Is provision of contraception at discharge following delivery associated with postpartum visit attendance?

OBJECTIVES: We examined whether provision of contraception at discharge following delivery was associated with lower rates of postpartum visit (PPV) attendance. METHODS: We conducted a retrospective cohort study of women who received pregnancy care at a Midwestern medical center in 2013. Attendance at the postpartum visit was compared for women with sterilization, contraception initiated prior to discharge (depot medroxyprogesterone acetate or etonogestrel implant), hormonal contraception prescription, or no contraception provided at postpartum discharge. Poisson regression models with robust standard errors were used to estimate the relative risk of postpartum visit attendance controlling for age, race, and parity, insurance status, and histories of both depression and drug abuse. RESULTS: Of the 1015 women who met inclusion criteria, 55% had been prescribed contraception, had initiated contraception prior to discharge, or were sterilized at the time of discharge following delivery. After adjustment for confounders, there was no association between receiving contraception and PPV attendance (relative risk for prescribed contraception = 1.09 [95% CI 0.85, 1.39], for contraception initiated prior to discharge = 0.83 [95% CI 0.67, 1.03], for sterilization = 0.86 [95% CI 0.63, 1.17] compared to no contraception). CONCLUSIONS: We found no evidence that prescribing or administering contraception post-delivery was associated with lower rates of return for postpartum follow up. IMPLICATIONS: This single site study suggests that providing effective contraception at discharge following delivery does not appear to impact PPV attendance.

Do patients associate adverse pregnancy outcomes with folkloric beliefs?

Many "old wives' tales" suggest that women can contribute to adverse outcomes through their behaviors and thoughts. Women attending a Midwestern American clinic were surveyed to determine how common such beliefs are. Two hundred women rated their agreement with a set of nine such beliefs. Women with a personal history of an adverse event had beliefs similar to those without such a history. The data suggest that such beliefs do not influence a woman's experience of pregnancy loss or birth defect.

A randomized trial of vaginal prostaglandin E(2) gel and dinoprostone vaginal insert for induction of labor at term.

Objective: The aim of this study was to determine whether dinoprostone vaginal insert (Cervidil) can ripen the cervix and induce labor more effectively and safely than a hospital-prepared intravaginal gel.Methods: Three hundred thirty-six patients undergoing cervical ripening for induction of labor at term were randomly assigned to receive either Cervidil insert or a hospital-formulated prostaglandin E(2) gel. Bishop scores were evaluated before and after administration of the ripening agent, and charts were subsequently reviewed for labor characteristics, mode of delivery, and complications of labor and delivery.Results: Cervical ripening as measured by a change in Bishop score was significantly better in those patients receiving Cervidil than those receiving the gel (3.54 vs 2.29, P <.0001). Although duration of labor was similar between the two groups, those receiving Cervidil were less likely to require oxytocin stimulation (RR 0.51, 95% CI 0.29-0.91). Though the Cervidil group had a lower cesarean section rate than the gel group, the difference did not achieve statistical significance (25.4% vs 33.8%, P =.089). Complication rates did not differ significantly between the two groups.Conclusions: Cervidil insert is superior to intravaginal gel in ripening the cervix and inducing labor, with no increase in morbidity. It has not been shown to have a significant effect on duration of labor or mode of delivery.

Incidence of pregnancy-induced hypertension among gestational diabetics.

Although hypertensive disorders of pregnancy are more likely to occur in pregestational diabetics, the question of whether they occur more frequently in gestational diabetics or certain subsets of gestational diabetics remains unclear. This study compared 197 gestational diabetics with 197 control patients matched on the basis of age, race, parity, and prepregnancy weight. No significant difference was found between the two groups in the incidence of either pregnancy-induced hypertension or preeclampsia. There was, however, a small but significant elevation in mean arterial blood pressure in the third trimester in gestational diabetics compared with control patients (90.1 versus 87.5 mm Hg; p = 0.006). Mean arterial pressures were also higher in diabetic patients on insulin compared with those on diet, and higher in diabetic patients diagnosed early (less than 24 weeks) compared with those diagnosed late (more than 24 weeks) in pregnancy; however, there were larger numbers of chronic hypertensives in these two groups. We conclude that gestational diabetics do not develop pregnancy-induced hypertension more frequently. Small increases in blood pressure late in pregnancy in these patients achieve statistical significance, but their clinical relevance is unclear.