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BACKGROUND The use of social media for study recruitment is increasingly common. Previous studies have typically focused on using Facebook; however, there is limited data to support the use of other social media platforms for participant recruitment, notably in the context of a pregnancy study. OBJECTIVE This study aimed to evaluate the effectiveness of Facebook, Twitter, and Instagram for recruiting a representative sample of pregnant women into a longitudinal pregnancy cohort study in Calgary, Alberta between September 27, 2021 and April 24, 2022. METHODS Paid advertisements were targeted to 18 to 50 year-old women in Calgary with interests in pregnancy. Data regarding reach, link clicks and cost were collected through Facebook Ads Manager and Twitter Analytics. The feasibility of each platform for recruitment was assessed based on recruitment rate and cost-effectiveness. Demographic characteristics of the participants recruited through each source were compared using chi-square tests. RESULTS Paid advertisements reached 159,778 social media users, resulting in 2390 link clicks and 324 recruited participants. Facebook reached and recruited the most participants, while Instagram saw the highest number of link clicks relative to the number of users who saw the advertisement (2.11%). Facebook and Instagram advertisements were cost-effective with an average cost-per-click of $0.61 and cost-per-completer of $7.89. Twitter advertisements were less successful in terms of recruitment and cost. Demographic characteristics of participants did not differ based on recruitment source except for educational attainment and income, where more highly educated and higher income participants were recruited through Instagram or Twitter. CONCLUSIONS Paid social media advertisements (especially Facebook and Instagram) were feasible and cost-effective methods for recruiting a large sample of pregnant women for survey research. However, future researchers should be aware of the potential for fraudulent responses when using social media for recruitment.

Background In 2016, the Academic Medical Center Neonatal Encephalopathy Task Force recommended therapeutic hypothermia (TH) as the standard-of-care for hypoxic ischemic encephalopathy (HIE). However, not all infants who meet the criteria for TH receive this treatment. The purpose of this study was to compare the risk of mortality for infants with HIE who did and did not receive TH, after accounting for confounders associated with receipt of TH. Methods A retrospective cohort study was conducted using the 2016 National Inpatient Sample (NIS), which contains 20% of all hospital discharges in the United States. Infants were included if they were diagnosed with HIE and were eligible for TH. Nearest-neighbor propensity score-matching (1:1) without replacement was performed prior to logistic regression analysis. The average treatment effect of TH was calculated to estimate the odds of mortality. Results There were 211 infants with HIE who received TH, which is an estimated proportion of 24.8% (95% CI: 20.9-29.1%). Infants who received TH were more likely to have a seizure (p Conclusions Receipt of TH varied across patient groups and was associated with clinical risk factors. The odds of in-hospital mortality were lower in infants who received TH. Key messages Infants who received TH had a decreased risk of in-hospital mortality compared to infants who did not receive TH.

Objective This study sought to describe how the implementation of recent labour guidelines may affect the cesarean delivery rate in a population in Alberta. Methods This retrospective study was conducted on primiparous women who were in labour with singleton term fetuses with cephalic presentation in Alberta from 2007 to 2016 (n = 181 738), and it used data from a perinatal database. Modelled cesarean delivery rates were calculated to determine the potential impact of the recent guidelines on the cesarean delivery rate by using the percentage of cesarean deliveries that occurred outside the threshold of the recent labour guidelines. Results A total of 21.7% of the cesarean deliveries for dystocia occurred outside of the guidelines related to the first stage of labour arrest for spontaneous labour (n = 9282), and 45.4% occurred outside of the guidelines related to the first stage of labour arrest for induced labours (n = 11 712). A total of 69.0% of the cesarean deliveries for dystocia occurred outside of the failed induction of labour guidelines (n = 4921), and 55.4% occurred outside of the second stage labour arrest guidelines (n = 6632). Assuming that the labour arrest guidelines are effective at reducing the cesarean delivery rate 25% of the time, the cesarean delivery rate for primiparous women in labour would be reduced from 22.5% to 20.7%. Assuming a 75% adherence/effectiveness rate, the cesarean delivery rate would be reduced to 17.1%. Conclusion The recent labour guidelines have the potential to have a substantial impact on the intrapartum cesarean delivery rate in primiparous women with singleton fetuses with cephalic presentation at term if the guidelines are put into practice.

Objective Traditionally, Canadian physicians provide care on a fee-for-service (FFS) basis; however, this model has been criticized as it incentivizes quantity of care over quality of care. Consequently, all Canadian provinces and territories have implemented some form of alternative payment plan. Evaluation of the impact of these policy changes, however, has typically focused on family physicians as opposed to specialists. Methods On January 1, 2004, obstetricians at the Medicine Hat Regional Hospital (MHRH) transitioned from FFS to salary. A difference-in-differences analysis was used to examine the impact of changes in obstetrician payment structure on the use of obstetric interventions and neonatal outcomes controlling for temporal trends at MHRH (intervention group) and the Chinook Regional Hospital (CRH; comparison group) from 2002 to 2005. Results Between the pre-intervention period (2002-2003) and the post-intervention period (2004-2005), the rate of cesarean delivery increased significantly at both sites. Following adjustment for time of day, day of week, and antepartum risk score, the difference-in-difference estimator demonstrated a 5.8% (95% CI 1.5–10.0) increase in cesarean deliveries performed by obstetricians at MHRH compared with cesarean deliveries done at CRH after accounting for baseline differences and temporal trends. No significant differences were observed for family physicians. No significant differences were observed for other obstetric interventions or neonatal outcomes. Conclusion Under an FFS model, obstetricians are incentivized to cesarean delivery due to the increased reimbursement rate; however, the increase in cesarean deliveries at MHRH following the transition to a salary model was unexpected. This finding suggests that, in Canada, financial incentives are not a factor that explains the increasing rate of cesarean delivery.