Postpartum Patients Research Articles

Risk Assessment Model for Postpartum Venous Thromboembolism Prevention in Patients with Systemic Lupus Erythematosus

Background Patients with Systemic Lupus Erythematosus (SLE) may be at increased risk for developing a venous thromboembolism (VTE), particularly in the postpartum period. The Royal College of Obstetricians and Gynaecologists (RCOG) guideline for postpartum VTE prophylaxis is often used to triage which patients should get VTE prophylaxis. In this RCOG guideline, a score ≥ 3 drives a formal recommendation for postpartum anticoagulation. RCOG is unique in its inclusion of “active SLE” as an actionable VTE risk factor (adding 3 points). We sought to determine if a cohort of postpartum patients with a known history of SLE a) qualify as having “active” SLE by standard rheumatologic criteria b) have other risk factors for VTE c) received the recommended prophylaxis based on RCOG VTE risk assessment scoring and d) had a postpartum VTE. Objective To assess the application of the RCOG venous thromboembolism (VTE) risk model on a cohort of postpartum patients with a history of Systemic Lupus Erythematosus (SLE). Study Design This is a secondary analysis of an ongoing patient registry of women with SLE from 2016-2022. There were 49 SLE patients with 55 pregnancies using Definitions of Remission in SLE (DORIS) criteria to determine SLE disease activity. RCOG risk assessment model scoring was calculated for each patient prior to and after delivery. The primary outcome was the qualification of “active SLE” by standard rheumatologic criteria and assessment of recommendations for VTE prophylaxis based on RCOG VTE risk assessment scoring. Data were analyzed using Fisher’s Exact test, chi-square test, and Mann-Whitney U test with significance defined as p<0.05. Results In the study cohort, 34 pregnancies (61.8%) were in DORIS remission at delivery. Twenty-one pregnancies (38.2%) were not and scored 3 points on the RCOG VTE risk model. Of these pregnancies, only 19% (n=4) were recommended for VTE prophylaxis by the obstetrical provider despite RCOG score ≥ 3. Only 35.7% (n=5) of pregnancies in DORIS remission, but with 3 points for non-SLE related VTE risk factors (n=14), were recommended for VTE prophylaxis. Of the 20 pregnancies in remission with an RCOG score < 3 after assessing all risk factors, 15% (n=3) were nevertheless recommended for VTE prophylaxis. No patients had a postpartum VTE regardless of therapy. Conclusion These data reveal a need to improve upon providing postpartum VTE prophylaxis to SLE patients not in remission while also recognizing a diagnosis of SLE alone should not equate with active disease. Moreover, SLE patients in remission may still warrant VTE prophylaxis if other non-SLE-related risk factors are present.

Furosemide for postpartum blood pressure control in patients with hypertensive disorders.

diuretics have the potential to reduce intravascular volume, decrease blood pressure The aim of our study is to evaluate the effectiveness of furosemide in postpartum patients with pre-eclampsia and chronic hypertension with superimposed pre-eclampsia. This is a retrospective cohort study. Data was extracted from the record of patients who delivered between 2017 and 2020 and had chronic hypertension or, chronic hypertension with superimposed pre-eclampsia, gestational hypertension, or pre-eclampsia. Patients who received intravenous furosemide in the postpartum period were compared to those who did not. The groups were also analyzed for fetal growth restriction, and pregnancy outcomes comparing those who did receive furosemide and those who did not. The furosemide group had a statistically significant longer postpartum length of stay (p<0.0001), required more antihypertensive medications (p<0.0001), medication increases (p<0.0001), and emergent blood pressure treatment (p<0.0001), than the group who did not. There was no difference between groups in hospital readmission, or fetal growth restriction. The postpartum length of stay and rates of readmission were not decreased in the group treated with intravenous furosemide. Future prospective studies that control for pregnancy comorbidities and severity of preeclampsia are needed to determine furosemide's effect on the volume status of the postpartum pre-eclamptic patient and determine its role in the treatment of these women.

Association of Opioid Use Disorder and Provision of Highly Effective Inpatient Postpartum Contraception.

