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Objectives: To explore socio-behavioral, clinical, and imaging findings associated with antepartum intimate partner violence (IPV) and aid in risk stratification of at-risk individuals. Methods: We analyzed electronic medical records during indexed pregnancies for 108 pregnant patients who self-reported antepartum IPV (cases) and 106 age-matched pregnant patients who did not self-report antepartum IPV (controls). Sociodemographic, clinical, and radiology data were analyzed via chi-squared and Fisher's exact tests with p < 0.05 as the threshold for significance. Stepwise logistic regression was applied to derive a risk prediction model. Results: The proportion of cases reporting emotional IPV (76% vs. 52%) and/or physical IPV (45% vs. 31%) during pregnancy significantly increased from prior to pregnancy. Cases were significantly more likely to report prepregnancy substance use (odds ratio [OR] = 2.60; 95% confidence interval [CI]: 1.13-5.98), sexually transmitted infections (OR = 3.48; 95%CI: 1.64-7.37), abortion (OR = 3.17; 95%CI: 1.79, 5.59), and preterm birth (OR = 5.97; 95%CI: 1.69-21.15). During pregnancy, cases were more likely to report unstable housing (OR = 5.26; 95%CI: 2.67-10.36), multigravidity (OR = 2.83; 95%CI: 1.44-5.58), multiparity (OR = 3.75; 95%CI: 1.72-8.20), anxiety (OR = 3.35; 95%CI: 1.85-6.08), depression (OR = 5.58; 95%CI: 3.07-10.16), substance use (OR = 2.92; 95%CI: 1.28-6.65), urinary tract infection (UTI) (OR = 3.26; 95%CI: 1.14-9.32), intrauterine growth restriction (OR = 10.71; 95%CI: 1.35-85.25), and cesarean delivery (OR = 2.25; 95%CI: 1.26-4.02). Cases had significantly more OBGYN abnormalities on imaging and canceled more radiological studies (OR = 5.31). Logistic regression found housing status, sexually transmitted infection history, preterm delivery history, abortion history, depression, and antepartum UTI predictive of antepartum IPV. The risk prediction model achieved good calibration with an area under the curve of 0.79. Conclusions: This study identifies significant disparities among patients experiencing antepartum IPV, and our proposed risk prediction model can inform risk assessment in this setting.
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OBJECTIVE: The purpose of this study is to understand experiences of respectful maternity care (RMC) from the perspective of birthing people in the United States from 2013 to 2018. METHODS: We conducted an online cross-sectional survey of United States birthing people ages 18-50 in April 2018 using SurveyMonkey Audience. Quantitative survey data consisted of demographics and responses to RMC indicators. Qualitative data consisted of comments from individuals regarding their birth experiences. RESULTS: 1036 birthing people participated in the survey. Most births (95%) occurred in hospitals. 16.3% of Black or African American participants reported discrimination compared to 5.5% of participants who did not identify as Black or African American (p < 0.001). Participants who speak a language other than English were also more likely to report discrimination. 19.5% of all respondents felt neglected during their birth experience. Most prevalent experiences of disrespect and mistreatment were related to neglect (most commonly in postpartum phase of care), poor interpersonal communication, lack of respect for patient wishes, negative experience with breastfeeding services, peripartum complications, and discrimination. CONCLUSION FOR PRACTICE: Birthing people in the United States experience many forms of mistreatment, particularly those who identify as Black or African American or speak a language other than English. Patients described experiencing neglect most commonly after birth-an opportunity to improve the provision of RMC postpartum. Strategies to improve quality of maternal health care in the United States should include the provision of RMC as part of a larger effort to reduce inequities in maternal health experiences and outcomes.
