Pub Date : 2023-05-01DOI: 10.1097/01.aog.0000930048.52342.92
Charlotte Orzolek, Danielle E. Durie, Amanda B. Flicker, Alexa Giacobbo, J. Quinones, E. Qureshey
INTRODUCTION: The objective of this study was to determine the difference in milliliters between calculated blood loss (CBL) and two measurement techniques: estimated blood loss (EBL) versus quantitative blood loss (QBL) for cesarean deliveries. METHODS: This was a retrospective cohort study at a tertiary hospital examining blood loss from singleton, term cesarean births. EBL and QBL groups contained 6 separate months of deliveries. Measurements were compared to a standard CBL: (0.75 × {[maternal height (inches)×50]+[maternal weight in pounds×25]}) by percent of blood volume lost ({predelivery HCT – postdelivery HCT}/predelivery HCT). Values of CBL − recorded blood loss=0 mL represented a more accurate measurement. Blood product transfusion was also compared. RESULTS: Median CBL did not differ between EBL (n=460) and QBL (n=507) groups: 836 mL (interquartile range [IQR] 566–1,135) versus 839 mL (IQR 608–1,175, P=.363). Reported blood loss was not different between EBL and QBL groups: 700 (IQR 600–800) mL and 677 (IQR 479–981, P=.501) mL, respectively. Differences between the CBL and recorded blood loss was larger in the EBL group (172 [IQR –101 to 474] mL) than the QBL group (−106 [IQR –379 to 118] mL), with P<.001. Transfusion rates did not differ between groups (P=.789). CONCLUSION: The positive value of 172 mL suggests that EBL is an underestimation of CBL, while the negative value of −106 mL suggests QBL is a slight overestimation, although a better approximator of CBL. These data offer insight into quantifiable value differences between EBL and QBL, which may be used in future investigation to adequately power studies that evaluate blood measurements techniques and influences on clinical decision-making.
{"title":"Quantitative Blood Loss in Cesarean Delivery Is More Accurate Than Visual Estimation [ID: 1376884]","authors":"Charlotte Orzolek, Danielle E. Durie, Amanda B. Flicker, Alexa Giacobbo, J. Quinones, E. Qureshey","doi":"10.1097/01.aog.0000930048.52342.92","DOIUrl":"https://doi.org/10.1097/01.aog.0000930048.52342.92","url":null,"abstract":"INTRODUCTION: The objective of this study was to determine the difference in milliliters between calculated blood loss (CBL) and two measurement techniques: estimated blood loss (EBL) versus quantitative blood loss (QBL) for cesarean deliveries. METHODS: This was a retrospective cohort study at a tertiary hospital examining blood loss from singleton, term cesarean births. EBL and QBL groups contained 6 separate months of deliveries. Measurements were compared to a standard CBL: (0.75 × {[maternal height (inches)×50]+[maternal weight in pounds×25]}) by percent of blood volume lost ({predelivery HCT – postdelivery HCT}/predelivery HCT). Values of CBL − recorded blood loss=0 mL represented a more accurate measurement. Blood product transfusion was also compared. RESULTS: Median CBL did not differ between EBL (n=460) and QBL (n=507) groups: 836 mL (interquartile range [IQR] 566–1,135) versus 839 mL (IQR 608–1,175, P=.363). Reported blood loss was not different between EBL and QBL groups: 700 (IQR 600–800) mL and 677 (IQR 479–981, P=.501) mL, respectively. Differences between the CBL and recorded blood loss was larger in the EBL group (172 [IQR –101 to 474] mL) than the QBL group (−106 [IQR –379 to 118] mL), with P<.001. Transfusion rates did not differ between groups (P=.789). CONCLUSION: The positive value of 172 mL suggests that EBL is an underestimation of CBL, while the negative value of −106 mL suggests QBL is a slight overestimation, although a better approximator of CBL. These data offer insight into quantifiable value differences between EBL and QBL, which may be used in future investigation to adequately power studies that evaluate blood measurements techniques and influences on clinical decision-making.","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":"88598898","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.0000930456.01286.8e
Xuezhi Jiang, Jonathan Rodger, G. Tegos, Rebecca Wu
INTRODUCTION: On occasion, obstetricians encounter difficulty delivering the floating fetal head at cesarean section; additional techniques may need to be employed beyond the traditional one-handed delivery technique. We propose a modified two-handed manual delivery method or “hand forceps,” with surgeon’s both hands shaped like a pair of forceps, as an alternative technique for fetal head delivery. The purpose of this study is to compare the efficacy and safety of two-handed technique by comparing with the traditional one-handed technique. METHODS: We conducted a randomized pilot study of women undergoing cesarean section (NCT04159857, ClinicalTrials.gov). Inclusion criteria included a singleton in cephalic presentation, at gestational age of 37 weeks or greater, with planned low transverse uterine incision, cervical dilation of 6 cm or lower and station less than −3. Patients were randomized to either the one-handed or two-handed delivery group. The primary outcome was “U-D interval,” defined as the time from entry of the hands into the uterus to the delivery of the fetal head. The secondary outcome was incidence of hysterotomy extension. Neonatal safety data were also collected. RESULTS: A total of 40 patients participated in the study; 16 randomized to the one-handed group, 19 randomized to the two-handed group, and 5 patients excluded because of protocol deviation. U-D interval (mean±SD) was significantly shorter in the two-handed group (6.0±7.4 seconds) than in the one-handed group (14.3±9.9 seconds), P<.001. There was no significant difference in incidence of hysterotomy extension, maternal and neonatal outcomes between the two groups. CONCLUSION: The two-handed method for fetal head delivery has a significantly decreased U-D interval compared to the one-handed method, without increasing the incidence of hysterotomy extension. A large-scale multicenter randomized controlled study is needed to further determine whether the “hand forceps” can be considered a safe alternative technique for delivery of the floating fetal head in cesarean sections.
