Postpartum Patients Research Articles

Extending Maternal Care After Pregnancy: An Initiative to Address Health Care Disparities and Enhance Access to Care After Delivery.

A substantial proportion of maternal morbidity and mortality occurs after birth. However, little is known about the optimal design of programs to improve outcomes and decrease disparities during this period. Parkland Health is a tax-supported health system in Dallas that delivers more than 11,000 patients annually. A community needs assessment identified substantial health disparities in this community. The proportion of women in this region with diabetes mellitus (DM) and chronic hypertension (CHTN) during pregnancy is higher than surrounding regions, but access to care in the area is difficult because of the limited availability of ambulatory care. The authors created extending Maternal Care After Pregnancy (eMCAP), a community-based program, to address health care disparities and enhance access to care for the 12 months after birth. The team also evaluated the ability of Z codes (ICD-10 codes for social determinants of health) to identify patients with health-related social needs. The eMCAP program demonstrated improvement in attendance and quality of postpartum care for women living in underserved areas with CHTN and DM. For both CHTN and DM, eMCAP patients were matched 1:2 to controls outside of the eMCAP target region with similar comorbidities for maternal age ± 4 years, Black race, and delivery date ± 45 days. Compared to matched controls who were provided standard referrals, follow-up postpartum attendance for eMCAP women with CHTN was significantly better at 2 weeks and 1, 3, 6, 9, and 12 months (all p < 0.001). Similarly, eMCAP women with DM had significantly better follow-up at 2 weeks (p = 0.04), 1 month (p = 0.002), and 3 months (p = 0.049), resulting in HbA1c values for DM being significantly lower (p < 0.05) throughout the postpartum period. Despite the health system leading in reporting of Z codes, nearly 99% of applicable Z codes were not recorded, underscoring a public health opportunity. Through the eMCAP program, this initiative has demonstrated improved clinical performance for health care outcomes relevant to postpartum patients that can be deployed elsewhere to improve maternal health in underserved communities.

Access and Barriers to Home Device Use in Pregnancy [ID: 1375585

INTRODUCTION: Virtual prenatal visits are promising for removing barriers to care; however, prior work suggests pregnant people who may benefit most might lack access to tools like home blood pressure (BP) monitors. We assessed drivers of pregnant patients' access to and use of home BP monitors. METHODS: We conducted an IRB-exempt cross-sectional survey of postpartum patients admitted for childbirth at an academic institution. After obtaining consent, we assessed patients' barriers to accessing home devices during pregnancy. Data were summarized using descriptive statistics and between-group comparisons. RESULTS: 78/200 (39%) patients surveyed completed at least one virtual visit, of whom 76.92% were White and 23.08% were publicly insured. Patients who completed at least one virtual visit were more likely to report having a home BP monitor (73.08%) than those who had none (44.26%) (P&lt;.001). More patients who had no virtual visits reported their provider did not recommend a BP monitor (41.80%) (P&lt;.001), and not knowing how to check their BP (13.93%) (P=.048). Patients with public insurance (15.6%) and Black patients (17.4%) were more likely to report inability to obtain a BP monitor than commercially insured (4.5%) and White patients (3.1%) (P&lt;.05). CONCLUSION: Access to BP monitors was limited in obstetrics patients who selected in-person care, were Black, and publicly insured. Policy change is needed to ensure patients who face the greatest barriers to care can access necessary tools for virtual visits.

Postpartum Home Blood Pressure Monitoring Program: Improving Care for Hypertension During Postpartum after a Hospital Birth.

Hypertensive disorders of pregnancy complicate about 10% of pregnancies and are a leading cause of maternal morbidity and mortality. The purpose of this quality improvement project was to evaluate a program to provide a home blood pressure monitor to all postpartum patients who had a hypertensive diagnosis and elevated blood pressure. The program includes a blood pressure monitor, instructions for its use, education about hypertension, and a guidance grid with standardized blood pressure parameters reviewed prior to discharge from the hospital. Patients are taught about potential adverse outcomes during postpartum. Patients are instructed to follow-up with their care provider based on the parameters. A retrospective medical record review was used to evaluate clinical outcomes. Medical records of 185 patients indicated that 20% ( n = 36) who received the home BP monitor reported one or more mild-to-severe range blood pressure(s) during postpartum. Twenty-eight percent ( n = 52) had outpatient medication adjustments, including decreasing, increasing, starting, and discontinuing medications. Nine percent ( n = 17) of patients returned to the obstetric triage for evaluation. There was patient overlap between those experiencing elevated blood pressures, medication adjustments, and those who returned to hospital for evaluation. Ongoing monitoring may improve identification and management of postpartum hypertension and potentially prevent progression to hypertensive-related adverse events.

