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Background. Hypertensive disorders of pregnancy (HDP) are increasingly common and have important implications for maternal health, healthcare utilization, and health disparities. There is limited evidence to support best management of postpartum individuals with HDP, including home blood pressure (BP) monitoring (HBPM) and choice of antihypertensive agents. For patients experiencing preeclampsia with severe features, there is robust evidence supporting delivery of the infant and treatment with magnesium sulfate (MgSO4). However, MgSO4 may cause unpleasant side effects and, less commonly, toxicity. Patients receiving MgSO4 require additional monitoring (e.g., urinary catheterization) and often have activity restrictions, which impact their postpartum experience. Evidence regarding the optimal (lowest effective) dose and (shortest effective) duration of MgSO4 treatment is needed. Methods. We searched Medline®, Cochrane, Embase®, CINAHL®, and ClinicalTrials.gov from inception to December 1, 2022. After double screening, we extracted study data and risk of bias assessments into the Systematic Review Data Repository Plus (SRDR+; https://srdrplus.ahrq.gov). We evaluated the strength of evidence (SoE) using standard methods. The protocol was registered in PROSPERO (registration number CRD42022313075). Results. We found 13 eligible studies (3 randomized controlled trials [RCTs], 2 nonrandomized comparative studies [NRCSs], 8 single-arm studies) evaluating postpartum HBPM, 17 RCTs evaluating pharmacological treatment of postpartum HDP, and 43 studies (41 RCTs and 2 NRCSs) that compared alternative MgSO4 regimens. HBPM programs probably increase submission of any BP measurements during recommended time intervals (moderate SoE) and may increase the number of BP measurements obtained overall (low SoE). Studies have not found that HBPM affects the rate of BP treatment initiation (low SoE), but HBPM may reduce unplanned hypertension-related hospital admissions (low SoE). Most patients were satisfied with management related to HBPM (low SoE), and HBPM probably compensates for racial disparities in office-based follow-up (moderate SoE). In patients with preeclampsia or gestational hypertension (HTN), oral furosemide may shorten the duration of postpartum hypertension (low SoE). There was insufficient evidence regarding the comparative benefits and harms of other antihypertensive medications. Compared with 24-hour treatments, shorter duration MgSO4 regimens shorten the urinary catheterization time (high SoE), time to ambulation (high SoE), and time to breastfeeding (moderate SoE); and may shorten time from delivery to contact with the infant and decrease toxicity as manifested by lost deep tendon reflexes (both low SoE). Loading dose only regimens increase the risk of a recurrent seizure in patients with eclampsia (moderate SoE). Lower dose MgSO4 regimens, compared to standard dose regimens, reduce early signs of magnesium toxicity (high SoE), may approximately double the risk of recurrent seizure in patients with eclampsia (low SoE), but may not affect 5-minute Apgar scores in infants of patients with preeclampsia with severe features (low SoE). There is insufficient evidence regarding potential harms of concomitant use of nifedipine or other antihypertensive medications. Conclusion. HBPM probably improves ascertainment of BP, allowing early recognition of hypertension in postpartum patients, and probably compensates for racial disparities in office based follow-up. The evidence suggests furosemide may shorten the duration of postpartum HTN. However, further evidence is needed regarding the comparative benefits and harms of the antihypertensive medications used to treat postpartum HTN. Large pragmatic trials, augmented by analysis of real-world data, are needed to evaluate the effect of postpartum HBPM on clinical event outcomes (not only process outcomes) and on the comparative effectiveness of alternative antihypertensive treatments. Given that lower dose MgSO4 regimens reduce Mg toxicity, and shorter regimens decrease urinary catheterization time, time to ambulation, time to breastfeeding, and time from delivery to contact with the infant, evidence is needed to identify MgSO4 regimens with the lowest effective dose and shortest effective duration that minimize side effects and toxicity but still prevent seizures among patients with preeclampsia with severe features.