We sought to examine the rates of the inpatient provision of postpartum long-acting and permanent methods (IPP LAPM) of contraception in patients with opioid use disorder (OUD). This is a retrospective cross-sectional regression analysis of the National Inpatient Sample between 2012 and 2016. Patients with a diagnosis of OUD that delivered and received postpartum permanent contraception or long acting reversible contraception placement during the same hospitalization were identified. Regression analyses were performed to identify the demographic and clinical factors associated with long acting and permanent contraception method utilization. Of the 22,294 patients with OUD who delivered during the study period, 2291 (10.3%) received IPP LAPM. The majority of patients (1989) (86.6%) with OUD who chose inpatient provision of long acting or permanent methods after delivery received permanent contraception. After adjusting for covariates, patients with OUD had an overall decreased probability of receiving IPP LAPM (aOR=0.89, 95% CI: 0.85-0.95), decreased probability of receiving permanent contraception (aOR: 0.82, 95% CI: 0.78-0.88), but an increased probability of receiving long-acting reversible contraception (aOR: 1.29, 95% CI: 1.04-1.60) compared to patients without OUD. This study highlights the continued need to ensure appropriate measures (such as antepartum contraceptive counseling, availability of access to inpatient LAPM, and removal of Medicaid policy barriers to permanent contraception) are in place so that the contraceptive needs of patients with OUD are fulfilled.

Quick Sequential Organ Failure Assessment Score in Recognizing Infected Patients with Organ Dysfunction &amp; Prediction of Mortality: Cohort Study

Objectives: To calculate the q-SOFA for postpartum patients admitted with infection and to correlate this with critical care unit admission &amp; patient outcome. Methods: An observational, prospective cohort hospital-based study. It was conducted in Omdurman Maternity Hospital from October 2018-to March 2019. The study included 59 postpartum patients who were diagnosed with postpartum infection; their q-SOFA score was calculated on admission and then on daily basis, to detect their in-hospital mortality and morbidity. The data was analyzed using SPSS, using Pearson Chi-square which was significant at P value of 0.05. Results: Fifty-nine participants were involved, mean age was 28years.Those who delivered by cesarean section was 54.3%, 33(55.9%) developed surgical site infection. Five patients (8.5%) died and 54 (91.5%) discharged. 17(28.8%) were admitted to critical care unit. q-SOFA score was calculated &amp; correlated to critical care unit admission &amp; fate of the patient using Pearson Chi-square which was found to be significant 0.01 and 0.001, respectively (P value of 0.05). Conclusion: q-SOFA is a useful tool in detecting infected patients at risk of poor outcome and death. If the score≥2 patients need to be, admitted to critical care units and to have further assessment.

Unusual cause of cervical lymphadenopathy in post-partum patient with atypical presentation: Kikuchi disease

Kikuchi-Fujimoto disease, also known as histiocytic necrotising lymphadenitis, is an unusual type of painful lymphadenopathy. It is a self-limiting benign disease; usual management includes supportive therapy. We described a case of Kikuchi Disease in a childbearing-age woman who presented with painless and localised cervical lymphadenopathy during her postpartum period. Histopathology of the affected cervical node reveals areas of apoptosis and necrosis with abundant foamy histiocytes and plasmacytoid monocytes. The cervical node resolves spontaneously, and no subsequent new cervical lymph node was observed in this patient. Patient was given reassurance. It is vital to recognise Kikuchi disease as one of the causes of persistent cervical lymphadenopathy, to provide optimal management and to avoid incorrect treatment.

Acute appendicitis complicated by ovarian vein thrombosis

Ovarian vein thrombosis (OVT) is a rare cause of acute abdominal pain and is mainly related to pregnancy and affects approximately 1 in every 2,000 deliveries and abortions. However, this diagnosis should be considered not only in postpartum patients but also in women with pelvic inflammatory disease (PID), malignancy, women who have recent abdominal surgery and who have a known hypercoagulable state. Anticoagulation and antibiotics are the mainstays of treatment for OVT. Complications of OVT include sepsis, the extension of the thrombus to the inferior vena cava and renal veins, and pulmonary embolism. The incidence of pulmonary embolism is reported to be 13.2% and represents the main cause of mortality due to OVT. We report a case of 40-years old female patient presenting with OVT, which was accompanied by acute appendicitis. In this woman, OVT was not related to pregnancy. The patient underwent an appendectomy, which proved positive on histopathology result. Patient symptoms improved after appendectomy with antibiotics and anticoagulation therapy. A month later, a follow-up computed tomography (CT) scan of the abdomen revealed a complete resolution of OVT. OVT, though a rare presentation, should be included in the differential diagnosis for women presenting with acute abdomen. Proper diagnosis and timely management can prevent catastrophic complications. Our case thus highlights the importance of considering the rare diagnosis of OVT with acute appendicitis.

