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Judith A Maloni

Publications and source records attributed to Judith A Maloni.

12 recordsLinked to original sources
PubMed2006

Multiple gestation: side effects of antepartum bed rest.

The birth rate for higher order multiples has dramatically increased in recent decades. Multiple gestation pregnancies are considered to be at high obstetric risk. Antepartum bed rest is often prescribed to offset complications despite the lack of evidence for its effectiveness in preventing complications. This longitudinal repeated-measures study identified side effects of antepartum bed rest treatment for 31 hospitalized women with twin or triplet gestation. Maternal weight gain and infant birth weight were recorded. Antepartum stressors were measured by the Antepartum Stressors Hospital Inventory, and depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale (CES-D). Antepartum and post-partum side effects of bed rest were also assessed by the Antepartum and Postpartum Symptom Checklists. The weekly rate of maternal weight gain during hospitalization was significantly less than recent recommendations for multiple gestation weight gain (t = - 2.14, p = .04). Infant birth weights were appropriate for gestational age. There were fewer than expected small-for-gestational-age infants. Concerns regarding family status and separation from family were the major antepartum stressors. Women reported a high number of symptoms during bed rest (M = 22), which did not significantly change across 2 weeks. CES-D scores for depressive symptoms were high on antepartum hospital admission. Postpartum symptoms were initially high but had significantly declined by 6 weeks: F(1, 27) = 15.68, p = .00. These findings suggest that interventions are needed to reduce antepartum maternal weight loss, stress, physiologic and psychosocial symptoms, and depressive symptoms, as well as reduce postpartum symptoms of maternal morbidity.

Adolescent↗
PubMed2005

Measurement of antepartum depressive symptoms during high-risk pregnancy.

This methodological study was designed to replicate three previous studies of depressive symptoms, compare assessment of antepartum depressive symptoms among high-risk pregnant women using three standardized instruments, and evaluate the psychometric properties of the instruments. The sample consisted of 89 high-risk pregnant women treated with bed rest, of whom 37 remained hospitalized at 4 weeks. Depressive symptoms were measured by the Multiple Affect Adjective Checklist Revised (MAACL-R) Dysphoria construct, the Profile of Mood States (POMS) Depression scale, and the Center for Epidemiologic Studies Depression Scale (CES-D) across antepartum hospitalization. Internal consistency, test-retest reliability, and convergent validity were high. Depressive symptoms were high on admission as measured by all three instruments and significantly decreased across time when measured by the MAACL-R and POMS.

Adolescent↗
PubMed2004

Reducing the risk for preterm birth: evidence and implications for neonatal nurses.

The incidence of preterm birth has been slowly rising despite advances in obstetric health care. Neonatal nurses have ongoing contact with women who have had a preterm birth and, thus, who are at high risk to have another preterm birth. This article discusses current evidence about reducing risk for preterm birth. Although preterm birth cannot always be prevented, preconception care can help identify and modify maternal risk and promote optimal health before conception. Quality prenatal care, as defined by the Institute of Medicine, consists of continuing risk assessment, health promotion, and interventions to modify medical and psychosocial risk. When these 3 components are consistently applied, they may confer some protection against preterm birth. Women at highest risk for preterm birth need to seek prenatal care from an expert in maternal-fetal medicine. Women also need to learn about the common, subtle signs of preterm labor so they can recognize symptoms and quickly seek treatment. Neonatal nurses can provide critical information and anticipatory guidance to women at risk for preterm birth so they can make sound decisions about future pregnancies.

Evidence-Based Medicine↗
PubMed2004

Antepartum bed rest: maternal weight change and infant birth weight.

