Pub Date : 2023-05-01DOI: 10.1097/01.AOG.0000930260.08822.c1
Subhashini Ladella, Cintia Gomes, Amber Shaver
INTRODUCTION: Maternal anemia affects 40% of pregnancies worldwide. It is associated with adverse birth outcomes, including preterm birth (PTB), which disproportionally affects Black women. We compared adverse perinatal outcomes and anemia as defined by World Health Organization/Centers for Disease Control and Prevention (hemoglobin [Hb]<11 g/dL) and institutional guidelines (Hb<12 g/dL), among Black women. METHODS: Institutional review board-approved retrospective cohort study was performed on patients delivered at Community Regional Medical Center, Fresno, California, from 2015 to 2016. Data abstraction included gestational age, first- and third-trimester Hb, race and ethnicity, parity, maternal age, mode of delivery, and neonatal outcomes. Exclusion criteria included hemoglobinopathies, tobacco use, uterine abnormalities, multiple gestation, and prior PTB or cervical surgery. RESULTS: Birth outcomes of 1,305 term and 990 PTB were analyzed for anemia at Hb less than 11 g/dL and less than 12 g/dL. Black women with PTB (83.8%) had significantly higher rates of anemia compared to term (68.8%) at Hb less than 12 g/dL (P<.05) versus Hb less than 11 g/dL (P>.05). Compared with other ethnicities (n=2,104), Black women (n=193) showed significantly higher rate of first- (47.60% versus 24.3%; P<.01) and third-trimester anemia (75.10% versus 59.50%, P<.01), low birth weight (LBW) neonates (38.70% versus 26.20% not-AA, P<.1), and lower 1- and 5-minute Apgar scores (32.30% and 15.30% versus 22.90% and 8.70% not-AA, respectively; P<.05) at Hb less than 12 g/dL. CONCLUSION: Significant association of anemia with PTB, LBW, and lower Apgar scores was noted in Black women at HB less than 12 g/dL. Further studies with larger sample sizes are needed to evaluate the need for redefining anemia Hb concentration for Black women, which may help initiate early treatment and prevent adverse perinatal outcomes.
{"title":"Effect of Anemia on Adverse Perinatal Outcomes Is Greater in Black Women at Varying Hemoglobin Concentrations [ID: 1380962]","authors":"Subhashini Ladella, Cintia Gomes, Amber Shaver","doi":"10.1097/01.AOG.0000930260.08822.c1","DOIUrl":"https://doi.org/10.1097/01.AOG.0000930260.08822.c1","url":null,"abstract":"INTRODUCTION: Maternal anemia affects 40% of pregnancies worldwide. It is associated with adverse birth outcomes, including preterm birth (PTB), which disproportionally affects Black women. We compared adverse perinatal outcomes and anemia as defined by World Health Organization/Centers for Disease Control and Prevention (hemoglobin [Hb]<11 g/dL) and institutional guidelines (Hb<12 g/dL), among Black women. METHODS: Institutional review board-approved retrospective cohort study was performed on patients delivered at Community Regional Medical Center, Fresno, California, from 2015 to 2016. Data abstraction included gestational age, first- and third-trimester Hb, race and ethnicity, parity, maternal age, mode of delivery, and neonatal outcomes. Exclusion criteria included hemoglobinopathies, tobacco use, uterine abnormalities, multiple gestation, and prior PTB or cervical surgery. RESULTS: Birth outcomes of 1,305 term and 990 PTB were analyzed for anemia at Hb less than 11 g/dL and less than 12 g/dL. Black women with PTB (83.8%) had significantly higher rates of anemia compared to term (68.8%) at Hb less than 12 g/dL (P<.05) versus Hb less than 11 g/dL (P>.05). Compared with other ethnicities (n=2,104), Black women (n=193) showed significantly higher rate of first- (47.60% versus 24.3%; P<.01) and third-trimester anemia (75.10% versus 59.50%, P<.01), low birth weight (LBW) neonates (38.70% versus 26.20% not-AA, P<.1), and lower 1- and 5-minute Apgar scores (32.30% and 15.30% versus 22.90% and 8.70% not-AA, respectively; P<.05) at Hb less than 12 g/dL. CONCLUSION: Significant association of anemia with PTB, LBW, and lower Apgar scores was noted in Black women at HB less than 12 g/dL. Further studies with larger sample sizes are needed to evaluate the need for redefining anemia Hb concentration for Black women, which may help initiate early treatment and prevent adverse perinatal outcomes.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73843838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.aog.0000930944.82945.80
Carolyn S. Sinow, Lyndsay A. Avalos, A. Beck, Jennifer N. Felder, J. Stark, Ayesha C. Sujan
