External Validation of a Prediction Model for External Cephalic Version Success.

External cephalic version (ECV) success correlates with numerous maternal and pregnancy factors. A prior study developed an ECV success prediction model based on body mass index, parity, placental location, and fetal presentation. We performed external validation of this model using a retrospective cohort of ECV procedures from a separate institution between July 2016 and December 2021. Four hundred thirty-four ECV procedures were performed, with a 44.4% success rate (95% CI 39.8-49.2%), which was similar to the derivation cohort (40.6%, 95% CI 37.7-43.5%, P =.16). There were significant differences in patients and practices between cohorts, including the rate of neuraxial anesthesia (83.5% derivation cohort vs 10.4% our cohort, P <.001). The area under the receiver operating characteristic curve (AUROC) was 0.70 (95% CI 0.65-0.75), which was similar to that in the derivation cohort (AUROC 0.67, 95% CI 0.63-0.70). These results suggest the published ECV prediction model's performance is generalizable outside the original study institution.

Factors Influencing Provider Behavior Around Delivery of Preconception Care.

OBJECTIVE: Despite growing consensus about the clinical value of preconception care (PCC), gaps and disparities remain in its delivery. This study aimed to examine the factors influencing behavior of health care providers around PCC in outpatient clinical settings in the United States. METHODS: Twenty health care providers who serve people of reproductive age were interviewed using semi-structured interviews. Data was coded based on a modified Theoretical Domains Framework and analyzed using deductive content analysis. RESULTS: We interviewed eight family medicine physicians, four obstetricians/gynecologists, seven nurse practitioners, and one nurse midwife. Overall, we found a wide variety in practices and attitudes towards PCC. Barriers and challenges to delivering PCC were shared across sites. We identified six themes that influenced provider behavior around PCC: (1) lack of knowledge of PCC guidelines, (2) perception of lack of preconception patient contact, (3) pessimism around patient "compliance," (4) opinion about scope of practice, (5) clinical site structure, and (6) reliance on the patient/provider relationship. CONCLUSIONS FOR PRACTICE: Overall, our findings call for improved provider understanding of PCC and creative incorporation into current health care culture and practice. Given that PCC-specific visits are perceived by some as outside the norm of clinical offerings, providers may need to incorporate PCC into other encounters, as many in this study reported doing. We amplify the call for providers to understand how structural inequities may influence patient behavior and the value of standardized screening, within and beyond PCC, as well as examination of implicit and explicit provider bias.

Are Wisconsin resident physicians trained in immediate postpartum long acting reversible contraception?

OBJECTIVES: To characterize perceived proficiency in immediate postpartum long-acting reversible contraception (LARC) provision among resident physicians in obstetrics and gynecology and family medicine in Wisconsin. STUDY DESIGN: We queried 254 Wisconsin obstetrics and gynecology or family medicine residents about competency and attitudes regarding family planning services via a confidential electronic survey. We used logistic regression to identify factors associated with the primary outcome of self-reported proficiency in immediate postpartum LARC. RESULTS: We recruited participants from 3 of 3 (100%) obstetrics and gynecology and 9 of 15 (60%) family medicine residency programs, achieving a 74% response rate among trainees (187/254 individuals). Seven of 12 programs (58%) offered immediate postpartum LARC training [100% (3/3) obstetrics and gynecology; 44% (4/9) family medicine]. Forty-eight percent of residents [68% (27/40) obstetrics and gynecology and 60/141 (43%) family medicine, p < 0.01)] reported immediate postpartum LARC proficiency (subdermal implant placement: 48%; immediate postpartum intrauterine device (IUD) placement: 16%). Residents (versus interns), who were younger, training in a program without religious affiliation, and who hoped to provide immediate postpartum LARC provision in practice, were more likely to report subdermal implant proficiency. Interns and family medicine trainees were less likely to report immediate postpartum IUD proficiency. CONCLUSIONS: Only 44% of participating family medicine programs provide immediate postpartum LARC training. Two-thirds of obstetrics and gynecology residents report proficiency in immediate postpartum LARC, compared to fewer than half of family medicine residents. Given that many Wisconsin counties do not have a practicing obstetrician/gynecologist, improving immediate postpartum LARC training among family medicine residents is paramount. IMPLICATIONS: STATEMENT: Family medicine physicians provide a significant portion of obstetric care, especially in rural areas. Family medicine residency programs should be supported to ensure that all trainees are proficient in placing subdermal implants and family physicians planning to provide obstetric care are trained in postpartum IUD placement.