(117) Postpartum Vulvovaginal Dryness: Disparities in Adequate Treatment for Postpartum Patients’ Sexual Health

Abstract Introduction Vaginal estrogen therapy (VET) use and efficacy is well established for genitourinary symptoms commonly seen in menopause. Despite the similar symptom profile and dramatic hormonal shifts in postpartum (PP) patients, they are not routinely offered the same therapies. The pathophysiology of these symptoms PP is multifactorial and frequently dismissed as “normal,” even with the subsequent negative effect on their quality of life. Concerns regarding potential harm on lactation and infant development further decreases utilization. However, these apprehensions may be outdated due to evolution of VET, warranting review of available literature. Objective To review the efficacy, concerns, and barriers of utilization of VET for vulvovaginal symptoms in PP patients. Methods A systematic review in the PubMed database spanning from January 1990 – June 2022 was performed to assess the relevant medical literature on the utilization of VET for vulvovaginal symptoms in PP patients. MeSH terms used to narrow the search include: [“dyspareunia” OR “vulvovaginal atrophy” OR “genitourinary”] AND [“hypoestrogenic state” OR “estrogenic endocrine disrupting compounds” OR “estrogen responsive tissues”] AND [“postpartum” OR “menopausal” OR “infant”] AND [“estrogen preparations” OR “vaginal estrogen”]. Results The published literature (n=33) was analyzed by relevant key terms. FDA has approved a number of estrogen-based formulations for vulvovaginal atrophy and dysparenuia in menopausal patients, including: 7.5ug/day (vaginal ring), ultra low dose 10ug (vaginal tablet), 0.01% estradiol creams, premarin (conjugated estrogen) cream, and vaginal DHEA. Data for PP patients is limited with varying results. Nonetheless, drastic improvement in tissue thickening, lubrication, and baseline elasticity within a few weeks of minimal applied dosage of VET has been shown. Addressing primary worries, while higher doses (&amp;gt;50mcg) of estrogen in the early PP period may negatively affect lactation, initiating VET after supply is well established (at 6-8 weeks) or using lower dose estrogen (≤50mcg) has no changes in lactation. In fact, the ultra-low-dose combined oral contraceptive pill (20mcg of ethinyl estradiol with progestins) is approved PP for contraception after 30 days with no adverse impact on breastfeeding. VET concentrations are smaller, and locally applied, implying even less risk of systemic effects. Tolerability is further enhanced with a personalized approach, prescribing the smallest effective dose for the shortest duration of time. Additionally, data suggests that if lactation is affected, there is no significant alteration to the infant’s growth, no to minimal increase of estradiol or estriol in breastfed infants, nor significant evidence of long-term prolongation of physiologic estrogenization. PP patients face numerous barriers, further limiting access to effective treatment, such as: varied clinical presentations, relatively high cost of therapies, minimal time and access to providers resulting in poor communication and hesitation, and limited research focused on therapeutic options for health concerns. Conclusions This review outlines the proven therapeutic uses, indications, and safety of VET, along with the scarcity of current literature for the PP population. The concurrent sexual dysfunction and discomfort can be devastating, supporting the need for focused research on the efficacy of VET connected to the specific needs and concerns of PP patients. Disclosure No

