Postpartum Hospital Research Articles

The impact of female genital mutilation/cutting on obstetric outcomes and its management

Objectives Female genital mutilation/cutting (FGM/C) is a surgical intervention that is still widely performed around the world with serious obstetric and neonatal outcomes. We aimed to determine the obstetric and neonatal effects of FGM/C in pregnant women in a hospital with high standards of care in Sudan, where this is a common case, using a homogenous patient group. Methods This is a retrospective cohort study in pregnant women with FGM/C, conducted at Nyala, Sudan-Turkey Training and Research Hospital. The inclusion criteria were: >18 years of age, history of FGM/C, vertex presentation, full-term birth, and single pregnancy. FGM/C group was compared with women without FGM/C (control group) who were monitored for the same period of 8 months in terms of age, parity, gestational age, and obstetric and neonatal outcomes. Results A total of 220 eligible pregnant women were included in the study. Each group consisted of 110 pregnant women (FGM/C and control groups). We noticed that in the FGM/C group more emergency C-sections occurred, the second stage of the delivery was prolonged significantly, and episiotomy and periclitoral injuries were higher. Also, it was seen that postpartum blood loss and hospitalization of the mother lasted longer in the FGM/C group. No significant differences were found between the two groups with regard to newborns. Conclusions FGM/C is definitely associated with poor obstetric outcomes. These patients should be diagnosed during the antenatal period, and the delivery processes should be managed by experienced healthcare professionals according to the type of FGM/C.

Delaying the First Newborn Bath and Exclusive Breastfeeding.

The purpose of this study was to determine if changing the timing of the initial newborn bath would have an impact on exclusive breastfeeding during hospitalization. The first newborn bath had been routinely done within 2 hours of age; practice was changed to the first bath being delayed until at least 12 hours of age. A secondary purpose was to examine the nurses' perceived benefits and challenges to such a change. Through a retrospective design, exclusive breastfeeding rates among mother-infant couplets prepractice change (cohort A) were compared with two postchange cohorts (B and C). Cohorts B and C were from the first 5 months and second 5 months, respectively after the practice change. Demographic information, birth type, bath timing, and feeding data were collected. Comparative statistics were applied to the three cohorts to examine differences in exclusive breastfeeding rates. Postpartum nurses were asked two open-ended questions on concerns and benefits of this change via an anonymous survey. Content analysis was completed on responses. There were 1,463 mother-infant couplets included in three cohorts (A: n = 564; B: n = 468; C: n = 431). There were no significant increases in the exclusive breastfeeding rates (baseline 74.1%) in both the first postimplementation delayed bath cohort (70.1%, p = .207) and the second "sustainability" cohort (79.4%, p = .060). Fifteen of the 60 postpartum nurses completed the survey, for a response rate of 25%. Themes generated from survey responses included concerns (infection control, work distribution), as well as benefits (perceived breastfeeding success, decreased workload) with delaying the first newborn bath. Delaying the first newborn bath may be one factor that can influence exclusive breastfeeding rates during postpartum hospitalization. Results have been mixed based on recent literature. In our study, the exclusive breastfeeding rate was already above average, as would be expected in a Baby-Friendly designated hospital and may be a reason we did not see a significant change in the rate among mother-infant couplets in our study. Randomized trials are needed for a rigorous evaluation of timing of the newborn bath and possible link to exclusive breastfeeding in the hospital and beyond.

Prescribing Video-Based Patient Education in the Hospital Setting: Can Bedside Breastfeeding Videos Affect Exclusive Breastfeeding at Postpartum Discharge?

Evaluate the impact of a standardized bundle of educational videos delivered via the bedside television to postpartum mothers on exclusive breastfeeding rates. Despite the growing use of videos for hospital discharge education, there is a paucity of literature evaluating their effectiveness. In November 2015, we began ordering 4 externally produced, peer-reviewed breastfeeding education videos for all postpartum mothers to view via their bedside televisions. Mothers could choose whether to watch the videos, and if they did, this was automatically documented in the electronic health record. We then performed a retrospective chart review generating a data set focusing on newborns who were healthy, term, and appropriate for gestational age, born in the year pre- and postintervention, and compared exclusive breastfeeding rates at the time of discharge among both groups. Our data set included 3115 newborns (1467 pre- and 1648 postintervention). In the postintervention year, the exclusive breastfeeding rate at discharge was 69.5% vs 68.4% preintervention (P value: .80). Most mothers (81.3%; 1339) watched all 4 videos, and 308 mothers (18.7%) watched none. The mothers who watched all 4 videos were more likely to breastfeed exclusively (72.7% vs 55.3%) and less likely to exclusively formula feed than the mothers who watched none (1.1% vs 19.8%; P < .0001). There was no change in exclusive breastfeeding rates pre- versus post-video education intervention. However, most mothers watched all 4 videos, and those who did were significantly more likely to engage in any breastfeeding (98.9%) compared with those who watched none (80.2%) during the postpartum hospitalization.

