Pub Date : 2023-05-01DOI: 10.1097/01.aog.0000929704.34094.4a
Savannah Groves, A. Hsu
INTRODUCTION: Public concern over the potential negative effect of COVID-19 vaccines on fertility has persisted, as confidence in COVID-19 vaccines remains low, especially in certain Midwestern populations. We evaluated the success of intrauterine inseminations (IUIs) in achieving pregnancy in women who self-report receiving at least one dose of the vaccine against SARS-CoV-2, compared with women who self-report declining the vaccine. METHODS: This is a retrospective cohort study of 109 IUI procedures in women receiving fertility treatment at the University of Missouri Reproductive Endocrinology and Infertility clinic from October 2021 through September 2022. Participants were grouped based on self-reported COVID-19 vaccination status, prior to their IUI. The primary outcome was pregnancy after IUI, as verified by a serum pregnancy test. This study was performed under University of Missouri IRB approval (IRB #MU2062683). RESULTS: In comparing women self-reporting COVID-19 vaccination versus nonvaccination, no statistical differences were found for positive serum pregnancy tests after IUI (17.3% among vaccinated; 21.7% among nonvaccinated). Although these IUI success rates are higher than the national average, there was no significant difference in pregnancy rates (P=.6331). CONCLUSION: In this limited sample, self-reported COVID-19 vaccination status does not appear to have a significant negative effect on the ability to conceive a pregnancy with IUI. Further prospective studies should evaluate the effect of male partner or sperm donor vaccination, the number and type of COVID-19 vaccines received, pregnancy outcomes, and confounders. This study may help address the ongoing questions of whether the COVID-19 vaccines have a significant negative effect on fertility and pregnancy outcomes.
{"title":"Intrauterine Insemination (IUI) Pregnancy Rates After COVID-19 Vaccination [ID: 1376042]","authors":"Savannah Groves, A. Hsu","doi":"10.1097/01.aog.0000929704.34094.4a","DOIUrl":"https://doi.org/10.1097/01.aog.0000929704.34094.4a","url":null,"abstract":"INTRODUCTION: Public concern over the potential negative effect of COVID-19 vaccines on fertility has persisted, as confidence in COVID-19 vaccines remains low, especially in certain Midwestern populations. We evaluated the success of intrauterine inseminations (IUIs) in achieving pregnancy in women who self-report receiving at least one dose of the vaccine against SARS-CoV-2, compared with women who self-report declining the vaccine. METHODS: This is a retrospective cohort study of 109 IUI procedures in women receiving fertility treatment at the University of Missouri Reproductive Endocrinology and Infertility clinic from October 2021 through September 2022. Participants were grouped based on self-reported COVID-19 vaccination status, prior to their IUI. The primary outcome was pregnancy after IUI, as verified by a serum pregnancy test. This study was performed under University of Missouri IRB approval (IRB #MU2062683). RESULTS: In comparing women self-reporting COVID-19 vaccination versus nonvaccination, no statistical differences were found for positive serum pregnancy tests after IUI (17.3% among vaccinated; 21.7% among nonvaccinated). Although these IUI success rates are higher than the national average, there was no significant difference in pregnancy rates (P=.6331). CONCLUSION: In this limited sample, self-reported COVID-19 vaccination status does not appear to have a significant negative effect on the ability to conceive a pregnancy with IUI. Further prospective studies should evaluate the effect of male partner or sperm donor vaccination, the number and type of COVID-19 vaccines received, pregnancy outcomes, and confounders. This study may help address the ongoing questions of whether the COVID-19 vaccines have a significant negative effect on fertility and pregnancy outcomes.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"86 1","pages":"2S - 2S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90073005","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.0000930548.19621.cb
M. Lardy, M. Caliendo, M. Gallo, Sarah Nims
INTRODUCTION: Placenta accreta spectrum (PAS) is associated with significant morbidity and mortality. A multidisciplinary team and standardized protocol for identified PAS cases were created to provide a clear preoperative plan for mitigation of intraoperative blood loss, and surgical and postoperative complications. METHODS: This is an ongoing quality improvement study. The PAS team was implemented January 2021. All cases of PAS resulting in cesarean hysterectomy from January 2018 through August 2022 at a single regional perinatal center were included. Estimated blood loss (EBL), number of blood products (packed red cells, platelets, fresh frozen plasma), whether surgical complication was incurred, intensive care unit (ICU) length of stay (LOS), and hospital LOS were compared. T tests and χ2 were used to calculate significance. RESULTS: Thirty-eight cases were reviewed, 18 cases before implementation of the PAS team, 20 after. Average EBL was 3,800 mL pre-team, 3,191 mL post-team (P=.522). Pre-team average units of packed red cells were 4.67, 3.55 post-team (P=.199); platelets 1.72 versus 1.35 units (P=.424); fresh frozen plasma 0.67 versus 0.55 units (P=.581). Average ICU LOS and hospital LOS pre-team were 0.67 and 3.56 days, 0.30 (P=.121) and 3.35 (P=.434) days, respectively, post-team. CONCLUSION: Estimated blood loss, total blood products, occurrence of surgical complication, ICU LOS, and hospital LOS were decreased after implementation of a PAS multidisciplinary team. Statistical insignificance in all parameters was attributable to small sample size necessitating further future analysis with additional cases. A standardized multidisciplinary approach to PAS may demonstrate morbidity reduction.
