Routine Postpartum Research Articles

Ultrasound by midwives in the postpartum period: feasibility, reproducibility and midwives' perspectives

Objective: To describe feasibility, reproducibility, and acceptability of introducing ultrasound by midwives as a routine in postpartum care. Materials and Methods: A quantitative, monocentric cross-sectional study used questionnaires to evaluate the viewpoint of the midwife and the mother; repeat transabdominal ultrasound measurements were made of uterine length, width, height, and endometrial thickness by midwives, junior gynaecology trainees, and experienced gynaecologic ultrasonographers, 24 to 48 hours after delivery; Bland-Altman plotting assessed interand intra-observer variability. Results: Fifty-five percent of midwives considered implementation of ultrasound in postpartum care as feasible; time restrictions were seen as an obstacle by 60%, and 97% considered themselves after training as capable to perform postpartum ultrasound autonomously. Almost all mothers valued the ultrasound as non-disturbing and interesting. Inter-observer variability demonstrated a fixed bias between midwives and gynaecologists for total uterine length but not for other measurements. Intra-observer variability decreased with experience but was generally low and there was no fixed bias. Conclusion: Midwives saw postpartum ultrasound as feasible in daily practice, reproducibility was acceptable, and the mothers’ experience was positive. More study is needed to evaluate the eventual clinical value of routine postpartum ultrasound.

Mental health from the perspective of women affected by the Zika virus: an ethnographic study in Pará State, Brazil

The current study reflects on the Zika virus outbreak that struck the Brazilian population, with both physical and emotional aspects for all those affected. There is a particular group that has to deal on a daily basis with all the difficulties imposed by this new reality: women. The basic assumption of this approach is the need to learn about, understand, and grasp these biopsychosocial issues in all their breadth. It becomes necessary to delve into a relatively new context that mainly affected poor black and brown Brazilian women with little schooling in order to improve attention to their reproductive rights and mental health. The study thus accessed the reality of women who had children with a diagnosis of microcephaly due to the Zika virus. An ethnographic study performed with a qualitative approach in a referral service for women and children's health in Pará State. The study showed that women in this situation were not listened or cared for, except with routine postpartum care. This shortcoming notwithstanding, the mental health of these women is affected from the beginning of the pregnancy. Thus, the family and social contexts become important for promoting discussions on the health practices and representations that Zika entails for women who have had their lives altered by a situation that sounded a huge alarm throughout Brazilian society.

Effect of sexual health education on sexual function and resumption of sexual intercourse after childbirth in primiparous women.

INTRODUCTION:A large number of women experience sexual health problems during the postpartum period. This study aimed to evaluate the effect of sexual health education on sexual function and time of sexual intercourse resumption after childbirth in primiparous women in Southeast Iran.MATERIALS AND METHODS:This randomized clinical trial was conducted on 94 primiparous women randomly divided into two groups of intervention and control. The intervention group was subjected to three training sessions 3–5, 10–14, and 30–45 days after childbirth (first session lasting 20 min and other sessions 60 min). On the other hand, the participants in the control group only received the routine postpartum training. The Female Sexual Function Index (FSFI) was completed by all participants before and 8 weeks after the intervention. Data were analyzed in SPSS software (version 22) using descriptive and inferential statistics, such as Chi-square test, independent t-test, and paired sample t-test. P < 0.05 was considered statistically significant.RESULTS:The mean score of FSFI in the intervention group was increased from 12.70 ± 6.166 before the onset of the intervention to 17.36 ± 5.407 after 8 weeks (P = 0.01). In the control group, the mean score of FSFI was decreased from 13.09 ± 4.306 to 12.29 ± 3.511 on the 8th week postpartum (P = 0.06). The mean times of sexual intercourse resumption in the intervention and control groups were 5.82 ± 0.17 and 5.81 ± 0.22 weeks, respectively, which were not significantly different between the two groups (P = 0.879).CONCLUSION:Sexual health education for women in the postpartum period could improve their sexual function after childbirth. However, it is recommended to use sexual health education programs in women during the postpartum period to promote female sexual function.

