Current Approaches to Following Up Women and Newborns After Discharge From Childbirth Facilities: A Scoping Review

Maxine Pepper; Oona M.R. Campbell; Susannah L. Woodd

doi:10.9745/GHSP-D-23-00377

Figures & Tables

Figures

Tables
Additional Files

Download figure
Open in new tab
Download powerpoint
FIGURE
Process of Selecting Studies on Follow-Up of Women and Newborns After Discharge From Childbirth Facilities

View popup

TABLE.

Overview of Included Studies on Follow-Up After Discharge From Childbirth Facilities

Study	Study Location, Design, Population, and Sample Size	Study Outcome(s)	Data Collection Method, Person Making Contact, Timing of Postpartum Contact, and Persistence	Response	Other Comments
1.1. Studies using primarily home visits for follow-up
Aftab 2021³⁰	Bangladesh, India, Pakistan, DRC, Ghana, Kenya, Tanzania, Zambia Prospective cohort of 125,716 pregnant individuals	Direct maternal morbidity and mortality, stillbirth, and neonatal death	Home visits by trained workers at week 1 and between week 7 and 11 after delivery; persistence not reported.	91% visited at least once	Study also included 3 home visits during pregnancy.
Creanga 2016³¹	Kenya Prospective cohort of 1,185 pregnant individuals	Intentions and behaviors regarding maternal and neonatal health service utilization	Home visits by trained interviewers up to week 6 after delivery; persistence not reported.	89%	Study also included 2 home visits during pregnancy.
Darmstadt 2010³²	Bangladesh Cluster RCT of 10,006 neonates	Neonatal illness and survival	Home visits by CHWs at days 2, 5, 8, and 28 after delivery; persistence not reported.	73% visited at least once	Study included 2 home visits during pregnancy. CHWs attended the delivery if possible and facilitated referral if necessary.
Surkan 2017³³	Bangladesh Prospective cohort within a cluster RCT of 59,666 pregnant individuals	Maternal morbidity and postpartum depression	Home visits by trained interviewers at months 3 and 6 after delivery; persistence not reported.	96% with depression data at 6 months
Ward 2008³⁴	United Kingdom Prospective cohort of 6,297 individuals with a CD	CD surgical site infection	Routine home visits by community midwives (median length of follow-up: 15 days after delivery); persistence not reported.	88% with completed follow-up records
1.2. Studies using primarily clinic visits for follow-up
Srun 2013³⁵	Cambodia Prospective cohort of 222 individuals with a CD	CD superficial surgical site infection	Clinical assessment of wound by nurses and surgeons during inpatient stay and 2 scheduled clinic visits post-discharge at days 15 and 30 after delivery (microbiological methods used); phone follow-up by surgeons if patients didn’t return.	86% (Day 15) and 80% (Day 30) across all methods	9% (17/190) of those reached on day 15 were contacted by phone (on day 30: 16% (29/176)). 36% (4/11) of superficial infections were diagnosed post-discharge.
Zejnullahu 2019³⁶	Kosovo Prospective cohort of 420 individuals with a CD	CD surgical site infection	Routine clinic visit (day 30) with gynecologists and additional outpatient department follow-up up to day 30 (microbiological methods used); persistence not reported.	77%
1.3. Studies using in-person visits for follow-up (location not specified)
Surveillance Monitoring for Antiretroviral Toxicities Yee 2021³⁷	United States Prospective dynamic cohort (recruitment ongoing) of 2,976 pregnant individuals and individuals after delivery who are living with HIV (2007–2019)	Substance use in caregivers (wider study looks at health of children and their caregivers)	In-person structured interviews conducted by trained interviewers up to week 1 and at month 12 after delivery; persistence not reported.	98% (Week 1), 60% (Month 12)
2. Studies using primarily telephone calls for follow-up
Bianco 2013³⁸	Italy Prospective cohort of 1,705 individuals after delivery	Postpartum infection	Telephone calls by 2 physicians (trained, not involved in patient care) at day 30 after discharge (medical records for validation); 5 attempts.	97%	Telephone surveillance identified more infections (8.9%) than traditional infection surveillance systems (1.4%).