INTRODUCTION: Sleep disturbances commonly occur in pregnancy; and the postpartum state confers elevated risk for mental health disorders. In nonpregnant populations, sleep problems have been linked to mental health problems. The scant research on the association between prenatal sleep disturbances and postpartum mental health has produced mixed results. The goal of this project was to evaluate the association between prenatal sleep and postpartum mental health. METHODS: This IRB-approved prospective cohort study included 336 individuals receiving prenatal care at a single institution between August 2020 and April 2021. Participants completed a baseline questionnaire upon recruitment, in the first or early second trimester, and a follow-up questionnaire at 4–8 weeks postpartum. Individuals completed surveys for sleep (Pittsburgh Sleep Quality Index [PSQI]), depression (Patient Health Questionnaire depression scale [PHQ-8]), and anxiety (General Anxiety Disorder scale [GAD-7]). RESULTS: After adjusting for baseline depression and potential confounders, prenatal global sleep quality (PSQI, >5) was associated with development of postpartum depression (PHQ-8, ≥10) (relative risk [RR] 1.12: 95% CI 1.01–1.25). Specifically, sleep quality (RR 2.18: 95% CI 1.22–3.91) and sleep latency (RR 1.52: 95% CI 1.06–2.17) were associated with postpartum depression. Prenatal sleep problems were associated with higher postpartum anxiety scores (RR 1.09: 95% CI 0.99–1.20), but findings did not reach statistical significance. CONCLUSION: Prenatal sleep problems are associated with the development of postpartum depression. Research suggests that treating prenatal insomnia may prevent postpartum depression. Screening for sleep disorders in pregnancy could potentially be used to target screening and prevention measures for postpartum depression.
睡眠障碍通常发生在怀孕期间;产后状态会增加精神健康障碍的风险。在未怀孕的人群中，睡眠问题与精神健康问题有关。关于产前睡眠障碍和产后心理健康之间关系的研究很少，结果好坏参半。本项目的目的是评估产前睡眠与产后心理健康之间的关系。方法:这项经irb批准的前瞻性队列研究包括336名在2020年8月至2021年4月期间在一家机构接受产前护理的个体。参与者在招募时完成了一份基线问卷，在妊娠早期或中期早期，并在产后4-8周完成了一份随访问卷。受试者完成了睡眠(匹兹堡睡眠质量指数[PSQI])、抑郁(患者健康问卷抑郁量表[PHQ-8])和焦虑(一般焦虑障碍量表[GAD-7])的调查。结果:在调整基线抑郁和潜在混杂因素后，产前整体睡眠质量(PSQI， >5)与产后抑郁(PHQ-8，≥10)的发生相关(相对危险度[RR] 1.12: 95% CI 1.01-1.25)。具体而言，睡眠质量(RR 2.18: 95% CI 1.22-3.91)和睡眠潜伏期(RR 1.52: 95% CI 1.06-2.17)与产后抑郁症相关。产前睡眠问题与产后焦虑评分较高相关(RR 1.09: 95% CI 0.99-1.20)，但研究结果无统计学意义。结论:产前睡眠问题与产后抑郁症的发生有关。研究表明，治疗产前失眠可以预防产后抑郁。妊娠期睡眠障碍的筛查可能用于针对产后抑郁症的筛查和预防措施。
{"title":"Prenatal Sleep Linked to Postpartum Mental Health Outcomes [ID: 1375042]","authors":"Carolyn S. Sinow, Lyndsay A. Avalos, A. Beck, Jennifer N. Felder, J. Stark, Ayesha C. Sujan","doi":"10.1097/01.aog.0000930944.82945.80","DOIUrl":"https://doi.org/10.1097/01.aog.0000930944.82945.80","url":null,"abstract":"INTRODUCTION: Sleep disturbances commonly occur in pregnancy; and the postpartum state confers elevated risk for mental health disorders. In nonpregnant populations, sleep problems have been linked to mental health problems. The scant research on the association between prenatal sleep disturbances and postpartum mental health has produced mixed results. The goal of this project was to evaluate the association between prenatal sleep and postpartum mental health. METHODS: This IRB-approved prospective cohort study included 336 individuals receiving prenatal care at a single institution between August 2020 and April 2021. Participants completed a baseline questionnaire upon recruitment, in the first or early second trimester, and a follow-up questionnaire at 4–8 weeks postpartum. Individuals completed surveys for sleep (Pittsburgh Sleep Quality Index [PSQI]), depression (Patient Health Questionnaire depression scale [PHQ-8]), and anxiety (General Anxiety Disorder scale [GAD-7]). RESULTS: After adjusting for baseline depression and potential confounders, prenatal global sleep quality (PSQI, >5) was associated with development of postpartum depression (PHQ-8, ≥10) (relative risk [RR] 1.12: 95% CI 1.01–1.25). Specifically, sleep quality (RR 2.18: 95% CI 1.22–3.91) and sleep latency (RR 1.52: 95% CI 1.06–2.17) were associated with postpartum depression. Prenatal sleep problems were associated with higher postpartum anxiety scores (RR 1.09: 95% CI 0.99–1.20), but findings did not reach statistical significance. CONCLUSION: Prenatal sleep problems are associated with the development of postpartum depression. Research suggests that treating prenatal insomnia may prevent postpartum depression. Screening for sleep disorders in pregnancy could potentially be used to target screening and prevention measures for postpartum depression.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79451445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.aog.0000931120.89215.39
K. Fowler, R. Josephson, K. O. O'Flynn O'Brien, R. Pitera
INTRODUCTION: Pubertal progression within a normal cadence is an important marker of natal female health. Data regarding causes of primary amenorrhea in a United States' adolescent population have not been published since 1981. We hypothesize that hyperandrogenism/polycystic ovarian syndrome (PCOS) is an increasingly common cause of primary amenorrhea. METHODS: A retrospective chart review was performed to identify patients with primary amenorrhea. A total of 1,785 charts were identified, of which 1,052 charts have been reviewed. Patients with hyperandrogenism/PCOS were classified by meeting any recommended diagnostic criteria for PCOS in adolescents or an elevated total or free testosterone based on Tanner staging with all other conditions ruled out. Other diagnoses for