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Disparidades en Atención de Salud , Servicios de Salud Materna , Respeto , Humanos , Femenino , Estudios Transversales , Adulto , Servicios de Salud Materna/normas , Servicios de Salud Materna/estadística & datos numéricos , Estados Unidos , Embarazo , Disparidades en Atención de Salud/etnología , Adolescente , Encuestas y Cuestionarios , Persona de Mediana Edad , Negro o Afroamericano/psicología , Negro o Afroamericano/estadística & datos numéricos , Adulto Joven , Calidad de la Atención de Salud/normasRESUMEN
The standard care model in the postpartum period is ripe for disruption and attention. Hypertensive disorders of pregnancy (HDPs) can continue to be a challenge for the postpartum person in the immediate postpartum period and is a harbinger of future health risks. The current care approach is inadequate to address the needs of these women. We propose a model for a multidisciplinary clinic and collaboration between internal medicine specialists and obstetric specialists to shepherd patients through this high-risk time and provide a bridge for lifelong care to mitigate the risks of a HDP. KEY POINTS: · HDPs are increasing in prevalence.. · The postpartum period can be more complex for women with HDPs.. · A multidisciplinary clinic could fill the postpartum care gap for women with HDP..
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Female genital cutting (FGC) is a persisting global practice that increases patients' risk for experiencing long-term health sequelae. Existing meta-analysis evidence strongly supports an association between FGC and the development of long-term dyspareunia, urinary tract infections, and sexual dysfunction as well as increased risk obstetrically of prolonged labor, cesarean section, perineal lacerations, and episiotomy. Surgical defibulation is recommended in patients with type III FGC to decrease obstetric and gynecologic morbidity. Existing evidence does not seem to definitively support clitoral reconstructive surgery. More research is needed to study conservative treatment and management approaches to long-term sequelae of FGC.
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Circuncisión Femenina , Dispareunia , Trabajo de Parto , Cesárea , Circuncisión Femenina/efectos adversos , Clítoris , Dispareunia/etiología , Dispareunia/terapia , Femenino , Humanos , EmbarazoAsunto(s)
Infecciones por Coronavirus , Coronavirus , Pandemias , Neumonía Viral , Complicaciones Infecciosas del Embarazo , Betacoronavirus , COVID-19 , Niño , Femenino , Humanos , Recién Nacido , Embarazo , SARS-CoV-2RESUMEN
Female genital mutilation or cutting (FGM/C) involves medically unnecessary cutting of parts or all of the external female genitalia. It is outlawed in the United States and much of the world but is still known to occur in more than 30 countries. FGM/C most often is performed on children, from infancy to adolescence, and has significant morbidity and mortality. In 2018, an estimated 200 million girls and women alive at that time had undergone FGM/C worldwide. Some estimate that more than 500 000 girls and women in the United States have had or are at risk for having FGM/C. However, pediatric prevalence of FGM/C is only estimated given that most pediatric cases remain undiagnosed both in countries of origin and in the Western world, including in the United States. It is a cultural practice not directly tied to any specific religion, ethnicity, or race and has occurred in the United States. Although it is mostly a pediatric practice, currently there is no standard FGM/C teaching required for health care providers who care for children, including pediatricians, family physicians, child abuse pediatricians, pediatric urologists, and pediatric urogynecologists. This clinical report is the first comprehensive summary of FGM/C in children and includes education regarding a standard-of-care approach for examination of external female genitalia at all health supervision examinations, diagnosis, complications, management, treatment, culturally sensitive discussion and counseling approaches, and legal and ethical considerations.
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Circuncisión Femenina , Niño , Maltrato a los Niños , Cicatriz/etiología , Circuncisión Femenina/efectos adversos , Circuncisión Femenina/clasificación , Circuncisión Femenina/legislación & jurisprudencia , Circuncisión Femenina/psicología , Competencia Clínica , Confidencialidad , Documentación , Femenino , Enfermedades Urogenitales Femeninas/etiología , Procedimientos Quirúrgicos Ginecológicos , Humanos , Infecciones/etiología , Infertilidad Femenina/etiología , Consentimiento Informado , Clasificación Internacional de Enfermedades , Notificación Obligatoria , Anamnesis , Salud Mental , Dolor/etiología , Pediatras , Examen Físico , Prevalencia , Refugiados/legislación & jurisprudencia , SexualidadRESUMEN
The coronavirus disease 2019 (COVID-19) pandemic is a public health emergency requiring significant changes in obstetric and gynecologic health care delivery to minimize the risk of transmission to healthy patients and health care workers. Although these changes are necessary, they will differentially affect patients in a way that highlights and exacerbates existing inequities in health care access and outcomes. Socially vulnerable groups are already disproportionately affected by COVID-19 infection and more likely to experience severe morbidity and mortality. Some reasons for this include a limited ability to practice risk-reducing behaviors such as physical distancing, higher prevalence of chronic medical conditions, and less access to medical care. Additionally, the structural changes now taking place in health care delivery have negatively affected the ability of socially vulnerable groups to obtain necessary obstetric and gynecologic care, which may lead to poorer outcomes. As physician-leaders enact new policies to respond to the COVID-19 public health crisis, it is important to consider the potential for exacerbating existing health inequities and to be proactive in creating policies that promote equity.