(122) Provider Attitude towards Postpartum Sexual Health

Abstract Introduction The prevalence of female sexual dysfunction (FSD) worldwide is estimated to be 41% and is even more prevalent in postpartum patients. There are significant barriers to addressing FSD in a busy clinic and the use of a standardized screening questionnaire could be implemented to improve outcomes during postpartum appointments. Objective To assess provider knowledge and practices towards postpartum sexual health with the goal of improving postpartum sexual health. Methods Providers who care for postpartum patients at [institution and city obscured], were asked to complete an anonymous survey online to assess providers’ general knowledge and practices. Results 79% of respondents answered that they felt very comfortable assessing postpartum sexual health and 88% expressed a need for continuing education on sexual medicine. The most common response for barriers to care was a lack of time. None of the respondents reported using questionnaires to assess sexual health. Conclusions The most significant barriers to assessing postpartum sexual health are a lack of time and provider knowledge. To overcome this, a standardized questionnaire should be created and improved continuing education should be implemented. Disclosure No

Outcomes Following Extracorporeal Membrane Oxygenation for Severe COVID-19 in Pregnancy or Post Partum

Existing reports of pregnant patients with COVID-19 disease who require extracorporeal membrane oxygenation (ECMO) are limited, with variable outcomes noted for the maternal-fetal dyad. To examine maternal and perinatal outcomes associated with ECMO used for COVID-19 with respiratory failure during pregnancy. This retrospective multicenter cohort study examined pregnant and postpartum patients who required ECMO for COVID-19 respiratory failure at 25 hospitals across the US. Eligible patients included individuals who received care at one of the study sites, were diagnosed with SARS-CoV-2 infection during pregnancy or up to 6 weeks post partum by positive nucleic acid or antigen test, and for whom ECMO was initiated for respiratory failure from March 1, 2020, to October 1, 2022. ECMO in the setting of COVID-19 respiratory failure. The primary outcome was maternal mortality. Secondary outcomes included serious maternal morbidity, obstetrical outcomes, and neonatal outcomes. Outcomes were compared by timing of infection during pregnancy or post partum, timing of ECMO initiation during pregnancy or post partum, and periods of circulation of SARS-CoV-2 variants. From March 1, 2020, to October 1, 2022, 100 pregnant or postpartum individuals were started on ECMO (29 [29.0%] Hispanic, 25 [25.0%] non-Hispanic Black, 34 [34.0%] non-Hispanic White; mean [SD] age: 31.1 [5.5] years), including 47 (47.0%) during pregnancy, 21 (21.0%) within 24 hours post partum, and 32 (32.0%) between 24 hours and 6 weeks post partum; 79 (79.0%) had obesity, 61 (61.0%) had public or no insurance, and 67 (67.0%) did not have an immunocompromising condition. The median (IQR) ECMO run was 20 (9-49) days. There were 16 maternal deaths (16.0%; 95% CI, 8.2%-23.8%) in the study cohort, and 76 patients (76.0%; 95% CI, 58.9%-93.1%) had 1 or more serious maternal morbidity events. The largest serious maternal morbidity was venous thromboembolism and occurred in 39 patients (39.0%), which was similar across ECMO timing (40.4% pregnant [19 of 47] vs 38.1% [8 of 21] immediately postpartum vs 37.5% postpartum [12 of 32]; P > .99). In this multicenter US cohort study of pregnant and postpartum patients who required ECMO for COVID-19-associated respiratory failure, most survived but experienced a high frequency of serious maternal morbidity.

(195) Postpartum Vulvovaginal Dryness: Disparities in Adequate Treatment for Postpartum Patients’ Sexual Health