简介:胎盘增生谱(PAS)与显著的发病率和死亡率相关。建立了一个多学科团队和标准化方案，以确定PAS病例，提供明确的术前计划，以减轻术中失血，手术和术后并发症。方法:这是一项正在进行的质量改进研究。PAS团队于2021年1月实施。纳入了2018年1月至2022年8月在单个区域围产中心进行的所有PAS导致剖宫产子宫切除术的病例。比较估计失血量(EBL)、血制品数量(红细胞、血小板、新鲜冷冻血浆)、是否发生手术并发症、重症监护病房(ICU)住院时间(LOS)和医院LOS。采用T检验和χ2计算显著性。结果:共回顾38例，PAS组实施前18例，实施后20例。治疗前平均EBL为3800 mL，治疗后平均EBL为3191 mL (P= 0.522)。组前平均红细胞密度为4.67个，组后平均红细胞密度为3.55个(P= 0.199);血小板1.72对1.35单位(P= 0.424);新鲜冷冻血浆0.67 vs 0.55单位(P=.581)。ICU组平均LOS为0.67天和3.56天，医院组平均LOS为0.30 (P= 0.121)天和3.35 (P= 0.434)天。结论:实施PAS多学科团队后，估计失血量、总血制品、手术并发症发生率、ICU LOS和医院LOS均有所降低。所有参数的统计不显著是由于样本量小，需要进一步分析其他病例。PAS的标准化多学科方法可能会降低发病率。
{"title":"The Effect of Implementation of a Standardized Multidisciplinary Placenta Accreta Spectrum Team: A Quality Improvement Initiative [ID: 1377806]","authors":"M. Lardy, M. Caliendo, M. Gallo, Sarah Nims","doi":"10.1097/01.AOG.0000930548.19621.cb","DOIUrl":"https://doi.org/10.1097/01.AOG.0000930548.19621.cb","url":null,"abstract":"INTRODUCTION: Placenta accreta spectrum (PAS) is associated with significant morbidity and mortality. A multidisciplinary team and standardized protocol for identified PAS cases were created to provide a clear preoperative plan for mitigation of intraoperative blood loss, and surgical and postoperative complications. METHODS: This is an ongoing quality improvement study. The PAS team was implemented January 2021. All cases of PAS resulting in cesarean hysterectomy from January 2018 through August 2022 at a single regional perinatal center were included. Estimated blood loss (EBL), number of blood products (packed red cells, platelets, fresh frozen plasma), whether surgical complication was incurred, intensive care unit (ICU) length of stay (LOS), and hospital LOS were compared. T tests and χ2 were used to calculate significance. RESULTS: Thirty-eight cases were reviewed, 18 cases before implementation of the PAS team, 20 after. Average EBL was 3,800 mL pre-team, 3,191 mL post-team (P=.522). Pre-team average units of packed red cells were 4.67, 3.55 post-team (P=.199); platelets 1.72 versus 1.35 units (P=.424); fresh frozen plasma 0.67 versus 0.55 units (P=.581). Average ICU LOS and hospital LOS pre-team were 0.67 and 3.56 days, 0.30 (P=.121) and 3.35 (P=.434) days, respectively, post-team. CONCLUSION: Estimated blood loss, total blood products, occurrence of surgical complication, ICU LOS, and hospital LOS were decreased after implementation of a PAS multidisciplinary team. Statistical insignificance in all parameters was attributable to small sample size necessitating further future analysis with additional cases. A standardized multidisciplinary approach to PAS may demonstrate morbidity reduction.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"57 1","pages":"61S - 62S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85177993","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.0000930236.89093.3c
Roxana Richardson, Lisa P. Kessler, L. Patchen, D. Perry, Caitlin Schille Jensen, A. Thomas
INTRODUCTION: Health-harming legal needs (HHLNs), social determinants of health that have a legal remedy, are drivers of poor health outcomes for Black women and children. HHLNs include inadequate access to safe housing, employment accommodations, and income supports. A medical–legal partnership (MLP) adds an attorney to the health care team to address patients’ HHLNs in a variety of health care settings. The Perinatal LAW Project (P-LAW), an MLP between the Georgetown University Health Justice Alliance and MedStar Washington Hospital Center Women’s & Infants’ Services, addresses perinatal patients’ HHLNs in an obstetrics and gynecology practice. METHODS: Perinatal LAW Project attorneys record client and case data in a legal case management system. The research team analyzed data for the first 18 months of the program (March 2021 to September 2022). RESULTS: One hundred thirty-one patients were referred for legal assistance, primarily by social workers and health navigators. Most patients were in their second and third trimesters. The majority of patients were Black or African American, aged 20–34, and lived under 200% FPL. The most common legal issues were in the areas of employment (parental leave, discrimination), housing (conditions, eviction), public benefits (food stamps, disability benefits), and family law (child support, domestic violence). The P-LAW addressed 150 legal issues and served 117 patients. CONCLUSION: Medical–legal partnership is a novel approach to addressing maternal health disparities. In our experience, legal services have a high utilization rate and patients often have more than one legal need. Future efforts to measure patient outcomes, including reduced maternal stress and medical appointment attendance, will build the evidence base for MLP in the perinatal context.
