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Obstetrics and Gynecology Clinics of... Sep 2023The one-size-fits-all model of prenatal care has remained largely unchanged since 1930. New models of prenatal care delivery can improve its efficacy, equity, and... (Review)
Review
The one-size-fits-all model of prenatal care has remained largely unchanged since 1930. New models of prenatal care delivery can improve its efficacy, equity, and experience through tailoring prenatal care to meet pregnant people's medical and social needs. Key aspects of recently developed prenatal care models include visit schedules based on needed services, telemedicine, home measurement of routine pregnancy parameters, and interventions that address social and structural drivers of health. Several barriers that affect the individual, provider, health system, and policy levels must be addressed to facilitate implementation of new prenatal care delivery models.
Topics: Pregnancy; Female; Humans; Prenatal Care; Delivery of Health Care; Telemedicine
PubMed: 37500209
DOI: 10.1016/j.ogc.2023.03.002 -
Obstetrics and Gynecology Clinics of... Sep 2023Group prenatal care (GPC) is a novel model of health care delivery for pregnant patients. In GPC, a small group of patients of similar gestational age meet at scheduled... (Review)
Review
Group prenatal care (GPC) is a novel model of health care delivery for pregnant patients. In GPC, a small group of patients of similar gestational age meet at scheduled intervals for both medical care and facilitated educational discussions. This care model encourages better communication and engages patients and providers in a supportive community. There is evidence that GPC leads to improved patient and provider satisfaction, health equity, and maternal and neonatal outcomes. Delivery of prenatal care in a group setting is a significant change from the traditional model and takes willingness, planning, and commitment for implementation and continued success.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Prenatal Care; Delivery of Health Care
PubMed: 37500210
DOI: 10.1016/j.ogc.2023.03.003 -
Einstein (Sao Paulo, Brazil) 2023To evaluate prenatal and puerperium care levels received and identify their association with sociodemographic and obstetric characteristics.
OBJECTIVE
To evaluate prenatal and puerperium care levels received and identify their association with sociodemographic and obstetric characteristics.
METHODS
This cross-sectional study was conducted from May to December 2020 and included women who gave birth at the Municipal Hospital of Fazenda Rio Grande, Paraná, Brazil. Data were collected through interviews and review of portfolios and medical records. The variables extracted from the prenatal protocols of Paraná and the Ministry of Health were grouped into five compliance indices: CI1 - clinical examination; CI2 - health education; CI3 - queries; CI4 - examinations and vaccines; and CI5 - postpartum appointments. Prenatal care was considered adequate when 80% or more adequacy was obtained.
RESULTS
A total of 307 women participated in this study. Prenatal compliance was 16.6% considering the entire set of variables. The best performance was for CI4 (54.7%) and the worst for CI5 (13.3%). The lowest adequacy occurred among single women (10.9%) compared to those who lived with a partner (19.9%) (p=0.043) and among women with black/brown skin color (9.5%) compared to those with white/yellow skin color (20.3%) (p=0.016).
CONCLUSION
Most women did not receive adequate care, with those in situations of greater social vulnerability received worse quality care.
Topics: Postpartum Period; Prenatal Care; Quality of Health Care; Humans; Female; Child; Adolescent; Young Adult; Adult; Middle Aged; Patient Satisfaction; Brazil; Health Education
PubMed: 37531474
DOI: 10.31744/einstein_journal/2023AO0094 -
Obstetrical & Gynecological Survey Aug 2023CenteringPregnancy (CP) is a model for group prenatal care associated with improved perinatal outcomes for preterm birth and low birthweight, increased rates of... (Review)
Review
IMPORTANCE
CenteringPregnancy (CP) is a model for group prenatal care associated with improved perinatal outcomes for preterm birth and low birthweight, increased rates of breastfeeding, and higher rates of patient and clinician satisfaction.
OBJECTIVE
The study aims to review the literature related to perinatal outcomes associated with CP, benefits and barriers to implementation, and utility of the model.
EVIDENCE
An electronic-based search was performed in PubMed using the search terms "CenteringPregnancy" OR "Centering Pregnancy," revealing 221 articles.
RESULTS
The CP model improves patient centeredness, efficiency, and equality in prenatal care. Challenges include administrative buy-in, limited resources, and financial support. Multisite retrospective studies of CP demonstrate improved maternal, neonatal, postpartum, and well-being outcomes, especially for participants from minority backgrounds; however, prospective studies had mixed results. CenteringPregnancy is feasibly implemented with high tenet fidelity in several low- and middle-income settings with improved perinatal outcomes compared with traditional care.
CONCLUSIONS
CenteringPregnancy is feasible to implement, largely accepted by communities, and shows positive qualitative and quantitative health outcomes. This body of literature supports CP as a potential tool for decreasing racial inequalities in prenatal access, quality of care, and maternal mortality. Further investigation is necessary to inform obstetric clinicians about the potential outcome differences that exist between group and traditional prenatal care.
Topics: Infant, Newborn; Female; Pregnancy; Humans; Premature Birth; Prospective Studies; Retrospective Studies; Postpartum Period; Prenatal Care
PubMed: 37594439
DOI: 10.1097/OGX.0000000000001169 -
MCN. the American Journal of Maternal...Oral health is an important aspect of overall health and should be maintained during pregnancy. Due to complex physiological changes during pregnancy, the pregnant woman...
