Pub Date : 2023-05-01DOI: 10.1097/01.AOG.0000931044.07378.99
J. Munoz, L. Blankenship, G. McCann, P. Ramsey
INTRODUCTION: The diagnostic criteria of fetal growth restriction (FGR) was modified by the Society of Maternal-Fetal Medicine in 2020 to include both an abdominal circumference (AC) and estimated fetal weight (EFW) less than the 10th percentile as opposed to previous definition using only the EFW. We sought to evaluate the outcomes of this criteria modification. METHODS: This retrospective study compared the incidence, obstetrical and neonatal outcomes before (group 1, 2020) and after (group 2, 2021) the implementation of the modified diagnostic criteria at a single institution. This is an IRB-approved study. RESULTS: Of the 459 pregnancies with FGR included in this study, 100 were diagnosed in 2020 (group 1) and 359, in 2021 (group 2). An increase in the incidence of FGR was noted after the modification, 1.5% versus 5.3% (P<.05). Median gestational age (weeks) at delivery decreased from 38.1 (Q1, 37.1; Q3, 39.1) in 2020 to 37.4 (Q1, 36.1; Q3, 38.3) in 2021 (P<.05). There were no statistically significant differences in obstetrical outcomes. An increase in the frequency of respiratory distress syndrome was observed, 6 (6%) versus 51 (14.2%), P<.05, and median length of neonatal stay 2.0 (Q1, 1.0; Q3, 3.0) and 2.0 (Q1, 2.0; Q3, 12.0) in group 1 compared to group 2 (P<.05). CONCLUSION: The new diagnostic criteria for FGR is associated with increased incidence of diagnosis, neonatal respiratory distress, longer neonatal hospital admissions, and lower gestational age of delivery with no difference in obstetrical outcomes. It remains uncertain whether this modification will translate to improved outcomes, and larger multicenter prospective studies are needed.
{"title":"Effect of the New Diagnostic Criteria of Fetal Growth Restriction on Obstetric and Neonatal Outcomes [ID: 1376466]","authors":"J. Munoz, L. Blankenship, G. McCann, P. Ramsey","doi":"10.1097/01.AOG.0000931044.07378.99","DOIUrl":"https://doi.org/10.1097/01.AOG.0000931044.07378.99","url":null,"abstract":"INTRODUCTION: The diagnostic criteria of fetal growth restriction (FGR) was modified by the Society of Maternal-Fetal Medicine in 2020 to include both an abdominal circumference (AC) and estimated fetal weight (EFW) less than the 10th percentile as opposed to previous definition using only the EFW. We sought to evaluate the outcomes of this criteria modification. METHODS: This retrospective study compared the incidence, obstetrical and neonatal outcomes before (group 1, 2020) and after (group 2, 2021) the implementation of the modified diagnostic criteria at a single institution. This is an IRB-approved study. RESULTS: Of the 459 pregnancies with FGR included in this study, 100 were diagnosed in 2020 (group 1) and 359, in 2021 (group 2). An increase in the incidence of FGR was noted after the modification, 1.5% versus 5.3% (P<.05). Median gestational age (weeks) at delivery decreased from 38.1 (Q1, 37.1; Q3, 39.1) in 2020 to 37.4 (Q1, 36.1; Q3, 38.3) in 2021 (P<.05). There were no statistically significant differences in obstetrical outcomes. An increase in the frequency of respiratory distress syndrome was observed, 6 (6%) versus 51 (14.2%), P<.05, and median length of neonatal stay 2.0 (Q1, 1.0; Q3, 3.0) and 2.0 (Q1, 2.0; Q3, 12.0) in group 1 compared to group 2 (P<.05). CONCLUSION: The new diagnostic criteria for FGR is associated with increased incidence of diagnosis, neonatal respiratory distress, longer neonatal hospital admissions, and lower gestational age of delivery with no difference in obstetrical outcomes. It remains uncertain whether this modification will translate to improved outcomes, and larger multicenter prospective studies are needed.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91277302","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.0000931024.22570.28
Miranda A Rep, J. Gillenwater, A. Mackeen, Michael Power, Adam D. Troy
INTRODUCTION: Data regarding patient satisfaction with telemedicine use in obstetrics are limited. Our objective was to identify demographics and their effect on patient satisfaction with telemedicine in maternal–fetal medicine (MFM) to better identify patients who may prefer this modality. METHODS: An IRB-approved prospective survey was offered to patients in MFM from March 2022 to May 2022. Telemedicine experience was not required. Demographics and responses to statements comparing telemedicine versus in-person appointments were collected via a 5-point Likert scale. Telemedicine was defined as an appointment where provider–patient interaction occurred via telecommunications technology. The primary outcome was patient characteristics associated with telemedicine satisfaction. Exploratory factor analysis was performed to identify components affecting patient satisfaction. RESULTS: Surveys were completed by 327 patients. Factor analysis yielded two components from eight statements: “attentiveness” from the provider and “technology” comfort. Telemedicine was viewed neutrally for attentiveness-related questions and favorably for technology-related questions. While both factors were significantly associated with desire for future telemedicine option, the effect of attentiveness was twice as strong as that of technology in multiple regression. Higher education level and being married were significantly associated with lower levels of perceived attentiveness. Employment and telemedicine experience were significantly associated with increased technology comfort. Those with telemedicine experience and higher technology comfort experienced statistically fewer connection problems. CONCLUSION: Telemedicine was viewed neutrally or favorably for the factors studied. Perceived provider attentiveness and technology comfort affected patient satisfaction with telemedicine; each is associated with certain patient demographics. Once validated, this scale can be used to identify patients who may prefer telemedicine appointments.