The effect of counseling based on ex-PLISSIT model on sexual function and marital satisfaction of postpartum women: A randomized controlled clinical trial.

INTRODUCTION:Since routine counseling does not suffice to resolve the sexual problems at postpartum period, the present study aimed to investigate the effect of counseling based on the Ex-PLISSIT model on sexual function and marital satisfaction of postpartum women.METHODS:This was a randomized controlled clinical trial that was conducted on 68 postpartum women (within 3–6 months after childbirth) who obtained a score <28 on the Female Sexual Function Index (FSFI). The participants were randomly assigned to the intervention and control groups. Participants in the intervention group received counseling based on the Ex-PLISSIT model and those in the control group received the routine postpartum care. The required data were collected using a demographics form, the FSFI, and the ENRICH Marital Satisfaction Scale. The primary outcomes were the mean function and martial satisfaction score of participants 4 and 8 weeks after the intervention.RESULTS:There was no statistically significant difference between the two groups in terms of sexual function at baseline (P = 0.381), but it was significantly higher in the intervention group than control group after intervention (the adjusted MD: 4.24, 95% confidence interval [CI]: 3.18–5.29, P < 0.001). There was no statistically significant difference between the two groups in marital satisfaction before the intervention (P = 0.433), but it increased significantly in the intervention group in comparison to control after intervention (adjusted MD: 23.17, 95% CI: 15.10–31.24, P < 0.001).CONCLUSIONS:The study findings suggested that sexual counseling based on the Ex-PLISSIT model can improve the sexual function and increase marital satisfaction of postpartum women.

539: Postpartum depression in women with pregnancies complicated by a fetal congenital cardiac anomaly

To investigate factors contributing to postpartum depression (PPD) in pregnancies complicated by a fetal congenital cardiac anomaly. We reviewed the medical records of all pregnancies complicated by a fetal congenital cardiac anomaly who received prenatal, intrapartum and postpartum care at a single academic center between October 2016 and October 2018. Women who completed the Edinburgh Postnatal Depression scales (EPDS), a standard assessment in our center, at their routine 6-week postpartum appointment were included in the analysis. PPD was defined as an EPDS score ≥10. Maternal sociodemographic, obstetric, and neonatal data were compared between women with and without PPD. Out of 235 women referred to our center due to a fetal congenital cardiac anomaly, we identified 45 women with complete prenatal, intrapartum, and neonatal data including EPDS scores. The EPDS was completed a median of 43 days postpartum (IQR 42-49) with a median score of 4 (IQR 1-9). Eleven women (24%) were identified as having PPD. There were no differences in sociodemographic factors, or a history of depression between those with and without PPD (Table 1). Moreover, women with obstetric complications including PPROM, PTL, chorioamnionitis, fetal growth restriction, cesarean delivery or postpartum hemorrhage did not have increased rates of PPD. When analyzing the effect of neonatal factors on PPD, the rates of neonatal intubation, ECMO, or surgery in first 6 weeks were similar between women with or without PPD; however, the frequency of PPD was significantly higher among women whose infant had a plan for surgery at the time of EPDS testing (70.0 vs. 24.2%, p=0.02) (Table 2). In pregnancies complicated by fetal congenital cardiac anomaly, women with a plan for neonatal cardiac surgery at the time of their postpartum appointment are at a significantly higher risk for postpartum depression.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

993: Quantitative blood loss: A potential screening tool to prevent unnecessary postpartum blood draws

