Televisits Compared With In-Person Visits for Routine Antenatal Care: A Systematic Review.

OBJECTIVE: To compare benefits and harms of televisits and in-person visits in people receiving routine antenatal care. DATA SOURCES: A search was conducted of PubMed, Cochrane databases, EMBASE, CINAHL, and ClinicalTrials.gov through February 12, 2022, for antenatal (prenatal) care, pregnancy, obstetrics, telemedicine, remote care, smartphones, telemonitoring, and related terms, as well as primary study designs. The search was restricted to high-income countries. METHODS OF STUDY SELECTION: Double independent screening was done in Abstrackr for studies comparing televisits and in-person routine antenatal care visits for maternal, child, health care utilization, and harm outcomes. Data were extracted into SRDRplus with review by a second researcher. TABULATION, INTEGRATION, AND RESULTS: Two randomized controlled trials, four nonrandomized comparative studies, and one survey compared visit types between 2004 and 2020, three of which were conducted during the coronavirus disease 2019 (COVID-19) pandemic. Number, timing, and mode of televisits and who provided care varied across studies. Low-strength evidence from studies comparing hybrid (televisits and in-person visits) and all in-person visits did not indicate differences in rates of neonatal intensive care unit admission of the newborn (summary odds ratio [OR] 1.02, 95% CI 0.82-1.28) or preterm births (summary OR 0.93, 95% CI 0.84-1.03). However, the studies with stronger, although still statistically nonsignificant, associations between use of hybrid visits and preterm birth compared the COVID-19 pandemic and prepandemic eras, confounding the association. There is low-strength evidence that satisfaction with overall antenatal care was greater in people who were pregnant and receiving hybrid visits. Other outcomes were sparsely reported. CONCLUSION: People who are pregnant may prefer hybrid televisits and in-person visits. Although there is no evidence of differences in clinical outcomes between hybrid visits and in-person visits, the evidence is insufficient to evaluate most outcomes. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42021272287.

Postnatal quietness - the dilemma of visiting hours. A qualitative interview study with maternity care staff.

BACKGROUND: As part of the Person and Family Centred Care, involvement of relatives is a key concept. This means that an unrestricted visiting policy in hospitals wards is widely accepted and implemented. In maternity care, benefits and drawbacks of unrestricted visiting is still discussed, while it is acknowledged that a quiet environment is important for both new parents and newborns to enhance breastfeeding. The COVID-19 lockdown provided an opportunity to study how the restrictions for visitors influenced the work of maternity care staff in Denmark. OBJECTIVE: This study aimed to explore the experience of maternity care staff on how visitation restrictions for visitors influenced the care of new families in a maternity ward. METHODS: Individual interviews (n = 10) were performed between 20 November 2020 and 25 February 2021. A qualitative descriptive study was performed using thematic analysis. RESULTS: One overarching theme was identified: "Framing time to the experience of becoming a parent". Further, five sub-themes were identified and illuminated in the analysis: "Increasing confidentiality and presence", "Changing availability and space for guidance", "Welcoming peacefulness", "Being gatekeepers", and "Structuring time is caring". CONCLUSION: Restrictions for visitors influenced the care of new families because it encourages the space and place of becoming a parent. The hospital environment was shaped in a calm way, which increased the staffs' bedside time. The experience of an increased confidentiality with new parents led to in-depth conversations, making it easier to identify new parents' needs, focus on the initiation of breastfeeding, and individual guidance.

COVID in obstetrics: labor analgesia and cesarean section.

PURPOSE OF REVIEW: This review is based on the latest evidence to provide a good standard of care for COVID-19 parturients and protection to healthcare givers. RECENT FINDINGS: COVID-19 by itself is not an indication for cesarean section. Different publications demonstrated the efficacy of neuraxial analgesia/anesthesia for delivery. Although SARS-CoV-2 was associated with a certain neurotropism, neuraxial block was not associated with neurological damage in COVID-19 parturients, and seems as safe and effective as in normal situations. It permits to avoid a general anesthesia in case of intrapartum cesarean section. Epidural failure is a concern: it may lead to a general anesthesia in case of emergency cesarean section. Local protocols and well-trained anesthesiologists will be helpful. COVID-19 patients require special circuits and every step (transfer to and from theatre, recovery, analgesia, and so on) should be planned in advance. For cesarean section under general anesthesia, personal protection equipment must be enhanced. Postoperative analgesia with neuraxial opioids, NSAIDs, or regional blocks are recommended. COVID-19 and pregnancy increase the risk of thrombosis, so thromboprophylaxis has to be considered and protocolized. SUMMARY: Anesthetic care for delivery in COVID-19 parturients should include neuraxial blocks. Special attention should be paid on the risk of thrombosis.