{"title":"Integrating Lawyers into the Perinatal Health Care Team: Initial Findings From an Innovative Medical–Legal Partnership [ID: 1377957]","authors":"Roxana Richardson, Lisa P. Kessler, L. Patchen, D. Perry, Caitlin Schille Jensen, A. Thomas","doi":"10.1097/01.aog.0000930236.89093.3c","DOIUrl":"https://doi.org/10.1097/01.aog.0000930236.89093.3c","url":null,"abstract":"INTRODUCTION: Health-harming legal needs (HHLNs), social determinants of health that have a legal remedy, are drivers of poor health outcomes for Black women and children. HHLNs include inadequate access to safe housing, employment accommodations, and income supports. A medical–legal partnership (MLP) adds an attorney to the health care team to address patients’ HHLNs in a variety of health care settings. The Perinatal LAW Project (P-LAW), an MLP between the Georgetown University Health Justice Alliance and MedStar Washington Hospital Center Women’s & Infants’ Services, addresses perinatal patients’ HHLNs in an obstetrics and gynecology practice. METHODS: Perinatal LAW Project attorneys record client and case data in a legal case management system. The research team analyzed data for the first 18 months of the program (March 2021 to September 2022). RESULTS: One hundred thirty-one patients were referred for legal assistance, primarily by social workers and health navigators. Most patients were in their second and third trimesters. The majority of patients were Black or African American, aged 20–34, and lived under 200% FPL. The most common legal issues were in the areas of employment (parental leave, discrimination), housing (conditions, eviction), public benefits (food stamps, disability benefits), and family law (child support, domestic violence). The P-LAW addressed 150 legal issues and served 117 patients. CONCLUSION: Medical–legal partnership is a novel approach to addressing maternal health disparities. In our experience, legal services have a high utilization rate and patients often have more than one legal need. Future efforts to measure patient outcomes, including reduced maternal stress and medical appointment attendance, will build the evidence base for MLP in the perinatal context.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"4 1","pages":"40S - 40S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83353823","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.0000930060.19431.a8
Francisco Ruiloba Portilla, Megan Barragan Wolff, Montserrat Cuevas, Salvador Jiménez Chaidez, Yolotzin Valdespino Vázquez, Ximena Alexandra van Tienhoven
INTRODUCTION: Placental mesenchymal dysplasia (PMD) is a rare placental anomaly associated with high perinatal mortality; it is predominantly seen in female fetuses and very few cases have been reported. The evaluation of first- and second-trimester products of conception is of the utmost importance when assessing molar pathologies such as complete hydatidiform moles, partial hydatidiform moles, and nonmolar samples. METHODS: We report a monochorionic 46XX,69XXY pregnancy with placental mesenchymal dysplasia (PMD) with possible androgenetic biparental mosaicism etiology (Instituto Nacional de Perinatología Isidro Espinosa de los Reyes approval number P-270-18). RESULTS: The patient is a 28-year-old gravida 2, para 1, female with no notable past medical history. She had a previous pregnancy resulting in an uncomplicated abdominal delivery at 39 weeks of gestation 5 years prior. The patient was transferred to our health center at 24.2 weeks of gestation with a molar component because of USG data consistent with a probable hepatic tumor, perimembranous ventricular septal defect, and probable PMD. Ultrasound at 24.3 weeks of gestation demonstrated a single intrauterine pregnancy with one-third of the placenta appearing normal, the second third showing irregular cystic masses, and the remaining third with larger cysts. Placental mesenchymal dysplasia was diagnosed retrospectively based on data from the gross, histologic, and genetic components. CONCLUSION: To our knowledge, this is the first reported case of PMD with a 46XX,69XXY karyotype. A radical and cautious approach to PMD cases is needed because of the lack of sufficient data and reports.
简介:胎盘间充质发育不良(PMD)是一种罕见的胎盘异常，与高围产期死亡率相关;它主要见于女性胎儿，很少有病例报道。在评估臼齿病变(如完全葡萄胎、部分葡萄胎和非葡萄胎)时，妊娠早期和中期产物的评估是最重要的。方法:我们报告了一个单绒毛膜46XX,69XXY妊娠胎盘间质发育不良(PMD)，可能的雄激素性双亲本嵌合病因(Instituto Nacional de Perinatología Isidro Espinosa de los Reyes批准号P-270-18)。结果:患者28岁，妊娠2期，女，1期，既往无明显病史。5年前，她有过一次妊娠，在妊娠39周时进行了一次简单的腹部分娩。由于USG数据与可能的肝肿瘤、膜外室间隔缺损和可能的PMD一致，该患者在妊娠24.2周时因磨牙成分转移到我们的健康中心。妊娠24.3周超声显示单次宫内妊娠，1 / 3胎盘正常，2 / 3出现不规则囊性团块，其余1 / 3出现较大囊肿。根据大体、组织学和遗传成分的资料回顾性诊断胎盘间充质发育不良。结论:据我们所知，这是首例核型为46XX、69XXY的PMD病例。由于缺乏足够的数据和报告，需要对PMD病例采取激进和谨慎的方法。
{"title":"A Rare Case of Biparental Placental Mesenchymal Dysplasia: A Case Report and Literature Review [ID: 1336615]","authors":"Francisco Ruiloba Portilla, Megan Barragan Wolff, Montserrat Cuevas, Salvador Jiménez Chaidez, Yolotzin Valdespino Vázquez, Ximena Alexandra van Tienhoven","doi":"10.1097/01.AOG.0000930060.19431.a8","DOIUrl":"https://doi.org/10.1097/01.AOG.0000930060.19431.a8","url":null,"abstract":"INTRODUCTION: Placental mesenchymal dysplasia (PMD) is a rare placental anomaly associated with high perinatal mortality; it is predominantly seen in female fetuses and very few cases have been reported. The evaluation of first- and second-trimester products of conception is of the utmost importance when assessing molar pathologies such as complete hydatidiform moles, partial hydatidiform moles, and nonmolar samples. METHODS: We report a monochorionic 46XX,69XXY pregnancy with placental mesenchymal dysplasia (PMD) with possible androgenetic biparental mosaicism etiology (Instituto Nacional de Perinatología Isidro Espinosa de los Reyes approval number P-270-18). RESULTS: The patient is a 28-year-old gravida 2, para 1, female with no notable past medical history. She had a previous pregnancy resulting in an uncomplicated abdominal delivery at 39 weeks of gestation 5 years prior. The patient was transferred to our health center at 24.2 weeks of gestation with a molar component because of USG data consistent with a probable hepatic tumor, perimembranous ventricular septal defect, and probable PMD. Ultrasound at 24.3 weeks of gestation demonstrated a single intrauterine pregnancy with one-third of the placenta appearing normal, the second third showing irregular cystic masses, and the remaining third with larger cysts. Placental mesenchymal dysplasia was diagnosed retrospectively based on data from the gross, histologic, and genetic components. CONCLUSION: To our knowledge, this is the first reported case of PMD with a 46XX,69XXY karyotype. A radical and cautious approach to PMD cases is needed because of the lack of sufficient data and reports.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"26 1","pages":"27S - 28S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85117352","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.0000930124.76180.1e
