High-risk Prenatal Care Research Articles

The effect of home ultrasound on maternal anxiety in patients with previous recurrent pregnancy loss: A randomized control trial

BackgroundPatients with previous recurrent pregnancy loss are subject to increased maternal anxiety and reduced antenatal attachment during the subsequent pregnancy. Maternal anxiety is associated with worse pregnancy and neonatal outcomes. Home ultrasound is a feasible tool with the potential to alleviate maternal anxiety by ensuring fetal well-being. ObjectiveThis study aimed to investigate the impact of complementing standard prenatal care with twice-weekly telemedicine visits incorporating home ultrasound on maternal anxiety and antenatal attachment in individuals with a history of recurrent pregnancy loss. Study designIn this randomized controlled trial, patients with a history of 2 or more prior abortions were randomized early in their subsequent pregnancy in a 1:1 ratio into either the control group, which received standard high-risk prenatal care, or the study group, which received additional twice-weekly home-ultrasound sessions. The home-ultrasound scans assessed fetal pulse, movements, and amniotic fluid volume, aiming to provide maternal reassurance. Patients performed the scans themselves using the Pulsenmore device, with real-time guidance from a physician. Maternal anxiety was assessed using the validated State-Trait Anxiety Inventory Scale (STAI-S) and the Revised Prenatal Distress Questionnaire (NuPDQ), while maternal attachment was measured with the validated Maternal Antenatal Attachment Scale (MAAS-2) at 3 time points during pregnancy. The primary outcome was the STAI-S score at the final prenatal visit. A sample size of 50 patients was calculated to detect a 20% difference in the primary outcome. ResultsOf the 57 patients recruited, 50 completed the follow-up, 25 in each group. There were no significant differences in demographics between the groups. The primary outcome (STAI score at the last visit) was significantly lower in the device group compared to the control group (P=.037). In addition, the study group exhibited a greater reduction in STAI scores between the first and last visits (P=.045), and a significantly higher MAAS score at the end of the follow-up period (P=.046). ConclusionIntegrating routine home-ultrasound telemedicine visits into prenatal care can significantly reduce maternal anxiety during pregnancy and contribute to greater maternal attachment in individuals with a history of recurrent pregnancy loss. These results emphasize the potential benefits of home ultrasound as a tool to alleviate anxiety, provide a sense of control, and foster a deeper maternal connection among pregnant individuals who have experienced previous pregnancy loss.

Assessment of prenatal care adequacy using different normative criteria in a municipality in Santa Catarina, Brazil

The current study aimed to evaluate the quality of prenatal care and identify associated factors among women admitted for delivery at a public maternity hospital in greater Florianópolis, Santa Catarina. This cross-sectional study included women who had received prenatal care through the Government Unified Health System in the city of São José and had been subsequently admitted to the hospital for delivery from November 2021 to April 2022. Data were obtained from the pregnant women’s booklet, their health records, and a specific questionnaire. The evaluation criteria included the Takeda-modified Kessner index, adapted adequacy of prenatal care utilization index, and Anversa classification. Adequacy was assessed based on pregnancy parameters and the patients’ characteristics. Among the 237 pregnant women in the sample, prenatal care adequacy ranged from 48.5 to 83.1% and was associated with older age, education, referral to high-risk prenatal care (HRPN) (20 – 30% higher prevalence of adequacy), and pregnancy planning. Notably, there was a tendency toward a reduction in the number of examinations (laboratory and physical) during pregnancy. The adequacy rate decreased with the application of stricter normative criteria and in advanced pregnancy stages. In conclusion, prenatal care quality was predominantly adequate, although it varied across indices and was associated with age, education, HRPN, and pregnancy planning.

