Table 2 Patient information sources before and during pregnancy Full size table. S3indicated a potential role of maternal fats on urine metabolome during pregnancy. MetPA pathway analysis showed that steroid hormone biosynthesis was upregulated in healthy controls during pregnancy with a Pregnant crossection impact. Herein, we Pregnant crossection to evaluate thyroid function among hypertensive disordered pregnant women in order to ascertain the most up to date information regarding the pathogenesis, etiology and implication of thyroid dysfunction in the development of GH. Armonk: IBM Corp; The latter has been found also among Korean men . Introduction Vitamin D status is a well-known determinant of bone health . The inclusion of a dietitian in Picture of pierced cock antenatal team has been suggested [ 41 ]. Article Google Scholar 2.
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Financial barriers cause many women in low- and middle-income countries to deliver outside of a health facility, contributing to maternal and neonatal mortality.
- Cross-sectional study design is a type of observational study design.
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- Once the zygote implants in the uterine wall, embryonic and fetal development continue through three trimesters to birth.
Archives of Clinical and Biomedical Research. Maduka Ignatius C 1 , Dioka C. Background: Gestational hypertension GH is defined by an elevated blood pressure BP at or beyond 20 weeks gestation in the absence of proteinuria in previously known normotensive women. These complications include pre-eclampsia, eclampsia and death if not managed properly. Despite being a major contributor of maternal and perinatal morbidity and mortality, the mechanisms underlying the pathogenesis of GH have not been fully elucidated.
This study was designed to evaluate thyroid function in hypertensive pregnant women. Materials and method: A total of subjects aged between 22 and 40 years were recruited for this study. These comprised hypertensive and age matched normotensive individuals as controls. Conclusion: Therefore, we observed that gestational hypertension is associated with decrease activity of thyroid hormones as indicated by the significantly lower FT3 and higher TSH levels.
Thus, estimation of TSH could provide an alternative prognostic tool for predicting the underlying cause of gestational hypertension. Assessment; Thyroid function; Pregnant women; Nigeria. Introduction Foods Gestational hypertension GH , is a condition characterized by high blood pressure during pregnancy and can lead to serious complications such as pre-eclampsia, eclampsia and death if not managed properly . Despite being a major contributor of maternal and perinatal morbidity and mortality, the mechanisms responsible for the pathogenesis of GH have not been fully elucidated.
However, several factors have been postulated as contributory mechanisms to the rise in blood pressure during pregnancy. In women generally, thyroid associated endocrinopathies are the second most common endocrine disorders after diabetes mellitus.
These disorders are times more prevalent in women during their reproductive ages and may likely be more frequent in those with other co-morbid conditions such as gestational hypertension . Also, thyroid hormones exert their effect on all tissues and can modulate the rate of metabolic activity. Alterations in thyroid function can therefore affect the various organ system of the body and may be the leading cause of hypertensive complications in pregnancy .
Currently used tests for the assessment of thyroid function thyroid-stimulating hormone TSH , tri-iodothyronine T3 and thyroxine T4 are sometimes insufficient to clearly make out the diagnosis as T3 and T4 levels are affected by so many other non-specific conditions . A total of participants were randomly selected for this study. The participants were made up of hypertensive pregnant women aged years as test subjects and age-matched normotensive pregnant women as controls.
The gestational age of each participant was established based on last menstrual period. The study was a cross sectional study designed to assess thyroid dysfunction among hypertensive and normotensive pregnant women in Aguata and Nnewi Local Government Area of Anambra state, Nigeria.
Informed written consent was obtained from the participants before the collection of data and blood samples. The biodata of all study participants were obtained using a structured interviewer administered pretested questionnaire. Blood pressure of each participant was measured using Accoson mercury sphygmomanometer. Two reviewers independently screened the titles and abstracts to determine if a citation met the general inclusion criteria. The full text of citations classified as include or unclear was reviewed independently with reference to the predetermined inclusion and exclusion criteria.
Finally, we hand-searched reference lists of any relevant conference abstracts and of the included trials for potentially relevant citation. Non-English full text citations were excluded. Disagreements between the two reviewers were resolved through consensus and by third-party adjudication, as needed.
