Obstetric Providers Research Articles

Over-The-Counter Drugs and Pregnancy

The obstetric provider should ask about over-the-counter drugs, although most are low dose, used only briefly, and any harm is unlikely and more theoretic than real.

Opioids and Opioid Use Disorder in Pregnancy.

Overdose is a leading cause of pregnancy-associated morbidity and mortality in the United States. As such, all obstetric providers have a responsibility to provide evidence-based care for patients with opioid use disorder to mitigate adverse outcomes associated with substance use during pregnancy.

An Overview of Antiviral Treatments in Pregnancy

Viral infections pose unique threats to pregnant persons and their infants. As the frequency of epidemics caused by novel pathogens increases, understanding pregnancy-specific considerations for antiviral treatments is critical for obstetric and nonobstetric providers alike. The use of pharmacologic therapeutics in pregnancy, which include antivirals, pathogen-specific antibodies, and vaccines, is limited due to the lack of purposeful, methodologic, pharmacometrics analyses in this special population. Our current understanding regarding dosing, safety, and efficacy stems from our knowledge of potential maternal or neonatal risks, observational data, and rarely clinical trials. In this review, we provide an overview on the use of antivirals during pregnancy.

Impact of the EURO-PERISTAT Reports on obstetric management: a difference-in-regression-discontinuity analysis.

Population health monitoring, such as perinatal mortality and morbidity rankings published by the European Perinatal Health (EURO-PERISTAT) reports may influence obstetric care providers' decision-making and professional behaviour. We investigated short-term changes in the obstetric management of singleton term deliveries in the Netherlands following publication of the EURO-PERISTAT reports in 2003, 2008 and 2013. We used a quasi-experimental difference-in-regression-discontinuity approach. National perinatal registry data (2001-15) was used to compare obstetric management at delivery in four time windows (1, 2, 3 and 5 months) surrounding publication of each EURO-PERISTAT report. The 2003 EURO-PERISTAT report was associated with higher relative risks (RRs) for an assisted vaginal delivery across all time windows [RR (95% CI): 1 month: 1.23 (1.05-1.45), 2 months: 1.15 (1.02-1.30), 3 months: 1.21 (1.09-1.33) and 5 months: 1.21 (1.11-1.31)]. The 2008 report was associated with lower RRs for an assisted vaginal delivery at the 3- and 5-month time windows [0.86 (0.77-0.96) and 0.88 (0.81-0.96)]. Publication of the 2013 report was associated with higher RRs for a planned caesarean section across all time windows [1 month: 1.23 (1.00-1.52), 2 months: 1.26 (1.09-1.45), 3 months: 1.26 (1.12-1.42) and 5 months: 1.19(1.09-1.31)] and lower RRs for an assisted vaginal delivery at the 2-, 3- and 5-month time windows [0.85 (0.73-0.98), 0.83 (0.74-0.94) and 0.88 (0.80-0.97)]. This study showed that quasi-experimental study designs, such as the difference-in-regression-discontinuity approach, are useful to unravel the impact of population health monitoring on decision-making and professional behaviour of healthcare providers. A better understanding of the contribution of health monitoring to the behaviour of healthcare providers can help guide improvements within the (perinatal) healthcare chain.

Telehealth Adoption During COVID-19: Lessons Learned from Obstetric Providers in the Rocky Mountain West.

Obstetric providers have used telemedicine to manage gestational diabetes, mental health, and prenatal care. However, the uptake of telemedicine in this field has not been universal. The COVID-19 pandemic catalyzed the adoption of telehealth in obstetric care, which will have lasting effects, especially for rural communities. We sought to understand the experience of adapting to telehealth among obstetric providers in the Rocky Mountain West to identify implications for policy and practice. This study included 20 semi-structured interviews with obstetric providers in Montana, Idaho, and Wyoming. The interviews followed a moderator's guide based on the Aday & Andersen Framework for the Study of Access to Medical Care, exploring domains of health policy, the health system, the utilization of health services, and the population at risk. All the interviews were recorded, transcribed, and analyzed using thematic analysis. Findings indicate that participants view telehealth as a useful tool during prenatal and postpartum care; many participants intend to continue telehealth practices after the pandemic. Participants shared that their patients reported benefits to telehealth beyond COVID-19 safety, including limiting travel time, reducing time off work, and alleviating childcare needs. Participants expressed concern that expanding telehealth will not equally benefit all patients and could widen existing health inequities. Success moving forward will require a telehealth infrastructure, adaptive telehealth models, and provider and patient training. As obstetric telehealth expands, efforts must prioritize equitable access for rural and low-income communities, so all patients can benefit from the technological advancements to support health.