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Infecciones por Coronavirus/prevención & control , Ginecología/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Obstetricia/estadística & datos numéricos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Betacoronavirus , COVID-19 , Femenino , Disparidades en el Estado de Salud , Humanos , Atención Perinatal/estadística & datos numéricos , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Complicaciones Infecciosas del Embarazo/virología , SARS-CoV-2RESUMEN
BACKGROUND: The aims of this study were to identify factors influencing participation in global health electives during residency and to understand the career impact of global health electives on alumni of an Obstetrics and Gynecology (OB/GYN) residency program. METHODS: This was a cross-sectional, web-based survey of alumni of a residency program in the United States. RESULTS: The response rate was 49%. Out of 73 respondents, 29 (39.7%) had completed a global health elective. Availability of funds and flexibility of elective time were the main enabling factors for participating in global health electives. Most participants of global health electives in residency reported a positive impact on their competence in domestic and global women's health and on their career choices. Completing a global health elective in residency was associated with career work in global health and/or local health disparities (OR 4.62 (95% CI: 1.20-17.87)). CONCLUSION: Global health electives are important in the career development of residents. To foster OB/GYNs that continue global health and health disparities work, OB/GYN programs should give trainees the opportunity to participate in funded global health electives.
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Salud Global/educación , Ginecología/educación , Disparidades en Atención de Salud/estadística & datos numéricos , Obstetricia/educación , Adulto , Actitud del Personal de Salud , Selección de Profesión , Movilidad Laboral , Estudios Transversales , Países en Desarrollo , Femenino , Salud Global/economía , Humanos , Internado y Residencia , Masculino , Estados UnidosRESUMEN
BACKGROUND: Group-based health services can improve maternal and newborn health outcomes. Group antenatal care and participatory learning and action cycles (PLA) with women's groups have been cited by the WHO as health systems interventions that can lead to improvements in adherence to care and health outcomes in pregnancy and the postpartum period. METHODS: We used a mixed-methods approach to assess the feasibility of a light touch group-based support intervention using the WhatsApp text-messaging platform. Pregnant women were enrolled at Jacaranda Health (JH), a maternity center in peri-urban Kiambu County, Kenya. Their phone numbers were added to WhatsApp groups consisting of participants with similar estimated due dates. The WhatsApp group administrator was a JH employee. Acceptability, demand, implementation, and practicality of this service were evaluated through in-depth interviews (IDIs), surveys, chart review, and analysis of group chats. Limited analysis of program efficacy (ANC visits, any PNC, and post-partum family planning uptake) was assessed by comparing participant data collected through chart review using a concurrent comparison of the general JH patient population. RESULTS: Fifty women (88%) of 57 eligible women who were approached to participate enrolled in the study. Five WhatsApp groups were created. A total of 983 messages were exchanged over 38 weeks. No harms or negative interactions were reported. Participants reported several benefits. Participants had differing expectations of the level of the group administrator's activity in the groups. ANC and PNC attendance were in line with the hospital's metrics for the rest of JH's patient population. Higher rates of postpartum long acting reversible contraception (LARC) uptake were observed among participants relative to the general patient population. CONCLUSIONS: A moderated mobile-based support group service for pregnant women and new mothers is safe and feasible. Additional research using experimental designs to strengthen evidence of the effectiveness of the support intervention is warranted.