Exploring the relationship of perinatal depression regarding body image dissatisfaction, intuitive eating, and gestational and social factors in high-risk pregnancy

To assess the prevalence of depressive symptoms and associated factors (i.e.: intuitive eating, body image dissatisfaction, and gestational and sociodemographic factors) in high-risk pregnant women. This cross-sectional study included 139 pregnant women, assisted by high-risk prenatal care in a university hospital in northeastern Brazil between January and May 2021. Self-report instruments were used to evaluate depressive symptoms, body image dissatisfaction, and intuitive eating (i.e.: Beck Depression Inventory, Body Shape Questionnaire, and Intuitive Eating Scale-2). Depressive symptoms were found in 33.09% of the sample, especially among women with lower education. Depressive symptoms, body image dissatisfaction, and intuitive eating were correlated (p<0.001; depression and body image dissatisfaction r=0.53; depression and intuitive eating r=-0.32; body image dissatisfaction and intuitive eating r=-0.39). Women presenting more depressive symptoms made more choices based on emotional reasons and with less attention to body-food congruence. This study has unveiled a notable occurrence of depressive symptoms within the examined group of high-risk pregnant women, particularly among those with limited educational backgrounds. The findings also highlight that positive eating behaviors, such as intuitive eating, and body image satisfaction are less displayed when there are high levels of depressive symptoms. These results emphasize the critical necessity for understanding of depression correlations with behaviors capable of exerting an influence on, or exacerbating, clinical conditions among high-risk pregnant individuals remains imperative.

The performance of nurses: practices, potential and weaknesses in high-risk prenatal care

Objective: To analyze the potential and weaknesses of nurses in the provision of high-risk prenatal care. Methods: Qualitative research, carried out with six nurses from the high-risk outpatient clinic of a reference maternity hospital in the municipality of Teresina, Piauí. Data were collected from February to March 2020 through semi-structured interviews and examined according to content analysis. Results: Nurses can provide high-risk prenatal care with emotional support, embracement and educational practices that directly impact maternal morbidity and mortality. The potentialities were the adequate physical space and the length of service in the institution and the fragility was the lack of nursing consultation. Conclusion: It was evidenced that nurses do not fully develop all the practices recommended by the Ministry of Health. Despite this, there is potential in the performance, namely, their acquired knowledge, and physical space, and the materials. These aspects facilitate the development of care practices that can promote a healthy birth and reduce maternal mortality. In addition, nurses aim for recognition and greater protagonism in specialized prenatal care.

Sociodemographic and obstetric factors associated with health-related quality of life of high-risk pregnant women.

To evaluate the association between sociodemographic and obstetric factors and the health-related quality of life of pregnant women in high-risk prenatal care. A cross-sectional study of women in high-risk prenatal care in Ceara, Brazil. The investigated outcomes were health-related quality of life, using the Medical Outcomes Study 36-item short-form health survey; the investigated covariates were sociodemographic and obstetric data. Associative analyses were performed using the Jamovi® software version 0.9. Of the 276 women included in the study, women with the following characteristics presented a better quality of life in some domain of the scale: age equal to or greater than 35 years, higher income per dependent, religious, living with three or fewer persons, with their own home, in primigestation, nulliparous, with no history of previous abortion, and with up to two living children. The regression model showed an association between the total scale score, which means a higher quality of life in women with age equal to or greater than 35 years and a higher income per dependent. The study identified sociodemographic and obstetric factors that may affect the quality of life of high-risk pregnant women, providing subsidies to health providers so that they can promote better prenatal care.

Evaluation of obstetric outcomes in Brazilian pregnant women with Takayasu arteritis