primary amenorrhea were classified per the American Society for Reproductive Medicine guidelines. RESULTS: Of the 1,052 charts reviewed so far, 263 patients met criteria for primary amenorrhea. Causes in order of prevalence were as follows: 85 hyperandrogenism/PCOS (32.3%), 71 hypothalamic hypogonadism (27%), 36 physiologic delay (13.7%), 19 primary hypogonadism (7.2%), 15 other endocrine causes (5.7%), 8 pituitary (3%), and 4 anatomic (1.5%). Twenty-five (9.5%) patients were unable to be classified. Of the 71 patients with hypothalamic hypogonadism, 27 (38%) had relative energy deficiency in sport (RED-S) making it the most common diagnosis of patients in this categorization. CONCLUSION: Polycystic ovarian syndrome/hyperandrogenism and RED-S are among the top three causes of primary amenorrhea. Proposed reasons for the shift in causes of primary amenorrhea over time include increasing obesity rates and metabolic syndrome in adolescents on one hand as well as increasing access to high-level athletics on the other.
{"title":"Updated Causes of Primary Amenorrhea [ID: 1381195]","authors":"K. Fowler, R. Josephson, K. O. O'Flynn O'Brien, R. Pitera","doi":"10.1097/01.aog.0000931120.89215.39","DOIUrl":"https://doi.org/10.1097/01.aog.0000931120.89215.39","url":null,"abstract":"INTRODUCTION: Pubertal progression within a normal cadence is an important marker of natal female health. Data regarding causes of primary amenorrhea in a United States' adolescent population have not been published since 1981. We hypothesize that hyperandrogenism/polycystic ovarian syndrome (PCOS) is an increasingly common cause of primary amenorrhea. METHODS: A retrospective chart review was performed to identify patients with primary amenorrhea. A total of 1,785 charts were identified, of which 1,052 charts have been reviewed. Patients with hyperandrogenism/PCOS were classified by meeting any recommended diagnostic criteria for PCOS in adolescents or an elevated total or free testosterone based on Tanner staging with all other conditions ruled out. Other diagnoses for primary amenorrhea were classified per the American Society for Reproductive Medicine guidelines. RESULTS: Of the 1,052 charts reviewed so far, 263 patients met criteria for primary amenorrhea. Causes in order of prevalence were as follows: 85 hyperandrogenism/PCOS (32.3%), 71 hypothalamic hypogonadism (27%), 36 physiologic delay (13.7%), 19 primary hypogonadism (7.2%), 15 other endocrine causes (5.7%), 8 pituitary (3%), and 4 anatomic (1.5%). Twenty-five (9.5%) patients were unable to be classified. Of the 71 patients with hypothalamic hypogonadism, 27 (38%) had relative energy deficiency in sport (RED-S) making it the most common diagnosis of patients in this categorization. CONCLUSION: Polycystic ovarian syndrome/hyperandrogenism and RED-S are among the top three causes of primary amenorrhea. Proposed reasons for the shift in causes of primary amenorrhea over time include increasing obesity rates and metabolic syndrome in adolescents on one hand as well as increasing access to high-level athletics on the other.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81548521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.aog.0000930200.58812.dc
Ray Stoddard, C. Duffy, H. Kim, A. Modest, G. Quesnelle, B. Wylie
INTRODUCTION: Differences in treatment and health outcomes by race are well-documented. Ultrasound photos represent important keepsakes and may affect patient experience and care. We examined whether race and other factors affected the number of keepsakes given during obstetric ultrasound. A secondary outcome was patient satisfaction. METHODS: From October 2021 to September 2022, we distributed a survey after outpatient obstetric ultrasounds at a tertiary care hospital, including questions on demographics, number of photos received, and overall satisfaction. Exclusion criteria included inability to complete the survey in one of four available languages or carrying a multifetal gestation. Ultrasound staff and faculty were blinded to the research question. This study was approved by the Beth Israel Deaconess Medical Center IRB. RESULTS: Of 405 individuals approached, 251 completed the survey (response rate of 62.0%). Of these, 53.4% identified as White, 16.3% Asian, 10.4% Black, 7.2% as multiple races, 6.8% other race, and 6.0% preferred not to say. In total, 81.3% of patients received photos (median, 4; interquartile range [IQR], 3–6), with no difference in number by race, ethnicity, primary language, or body mass index. Most patients expected to receive photos, with no appreciable differences by race. Ratings for visits were high (IQR, 8–10/10) with no difference between patients who did or did not receive photos or by number of photos. CONCLUSION: We found no difference in number of photos patients received by race. Overall ratings of ultrasound visits were high and not associated with number of keepsakes received. While reassuring, further research is needed into equitable treatment in obstetric ultrasound.
