Telehealth Interventions to Improve Obstetric and Gynecologic Health Outcomes: A Systematic Review

Racial and Sociodemographic Disparities in Telehealth Access and Utilization during the COVID-19 Pandemic

BACKGROUND: Telehealth is not new, but licensing restrictions, HIPAA compliance issues, and lack of reimbursement were significant barriers that hindered its success in the past. Enabling practices to adopt telehealth so that in-person care could be limited to urgent patients and curbed use of finite clinical resources like personal protective equipment for which there was significant shortages. This expansion allowed services including, but not limited to, home visits, therapy services, emergency consults, and nursing facilities visits to be conducted remotely. AIMS: The study objectives are to describe telehealth utilization rates among OB/GYN patients during the first four months of the COVID-19 pandemic by race/ethnicity and insurance coverage and to investigate telehealth access disparities. METHODS: A cross-sectional analysis design was employed. Data abstraction was performed using the electronic medical records of UMass Memorial Medical Center (UMMMC). A convenience sample of 9370 Women who received their telehealth or in-person care at the UMass Memorial Medical Center (UMMMC). RESULTS: Between March 15, 2020, and July 30, 2020, in total, 15,362 encounters were completed. Throughout the timeframe included in this study, 81.34% of appointments were conducted in person, and 18.66% were completed using telehealth. The age of telehealth patients ranged from 17 to 97, with a mean age of 45. Most of the patients were white (n=1202, 63.4%) and held private health insurance (n= 975, 52.4%). Hispanic and Asian patients were less likely to attend their telehealth appointment than patients of other races (p <0.001). Patients with private health insurance were more likely to attend their telehealth appointments than patients with public health insurance (p <0.001). CONCLUSIONS: Telehealth services have been providing patients with access to OB/GYN care during this challenging time and have enhanced health care delivery opportunities. This study identifies a clear need to improve telehealth access and utilization rates among racial and ethnic minority groups and persons with public insurance. Keywords: Telehealth, Health disparity, Telemedicine, Obstetrics

Maternal and infant outcomes in women with and without gestational diabetes mellitus in the COVID-19 era in China: Lessons learned

Aims

The global COVID-19 pandemic has required a drastic transformation of prenatal care services. Whether the reformulation of the antenatal care systems affects maternal and infant outcomes remains unknown. Particularly, women with gestational diabetes mellitus (GDM) are among those who bear the greatest brunt. Thus, this study aimed to evaluate the impact of COVID-19 lockdown during late pregnancy on maternal and infant outcomes in women stratified by the GDM status in China.

Study design

The participants were women who experienced the COVID-19 lockdown during late pregnancy (3185 in the 2020 cohort) or not (2540 in the 2019 cohort) that were derived from the Beijing Birth Cohort Study. Maternal metabolic indicators, neonatal outcomes, and infant anthropometrics at 12 months of age were compared between the two cohorts, stratified by the GDM status.

Results

Participants who experienced COVID-19 lockdown in late pregnancy showed lower gestational weight gain than those in the control cohort. Nevertheless, they displayed a worse metabolic profile. COVID-19 lockdown during pregnancy was associated with higher glycosylated hemoglobin (HbA1c) (β= 0.11, 95% CI = 0.05-0.16, q-value = 0.002) and lower high density lipoprotein cholesterol level (HDL-C) level (β=-0.09, 95% CI = -0.14 to -0.04, q-value = 0.004) in women with GDM, adjusted for potential confounders. In normoglycemic women, COVID-19 lockdown in late pregnancy was associated with higher fasting glucose level (β= 0.10, 95% CI = 0.08-0.12, q-value <0.0001), lower HDL-C level (β=-0.07, 95% CI = -0.08 to -0.04, q-value <0.0001), and increased risk of pregnancy-induced hypertension (adjusted OR=1.80, 95%CI=1.30-2.50, q-value=0.001). The fasting glucose level decreased less from early to late pregnancy in women who experienced COVID-19 lockdown than in the controls, regardless of the GDM status. The HDL-C has risen less with COVID-19 lockdown in the normoglycemic subgroup. In contrast, no significant differences regarding neonatal outcomes or infant weight were found between the two cohorts.

Conclusion

Experiencing the COVID-19 lockdown in pregnancy was associated with worse maternal metabolic status but similar neonatal outcomes and infant weight.

Maternal Perinatal Telemonitoring in the Context of the Coronavirus Disease 2019 Pandemic in a Tertiary Health Center in Peru

OBJECTIVE

This study aimed to describe the characteristics of a telemonitoring program that was rapidly implemented in our institution as a response to the coronavirus disease 2019 (COVID-19) pandemic, as well as the maternal and perinatal outcomes of women who attended this program.

STUDY

DESIGN: Retrospective study of patients via phone-call telemonitoring during the peak period of the COVID-19 pandemic (May 2020-August 2020). Maternal and perinatal outcomes were collected and described. Health providers' satisfaction with the telemonitoring program was assessed via an email survey.

RESULTS

Twenty-three (69.7%) health providers answered the survey. The mean age was 64.5 years, 91.3% were OB/GYN (obstetrician-gynecologist) doctors, and 95% agreed that telemonitoring is an adequate method to provide health care when in-person visits are difficult. The 78.7% of scheduled telemonitoring consultations were finally completed. We performed 2,181 telemonitoring consultations for 616 pregnant women and 544 telemonitoring consultations for puerperal women. Other medical specialties offering telemonitoring included gynecology, reproductive health, family planning, cardiology, endocrinology, and following up with patients with reactive serology to severe respiratory syndrome coronavirus 2 (SARS-CoV-2). The majority of the population attending our telemonitoring program were categorized as the lowest strata, i.e., III and IV, according to the Human Development Index, and approximately 42% were deemed as high-risk pregnant women. Additionally, we reported the perinatal outcomes of 424 (63%) pregnant women, the most relevant finding being that approximately 53% of them had cesarean sections.

CONCLUSION

Telemonitoring is an adequate method of continuing the provision of prenatal care when in-person visits are difficult in situations such as the COVID-19 pandemic. Telemonitoring is feasible even in institutions with no or little experience in telemedicine. The perinatal outcomes in women with telemonitoring seem to be similar to that in the general population.

KEY POINTS

· Telemonitoring for prenatal care is feasible even in low-income countries and in a critical scenario.. · OB/GYN doctors agreed with that telemonitoring is an adequate method to provide prenatal care.. · Maternal and perinatal outcomes are similar in women attending a telemonitoring program..

Use of Telehealth During the COVID-19 Pandemic Among Practicing Maternal-Fetal Medicine Clinicians

Background: Limited knowledge exists about the drivers of telehealth use among obstetricians during COVID-19 in the United States. We investigated the use of live video visits by Maternal-Fetal Medicine (MFM) clinicians, the factors associated with use and interest in future use. Methods: We drew survey data from 373 clinicians on two outcomes: (1) use of any (vs. no) live video visits during COVID-19 and (2) among users, the extent of live video use. Bivariate and multivariate logistic regressions quantified the association between predisposing (demographic and practice setting characteristics) and enabling factors (prepandemic telehealth use, structural and perceived patient barriers) and each outcome. Results: During the pandemic, 88% reported any use, a jump from 29% prepandemic utilization. Users (vs. nonusers) were younger (p = 0.02); tended to provide comprehensive prenatal care (p = 0.01) and/or inpatient care (p = 0.02), practice in university settings (p = 0.01), engage in various telehealth modalities prepandemic (p ≤ 0.01), and to perceive challenges with technical (p < 0.01), reimbursement (p = 0.05), and patient barriers to internet or data plan access (p ≤ 0.001). After adjusting for covariates, only prepandemic communication through patient portal (adjusted odds ratio [aOR] = 3.85; 95% confidence interval [CI] = 1.33-11.12), perceived patient access barriers (aOR = 5.27; 95% CI = 1.95-14.23), and practice in multiple versus university settings (aOR = 0.18; 95% CI = 0.06-0.56) remained significantly associated with use. Approximately 44% were high users. Prepandemic ultrasound use (aOR = 1.92; 95% CI = 1.17-3.16), perceived patient access barriers (aOR = 1.85; 95% CI = 1.12-3.06) and Midwest versus North practice location (aOR = 0.46; 95% CI = 0.21-0.98) predicted high use. Among high users, 99% wanted to continue offering video visits. Conclusions: We found widespread use of live video obstetric care by MFM clinicians and continued interest in use postpandemic.

Experiences With Prenatal Care Delivery Reported by Black Patients With Low Income and by Health Care Workers in the US: A Qualitative Study

IMPORTANCE

Black pregnant people with low income face inequities in health care access and outcomes in the US, yet their voices have been largely absent from redesigning prenatal care.

OBJECTIVE

To examine patients' and health care workers' experiences with prenatal care delivery in a largely low-income Black population to inform care innovations to improve care coordination, access, quality, and outcomes.

DESIGN, SETTING, AND PARTICIPANTS

For this qualitative study, human-centered design-informed interviews were conducted at prenatal care clinics with 19 low-income Black patients who were currently pregnant or up to 1 year post partum and 19 health care workers (eg, physicians, nurses, and community health workers) in Detroit, Michigan, between October 14, 2019, and February 7, 2020. Questions focused on 2 human-centered design phases: observation (understanding problems from the end user's perspective) and ideation (generating novel potential solutions). Questions targeted participants' experiences with the 3 goals of prenatal care: medical care, anticipatory guidance, and social support. An eclectic analytic strategy, including inductive thematic analysis and matrix coding, was used to identify promising strategies for prenatal care redesign.

MAIN OUTCOMES AND MEASURES

Preferences for prenatal care redesign.

