Obstetric Health Research Articles

"Just Because You Have Ears Doesn't Mean You Can Hear"-Perception of Racial-Ethnic Discrimination During Childbirth.

Black and Latina women in New York City are twice as likely to experience a potentially life-threatening morbidity during childbirth than White women. Health care quality is thought to play a role in this stark disparity, and patient-provider communication is one aspect of health care quality targeted for improvement. Perceived health care discrimination may influence patient-provider communication but has not been adequately explored during the birth hospitalization. Our objective was to investigate the impact of perceived racial-ethnic discrimination on patient-provider communication among Black and Latina women giving birth in a hospital setting. We conducted four focus groups of Black and Latina women (n=27) who gave birth in the past year at a large hospital in New York City. Moderators of concordant race/ethnicity asked a series of questions on the women's experiences and interactions with health care providers during their birth hospitalizations. One group was conducted in Spanish. We used an integrative analytic approach. We used the behavioral model for vulnerable populations adapted for critical race theory as a starting conceptual model. Two analysts deductively coded transcripts for emergent themes, using constant comparison method to reconcile and refine code structure. Codes were categorized into themes and assigned to conceptual model categories. Predisposing patient factors in our conceptual model were intersectional identities (eg, immigrant/Latina or Black/Medicaid recipient), race consciousness ("…as a woman of color, if I am not assertive, if I am not willing to ask, then they will not make an effort to answer"), and socially assigned race (eg, "what you look like, how you talk"). We classified themes of differential treatment as impeding factors, which included factors overlooked in previous research, such as perceived differential treatment due to the relationship with the infant's father and room assignment. Themes for differential treatment co-occurred with negative provider communication attributes (eg, impersonal, judgmental) or experience (eg, not listened to, given low priority, preferences not respected). Perceived racial-ethnic discrimination during childbirth influences patient-provider communication and is an important and potentially modifiable aspect of the patient experience. Interventions to reduce obstetric health care disparities should address perceived discrimination, both from the provider and patient perspectives.

Promoting Antenatal Care: Identifying Policy Levers in Indian Context

Abstract Background The growing body of literature associates Antenatal Care (ANC) with early detection and prevention of maternal complications which in turn reduce the likelihood of maternal and infant death. Studies report that only about 40% of pregnant women in developing countries have attended four ANC visits. This situation mandates identifying policy levers for promoting ANC visits. Methods The study uses data from the Demographic and Health Survey (DHS) India (2015-16). We analyze a sample of about 100,000 women in the age group of 15-49 years who gave birth in three years preceding the survey. Using the theory of health seeking behaviour we propose a conceptual model to understand the a) Predisposing factors; b) Enabling factors and c) Need factors affecting the ANC visits in Indian context. Results 17 % women in our sample never went for ANC. 46 % women in our sample went for at least four ANC visits. SEM analysis suggests that our structural model fits well with the sample data (RMSEA: 0.05; TFI: 0.93; SRMR: 0.038). Higher age, lower parity, higher awareness and higher levels of education significantly predisposes women to go for ANC visits. The significant (95% CI) enablers include higher socio-economic status, meeting with Community Health Worker (CHW) and enrolment in government sponsored nutrition support program. While health system barriers and personal barriers act as disablers. Bad obstetric history and health issues during pregnancy are significant need factors. Our analysis suggests that meeting CHWs increases ANC visits by 1.8 units and enrolment in nutrition support programme increases ANC visits by 1.4 units. Conclusions CHW and nutrition support programme are significant policy levers to promote ANC care and reduce maternal and child morbidity and mortality. Antenatal care services must be included under universal health coverage domain to reduce financial barriers for women of low socio-economic strata Key messages Involvement of Community Health workers in the promotion of maternal and child health care is a cost-effective strategy. Nutrition support programmes through Anganwadi centres help advance maternal and child health care by promoting ANC care.

