Are neonatal birthweights reduced in low-risk patients diagnosed with COVID-19 during pregnancy?

OBJECTIVE: Studies have shown that 2019 novel coronavirus disease (COVID-19) may be associated with an increased risk of adverse pregnancy outcomes including preeclampsia, preterm birth, and stillbirth. However, the relationship between COVID-19 and abnormal fetal growth (i.e., low neonatal birthweight) has not been elucidated. Because other viruses affect fetal growth, obstetrical providers began to recommend ultrasound studies during the third trimester to assess fetal growth in patients with COVID-19 during pregnancy.The aim of this study was to determine if neonatal birthweight was different between low-risk patients diagnosed with COVID-19 during pregnancy and low-risk patients without COVID-19 in pregnancy, to ascertain if third trimester growth ultrasound is warranted in this patient population. STUDY DESIGN: We performed a retrospective cohort study of low-risk pregnant patients (who had no other indications for sonographic fetal surveillance during the third trimester) with and without COVID-19 during pregnancy. Patient demographics, gestational dating, neonatal birthweights, and corresponding Alexander growth curve birthweight percentiles were collected. The primary outcome was small-for-gestational age (SGA) neonates, defined as birthweight <10th percentile for gestational age at delivery (SGA10). RESULTS: Our cohort (N=513) included 248 COVID-19-exposed patients and 265 patients who did not have COVID-19 during pregnancy. Gestational age at delivery and average neonatal birthweights were similar in COVID-19 exposed (38 weeks 5 days, 3,266 grams) and unexposed patients (38 weeks 4 days, 3,224 grams P=0.434, P=0.358). Rates of SGA10 neonates were similar in the COVID-19 exposed (22/248, 8.9%) and unexposed (23/265, 8.7%, P=0.939). Timing and severity of COVID-19 during pregnancy also were not associated with rates of SGA neonates. CONCLUSION: In a cohort of low-risk patients, rates of SGA neonates were similar in patients with and without COVID-19 during pregnancy. These findings suggest that ultrasound surveillance to detect fetal growth restriction in low-risk patients with COVID-19 during pregnancy is not warranted.

A Simple Intervention to Improve Equity in Obstetric Research.

Introduction: To evaluate if a simple intervention, including formation of a Research Equity Committee and a dashboard detailing study approach and enrollment statistics by race, could improve equitable inclusion in obstetric research. Methods: Our intervention had four components: (1) research personnel submitted dashboards every 3 months to the Research Equity Committee; (2) approach and enrollment by race were compared with expected racial breakdown; (3) study teams with rates of approach and/or enrollment of black birthing people below goal met with the committee for root cause analysis (RCA) and action planning; (4) all dashboards, RCAs, and action plans were presented at 3-month intervals. We prospectively evaluated the impact of this intervention on the inclusion of self-reported black birthing people in actively enrolling obstetrical studies at an academic university from July 2021 to June 2022. Results: Seven qualifying prospective studies submitted 23 equity dashboards, which encompassed 692 patients. Six RCAs and action planning were held. Themes of developed action plans included: (1) standardizing how, when, and which patients to approach to eliminate approach bias, (2) standardized scripts for patient recruitment, and (3) study expansion to more diverse clinics. All four studies that underwent an RCA demonstrated improvements after the intervention; however, only one study demonstrated a statistically significant increase in approach (p=0.002) and enrollment (p=0.02) of black birthing people across the study period. Discussion and Health Equity Implications: A simple intervention can improve approach and enrollment of black birthing people in obstetric research.