Results The demographic and anthropometric parametric analysis shows that the mean value of age in hypertensive pregnant women There was also no significant differences in the mean levels of height 1. However, the mean values of systemic blood pressure SBP and diastolic blood pressure DBP in hypertensive subjects Of the citations identified through electronic and hand searches, we included 6 trials enrolling a total of participants Figure 1 Trials were published between and The outcomes relevant to peripheral blood flow included: total peripheral resistance, flow mediated vasodilatation, forearm blood flow and blood pressure.
Only two trials did not measure flow mediated vasodilatation 23, The key features of the included studies are outlined in Table 1. Table 1: Demographic and anthropometric characteristics of the study participants. The incidence rate of thyroid dysfunction was The gestational hypertensive women with apparently normal thyroid function euthyroid accounted for Table 3: Incidence of thyroid disorders among hypertensive and normotensive pregnant women. Discussion Gestational hypertension being considered a transient condition is the most common form of hypertension in pregnancy .
Most researchers have focused their efforts on pre-eclampsia because of its implications for maternal-fetal health, whereas information about the implications of a diagnosis of GH is much more limited . Some evidence shows that thyroid associated endocrinopathies are among the most common endocrine disorders in women of maternal age .
According to Klein et al. As a result, thyroid dysfunction may be the underlying disorder in GH and other endothelial vascular diseases.
Herein, we attempt to evaluate thyroid function among hypertensive disordered pregnant women in order to ascertain the most up to date information regarding the pathogenesis, etiology and implication of thyroid dysfunction in the development of GH.
The significant apparent elevation of TSH in hypertensive pregnant women may be attributed to a state of thyroid dysfunction known as hypothyroidism. Hypothyroidism is predominantly an autoimmune disorder mostly characterized by the activation of antigen presenting dendritic cells by self-proteins. However, the activated antigen presenting dendritic cells can in turn stimulate the T-cells to produce cytokines that promote hypertension through vascular remodeling increased peripheral vascular resistance .
This finding is similar to related studies conducted in Australia, India and Kano, Nigeria and in Australia , that reported significantly increased mean values of TSH in hypertensive pregnant women in their respective locations. This finding however is in contrast to the findings of Pasupathi et al.
The mean level of TSH 3. Conversely, the mean serum level of FT3 was significantly decreased in hypertensive pregnant women compared to the normotensive pregnant women, whereas there was no significant difference in the mean serum level of FT4 when compared with both hypertensive and normotensive cases. FT4 and FT3 are the free circulating thyroid hormones Thyroxine, T4 and Triiodothyronine, T3 which are produced from thyroid follicular cells within the thyroid gland through thyroperoxidase, the enzyme responsible for the copulation of iodine to tyrosine residues to form the thyroid hormone, T4 which is believed to be the pro-hormone and a reservoir for the active and main thyroid hormone, T3 .
More so, T3 is converted as required in the tissues by iodothyronine deiodinase . Therefore, the relative non significance difference in serum level of FT4 in both hypertensive and normotensive pregnant women may be due the normal functioning of the enzyme, thyroperoxidase in both subjects while the apparent decrease of FT3 in GH than in normotensive individuals may be due to the relative inhibition of iodothyronine deiodinase in hypertensive pregnant women.
T3 represents the metabolically active thyroid agent that possibly has a vasodilatory effect on the vascular muscle cells . It has also been documented that hypertension is an autoimmune disorder that leads to impaired production of vasodilators such as endothelin, nitric oxide NO and T3 inclusive .
Therefore, the significant decrease in the serum level of FT3 could be due to the relative inhibition of FT3 secretion; a resultant effect of thyroid dysfunction associated with increased peripheral vasoconstriction which is also implicated in blood pressure elevation.
This finding is in line with the findings of Ref [10, 12, 16]. The observed values were in variance with the values reported by Pasupathi et al. Therefore, the serum level of TSH increases as hypertension advances. This finding indicates that there is a state of hypothyroidism that is associated with the development of hypertension in pregnancy as demonstrated by the significant difference in subclinical hypothyroidism between hypertensive and normotensive pregnant women.
According to , the hypo-metabolic state of hypothyroidism can cause an increased arterial stiffness which is an important determinant of vascular endothelial dysfunction and changes in arterial wall elasticity the major underlying cause of elevated blood pressure , therefore resulting in the development of hypertension in pregnancy. Thus, subclinical hypothyroidism being an autoimmune disorder may therefore be the factor implicated in the vascular changes that promotes hypertensive disorder in pregnancy.