Implementation of a Postpartum Furosemide Protocol in Patients With Hypertensive Disorders of Pregnancy (HDP) [ID: 1381582

INTRODUCTION: Increasing evidence has shown benefits with the use of furosemide for patients with hypertensive disorders of pregnancy (HDP) in the postpartum period. We compared outcomes of patients diagnosed with HDP who received a standard protocol of postpartum furosemide versus those who had routine postpartum care. METHODS: In February 2022, a standardized, multidisciplinary postpartum furosemide protocol was instituted for patients with HDP. Exclusion criteria included hypokalemia, receiving concomitant diuretics, creatinine greater than 1.2 mg/dL, stenotic valvular cardiac disease, hemodynamic instability, or body mass index less than 18. We compared patients prior to routine furosemide use (June 2020 to January 2022) to patients treated under the protocol (February 2022 to July 2022). Outcomes included hypertension defined as systolic blood pressure (BP) greater than 139 or diastolic BP greater than 89 at 6–14 days postpartum, need for additional antihypertensive medications, readmissions, and show-rate for postpartum outpatient visits. Nonparametric tests were used to compare outcomes between the groups. Study was exempt from the IRB. RESULTS: A total of 129 patients were identified who met inclusion criteria. 80 patients met criteria prior to protocol implementation, and 49 patients met criteria after implementation. The furosemide group had a significant reduction in hypertension at 6–14 days postpartum (22.86% versus 55.26%, odds ratio 0.24, 95% CI 0.09–0.66) compared to the group who did not receive furosemide. No adverse events were noted in the furosemide group. CONCLUSION: Administration of a short course of furosemide to postpartum patients with HDP appears to improve BP recovery in the days immediately after delivery. Further studies examining hemodynamic changes after furosemide use are needed.

Clinical and Radiological Features of Intracerebral Hemorrhage in Pregnant and Postpartum Patients (P11-5.007)

Clinical and Radiological Features of Intracerebral Hemorrhage in Pregnant and Postpartum Patients (P11-5.007)

Application of the Modified Early Obstetrical Warning System (MEOWS) in postpartum patients in the emergency department.

Over the last two decades, there has been a steady rise in severe maternal morbidity and pregnancy-related deaths in Canada and the USA. The Modified Early Obstetric Warning System (MEOWS) is a risk stratification tool designed to predict severe maternal morbidity and mortality and has been validated for use in obstetrical wards. The objective of this study was to determine if MEOWS could accurately identify patients at risk of severe maternal morbidity and mortality in the ED setting. This was a chart review of patients presenting to an academic tertiary care centre (annual ED census 65,000) with a postpartum complaint within 6 weeks of delivery between May 2020 and March 2022. The exposure was the presence of a trigger, defined as one severely abnormal (red) or two mildly abnormal (yellow) physiological measurements during the ED visit. The diagnostic accuracy of the tool to identify patients at risk of severe maternal morbidity severe maternal morbidity or mortality was estimated by calculating the sensitivity, specificity, positive predictive value and negative predictive value. Two hundred and sixty-seven patients were included, of which 21 (7.9%) met the criteria for severe maternal morbidity. There were no maternal deaths. Overall, the sensitivity of the MEOWS tool was 85.7% (95% CI 63.7-97.0%), specificity was 67.9% (95% CI 61.7-73.7%), positive predictive value was 18.6% (95% CI 15.1-22.7%), and negative predictive value was 98.2% (95% CI 95.1-99.4%). Severe preeclampsia and eclampsia were the most common outcome category of severe maternal morbidity, representing 16 (76.2%) cases. Most patients (86.5%) were discharged directly from the ED, and 90.0% did not return within 30days. This study is the first to explore the utility of MEOWS in postpartum ED patients. The presence of a MEOWS trigger at ED triage or the first ED nursing assessment was associated with severe maternal morbidity. Thus, MEOWS may be a valuable tool to identify postpartum patients at risk of severe outcomes early in an ED visit.