Visual estimation of blood loss (EBL) is an imprecise method to identify severity of postpartum hemorrhage ( pph). It is a common practice to obtain routine postpartum (PP) CBCs even when clinical suspicion for pph is low, to screen for anemia requiring intervention. We sought to determine whether quantified blood loss (QBL) correlates with PP hematocrit(hct) and is there a cutoff that can be used as a screening tool to predict the need for obtaining PP hct. We conducted a prospective pilot cohort study to ascertain the correlation between QBL and PP hct in low risk pregnancy. A CBC was obtained on admission, postpartum day 1 (PPd1), and postpartum day 2 (PPd2) for all women. Blood loss during delivery was objectively quantified to determine the QBL for each delivery. Paired t-test analysis compared PPd1 and PPd2 hct levels to determine optimal timing of hct levels. Correlation analyses were performed to assess the interdependence of QBL and the absolute change in hct. Multivariable regression was performed to control for potential covariates. A receiver operator curve (ROC) was used to assess the QBL cutoff predictive of an hct level of 25% or less, the hct level chosen as a proxy for PP blood transfusion requirement. A total of 100 women were included in the study, none of them had any significant medical comorbidities. Mean hct on admission was 35.5%. There was no significant difference between mean hct on PPd1 and PPd2 (31 3.4vs. 31 3.8 respectively; p=0.37). QBL was negatively correlated with ppd1 (p< 0.001) and ppd2 (p< 0.001) hct levels and had a strong positive correlation with the absolute change in PP hct levels (p< 0.001). Results were unchanged after controlling for intravenous fluid administration (p=0.002). QBL of 600 mL had a 100% sensitivity and 52% specificity for predicting an hct level ≤25% with an AUC 0.79 [95% CI (0.58 – 0.99)]. QBL is a strong predictor of PP hct. A QBL 600 mL can serve as a potential screening tool to determine the need for obtaining PP hct. Larger prospective studies are needed to assess the validity of this screening tool.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

114: Disparities in postpartum glucose screening in a large tertiary center with respect to socioeconomic factors

Per current recommendations, all women diagnosed with gestational diabetes mellitus (GDM) should undergo a 2-hour glucose challenge test postpartum to determine persistence of disease. The aim of this study was to determine the frequency of GDM postpartum guideline adherence among providers and patients in accordance with socioeconomic factors in a tertiary care center in Houston, TX. In a retrospective review, charts of women who delivered at Texas Children’s Hospital Pavilion for Women from 1/1/2016 to 12/31/2017 were analyzed for significance according to demographics, insurance status, prenatal diagnosis of GDM, and completion of the postpartum 2-hour GTT. Of 17,705 women who delivered, 691 (3.9%) were diagnosed with GDM using the standard 1-hour GTT followed by the 3-hour GTT per Carpenter-Coustan criteria. Of the 691 women, 98% (n=612) were insured. Of these, 55% (n=194) completed the postpartum GTT ordered by their provider at hospital discharge or during the routine postpartum visit. There was no significant difference in provider ordering patterns between insured and uninsured women (p=0.5). However, uninsured women were significantly less likely to complete the postpartum GTT ordered by their provider (p=0.001). No significant difference in insurance status was observed between White non-Hispanic and White Hispanic women in whom the postpartum GTT was ordered and completed (p=0.6). However, regardless of insurance status, Black women were significantly less likely to complete the postpartum GTT compared to White non-Hispanic and White Hispanic women (p=0.01 and p=0.04 respectively). Other racial groups were not analyzed due to the small percentage of GDM patients in this cohort. Independent of insurance status, providers at this tertiary care center ordered the postpartum GTT for only 32% of women prenatally diagnosed with GDM. Black women were significantly less likely to complete the postpartum GTT, even when ordered appropriately. Quality efforts to improve postpartum care for this population is critical due to the high-risk for incomplete follow-up.

