Pub Date : 2023-05-01DOI: 10.1097/01.AOG.0000930396.14863.a2
Paxton E. Voigt, Sasha Hernandez, Beralis Ramos, T. Shirazian
INTRODUCTION: Maternal mortality from postpartum hemorrhage (PPH) can be reduced through timely management. Interdisciplinary simulation-based training (SBT) has been shown to improve team response to PPH, but SBT is not widely available in low-resource settings. The purpose of this study is to assess the acceptability of SBT and its effect on interdisciplinary personnel’s self-efficacy in a low-resource setting. METHODS: A pilot low-fidelity PPH SBT program using PRONTOPack was conducted from November 2021 to September 2022 after an initial audit revealed inadequate training at a public teaching hospital with the highest national maternal mortality rate in the Dominican Republic. Thirty interdisciplinary providers were trained in two cohorts. Self-efficacy was assessed via anonymous, postsimulation surveys. RESULTS: One hundred percent of providers reported that the SBT was an effective form of training that will help them manage PPH in the future. In the first cohort (n=7), providers reported high comfort with their teamwork (4.57/5 S 0.49) and communication skills (4.29/5 S 0.45) after SBT. In the second cohort (n=23), 100% of trainees agreed that SBT improved their ability to communicate effectively, work in teams, and manage PPH. CONCLUSION: Low-fidelity interdisciplinary SBT was found to be useful in improving trainees’ self-perceived nontechnical skills in the management of PPH. Most notably, communication skills were improved between providers that routinely manage real-time PPHs in clinical practice. Next steps are to integrate and standardize SBT into the obstetric department’s workflow to train all personnel managing PPHs.
导言:产后出血(PPH)的产妇死亡率可以通过及时的管理来降低。基于跨学科模拟的培训(SBT)已被证明可以改善团队对PPH的反应，但SBT在资源匮乏的环境中并没有广泛应用。摘要本研究旨在探讨低资源环境下跨学科人员的自我效能感及其可接受性。方法:在初步审计发现多米尼加共和国全国孕产妇死亡率最高的公立教学医院培训不足后，于2021年11月至2022年9月使用PRONTOPack进行了低保真PPH SBT试点项目。30名跨学科提供者接受了两组培训。自我效能感通过匿名模拟后调查进行评估。结果:100%的提供者报告SBT是一种有效的培训形式，将帮助他们在未来管理PPH。在第一队列(n=7)中，提供者报告了SBT后他们的团队合作(4.57/5 S 0.49)和沟通技巧(4.29/5 S 0.45)的高舒适度。在第二组(n=23)中，100%的学员认为SBT提高了他们有效沟通、团队合作和管理PPH的能力。结论:低保真度跨学科SBT有助于提高学员在PPH管理中自我感知的非技术技能。最值得注意的是，在临床实践中，日常管理实时pph的提供者之间的沟通技巧得到了改善。接下来的步骤是将性传播感染纳入产科部门的工作流程并使之标准化，以培训所有管理小灵通的人员。
{"title":"Evaluating the Effect of Interdisciplinary Simulation Training on Provider Comfort in the Management of Postpartum Hemorrhage (PPH) in a Low-Resource Setting [ID: 1363496]","authors":"Paxton E. Voigt, Sasha Hernandez, Beralis Ramos, T. Shirazian","doi":"10.1097/01.AOG.0000930396.14863.a2","DOIUrl":"https://doi.org/10.1097/01.AOG.0000930396.14863.a2","url":null,"abstract":"INTRODUCTION: Maternal mortality from postpartum hemorrhage (PPH) can be reduced through timely management. Interdisciplinary simulation-based training (SBT) has been shown to improve team response to PPH, but SBT is not widely available in low-resource settings. The purpose of this study is to assess the acceptability of SBT and its effect on interdisciplinary personnel’s self-efficacy in a low-resource setting. METHODS: A pilot low-fidelity PPH SBT program using PRONTOPack was conducted from November 2021 to September 2022 after an initial audit revealed inadequate training at a public teaching hospital with the highest national maternal mortality rate in the Dominican Republic. Thirty interdisciplinary providers were trained in two cohorts. Self-efficacy was assessed via anonymous, postsimulation surveys. RESULTS: One hundred percent of providers reported that the SBT was an effective form of training that will help them manage PPH in the future. In the first cohort (n=7), providers reported high comfort with their teamwork (4.57/5 S 0.49) and communication skills (4.29/5 S 0.45) after SBT. In the second cohort (n=23), 100% of trainees agreed that SBT improved their ability to communicate effectively, work in teams, and manage PPH. CONCLUSION: Low-fidelity interdisciplinary SBT was found to be useful in improving trainees’ self-perceived nontechnical skills in the management of PPH. Most notably, communication skills were improved between providers that routinely manage real-time PPHs in clinical practice. Next steps are to integrate and standardize SBT into the obstetric department’s workflow to train all personnel managing PPHs.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"11 1","pages":"51S - 51S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82379423","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.0000931172.95365.a6
A. Larkin, I. Misiuta
INTRODUCTION: We sought to determine whether an online continuing medical education (CME) series could improve the clinical knowledge and confidence of obstetrician–gynecologists related to cytomegalovirus (CMV). METHODS: Two online, 30-minute panel discussions, with educational effects assessed for matched learners completing all pre/post questions. The McNemar's test assessed differences from pre to post (P<.05 are statistically significant). The activities launched in March and April 2022, and data were collected for 3 months for each activity. RESULTS: Overall, 50–51% of obstetrician–gynecologists demonstrated improvements. For activity 1 (N=147), 31% improved at recognizing the burden of CMV (P<.01, 44% need additional education); 20% improved at selecting CMV acquisition risk reduction strategies (P<.01, 25% need additional education); 24% improved at identifying complications of congenital CMV (P<.01, 26% need additional education); 51% increased confidence at educating pregnant women about CMV risk reduction (P<.01), with an average confidence shift of +78% among those who improved. For activity 2 (N=130), 32% improved at recognizing the lifecycle of CMV (P<.01, 32% need additional education); 24% improved at selecting factors associated with CMV seropositivity (P<.01, 35% need additional education); 15% improved at identifying common complications of CMV at birth (P<.01, 35% need additional education); 48% increased confidence at understanding of the role of CMV serostatus in pregnant patients (P<.01), with an average confidence shift of +79% among those who improved. CONCLUSION: This study demonstrates the success of an online, serial learning initiative at improving clinical knowledge and confidence of obstetrician–gynecologists related to CMV. Continued gaps were identified for future education.