Nanda et al. Therefore, the results obtained in this work can be explained at the level of thyroid hormonal activity which is associated with significant increases in peripheral vascular resistance, vasoconstriction and vascular endothelial dysfunction. The increased peripherial vascular resistance and vasoconstriction reflects the induction of TSH and the absence of demonstrated vasodilatory FT3 effect on vascular endothelial cells which invariably could be the reason behind the hypertensive disorder often seen in late pregnancies.
The negative correlation between TSH, FT3 and FT4 implies that; with higher circulating levels of TSH and low or normal circulating levels of FT3 and FT4, there is a significant volume change caused by increase in peripheral vascular resistance and vasoconstriction , initiating a volume-dependent, low plasma renin activity PRA which is the mechanism of blood pressure elevation [7, 15].
The key finding in the study is the significant positive correlation between SBP, DBP and TSH and the significant negative correlation between TSH, FT3 and FT4 which indicate that there is a state of thyroid dysfunction that is implicated in the development of hypertension in pregnancy. This is due to the fact that TSH has been an established marker for thyroid dysfunction and has also been documented to have a negative correlation between FT3 and FT4 .
Consequently, its significant elevation in increasing SBP and DBP in gestational hypertension could be help in predicting the occurrence of gestational hypertension. Thus, estimation of TSH could be a good predictor of the development of hypertension in pregnancy. This is due to the fact that TSH has been an established marker for thyroid dysfunction and was found to be significantly elevated as systemic and diastolic blood pressure progresses in pregnancy.
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Elder stepsister gets punished with a big cock in her little mouth l My sexiest gameplay moments l Bones' Tales: The Manor l Part Pussy camera inside showing cum - teenandmilfcams. Inadequate nutrition, especially starvation, can delay menstruation. Key Terms prolactin : a peptide gonadotrophic hormone secreted by the pituitary gland; it stimulates growth of the mammary glands and lactation in females parturition : the act of giving birth; childbirth oxytocin : a hormone that stimulates contractions during labor, and then the production of milk. Labor and birth are divided into three stages: the dilation of the cervix, the delivery of the baby, and the expulsion of the placenta. Waking up stepsister and cumming inside her fantastic and hot pussy l My sexiest gameplay moments l Summertime Saga[v0.
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Furthermore, we will also be able to estimate the odds ratios to study the association between exposure and the outcomes in this design. As discussed in the earlier articles, we have highlighted that in an observational study, the investigator does not alter the exposure status. The investigator measures the outcome and the exposure s in the population, and may study their association. After the entry into the study, the participants are measured for outcome and exposure at the same time [ Figure 1 ].
The investigator can study the association between these variables. It is also possible that the investigator will recruit the study participants and examine the outcomes in this population. The investigator may also estimate the prevalence of the outcome in those surveyed.
A study by Sardana et al. They recruited 80 patients of acne vulgaris, collected specimen for isolation from open or closed comedones. These specimens were then cultured, the growth identified, and antibiotic susceptibility and resistance were assessed. They isolated P. We will discuss this study briefly later in the manuscript as well. The authors presented a cross-sectional analysis to assess the prevalence of HIV and risk behaviors in male sex workers. They also evaluated the association between HIV and sociodemographic factors.
The data were collected by interviewer-administered questionnaires for sociodemographic and behavior data , clinical evaluation for sexually transmitted infections STIs , and serological evaluation for STIs including HIV. They also found that male-to-female transgendered people were significantly more likely to be HIV-infected compared with males odds ratio [OR]: 3. There are numerous cross-sectional studies in the literature.
We encourage the readers to go through some of these studies to understand the design and analysis of cross-sectional studies. Example: We are interested to know the prevalence of vitiligo in a village. We design a population-based survey to assess the prevalence of this condition. We go to all the houses that were supposed to be included in the study and examine the population.
The total sample surveyed is Of these, we found that 98 individuals have vitiligo. Cross-sectional studies may also be used for estimating the prevalence in clinic-based studies. We evaluate patients with an STI clinic. We find that 60 of these individuals are HIV infected. This type of study will be classified as a cross-sectional study.