ObjectiveTakayasu arteritis (TAK) is a rare chronic granulomatous vasculitis that affects large vessels and usually begins in women of childbearing age, so it is not uncommon for pregnancies to occur in these patients. However, there is limited information about these pregnancies, with reports of adverse maternal and obstetric outcomes. The objective of this study is to evaluate adverse maternal, fetal and neonatal events in pregnant patients with TA.MethodsThis is a cross-sectional study with retrospective data collection. We reviewed 22 pregnancies in 18 patients with TAK, according to the American College of Rheumatology criteria, that were followed up in a high-risk prenatal clinic specialized in systemic autoimmune diseases and thrombophilia (PrAT) at Hospital Universitário Pedro Ernesto, from 1998 to 2021.ResultsIn twenty-two pregnancies, the mean age of patients was 28.09 years and the mean duration disease was 10.9 years. Of the 18 patients with TAK studied, only one had the diagnosis during pregnancy and had active disease. All other patients had a previous diagnosis of TAK and only 3 had disease activity during pregnancy. Twelve patients (66.6%) had previous systemic arterial hypertension and eleven (61.1%) had renal involvement. Among maternal complications, eight patients (36.3%) developed preeclampsia and six (27.2%) had uncontrolled blood pressure without proteinuria, while 10 (45%) had puerperal complications. Four (18.1%) births were premature, all due to severe preeclampsia and eight newborns (34.7%) were small for gestational age. When all maternal and fetal/neonatal outcomes included in this study were considered, only 6 (27.2%) pregnancies were uneventful.ConclusionAlthough there were no maternal deaths or pregnancy losses in this study, the number of adverse events was considerably high. Hypertensive disorders and small for gestational age newborns were more common than general population, while the number of patients with active disease was low. These findings suggest that pregnancies in patients with TAK still have several complications and a high-risk prenatal care and delivery are necessary for these patients.

Disparities in high risk prenatal care adherence along racial and ethnic lines.

The term "high-risk pregnancy" describes a pregnancy at increased risk for complications due to various maternal or fetal medical, surgical, and/or anatomic issues. In order to best protect the pregnant patient and the fetus, frequent prenatal visits and monitoring are often recommended. Unfortunately, some patients are unable to attend these appointments for various reasons. Moreover, it has been documented that patients from ethnically and racially diverse backgrounds are more likely to miss medical appointments than are Caucasian patients. For instance, a case-control study retrospectively identified the race/ethnicity of patients who no-showed for mammography visits in 2018. Women who no-showed were more likely to be African American than patients who kept their appointments, with an odds ratio of 2.64 (4). Several other studies from several other primary care and specialty disciplines have shown similar results. However, the current research on high-risk obstetric no-shows has focused primarily on why patients miss their appointments rather than which patients are missing appointments. This is an area of opportunity for further research. Given disparities in health outcomes among underrepresented racial/ethnic groups and the importance of prenatal care, especially in high-risk populations, targeted attempts to increase patient participation in prenatal care may improve maternal and infant morbidity/mortality in these populations.

Twin reversed arterial perfusion sequence: A review of cases in the Philippines from 2000 to 2022

Twin reversed arterial perfusion (TRAP) sequence, or acardiac twinning, is a congenital anomaly associated with monochorionic twin pregnancies. It occurs when the cardiac system of one twin supplies blood for both twins. This congenital anomaly has been previously reported in several case reports from the Philippines. However, there is still limited information about its local epidemiology and management. This study reviewed the previous cases of TRAP sequence and discussed the diagnosis, management, and ways to improve care for pregnant patients affected by this condition. There were five reported cases of TRAP sequence from the Philippines. Ultrasonography was used in diagnosing the disease antenatally. Preterm birth was reported in 60% of the cases, while 80% were delivered via Cesarean section. The most common type of acardiac twinning in the Philippines was the acardius acephalus. The most common placentation observed in TRAP sequence cases was monochorionic, monoamnionic placenta (75%), two of which had arterio-arterial and veno-venous anastomoses. All donor twins in the Philippines were delivered alive, with only one (20%) neonatal death due to Pseudomonas infection. Only a few centers can perform minimally invasive fetal interventions; one center has been performing fetoscopic surgery in the Philippines since 2021. Thus, cases of TRAP sequence in the Philippines have only been managed through antenatal surveillance with serial ultrasound and high-risk prenatal care until their eventual delivery.