Variation in Tdap and Influenza Vaccination Coverage Among Pregnant Women by Insurance Type — Florida, 2016–2018

Infants are at increased risk for pertussis-associated morbidity and mortality, and pregnant women and their infants are more likely than other patient populations to experience severe influenza-related illness (1,2). The Advisory Committee on Immunization Practices (ACIP) recommends that all women receive the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during each pregnancy, preferably during the early part of gestational weeks 27-36 (3). ACIP also recommends that women who are or might be pregnant during the influenza season receive the inactivated influenza vaccine at any time during pregnancy (4). Despite these recommendations, coverage with Tdap and influenza vaccines during pregnancy has been low, with approximately one half of women receiving each vaccine and only one third receiving both, based on a survey during March-April 2019 (5). Data obtained through a retrospective chart review of randomly selected pregnant women who delivered at the University of Florida Health Shands Hospital in Gainesville, Florida, from January 1, 2016, to December 31, 2018, were analyzed to assess vaccination coverage by insurance type. Because the Florida Medicaid policy at that time did not cover these vaccines during pregnancy, the hospital system offered Tdap and influenza vaccines at no additional cost to mothers during the immediate postpartum hospital stay. Among 341 women, 68.6% of privately insured and 13.4% with Medicaid received Tdap during pregnancy, and among 316 women, 70.4% of privately insured and 35.6% with Medicaid received influenza vaccine during pregnancy. Many women, especially those with Medicaid, were vaccinated in the immediate postpartum period, when vaccination was available at no cost, increasing Tdap vaccination rates to 79.3% for privately insured and 51.7% for women with Medicaid; influenza vaccination rates rose to 72.0% for privately insured and 43.5% for women with Medicaid. These data suggest that the state Medicaid policy to not cover these vaccines during pregnancy might have significantly reduced coverage among its enrollees.

Health resource utilization of labor induction versus expectant management

Although induction of labor of low-risk nulliparous women at 39 weeks reduces the risk of cesarean delivery compared with expectant management, concern regarding more frequent use of labor induction remains, given that this intervention historically has been thought to incur greater resource utilization. The objective of the study was to determine whether planned elective labor induction at 39 weeks among low-risk nulliparous women, compared with expectant management, was associated with differences in health care resource utilization from the time of randomization through 8 weeks postpartum. This is a planned secondary analysis of a multicenter randomized trial in which low-risk nulliparous women were assigned to induction of labor at 39 weeks or expectant management. We assessed resource utilization after randomization in 3 time periods: antepartum, delivery admission, and discharge through 8 weeks postpartum. Of 6096 women with data available, those in the induction of labor group (n= 3059) were significantly less likely in the antepartum period after randomization to have at least 1 ambulatory visit for routine prenatal care (32.4% vs 68.4%), unanticipated care (0.5% vs 2.6%), or urgent care (16.2% vs 44.3%), or at least 1 antepartum hospitalization (0.8% vs 2.2%, P < .001 for all). They also had fewer tests (eg, sonograms, blood tests) and treatments (eg, antibiotics, intravenous hydration) prior to delivery. During the delivery admission, women in the induction of labor group spent a longer time in labor and delivery (median, 0.83 vs 0.57 days), but both women (P= .002) and their neonates (P < .001) had shorter postpartum stays. Women and neonates in both groups had similar frequencies of postpartum urgent care and hospital readmissions (P > .05 for all). Women randomized to induction of labor had longer durations in labor and delivery but significantly fewer antepartum visits, tests, and treatments and shorter maternal and neonatal hospital durations after delivery. These results demonstrate that the health outcome advantages associated with induction of labor are gained without incurring uniformly greater health care resource use.

