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Abstract Objectives: to evaluate patients' satisfaction of mixed prenatal care during the COVID-19 pandemic in a tertiary hospital in Lima, Peru. Methods: we conducted a cross-sectional evaluation of satisfaction in patients receiving mixed prenatal care that includes in-person and virtual visits. All women who gave a written consent between June and July 2021 were included. The survey was based on the Short Assessment of Patient Satisfaction (SAPS) scale which evaluated seven dimensions of satisfaction: access and facilities, effectiveness, information, technical skills, participation, relationship, and general satisfaction. Results: the overall satisfaction on mixed prenatal care was 3.28 ± 0.71. The mean SAPS score was 33.88 (SD = 5.56). In total, 144 patients (65%) preferred the mixed prenatal care. The mean maternal age of 221 included pregnant women was 30 years and the mean gestational age at the first appointment was 24 weeks. Overall, 88.2% of patients had up to 6 visits among virtual and in-person. Patients with non-health insurance had lower rates of satisfaction when compared with pregnant women with national health insurance (p=0.026). Conclusions: women receiving the mixed prenatal care during the COVID-19 pandemic reported a high level of satisfaction. In general, pregnant women would recommend mixed prenatal care.

Resumen Objetivos: evaluar la satisfacción de las pacientes con la atención prenatal mixta durante la pandemia de COVID-19 en un hospital terciario de Lima, Perú. Métodos: realizamos una evaluación transversal de la satisfacción en pacientes que recibieron atención prenatal mixta, que incluyó consultas presenciales y virtuales. Se incluyeron todas las mujeres que dieron su consentimiento por escrito entre junio y julio de 2021. Se aplico la escala Short Assessment of Patient Satisfaction (SAPS), que evaluó siete dimensiones de satisfacción: acceso e instalaciones, efectividad, información, habilidades técnicas, participación. relación y satisfacción general. Resultados: la satisfacción global con la atención prenatal mixta fue de 3,28±0,71. La puntuación media del SAPS fue 33,88 (DE = 5,56). En total, 144 pacientes (65%) prefirieron la atención prenatal mixta. La edad materna promedio de las 221 gestantes incluidas fue de 30 años y la edad gestacional promedio en la primera consulta fue de 24 semanas. En total, el 88,2% de los pacientes realizaron hasta 6 consultas entre virtuales y presenciales. Los pacientes sin seguro de salud tuvieron menores índices de satisfacción en comparación con las mujeres embarazadas con seguro de salud público (p=0,026). Conclusiones: Las mujeres que recibieron atención prenatal mixta durante la pandemia de COVID-19 reportaron un alto nivel de satisfacción. En general, las mujeres embarazadas recomendarían atención prenatal mixta.

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OBJECTIVE: We describe the development and structure of a novel mobile application in a mixed model of prenatal care, in the context of the COVID-19 pandemic. Furthermore, we assess the acceptability of this mobile app in a cohort of patients. METHODS: First, we introduced a mixed model of prenatal care; second, we developed a comprehensive, computer-based clinical record to support our system. Lastly, we built a novel mobile app as a tool for prenatal care. We used Flutter Software version 2.2 to build the app for Android and iOS smartphones. A cross-sectional study was carried out to assess the acceptability of the app. RESULTS: A mobile app was also built with the main attribute of being connected in real-time with the computer-based clinical records. The app screens detail information about activities programmed and developed in the prenatal care according to gestational age. A downloadable maternity book is available and some screens show warning signs and symptoms of pregnancy. The acceptability assessment was mostly rated positively regarding the characteristics of the mobile app, by 50 patients. CONCLUSION: This novel mobile app was developed as a tool among pregnant patients to increase the information available about their pregnancies in the provision of a mixed model of prenatal care in the context of the COVID-19 pandemic. It was fully customized to the needs of our users following the local protocols. The introduction of this novel mobile app was highly accepted by the patients.

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Abstract Objective We describe the development and structure of a novel mobile application in a mixed model of prenatal care, in the context of the COVID-19 pandemic. Furthermore, we assess the acceptability of this mobile app in a cohort of patients. Methods First, we introduced a mixed model of prenatal care; second, we developed a comprehensive, computer-based clinical record to support our system. Lastly, we built a novel mobile app as a tool for prenatal care. We used Flutter Software version 2.2 to build the app for Android and iOS smartphones. A cross-sectional study was carried out to assess the acceptability of the app. Results A mobile app was also built with the main attribute of being connected in real-time with the computer-based clinical records. The app screens detail information about activities programmed and developed in the prenatal care according to gestational age. A downloadable maternity book is available and some screens show warning signs and symptoms of pregnancy. The acceptability assessment was mostly rated positively regarding the characteristics of the mobile app, by 50 patients. Conclusion This novel mobile app was developed as a tool among pregnant patients to increase the information available about their pregnancies in the provision of a mixed model of prenatal care in the context of the COVID-19 pandemic. It was fully customized to the needs of our users following the local protocols. The introduction of this novel mobile app was highly accepted by the patients.