Feelings about birth by a group of high-risk pregnant women.

to understand feelings about birth among a group of high-risk pregnant women. a descriptive and qualitative study, using Alfred Schütz's social phenomenology as a philosophical theoretical framework. The study included 25 pregnant women undergoing high-risk prenatal care. The interview had the following guiding questions: tell me about your feelings regarding the moment of birth/childbirth; How do you deal with the high-risk diagnosis? What are your expectations for birth/childbirth? five categories emerged: Fear of obstetric care; Fear of complications with the baby; Fear of cesarean section; Resilience in the face of high-risk pregnancy; and Expectations for birth. high-risk pregnant women are afraid of the care they will receive, the risks and concern about the baby's vitality at birth. The importance of care is emphasized, with a welcoming environment, bonding and communication between health team and pregnant woman.

Prenatal assessment of high-risk pregnancies in primary and specialized outpatient care: a mixed study.

to assess high-risk prenatal care and identify strategies for improving care. a mixed study of a prospective cohort, with 319 mothers in a public maternity hospital, from October 2016 to August 2017, using a semi-structured instrument and interview. Analysis was performed using the chi-square test (p≤0.05). The qualitative approach was carried out through interviews with guiding questions to 13 managers, at their workplace, between January and March 2020, analyzed under social phenomenology. higher rates of inadequacy were identified for all criteria. However, when care was shared, there was a higher rate for performing tests (p=0.023), consultations (p=0.002), risk stratification (p=0.013) and emergency information (≤0.000). Weaknesses in the record evidenced impairment in communication and continuity of care. shared care is a strategy for improving care, however there is a need to strengthen effective referral and counter-referral to care continuity.

Nailfold Video Capillaroscopy in Pregnant Women With and Without Cardiovascular Risk Factors.

ObjectiveTo evaluate microvasculature in pregnant women with and without cardiovascular risk factors.DesignCross-sectional, observational study.PopulationWomen were recruited at the outpatient clinic for high risk prenatal care. Out of a total of 345 women assessed at first and/or second and/or third trimester, 169 women without and 176 with cardiovascular risk factors were included.MethodsNailfold video capillaroscopy (NVC) measurements were performed at magnification of 200x at all fingers except thumbs. Images were stored for offline measurement of capillary density (CDe) and capillary diameters (CDi). Maternal anthropometrics, obstetric, and medical history were used for categorization in low and high cardiovascular risk. Comparison between groups and trimesters, with respect to pregnancy outcome, was performed using linear mixed model analysis.ResultsWomen with a high risk cardiovascular profile show higher CDe, regardless of pregnancy outcome. CDi drops during pregnancy, with lowest CDi in third trimester in patients with preeclampsia. Capillary bed (CB), as a composite of CDe and CDi, is stable during pregnancy in women with low risk cardiovascular profile. In women with high risk cardiovascular profile, CB drops from the first to the second trimester, regardless of pregnancy outcome. Only in women with pre-eclampsia, the CB is lower in the third trimester as compared to the first trimester.There is an inverse association between CDe and mean arterial pressure (MAP) in women with high cardiovascular risk and pre-eclampsia.ConclusionMicrocirculation is altered during the course of pregnancy and microcirculatory behavior is different in patients with low and high cardiovascular risk profile, as well as in patients with preeclampsia.

Pregnancy After 40: Recommendations for Counseling, Evaluation, and Management From Preconception to Delivery.