Kindly note that this being a clinic-based study, it may have all the limitations of a clinic-based study. Thus, the prevalence from these data may have limited generalizability.
Nonetheless, this type of study design will be classified as a cross-sectional study. Of the individuals evaluated, we have recruited male and female participants. Of the 60 HIV-infected individuals, 50 are males and 10 are females. Thus, the OR is 3. The interpretation of this OR is that males had a higher odds of being HIV infected compared with females.
However, we will require confidence intervals to comment on further interpretation of the OR. Cross-sectional studies can usually be conducted relatively faster and are inexpensive — particularly when compared with cohort studies prospective. These are studies are conducted either before planning a cohort study or a baseline in a cohort study. These study designs may be useful for public health planning, monitoring, and evaluation.
For example, sometimes the National AIDS Programme conducted cross-sectional sentinel surveys among high-risk groups and ante-natal mothers every year to monitor the prevalence of HIV in these groups. Since this is a 1-time measurement of exposure and outcome, it is difficult to derive causal relationships from cross-sectional analysis. These studies are also prone to certain biases. We conduct a cross-sectional study and recruit individuals.
We assess their dietary habits, exercise habits, and body mass index at one point of time in a cross-sectional survey. Thus, we have to be careful about interpreting the associations and direction of associations from a cross-sectional survey. The prevalence of an outcome depends on the incidence of the disease as well as the length of survival following the outcome. For example, even if the incidence of HIV number of new cases goes down in one particular community, the prevalence total number of cases — old as well as new may increase.
This may be due to cumulative HIV positive cases over a period. Thus, just performing cross-sectional surveys may not be sufficient to understand disease trends in this situation. As briefly discussed earlier, multiple cross-sectional surveys are used to assess the changes in exposures and outcomes in a particular population. Sentinel Surveillance in Antenatal Clinic: The surveillance recruits consecutive consenting pregnant women, aged 15—45 years in these clinics. The exercise has been in place for nearly two decades.
The formal annual sentinel surveillance was instituted in The surveillance provided data on the prevalence of HIV infection in antenatal women, and thus, the trends of HIV infection in this population. Such surveys are also conducted in female sex workers, men who have sex with men, and people who inject drugs, migrants, truckers, and male-to-female transgendered people. Repeated cross-sectional surveys provide useful information on the prevalence of HIV in these groups [ Figure 2 ].
It can be seen that the prevalence has, in general, reduced over the past decade in these groups. Thus, repeated cross-sectional surveys are also useful to monitor the trends over a period. We will discuss the previous study by Sardana et al. They conducted one cross-sectional survey to assess the resistance patterns in P. Waking up stepsister and cumming inside her fantastic and hot pussy l My sexiest gameplay moments l Summertime Saga[v0.
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Metrics details. Risk perception in relation to pregnancy and birth is a complex process influenced by multiple personal, psychological and societal factors. Traditionally, the risk perception of healthcare professionals has been presented as more objective and authoritative than that of pregnant women. Doctors have been presented as more concerned with biomedical risk than midwives. Such dichotomies oversimplify and obscure the complexity of the process.
A cross sectional survey of set in UK maternity services. Participants were recruited in person from two hospitals. Doctors were also recruited online. Participants completed a questionnaire measuring the degree of perceived risk in various childbirth-related scenarios; and the extent to which they believed others agreed with them about the degree of risk generally involved in childbirth. Main outcome measures were the degree of risk perceived to the mother in baby in pregnancy scenarios, and beliefs about own perception of risk in comparison to their own group and other groups.
Doctors most frequently rated risks lowest. Total scores for perceived risk to the baby were not significantly different. There was substantial variation within each group. There was more agreement on the ranking of scenarios according to risk.
Each group believed doctors perceived most risk whereas actually doctors most frequently rated risks lowest. Each group incorrectly believed their peers rated risk similarly to themselves. Further research should consider what factors are taken into account when making risk assessments,. Risk perception in relation to pregnancy and birth is a complex process based on multiple factors [ 1 , 2 ].
It is influenced by factors pertaining to risk perception beyond the subject of childbirth and pregnancy-specific factors. Factors involved in general risk perception include the degree of perceived control involved in undertaking the risk activity, the ways in which information about the risk is presented, and the degree of trust placed in the source of the information [ 3 , 4 , 5 ].
