Postpartum Remote Blood Pressure Monitoring Using a Mobile App in Women with a Hypertensive Disorder of Pregnancy.

BACKGROUND: Hypertensive disorders of pregnancy affect approximately 15% of pregnancies in the United States and are a leading cause of postpartum readmissions. Morbidity due to hypertension may be higher in the first several weeks postpartum. The ability to monitor blood pressure and intervene in the postpartum period is critical to reducing morbidity and mortality. LOCAL PROBLEM: At WellSpan Health, hypertensive disorders were increasing and a leading cause of severe maternal morbidity and readmission. INTERVENTIONS: A remote blood pressure monitoring app called BabyScripts™ myBloodPressure was implemented in September 2020. Prior to discharge postpartum, all patients with a diagnosis of a hypertensive disorder of pregnancy were given an automatic blood pressure cuff and instructions on how to monitor and track their blood pressure daily in the app. RESULTS: A total of 1,260 patients were enrolled in the BabyScripts™ myBloodPressure module between September 2020 and July 2022 across five maternity hospitals. Of those enrolled 74% (n = 938) entered seven or more blood pressures, and of those who entered at least one blood pressure 9% (n = 107) entered at least one critical range blood pressure (≥150 mmHg systolic and or ≥100 mmHg diastolic). CONCLUSION: Most women enrolled in the app were highly engaged and entered seven or more readings. Patients with critical blood pressures were identified; thus, the program has the potential to identify those at risk of severe complications. Barriers should be removed, and remote patient monitoring considered as a solution to improve postpartum assessment in patients with hypertensive disorders of pregnancy.

Survey of Postpartum People in the United States During the First Wave of the COVID-19 Pandemic to Explore Their Perspective on Support After Discharge.

INTRODUCTION: The purpose of this study was to capture the experiences of postpartum people during the first wave of COVID-19, specifically their access to contraception and lactation support. METHODS: This cross-sectional study surveyed individuals in the United States who used the Ovia Pregnancy and Parenting app. The survey was administered via an email Web link sent to postpartum people who gave birth between March 1, 2020, and June 11, 2020. Quantitative and qualitative analyses were conducted. RESULTS: A total of 388 postpartum people completed the survey. Most participants had just given birth to their first baby (68.5%; n = 261) at term gestation (37-41 weeks) (92.9%; n = 355). From the qualitative data, using content analysis, we derived 6 themes and 2 subthemes: quarantine, changes in postpartum care, loneliness and isolation, stress, resource changes, and positive impact. The theme loneliness and isolation had 2 subthemes: depression/sadness/hopelessness and anxiety. DISCUSSION: The experience of being postpartum during the COVID-19 pandemic brought unforeseen challenges. Providing care and support to postpartum people during a pandemic, specifically during a time of quarantine, should be reimagined. Increased use of virtual postpartum care services and expanded mental health support could serve to fill the gaps identified by participants.

Improving Cardiovascular Follow-Up after Diagnosis of a Hypertensive Disorder of Pregnancy using the Electronic Health Record.

BACKGROUND: Cardiovascular disease is the leading cause of death among women. Sex-specific risk factors for cardiovascular disease include history of a hypertensive disorder of pregnancy. PROBLEM: After diagnosis of a hypertensive disorder of pregnancy, professional societies recommend follow-up with a primary care provider for preventative care. There are gaps in patient and health care provider knowledge of the association between a hypertensive disorder of pregnancy and cardiovascular disease. That gap has a negative effect on patients receiving recommended follow-up. METHODS: An electronic registry was created to identify those who gave birth in our health system and had a diagnosis of hypertensive disorder of pregnancy. From this, information outreach was sent electronically to the patient and their primary care provider. INTERVENTIONS: Communication in the outreach included education on the association between hypertensive disorders of pregnancy and cardiovascular disease, the importance of follow-up, cardiopreventative strategies, and biochemical assessment. Medical records were audited at approximately 6 months postpartum to determine if patients completed a visit with their primary care provider to discuss cardiovascular risks. RESULTS: Between May 2021 and June 2022, 15% ( n = 1,131) of patients who gave birth in our health system had a diagnosis of hypertensive disorder of pregnancy. Ninety percent of those patients who received outreach communication viewed the letter. At baseline, 16% of patients during postpartum with a hypertensive disorder of pregnancy saw their primary care provider to discuss cardiopreventative strategies. After implementation of our program, 26% of those with a hypertensive disorder of pregnancy saw their primary care provider for follow-up and discussed cardiopreventative strategies. CLINICAL IMPLICATIONS: Nurses should ensure that women during postpartum and their primary care providers are educated about the association of hypertensive disorders of pregnancy and long-term cardiovascular risk. The electronic health record may be an optimal way to ensure education is provided and follow-up scheduled.

