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Newborns and children of the nation
Published in Kah Seng Loh, Li Yang Hsu, Tuberculosis – The Singapore Experience, 1867–2018, 2019
The anti-tuberculosis programme also reached the adult population of Singapore through newborn infants and young children. The maternity hospital was an important place where parental consent was sought and given for the BCG vaccination of infants. This was key to the prevention of tuberculosis across the colonial and postcolonial periods; as two government doctors stated in 1974, ‘The newborn infants have always been our first priority’ in the immunisation programme.1 Principals, teachers and other school staff likewise worked with the state’s medical officers and parents to conduct X-ray screening, health checks, contact tracing, tuberculin tests, and vaccination for school students, and to implement the feeding scheme for malnourished pupils. Another feeding scheme for children with tuberculosis operated in their homes, which sought not only to improve their diet but also transform the attitudes and behaviour of their parents.
SBA Questions
Published in Justin C. Konje, Complete Revision Guide for MRCOG Part 2, 2019
The midwife is admitting a woman into the alongside midwifery unit in your maternity hospital. What feature in her initial assessment will warrant a transfer of this low-risk woman to an obstetric unit?A pulse of over 110 beats/min on two occasions 30 min apartA single diastolic reading of 100 mmHg or more or raised systolic BP of 150 mmHg or moreEither raised diastolic BP of 90 mmHg or more or raised systolic BP of 140 mmHg or more on 2 consecutive readings taken 30 min apartRupture of fetal membranes 12 h before onset of established labourThe presence of single strands of meconium
The Birth Centre: ideals, models and tensions
Published in Ruth Deery, Deborah Hughes, Mavis Kirkham, Sheila Kitzinger, Tensions and Barriers in Improving Maternity Care, 2018
Ruth Deery, Deborah Hughes, Mavis Kirkham, Sheila Kitzinger
The midwives in the area studied had recently experienced major changes in their work, as well as the closure of their maternity hospital despite their best efforts to retain it. In all of this they can be said to have experienced a loss of autonomy at a political as well as a clinical level. Yet birth centres are associated with considerable autonomy for midwives (Hunter, 2003), and the setting up of such a centre, staffed by midwives from outside the area, must have generated mixed feelings among local midwives, clinicians and managers. Since no help had been available to work through the losses that these midwives had experienced, it is not surprising that their attitude to the Birth Centre and its midwives was less than welcoming.
“I suppose we’ve all been on a bit of a journey”: a qualitative study on providers’ lived experiences with liberalised abortion care in the Republic of Ireland
Published in Sexual and Reproductive Health Matters, 2023
Brendan Dempsey, Michael Connolly, Mary F. Higgins
Liberalised abortion care is now offered in general practices and maternity hospitals nationwide. At the time of writing in March 2023, 11 of the 19 maternity hospitals offer abortion care16 and just over 400 of the approximately 3500 general practitioners (GPs) have completed training in early medical abortion (EMA) care.17 GPs offer EMA as an out-patient service up to 8+6 weeks’ gestation. Placing abortion within community-based practice helped to ensure it would be widely accessible.18 Care between 9+0 and 12+0 weeks’ gestation is managed medically in a maternity hospital, with at least five units also routinely giving women the option to access surgical care via vacuum aspiration. After 12 weeks, care is largely managed medically in hospitals, with surgery generally reserved for cases where medical abortion is not appropriate. Prior to the introduction of liberalised abortion care, the Irish College of General Practitioners and the Southern Taskforce for Abortion and Reproductive Topics (START) offered GPs training in EMA, while the Royal College of Physicians Ireland provided training for obstetricians. The World Health Organization also provided values clarification workshops, which rolled out in late 2018. Training in technical and non-technical skills continues nationally.
Assessment of hearing screening programmes across 47 countries or regions II: coverage, referral, follow-up and detection rates from newborn hearing screening
Published in International Journal of Audiology, 2021
Allison R. Mackey, Andrea M. L. Bussé, Hans L. J. Hoeve, André Goedegebure, Gwen Carr, Huibert J. Simonsz, Inger M. Uhlén
When an NHS programme is implemented in a country, healthcare policy makers must make a few essential decisions. First, they must decide on the location where screening takes place, which is closely related to the age of the infant when screened. Screening is typically performed before discharge from the maternity hospital among countries with a high percentage of hospital births. This offers a major advantage, as it results in inherently high coverage. However, screening within 24 h after birth can result in a high referral rate from step 1 because of residual amniotic fluid in the middle ear. In this study, programmes performing step 1 after 24 h reported a range of referral rates from 2% to 15%. It is possible to achieve low referral rates when screening closely after birth with highly trained professionals (Vohr et al. 2001) and quiet test environments. For programmes with step 1 at 72 h of age or later, step 1 referral rates were 4%. Although low false positive rates are achieved, this strategy may be more expensive, and coverage may be lower. Still, high coverage after discharge from the maternity hospital has been obtained by programmes in this study and others, by combining step 1 with an existing postnatal health visit (Olusanya, Ebuehi, and Somefun 2009; Khoza-Shangase and Harbinson 2015). Second, a screening professional should be selected and trained. The decision on screening professional is described in more detail in the accompanying article (Bussé et al. 2021).
Erythromycin compared to amoxicillin and azithromycin for antimicrobial prophylaxis for preterm premature rupture of the membranes: a retrospective study
Published in Journal of Obstetrics and Gynaecology, 2021
Alva Fitzgibbon, Lisa Clooney, Deirdre Broderick, Maeve Eogan, Naomi McCallion, Richard J. Drew
This retrospective study was carried out in a large Maternity Hospital in Ireland. The Hospital also acts as a regional referral unit for women with PPROM in the early third trimester from maternity units with lower level neonatal intensive care units (NICUs). The study was approved by the Ethics Committee of the Rotunda Hospital (RAG-2018-004). Included patients were those with confirmed preterm premature rupture of membranes between 23 weeks and 36 + 6 days gestation, who received at least a single dose of the PPROM regimen of either erythromycin (controls) or amoxicillin and azithromycin (cases). Singleton and multiple pregnancies were included. Patients that received amoxicillin and azithromycin (cases) were recruited from January to December 2018. These patients were prescribed a single stat dose of azithromycin 1 g orally, as well as intravenous amoxicillin 2 g every six hours for 48 h, then 5 days of oral amoxicillin 250 mg three times per day. Intravenous ampicillin was not used as it was not available in Ireland, and intravenous amoxicillin was used instead. They were identified by daily ward rounds by the Microbiologist and Infection Control service, through clinical consults and clincial laboratory samples processed-lower vaginal swabs and rectal screens for group B Streptococcus screening. Patients were excluded if they had a penicillin or macrolide allergy, or if they had delivered prior to receiving a dose of amoxicillin and a dose of azithromycin. Data, recorded in real-time, was obtained through electronic healthcare records.