Prevalence and Factors Associated with Antenatal Depression in Makkah Al-Mokarramah, 2019

Background: Depression is one of the major disease affecting women and is considered as one of the most common causes of mental illness during pregnancy. Antenatal depression is a risk factor for postpartum depression, adverse effect on obstetric and neonatal health conditions. Objectives: To estimate the prevalence and determine the risk factors of depression among pregnant women attending the antenatal clinic in Makkah between 1st and 26th of December 2019. Subjects and methods: Analytic cross-sectional study was conducted in Makkah Al-Mokarramah including a representative random sample of pregnant women who attending selected during the time of 1st - 26th of December 2019. Data were collected by using a questionnaire including sociodemographic data and risk factors associated with antenatal depression as well as the Edinburgh Postnatal Depression Scale (EPDS) to screen for depression. Results: The study included 136 women. Their age ranged between 20 and 52 with a mean±SD of 31.0±6.2 years. More than one third (41.2%) of the women were at high risk for depression whereas 24.3% were at possible risk for depression. Paticipants` house income was the only socio-demographic factor significantly associated with risk of antenatal depression, p=0.012. None of obstetric factors was significantly associated with the risk of antenatal depression. In the current pregnancy, having no family support, particularly from the husband was a significant factor for antenatal depression, p=0.007. Also, having family history of antenatal depression was significantly associated with antenatal depression, p=0.018. Conclusion: Antenatal depression is a relatively common health problems encountered by pregnant women attending antenatal care at primary healthcare centers, Ministry of Health in Makkah city.

The Influence of Personality and Anxiety Traits on Birth Experience and Epidural Use in Vaginal Deliveries – A Cohort Study

ABSTRACT A positive birth experience for the mother is an important goal in obstetric health care and is influenced by several factors. For this study, 186 women filled in questionnaires between 24 and 72 hours after giving birth vaginally. We evaluated the Big-Five personality traits (extraversion, neuroticism, openness, conscientiousness and agreeableness), trait anxiety, different dimensions of childbirth experience and pain management. Correlation analysis revealed that trait anxiety and neuroticism were negatively associated with several dimensions of the birth experience. Furthermore, conscientiousness and extraversion were positively correlated with the dimension Participation. Regression analysis for the individual dimensions and overall score respectively, confirmed the independent impact of anxiety trait on Perceived Safety, Participation and Professional Support and the overall score as well as of neuroticism on Perceived Safety and conscientiousness on Participation. The significant regression models showed small R2-scores (.084–.154). The birth experience did not differ whether the women received an epidural or not. Women who did not receive an epidural displayed higher scores on the personality trait conscientiousness. The study highlights small but important associations between personality traits and birth experience in vaginal births which should sensitize the medical staff when supporting women during labor.

The Psychological Experience of Obstetric Patients and Health Care Workers after Implementation of Universal SARS-CoV-2 Testing.

Objective This study was aimed to describe the hospitalization and early postpartum psychological experience for asymptomatic obstetric patients tested for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) as part of a universal testing program and report the impact of this program on labor and delivery health care workers' job satisfaction and workplace anxiety. Study Design This is a cohort study of asymptomatic pregnant women who underwent SARS-CoV-2 testing between April 13, 2020 and April 26, 2020. Semistructured interviews were conducted via telephone at 1 and 2 weeks posthospitalization to assess maternal mental health. Depression screening was conducted using the patient health questionnaire-2 (PHQ-2). An online survey of labor and delivery health care workers assessed job satisfaction and job-related anxiety before and during the novel coronavirus disease 2019 (COVID-19) pandemic, as well as employees' subjective experience with universal testing. Patient and employee responses were analyzed for recurring themes. Results A total of 318 asymptomatic women underwent SARS-CoV-2 testing during this 2-week period. Six of the eight women (75%) who tested positive reported negative in-hospital experiences secondary to perceived lack of provider and partner support and neonatal separation after birth. Among the 310 women who tested negative, 34.4% of multiparous women reported increased postpartum anxiety compared with their prior deliveries due to concerns about infectious exposure in the hospital and lack of social support. Only 27.6% of women, tested negative, found their test result to be reassuring. Job satisfaction and job-related anxiety among health care workers were negatively affected. Universal testing was viewed favorably by the majority of health care workers despite concerns about delays or alterations in patient care and maternal and neonatal separation. Conclusion Universal testing for SARS-CoV-2 in obstetric units has mixed effects on maternal mental health but is viewed favorably by labor and delivery employees. Ongoing evaluation of new testing protocols is paramount to balance staff and patient safety with quality and equality of care. Key Points Women with SARS-CoV-2 had a negative hospital experience.A negative SARS-CoV-2 test was not reassuring for patients.COVID-19 negatively impacts healthcare workers’ well-being.