Pregnant patients over age 40 often have unique risk factors and potential complications before and during pregnancy that play a role in their counseling and management. To provide practitioners an overview on how to approach preconception evaluation and counseling, prenatal care, and management of associated comorbidities, as well as potential complications, in pregnant patients over age 40. Literature review was performed using OVID and PubMed, with further relevant information queried from guidelines of professional organizations. Pregnant patients over age 40 should receive preconception evaluations by their obstetrician-gynecologist and other appropriate specialty care providers as they pertain to preexisting medical comorbidities. In the preconception period, attention should be given to managing and optimizing preexisting medical conditions and associated pharmacotherapeutics. Referral to specialists in assisted reproductive technologies or maternal-fetal medicine should be considered if indicated for appropriate evaluation and counseling. During pregnancy, accurate dating and counseling on aneuploidy screening, with consideration for early diabetes screening, should be performed in the first trimester. A detailed anatomy scan and fetal echocardiogram should be completed by 22 weeks' gestation, along with routine and high-risk (if indicated) prenatal care. Close attention should be given to the development of pregnancy-related complications associated with advancing age. Third-trimester fetal surveillance can be considered. Given that no contraindications exist, these patients should be encouraged to pursue a vaginal delivery with consideration for induction at 39 to 40 weeks' gestation. Pregnancy rates are increasing in persons over age 40. As a result, preconception evaluation and counseling tailored to that demographic are essential. In addition to standard prenatal care, they should have early screening and diligent monitoring for pregnancy-related comorbidities associated with advancing age. With the increased pregnancy-associated comorbidities in patients over age 40, providers should be familiar with how to evaluate, counsel, and manage them during the preconception and pregnancy periods.

Risk of depression in pregnancy among pregnant women undergoing high-risk prenatal care.

to identify the risk of depression in pregnancy among pregnant women undergoing follow-up in high-risk prenatal care, to assess the factors associated with higher risk of depression in pregnancy and to compare the risk of depression in each gestational trimester. this is a descriptive, correlational, cross-sectional study, conducted with 151 pregnant women in prenatal care in a high-risk pregnancy outpatient clinic at a university hospital in the state of São Paulo, Brazil. Data were collected through an online form. Chi-square and Fisher's exact tests were performed. After the bivariate analysis, the variables were included in the logistic regression model. In the final model, the Odds Ratio was calculated. 118 (78.1%) pregnant women had a higher risk of depression during pregnancy, which was higher in the first trimester, but without statistical significance. The number of pregnancies (OR = 0.32) and marital status (OR = 0.07) remained significantly associated with higher risk of depression during pregnancy as protective factors. the results elucidate the importance of screening for depression risk and the significant need to improve access to effective interventions for preventing prenatal depression and promoting mental health.

PERCORRENDO CAMINHOS: ITINERÁRIO TERAPÊUTICO DE MULHERES USUÁRIAS DE ÁLCOOL E/OU OUTRAS DROGAS DURANTE CICLO GRAVÍDICO-PUERPERAL

Pregnancy, childbirth and postpartum care is provided in accordance with gestational risk factors, such as use of alcohol and/or other drugs by pregnant women. The objective of this study was to trace the therapeutic itinerary of pregnant women who use alcohol and/or other drugs in the health network of a city in the Mid-North of the state of Paraná. This is a qualitative, exploratory study conducted through individual interviews. Firstly, the therapeutic itineraries were built, then the speeches were analyzed in accordance with Bardin and discussed with the aid of current literature. Regarding the therapeutic itinerary, the interviewees accessed primary care, high-risk prenatal care, and hospital services. The results identified two categories: Considerations on the use of alcohol and drugs during pregnancy, and Strengths and weaknesses of the healthcare network’s points of attention. From the statements, probable biological and social implications of using psychoactive substances during pregnancy emerged, such as complications during gestation, fetal alterations, and loss of legal rights over children. As for the points of attention, the importance of multidisciplinarity and the role of nursing were highlighted. On the other hand, the network’s disarticulation and professionals’ inability, represented by inappropriate comments and lack of guidance, appear as weakness. It was concluded that it is necessary to provide comprehensive follow-up to pregnant and postpartum women who use alcohol and drugs, with the articulation of the healthcare network and professionals free from judgment to provide a care that meets their biopsychosocial demands.