Perinatal Mental Health Disorders: A Review of Lessons Learned from Obstetric Care Settings.

Perinatal mental health has garnered significant attention within obstetrics over the last couple of decades as the long- and short-term morbidities of untreated perinatal mental health disorders on both the mother and fetus/neonate have become increasingly apparent. There have been major strides in increasing screening for perinatal mental health disorders, clinician comfort with prescribing common psychiatric medications, and integrating mental health professionals into prenatal care via health services approaches such as the collaborative care model. Despite these advances, however, gaps still remain in the tools used for screening and diagnosis, obstetric clinician training in diagnosis and management of perinatal mood and anxiety disorders, as well as patient access to mental health care during pregnancy and especially postpartum. Herein we review the state of perinatal mental health from the perspective of the obstetric provider and identify areas of ongoing innovation.

Evidence-based intrapartum care practice and associated factors among obstetric care providers working in hospitals of the four Wollega Zones, Oromia, Ethiopia.

Even though Evidence-Based Practice (EBP) is a key component of quality of Intrapartum care and links to improved health care outcomes, consistent application of EBP in patient care remains a challenge for health care providers. In the study area, there are no previous studies conducted on evidence-based Intrapartum care practice among obstetric care providers. Therefore, this study was aimed to assess the magnitude of evidence based intra-partum care practice and its associated factors among obstetric care providers working in hospitals of Wollega zones, Oromia Region, West Ethiopia, 2022. An institution-based cross-sectional study using quantitative method was conducted from January to April/2022 in 11 hospitals of the four Wollega zones. All obstetric care providers (278) who were practicing intrapartum care in the selected hospitals were included. The data was collected using structured self-administered questionnaire and observational checklist. Data was entered via Epi-Data version 3.1 and analyzed by SPSS version 25 statistical software. To see the association between the independent variables and evidence based Intrapartum care practice, multivariable logistic regression analysis was done. The statistical significance of association was declared at p-value ≤ 0.05. Tables, figures and charts were also used in descriptive statistics. The overall magnitude of evidence-based Intrapartum care practice was found to be 63.7% [95% CI (59.7, 67.7)]. There was a statistically significant association between evidence-based Intrapartum care practice and having good knowledge about Intrapartum care practice [AOR = 2.95; 95% CI (1.52,5.73)], positive attitude towards Intrapartum care practice [AOR = 3.13; 95% CI (1.59,6.16)], availability of updated Intrapartum care guideline [AOR = 2.88; 95% CI (1.46,5.70)], number of obstetric care providers per a shift (≥5 care providers) [AOR = 2.31; 95% CI (1.01,5.29)], number of deliveries within a day (<10 deliveries) [AOR = 4.61; 95% CI (2.28,9.31)], educational level (MSc and above) [AOR = 5.75; 95% CI (2.23,14.84)] at p-value ≤ 0.05. Our study revealed that, magnitude of evidence-based Intrapartum care practice was found to be low according to the WHO recommendation. These findings indicate that additional attention and monitoring is required to implement current Intrapartum care practices with the WHO guidelines.

Predictors of successful vaginal birth after a cesarean section in Ethiopia: a systematic review and meta-analysis