{"title":"Effect of Race on Obstetric Ultrasound Keepsakes [ID: 1376924]","authors":"Ray Stoddard, C. Duffy, H. Kim, A. Modest, G. Quesnelle, B. Wylie","doi":"10.1097/01.aog.0000930200.58812.dc","DOIUrl":"https://doi.org/10.1097/01.aog.0000930200.58812.dc","url":null,"abstract":"INTRODUCTION: Differences in treatment and health outcomes by race are well-documented. Ultrasound photos represent important keepsakes and may affect patient experience and care. We examined whether race and other factors affected the number of keepsakes given during obstetric ultrasound. A secondary outcome was patient satisfaction. METHODS: From October 2021 to September 2022, we distributed a survey after outpatient obstetric ultrasounds at a tertiary care hospital, including questions on demographics, number of photos received, and overall satisfaction. Exclusion criteria included inability to complete the survey in one of four available languages or carrying a multifetal gestation. Ultrasound staff and faculty were blinded to the research question. This study was approved by the Beth Israel Deaconess Medical Center IRB. RESULTS: Of 405 individuals approached, 251 completed the survey (response rate of 62.0%). Of these, 53.4% identified as White, 16.3% Asian, 10.4% Black, 7.2% as multiple races, 6.8% other race, and 6.0% preferred not to say. In total, 81.3% of patients received photos (median, 4; interquartile range [IQR], 3–6), with no difference in number by race, ethnicity, primary language, or body mass index. Most patients expected to receive photos, with no appreciable differences by race. Ratings for visits were high (IQR, 8–10/10) with no difference between patients who did or did not receive photos or by number of photos. CONCLUSION: We found no difference in number of photos patients received by race. Overall ratings of ultrasound visits were high and not associated with number of keepsakes received. While reassuring, further research is needed into equitable treatment in obstetric ultrasound.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81610671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.aog.0000930664.18246.a7
Allan C. Dong, M. Lott
INTRODUCTION: Universal screening for thyroid disease in pregnancy is not currently recommended. Guidelines support targeted screening of high-risk individuals. Prior studies have provided some evidence to the cost-effectiveness of universal screening. We aim to evaluate adherence to targeted screening criteria as well as outcome differences between screened and unscreened patients. METHODS: All patients presenting for new obstetrical visits in 2020 were reviewed. Institutional review board approval was obtained for this study. Risk factors meeting thyroid screening criteria based on American Thyroid Association (ATA) and/or American College of Obstetricians and Gynecologists (ACOG) guidelines, and pregnancy outcomes were extracted. Pregnancy outcomes were compared between patients meeting ATA and/or ACOG criteria who did or did not receive screening via thyroid function testing (TFT). RESULTS: One thousand twenty-five records were included. 87/198 patients meeting ACOG criteria for screening (43.9%) and 108/826 patients meeting ATA criteria (13.1%) had TFT. Patients meeting ATA criteria who underwent TFT had higher live-birth rates and lower miscarriage rates compared to unscreened patients meeting ATA criteria, 92.6% versus 83.26% (P=.006) and 4.63% versus 12.41% (P=.009), respectively. No difference was found between patients meeting ACOG criteria who did or did not receive TFT. No differences were observed in preterm delivery rates. CONCLUSION: In a real-world study of obstetrical practice, less than 50% of patients were appropriately screened for thyroid disease in pregnancy. ATA criteria identified threefold more patients for screening compared to ACOG criteria. Those screened appropriately per ATA criteria had higher live-birth rates and lower miscarriage rates compared to unscreened patients meeting ATA criteria.