RESULTS

Nineteen Black patients (mean [SD] age, 28.4 [5.9] years; 19 [100%] female; and 17 [89.5%] with public insurance) and 17 of 19 health care workers (mean [SD] age, 47.9 [15.7] years; 15 female [88.2%]; and 13 [76.5%] Black) completed the surveys. A range of health care workers were included (eg, physicians, doulas, and social workers). Although all affirmed the 3 prenatal care goals, participants reported failures and potential solutions for each area of prenatal care delivery. Themes also emerged in 2 cross-cutting areas: practitioners and care infrastructure. Participants reported that, ideally, care structure would enable strong ongoing relationships between patients and practitioners. Practitioners would coordinate all prenatal services, not just medical care. Finally, care would be tailored to individual patients by using care navigators, flexible models, and colocation of services to reduce barriers.

CONCLUSIONS AND RELEVANCE

In this qualitative study of low-income, Black pregnant people in Detroit, Michigan, and the health care workers who care for them, prenatal care delivery failed to meet many patients' needs. Participants reported that an ideal care delivery model would include comprehensive, integrated services across the health care system, expanding beyond medical care to also include patients' social needs and preferences.

Emergency Visits and Hospitalization After Chat Message, Voice Call, or Video Call for Telehealth in Obstetrics and Gynecology Using Telehealth Service User Data in Japan: Cross-sectional Study

Background

In obstetric and gynecologic practices, synchronous telehealth services via chat message, voice calls, and video calls have been increasingly equipped to improve patients’ health care accessibility and clinical outcomes. Nevertheless, differences in clinical outcomes between communication tools remain unknown, especially in terms of safety.

Objective

This study compared the occurrence of emergency visits and hospitalization after telehealth services through different communication tools, including chat messages, voice calls, and video calls.

Methods

We collected data on obstetric and gynecologic concerns of women who consulted specialized doctors and midwives through a telehealth consulting service in Japan (Sanfujin-ka Online) between January 1, 2019, and December 31, 2020. The outcomes were emergency visits or hospitalizations at night after the consultation. Chi-square test and multivariate logistic regression analysis were performed to compare the clinical outcomes between the groups who received telehealth services via chat message, voice calls, and video calls.

Results

This study included 3635 participants. The mean age of the participants was 31.4 (SD 5.7) years, and the largest age group (n=2154, 59.3%) was 30-39 years. The numbers (or proportions) of those who received telehealth services via chat message, voice calls, and video calls were 1584 (43.5%), 1947 (53.6%), and 104 (2.9%), respectively. The overall incidence of the outcome was 0.7% (26/3635), including 10 (0.3%) cases of chat message, 16 (0.5%) cases of voice calls, and no video calls. There were no emergency visits that happened due to inappropriate advice. No significant difference in the proportions of the outcomes was observed between the communication tools (P=.55). The multivariate logistic regression analysis showed no significant differences in the outcome between those who used chat message and those who used voice calls (odds ratio 1.63, 95% CI 0.73-3.65).

Conclusions

The communication tools of telehealth services in obstetrics and gynecology did not show a significant difference in terms of emergency visits or hospitalizations after using the service.

Realist inquiry into Maternity care @ a Distance (ARM@DA): realist review protocol

INTRODUCTION

One of the most commonly reported COVID-19-related changes to all maternity services has been an increase in the use of digital clinical consultations such as telephone or video calling; however, the ways in which they can be optimally used along maternity care pathways remain unclear. It is imperative that digital service innovations do not further exacerbate (and, ideally, should tackle) existing inequalities in service access and clinical outcomes. Using a realist approach, this project aims to synthesise the evidence around implementation of digital clinical consultations, seeking to illuminate how they can work to support safe, personalised and appropriate maternity care and to clarify when they might be most appropriately used, for whom, when, and in what contexts?

METHODS AND ANALYSIS

The review will be conducted in four iterative phases, with embedded stakeholder involvement: (1) refining the review focus and generating initial programme theories, (2) exploring and developing the programme theories in light of evidence, (3) testing/refining the programme theories and (4) constructing actionable recommendations. The review will draw on four sources of evidence: (1) published literature (searching nine bibliographic databases), (2) unpublished (grey) literature, including research, audit, evaluation and policy documents (derived from Google Scholar, website searches and e-thesis databases), (3) expertise contributed by service user and health professional stakeholder groups (n=20-35) and (4) key informant interviews (n=12). Included papers will consist of any study design, in English and from 2010 onwards. The review will follow the Realist and Meta-narrative Evidence Synthesis Evolving Standards quality procedures and reporting guidance.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the University of Nottingham, Faculty of Medicine and Health Sciences Ethics Committee (FMHS 426-1221). Informed consent will be obtained for all key informant interviews. Findings will be disseminated in a range of formats relevant to different audiences.

PROSPERO REGISTRATION NUMBER

CRD42021288702.

Telehealth Strategies for the Delivery of Maternal Health Care : A Rapid Review

BACKGROUND

Telehealth strategies to supplement or replace in-person maternity care may affect maternal health outcomes.

PURPOSE

To conduct a rapid review of the effectiveness and harms of telehealth strategies for maternal health care given the recent expansion of telehealth arising from the COVID-19 pandemic, and to produce an evidence map.

DATA SOURCES

Systematic searches of MEDLINE, the Cochrane Library, CINAHL, Embase, and Scopus for English-language studies (January 2015 to April 2022).

STUDY SELECTION

Randomized controlled trials (RCTs) and observational studies of maternal care telehealth strategies versus usual care.

DATA EXTRACTION

Dual data extraction and risk-of-bias assessment of studies, with disagreements resolved through consensus.

DATA SYNTHESIS

28 RCTs and 14 observational studies (n = 44 894) were included. Maternal telehealth interventions supplemented in-person care for most studies of mental health and diabetes during pregnancy, primarily resulting in similar, and sometimes better, clinical and patient-reported outcomes versus usual care. Supplementing in-person mental health care with phone- or web-based platforms or mobile applications resulted in similar or better mental health outcomes versus in-person care. A reduced-visit prenatal care schedule using telehealth to replace in-person general maternity care for low-risk pregnancies resulted in similar clinical outcomes and higher patient satisfaction versus usual care. Overall, telehealth strategies were heterogeneous and resulted in similar obstetric and patient satisfaction outcomes. Few studies addressed disparities, health equity, or harms.

LIMITATIONS

Interventions varied, and evidence was inadequate for some clinical outcomes.

CONCLUSION

Replacing or supplementing in-person maternal care with telehealth generally results in similar, and sometimes better, clinical outcomes and patient satisfaction compared with in-person care. The effect on access to care, health equity, and harms is unclear.

PRIMARY FUNDING SOURCE

Patient-Centered Outcomes Research Institute. (PROSPERO: CRD42021276347).

Mother's Milk Messaging™: trial evaluation of app and texting for breastfeeding support

BACKGROUND

New mothers experience BF challenges but have limited evidence-based technology-enabled support.

OBJECTIVES

1) Determine if using the Mother's Milk Messaging™ app improved aspects of breastfeeding and breastfeeding rates and 2) Describe engagement as well as themes from the qualitative feedback on the app.

METHOD

Randomized Controlled Trial National sample of primiparous, singleton mothers recruited online and then randomized using stratification by language into three arms: 1) BF text messages plus app; 2) BF text messages, app and physician-moderated private Facebook (FB) group; 3) Attention control group who received injury prevention texts. Exclusive breastfeeding rates as primary outcome and knowledge/attitude, confidence, and social support as secondary outcomes. We determined engagement through analysis of app usage metrics. We conducted and content-coded interviews with participants to learn more about app usage and BF experience. Due to the nature of the intervention participants could not be blinded.

RESULTS

There were a total of 346 participants in the trial, with 227 in the Intervention (n = 154 group 1 and n = 156 group 2) and 119 in the control group. Because of minimal Facebook activity, the two intervention groups 1 and 2 were combined. There were no differences in breastfeeding exclusivity and duration. (NS). Women in the intervention arm reported significantly higher confidence with breastfeeding and perceived social support to the control group (p < .05). Greater than 80% registered the app and those that engaged with the app had higher scores with time. Mothers appreciated receiving text messages and videos with reliable information. No harm was reported in this study.

CONCLUSION

MMM increased confidence with breastfeeding and with gathering social supports. Exclusively BF was high in all participants. Mothers perceived it as useful and dependable especially the texting.

A qualitative research study of primary care physicians' views of telehealth in delivering postnatal care to women

BACKGROUND

The postpartum period is a critical time for women to optimise their physical and mental health. Primary care physicians (PCP) often manage postpartum women in the community setting after uneventful births. However, women encounter difficulties accessing care before and after their conventional 6-week physical review. Telehealth-based interventional studies have demonstrated their successful applications in several areas of postpartum care but is not widely adopted. The study aimed to explore the PCPs' views on their acceptability and perceived barriers of telehealth in delivering postpartum care to women in primary care.

METHODS

Twenty-nine PCPs participated in eleven in-depth interviews and four focus group discussions for this qualitative study conducted in Singapore. The purposively sampled PCPs had varied demographic background and medical training. Two investigators independently coded the audited transcripts. Thematic content analysis was performed using the codes to identify issues in the pertaining to the perceived usefulness, ease of use and attitudes towards telehealth in postpartum care as described in the "Telehealth Acceptance Model" framework.

RESULTS

Most PCPs perceived usefulness and ease of use of video consultation in delivering postpartum care. They recognised telehealth service to complement and support the current face-to-face postpartum care amidst the pandemic. However, training, leadership support, organizational infrastructure, healthcare financial policy and personal demographic profile influence their acceptance of a new care model for postnatal mothers.