Effectiveness of the doula program in Northern Taiwan.

Objective:The cesarean section rate in Taiwan is 32%–34%, exceeding the rate that the World Health Organization considers reasonable. A doula is a trained woman who provides physical, emotional, and informational support to pregnant women before, during, and after delivery. This study investigated the effectiveness of a new doula program in Northern Taiwan.Materials and Methods:A quasi-experimental research design was employed. Two hundred and twenty women, divided into an experimental group with doula services and a no-doula control group receiving routine hospital care, participated in the present study. Participants' basic information was collected; the study tools were the State-Trait Anxiety Inventory, Edinburgh Postnatal Depression Scale, labor pain visual analog scale, a labor timetable, and Mother's Level of Childbirth Satisfaction Rating Scale, which were distributed to participants during the postpartum hospitalization period.Results:The highest level of satisfaction was with the spouse in the control group and the doula in the experimental group. The results indicated that the childbirth process involved considerable anxiety in both groups. After delivery, the doula group exhibited a greater reduction in anxiety than the control group, but the reduction was not significant; however, a statistically significant difference was identified in the cesarean section (C/S) rate (13.0% vs. 43.2%) and normal spontaneous delivery (NSD) rate (87.0% vs. 56.8%) between the doula and control groups after controlling for the factor of primara.Conclusion:Providing continuous doula program to pregnant women requiring labor support may reduce the C/S rate and increase the NSD rate. The regression model showed that the factors including high prenatal anxiety, total time needed for doula accompaniment, and epidural and analgesics use were associated with labor women receiving C/S. The factors of continuous doula support and oxytocin use were associated with receiving NSD.

Perinatal and Postpartum Care During the&amp;nbsp;COVID-19 Pandemic: A Nationwide Cohort Study

Background: The coronavirus disease (COVID-19) pandemic limited services during pregnancy, labour, and childbirth that affected families worldwide. However, data on the effects of limiting obstetrical care during the pandemic’s first wave are sparse.Methods: This nationwide cohort study analysed birth registry data from all obstetric departments in Austria. Women who delivered between January and June 2020 were classified as cases, whereas those who delivered between January and June 2015–2019 were classified as controls. We excluded data concerning preterm delivery, birthweight below 500 g, multiple fetuses, fetal malformations and chromosomal anomalies, intrauterine fetal death, maternal cancer, or HIV-infection, and inter-hospital transfers. Perinatal outcomes, postpartum hospitalisation and adverse events were assessed.Findings: Of 33.198 cases and 188.225 controls, data analysis showed significantly increased rates of labour induction, instrumental delivery, obstetric anaesthesia, NICU transfer, and 5-min Apgar score below 7 during the COVID-19 period. There was a significantly shorter length of postpartum hospitalisation during the COVID-19 period compared to the non-COVID-19 period (3·1 ± 1·4 vs. 3·5 ± 1·5 days pInterpretation: Perinatal and postpartum care during the first wave of the COVID-19 pandemic differed significantly from that provided before. Increased rates of adverse events underline the need to ensure access to high-quality obstetrical care in order to prevent collateral damage.Funding Statement: None.Declaration of Interests: The authors report no conflict of interest in connection with this article.Ethics Approval Statement: The study was approved by the Ethics Committee of the Medical University of Vienna (reference number 1637/2020). Due to the retrospective study design, patient informed consent was not required. All patient data were handled anonymously.

An Exploration of the Relationship between Maternal and Child Factors Contributing to Child Abuse

Background: There are many reports in the mass media and scientific literature about child abuse caused by parents. Medical practitioners also are concerned about child abuse and need to grapple with the prevention and early detection of child abuse when working in medical facilities. Aim: The aim of this descriptive study was to explore the relationship between maternal and child factors contributing to child abuse. Methods: A sample of 50 multiparas (mothers with more than 1 child) in a 48-bed postpartum hospital unit in Okinawa prefecture were asked to fill out an anonymous questionnaire regarding the relationship between mothers and their first child in September, 2007. The questionnaire contained 30 items of physical punishment that are quoted from “The Handbook of Correspondence to Child Abuse” (Ministry of Health, Labor and welfare in Japan), 24 items relating to maternal factors and 22 items to child factors, plus items related to mothers’ satisfaction with the health guidance given in the hospital. Data were analyzed using JMP (ver. 14.2; SAS Institute Inc., Cary, NC, U.S.). The significance level was set at 0.05. Results: Forty-one (82%) questionnaires were analyzed. Of the 41 valid responses, 19 mothers reported abusing their children. Child factors contributing to the abuse included the first child’s regression to infantile behavior, bullying younger brothers or sisters and being rough and violent to their friends. The significant maternal factor leading to abuse was the belief that mothers were irritated by their child. Conclusion: A first child’s developmental difficulties had a significant relationship with the harsh punishment by their mothers. The mothers need to understand their child’s developmental behavior and provide a favorable environment for nurturing young children.

