Harold C. Pollard, MDOctober 27, 2009

No disclosures

The number of stillborns and the number of neonatal deaths (deaths in the first four weeks of life) per 1000 births (births after 22 weeks)

Prenatal care Labor and delivery Imaging in pregnancy Surgery and anesthesia Obstetric technology – “for better or worse” Obstetric research/evidence based medicine NICU care

VIC SODA

V I C S O D A i n o m b e c o f n o e p c l e t k s r i e c r i i e d

n t a n t s e c i c g y s n

e o e i t n p o s

t nion

Prevalence 6.5 to 13% in the first year post partum

Negative long-term impact on maternal health and child development but often undetected by post partum care providers

Accurate and feasible screening◦ Postpartum Depression Screening Scale (PDSS)◦ Edinburgh Postnatal Depression Scale (EPDS)◦ Beck Depression Inventory (BDI)

Limited evidence suggests providing psychosocial support to postpartum women at risk may decrease depression symptoms

Gaynes BN (2005) AHRQ

Tdap: Tetanus, diphtheria and pertussis booster every 10 years

Measles and mumps vaccine if no evidence of immunity

Immunize women susceptible to rubella or varicella immediately following delivery

HPV is recommended for women to age 26 if they have not been previously vaccinated

Hepatitis B series of 3 for young adults

25% of white women and 45% of black women are 9 pounds heavier at one year. (1988 National Maternal and Infant Health Survey)

Promote gradual increase in activity to goal of 30 minutes or more of moderate-intensity physical activity on most days of the week.

Cigarette smoking poses threat to health of mother, her infant and her subsequent pregnancy

11.2% of women who gave birth in 2002 reported smoking cigarettes during pregnancy

70% of women who quit during pregnancy will relapse within 6 months of delivery

Incorporate clinical intervention for smoking cessation and relapse prevention (e.g. 5A’s) into post partum and internatal care◦ Begin inpatient, follow up at two weeks◦ www.youquittwoquit.com

Postpartum screening◦ 1/3 have diabetes of impaired glucose

metabolism at pp screen◦ 15-50% develop diabetes in the decade following

pregnancy◦ Establishing the diagnosis

Opportunity to improve subsequent pregnancy outcome

Affect risk factors associated with development of type 2 diabetes

According to the Healthcare Effectiveness Data and Information Set (HEDIS) indicator for the postpartum visit◦ 20% of women with commercial insurance and◦ 50% of women with Medicaid

do not receive this visit.

Unaware of importance of visit (marketing)

Inadequate appointment reminders Timing may be too late to meet some needs (e.g., breastfeeding concerns)

Mothers not perceiving a return value on their time investment in receiving the visit

Lack of continuity of care – relationship/experience with clinic

Lack of transportation Unable to access other services at same

time (WIC, well baby care, etc) Lack of adequate referral services for other

care (mental health, family planning) Medicaid coverage ends at 60 days

postpartum Child care issues – different clinic cultures

about bringing infant to visit

NCOGS ACOG, NC Section UNC School of Public Health NC Public Health System Academic programs, including AHEC programs Specific examples of co-operation/co-ordination NC HIV Public/Private Partnership, 2000 NC Public-Private Partnership on Smoking

Cessation in Pregnancy, 2002