{"title":"Do Clinicians Appropriately Screen for Thyroid Disease in Pregnancy Using Targeted Screening Guidelines? A Real-World Retrospective Study [ID: 1368322]","authors":"Allan C. Dong, M. Lott","doi":"10.1097/01.aog.0000930664.18246.a7","DOIUrl":"https://doi.org/10.1097/01.aog.0000930664.18246.a7","url":null,"abstract":"INTRODUCTION: Universal screening for thyroid disease in pregnancy is not currently recommended. Guidelines support targeted screening of high-risk individuals. Prior studies have provided some evidence to the cost-effectiveness of universal screening. We aim to evaluate adherence to targeted screening criteria as well as outcome differences between screened and unscreened patients. METHODS: All patients presenting for new obstetrical visits in 2020 were reviewed. Institutional review board approval was obtained for this study. Risk factors meeting thyroid screening criteria based on American Thyroid Association (ATA) and/or American College of Obstetricians and Gynecologists (ACOG) guidelines, and pregnancy outcomes were extracted. Pregnancy outcomes were compared between patients meeting ATA and/or ACOG criteria who did or did not receive screening via thyroid function testing (TFT). RESULTS: One thousand twenty-five records were included. 87/198 patients meeting ACOG criteria for screening (43.9%) and 108/826 patients meeting ATA criteria (13.1%) had TFT. Patients meeting ATA criteria who underwent TFT had higher live-birth rates and lower miscarriage rates compared to unscreened patients meeting ATA criteria, 92.6% versus 83.26% (P=.006) and 4.63% versus 12.41% (P=.009), respectively. No difference was found between patients meeting ACOG criteria who did or did not receive TFT. No differences were observed in preterm delivery rates. CONCLUSION: In a real-world study of obstetrical practice, less than 50% of patients were appropriately screened for thyroid disease in pregnancy. ATA criteria identified threefold more patients for screening compared to ACOG criteria. Those screened appropriately per ATA criteria had higher live-birth rates and lower miscarriage rates compared to unscreened patients meeting ATA criteria.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76931880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.aog.0000930012.71134.7d
S. Brescia, Katlin Davitt, Veronica Galaviz, J. Gibbs, Sameer Khan, Salvatore Paolillo
INTRODUCTION: Vaginal cuff dehiscence (VCD) is one of the few surgical complications identified more commonly in minimally invasive hysterectomies (MIHs) versus open hysterectomies. The objective of this study is to determine perioperative risk factors that contribute to the development of VCD in patients undergoing MIH. METHODS: From 2016 to 2022, a multicenter retrospective analysis of patients undergoing MIH was conducted. Patient characteristics, preexisting conditions, surgical history, intraoperative factors, and type of MIH were evaluated to determine factors contributing to the development of VCD. RESULTS: One thousand one hundred eighty-nine patients underwent MIH. Only 10 (0.8%) patients developed VCD. There was no significant difference in mean body mass index, postoperative length of stay, or estimated blood loss between those with VCD versus those without. Incidence of VCD was highest in total laparoscopic hysterectomy versus all other MIH modalities (P=.002). There were no cases of VCD in laparoscopic-assisted vaginal hysterectomy. No patients with endometriosis experienced VCD, and there was no difference in the incidence in patients with cancer versus benign conditions (1.3% versus 0.8%, P=.488, odds ratio [OR] 1.29, 95% CI 0.68–8.23). Personal history of diabetes, hypertension, cesarean delivery, prior laparoscopy, prior laparotomy, or smoking did not affect the incidence of VCD (P>.05) as well as insurance status and race (P=.728 and P=.775, respectively). Patients who developed deep surgical site infections (SSIs) had significant increase in VCD (10.0% versus 2.3%, P=.006, OR 4.79, 95% CI 0.587–33.22). CONCLUSION: We observed that mode of MIH and SSI were perioperative risk factors that contribute to the development of VCD. What is notable is that demographics and medical comorbidities did not affect the incidence of VCD.