The REBECGA Brazilian Registry of Pregnancy and Heart Disease: Rationale and Design

Abstract Background: Maternal mortality rates in Brazil remain above the goals established by the United Nations Sustainable Development Goals. Heart disease is estimated to affect 4% of all pregnancies and remains by itself the main indirect obstetric cause of maternal death. In the last decades, a significant improvement in the prognosis of heart diseases has made pregnancy possible in women with heart disease and provided better maternal and fetal outcomes. Objective: To establish a multicenter Brazilian Registry of pregnant women with heart disease; to study the causes of immediate and late maternal mortality; and to assess the prevalence of heart disease in the country’s macro-regions. Method: This is an observational study, with retrospective and prospective stages, of the clinical and obstetric progression of pregnant women with heart disease. These women consecutively received care during pregnancy and will be followed up for up to a year after delivery at public and private hospitals with infrastructure for the execution of this project, a principal investigator, and approval by Ethics and Research Committees. Results: Our results will be presented after data collection and statistical analysis, aiming to demonstrate immediate and late maternal mortality rates, as well as the prevalence of heart disease in the country and its cardiovascular and obstetric complications during pregnancy. Conclusion: REBECGA will be the Brazilian Registry of heart disease and pregnancy and it will contribute to planning preventive measures, raising financial resources for the improvement of high-risk prenatal care, and reducing immediate and late maternal mortality due to heart disease.

Development of an application prototype for mobile devices about pregnancy and syphilis in pregnancy as a health education strategy

Introduction: Syphilis is a systemic sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. It has chronic evolution and is subject to flare-ups and latency periods when untreated, which can produce the acquired or congenital forms of the disease. It has been acknowledged in 2016 as an epidemic in Brazil. Objective: To identify the information needs of pregnant women regarding syphilis during pregnancy and congenital syphilis, aiming to assist in the development of a technology-mediated educational resource as a strategy to promote health and fight the syphilis epidemic. Methods: The prior knowledge of pregnant women assisted in high-risk prenatal care at the Maternity of Divino Amor in Parnamirim/RN was investigated, in order to identify the information needs of this population and support the development of a prototype of an educational resource in prenatal care services that use technological mediation, education and communication as distance health education strategies. Results: Forty-six pregnant women who demonstrated to have gaps in knowledge about syphilis were assessed with regard to: signs and symptoms of the disease, prevention measures, and vertical transmission. Conclusion: These findings supported the development of a prototype educational resource that intends to be an important source of information for the adoption of preventive health measures, contributing to the learning process of pregnant women, to the improvement of health indicators in this population and the reduction of congenital syphilis cases.

Orientações sobre parto no pré-natal de alto risco nos serviços de saúde

Objetivo: desvelar as orientações recebidas sobre parto durante o pré-natal de alto risco nos serviços de saúde à luz da teoria das representações sociais. Método: estudo descritivo exploratório com abordagem qualitativa, tendo a Teoria das Representações Sociais como referencial teórico metodológico. A coleta de dados ocorreu entre outubro de 2017 e janeiro de 2018, em uma maternidade do norte do Paraná, durante a internação de 20 puérperas. Utilizou-se entrevista semiestruturada e análise de conteúdo temática. Resultados: emergiu-se a categoria: conhecimento elaborado frente as orientações em saúde para gestantes. O núcleo central configurou-se no cuidado direcionado à saúde da mulher e seu empoderamento no ciclo gravídico-puerperal. Conclusão: orientações em saúde foram similares nos dois níveis assistenciais, sendo direcionadas à saúde e bem-estar fetal. Foram identificadas situações de risco ao bebê nas urgências que poderiam resultar em um parto cesáreo prematuro e complicações ao concepto.

Humanized care in high-risk prenatal care: nurses’ perceptions

Objective: to unveil nurses’ perceptions about humanized care in high-risk prenatal care. Methods: a qualitative study, with six nurses who worked in high-risk prenatal care. Data collection took place using semi-structured interviews. To analyze the results, the content analysis technique was used. Results: the adoption of humanized care consisted of actions related to user embracement, personalized care, dialogue with pregnant women and the establishment of a trustful relationship. The main humanization practices were guided visits to maternity hospitals; creating educational groups; the use of non-pharmacological methods for pain relief during labor; and encouraging companion support. Conclusion: participating nurses understood the humanization concept and associated humanization practices to the embracement of pregnant women, guided visits, personalized care, guidance on the use of non-pharmacological methods and the promotion of connections with pregnant women.