{"title":"Patient Characteristics Associated With Optimal Telemedicine Experience in Maternal–Fetal Medicine (MFM) [ID: 1368093]","authors":"Miranda A Rep, J. Gillenwater, A. Mackeen, Michael Power, Adam D. Troy","doi":"10.1097/01.AOG.0000931024.22570.28","DOIUrl":"https://doi.org/10.1097/01.AOG.0000931024.22570.28","url":null,"abstract":"INTRODUCTION: Data regarding patient satisfaction with telemedicine use in obstetrics are limited. Our objective was to identify demographics and their effect on patient satisfaction with telemedicine in maternal–fetal medicine (MFM) to better identify patients who may prefer this modality. METHODS: An IRB-approved prospective survey was offered to patients in MFM from March 2022 to May 2022. Telemedicine experience was not required. Demographics and responses to statements comparing telemedicine versus in-person appointments were collected via a 5-point Likert scale. Telemedicine was defined as an appointment where provider–patient interaction occurred via telecommunications technology. The primary outcome was patient characteristics associated with telemedicine satisfaction. Exploratory factor analysis was performed to identify components affecting patient satisfaction. RESULTS: Surveys were completed by 327 patients. Factor analysis yielded two components from eight statements: “attentiveness” from the provider and “technology” comfort. Telemedicine was viewed neutrally for attentiveness-related questions and favorably for technology-related questions. While both factors were significantly associated with desire for future telemedicine option, the effect of attentiveness was twice as strong as that of technology in multiple regression. Higher education level and being married were significantly associated with lower levels of perceived attentiveness. Employment and telemedicine experience were significantly associated with increased technology comfort. Those with telemedicine experience and higher technology comfort experienced statistically fewer connection problems. CONCLUSION: Telemedicine was viewed neutrally or favorably for the factors studied. Perceived provider attentiveness and technology comfort affected patient satisfaction with telemedicine; each is associated with certain patient demographics. Once validated, this scale can be used to identify patients who may prefer telemedicine appointments.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89544037","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.0000929852.03048.10
J. Simon, Jin Hee Kim, P. Miller, J. Ng, M. Snabes, James W. Thomas
INTRODUCTION: Herein, we report updated safety results to 36 months from an ongoing phase 3, 48-month study evaluating the long-term safety of elagolix (ELA) with add-back (AB) for endometriosis-associated pain (EAP) (NCT03213457). METHODS: Premenopausal women with moderate-to-severe EAP were randomized in this IRB-approved study 4:1:2 to receive 12-month blinded treatment with ELA 200 mg twice daily (BID)+AB, ELA 200 mg BID for 6 months followed by 6-month ELA+AB, or placebo; followed by open-label ELA+AB for all patients for 36 months. This 36-month analysis assessed long-term safety, including bone mineral density (BMD). RESULTS: Throughout the open-label treatment period up to 36 months, BMD mean percent change from baseline measurements remained relatively stable at the total hip and lumbar spine and showed a decrease between 1% and 2% in the femoral neck over the open-label period. At 36 months, mean percent change from baseline in BMD for patients treated with ELA+AB throughout the study was −0.77% (spine, n=94); −0.36% (total hip, n=92); and −1.39% (femoral neck, n=92). The overall safety profile of ELA+AB, including AEs and SAEs, observed up to 36 months of treatment continues to be consistent with that previously observed at 12 and 24 months. CONCLUSION: This was the longest evaluation of ELA+AB to date. ELA+AB continued to maintain a favorable safety profile with minimal long-term effect on BMD and no newly identified safety events to 36 months. Combined with previously reported efficacy data, these safety data suggest ELA+AB may provide a long-term therapeutic option for women with EAP beyond 24 months.
