Urgent Follow-up after Outpatient Nonstress Tests and the Potential for Fetal Monitoring at Home.

OBJECTIVE: This study aimed to measure the proportion of patients needing urgent clinical follow-up after an abnormal outpatient nonstress test (NST). We further sought to capture the patient perspective on the acceptability of performing NSTs at home. STUDY DESIGN: A retrospective cohort study was performed over a 2-year period to determine the frequency of abnormal NSTs in a hospital-based, antepartum testing unit in patients greater than or equal to 32 weeks' gestation. The proportion of patients who delivered within 24 hours of an abnormal NST was also determined. A cross-sectional, web-based patient survey was conducted to obtain insight into the patient's comfort level with potentially performing NSTs at home. RESULTS: The chart review yielded 665 patients who underwent 2,122 NSTs at greater than or equal to 32 weeks. Of the 2,122 NSTs, 111 were categorized as abnormal and required urgent clinical follow-up, or 5.2% (95% confidence interval [CI] 4.3, 6.3%). Of the 665 patients, 13 delivered within 24 hours of an abnormal NST, or 2.0% (95% CI 1.0, 3.3%). In the web-based survey, the proportion of respondents who would feel comfortable or very comfortable conducting NSTs at home was 87/125, or 69.6% (95% CI 60.9, 77.1%). CONCLUSION: This study revealed that 5.2% of NSTs performed in a hospital-based antepartum testing unit were abnormal and required urgent clinical follow-up. Of the patients being followed in the antepartum testing unit, 2.0% delivered within 24 hours of an abnormal NST. The majority of the survey respondents indicated they would feel comfortable performing NSTs at home. The present study adds important information regarding the risks and benefits of NSTs at home. KEY POINTS: · Telehealth for NSTs offers advantages over in-person NSTs.. · The proportion of NSTs that need urgent follow-up was 5.2%.. · A majority of patients are interested in telehealth for NSTs.. · Guidelines are needed before adoption of telehealth for NSTs..

Bridging the Chasm between Pregnancy and Health over the Life Course: A National Agenda for Research and Action.

BACKGROUND: Many pregnant people find no bridge to ongoing specialty or primary care after giving birth, even when clinical and social complications of pregnancy signal need. Black, indigenous, and all other women of color are especially harmed by fragmented care and access disparities, coupled with impacts of racism over the life course and in health care. METHODS: We launched the initiative "Bridging the Chasm between Pregnancy and Health across the Life Course" in 2018, bringing together patients, advocates, providers, researchers, policymakers, and systems innovators to create a National Agenda for Research and Action. We held a 2-day conference that blended storytelling, evidence analysis, and consensus building to identify key themes related to gaps in care and root causes of inequities. In 2019, more than 70 stakeholders joined six working groups to reach consensus on strategic priorities based on equity, innovation, effectiveness, and feasibility. FINDINGS: Working groups identified six key strategic areas for bridging the chasm. These include: 1) progress toward eliminating institutional and interpersonal racism and bias as a requirement for accreditation of health care institutions, 2) infrastructure support for community-based organizations, 3) extension of holistic team-based care to the postpartum year and beyond, with integration of doulas and community health workers on the team, 4) extension of Medicaid coverage and new quality and pay-for-performance metrics to link maternity care and primary care, 5) systems to preserve maternal narratives and data across providers, and 6) alignment of research with women's lived experiences. CONCLUSIONS: The resulting agenda presents a path forward to remedy the structural chasms in women's health care, with key roles for advocates, policymakers, researchers, health care leaders, educators, and the media.

Device Prototype for Vaginal Delivery of Extremely Preterm Fetuses in the Breech Presentation.

Vaginal delivery is typically avoided in the extremely preterm breech population due to the concern of entrapment by the cervix of the aftercoming head. A mechanical device concept is presented to enable vaginal delivery by preventing retraction of the cervix against the fetus during delivery. The two-part device was designed to dilate the cervix, prevent prolapse of small fetal parts and maintain sufficient dilation during delivery. The two-part device was designed and manufactured with the following modules: an inflatable saline-filled cervical balloon for dilation and a cervical retractor composed of semirigid beams to stabilize the cervix and maintain adequate dilation. The device was tested using a cervical phantom designed to simulate the compressive force the cervix exerts. The cervical balloon reached a maximum dilation of 8.5 cm, after which there was leakage of saline from the balloon. While this dilation was less than the target goal of 10 cm, the leaking was attributed to prototype manufacturing defects, which could be resolved with further development. The cervical retractor was able to withstand between 1-3 kPa. Although estimates of cervical pressure values can be upward of 30 kPa, there are no in vivo measurements to formally identify the pressure values for patients in preterm labor. This device serves as a viable proof-of-concept for utilizing an inflatable balloon device to prevent cervical retraction in the setting of extremely preterm vaginal breech delivery. Further manufacturing improvements and design changes could improve the device for continued development and testing.

Inpatient prenatal yoga sessions for women with high-risk pregnancies: A feasibility study.

BACKGROUND: Antenatal hospitalization for pregnancy complications can result in significant stress for pregnant women and their families. Prenatal yoga has been investigated in the outpatient setting as a method to alleviate stress. This study was designed to investigate the feasibility of incorporating prenatal yoga into the inpatient environment for women hospitalized with pregnancy complications. STUDY DESIGN: High-risk women were recruited from the inpatient antepartum service at Tufts Medical Center (Boston, MA; March 2016 to February 2017) to evaluate the feasibility of an inpatient prenatal yoga program. The thirty-minute session was led by a certified instructor in a room adjacent to Labor and Delivery. Participants and antepartum nurses completed study questionnaires addressing logistics such as class duration and frequency. Perceived benefits of yoga were also explored. RESULTS: Thirty-nine women were found eligible for this study and were consented for participation. Of these, fifteen (38%) participated in at least one yoga session. Responses to the to the post-class questionnaire by study participants indicated that the thirty minutes allocated for the yoga class was appropriate. Of the eight participants who responded to the discharge questionnaire, all indicated that the class was helpful with regards to stress reduction. Completed questionnaires by the antepartum nursing staff (n = 14) unanimously indicated that the yoga session was helpful for the patients and was not disruptive to medical care. CONCLUSION(S): Prenatal yoga is a technique that has been currently limited to the outpatient setting. This study provides a foundation for continued investigation of inpatient prenatal yoga for women hospitalized with pregnancy complications.

The impact of gentle language on pain perception during colposcopy: a randomized controlled trial.

OBJECTIVE: To determine whether language and word choice can reduce patients' perception of pain experienced during colposcopy with biopsies. MATERIALS AND METHODS: Women reporting for colposcopy at an academic medical center were randomized to hear standard language or gentle, non-pain-based language during colposcopy with biopsy and/or endocervical curettage. Participants then rated their pain during the procedure on a 10-cm visual analog scale. The pain scores among the 2 groups were compared using a Student t test. RESULTS: Both women hearing standard language and those hearing gentle language during colposcopy reported low pain during the procedure (3.1 and 2.9, respectively), which was not significantly different between groups (p=.80). CONCLUSIONS: Although gentle language has been shown to effectively reduce pain associated with other procedures, it did not reduce the pain associated with colposcopy and biopsies in this study.