Considerations for Treating Nonobstetric Diseases in Pregnant Patients in the Emergency Department Setting.

To provide nonobstetric practitioners with an overview of key concepts for the pregnant patient and review treatment of 3 common acute nonobstetric diseases encountered in the emergency department setting. A literature search of PubMed was performed (1997-February 2023) using key search terms related to pregnancy, pain, urinary tract infection (UTI), venous thromboembolism (VTE), and anticoagulants. Relevant articles in English and humans were considered. When caring for a pregnant patient, it is important to utilize appropriate assessments, understand terms used in this population, and recognize how the physiological and pharmacokinetic changes that occur in pregnancy can influence medication use. Pain, UTIs, and VTE are common in this population. Acetaminophen is the most widely used medication for the management of pain during pregnancy and the drug of choice for mild pain in pregnancy not responsive to nonpharmacologic treatment. Pyelonephritis is the most common nonobstetric cause of hospitalization for pregnant patients. Antimicrobial treatment should consider maternal-fetal safety and local resistance patterns. Pregnant and postpartum patients have a 4- to 5-fold increased risk of developing a VTE compared with nonpregnant patients. Low-molecular-weight heparin is the preferred treatment. Pregnant patients often seek acute care in the emergency department setting for nonobstetric needs. Pharmacists in this setting should understand appropriate assessment questions and terms used within this population, the basics of physiological and pharmacokinetic changes in pregnancy that can impact treatment, and which resources are best to utilize for drug information of the pregnant patient. Practitioners in the acute care setting commonly encounter pregnant patients seeking care for nonobstetric concerns. This article covers key pregnancy-related information for the nonobstetric practitioner and focuses on the management of acute pain, UTI, and VTE during pregnancy.

Systematic Review of Lymphangioleiomyomatosis Outcomes in Pregnancy and a Proposed Management Guideline.

Lymphangioleiomyomatosis (LAM) is a rare, multisystem disease that primarily affects women of reproductive age. Disease progression has been linked to estrogen exposure, and as such many patients are advised to avoid pregnancy. Data are limited regarding the interaction between LAM and pregnancy, and as such we performed a systematic review to summarize available literature reporting outcomes of pregnancies complicated by maternal LAM. This was a systematic review including randomized controlled trials, observational studies, systematic reviews, case reports, clinical practice guidelines, and quality improvement studies with full-text manuscripts or abstracts in the English language with primary data on pregnant or postpartum patients with LAM. The primary outcome was maternal outcomes during pregnancy as well as pregnancy outcomes. Secondary outcomes were neonatal outcomes and long-term maternal outcomes. This search occurred in July 2020 and included MEDLINE, Scopus, clinicaltrials.gov, Embase, and Cochrane Central. Risk of bias was ascertained using the Newcastle-Ottawa Scale. Our systematic review was registered with PROSPERO as protocol number CRD 42020191402. A total of 175 publications were identified in our initial search; ultimately 31 studies were included. Six (19%) studies were retrospective cohort studies and 25 (81%) studies were case reports. Patients diagnosed during pregnancy had worse pregnancy outcomes compared to those diagnosed with LAM prior to pregnancy. Multiple studies reported a significant risk of pneumothoraces during pregnancy. Other significant risks included preterm delivery, chylothoraces, and pulmonary function deterioration. A proposed strategy for preconception counseling and antenatal management is provided. Patients diagnosed with LAM during pregnancy generally experience worse outcomes including recurrent pneumothoraces and preterm delivery as compared to patients with a LAM diagnosis prior to pregnancy. Given that there are limited studies available, and that the majority are low-quality evidence and subject to bias, further investigation of the interaction between LAM and pregnancy is warranted to guide patient care and counseling. · Data are limited on the effects of lymphangioleiomyomatosis on pregnancy outcomes.. · We performed a systematic review to summarize pregnancy outcomes complicated by LAM.. · Patients diagnosed with LAM during pregnancy experience worse outcomes..