Abstract Introduction Vaginal estrogen therapy (VET) use and efficacy is well established for genitourinary symptoms commonly seen in menopause. Despite the similar symptom profile and dramatic hormonal shifts in postpartum (PP) patients, they are not routinely offered the same therapies. The pathophysiology of these symptoms PP is multifactorial and frequently dismissed as “normal,” even with the subsequent negative effect on their quality of life. Concerns regarding potential harm on lactation and infant development further decreases utilization. However, these apprehensions may be outdated due to evolution of VET, warranting review of available literature. Objective To review the efficacy, concerns, and barriers of utilization of VET for vulvovaginal symptoms in PP patients. Methods A systematic review in the PubMed database spanning from January 1990 – June 2022 was performed to assess the relevant medical literature on the utilization of VET for vulvovaginal symptoms in PP patients. MeSH terms used to narrow the search include: [“dyspareunia” OR “vulvovaginal atrophy” OR “genitourinary”] AND [“hypoestrogenic state” OR “estrogenic endocrine disrupting compounds” OR “estrogen responsive tissues”] AND [“postpartum” OR “menopausal” OR “infant”] AND [“estrogen preparations” OR “vaginal estrogen”]. Results The published literature (n=33) was analyzed by relevant key terms. FDA has approved a number of estrogen-based formulations for vulvovaginal atrophy and dysparenuia in menopausal patients, including: 7.5ug/day (vaginal ring), ultra low dose 10ug (vaginal tablet), 0.01% estradiol creams, premarin (conjugated estrogen) cream, and vaginal DHEA. Data for PP patients is limited with varying results. Nonetheless, drastic improvement in tissue thickening, lubrication, and baseline elasticity within a few weeks of minimal applied dosage of VET has been shown. Addressing primary worries, while higher doses (&amp;gt;50mcg) of estrogen in the early PP period may negatively affect lactation, initiating VET after supply is well established (at 6-8 weeks) or using lower dose estrogen (≤50mcg) has no changes in lactation. In fact, the ultra-low-dose combined oral contraceptive pill (20mcg of ethinyl estradiol with progestins) is approved PP for contraception after 30 days with no adverse impact on breastfeeding. VET concentrations are smaller, and locally applied, implying even less risk of systemic effects. Tolerability is further enhanced with a personalized approach, prescribing the smallest effective dose for the shortest duration of time. Additionally, data suggests that if lactation is affected, there is no significant alteration to the infant’s growth, no to minimal increase of estradiol or estriol in breastfed infants, nor significant evidence of long-term prolongation of physiologic estrogenization. PP patients face numerous barriers, further limiting access to effective treatment, such as: varied clinical presentations, relatively high cost of therapies, minimal time and access to providers resulting in poor communication and hesitation, and limited research focused on therapeutic options for health concerns. Conclusions This review outlines the proven therapeutic uses, indications, and safety of VET, along with the scarcity of current literature for the PP population. The concurrent sexual dysfunction and discomfort can be devastating, supporting the need for focused research on the efficacy of VET connected to the specific needs and concerns of PP patients. Disclosure No

Influence of the COVID-19 pandemic on social determinants of health among an inner-city obstetrical population

Social determinants of health are a well-described influencer of pregnancy-related morbidity and mortality. It is unclear how societal changes secondary to the COVID-19 pandemic altered the social determinants of health among pregnant patients.This study aimed to investigate differences in the social determinants of health among patients who experienced pregnancy before and during the COVID-19 pandemic.This was a secondary analysis of an ongoing prospective cohort study examining the social determinants of health in postpartum patients at a single inner-city academic medical center. The planned secondary analysis was to compare the social determinants of health between patients that experienced societal changes before the pandemic and patients that experienced societal changes during the pandemic. Patients were included in the pandemic group if they delivered on or after March 30, 2020; moreover, patients in the pandemic group were compared with those who delivered before March 30, 2020 (referent group). Medical records were used to collect sociodemographic, pregnancy, and infant outcome data. The study participants were interviewed to collect detailed information regarding their perceived social, emotional, and physical environment as indicators of social determinants of health. Generalized linear modeling estimated the influence of social determinants of health on births during the COVID-19 pandemic.Overall, 577 patients were enrolled in the study, of which 452 (78%) delivered before the COVID-19 pandemic and 125 (22%) delivered during the pandemic. Patients who delivered during the pandemic were more likely to report limited social or emotional support (relative risk, 1.62; 95% confidence interval, 1.02-2.59) and higher race-based discrimination (relative risk, 1.59; 95% confidence interval, 1.00-2.53). Mothers in the prepandemic group were more likely to have used federally funded programs, such as Medicaid, food stamps, and the Special Supplemental Nutrition Program for Women, Infants, and Children, during their pregnancy. Furthermore, the referent group reported more limited access to transportation. In addition, mothers in the prepandemic group were more likely to initiate prenatal care at a later gestational age and have fewer total prenatal care visits.The COVID-19 pandemic created unprecedented changes in pregnancy care, and these were reflected in social determinants of health. It is imperative that we focus on the social determinants of health that were mitigated during this time and their effects on maternal and infant health.