{"title":"Long-Term Safety of Elagolix With Add-Back in Women With Endometriosis-Associated Pain: 36-Month Results [ID: 1368036]","authors":"J. Simon, Jin Hee Kim, P. Miller, J. Ng, M. Snabes, James W. Thomas","doi":"10.1097/01.aog.0000929852.03048.10","DOIUrl":"https://doi.org/10.1097/01.aog.0000929852.03048.10","url":null,"abstract":"INTRODUCTION: Herein, we report updated safety results to 36 months from an ongoing phase 3, 48-month study evaluating the long-term safety of elagolix (ELA) with add-back (AB) for endometriosis-associated pain (EAP) (NCT03213457). METHODS: Premenopausal women with moderate-to-severe EAP were randomized in this IRB-approved study 4:1:2 to receive 12-month blinded treatment with ELA 200 mg twice daily (BID)+AB, ELA 200 mg BID for 6 months followed by 6-month ELA+AB, or placebo; followed by open-label ELA+AB for all patients for 36 months. This 36-month analysis assessed long-term safety, including bone mineral density (BMD). RESULTS: Throughout the open-label treatment period up to 36 months, BMD mean percent change from baseline measurements remained relatively stable at the total hip and lumbar spine and showed a decrease between 1% and 2% in the femoral neck over the open-label period. At 36 months, mean percent change from baseline in BMD for patients treated with ELA+AB throughout the study was −0.77% (spine, n=94); −0.36% (total hip, n=92); and −1.39% (femoral neck, n=92). The overall safety profile of ELA+AB, including AEs and SAEs, observed up to 36 months of treatment continues to be consistent with that previously observed at 12 and 24 months. CONCLUSION: This was the longest evaluation of ELA+AB to date. ELA+AB continued to maintain a favorable safety profile with minimal long-term effect on BMD and no newly identified safety events to 36 months. Combined with previously reported efficacy data, these safety data suggest ELA+AB may provide a long-term therapeutic option for women with EAP beyond 24 months.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89658253","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}
INTRODUCTION: We sought to determine the effect of obstetrician–gynecologist characteristics on contraceptive recommendations for patients of various racial and socioeconomic backgrounds. METHODS: U.S. obstetrician–gynecologists were administered an online survey depicting photographic scenarios of reproductive-aged women of differing races (White, Black, Latina, Asian) and described socioeconomic status (SES) (high versus low), with all other factors identical, and asked to provide contraceptive recommendations. We used logistic regression to analyze recommendation differences based on physician and patient characteristics. Institutional review board approval was obtained. RESULTS: One hundred thirty-five total respondents were included: 55% attending physicians, 45% trainees (residents/fellows); 73% White, 27% non-White. Among all patients: Non-White physicians had significantly lower odds of recommending tubal (odds ratio [OR] 0.493), vaginal ring (OR 0.401), and patch (OR 0.513) compared to White physicians. Non-White physicians had significantly higher odds of recommending any long-acting reversible contraception (LARC) (OR 1.846) and condoms (OR 1.438) compared to White physicians. Trainees had significantly lower odds of recommending tubal (OR 0.632), condoms (OR 0.595), pills (OR 0.428), vaginal ring (OR 0.326), and patch (OR 0.536) compared to attendings. Trainees had significantly higher odds of recommending any LARC (OR 18.374) and medroxyprogesterone injection (OR 1.797) compared to attendings. All physicians had a significantly lower odds of recommending any self-administered contraceptive method to Black high-SES patients compared to White high-SES patients (OR 0.418). Other variations were noted but did not reach statistical significance. CONCLUSION: In our study, contraceptive recommendations differed by race and training level of the recommending physician and by patients' perceived race and SES. This suggests that physician bias contributes to contraceptive recommendations.
{"title":"Physician Characteristics Associated With Bias in Contraceptive Recommendations [ID: 1349236]","authors":"Natalie DiCenzo, Kristyn Brandi, Kylie Getz, Glenmarie Matthews","doi":"10.1097/01.aog.0000929760.23214.eb","DOIUrl":"https://doi.org/10.1097/01.aog.0000929760.23214.eb","url":null,"abstract":"INTRODUCTION: We sought to determine the effect of obstetrician–gynecologist characteristics on contraceptive recommendations for patients of various racial and socioeconomic backgrounds. METHODS: U.S. obstetrician–gynecologists were administered an online survey depicting photographic scenarios of reproductive-aged women of differing races (White, Black, Latina, Asian) and described socioeconomic status (SES) (high versus low), with all other factors identical, and asked to provide contraceptive recommendations. We used logistic regression to analyze recommendation differences based on physician and patient characteristics. Institutional review board approval was obtained. RESULTS: One hundred thirty-five total respondents were included: 55% attending physicians, 45% trainees (residents/fellows); 73% White, 27% non-White. Among all patients: Non-White physicians had significantly lower odds of recommending tubal (odds ratio [OR] 0.493), vaginal ring (OR 0.401), and patch (OR 0.513) compared to White physicians. Non-White physicians had significantly higher odds of recommending any long-acting reversible contraception (LARC) (OR 1.846) and condoms (OR 1.438) compared to White physicians. Trainees had significantly lower odds of recommending tubal (OR 0.632), condoms (OR 0.595), pills (OR 0.428), vaginal ring (OR 0.326), and patch (OR 0.536) compared to attendings. Trainees had significantly higher odds of recommending any LARC (OR 18.374) and medroxyprogesterone injection (OR 1.797) compared to attendings. All physicians had a significantly lower odds of recommending any self-administered contraceptive method to Black high-SES patients compared to White high-SES patients (OR 0.418). Other variations were noted but did not reach statistical significance. CONCLUSION: In our study, contraceptive recommendations differed by race and training level of the recommending physician and by patients' perceived race and SES. This suggests that physician bias contributes to contraceptive recommendations.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135095422","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.0000930388.39095.11
Yosra Elsayed, Beth Bailey, Elena Oatey
INTRODUCTION: COVID-19 poses health risks in pregnancy including increased rates of cesarean sections, preeclampsia, and miscarriage. However, less is known about newborn effects and the effect of severity of infection. We evaluated the link between pregnancy COVID-19 infection status and severity, and newborn outcomes. METHODS: Participants in this IRB-approved retrospective chart review study were identified via medical records from a single university-affiliated obstetric practice and grouped as COVID-19 positive during pregnancy (n=69), or COVID-19 negative delivering pre-COVID (n=59). Severity of infection was based on emergency department visit, hospitalization, oxygen treatment, steroids, antibodies, or ventilation. Information on socioeconomic factors, medical history, and birth outcomes was also abstracted. RESULTS: Compared to controls, and after adjustment for background differences, those with COVID-19 infection during pregnancy had newborns 242 g lighter and were 4.3 times more likely to deliver preterm, 2.6 times more likely to have a newborn with a 1-minute Apgar score less than 8, and 2.9 times more likely to remain hospitalized a week or more. Differences were largely driven by earlier delivery. Finally, severe COVID-19 infection (which occurred for 41% of participants with COVID-19) was a strong predictor of preterm delivery, low birth weight, receipt of oxygen, neonatal intensive care unit admission, and longer hospital stay. CONCLUSION: COVID-19 infection during pregnancy predicts adverse newborn outcomes, especially as a result of reduced gestational duration. Additionally, severity of infection may predict worse outcomes. A larger, more diverse sample is needed to confirm findings, and to examine potential effect of vaccination in reducing the effect of COVID-19 infection during pregnancy.
