BACKGROUND: Chorioamnionitis has serious maternal-newborn risks. Risk factors include prelabor rupture of membranes (PROM), vaginal exams, and inadequate perineal hygiene. There may be opportunities to reduce chorioamnio...BACKGROUND: Chorioamnionitis has serious maternal-newborn risks. Risk factors include prelabor rupture of membranes (PROM), vaginal exams, and inadequate perineal hygiene. There may be opportunities to reduce chorioamnionitis with PROM and newborns affected by chorioamnionitis within the Joint Commission Measure of Unexpected Newborn Complications (PC-06) using an infection prevention bundle. PROBLEM: An internal audit found an increased incidence of newborns born to women with chorioamnionitis. Patients with PROM had a 6.2% chorioamnionitis rate compared to a 3.6% overall chorioamnionitis rate. INTERVENTIONS: A quality improvement project using an infection prevention bundle for PROM was implemented using three interventions: avoiding unnecessary vaginal exams in PROM diagnosis, hourly pericare with peripad changes, and hand hygiene compliance. RESULTS: Data were compared from first quarter 2023 before bundle implementation through third quarter 2023 post bundle implementation. The rate of chorioamnionitis was decreased among patients with PROM from 8.1% (9/111) in first quarter 2023 to 3.1% (4/126) in third quarter 2023. There were fewer newborns affected by chorioamnionitis within PC-06, from 9% (3/32) in first quarter 2023 to 7% (3/46) in third quarter 2023. PROM with chorioamnionitis within PC-06 was 0% (0/32) at first and (0/46) third quarter 2023. CONCLUSIONS: Bundle adherence with PROM could help decrease chorioamnionitis and contribute to fewer newborn complications related to chorioamnionitis.
Young mothers are depicted in the literature as inept parents whose poor decisions and risky behavior lead to early and unprotected sex, a poorly timed birth, and adverse outcomes. This risky conception of teen mothering...Young mothers are depicted in the literature as inept parents whose poor decisions and risky behavior lead to early and unprotected sex, a poorly timed birth, and adverse outcomes. This risky conception of teen mothering emerged in the 1970s as social scientists, policy makers, and advocacy groups embraced theories and assumptions of deviance that blame young mothers for jeopardizing their future and their child's well-being. This individualistic framing of young mothering is increasingly debunked by innovative well-designed studies over the last 3 decades. A hypothetical teenage couple is presented to highlight the limitations of the risky conception and to argue for its replacement. The Reproductive Justice movement challenges the individualistic framework by highlighting the socioeconomic conditions that contribute to teen births and health and social disparities among marginalized women and their children. Policies that rectify these conditions are required.
BACKGROUND: Maternal mortality rates in the United States are alarmingly high, especially in rural areas with limited access to care. Clinicians in rural hospitals are challenged to maintain their obstetric knowledge and...BACKGROUND: Maternal mortality rates in the United States are alarmingly high, especially in rural areas with limited access to care. Clinicians in rural hospitals are challenged to maintain their obstetric knowledge and skills due to low patient volumes and limited educational opportunities. The purpose of this project was to improve maternity care in rural Texas by providing tailored obstetric education and simulations to enhance emergency response and team collaboration. INTERVENTIONS: A team of five nurses provided simulation-based perinatal education to clinicians in 10 rural facilities and maternity deserts, including county emergency services. Tailored simulations conducted in situ addressed various obstetric emergencies and were designed to match each facility's staffing ratios. Post-simulation surveys were sent to evaluate participants' understanding, recognition, communication, and collaboration. RESULTS: Surveys from 48 participants, including nurses, technicians, and other health care professionals, indicated significant improvements in understanding, recognition, communication, and preparedness for obstetrical emergencies after simulation training. Qualitative feedback underscored the project's success, highlighting the increased confidence, knowledge, and multidisciplinary collaboration among the participants. The simulation education effectively addressed facility-specific needs, enhancing overall effectiveness and engagement, despite challenges with participant attendance and group sizes. DISCUSSION: Perinatal outreach has improved rural health care teams' confidence, preparedness, and competence in managing obstetric emergencies through specialized education and hands-on simulations. To ensure continued success, it is crucial to continually reassess and adapt educational programs to meet the evolving needs of rural health care facilities, thereby enhancing patient care and outcomes.