BACKGROUND
Oral health is an important aspect of overall health and should be maintained during pregnancy. Due to complex physiological changes during pregnancy, the pregnant woman is at risk for developing periodontal disease and dental caries which are associated with poor birth outcomes including preterm births and low birthweight infants. Evidence-based guidelines developed by several professional organizations recommend oral screening be included in the first prenatal visit. The purpose of this quality improvement project was to implement a dental screening tool during prenatal care to identify pregnant patients with oral health needs and provide subsequent referrals to a dentist.
METHODS
The project was implemented over a 14-week period and included an oral health screening using a valid and reliable tool to identify oral health needs. Patients were screened and received a referral for dental care.
RESULTS
N = 826 pregnant women were screened. Of those screened 36.3% (n = 300) had not had their teeth cleaned in the past 12 months. More than 30% of pregnant patients (n = 316) reported some type of dental problem, 29.5% (n = 244) were screened during the first prenatal visit, and 36.7% (n = 303) were enrolled in Medicaid. At project completion, 74.6% (n = 616) of patients received dental referrals.
CONCLUSION
Conducting oral health screenings during the first prenatal visit is important for identifying pregnant women at risk for oral health problems and improving birth outcomes and allows the patient time to visit the dentist prior to birth. Integration of an oral health screening and referral process can be successfully implemented during prenatal care to meet the needs of childbearing women.
Topics: Infant; Infant, Newborn; Pregnancy; Female; Humans; Prenatal Care; Dental Caries; Pregnant Women; Oral Health; Referral and Consultation; Dental Care
PubMed: 37840202
DOI: 10.1097/NMC.0000000000000957 -
Obstetrics and Gynecology Clinics of... Sep 2023Pregnancy care should include open discussions with patients about their ideal family size and pregnancy spacing. With these patient-voiced goals in mind, clinicians... (Review)
Review
Pregnancy care should include open discussions with patients about their ideal family size and pregnancy spacing. With these patient-voiced goals in mind, clinicians should review contraceptive tools to meet these goals, including special considerations after birth. For patients that desire contraception, it is important to prioritize the provision of their chosen method as soon as safely possible and desired after birth.
Topics: Pregnancy; Female; Humans; Contraceptive Agents; Postpartum Period; Counseling; Contraception; Prenatal Care
PubMed: 37500213
DOI: 10.1016/j.ogc.2023.03.006 -
Obstetrics and Gynecology Clinics of... Sep 2023
Topics: Pregnancy; Female; Humans; Prenatal Care; Prenatal Diagnosis
PubMed: 37500224
DOI: 10.1016/j.ogc.2023.03.001 -
Medical Anthropology Quarterly Dec 2023Drawing from ethnographic research with Latin American migrant mothers seeking prenatal care at a safety net clinic in southern Connecticut, I describe the racial...
Drawing from ethnographic research with Latin American migrant mothers seeking prenatal care at a safety net clinic in southern Connecticut, I describe the racial dynamics of a medical hierarchy that situates White providers and nurses above Black and Brown medical assistants and patients, terming this the prenatal care color line. I characterize three segments of the prenatal care color line: through (1) onerous enrollment in prenatal care support that strips rights from migrant mothers; (2) differences in racialized embodiment that harden essentialist and stereotyped notions surrounding Latinx reproduction, making the experience of pregnancy and birth a process of race-making; and (3) obstetric racism manifest through both denying or delaying critical medical care to Latinx pregnant patients while also overmedicalizing their uncomplicated births. I argue that the presence of the prenatal care color line-in my study clinic as in other safety net clinics-permits the harsher racialization of Latinx birthers.
Topics: Female; Humans; Pregnancy; Anthropology, Medical; Hispanic or Latino; Mothers; Prenatal Care; Racism; Transients and Migrants; Connecticut; Safety-net Providers
PubMed: 37354543
DOI: 10.1111/maq.12782 -
Obstetrics and Gynecology Clinics of... Sep 2023The challenges of providing prenatal care for undocumented immigrants require patience. Pregnant undocumented immigrant women should receive routine prenatal care... (Review)
Review
The challenges of providing prenatal care for undocumented immigrants require patience. Pregnant undocumented immigrant women should receive routine prenatal care tailored to their specific needs, with an emphasis on basic needs (eg, housing, safety, food, transportation to appointment). Financial, cultural, and language barriers can impede undocumented immigrants from receiving adequate or optimal prenatal care. Adverse maternal and fetal outcomes may be more common but have not been well-quantified and cannot be compared with outcomes if care had been provided in their country of origin. An example of a community-funded clinic is described in minimizing cost and optimizing outcomes.
Topics: Pregnancy; Humans; Female; Undocumented Immigrants; Pregnant Women; Prenatal Care; Health Services Accessibility
PubMed: 37500222
DOI: 10.1016/j.ogc.2023.03.012 -
Obstetrics and Gynecology Clinics of... Sep 2023Modifications of prenatal care will be needed in expected weight gain, nutritional recommendations, screening tests, thromboprophylaxis, ultrasound, antenatal testing,... (Review)
Review
Modifications of prenatal care will be needed in expected weight gain, nutritional recommendations, screening tests, thromboprophylaxis, ultrasound, antenatal testing, and timing and mode of delivery.
Topics: Pregnancy; Female; Humans; Prenatal Care; Anticoagulants; Pregnancy Complications; Venous Thromboembolism; Obesity
PubMed: 37500214
DOI: 10.1016/j.ogc.2023.03.013