BackgroundPrenatal care, one of the most common preventive care services in the United States, endeavors to improve pregnancy outcomes through evidence-based screenings and interventions. Despite the prevalence of prenatal care and its importance to maternal and infant health, there are several debates about the best methods of prenatal care delivery, including the most appropriate schedule frequency and content of prenatal visits. Current U.S. national guidelines recommend that low-risk individuals receive a standard schedule of 12 to 14 in-office visits, a care delivery model that has remained unchanged for almost a century.ObjectivesIn early 2020, to mitigate individuals’ exposure to the SARS-CoV-2 virus, prenatal care providers implemented new paradigms that altered the schedule frequency, interval, and modality (e.g., telemedicine) of how prenatal care services were offered. In this manuscript, we describe development of a core outcome set (COS) that can be used to evaluate the effect of the frequency of prenatal care schedules on maternal and infant outcomes.MethodsWe will systematically review the literature to identify previously reported outcomes important to individuals who receive prenatal care and the people who care for them. Stakeholders with expertise in prenatal care delivery (i.e., patients/family members, healthcare providers, and public health professionals and policymakers) will rate the importance of identified outcomes in an online survey using a three-round Delphi process. A virtual consensus meeting will be held for a group of stakeholder representatives to discuss and vote on the outcomes to include in the final COS.ResultsThe Delphi survey was initiated in July 2022 with 71 stakeholders invited. A virtual consensus conference was conducted on October 11, 2022. Data is currently under analysis.ConclusionsMore research about the optimal schedule frequency and modality for prenatal care delivery is needed. Standardizing outcomes that are measured and reported in evaluations of the recommended prenatal care schedules will assist evidence synthesis and results reported in systematic reviews and meta-analyses. Overall, this COS will expand the consistency and patient-centeredness of reported outcomes for various prenatal care delivery schedules and modalities, hopefully improving the overall efficacy of recommended care delivery for pregnant people and their families.Trial RegistrationThis study was registered in the Core Outcome Measures for Effectiveness (COMET) database on January 18, 2022, registration #2021http://www.comet-initiative.org/Studies/Details/2021.

Objectives The ongoing COVID-19 pandemic may significantly affect the peripartum experience; however, little is known about the perceptions of women who gave birth during the COVID-19 pandemic. Thus, the purpose of our study was to describe the peripartum experiences of women who gave birth during the COVID-19 pandemic in the United States. Methods Using a cross-sectional design, we collected survey data from a convenience sample of postpartum women recruited through social media. Participants were 18 years of age or older, lived in the United States, gave birth after February 1, 2020, and could read English. This study was part of the COVID-19 Maternal Attachment, Mood, Ability, and Support study, which was a larger study that collected survey data describing maternal mental health and breastfeeding during the COVID-19 pandemic. This paper presents findings from the two free-text items describing peripartum experiences. Using the constant comparative method, responses were thematically analyzed to identify and collate major and minor themes. Results 371 participants responded to at least one free-text item. Five major themes emerged: (1) Heightened emotional distress; (2) Adverse breastfeeding experiences; (3) Unanticipated hospital policy changes shifted birthing plans; (4) Expectation vs. reality: “mourning what the experience should have been;” and (5) Surprising benefits of the COVID-19 pandemic to the delivery and postpartum experience. Conclusions for Practice Peripartum women are vulnerable to heightened stress induced by COVID-19 pandemic sequalae. During public health crises, peripartum women may need additional resources and support to improve their mental health, wellbeing, and breastfeeding experiences.

In this work we experimentally demonstrate a fully packaged one-dimensional beam steering system that is based on a fully CMOS compatible silicon photonics platform. This configuration enables multi-wavelength operation and is suitable for short-wavelength infrared (SWIR) applications from light detection and ranging (LIDAR) to telecommunication and sensing applications. The switching fabric in this system employs a 1x9 array of add/drop ring resonators that are fed by a common waveguide through a single etch input grating. The switching fabric re-directs the resonance wavelengths at each drop waveguide to the output facet at the edge of the chip and into free space. The divergent beams that exit the waveguides along the output facet are then collimated and magnified using an array of micro-lenses (pitch = 750 μm, Diameter = 700 μm) in addition to a two lens afocal system in order to enhance the fill factor and diminish any blind zones between adjacent beams. Each one of these drop waveguides is used to address portion of the steering aperture. Combined together they enable steering across the entire aperture. Multi-wavelength operation is obtained by placing individual titanium tungsten alloy (TiW) heaters on top of each ring resonator to enable wavelength tuning.