BackgroundThe rates of successful vaginal birth after previous cesarean section (VBAC) have been increasing with minimal complication. Successful vaginal birth after cesarean section improves maternal and fetal outcomes by shortening the length of hospital stay, avoiding abdominal surgery, decreasing the risk of infections and hemorrhage, and decreasing injury of the bladder and bowel. Despite a few single studies stating different predictors of successful VBAC, there is a lack of nationwide data to show the determinants of successful VBAC. Thus, this meta-analysis aimed to determine the predictors of successful VBAC in Ethiopia.MethodsA systematic literature search was performed from PubMed, Web of Sciences, EMBASE, CINAHL, and Google scholar until July 25, 2022. The quality of included studies was evaluated using the Joanna Briggs Institute (JBI) critical appraisal checklist. The analysis was executed using Stata 14 statistical software. Heterogeneity was evaluated statistically using Cochran’s Q-statistic and quantified by the I2 value. A random-effects model was used to estimate the determinants of successful vaginal birth after a cesarean section if substantial heterogeneity was detected across included studies; otherwise, a fixed-effects model was used.ResultsWomen living in rural residence (AOR: 2.14; 95% CI: 1.01, 4.52), history of previous spontaneous vaginal delivery (AOR: 2.92; 95% CI: 2.02, 4.23), previous successful vaginal birth after previous cesarean section (AOR: 5.29; 95% CI: 2.20, 12.69), history of stillbirth (AOR: 1.57; 95% CI: 1.20, 2.04), cervical dilation of ≥ 4 cm at admission (AOR: 2.14; 95% CI: 1.27, 3.61), spontaneous ruptured membranes at admission (AOR: 1.32; 95% CI: 1.17, 1.48) were independent determinants of successful vaginal birth after previous cesarean section.ConclusionThe results of this meta-analysis showed that successful VBAC was influenced by past and present obstetric conditions and other predictors. Thus, it is recommended that obstetric care providers should emphasize those factors that lead to successful vaginal birth during counseling and optimal selection of women for the trial of labour after cesarean section.Systematic review and meta-analysis registrationPROSPERO CRD42022329567.

Etiology and factors associated with urogenital fistula among women who have undergone cesarean section: a cross-sectional study

BackgroundThe prevalence and impact of fistulas are more common in developing countries with limited access to emergency obstetric care. As a result, women in these settings often experience adverse psychosocial factors. The purpose of this study was to describe the characteristics of Congolese women who developed urogenital fistula following Cesarean sections (CS) to determine the characteristics associated with two etiologies: (1) prolonged obstructed labor; and (2) a complication of CS following obstructed labor.MethodsWe performed a cross-sectional study on abstracted data from all patients with urogenital fistula following CS who received care during a surgical campaign in a remote area of the Democratic Republic of the Congo (DRC). Descriptive analyses characterized patients with fistula related to obstructed labor versus CS. Univariate and multivariate logistic regression models identified factors associated with obstetric fistula after cesarean delivery following obstructed labor. Variables were included in the logistic regression models based upon biological plausibility.ResultsAmong 125 patients, urogenital fistula etiology was attributed to obstructed labor in 77 (62%) and complications following CS in 48 (38%). Women with a fistula, attributed to obstructed labor, developed the fistula at a younger age (p = .04) and had a lower parity (p = .02). Attempted delivery before arriving at the hospital was associated with an increased risk of obstetric fistula after cesarean delivery following obstructed labor (p < .01).ConclusionCS are commonly performed on women who arrive at the hospital following prolonged obstructed labor and fetal demise, and account for almost 40% of urogenital fistula. Obstetric providers should assess maternal status upon arrival to prevent unnecessary CS and identify women at risk of developing a fistula.

An Electronic Medical Record Intervention to Increase Early Screening Rates for Gestational Diabetes.

Our objective was to implement an electronic medical record reminder to perform the early gestational diabetes mellitus (GDM) screening test and to evaluate if this intervention increased screening rates. We performed a retrospective chart review of all deliveries at Mount Sinai West in January 2020 to determine the number of patients that met criteria for and actually underwent early GDM screening. A total of 314 patients had complete charts with pregnancy data. The following American College of Obstetricians and Gynecologists (ACOG)-defined risk factors were collected: body mass index greater than 25 (Asians greater than 23), history of GDM, history of macrosomia, hypertension (systolic >140 or diastolic >90), polycystic ovarian syndrome, hemoglobin A1c above 5.7, cardiovascular disease, and family history of diabetes. We used this data to advocate for and design an electronic medical record-based intervention to remind obstetric providers to complete the early glucose challenge test screening for eligible patients at the first prenatal visit. Our investigation confirms there is a low adherence rate of 12% at our facility to ACOG's updated early GDM screening guidelines (12 out of 97 patients). Furthermore, nearly one-fifth (16 out of 85) of eligible patients who did not receive screening were eventually diagnosed with GDM by screening at 24 to 28 weeks. After implementing an electronic medical record reminder at the initial prenatal visit, screening rates more than doubled to 28% (33 out of 115 eligible patients). The most common diabetic risk factors were high-risk ethnic background, current hypertension, family history of diabetes, history of polycystic ovarian syndrome, and body mass index of 40 or greater. Our data suggests that obstetricians could be missing an opportunity to improve maternal and neonatal outcomes by diagnosing GDM earlier in pregnancy, as recommended by ACOG. The adoption of an electronic medical record reminder seems to improve the rate of indicated early GDM screening. · There is a low adherence rate of 16% to ACOG's updated early GDM screening guidelines.. · After implementing an electronic medical record alert at the initial prenatal visit, screening rates nearly doubled.. · Screening rates were higher at prenatal practices with resident physician involvement in patient care..