Standardizing Screening for Preeclampsia Risk Factors to Improve Prescribing of Low-Dose Aspirin.

ABSTRACT: Preeclampsia is a serious health condition and leading cause of perinatal and neonatal morbidity and mortality. Research supports the use of low-dose aspirin therapy to prevent preeclampsia in high-risk pregnant people. This quality improvement project outlines the implementation of a preeclampsia risk screen in the electronic health record to ensure standardized screening for, and provision of, low-dose aspirin therapy consistent with professional guidelines. Two thousand three hundred seventy-one patients were seen between March and November 2020 at 13 OB/GYN and family practice offices at a large health system in our state. Provider screening and prescribing rates were evaluated at the first prenatal visit, and at 3-month intervals using an analytics dashboard built in the EHR. In the first 3 months after rollout visits at all offices in our system (March to May 2020), the average screening rate during first prenatal visits at all offices was 74.2% (n = 561), 41% (n = 230) had a positive screen, and 81.3% (n = 187) of those who screened high risk were prescribed aspirin as recommended. At 9 months after rollout, the screening rate during first prenatal visits at all offices improved to 95.6% (n = 782), 39.6% (n = 310) of those screened, screened positive, and 97.1% (n = 301) were prescribed low-dose aspirin therapy appropriately.

A Pilot Randomized Control Trial to Assess the Impact of Lavender on Anxiety and Comfort After Cesarean Birth and the Barriers Encountered.

PURPOSE: This study aimed to assess the effect of lavender aromatherapy on anxiety and comfort after cesarean birth. STUDY DESIGN: Randomized control trial. METHODS: Forty-eight patients who had a cesarean birth were asked to complete the six-item State and Trait Anxiety (STAI-6) score to assess their level of anxiety pre- and postapplication of either lavender aromatherapy or placebo during their inpatient postpartum stay. Their comfort and pain levels pre- and postadministration were assessed, and differences between groups were analyzed. Results: There was no difference in postintervention STAI-6 scores between the aromatherapy and placebo groups (p = .56). Women who received the lavender aromatab® had significantly (p = .037) higher self-reported levels of comfort (M 2.6 SD .82) when compared with those who received placebo (M 2.0 SD 1.0). CLINICAL IMPLICATIONS: Many women use aromatherapy at home to promote comfort and relaxation. Women feel lavender aromatherapy improves their comfort in the hospital setting after cesarean birth. Clinicians should consider ways to safely use aromatherapy as one option to promote postoperative cesarean birth care.

Impact of COVID-19 on pregnancy worry in the United States.

BACKGROUND: Several recent studies confirm that the COVID-19 pandemic has increased symptoms of stress, anxiety, and depression in pregnant persons around world. In this study, we aimed to uncover the impact of COVID-19 on worry during pregnancy. METHODS: This study used a cross-sectional descriptive research design. A link to a survey was emailed to users of the Ovia Pregnancy app. Participants (N = 253) completed the survey, which included the Cambridge Worry in Pregnancy Scale, and answered several free text questions. The free-text questions were included to capture worries not listed on the scale and to allow participants the opportunity to more clearly describe COVID-19-related worries. Descriptive statistics were reported, and content analysis performed to determine themes. RESULTS: Overall, respondents reported they were quite or very worried about having their partner with them at birth (31.7%, n = 80), giving birth (28.2%; n = 71), and something being wrong with the baby (27.3%; n = 69). Results on worries also differed by participants' race, parity, and trimester. When comparing White to other racial groups, other racial groups had statistically significantly higher median scores for questions on worries about employment (P = .001), going to the hospital (P = .002), and internal examinations (P = .03). Content analysis revealed isolation, loss of support, anxiety/stress, and grief as major themes. DISCUSSION: The worry, isolation, loss of support, anxiety, and grief reported by pregnant persons during the COVID-19 pandemic may impact maternal pre- and postnatal mental health and are not borne equally. Birthing persons of color appear disproportionately impacted. Prenatally, maternity care providers should assess for worry and provide individualized education and resources to pregnant patients, centering individuals and communities made most vulnerable by structural inequality.