Enhancing Breastfeeding - Home-Based Education on Self-Efficacy: A Preventive Strategy.

Background:The aim of this study is to evaluate the effects of home-based education intervention on the exclusivity and promoting the rates of self-efficacy of breastfeeding.Materials and Methods:A randomized controlled trial was conducted Arak University of Medical Sciences in Takeghani Hospital in Iran between June 2015 and October 2015. A total of 130 eligible and voluntary women hospitalized in Arak University of Medical Sciences Hospital postpartum wards were randomized to receive usual care (n = 65) or education with CD and pamphlets (n = 65). Data regarding exclusive breastfeeding were collected using Denis and Fox's breastfeeding self-efficacy questionnaire. The primary outcome was collected by one assistant researcher during first postpartum visit. The secondary outcome was collected 4 weeks after birth of babies by telephone interviews. Data analysis was performed using descriptive (frequency, mean), independent samples t-test, Student's t-test, t2-test, and Chi-square test. All values of P < 0.05 were considered statistically significant.Results:There was no significant differences between the intervention and control groups with regard to age (P = 0.086) and gestational age (P = 0.741). The breastfeeding self-efficacy scores were higher in the intervention group (63.66 ± 6.11) than in the control group (57.04 ± 6.18) after 1 month of childbirth (P = 0.001). The exclusive breastfeeding rate in intervention group was 89.2 (n = 58) at 1st month after education compared with 55.4% (n = 36) in control group (P = 0.001).Conclusions:In a setting, a high breastfeeding rate and self-efficacy scores were found in education group. Therefore, nurses and midwives are thus required to adopt various health education strategies, such as home education, encourage breastfeeding.

995: Maternal race and risk for uninsured antepartum and postpartum hospitalizations

To date, there is limited national data on maternal race and risk for uninsured antepartum (AP) and postpartum (PP) hospitalizations. The objective of this study was to determine risk of uninsured AP and PP hospitalizations by maternal race. We utilized the 2002-2014 Nationwide Inpatient Sample to identify AP and PP hospitalizations. Insurance status was ascertained and dichotomized into uninsured (self-pay, no charge) versus insured (Medicare, Medicaid, and private insurance). Maternal race was categorized as: non-Hispanic black, non-Hispanic white, Hispanic, unknown, and other (Asian or Pacific Islander, Native American, other). Adjusted risk of being uninsured was evaluated individually for AP and PP hospitalizations via log linear regression models with the primary exposure of maternal race, adjusting for additional demographic, hospital, and obstetrical and medical factors. Of 5.9 million antepartum and 892,434 postpartum hospitalizations, 9.5% and 7.9% of women, respectively, were uninsured. Hispanic women and women of other race/ethnicity were most likely to be uninsured during both AP and PP hospitalizations (Table 1, p< 0.01). In multivariable analysis of antepartum hospitalizations, Hispanic women and women of other race/ethnicity were at 61% and 60% higher risk, respectively, of being uninsured compared to non-Hispanic white women (Table 2). In adjusted analyses of PP hospitalizations, Hispanic women and women of other race/ethnicity were at 85% and 65% higher risk, respectively, of being uninsured compared to non-Hispanic white women. (Table 2). Comparisons between non-Hispanic black and white women did not demonstrate large differentials. Hispanic women and women of other race/ethnicity were more likely to have no insurance during AP or PP hospitalizations. Further research is indicated to determine the health outcomes consequences of these differentials and how lack of insurance during pregnancy may contribute to AP and PP hospitalization risk.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

701: The effects of antepartum depressive symptoms on post-cesarean opioid consumption