Design and Application of Intelligent Information System for Comprehensive Management of Obstetrics and Gynecology Health Care

With the cross-infiltration of information technology in the field of hospital management and the application of computer network technology, the digital construction of hospitals has been gradually promoted and applied, which laid the foundation for the development of hospital nursing management system. Obstetrics and Gynecology Nursing is a discipline with strong theoretical, practical and operational skills. At the same time, the specialty of obstetrics and gynecology, the privacy of the cause and the influence of traditional ideas make nursing staff in clinical nursing work. Was hindered. At this stage, the nursing management information system is a software system for processing nursing information established by using information science theory and computer technology method, and is an important part. It can improve the utilization of important resources and the quality and efficiency of nursing work. Based on this, this paper develops and applies the integrated management information system for obstetrics and gynecology health care, and under the guidance of modern software engineering methods, completes the analysis, design and implementation of the system. PowerBuilder is selected as the front-end development tool, and the network structure of the system C/S mode is realized by combining the Oracle database. As a self-developed system, it has great flexibility.

The role of diet and probiotics in prevention and treatment of bacterial vaginosis and vulvovaginal candidiasis in adolescent girls and non-pregnant women.

The article raises important issues regarding the use of diet and probiotics in prevention and treatment of vaginitis. Vaginitis is defined as any condition with symptoms of abnormal vaginal discharge. The most common causes of vaginitis are vulvovaginal candidiasis (VVC), trichomoniasis and bacterial vaginosis (BV). Vaginitis has been linked to itching, burning, pain, discharge, irritation and also adverse reproductive and obstetric health outcomes. Moreover, microorganisms that build vaginal flora in the state of bacterial vaginosis are a source of cervicitis and endometritis (often in subclinical forms) and pelvic inflammatory disease (PID) The proper diet and probiotics consumption may influence the composition of the gut microbiota, improve gut integrity, and have an impact on maintaining and recovering the normal vaginal microbiota. Future studies and reviews investigating the role of diet and probiotics in changes to gut and vaginal microbiome need to focus on deciphering the mechanismus of host bacteria interaction in vulvovaginal health.

Web-Based Application Development of Early Detection of High-Risk Maternal Referral System in the Islands Region (SIDILAN) in South Bangka Regency

Every pregnancy can develop into complications at any time; therefore, pregnant women need to monitor their health during pregnancy. Maternal problems/complications can be reduced or prevented by various improvement efforts in the field of obstetric health services. Failure in handling obstetric emergency cases is generally caused by failure to recognize early risk in pregnancy. Currently, there are many efforts as early detection of pregnancy risk factors, one of them is by using the Scor Poedji Rochyati Card method as a means of detecting pregnancy risk and as a recording and reporting system for midwives. Computerization is very helpful in the process of early detection and recording of reports for midwives in health centers/regions. This research developed a web-based application of early detection of high-risk maternal referral systems in the island regions (SIDILAN) in South Bangka Regency in 2018. This study uses a study Quasi Experiment Design with research design of pre-post only group design. The results of the study using the Willcockson test and obtained a value of P 0.001. It is found that SIDILAN has higher benefits compared to manual data recording and detection.

Going solo: the law and ethics of childbirth during the COVID-19 pandemic.

The COVID-19 pandemic has had devastating effects on women’s reproductive lives. Women’s access to both abortion and contraceptive care has been restricted in many states across the U.S. Yet, the coronavirus has put a strain on another aspect of women’s reproductive rights: childbirth. In New York, for example, several hospitals instituted bans on all visitors in order to protect obstetric health care providers, as well as patients and newborn babies, from the risks posed by the virus. The policies were met with anger and confusion among expectant parents. An executive order issued in response to such criticism, overruling these policies, was described by some health professionals as unethical and ill-informed. Against this background this Essay maps the ethical and legal issues raised by childbirth visitation bans. It argues that the benefits of such visitation bans should be weighed against the implications they may have on laboring women’s emotional and physical well-being, considering the challenges they already face during facility-based childbirth. It then considers several national and international legal frameworks through which women’s birthing rights may be affirmed, also pointing out where they fall short. Lastly, this Essay makes recommendations for how such rights may be better addressed by different legal actors, including scholars, courts, and legislators.