{"title":"Newborn Outcomes After Maternal COVID-19 Infection in Pregnancy and the Potential Role of Infection Severity [ID: 1373946]","authors":"Yosra Elsayed, Beth Bailey, Elena Oatey","doi":"10.1097/01.aog.0000930388.39095.11","DOIUrl":"https://doi.org/10.1097/01.aog.0000930388.39095.11","url":null,"abstract":"INTRODUCTION: COVID-19 poses health risks in pregnancy including increased rates of cesarean sections, preeclampsia, and miscarriage. However, less is known about newborn effects and the effect of severity of infection. We evaluated the link between pregnancy COVID-19 infection status and severity, and newborn outcomes. METHODS: Participants in this IRB-approved retrospective chart review study were identified via medical records from a single university-affiliated obstetric practice and grouped as COVID-19 positive during pregnancy (n=69), or COVID-19 negative delivering pre-COVID (n=59). Severity of infection was based on emergency department visit, hospitalization, oxygen treatment, steroids, antibodies, or ventilation. Information on socioeconomic factors, medical history, and birth outcomes was also abstracted. RESULTS: Compared to controls, and after adjustment for background differences, those with COVID-19 infection during pregnancy had newborns 242 g lighter and were 4.3 times more likely to deliver preterm, 2.6 times more likely to have a newborn with a 1-minute Apgar score less than 8, and 2.9 times more likely to remain hospitalized a week or more. Differences were largely driven by earlier delivery. Finally, severe COVID-19 infection (which occurred for 41% of participants with COVID-19) was a strong predictor of preterm delivery, low birth weight, receipt of oxygen, neonatal intensive care unit admission, and longer hospital stay. CONCLUSION: COVID-19 infection during pregnancy predicts adverse newborn outcomes, especially as a result of reduced gestational duration. Additionally, severity of infection may predict worse outcomes. A larger, more diverse sample is needed to confirm findings, and to examine potential effect of vaccination in reducing the effect of COVID-19 infection during pregnancy.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135095425","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.0000930540.06057.63
Anna Kheyfets, Claire Conklin, Ronald Iverson, Audra Meadows, Kali Vitek
INTRODUCTION: The Perinatal Neonatal Quality Improvement Network (PNQIN) of Massachusetts engaged hospital teams in a statewide improvement initiative to address maternal morbidity from obstetric hemorrhage (OB HEM) through support of implementation and adherence to best practices in screening for and diagnosis of OB HEM. METHODS: The Alliance for Innovation on Maternal Health (AIM) OB HEM bundle was adapted and implemented across hospitals in Massachusetts from June to December 2021. Each month, participating hospital teams joined educational webinars, learned quality improvement strategies, received access to resources for the intervention, and submitted data on six structure and five process measures. Severe maternal morbidity rates were provided using state hospital discharge data. Reliability of implementation was monitored by structure and process measure submission. Aggregate data were shared statewide. RESULTS: Fifty-three percent of birthing hospitals in the state (21 of 40) voluntarily participated. Baseline risk screening for OB HEM was 93% and quantitative blood loss measurement (QBL) was 60% in aggregate for all teams. Six participating hospitals reported all 11 measures monthly across the 6-month period. Half of these sites had all six structure measures in place at baseline and 83% reported completion of structure measures by the end of the study period. Among these six sites, the cumulative proportion QBL utilization increased 178% from 28% to 78% and documented OB HEM risk assessment during labor admission increased 8.4% from 83% to 90%. CONCLUSION: Implementation of the OB HEM bundle was effective in increasing adherence to evidence-based care among participating birth hospitals through a collaborative, quality improvement approach.
