Here's a breakdown of some of the highlights from the third day of the 2021 American College of Obstetricians and Gynecologists (ACOG) Annual Clinical and Scientific Meeting.
As the annual ACOG 2021 meeting comes to a close, let’s take a look at some of the highlights from the final day on mobile apps, VR during labor, and addressing maternal health.
Mobile Apps in Obstetrics & Gynecology: The Good, The Bad, & The Ugly
With nearly 2,000 pregnancy and fertility apps available, it’s become critical that OB-GYNs stay up to date on what these apps can do for clinicians and patients alike—and perhaps even more importantly, what these apps can’t do.
Featuring Dr. Kathryn Marko, an Assistant Professor of Obstetrics & Gynecology at The George Washington School of Medicine & Health Sciences, Dr. Katherine Chen, a Professor of Obstetrics, Gynecology and Reproductive Science at Mount Sinai, and Dr. Tamika Auguste, an Associate Professor in OB/GYN at Georgetown School of Medicine, this panel discussion focused on the utilization of mobile apps in practice and among patients.
Although in-person visits are decreasing due to the COVID-19 pandemic, it’s still just as important to give patients vital information and quality healthcare throughout their pregnancy, and apps are a great avenue to do that. But according to Dr. Marko, this idea isn’t entirely new.
A pre-pandemic study found that certain platforms like mobile prenatal care apps can be used to space out visits, resulting in high patient satisfaction. In fact, one patient reported feeling empowered that she should see her stats in real-time instead of waiting for her next appointment.
Another study Dr. Marko discussed found that web- and text-based interactions resulted in improvements in smoking cessation and breastfeeding. But when the same was done to promote influenza vaccinations and pregnancy wellness, improvements were only seen in high utilizers of the app, which is why Dr. Marko stressed the importance of encouraging app utilization.
Two of the biggest issues are app abundancy and inaccuracy. Dr. Chen discussed the fact that there’s no direction within app stores for users or OB-GYNs to find quality apps.
To help address this issue, Dr. Chen and her team developed an application scoring system based on 12 factors, including its comprehensiveness, whether or not literature was referenced, and price.
Regarding app inaccuracy, Dr. Auguste recounted research finding that the majority of fertility apps don’t incorporate evidence-based methods of fertility awareness and that out of 22 apps, none were able to accurately detect fetal heart rate.
The Role of the OB-GYN
Since mobile apps are here to stay, Dr. Auguste provided the following ways OB-GYNs can help keep patients safe:
- Know what apps are out there and what the data shows.
- Ask if patients are using any apps, and if they are, ask how they use them. If they mention an app you’ve never heard of before, take the time to research it at that moment.
- Ensure patients know that apps are NOT a form of contraception.
- Discuss what apps can and can’t do so that patients don’t have a false sense of security.
As technology continues to evolve, Drs. Marko, Chen, and Auguste all stressed the importance of incorporating it into everyday practice so that OB-GYNs stay up to date for their patients.
Virtuo Birthing: Experiences Using VR During Labor
Due to the intense labor pain, women experience that, according to research, is akin to getting a finger amputated, many women seek pharmacologic pain relief while others are more interested in alternatives to medication.
However, many of these alternatives like aromatherapy and biofeedback have been shown to have little to no effect on labor pain. So where might virtual reality (VR) fit in all of this?
That’s the question Dr. Melissa Wong, a maternal-fetal medicine physician at Cedars-Sinai Medical Center, sought to answer in her recent study that’s currently the largest trial looking at the use of VR in laboring women.
The study recruited 40 women, all of whom were in their first stage of labor and had not received pain management yet. Half of the women wore a VR headset for 30 minutes while the other half received no intervention. Throughout the 30 minutes, both maternal and fetal vital measures were monitored, and after the 30 minutes, a survey was conducted.
When both groups of women were asked to rate their pain, the women in the no intervention arm reported having the same or much worse pain, and while some women in the VR arm also experienced the same or worse pain, many more experienced less pain at a statistically significant rate. In fact, Dr. Wong recalled one patient in the VR arm of the study who went from digging her nails into the bedside rail to falling asleep during the intervention period.
Maternal heart rate was also found to be lower among patients in the VR arm, but the blood pressure of patients didn’t differ between the two groups.
Based on these findings, Dr. Wong’s study concluded that VR was effective in reducing labor pain. As to what might come next, Dr. Wong looks forward to the possibility of having a trial in which a VR headset is left on the bedside so that patients can continue to use it in the second stage and throughout their labor.
Maternal Suicide: Why Is It the Leading Cause of Death for New Mothers?
Death by suicide or overdose is one of the leading causes of death for women in the first year postpartum. In this session, Dr. Adrienne Griffen, Executive Director of the Maternal Mental Health Leadership Alliance, shared what we know about mothers who die by suicide along with screening tools and interventional strategies OB-GYNs can employ to help address this public health challenge.
Dr. Griffen explained that approximately 34 percent of pregnancy-related suicide deaths had a documented prior suicide attempt, and a majority of women who commit suicide do it within 43-364 days following pregnancy. However, according to the CDC, mental health surveillance for these women stops after 48 days postpartum.
She also provided some key data on maternal self-harm, including the following:
- Suicide and overdose are the leading causes of death postpartum
- These patients often utilize some of the most violent forms of suicide, specifically hanging and firearms
- Most suicide attempts happen late in the postpartum timeframe, with 66 percent of patients attempting suicide after day 42 postpartum
To help fight this public health challenge, Dr. Griffen recommends discussing mental health with pregnant and postpartum women early and often. She emphasized that asking about mental health issues and suicide cannot cause them and that these patients will look to the obstetric provider for help in these situations. She then provided the following tools and recommendations for OB-GYNs:
- Edinburgh Postnatal Depression Scale (EPDS): This scale is a quick, easy, free resource comprised of 10 questions that can assess for anxiety depression and suicidality. This screening tool is validated in pregnancy and postpartum—not only for obstetric patients, but for fathers and partners as well—is available in many languages, and is accessible online and in apps.
- Screening Guidelines: She recommends screening each trimester, prior to discharge after delivery and throughout the fourth trimester, at all well-baby visits starting at 2 weeks, and then monthly up until at least a year.
- Support for Parents: OB-GYNS can provide several international postpartum support services for parents, such as Postpartum Support International; Warmline, a peer-run hotline for emotional support; virtual support groups; state coordinators; and a directory of mental health providers.
- Education for Providers: Education is a critical component for OB-GYNs, and they can take advantage of annual conferences, online training opportunities, certification courses, and psychiatry consultation lines at Postpartum Support International, National Curriculum in Reproductive Psychiatry, and Seleni.
For pregnant and postpartum patients, the path to wellness can be challenging, but by taking the right steps, OB-GYNs can help protect patients’ mental health and save their lives.
Presidential Inauguration & Convocation of New Fellows
As the 2021 meeting came to an end, OB-GYNs around the world were presented with achievement awards for their contributions to the American College of Obstetrics and Gynecology and to the fields of obstetrics and gynecology.
Dr. J. Martin Tucker was appointed as the 72nd president of ACOG, and new fellows were then inducted into college, marking the end of ACOG’s first virtual meeting.