{"title":"Online CME Effectively Improves Obstetrician–Gynecologists' Clinical Knowledge and Confidence Related to Cytomegalovirus [ID: 1368765]","authors":"A. Larkin, I. Misiuta","doi":"10.1097/01.aog.0000931172.95365.a6","DOIUrl":"https://doi.org/10.1097/01.aog.0000931172.95365.a6","url":null,"abstract":"INTRODUCTION: We sought to determine whether an online continuing medical education (CME) series could improve the clinical knowledge and confidence of obstetrician–gynecologists related to cytomegalovirus (CMV). METHODS: Two online, 30-minute panel discussions, with educational effects assessed for matched learners completing all pre/post questions. The McNemar's test assessed differences from pre to post (P<.05 are statistically significant). The activities launched in March and April 2022, and data were collected for 3 months for each activity. RESULTS: Overall, 50–51% of obstetrician–gynecologists demonstrated improvements. For activity 1 (N=147), 31% improved at recognizing the burden of CMV (P<.01, 44% need additional education); 20% improved at selecting CMV acquisition risk reduction strategies (P<.01, 25% need additional education); 24% improved at identifying complications of congenital CMV (P<.01, 26% need additional education); 51% increased confidence at educating pregnant women about CMV risk reduction (P<.01), with an average confidence shift of +78% among those who improved. For activity 2 (N=130), 32% improved at recognizing the lifecycle of CMV (P<.01, 32% need additional education); 24% improved at selecting factors associated with CMV seropositivity (P<.01, 35% need additional education); 15% improved at identifying common complications of CMV at birth (P<.01, 35% need additional education); 48% increased confidence at understanding of the role of CMV serostatus in pregnant patients (P<.01), with an average confidence shift of +79% among those who improved. CONCLUSION: This study demonstrates the success of an online, serial learning initiative at improving clinical knowledge and confidence of obstetrician–gynecologists related to CMV. Continued gaps were identified for future education.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"10 1","pages":"96S - 96S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82272312","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.0000930204.85115.f2
Nicholas Baranco, Alexander Mastrogiannis, D. Mastrogiannis, Brian Thompson
INTRODUCTION: The objective of this study was to evaluate changes in obstetric outcomes in a Native American population compared with other racial groups. METHODS: An electronic birth certificate based system was used to obtain data for all singleton births in the Central New York region from January 2012 to June 2022 after IRB exemption. Race was self-identified and categorized as White, Black, Native American, or other. We compared delivery before or after January 2020. The primary outcome was premature birth. Secondary outcomes included prenatal care adequacy, fetal growth restriction, neonatal outcome, diabetes, hypertension, and obesity. Analysis was preformed using χ2 and logistic regression including body mass index (BMI), smoking, hypertension, and diabetes. RESULTS: Out of 178,420 singleton births, 2,647 (1.4%) identified as Native American, 143,743 (77.7%) as White, and 15,476 (8.4%) as Black. Compared to patients before 2020, no racial group had a higher rate of inadequate or late prenatal care, and all groups had increased obesity (BMI >30) and decreased smoking. Preterm birth increased in the Native American population before 37, 34, and 28 weeks of gestation: adjusted odds ratio (95% CI) 1.42 (1.02–1.99), 1.81 (1.02–3.22), and 3.68 (1.39–9.77). No other population had increased preterm birth before 34 or 28 weeks of gestation. CONCLUSION: There was a significant increase in all categories of preterm birth in the Native American population during the COVID-19 pandemic without a differential increase in known risk factors compared to other racial groups. This highlights the need for more research on the causes of adverse outcomes in Native American populations.