简介:马萨诸塞州围产期新生儿质量改善网络(PNQIN)在全州范围内开展了一项改善倡议，通过支持实施和遵守产科出血筛查和诊断的最佳实践，解决产科出血(OB HEM)的孕产妇发病率。方法:从2021年6月至12月，在马萨诸塞州的医院调整并实施了孕产妇健康创新联盟(AIM) OB HEM捆绑包。每个月，参与的医院团队参加教育网络研讨会，学习质量改进战略，获得干预资源，并提交关于六项结构和五项过程措施的数据。使用国家医院出院数据提供了严重产妇发病率。通过提交结构和过程测量来监测实施的可靠性。汇总数据在全州范围内共享。结果:该州53%的分娩医院(40家医院中的21家)自愿参与。所有团队OB HEM基线风险筛查率为93%，定量失血量测量(QBL)总计为60%。6家参与调查的医院在6个月期间每月报告所有11项指标。这些地点中有一半在基线时完成了所有六项结构测量，83%的人报告在研究期结束时完成了结构测量。在这6个地点中，QBL的累计利用率从28%增加到78%，增加了178%，分娩时记录的OB - HEM风险评估从83%增加到90%，增加了8.4%。结论:通过协作、质量改进的方法，实施OB - HEM一揽子计划有效地提高了参与分娩医院对循证护理的依从性。
{"title":"Promoting Best Practice in Obstetrics: Findings From a State-Based Perinatal Quality Collaborative Implementing the Obstetric Hemorrhage Maternal Safety Bundle [ID: 1377611]","authors":"Anna Kheyfets, Claire Conklin, Ronald Iverson, Audra Meadows, Kali Vitek","doi":"10.1097/01.aog.0000930540.06057.63","DOIUrl":"https://doi.org/10.1097/01.aog.0000930540.06057.63","url":null,"abstract":"INTRODUCTION: The Perinatal Neonatal Quality Improvement Network (PNQIN) of Massachusetts engaged hospital teams in a statewide improvement initiative to address maternal morbidity from obstetric hemorrhage (OB HEM) through support of implementation and adherence to best practices in screening for and diagnosis of OB HEM. METHODS: The Alliance for Innovation on Maternal Health (AIM) OB HEM bundle was adapted and implemented across hospitals in Massachusetts from June to December 2021. Each month, participating hospital teams joined educational webinars, learned quality improvement strategies, received access to resources for the intervention, and submitted data on six structure and five process measures. Severe maternal morbidity rates were provided using state hospital discharge data. Reliability of implementation was monitored by structure and process measure submission. Aggregate data were shared statewide. RESULTS: Fifty-three percent of birthing hospitals in the state (21 of 40) voluntarily participated. Baseline risk screening for OB HEM was 93% and quantitative blood loss measurement (QBL) was 60% in aggregate for all teams. Six participating hospitals reported all 11 measures monthly across the 6-month period. Half of these sites had all six structure measures in place at baseline and 83% reported completion of structure measures by the end of the study period. Among these six sites, the cumulative proportion QBL utilization increased 178% from 28% to 78% and documented OB HEM risk assessment during labor admission increased 8.4% from 83% to 90%. CONCLUSION: Implementation of the OB HEM bundle was effective in increasing adherence to evidence-based care among participating birth hospitals through a collaborative, quality improvement approach.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135095426","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.0000930916.29468.5a
Katherine Lambert, Jennifer Cate, Sarah Dotters-Katz, Matthew Grace, Anne West Honart
INTRODUCTION: Antibiotics administered when membranes rupture (ROM) after viability increase latency to delivery. This may also be true in previable prelabor preterm rupture of membranes (pPPROM). This study assesses the effect of prophylactic antibiotics on latency in individuals with pPPROM. METHODS: Retrospective cohort of pregnancies with pPPROM less than 23 weeks 0 days in a single health system (2013–2022). Patients opting for termination or with contraindication to expectant management were excluded. Prophylactic antibiotic administration (48 hours IV azithromycin/ampicillin followed by 5 days oral amoxicillin) was at clinician discretion. The primary outcome was latency (weeks) from diagnosed pPPROM to delivery. Secondary outcomes included maternal and neonatal morbidity and mortality. Bivariate statistics compared patients who did and did not receive antibiotics. Kaplan-Meier/Cox proportional hazards ratio using significant covariates ( P <.1) in bivariate analysis models antibiotic effect on latency. RESULTS: Ninety-three patients had pPPROM; 46 (49%) met inclusion criteria. Thirty-four (74%) received prophylactic antibiotics. Median gestational age (GA) at ROM trended later among those who received antibiotics (22.0 weeks [20.6, 22.4] versus 20.9 weeks [19.6, 21.7], P =.09). Median latency (interquartile range) did not differ with antibiotic receipt (1 week [0.4, 2.6] versus 0.6 weeks [0.3, 0.9], P =.27). When adjusted for GA at ROM, antibiotics were not associated with longer latency (hazard ratio 1.33 [0.91, 1.93]). Antibiotic receipt was associated with lower rates of previable delivery (23.0 weeks [22.7, 24.0] versus 21.3 weeks [20.5, 23.1], P =.006). After controlling for GA at ROM, adjusted odds of previable delivery remained lower with receipt of antibiotics (adjusted odds ratio 0.20 [0.04, 0.90]). CONCLUSION: Antibiotics at the time of pPPROM were not associated with longer latency but, after controlling for confounders, did increase the odds of delivering after viability. Further study should address optimal antibiotics strategies for this unique population.
