Health literacy plays an important role in reproductive knowledge and may impact behaviors and outcomes. While further research is necessary, healthcare providers should utilize health literacy best practices now to promote high-quality care for patients.

Background Emergency department use is common among pregnant women. Non-urgent emergency department use may represent care that would be better provided by an established obstetric provider in an ambulatory setting. Objective To identify socio-demographic factors associated with non-urgent emergency department use in pregnancy. Study Design This is a cross-sectional study of women recruited during their postpartum hospitalization. Data regarding prenatal care and emergency department visits was collected from medical records; participants completed a survey with questions regarding demographics and emergency department use. Urgency of an emergency department visit was pre-specified based on a-priori criteria abstracted from medical record review. Women with any non-urgent emergency department use were compared with women without non-urgent emergency department use. Logistic regression was performed to identify factors associated with non-urgent emergency department use. Results Two hundred and thirty-three women participated in this study; 197 (84%) received care in the emergency department during pregnancy. Eighty-three (35.6%) women had at least one visit to the emergency department that was non-urgent. In regression analysis, increased odds of non-urgent emergency department use was associated with a preferred language other than English (OR 2.02, 95% CI 1.01-4.05) and lack of private insurance (OR 5.55, 95% CI 2.54-12.12). The two most common reasons for presentation to the emergency department were concern that there was an emergency (45%) or being referred by a healthcare provider (36%). Conclusion Women frequently use the emergency department during pregnancy, including visits for non-urgent indications. Identifying risk factors for non-urgent emergency department use in pregnancy is important for identifying women likely to use the emergency department, including for non-urgent visits, and the development of strategies to decrease non-urgent emergency department utilization in pregnancy.

Overall positive attitudes toward HPV self-collection compared with Pap testing among underscreened women suggest that self-collection is a promising option to increase cervical cancer screening in this high-risk population.

Background: Young adult women find it acceptable to be offered the human papillomavirus (HPV) vaccine postpartum. Little is known about the practice of administering the HPV vaccine during the postpartum period. Materials and Methods: The Truven Health Analytics MarketScan Commercial Claims and Encounters database was used to develop a cohort of privately insured 18 to 26-year-old women with uncomplicated live-born pregnancies. Eligibility required no previous doses of HPV vaccine before delivery and continuous insurance enrollment from June 2006 through 1 year postpartum. Descriptive statistics were performed. Results: A total of 51,913 women meet age and enrollment criteria, with 3912 (7.5%) having received any doses of vaccine before their delivery, leaving 48,001 women in this cohort. In the year postpartum, 861 women (1.8%) received any HPV vaccine. Of the women initiating the vaccine, only 337 (39%) completed the threevaccine series. Women who received the vaccine, compared with women who did not, were younger (21 vs. 23 years old), more often the dependent to the insurance beneficiary (56% vs. 30%), and were more likely to have had an abnormal pap smear in the year prior (19.6% vs. 9.1%) or postdelivery (16.4% vs. 4.9). More women completed the HPV vaccine series when initiated within 2 months postpartum compared with women initiating the vaccine series >2 months postpartum (44% vs. 38%). Conclusions: Postpartum women are eligible for the HPV vaccine, yet very few are receiving it. The postpartum period is a missed opportunity for administration of this cancer-preventing vaccine.

INTRODUCTION: Efforts to lower cesarean delivery rates have largely been unsuccessful. At our community hospital, a multifaceted strategy was initiated to lower cesarean delivery rates, and we analyzed the results over a 4-year period.METHODS: Beginning in 2011, we reviewed cesarean delivery indications daily, initiated a physician and nursing education program, encouraged resident involvement, and implemented a laborist program. Cesarean delivery rates between January 2010 and June 2013 were calculated overall and per individual physician based on inpatient records. STATA 12.1 was used to calculate risk ratios of cesarean delivery by calendar year, which was compared using the x 2 test. To explore the effect of individual physicians, a sensitivity analysis was performed to remove the highest individual physician rates from the 2010 data and compare the results with 2013.RESULTS: Cesarean delivery rates decreased from 44.6% to 35.6% from 2010 to 2013 with a 20% lower risk of having a cesarean delivery overall (relative risk [RR] 0.80, 95% confidence interval [CI] 0.69-0.92; P5.001) and a 28% lower risk of having a primary cesarean delivery (RR 0.72, 95% CI 0.57-0.90; P5.003) ( Table 1). In 2010, the highest three individual rates were 72.0%, 63.8%, and 47.9%, accounting for 314 (22%) deliveries. After removing these physicians from the 2010 data set, there is no significant difference between 2010 and 2013 rates for primary CD (RR 0.87, 95% CI 0.69-1.11; P5.3) or cesarean delivery overall (RR 0.90, 95% CI 0.78-1.04; P5.1).CONCLUSION: Implementing a comprehensive strategy can dramatically lower cesarean delivery rates. Although many factors were involved, the effect of the individual physician should not be underestimated.

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RESULTS: Three cases of MERS in pregnancy have been reported. One led to stillbirth at 20 weeks, the second resulted in maternal death immediately after cesarean section, and the third delivered and recovered without any long term complications. Because of limited numbers of MERS cases, SARS cases were examined. In the twelve reported cases of SARS in pregnancy, the case fatality rate of 25%, ICU admission (50%) and mechanical ventilation (33%), compared with the non-pregnant population (20%). Also, 57% of patients had spontaneous miscarriage, and 84% who presented after 24 weeks were delivered preterm. CONCLUSION: MERS has the potential to be a serious epidemic. Our recommendations for pregnant patients with MERS include: 1) Standard supportive measures for critically ill respiratory infection 2) Early delivery to better permit ventilation 3) Preventive measures at delivery, including nasopharyngeal suction and cleansing to reduce the viral load. Cesarean section at this time is not encouraged 4) Isolation of the mother from neonate until incubation period (14 days) is completed 5) Delay breast feeding until antibodies are detected in breastmilk.