CONCLUSION

Addressing the barriers and strengthening the facilitators will enhance PCPs' acceptance and utilisation of the proposed hybrid (telehealth and in-person) postnatal care model for mothers.

Use of telehealth: Evidence from French teleconsultation for women's healthcare, prior and during COVID-19 pandemic

Prior to the COVID-19 pandemic, French healthcare practitioners seldom used teleconsultations in France. COVID-19 has brought with it a great need for the use of teleconsultation and other interventions using digital technology. The study’s objective was to identify how French healthcare practitioners used teleconsultation for obstetrics and gynecology care services before and during COVID-19. Our study used a survey of French healthcare practitioners specializing in obstetrics and gynecology from 1 March 2020, to 31 April 2020. We first described the global picture of the teleconsultation context prior to COVID-19 and then during the first lockdown measures. For both contexts, we set up three aspects: 1- teleconsultation regarding providers’ ability; 2- teleconsultation with regards to its technological features; and 3- teleconsultation for which type of healthcare. Second, we mobilized logit models to study the determinant factors of teleconsultation use as well as what drives provider satisfaction with teleconsultation practice. We show the central role of training, and the importance of some main digital technology benefits, namely improving public health, responding to patients’ requests, and facilitating healthcare access. We also exhibit the importance of the limitations specifically related to the lack of convenience in digital technology use and the lack of trust in the digital service provided. Our results guide policy makers on suppliers’ motivation and needs for teleconsultation adoption. These results highlight the conditions for efficient use of teleconsultation.

A Novel, Cardiac-Derived Algorithm for Uterine Activity Monitoring in a Wearable Remote Device

Background: Uterine activity (UA) monitoring is an essential element of pregnancy management. The gold-standard intrauterine pressure catheter (IUPC) is invasive and requires ruptured membranes, while the standard-of-care, external tocodynamometry (TOCO)’s accuracy is hampered by obesity, maternal movements, and belt positioning. There is an urgent need to develop telehealth tools enabling patients to remotely access care. Here, we describe and demonstrate a novel algorithm enabling remote, non-invasive detection and monitoring of UA by analyzing the modulation of the maternal electrocardiographic and phonocardiographic signals. The algorithm was designed and implemented as part of a wireless, FDA-cleared device designed for remote pregnancy monitoring. Two separate prospective, comparative, open-label, multi-center studies were conducted to test this algorithm.

Methods: In the intrapartum study, 41 laboring women were simultaneously monitored with IUPC and the remote pregnancy monitoring device. Ten patients were also monitored with TOCO. In the antepartum study, 147 pregnant women were simultaneously monitored with TOCO and the remote pregnancy monitoring device.

Results: In the intrapartum study, the remote pregnancy monitoring device and TOCO had sensitivities of 89.8 and 38.5%, respectively, and false discovery rates (FDRs) of 8.6 and 1.9%, respectively. In the antepartum study, a direct comparison of the remote pregnancy monitoring device to TOCO yielded a sensitivity of 94% and FDR of 31.1%. This high FDR is likely related to the low sensitivity of TOCO.

Conclusion: UA monitoring via the new algorithm embedded in the remote pregnancy monitoring device is accurate and reliable and more precise than TOCO standard of care. Together with the previously reported remote fetal heart rate monitoring capabilities, this novel method for UA detection expands the remote pregnancy monitoring device’s capabilities to include surveillance, such as non-stress tests, greatly benefiting women and providers seeking telehealth solutions for pregnancy care.

Remote care and triage of obstetric patients with COVID-19 in the community: operational considerations

Background

During the SARS-CoV-2 (COVID-19) pandemic, routine antenatal care was disrupted, and pregnant women positive for COVID-19 were at increased risk of caesarean section, intensive care admission or neonatal unit admission for their baby. Virtual care and telehealth can reduce barriers to care and improve maternity outcomes, and adoption has been encouraged by health authorities in the United Kingdom.

Methods

Norfolk and Norwich University Hospitals Trust deployed a flexible maternity virtual ward (MVW) service using the Current Health platform to care for pregnant women during the pandemic. Patients were monitored either intermittently with finger pulse oximetry or continuously with a wearable device. We outline the MVW technology, intervention and staffing model, triage criteria and patient feedback, as an example of an operational model for other institutions.

Results

Between October 2021 and February 2022, 429 patients were referred, of which 228 were admitted to the MVW. Total bed-days was 1,182, mean length of stay was 6 days (SD 2.3, range 1–14 days). Fifteen (6.6%) required hospital admission and one (0.4%) critical care. There were no deaths. Feedback alluded to feelings of increased safety, comfort, and ease with the technology.

Conclusions

The MVW offered a safety net to pregnant women positive for COVID-19. It provided reassurance for staff, while relieving pressures on infrastructure. When setting up similar services in future, attention should be given to identifying clinical champions, triage criteria, technology and alarm selection, and establishing flexible escalation pathways that can adapt to changing patterns of disease.

Cardio-Obstetrics: the Next Frontier in Cardiovascular Disease Prevention

PURPOSE OF REVIEW

Internationally, cardiovascular disease (CVD) is the leading cause of death in women. With risk factors for CVD continuing to rise, early identification and management of chronic diseases such as hypertension, diabetes, and obstructive sleep apnea is necessary for prevention. Pregnancy is a natural stress test for women with risk factors who may be predisposed to CVD and offers a unique opportunity to not only recognize disease but also implement effective and long-lasting strategies for prevention.

RECENT FINDINGS

Prevention begins before pregnancy, as preconception screening, counseling, and optimization of chronic diseases can improve maternal and fetal outcomes. Throughout pregnancy, women should maintain close follow-up, continued reevaluation of risk factors, with counseling when necessary. Continued healthcare engagement during the "fourth trimester," 3 months following delivery, allows clinicians to continue monitoring the evolution of chronic diseases, encourage ongoing lifestyle counseling, and connect women with primary care and appropriate specialists if needed. Unfortunately, this postpartum period represents a major care gap, as a significant proportion of most women do not attend their scheduled visits. Social determinants of health including decreased access to care and economic instability lead to increased risk factors throughout pregnancy but particularly play a role in poor compliance with postpartum follow-up. The use of telemedicine clinics and remote monitoring may prove to be effective interventions, bridging the gap between physicians and patients and improving follow-up for at-risk women. While many clinicians are beginning to understand the impact of CVD on women, screening and prevention strategies are not often implemented until much later in life. Pregnancy creates an opportunity to begin engaging women in cardiovascular protective strategies before the development of the disease.

Michigan Plan for Appropriate Tailored Healthcare in Pregnancy Prenatal Care Recommendations: A Practical Guide for Maternity Care Clinicians

Prenatal care is an important preventive service designed to improve the health of pregnant patients and their infants. Prenatal care delivery recommendations have remained unchanged since 1930, when the 12-14 in-person visit schedule was first established to detect preeclampsia. In 2020, the American College of Obstetricians and Gynecologists, in collaboration with the University of Michigan, convened a panel of maternity care experts to determine new prenatal care delivery recommendations. The panel recognized the need to include emerging evidence and experience, including significant changes in prenatal care delivery during the COVID-19 pandemic, pre-existing knowledge of the importance of individualized care plans, the promise of telemedicine, and the significant influence of social and structural determinants of health (SSDoH) on pregnancy outcomes. Recommendations were derived using the RAND-UCLA appropriateness method, a rigorous e-Delphi method, and are designed to extend beyond the acute public health crisis. The resulting Michigan Plan for Appropriate Tailored Healthcare in pregnancy (MiPATH) includes recommendations for key aspects of prenatal care delivery: (1) the recommended number of prenatal visits, (2) the frequency of prenatal visits, (3) the role of monitoring routine pregnancy parameters (blood pressure, fetal heart tones, weight, and fundal height), (4) integration of telemedicine into routine care, and (5) inclusion of (SSDoH). Resulting recommendations demonstrate a new approach to prenatal care delivery that incorporates medical, SSDoH, and patient preferences, to develop individualized prenatal care delivery plans. The purpose of this document is to outline the new MiPATH recommendations and to provide practical guidance on implementing them in routine practice.

Telemedicine for medical abortion service provision in Mexico: A safety, feasibility, and acceptability study

OBJECTIVE

We aimed to obtain evidence about the safety, acceptability, and feasibility of a direct-to-patient telemedicine medical abortion service in Mexico's private health sector.

STUDY DESIGN

A prospective observational one-group study to evaluate a telemedicine abortion service, referred to as TeleAborto, was conducted at three private clinics and one non-clinician community-based provider. Information about the study was provided by phone, websites, and social media. Abortion seekers were screened for eligibility and underwent any pre-abortion tests requested by the study site at services close to home. Eligible participants received packages with abortion medication, analgesics, and instructions and a remote follow-up contact was scheduled for 7-14 days later. Primary outcomes include abortion outcome, management of adverse events, acceptability, and feasibility measures such as package reception and follow-up contact, and challenges to get pre- and post-abortion tests.

RESULTS

We conducted 581 screenings and sent 378 study packages, all successfully received, reaching abortion seekers in all 32 states. All participants took medications before 70 days gestational age as per study protocol. Abortion outcome was determined for 87% participants (330/378); 93% (306/330) had a successful abortion without intervention and 18 with intervention; six individuals decided to continue the pregnancy. Participants reported high satisfaction with TeleAborto, citing convenience as their most valued aspect (85%; 264/311).

CONCLUSIONS

This study showed that guided self-management telemedicine abortion is safe, acceptable, and feasible in Mexico. The model has the potential to close the access gap for indigenous and rural populations, particularly those that rely on public sector services.