{"title":"Increased Risk of Preterm Birth in a Native American Population Concurrent With the COVID-19 Pandemic [ID: 1377321]","authors":"Nicholas Baranco, Alexander Mastrogiannis, D. Mastrogiannis, Brian Thompson","doi":"10.1097/01.aog.0000930204.85115.f2","DOIUrl":"https://doi.org/10.1097/01.aog.0000930204.85115.f2","url":null,"abstract":"INTRODUCTION: The objective of this study was to evaluate changes in obstetric outcomes in a Native American population compared with other racial groups. METHODS: An electronic birth certificate based system was used to obtain data for all singleton births in the Central New York region from January 2012 to June 2022 after IRB exemption. Race was self-identified and categorized as White, Black, Native American, or other. We compared delivery before or after January 2020. The primary outcome was premature birth. Secondary outcomes included prenatal care adequacy, fetal growth restriction, neonatal outcome, diabetes, hypertension, and obesity. Analysis was preformed using χ2 and logistic regression including body mass index (BMI), smoking, hypertension, and diabetes. RESULTS: Out of 178,420 singleton births, 2,647 (1.4%) identified as Native American, 143,743 (77.7%) as White, and 15,476 (8.4%) as Black. Compared to patients before 2020, no racial group had a higher rate of inadequate or late prenatal care, and all groups had increased obesity (BMI >30) and decreased smoking. Preterm birth increased in the Native American population before 37, 34, and 28 weeks of gestation: adjusted odds ratio (95% CI) 1.42 (1.02–1.99), 1.81 (1.02–3.22), and 3.68 (1.39–9.77). No other population had increased preterm birth before 34 or 28 weeks of gestation. CONCLUSION: There was a significant increase in all categories of preterm birth in the Native American population during the COVID-19 pandemic without a differential increase in known risk factors compared to other racial groups. This highlights the need for more research on the causes of adverse outcomes in Native American populations.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"30 1","pages":"37S - 37S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82347980","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.0000930232.53045.07
E. Sutton, A. Cowan, C. Haverty, Briasha D. Jones, Alison Moe, Donna Russell
INTRODUCTION: The same factors contributing to disproportionately worse health outcomes are also barriers to inclusion in research for Black, Hispanic, and Indigenous patients. In this subanalysis of a large, multisite prospective cohort study of maternal plasma mRNA signatures and adverse pregnancy outcomes (APOs), we sought to determine whether equitable representation was aided by the inclusion of a large community hospital as an enrollment site. METHODS: Pregnant persons between 18 and 45 year old with a singleton pregnancy eligible to enroll in this IRB-approved prospective cohort study at Woman’s Hospital (Baton Rouge, Louisiana). A hybrid of indirect and direct recruitment strategies, bolstered by text message communication and gift card compensation, were deployed to facilitate enrollment that mirrored the community’s diversity. RESULTS: Two thousand five hundred twenty-two participants have been enrolled over 22 months (18% of the hospital’s eligible patient population): 41% of participants are Black, 9% are of Hispanic origin, 50% are White, and 9% Other race. This identically mirrors the demographics of the hospital obstetric patient population (38% Black, 7% Hispanic, 49% White, and 13% Other). CONCLUSION: Participants overall mirrored the diverse population served. Inclusion of study sites outside of the traditional academic setting is an effective strategy for promoting equitable access to clinical research, combating barriers to inclusion in research faced by the populations that are disproportionately affected by APOs.
{"title":"Main Street, USA Enrollment: Community Hospital Recruitment Strategies for Diverse and Equitable Selection of Pregnant Participants in a Prospective Cohort Study [ID: 1377833]","authors":"E. Sutton, A. Cowan, C. Haverty, Briasha D. Jones, Alison Moe, Donna Russell","doi":"10.1097/01.aog.0000930232.53045.07","DOIUrl":"https://doi.org/10.1097/01.aog.0000930232.53045.07","url":null,"abstract":"INTRODUCTION: The same factors contributing to disproportionately worse health outcomes are also barriers to inclusion in research for Black, Hispanic, and Indigenous patients. In this subanalysis of a large, multisite prospective cohort study of maternal plasma mRNA signatures and adverse pregnancy outcomes (APOs), we sought to determine whether equitable representation was aided by the inclusion of a large community hospital as an enrollment site. METHODS: Pregnant persons between 18 and 45 year old with a singleton pregnancy eligible to enroll in this IRB-approved prospective cohort study at Woman’s Hospital (Baton Rouge, Louisiana). A hybrid of indirect and direct recruitment strategies, bolstered by text message communication and gift card compensation, were deployed to facilitate enrollment that mirrored the community’s diversity. RESULTS: Two thousand five hundred twenty-two participants have been enrolled over 22 months (18% of the hospital’s eligible patient population): 41% of participants are Black, 9% are of Hispanic origin, 50% are White, and 9% Other race. This identically mirrors the demographics of the hospital obstetric patient population (38% Black, 7% Hispanic, 49% White, and 13% Other). CONCLUSION: Participants overall mirrored the diverse population served. Inclusion of study sites outside of the traditional academic setting is an effective strategy for promoting equitable access to clinical research, combating barriers to inclusion in research faced by the populations that are disproportionately affected by APOs.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"8 1","pages":"39S - 40S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87620646","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.0000929780.96171.fa