Factors specific to pregnant women include the extent to which women view childbirth as benefitting from medical management, and common concerns for the wellbeing of their babies [ 6 , 7 ]. The two main discourses within which childbirth can be understood also each have different approaches to risk. The biomedical model regards birth as inherently risky [ 8 ], whereas the social model regards pregnancy risk as a concept constructed from multiple cultural and personal factors [ 9 ].
Risk in the biomedical model is generally presented in terms of potential physiological outcomes whereas the social model recognises a more holistic definition encompassing potential threats to psychological and social wellbeing. In line with these discourses, views of maternity healthcare professionals have often been presented in a polarised fashion: typically doctors are presented as supporting the medical model and midwives the social model [ 10 , 11 ].
However, presenting these approaches as entrenched opposites oversimplifies the issue [ 14 ]. Such dichotomous depictions overlook the fact all healthcare professionals are likely to be aiming to provide high quality healthcare and ensure positive outcomes [ 15 ] and may well move along the spectrum between approaches [ 16 ].
Again, such dichotomous terms obscure and oversimplify the differences and similarities of risk perception between lay and professional groups. Perception of risk by members of both groups will entail an assessment of numerical odds but also be contingent on personal experience, context and interactions with others [ 1 ]. However, research examining lay and medical risk perception does find differences.
A review of quantitative risk perception research found little correlation between perceptions held by healthcare professionals and of pregnant women with regard to pregnancy and childbirth [ 20 ]. Qualitative research has similarly shown differences in the way professionals and women define concepts of risk and safety [ 21 ]. However, there is little research in this area and existing studies have used different criteria for assessing risk perception of professionals and women, making them difficult to compare and reinforcing the idea the groups assess risk in different ways.
This study will contribute to the understanding of risk perception and inform professionals seeking to understand awareness of risk and improve communication with pregnant women. A sample of pregnant women, midwives and doctors was recruited from two NHS Trusts organisations providing state-funded healthcare and utilised by the majority of the population in South East England.
The final sample for analyses was 68 pregnant women, 59 midwives and 53 doctors. The midwives worked in obstetric units and community settings; neither trust involved in the study has a midwifery-led unit. Inclusion criteria for healthcare professionals were a recognised medical or midwifery qualification and currently working as a doctor or midwife in a UK maternity service.
This allowed for participation by junior doctors not specialising in obstetrics but currently on an obstetric placement. Recruitment occurred between June and April However, difficulties recruiting doctors to the study meant it was necessary to extend recruitment to include any doctor practising obstetrics in the UK. These additional participants were recruited via social media and completed the study online.
Pregnant women were approached by a researcher while waiting for their mid-pregnancy anomaly scan. All women in the UK are offered this scan so this time was chosen to reach the maximum number of women. They were given verbal and written information about the study and reassurance about confidentiality.
If they agreed to participate, they completed the questionnaire straight away and returned it to the researcher. Information about the study was placed in the maternity departments for doctors and midwives along with copies of the questionnaire for them to complete at their convenience.
Researchers also visited the maternity units to provide further information and approach staff in person. Consent, agreed as part of the ethics approval for the study, was considered indicated by completion of the questionnaire.
All participants received information about the study explaining the procedure. The questionnaire consisted of two elements. The first measured risk in relation to pregnancy and childbirth scenarios 80 items and was adapted from the work of Gray [ 22 ], a who used a similar scale to measure risk perception in relation to hospitalisation in pregnancy.
Each item in the first element briefly described a pregnancy or birth scenario, e. This definition was intended to allow participants to formulate their own interpretations of scenarios as far as possible. Three obstetricians, three midwives and six pregnant women assisted in the development and piloting of the questionnaire to ensure user acceptability and face validity.
All participants received the same questionnaire but the version for pregnant women also included definitions of medical terms e. Risks to mother and baby were scored separately, providing total possible risk scores of for risk to mother and for risk to baby 80 scenarios, maximum score per scenario.
Participants were asked to compare the extent to which they believed others agreed with them about the degree of risk generally involved in pregnancy and birth. A score of 4 therefore indicated they believed the comparison group agreed with them about the degree of risk. Participants first compared themselves with members of their own group other doctors, midwives or pregnant women and then with the remaining two groups. The primary outcomes were degree of perceived risk, and perception of own sense of risk in comparison to others in their own group and other groups.