MRI comparative study of levator ani muscle changes in nulliparous and multiparous females

BackgroundPelvic floor dysfunction is known to be among the principal factors influencing public health, regarding frequency, cost and effect on women’s quality of life. Radiographic assessment of the pelvic floor function and anatomy plays a vital role in the recognition of pelvic floor defects. The aim of this study is to detect the postpartum-related levator ani muscle changes thus defining the relationship between the vaginal deliveries and the etiology of pelvic floor dysfunction in order to provide guidelines to decrease the incidence of pelvic floor injuries during parturition and guide the treatment plan.ResultsThere was a significant difference in the puborectalis muscle thickness between the case and control groups in the right puborectalis (P value ≤ 0.001) and in the left puborectalis (P value (≤ 0.001) as well as significant midpoint thickness (P value = 0.03) with 46.2% puborectalis muscle injury in the case group compared with none in the control group.ConclusionPelvic floor MRI is highly recommended as it is a contrast-free modality that allows for both anatomical and functional analysis. Its incorporation in the routine postpartum assessment will allow early detection of abnormalities even in asymptomatic cases thus ensuring proper management and preventing the development of pelvic floor dysfunction predisposed to by repeated vaginal deliveries.

Effect of the Pregnant+ smartphone application in women with gestational diabetes mellitus: a randomised controlled trial in Norway

ObjectiveTo assess the effect of the Pregnant+ app on the 2-hour glucose level of the routine postpartum oral glucose tolerance test (OGTT) among women with gestational diabetes mellitus (GDM). The...

Beyond postpartum depression: posttraumatic stress-depressive response following childbirth.

Although depression following childbirth is well recognized, much less is known about comorbid postpartum psychiatric conditions. Some women can endorse posttraumatic stress related to the childbirth experience accompanied by symptoms of depression. The objective of our study was to examine the nature of the comorbidity of symptoms of childbirth-related posttraumatic stress disorder (PTSD) and postpartum depression. We studied a sample of 685 women who were on average 3 months following childbirth and collected data about their mental health pertaining to PTSD, depression, general distress, and childbirth experience. The vast majority of women with elevated childbirth-related PTSD symptoms also endorsed elevated postpartum depression symptoms. Factor analysis revealed that symptoms of childbirth-related PTSD and postpartum depression loaded onto one single factor rather than two factors. Stepwise multi-nominal regression analysis revealed that childbirth stressors, including obstetric complications and peritraumatic distress in birth, predicted the likelihood of developing comorbid childbirth-related PTSD and postpartum depression, but not depression alone. The findings suggest that beyond postpartum depression, postpartum women suffer from a posttraumatic stress-depressive response in the wake of a traumatic childbirth experience. Increasing awareness in routine postpartum care about traumatic childbirth and its associated emotional sequela is warranted.

Standardizing Postpartum Discharge Instructions With an Educational Video: A Quality Improvement Project

Background The World Health Organization (WHO) estimates that, in the United States, 1200 women annually experience perinatal events that prove fatal and 60,000 suffer complications that are near-fatal. Postpartum morbidity and mortality may be decreased by explicit patient education. At our institution, the maternal discharge education process was varied among providers. Of the available literature, most focus on maternal knowledge of pediatric concerns with a limited amount of studies looking at maternal postpartum health. Objective The objective of this quality improvement project is to standardize postpartum education with the use of a postpartum education video available on a bedside tablet in order to improve maternal perception and knowledge of postpartum warning signs. Methods This prospective cohort study was designed using a patient survey which was administered to evaluate the effectiveness of the maternal discharge education procedures in our institution. The baseline results were reviewed by a team of physicians and nurses. A 10-question survey was provided to patients following the birth of their first baby about maternal warning signs and complications after discharge from the hospital. A standardized discharge education video was created using information from ACOG and AWHONN. The video was made accessible on bedside tablet devices. Patients were able to indicate understanding or request clarification on the devices after review of the materials, and this was communicated from the tablets to the electronic health record. All postpartum nurses were trained on the video content and how to operate the tablets. Survey responses were collected via bedside tablets following implementation of the video and were compared with the baseline results. Educational information was available to patients after discharge from the hospital via a patient portal. Results Twenty-nine women were surveyed prior to implementation of the standardized educational video available on bedside tablets. After implementation, 50 women were surveyed. Comparison of the survey responses showed there was an increase in patient-reported knowledge and understanding in all 10 questions on the survey. Of those, 4 areas were statistically significant with P values &lt;.05: when to call 911 (82.8% before and 98% after), when to call your doctor (75.9% before and 98.0% after), heavy vaginal bleeding (62.1% before and 87.8% after), and symptoms of acute blood loss (51.7% before and 83.7% after). Conclusions The implementation of a postpartum education video available to patients on bedside tablets improved and standardized workflow for routine postpartum care and discharge processes. Survey questions regarding patient knowledge and perception of when to call 911, when to call your doctor, heavy bleeding, and signs of acute blood loss were all noted to be statistically significant. The improved perception of postpartum warning signs after the educational video appears to be beneficial in patient education at this high volume OB institution. The establishment of this platform for education became a model for education in other hospital units using bedside tablets. The use of a multidisciplinary team to review, revise, and standardize the postpartum education program at our institution was well received and supported by nurses, providers, and ultimately patients.

