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.

Features of the course of pregnancy and childbirth in women with a new coronavirus infection

The article describes the features of the course of pregnancy and childbirth in women with a new coronavirus infection. Aim. To consider the features of the course of pregnancy and its outcome in women infected with a new coronavirus infection, reflected in current literary sources. Materials and methods. Scientific literature and reviews in the WoS and Scopus systems. A review of scientific papers was carried out. Different cases of pregnancy and childbirth under the condition of infection of a woman with the Covid-19 virus are considered in the scientific literature. Results. Physiological changes that occur in a woman's body during pregnancy make her body more vulnerable to various pathogens. The experience of managing pregnant women in the conditions of a pandemic of a new coronavirus infection allows us to form a the-oretical idea of the susceptibility of the body of a woman infected with Covid-19 and the features of possible complications caused by the course of the disease for the mother and fetus. Conclusion. The course of the disease in pregnant women with a confirmed new coronavirus infection is on average similar to the course of the disease in non-pregnant women with pneumonia caused by infection with the SARS-Cov-2 virus. However, pregnancy management of patients infected with the SARS-Cov-2 virus requires special attention and individualization based on obstetric indications and characteristics of the condition of the mother and fetus. © 2023, Media Sphera Publishing Group. All rights reserved.

Telehealth Adoption During COVID-19: Lessons Learned from Obstetric Providers in the Rocky Mountain West.

Introduction: Obstetric providers have used telemedicine to manage gestational diabetes, mental health, and prenatal care. However, the uptake of telemedicine in this field has not been universal. The COVID-19 pandemic catalyzed the adoption of telehealth in obstetric care, which will have lasting effects, especially for rural communities. We sought to understand the experience of adapting to telehealth among obstetric providers in the Rocky Mountain West to identify implications for policy and practice. Methods: This study included 20 semi-structured interviews with obstetric providers in Montana, Idaho, and Wyoming. The interviews followed a moderator's guide based on the Aday & Andersen Framework for the Study of Access to Medical Care, exploring domains of health policy, the health system, the utilization of health services, and the population at risk. All the interviews were recorded, transcribed, and analyzed using thematic analysis. Results: Findings indicate that participants view telehealth as a useful tool during prenatal and postpartum care; many participants intend to continue telehealth practices after the pandemic. Participants shared that their patients reported benefits to telehealth beyond COVID-19 safety, including limiting travel time, reducing time off work, and alleviating childcare needs. Participants expressed concern that expanding telehealth will not equally benefit all patients and could widen existing health inequities. Discussion: Success moving forward will require a telehealth infrastructure, adaptive telehealth models, and provider and patient training. As obstetric telehealth expands, efforts must prioritize equitable access for rural and low-income communities, so all patients can benefit from the technological advancements to support health.

2022: A year in review

The article offers a look at the advances in obstetrics and gynecology in 2022 along with some impactful articles that were important to women's health care providers. It includes an article on addressing physician burnout published in the January 2021 issue, another on a study on the treatment for mild chronic hypertension in pregnancy, and another study which evaluated whether the addition of lenvatinib and pembrolizumab improved outcome in women with recurrent advanced endometrial cancer.

Antenatal and Postnatal Care.

Optimal care during the antenatal and postnatal phases of the life cycle is a potentially positive determinant of health elsewhere in the continuum. A successful transition from the antenatal to the postnatal period requires early detection, optimal management, and prevention of disease; health promotion; birth preparedness; and complication readiness. Women, their babies, and families need appropriate evidence-based care based on their dignity and human rights before, during, and after birth. In this review, we present an overview of the components of antenatal and postnatal care needed to provide women a culturally sensitive and positive pregnancy and postnatal experience. The challenge of antenatal and postnatal care is determining their core components and underpinning them with evidence without overmedicalizing their practice.

2022: A year in review

The article offers a look at the advances in obstetrics and gynecology in 2022 along with some impactful articles that were important to women's health care providers. It includes an article on addressing physician burnout published in the January 2021 issue, another on a study on the treatment for mild chronic hypertension in pregnancy, and another study which evaluated whether the addition of lenvatinib and pembrolizumab improved outcome in women with recurrent advanced endometrial cancer.

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.