The effect of a tele-educational intervention on modifying dysfunctional sexual beliefs of pregnant women: a randomized controlled trial

BACKGROUND & AIM

Some cultural scenarios in pregnancy and childbirth reinforce dysfunctional sexual beliefs that reverse changes in the couple's sexual life. The present study aimed to investigate the effect of education by sending text messages on modifying dysfunctional sexual beliefs in pregnant women.

METHODS & MATERIALS

This study is a randomized clinical trial, and 82 eligible pregnant women referred to educational-medical centers to receive prenatal care were randomly assigned to intervention or control group. The intervention group received 24 text messages during eight weeks (three text messages per week), and the control group received only routine care. Data was collected through a demographic questionnaire, reproductive profile, Spinner's Dyadic Adjustment Scale (DAS), and dysfunctional sexual beliefs questionnaire. Both groups completed the questionnaires before and one week after the intervention. Independent t-test, paired t-test, and analysis of covariance was used to analyze the data.

RESULTS

The findings revealed no statistically significant difference in the baseline Dyadic Adjustment mean scores of control (132.4 ± 11.01) and intervention (130.10 ± 10.66) groups. Paired t-test analysis showed that the mean score of dysfunctional sexual beliefs was significantly decreased from (29 ± 7.61) at baseline compared to one week after intervention (10.54 ± 6.97) (p < 0.001). Analysis of covariance test to compare the scores of dysfunctional sexual beliefs in the intervention group (10.54 ± 6.97) and control group (26.80 ± 7.80) showed a statistically significant difference (p < 0.01) with an effect size of 0.67.

CONCLUSION

This study showed that sending text messages to mobile phones of pregnant women has corrected their dysfunctional sexual beliefs. Therefore, this approach can be used in pregnancy care to promote women's sexual health.

TRIAL REGISTRATION

Clinical trial registry: IRCT20161230031662N9 .

Impact of COVID-19 on gynecologic and obstetrical services at two large health systems

BACKGROUND

The COVID-19 pandemic disrupted medical care in the US, leading to a significant drop in utilization of some types of health services. We sought to quantify how the pandemic influenced obstetrics and gynecology care at two large health care organizations.

MATERIALS AND METHODS

Comparing 2020 to 2019, we quantified changes to obstetrics and gynecology care at two large health care organizations in the United States, Allegheny Health Network (in western Pennsylvania) and Johns Hopkins University (in Maryland). The analysis considered the numbers of surgical encounters, in-person visits, and telemedicine visits. For each system, we quantified temporal changes in surgical volume, in-person and telemedicine visits, and financial impact related to professional fee revenues. We used segmented regression to evaluate longitudinal effects.

RESULTS

At both institutions, the volume of care was similar in the first few months of 2020 compared to 2019 but dropped precipitously in March 2020. From April to June 2020, surgical volumes were 67% of the same period in 2019 at Allegheny Health and 48% of the same period in 2019 at Johns Hopkins. During that same interval, televisits accounted for approximately 21% of all ambulatory care at both institutions. Although surgical and ambulatory volumes recovered in the second half of 2020, annual surgical volumes in 2020 were significantly lower than 2019 at both institutions (p<0.05) and 2020 ambulatory volumes remained significantly lower at Johns Hopkins (p = .0006). Overall, revenues in 2020 were 91% of 2019 revenues for both institutions.

CONCLUSIONS

Obstetrical and gynecologic ambulatory visits and gynecologic surgeries were sharply reduced during the COVID-19 pandemic. Although care volumes returned to 2019 levels in late 2020, we observed an overall reduction in the volume of care provided and a 9% reduction in professional revenue for both institutions.

Source of Prenatal Care and Nonreceipt of Postpartum Health Care in the United States

Background: Prior work finds that receiving prenatal care is positively associated with receiving postpartum health care. However, less is known about whether postpartum health care receipt varies by the source of prenatal care. Materials and Methods: This study analyzed data from the 2011-2017 U.S. National Survey of Family Growth to examine associations between the source of prenatal care (private care facility, public/community health facility, other source, or no prenatal care) and nonreceipt of postpartum health care using weighted multivariable logistic regression models. This analysis did not require institutional review board approval. Results: Of the total estimation sample (N = 1,190), 10.8% of respondents reported not receiving postpartum health care. There were no statistically significant differences in nonreceipt of postpartum health care between women who received prenatal care from a public/community health facility or other source and those who attended a private facility. However, women who received no prenatal care had a higher likelihood of not receiving postpartum health care compared with those who attended a private facility (adjusted odds ratio 8.7, 95% confidence interval 4.3-17.5). Conclusions: Receiving prenatal care, regardless of the source, reduced the likelihood of a woman not receiving postpartum health care within a year after delivery. Interventions aimed at women who did not receive any prenatal care may be critical for improving postpartum health care use and subsequently preventing adverse maternal outcomes.

Lessons Learned from the Pandemic—We Can Do Better

Many breastfeeding issues can be addressed with postpartum lactation support. However, COVID-19 presented new challenges for the breastfeeding dyad with a disruption in normal healthcare practices. The objective of the study was to examine new mothers’ breastfeeding intentions and practices during the COVID-19 pandemic. A 40-question survey was administered to a convenience sample of 50 new mothers during April–June 2020. Findings revealed most mothers (52%) had the intention to breastfeed for one year or longer. However, at the time of hospital discharge only 34% of mothers were exclusively breastfeeding and 60% of mothers were supplementing with formula within the first four days of life. Recommendations for bridging the gap between the hospital and primary care setting include educating providers and nurses on breastfeeding management practices, increasing hospital lactation support, and using telelactation to provide remote support to mothers.

Telehealth for Contraceptive Services During the COVID-19 Pandemic: Provider Perspectives

Background

Telehealth use rapidly increased during the COVID-19 pandemic, including for contraceptive care (e.g., counseling and method provision). This study explored providers’ experiences with contraceptive care via telehealth.

Methods

We conducted a survey with open-ended responses among contraceptive providers across the United States. The study population included physicians, nurse practitioners, health educators, and other health professionals (n = 546). Data were collected from April 10, 2020, to January 29, 2021. We conducted qualitative content analysis of the open-ended responses.

Results

Providers highlighted the benefits of telehealth, including continuing access to contraceptive services and accommodating patients who faced challenges attending in-person contraceptive visits. Providers at school-based health centers reported telehealth allowed them to reach young people while schools were closed. However, many providers noted a lack of patient awareness about the availability of telehealth services and disparities in access to technology. Providers felt there was less personal connection in virtual contraceptive counseling, noted challenges with confidentiality, and expressed concern about the inability to provide the full range of contraceptive methods through telehealth alone.

Conclusions

The pandemic significantly impacted contraceptive health care delivery. Telehealth has sustained access to contraception in important ways, but has been accompanied by various challenges, including technological access and confidentiality. As hybrid models of care evolve, it is important to assess how telehealth can play a role in providing contraceptive care while addressing its barriers.

The impact on postpartum care by telehealth: a retrospective cohort study

BACKGROUND

During the COVID-19 pandemic, our institution turned to telehealth as the primary method of postpartum care delivery.

OBJECTIVE

We aimed to determine the impact of telehealth on completion of postpartum care goals.

STUDY DESIGN

In a single-center retrospective cohort study, we compared a 14-week period, March to June 2019, before implementation of telehealth, with the same calendar months after implementation during 2020. Patients with a postpartum visit scheduled at our institution during the study period were included. To demonstrate a 10% difference in attendance to the postpartum visit in the postimplementation compared with the preimplementation group, a power analysis calculation resulted in a requirement of at least 356 subjects per group. Our primary outcome was attendance to the postpartum visit. Secondary outcomes included completion of postpartum depression screening, contraception selection, breastfeeding status at postpartum visit, completion of 2-hour glucose tolerance test postpartum for those with gestational diabetes mellitus, and cardiology follow-up when recommended. Multivariable logistic regression with backward elimination was used to control for confounders.

RESULTS

Of the 1579 patients meeting inclusion criteria, 780 were in the preimplementation group and 799 in the postimplementation group. Subjects in the postimplementation group were at 90% increased odds of attending a postpartum visit compared with those in the preimplementation group, even when controlling for race, prenatal care provider, parity, gestational age at delivery, and insurance status (82.9% vs 72.4%; P<.001; adjusted odds ratio, 1.90; 95% confidence interval, 1.47-2.46). Patients in the postimplementation group were also more likely to be screened for postpartum depression (86.3% vs 65.1%; P<.001). Although subjects in both groups were equally likely to choose contraception, those in the postimplementation group were less likely to select long-acting reversible contraception or permanent sterilization (26.2% vs 33.2%; P=.03). There was no significant difference in breastfeeding status, postpartum 2-hour glucose tolerance test completion, or cardiology follow-up between groups.

CONCLUSION

Availability of telehealth during the COVID-19 pandemic is associated with increased postpartum visit attendance and postpartum depression screening. However, telehealth was also associated with a decrease in use of long-acting reversible contraception or permanent sterilization.

Assessing differences in contraceptive provision through telemedicine among reproductive health providers during the COVID-19 pandemic in the United States

Background

Providers faced challenges in maintaining patient access to contraceptive services and public health safety during the COVID-19 pandemic. Due to increased barriers to care, providers increasingly used telemedicine for contraceptive care, curbside services, mail-order pharmacies, and on-line or home delivery of contraceptive methods, including self-administration of subcutaneous depo medroxyprogesterone acetate (DMPA-SQ). To better understand how reproductive health providers adapted service provision during the pandemic, this study assessed clinical practice changes and strategies providers adopted throughout the United States to maintain contraceptive care, particularly when clinics closed on-site, and the challenges that remained in offering contraceptive services, especially to marginalized patient populations.