简介:阴道袖带破裂(VCD)是微创子宫切除术(MIHs)与开放式子宫切除术中常见的少数手术并发症之一。本研究的目的是确定导致MIH患者发生VCD的围手术期危险因素。方法:对2016 - 2022年接受MIH治疗的患者进行多中心回顾性分析。评估患者特征、既往病史、手术史、术中因素和MIH类型，以确定导致VCD发生的因素。结果:1189例患者接受了MIH治疗。仅有10例(0.8%)患者发生VCD。VCD患者与非VCD患者在平均体重指数、术后住院时间或估计失血量方面没有显著差异。与所有其他MIH方式相比，腹腔镜全子宫切除术中VCD的发生率最高(P= 0.002)。腹腔镜辅助阴道子宫切除术无VCD病例。没有子宫内膜异位症患者发生VCD，癌症患者与良性患者的发病率没有差异(1.3%对0.8%，P=。488，优势比[OR] 1.29, 95% CI 0.68-8.23)。个人糖尿病史、高血压史、剖宫产史、既往腹腔镜手术史、既往剖腹手术史、吸烟史均不影响VCD的发生率(P> 0.05)、保险状况和种族(P= 0.05)。728, P=。775年,分别)。发生深部手术部位感染(ssi)的患者VCD显著增加(10.0% vs 2.3%， P=。006，或4.79,95% ci 0.587-33.22)。结论:我们观察到MIH和SSI的方式是VCD发生的围手术期危险因素。值得注意的是，人口统计学和医学合并症不影响VCD的发病率。
{"title":"Evaluation of Perioperative Factors Influencing Vaginal Cuff Dehiscence After Minimally Invasive Hysterectomy [ID: 1372339]","authors":"S. Brescia, Katlin Davitt, Veronica Galaviz, J. Gibbs, Sameer Khan, Salvatore Paolillo","doi":"10.1097/01.aog.0000930012.71134.7d","DOIUrl":"https://doi.org/10.1097/01.aog.0000930012.71134.7d","url":null,"abstract":"INTRODUCTION: Vaginal cuff dehiscence (VCD) is one of the few surgical complications identified more commonly in minimally invasive hysterectomies (MIHs) versus open hysterectomies. The objective of this study is to determine perioperative risk factors that contribute to the development of VCD in patients undergoing MIH. METHODS: From 2016 to 2022, a multicenter retrospective analysis of patients undergoing MIH was conducted. Patient characteristics, preexisting conditions, surgical history, intraoperative factors, and type of MIH were evaluated to determine factors contributing to the development of VCD. RESULTS: One thousand one hundred eighty-nine patients underwent MIH. Only 10 (0.8%) patients developed VCD. There was no significant difference in mean body mass index, postoperative length of stay, or estimated blood loss between those with VCD versus those without. Incidence of VCD was highest in total laparoscopic hysterectomy versus all other MIH modalities (P=.002). There were no cases of VCD in laparoscopic-assisted vaginal hysterectomy. No patients with endometriosis experienced VCD, and there was no difference in the incidence in patients with cancer versus benign conditions (1.3% versus 0.8%, P=.488, odds ratio [OR] 1.29, 95% CI 0.68–8.23). Personal history of diabetes, hypertension, cesarean delivery, prior laparoscopy, prior laparotomy, or smoking did not affect the incidence of VCD (P>.05) as well as insurance status and race (P=.728 and P=.775, respectively). Patients who developed deep surgical site infections (SSIs) had significant increase in VCD (10.0% versus 2.3%, P=.006, OR 4.79, 95% CI 0.587–33.22). CONCLUSION: We observed that mode of MIH and SSI were perioperative risk factors that contribute to the development of VCD. What is notable is that demographics and medical comorbidities did not affect the incidence of VCD.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81233341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.AOG.0000931264.93401.76
A. Whelan, Halie Ciomperlik, I. Ghose, H. Mendez-Figueroa, S. Wagner, R. Wiley
INTRODUCTION: Unlike neonatal morbidity with preterm birth (PTB; <37 weeks), maternal complications with PTB are infrequently reported. We aimed to assess the risk of postpartum hemorrhage (PPH)-related maternal morbidity among preterm versus term deliveries. METHODS: This was a secondary analysis of an IRB-approved retrospective cohort of all in-house singleton deliveries over 1 year. Demographics, pregnancy and delivery characteristics were abstracted from charts. Individuals who delivered preterm were compared to those who delivered at term (>37 weeks) for the primary outcome of composite maternal morbidity (CMM—blood loss >1,000 mL, uterotonic use, transfusion, uterine tamponade, surgical intervention, intensive care unit [ICU] admission, hysterectomy, and maternal death). Multivariable regression was performed to assess the adjusted relative risk (aRR) of preterm delivery on CMM with variables specified a priori. RESULTS: Of the 4,554 deliveries in our level 4 hospital, 4,514 (99%) met the inclusion criteria, with 1,062 (23%) delivering preterm. The overall CMM was 23.2%, with it being 30.4% in PTB and 21.0% in term births. Controlling for age, body mass index greater than 30 kg/m2, nulliparity, insurance status, race, smoking status, and cesarean delivery, preterm deliveries had a 42% higher rate of the CMM compared to term births (aRR 1.42: 95% CI, 1.27, 1.60). Transfusion, ICU admission, and hysterectomy were significantly more common among PTB than term. CONCLUSION: Preterm deliveries were associated with significantly higher rates of postpartum hemorrhagic CMM than those who delivered at term. Interventional trials are needed to decrease the hemorrhagic morbidity with PTB.