{"title":"The Effect of Antibiotics on Latency When Given at the Time of Membrane Rupture Prior to Viability [ID: 1357946]","authors":"Katherine Lambert, Jennifer Cate, Sarah Dotters-Katz, Matthew Grace, Anne West Honart","doi":"10.1097/01.aog.0000930916.29468.5a","DOIUrl":"https://doi.org/10.1097/01.aog.0000930916.29468.5a","url":null,"abstract":"INTRODUCTION: Antibiotics administered when membranes rupture (ROM) after viability increase latency to delivery. This may also be true in previable prelabor preterm rupture of membranes (pPPROM). This study assesses the effect of prophylactic antibiotics on latency in individuals with pPPROM. METHODS: Retrospective cohort of pregnancies with pPPROM less than 23 weeks 0 days in a single health system (2013–2022). Patients opting for termination or with contraindication to expectant management were excluded. Prophylactic antibiotic administration (48 hours IV azithromycin/ampicillin followed by 5 days oral amoxicillin) was at clinician discretion. The primary outcome was latency (weeks) from diagnosed pPPROM to delivery. Secondary outcomes included maternal and neonatal morbidity and mortality. Bivariate statistics compared patients who did and did not receive antibiotics. Kaplan-Meier/Cox proportional hazards ratio using significant covariates ( P <.1) in bivariate analysis models antibiotic effect on latency. RESULTS: Ninety-three patients had pPPROM; 46 (49%) met inclusion criteria. Thirty-four (74%) received prophylactic antibiotics. Median gestational age (GA) at ROM trended later among those who received antibiotics (22.0 weeks [20.6, 22.4] versus 20.9 weeks [19.6, 21.7], P =.09). Median latency (interquartile range) did not differ with antibiotic receipt (1 week [0.4, 2.6] versus 0.6 weeks [0.3, 0.9], P =.27). When adjusted for GA at ROM, antibiotics were not associated with longer latency (hazard ratio 1.33 [0.91, 1.93]). Antibiotic receipt was associated with lower rates of previable delivery (23.0 weeks [22.7, 24.0] versus 21.3 weeks [20.5, 23.1], P =.006). After controlling for GA at ROM, adjusted odds of previable delivery remained lower with receipt of antibiotics (adjusted odds ratio 0.20 [0.04, 0.90]). CONCLUSION: Antibiotics at the time of pPPROM were not associated with longer latency but, after controlling for confounders, did increase the odds of delivering after viability. Further study should address optimal antibiotics strategies for this unique population.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135095427","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.0000930208.00402.a6
Jamie Krashin, Patricia Black, Eric Brannen, Charlotte Gard, Yan Lin, Courtney Schreiber
INTRODUCTION: Little is known about availability of evidence-based early pregnancy loss (EPL) treatment in emergency departments (EDs), where patients often first seek care. We evaluated geographic access to mifepristone/misoprostol and uterine aspiration in New Mexican hospitals. METHODS: We used an enhanced two-step floating catchment area method to model accessibility from census block groups’ population-weighted centroids to hospitals. Our primary outcome was access to mifepristone/misoprostol and uterine aspiration in EDs; our secondary outcome was access to in-hospital aspiration, both outcomes defined as less than a 60-minute commute. We surveyed all EDs in New Mexico and used public databases to compute census block groups’ demographic, transportation, rurality, and area deprivation data. We used logistic regression to evaluate the associations between access and race and ethnicity, area deprivation, and rural location. The University of New Mexico IRB approved this study. RESULTS: Thirty-five (83%) of 42 hospitals responded. Two (6%) provided in-ED treatment, and 24 (69%) in-hospital aspiration. Half of reproductive-aged women had access to in-ED treatment, and 90% to in-hospital aspiration. Census block groups with higher quartile proportions of American Indian/Native Alaskan reproductive-aged women had higher adjusted odds ratios of accessing in-ED treatment (2.5–7.3, P <.05). Rural areas and higher area deprivation quartiles had lower in-ED access adjusted odds ratios (0.03–0.07 [ P <.05] and 0.3–0.4 [ P <.05], respectively) compared with urban and lower area deprivation quartiles. In-hospital aspiration results were similar to in-ED treatment results across all categories. CONCLUSION: By prioritizing rural areas and areas with higher socioeconomic deprivation, EPL treatment implementation efforts can improve equitable care access and equity for patients.