To test the hypothesis that antepartum depressive symptoms are associated with increased pain scores and opioid use during postpartum hospitalization. Retrospective cohort of English or Spanish-speaking women > 18 years who had prenatal care for a singleton gestation and delivered by cesarean (CS) at > 36 weeks within a tertiary center during 2017 where all women are screened for depression with an antenatal Edinburgh Depression Scale (EDS). Exclusions included fetal anomalies or death, sickle cell disease, substance misuse, chronic pain, and fibromyalgia. Women with no EDS scores recorded antenatally were excluded. Major depressive symptoms (MDS) were defined as a documented antenatal EDS >=12 and no MDS if EDS< 12. MDS groups were compared with Student’s t-test, Wilcoxon rank sum tests, Chi-square, and exact tests where appropriate. Multiple linear regression modeled pain by MDS status controlling for smoking and anesthesia; model for opioid use included pain as well. Of the 891 patients reviewed, 676 (76%) had documented antenatal EDS scores, and 104 (15.4%) had MDS. Women with MDS were more likely to be single, use tobacco, and have general anesthesia for CS, but were otherwise similar (Table 1). Women with MDS reported higher daily and average pain scores (Table 2). In bivariate analyses, women with MDS used more morphine milligram equivalents (MME) each day during their postpartum hospitalization, leading to a higher total MME use (121mg (60.5-214.5) vs 75mg (28.5-133.5), p< 0.001). However, when adjusted for pain, MME use was not statistically significant (p=0.15). Our study supports an association between antepartum MDS and acute pain after CS leading to increased opioid use. Given the current focus on opioid stewardship, further research into this association, exploration of tailored pain control, and determining whether treatment of antepartum MDS reduces postpartum pain, and therefore opioid use, will be of the utmost priority.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Coping with the Unexpected: Patient Trust in Physicians following Delivery.

Patient's trust in physicians is a significant predictor of continuity, adherence, and satisfaction with care. However, it is unclear what influences a woman's trust in her physician. This study sought to determine if women's trust in their clinicians was affected by unexpected outcomes at the time of delivery. This is a secondary analysis of a prospective cohort of 300 postpartum women with gestational diabetes mellitus. Participants completed the validated Trust in Physician Scale during their postpartum hospitalization. Participants' scores were compared based on their exposure to an unexpected pregnancy outcome. Of the 300 women consented to participate in this study, 294 completed the Trust in Physician Scale. The mean overall trust score was 80/100 with a range of 42 to 100. Unexpected pregnancy outcomes occurred in 41% (120) of women in this cohort. There was no significant difference in the trust score between women who did and did not have at least one unexpected outcome (0.79 vs. 0.79, p = 0.93). Additionally, there was no significant association between the trust score and any individual unexpected pregnancy outcome. Unexpected pregnancy outcomes are not associated with changes in women's trust in their obstetric clinicians. These results emphasize the antepartum period as the essential time for patient-physician relationship building which has important implications for postpartum follow-up and long-term psychiatric sequelae from unexpected outcomes.

1121: Correlation of universal screening for maternal depression with birth weight and preterm birth

Perinatal mood and anxiety disorders (PMADs) are the most common perinatal complications. As awareness of PMADs grows, questions have arisen regarding the therapeutic value of screening alone. This study investigated whether universal screening for maternal depression and the Edinburgh Postnatal Depression Survey (EPDS) scores correlated with birth weight between a pre-implementation control cohort and a post-implementation study cohort. This study also investigated whether preterm birth rates varied between the two cohorts. The two cohorts received prenatal care from the same obstetric practices and delivered at the same large, urban hospital. Beginning in 9/2019 an EPDS was universally administered three times to the study cohort. This occurred at the first prenatal visit, once during the third trimester, and at the hospital postpartum. Gestational age at delivery (GA), birth weight and EDPS scores were compared to a control cohort who did not receive universal screening as pregnancies were prior to 9/2019. T-tests were used to assess continuous data and Pearson correlations were used to assess screening data and pregnancy outcomes. 3884 pregnancies prior to implementation of universal screening were compared with 3885 pregnancies after implementation. GA and birth weight were similar between the two groups. Preterm birth rate was 12% in control cohort versus 12.35 % in the study cohort. Negative correlations were seen between EPDS scores postpartum and GA at delivery (r= -0.12, p < 0.0001) as well as between EDPS scores and birth weight (r= -0.08, p < 0.0001). EPDS was significantly correlated to age and parity. Higher EPDS score postpartum is associated with earlier GA at delivery and lower birth weight. As universal screening for PMADs expands, we should regard PMADs with the same attention as other “high-risk” pregnancy complications to improve perinatal outcomes such as preterm birth and birth weight.