A Systemwide Postpartum Inpatient Maternal Mental Health Education and Screening Program

ObjectiveTo expand a hospital system’s maternal mental health program to standardize screening for perinatal mood and anxiety disorders. DesignQuality improvement initiative using a continuous Plan–Do–Study–Act (PDSA) cycle. Setting/Local ProblemIn a hospital system consisting of 66 maternity care centers across the United States, there was significant variation in maternal mental health screening, referral, and education practices. The COVID-19 pandemic and increasing rates of severe maternal morbidity further elevated system-level concern about the quality of maternal mental health care being provided. ParticipantsPerinatal nurses. MethodsAn “all-or-none” bundle methodology was used to measure adherence to a system standard for maternal mental health screening, referral, and education. InterventionsA toolkit was designed internally to support streamlined implementation and ensure standardization for screening, referral, and education. This comprehensive toolkit includes screening forms, a referral algorithm, staff education, patient education literature, and a community resource list template. Training on how to use the toolkit was provided to nurses, chaplains, and social workers. ResultsThe initial system bundle adherence rate was 76% (2017) in the first year of the program. The following year, the bundle adherence rate increased to 97% (2018). Despite the disruption caused by the COVID-19 pandemic, this mental health initiative has maintained an overall adherence rate of 92% (2020–2022). ConclusionThis nurse-led quality improvement initiative has been successfully implemented across a geographically and demographically diverse hospital system. The initial and sustained high rates of adherence with the system standard for screening, referral, and education illustrate perinatal nurses’ commitment to the delivery of high-quality maternal mental health care in the acute care setting.

Post-partum myocardial ischemia due to intramuscular methylergonovine-induced coronary vasospasm: case report

BackgroundMethylergonovine is a vasoconstrictive agent historically used as a provocative agent in the lab for coronary vasospasm; it is also a first line uterotonic agent for management of postpartum hemorrhage.Case PresentationA 29-year-old female with history of smoking and idiopathic thrombocytopenia received intramuscular methylergonovine after delivery of twins for intrauterine hemorrhage management. Subsequently, she had episodes of chest pain with high sensitivity Troponin I elevation to 1509 ng/L with accompanying septal T wave inversions, decreased left ventricular ejection fraction to 49% and basal septal wall hypokinesis. Computed tomography (CT) coronary angiogram showed patent coronary arteries and no coronary arterial dissection. The patient was conservatively managed with aspirin and metoprolol, and on follow up had fully recovered left ventricular function with resolution of wall motion abnormalities. Given this, coronary vasospasm due to intramuscular methylergonovine is the most likely cause of patient’s chest pain and associated myocardial ischemia.ConclusionsIntramuscular, intrauterine, intravenous, and even oral methylergonovine can rarely cause coronary vasospasm leading to myocardial ischemia. Cardiologists caring for postpartum patients should be aware of these potential lethal complications; prompt identification and administration of sublingual nitroglycerin can prevent severe complications of arrythmias, heart block, or cardiac arrest.

Extracorporeal life support in pregnant and postpartum women with COVID-19-related acute respiratory distress syndrome.

Extracorporeal membrane oxygenation (ECMO) is an intervention used for patients with acute respiratory distress syndrome (ARDS) from COVID-19 who have failed conventional ventilatory strategies. Very few studies have given insight into the outcomes of pregnant and postpartum patients requiring ECMO support. Single center, retrospective, observational study of female pregnant and postpartum patients suffering COVID-19 ARDS and requiring ECMO. Eight SARS-CoV-2 positive patients were identified. The average age was 31 ± 4 years, with Body Mass Indices (BMI) and SOFA scores ranging between 32-49 and 8-11, respectively. Two patients were pregnant at the time of ECMO initiation, two were peripartum, and four were postpartum. Five patients (63%) had bleeding, and one patient had a hysterectomy. Seven patients (88%) were supported by V-V ECMO and one with V-A ECMO. Patients had between one and three circuit exchanges due to oxygenator failure or clots in the circuit. All patients were in ICU between 7 and 74 days, with hospital length of stay between 8 and 81 days. All patients were weaned off ECMO and were successfully discharged from the hospital. All newborns were born via cesarean section, and all survived to discharge. Our study shows a 100% neonatal and maternal survival rate demonstrating that ECMO in this patient population is safe. These patients should be transferred to experienced high-volume ECMO centers with the ability to perform emergent cesarean sections. ECMO should be considered a life-saving therapy for pregnant women with severe COVID-19 with an overall excellent maternal and neonatal survival rate.