Efficacy of Propranolol to Reduce Cesarean Delivery in Prolonged Labor: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the rates of cesarean delivery in patients with prolonged labor randomized to receive intravenous (IV) propranolol compared with placebo. METHODS: A double-blind, placebo-controlled, randomized trial was conducted at two hospitals within a large academic health system. Eligible patients were at 36 weeks or more with a singleton gestation and prolonged labor , defined as: 1) prolonged latent phase of labor (dilation less than 6 cm after 8 hours or more with ruptured membranes and receiving oxytocin infusion) or 2) prolonged active phase of labor (dilation 6 cm or greater and less than 1-cm cervical dilation change over 2 hours or more with ruptured membranes and receiving oxytocin infusion). Patients were excluded for severe preeclampsia, maternal heart rate less than 70 beats per minute, maternal blood pressure less than 90/50 mm Hg, asthma, diabetes requiring insulin during labor, or a cardiac contraindication to ß-blockade. Patients were randomized to propranolol (2 mg IV) compared with placebo (2 mL normal saline IV), with one possible repeat dose. The primary outcome was cesarean delivery; secondary outcomes included labor duration, shoulder dystocia, and maternal and neonatal morbidity. With an estimated cesarean delivery rate of 45%, α 0.05, and 80% power, we required 163 patients per group to detect a 15% absolute reduction in cesarean delivery rate. A planned interim analysis was performed, and the trial was stopped for futility. RESULTS: From July 2020 to June 2022, 349 patients were eligible and approached; 164 were enrolled and randomized, with 84 in the propranolol group and 80 in the placebo group. The rate of cesarean delivery was not different between groups (57.1% propranolol vs 57.5% placebo, relative risk [RR] 0.99, 95% CI 0.76-1.29). Results were similar by subgroup of prolonged latent (n=123) and active (n=41) phases of labor and nulliparous (n=137) and multiparous (n=27) patients. Though not statistically significant, the frequency of postpartum hemorrhage was higher in the propranolol group (20% vs 10%, RR 2.02, 95% CI 0.93-4.43). CONCLUSION: In this multisite, double-blind, placebo-controlled randomized trial, there was no difference in cesarean delivery rate for patients who received propranolol compared with those who received placebo for management of prolonged labor. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov , NCT04299438.

A randomized trial assessing the impact of educational podcasts on personal control and satisfaction during childbirth.

BACKGROUND: Childbirth education can help pregnant individuals feel in control, relieve anxiety and fear, and decrease pain perception. However, many barriers exist that impede patients from obtaining adequate childbirth education, especially in the era of the COVID-19 pandemic. Advances in technology, such as podcasts, can allow for asynchronous patient education. OBJECTIVE: This study aimed to assess the effect of a labor education podcast on personal perception of control and patient satisfaction during childbirth. STUDY DESIGN: This was a randomized controlled trial that included nulliparous, low-risk women with singleton gestations who reached 36 weeks' gestation at 2 academic hospitals in Philadelphia, Pennsylvania. Participants were randomized at 28 weeks and 0 days of gestation to usual education (control) or podcast education (intervention), which included links to 7 labor-related podcast episodes on patient-suggested topics that were available on widely-used podcatchers. Primary outcomes were assessed with a 3-question birth satisfaction survey and the Labour Agentry Scale to evaluate personal perception of control during childbirth. Secondary outcomes included the Edinburgh Postnatal Depression Scale score. Analyses were performed as intention-to-treat. Parametric and nonparametric data were compared using the Student t-test or Wilcoxon rank-sum test, as appropriate. RESULTS: A total of 201 women were randomized, and 153 were included in the final analysis (78 in podcast and 75 in control group). There were no significant differences in maternal demographics. Patients in the podcast group had higher median birth satisfaction scores compared with the control group (20 [18-21] vs 18 [16-21]; P=.002), without a significant difference in median Labour Agentry Scale scores (57 [50-63] vs 54 [47-62]; P=.12). When restricting analysis to patients who underwent induction, Labour Agentry Scale scores were significantly higher in the podcast group (58 [53-64] vs 54 [47-61]; P=.045), representing an increased perception of control. However, birth satisfaction score was not different between the groups (P=.06). The most downloaded podcasts were on induction and labor anesthesia. More than 95% of participants would recommend the podcasts to family and friends. CONCLUSION: An educational podcast on labor topics was well-received, increased patient satisfaction overall, and increased labor agentry among those who were induced. Podcasts are a promising educational modality to improve patient experience during childbirth, and warrant further exploration.