Effect of Nursing Care Guided by Roy’s Adaptation Model on Self-Evaluation of Women After Caesarean Section

Postpartum caesarean section is a critical time in the women life. During that time, the women need physical and psychological care as well as guidance for healthy practices for their health and newborns. Aim: The study aimed to assess the effect of nursing care guided by Roy’s adaptation model on self-evaluation of women after caesarean section. Methods: A quasi-experimental design with pre and post-test was utilized. Sample: A purposive sample of 60 women after caesarean section. Setting: The study was carried out at University and Teaching Hospital at Shebin El-Kom. instruments: An interviewing questionnaire, postpartum follow-up form and post-partum self-evaluation questionnaire Results: There was a highly statistically significant improvement in the post intervention than the pre intervention regarding of puerperium problems and adaptation after cesarean section after implementation of Roy’s adaptation model (P &lt; 0.001) Conclusions : The implementation of Roy’s adaptation model assisted in stopping the majority of puerperium issues after cesarean section. The difference between most complaints was found to be statistically significant (p &lt; 0.05; p &lt; 0.001) during the week of data collection. Recommendations : Roy’s adaptation model will be helpful if included incorporated as essential part of routine postpartum care. Keywords: Roy’s adaptation model, caesarean section, self-evaluation of women after caesarean section DOI : 10.7176/JHMN/67-05 Publication date :October 31 st 2019