K. Hessami, Lorie M. Harper, A. Shamshirsaz, E. Werner
INTRODUCTION: This meta-analysis aims to determine whether early treatment of hyperglycemia in gestational diabetes mellitus (GDM) and prediabetic pregnancies improve perinatal outcomes. METHODS: PubMed/Medline, EMBASE, ClinicalTrials.gov and Web of Science were systematically searched up to June 30, 2022. Randomized clinical trials (RCTs) of early treatment for gestational diabetes mellitus (International Association of the Diabetes and Pregnancy Study Groups [IADPSG] or Carpenter and Coustan [C&C] criteria) and prediabetes (HbA1c 5.7–6.4%) before 20 weeks of gestation were considered eligible. Random-effects model meta-analysis was used to pool the odds ratios (OR) and/or mean differences (MD) with 95% CI. Furthermore, subgroup analysis was performed stratifying by indication for intervention (GDM versus prediabetic). RESULTS: Seven RCTs including 2,757 pregnant individuals, of whom 647 had positive screening before 20 weeks of gestation, were included. Of 647 individuals, 346 were allocated to early treatment and 301 to the routine treatment. There was no significant difference in terms of gestational age at delivery (MD –0.21 [95% CI: −0.44, 0.02], P=.089), rate of cesarean delivery (OR 0.93 [95% CI: 0.64, 1.34], P=.394), hypertensive disorder of pregnancy (OR 1.19 [95% CI: 0.59, 2.39], P=.341), any diabetic medication use (OR 1.31 [95% CI: 0.89, 1.93], P=.177), and neonatal hypoglycemia (OR 1.02 [95% CI: 0.50, 2.08], P=.952). However, there was a decreased risk of macrosomia (OR 0.42 [95% CI: 0.19, 0.92], P=.031) and increased need for insulin use (OR 2.23 [95% CI: 1.30, 3.84], P=.004) for early treatment group. After separate analyses on GDM and prediabetics as distinct groups, the risk of macrosomia was not decreased for GDM and prediabetic subgroups after early treatment. CONCLUSION: Treatment in early pregnancy for GDM or prediabetes does not appear to improve the maternal or neonatal outcomes.
{"title":"Early Treatment of Gestational Diabetes Mellitus and Prediabetes: A Systematic Review and Meta-Analysis of Randomized Clinical Trials [ID: 1377137]","authors":"K. Hessami, Lorie M. Harper, A. Shamshirsaz, E. Werner","doi":"10.1097/01.aog.0000930124.76180.1e","DOIUrl":"https://doi.org/10.1097/01.aog.0000930124.76180.1e","url":null,"abstract":"INTRODUCTION: This meta-analysis aims to determine whether early treatment of hyperglycemia in gestational diabetes mellitus (GDM) and prediabetic pregnancies improve perinatal outcomes. METHODS: PubMed/Medline, EMBASE, ClinicalTrials.gov and Web of Science were systematically searched up to June 30, 2022. Randomized clinical trials (RCTs) of early treatment for gestational diabetes mellitus (International Association of the Diabetes and Pregnancy Study Groups [IADPSG] or Carpenter and Coustan [C&C] criteria) and prediabetes (HbA1c 5.7–6.4%) before 20 weeks of gestation were considered eligible. Random-effects model meta-analysis was used to pool the odds ratios (OR) and/or mean differences (MD) with 95% CI. Furthermore, subgroup analysis was performed stratifying by indication for intervention (GDM versus prediabetic). RESULTS: Seven RCTs including 2,757 pregnant individuals, of whom 647 had positive screening before 20 weeks of gestation, were included. Of 647 individuals, 346 were allocated to early treatment and 301 to the routine treatment. There was no significant difference in terms of gestational age at delivery (MD –0.21 [95% CI: −0.44, 0.02], P=.089), rate of cesarean delivery (OR 0.93 [95% CI: 0.64, 1.34], P=.394), hypertensive disorder of pregnancy (OR 1.19 [95% CI: 0.59, 2.39], P=.341), any diabetic medication use (OR 1.31 [95% CI: 0.89, 1.93], P=.177), and neonatal hypoglycemia (OR 1.02 [95% CI: 0.50, 2.08], P=.952). However, there was a decreased risk of macrosomia (OR 0.42 [95% CI: 0.19, 0.92], P=.031) and increased need for insulin use (OR 2.23 [95% CI: 1.30, 3.84], P=.004) for early treatment group. After separate analyses on GDM and prediabetics as distinct groups, the risk of macrosomia was not decreased for GDM and prediabetic subgroups after early treatment. CONCLUSION: Treatment in early pregnancy for GDM or prediabetes does not appear to improve the maternal or neonatal outcomes.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"65 1","pages":"32S - 32S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84413357","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.0000929700.03453.26
Anna Hemminger, J. Louis, Corley Rachelle Price
INTRODUCTION: During the early months of the COVID-19 pandemic, policies were implemented that sought to reduce in-person prenatal visits and ultrasounds. We sought to evaluate the effect of those policies on the rate of diagnosed fetal growth restriction and infant low birth weight. METHODS: We performed a cohort study of patients delivered at an academic center. Participants who received prenatal care during the time period of restricted visits were matched in a 1:1 ratio to patients receiving care during an equivalent time period when there were no such restrictions (group I: July 1, 2019, to December 31, 2019; and group II: March 23, 2020, to September 23, 2020). Medical records were reviewed for clinical and demographic characteristics. Neonatal morbidity was defined as any of the following: stillbirth, neonatal death, preterm birth, neonatal intensive care unit admission, low birth weight. Data were analyzed using chi-square and Mann-Whitney U test where appropriate. P<.05 was significant. RESULTS: Our cohort included 580 patients. Overall, the group had a 13% preterm birth rate, 8.2% were diagnosed with fetal growth restriction, and 26% had the composite neonatal morbidity. All patients in the cohort had at least one ultrasound. Compared to group I, group II had more individuals who had only one ultrasound during the pregnancy (3.1 versus 0%, P=.004), but overall the group had more total ultrasounds performed (1.5 [1–3] versus 1 [1–2], P=.02) and had more patients who required fetal surveillance for maternal and fetal conditions (56 versus 44, P=.014). Group II was more likely to have a neonatal demise (1.4 versus 0.3%, P<.01), but there was no difference in the rate of prenatal diagnosis of fetal growth restriction or low birth weight. CONCLUSION: Policies to reduce prenatal ultrasounds were not effective in reducing ultrasounds performed, and there was no difference in the diagnosis of fetal growth restriction despite an increase in comorbidity.