Kelsey Holland, A. Mastronardi, M. Young, N. Zite
INTRODUCTION: Tennessee Medicaid began covering immediate postpartum (IPP) long-acting reversible contraception (LARC) in November 2017 with the goal of reducing the rate of short-interval births (SIBs) (defined as less than 24 months after a previous birth). In 2014, 22.7% of births in Tennessee were SIBs. We sought to determine IPP LARC uptake and SIB outcomes for women who received IPP LARC after this policy was implemented. METHODS: A retrospective chart review of women who delivered from March to December 2018 and received IPP LARC was conducted. LARC receipt and SIB outcomes were determined utilizing local, regional, and state records (IRB: 4768, 2021-0303). RESULTS: Among the 406 IPP LARC recipients, the average age was 25.9 (15–42), and the average number of living children was 1.28 (0–6). LARC type elected was 4.7% copper intrauterine system (Cu-IUS), 39.9% levonorgestrel-releasing intrauterine system (LNG-IUS), and 55.4% contraceptive implant. Subsequent SIB was identified in only 5.4% (22). Of these, 2 received Cu-IUS, 10 received LNG-IUS, and 10 received contraceptive arm implants. Timing and reason for removal were documented for 7 of these. Expulsion was identified in 1 copper and 1 hormonal IUD. Removals due to side effects were reported in 3 implant and 2 hormonal IUD users. CONCLUSION: The rate of SIB among the IPP LARC recipients was much lower than the general rate among Tennessee women, highlighting the benefit of IPP LARC provision. Additionally, the high preference for contraceptive implants may reflect provider counseling on the increased risk of IUD expulsion when placed IPP or other factors that may be elucidated by future studies.
{"title":"Immediate Postpartum Long-Acting Reversible Contraception Uptake and Outcomes [ID: 1371558]","authors":"Kelsey Holland, A. Mastronardi, M. Young, N. Zite","doi":"10.1097/01.aog.0000929780.96171.fa","DOIUrl":"https://doi.org/10.1097/01.aog.0000929780.96171.fa","url":null,"abstract":"INTRODUCTION: Tennessee Medicaid began covering immediate postpartum (IPP) long-acting reversible contraception (LARC) in November 2017 with the goal of reducing the rate of short-interval births (SIBs) (defined as less than 24 months after a previous birth). In 2014, 22.7% of births in Tennessee were SIBs. We sought to determine IPP LARC uptake and SIB outcomes for women who received IPP LARC after this policy was implemented. METHODS: A retrospective chart review of women who delivered from March to December 2018 and received IPP LARC was conducted. LARC receipt and SIB outcomes were determined utilizing local, regional, and state records (IRB: 4768, 2021-0303). RESULTS: Among the 406 IPP LARC recipients, the average age was 25.9 (15–42), and the average number of living children was 1.28 (0–6). LARC type elected was 4.7% copper intrauterine system (Cu-IUS), 39.9% levonorgestrel-releasing intrauterine system (LNG-IUS), and 55.4% contraceptive implant. Subsequent SIB was identified in only 5.4% (22). Of these, 2 received Cu-IUS, 10 received LNG-IUS, and 10 received contraceptive arm implants. Timing and reason for removal were documented for 7 of these. Expulsion was identified in 1 copper and 1 hormonal IUD. Removals due to side effects were reported in 3 implant and 2 hormonal IUD users. CONCLUSION: The rate of SIB among the IPP LARC recipients was much lower than the general rate among Tennessee women, highlighting the benefit of IPP LARC provision. Additionally, the high preference for contraceptive implants may reflect provider counseling on the increased risk of IUD expulsion when placed IPP or other factors that may be elucidated by future studies.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"32 1","pages":"7S - 7S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87167672","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.0000930632.45067.94
Kali Stewart, Alexander M. Hincker, L. Holroyd, R. Rimsza, A. Veade
INTRODUCTION: The numerical pain rating scale (NPRS) is a validated measure to quantify acute pain; however, its utility after vaginal delivery is unclear. Poorly controlled postpartum pain can increase rates of complications; therefore, pain control is paramount. We investigated how subjective pain relates to objective pain in the postpartum period. METHODS: A prospective, observational study at a single academic hospital included patients with vaginal deliveries February to October 2021. Women with opioid use disorder, wound complication, hysterectomy, or readmission were excluded. Subjective pain assessment and NPRS were completed 2 weeks postdischarge. Subjective pain was recorded as “well controlled” versus “poorly controlled.” The numerical pain rating scale was scored 0–10. RESULTS: Two hundred thirty-eight patients were included, and 174 (73%) followed up. One hundred twenty (69%) reported “well-controlled” pain, and 54 (31%) reported “poorly controlled.” There was no significant difference in delivery mode, laceration, or nonopioid medication use (P>.05). Patients who used oxycodone were significantly more likely to report “poorly controlled” pain (P=.02). “Poorly controlled” pain was associated with higher median NPRS score (5 [interquartile range (IQR) 4–6] versus 2 [IQR 0–3], P<.001). Among patients with “poorly controlled” pain, 11 (20.4%) had NPRS scores of 0–3. Of those who reported “well-controlled” pain, 22 (18.3%) had NPRS scores of 4–10. CONCLUSION: While NPRS scores were higher for patients with “poorly controlled” pain, this was not universal. It is critical to accurately respond to postpartum pain for the nearly 20% of patients whose subjective experience did not correlate with their objective score. Titrating pain control to subjective and objective goals may improve patient experience and outcomes.