Adherence and acceptability of telehealth appointments for high-risk obstetrical patients during the coronavirus disease 2019 pandemic

BackgroundTelehealth has been successfully implemented for the delivery of obstetrical care. However, little is known regarding the attitudes and acceptability of patients and providers in high-risk obstetrics and whether the implementation of a telehealth model improves access to care in nonrural settings.ObjectiveThis study aimed to describe patient and provider attitudes toward telehealth for the delivery of high-risk obstetrical care in a large healthcare system with both urban and suburban settings and to determine whether the implementation of a telehealth model improves patient adherence to scheduled appointments in this patient population.Study DesignTwo self-administered surveys were designed. The first survey was sent to all high-risk obstetrical patients who received a telehealth visit between March 1, 2020, and May 30, 2020. The second survey was designed for providers who participated in these visits. We also compared the attended, cancelled, and no-show visit rates before (March 1 to May 30, 2019) and after (March 1 to May 30, 2020) the telehealth implementation and telehealth vs in-person visits in 2020. We reviewed scheduled high-risk prenatal care appointments, diabetes mellitus education sessions, and genetic counseling and Maternal-Fetal Medicine consultations.ResultsA total of 91 patient surveys and 33 provider surveys were analyzed. Overall, 86.9% of patients were satisfied with the care they received and 78.3% would recommend telehealth visits to others. Notably, 87.8% of providers reported having a positive experience using telehealth, and 90.9% believed that telehealth improved patients’ access to care. When comparing patient and provider preference regarding future obstetrical care after experiencing telehealth, 73.8% of patients desired a combination of in-person and telehealth visits during their pregnancy. However, a significantly higher rate of providers preferred in-person than telehealth visits (56% vs 23%, P=.024, respectively). When comparing visits between 2019 and 2020, there was a significantly lower rate of no-show appointments (8.49% vs 4.61%, P<.001), patient-cancelled appointments (7.06% vs 4.96%, P<.001), and patient same-day cancellations (2.30% vs 1.35%, P<.001) with the implementation of telehealth. There was also a significantly lower rate of patient-cancelled appointments (3.82% vs 5.44%, P=.021) and patient same-day cancellations (0.60% vs 1.65%, P=.002) with those receiving telehealth visits than in-person visits in 2020.ConclusionThe implementation of a telehealth model in high-risk obstetrics has the potential to improve access to high-risk obstetrical care, by reducing the rate of missed appointments. Both patients and providers surveyed expressed a high rate of satisfaction with telehealth visits and a desire to integrate telehealth into the traditional model of high-risk obstetrical care.

A Importância das Orientações do Enfermeiro para gestante com Doença Hemolítica Perinatal: revisão integrativa

O presente estudo visa identificar as orientações fornecidas pelo enfermeiro à gestante, durante o pré-natal e descrever a influência dessas orientações na construção do conhecimento da gestante portadora da Doença Hemolítica Perinatal. Trata-se de uma revisão integrativa realizada na base de dados da Biblioteca Virtual de Saúde, onde se encontram disponíveis dados do LILACS, SciELO e Bdenf. Foram incluídas 03 publicações entre o período de 2011 a 2018 na categoria Importância da educação de clientes e profissionais da saúde no cuidado da Doença Hemolítica Perinatal. Percebemos que há uma vasta deficiência de acesso às informações pertinentes ao pré-natal e a patologia em questão. Á vista disto, o estudo resgata a significância da realização de um pré-natal de alto risco realizado concomitantemente pelo profissional médico e enfermeiro, visto que o enfermeiro, enquanto educador, pode ser um elemento chave no processo de remodelação da assistência.