{"title":"Effect of Policies Aiming to Restrict Ultrasound Use [ID: 1375832]","authors":"Anna Hemminger, J. Louis, Corley Rachelle Price","doi":"10.1097/01.AOG.0000929700.03453.26","DOIUrl":"https://doi.org/10.1097/01.AOG.0000929700.03453.26","url":null,"abstract":"INTRODUCTION: During the early months of the COVID-19 pandemic, policies were implemented that sought to reduce in-person prenatal visits and ultrasounds. We sought to evaluate the effect of those policies on the rate of diagnosed fetal growth restriction and infant low birth weight. METHODS: We performed a cohort study of patients delivered at an academic center. Participants who received prenatal care during the time period of restricted visits were matched in a 1:1 ratio to patients receiving care during an equivalent time period when there were no such restrictions (group I: July 1, 2019, to December 31, 2019; and group II: March 23, 2020, to September 23, 2020). Medical records were reviewed for clinical and demographic characteristics. Neonatal morbidity was defined as any of the following: stillbirth, neonatal death, preterm birth, neonatal intensive care unit admission, low birth weight. Data were analyzed using chi-square and Mann-Whitney U test where appropriate. P<.05 was significant. RESULTS: Our cohort included 580 patients. Overall, the group had a 13% preterm birth rate, 8.2% were diagnosed with fetal growth restriction, and 26% had the composite neonatal morbidity. All patients in the cohort had at least one ultrasound. Compared to group I, group II had more individuals who had only one ultrasound during the pregnancy (3.1 versus 0%, P=.004), but overall the group had more total ultrasounds performed (1.5 [1–3] versus 1 [1–2], P=.02) and had more patients who required fetal surveillance for maternal and fetal conditions (56 versus 44, P=.014). Group II was more likely to have a neonatal demise (1.4 versus 0.3%, P<.01), but there was no difference in the rate of prenatal diagnosis of fetal growth restriction or low birth weight. CONCLUSION: Policies to reduce prenatal ultrasounds were not effective in reducing ultrasounds performed, and there was no difference in the diagnosis of fetal growth restriction despite an increase in comorbidity.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"57 1","pages":"1S - 2S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83482050","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.0000931016.50292.eb
Matilda Francis, T. Kawakita, Juliana Martins
INTRODUCTION: Preeclampsia (PEC) and fetal growth restriction (FGR) share common pathophysiology of placental insufficiency. In pregnancies complicated by PEC, the incidence of FGR increases significantly. We sought to examine the timing of FGR development in patients with PEC. METHODS: This was a retrospective cohort study of patients with PEC and singleton pregnancy who delivered at 23 weeks or greater. Patients who had been diagnosed with FGR prior to PEC diagnosis, those who were diagnosed with FGR at the same time as PEC, and those who delivered immediately after PEC diagnosis were excluded. Demographics were compared between patients with FGR and those without FGR. We plotted Kaplan-Meier curves for the interval from the diagnosis of PEC to the development of FGR. A Cox proportional hazards model was used to estimate the adjusted hazard ratios (HRs) for FGR. Our IRB approved this analysis. RESULTS: Of 392 patients with PEC, 31 (7.9%) developed FGR. Compared to patients who did not develop FGR, patients who developed FGR were more likely to have early-onset PEC and lower maternal weight and were less likely to have gestational diabetes (P<.05). The incidence rate of FGR increased by 11.6% each week from the PEC diagnosis. Compared to patients with late-onset PEC, those with early-onset PEC had a significantly higher cumulative incidence of FGR (P<.01). The Cox proportional hazards model showed that early-onset PEC was associated with FGR (adjusted HR 4.12, 95% CI 1.19–14.33) compared to late-onset PEC. CONCLUSION: Patients with early-onset PEC had a significantly higher incidence of FGR compared to those with late-onset PEC. There was a high cumulative incidence rate of FGR in patients with early-onset PEC. Patients with PEC should be followed by serial fetal growth ultrasound.