{"title":"Geospatial Analysis of Access to Evidence-Based Early Pregnancy Loss Management in New Mexico [ID: 1377363]","authors":"Jamie Krashin, Patricia Black, Eric Brannen, Charlotte Gard, Yan Lin, Courtney Schreiber","doi":"10.1097/01.aog.0000930208.00402.a6","DOIUrl":"https://doi.org/10.1097/01.aog.0000930208.00402.a6","url":null,"abstract":"INTRODUCTION: Little is known about availability of evidence-based early pregnancy loss (EPL) treatment in emergency departments (EDs), where patients often first seek care. We evaluated geographic access to mifepristone/misoprostol and uterine aspiration in New Mexican hospitals. METHODS: We used an enhanced two-step floating catchment area method to model accessibility from census block groups’ population-weighted centroids to hospitals. Our primary outcome was access to mifepristone/misoprostol and uterine aspiration in EDs; our secondary outcome was access to in-hospital aspiration, both outcomes defined as less than a 60-minute commute. We surveyed all EDs in New Mexico and used public databases to compute census block groups’ demographic, transportation, rurality, and area deprivation data. We used logistic regression to evaluate the associations between access and race and ethnicity, area deprivation, and rural location. The University of New Mexico IRB approved this study. RESULTS: Thirty-five (83%) of 42 hospitals responded. Two (6%) provided in-ED treatment, and 24 (69%) in-hospital aspiration. Half of reproductive-aged women had access to in-ED treatment, and 90% to in-hospital aspiration. Census block groups with higher quartile proportions of American Indian/Native Alaskan reproductive-aged women had higher adjusted odds ratios of accessing in-ED treatment (2.5–7.3, P <.05). Rural areas and higher area deprivation quartiles had lower in-ED access adjusted odds ratios (0.03–0.07 [ P <.05] and 0.3–0.4 [ P <.05], respectively) compared with urban and lower area deprivation quartiles. In-hospital aspiration results were similar to in-ED treatment results across all categories. CONCLUSION: By prioritizing rural areas and areas with higher socioeconomic deprivation, EPL treatment implementation efforts can improve equitable care access and equity for patients.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135096058","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.0000930020.37123.0c
Jennifer Wong, Olga Ramm, Shayna Vega, Miranda Weintraub, Richie Houhong Xu, Eve Zaritsky
INTRODUCTION: Testosterone-induced vaginal atrophy is hypothesized to increase the risk of vaginal cuff dehiscence (VCD); however, current studies are limited and conflicting. This study compares risk of VCD among gender-diverse people on testosterone (GDT) and ciswomen (CW) and evaluates factors associated with VCD. METHODS: An IRB-approved retrospective cohort study was conducted among adults who underwent total hysterectomy (June 1, 2014 to December 31, 2019) for benign indications at Kaiser Permanente Northern California. Patients had 6 months postoperative follow-up, and GDT had greater than 6 months testosterone use prior to hysterectomy. Differences between GDT and CW were evaluated using Wald χ 2 , Fisher’s exact, Student’s t test, or Kruskal–Wallis tests. Unadjusted logistic regression was conducted to estimate odds ratios (OR) for VCD. RESULTS: The cohort (n=22,109) included 154 (0.7%) GDT and 21,995 (99.3%) CW. GDT were younger (median 27 [interquartile range (IQR) 22–36] versus 47 [IQR 42–52] years, P <.001) and had lower proportion with Charlson Comorbidity Index (CCI) greater than or equal to 1 (18.2% versus 27.1%, P =.013) than CW. A greater proportion of GDT experienced VCD (5.8% versus 2.5%, P <.016; OR 2.42, 95% CI 1.23–4.77, P =.011). Patients with CCI greater than or equal to 1 or had hypertension were associated with 25% (95% CI 4–50%, P =.015) and 41% (95% CI 18–68%, P <.001) higher odds of VCD, respectively. CONCLUSION: The odds of VCD was 2.4 times higher in GDT despite being younger and healthier than CW. Charlson Comorbidity Index of 1 or higher and hypertension were also associated with higher risk of VCD. These findings support the theory of testosterone-induced vaginal atrophy as a risk factor for VCD. Additional studies are needed to better understand the pathophysiology of VCD among GDT and prevent this morbid complication.
简介:睾酮诱导的阴道萎缩被认为会增加阴道袖带破裂(VCD)的风险;然而，目前的研究是有限和相互矛盾的。本研究比较了不同性别的睾酮(GDT)和顺性女性(CW)患VCD的风险，并评估了与VCD相关的因素。方法:一项经irb批准的回顾性队列研究在Kaiser Permanente北加州进行了良性适应症的全子宫切除术(2014年6月1日至2019年12月31日)的成年人中进行。患者术后随访6个月，GDT在子宫切除术前使用睾酮超过6个月。使用Wald χ 2、Fisher精确检验、Student t检验或Kruskal-Wallis检验评估GDT和CW之间的差异。采用未经校正的逻辑回归来估计VCD的优势比(OR)。结果:该队列(n= 22109)包括154例(0.7%)GDT和21995例(99.3%)CW。GDT患者较年轻(中位数为27[四分位数间距(IQR) 22-36]对47 [IQR 42-52]岁，P < 001)，且Charlson共病指数(CCI)大于或等于1的比例较CW患者低(18.2%对27.1%，P = 0.013)。GDT经历VCD的比例更高(5.8% vs 2.5%， P <或2.42,95% ci 1.23-4.77, p = 0.011)。CCI大于等于1或有高血压的患者发生VCD的几率分别增加25% (95% CI 4-50%， P = 0.015)和41% (95% CI 18-68%， P < 0.001)。结论:GDT患者年轻健康，但VCD的发生率是CW患者的2.4倍。Charlson合并症指数≥1和高血压也与VCD的高风险相关。这些发现支持睾酮诱导的阴道萎缩是VCD危险因素的理论。需要进一步的研究来更好地了解GDT中VCD的病理生理学和预防这种病态并发症。
