The International Transfer of Patients With Positive SARS-CoV-2 Test Using a Framework.

The Japanese Fellowship Program at the U.S. Naval Hospital Yokosuka has served as a liaison with Japanese hospitals during the transfer of acutely ill U.S. Navy patients since 1952. The SARS-CoV-2 pandemic has complicated this process and prompted the creation of a new framework that involves the Public Health Center. We present two international transfer cases of patients with positive SARS-CoV-2. The creation of a framework enabled a safe and smooth transfer process of patients with a favorable outcome. This report can help guide future cases of international transfer, especially for patients who need infectious disease surveillance. To our knowledge, we describe the first report of an international transfer of patients with positive SARS-CoV-2 test using a framework.

Extra-amniotic balloon for preinduction cervical ripening: a randomized comparison of weighted traction versus unweighted.

OBJECTIVE: To determine whether a weighted versus unweighted balloon catheter achieved a shorter first stage of labor. METHODS: This was a randomized trial of patients undergoing induction with Bishop score <4. Women were randomized to weighted balloon catheter with 1000 mL fluid bag or unweighted catheter taped to the thigh. RESULTS: A total of 60 women were randomized. The time from balloon catheter insertion until discontinuation was significantly longer in the unweighted group 4.62 ± 0.65 h versus 1.59 ± 0.2 h in the weighted group (p = 0.001). This resulted in longer cervical ripening/first stage of labor in the unweighted (18.52 ± 0.96 h) versus weighted group (15.3 ± 0.99 h) (p = 0.025). The unweighted balloon catheter had a shorter first stage of labor as gravidity increased (p = 0.007) and as race went from white to non-white (p = 0.003). There was no difference in perceived pain after balloon insertion (p = 0.0942), or Bishop score after balloon discontinuation (p = 0.1661). CONCLUSION: The total time from cervical ripening to the end of the first stage of labor is significantly shortened with the weighted balloon catheter.

Postpartum use of long-acting reversible contraception in a military treatment facility.

OBJECTIVE: To determine the rate at which long-acting reversible contraception (LARC) is desired immediately postpartum and utilized within 12 weeks of delivery at our institution. METHODS: This prospective cohort study analyzed 400 consecutive postpartum patients between January 2009 and March 2009. We followed contraceptive desire prior to discharge and actual contraception utilized within 12 weeks postpartum. Patient demographics and LARC utilization was analyzed to determine characteristics predictive of use. RESULTS: There was complete follow-up information on 329 (82.3%) of the studied women. Thirty-three percent (132/400) desired LARC immediately postpartum, and overall LARC utilization at 12 weeks was 31% (100/329). Demographic characteristics predictive of LARC desire and utilization included age <25 years (adjusted RR=1.53, 95% CI 1.17-1.92) and African-American ethnicity (adjusted RR=1.39, 95% CI 1.03-1.78). CONCLUSION: In our institution, LARC is highly desired and utilized within 12 weeks postpartum with African-American ethnicity and age <25 years predictive of use.

Postpartum insertion of levonorgestrel--intrauterine system at three time periods: a prospective randomized pilot study.

BACKGROUND: The study was conducted to determine the feasibility of levonorgestrel-intrauterine system (LNG-IUS) insertion at three different times postpartum. STUDY DESIGN: From August 2009 to January 2010, all women desiring LNG-IUS for postpartum contraception were offered enrollment into our study and randomized to three insertion times: immediate (within 10 min of placenta delivery), early (10 min to 48 h postpartum) or interval (≥6 weeks postpartum). RESULTS: Forty-six women met inclusion criteria and were analyzed. There was no difference in utilization rates at 3 and 6 months between groups (p=.931). Expulsion rates were significantly higher and pain during insertion was significantly lower in the immediate and early groups (p<.001) when compared to the interval group. CONCLUSION: Insertion of LNG-IUS ≤48 h postpartum is feasible in our institution and may be associated with similar utilization at 6 months, increased expulsion rates and decreased pain at insertion when compared to placement after 6 weeks.