Despite lack of evidence for effectiveness, obstetricians in the United States prescribe antepartum bed rest for more than 700,000 women per year. However, in nonpregnant samples, bed rest treatment produces weight loss. This study assessed maternal weight change (gain) during antepartum hospitalization for bed rest treatment; compared appropriateness of infant birth weights for gestational age, race, and gender; and determined whether maternal weight change predicted infant birth weight. The convenience sample for this longitudinal study consisted of 141 women with high-risk pregnancies who were treated with hospital bed rest. Weekly rate of pregnancy weight change by body mass index was compared with Institute of Medicine recommendations for rate of pregnancy weight gain. Infant birth weight was compared with current US infant birth weights for matching gestational age, gender, and race. Weekly antepartum weight change was significantly lower than Institute of Medicine recommendations (P < 0.001). Infant birth weights were also significantly lower than the national mean when matched for each infant's gestational age, race, and gender (P < 0.001). Maternal weight change predicted infant birth weight (P = 0.05). Bed rest treatment is ineffective for improving pregnancy weight gain. Lower infant birth weights across all gestational ages suggest that maternal weight loss during bed rest may be associated with an increased risk of fetal growth restriction. A randomized trial comparing women with high-risk pregnancies who are ambulatory with those on bed rest is needed to determine whether bed rest treatment, underlying maternal-fetal disease, or both influence inadequate maternal weight gain and poor intrauterine growth.

Adult↗
PubMed2002

Inactivity: symptoms associated with gastrocnemius muscle disuse during pregnancy.

This longitudinal study assessed change in gastrocnemius muscle metabolism across antepartum bed rest and recovery during the first 6 weeks postpartum as well as symptoms during recovery. The convenience sample consisted of 65 pregnant women, hospitalized on bed rest for a mean of 24.8 days (range 5-70 days). A dual wavelength hemoglobin/ myoglobin spectrophotometer and ergometer assessed muscle reoxygenation times after plantar flexion exercise from hospital admission through 6 weeks postpartum. The Postpartum Symptom Checklist assessed symptoms of muscle deconditioning. The time for gastrocnemius muscle reoxygenation after exercise significantly increased across antepartum bed rest (t = -2.1, P <.05) and significantly decreased during the 6-week postpartum period (t = 1.83, P <.05). Women who were on bed rest prior to hospital admission had significantly higher reoxygenation scores upon enrollment (t = -8.6, P <.05). Symptoms of postpartum muscle soreness, deconditioning, and difficulty with mobility were reported. Postpartum assessment and rehabilitation are needed to facilitate recovery and prevent long-term injury.

Adolescent↗
PubMedDate not supplied

Dysphoria among high-risk pregnant hospitalized women on bed rest: a longitudinal study.

BACKGROUND: While approximately 700,000 women experience pregnancy complications and are treated with bed rest in the hospital each year, little is known about negative affect in these women. OBJECTIVES: The study purpose was to describe dysphoria, a composite of symptoms of negative affect across the antepartum and postpartum and to identify the relationship between dysphoria and the length of pre-admission home bed rest, hospital bed rest, and maternal and fetal/neonatal indices of risk. METHODS: The convenience sample for this longitudinal repeated measures study consisted of 63 high-risk pregnant women admitted on antepartum bed rest to one of three university-affiliated hospitals. Women were included if they were diagnosed with (a) preterm labor, (b) premature rupture of membranes, (c) incompetent cervix, (d) placenta previa, (e) placental abruption or multiple gestation, and (f) did not have a psychiatric disorder. The Multiple Affect Adjective Checklist-Revised (MAACL-R) was used to assess dysphoria. Obstetric risk status was assessed by both the Hobel and Creasy Risk Assessment tools. RESULTS: Dysphoria was highest upon hospital admission and decreased significantly across time (F (5) = 23.58, p <.001). Positive Affect-Sensation Seeking significantly increased across time (F (5) = 53.16, p <.001). Dysphoria scores were significantly greater for those with highest Hobel obstetric risk scores (F (1, 60) = 4.53, p =.037). Antepartum dysphoria was not correlated with gestational age upon hospital admission, length of bed rest, or Creasy risk status. However, gestational age at birth was significantly correlated with postpartum dysphoria. DISCUSSION: The stimulus for antepartum dysphoria is unclear. However, postpartum dysphoria appears to be related to indicators of the infant's state of health at birth.

Abruptio Placentae↗
PubMedDate not supplied

Implementing evidence-based practice: reducing risk for low birth weight through pregnancy smoking cessation.