A Case of Burkholderia cepacia Sepsis in a postpartum patient with colonic perforation due to Ogilvie's syndrome: Case from a tertiary care hospital in Bangladesh

Traditionally known as a nosocomial organism and preponderance to infect the immunocompromised patients or withpreexisting structural damage in lung parenchyma1, Burkholderia cepacia infection in an apparentlyimmunocompetent host in ICU settings is not very commonly heard of. On the other hand, acute colonicpseudo-obstruction (Ogilvie’s syndrome) is also a very rare surgical complication. Here we present a case of apostpartum lady who developed colonic perforation following caesarean section due to Ogilvie’s syndrome andBurkholderia cepacia sepsis and eventually expired.&#x0D; Bangladesh Crit Care J March 2023; 11 (1): 43-45

Postpartum recovery of nulliparous women following scheduled cesarean delivery and spontaneous vaginal delivery: a prospective observational study

Inpatient postpartum recovery trajectories following cesarean delivery and spontaneous vaginal delivery are underexplored. This study primarily aimed to compare recovery following cesarean delivery and spontaneous vaginal delivery in the first postpartum week, and secondarily to evaluate psychometrically the Japanese version of the Obstetric Quality of Recovery-10 scoring tool. Following institutional review board approval, the EQ-5D-3L (EuroQoL 5-Dimension 3-Level) questionnaire and a Japanese version of the Obstetric Quality of Recovery-10 measure were used to evaluate inpatient postpartum recovery in uncomplicated nulliparous parturients delivering via scheduled cesarean delivery or spontaneous vaginal delivery. A total of 48 and 50 women who delivered via cesarean delivery and spontaneous vaginal delivery, respectively, were recruited. Women delivering via scheduled cesarean delivery experienced significantly worse quality of recovery on days 1 and 2 compared with those who had spontaneous vaginal delivery. Quality of recovery significantly improved daily, plateauing at days 4 and 3 for cesarean delivery and spontaneous vaginal delivery groups, respectively. Compared with cesarean delivery, spontaneous vaginal delivery was associated with prolonged time to analgesia requirement, decreased opioid consumption, reduced antiemetic requirement, and reduced times to liquid/solid intake, ambulation, and discharge. Obstetric Quality of Recovery-10-Japanese is a valid (correlates with the EQ-5D-3L including a global health visual analog scale, gestational age, blood loss, opioid consumption, time until first analgesic request, liquid/solid intake, ambulation, catheter removal, and discharge), reliable (Cronbach alpha=0.88; Spearman-Brown reliability estimate=0.94; and intraclass correlation coefficient=0.89), and clinically feasible (98% 24-hour response rate) measure. Inpatient postpartum recovery is significantly better in the first 2 postpartum days following spontaneous vaginal delivery compared with scheduled cesarean delivery. Inpatient recovery is largely achieved within 4 and 3 days following scheduled cesarean delivery and spontaneous vaginal delivery, respectively. Obstetric Quality of Recovery-10-Japanese is a valid, reliable, and feasible measure of inpatient postpartum recovery.

Postpartum long-acting reversible contraception among privately insured: U.S. National analysis 2007–2016, by term and preterm birth

ObjectivesTo investigate postpartum long-acting reversible contraception (LARC) use among privately insured women, with specific consideration of use after preterm delivery. Study designWe used the national IBM MarketScan Commercial Database to identify singleton deliveries from 2007 to 2016, spontaneous preterm birth, and follow-up ≤12 weeks postpartum. We assessed ≤12-week postpartum LARC placement overall and after spontaneous preterm deliveries, across study years. We examined timing of placement, rates of postpartum follow-up, and state-level variation in postpartum LARC. ResultsAmong 3,132,107 singleton deliveries, 6.6% were spontaneous preterm. Over the time period, total postpartum LARC use increased 4.8% to 11.7% for intrauterine devices (IUDs), 0.2% to 2.4% for implants. In 2016, those who experienced a spontaneous preterm birth were less likely to initiate postpartum IUDs compared to their peers (10.2% vs 11.8%, p < 0.001), minimally more likely to initiate implants (2.7% vs 2.4%, p = 0.04) and more likely to present for postpartum care (61.7% vs 55.9%, p < 0.001). LARC placement prior to hospital discharge was rare (preterm: 8 per 10,000 deliveries vs all others: 6.3 per 10,000 deliveries, p = 0.002). State-level analysis showed wide variation in postpartum LARC (range 6%–32%). ConclusionsWhile postpartum LARC use increased among the privately insured 2007–2016, few received LARC prior to hospital discharge. Those experiencing preterm birth were no more likely to receive inpatient LARC. Postpartum follow-up remained low and regional variation of LARC was high, highlighting the need for efforts to remove barriers to inpatient postpartum LARC for all who desire it—public and privately insured alike. ImplicationsAmong the half of U.S. births that are privately insured, postpartum LARC is increasing after both term and preterm births, yet exceedingly few (<0.1%) received LARC prior to hospital discharge.