Feasibility of Using Blood Pressure Self-Monitoring and the Epic MyChart Blood Pressure Flowsheet to Monitor Blood Pressure After Preeclampsia.

Preeclampsia is associated with significant morbidity and mortality. Women who experienced preeclampsia require close blood pressure surveillance postpartum. Remote monitoring of blood pressure using a mobile health application may be a viable method of surveillance in this population. The purpose of this project was to assess the feasibility of using the MyWellSpan mobile application to engage postpartum women who experienced preeclampsia in blood pressure self-monitoring. Women who chose to participate were provided an automatic blood pressure cuff and educational materials and were enrolled in MyWellSpan. A survey created by the authors asked participants to rate by Likert scale their satisfaction with the program and ease of use of the blood pressure cuff and self-monitoring. The electronic health record was reviewed retrospectively to assess utilization of the MyWellSpan mobile application to document blood pressure. The majority of women who participated reported that operating the blood pressure cuff was very easy and felt that it would be very easy to monitor their blood pressure twice daily. Sixty-nine percent of those women in the program electronically submitted at least 1 blood pressure measurement, thus confirming the feasibility of self-monitoring and reporting using a mobile application.

Giving birth during the COVID-19 pandemic, perspectives from a sample of the United States birthing persons during the first wave: March-June 2020.

BACKGROUND: The COVID-19 pandemic forced hospitals in the United States to adjust policy and procedure in order to provide safe care and prevent the spread of disease. At the beginning of the pandemic, media and case reports described pressure for medical interventions, visitor restrictions, separation from newborns, and an increase in patient demand for community birth (home and birth center). The purpose of this study was to describe birth experiences during the COVID-19 pandemic centering the birthing person's perspective. METHODS: A survey was e-mailed to users of the Ovia Pregnancy app reaching a national convenience sample who gave birth between March 1, 2020, and June 11, 2020. Survey topics included birth location, the Mothers on Respect index, and open-ended questions capturing patient perspectives on the pandemic's effect on their birth experiences. Differences were assessed based on state-level COVID rate and by race. Content analysis was performed to analyze open-ended responses. RESULTS: Respondents from highly impacted COVID-19 states more frequently changed or considered changing their birth location. Racial differences were also found with Black respondents reporting significantly more preterm births and lower respect scores when compared to White respondents. Six themes emerged from the content analysis: Institutional Policies, Changes in Care, Hospital Staff Interactions, Sub-par Care, Issues of Support, and Mental Health. DISCUSSION: The health care community must continue to adapt policies and procedures to best support birthing patients during the COVID-19 pandemic. The community must also continue to address the reality that Black patients receive less respectful care compared with White patients.

Lactation Patterns in Women with Hypertensive Disorders of Pregnancy: An Analysis of Illinois 2012-2015 Pregnancy Risk Assessment Monitoring System (PRAMS) Data.