In 1989, the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) developed a research utilization program to integrate evidence into practice areas where there were large discrepancies between research evidence and clinical practice. The current program, renamed Research-Based Practice (RBP), uses translational research methods to build from evidence such as that in the Cochrane database and to create protocols for integration of research directly into clinical practice. This article describes the development of the sixth project (RBP6), in which an evidence-based protocol to address smoking in pregnancy was integrated into clinical practice. The protocol includes screening women using descriptive statements and integrates the 5 As (ask, advise, assess, assist, arrange) into prenatal and postpartum care at every visit. By integrating smoking cessation counseling into care, nurses may reduce the risk of low birth weight among pregnant women in both the United States and Canada.

Female↗
PubMedDate not supplied

Smoking cessation counseling for pregnant women who smoke: scientific basis for practice for AWHONN's SUCCESS project.

OBJECTIVES: To review the literature addressing smoking cessation in pregnant women. To develop the project protocol for the Association of Women's Health, Obstetric and Neonatal Nurse's (AWHONN) 6th research-based practice project titled "Setting Universal Cessation Counseling, Education and Screening Standards (SUCCESS): Nursing Care of Pregnant Women Who Smoke." To evaluate the potential of systematic integration of this protocol in primary care settings in which women seek care at the preconception, pregnant, or postpartum stages. LITERATURE SOURCES: Computerized searches in MEDLINE and CINAHL, as well as references cited in articles reviewed. Key concepts in the searches included low-birth-weight infants and effects of prenatal smoking on the infant and the effects of preconception and prenatal smoking cessation intervention on premature labor and birth weight. LITERATURE SELECTION: Comprehensive articles, reports, and guidelines relevant to key concepts and published after 1964 with an emphasis on new findings from 1996 through 2002. Ninety-eight citations were identified as useful to this review. LITERATURE SYNTHESIS: Tobacco use among pregnant women and children's exposure to tobacco use (secondhand smoke) are associated with pregnancy complications such as placental dysfunction (including previa or abruption), preterm labor, premature rupture of membranes, spontaneous abortions, and decreased birth weight and infant stature. Neonates and children who are exposed to secondhand smoke are at increased risk for developing otitis media, asthma, other respiratory disorders later in childhood; dying from sudden infant death syndrome; and learning disorders. The "5 A's" intervention and use of descriptive statements for smoking status assessment were synthesized into the SUCCESS project protocol for AWHONN's 6th research-based practice project. CONCLUSIONS: The literature review generated evidence that brief, office-based assessment, client-specific tobacco counseling, skill development, and support programs serve as an effective practice guideline for clinicians. Implementation and evaluation of the guideline is under way at a total of 13 sites in the United States and Canada.

Adult↗
PubMedDate not supplied

Postpartum symptoms after antepartum bed rest.

OBJECTIVE: To determine the type and frequency of postpartum symptoms during recovery from antepartum bed rest treatment across 6 weeks postpartum. DESIGN: Longitudinal repeated measures study. SETTING: Three perinatal tertiary care hospitals in two cities in the Midwest. PARTICIPANTS: One hundred six postpartum women who had a singleton high-risk pregnancy and were treated with antepartum bed rest. MAIN OUTCOME MEASURES: A Postpartum Symptom Checklist assessed physiologic and psychological symptoms. RESULTS: Women reported 12.5 symptoms at 2 days postpartum, but symptoms rapidly declined at 1 week. Ninety-three percent reported a mean of 6.6 symptoms at 6 weeks postpartum. Symptoms that continued to be reported at 6 weeks by at least 40% of women were fatigue, mood changes, tenseness, difficulty concentrating, back muscle soreness, dry skin, and headache. Women who had a cesarean delivery reported significantly more symptoms than those who had a vaginal delivery (p = .006). Length of maternal bed rest was significantly correlated with the number of symptoms at postpartum weeks 1, 2, 4, 5, and 6. CONCLUSION: Postpartum symptoms decreased across time but reveal an underlying morbidity that is not resolved by 6 weeks postpartum.

Adolescent↗