Louise Kornman

Maternity clinical handover serves to address the gaps in knowledge existing when transitions between individuals or groups of clinicians occur throughout the antenatal, intra-partum and postnatal period. There are limited published studies on maternity handover and a paucity of information about patients' perceptions of the same. This paper reports postnatal patients' perceptions of how maternity handover contributes to the quality and safety of maternity care. This paper reports on a mixed-methods study consisting of qualitative interviews and quantitative medical record analysis. Thirty English-speaking postnatal patients who gave birth at an Australian tertiary maternity hospital participated in a semi-structured interview prior to discharge from hospital. Interview data were coded thematically using the constant comparative method and managed via NVivo software; this data set was supplemented by medical record data analysed using STATA. Almost half of the women were aware of a handover process. Clinician awareness of patient information was seen as evidence that handover had taken place and was seen as representing positive aspects of teamwork, care and communication by participants, all important factors in the perception of quality health care. Collaborative cross-checking, including the use of cognitive artefacts such as hand held antenatal records and patient-authored birth plans, and the involvement of patients and their support people in handover were behaviours described by participants to be protective mechanisms that enhanced quality and safety of care. These human factors also facilitated team situational awareness (TSA), shared decision making and patient motivation in labour. This study illustrates that many patients are aware of handover processes. For some patients, evidence of handover, through clinician awareness of information, represented positive aspects of teamwork, care and communication. Cross-checking and cognitive artefacts were observed to support handover. Patient-authored birth plans were described by some to enhance the quality and safety of the handover by providing a 'voice' to the patient in this process. This was a novel and potentially important perspective. Future research involving patients and their support people in supporting and evaluating handover should be considered.

Fragile X is the most common cause of mental retardation after Down syndrome. It is the commonest inherited cause of mental retardation, and results from a dynamic mutation in a gene on the long arm of the X chromosome. Various strategies are used for prenatal screening. To determine whether preconceptional or antenatal screening for fragile X carrier status in apparently low-risk women confers any additional benefit over the existing practice of offering testing to women thought to be at increased risk. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (October 2008). Randomised clinical trials comparing women being tested regardless of family history (intervention group) with women tested only when there is a family history of either fragile X and/or other undiagnosed mental illness/impairment (control group). Three review authors independently assessed trial quality. No trials were included. No information is available from randomised trials to indicate whether routine preconceptional or antenatal screening for fragile X carrier status confers any benefit over testing women thought to be at increased risk. Dépistage préconceptionnel et prénatal du site fragile sur le chromosome X Le syndrome de l'X fragile est la cause la plus fréquente de retard mental après le syndrome de Down. Il s'agit de la cause la plus fréquente de retard mental héréditaire et il est imputable à une mutation dynamique d'un gène sur le bras long du chromosome X. Diverses stratégies sont utilisées pour le dépistage prénatal. Déterminer si un dépistage préconceptionnel ou prénatal du statut de porteuse de l'X fragile chez les femmes apparemment à faible risque confère un quelconque bénéfice supplémentaire par rapport à la pratique actuelle consistant à proposer des tests de dépistage uniquement aux femmes considérées comme présentant un risque élevé. Nous avons effectué des recherches dans le registre des essais cliniques du groupe Cochrane sur la grossesse et la naissance (octobre 2008). Les essais cliniques randomisés comparant des femmes testées indépendamment de leurs antécédents familiaux (groupe d'intervention) avec des femmes testées uniquement en cas d'antécédents familiaux de l'X fragile et/ou d'autres maladies/atteintes mentales non diagnostiquées (groupe témoin). Trois auteurs de la revue ont évalué la qualité méthodologique des essais de façon indépendante. Aucun essai n'a été inclus. Il n'existe aucune information provenant des essais cliniques randomisés permettant d'indiquer si un dépistage préconceptionnel ou prénatal systématique du statut de porteuse de l'X fragile confère un quelconque bénéfice supplémentaire par rapport à la pratique consistant à ne dépister que les femmes considérées comme présentant un risque élevé. Cribaje (screening) previo al embarazo y prenatal del sitio frágil del cromosoma X El síndrome de X frágil es la causa más frecuente de retraso mental después del síndrome de Down. Es la causa congénita de retraso mental más frecuente, como consecuencia de una mutación dinámica en un gen del brazo largo del cromosoma X. Se utilizan diversas estrategias para el cribaje (screening) prenatal. Determinar si el cribaje (screening) previo al embarazo o prenatal del estado de portador del síndrome de X frágil, en mujeres aparentemente con bajo riesgo, ofrece algún beneficio adicional sobre la práctica existente de ofrecer dicha prueba a mujeres consideradas con mayor riesgo. Se realizaron búsquedas en el registro de ensayos del Grupo Cochrane de Embarazo y Parto (Cochrane Pregnancy and Childbirth Group) (noviembre de 2002), el Registro Cochrane Central de Ensayos Controlados (Cochrane Central Register of Controlled Trials) (la Cochrane Library, Número 4, 2002), MEDLINE (enero de 1980 a octubre de 2002) y listas de referencias de artículos. Ensayos clínicos aleatorios que comparan a mujeres evaluadas independientemente de los antecedentes familiares (grupo de intervención) con mujeres evaluadas sólo cuando existen antecedentes familiares de X frágil u otra enfermedad o deficiencia mental no diagnosticadas (grupo de control). Tres revisores evaluaron de forma independiente la calidad de los ensayos. No se incluyeron ensayos. No existe información disponible de ensayos aleatorios que indiquen si el cribaje (screening) habitual previo al embarazo o prenatal del estado de portador del síndrome de X frágil ofrece algún beneficio sobre las mujeres consideradas con mayor riesgo.