子痫前期(PEC)和胎儿生长受限(FGR)有共同的胎盘功能不全病理生理。在合并PEC的妊娠中，FGR的发生率显著增加。我们试图研究在PEC患者中FGR发展的时间。方法:这是一项回顾性队列研究，研究对象是分娩时间在23周或更大的PEC和单胎妊娠患者。排除在PEC诊断前已诊断为FGR的患者、与PEC同时诊断为FGR的患者以及PEC诊断后立即分娩的患者。比较FGR患者和非FGR患者的人口统计学特征。我们绘制了从诊断为PEC到发展为FGR的时间间隔的Kaplan-Meier曲线。采用Cox比例风险模型估计FGR的调整风险比(hr)。我们的IRB批准了这个分析。结果:392例PEC患者中，31例(7.9%)发生FGR。与未发生FGR的患者相比，发生FGR的患者更容易发生早发性PEC和较低的母亲体重，更不容易发生妊娠糖尿病(P< 0.05)。自PEC诊断以来，FGR的发病率每周增加11.6%。与迟发性PEC患者相比，早发性PEC患者FGR累积发生率显著高于晚发性PEC患者(P< 0.01)。Cox比例风险模型显示，与迟发性PEC相比，早发性PEC与FGR相关(校正HR 4.12, 95% CI 1.19-14.33)。结论:早发性PEC患者FGR发生率明显高于晚发性PEC患者。早发性PEC患者FGR的累积发病率较高。患有PEC的患者应进行连续的胎儿生长超声检查。
{"title":"Timing of Fetal Growth Restriction Development in Patients With Preeclampsia [ID: 1363469]","authors":"Matilda Francis, T. Kawakita, Juliana Martins","doi":"10.1097/01.AOG.0000931016.50292.eb","DOIUrl":"https://doi.org/10.1097/01.AOG.0000931016.50292.eb","url":null,"abstract":"INTRODUCTION: Preeclampsia (PEC) and fetal growth restriction (FGR) share common pathophysiology of placental insufficiency. In pregnancies complicated by PEC, the incidence of FGR increases significantly. We sought to examine the timing of FGR development in patients with PEC. METHODS: This was a retrospective cohort study of patients with PEC and singleton pregnancy who delivered at 23 weeks or greater. Patients who had been diagnosed with FGR prior to PEC diagnosis, those who were diagnosed with FGR at the same time as PEC, and those who delivered immediately after PEC diagnosis were excluded. Demographics were compared between patients with FGR and those without FGR. We plotted Kaplan-Meier curves for the interval from the diagnosis of PEC to the development of FGR. A Cox proportional hazards model was used to estimate the adjusted hazard ratios (HRs) for FGR. Our IRB approved this analysis. RESULTS: Of 392 patients with PEC, 31 (7.9%) developed FGR. Compared to patients who did not develop FGR, patients who developed FGR were more likely to have early-onset PEC and lower maternal weight and were less likely to have gestational diabetes (P<.05). The incidence rate of FGR increased by 11.6% each week from the PEC diagnosis. Compared to patients with late-onset PEC, those with early-onset PEC had a significantly higher cumulative incidence of FGR (P<.01). The Cox proportional hazards model showed that early-onset PEC was associated with FGR (adjusted HR 4.12, 95% CI 1.19–14.33) compared to late-onset PEC. CONCLUSION: Patients with early-onset PEC had a significantly higher incidence of FGR compared to those with late-onset PEC. There was a high cumulative incidence rate of FGR in patients with early-onset PEC. Patients with PEC should be followed by serial fetal growth ultrasound.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"67 1","pages":"84S - 85S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86077952","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.0000929904.21738.96
Gabrielle Taper, M. Álvarez, L. Thaxton, S. Tristan
INTRODUCTION: The purpose of this study was to compare readmission rates for early pregnancy concerns in the emergency department (ED) among patients that speak English versus Spanish as their primary language. METHODS: From January 1, 2020 to June 1, 2021, we conducted a chart review to identify pregnant patients presenting to the ED using ICD-10 codes for pregnancy and first-trimester diagnoses (n=383). Charts were excluded if pregnancy was beyond 13 weeks or an ultrasound-confirmed ectopic pregnancy. Readmission was a separate ED encounter during the first trimester of that same pregnancy. Preventable readmission was one that could have been prevented if the patient had received correct counseling, diagnosis, or management at the index admission. Our primary outcome was frequency of ED readmission among English versus Spanish speakers. This protocol was approved for IRB exemption by the University of Texas. RESULTS: Threatened abortion was the most common diagnosis among both groups. Readmissions were more frequent among Spanish speakers (40% versus 26% [P=.01]). Preventable readmissions were more common among Spanish speakers (31% versus 25%). The majority of preventable readmissions (81%) among Spanish speakers could have been prevented if correct management was offered, compared to 25% in English speakers (P=.03). CONCLUSION: Spanish and English speakers present with similar types of early pregnancy concerns, but Spanish speakers are not offered management of early pregnancy concerns at the same frequency. Standardization of care for early pregnancy concerns in the ED may help reduce language-based disparities in quality and equity of care.