Cardoso Del Monte 2010³⁹	Brazil Prospective cohort of 204 individuals with a CD	CD surgical site infection	Telephone calls by study investigator and trained student nurse at days 15 and 30 after delivery; 3 attempts at each time point.	92%
Hacker 2022⁴⁰	United States Prospective cohort of 10,092 individuals after delivery	Hypertensive disorders	Telephone calls by a nurse or patient educator (and self-administered blood pressure measurement if cuff available) at week 1 after delivery; persistence not reported.	59%
Halwani 2016⁴¹	United States Prospective cohort of 193 individuals with a CD	CD surgical site infection	Telephone calls by study investigator at days 7, 14, and 30 after delivery; 3 attempts at each time point.	82% interviewed at least once. 65% interviewed 3 times.	Incidence of infections detected by telephone 10% (19/193) compared to 7% (14/193) by traditional surveillance.
Hill 2021⁴²	United States Prospective cohort of 631 individuals with a positive COVID-19 test during their hospital stay after delivery (individuals who tested negative were also included at 1 site)	Well-being of COVID-19 patients	Hospital records and telephone calls after discharge by physicians and clinical nurses up to week 2 after discharge (2 calls per week; first call within 3 days after discharge); persistence not reported.	36% reached a least once
Lima 2016⁴³	Brazil Prospective cohort of 528 individuals with a CD	CD surgical site infection	Telephone calls by trained undergraduate students up to day 15 and up to day 30 after delivery; 5 calls at each time point.	67% contacted at least once. 30% on day 15, 63% on day 30.
Nguhuni 2017⁴⁴	Tanzania Prospective cohort of 316 individuals with a CD	CD surgical site infection	Telephone calls by a clinically trained investigator or nurse at days 5, 12, 28 after delivery (clinical reviews for validation); at least 2 attempts.	87% reached at least once	85% of enrolled women provided a telephone number. Compared to clinical reviews, sensitivity and specificity of phone interviews was 72% and 100%, respectively.
PRAMS Salvesen von Essen 2022⁴⁵	Puerto Rico Prospective cohort of individuals with a live birth: 1,536 (Phase 1), 1,485 (Phase 2)	Maternal and infant postpartum (ill-) health and behaviors (partly Zika-related)	Telephone calls by 6 interviewers at month 3 after delivery (Phase 1) and month 9 after delivery (Phase 2); persistence not reported.	77% (Phase 1), 83% (Phase 2)	Telephone surveys followed standard PRAMS protocol procedures.
Swissnoso SSI surveillance system Troillet 2017⁴⁶	Switzerland Prospective cohort of 187,501 surgery patients including 32,814 individuals with a CD	Surgical site infection	Telephone calls by infection control nurses at 1 month after operation; 5 attempts.	91% for individuals with a CD	87% of CD surgical site infections diagnosed after discharge.
Woodd 2021⁴⁷	Tanzania Prospective cohort of 879 individuals after delivery	Maternal postnatal infections and newborn infections	Telephone calls by research nurses (2 per hospital) at days 7 and 28 after delivery; 4 attempts over 7 days.	90% interviewed at least once. 86% interviewed on day 28.	3% of the initial sample had no access to a telephone.
3.1. Studies using self-administered postal questionnaires for follow-up
The Norwegian Mother and Child Cohort Study Magnus 2016⁴⁸ Bjelland 2016⁴⁹	Norway Prospective cohort of 112,908 pregnant individuals	Maternal and child health	Self-administered postal questionnaire at month 6 after delivery; persistence not reported.	80% (Month 6)	Study also included additional questionnaires sent during pregnancy, at 18 months after delivery and later in childhood.
	NorwayProspective cohort of 20,248 pregnant individuals without pelvic pain in pregnancy			85% (Month 6)
PRAMS Shulman 2018⁵⁰ Kortsmit 2022⁵¹	United States Prospective cohort of individuals with a live birth (Annual state sample size: 1,000–3,000)	Maternal behaviors, attitudes, and experiences	Self-administered postal questionnaire with sampling taking place at months 2 to 6 after delivery; telephone follow-up for non-responders, 5 mailings and 15 call attempts.	47%–74% (median = 61%; in 2014)
