Background: Early initiation of prenatal care is widely accepted to improve the health outcomes of pregnancy for both mothers and their infants. Identification of the various barriers to entry into care that patients experience may inform and improve health care provision and, in turn, improve the patient's ability to receive necessary care.
Aim: This study implements a mixed-methods approach to establish methods and procedures for identifying barriers to early entry to prenatal care in a medically-vulnerable patient population and areas for future quality improvement initiatives.
Methods: An initial chart review was conducted on obstetrics patients that initiated prenatal care after their first trimester at a large federally qualified health center in Brooklyn, NY, to determine patient-specified reasons for delay. A thematic analysis of these data was implemented in combination with both parametric and non-parametric analyses to characterize the population of interest, and to identify the primary determinants of delayed entry.
Results: The age of patients in the population of interest (n = 169) was bimodal, with a range of 15 - 43 years and a mean of 28 years. The mean gestational age of entry into prenatal care was 19 weeks. The chart review revealed that 8% recently moved to Brooklyn from outside of NYC or the USA. Nine percent had difficulty scheduling an initial prenatal visit within their first trimester. Teenage pregnancy accounted for 7%. Provider challenges with documentation (21%) were noted. The most common themes identified (n = 155) were the patient being in transition (21%), the pregnancy being unplanned (17%), and issues with linkage to care (15%), including no shows or patient cancellations. Patients who were late to prenatal care also differed from their peers dramatically, as they were more likely to be Spanish-speaking, to be young, and to experience a relatively long delay between pregnancy confirmation and entry into care. Moreover, the greatest determinant of delayed entry into care was patient age.
Conclusion: Our study provides a process for other like clinics to identify patients who are at risk for delayed entry to prenatal care and highlight common barriers to entry. Future initiatives include the introduction of a smart data element to document reasons for delay and use of community health workers for dedicated outreach after no show appointments or patient cancellations.
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http://dx.doi.org/10.1186/s12884-024-06630-9 | DOI Listing |
Lancet Reg Health Am
November 2024
Ministry of Health - Brazil, Department of Surveillance, Prevention and Control of STIs, AIDS, and Viral Hepatitis, SRTVN Quadra 701, Lote D, Edifício PO700 - 5º Andar, CEP: 70719-040, Brasília/DF, Brazil.
Background: We aimed to examine factors associated with prenatal syphilis, including prenatal care, and pregnancy outcomes of pregnant women with HIV in Brazil.
Methods: Retrospective data were gathered from a national cohort of Brazilian women with HIV on antiretroviral therapy who became pregnant between January 2015 and May 2018. Prenatal syphilis was defined by clinical diagnoses with treatment or any positive syphilis laboratory result between 30 days before conception and pregnancy conclusion.
Front Public Health
January 2025
Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
Background: Previous studies documented the existence of substantial inequalities in the utilization of maternal health services across different population subgroups in Ethiopia. Regularly monitoring the state of inequality could enhance efforts to address health inequality in the utilization of maternal health services. Therefore, this study aimed to measure the level of inequalities in the utilization of maternal health services in Ethiopia.
View Article and Find Full Text PDFBMC Public Health
January 2025
Centro de Investigação Em Saúde de Manhiça (CISM), Rua 12, Maputo, Vila da Manhiça, PO Box 1929, Mozambique.
Background: Monitoring HIV infection estimates is critical to guide health interventions and assess their impact, especially in highly vulnerable groups to the infection such as African pregnant women. This study describes the trends of HIV infection over eleven years in women attending selected antenatal care (ANC) clinics from southern Mozambique.
Methods: We performed a secondary analysis of data registered at the ANC clinic of the Manhiça District Hospital and from the Ministry of Health's HIV National Program Registry between 2010 and 2021.
J Community Genet
January 2025
Red Nacional de Anomalías Congénitas (RENAC), Instituto Nacional de Epidemiología, ANLIS Malbrán, Buenos Aires, Argentina.
Patiens with major congenital anomalies diagnosed prenatally should be referred to and delivered in institutions with the appropriate level of complexity, as this reduces morbidity and mortality. We aimed to assess the prevalence and prenatal diagnosis proportion of selected congenital abnormalities and the complexity levels of birth institutions in a sample of public maternity hospitals in Argentina. Data sources were (1) National Congenital Anomalies Registry, covering the period from 2013 to 2021; and (2) Categorization of birth institutions according to their complexity (high or low).
View Article and Find Full Text PDFSci Rep
January 2025
Office of the National Agency for Drug Clinical Trials, Changsha Hospital for Maternal, Child Health Care of Hunan Normal University, 416 Chengnan Dong Rd, Yuhua, Changsha, 410007, Hunan, China.
Pulmonary sequestration (PS) is a rare congenital malformation that is characterized by the absence of a connection between a portion of the lung tissue and the tracheobronchial tree, with blood supply from arteries throughout the body. Abnormal lung tissue cannot perform the normal gas exchange function. In the absence of timely diagnosis and early intervention, some cases may need labor induction, and some of the infants who survive may develop symptoms in childhood.
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