{"title":"Increased Vaginal Cuff Dehiscence Among Gender-Diverse People on Testosterone [ID: 1377373]","authors":"Jennifer Wong, Olga Ramm, Shayna Vega, Miranda Weintraub, Richie Houhong Xu, Eve Zaritsky","doi":"10.1097/01.aog.0000930020.37123.0c","DOIUrl":"https://doi.org/10.1097/01.aog.0000930020.37123.0c","url":null,"abstract":"INTRODUCTION: Testosterone-induced vaginal atrophy is hypothesized to increase the risk of vaginal cuff dehiscence (VCD); however, current studies are limited and conflicting. This study compares risk of VCD among gender-diverse people on testosterone (GDT) and ciswomen (CW) and evaluates factors associated with VCD. METHODS: An IRB-approved retrospective cohort study was conducted among adults who underwent total hysterectomy (June 1, 2014 to December 31, 2019) for benign indications at Kaiser Permanente Northern California. Patients had 6 months postoperative follow-up, and GDT had greater than 6 months testosterone use prior to hysterectomy. Differences between GDT and CW were evaluated using Wald χ 2 , Fisher’s exact, Student’s t test, or Kruskal–Wallis tests. Unadjusted logistic regression was conducted to estimate odds ratios (OR) for VCD. RESULTS: The cohort (n=22,109) included 154 (0.7%) GDT and 21,995 (99.3%) CW. GDT were younger (median 27 [interquartile range (IQR) 22–36] versus 47 [IQR 42–52] years, P <.001) and had lower proportion with Charlson Comorbidity Index (CCI) greater than or equal to 1 (18.2% versus 27.1%, P =.013) than CW. A greater proportion of GDT experienced VCD (5.8% versus 2.5%, P <.016; OR 2.42, 95% CI 1.23–4.77, P =.011). Patients with CCI greater than or equal to 1 or had hypertension were associated with 25% (95% CI 4–50%, P =.015) and 41% (95% CI 18–68%, P <.001) higher odds of VCD, respectively. CONCLUSION: The odds of VCD was 2.4 times higher in GDT despite being younger and healthier than CW. Charlson Comorbidity Index of 1 or higher and hypertension were also associated with higher risk of VCD. These findings support the theory of testosterone-induced vaginal atrophy as a risk factor for VCD. Additional studies are needed to better understand the pathophysiology of VCD among GDT and prevent this morbid complication.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135096061","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.0000931224.33139.dc
David Boedeker, Lindsay Chatfield, Rene MacKinnon, Amanda Owens
INTRODUCTION: Simulation has rapidly expanded in obstetrics and gynecology for teaching medical knowledge, surgical skills, and maintenance of certification. Low-fidelity simulations are typically lower cost to produce and have been proven beneficial for surgical training. METHODS: The Junior Fellows of the American College of Obstetricians and Gynecologists District X created a competition at their Annual District Meeting in October 2022. All nine residency programs submitted and showcased a low-cost, novel simulation in obstetrics and gynecology at a 1-hour event open to all attendees. After IRB exemption was obtained, a postevent survey was completed by the participants at the event. RESULTS: A total of 77 individuals completed our postevent survey (medical students 12.99%, residents 58.44%, staff or fellows 28.57%). The majority of respondents felt simulation is valuable to ob-gyn training (96.10%). All respondents reported they would like to see the event repeated at future Annual District Meetings. The majority of resident responders reported they would be very likely (79.07%) or likely (18.60%) to use one of the simulations presented at the festival in future teaching or training. Fifteen respondents were involved in creating a simulation for the festival. Most simulations were very easy (60.00%) or easy (33.33%) to make, and all were reported to be very reproducible (100.00%). CONCLUSION: This unique event for Junior Fellows was successful in fostering innovative, low-cost, low-fidelity, highly reproducible simulations in obstetrics and gynecology. Our goals are to continue this event in future years, expand to other districts, foster reproduction of simulations at residency programs and medical schools, and support the publication of novel ideas.
{"title":"A Novel, Low-Fidelity, Low-Cost Residency “Simulation Festival” Competition: An Opportunity for Scholarly Innovation [ID: 1381241]","authors":"David Boedeker, Lindsay Chatfield, Rene MacKinnon, Amanda Owens","doi":"10.1097/01.aog.0000931224.33139.dc","DOIUrl":"https://doi.org/10.1097/01.aog.0000931224.33139.dc","url":null,"abstract":"INTRODUCTION: Simulation has rapidly expanded in obstetrics and gynecology for teaching medical knowledge, surgical skills, and maintenance of certification. Low-fidelity simulations are typically lower cost to produce and have been proven beneficial for surgical training. METHODS: The Junior Fellows of the American College of Obstetricians and Gynecologists District X created a competition at their Annual District Meeting in October 2022. All nine residency programs submitted and showcased a low-cost, novel simulation in obstetrics and gynecology at a 1-hour event open to all attendees. After IRB exemption was obtained, a postevent survey was completed by the participants at the event. RESULTS: A total of 77 individuals completed our postevent survey (medical students 12.99%, residents 58.44%, staff or fellows 28.57%). The majority of respondents felt simulation is valuable to ob-gyn training (96.10%). All respondents reported they would like to see the event repeated at future Annual District Meetings. The majority of resident responders reported they would be very likely (79.07%) or likely (18.60%) to use one of the simulations presented at the festival in future teaching or training. Fifteen respondents were involved in creating a simulation for the festival. Most simulations were very easy (60.00%) or easy (33.33%) to make, and all were reported to be very reproducible (100.00%). CONCLUSION: This unique event for Junior Fellows was successful in fostering innovative, low-cost, low-fidelity, highly reproducible simulations in obstetrics and gynecology. Our goals are to continue this event in future years, expand to other districts, foster reproduction of simulations at residency programs and medical schools, and support the publication of novel ideas.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135096063","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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