简介:本研究的目的是比较以英语和西班牙语为主要语言的早期妊娠患者在急诊科(ED)的再入院率。方法:从2020年1月1日至2021年6月1日，我们进行了一项图表回顾，以确定使用ICD-10代码进行妊娠和早期妊娠诊断的妊娠患者(n=383)。如果怀孕超过13周或超声确认宫外孕，则排除图表。再入院是一个单独的ED遭遇在同一怀孕的前三个月。可预防的再入院是指如果患者在入院时接受了正确的咨询、诊断或管理，就可以预防的再入院。我们的主要结局是英语和西班牙语患者再入院的频率。该方案已获得德克萨斯大学IRB豁免批准。结果:先兆流产是两组中最常见的诊断。西班牙语患者的再入院率更高(40% vs 26% [P= 0.01])。可预防的再入院在说西班牙语的人群中更为常见(31%对25%)。如果提供正确的管理，西班牙语患者中大多数可预防的再入院(81%)是可以避免的，而英语患者中这一比例为25% (P=.03)。结论:西班牙语和英语患者出现的早孕问题类型相似，但西班牙语患者未获得相同频率的早孕问题管理。在急诊科对早孕问题的标准化护理可能有助于减少基于语言的护理质量和公平性的差异。
{"title":"Emergency Department Readmission for Early Pregnancy Concerns Among Patients Who Speak Spanish [ID: 1366721]","authors":"Gabrielle Taper, M. Álvarez, L. Thaxton, S. Tristan","doi":"10.1097/01.AOG.0000929904.21738.96","DOIUrl":"https://doi.org/10.1097/01.AOG.0000929904.21738.96","url":null,"abstract":"INTRODUCTION: The purpose of this study was to compare readmission rates for early pregnancy concerns in the emergency department (ED) among patients that speak English versus Spanish as their primary language. METHODS: From January 1, 2020 to June 1, 2021, we conducted a chart review to identify pregnant patients presenting to the ED using ICD-10 codes for pregnancy and first-trimester diagnoses (n=383). Charts were excluded if pregnancy was beyond 13 weeks or an ultrasound-confirmed ectopic pregnancy. Readmission was a separate ED encounter during the first trimester of that same pregnancy. Preventable readmission was one that could have been prevented if the patient had received correct counseling, diagnosis, or management at the index admission. Our primary outcome was frequency of ED readmission among English versus Spanish speakers. This protocol was approved for IRB exemption by the University of Texas. RESULTS: Threatened abortion was the most common diagnosis among both groups. Readmissions were more frequent among Spanish speakers (40% versus 26% [P=.01]). Preventable readmissions were more common among Spanish speakers (31% versus 25%). The majority of preventable readmissions (81%) among Spanish speakers could have been prevented if correct management was offered, compared to 25% in English speakers (P=.03). CONCLUSION: Spanish and English speakers present with similar types of early pregnancy concerns, but Spanish speakers are not offered management of early pregnancy concerns at the same frequency. Standardization of care for early pregnancy concerns in the ED may help reduce language-based disparities in quality and equity of care.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"40 1","pages":"16S - 17S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86293106","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.0000931260.84787.fb
J. Simon, S. Jewell, Moming Li, J. Ng, B. Pinsky
INTRODUCTION: Patients with heavy menstrual bleeding (HMB) associated with uterine fibroids (UFs) have significantly improved menstrual blood loss (MBL) when taking elagolix+estradiol/norethindrone acetate add-back therapy (ELA+AB) versus placebo. However, data on the effect of ELA+AB on nonbleeding symptoms are limited. METHODS: This post hoc analysis from the duplicate, IRB-approved, randomized, double-blind, placebo-controlled, 6-month, phase 3 Elaris UF-1 and UF-2 studies (NCT02654054 and NCT02691494) evaluated the Patients Global Impression of Change (PGIC). Patients rated symptom change for menstrual bleeding (MB) and nonbleeding symptoms on a 7-point scale from “very much improved” (1) to “very much worse” (7). RESULTS: By 6 months, scores for the PGIC-MB and the domains of “abdominal or pelvic pain,” “abdominal or pelvic pressure,” “abdominal or pelvic cramping,” “back pain,” and “abdominal bloating” were significantly better (P<.001 for all; no adjustment for multiple comparisons were made) in the ELA+AB versus placebo groups, regardless of patient age (<40 years, 40 to <45 years, ≥45 years), baseline MBL (less than median [187.0 mL], greater than or equal to median), International Federation of Gynecology and Obstetrics (FIGO) classification (0–3, 4, 5–8), or baseline uterine volume (less than median [356.5 cm3], greater than or equal to median). Patients receiving ELA+AB reported PGIC domain scores that consistently exceeded “minimally improved” (≤3) and often reached or exceeded “much improved” (≤2) by 6 months. CONCLUSION: ELA+AB provides better bleeding and nonbleeding symptom improvement versus placebo for patients with HMB associated with UFs, regardless of subpopulation investigated. In all populations, PGIC-MB and domain scores consistently reached or exceeded “much improved” by 6 months with ELA+AB.