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OBJECTIVE: This study aimed to describe the characteristics of a telemonitoring program that was rapidly implemented in our institution as a response to the coronavirus disease 2019 (COVID-19) pandemic, as well as the maternal and perinatal outcomes of women who attended this program. STUDY: DESIGN: Retrospective study of patients via phone-call telemonitoring during the peak period of the COVID-19 pandemic (May 2020-August 2020). Maternal and perinatal outcomes were collected and described. Health providers' satisfaction with the telemonitoring program was assessed via an email survey. RESULTS: Twenty-three (69.7%) health providers answered the survey. The mean age was 64.5 years, 91.3% were OB/GYN (obstetrician-gynecologist) doctors, and 95% agreed that telemonitoring is an adequate method to provide health care when in-person visits are difficult. The 78.7% of scheduled telemonitoring consultations were finally completed. We performed 2,181 telemonitoring consultations for 616 pregnant women and 544 telemonitoring consultations for puerperal women. Other medical specialties offering telemonitoring included gynecology, reproductive health, family planning, cardiology, endocrinology, and following up with patients with reactive serology to severe respiratory syndrome coronavirus 2 (SARS-CoV-2). The majority of the population attending our telemonitoring program were categorized as the lowest strata, i.e., III and IV, according to the Human Development Index, and approximately 42% were deemed as high-risk pregnant women. Additionally, we reported the perinatal outcomes of 424 (63%) pregnant women, the most relevant finding being that approximately 53% of them had cesarean sections. CONCLUSION: Telemonitoring is an adequate method of continuing the provision of prenatal care when in-person visits are difficult in situations such as the COVID-19 pandemic. Telemonitoring is feasible even in institutions with no or little experience in telemedicine. The perinatal outcomes in women with telemonitoring seem to be similar to that in the general population. KEY POINTS: · Telemonitoring for prenatal care is feasible even in low-income countries and in a critical scenario.. · OB/GYN doctors agreed with that telemonitoring is an adequate method to provide prenatal care.. · Maternal and perinatal outcomes are similar in women attending a telemonitoring program..

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La pandemia del coronavirus 19 (COVID-19) y las medidas instauradas para su control significaron la interrupción de la atención prenatal, con potencial riesgo en la salud materna y fetal. Por otro lado, la atención prenatal convencional presencial implicaría exposición y riesgo de infección en pacientes y proveedores de salud. El Instituto Nacional Materno Perinatal (INMP) ha incorporado la teleconsulta como parte de un nuevo modelo de atención prenatal mixto, cuyo objetivo es disminuir las citas presenciales y, por tanto, el contacto y riesgo de transmisión viral. El paquete de atención prenatal incluye actividades esenciales para atender gestantes en edades gestacionales específicas con mayor impacto en los desenlaces perinatales y maternos. Este nuevo modelo podría generalizarse a nivel nacional y ser parte de la solución a las disparidades de atención en el Perú, mediante políticas del uso de la telemedicina en la atención prenatal que faciliten su implementación, así como su sostenibilidad después de la pandemia de COVID-19.

The coronavirus 19 (COVID-19) pandemic and the measures implemented for its control meant the interruption of prenatal care, with potential risk to maternal and fetal health. However, conventional in-person prenatal care would imply exposure and risk of infection in patients and health care providers. The Instituto Nacional Materno Perinatal (INMP) has incorporated teleconsultation as part of a new model of mixed prenatal care, which aims to reduce in-person appointments and, therefore, the contact and risk of viral transmission. The prenatal care package performs essential activities to care for pregnant women of specific gestational ages with a greater impact on perinatal and maternal outcomes. This new model could be generalized nationally and be part of the solution to the disparities of healthcare in Peru, through policies for the use of telemedicine in prenatal care that facilitate its implementation, as well as its sustainability after the COVID-19 pandemic.

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Objetivos Determinar la morfología y el peso del árbol vascular placentario a nivel del mar. Material y Métodos: Se seleccionó al azar 27 placentas, cuyas madres cumplían con los criterios de inclusión (CPN, ausencia de diabetes, hipertensión arterial, preeclampsia, nefropatías, isoinmunización Rh). Obtenida la placenta se procedía a lavado por 30 minutos con agua potable, corte de membranas al ras del borde placentario, corte del cordón umbilical a 5 cm de su inserción, cateterización de los vasos umbilicales, lavado con 200 cmL de solución salina 9 por ciento, se inyecta solución de acrílico, curado lento, a presión conocida 15 mL de solución y 7,5 g de polvo acrílico, teñido de rojo para las arterias y de azul para la vena. Sumersión en agua hervida por 30 minutos, luego formol 10 por ciento por dos horas y ácido perclórico (ácido muriático) por siete días. Se rociaba las placentas con agua y se obtenía el árbol. Resultados: El peso promedio del árbol vascular placentario fue 16,9 g, rango: 8,7–25,3 g; el índice placentario fue: 0,1571, rango: 0,1081–0,1944 g y el índice vascular placentario 0,0317, rango: 0,0230–0,0560. A mayor peso placentario, mayor peso vascular placentario. Conclusiones: Los datos obtenidos, servirán de comparación con los resultados a obtener en placentas de altura, a fin de determinar si la hipoxia de altura incrementa la vasculatura placentaria.

Objective: To determine the morphology and weight of the placental vascular tree. Material and Methods: Twenty seven placentas were collected from normal pregnant women who had prenatal care at Clinica Villa Maria–EsSalud. Patients who had diabetes mellitus, arterial hypertension, preeclampsia, nephropathy, Rh isoimmunization and anemia were not included. The specimens were rinsed with tap water for 30 minutes, the fetal membranes were trimmed off at the level of its insertion. The placentas were weighed and the umbilical vessels were catheterized and flushed with 100 mL of normal saline solution and then the acrylic solution (15 mL of liquid with 7,5 of powder) was injected. The placentas were immersed in hot water for 30 minutes then fixed in 10 percent formaldehyde for two hours and finally immersed in hydrochloric acid for 7 days in order to obtain the acrylic cast of the placental vascular tree by corrosion. Results: The mean weight of the vascular tree was 16,9 g (8,7-25,3 g). The mean placental ratio was 0,1571 (0,1081-0,1944) and the mean placental vascular ratio was 0,0317 (0,0230-0,0560); in addition there was a direct relation between the weight of the placenta and the weight of the vascular tree. Conclusions: Our data will permit comparison with high altitude placentae, where hypoxia could modify placental vascular tree.

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