AN UNEXPECTED CULPRIT OF SHORTNESS OF BREATH

SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Nitrofurantoin is one of the recommended first-line agents for the treatment of uncomplicated urinary tract infections. Nitrofurantoin-induced pulmonary toxicity is a documented rare, though potentially fatal adverse reaction. CASE PRESENTATION: A 35-year-old woman presented with complaints of worsening shortness of breath, fevers and abdominal discomfort. She had had an uncomplicated pregnancy and uncomplicated vaginal delivery 11 weeks prior to presentation. Two weeks prior she had been diagnosed with an uncomplicated urinary tract infection at a routine postpartum follow-up visit and prescribed Nitrofurantoin. Six days into treatment she developed subjective fevers and a generalized lace-like rash; both resolved spontaneously. Three days after the rash she started experiencing progressively worsening shortness of breath and recurrent subjective fevers which prompted her presentation to the Emergency Department. On presentation, she was febrile, tachycardic and tachypneic. The only notable physical exam finding was crackles at bilateral lung bases prompting concern for pulmonary edema due to peripartum cardiomyopathy. CBC, CMP, BNP, and UA were within normal limits and an echocardiogram revealed elevated right ventricular systolic (35-40mmHg) and a dilated inferior vena cava suggestive of increased right atrial pressure. This prompted a CT-Chest with contrast which showed increased interlobular septi and prominent of peribronchial interstitial structures, particularly in the right lower lobe and mediastinum. A careful reexamination of her history of presenting illness lead to a clinical diagnosis of acute Nitrofurantoin-induced pulmonary toxicity. This diagnosis was made on the basis of her unremarkable past medical history, previously uncomplicated peripartum clinical course, prior normal chest imaging and the temporal relationship between the initiation of Nitrofurantoin and the onset of her symptoms. She was managed supportively. She did not receive glucocorticoids and had already completed her course of Nitrofurantoin at the time of diagnosis. DISCUSSION: Nitrofurantoin-induced pulmonary toxicity has an incidence of less than 1%. Diagnosis can be made based on characteristic symptoms and temporal relation to drug exposure. Symptoms typically include fever, dyspnea, cough and/or rash. Crepitant crackles at the lung bases are heard in most patients and the most common laboratory findings are eosinophilia, leukocytosis, and elevated ESR. The majority of patients have parenchymal changes on imaging. Treatment is the cessation of Nitrofurantoin, however, it may take weeks to months for complete symptom resolution. The benefit of glucocorticoids has not been clearly demonstrated and typically are only employed in patients with significant respiratory compromise. CONCLUSIONS: This case illustrates the importance of knowing the possible adverse reactions to commonly prescribed medications. Reference #1: Camus P, Fanton A, Bonniaud P, et al. Interstitial lung disease induced by drugs and radiation. Respiration 2004; 71:301. Reference #2: Holmberg L, Boman G. Pulmonary reactions to nitrofurantoin. 447 cases reported to the Swedish Adverse Drug Reaction Committee 1966-1976. Eur J Respir Dis 1981; 62:180. Reference #3: Bhullar S, Lele SM, Kraman S. Severe nitrofurantoin lung disease resolving without the use of steroids. J Postgrad Med 2007; 53:111. DISCLOSURES: No relevant relationships by Oshioke Esivue, source=Web Response No relevant relationships by Diana Rodriguez, source=Web Response

The impact of parent-targeted eHealth educational interventions on infant procedural pain management: a systematic review protocol.

The objective of this review is to determine if electronic health (eHealth) educational interventions for infant procedural pain and pain management impact parental outcomes (mental health outcomes, knowledge utilization outcomes, and parental involvement in care outcomes) and infant outcomes (morbidity outcomes, pain outcomes, health system outcomes). Pain in infants is a common concern for parents. Routine postpartum care for infants in early life requires them to endure painful procedures, yet infants often receive little to no pain management. While research has shown that parents can reduce their infant's pain during procedures by breastfeeding or skin-to-skin contact, parents may not be aware of their role in pain management. Despite the recent rapid increase in eHealth resources to educate parents about infant pain management, their impact has yet to be evaluated. This review will consider studies that include eHealth educational interventions targeted at parents during pregnancy and up to one year postpartum. All experimental study designs will be included. Primary outcomes will include: parental stress and anxiety, self-efficacy, knowledge, attitudes, eHealth intervention usage, acceptance of eHealth intervention, involvement in pain management, and infant pain response. PubMed, CINAHL, PsycINFO, Embase, Scopus, Web of Science, and SciELO will be searched for studies published in English. Critical appraisal and data extraction will be conducted by two independent reviewers using standardized tools. Quantitative data, where possible, will be pooled in statistical meta-analysis, or if statistical pooling is not possible, the findings will be reported narratively.

The Effect of Routine Postpartum Uterine Lavage on Endometrial Cytology, Culture, and Pregnancy Rates in Thoroughbred Broodmares