Methods

We surveyed U.S. providers and clinic staff (n = 907) in April 2020–January 2021, collecting data on contraceptive service delivery challenges and adaptations, including telemedicine. We assessed clinical practice changes with multivariate regression analyses using generalized linear models with a Poisson distribution and cluster robust standard errors, adjusting for clinic patient volume, practice setting, region, Title X funding, and time of survey.

Results

While 80% of providers reported their clinic remained open, 20% were closed on-site. Providers said the pandemic made it more difficult to offer the full range of contraceptive methods (65%), contraceptive counseling (61%) or to meet the needs of patients in marginalized communities (50%). While only 11% of providers offered telemedicine pre-pandemic, most offered telemedicine visits (79%) during the pandemic. Some used mail-order pharmacies (35%), curbside contraceptive services (22%), and DMPA-SQ for self-administration (10%). Clinics that closed on-site were more likely to use mail-order pharmacies (aRR 1.83, 95% CI [1.37–2.44]) and prescribe self-administered DMPA-SQ (aRR 3.85, 95% CI [2.40–6.18]). Clinics closed on-site were just as likely to use telemedicine as those that remained open. Among clinics using telemedicine, those closed on-site continued facing challenges in contraceptive service provision.

Conclusions

Clinics closing on-site were just as likely to offer telemedicine, but faced greater challenges in offering contraceptive counseling and the full range of contraceptive methods, and meeting the needs of marginalized communities. Maintaining in-person care for contraceptive services, in spite of staffing shortages and financial difficulties, is an important objective during and beyond the pandemic.

Providers faced challenges in maintaining patient access to contraceptive services and public health safety during the COVID-19 pandemic. Due to increased barriers to care, providers increasingly used telemedicine for contraceptive care as well as using curbside services, mail-order pharmacies, and on-line or home delivery of contraceptive methods, including self-administration of subcutaneous depo medroxyprogesterone acetate (DMPA-SQ). This study examined use of telemedicine and other clinical practice changes among U.S. contraceptive providers during the COVID-19 pandemic. We surveyed providers (n=907) in April 2020–January 2021, collecting data on contraceptive service delivery challenges and adaptations, including telemedicine. Our analyses showed that, in response to the pandemic, many clinics adopted telemedicine to offer contraceptive services. Furthermore, clinics that were closed on-site were just as likely to start offering telemedicine visits during the pandemic as those that remained open. Despite these adaptions, clinics still faced challenges in offering the full range of contraceptive methods, providing contraceptive counseling, and meeting the needs of patients in marginalized communities. Offering telemedicine visits during the pandemic did not reduce the challenges in offering contraceptive services. Few studies have focused on providers and the clinical practice changes they rapidly achieved to maintain contraceptive access for their patients during the pandemic. Our results highlighted that telemedicine should be considered as a complement to on-site care because of the challenges in providing full services without in-person visits. Maintaining in-person care for contraceptive services, in spite of staffing shortages and financial difficulties, is an important objective during and beyond the pandemic.

Evaluation of a Rapid Implementation of Telemedicine for Delivery of Obstetric Care During the COVID-19 Pandemic

Introduction: The aim of this evaluation was to assess the rapid implementation of obstetric telemedicine during the COVID-19 pandemic using the Consolidated Framework in Implementation Research (CFIR) evaluation framework. Study Design: Following 1 month of telemedicine implementation, obstetric providers at the University of South Florida clinic completed qualitative surveys and in-depth interviews about the implementation of obstetric telemedicine in the clinic guided by the CFIR evaluation framework. Results: Overall, providers considered obstetric telemedicine comparable to traditional in-person clinic visits and acknowledged that they were adequately prepared for the telemedicine implementation. They perceived that obstetric telemedicine mostly met the needs of patients in terms of convenience and comfort of visits, decreased exposure to COVID-19 infection, and the ability of the patient to listen to fetal heart sounds if at-home doppler monitoring was available. Conclusions: The implementation of the obstetric telemedicine care model was deemed a favorable alternative option for patients during the COVID-19 pandemic.

Seizing the Window of Opportunity Within 1 Year Postpartum: Early Cardiovascular Screening

Background Our objective was to assess new chronic hypertension 6 to 12 months postpartum for those with hypertensive disorder of pregnancy (HDP) compared with normotensive participants. Methods and Results We performed a prospective cohort study of participants with singleton gestations and no known preexisting medical conditions who were diagnosed with HDP compared with normotensive women with no pregnancy complications (non-HDP). Participants underwent cardiovascular risk assessment 6 to 12 months after delivery. Primary outcome was onset of new chronic hypertension at 6 to 12 months postpartum. We also examined lipid values, metabolic syndrome, prediabetes, diabetes, and 30-year cardiovascular disease (CVD) risk. Multivariable logistic regression was performed to assess the association between HDP and odds of a postpartum diagnosis of chronic hypertension while adjusting for parity, body mass index, insurance, and family history of CVD. There were 58 participants in the HDP group and 51 participants in the non-HDP group. Baseline characteristics between groups were not statistically different. Participants in the HDP group had 4-fold adjusted odds of developing a new diagnosis of chronic hypertension 6 to 12 months after delivery, compared with those in the non-HDP group (adjusted odds ratio, 4.60 [95% CI, 1.65-12.81]), when adjusting for body mass index, parity, family history of CVD, and insurance. Of the HDP group, 58.6% (n=34) developed new chronic hypertension. Participants in the HDP group had increased estimated 30-year CVD risk and were more likely to have metabolic syndrome, a higher fasting blood glucose, and higher low-density lipoprotein cholesterol. Conclusions Participants without known underlying medical conditions who develop HDP have 4-fold increased odds of new diagnosis of chronic hypertension by 6 to 12 months postpartum as well as increased 30-year CVD risk scores. Implementation of multidisciplinary care models focused on CVD screening, patient education, and lifestyle interventions during the first year postpartum may serve as an effective primary prevention strategy for the development of CVD.

The Use of Telemedicine in Pediatric and Adolescent Gynecology

STUDY OBJECTIVE

To study the feasibility of virtual visits for ambulatory encounters in pediatric and adolescent gynecology DESIGN: A retrospective review SETTING: Boston Children's Hospital PARTICIPANTS: Patients who were seen virtually through the Division of Gynecology between January 1, 2020 and June 1, 2020 MAIN OUTCOME MEASURE(S): Patient demographics, visit diagnoses, and operational characteristics of the completed visits RESULTS: There were a total of 654 virtual visits for 614 patients. Ninety-one percent (n=558) of patients were in-state, and the median age of patients was 17 years (range 0 - 37 years). The majority were return visits (n=502, 76.8%), 115 (17.6%) were new patient visits, and 32 (4.89%) were post-operative visits. The median virtual visit duration was 12 minutes and 39 seconds (range 5 minutes to over 1 hour). The most common gynecologic diagnoses were dysmenorrhea/endometriosis (n=485, 74.2%), abnormal uterine bleeding (n=225, 34.4%), and pelvic pain (n=82, 12.5%). The percentage of virtual visits which required an in-person follow-up visit within 90 days was low (n=14, 2.1%). Five of these were within 30 days from the initial virtual visit, 6 were within 60 days, and 3 were within 90 days.

CONCLUSION

Telemedicine is a feasible method for expanding access to, and healthcare delivery for, pediatric and adolescent gynecology, with low rates of short interval in-person follow-up required. Virtual visits can be conducted for a range of patients with a variety of gynecologic conditions, upon initial presentation and follow-up.

Remote gestational weight gain monitoring in a large low-risk US population

Background

Over the past decade there have been rapid advancements in telemedicine and mobile health technology (mHealth) and rapid increases in adoption of these technologies among OB-GYN providers. Mobile technology is routinely used in the general adult population to simplify monitoring of food intake and weight. Studies have demonstrated that weight loss achieved via remote monitoring, through use of wi-fi scales and web applications, is similar to weight loss achieved with in-person support. These technologies also increase flexibility for subjects and providers. However, there has been limited large-scale research to evaluate the use of these technologies to improve adherence to weight-gain recommendations during pregnancy.

Objectives

To evaluate gestational weight gain tracking in a large low-risk obstetrical population using remote patient monitoring and a mobile phone app.

Methods

Self-reported age, height, estimated due date, and weight data were extracted from low-risk, singleton pregnancies entered from 50,769 participants who were enrolled in the BabyScripts TM phone app between 1 January 2016 and 1 March 2020. After data cleaning, 15,468 participants were included the final analysis. Linear regression and Spearman's correlation were used to examine the relationships between total weight gain, rate of weight gain, body mass index (BMI), postpartum weight loss, and app engagement.

Results

The average weight gain in the first, second, and third trimester were 0.09 ± 1.8 kg, 4.2 ± 3.3 kg, and 3.9 ± 3.9 kg, respectively. The average rate of weight gain per week for the second and third trimesters were 0.5 ± 0.4 kg/wk and 0.6 ± 0.8 kg/wk, respectively. Participants with higher initial BMI had slower rate of weight gain than those with lower initial BMI (r = -0.24, r = -0.05, for second and third trimester, respectively). Overall, 21.4% of participants met the Institutes of Medicine (IOM) recommendation for total weight gain during pregnancy. Patients who were highly engaged with the mobile app had increased adherence to the IOM guidelines (29.8% vs. 9.4%, p < 0.001). A larger proportion of highly engaged patients adhered to the IOM guidelines for rate of weight gain in the second and third trimester, compared to the lowest engaged patients (12.7% vs. 6.8%, p < 0.001). On average, participants lost 8.8 ± 3.3 kg over an average of 8.1 ± 4.6 weeks in the immediate postpartum period. This weight loss was positively associated with engagement (r = 0.3, p < 0.001).