PRAMS Shulman 2018⁵⁰ Kortsmit 2022⁵¹	United States Prospective cohort of 347,363 individuals with a live birth stratified by whether infant is alive or deceased			48.3% if infant is deceased, 56.2% if infant is alive
Williams 2007⁵²	United KingdomCross-sectional survey of 2,100 individuals after delivery	Perineal morbidity	Self-administered postal questionnaire at month 12; reminder after 3 weeks.	23%
3.2. Studies using self-administered electronic questionnaires for follow-up
Hirshberg 2018⁵³	United StatesRCT of 206 individuals after delivery with pregnancy-related hypertension	Blood pressure monitoring	Text messages with individuals responding to automated text messages sent by web-based platform up to week 2 after discharge; 2 requests for blood pressure readings per day.	92% submitted at least 1 reading in the first 10 days postpartum	Texting reached more individuals than standard clinic visits (92% compared to 44%).
Zhu 2021⁵⁴	ChinaProspective cohort of 674 individuals after delivery belonging to the rural-to-urban floating population	Self-efficacy, postpartum depression, and social support	Self-administered electronic questionnaire distributed via email or WeChat at weeks 6 and 12 after delivery; WeChat reminders 1 week and 1 day before data collection time points.	81% (Week 6), 65% (Week 12)
4. Studies using a combination of methods for follow-up
Baxter 2021⁵⁵	EnglandRepeated point-prevalence study (4 time points) of 1,639 individuals with a CD	CD surgical site infection	Inpatient and re-admission cases identified via electronic records. Post-discharge cases identified via telephone and text messages (1st time point: telephone; 2nd–4th time point: text messages with telephone follow-up). Program led by midwife with infection control experience. Timing of contact not reported; 3 attempts for telephone calls.	47%–68% across all methods (1st time point: 60%, 2nd: 47%, 3rd: 68%, 4th: 60%)	Small quality improvement initiatives between time points. As accuracy of telephone numbers improved, response rates increased to 74%.
MINA-Brazil CohortCardoso 2020⁵⁶Mosquera 2019⁵⁷	BrazilProspective cohort of 1,246 pregnant individuals and individuals after delivery	Growth and development of Amazonian children	Linkage to hospital records, telephone calls (up to month 3), and study visits (from month 6 on) conducted by trained fieldworkers (including research assistants and nurses) on days 30 to 45, and months 3, 6 and 12 after delivery; multiple phone calls to schedule assessment and text message reminders before clinic visit.	64% (Month 6), 63% (Month 12)	Study also included visits during pregnancy, after delivery in hospital, and later during childhood (year 2 and planned for year 5).
MINA-Brazil CohortCardoso 2020⁵⁶Mosquera 2019⁵⁷	BrazilProspective cohort of 1,523 pregnant individuals and individuals after delivery			63% (Day 30–45)	3% of women did not provide valid telephone number.
Ferraro 2016⁵⁸	ItalyProspective cohort of 3,685 individuals with a CD (4 time points)	CD surgical site infection	Routine clinic visit or telephone calls up to day 30 after delivery. Person making contact not reported; persistence not reported.	94% across all methods and time points	89% (129/145) of infections were diagnosed post-discharge.
Madhi 2018⁵⁹	Panama, Dominican Republic, South Africa, MozambiqueProspective cohort of 3,243 pregnant individuals	Maternal and infant access to health care facilities	Visit to study site and, if necessary, telephone calls or home visits up to day 30. Person making contact not reported; persistence not reported.	98%	Study also included data collection at time of delivery.
Opøien 2007⁶⁰	NorwayProspective cohort of 326 individuals with a CD	CD surgical site infection	Wound inspection in hospital by study authors, patients instructed to monitor symptoms and contact hospital, and self-administered postal questionnaire up to day 30 after delivery; reminders sent to non-responders and telephone follow-up if necessary.	100%	Incidence of infections detected by day 30 was 9% (29/326) compared to 2% detected before discharge.

Abbreviations: CD, cesarean delivery; CHW, community health worker; DRC, Democratic Republic of Congo; PRAMS, Pregnancy Risk Assessment Monitoring System; RCT, randomized controlled trial.