Optimizing telemedicine for providing obstetric and reproductive health care services during COVID-19 pandemic

The coronavirus disease (COVID-19) outbreak was first declared in China in December 2019, and WHO declared the outbreak as a pandemic on 11 March 2020. A fast-rising number of confirmed cases has been observed in countries across all continents over the past few months. This pandemic is forcing government of nations to take strict measures such as complete lockdown and curfews to ensure that citizens stay at home, as a measure to contain the spread of infection. Health sector is facing challenges such as high demand for doctors, limited resources of personal protective equipment and challenges in providing in-person consultation due to fear of spread of infection. Telemedicine is making positive contribution to healthcare during this pandemic, as it caters to health care of people in wide geographical area without risk of acquiring COVID-19. Telemedicine is defined as the provision of health care services by health care professionals, using technology to exchange information. A broad range of obstetric and reproductive health services can be offered via telemedicine. Telemedicine can help pregnant women to maintain high quality of care during this pandemic without compromising on the perinatal outcome. It allows for constant interaction between patient and doctor throughout pregnancy, thereby ensuring that the goals of antenatal care are fulfilled, while limiting unnecessary travel and time away from work and family. This article mainly concentrates on the essential obstetric and reproductive health care services that can be provided by telemedicine during COVID-19 pandemic.

Antenatal survey of women's birthing choices in Qatar.

Objectives Attitudes towards labour care and women's choices for their preferred mode of delivery are documented in studies from the around the world, however less is known about women's birth choices in the Middle East. This study was designed with the aim of exploring beliefs and attitudes in this region. Methods Voluntary participation in an ethics-approved survey was offered to pregnant women attending the antenatal clinic at Sidra Medicine from August 2018 to January 2019 with no exclusion criteria. Results Of the 346 respondents, 58.1% were Arabic and the remainder expatriates. This group composition allowed comparison between women native and non-native to the Gulf region. Arabic and non-Arabic women differed significantly in previous birth experiences: the Arabs had had more doctor-led deliveries (45 vs. 34%), epidurals (56.6 vs. 45%) and episiotomies (65.7 vs. 54%). 70.2% of the respondents chose a normal delivery as their preferred birth mode though a smaller majority of the Arabic subgroup did (63.2 %). 60.4% preferred delivery by doctors and longer hospital stays (47.6), more so Arabic participants (64.7 and 68.6 %). Significantly less Arabs, would choose husbands as birth partners (51.2 vs. 86.2%) and more expressed a gender preference for doctors. Other group choices are presented. Conclusions Though women in this region made comparable choices about mode of delivery as their Western counterparts, they demonstrated an expectation of a culturally distinct and more medicalized approach to care in labour. The findings highlight the need for further studies to inform regional obstetric care and health education interventions as well as tailoring maternity care services.

Examining Inequities Associated With Changes in Obstetric and Gynecologic Care Delivery During the Coronavirus Disease 2019 (COVID-19) Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic is a public health emergency requiring significant changes in obstetric and gynecologic health care delivery to minimize the risk of transmission to healthy patients and health care workers. Although these changes are necessary, they will differentially affect patients in a way that highlights and exacerbates existing inequities in health care access and outcomes. Socially vulnerable groups are already disproportionately affected by COVID-19 infection and more likely to experience severe morbidity and mortality. Some reasons for this include a limited ability to practice risk-reducing behaviors such as physical distancing, higher prevalence of chronic medical conditions, and less access to medical care. Additionally, the structural changes now taking place in health care delivery have negatively affected the ability of socially vulnerable groups to obtain necessary obstetric and gynecologic care, which may lead to poorer outcomes. As physician-leaders enact new policies to respond to the COVID-19 public health crisis, it is important to consider the potential for exacerbating existing health inequities and to be proactive in creating policies that promote equity.

