Background and aims COVID‐19 forced healthcare systems to implement telehealth programs, facilitated in Massachusetts by a policy requiring insurers to reimburse for telehealth visits. Prior studies suggest that telehealth is effective for obstetric care, but little is known about its implementation in response to policy changes in underserved communities. We utilized the RE‐AIM framework to evaluate telehealth implementation in a large academic urban obstetric practice that serves a medically underserved population. Methods RE‐AIM elements were assessed through retrospective review of electronic health record (EHR) data for all obstetric encounters between March 19 and August 31, 2020 and review of clinic implementation processes. Data extracted included demographics, number and type (in‐person or telehealth) of prenatal visits, prenatal diagnoses, delivery outcomes, and number and type of postpartum visits. Data were analyzed using descriptive statistics. Results A total of 558 patients (60.6% Hispanic; 13.2% primary language Spanish) had 1788 prenatal visits, of which 698 (39.0%) were telehealth visits. A total of 209 patients had 230 postpartum visits, of which 101 (48.3%) were telehealth visits. The Reach of the intervention increased from 0% of patients at baseline to 69% in August. Effectiveness measures were limited but suggested potential for earlier diagnosis of some prenatal conditions. Adoption was high, with all 30 providers using telehealth, and the telehealth was found to likely be feasible and acceptable based on uptake. Increases in the percentage of telehealth visits over time and continuation post‐lockdown suggested maintenance was potentially achievable. Conclusions The COVID‐19 pandemic has changed traditional approaches to healthcare delivery. We demonstrate that the use of the RE‐AIM framework can be effective in facilitating implementation of telephone visits in a large academic urban obstetric practice after state‐level policy change. This may be of particular importance in settings serving patients at higher risk for maternal morbidity and poor birth outcomes.

deviation [SD], 11.8 years); 59.7% were female. The majority (80.8%) had neurogenic TOS with venous and/or arterial components based on clinical presentation and/or radiologic evidence; 16.5% had isolated venous TOS; and 2.7% had isolated arterial TOS. Most common symptoms were paresthesia (78.1%), pain (66.9%), and weakness (55.4%); a prior history of trauma was present in 19.6%. Paget-Schrotter Syndrome was the presentation in 60/260 (23.8%) e one-third of these were treated with subclavian vein thrombolysis, with a median time from thrombolysis to decompression being 119 (interquartile range [IQR], 98-270) days. Six (2.3%) presented with acute or chronic limb-threatening ischemia. Three (1.2%) underwent redo-decompression in the context of prior incomplete decompression and persistent symptoms. Surgical approach was supraclavicular in 99.2% and paraclavicular for arterial reconstruction in 0.8%. Adjunctive procedures included accessory cervical rib resection (12.3%); long C7 resection (2.7%); subclavian artery reconstruction (1.5%); and arterial thrombectomy (0.4%). Mean hospital length of stay was 3.4 days (SD, 2.8 days). Most common 90-day complications were pleural effusion requiring thoracostomy tube (5.0%), pneumonia (3.8%), chyle leak (3.1%), transient long-thoracic nerve neuropraxia requiring intensive physiotherapy (1.2%), and hemothorax requiring re-intervention or thoracostomy tube (1.2%) (Table ). There were no perioperative mortalities. Rates of 90-day readmission and emergency room visit were 3.9% and 8.5%, respectively. After a mean follow-up of 202 days (SD, 273 days), 93.3% of patients reported improvement or resolution of TOS symptoms.Conclusions: Supraclavicular decompression in patients with neurogenic, venous, and/or arterial TOS can be performed safely with low perioperative event rates. Careful patient selection and a comprehensive approach to decompression are keys to achieving optimal outcomes.

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INTRODUCTION: Intrapartum vertical transmission of group B streptococcus (GBS) occurs in approximately 50% of vaginal births without antibiotic prophylaxis. This prospective cohort study aimed to determine if <4 hours duration of intrapartum antibiotic prophylaxis (IAP) before delivery reduces GBS vertical transmission rates. METHODS: 1354 GBS positive parturients presented to Yale New Haven Hospital between 10/1/2009 and 3/28/2012. Of eligible patients ≥37 weeks with singleton gestations in labor (n=1111), 316 were invited after IRB approval to participate and 240 completed the study. Maternal characteristics, labor course, delivery and neonatal outcomes were obtained. Of 240 maternal-infant dyads, 69 received <4 hours of IAP and 158 received ≥4 hours. Nine did not receive IAP. Infant oropharyngeal and rectal swabs were collected after 24 hours to detect mucosal GBS colonization. RESULTS: Rates of GBS transmission were equivalent in those receiving less than and greater than 4 hours of prophylaxis before delivery, respectively (1.5 vs 1.2%; P=1.0). No significant differences in GBS transmission were observed between those with and without risk factors for early neonatal GBS disease. No cases of GBS vertical transmission occurred in those who received IAP prior to membrane rupture versus 3 (3.9%) cases of transmission (P=.036) among those who received IAP after membrane rupture. CONCLUSION: GBS vertical transmission rates among individuals who received IAP <4 hours were equivalent to those receiving IAP ≥4 hours before delivery. Antibiotic prophylaxis duration may be less relevant than membrane rupture timing in vertical transmission and deserves further exploration to optimize newborn monitoring protocols after delivery in maternal GBS colonization.