A COMPARISON OF POST-OPERATIVE PAIN RELIEF AFTER ELECTIVE LSCS WITH LOCAL AND INTRAPERITONEAL ROPIVACAINE INSTILLATION AGAINST LOCAL ROPIVACAINE INFILTRATION ALONE

Objectives: For an anesthesiologist, the post-operative phase is just as crucial as the pre-operative and intraoperative periods. Whether a surgery is performed under regional or general anesthesia, the goal should always be to provide patients with a pain-free and comfortable recovery. Spinal anesthesia is frequently used during caesarean sections, but its effects only last for a few hours. As a result, various multidisciplinary analgesia strategies with few side effects have been attempted for postpartum patients to relieve pain because they may also be harmful to the newborn baby’s health. It has already been proven; injecting ropivacaine is a far safer alternative to injecting bupivacaine. We compared local infiltration of injectable ropivacaine alone to both intraperitoneal instillation and local infiltration for post-operative analgesia in individuals who had cesarean surgery. In the present study, intraperitoneal instillation and local infiltration of ropivacaine 0.5% were compared to local infiltration of ropivacaine 0.5% alone for the management of post-operative pain following elective cesarean section under spinal anesthesia. Methods: Pregnant women in ASA Grades I and II who were having a planned caesarean section under spinal anesthesia were divided into two groups at random (R1 and R2 group, each have 30 patients). Patients in Group R1 received a 15 mL injection of 0.5% ropivacaine at the incision site. Patients in Group R2 had intraperitoneal injections of 0.5% ropivacaine in 5 mL before to peritoneal closure and local infiltrations of 10 mL ropivacaine at the site of the incision before skin closure. The duration of the analgesia was calculated by timing the start of the sensory block to a point at which rescue analgesia was sought throughout the post-operative period. Pain intensity was measured using the visual analog scale (VAS). Data on the hemodynamics and side effects of the patients were also gathered. Results: Group R2 analgesia lasted much longer than that of Group R1 (p&lt;0.05). The mean (±SD) analgesic duration in the R1 and R2 groups was 147.17±4.67 and 170.33±3.69 min, respectively. The mean (SD) VAS scores for Group R1 and Group R2 at the moment of the first analgesic demand were 36.7±5.14 and 32.6±6.52, respectively. Conclusion: When combined with intraperitoneal instillation during spinal anesthesia, inj. ropivacaine 0.5% local infiltration enhances post-operative analgesia in cesarean section procedures.

Co-occurrence of depression, anxiety, and perinatal posttraumatic stress in postpartum persons