{"title":"Hand Forceps for Delivery of Floating Fetal Head at Cesarean Section: A Randomized Pilot Study [ID: 1375984]","authors":"Xuezhi Jiang, Jonathan Rodger, G. Tegos, Rebecca Wu","doi":"10.1097/01.AOG.0000930456.01286.8e","DOIUrl":"https://doi.org/10.1097/01.AOG.0000930456.01286.8e","url":null,"abstract":"INTRODUCTION: On occasion, obstetricians encounter difficulty delivering the floating fetal head at cesarean section; additional techniques may need to be employed beyond the traditional one-handed delivery technique. We propose a modified two-handed manual delivery method or “hand forceps,” with surgeon’s both hands shaped like a pair of forceps, as an alternative technique for fetal head delivery. The purpose of this study is to compare the efficacy and safety of two-handed technique by comparing with the traditional one-handed technique. METHODS: We conducted a randomized pilot study of women undergoing cesarean section (NCT04159857, ClinicalTrials.gov). Inclusion criteria included a singleton in cephalic presentation, at gestational age of 37 weeks or greater, with planned low transverse uterine incision, cervical dilation of 6 cm or lower and station less than −3. Patients were randomized to either the one-handed or two-handed delivery group. The primary outcome was “U-D interval,” defined as the time from entry of the hands into the uterus to the delivery of the fetal head. The secondary outcome was incidence of hysterotomy extension. Neonatal safety data were also collected. RESULTS: A total of 40 patients participated in the study; 16 randomized to the one-handed group, 19 randomized to the two-handed group, and 5 patients excluded because of protocol deviation. U-D interval (mean±SD) was significantly shorter in the two-handed group (6.0±7.4 seconds) than in the one-handed group (14.3±9.9 seconds), P<.001. There was no significant difference in incidence of hysterotomy extension, maternal and neonatal outcomes between the two groups. CONCLUSION: The two-handed method for fetal head delivery has a significantly decreased U-D interval compared to the one-handed method, without increasing the incidence of hysterotomy extension. A large-scale multicenter randomized controlled study is needed to further determine whether the “hand forceps” can be considered a safe alternative technique for delivery of the floating fetal head in cesarean sections.","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":"87367003","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.0000929692.26526.7b
Karen Fassett, S. Combs
INTRODUCTION: Vulvar aphthous ulcers are uncommon, non-sexually transmitted genital lesions that typically arise in adolescents and young women after viral infection. The pathogenesis of this condition is poorly understood but is thought to arise from an immune-mediated process. More recently, there have been several reports of vulvar aphthosis after COVID-19 infection, and to date, we have identified five case reports describing the development of this condition within days of receiving one of the existing U.S. Food and Drug Administration-approved mRNA COVID-19 vaccines. METHODS: We present the cases of two adolescents, aged 13 and 16 years, who both developed acute genital aphthous ulcers within days of their second Pfizer-BioNTech COVID-19 vaccinations with no other apparent triggers. CONCLUSION: These two cases represent a growing number of patients who have developed acute genital ulceration (AGU) in close temporal proximity to COVID-19 vaccination, which represents a potential novel etiology for this uncommon condition. If vaccination is indeed a trigger for AGU, this may support an immune-mediated pathogenesis, although future studies are needed to explore this further. The continued publication of high-quality case reports describing AGU will allow us to gather enough data to make statistical inferences and to raise awareness for this condition, which is underrecognized and often misdiagnosed by providers.