{"title":"Postpartum Hemorrhage: Preterm Versus Term Pregnancies [ID: 1356883]","authors":"A. Whelan, Halie Ciomperlik, I. Ghose, H. Mendez-Figueroa, S. Wagner, R. Wiley","doi":"10.1097/01.AOG.0000931264.93401.76","DOIUrl":"https://doi.org/10.1097/01.AOG.0000931264.93401.76","url":null,"abstract":"INTRODUCTION: Unlike neonatal morbidity with preterm birth (PTB; <37 weeks), maternal complications with PTB are infrequently reported. We aimed to assess the risk of postpartum hemorrhage (PPH)-related maternal morbidity among preterm versus term deliveries. METHODS: This was a secondary analysis of an IRB-approved retrospective cohort of all in-house singleton deliveries over 1 year. Demographics, pregnancy and delivery characteristics were abstracted from charts. Individuals who delivered preterm were compared to those who delivered at term (>37 weeks) for the primary outcome of composite maternal morbidity (CMM—blood loss >1,000 mL, uterotonic use, transfusion, uterine tamponade, surgical intervention, intensive care unit [ICU] admission, hysterectomy, and maternal death). Multivariable regression was performed to assess the adjusted relative risk (aRR) of preterm delivery on CMM with variables specified a priori. RESULTS: Of the 4,554 deliveries in our level 4 hospital, 4,514 (99%) met the inclusion criteria, with 1,062 (23%) delivering preterm. The overall CMM was 23.2%, with it being 30.4% in PTB and 21.0% in term births. Controlling for age, body mass index greater than 30 kg/m2, nulliparity, insurance status, race, smoking status, and cesarean delivery, preterm deliveries had a 42% higher rate of the CMM compared to term births (aRR 1.42: 95% CI, 1.27, 1.60). Transfusion, ICU admission, and hysterectomy were significantly more common among PTB than term. CONCLUSION: Preterm deliveries were associated with significantly higher rates of postpartum hemorrhagic CMM than those who delivered at term. Interventional trials are needed to decrease the hemorrhagic morbidity with PTB.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85557624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.aog.0000931280.69366.ad
Ali M. Michelotti, C. Schenken, R. Schenken, N. Stansbury, Rebecca N. Treffalls
INTRODUCTION: The competitiveness of obstetrics and gynecology residency programs in the last two decades is not well described in the literature. As such, we aimed to assess the change in competitiveness of obstetrics and gynecology programs over a 20-year period using a normalized competitive index (NCI). METHODS: Obstetrics and gynecology match data was obtained from the National Resident Matching Program (NRMP) (2003–2022). Applicant metrics (USMLE scores, research output and experiences, and work and volunteer experiences) were obtained from the NRMP and the Association of American Medical Colleges (AAMC) (2007–2021). The competitive index (CI) was assessed using the average number of programs ranked per applicant divided by match rate each year. The NCI was normalized by dividing the yearly CI by averaged CI over 20 years. Data were analyzed using univariate analysis and linear regression. RESULTS: When comparing the two decades (2003–2012 versus 2013–2022), applicants (1,539±77 versus 1,902±46, P<.001), positions (1,173±10 versus 1,345±31, P<.001), and number of programs ranked per applicant (13±0.04 versus 15±0.02, P<.001) have increased. While the match rate did not significantly change from 2003 to 2022 (76±3 versus 71±1, P=.14), the NCI increased (R2=0.92, P<.001), indicating increased competitiveness. Applicant metrics increased over time, including step 1 scores (212±3 versus 229±1, P=.01), step 2 scores (232± 4 versus 245±1, P=.002), and research output (2.5±0.4 versus 5.0±0.3, P=.002). CONCLUSION: Despite an increase in obstetrics and gynecology applicants and applicant metrics, match rates remain unchanged. However, the competitiveness of programs has significantly increased, as demonstrated by the NCI. The NCI may be a useful metric for applicants to determine competitiveness in comparison to match rates.
{"title":"A 20-Year Analysis Assessing the Competitiveness of Obstetrics and Gynecology Residency Programs and Medical School Applicants [ID: 1365966]","authors":"Ali M. Michelotti, C. Schenken, R. Schenken, N. Stansbury, Rebecca N. Treffalls","doi":"10.1097/01.aog.0000931280.69366.ad","DOIUrl":"https://doi.org/10.1097/01.aog.0000931280.69366.ad","url":null,"abstract":"INTRODUCTION: The competitiveness of obstetrics and gynecology residency programs in the last two decades is not well described in the literature. As such, we aimed to assess the change in competitiveness of obstetrics and gynecology programs over a 20-year period using a normalized competitive index (NCI). METHODS: Obstetrics and gynecology match data was obtained from the National Resident Matching Program (NRMP) (2003–2022). Applicant metrics (USMLE scores, research output and experiences, and work and volunteer experiences) were obtained from the NRMP and the Association of American Medical Colleges (AAMC) (2007–2021). The competitive index (CI) was assessed using the average number of programs ranked per applicant divided by match rate each year. The NCI was normalized by dividing the yearly CI by averaged CI over 20 years. Data were analyzed using univariate analysis and linear regression. RESULTS: When comparing the two decades (2003–2012 versus 2013–2022), applicants (1,539±77 versus 1,902±46, P<.001), positions (1,173±10 versus 1,345±31, P<.001), and number of programs ranked per applicant (13±0.04 versus 15±0.02, P<.001) have increased. While the match rate did not significantly change from 2003 to 2022 (76±3 versus 71±1, P=.14), the NCI increased (R2=0.92, P<.001), indicating increased competitiveness. Applicant metrics increased over time, including step 1 scores (212±3 versus 229±1, P=.01), step 2 scores (232± 4 versus 245±1, P=.002), and research output (2.5±0.4 versus 5.0±0.3, P=.002). CONCLUSION: Despite an increase in obstetrics and gynecology applicants and applicant metrics, match rates remain unchanged. However, the competitiveness of programs has significantly increased, as demonstrated by the NCI. The NCI may be a useful metric for applicants to determine competitiveness in comparison to match rates.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85701893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.AOG.0000931012.09612.75