Utilization of Nonpneumatic Antishock Garment and Associated Factors among Obstetric Care Providers in Public Hospitals of Sidama Region, Hawassa, Ethiopia, 2022.

Nonpneumatic antishock garment is one of the newly emerging technology advances that reduce blood loss which is caused by obstetric hemorrhage and help women survive during delays to get definitive care. Over 80% of maternal mortality due to hemorrhagic shock may have been prevented if a nonpneumatic antishock garment had been utilized by an obstetric care provider. However, to the current knowledge, the utilization of nonpneumatic antishock garments is low and even no single study was conducted in the study area. Hence, we found that it is necessary to assess the magnitude and factors affecting the utilization of antishock garments among obstetric care providers in public hospitals of the Sidama region, Ethiopia, 2022. A facility-based cross-sectional study design was employed among 403 obstetric care providers from June 15 to July 15, 2022. A two-stage sampling technique was applied; the data was collected by 5 trained BSc midwives using pretested and structured self-administered questionnaires. Data was entered into EpiData Manager version 4.6 and exported to Statistical Package for Social Sciences (SPSS) version 26 software. Bivariate and multivariable logistic regression analyses were used. A total of 394 (97.8%) health professionals participated in this study. Overall, 30.71% (95% CI: 26.4%, 35%) of the obstetric care providers had utilized nonpneumatic antishock garments for the management of postpartum hemorrhage. Training on the antishock garment (AOR = 4.183, 95% CI: 2.167, 8.075, p < 0.00), tertiary hospital (AOR = 0.355, 95% CI: 0.132, 0.952, p < 0.04), having protocol in the facility (AOR = 2.758, 95% CI: 1.269, 5.996), availability of NASG in the facility (AOR = 4.6, 95% CI: 1.603, 13.24), good knowledge (AOR = 2.506, 95% CI: 1.26, 4.984), and positive attitude (AOR = 2.381, 95% CI: 1.189, 4.766) were significantly associated factors. Conclusion and Recommendation. We found that less than one-third of the study participants have used the antishock garment in the management of postpartum hemorrhage in the current study. In addition to enhancing in-service and ongoing professional development training, it is preferable to insure the availability and accessibility of antishock in the facilities in order to close the knowledge and attitude gap among obstetric care providers.

Assessing maternal cardiac function by obstetricians: technique and reference ranges