{"title":"Subjective Versus Objective Pain Assessment in the Postpartum Period: Improving Pain Control After Vaginal Delivery [ID: 1378006]","authors":"Kali Stewart, Alexander M. Hincker, L. Holroyd, R. Rimsza, A. Veade","doi":"10.1097/01.aog.0000930632.45067.94","DOIUrl":"https://doi.org/10.1097/01.aog.0000930632.45067.94","url":null,"abstract":"INTRODUCTION: The numerical pain rating scale (NPRS) is a validated measure to quantify acute pain; however, its utility after vaginal delivery is unclear. Poorly controlled postpartum pain can increase rates of complications; therefore, pain control is paramount. We investigated how subjective pain relates to objective pain in the postpartum period. METHODS: A prospective, observational study at a single academic hospital included patients with vaginal deliveries February to October 2021. Women with opioid use disorder, wound complication, hysterectomy, or readmission were excluded. Subjective pain assessment and NPRS were completed 2 weeks postdischarge. Subjective pain was recorded as “well controlled” versus “poorly controlled.” The numerical pain rating scale was scored 0–10. RESULTS: Two hundred thirty-eight patients were included, and 174 (73%) followed up. One hundred twenty (69%) reported “well-controlled” pain, and 54 (31%) reported “poorly controlled.” There was no significant difference in delivery mode, laceration, or nonopioid medication use (P>.05). Patients who used oxycodone were significantly more likely to report “poorly controlled” pain (P=.02). “Poorly controlled” pain was associated with higher median NPRS score (5 [interquartile range (IQR) 4–6] versus 2 [IQR 0–3], P<.001). Among patients with “poorly controlled” pain, 11 (20.4%) had NPRS scores of 0–3. Of those who reported “well-controlled” pain, 22 (18.3%) had NPRS scores of 4–10. CONCLUSION: While NPRS scores were higher for patients with “poorly controlled” pain, this was not universal. It is critical to accurately respond to postpartum pain for the nearly 20% of patients whose subjective experience did not correlate with their objective score. Titrating pain control to subjective and objective goals may improve patient experience and outcomes.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"34 1","pages":"68S - 68S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87992854","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.0000930372.93798.a3
N. Hussein, R. Harrison, Calla M. Holmgren, Alexandra J D Phelps, G. Steinberg
INTRODUCTION: Risk factors for placenta accreta spectrum (PAS) are overall well understood. We sought to evaluate whether those with more severe disease (increta/percreta) have a subset of patient-specific risk factors that could assist in preoperative planning. METHODS: Institutional review board-approved case–control study of patients diagnosed with PAS who underwent cesarean hysterectomy with pathology confirmed findings. Those with final pathology of placenta increta or percreta were compared to those whose final pathology demonstrated placenta accreta. Baseline characteristics and pregnancy histories were compared between groups via Student’s t tests and χ2 analysis, and a backwards logistic regression was performed to evaluate individual factors associated with more severe PAS invasion. RESULTS: A total of 83 participants met criteria with 51 (61.4%) diagnosed on pathology with increta/percreta. Those with increta/percreta had higher body mass index (34.3±7.0 versus 30.8±8.0) and higher number of prior cesarean births (2.2±1.0 versus 1.7±0.9), and were less likely to have undergone in vitro fertilization (3.9% versus 21.9%) or have a previous cesarean birth with two-layer closure compared to single-layer closure (25.0% versus 63.6%) (all P<.05). After controlling for confounders, there was a trend for more prior cesarean births to increase the risk of increta/percreta and for prior cesarean birth with two-layer closure to decrease the risk, but these were not statistically significant (adjusted odds ratio [aOR] 1.18, 95% CI 0.43–3.23, and aOR 0.51, 95% CI 0.18–1.46, respectively). CONCLUSION: Our study did not identify patient-specific factors that increased the risk for more severe PAS invasion; however, there was a trend for multiple prior cesarean births and previous cesarean birth with single-layer closure to be associated with increased risk.
