Provider confidence in counseling preconception, pregnant, and postpartum patients regarding COVID‐19 vaccination: A cross‐sectional survey study

Background and Aims Healthcare provider counseling surrounding COVID‐19 vaccine in pregnancy and lactation is essential to vaccination uptake in this population; however, provider knowledge and confidence are not well characterized. We aimed to assess knowledge and confidence in COVID‐19 vaccine counseling among practitioners who provide care to pregnant persons and to describe factors associated with confidence in counseling. Methods A web‐based anonymous survey was distributed via email to a cross‐sectional convenience sample of Obstetrics and Gynecology, Primary Care, and Internal Medicine faculty at three hospitals in a single healthcare network in Massachusetts, United States. Individual demographics and institution‐specific variables were included in the survey along with questions assessing both attitudes toward COVID‐19 illness and confidence in counseling regarding the use of the vaccine in pregnancy. Results Almost all providers (151, 98.1%) reported that they received a COVID‐19 vaccine, and most (111, 72.1%) reported that they believe the benefits of the vaccine in pregnancy outweigh the risks. Forty‐one (26.6%) reported feeling very confident in counseling patients who primarily speak English about the evidence for messenger ribonucleic acid vaccination in pregnancy, and 36 (23%) reported feeling very confident in counseling patients who are not primarily English‐speaking. Forty‐three providers (28.1%) expressed strong confidence in their comfort talking to individuals with vaccine hesitancy based on historic and continued racism and systemic injustices. The sources that survey respondents most used to find information regarding COVID‐19 vaccination in pregnancy were the Centers for Disease Control (112, 74.2%), hospital‐specific resources (94, 62.3%), and the American College of Obstetricians and Gynecologists (82, 54.3%). Conclusion Ensuring that providers feel comfortable bridging the gap between their belief that the vaccine is beneficial for pregnant patients and their comfort with holding conversations with patients regarding vaccination is paramount to ensure equitable access to vaccines for pregnant patients

Resident and Program Director’s Perceptions of Milestone-Based Feedback in Obstetrics and Gynecology

Introduction: In July 2014, US residency programs fully implemented the Next Accreditation System including the use of milestone evaluation and reporting. Currently, there has been little investigation into the result of implementation of this new system. Therefore, this study sought to evaluate perceptions of Obstetrics and Gynecology residents and program directors regarding the use of milestone-based feedback and identify areas of deficiency. Methods: A Web-based survey was sent to US-based Obstetrics and Gynecology residents and program directors regarding milestone-based assessment implementation. Results: Out of 245 program directors, 84 responded to our survey (34.3% response rate). Of responding program directors, most reported that milestone-based feedback was useful (74.7%), fair (83.0%), and accurate (76.5%); however, they found it administratively burdensome (78.1%). Residents felt that milestone-based feedback was useful (62.7%) and fair (70.0%). About 64.3% of residents and 74.7% of program directors stated that milestone-based feedback is an effective tool to track resident progression; however, a sizable minority of both groups believe that it does not capture surgical aptitude. Qualitative analysis of free response comments was largely negative and highlighted the administrative burden and lack of accuracy of milestone-based feedback. Conclution: Overall, both Obstetrics and Gynecology program directors and residents report that milestone-based feedback is useful and fair. Issues of administrative burden, timeliness, evaluation of surgical aptitude, and ability to act on assigned milestone levels were identified. Although this study is limited to one specialty, such issues are likely important to all residents, faculty, and program directors who have implemented the Next Accreditation System requirements

Strength of preference for vaginal birth as a predictor of delivery mode among women who attempt a vaginal delivery

ObjectiveWe sought to assess the relationship between strength of preference for vaginal birth and likelihood of vaginal delivery among women attempting this delivery mode.Study designWe conducted a longitudinal study of mode of delivery preferences among women who were <36 weeks' pregnant. Participants completed a sociodemographic and clinical questionnaire and were asked if they preferred vaginal or cesarean delivery. Participants who preferred vaginal delivery completed a standard gamble exercise to assess the strength of this preference on a 0-to-1 scale (higher scores indicate stronger preference for vaginal delivery); those preferring cesarean delivery were assigned a value of 0. Data on clinical characteristics and delivery mode were obtained via telephone interview or chart review. Logistic regression was used to identify predictors of delivery mode among women who attempted a vaginal delivery.ResultsOf 210 participants, 156 attempted a vaginal delivery. Their mean and median vaginal delivery preference scores were 0.70 (SD 0.31) and 0.75 (interquartile range, 0.50-0.99), respectively. In multivariate analyses, women with a prior cesarean delivery (adjusted odds ratio [aOR], 0.08; 95% confidence interval [CI], 0.02-0.39) or who delivered an infant ≥4000 g (aOR, 0.04; 95% CI, 0.01-0.28) had significantly lower odds of having a vaginal delivery. After controlling for potential confounders, participants with a stronger preference for vaginal delivery were at significantly higher odds of having a vaginal delivery (aOR, 1.54; 95% CI, 1.01-2.34 for every 0.2 increase on the 0-to-1 scale).ConclusionAmong women who attempt a vaginal delivery, the strength of preference for vaginal birth is predictive of the delivery mode ultimately undergone

