This study aimed to establish the prevalence and effect of urinary incontinence on quality of life during pregnancy and after parturition. A prospective cohort of primigravidae was recruited. The Kings Health Questionnaire (KHQ) was self-administered antenatally (34 weeks to term) and postnatally (3 months after delivery). Four hundred ninety-two primigravidae were recruited. The prevalence of urinary incontinence was reported as: pre-pregnancy 3.5% (17/492), antenatal 35.6% (175/492), 3-5 days postpartum 13.7% (51/370) and 3 months postnatal 13.0% (47/362). Most women with urinary incontinence experienced an impact on quality of life antenatally (54.3%) and postnatally (71.1%), although those experiencing an impact usually reported it as 'a little' (75.8 and 87.5%). There was a higher prevalence of urinary incontinence after forceps delivery ( p<0.05) but not of greater impairment in quality of life ( p>0.05). Personal and general health deteriorated postnatally ( p<0.05). During pregnancy most women with urinary incontinence experience minimal impact on quality of life. Postnatally, other causes of morbidity may contribute to worsening of general and personal health.
BackgroundMental disorders in pregnancy are common causes of morbidity and mortality with associated risks of adverse neonatal outcomes. Our aims were to evaluate the prevalence of self-reported mental disorders in women presenting to maternity services and to determine the association between history of self-reported maternal mental disorder and adverse neonatal outcomes.MethodsData on all singleton pregnancies known to maternity services in Northern Ireland over the period 2010 to 2015 were extracted from the Northern Ireland Maternity System (NIMATS), including frequency data for number of pregnancies where the mother reported a history of mental disorder. Odds ratios were derived from logistic regression analyses to determine the associations between self-reported maternal mental disorder and preterm birth, low infant birth weight and APGAR scores.ResultsIn total, 140,569 singleton pregnancies were registered using NIMATS over this period. In 18.9% of these pregnancies, the mother reported a history of at least one mental disorder. After adjustment for potential confounding factors, significant associations were demonstrated between self-reported maternal mental disorder and preterm birth (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.25–1.37), low infant birth weight (OR 1.29, 95% CI 1.21–1.38) and APGAR score < 7 at 1 min (OR 1.14, 95% CI 1.10–1.19) and 5 min (OR 1.23, 95% CI 1.12 to 1.34).ConclusionsThese findings emphasise the critical importance of routine enquiry regarding psychiatric history when women present to maternity services and the impact of maternal mental illnesses upon outcomes for their infants.
Contemporary maternity care in Northern Ireland will be driven by the aims of Midwifery 2020 ( Department of Health (DH), 2010 ), High Quality Woman’ s Health Care ( Royal College of Obstetricians and Gynaecologists (RCOG), 2011 ), Maternity Strategy for Northern Ireland2012–2018 ( Department of Health, Social Services and Public Safety (DHSSPSNI), 2011 ) and Transforming Your Care ( DHSSPSNI, 2011 ). These reports all have at their core the idea of’ promoting normality’ within a maternity service that will be community based and led by midwives. With this shift, general practitioners (GPs) will be expected to play a significant role within the teams that care for pregnant women. Effective collaboration between professional groups is an essential element in good quality and safe care. It is necessary if the planned transfer of services is to succeed. This study explores if midwives, GPs and those planning maternity services believed that systems were in place for effective collaborative working in the community. The service evaluation used mixed methods to collect data, including five in-depth interviews, questionnaires and a professional forum, with the results demonstrating that few community practices have implemented systems for sharing information between community midwives and GPs. The study found that collaborative working is not a characteristic within community maternity services. It revealed four recurrent themes that hinder effective collaboration: organisation, inter-professional relationships, communication, and quality and safety.
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