PURPOSE: Less invasive surfactant administration (LISA) uses a thin catheter that allows infants to breathe spontaneously throughout surfactant administration. The procedure potentially reduces adverse effects and enhanc...PURPOSE: Less invasive surfactant administration (LISA) uses a thin catheter that allows infants to breathe spontaneously throughout surfactant administration. The procedure potentially reduces adverse effects and enhances clinical outcomes compared to the INtubate, SURfactant, Extubate (INSURE) method, which requires transient intubation with an endotracheal tube and positive pressure ventilation. The purpose is to share how the Plan-Do-Study-Act (PDSA) cycle method can identify improvement opportunities, guide interventions, and improve outcomes in a LISA quality improvement (QI) initiative via interprofessional collaboration. METHODS: A QI project was implemented via an interprofessional team using PDSA cycles in a 63-bed level III neonatal intensive care unit. Compliance rates, infant outcomes, and clinician feedback were analyzed and discussed monthly. An interprofessional team developed a step-by-step LISA checklist and LISA video, improved equipment storage, standardized charting, and rolled out re-education. RESULTS: Implementation of this quality project increased compliance levels of LISA (16 infants pre-project, 43 infants post-project) in place of INSURE (16 infants pre-project, 4 post-project) from 47% to a consistent 100% for eligible infants by 2 months after the project implementation. It also improved multiple outcome measures for the LISA procedure, including a reduction of grade III and IV intraventricular hemorrhage (IVH), a decrease in the percentage of infants requiring a second surfactant dose, and a decrease in chronic lung disease (CLD). LISA was expanded to other hospitals in the physician group's network.
Nowlin SY, Boychuk N, Essein N
… +12 more, Glazer K, Howell FM, Burdick M, Oshewa O, Monterroso M, Rodriguez A, Cabrera C, Maru S, Lewey J, Howell EA, Levine L, Janevic T
MCN Am J Matern Child Nurs
· 2026 Jan-Feb 01 · PMID 40960287
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PURPOSE: Research on remote monitoring for postpartum patients is lacking, particularly in a Spanish speaking population. We examined satisfaction and engagement with remote blood pressure monitoring by preferred languag...PURPOSE: Research on remote monitoring for postpartum patients is lacking, particularly in a Spanish speaking population. We examined satisfaction and engagement with remote blood pressure monitoring by preferred language and other participant characteristics. STUDY DESIGN AND METHODS: This was an observational longitudinal ohort study of n = 388 Asian, Black, and Hispanic postpartum patients from four hospitals from Philadelphia and New York City recruited between 2022 and 2023. English and Spanish speaking patients were enrolled. Participants were asked to track their blood pressures for 12 weeks after birth via a two-way text platform. We examined engagement with the platform (≥70% response to text prompts). RESULTS: Most participants reported satisfaction with the program, with 92.0% of English speakers and 96.4% of Spanish speakers reporting satisfaction. Spanish speakers were more likely to engage in the program than English speakers (risk ratio: 1.22; 95% CI: 1.03, 1.44; adjusted risk ratio: 1.21; 95% CI: 1.01, 1.46). CLINICAL IMPLICATIONS: Among Spanish speakers, text-message-based remote blood pressure monitoring during the postpartum period was satisfactory. Spanish speakers were just as, if not more, likely than English speakers to engage in the remote monitoring program, suggesting the potential utility of remote monitoring for postpartum follow-up among a population at increased risk of adverse maternal outcomes.