简介:胎盘增生谱(PAS)的危险因素总体上很好理解。我们试图评估那些更严重的疾病(increta/percreta)是否有患者特异性的危险因素子集，可以帮助术前计划。方法:经机构审查委员会批准的经病理证实的剖宫产子宫切除术诊断为PAS的患者的病例对照研究。将最终病理表现为增生性胎盘或完全性胎盘的患者与最终病理表现为增生性胎盘的患者进行比较。通过Student’s t检验和χ2分析比较各组的基线特征和妊娠史，并进行反向logistic回归来评估与更严重PAS侵袭相关的个体因素。结果:共有83名参与者符合标准，其中51名(61.4%)被诊断为病理上的增量/percreta。increta/percreta患者的体重指数更高(34.3±7.0比30.8±8.0)，既往剖宫产次数更高(2.2±1.0比1.7±0.9)，并且接受过体外受精(3.9%比21.9%)或既往剖宫产两层封闭比单层封闭(25.0%比63.6%)的可能性更低(均P< 0.05)。在控制混杂因素后，既往剖宫产有增加增量/percreta风险的趋势，而既往剖宫产有两层闭合风险降低的趋势，但这些趋势均无统计学意义(调整比值比[aOR] 1.18, 95% CI 0.43-3.23, aOR为0.51,95% CI 0.18-1.46)。结论:我们的研究没有确定患者特异性因素增加更严重PAS侵袭的风险;然而，有趋势表明，既往多次剖宫产和既往剖宫产单层闭合与风险增加有关。
{"title":"Risk Factors for Worsening Placental Invasion Within a Cohort of Placenta Accreta Spectrum Patients [ID: 1380333]","authors":"N. Hussein, R. Harrison, Calla M. Holmgren, Alexandra J D Phelps, G. Steinberg","doi":"10.1097/01.AOG.0000930372.93798.a3","DOIUrl":"https://doi.org/10.1097/01.AOG.0000930372.93798.a3","url":null,"abstract":"INTRODUCTION: Risk factors for placenta accreta spectrum (PAS) are overall well understood. We sought to evaluate whether those with more severe disease (increta/percreta) have a subset of patient-specific risk factors that could assist in preoperative planning. METHODS: Institutional review board-approved case–control study of patients diagnosed with PAS who underwent cesarean hysterectomy with pathology confirmed findings. Those with final pathology of placenta increta or percreta were compared to those whose final pathology demonstrated placenta accreta. Baseline characteristics and pregnancy histories were compared between groups via Student’s t tests and χ2 analysis, and a backwards logistic regression was performed to evaluate individual factors associated with more severe PAS invasion. RESULTS: A total of 83 participants met criteria with 51 (61.4%) diagnosed on pathology with increta/percreta. Those with increta/percreta had higher body mass index (34.3±7.0 versus 30.8±8.0) and higher number of prior cesarean births (2.2±1.0 versus 1.7±0.9), and were less likely to have undergone in vitro fertilization (3.9% versus 21.9%) or have a previous cesarean birth with two-layer closure compared to single-layer closure (25.0% versus 63.6%) (all P<.05). After controlling for confounders, there was a trend for more prior cesarean births to increase the risk of increta/percreta and for prior cesarean birth with two-layer closure to decrease the risk, but these were not statistically significant (adjusted odds ratio [aOR] 1.18, 95% CI 0.43–3.23, and aOR 0.51, 95% CI 0.18–1.46, respectively). CONCLUSION: Our study did not identify patient-specific factors that increased the risk for more severe PAS invasion; however, there was a trend for multiple prior cesarean births and previous cesarean birth with single-layer closure to be associated with increased risk.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"7 1","pages":"49S - 49S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88325206","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.0000930044.38698.81
Bridget C. Huysman, E. Carter, Shelby M. Dickison, J. Kelly, N. Raghuraman, C. Woolfolk
INTRODUCTION: Nonreassuring fetal status (NRFS) is a diagnosis lacking standardized definitions, making the diagnosis susceptible to bias and systemic factors. We assessed whether the decision to proceed with intrapartum cesarean delivery (CD) was associated with time of the day and whether this relationship was influenced by the presence of in-house obstetricians. METHODS: This was a retrospective cohort study of term pregnancies admitted in spontaneous labor or for induction between January 2019 and June 2021. The primary outcome was decision to perform intrapartum CD for NRFS. Generalized additive models with smoothing splines were used to explore nonlinear associations between time of day and CD rates. Results were then stratified by whether the attending obstetrician was in-house or remote. RESULTS: Of 5,526 deliveries, 6.0% were intrapartum CD for NRFS. In the overall cohort, CD for NRFS was consistent throughout the day (P=.056). For patients with in-house obstetricians, the decision for CD for NRFS was not influenced by time of day (P=.072). For patients without in-house obstetricians, the decision to perform CD for NRFS was influenced by the time of day (P=.028), with a decreasing frequency from midnight to afternoon with nadir at 15:00 (2.5%), and a subsequent increasing frequency that peaked at 23:00 (10.3%). CONCLUSION: The decision to perform CD for NRFS is influenced by the time of day when the obstetrician is not in-house. This decision is not affected by time of day when the obstetrician is in-house. Systemic factors such as immediate obstetrician availability affect the diagnosis of NRFS.