Comments

Engagement with the mobile app was associated with increased adherence to the IOM gestational weight gain guidelines and with increased postpartum weight loss. Use of remote patient monitoring in conjunction with mHealth technology may be a strategy to improve adherence to IOM guidelines.

STORK: Collaborative Online Monitoring of Pregnancies Complicated with Gestational Diabetes Mellitus

Background: A novel digital platform, named STORK, was developed in the COVID-19 pandemic when clinic visits were restricted. A study of its clinical use during the pandemic was conducted. The study aims to advance the state of the art in monitoring and care of pregnancies complicated with gestational diabetes mellitus (GDM) via online collaboration between patients and care providers. Methods: This study involved 31 pregnant women diagnosed with GDM and 5 physicians. Statistical comparisons were made in clinic-visit frequency and adverse outcomes between the STORK group and a historical control group of 32 women, compatible in size, demographics, anthropometrics and medical history. Results: The average number of submitted patient measurements per day was 3.6±0.4. The average number of clinic visits was 2.9±0.7 for the STORK group vs. 4.1±1.1 for the control group (p<0.05). The number of neonatal macrosomia cases was 2 for the STORK group vs. 3 for the control group (p>0.05); no other adverse incidents. Conclusions: The patient compliance with the pilot use of STORK was high and the average number of prenatal visits was reduced. The results suggest the general feasibility to reduce the average number of clinic visits and cost, with enhanced monitoring, case-specific adaptation, assessment and care management via timely online collaboration.

Virtual Prenatal and Postpartum Care Acceptability Among Maternity Care Providers

Introduction

The Covid-19 pandemic and statewide stay-at-home orders abruptly impacted clinic operations necessitating the incorporation of telehealth. Uptake of telehealth is multifaceted. Clinician acceptance is critical for success. The aim of this study is to understand maternity care providers’ acceptance of and barriers to providing virtual maternity care.

Methods

Providers completed a baseline and 3-month follow up survey incorporating the validated implementation outcome measures, feasibility of intervention measure (FIM), intervention appropriateness measure (IAM), and acceptability of intervention measure (AIM).Statistical analyses evaluated differences between groups in this small convenience sample to understand trends in perceptions and barriers to telehealth. While not intended to be a qualitative study, a code tree was used to evaluate open-ended responses.

Results

Baseline response rate 50.4% (n = 56). Follow-up retention/response-rate 68% (n = 38). Most reported no prior telehealth experience. 94% agreed with the FIM, decreasing to 92% at follow-up. 80% (prenatal) and 84% (postpartum) agreed with the IAM. Agreement with the AIM increased to 83%.Differences in the FIM and AIM found by division (p < 0.01) and years in practice (p < 0.01). Identified barriers included patient lack of essential tools, inadequate clinic support, and patients prefer in person visits. Themes that emerged included barriers, needs, and areas of success.

Discussion

Telehealth was found to be feasible, appropriate, and acceptable across provider types and divisions. Improving patient/provider access to quality equipment is imperative. Future research must address how and when to incorporate telehealth.

Maternal, Sexual and Reproductive Health in Marginalised Areas: Renewing Community Involvement Strategies beyond the Worst of the COVID-19 Pandemic

The COVID-19 pandemic and resultant lockdowns have brought unprecedented challenges for Maternal, Sexual and Reproductive Health (MSRH) services. Components of MSRH services adversely affected include antenatal, postnatal, and newborn care; provision of family planning and post-abortion care services; sexual and gender-based violence care and prevention; and care and treatment for sexually transmitted infections including HIV. Resuscitating, remodeling or inventing interventions to restore or maintain these essential services at the community level, as a gateway to higher care, is critical to mitigating short and long-term effects of the COVID-19 pandemic on essential MSRH. We propose a possible framework for community involvement and propose integrating key information, education, and communication of MSRH messages within COVID-19 messages.

Association of admission unit and birth satisfaction during induction of labor

OBJECTIVE

As induction of labor (IOL) becomes more common, hospitals must adjust to accommodate longer length of stays on labor and delivery. An alternative to reduce the length of time spent on labor and delivery during an IOL is to perform cervical ripening on an antepartum unit. However, this may affect patient satisfaction and knowledge about the birthing process. This study aimed to evaluate whether cervical ripening conducted in an antepartum unit, rather than on a labor and delivery unit, was associated with changes in patient satisfaction with birth experience and baseline knowledge about IOL. Additionally, the study aimed to understand how patients would prefer to receive education on the IOL process.

METHODS

This prospective observational study recruited English and Spanish-speaking patients at or after 39 weeks and 0 days gestation who were admitted for IOL. Consenting patients completed a preliminary survey containing sociodemographic and obstetric information as well as a previously validated survey on IOL knowledge on admission. Within 48 h of delivery, patients completed a follow-up survey including a validated birth satisfaction survey, the Birth Satisfaction Scale-Revised, and questions eliciting their preferred IOL education method. Data analyses compared patients who were admitted to antepartum for IOL to those admitted directly to labor and delivery. Multivariate analyses adjusted for sociodemographic and obstetric differences between the two groups. The primary outcomes were scores on the Birth Satisfaction Scale-Revised and on a test examining IOL knowledge. Secondary outcomes included preferred method of IOL education, obstetric outcomes, and neonatal outcomes.

RESULTS

A total of 277 eligible patients were approached from October 2020 to March 2021. Of the 216 (78%) that consented, 159 (74%) completed the follow-up survey and were subsequently included in this analysis. Individuals admitted directly to antepartum (n = 122) more commonly self-identified as Latina, Latin American, or Hispanic (27.9% vs. 8.1%, p = .01) and were nulliparous (68.0% vs. 21.6%, p < .001) compared to participants admitted to labor and delivery for IOL (n = 37). Patients admitted to labor and delivery were more likely to undergo elective induction (29.7% vs. 9.8%, p = .006). Admission unit was not associated with differences in birth satisfaction scores or obstetric or neonatal outcomes. However, after controlling for potential confounders, patients admitted to the antepartum unit correctly answered a greater percentage of questions assessing IOL knowledge compared to patients admitted to labor and delivery (73.9% vs. 62.3%, adjusted mean difference (aMD) 12.6 [95% CI 7.2, 18.0]). Patients in both groups indicated preference for reviewing an induction checklist with a provider during prenatal care (59.1%) or using a technology-based intervention (37.1%) over attending in-person classes (3.1%) to learn more about IOL.

CONCLUSION

Unit of admission for IOL is not associated with satisfaction with birth experience but is associated with patient knowledge of IOL. This suggests that IOL may be initiated in less acute units than labor and delivery without altering birth experience and may potentially allow for increased patient knowledge. Additionally, IOL checklists or technology-based education may help to further increase patient knowledge about IOL.

Obstetrical Telehealth and Virtual Care Practices During the COVID-19 Pandemic

The coincidence of a global pandemic with 21st-century telecommunication technology has led to rapid deployment of virtual obstetric care beginning in March of 2020. Pregnancy involves uniquely time-sensitive health care that may be amenable to restructuring into a hybrid of telemedicine and traditional visits to optimize accessibility and outcomes. The coronavirus disease 2019 pandemic has provided an unprecedented natural laboratory to explore how virtual obstetric care programs can be developed, implemented, and maintained, both as a contingency model for the pandemic and potentially for the future. Here, we discuss the role of telehealth and virtual care for pregnancy management in the coronavirus disease 2019 pandemic, as well as anticipated barriers, challenges, and strategies for success for obstetric telemedicine.

Access to Contraceptives in School-Based Health Centers: Progress and Opportunities

INTRODUCTION

The U.S. has a higher adolescent pregnancy rate than other industrialized countries. School-based health centers can improve access to contraceptives among youth, which can prevent unplanned pregnancies. This cross-sectional study examines the characteristics and predictors of contraceptive provision at school-based health centers in 2016-2017 and changes in and barriers to provision between 2001 and 2017.

METHODS

In 2020-2021, the authors conducted analyses of the National School-Based Health Care Census data collected from 2001 to 2017. The primary outcome of interest was whether adolescent-serving school-based health centers dispense contraceptives, and a secondary outcome of interest was the policies that prohibit school-based health centers from dispensing contraceptives. A multivariate regression analysis examined the associations between contraceptive provision and various covariates, including geographic region, years of operation, and provider team composition.

RESULTS

Less than half of adolescent-serving school-based health centers reported providing contraceptives on site. Those that provided contraceptives were more likely located in the Western and Northeastern regions of the U.S., older in terms of years of operation, and staffed by a wide variety of health provider types. Among school-based health centers that experienced policy barriers to providing access to contraceptive methods, most attributed the source to the school or school district where the school-based health center was located.

CONCLUSIONS

School-based health centers are an evidence-based model for providing contraceptives to adolescents but not enough are providing direct access. Understanding the predictors, characteristics, and barriers influencing the provision of contraceptives at school-based health centers may help to expand the number doing so.

Role of Telemedicine in Diabetes Management

INTRODUCTION

Telemedicine is a growing arena that may increase access to care for patients with diabetes. It has more relevance for rural populations or those with limited physical access to health care, for improving diabetes care. Telemedicine can also be used to offer diabetes self-education and transportation barriers for patients living in under-resourced areas or with disabilities.

METHOD

"This review explores the landscape of telemedicine approaches and evidence for incorporation into general practice.