BackgroundThe study aim was to describe the incidence of depression, anxiety, perinatal-post-traumatic stress disorder (PTSD), and their co-occurrences in the early postpartum period in a low-resource OB/GYN clinic serving majority Medicaid-eligible persons. We hypothesized that postpartum persons screening positive for depression will have an increased risk of a positive screen for anxiety and perinatal PTSD.MethodsA retrospective study of postpartum persons receiving care in Baton Rouge, Louisiana was conducted using responses abstracted from the electronic medical record (EMR) of the Patient Health Questionnaire-9 (PHQ9), Generalized Anxiety Disorder-7 (GAD7), and Perinatal Post Traumatic Stress Disorder Questionnaire-II (PPQII). Categorical distributions were compared using Fisher exact tests, while t-tests were used to compare continuous covariates. Multivariable logistic regression was used to predict anxiety (GAD7) and perinatal PTSD (PPQII) scores while adjusting for potential confounders, as well as to predict continuous PPQII and GAD7 based on continuous PHQ9 scores.ResultsThere were 613 birthing persons 4–12 weeks postpartum that completed mental health screening (PHQ9, GAD7, and PPQII) between November 2020 and June 2022 as part of routine postpartum care in the clinic. The incidence of screening positive for symptoms of depression (PHQ9 > 4) was 25.4% (n = 156), while the incidence of positive screening for symptoms of anxiety (GAD7 > 4) and perinatal PTSD (PPQII ge 19) were 23.0% (n = 141) and 5.1% (n = 31) respectively. Postpartum patients with mild anxiety or more (i.e. GAD7 > 4) had 26 times higher odds of screening positive for symptoms of depression (PHQ9 > 4) (adjusted odds ratio [aOR] 26.3; 95% confidence interval [CI] 15.29–46.92; p < 0.001). Postpartum persons with a PPQII score indicating symptoms of perinatal PTSD (PPQII ge 19) had 44 times higher odds of screening positive for symptoms of depression (PHQ > 4) (aOR 44.14; 95%CI 5.07–5856.17; p < 0.001).ConclusionsDepression, anxiety, and perinatal PTSD are each independent risk factors for each other. To comply with the American College of Obstetricians and Gynecologists (ACOG) recommendations, providers should universally screen postpartum persons with validated screening tools for mood disturbances. However, if a complete full mood assessment is not feasible, this study provides evidence to support screening patients for depression, and if the patient screens positive, prompt additional screening for anxiety and perinatal PTSD.

Effectiveness of extended postpartum inpatient monitoring for hypertensive disorders of pregnancy to reduce the risk of readmission for preeclampsia with severe features

Preeclampsia is an obstetrical disorder, which complicates 3% to 6% of pregnancies and contributes to 21.6% of readmissions in the postpartum period. The optimal strategy for inpatient monitoring of blood pressures to minimize readmissions for postpartum patients with hypertensive disorders is not known. We hypothesized that extended monitoring of postpartum patients with hypertensive disorders of pregnancy for at least 36 hours after the last blood pressure that was ≥150/100 mm Hg would result in decreased readmission rates for preeclampsia with severe features compared with those who were not observed by these blood pressure goals. This study aimed to evaluate whether extended inpatient monitoring of postpartum patients with hypertensive disorders of pregnancy for at least 36 hours after their last blood pressure that was ≥150/100 mm Hg would improve readmission rates for preeclampsia with severe features within 6 weeks of delivery. This was a retrospective cohort study in patients with a singleton pregnancy and a diagnosis of a hypertensive disorder of pregnancy at their delivery admission or at any point during pregnancy who delivered 1 year before and 1 year after the implementation of extended inpatient monitoring of postpartum hypertension. The primary outcome was readmission for preeclampsia with severe features within 6 weeks of delivery. The secondary outcomes were length of stay during first admission, number of readmissions for any indication, intensive care unit admission, postpartum day at readmission, median systolic blood pressure in the 24-hour period before discharge, median diastolic blood pressure in the 24-hour period before discharge, intravenous antihypertensive medication required during first admission, and intravenous antihypertensive medication required during second admission. Univariable analysis was performed for the association between baseline maternal characteristics and the primary outcome. Multivariable analysis was performed, adjusting for baseline maternal characteristic differences between exposure groups. A total of 567 patients met the inclusion criteria of which 248 patients delivered before and 319 delivered after the implementation of extended monitoring. For baseline characteristics, the extended monitoring group had a significantly higher proportion of patients who were non-Hispanic Black and Hispanic, more diagnoses of hypertensive disorders and/or diabetes mellitus at the time of admission for delivery, a difference in the distribution of hypertensive diagnoses at the time of discharge from the first admission, and fewer discharged patients from their first admission on labetalol than the preintervention group. In a univariable analysis of the primary outcome, there was a significantly increased risk of readmission for preeclampsia with severe features in the extended monitoring group (62.5% vs 96.2% of total readmissions; P=.004). In multivariable analysis, patients in the extended monitoring group were more likely to be readmitted for preeclampsia with severe features than patients in the preintervention group (adjusted odds ratio, 3.45; 95% confidence interval, 1.03-11.5; P=.044). Extended monitoring with a strict blood pressure goal of <150/<100 mm Hg did not decrease readmissions for preeclampsia with severe features in patients with a previous diagnosis of a hypertensive disorder of pregnancy.