PURPOSE: Medicaid-eligible pregnant women are a chronically stressed population with various negative perinatal effects due in part to their challenging financial status. Increasingly, they use social media to obtain soc...PURPOSE: Medicaid-eligible pregnant women are a chronically stressed population with various negative perinatal effects due in part to their challenging financial status. Increasingly, they use social media to obtain social support; however, experiences of using social media for social support are unknown. The purpose of this study was to explore experiences of Medicaid-eligible pregnant women using Facebook groups. STUDY DESIGN AND METHODS: Semistructured interviews of pregnant women who used Facebook groups for social support were conducted. Eligibility or insurance coverage by Medicaid was considered as a proxy for low socioeconomic status. Thematic analysis was completed. RESULTS: Fourteen pregnant women were interviewed. Several themes were identified. The overarching theme was social support through an online community, connections, and information support with affirmation woven through to build connections. Participants felt nurses, midwives, and physicians should recommend Facebook groups to obtain social support. CLINICAL IMPLICATIONS: Most participants found their experiences via Facebook overwhelmingly positive, even if they had some negative encounters. Participants found social support via Facebook groups. Recommendations for nurses include recognizing social media as a venue to access social support, starting peer-led communities for Medicaid-eligible women using social media, and engaging in policy work on social media recommendations for pregnant women. It is unknown what effect this social support has on their chronic stress.
PURPOSE: The purpose of this quality improvement project was to promote newborn thermoregulation. BACKGROUND: Thermoregulation is a primary concern in the newborn population because poor thermoregulation contributes to i...PURPOSE: The purpose of this quality improvement project was to promote newborn thermoregulation. BACKGROUND: Thermoregulation is a primary concern in the newborn population because poor thermoregulation contributes to impaired metabolic functioning, specifically glucose and respiratory regulation. In severe cases, if untreated, impaired thermoregulation can lead to increased risk of morbidity and mortality. METHODS: Two types of newborn bathing methods were evaluated for their effects on thermoregulation in a sample of healthy newborns: traditional sponge baths and immersion swaddle baths. Nurses monitored newborn temperatures pre- and postbathing. Temperatures were taken immediately prebath then postbath for each bathing technique until the infants were warm. Weekly data were collected over the course of 6 weeks, with 2 cycles of sponge and swaddle baths for comparison. The goal was to decrease the amount of time infants spent under the warmer after their first bath. Three Plan-Do-Study-Act cycles were initiated throughout this project to monitor existing bathing methods as well as successful implementation of the change. RESULTS: Ninety newborns were enrolled; 30 preintervention and 60 newborns per postintervention (30 per cycle). Postintervention, significant improvements in thermoregulation were found among immersion swaddle bath infants in shorter return times to baseline prebath temperatures ( p = .001). CONCLUSION: In this project, introduction of immersion swaddle bathing positively correlated with improved thermoregulation in newborns. Using swaddle bathing instead of traditional sponge bathing may potentially have positive implications in other newborn settings. More research is needed on types of newborn bathing techniques.
PURPOSE: To analyze the effect of peanut balls for labor support on the nulliparous term singleton vertex (NTSV) cesarean and overall cesarean birth rates in our maternity service. STUDY DESIGN AND METHODS: Retrospective...PURPOSE: To analyze the effect of peanut balls for labor support on the nulliparous term singleton vertex (NTSV) cesarean and overall cesarean birth rates in our maternity service. STUDY DESIGN AND METHODS: Retrospective analysis of participants from a 30-bed maternity unit discharged between January 1, 2018, and December 31, 2023. RESULTS: Among 4,005 participants, those who used a peanut ball ( n = 1,680) during labor were significantly younger, more likely to be nulliparous, and more likely to give birth at term compared to nonpeanut ball users. Multivariable logistic regression showed that peanut ball use was associated with increased odds of vaginal birth (OR = 1.21, 95% CI [1.03, 1.43], p = .0239), after adjusting for age, gestational age, and parity. Age and gestational age were also significant predictors of vaginal birth, whereas race was not. CLINICAL IMPLICATIONS: Using peanut balls for labor support may support vaginal birth without compromising neonatal outcomes. Education for all members of the maternity team is an important aspect of implementing peanut balls for labor support. Continued implementation and evaluation of peanut ball use, along with other labor support strategies, shows potential for improving vaginal birth rates while maintaining safe neonatal outcomes.
