There is great evidence to support improved maternal and neonatal outcomes when a patient delivers in a center that is suited to the needs of both the birthing person and the fetus. As rural centers have closed, access remains challenging. This manuscript examines The Emergency Medical Treatment and Labor Act, Emergency Medical Services (EMS) challenges, needs of rural hospitals including education, and elaborates further upon the need to expand maternal transport in rural areas to improve outcomes in the future.
ANOVA, chi square, and regression analyses, adjusting for body mass index (BMI), fetal sex, and gestational age at sample collection. RESULTS: 1475 patients were included. Mean gestational age was 14.3 (AE4.4) weeks and mean BMI 26.9kg/m2 (AE6.7). Overall, 3% (N¼42) had a documented AID, with 25 on no therapy and 17 on IM therapy. There was a significant stepwise decrease in mean FF, with 12.0%, 10.4% and 9.6% in the control, AID on IM therapy, and AID on no therapy groups, respectively (p¼0.03) [Figure 1A]. An inverse relationship was observed in the rate of indeterminate results from 3% to 6% to 24% for controls, AID on IM therapy, and AID on no therapy, respectively (p<0.001) [Figure 1B]. Logistic regression showed an increased odds of an indeterminate result for women with AID on no therapy compared to controls, OR 9.1 (95%CI 3.2, 25.7). Linear regression showed a significant decrease in FF for women with AID on no therapy compared to controls, b -2.0 (95% CI -3.8, -0.2). CONCLUSION: Women with AID on no therapy have higher rates of indeterminate cfDNA results compared to controls. Treatment of AID with IM therapies may improve FF, which could be further evaluated in future studies.
Hypertension in pregnancy is a leading cause of maternal morbidity and mortality. Studies demonstrate that body positions affect the blood pressure (BP) measurements and have led to guidelines for proper positioning by the ACC and AHA. However, studies excluded pregnant women and did not include all common patient positions, such as semi-Fowlers. These studies cannot be applied to pregnant women due to dynamic cardiovascular changes in pregnancy. We measured BP in pregnant women in inpatient and outpatient settings in various positions. These BPs were compared to the published ACC/AHA guideline position: seated with arms and feet supported. Trained team members used an aneroid sphygmomanometer and stethoscope and/or a validated electronic BP machine. There is no significant difference between BP measurements using a sphygmomanometer/stethoscope vs. an electronic BP machine in the ACC/AHA guideline position (systolic p=0.60 diastolic p=0.91). There was not a significant difference in either systolic or diastolic means in the semi-Fowlers position (at 45 degrees measured by goniometer) (systolic=0.60 diastolic=0.95). Positioning did affect the diastolic BP measurement in the seated without support position (p=0.01) and both the systolic (p< 0.001) and diastolic (p<0.001) measurements in the left lateral recumbent position. Our data demonstrate that an accurate BP measurement in pregnancy is dependent upon patient position. Monitoring BP position in left lateral recumbent may mask an elevated BP. This study also suggests that it may be possible to substitute semi-Fowlers position for reliable BP measurements when chair sitting is not practical, such as labor.
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