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Q&A

Clinical Obstetrics

Poster Session 4

(1053) Postpartum visit timing and the effect on visit attendance: A randomized controlled trial

Wednesday, February 14, 2024

1:00 PM – 2:30 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Martha B. Kole-White, MD

Assistant Professor
Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University
Providence, RI, United States

Coauthor(s)

LS

Lauren Schlichting, PhD

Hassenfeld Child Health and Innovation Institute of Brown University
Providence, RI, United States
Nina K. Ayala, MD, ScM (she/her/hers)

Assistant Professor
Women & Infants Hospital of Rhode Island / Warren Alpert Medical School of Brown University
Providence, RI, United States
RE

Renee R. Eger, MD

Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University
Providence, RI, United States
MH

Margaret Howard, PhD

Professor of Psychiatry and Human Behavior
Department of Psychiatry & Human Behavior, Brown University
Providence, RI, United States
SM

Srilakshmi Mitta, MD

Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University
Providence, RI, United States
Adam K. Lewkowitz, MD, MPH

Assistant Professor
Warren Alpert Medical School of Brown University, Women & Infants Hospital Rhode Island
Providence, RI, United States

Objective: More than 60% of maternal deaths in the US occur postpartum (PP). Optimal PP care may reduce mortality, but ~40% of women do not attend the standard 6-week PP visit. We sought to examine if adding an early PP visit improves PP visit attendance.

Study Design: We conducted a randomized controlled trial (RCT) at a single tertiary care center at which PP visits are scheduled prior to discharge from birth hospitalization. Patients were excluded if they planned to obtain PP care at non-hospital-based clinics or had pregnancies complicated by hypertension, 3^rd- or 4^th-degree lacerations, blood transfusion, intensive care unit admission or were prescribed anxiolytic or antidepressant medication in the antepartum period. Consenting patients were randomized to routine care (6-week PP visit) or to receive an additional visit 2-3 weeks PP. The primary outcome was attending any PP visit. Secondary outcomes included number of topics addressed in PP care, and PP Emergency Department (ED) visits or readmissions. To detect a difference of 20% in PP visit attendance with an alpha of 0.05 and power of 80%, 81 patients per group were required. Outcomes were compared between those randomized to two versus one PP visits via Fisher’s exact test.

Results: Among the 162 patients who were enrolled, those randomized to two PP visits were not more likely to attend any PP visit compared to those randomized to one PP visit (n=63 (78%) vs n=65 (80%), 0=0.85). Among participants who attended any PP care (n=128), there was no difference between groups in term of number of PP topics addressed (5 vs 5, p=0.49). Of patients randomized to 2 PP visits, 36% attended 1 visit and 37% attended both visits. There was no difference in PP ED visits (11% vs 9%, p=0.79) or PP readmission rates (3% vs 1%, p=0.99) between groups.

Conclusion: In this RCT, being scheduled for two PP visits was not associated with increased PP visit attendance, differences in number of PP topics addressed, or PP ED utilization. Thus, adding an additional PP visit does not facilitate improved PP outcomes in low-risk patients.