{"title":"Acute Vulvar Aphthous (Lipschütz) Ulcer After COVID-19 Vaccine: Two Cases [ID: 1337743]","authors":"Karen Fassett, S. Combs","doi":"10.1097/01.aog.0000929692.26526.7b","DOIUrl":"https://doi.org/10.1097/01.aog.0000929692.26526.7b","url":null,"abstract":"INTRODUCTION: Vulvar aphthous ulcers are uncommon, non-sexually transmitted genital lesions that typically arise in adolescents and young women after viral infection. The pathogenesis of this condition is poorly understood but is thought to arise from an immune-mediated process. More recently, there have been several reports of vulvar aphthosis after COVID-19 infection, and to date, we have identified five case reports describing the development of this condition within days of receiving one of the existing U.S. Food and Drug Administration-approved mRNA COVID-19 vaccines. METHODS: We present the cases of two adolescents, aged 13 and 16 years, who both developed acute genital aphthous ulcers within days of their second Pfizer-BioNTech COVID-19 vaccinations with no other apparent triggers. CONCLUSION: These two cases represent a growing number of patients who have developed acute genital ulceration (AGU) in close temporal proximity to COVID-19 vaccination, which represents a potential novel etiology for this uncommon condition. If vaccination is indeed a trigger for AGU, this may support an immune-mediated pathogenesis, although future studies are needed to explore this further. The continued publication of high-quality case reports describing AGU will allow us to gather enough data to make statistical inferences and to raise awareness for this condition, which is underrecognized and often misdiagnosed by providers.","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":"85979858","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.0000930620.16656.fa
Lauren Gimbel, Ann Bruno, Joshua Horns, Niraj Paudel, Robert Silver, Marcela Smid
INTRODUCTION: The objective of this study was to evaluate pharmacologic and psychotherapy treatment among individuals with postpartum depression or anxiety living in urban versus rural areas of the United States. METHODS: We performed a retrospective cohort study of individuals diagnosed with postpartum depression or anxiety within 12 months of delivery from 2011 to 2020 in the MarketScan Commercial Research Database. Individuals with postpartum depression and anxiety were identified using International Classification of Diseases codes. Individuals previously receiving treatment were excluded. The exposure, urban residence, was determined by residence in a metropolitan statistical area. The primary outcome was a composite of pharmacologic and psychotherapy treatment. Secondary outcomes included components of the primary outcome and time from delivery to first prescription fill. Multivariable modeling adjusted for clinically relevant confounders including history of depression or anxiety. Sensitivity analysis included individuals with prior treatment. RESULTS: Of 1,602,058 individuals included, 1,415,793 (88%) had urban residence. Individuals with postpartum depression or anxiety residing in urban areas were less likely to receive treatment (adjusted hazard ratio [aHR] 0.86, 95% CI 0.85–0.88) than those residing in rural areas, including pharmacologic (aHR 0.75, 95% CI 0.73–0.77), and psychotherapy (aHR 0.94, 95% CI 0.92–0.96). Fifty percent of individuals filled a prescription by 107 days from delivery in urban compared to 100 days in rural areas. Results were similar in sensitivity analysis. CONCLUSION: Urban-residing individuals with postpartum depression or anxiety were less likely to receive pharmacologic or psychotherapy treatment than rural-residing individuals in this U.S. cohort. Future studies evaluating reasons for treatment differences are warranted.