Prenatal Telehealth During the Pandemic: Sociodemographic and Clinical Associations

Objectives: Like other areas of care affected by the COVID-19 pandemic, telehealth (both audio and video) was rapidly adopted in the obstetric setting. We performed a retrospective analysis of electronic health record (EHR) data to characterize the sociodemographic and clinical factors associated with telehealth utilization among patients who received prenatal care. Materials and Methods: The study period covered March 23rd, 2020 to July 2nd, 2020, during which time 2,521 patients received prenatal care at a large academic medical center. We applied a generalized logistic regression to measure the relationship between the patients’ sociodemographic factors (in terms of age, race, ethnicity, urbanization level, and insurance type), pregnancy complications (namely, type 2 diabetes, chronic hypertension, and fetal growth restriction), and telehealth usage, as documented in the EHR. Results: During the study period, 2,521 patients had 16,516 prenatal care visits. 938 (37.2%) of the patients participated in at least one of 1,934 virtual prenatal care visits. Prenatal visits were more likely to be conducted through telehealth for patients who were older than 25 years old and lived in rural areas. In addition, patients who were with type 2 diabetes were more likely to use telehealth in their prenatal care (adjusted Odds Ratio (aOR) 7.247 [95% Confidence Interval (95% CI) 4.244 – 12.933]). By contrast, patients from racial and ethnic minority groups were less likely to have a telehealth encounter compared to white or non-Hispanic patients (aOR 0.603 [95% CI 0.465 – 0.778] and aOR 0.663 [95% CI 0.471 – 0.927], respectively). Additionally, patients who were on state-level Medicaid were less likely to use telehealth (aOR 0.495 [95% CI 0.402 – 0.608]). Discussion: Disparities in telehealth use for prenatal care suggest further investigations into access barriers. Hispanic patients who had low English language proficiency may not willing to see doctors via virtual care. Availability of high-speed internet and/or hardware may hold these patients who were insured through state-level Medicaid back due to poverty. Future work is advised to minimize access barriers to telehealth in its implementation. Conclusions: While telehealth expanded prenatal care access for childbearing women during the COVID-19 pandemic, this study suggested that there were non-trivial differences in the demographics of patients who utilized such settings.

Monoclonal Antibody Infusion Service for Obstetric Women Infected With COVID-19...Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) Convention, June 25-29, 2022, Aurora, Colorado

The article offers information on monoclonal antibody infusion service for obstetric women infected with Covid-19. It mentions that monoclonal antibody (MAB) infusions were approved under an emergency use authorization for treatment of mild to moderate Covid-19 infection in adults and pediatric patients.

Experiences of Dutch Midwives Regarding the Quality of Care during the COVID-19 Pandemic.

This study assessed how the quality of care during the COVID-19 pandemic has been experienced by Dutch midwives. At the beginning of May 2020, 15 Dutch midwives were interviewed during the first wave of the pandemic. The interviews included questions based on the value-based healthcare framework by Porter. The interviews were transcribed verbatim, coded, and analyzed according to recurrent themes using the directed content analysis approach. Key themes identified included high quality midwifery care, information provision, costs, under/over treatment, interprofessional collaboration, and shared decision making. The quality of midwifery care during the COVID-19 pandemic was experienced to be sufficient, given the challenging circumstances. The midwives experienced the lack of face-to-face check-ups to be problematic. Unclear information and lack of personal protective equipment caused stress and confusion, and they worked an additional 2-4 h per working day. Some pregnant women were hesitant to call or visit them when they thought something was wrong. The midwives perceived some advantages in using video or telephone calls. Considerations for future pandemics include an additional face-to-face check-up between 16 and 27 weeks of pregnancy and one postpartum visit. For post-pandemic care, providing a check-up through telephone or video call could be offered in certain cases.

Pregnancy and childbirth during the coronavirus pandemic. The cross-sectional study of 1321 participants in Poland.