419: Emergency postpartum hospital visits: who gets admitted?

Emergent postpartum hospital encounters in the first 42 days after birth are estimated to complicate 5-12% of births. Approximately 2% of these visits result in admission. Data on emergent visits and admission during this time period is critically needed to address the current maternal morbidity crisis. Our objective is to characterize postpartum hospital encounters to the emergency room that resulted in admission. All postpartum hospital encounters within 42 days of birth from 2015 to 2019 at our institution were included. We reviewed demographic information, delivery route, and postpartum hospital encounters. Comparisons between women who were admitted to those managed outpatient were performed. Statistical analysis included Chi square and students t-test with p < 0.05 considered significant. Of the 8589 deliveries, 491 (5.7%) presented emergently to the hospital within 42 days of discharge and resulted in 576 hospital encounters. Of these hospital encounters, 224 (38.9%) resulted in an admission, accounting for 188 of the 491 deliveries (38.2%) re-admitted. Women with higher BMI, cesarean delivery, and blood loss ≥1000ml during delivery were significantly more likely to be admitted to the hospital (Table 1). Common chief complaints included fever, abdominal pain, headache, vaginal bleeding, wound, and hypertension (Figure 1). Admitting diagnoses were predominantly hypertensive disorder (21.0%), wound complications (11.6%), endometritis (11.2%), delayed postpartum hemorrhage (4.9%), and headache (4.5%) (Figure 1). Approximately 6% of deliveries are complicated by an emergency hospital visit within 42 days of discharge. Nearly 40% of emergent hospital encounters resulted in admission. The most common reasons for admission were hypertension, endometritis, and wound complications.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

970: Factors associated with postpartum hospital readmission

970: Factors associated with postpartum hospital readmission

294: Timing of emergency postpartum hospital visits in the fourth trimester

294: Timing of emergency postpartum hospital visits in the fourth trimester

Pacifier Use and Breastfeeding: A Qualitative Study of Postpartum Mothers.

Objective: Due to the inconclusive evidence supporting the traditional recommendation to avoid early pacifier use among breastfeeding newborns, this study aims to understand what information mothers are receiving from hospital based care providers and their perspectives about pacifier use in the newborn period. Methods: Interviews with mothers of healthy, term newborns during the postpartum hospitalization were conducted in this qualitative study. Results: Qualitative data analysis yielded several major themes that included the following: (1) pacifiers are beneficial for the maternal/infant experience, (2) concerns that pacifiers may interfere with breastfeeding, and (3) concerns about long-term use (including reliance and effect on teeth). Conclusion: Given the maternal perception of benefit and the paucity of high-quality evidence showing harm, further research on the effects of early pacifier use is needed.

The association between intrauterine balloon tamponade volume and postpartum hemorrhage outcomes.

To determine the effect of intrauterine balloon tamponade (IUBT) on the outcomes of postpartum hemorrhage (PPH) according to the balloon volume and to investigate the clinical factors associated with poor PPH outcomes. A retrospective cohort study was conducted in which patients with PPH underwent IUBT from January 2016 to August 2018. Patients with an IUBT volume greater than 350mL (n=76) were compared to patients with an IUBT volume less than 350mL (n=213). The clinical outcomes related to PPH included blood transfusion, estimated blood loss (EBL) after balloon placement, uterine artery embolization (UAE) after IUBT, and postpartum hospitalization. The results were analyzed by multivariate logistic regression models. None of the clinical outcomes related to PPH and evaluated in our study were favorable in patients with an IUBT volume greater than 350mL. Other factors associated with poor PPH outcomes after IUBT were placental site hemorrhage, shock index (SI) before IUBT, and antenatal hemoglobin. It is better to avoid unnecessary balloon inflation in IUBT if the bleeding is reduced, and more attention should be paid to the procedure when the balloon is large (≥350mL) than when it is small (<350mL).

Efficacy of allylestrenol combined with ritodrine on threatened premature labor and its influence on inflammatory factors in peripheral blood.