Extensive renal cortical necrosis in a postpartum patient after COVID-19 infection

It has been more than two years since the COVID-19 pandemic affects the world. COVID-19 affects other organs in addition to the respiratory system. Renal cortical necrosis is a severe kidney injury due to decreased renal arterial perfusion induced by vascular spasm, microvascular injury and endovascular thrombosis. Acute kidney injury is a common finding in COVID-19; however, renal cortical necrosis is rare. To the best of our knowledge, only one case of renal cortical necrosis has been reported in the literature.

Kepuasan Pasien Post Partum terhadap Kualitas Hidup di Ruang Bersalin

The labor period causes physiological, physical, and psychological changes in the patient that can affect the quality of life, such as vaginal delivery or caesarean section, skin contact, breastfeeding, and the psychological state after childbirth. Treatment by health facilities must include the level of safety, effectiveness, timeliness, organization, feasibility, and approach to patients from the external side that will affect the patient. Health services must be efficient; on the other hand, poor or unqualified health services will decrease the quality of life of postpartum patients. This review contains information on how postpartum patient satisfaction affects the quality of life in the delivery room.

Implementation of a home blood pressure monitoring program for the management of hypertensive disorders of pregnancy, an observational study in British Columbia, Canada.

COVID-19 pandemic has influenced health care delivery. We conducted an observational study to understand how obstetric medicine (ObM) physicians utilized home blood pressure monitoring (HBPM) to manage hypertension in pregnancy. Pregnant participants with risk factors or diagnosis of hypertensive disorders of pregnancy (HDP) were enrolled, May 2020-December 2021, and provided with validated home blood pressure (BP) monitor. ObM physicians completed questionnaires to elicit how home BP readings were interpreted to manage HDP. We enrolled 103 people: 44 antepartum patients (33.5 ± 5 years, gestational age of 24 ± 5 weeks); 59 postpartum patients (35 ± 6 years, enrolled 6 ± 4 days post-partum). ObM physicians used range of home BP readings (70%) for management of HDP. HBPM to manage HDP is acceptable and can be used to manage hypertension during pregnancy. Further studies are needed to assess the generalizability of our findings and the safety of HBPM reliance alone in management of HDP.

Knowledge and Attitudes Toward Inpatient Postpartum HPV Vaccination Among Pregnant Women [ID: 1376898

INTRODUCTION: Inpatient postpartum human papillomavirus (HPV) vaccination is a novel strategy to increase HPV vaccine uptake; however, data on pregnant women's perspectives are lacking. We sought to assess knowledge and attitudes toward inpatient postpartum HPV vaccination among pregnant women. METHODS: An electronic survey assessing HPV vaccination knowledge, status, and attitudes toward postpartum HPV vaccination was distributed among pregnant women aged 15–45 years engaged in prenatal care at a large health system in Baltimore, Maryland. Reasons for their attitudes toward postpartum HPV vaccination were measured on a 5-point Likert scale. Responses were analyzed using descriptive statistics and χ2 tests. RESULTS: Mean age was 31.3+6.2 years among 309 pregnant participants. Self-identified race and ethnicity included 47.5% White, 29% Black/African American, 11.2% Asian, and 16.2% Hispanic/Latina. 88.7% had heard of the HPV vaccine, 50.5% had received at least one dose, and 35.0% had completed the series. HPV vaccination status did not differ by socioeconomic characteristics (P&gt;.05). Of the 153 HPV vaccine-naive women, 40.0% desired to receive it after delivery, with the top reasons being “I think it is safe” and “I think the protection can benefit me.” 24.2% were not interested (“I don't think it will benefit me” and “I'm worried about the side effects”), and 36.0% were unsure (“No healthcare provider has recommended it to me so far” or “I usually don't say yes to all vaccines”). CONCLUSION: The majority of pregnant HPV vaccine-naive women were willing to receive an HPV vaccine dose postpartum. HPV vaccine education during prenatal care may further increase uptake.