OBJECTIVES: The impact of infection with novel coronavirus - SARS-CoV-2 - on women's and fetus' was unclear; therefore, it was the reason for many worries. We wanted to understand and describe the worries of pregnant women, assess mental well-being, and analyse the problems affecting prenatal care and hospital stay in this unprecedented time. MATERIAL AND METHODS: We designed an original 23-question survey aimed at women who were pregnant during the pandemic or who gave birth at that time. The survey included demographic data, questions about prenatal care, mental status and worries, and hospitalisation. RESULTS: Our study included 1321 women: 1010 (76.5%) during pregnancy and 311 (23.5%) after the delivery in the studied time. For 1168 (88,4%) respondents, the pandemic had a negative impact on their mood. The three main concerns were: the need for isolation from the child (n = 498, 37.7%), the childbirth without a partner/trusted companion (n = 417, 31.6%) and the risk of infection of the child in hospital (n = 381, 28.8%). CONCLUSIONS: The novel coronavirus pandemic affects the mental health of pregnant women. Pregnant patients should be considered a group of particular concerns. Patients consider remote obstetrical consultations as an insufficient approach. The reason for the highest worries of pregnant patients is a lack of companionship during labour. There was no difference between the rate of childbirth via caesarean sections over vaginal delivery during the "first wave" of the pandemic.

Optimizing mother-baby wellness during the 2019 coronavirus disease pandemic: A case for telemedicine.

BACKGROUND: The 2019 coronavirus disease pandemic poses unique challenges to healthcare delivery. To limit the exposure of providers and patients to severe acute respiratory syndrome coronavirus 2, the Centers for Disease Control and Prevention encourages providers to use telehealth platforms whenever possible. Given the maternal mortality crisis in the United States and the compounding 2019 coronavirus disease public health emergency, continued access to quality preconception, prenatal, intrapartum, and postpartum care are essential to the health and well-being of mother and baby. OBJECTIVE: This commentary explores unique opportunities to optimize virtual obstetric care for low-risk and high-risk mothers at each stage of pregnancy. METHODS: In this review paper, we present evidence-based literature and tools from first-hand experience implementing telemedicine in obstetric care clinics during the pandemic. RESULTS: Using the best evidence-based practices with telemedicine, health care providers can deliver care in the safest, most respectful, and appropriate way possible while providing the critical support necessary in pregnancy. In reviewing the literature, several studies endorse the implementation of specific tools outlined in this article, to facilitate the implementation of telemedicine. From a quality improvement standpoint, evidence-based telemedicine provides a solution for overburdened healthcare systems, greater confidentiality for obstetric services, and a personalized avenue for health care providers to meet maternal health needs in the pandemic. CONCLUSION: During the COVID-19 pandemic, continued access to quality prenatal, intrapartum, and postpartum care are essential to the health and well-being of mother and baby.

Access to and Quality of Healthcare for Pregnant and Postpartum Women During the COVID-19 Pandemic.

Introduction: During the COVID-19 pandemic, obstetric care has adopted new precautions to ensure services can be maintained for pregnant women. The aim of this study was to describe access to and quality of obstetric care for pregnant and postpartum women during the COVID-19 pandemic and to identify factors that predict quality of care at this time. Methods: Between May 3 and June 28, 2020, we recruited women who were pregnant or within the first 6 months after delivery to participate in an online survey. This included questions on access to obstetric healthcare (type and place of health care provider, changes to obstetric appointments/services, appointment preferences) and the Quality of Prenatal Care Questionnaire (QPCQ). Results: Of the 917 eligible women, 612 (67%) were pregnant and 305 (33%) were in the first 6 months after delivery. Sixty-two percent (n = 571) reported that COVID-19 had affected their healthcare; appointments were rearranged, canceled or occurred via virtual means for 29% (n = 166), 29% (n = 167), and 31% (n = 175) of women, respectively. The majority preferred to physically attend appointments (74%; n = 676) and perceived the accompaniment of birth partners as important (77%; n = 471). Sixty-two percent (n = 380) were permitted a birth partner at delivery, 18% (n = 111) were unsure of the rules while 4% (n = 26) were not permitted accompaniment. During pregnancy, QPCQ was negatively associated with disruption to obstetric services including exclusion or uncertainty regarding birth partner permissions [F (7, 433) = 11.5, p < 0.001, R 2 = 0.16] while QPCQ was negatively associated with inadequate breastfeeding support postpartum [F (1, 147) = 12.05, p = 0.001, R 2 = 0.08]. Conclusion: Pregnant and postpartum have experienced disruption in their access to obstetric healthcare. Perceived quality of obstetric care was negatively influenced by cancellation of appointment(s), suspension of services and exclusion of birth partners at delivery. During this time, continuity of care can be fulfilled via virtual and/or phone appointments and women should receive clear guidance on changes to services including birth partner permissions to attend delivery.