{"title":"Elagolix Plus Add-Back Consistently Improves Uterine Fibroids-Associated Bleeding and Nonbleeding Symptoms Across Subpopulations [ID: 1368059]","authors":"J. Simon, S. Jewell, Moming Li, J. Ng, B. Pinsky","doi":"10.1097/01.aog.0000931260.84787.fb","DOIUrl":"https://doi.org/10.1097/01.aog.0000931260.84787.fb","url":null,"abstract":"INTRODUCTION: Patients with heavy menstrual bleeding (HMB) associated with uterine fibroids (UFs) have significantly improved menstrual blood loss (MBL) when taking elagolix+estradiol/norethindrone acetate add-back therapy (ELA+AB) versus placebo. However, data on the effect of ELA+AB on nonbleeding symptoms are limited. METHODS: This post hoc analysis from the duplicate, IRB-approved, randomized, double-blind, placebo-controlled, 6-month, phase 3 Elaris UF-1 and UF-2 studies (NCT02654054 and NCT02691494) evaluated the Patients Global Impression of Change (PGIC). Patients rated symptom change for menstrual bleeding (MB) and nonbleeding symptoms on a 7-point scale from “very much improved” (1) to “very much worse” (7). RESULTS: By 6 months, scores for the PGIC-MB and the domains of “abdominal or pelvic pain,” “abdominal or pelvic pressure,” “abdominal or pelvic cramping,” “back pain,” and “abdominal bloating” were significantly better (P<.001 for all; no adjustment for multiple comparisons were made) in the ELA+AB versus placebo groups, regardless of patient age (<40 years, 40 to <45 years, ≥45 years), baseline MBL (less than median [187.0 mL], greater than or equal to median), International Federation of Gynecology and Obstetrics (FIGO) classification (0–3, 4, 5–8), or baseline uterine volume (less than median [356.5 cm3], greater than or equal to median). Patients receiving ELA+AB reported PGIC domain scores that consistently exceeded “minimally improved” (≤3) and often reached or exceeded “much improved” (≤2) by 6 months. CONCLUSION: ELA+AB provides better bleeding and nonbleeding symptom improvement versus placebo for patients with HMB associated with UFs, regardless of subpopulation investigated. In all populations, PGIC-MB and domain scores consistently reached or exceeded “much improved” by 6 months with ELA+AB.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"82 1","pages":"102S - 102S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83926786","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.0000930872.37320.85
Sabrina C Burn, Lou Clark, Sarah Cross, Julie Johnson Rolfes, Joseph M. Miller
INTRODUCTION: The objective of this study was to determine the feasibility and effectiveness of multidisciplinary simulation in the development of skills required for high-risk periviability counseling. METHODS: Trainees were recruited from the University of Minnesota to participate in a faculty-observed standardized high-risk periviability patient simulation. The simulation was unique in that multiple specialties collaborated in the evaluation, counseling, and management of their patient. Trainees completed presimulation and postsimulation knowledge and comfort self-assessment surveys to evaluate skill improvement and merit of the study. Evaluations were also performed by faculty and simulated patients. An IRB waiver was obtained. RESULTS: Of the 18 participants, there were 6 neonatal intensive care unit fellows, 2 maternal–fetal medicine fellows, and 10 senior ob-gyn residents. Presimulation and postsimulation Likert surveys with scale 1–5, showed improvement in the ability of trainees to elicit patient values and tailor their conversations (pre-mean 2.84, SD 0.67; post-mean 3.39, SD 0.59), use patient-centered language (pre-mean 3.37, SD 0.74; post-mean 3.89, SD 0.57), ally with patients (pre-mean 3.37, SD 0.93; post-mean 3.94, SD 0.52), provide difficult medical information (pre-mean 3.32, SD 1.03; post-mean 3.67, SD 0.58), discuss medical uncertainty (pre-mean 3.11, SD 0.79; post-mean 3.50, SD 0.60), and understand their own implicit biases (pre-mean 3.26, SD 0.71; post-mean 3.50, SD 0.60). Trainees also reported an increased use of hopeful language that did not focus on statistical outcomes (pre-mean 3.00, SD 0.65; post-mean 3.33, SD 0.47) and discussion of multiple management options, including comfort cares (pre-mean 2.05, SD 1.05; post-mean 2.94, SD 0.85). The post surveys also reflected that trainees felt the simulation was useful, provided a safe environment to practice counseling (mean 4.83, SD 0.37), and better prepared them for future high-risk obstetrical scenarios (mean 4.83, SD 0.37). CONCLUSION: Multidisciplinary high-risk obstetrical simulation offers a unique opportunity for trainees to receive structured training and improve their ability to collaboratively counsel in rare high-risk obstetrical scenarios.
{"title":"Multidisciplinary High-Risk Obstetrical Simulation Improves Periviability Counseling [ID: 1366577]","authors":"Sabrina C Burn, Lou Clark, Sarah Cross, Julie Johnson Rolfes, Joseph M. Miller","doi":"10.1097/01.aog.0000930872.37320.85","DOIUrl":"https://doi.org/10.1097/01.aog.0000930872.37320.85","url":null,"abstract":"INTRODUCTION: The objective of this study was to determine the feasibility and effectiveness of multidisciplinary simulation in the development of skills required for high-risk periviability counseling. METHODS: Trainees were recruited from the University of Minnesota to participate in a faculty-observed standardized high-risk periviability patient simulation. The simulation was unique in that multiple specialties collaborated in the evaluation, counseling, and management of their patient. Trainees completed presimulation and postsimulation knowledge and comfort self-assessment surveys to evaluate skill improvement and merit of the study. Evaluations were also performed by faculty and simulated patients. An IRB waiver was obtained. RESULTS: Of the 18 participants, there were 6 neonatal intensive care unit fellows, 2 maternal–fetal medicine fellows, and 10 senior ob-gyn residents. Presimulation and postsimulation Likert surveys with scale 1–5, showed improvement in the ability of trainees to elicit patient values and tailor their conversations (pre-mean 2.84, SD 0.67; post-mean 3.39, SD 0.59), use patient-centered language (pre-mean 3.37, SD 0.74; post-mean 3.89, SD 0.57), ally with patients (pre-mean 3.37, SD 0.93; post-mean 3.94, SD 0.52), provide difficult medical information (pre-mean 3.32, SD 1.03; post-mean 3.67, SD 0.58), discuss medical uncertainty (pre-mean 3.11, SD 0.79; post-mean 3.50, SD 0.60), and understand their own implicit biases (pre-mean 3.26, SD 0.71; post-mean 3.50, SD 0.60). Trainees also reported an increased use of hopeful language that did not focus on statistical outcomes (pre-mean 3.00, SD 0.65; post-mean 3.33, SD 0.47) and discussion of multiple management options, including comfort cares (pre-mean 2.05, SD 1.05; post-mean 2.94, SD 0.85). The post surveys also reflected that trainees felt the simulation was useful, provided a safe environment to practice counseling (mean 4.83, SD 0.37), and better prepared them for future high-risk obstetrical scenarios (mean 4.83, SD 0.37). CONCLUSION: Multidisciplinary high-risk obstetrical simulation offers a unique opportunity for trainees to receive structured training and improve their ability to collaboratively counsel in rare high-risk obstetrical scenarios.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"122 1","pages":"74S - 74S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79468128","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}
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