Provider confidence in counseling preconception, pregnant, and postpartum patients regarding COVID-19 vaccination: A cross-sectional survey study.

Healthcare provider counseling surrounding COVID-19 vaccine in pregnancy and lactation is essential to vaccination uptake in this population; however, provider knowledge and confidence are not well characterized. We aimed to assess knowledge and confidence in COVID-19 vaccine counseling among practitioners who provide care to pregnant persons and to describe factors associated with confidence in counseling. A web-based anonymous survey was distributed via email to a cross-sectional convenience sample of Obstetrics and Gynecology, Primary Care, and Internal Medicine faculty at three hospitals in a single healthcare network in Massachusetts, United States. Individual demographics and institution-specific variables were included in the survey along with questions assessing both attitudes toward COVID-19 illness and confidence in counseling regarding the use of the vaccine in pregnancy. Almost all providers (151, 98.1%) reported that they received a COVID-19 vaccine, and most (111, 72.1%) reported that they believe the benefits of the vaccine in pregnancy outweigh the risks. Forty-one (26.6%) reported feeling very confident in counseling patients who primarily speak English about the evidence for messenger ribonucleic acid vaccination in pregnancy, and 36 (23%) reported feeling very confident in counseling patients who are not primarily English-speaking. Forty-three providers (28.1%) expressed strong confidence in their comfort talking to individuals with vaccine hesitancy based on historic and continued racism and systemic injustices. The sources that survey respondents most used to find information regarding COVID-19 vaccination in pregnancy were the Centers for Disease Control(112, 74.2%), hospital-specific resources (94, 62.3%), and the American College of Obstetricians and Gynecologists(82, 54.3%). Ensuring that providers feel comfortable bridging the gap between their belief that the vaccine is beneficial for pregnant patients and their comfort with holding conversations with patients regarding vaccination is paramount to ensure equitable access to vaccines for pregnant patients.

Does a Lower Target of Postpartum Blood Pressure Reduce Readmission Rates in Patients With Hypertensive Disorders of Pregnancy? [ID: 1377089

INTRODUCTION: The classification of normal blood pressure in the general population, as determined by multiple organizations including the American Heart Association, American College of Cardiology, and National Institutes of Health, has been evolving. In the pregnant and postpartum population, the threshold of normal blood pressure is higher. Postpartum hypertension has been estimated to affect 20% of women and plays a large role in maternal readmissions. In those with hypertensive disorders of pregnancy, the target postpartum blood pressure should be reevaluated in light of the lower thresholds of the general population. METHODS: This study included pregnant patients with singleton fetuses and a diagnosis of chronic hypertension, gestational hypertension, preeclampsia, and eclampsia who delivered at Luminis Health Anne Arundel Medical Center from January 2019 to 2022. The primary outcome was hospital readmission for a hypertensive diagnosis or related sequelae within the first 30 days of delivery. This study was approved by IRB ID 1735193-1. RESULTS: Out of 1,433 patients with hypertensive disorders of pregnancy, 55 patients (3.8%) were readmitted because of hypertensive disorders or related complications. Patients with a maximum blood pressure after delivery of greater than or equal to 150/100 mm Hg were significantly more likely to be readmitted (odds ratio 1.99 [1.06, 3.75]). The maximum blood pressure on the day of discharge and oral antihypertensive initiation were not significantly associated with readmission. CONCLUSION: For postpartum patients with mild hypertension, a target blood pressure of below 150/100 mm Hg should be considered. Next steps include examining the effect of magnesium sulfate, furosemide, and discharge medication compliance in this population.