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ObjectiveThe objective is to evaluate whether the implementation of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) postpartum discharge educational initiative is associated with improved patient knowledge of warning signs of severe maternal morbidity (SMM) and if the initiative is self-sustaining.DesignA pre–post design was used to evaluate patient knowledge of warning signs of SMM (Plan–Do–Study–Act, PDSA cycle 1) and if the quality improvement initiative was self-sustaining (PDSA cycle 2). Patient understanding of warning signs of SMM prior to initiation of the AWHONN education (Usual Discharge) was compared with understanding of those who were discharged after implementation (POST-BIRTH discharge). The initiative was designed to be self-sustaining. The POST-BIRTH flyer describes nine warning signs of SMM. Eligible participants were English-speaking patients discharged with a live newborn who were able to be contacted within 2 weeks. Participants completed a telephone administered nine-item survey to assess knowledge of SMM. The primary outcome was the percentage of correct answers. To evaluate sustainability, whether the POST-BIRTH fliers and discharge checklist were still being used at 19 months postinitiative was planned.ResultsFor PDSA cycle 1, in the Usual Discharge group, 347 patients were discharged, 164 (44.7%) were eligible and 151 (92.1%) completed the survey. In the POST-BIRTH discharge group, 268 patients were discharged, 199 (74.3%) were eligible and 183 (92.0%) completed the survey. Compared with the Usual Discharge group, the POST-BIRTH group had significantly more correct responses (30% vs 60%, p<0.001). In PDSA cycle 2, POST-BIRTH flyers were still being used universally on one of the two floors from which postpartum patients are discharged, but not the other.ConclusionThe implementation of an educational initiative for postpartum patients is associated with improved knowledge of warning signs of SMM. The use of the education was self-sustaining on one discharge floor but not the other.

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OBJECTIVE: Antenatal corticosteroid (ANCS) administration between 22 0/7 e 22 6/7 wks is not recommended by SMFM and ACOG given current existing evidence. We sought to evaluate whether ANCS exposure was associated with improved survival among resuscitated newborns delivered at 22 and 23 wks. STUDY DESIGN: We conducted a population-based cohort study of all resuscitated livebirths delivered between 22 0/7 and 23 6/7 wks in the United States from 2009-2014. The primary outcome was difference in rate of survival to 1 year of life (YOL) based on ANCS exposure. Secondary outcomes included neonatal survival (< 28 days of life), cesarean delivery, and composite adverse maternal outcome (CAMO) associated with ANCS utilization. Multivariable logistic regression provided confounder adjusted effect estimates. RESULTS: In the United States between 2009-2014, there were 2,635 and 7,992 infants who received postnatal resuscitation after delivery between 22 0/7 e 22 6/7 and 23 0/7 e 23 6/7 wks, respectively. Few infants who were resuscitated after birth between 22 0/7 e 22 6/7 (15.9%) and 23 0/7-23 6/7 (26.0%) wks received ANCS. Infant survival to 1 YOL was 45.2 vs 27.8% (aRR 1.6, 95% CI 1.2-2.1) among infants exposed to ANCS compared to those who did not receive ANCS at 22 wks. Survival to 1 YOL was 57.9 vs 47.7% (aRR 1.3, 95% CI 1.1-1.5) among infants exposed to ANCS compared to those who did not receive ANCS at 23 wks. When stratified by 100g birthweight category (400-499g, 500-599g, 600-699g, and 700-799g), ANCS was associated with increased survival among neonates weighing 500-599g (aRR 1.9, 95% CI 1.3-2.9) and 600-699g (aRR 1.7, 95% CI 1.1-2.6) at 22 wks. ANCS exposure had a positive association with cesarean delivery (aRR 2.1, 95% CI 1.4-3.0) and composite adverse maternal outcome (aRR 2.3, 95% CI 1.2-4.3) among infants born at 22 wks. CONCLUSION: Exposure to ANCS was associated with increased survival to 1 YOL among infants born at 22 and 23 wks. Counseling regarding the utilization of ANCS at the limits of viability should be investigated further given emerging evidence of benefit.