BACKGROUND: Hypertensive disorders of pregnancy have lifelong implications on maternal cardiovascular health. Breastfeeding has a variety of maternal benefits, including improved lifelong maternal cardiovascular outcomes, with longer periods of lactation resulting in further improvement. Women with hypertensive disorders of pregnancy encounter many barriers to breastfeeding. Little is known about lactation initiation and duration rates in women with hypertensive disorders of pregnancy. The purpose of this study is to describe lactation patterns in women with HDP, hypertensive disorders of pregnancy, compared to normotensive controls using data from the phase 7 Illinois Pregnancy Risk Assessment Monitoring System (PRAMS). SUBJECTS AND METHODS: Illinois PRAMS 2012-2015 (Phase 7) data was used to assess lactation patterns as well as rationale for not initiating breastfeeding or earlier cessation. Women who delivered during this time period were eligible to participate in the PRAMS survey, 5285 were included the analysis. RESULTS: Overall, 17.6% of all women in the study reported their healthcare provider did not speak with them prenatally about breastfeeding. Women who reported they had HDP, were significantly less likely (p ≤ 0.001) to ever breastfeed or pump breast milk to feed their baby, even for a short period, than those women without an HDP. At the time the PRAMS survey was completed, more women without an HDP were still breastfeeding or providing their baby with pumped milk (54.9 v. 48%; p = 0.002). More women with HDP reported stopping breastfeeding because they got sick or had to stop for medical reasons (p = 0.002) and/or because their baby was jaundiced (p = 0.007). CONCLUSION: Cardiovascular disease remains the leading cause of death among women and women with a history of HDP are at increased risk for cardiovascular related morbidity and mortality. Obstetrical providers and nurses caring for this high-risk population should ensure they educate women about the increased cardiovascular risk associated with HDP and the maternal cardiovascular benefits associated with lactation in order to promote and support lactation in this population of women.

Pregnant Women's Reports of the Impact of COVID-19 on Pregnancy, Prenatal Care, and Infant Feeding Plans.

PURPOSE: The aim of this study is to describe how the COVID-19 (coronavirus) pandemic has affected pregnancy, prenatal maternity care practices, and infant feeding plans among pregnant persons in the United States. STUDY DESIGN: Cross-sectional descriptive study using an app-based survey. METHODS: A link to the survey was sent via email to users of the Ovia Pregnancy app on May 20, 2020 and was open for 1 week. Participants were asked to complete the survey as it applied to their pregnancy, breastfeeding, and maternity care received during the COVID-19 pandemic, beginning approximately February 2020 through the time of the survey. There were 258 respondents who completed the survey. RESULTS: The majority (96.4%; n = 251) of pregnant women felt they received safe prenatal care during this time period. Slightly less 86.3% (n = 215) felt they received adequate prenatal care during this time period. 14.2% (n = 33) reported changing or considering changing the location where they planned to give birth due to COVID-19. Of those who reported they had begun purchasing items for their baby, 52.7% reported that the COVID-19 pandemic has affected their ability to get items they need for their baby. CLINICAL IMPLICATIONS: Although it is imperative to implement policies that reduce risk of transmission of COVID-19 to pregnant women and health care providers, it is necessary for health care providers and policy makers to listen to the collective voices of women during pregnancy about how COVID-19 has affected their birth and infant feeding plans and their perception of changes in prenatal care.

A comparison of cervical ripening modalities among overweight and obese nulliparous gravidas.

