Objective The aim of this study was to investigate the use of complementary and alternative medicines (CAMs) therapy by UK healthcare professionals involved in the care of pregnant women, and to identify key predictors of use.Design A prospective survey.Setting Maternity services in Grampian, North East Scotland.Sample All healthcare professionals (135) involved in the care of pregnant women (midwives, obstetricians, anaesthetists).Methods Questionnaire development, piloting, and distribution. Descriptive and inferential statistical analysis.Results A response rate of 87% was achieved. A third of respondents (32.5%) had recommended (prescribed, referred, or advised) the use of CAMs to pregnant women. The most frequently recommended CAMs modalities were: vitamins and minerals (excluding folic acid) (55%); massage (53%); homeopathy (50%); acupuncture (32%); yoga (32%); reflexology (26%); aromatherapy (24%); and herbal medicine (21%). Although univariate analysis identified that those who recommended CAMs were significantly more likely to be midwives who had been in post for more than 5 years, had received training in CAMs, were interested in CAMs, and were themselves users of CAMs, the only variable retained in bivariate logistic regression was 'personal use of CAM', with an odds ratio of 8.26 (95% CI 3.09-22.05; P < 0.001).Conclusion Despite the lack of safety or efficacy data, a wide variety of CAM therapies are recommended to pregnant women by approximately a third of healthcare professionals, with those recommending the use of CAMs being eight times more likely to be personal CAM users.
BackgroundOver the last decade academic interest in the prevalence and nature of herbal medicines use by pregnant women has increased significantly. Such data are usually collected by means of an administered questionnaire survey, however a key methodological limitation using this approach is the need to clearly define the scope of ‘herbals’ to be investigated. The majority of published studies in this area neither define ‘herbals’ nor provide a detailed checklist naming specific ‘herbals’ and CAM modalities, which limits inter-study comparison, generalisability and the potential for meta-analyses. The aim of this study was to compare the self-reported use of herbs, herbal medicines and herbal products using two different approaches implemented in succession.MethodsCross-sectional questionnaire surveys of women attending for their mid-trimester scan or attending the postnatal unit following live birth at the Royal Aberdeen Maternity Hospital, North-East Scotland. The questionnaire utilised two approaches to collect data on ‘herbals’ use, a single closed yes/no answer to the question “have you used herbs, herbal medicines and herbal products in the last three months”; and a request to tick which of a list of 40 ‘herbals’ they had used in the same time period.ResultsA total of 889 responses were obtained of which 4.3% (38) answered ‘yes’ to herbal use via the closed question. However, using the checklist 39% (350) of respondents reported the use of one or more specific ‘herbals’ (p<0.0001). The 312 respondents who reported ‘no’ to ‘herbals’ use via the closed question but “yes” via the checklist consumed a total of 20 different ‘herbals’ (median 1, interquartile range 1–2, range 1–6).ConclusionsThis study demonstrates that the use of a single closed question asking about the use of ‘herbals’, as frequently reported in published studies, may not yield valid data resulting in a gross underestimation of actual use.
BackgroundAs COVID-19 continues to infect women of all gestational ages; gravida in labor and the acutely ill parturient are particularly at higher risk of infection. No therapeutic agent or vaccine is approved to treat COVID-19 till date. Thus, managing COVID-19 and associated complications during pregnancy is often challenging and requires a multidisciplinary approach to treatment. Case PresentationWe narrate our perspectives on managing a 32-year-old, critically ill obstetric patient at 32-week gestation, diagnosed with acute respiratory distress syndrome (ARDS) secondary to COVID-19 pneumonia. Upon confirmation of COVID-19, as per the local protocol antivirals, antimalarial, and antibiotics were commenced. Due to rapidly exacerbating maternal respiratory functions, and potential chances of fetal hypoxemia emergency caesarian was performed. Following delivery, the maternal respiratory functions further deteriorated as she required prolonged mechanical ventilation and initiation of extracorporeal membrane oxygenation until she was clinically stable on day 23. The patient also received convalescent plasma and tocilizumab as a part of the treatment protocol. The newborn was shifted to neonatal intensive care for intubation for respiratory distress and was found negative for SARS-CoV-2 and COVID-19 immunoglobulin (Ig). At day 25, the patient was clinically stable and was transferred to step down unit and discharged thereafter. Conclusion Through this case, we present the thought process, multidisciplinary team-based strategy and sequel of managing a complex, critically ill obstetric patient with ARDS and COVID-19 pneumonia. We anticipate that this case report will assist other healthcare institutions to manage critically ill patients with COVID-19 pneumonia.Key words: COVID-19, maternal, pandemic, perinatal, ECMO, convalescent plasma, pharmacological interventions.
17.31% of those exposed to b-blockers only compared with 14.5% of those receiving only methyldopa; rates for SGA <3rd percentile were 5.53% and 5.50%, respectively. Preterm birth occurred in 24.28% and 26.90% of the b-blocker and methyldopa groups, respectively; stillbirth rates were 0.96% and 0.40%, respectively. Infant hospitalization rates were 5.53% and 3.90%, respectively. Infant death occurred in 2 neonates in the b-blocker group (0.48%) and 6 in the methyldopa group (0.60%). In women with a diagnosis of chronic hypertension, the risk of SGA <10th percentile and hospitalization for RDS, sepsis, or seizures during infancy were higher in infants of mothers who were given bblockers compared with those whose mothers received methyldopa (21.23% vs. 12.92% for SGA <10th percentile and 8.94% vs. 4.68% for hospitalization). After adjustment for the time of initiation of antihypertensive drugs, the rates of SGA (both <10th and <3rd percentiles) and hospitalization for RDS, sepsis, or seizures during infancy were significantly higher for infants born to mothers given b-blockers compared with those given methyldopa. For women with gestational hypertension or preeclampsia/ eclampsia, no statistically significant differences in the incidence of adverse perinatal outcomes were seen between the 2 groups, except for preterm birth, for which the rate was higher in the methyldopa group (28.31% vs. 21.52%).These results add to the accumulating evidence for the association between antihypertensive medications and adverse perinatal outcome, especially the impact of bblockers used for treating chronic hypertension during pregnancy. Future studies are needed to examine the effect of individual b-blocker medications more thoroughly. Topic: Systems-based PracticeO n the basis of the World Health Organization's definition of complementary and alternative medicine (CAM), the scope of CAM can include acupuncture, aromatherapy, herbal medicines, and spiritual healing. Few CAM therapies are based on or supported by robust efficacy or safety data. Yet, the use of CAM is widespread, with women the major users, including those who are pregnant or undergoing fertility treatment. This study was undertaken to investigate the experience with CAM therapies of health care professionals involved in caring for pregnant women and to identify key predictors of CAM use.The 135 participants were all health care professionals involved in the care of parturients in North East Scotland. A pilot questionnaire was developed from published literature on CAM-related health care professional recommendations to pregnant women. After a pilot study, the questionnaire was reviewed and minor modifications made. The final version had 3 sections of closed questions and Likert-type statements on the use of CAM in pregnant women, factors influencing decision making, attitudes toward the use of CAM in pregnancy, and personal and practice demographics. Data were coded and analyzed using descriptive statistics. Variables considered as significant in univariate analysis w...
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