Doctors and midwives were also asked how long they had held their medical or midwifery qualification. Analysis was conducted using SPSS version 23 [ 23 ]. ANOVA was used to test for differences in total scores between groups. The data were found to be skewed for scores on individual items so the non-parametric Kruskal-Wallis test was used to test for differences between the groups.
Overall mean risk scores were low to moderate for mother and baby, ranging from Doctors reported the lowest mean scores. There were significant differences between groups for risk to the mother but not for risk to the baby. Post hoc tests revealed significant differences for perceived risk to the mother between doctors and midwives mean difference SE Of the 12 scenarios which showed no difference in risk scores for risk to the mother, 11 of these also showed no difference for risk to the baby.
In scenarios where there was a difference between risk scores, doctors consistently rated the risk lowest. With regards to risks to the mother, doctors rated the risks lowest for the majority of scenarios where there was a significant difference between groups 56 times out of There was a similar picture with scores of risk to the baby where doctors rated the risks lowest for the majority of scenarios where there was a significant difference between groups 41 times out of However, although there was variation between groups in the risk scores assigned to the mothers and babies in the scenarios, there were similarities across the groups when the scenarios were ranked in order of degree of perceived risk.
Six scenarios were consistently rated highest for risk to the mother by participants in all three groups. Four scenarios were consistently rated highest risk to the baby by participants in all three groups. Thus while there was frequent disagreement about the degree of risk posed in each scenario, there was more consensus about the scenarios that posed the greatest risk to mothers and babies.
Each group believed their peers agreed with them about the degree of risk generally involved in pregnancy and childbirth. Doctors believed midwives perceived birth as a little less risky than they did and pregnant women perceived it as somewhat less risky. Midwives believed doctors perceived pregnancy and birth as somewhat more risky and pregnant women as a little less risky than they did. Pregnant women believed doctors agreed with them about the degree of risk involved in pregnancy and birth.
Their mean score for comparison with midwives fell between midwives believing birth is a little less risky and agreeing with the degree of risk. This study aimed to examine risk perception in relation to pregnancy and childbirth in pregnant women and maternity healthcare professionals in contemporary English society, and to examine what pregnant women and professionals believe about the risk perceptions of each other.
Results showed there were differences in risk perception in relation to pregnancy and birth within and between pregnant women, doctors and midwives. When rating risk of different scenarios to mothers, there were significant differences between pregnant women, doctors and midwives for 68 out of 80 pregnancy-related scenarios. This was less marked when rating risks for babies where overall mean risk scores were not significantly different between groups, but there were differences in the scores of 58 out of 80 scenarios.
While assessments of the degree of risk pertaining to scenarios differed, there was more agreement on the ranking of scenarios according to risk. Interestingly, when comparing their own ratings of risk to others, each group incorrectly believed their peers rated risk similarly to themselves. These beliefs were not supported by the first part of the study. The mean risk score for each group, and in particular the doctors, had large standard deviations, indicating a wide range of scores within groups see Table 1.
Each group also believed doctors perceived most risk in pregnancy and birth. However, where there were significant differences in scores for individual scenarios, where doctors consistently rated the risks lower than women and midwives.
It showed pregnant women had the highest risk perception scores. Most pregnant women experience some fears regarding risk, especially concerning the birth process and the wellbeing of their babies [ 24 ].
While this may appear concerning, these fears are not necessarily perceived negatively by women however and, though common, are often not perceived as very intense or intrusive.
They may be viewed as an integral part of pregnancy which confers an element of protection by motivating women to speak out about their concerns [ 25 ]. Thus while women acknowledge pregnancy and birth may involve a degree of risk they also utilise psychological strategies to manage these concerns and may tolerate greater degrees of risk than professionals recommend, or would be prepared to tolerate for themselves, if they believe doing so will result in a better outcome for themselves and their babies [ 26 , 27 ].
While midwifery care is based on the assumption and promotion of normality in pregnancy, much midwifery activity is focussed on concerns regarding the abnormal so creating a degree of tension and disjunction between rhetoric and practice [ 28 , 29 ].