Background. The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine plan a new evidence-based joint consensus statement to address the preferred visit schedule and the use of televisits for routine antenatal care. This systematic review will support the consensus statement. Methods. We searched PubMed®, Cochrane databases, Embase®, CINAHL®, ClinicalTrials.gov, PsycINFO®, and SocINDEX from inception through February 12, 2022. We included comparative studies from high-income countries that evaluated the frequency of scheduled routine antenatal visits or the inclusion of routine televisits, and qualitative studies addressing these two topics. We evaluated strength of evidence for 15 outcomes prioritized by stakeholders. Results. Ten studies evaluated scheduled number of routine visits and seven studies evaluated televisits. Nine qualitative studies also addressed these topics. Studies evaluated a wide range of reduced and traditional visit schedules and approaches to incorporating televisits. In comparisons of fewer to standard number of scheduled antenatal visits, moderate strength evidence did not find differences for gestational age at birth (4 studies), being small for gestational age (3 studies), Apgar score (5 studies), or neonatal intensive care unit (NICU) admissions (5 studies). Low strength evidence did not find differences in maternal anxiety (3 studies), preterm births (3 studies), and low birth weight (4 studies). Qualitative studies suggest that providers believe fewer routine visits may be more convenient for patients and may free up clinic time to provide additional care for patients with high-risk pregnancies, but both patients and providers had concerns about potential lesser care with fewer visits. In comparisons of hybrid (televisits and in-person) versus in-person only visits, low strength evidence did not find differences in preterm births (4 studies) or NICU admissions (3 studies), but did suggest greater satisfaction with hybrid visits (2 studies). Qualitative studies suggested patients and providers were open to reduced schedules and televisits for routine antenatal care, but importantly, patients and providers had concerns about quality of care, and providers and clinic leadership had suggestions on how to best implement practice changes. Conclusion. The evidence base is relatively sparse, with insufficient evidence for numerous prioritized outcomes. Studies were heterogeneous in the care models employed. Where there was sufficient evidence to make conclusions, studies did not find significant differences in harms to mother or baby between alternative models, but evidence suggested greater satisfaction with care with hybrid visits. Qualitative evidence suggests diverse barriers and facilitators to uptake of reduced visit schedules or televisits for routine antenatal care. Given the shortcomings of the evidence base, considerations other than proof of differences in outcomes may need to be considered regarding implications for clinical practice. New studies are needed to evaluate prioritized outcomes and potential differential effects among different populations or settings.

Prenatal care is an important preventive service designed to improve the health of pregnant patients and their infants. Prenatal care delivery recommendations have remained unchanged since 1930, when the 12-14 in-person visit schedule was first established to detect preeclampsia. In 2020, the American College of Obstetricians and Gynecologists, in collaboration with the University of Michigan, convened a panel of maternity care experts to determine new prenatal care delivery recommendations. The panel recognized the need to include emerging evidence and experience, including significant changes in prenatal care delivery during the COVID-19 pandemic, pre-existing knowledge of the importance of individualized care plans, the promise of telemedicine, and the significant influence of social and structural determinants of health (SSDoH) on pregnancy outcomes. Recommendations were derived using the RAND-UCLA appropriateness method, a rigorous e-Delphi method, and are designed to extend beyond the acute public health crisis. The resulting

In this article, a novel concept of an inductive, saturated-core fault-current limiter (FCL) design is presented, capable of limiting three-phase faults. The design is based on high-remanence permanent magnets for biasing high-saturation electrical steel cores, thus minimizing the device volume, dimensions, and cost and allowing a relatively easy assembly process due to the magnetic symmetry of the model. By implementing a three-phase design in a single device, we harness the full potential of each magnet, substantially reducing the required material for achieving negligible losses during nominal operation while increasing current limiting during faults. A laboratory-scale, low-voltage prototype has been built and tested to prove the feasibility of the new concept, suggesting that upscaling to higher voltage devices is plausible. Extensive simulations, using finite-element analysis, have yielded insight into several measured phenomena, including a unique phase-coupling effect experienced during three-phase fault measurements.

Objective: Studies have examined the impact of race on infertility, but few have compared ethnic differences in infertility within a given race. We sought to determine whether infertility etiologies differ between Black ethnic subgroups. Design/Setting: Retrospective study in an urban safety net hospital. Population: Women seeking infertility care between 2005-2015. Methods: Charts of women with infertility and PCOS ICD-9 diagnoses were reviewed to confirm diagnoses. Data was stratified by race and subsequently by ethnicity to evaluate differences in infertility etiologies between Black American, Haitian, and African women. White American women were used as the comparison group. Main outcome measures: Infertility diagnoses between ethnic groups. Results: A total of 358 women met inclusion criteria including 99 Black American, 110 Black Haitian, 61 Black African, and 88 White American women. Anovulation/polycystic ovarian syndrome (PCOS) was the most common diagnosis in each ethnic group, accounting for 40% of infertility among White American, 57% among Black American, 25% among Haitian, and 21% among African women. There were no significant differences in individual infertility diagnoses between Black and White women. Between ethnic subgroups, multivariate analysis showed significantly higher odds of infertility due to anovulation/PCOS in Black American women compared to African women (odds ratio [OR]=4.9; 95% CI=1.4-17.0). Compared to African women, higher odds of tubal factor infertility were observed in Black American (OR=4.7; 95% CI=1.16-18.7) and Haitian women (OR=4.0; 95% CI=1.1-14.0). Conclusions: Causes of infertility weren’t homogeneous across Black ethnic groups. Studies examining infertility should specify ethnic subgroups within race as this may affect results.

OBJECTIVE: To characterize clinical management of deliveries resulting in neonatal hypoxic ischemic encephalopathy. DESIGN: Retrospective case series SETTING: Three academic referral medical centers in the United States POPULATION: All neonates ≥35 weeks’ gestation with HIE based on cord blood pH40% had variability, accelerations, or both in the half hour before delivery. This suggests additional insights are required to prevent some cases of HIE.