A strong body of evidence has now coalesced indicating that some obstetrical syndromes may result from maladaptive responses of the maternal cardiovascular system. Longitudinal studies have shown that these changes are complex and present before the clinical recognition of preeclampsia and fetal growth restriction, suggesting that hemodynamic maladaptation may play an etiologic role in obstetrical complications. Chronic hypertension is one of the most frequent complications of pregnancy, and recent evidence suggests that control of mild hypertension in early pregnancy improves outcome. The management of chronic hypertension can be improved by understanding specific cardiovascular hemodynamic abnormalities such as increased cardiac output or increased systemic vascular resistance, which can respond to either beta or calcium channel blockers, depending on the hemodynamic findings. Evaluation of maternal cardiac function has not been previously available to obstetrical healthcare providers using diagnostic ultrasound equipment used for fetal evaluation. Obstetrical ultrasound machines may be configured for various probes (endovaginal, abdominal, 3D/4D, and cardiac). This study used a cardiac probe placed in the suprasternal notch to image and measure the descending aorta diameter and the velocity time integral using pulsed and continuous wave Doppler ultrasound in normal pregnant women between 11 and 39 weeks of gestation. These measurements were followed by computation of maternal left ventricular preload, afterload, contractility, and blood flow. This was a prospective cross-sectional study. A total of 400 pregnant women were recruited between 11 and 39 weeks of gestation. Imaging of the maternal aortic arch was performed by placing a cardiac probe in the suprasternal notch to identify the aortic arch using 2D and color Doppler ultrasound. The end-systolic diameter of the aorta was measured at the junction of the left subclavian artery with the descending aorta, which was followed by insonation of the descending aorta to obtain the Doppler waveform. Following insonation of the descending aorta, measurements of the aortic diameter, velocity time integral, ejection time, mean pressure gradient, heart rate, maternal weight and height, and systolic and diastolic blood pressures were entered into an Excel spreadsheet to compute the following: (1) preload measurements of stroke volume, stroke volume index, and stroke work index; (2) afterload measurements of systemic vascular resistance and the potential-to-kinetic energy ratio; (3) contractility measurements of inotropy and the Smith-Madigan inotropy index; and (4) blood flow measurements of cardiac output and the cardiac output index. Fractional polynomial regression analysis was performed for each of the above measurements using gestational age as the independent variable. The diastolic and mean arterial blood pressure decreased from 11 to 18 weeks of gestation and then increased until term. The afterload measurements demonstrated similar characteristics, as all values decreased from 11 weeks until the mid and late second trimester, after which all values increased until term. Changes in contractility demonstrated an increase from 11 weeks to 25 to 28 weeks, followed by a decline until term. Changes in blood flow demonstrated an increase from 11 to 27 weeks and then declined until term. The continuous wave Doppler values were greater than the pulsed Doppler values except for the contractility measurements. Examples of abnormal cardiac measurements were identified in pregnant patients with hypertension and fetal growth restriction. An Excel calculator was created to provide quick computation of z-score measurements and their corresponding centiles described in this study. The technique for evaluation of maternal cardiac function described in this study would allow screening of maternal left ventricular preload, afterload, contractility, and blood flow in the obstetrical clinical milieu once a cardiac probe is acquired for obstetrical ultrasound machines used for fetal evaluation. The above measurements would allow the clinician to select appropriate hypertensive medication on the basis of the results of the evaluation of the maternal left ventricle.

Assessment of Syrian Obstetric Care Providers Knowledge, Attitude, and Practice Towards Preconception Care and Associated Factors: An Online Cross-Sectional Study

Background: Preconception care was instituted in 2013 by the World Health Organization (WHO) to promote more attention to pregnant women by medical staff. Preconception care attempts to optimize pregnancy outcomes and promote health by managing and treating variables that influence it. Obstetric care providers in LAMICs have been reported to have low levels of preconception care awareness. This study investigates the Knowledge, attitudes, and practice-related features of obstetric care providers in Syria's public health institutions about preconception care.&#x0D; &#x0D; Methods: A cross-sectional study was undertaken in Syria between 6 September 2022 and 7 October 2022 to evaluate obstetric care providers' Knowledge, attitudes, and practice at public health institutions regarding preconception care and related concerns. The questionnaire was designed using a validated scale from a prior study conducted in Ethiopia. The inclusion criteria for study participants were obstetricians and gynaecologists, midwives and residents, and nurses of Obstetrics and Gynecology. There were six sections in the questionnaire (sociodemographic information, Knowledge, practice attitude, additional factors associated with Preconception practice, and related actual &amp; potential access to resources). The data were subjected to descriptive and multivariate logistic regression analysis using the IBM SPSS V. 28.0 software.&#x0D; &#x0D; Results: The mean age of 499 participants was 31.8 (SD = 9.7). Most participants were female (81.8%) and physicians (60%). 91.4% of respondents were deemed knowledgeable about preconception care. the most identified question (96.2%) was (Women intending pregnancy should be encouraged to defer pregnancy until they have reduced their drug, alcohol, and cigarette usage). (24.8%) participants regularly queried their patients about their reproductive life plan, with women aged 18 to 49 being the most often questioned group (92.3%). Only 18.6% of physicians routinely informed their patients about environmental dangers and contaminants. In addition, 53.5% of responders inquired about the patient's surgical and medical histories. 29.7% of participants strongly agreed that PCC provides an opportunity to improve the health of couples, particularly women, whereas 18.2% are certain that PCC does not belong to their scope of duties. Knowledge was more likely to be poor among participants who had never seen a doctor practicing PCC than among those who had (OR=2.81, P value = 0.026). Participants who did not get training on reproductive life plan examination throughout their practice time were less knowledgeable than those who did (OR = 2.91, P value= 0.04). &#x0D; &#x0D; Conclusion: Our results have shown that obstetric care providers in Syria have good Knowledge of and low to moderate practice and attitude towards preconception care. Improving access to training, carrier development, Internet, and library services is vital to improving PCC training. It is recommended that extra platforms be made accessible to obstetric care providers during their training to assist them in becoming preconception carers and in raising awareness about the significance of preconception care.