Diabetic ketoacidosis in pregnancy is a rare but serious complication caused by insulin deficiency. Hyperglycemia is considered a hallmark sign of diabetic ketoacidosis; however, physiologic changes of pregnancy predispo...Diabetic ketoacidosis in pregnancy is a rare but serious complication caused by insulin deficiency. Hyperglycemia is considered a hallmark sign of diabetic ketoacidosis; however, physiologic changes of pregnancy predispose pregnant women to developing euglycemic diabetic ketoacidosis, where the plasma glucose level is normal or near normal. Euglycemic diabetic ketoacidosis during pregnancy poses many challenges to diagnosis including signs and symptoms that can be attributed to pregnancy, rapid progression of signs and symptoms, and near-normal glucose levels. Fetal acidosis also develops as a result of the maternal disease process. The fetal heart rate tracing in diabetic ketoacidosis often features minimal to absent variability, fetal tachycardia, or recurrent or late decelerations. Treatment should focus on correcting maternal acidosis and electrolyte imbalances. Despite the state of the fetal heart rate tracing, birth is not typically indicated as fetal status should improve over time after correcting maternal acidosis. To improve outcomes and prevent worsening complications, early diagnosis and intervention is vital for patients with diabetic ketoacidosis. A collaborative, multidisciplinary approach to these patients can facilitate timely diagnosis and initiation of treatment. We present a case study of a patient diagnosed with euglycemic diabetic ketoacidosis secondary to influenza A that required emergency cesarean birth due to worsening maternal and fetal status despite corrective interventions.
The unique physiology of the pregnant and postpartum patient, along with the challenges of the emergency department setting, may increase the risk factors for preventable harm in highly complex care situations. Communica...The unique physiology of the pregnant and postpartum patient, along with the challenges of the emergency department setting, may increase the risk factors for preventable harm in highly complex care situations. Communication, following standardized processes, and reviewing maternal events to identify improvements are vital to minimize the risk of patient safety events and improve patient care outcomes for pregnant and postpartum patients in the emergency department setting. Implementing a standardized debriefing process will help reduce anxiety about discussing adverse events by making it a formula clinicians can follow and provide valuable real-time insight into barriers and resource needs. Two case studies of pregnant patients who presented to the emergency department at a level 2 trauma center highlight how the debriefing process improved maternity care and helped prevent future safety events. It is the goal that the lessons learned can provide insight to refine processes and improve safety throughout the continuum of care for mothers and babies.
Thrombotic thrombocytopenic purpura (TTP) is a rare and serious condition caused by a deficiency in the enzyme ADAMTS-13, leading to abnormal clotting and potential organ damage. Pregnancy can trigger TTP due to physiolo...Thrombotic thrombocytopenic purpura (TTP) is a rare and serious condition caused by a deficiency in the enzyme ADAMTS-13, leading to abnormal clotting and potential organ damage. Pregnancy can trigger TTP due to physiological changes in coagulation, significantly increasing the risk when ADAMTS-13 levels are severely deficient. The enzyme ADAMTS-13 cleaves vWF multimers, but in TTP, its deficiency leads to abnormal platelet aggregation and microvascular thrombi formation, causing organ damage, hemolytic anemia, and thrombocytopenia. This results in impaired blood flow and significant end-organ perfusion issues. TTP symptoms range from asymptomatic to severe, often mimicking other pregnancy-related complications like HELLP syndrome and preeclampsia, making diagnosis challenging. Clinical signs include thrombocytopenia, hemolytic anemia, neurological deficits, fever, and renal dysfunction, with recurrent fetal loss and intrauterine growth restriction also common. Diagnosis relies on clinical evaluation and laboratory findings, while awaiting ADAMTS-13 activity results. Effective communication and prompt multidisciplinary collaboration are crucial in diagnosing and treating TTP. Nurses play a vital role in assessment, collaboration, and patient and family communication to address complex complications during pregnancy.