K. Edwards, E. Defranco, Taylor Griffith, H. Masters
INTRODUCTION: Although the American College of Obstetricians and Gynecologists recommends insulin as first-line pharmacologic treatment for gestational diabetes mellitus (GDM) since 2017, use of oral agents as first-line remains common. This study aims to identify patient-level factors associated with choice of initial pharmacologic treatment of GDM with oral agents compared to insulin. METHODS: Case–control study of 617 patients with White's class A2 GDM treated at a single academic center in a comprehensive GDM treatment program, 2011–2018. Pregestational diabetes and GDM not requiring medication (A1 GDM) were excluded. Case group was GDM pregnancies treated with any oral agent first-line and control group was treated with insulin as first-line treatment. Logistic regression was performed to identify patient factors associated with oral agents as first-line pharmacologic treatment. Receiver-operator characteristic (ROC) curve estimated the ability of these factors to predict initial medication choice. RESULTS: Among those with GDMA2, 80% were started on an oral agent and 20% were started on insulin. Those started initially on oral agents were more likely to be Hispanic or non-Hispanic White, be non-English speakers, have private insurance, and have normal body mass index (BMI). Factors strongly associated with starting on an oral agent rather than insulin were Hispanic ethnicity, treatment initiated later in pregnancy (>28 weeks), normal BMI, and 1-hour glucose challenge test (GCT) greater than 200. The ROC derived from the adjusted logistic regression model found a predictive value of these variables for initiating oral agents of 79% (area under the curve 0.79). CONCLUSION: Patient-level factors are predictive of pharmacological agent chosen for first-line treatment of GDM. Factors that are typically associated with more difficult to control GDM, such as obesity, high values on the GCT screening test and earlier gestational age at diagnosis are more common in patients treated initially with insulin. However, some demographic factors such as Hispanic ethnicity and non-English primary language are more common among patients initiated on oral agents for treatment of GDM.
{"title":"Initiation of Oral Agents Versus Insulin as First-Line Therapy for Gestational Diabetes Mellitus [ID: 1360154]","authors":"K. Edwards, E. Defranco, Taylor Griffith, H. Masters","doi":"10.1097/01.AOG.0000931012.09612.75","DOIUrl":"https://doi.org/10.1097/01.AOG.0000931012.09612.75","url":null,"abstract":"INTRODUCTION: Although the American College of Obstetricians and Gynecologists recommends insulin as first-line pharmacologic treatment for gestational diabetes mellitus (GDM) since 2017, use of oral agents as first-line remains common. This study aims to identify patient-level factors associated with choice of initial pharmacologic treatment of GDM with oral agents compared to insulin. METHODS: Case–control study of 617 patients with White's class A2 GDM treated at a single academic center in a comprehensive GDM treatment program, 2011–2018. Pregestational diabetes and GDM not requiring medication (A1 GDM) were excluded. Case group was GDM pregnancies treated with any oral agent first-line and control group was treated with insulin as first-line treatment. Logistic regression was performed to identify patient factors associated with oral agents as first-line pharmacologic treatment. Receiver-operator characteristic (ROC) curve estimated the ability of these factors to predict initial medication choice. RESULTS: Among those with GDMA2, 80% were started on an oral agent and 20% were started on insulin. Those started initially on oral agents were more likely to be Hispanic or non-Hispanic White, be non-English speakers, have private insurance, and have normal body mass index (BMI). Factors strongly associated with starting on an oral agent rather than insulin were Hispanic ethnicity, treatment initiated later in pregnancy (>28 weeks), normal BMI, and 1-hour glucose challenge test (GCT) greater than 200. The ROC derived from the adjusted logistic regression model found a predictive value of these variables for initiating oral agents of 79% (area under the curve 0.79). CONCLUSION: Patient-level factors are predictive of pharmacological agent chosen for first-line treatment of GDM. Factors that are typically associated with more difficult to control GDM, such as obesity, high values on the GCT screening test and earlier gestational age at diagnosis are more common in patients treated initially with insulin. However, some demographic factors such as Hispanic ethnicity and non-English primary language are more common among patients initiated on oral agents for treatment of GDM.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73307755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：