Ensuring quality obstetric care in rural Ghana: Shared experiences of obstetric care providers

PurposeTo explore care provider lived experiences with obstetric care delivery in rural Ghana. MethodsThis interpretative phenomenological study utilised a semi-structured interview guide to collect data on care provider lived experiences with obstetric care delivery. Participants comprised purposively sampled obstetric care providers in selected health care facilities in the Northern Region of Ghana. Data processing and presentation followed interpretative phenomenological analysis procedure. ResultsFindings reveal four superordinate themes: being persuasive, striving to provide quality care, using evasive mechanisms and subtle preventive schemes. These specifically refer to the use of alternative care, soliciting partner involvement, voluntarily donating blood, stocking essential items and drugs, refusing care in some instances and performing unconsented interventions. ConclusionIn their quest to provide quality care, obstetric care providers in some of Ghana’s rural health facilities adopt a mix of altruistic, innovative, excessive and unethical approaches most of which are driven by systemic failures. A government-community collaboration and commitment to quality maternal health care delivery is essential to improving health outcomes of rural mothers.

Toward recovery-oriented perinatal healthcare: A participatory qualitative exploration of persons with lived experience and health providers' views and experiences.

Perinatal mental health disorders (PMHD) remain often undetected, undiagnosed, and untreated with variable access to perinatal mental health care (PMHC). To guide the design of optimal PMHC (i.e., coproduced with persons with lived experience [PLEs]), this qualitative participatory study explored the experiences, views, and expectations of PLEs, obstetric providers (OP), childcare health providers (CHPs), and mental health providers (MHPs) on PMHC and the care of perinatal depression. We conducted nine focus groups and 24 individual interviews between December 2020 and May 2022 for a total number of 84 participants (24 PLEs; 30 OPs; 11 CHPs; and 19 MHPs). The PLEs group included women with serious mental illness (SMI) or autistic women who had contact with perinatal health services. We recruited PLEs through social media and a center for psychiatric rehabilitation, and health providers (HPs) through perinatal health networks. We used the inductive six-step process by Braun and Clarke for the thematic analysis. We found some degree of difference in the identified priorities between PLEs (e.g., personal recovery, person-centered care) and HPs (e.g., common culture, communication between providers, and risk management). Personal recovery in PMHD corresponded to the CHIME framework, that is, connectedness, hope, identity, meaning, and empowerment. Recovery-supporting relations and peer support contributed to personal recovery. Other factors included changes in the socio-cultural conception of the peripartum, challenging stigma (e.g., integrating PMH into standard perinatal healthcare), and service integration. This analysis generated novel insights into how to improve PMHC for all users including those with SMI or autism.

The Extent of Partograph Use and Associated Factors among Obstetric Care Providers in Government Hospitals in Southern Ethiopia: A Cross-Sectional Study

The Extent of Partograph Use and Associated Factors among Obstetric Care Providers in Government Hospitals in Southern Ethiopia: A Cross-Sectional Study

“It feels like you have to choose one or the other”: periviability counseling focus groups