(720) Extracorporeal Membrane Oxygenation Utilization in Pregnant and Post-Partum Patients During the Covid-19 Pandemic

(720) Extracorporeal Membrane Oxygenation Utilization in Pregnant and Post-Partum Patients During the Covid-19 Pandemic

225 The Feasibility and Acceptability of a Remote Glucose Monitoring Program for Pregnant Marshallese Women with Pre-Gestational and Gestational Diabetes

OBJECTIVES/GOALS: The objective of the study is to test the feasibility and acceptability of a remote glucose monitoring program for pregnant Marshallese women with pre-gestational (PGDM) or gestational diabetes (GDM) without excluding women with limited English proficiency. The study will explore changes in patient-physician communication and self-efficacy. METHODS/STUDY POPULATION: Twenty Marshallese pregnant women with PGDM or GDM will be identified for recruitment. The patient will meet with a bilingual staff member to explain the study and provide consent. At enrollment, patients will complete an enrollment survey and be provided with the iGlucose monitor and receive training its use. Their provider(s) will receive access to their patient’s online portal for monitoring. At 14 days postpartum patients will receive a post-intervention survey and invitation to participate in interview, and their provider(s) will receive a satisfaction survey for the remote monitoring program. RESULTS/ANTICIPATED RESULTS: We hypothesize that the use of a remote glucose monitoring intervention is feasible and acceptable for Marshallese women with PGDM or GDM. Further, we hypothesize that the remote glucose monitoring program will increase satisfaction with physician-patient communication and will increase self-efficacy with glucose management. We anticipate that providers will find the program feasible and acceptable for use with the Marshallese population. DISCUSSION/SIGNIFICANCE: RPM technology can transform the way PGDM and GDM are managed. RPM may have greater benefits when there is a lack of language concordance by providing more time for patient-provider communication, thereby improving patient satisfaction and decreasing the risk of negative outcomes for Marshallese women.

THE EFFECT OF BACK ROLING MASSAGE ON THE EXPENDITURE OF BREAST MILK IN POSTPARTUM MOTHER AT AL-IHSAN BALE ENDAH BANDUNG HOSPITAL

Back rolling massage is a massage performed on postpartum mothers to stimulate breastfeeding. Expenditure of breast milk will be smooth if the excess milk production marked by breast milk will drip and will radiate profusely when the baby suction (Purwanti, 2010). The government hopes that breastfeeding sufficiency in babies can reduce the number of shunting, which prevention was being promoted starting in 2018.The research objective was the effect of back rolling massage on breastfeeding in postpartum mothers in Zaitun 3 Al Ihsan Hospital. This research method used a quantitative research design, using the Quasi Experiment method, the research design used pre-test and post-test with control group design. The population in this research were postpartum patients in Zaitun III Room at Al-Ihsan Hospital were hospitalized for August to October 2019 totaled 238 people. The sample in this research amounted to 15 people. The sampling technique in this research used nonprobability sampling, namely accidental sampling. Prior to the rolling back massage, most of the 11 respondents (73.3%) had sufficient milk expenditure and a small proportion of 4 respondents had insufficient breastfeeding (26.7%). Results, After being given a rolling massage, most of the 12 respondents (80.0%) had smooth breastfeeding, a small proportion, namely 3 respondents (20.0%) had sufficient milk expenditure. Conclusions, There are differences before and after being given rolling massage back then it is stated that H0 is accepted, thus it can be concluded that there is an influence rolling massage back on breastfeeding for post-partum mothers in the Zaitun III Hospital Al-Ihsan West Java Province. Keywords: Back rolling massage, Breast Milk, Quasi Experiment

Utilization of Contraceptive Methods by Postpartum Patients at An-Nisaa' Hospital Blitar During the COVID-19 Pandemic

