Educational Multimedia Tool Compared With Routine Care for the Uptake of Postpartum Long-Acting Reversible Contraception in Individuals With High-Risk Pregnancies: A Randomized Controlled Trial.

OBJECTIVE: To assess whether an intervention with a multimedia educational tool, compared with routine care, would increase the use of long-acting reversible contraceptives (LARC) at 12 weeks postpartum in individuals with high-risk pregnancies. METHODS: In this single-center randomized trial, we assigned individuals aged 13-50 years with high-risk pregnancies to either a multimedia educational tool or routine care. Participants were included during pregnancy through postpartum day 1. Those randomized to the multimedia educational tool (MET) group were provided a tablet with the preloaded 3-5-minute multimedia presentation (https://prezi.com/view/jpFrXaPnnxuqRkcI3A4a/), which was viewed without the presence of research staff and resent by secure email every 4 weeks if undelivered. The primary outcome was uptake of LARC (implant or intrauterine device) within 12 weeks of delivery. The secondary outcomes included overall use of any method of contraception and composite maternal and neonatal adverse outcomes. A priori estimates indicated that 380 participants were needed to detect a 40% difference in use of LARC (baseline 40%; alpha=0.05, power=0.8, assumed loss to follow-up 20%). Relative risk (RR) and number needed to treat (NNT), along with 95% CIs, were calculated. RESULTS: From July 2020 through December 2020, 536 persons were screened and 380 randomized as follows: 190 for the multimedia educational tool and 190 for routine care. Demographic characteristics were similar between groups. The primary outcome-available for more than 90% of participants-was higher in the MET group (32.4%) than in the routine care (RC) group (20.9%) (RR 1.55; 95% CI 1.09-2.21; NNT nine, with 95% CI 5-42). Overall use of contraception was also higher in the MET group than in the RC group (RR 1.16; 95% CI 1.03-1.32). CONCLUSION: Among individuals with high-risk pregnancies, compared with routine care, use of a multimedia-based educational tool increased the uptake of postpartum LARC by 55%. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT04291040. FUNDING SOURCE: Funded in part by Investigator-Initiated studies of Organon.

Identifying Risk Factors for Cesarean Delivery in a Predominantly Hispanic Teenage Population: A 5-Year Retrospective Study.

STUDY OBJECTIVE: To identify risk factors for primary nonelective cesarean delivery, in a predominantly Hispanic teen population of an urban tertiary care center. DESIGN: Retrospective descriptive study. SETTING: A tertiary academic center with approximately 3000 deliveries per year. PARTICIPANTS: Our study population comprised all women (ages 13-19 years at time of delivery) who gave birth at our tertiary university hospital between July 2011 and July 2016. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Our main outcome of interest was primary nonelective cesarean delivery. RESULTS: Of the 958 included deliveries, 9.6% (92/958) were delivered via nonelective cesarean section. The population was 89% Hispanic with a mean age of 17.7 years. Age, body mass index at delivery, and neonatal birth weight were significantly associated with delivery via cesarean section. Mothers of neonates with extremes of birth weights (<2500 g, >4000 g) had higher odds of having a cesarean delivery, compared with neonates with normal birth weight (odds ratio, 3.27; 95% confidence interval, 1.90-5.63 and odds ratio, 4.43; 95% confidence interval, 1.33-14.72). CONCLUSION: Among adolescent patients, age, body mass index at delivery, and birth weight of the neonate were found to be risk factors that place the gravid teen at increased risk for cesarean delivery.