Periviability counseling is both a difficult skill to master and an ideal application of shared decision-making, as it involves high stakes decisions that hinge upon individual patient values. Previous research shows that counseling varies between providers, and that obstetric (OB) providers often fail to integrate shared decision-making principles into counseling. The objective of this study was to understand baseline knowledge about periviability counseling among OB providers, and to ascertain challenges to counseling to inform curricular development. This qualitative study included four focus groups of OB providers encompassing upper-level OB residents, maternal fetal medicine (MFM) fellows, general obstetrician/gynecologists, and MFM specialists. The same series of open-ended questions was posed to each group; responses were audio recorded and transcribed. Transcriptions were analyzed independently by two coders using thematic analysis. Themes were finalized and inconsistencies resolved through discussion. Sixteen providers were included in the focus groups. Four main themes were identified (Table): (1) Periviability counseling is both time intensive and time-challenged, (2) Patient processing of information relies on the content, delivery and patient readiness, (3) Decisions regarding periviable cesarean highlight the conflict between the obstetrician’s concern for maternal risks, the neonatologists focus on neonatal risks, and the parental desire to “do everything” and (4) OB provider knowledge about neonatal outcomes is limited and plagued by uncertainty. We identified at least four specific challenges faced by OB providers when performing periviability counseling. Some, like the knowledge gap regarding neonatal outcomes, can be modified through education while others, such as time intensivity, cannot be. Practicing shared decision-making through advanced communication training may help address the issues related to optimal means of information delivery and balancing one’s own biases with patient values.

Challenges and Opportunities Confronting Factors in Governmental Health Institutions of Addis Ababa, Ethiopia, 2022: Qualitative Study

Background: Partograph is a graphic record of progress of labor, maternal and fetal condition plotted against time for intrapartum monitoring. World Health Organization (WHO) recommends using the Partograph to follow labour and delivery, with the objective to improve health care and reduce maternal and foetal morbidity and death. The aim of this study is to challenges and opportunities confronting factors in governmental health institutions of Addis Ababa, Ethiopia, 2022 Method: Institution based study was conducted among obstetric care givers working in governmental health institution of Addis Ababa city from February to June 2022. Sixty-eight cases were observed directly, and 34 delivery case team leaders were interviewed. Five data collectors were trained. Data were collected using a interview and observation Result: Even though high proportion of obstetric care providers use partograph to follow the progress of labour, the observation findings indicated that continues monitoring of maternal and foetal condition in the right time was lacking. This affects proper identification of the action line which in turn farther affects maternal and fetal outcome. Monitoring and supervision of obstetric staff in hospitals, increasing number of obstetric care givers, motivation and initiation of obstetric care givers who didn’t use partograph routinely would improve partograph utilization.

Racial implicit biases among obstetric care providers and associated differential care: The BiP research program

Racial implicit biases among obstetric care providers and associated differential care: The BiP research program

Inpatient versus outpatient management of gestational hypertension or preeclampsia without severe features

To compare maternal and neonatal outcomes along with gestational latency, in patients diagnosed with a hypertensive disorder of pregnancy (HDP) (gestational hypertension or preeclampsia), without severe features managed inpatient versus outpatient setting. A retrospective, cohort study of patients with HDP without severe features before 37 weeks from 2014-2021. Patients were managed inpatient or outpatient at discretion of obstetric provider. Patients with initial presentation with severe features were excluded. The primary outcome was severe maternal morbidity (SMM) as defined by the 21 CDC maternal morbidity identifiers. Secondary outcomes included maternal ICU admission, development of severe features, placental abruption, time from diagnosis to delivery, preterm birth< 37 weeks, low birthweight (< 2500g), 5-minute Apgar score < 7, and stillbirth. A total of 279 patients met the inclusion criteria with 236 (84.6%) being managed outpatient and 43 (15.4%) being managed inpatient. In univariate analysis, SMM rates were higher in inpatient compared to outpatient group (14.0% vs. 2.3%, p=0.001). Maternal ICU admission was higher in the inpatient management group (7.0% vs. 0.4%, p< 0.001). Frequencies of placental abruption and development of severe features did not differ between the groups. Time from diagnosis to delivery was longer in the outpatient compared to inpatient group (13d vs. 3d, p< 0.001). Low birth weight and preterm birth were more frequent in the inpatient group (Table 1). In multivariate analyses, controlling for gestational age at HDP diagnosis, HDP type, twin gestation, maternal diabetes, BMI, and residential distance from the hospital, SMM did not differ between the groups (aOR 0.17, 95% CI 0.02-1.78) Secondary outcomes did not differ between outpatient and inpatient management groups (Table 2). Outpatient management of gestational hypertension or preeclampsia without severe features was not associated with adverse maternal or neonatal outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)