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OBJECTIVE: To investigate the association among public health insurance, preconception care, and pregnancy outcomes in pregnant women with pregestational diabetes. METHODS: This is a retrospective cohort of pregnant women with pregestational type 1 or type 2 diabetes from 2006 to 2011 in Massachusetts-a state with universal insurance coverage since 2006. Women delivering after 24 weeks of gestation and receiving endocrinology and obstetric care in a multidisciplinary clinic were included. Rates of preconception consultation, our primary outcome of interest, were then compared between publicly and privately insured women. We used univariate analysis followed by logistic regression to compare receipt of preconception consultation and other secondary diabetes care measures and pregnancy outcomes according to insurance status. RESULTS: Fifty-four percent (n=106) of 197 women had public insurance. Publicly insured women were younger (median age 30.4 compared with 35.3 years, P<.01) with lower rates of college education (12.3% compared with 45.1%, P<.01). Women with public insurance were less likely to receive a preconception consult (5.7% compared with 31.9%, P<.01), had lower rates of hemoglobin A1C less than 6% at the onset of pregnancy (37.2% compared with 58.4%, P=.01), and experienced higher rates of pregnancies affected by congenital anomalies (10.4% compared with 2.2%, P=.02) compared with those with private insurance. In adjusted analyses controlling for educational attainment, maternal age, and body mass index, women with public insurance were less likely to receive a preconception consult (adjusted odds ratio [OR] 0.21, 95% CI 0.08-0.58), although the odds of achieving the target hemoglobin A1C (adjusted OR 0.45, 95% CI 0.20-1.02) and congenital anomaly (adjusted OR 2.23, 95% CI 0.37-13.41) were similar after adjustment. CONCLUSION: Despite continuous access to health insurance, publicly insured women were less likely than privately insured women to receive a preconception consult-an evidence-based intervention known to improve pregnancy outcomes. Improving use of preconception care among publicly insured women with diabetes is critical to reducing disparities in outcomes.
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Disparidades en Atención de Salud/estadística & datos numéricos , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Atención Preconceptiva/estadística & datos numéricos , Embarazo en Diabéticas/terapia , Adulto , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/terapia , Femenino , Hemoglobina Glucada/análisis , Humanos , Modelos Logísticos , Massachusetts , Edad Materna , Oportunidad Relativa , Embarazo , Resultado del Embarazo , Embarazo en Diabéticas/sangre , Embarazo en Diabéticas/etiología , Estudios RetrospectivosRESUMEN
IMPORTANCE: Mosquitoes are the most common disease vectors worldwide. A combination of factors, including changes in public health policy, climate change, and global travel, has led to the resurgence and spread of these diseases in our modern world. Pregnant women are vulnerable to a number of these illnesses, and obstetricians are likely to encounter pregnant travelers who have been exposed. OBJECTIVE: This review was conducted to summarize knowledge of mosquito-borne diseases and their relevance in pregnancy. This will allow obstetricians to provide proper advice regarding travel and prepare providers to recognize manifestations of these illnesses in the pregnant woman. EVIDENCE ACQUISITION: A review of the current literature was performed to summarize the various manifestations of mosquito-borne illnesses in pregnant women and discuss obstetric outcomes and management of disease in pregnancy. RESULTS: Mosquito-borne illnesses usually manifest after a period of incubation lasting from days to weeks. Symptoms usually include a febrile illness but may be nonspecific and may masquerade as pregnancy-specific illnesses such as preeclampsia or HELLP (hemolysis, elevated liver enzyme levels, and low platelet levels); a large number of patients remain asymptomatic. Pregnancy-related outcomes include spontaneous abortion, intrauterine fetal demise, intrauterine transmission to the fetus, and congenital anomalies. Management during pregnancy is mainly supportive. Precautions against disease include protective clothing and insect repellents. Vaccines are either available or in development. CONCLUSIONS AND RELEVANCE: Mosquito-borne disease should be considered in pregnant women who present with a febrile illness and a relevant exposure history. Prompt recognition can allow supportive treatment to the mother and fetal resuscitation and surveillance.