Efficacy of allylestrenol combined with ritodrine on threatened premature labor (TPTL) and its influence on inflammatory factors in peripheral blood were investigated. A total of 206 cases of TPTL patients from 2014 to 2016 were collected in Zhongshan Hospital Affiliated to Fudan University, and 106 cases were treated with allylestrenol combined with ritodrine as a research group and 100 cases were treated with allylestrenol combined with magnesium sulfate as a control group. General information of patients was collected, and changes in the expression levels of IL-17, IL-10 and IL-6 were detected by enzyme-linked immunosorbent assay. Prolonged pregnancy time, success rate of fetal protection and average delivery time of patients were recorded. The adverse pregnancy conditions were compared, including the Apgar score of newborns, birth weight and adverse conditions, and postpartum hemorrhage volume and postpartum hospital stays in the two groups were recorded. Prolonged pregnancy time, success rate of fetal protection and average delivery time in the research group were significantly higher than those in the control group (P<0.05). After treatment, the levels of IL-17, IL-10 and IL-6 in serum of the two groups were significantly lower than those before treatment (P<0.05), and were significantly lower in the research group than in the control group (P<0.05). The average neonatal weight and Apgar score in the research group were significantly better than those in the control group (P<0.05). Postpartum hemorrhage, postpartum hospital stays and incidence rate of toxic side effects, neonatal death, malformation and asphyxia in the research group were significantly lower than those in the control group (P<0.05). Allylestrenol combined with ritodrine can significantly reduce the expression levels of IL-17, IL-10 and IL-6 in TPTL, reduce adverse pregnancy conditions, prolong gestational weeks, and has higher safety and better application value.

Food insecurity during pregnancy and gestational weight gain

Limited or uncertain availability of nutritionally adequate and safe food, known as food insecurity, has been associated with obesity and other adverse health outcomes, but has rarely been studied in pregnancy. Food insecurity may negatively affect behavioral and physiological changes during pregnancy and may be associated with poor perinatal outcomes including gestational weight gain. Given the lack of information on the role of food insecurity in pregnancy and the possible relationship with perinatal outcomes such as gestational weight gain, the objective of this study was to examine the association between food insecurity and gestational weight gain in a diverse cohort of pregnant women. This was an observational study of 299 English-speaking women who delivered live-born singleton gestations at ≥24 weeks at a single tertiary care center. During their postpartum hospitalizations, enrolled women completed a survey of food security status during pregnancy using the United States Department of Agriculture Household Food Security Survey Module. Scores were analyzed as inadequate (marginal, low, or very low) vs adequate (high) food security. Women without prepregnancy body mass index and gestational weight gain data were excluded. The primary outcome was gestational weight gain categorized as inadequate, adequate, or excessive based on 2009 National Academy of Medicine guidelines, which account for body mass index. Secondary outcomes included total gestational weight gain and other maternal and neonatal outcomes. Multivariable linear and multinomial logistic regressions were performed to assess the independent associations of food insecurity with gestational weight gain after controlling for potential confounding factors. Of the 299 women enrolled in the study, 11.0% (n = 33) reported inadequate food security during pregnancy. Women with inadequate food security were younger (P = .007), had a greater mean body mass index (P < .001), were more likely to be non-Hispanic black or Hispanic (P < .001) and publicly insured (P < .001), but were less likely to be employed (P < .001). Women with inadequate food security also had fewer prenatal visits (P < .001) and were less likely to have initiated prenatal care in the first trimester (P < .001). The occurrence of excessive gestational weight gain did not differ by food security status (33.3% inadequate food security vs. 43.6% adequate food security, an adjusted relative risk ratio of 0.42, 95% confidence interval 0.16 - 1.14). Median total gestational weight gain was lower for women with inadequate food security (9.2 kg, interquartile range 7.5 - 14.1) than for women with adequate food security (13.9 kg, interquartile range 10.6 - 16.7) (P < .001), and this difference persisted when controlling for potential confounders including prepregnancy body mass index (β = -2.5, 95% confidence interval -5.0 to -0.21). In this diverse, urban population, more than 1 in 10 women experienced food insecurity during pregnancy. Inadequate food security was associated with lower median total gestational weight gain, but not with excessive gestational weight gain as determined by the 2009 National Academy of Medicine categories.