{"title":"Does the Decision to Perform Cesarean Delivery for Nonreassuring Fetal Status Vary by Time of Day? [ID: 1376814]","authors":"Bridget C. Huysman, E. Carter, Shelby M. Dickison, J. Kelly, N. Raghuraman, C. Woolfolk","doi":"10.1097/01.aog.0000930044.38698.81","DOIUrl":"https://doi.org/10.1097/01.aog.0000930044.38698.81","url":null,"abstract":"INTRODUCTION: Nonreassuring fetal status (NRFS) is a diagnosis lacking standardized definitions, making the diagnosis susceptible to bias and systemic factors. We assessed whether the decision to proceed with intrapartum cesarean delivery (CD) was associated with time of the day and whether this relationship was influenced by the presence of in-house obstetricians. METHODS: This was a retrospective cohort study of term pregnancies admitted in spontaneous labor or for induction between January 2019 and June 2021. The primary outcome was decision to perform intrapartum CD for NRFS. Generalized additive models with smoothing splines were used to explore nonlinear associations between time of day and CD rates. Results were then stratified by whether the attending obstetrician was in-house or remote. RESULTS: Of 5,526 deliveries, 6.0% were intrapartum CD for NRFS. In the overall cohort, CD for NRFS was consistent throughout the day (P=.056). For patients with in-house obstetricians, the decision for CD for NRFS was not influenced by time of day (P=.072). For patients without in-house obstetricians, the decision to perform CD for NRFS was influenced by the time of day (P=.028), with a decreasing frequency from midnight to afternoon with nadir at 15:00 (2.5%), and a subsequent increasing frequency that peaked at 23:00 (10.3%). CONCLUSION: The decision to perform CD for NRFS is influenced by the time of day when the obstetrician is not in-house. This decision is not affected by time of day when the obstetrician is in-house. Systemic factors such as immediate obstetrician availability affect the diagnosis of NRFS.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"140 1","pages":"26S - 27S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86152104","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.0000930404.40622.f2
L. Admon, Samantha G Auty, J. Daw, E. Declercq, Sarah Gordon, K. Kozhimannil
INTRODUCTION: Interventions designed to address high rates of severe maternal morbidity (SMM) and improve maternal health equity often lack comprehensive data on the relative burden of specific SMM indicators across populations. This study examines variation in indicators of delivery-related SMM among non-Hispanic Black compared with non-Hispanic White Medicaid beneficiaries in 27 states. METHODS: We conducted a pool, cross-sectional analysis of the 2016–2018 Transformed Medicaid Statistical Information System. Unadjusted estimates of indicator frequency were generated for 27 states with adequate quality data on non-Hispanic Black and non-Hispanic White race and ethnicity. We estimated rates for each indicator for each racial group overall and within each state. This study was approved by the IRB at Boston University. RESULTS: Among deliveries to the non-Hispanic Black population (n=629,774), six indicators occurred at overall rates greater than 25 per 10,000 deliveries: eclampsia (leading indicator in 15 states), pulmonary edema/heart failure (3 states), renal failure (1 state), adult respiratory distress syndrome (3 states), sepsis (2 states), and disseminated intravascular coagulation (2 states). Among deliveries to the non-Hispanic White population (n=1,051,459), indicators occurred in different rank-order and at rates typically less than half of those identified among the non-Hispanic Black population. Morbidity indicators among the non-Hispanic White population were distributed differently across states. CONCLUSION: These findings provide opportunities for interventions designed to reduce SMM and improve maternal health equity in Medicaid to be tailored to the leading causes of SMM, which differ among non-Hispanic Black and White populations across and within states.
{"title":"Variation in Severe Maternal Morbidity Among Black and White Medicaid Enrollees in 27 States [ID: 1368013]","authors":"L. Admon, Samantha G Auty, J. Daw, E. Declercq, Sarah Gordon, K. Kozhimannil","doi":"10.1097/01.AOG.0000930404.40622.f2","DOIUrl":"https://doi.org/10.1097/01.AOG.0000930404.40622.f2","url":null,"abstract":"INTRODUCTION: Interventions designed to address high rates of severe maternal morbidity (SMM) and improve maternal health equity often lack comprehensive data on the relative burden of specific SMM indicators across populations. This study examines variation in indicators of delivery-related SMM among non-Hispanic Black compared with non-Hispanic White Medicaid beneficiaries in 27 states. METHODS: We conducted a pool, cross-sectional analysis of the 2016–2018 Transformed Medicaid Statistical Information System. Unadjusted estimates of indicator frequency were generated for 27 states with adequate quality data on non-Hispanic Black and non-Hispanic White race and ethnicity. We estimated rates for each indicator for each racial group overall and within each state. This study was approved by the IRB at Boston University. RESULTS: Among deliveries to the non-Hispanic Black population (n=629,774), six indicators occurred at overall rates greater than 25 per 10,000 deliveries: eclampsia (leading indicator in 15 states), pulmonary edema/heart failure (3 states), renal failure (1 state), adult respiratory distress syndrome (3 states), sepsis (2 states), and disseminated intravascular coagulation (2 states). Among deliveries to the non-Hispanic White population (n=1,051,459), indicators occurred in different rank-order and at rates typically less than half of those identified among the non-Hispanic Black population. Morbidity indicators among the non-Hispanic White population were distributed differently across states. CONCLUSION: These findings provide opportunities for interventions designed to reduce SMM and improve maternal health equity in Medicaid to be tailored to the leading causes of SMM, which differ among non-Hispanic Black and White populations across and within states.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"121 1","pages":"51S - 51S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86160674","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.0000931204.97655.6f