Perinatal mental health around the world: priorities for research and service development in South America.

Research on the topic of poor perinatal mental health in South America is scarce. Nevertheless, studies have shown that it is not uncommon, and that it is linked to women's experience of sexual and intimate partner violence and to inequality, poverty and low educational attainment. High-quality research in large samples with rigorous methodology is a priority, so that data from this region may be compared and analysed in systematic reviews. The links with intimate partner violence need to be explored. Risk and protective factors must be investigated with a strong intercultural perspective. Service integration needs to be implemented. This will require improvements in the availability, accessibility and quality of obstetric and mental health services. There is a need for targeted evidence-based interventions for women and children at risk that incorporate a strong gender and rights perspective.

Determinants of healthcare providers\u2019 confidence in their clinical skills to deliver quality obstetric and newborn care in Uganda and Zambia

BackgroundPoor quality obstetric and newborn care persists in sub-Saharan Africa and weak provider competence is an important contributor. To be competent, providers need to be both knowledgeable and confident in their ability to perform necessary clinical actions. Confidence or self-efficacy has not been extensively studied but may be related to individuals’ knowledge, ability to practice their skills, and other modifiable factors. In this study, we investigated how knowledge and scope of practice are associated with provider confidence in delivering obstetric and newborn health services in Uganda and Zambia.MethodsThis study was a secondary analysis of data from an obstetric and newborn care program implementation evaluation. Provider knowledge, scope of practice (completion of a series of obstetric tasks in the past 3 months) and confidence in delivering obstetric and newborn care were measured post intervention in intervention and comparison districts in Uganda and Zambia. We used multiple linear regression models to investigate the extent to which exposure to a wider range of clinical tasks associated with confidence, adjusting for facility and provider characteristics.ResultsOf the 574 providers included in the study, 69% were female, 24% were nurses, and 6% were doctors. The mean confidence score was 71%. Providers’ mean knowledge score was 56% and they reported performing 57% of basic obstetric tasks in the past 3 months. In the adjusted model, providers who completed more than 69% of the obstetric tasks reported a 13-percentage point (95% CI 0.08, 0.17) higher confidence than providers who performed less than 50% of the tasks. Female providers and nurses were considerably less confident than males and doctors. Provider knowledge was moderately associated with provider confidence.ConclusionsOur study showed that scope of practice (the range of clinical tasks routinely performed by providers) is an important determinant of confidence. Ensuring that providers are exposed to a variety of services is crucial to support improvement in provider confidence and competence. Policies to improve provider confidence and pre-service training should also address differences by gender and by cadres.

Extragenital Pathologies of Pregnant Women in the Southern Regions of The Republic of Kazakhstan

The main priorities of the health care system is to strengthen the health of pregnant women and child. Currently, risk factors pregnancy include age, first pregnancy, multiple pregnancies, genetic factors, endocrine system pathology, social aspects, occupational hazards etc. The purpose of our study is to study the prevalence of extragenital pathology in pregnant women in the southern regions of Kazakhstan. Methods: As part of the study, the facilities were obstetric services in Almaty, Zhambyl, Kyzylorda, South Kazakhstan oblasts and the city of Almaty. The subject of the study was the indicators of the activities of obstetrical health organizations in the southern regions of the country from 2012 to 2016. The materials of the study were dynamic indicators of the activities of inpatient obstetric health care organizations (frequency of preterm labor, bleeding, surgical interventions, etc.) for 2012 to 2016. Statistical data processing was carried out using Excel. Results: Comparative studies have shown that the incidence of kidney and urinary tract diseases is the highest among all extragenital diseases accompanying pregnancy. The results may indicate a lack of female consultations to identify and treat major endocrine diseases before pregnancy, early pregnancy, and the need for more intensive monitoring of compliance with clinical protocols for pregnancy management aimed at limiting perinatal risks for the mother and fetus. Conclusion: There is a need to strengthen the work of the primary link to the issues of early detection, comprehensive diagnosis and quality treatment to minimize perinatal risks for pregnant women and the fetus.