Minimizing the interval between parturition and successful rebreeding of thoroughbred broodmares is important in maintaining annual foal production and broodmare profitability. Routine postpartum uterine lavage may help achieve this by aiding uterine clearance and involution in the early postpartum period and increasing pregnancy rates. This retrospective study investigates the effect of postpartum uterine lavage in 32 thoroughbred mares housed on a single farm in Australia in 2014 and 2015. In the control year (2014), postpartum uterine lavage was not performed. In the treatment year (2015), all mares received a uterine lavage 3 days postpartum. In both years, endometrial swabs were obtained for culture and cytology at the first postpartum estrus (foal heat swab) and the second postpartum estrus (second heat swab), prior to the mare being bred by natural cover at the second postpartum estrus. There was no significant difference in bacterial culture rates from foal heat or second heat swabs between the control and treatment years. Assessment of endometrial cytology of the foal heat swab and second heat swab revealed a significantly higher proportion of polymorphonuclear cells (PMNs) in the control year compared with the treatment year. Positive culture and cytology rates were significantly higher at foal heat than at the second postpartum heat in both years. No association of year, cytology, or culture with pregnancy rates was identified. In conclusion, routine postpartum uterine lavage significantly reduces the presence of endometrial PMNs at first and second postpartum estrus but does not reduce endometrial culture rates or increase pregnancy rates.

Vitamin D reduces postpartum depression and fatigue among Iranian women

Background Depression and fatigue have been recognised as common postpartum morbidities. One of the proposed well established aetiologies is vitamin D deficiency, which is prevalent among Iranian women. Aim To determine the efficiency of vitamin D supplement on postnatal depression and fatigue. Method In this double blind, randomised controlled trial, 80 primiparous women, who scored ≥13 and ≥20 on the Edinburgh Postnatal Depression Scale and the Fatigue Identification Form, respectively, were randomly distributed into the control and intervention groups over 4-10 months following birth. Groups received vitamin D3 1000IU and placebo pills daily for 6 months. Logistic regression tests assessed the relation between variables. Findings Vitamin D decreased depression scores and fatigue scores in the intervention group (P&gt;0.001). Conclusion Considering vitamin D supplements as routine postpartum care among high-risk women would be useful. However, more studies are needed to support this conclusion.

Postpartum contraceptive counseling for first-time adolescent mothers: a randomized controlled trial.

Rapid repeat pregnancy is common among adolescent mothers and is associated with increased risks of adverse perinatal and maternal outcomes. Increasing contraceptive uptake among postpartum adolescents may decrease these outcomes through pregnancy prevention. This randomized controlled trial of 100 postpartum adolescent women assessed the effect of a standardized immediate postpartum contraceptive counseling intervention emphasizing healthy birth spacing and the use of long-acting reversible contraceptives (LARC). After a baseline survey about reproductive health and pregnancy intentions, all subjects received routine postpartum contraceptive counseling. The intervention group also received the standardized counseling intervention. All participants had access to immediate postpartum contraceptive implant initiation or to intrauterine device (IUD) insertion at postpartum follow-up. Contraceptive use and repeat pregnancy were assessed quarterly for 12months. Differences in repeat pregnancy, as well as contraceptive initiation, continuation, and satisfaction were analyzed. There was no difference in repeat pregnancy or contraceptive initiation, continuation or satisfaction between the study groups. However, regardless of group assignment, all subjects who desired the contraceptive implant used the method, compared to 15% of subjects who desired the IUD (p < 0.001). Three pregnancies occurred among subjects who desired the IUD versus none amongst subjects who desired the implant (p = 0.10). This standardized postpartum contraceptive counseling intervention did not affect teens' repeat pregnancies or contraceptive use. However, immediate postpartum availability of the contraceptive implant was associated with increased utilization of this method when compared to the IUD. Future postpartum contraceptive efforts should investigate procedures to improve teens' access to postpartum contraception. CLINICALTRIALS. NCT01814930.