Connie W. Cheng, K. ElSahwi, G. Vurture
INTRODUCTION: Surgical training is often carried out through observation and practice in the clinical setting. Gagne's model of instructional design is an organized method of teaching motor skills. The purpose of the study is to evaluate the feasibility and effectiveness of using Gange's model to improve surgical knowledge on transfixation stitches used during hysterectomy on a low-fidelity pelvic model trainer. METHODS: A simple teaching curriculum for transfixation stitches was developed following Gange's model. A thought-provoking clinical vignette was presented and followed by clear learning objectives. Prerequisite knowledge was tested using a quiz. Stimulus material included relevant anatomy, instruments used in a hysterectomy, and steps of an abdominal hysterectomy. Learning guidance was provided in the form of diagrams and videos of various transfixation stitches. Learners practiced on low-fidelity pelvic models with supervision by faculty members. At the end, learners repeated the knowledge test and provided feedback. Comparisons were made between pretest and posttest scores using Fisher exact test and chi-square test as appropriate for nominal variables, and Mann-Whitney test for continuous variables. RESULTS: The simulation was performed by 18 participants (n=18). There was significant improvement in test scores after completing the simulation (59.6±21.8% versus 89.3±9.7%, P<.0001). Additionally, the number of transfixation stitches each learner was familiar with increased significantly after the simulation (0 interquartile range [IQR] [0–1] versus 4 IQR [2–4], P<.0001). CONCLUSION: These findings suggest that using Gagne's model of instructional design on a low-fidelity pelvic model trainer in a low-stress environment can help improve surgical skill education. Our experience demonstrates that simulation training can be organized without much time or resource and help build lasting surgical skills.
简介:外科训练通常通过在临床环境中的观察和实践来进行。加涅的教学设计模式是一种有组织的运动技能教学方法。本研究的目的是评估在低保真骨盆模型训练器上使用Gange模型提高子宫切除术中穿针术知识的可行性和有效性。方法:根据Gange模型编制简单的穿刺针教学大纲。一个发人深省的临床小插曲被提出，并遵循明确的学习目标。前提知识是通过测验来测试的。刺激材料包括相关解剖，子宫切除术中使用的器械，以及腹部子宫切除术的步骤。在教师的监督下，学员在低保真骨盆模型上练习。最后，学习者重复知识测试并给出反馈。对名义变量采用Fisher精确检验和卡方检验，对连续变量采用Mann-Whitney检验，对前测和后测成绩进行比较。结果:18名参与者(n=18)进行了模拟。完成模拟后，测试成绩有显著提高(59.6±21.8% vs 89.3±9.7%，P< 0.0001)。此外，每个学习者熟悉的穿针数在模拟后显著增加(0个四分位数范围[IQR][0 - 1]与4个IQR[2-4]相比，P< 0.0001)。结论:在低压力环境下，在低保真骨盆模型训练器上应用Gagne模型教学设计有助于提高手术技能教育水平。我们的经验表明，模拟训练可以在没有太多时间或资源的情况下组织起来，并有助于建立持久的手术技能。
{"title":"A Simple Curriculum for Teaching Transfixion Stitches Using a Low-Fidelity Model and Following Gagne's Instructional Design [ID: 1377582]","authors":"Connie W. Cheng, K. ElSahwi, G. Vurture","doi":"10.1097/01.aog.0000931204.97655.6f","DOIUrl":"https://doi.org/10.1097/01.aog.0000931204.97655.6f","url":null,"abstract":"INTRODUCTION: Surgical training is often carried out through observation and practice in the clinical setting. Gagne's model of instructional design is an organized method of teaching motor skills. The purpose of the study is to evaluate the feasibility and effectiveness of using Gange's model to improve surgical knowledge on transfixation stitches used during hysterectomy on a low-fidelity pelvic model trainer. METHODS: A simple teaching curriculum for transfixation stitches was developed following Gange's model. A thought-provoking clinical vignette was presented and followed by clear learning objectives. Prerequisite knowledge was tested using a quiz. Stimulus material included relevant anatomy, instruments used in a hysterectomy, and steps of an abdominal hysterectomy. Learning guidance was provided in the form of diagrams and videos of various transfixation stitches. Learners practiced on low-fidelity pelvic models with supervision by faculty members. At the end, learners repeated the knowledge test and provided feedback. Comparisons were made between pretest and posttest scores using Fisher exact test and chi-square test as appropriate for nominal variables, and Mann-Whitney test for continuous variables. RESULTS: The simulation was performed by 18 participants (n=18). There was significant improvement in test scores after completing the simulation (59.6±21.8% versus 89.3±9.7%, P<.0001). Additionally, the number of transfixation stitches each learner was familiar with increased significantly after the simulation (0 interquartile range [IQR] [0–1] versus 4 IQR [2–4], P<.0001). CONCLUSION: These findings suggest that using Gagne's model of instructional design on a low-fidelity pelvic model trainer in a low-stress environment can help improve surgical skill education. Our experience demonstrates that simulation training can be organized without much time or resource and help build lasting surgical skills.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"10 1","pages":"98S - 98S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86533782","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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