EFICÁCIA DAS RECOMENDAÇÕES DA CEDAW E AS POLÍTICAS PÚBLICAS DE PROTEÇÃO À MATERNIDADE E SAÚDE DA MULHER NO BRASIL

O presente artigo original tem como objetivo responder ao seguinte problema de pesquisa: de que maneira as iniciativas propostas pelo Comitê de Eliminação de Todas as Formas de Discriminação Contra a Mulher são aplicáveis no Brasil? A discussão aborda teorias como a atenção à saúde da mulher no Brasil e políticas públicas voltadas à promoção da saúde obstétrica. A abordagem metodológica é qualitativa e quantitativa, a base de dados é secundária e as informações disponibilizadas pelo Latinobarómetro, Instituto Brasileiro de Geografia e Estatística (IBGE) e Departamento de Ações Programáticas Estratégicas do Ministério da Saúde do Brasil, com periodização de 1996 até 2018. Conclui-se que as políticas públicas de proteção à mulher e à maternidade são úteis e que as iniciativas propostas pela CEDAW são aplicáveis, o que se confirma pelos sete relatórios encaminhados pelo Brasil ao Comitê.

Is it home delivery or health facility? Community perceptions on place of childbirth in rural Northwest Tanzania using a qualitative approach

BackgroundIn low and middle-income countries, pregnancy and delivery complications may deprive women and their newborns of life or the realization of their full potential. Provision of quality obstetric emergency and childbirth care can reduce maternal and newborn deaths. Underutilization of maternal and childbirth services remains a public health concern in Tanzania. The aim of this study was to explore elements of the local social, cultural, economic, and health systems that influenced the use of health facilities for delivery in a rural setting in Northwest Tanzania.MethodsA qualitative approach was used to explore community perceptions of issues related to low utilization of health facilities for childbirth. Between September and December 2017, 11 focus group discussions were conducted with women (n = 33), men (n = 5) and community health workers (CHWs; n = 28); key informant interviews were conducted with traditional birth attendants (TBAs; n = 2). Coding, identification, indexing, charting, and mapping of these interviews was done using NVIVO 12 after manual familiarization of the data. Data saturation was used to determine when no further interviews or discussions were required.ResultsFour themes emerge; self-perceived obstetric risk, socio-cultural issues, economic concerns and health facility related factors. Health facility delivery was perceived to be crucial for complicated labor. However, the idea that childbirth was a “normal” process and lack of social and cultural acceptability of facility services, made home delivery appealing to many women and their families. In addition, out of pocket payments for suboptimal quality of health care was reported to hinder facility delivery.ConclusionHome delivery persists in rural settings due to economic and social issues, and the cultural meanings attached to childbirth. Accessibility to and affordability of respectful and culturally acceptable childbirth services remain challenging in this setting. Addressing barriers on both the demand and supply side could result in improved maternal and child outcomes during labor and delivery.

Reply by Authors.