Introduction: The COVID-19 pandemic has had a significant impact on various aspects of health services, one of which is access to contraception. Objective: The people of Blitar Regency, in choosing the Long-Term Contraceptive Method, have preferences that refer to safe use, ease to use, effectiveness, and advantages over other methods. Method: This research is quantitative descriptive research. This research was conducted to describe the use of contraceptive methods in postpartum patients at An-Nisaa Hospital in 2020 and 2021. Data analysis used univariate or descriptive analysis by looking at the frequency distribution of each contraceptive method used. Result and Discussion: Generally, the percentage of acceptors for postpartum patients compared to the number of deliveries is still at the same percentage, namely 67.64% in 2020 and 69.4% in 2021. Conclusion: The result is that the intrauterine device (IUD) method of contraception was widely chosen by patients postpartum during 2020-2021, where in 2020 there were 91.66% of Family Planning acceptors, and in 2021 there were 92.23% of PROGRAM KELUARGA BERENCANA PASCA PERSALINAN acceptors chose intrauterine devices

The prediction and treatment of postpartum myofascial pelvic pain.

The clinical manifestations of myofascial pelvic pain (MFPP) are mainly acute or chronic muscle pain at one or more trigger points in the pelvic cavity or pelvic floor. This study aims to explore the predictive value of pelvic floor myoelectric parameters with respect to MFPP and the effect of its clinical treatment. Two hundred and one women followed up in the Wenzhou People's Hospital 6-12 weeks postpartum between July 2020 and July 2021. They were divided into an MFPP group (n= 90) and a non-MFPP group (n= 102), but 9 MFPP patients without a pelvic floor electromyography evaluation were not included. The general demographic data and pelvic floor electromyography evaluation parameters of the two groups were compared; the related factors of postpartum women suffering from MFPP were analyzed, and a nomogram model of the postpartum risk of suffering from MFPP was established. The 99 patients with postpartum MFPP were divided into a treatment group (n= 10) and a control group (n= 89). The difference in visual analog scale scores between the two groups initially and after three months of treatment was compared to evaluate the effective remission rate of postpartum MFPP after treatment. A significant difference was observed in the relaxation time at the rapid contraction stage (z= 4.369, p< 0.05) and the tension contraction stage (z= 135.645, p< 0.01) between the MFPP group and the non-MFPP group. The nomogram model for predicting postpartum MFPP was established with nine variables as potential predictors. The calibration chart and C index of 0.68 (95% CI: 0.65-0.71) proved that the model had a certain degree of discrimination. The clinical decision-making curve showed that the model could increase the net benefit rate of patients. The pain relief rate in the treatment group was significantly higher than that in the control group (p< 0.01). There is a significant correlation between postpartum MFPP and relaxation time at rapid contraction stage and tension contraction stage. The risk prediction nomogram model of postpartum MFPP established with nine potential predictors has a certain prediction capability, and clinical treatment can effectively relieve MFPP in postpartum patients.

Thyroid storm in a postpartum and uncontrolled graves' disease patient: the challenges of accurate and multidisciplinary disease management

Background: Graves' disease is an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism). Although pregnancy hyperthyroidism is a relatively uncommon, thyroid crisis is a medical emergency caused by hyperthyroidism exacerbation with symptoms of organ decompensation in one or more organs. Therefore, managing this disease in pregnant women is critical as well as the safety of using antithyroid drugs for pregnant women and the foetus. Case presentation: A 26-year-old woman presented to the Dr Soetomo General Academic Hospital Surabaya, Indonesia with complaints of shortness of breath that had worsened one hour before the admission as well as sudden fever, diarrheal, anxiety, and decreased consciousness. The patient had hyperthyroidism for three years, and the controls were inconsistent. The patient was diagnosed with P1101 postpartum day 1, thyrotoxicosis due to Graves' disease, thyroid crisis, hypertension, microcytic hypochromic anemia, hypoglycemia, hypoalbuminemia, keratitis, and lagophthalmos. The patient was treated with supportive therapy with an oxygen mask 8 liters per minute (lpm), intravenous fluids, and antipyretic acetaminophen 500 mg every 8 hours. Propylthiouracil 400 mg loading dose followed by maintenance 6x100 mg, 8 drops of Lugol's solution after propylthiouracil administration, intravenous (IV) dexamethasone 2 mg every 6 hours, and oral propranolol 20 mg every 6 hours. The patient was discharged from the hospital after presented favorable improvement. Conclusion: This case demonstrates that the stage of the disease determines the management of Grave's disease during pregnancy, and that multidisciplinary involvement could improve the success and reduce the patient mortality.