Objective: To determine if differences exist among nulliparous overweight and obese gravidas undergoing cervical ripening employing three different agents (dinoprostone, misoprostol, or cervical catheter).Methods: A retrospective cohort study of nulliparous overweight and obese women who underwent induction of labor at two south-central Pennsylvania hospitals between January 2014 and December 2017. Nulliparous gravidas, ≥37 weeks' gestational age, with singleton pregnancies in the vertex presentation, were included in the study. We employed the following definitions: (1) overweight: BMI 25.0-29.9 kg/m2; (2) class I obesity: BMI 30.0-34.9 kg/m2; (3) class II obesity: BMI 35.0-39.9 kg/m2; and (4) class III obesity: BMI >40.0 kg/m2. The primary outcome measure was the mean difference in induction-to-birth time. A subanalysis was performed to assess the effect of BMI on the primary outcome. Secondary outcome measures included mode of delivery, induction-to-second-stage-of-labor time, estimated blood loss, neonatal feeding type, neonatal Apgar scores, and neonatal admission to triage or intensive care unit (ICU) after delivery. A priori power calculation estimated that 156 patients would be needed using the medium effective size. Data analysis was performed using ANOVA for continuous variables and chi-square tests for categorical variables.Results: Among 192 nulliparous overweight and obese gravidas, 70 received dinoprostone, 72 were given misoprostol, and 50 had cervical ripening with cervical catheters. There were no significant differences in mean induction to birth times among overweight and obese women when comparing the three cervical ripening agents (dinoprostone 24.5 ± 15.2 versus misoprostol 28.7 ± 12.3 and catheters 25.1 ± 12.9 hours), (p = .145, 95% CI -8.7 to 0.2 and -5.5 to 4.3, respectively). Overweight nulliparous women had shorter mean induction to birth time (22.9 ± 11.4 versus 29.2 ± 15.8 hours) as compared to class II obese women, (p = .037, 95% CI -12.0 to -0.38). When overweight women were compared to class III obese women, shorter mean induction to birth time (22.9 ± 11.4 versus 30.9 ± 13.9 hours) was also found, (p = .005, 95% CI -13.4 to -2.4).Conclusion: Among nulliparous overweight and obese gravidas, neither dinoprostone, misoprostol, or cervical catheter significantly impacted the induction to birth time. There was a longer induction to birth time for class II and class III obese women when compared to overweight women. Additional studies are warranted to improve cervical ripening in nulliparous overweight and obese women.

Surgical-Site Infection Prevention After Hysterectomy: Use of a Consensus Bundle to Guide Improvement.

Hysterectomy is one of the most commonly performed surgeries in women. Surgical-site infections (SSI) after hysterectomy can lead to increased morbidity and mortality as well as readmission, which is associated with increased costs for health systems. The aim of the project was to improve standardization of preoperative education on infection prevention and incorporate the use of preoperative chlorhexidine (CHG) bathing for patients undergoing hysterectomy to decrease rates of SSI. Data on SSI after hysterectomy were reviewed. Tracer methodology was used to identify gaps in the preoperative process by comparing the current process to the Council on Patient Safety in Women's Health Care Patient Safety Bundle "Prevention of Surgical Site Infection after Gynecologic Surgery." After implementation, survey data were collected on adherence to the washing protocol, and SSI data were monitored. Survey results reflected high compliance with the CHG washing protocol, provision of patient education, and overall patient satisfaction with the process. Before implementation in 2016, we reported 8 deep or organ/space SSI to the National Healthcare Safety Network. After implementation in 2018, we reported 3 deep or organ/space SSI. Standardizing infection prevention processes to align with safety bundles improves the quality of care provided to patients.

Women's Knowledge of Cardiovascular Risk After Preeclampsia.

OBJECTIVE: To determine women's self-reported knowledge of the association between preeclampsia and cardiovascular disease and to determine if they received appropriate education on the recommendations of the American Heart Association for follow-up and for cardiovascular risk reduction strategies after preeclampsia. DESIGN: Cross-sectional descriptive study using an online survey. SETTING/LOCAL PROBLEM: A survey link was placed on the Facebook pages for two preeclampsia support groups. PARTICIPANTS: A total of 241 women who were members of these Facebook groups completed the online survey. INTERVENTION/MEASUREMENTS: An online survey was created using Campus Labs software. Most questions were closed response. Participants were asked to answer survey questions about their first pregnancy with preeclampsia and the education/referrals they received specific to the association between preeclampsia and cardiovascular risk. RESULTS: Of all those who responded, 36.9% (n = 89) reported being unaware of the association between preeclampsia and cardiovascular disease. Of those who gave birth since the American Heart Association issued recommendations for follow-up after preeclampsia, 43.9% (n = 61) reported that they received no counseling regarding incorporating healthful lifestyle changes or follow-up after their diagnosis of preeclampsia. CONCLUSION: Women with a history of preeclampsia may not be receiving adequate education on its association with cardiovascular disease. Nurses can work to fill this gap through collaboration with cardiovascular and primary care providers to orchestrate seamless cardioprotective follow-up for this population of women.

A Quality Improvement Initiative to Reduce Opioid Consumption after Cesarean Birth.