No AccessJournal of UrologyAdult Urology1 May 2020Reply by Authors Heidi S. Harvie, Cindy L. Amundsen, Simon J. Neuwahl, Amanda A. Honeycutt, Emily S. Lukacz, Vivian W. Sung, Rebecca G. Rogers, David Ellington, Cecile A. Ferrando, Christopher J. Chermansky, Donna Mazloomdoost, and Sonia Thomas Heidi S. HarvieHeidi S. Harvie *Correspondence: Hospital of the University of Pennsylvania, 3400 Spruce St., Dulles Building 5th Floor, Philadelphia, Pennsylvania 19104 telephone: 215-662-3230; FAX: 215-349-8513; E-mail Address: [email protected] Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania More articles by this author , Cindy L. AmundsenCindy L. Amundsen Department of Obstetrics and Gynecology, Duke University, Durham More articles by this author , Simon J. NeuwahlSimon J. Neuwahl Social, Statistical and Environmental Sciences Group, RTI International, Research Triangle Park, North Carolina More articles by this author , Amanda A. HoneycuttAmanda A. Honeycutt Social, Statistical and Environmental Sciences Group, RTI International, Research Triangle Park, North Carolina More articles by this author , Emily S. LukaczEmily S. Lukacz Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Diego, La Jolla, California Financial interest and/or other relationship with Axonics, Boston Scientific, Pfizer, Uroplasty/Cogentix and UpToDate. More articles by this author , Vivian W. SungVivian W. Sung Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island More articles by this author , Rebecca G. RogersRebecca G. Rogers Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico Department of Women's Health, Dell Medical School, University of Texas, Austin, Texas Financial interest and/or other relationship with American Medical Systems, American Board of Obstetrics and Gynecology, International Urogynecological Association and UpToDate. More articles by this author , David EllingtonDavid Ellington Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama More articles by this author , Cecile A. FerrandoCecile A. Ferrando Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio Financial interest and/or other relationship with UpToDate. More articles by this author , Christopher J. ChermanskyChristopher J. Chermansky Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania More articles by this author , Donna MazloomdoostDonna Mazloomdoost Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland More articles by this author , and Sonia ThomasSonia Thomas Social, Statistical and Environmental Sciences Group, RTI International, Research Triangle Park, North Carolina More articles by this author for the NICHD Pelvic Floor Disorders Network View All Author Informationhttps://doi.org/10.1097/JU.0000000000000656.02AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Reply by Authors." The Journal of Urology, 203(5), p. 977

Oral Health Care in Pregnancy, ACOG Fellow Perspectives [27N

INTRODUCTION: The American College of Obstetrics and Gynecology recommends routine oral health care during pregnancy. Despite this recommendation, many pregnant women do not receive routine dental care. The reasons for discordance are complex. This study, conducted in conjunction with the ACOG District XII Committee on Healthcare of Underserved Women, surveyed ACOG District XII Fellows regarding their perceptions of factors that impact oral health care in pregnancy. METHODS: Between May and October 2019, ACOG District XII Fellows were asked to participate in an anonymous electronic survey on their practices regarding oral health in pregnancy. IRB approval was obtained. Descriptive statistics were estimated using SPSS (V25). RESULTS: 107 ACOG Fellows completed this survey. Twenty-one percent of Fellows reported receiving education/training related to oral health in pregnancy. Less than half (48%) of Fellows reported asking oral health screening questions, 60% recommend that women undergo routine dental cleaning, and 65% reported counseling patients on the importance of oral health in pregnancy. Seventeen percent (17%) reported insufficient clinic time and 17% of Fellows reported lack of accepting dentists as reasons for not discussing oral health during prenatal care. However, 55% of Fellows reported patients would easily find an accepting dentist. CONCLUSION: District XII ACOG Fellows acknowledge the importance of routine oral health care in pregnancy. However, they perceive barriers to recommending care such as limited clinic time and patient access. Offering oral health education during provider training could improve screening rates and counseling. Additionally, increasing access to dental care could improve overall oral health in pregnant women.

Rapid Deployment of a Drive-Through Prenatal Care Model in Response to the Coronavirus Disease 2019 (COVID-19) Pandemic.

Coronavirus disease 2019 (COVID-19) has been declared a public health emergency for the entire United States. Providing access to prenatal health care while limiting exposure of both obstetric health care professionals and patients to COVID-19 is challenging. Although reductions in the frequency of prenatal visits and implementation of telehealth interventions provide some options, there still remains a need for patient-health care professional visits. A drive-through prenatal care model was developed in which pregnant women would remain in their automobiles while being assessed by the health care professional, thus reducing potential patient, health care professional, and staff exposure to COVID-19. Drive-through prenatal visits would include key elements that some institutions cannot perform by telehealth encounters, such as blood pressure measurements for evaluation for hypertensive disorders of pregnancy, fetal heart rate assessment, and selected ultrasound-based measurements or observations, as well as face-to-face patient-health care professional interaction, thereby reducing patient anxiety resulting from the reduction in the number of planned clinic visits with an obstetric health care professional as well as fear of virus exposure in the clinic setting. We describe the rapid development of a drive-through prenatal care model that is projected to reduce the number of in-person clinic visits by 33% per patient compared with the traditional prenatal care paradigm, using equipment and supplies that most obstetric clinics in the United States can access.