RESULTS & DISCUSSION

Telehealth platforms have been shown to be both feasible and effective for health care delivery in diabetes, although there are many caveats that require tailoring to the institution, clinician, and patient population. Research in diabetes telehealth should focus next on how to increase access to patients who are known to be marginalized from traditional models of health care.

Patient Preferences for Receiving Gender-Affirming Hormone Therapy

Purpose

To characterize patient preferences regarding gender-affirming hormone therapy (HT) providers and telemedicine use.

Methods

Between May and October 2019, a survey was administered to adult patients attending a tertiary medical center's HT clinic. The survey included questions on demographics, barriers to care, and preferences for HT follow-up care. Interest in telemedicine was measured using a Likert scale. Multivariable logistic regression was used to identify patient factors associated with interest in telemedicine.

Results

Among 111 patients, 63.1% (n=70) preferred an in-person visit with a specialist and 21.6% (n=24) preferred a video visit with their specialist. While only 15.3% (n=17) preferred follow-up with a primary care provider (PCP), 71.0% (n=80) felt comfortable transitioning future care to a PCP. Notably, 52.3% (n=58) of patients were interested in a telemedicine visit. Factors associated with interest in telemedicine included identifying as a transgender man (aOR 3.94, 95% CI [1.24-12.53], p=0.02), minority race/ethnicity (aOR 6.71, 95% CI [1.79-25.17], p=0.005), no need to travel (aOR 3.34, 95% CI [1.14-9.85], p=0.03), no concerns about video visits (aOR 14.66, 95% CI [4.34-49.56], p<0.0001), and concern about their PCP offering a broad range of gender services (aOR 8.63, 95% CI [2.41-29.67], p=0.0006).

Conclusions

Patients presenting for HT follow-up prefer continued care with a specialist. However, patients were willing to transition care to PCPs and were interested in telemedicine before the COVID-19 pandemic.

Prenatal telemedicine during COVID-19: patterns of use and barriers to access

Objective

To evaluate patient experience with a prenatal telemedicine visit and identify barriers to accessing telemedicine among rural pregnant people in northern New England during the beginning of the COVID-19 pandemic.

Materials and Methods

We conducted a postvisit electronic survey of pregnant people who successfully participated in a prenatal telemedicine visit at a rural academic medical center in Northern New England. Nineteen questions were included in 5 domains: (1) engagement with prenatal care; (2) barriers to telemedicine and in person healthcare; (3) experience of prenatal care; (4) remote pregnancy surveillance tools; and (5) sources of COVID-19 information.

Results

Responses were obtained from 164 pregnant people. Forty percent of participants had participated in an audio-only telemedicine visit, and 60% in a video telemedicine visit. The visit was easy or somewhat easy for 79% of respondents and somewhat difficult or difficult for 6.8%. The most common barrier to accessing telemedicine was poor internet or phone connectivity, followed by childcare responsibilities, lack of equipment, and lack of privacy. Participants also engaged in additional remote prenatal care including phone calls with registered nurses (7.6%), communication with the obstetrics team through a secure health messaging portal (21.1%), and home health monitoring (76.3%).

Discussion and Conclusions

In this survey, evaluating the experience of pregnant people participating in a prenatal telemedicine visit during the COVID-19 pandemic, respondents had a positive experience with telemedicine overall, but also identified significant barriers to participation including issues with connectivity and lack of equipment for the visit. Most participants used telemedicine in combination with other tools for remote self-care.

To protect pregnant patients from infection during the COVID pandemic, maternity care providers turned to video and phone visits (“telemedicine”) to provide as much prenatal care as possible. To evaluate this change in our prenatal care program, we surveyed 164 pregnant people who had participated in a virtual prenatal visit about their care. Participants reported both positive and negative experiences, ranging from appreciation for having a safer option than in-person visits during the pandemic, to problems due to poor internet connection, lack of privacy, and lack of access to necessary equipment. Although 77.4% of respondents indicated they would recommend telemedicine to a friend, our program evaluation highlights the fact that the ability to participate in virtual care is not equally distributed. Unless steps are taken to address this problem, relying on telemedicine for a significant portion of prenatal care could result in widening disparities in prenatal care and outcomes. Policymakers and healthcare systems which provide telemedicine must address issues of access to technology and connectivity to avoid adding to maternal health disparities.

Triage of antenatal care through telehealth during COVID-19 pandemic in a tertiary care centre of North India

Background:

Telemedicine facilitates patient care in various fields including antenatal care. Its application and usefulness need objectification and can be a guide to using this service in the care of pregnant women.

Material and Methods:

This was a prospective observational study conducted from May 2020 to December 2020. Following the telemedicine practice guideline of the country, 3,360 teleconsultations were sought by 862 antenatal patients. The duration of each call, an indication of referral and pregnancy risk stratification were noted. Further management was classified into three categories depending upon the need for an immediate hospital visit, no hospital visit or scheduled visit after at least 48 h after the first contact.

Results:

The antenatal cases were referred for either maternal, foetal or both indications in 24.7, 54.8 and 20.5% of the cases, respectively. Women were classified as low risk (61.6%), high risk (35.7%) and severe risk (2.7%). In 1.4% of the patients, history and review of the records could not be done through telemedicine. The average time spent was 16.6 min for the first contact and 3.1 min for subsequent contacts. Further management was done with immediate visits in 385 (45.3%), scheduled hospital visits in 292 (34.3%) women and no tertiary care hospital visit in 173 (20.4%).

Discussion:

Women (20.4%) not called to the maternal-foetal medicine department of the institute were managed along with the treating obstetrician and no difference in pregnancy outcome was noted.

Conclusion:

Antenatal care can be provided following triage over teleconsultation and 1.4% of the women may not be able to use telehealth.

Use of Telehealth Services for Prenatal Care in Mississippi: Comparison of Pre-COVID-19 Pandemic and Pandemic Obstetric Management

BACKGROUND

The SARS-CoV-2 (COVID-19) pandemic resulted in major shifts in service delivery for patient care not involving COVID-19 illness. The preexisting telehealth infrastructure in Mississippi allowed the state to rapidly expand the scope of telehealth programs. Little research has been done to examine the use of telehealth during the COVID-19 pandemic and its impact on the delivery of care during pregnancy and outcomes associated with pregnancy. The objectives of this study are to (1) describe prenatal care practices during the height of the first wave of the COVID-19 pandemic, compared to the immediate prepandemic time period, and (2) explore maternal and birth outcomes during these time periods.

METHODS

This study was conducted as a retrospective historical cohort study from medical records at one Maternal Care Level IV (Regional Perinatal Health Care Center) in Mississippi and its affiliated centers. The participant cohort was inclusive of women who received prenatal care prior to a single birth delivery between May 1, 2020, and January 31, 2021. The pandemic cohort was defined through the timeframe of the included participants' end-term prenatal care, with reference to the beginning of the COVID-19 pandemic. The prepandemic cohort received a majority of their prenatal care prior to the COVID-19 pandemic.

RESULTS

There were 1,894 women included. Among them, 620 (32.77%) completed the majority of their end-term pregnancy in the pre-COVID-19 time period and 1,272 (67.23%) completed the end-term pregnancy during the pandemic. The odds ratio for patients from the pandemic cohort of scheduling telehealth visits compared to not scheduling telehealth visits is 8.19 (95% CI: 3.98, 16.86) times the odds ratio for patients from the prepandemic cohort. The pandemic exposure as well as infant's gestational age and very low birth weight (VLBW) show significant effects on the infant's living status in the univariate logistic regression. However, after controlling for the infant's gestational age and VLBW, we did not detect a significant effect of pandemic exposure.

CONCLUSION

This study demonstrated a very small reliance of telehealth for the medical supervision of pregnant women during the COVID-19 pandemic. This is likely because of the essential physical examinations that occur in women who are considered to be at high risk for poor maternal and birth outcomes. Additional studies on the impact of COVID-19 infection on maternal and infant outcomes are also needed as there may be important risk factors not yet identified for poor maternal or birth outcomes.

Impact of Coronavirus Disease 2019 (COVID-19) On Contraception Use in 2020 and up until the end of April 2021 in France

Objectives

To assess the impact of the COVID-19 pandemic on the use of reimbursed contraceptives in France after 15 months of the pandemic, according to age-group and updating previous data only pertaining to the first lockdown (2 months).

Study design

We conducted a national register-based study by extracting all reimbursements of oral contraceptives (OC), emergency contraception (EC), intrauterine devices (IUD), and implants from the French National Health Insurance database (SNDS), which includes and covers 99.5% of the French population, in 2018, 2019, 2020 and from January 1, 2021 to April30, 2021. We calculated the expected use of contraceptives in 2020 and 2021 in the absence of the pandemic, based on 2018 and 2019 usage and taking annual trends into account. We assessed the difference between observed and expected dispensing rates by contraceptive type and by age-group (≤18 years old, 18< age ≤25, 25< age ≤35, >35).

Results

Dispensing of all contraceptives decreased compared to expect dispensing numbers: −2.0% for OC, −5.3% for EC, −9.5% for LNG-IUS, −8.6% for C-IUD, and −16.4% for implant. This decrease in the dispensing of contraceptives was observed in all age-groups, but mainly concerned women under the age of 18 years (−22% for OC, −10% for EC, −37.2% for LNG-IUS, −36.4% for C-IUD, −26.4% for implant) and those aged 18 to 25 (−5.1% for OC, −11.9% for EC, −18.1% for LNG-IUS, −15.9% for C-IUD, −17.6% for implants).