BACKGROUND: One in 300 opioid naïve women become addicted to opiates after cesarean birth. After cesarean, women are often prescribed more opiates at discharge than necessary, resulting in increased opportunity for diversion. PURPOSE: To improve use of comfort strategies and nonopioid medications to decrease the amount of opioids required postoperatively and prescribed at discharge, in women who gave birth via cesarean. METHODS: An interdisciplinary workgroup was convened to assess data on opioid use, prescribing practices at discharge, and nurses' use of alternative comfort strategies from January to March 2018. A comfort bundle was designed to include standardized use of preoperative acetaminophen, postoperative comfort education, simethicone, postoperative gum chewing, and abdominal binders. Nurses and healthcare providers were educated on the initiative. Data were reevaluated and compared with preintervention data assessing for improvement and adherence to the bundle components. RESULTS: There was a 61% reduction in morphine milliequivalents given to women after cesarean birth between the first quarter in 2018 and the fourth quarter in 2018. Comparing March with December, 2018 data, adherence to each bundle component improved. The percentage of women receiving less than 20 tabs of oxycodone at discharge increased from 26.3% to 96.7%. IMPLICATIONS FOR NURSING PRACTICE: Nurses should evaluate comfort options provided after cesarean birth and educate women about use of nonopioid pain relief strategies. A standardized process to address pain and comfort after cesarean birth may decrease exposure to opioids while maintaining comfort.

A Labor Support Workshop to Improve Undergraduate Nursing Students' Understanding of the Importance of High Touch in a High-Tech World.

This article presents the development and evaluation of a labor support workshop aimed at providing senior undergraduate nursing students with education on the provision of labor support. In collaboration with a Lamaze educator, a two and half hour interactive educational session was developed. The workshop included both a didactic and a hands-on component which included physical labor support strategies, which could be utilized in the clinical setting. Pre-and postintervention data was collected on students' knowledge and self-efficacy in the provision of labor support, as well as, data on their use of these strategies while in the clinical setting. The labor support workshop was well received by students (4.9/5) and increased their self-reported knowledge (p = <.001) and self-efficacy (p = <.001) in the provision of labor support.

Maternal ABO Blood Type and Factors Associated With Preeclampsia Subtype.

BACKGROUND: The pathophysiology of preeclampsia remains unclear. The disorder is heterogeneous, and the pathophysiology may vary by subtype. Identification of relevant biomarkers will help to better elucidate the pathophysiologic basis of each preeclampsia subtype. Blood type may be a biomarker that allows risk identification for preeclampsia. OBJECTIVE: The purpose of this study was to investigate the associations among maternal ABO blood type and preeclampsia subtype and fetal growth restriction (FGR). METHOD: Medical records of 126 women with early-onset preeclampsia (≤33 6/7 weeks' gestation), 126 women with late-onset preeclampsia (≥34 0/7 weeks' gestation), and 259 controls who gave birth between January 2012 and June 2016 were retrospectively abstracted from a large suburban tertiary referral center in South Central Pennsylvania for this hospital-based case-control study. RESULTS: Women with AB blood type had >3 times the odds of late-onset preeclampsia (odds ratio [ OR] = 3.35, 95% confidence interval (CI) = [1.02, 11.05]) compared to those with O blood type. Among women with early-onset preeclampsia, those with B blood type had 5 times the odds of having a growth-restricted fetus than did women with O blood type ( OR = 5.44, 95% CI [1.65, 17.94]). DISCUSSION: Our findings suggest that AB blood type may be an important risk factor for late-onset preeclampsia and that among women with early-onset preeclampsia, those with B blood type have increased odds of FGR. These findings warrant further study in women and their offspring to identify the pathophysiologic processes that may link ABO blood type, preeclampsia subtype, and FGR.

Association Between Lactation and Postpartum Blood Pressure in Women with Preeclampsia.

