spironolactone as a control group. In all patients, serum HIF-1α and troponin I levels were determined before as well as 24 hours and 7 days after CABG, serum N-terminal probrain natriuretic peptide (NT-proBNP) level was determined before as well as 12, 24, and 36 hours after CABG, and electrocardiographic monitoring was performed within 36 hours after CABG. The results indicated that there were no significant differences in the HIF-1α level between the test group and the control group before and 7 days after CABG, but the HIF-1α level was significantly lower in the test group than that in the control group 24 hours after CABG (P < 0.01). The 2 groups were not significantly different in the troponin I level at any time point. There was no significant difference in the serum NT-proBNP level between the test group and the control group before CABG, but NT-proBNP (BNP) levels were all significantly lower in the test group than those in the control group at postoperative 12, 24, and 36 hour time points (all P <0.05). The incidence of postoperative atrial fibrillation was also significantly lower in the test group than that in the control group (P = 0.035). Spironolactone protects cardiac function probably by improving myocardial hypoxia and inhibiting myocardial remodeling.