Conclusions

Our study showed that the dispensing of contraceptives in France was markedly impacted by the COVID-19 pandemic. Prescriptions for long-acting contraceptive use and women under the age of 25 years were the most substantially impacted. Ensuring access to contraceptive methods during health emergencies must be a public health policy priority.

Implications

The COVID-19 pandemic strongly impacted the dispensing of contraceptives in France with varying degrees of decreased dispensing according to the type of contraceptive, the age-group and the level of pandemic-related restrictions. The impact of these restrictions on unintended pregnancy at the population level remains undetermined.

Successes and Challenges of Implementing Telehealth for Diverse Patient Populations: Attending to Prenatal Care during COVID-19

Background

Although telehealth appears to have been accepted among some obstetric populations before the COVID-19 pandemic, patients’ receptivity and experience with the rapid conversion of this mode of health care delivery are unknown.

Objective

In this study, we examine patients' prenatal care needs, preferences, and experiences during the COVID-19 pandemic, with the aim of supporting the development of successful models to serve the needs of pregnant patients, obstetric providers, and health care systems during this time.

Methods

This study involved qualitative methods to explore pregnant patients’ experiences with prenatal health care delivery at the onset of the COVID-19 pandemic. We conducted in-depth interviews with pregnant patients in the first and second trimester of pregnancy who received prenatal care in Cleveland, Ohio, from May to July 2020. An interview guide was used to probe experiences with health care delivery as it rapidly evolved at the onset of the pandemic.

Results

Although advantages of telehealth were noted, there were several concerns noted with the broad implementation of telehealth for prenatal care during the pandemic. This included concerns about monitoring the pregnancy at home; the need for additional reassurance for the pregnancy, given the uncertainties presented by the pandemic; and the ability to have effective patient-provider discussions via a telehealth visit. The need to tailor telehealth to prenatal health care delivery was noted.

Conclusions

Although previous studies have demonstrated that telehealth is a flexible and convenient alternative for some prenatal appointments, our study suggests that there may be specific needs and concerns among the diverse patient groups using this modality during the pandemic. More research is needed to understand patients' experiences with telehealth during the pandemic and develop approaches that are responsive to the needs and preferences of patients.

COVID-19 restrictive control measures and maternal, sexual and reproductive health issues: risk of a double tragedy for women in sub-Saharan Africa

Governments in sub-Saharan Africa implemented restrictive measures, including lockdowns, to curb the spread of COVID-19, without measures to protect women and girls. Evidence from previous humanitarian crises in resource-limited settings in sub-Saharan Africa indicates that these populations may suffer disproportionately from the effects of the restrictive control measures, owing to differential access to services, including maternal, sexual and reproductive health services. These services are time-sensitive, and delays and disruptions introduced by the restrictive measures may result in adverse consequences, including increased maternal and perinatal morbidity and mortality. Therefore, governments must find ways of ensuring continuity of these essential services during pandemic times, in a conducive environment, protective to both care providers and care seekers. Surveillance of the impact of the pandemic must be ongoing to inform practice and refine public health interventions, as the indirect effects of the COVID-19 pandemic might be worse than the direct effects.

Smartphone-based counseling and support platform and the effect on postpartum lactation: a randomized controlled trial

BACKGROUND

Human milk lactation provides health benefits for both the mother and infant. Patients commonly report stopping breastfeeding sooner than they planned. Interventions with proper accessible counseling and support to the mother can potentially increase lactation rates and duration.

OBJECTIVE

This study aimed to investigate the impact of introducing a smartphone-based daily feedback and counseling platform between women after delivery and a multidisciplinary lactation support team on lactation rates and various maternal and neonatal outcomes. Counseling was provided via a specifically developed application from a multidisciplinary team (obstetricians, nurses, lactation counselors, and psychologist) in an attempt to assist and counsel to maintain lactation.

STUDY DESIGN

This was a prospective, single-center, randomized controlled trial. Women planning to lactate were recruited at postpartum day 1 and were randomized to (1) routine lactation counseling and support (control group) or (2) additional daily detailed counseling and feedback on lactation from the team via the application (App group). The primary outcome was partial or full lactation at 3 months after delivery. The secondary outcomes included lactation at additional time points up to 6 months after delivery. The study was adequately powered to detect a 15% difference in the primary outcome.

RESULTS

A total of 197 patients were recruited, 97 in the App group and 100 in the control group. The 2 groups did not differ in any background or delivery characteristics. The App group showed higher rates of lactation 6 weeks after delivery (96.9% vs 82.0%; P<.001) and 3 months after delivery (81.4% vs 69.0%; P=.049) than the control group. Patients in the App group reported excellent satisfaction from the use of the application and their overall postnatal care.

CONCLUSION

Our study has provided further information on the growing efficacy of technology platforms in obstetrical care. The introduction of a smartphone-based daily feedback and counseling platform between postpartum patients and a multidisciplinary lactation support team increased the lactation rates after delivery with excellent patient satisfaction.

Society for Maternal-Fetal Medicine Special Statement: COVID-19 research in pregnancy: progress and potential

The COVID-19 global pandemic has broad implications for obstetrical care and perinatal outcomes. As we approach the 2-year mark into an unprecedented international pandemic, this review presents the progress and opportunities for research related to COVID-19 and pregnancy. Research is the basis for evidence-based clinical guidelines, and we aim to provide the structure and guidance for framing COVID-19-related obstetrical research. This structure will pertain not only to this pandemic but future ones as well.

Evaluation of rapid telehealth implementation for prenatal and postpartum care visits during the COVID-19 pandemic in an academic clinic in Springfield, Massachusetts, United States of America

BACKGROUND AND AIMS

COVID-19 forced healthcare systems to implement telehealth programs, facilitated in Massachusetts by a policy requiring insurers to reimburse for telehealth visits. Prior studies suggest that telehealth is effective for obstetric care, but little is known about its implementation in response to policy changes in underserved communities. We utilized the RE-AIM framework to evaluate telehealth implementation in a large academic urban obstetric practice that serves a medically underserved population.

METHODS

RE-AIM elements were assessed through retrospective review of electronic health record (EHR) data for all obstetric encounters between March 19 and August 31, 2020 and review of clinic implementation processes. Data extracted included demographics, number and type (in-person or telehealth) of prenatal visits, prenatal diagnoses, delivery outcomes, and number and type of postpartum visits. Data were analyzed using descriptive statistics.

RESULTS

A total of 558 patients (60.6% Hispanic; 13.2% primary language Spanish) had 1788 prenatal visits, of which 698 (39.0%) were telehealth visits. A total of 209 patients had 230 postpartum visits, of which 101 (48.3%) were telehealth visits. The Reach of the intervention increased from 0% of patients at baseline to 69% in August. Effectiveness measures were limited but suggested potential for earlier diagnosis of some prenatal conditions. Adoption was high, with all 30 providers using telehealth, and the telehealth was found to likely be feasible and acceptable based on uptake. Increases in the percentage of telehealth visits over time and continuation post-lockdown suggested maintenance was potentially achievable.

CONCLUSIONS

The COVID-19 pandemic has changed traditional approaches to healthcare delivery. We demonstrate that the use of the RE-AIM framework can be effective in facilitating implementation of telephone visits in a large academic urban obstetric practice after state-level policy change. This may be of particular importance in settings serving patients at higher risk for maternal morbidity and poor birth outcomes.

Reducing disparities in adverse pregnancy outcomes in the United States

There is growing evidence that rural and racial disparities and social determinants of health (SDOH) impact adverse pregnancy outcomes (APOs) and overall maternal mortality in the United States. These APOs, such as preeclampsia, preterm birth, and intrauterine growth restriction, are in-turn associated with increased risk of future cardiovascular disease (CVD) later in life. Importantly, SDOH such as socioeconomic disadvantages, poor health literacy, transportation barriers, lack of access to adequate health care, food insecurity, and psychosocial stressors have cascading effects on APOs and downstream cardiovascular health. These SDOH are also deeply intertwined with and compounded by existing racial and rural disparities. Pregnancy thus provides a unique opportunity to identify at-risk women from a social determinants perspective, and provide early interventions to optimize long-term CVD and mitigate cardiovascular health disparities. Addressing the challenges posed by these disparities requires a multi-pronged approach and involves national, regional, and individual level solutions. Eliminating disparities will necessitate a nationwide obligation to ensure health care equity via enhanced health insurance coverage, resource investment, and public and clinician accountability.

A Medical Student Postpartum Telehealth Initiative During the COVID-19 Pandemic

PURPOSE

The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact on our health systems and delivery of care and on the disruption of medical education. It has forced hospitals to move to a telehealth model for prenatal and postpartum visits and expedite discharges for postpartum patients in order to reduce exposure. We describe our medical school and hospital system initiative to employ medical student volunteers for postpartum telehealth calls during the peak of the COVID-19 pandemic in New York City.

DESCRIPTION

Ten medical students conducted phone interviews with postpartum patients within 72 h of discharge at three hospitals in a large NYC health system, with faculty preceptors at each site who provided daily call assignments and oversight. Students called patients to screen for risk factors for postpartum complications, including preeclampsia and postpartum depression; provide additional contraception counseling; and address newborn care and health. One week and 2 week post-discharge calls were also made for COVID-19 positive patients for ongoing symptom monitoring and counseling.

ASSESSMENT

We found numerous opportunities for intervention in postpartum health via telehealth, including addressing pharmacy-related needs, patient counseling, improving pain management, and identifying patients in need of emergent re-evaluation.

CONCLUSION

As this pandemic continues to evolve, our model demonstrates the feasibility of telehealth and medical student involvement in postpartum care and its benefits to patients, medical student learning, and alleviation of burden on obstetric staff.