PURPOSE: Preeclampsia affects 3% to 8% of all pregnancies. There are two distinct subtypes; early- (<34 weeks) and late-onset (≥34 weeks). Each subtype is associated with increased risk of cardiovascular disease. Lactation has been shown to improve cardiovascular outcomes. The purpose of this study was to describe lactation practices among women with each subtype of preeclampsia and determine the association between lactation and blood pressure at the initial postpartum visit. STUDY DESIGN AND METHODS: This retrospective cohort study included 246 subjects; 120 early- and 126 with late-onset preeclampsia who gave birth to live singleton newborns at a large suburban tertiary referral center in south central Pennsylvania between January 2012 and June 2016. Electronic health records were reviewed and data abstracted. Univariate and bivariate analyses were conducted. RESULTS: There was a significant difference in breastfeeding intent (p = .004) as well as rate of breastfeeding at maternal hospital discharge (p< .001) by preeclampsia subtype. However, there was no difference in rate of breastfeeding at the initial postpartum visit (p = .21) between subtypes. There was a significant difference in systolic (p = .03) and diastolic (p = .04) blood pressure between those breastfeeding and those who were not breastfeeding at the initial postpartum visit. CLINICAL IMPLICATIONS: Healthcare providers should provide women with preeclampsia clear and consistent messaging about importance of breastfeeding during pregnancy and the postpartum period on its association with improved neonatal outcomes, and specifically education on the cardioprotective benefit of sustained lactogenesis.

A Quality Study to Explore Rationale for Pregnant Women to Decline Transvaginal Cervical Length Screening.

OBJECTIVES: To identify patient rationale for pregnant women to decline transvaginal cervical length screening. METHODS: Survey data from 511 women presenting for second-trimester anatomy and transvaginal cervical length sonography were collected during a 4-month period from September 2016 to January 2017. Each patient completed a medical questionnaire that includes demographic and obstetric history data and a survey to document their acceptance or declination of transvaginal cervical length screening. RESULTS: Of the 511 women included in the study, 5.9% (n = 30) declined transvaginal cervical length screening. Demographic characteristics and risk factors for prematurity were similar between those who accepted and declined. The sonographer performing the study was significantly associated with declination of transvaginal cervical length screening (P < .001), with 4 of 13 sonographers accounting for 83.3% of all declinations. The most frequently reported reasons for declining the transvaginal cervical length screening were feeling that it was not needed (47%; n = 14) and not feeling prepared for the transvaginal sonography (27%; n = 8). CONCLUSION: The findings of this study indicate that the sonographer performing transvaginal cervical length screening may be associated with declination. The most common reasons patients cited for declining included not feeling that the study was needed and not feeling prepared for the procedure. Increased sonographer education and sonographer use of a scripted approach when discussing the procedure with patients may improve patient acceptance.

Evaluation of Nursing School Educators' Knowledge and Attitudes Regarding Infant Sleep Safety.

AIM: The purpose of this study was to evaluate nursing educators' attitudes and knowledge regarding current American Academy of Pediatrics recommendations for a safe infant sleeping environment. METHOD: This was a cross-sectional prospective survey of all nursing programs with associate degrees or higher in the United States. Instructors teaching pediatric and obstetric didactic or clinical material at an Accreditation Commission for Education in Nursing-approved nursing school could participate. RESULTS: Of 396 educators surveyed, 70 percent identified all sudden infant death syndrome risk factors. Correct responses for individual safe sleep recommendations ranged from 99 percent for correct room temperature to 53 percent for pacifier use; 9 percent said it was safest for infants to sleep in a position other than on the back. CONCLUSION: Nursing educators need ongoing training on infant sleep safety to maintain mastery of the information that students need for competency in the workforce involving infant care.

Collaborative Testing Using Quizzes as a Method to Improve Undergraduate Nursing Student Engagement and Interaction.

Alternative testing methods are gaining popularity as an innovative means of assessing learning and retention of knowledge. Collaborative testing, an alternative to traditional testing, fosters interaction and collaboration among students. This article describes the use of collaborative testing using quizzes in an accelerated second-degree baccalaureate nursing program in order to enhance learning and retention of course content. Feedback from students was overwhelmingly positive, and most believed this strategy provided a structured method to their studying and acquisition of course concepts, which was particularly beneficial within an accelerated course format.