BackgroundExcessive weight gain and elevated blood pressure are significant risk factors for adverse pregnancy outcomes such as gestational diabetes, premature birth, and preeclampsia. More effective strategies to facilitate adherence to gestational weight gain goals and monitor blood pressure may have a positive health benefit for pregnant women and their babies. The impact of utilizing a remote patient monitoring system to monitor blood pressure and weight gain as a component of prenatal care has not been previously assessed.ObjectiveThe objective of this study is to determine the feasibility of monitoring patients remotely in prenatal care using a mobile phone app and connected digital devices.MethodsIn this prospective observational study, 8 women with low risk pregnancy in the first trimester were recruited at an urban academic medical center. Participants received a mobile phone app with a connected digital weight scale and blood pressure cuff for at-home data collection for the duration of pregnancy. At-home data was assessed for abnormal values of blood pressure or weight to generate clinical alerts to the patient and provider. As measures of the feasibility of the system, participants were studied for engagement with the app, accuracy of remote data, efficacy of alert system, and patient satisfaction.ResultsPatient engagement with the mobile app averaged 5.5 times per week over the 6-month study period. Weight data collection and blood pressure data collection averaged 1.5 times and 1.1 times per week, respectively. At-home measurements of weight and blood pressure were highly accurate compared to in-office measurements. Automatic clinical alerts identified two episodes of abnormal weight gain with no false triggers. Patients demonstrated high satisfaction with the system.ConclusionsIn this pilot study, we demonstrated that a system using a mobile phone app coupled to remote monitoring devices is feasible for prenatal care.

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IntroductionFourth-degree lacerations are infrequent but serious complications that involve the tearing of the vaginal epithelium, tissues of the perineal body, anal sphincter complex, and the rectal mucosa at the time of vaginal delivery.1 Prior studies 2 have shown a high incidence (up to 60%) of perineal pain, anal incontinence, and dyspareunia after severe perineal injury during childbirth. Perineal lacerations after childbirth are classified as first-, second-, third-, and fourth-degree on the basis of the tissues involved; third-and fourth-degree are considered serious because the external anal sphincter is involved in the laceration. Unfortunately, residents are universally undertrained in the repair of fourth-degree lacerations because of their infrequency. However, it is vital that graduating residents be able to repair a fourth-degree laceration even if they did not encounter one during their training. Prior research has demonstrated that the combination of the Objective Structured Assessment of Technical Skills (OSATS) and a written examination before and after an educational workshop is a valid and reliable way of assessing residents' improvement in surgical skills and knowledge in the repair of fourth-degree lacerations. 4,5We sought to expand this work by including a 6-month follow-up OSATS and written examination to evaluate the retention of information learned during the workshop. We hypothesized that residents' technical skills and knowledge to repair fourth-degree perineal lacerations will reflect AbstractBackground Fourth-degree perineal lacerations are a serious but infrequent complication of childbirth.

INTRODUCTION: Excessive weight gain and high blood pressure are strong risk factors for pregnancy outcome. Mobile applications are increasingly posited to facilitate a high-resolution, bidirectional exchange between physician and patient. We developed an integrated system of mobile applications that incorporates remote patient monitoring together with an algorithm for triage system alerts ("triggers") on deviation from established American College of Obstetricians and Gynecologists clinical guidelines. This study aimed to determine the efficacy and accuracy of our integrated system in regard to home vital sign measurement, triggers, and clinical measurements used in prenatal care. METHODS:We validated our trigger algorithm through 38 random simulations of longitudinal weight and blood pressure data. To demonstrate clinical utility, six low-risk obstetric patients owning iPhone devices received a U.S. Food and Drug-approved Wi-Fi sphygmomanometer and weight scale together with a mobile app that integrated the data and provided prenatal educational material. Participants were asked to record weekly measurements. Weight and blood pressure baselines were calculated through the mobile app and compared with in-clinic measurements to evaluate trigger alerts. RESULTS:Remote digital data collection was successful, with all participants recording both metrics with a frequency of more than once a week. Remote measurements fell within the 95% confidence interval of clinical measurements. The trigger system produced zero falsepositive and zero false-negative results. CONCLUSION: Pregnant participants demonstrated ability and compliance using digital devices for remote clinical monitoring. Remote readings were highly correlated to clinical measurements, demonstrating validity of remote devices in collecting high-resolution weight and blood pressure data. This model may have utility in monitoring and managing pregnant women between prenatal appointments.

Bilateral ectopic pregnancy is a rare phenomenon which is found with increased frequency when using assisted reproductive technology (ART). This diagnosis is most often made incidentally and intraoperatively, as ultrasound and serial β-hCG trends have shown poor efficacy for accurate diagnosis. Management of bilateral ectopic pregnancies is most commonly reported using bilateral surgical removal of the ectopic pregnancy (salpingostomy and/or salpingectomy). We present a case of an ART patient with incidentally found bilateral tubal ectopic pregnancies, where multiple management strategies including medical and surgical techniques were used concurrently which resulted in a subsequent spontaneous intrauterine pregnancy. While the standard of care is difficult to establish, we recommend individualizing management decisions based on the patient's reproductive goals and overall risk profile.