Perinatal morbidity associated with late preterm deliveries compared to deliveries between 37–40 weeks

ObjectiveTo estimate the risk of short-term complications in neonates born between 34 and 36 weeks by week of gestation.DesignThis is a retrospective cohort study.SettingDeliveries in 2005 in the United States of America.PopulationSingleton live births between 34 and 40 weeks gestational age.MethodsGestational age was subgrouped into 34, 35, 36 and 37–40 completed weeks. Statistical comparisons were performed using chi-square test and multivariable logistic regression models, with 37–40 weeks gestational age designated as referent.Main Outcome MeasuresPerinatal morbidities, including 5-minute Apgar scores, hyaline membrane disease, neonatal sepsis/antibiotics use, and admission to the intensive care unit.ResultsThere were 175,112 neonates born between 34 and 36 weeks in 2005. Compared to neonates born between 37 and 40 weeks, neonates born at 34 weeks had higher odds of 5-minute Apgar<7 (adjusted odds ratio [aOR]=5.51, 95% CI [5.16–5.88]), hyaline membranes disease (aOR=10.2 [9.44–10.9]), mechanical ventilation use >6 hours (aOR=9.78 [8.99–10.6]) and antibiotics use (aOR=9.00 [8.43–9.60]). Neonates born at 35 weeks were similarly at risk of morbidity, with higher odds of 5-minute Apgar <7 (aOR 3.42 [3.23–3.63], surfactant use (aOR 3.74 [3.21–4.22], ventilation use >6 hours (aOR 5.53 [5.11–5.99] and NICU admission (aOR 11.3 [11.0–11.7). Further, neonates born at 36 weeks remain at higher risk of morbidity compared to deliveries at 37–40 weeks.ConclusionsWhile the risk of undesirable neonatal outcomes decreases with increasing gestational age, the risk of neonatal complications in late preterm births remains higher compared to infants delivered at 37–40 weeks gestation

Perinatal morbidity associated with late preterm deliveries compared to deliveries between 37–40 weeks

ObjectiveTo estimate the risk of short-term complications in neonates born between 34 and 36 weeks by week of gestation.DesignThis is a retrospective cohort study.SettingDeliveries in 2005 in the United States of America.PopulationSingleton live births between 34 and 40 weeks gestational age.MethodsGestational age was subgrouped into 34, 35, 36 and 37–40 completed weeks. Statistical comparisons were performed using chi-square test and multivariable logistic regression models, with 37–40 weeks gestational age designated as referent.Main Outcome MeasuresPerinatal morbidities, including 5-minute Apgar scores, hyaline membrane disease, neonatal sepsis/antibiotics use, and admission to the intensive care unit.ResultsThere were 175,112 neonates born between 34 and 36 weeks in 2005. Compared to neonates born between 37 and 40 weeks, neonates born at 34 weeks had higher odds of 5-minute Apgar<7 (adjusted odds ratio [aOR]=5.51, 95% CI [5.16–5.88]), hyaline membranes disease (aOR=10.2 [9.44–10.9]), mechanical ventilation use >6 hours (aOR=9.78 [8.99–10.6]) and antibiotics use (aOR=9.00 [8.43–9.60]). Neonates born at 35 weeks were similarly at risk of morbidity, with higher odds of 5-minute Apgar <7 (aOR 3.42 [3.23–3.63], surfactant use (aOR 3.74 [3.21–4.22], ventilation use >6 hours (aOR 5.53 [5.11–5.99] and NICU admission (aOR 11.3 [11.0–11.7). Further, neonates born at 36 weeks remain at higher risk of morbidity compared to deliveries at 37–40 weeks.ConclusionsWhile the risk of undesirable neonatal outcomes decreases with increasing gestational age, the risk of neonatal complications in late preterm births remains higher compared to infants delivered at 37–40 weeks gestation