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Salud Global , Mosquitos Vectores , Complicaciones Infecciosas del Embarazo/microbiología , Viaje , Animales , Infecciones por Arbovirus/transmisión , Femenino , Humanos , Embarazo , Factores de RiesgoRESUMEN
Purpose The mistreatment of women during childbirth in health facilities is a growing area of research and public attention. Description In many countries, disrespect and abuse from maternal health providers discourage women from seeking childbirth with a skilled birth attendant, which can lead to poor maternal and neonatal outcomes. This commentary highlights examples from three countries-Kenya, Mexico and the United States-and presents different forms of mistreatment during childbirth, which range from physical abuse to non-consented care to discriminatory practices. Assessment Building on the momentum from the United Nations Sustainable Development Goals, the International Federation of Gynecology and Obstetrics, and the Global and Maternal Neonatal Health Conference, the global community has placed respectful maternity care at the forefront of the maternal and neonatal health agenda. Conclusion Research efforts must focus on context-specific patient satisfaction during childbirth to identify areas for quality improvement.
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Parto Obstétrico/normas , Satisfacción del Paciente , Mejoramiento de la Calidad , Calidad de la Atención de Salud , Adulto , Actitud del Personal de Salud , Femenino , Instituciones de Salud , Humanos , Kenia , Servicios de Salud Materna/normas , México , Estados Unidos , Derechos de la MujerRESUMEN
UNLABELLED: Background Currently there are no guidelines regarding optimal screening for latent tuberculosis infection during pregnancy. Objective This study measures completion rates and the concordance between the TSPOT.TB, a commercially available interferon gamma release assay (IGRA), and the traditional tuberculin skin test (TST) in a predominantly urban minority obstetrics practice. Design This is an observational cohort study of 141 pregnant women enrolled from an obstetrics practice with a large immigrant population. Women with a history of a positive TST result were excluded. Demographic and clinical risk factors for tuberculosis were assessed. Enrolled women underwent a T-SPOT.TB test and placement of TST, and returned in 48-72 h for TST interpretation. We calculated the completion rate and frequency of a positive result for each test, as well as the concordance between the T-SPOT.TB and TST. Results Among the 141 women enrolled, 75 % were either Latina or African-American, 44 % were born in a country with a high TB prevalence, and 52 % had received the Bacillus Calmette-Guerin vaccine. Seven women (5 %) had a positive screening test, a total of 3 positive T-SPOT.TB results and 6 positive TST results, and all were from countries with a high TB prevalence. The concordance of the two tests was 96.3 %. The completion rate for the T-SPOT.TB was 98 %, while the completion rate for the TST was 63 %. CONCLUSION: The IGRA test had a markedly higher completion rate in addition to maintaining high concordance with the two-step TST in this population of pregnant women with a high prevalence of prior TB exposure. Targeted screening of women from countries with a high prevalence of tuberculosis may be warranted during prenatal care.
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Ensayos de Liberación de Interferón gamma/estadística & datos numéricos , Tamizaje Masivo/métodos , Prueba de Tuberculina/estadística & datos numéricos , Tuberculosis/diagnóstico , Adulto , Emigrantes e Inmigrantes , Femenino , Humanos , Memoria Episódica , Valor Predictivo de las Pruebas , Embarazo , Atención Prenatal , Prevalencia , Factores de Riesgo , Sensibilidad y Especificidad , Tuberculosis/epidemiología , Tuberculosis/microbiología , Tuberculosis/prevención & control , Población UrbanaRESUMEN
With the growing number of Muslim patients in the United States, there is a greater need for obstetrician-gynecologists (ob-gyns) to understand the health care needs and values of this population to optimize patient rapport, provide high-quality reproductive care, and minimize health care disparities. The few studies that have explored Muslim women's health needs in the United States show that among the barriers Muslim women face in accessing health care services is the failure of health care providers to understand and accommodate their beliefs and customs. This article outlines health care practices and cultural competency tools relevant to modern obstetric and gynecologic care of Muslim patients, incorporating emerging data. There is an exploration of the diversity of opinion, practice, and cultural traditions among Muslims, which can be challenging for the ob-gyn who seeks to provide culturally competent care while attempting to avoid relying on cultural or religious stereotypes. This commentary also focuses on issues that might arise in the obstetric and gynecologic care of Muslim women, including the patient-physician relationship, modesty and interactions with male health care providers, sexual health, contraception, abortion, infertility, and intrapartum and postpartum care. Understanding the health care needs and values of Muslims in the United States may give physicians the tools necessary to better deliver high-quality care to this minority population.