Centralisation of acute obstetric care in the Netherlands: a qualitative study to explore the experiences of stakeholders with adaptations in organisation of care.

BACKGROUND: In the past decade, acute obstetric care (AOC) has become centralised in many high-income countries. In this qualitative study, we explored how stakeholders in maternity care perceived and experienced adaptations in the organisation of maternity care in areas in the Netherlands where AOC was centralised. METHODS: A heterogenic group of fifteen maternity care stakeholders, including patients, were purposively selected for semi-structured interviews. An inductive thematic analysis was used. RESULTS: Three main themes were identified: (1) lack of involvement. (2) the process of making adaptations in the organisation of maternity care. (3) maintaining quality of care. Stakeholders in this study were highly motivated to maintain a high quality of maternity care and therefore made adaptations at several organisational levels. However, they felt a lack of involvement during the planning of centralisation of AOC and highlighted the importance of a collaborative process when making adaptations after centralisation of AOC. CONCLUSIONS: Regions with AOC centralisation plans should invest time and money in change management, encourage early involvement of all maternity care stakeholders and acknowledge centralisation of AOC as a professional life event with associated emotions, including a feeling of unsafety.

Critical comparative analysis of data sources toward understanding referral during pregnancy and childbirth: three perspectives from Nigeria.

BACKGROUND: The highest risk of maternal and perinatal deaths occurs during and shortly after childbirth and is preventable if functional referral systems enable women to reach appropriate health services when obstetric complications occur. Rising numbers of deliveries in health facilities, including in high mortality settings like Nigeria, require formalised coordination across the health system to ensure that women and newborns get to the right level of care, at the right time. This study describes and critically assesses the extent to which referral and its components can be captured using three different data sources from Nigeria, examining issues of data quality, validity, and usefulness for improving and monitoring obstetric care systems. METHODS: The study included three data sources on referral for childbirth care in Nigeria: a nationally representative household survey, patient records from multiple facilities in a state, and patient records from the apex referral facility in a city. We conducted descriptive analyses of the extent to which referral status and components were captured across the three sources. We also iteratively developed a visual conceptual framework to guide our critical comparative analysis. RESULTS: We found large differences in the proportion of women referred, and this reflected the different denominators and timings of the referral in each data source. Between 16 and 34% of referrals in the three sources originated in government hospitals, and lateral referrals (origin and destination facility of the same level) were observed in all three data sources. We found large gaps in the coverage of key components of referral as well as data gaps where this information was not routinely captured in facility-based sources. CONCLUSIONS: Our analyses illustrated different perspectives from the national- to facility-level in the capture of the extent and components of obstetric referral. By triangulating across multiple data sources, we revealed the strengths and gaps within each approach in building a more complete picture of obstetric referral. We see our visual framework as assisting further research efforts to ensure all referral pathways are captured in order to better monitor and improve referral systems for women and newborns.

Impact of COVID-19 on the cost of surgical and obstetric care: experience from a Nigerian teaching hospital and a review of the Nigerian situation.

The public health impact of the COVID-19 pandemic cannot be overstated. Its impact on the cost of surgical and obstetric care is significant. More so, in a country like Nigeria, where even before the pandemic, out-of-pocket spending (OOPS) has been the major payment method for healthcare. The increased cost of surgical and obstetric care occasioned by the pandemic has principally been due to the additional burden of ensuring the use of adequate/appropriate personal protective equipment (PPE) during patient care as a disease containment measure. These PPE are not readily available in public hospitals across Nigeria. Patients are therefore compelled to bear the financial burden of procuring scarce PPE for use by health care personnel, further increasing the already high cost of healthcare. In this study, we sought to appraise the impact of the COVID-19 pandemic on the cost of surgical and obstetric care in Nigeria, drawing from the experience from one of the major Nigerian teaching hospitals- the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun State. The cost of surgical and obstetric care was reviewed and compared pre- and during the COVID-19 pandemic, deriving relevant examples from some commonly performed surgical operations in our centre (OAUTHC). We reviewed patients' hospital bills and receipts of consumables procured for surgery. Our findings revealed that the cost of surgical and obstetric care during the COVID-19 pandemic had significantly increased. We identified gaps and made relevant recommendations on measures to reduce the additional costs of surgical and obstetric care during and beyond pandemic.