Comparison of an additional early visit to routine postpartum care on initiation of long-acting reversible contraception: A randomized trial

Abstract Objective To investigate whether an early 3-week postpartum visit in addition to the standard 6-week visit increases long-acting reversible contraception (LARC) initiation by 8 weeks postpartum compared to the routine 6-week visit alone. Study design We enrolled pregnant and immediate postpartum women into a prospective randomized, non-blinded trial comparing a single 6-week postpartum visit (routine care) to two visits at 3 and 6 weeks postpartum (intervention), with initiation of contraception at the 3-week visit, if desired. All participants received structured contraceptive counseling. Participants completed surveys in-person at baseline and at the time of each postpartum visit. A sample size of 200 total participants was needed to detect a 2-fold difference in LARC initiation (20% vs. 40%). Results Between May 2016 and March 2017, 200 participants enrolled; outcome data are available for 188. The majority of LARC initiation occurred immediately postpartum (25% of the intervention arm and 27% of the routine care arm). By 8 weeks postpartum, 34% of participants in the intervention arm initiated LARC, compared to 41% in the routine care arm (p=.35). Overall contraceptive initiation by 8 weeks was 83% and 84% in the intervention and routine care arms, respectively (p=.79). There was no difference between the arms in the proportion of women who attended at least one postpartum visit (70% vs. 74%, p=.56). Conclusion The addition of a 3-week postpartum visit to routine care does not increase LARC initiation by 8 weeks postpartum. The majority of LARC users desired immediate rather than interval postpartum initiation. Clinical trial registration Clinicaltrials.gov NCT02769676 Implications The addition of a 3-week postpartum visit to routine care does not increase LARC or overall contraceptive initiation by 8 weeks postpartum when the option of immediate postpartum placement is available. The majority of LARC users desired immediate rather than interval postpartum initiation.

Increasing IUD and Implant Use Among Those at Risk of a Subsequent Preterm Birth: A Randomized Controlled Trial of Postpartum Contraceptive Counseling

To assess the impact of contraceptive counseling on the uptake of long-acting reversible contraception (LARC), namely, intrauterine devices and the contraceptive implant, by 3months postpartum among women with a recent preterm birth. We enrolled patients in a single-blinded, one-to-one, randomized, controlled trial to assess the impact of enhanced family planning counseling immediately after a viable preterm birth in the inpatient setting. Participants received either structured counseling with an emphasis on LARC by a family planning specialist (intervention) or routine postpartum care (control). We followed participants to the primary outcome of LARC use 3months postpartum. We followed 121 participants for 3months. Primary outcome data were available for 119 participants (61 intervention, 58 control). We found no demographic differences between the groups. Participants in the intervention group were significantly more likely to use LARC at 3months postpartum compared with controls (51% vs. 31%; p<.05). For every six women who received the counseling intervention, one additional woman was using a LARC method at 3months. After a preterm birth, brief LARC-focused, structured counseling before hospital discharge significantly increased LARC method use at 3months postpartum.

Postpartum depression and social support in a racially and ethnically diverse population of women.

Lack of social support is an important risk factor for postpartum depression (PPD), whereas the presence of social support can buffer against PPD. However, the relationship between social support and PPD in racial/ethnic minority women is still largely unknown. Our purpose was to examine the role of social support in a large, diverse population of PPD cases and controls. Participants (N= 1517) were recruited at the routine 6-week postpartum visit (± 1-2weeks) from four different outpatient clinics in North Carolina. Case status was determined using the MINI International Neuropsychiatric Interview. Social support was measured using the Medical Outcomes Social (MOS) Support survey and the Baby's Father Support Scale (DAD). We found that higher levels of social support had a strong protective association against PPD (MOS total score OR, 0.23; 95% CI, 0.19-0.27; p = 6.92E-90; DAD total score OR, 0.89; 95% CI, 0.88-0.92; p = 1.69E-29), and the effects of social support did not differ when accounting for race/ethnicity. Additionally, PPD symptom severity is significantly and negatively correlated with the degree of social support. Our findings suggest that multi-dimensional aspects of social support may be protective for racial/ethnic minority women. We believe this study is currently the largest and most robust characterizing PPD case status and its association with social support in a diverse cohort of mothers. Future work is required to understand how best to implement culturally sensitive interventions to increase social support in minority perinatal women.