{"title":"Differences in Rural and Urban Treatment of Postpartum Depression and Anxiety in the United States [ID: 1377353]","authors":"Lauren Gimbel, Ann Bruno, Joshua Horns, Niraj Paudel, Robert Silver, Marcela Smid","doi":"10.1097/01.aog.0000930620.16656.fa","DOIUrl":"https://doi.org/10.1097/01.aog.0000930620.16656.fa","url":null,"abstract":"INTRODUCTION: The objective of this study was to evaluate pharmacologic and psychotherapy treatment among individuals with postpartum depression or anxiety living in urban versus rural areas of the United States. METHODS: We performed a retrospective cohort study of individuals diagnosed with postpartum depression or anxiety within 12 months of delivery from 2011 to 2020 in the MarketScan Commercial Research Database. Individuals with postpartum depression and anxiety were identified using International Classification of Diseases codes. Individuals previously receiving treatment were excluded. The exposure, urban residence, was determined by residence in a metropolitan statistical area. The primary outcome was a composite of pharmacologic and psychotherapy treatment. Secondary outcomes included components of the primary outcome and time from delivery to first prescription fill. Multivariable modeling adjusted for clinically relevant confounders including history of depression or anxiety. Sensitivity analysis included individuals with prior treatment. RESULTS: Of 1,602,058 individuals included, 1,415,793 (88%) had urban residence. Individuals with postpartum depression or anxiety residing in urban areas were less likely to receive treatment (adjusted hazard ratio [aHR] 0.86, 95% CI 0.85–0.88) than those residing in rural areas, including pharmacologic (aHR 0.75, 95% CI 0.73–0.77), and psychotherapy (aHR 0.94, 95% CI 0.92–0.96). Fifty percent of individuals filled a prescription by 107 days from delivery in urban compared to 100 days in rural areas. Results were similar in sensitivity analysis. CONCLUSION: Urban-residing individuals with postpartum depression or anxiety were less likely to receive pharmacologic or psychotherapy treatment than rural-residing individuals in this U.S. cohort. Future studies evaluating reasons for treatment differences are warranted.","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":"135095270","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: The objective of this study was to describe sociodemographic and clinical characteristics of patients who “no-show” urogynecology appointments and identify risk factors for “no-show” appointments. METHODS: We conducted an IRB-approved prospective chart review study of women aged 18 years or older scheduled for a urogynecology appointment at four outpatient clinical sites associated with an urban academic tertiary care referral center over 4 months. Patients were included in the no-show group if they did not show up for their appointment or cancelled their appointment the same day. For a comparison group, the patient immediately prior to or after the one who “no-showed” with the same visit type was included. Logistic regression was used to identify risk factors for “no-show” appointments. RESULTS: Four hundred twenty-six women were included, 213 in both the no-show and show groups. Women who “no-showed” were younger (median age 60 [interquartile range (IQR) 47–72] versus 69 [IQR 59–78], P <.001). More women in the no-show group were Hispanic (24.4% versus 13.1%) and non-Hispanic Black (7.51% versus 3.76%, P =.0093), had Medicaid (17.4% versus 6.57%, P =.0006), no-showed a previous appointment (24.9% versus 11.7% P =.0005), had to wait longer for an appointment (median 39 days [IQR 23.5–55.5] versus 30.5 days [IQR 12.8–47.0], P =.002), and made appointments for urinary incontinence (44.1% versus 26.8%, P =.0002). On multivariate logistic regression, women with Medicaid had significantly higher odds of “no-showing” their appointment (adjusted odds ratio, 2.11 [1.04–4.48], P =.0440). CONCLUSION: Women with Medicaid are particularly likely to “no-show” urogynecology appointments. Further research is needed to identify and address potential barriers this group faces when accessing care.
前言:本研究的目的是描述“未到”泌尿妇科预约的患者的社会人口学和临床特征，并确定“未到”预约的危险因素。方法:我们进行了一项经irb批准的前瞻性图表回顾研究，研究对象为18岁或以上的女性，她们在一家城市三级学术转诊中心的4个门诊诊所接受泌尿妇科预约，时间超过4个月。如果患者当天没有赴约或取消了预约，他们就被归为“未赴约组”。作为比较组，在同一就诊类型的“不来”患者之前或之后的患者被包括在内。使用逻辑回归来确定“未赴约”的风险因素。结果:共纳入426名女性，其中不出席组和出席组各213名。“缺席”的女性更年轻(中位年龄为60岁[四分位间距(IQR) 47-72]对69岁[IQR 59-78]， P < 0.001)。未就诊组中更多的女性是西班牙裔(24.4%比13.1%)和非西班牙裔黑人(7.51%比3.76%，P = 0.0093)，有医疗保险(17.4%比6.57%，P = 0.0006)，未就诊(24.9%比11.7% P = 0.0005)，等待就诊时间更长(中位数为39天[IQR 23.5-55.5]比30.5天[IQR 12.8-47.0]， P = 0.002)，因尿失禁就诊(44.1%比26.8%，P = 0.0002)。在多因素logistic回归中，接受医疗补助的女性“不赴约”的几率明显更高(调整后的优势比为2.11 [1.04-4.48]，P = 0.0440)。结论:接受医疗补助的女性特别有可能“缺席”泌尿妇科预约。需要进一步的研究来确定和解决这一群体在获得护理时面临的潜在障碍。
{"title":"Determinants of Patient No-Shows in a Multisite Urogynecology Clinic [ID: 1376316]","authors":"Jeannine Miranne, Alexa Courtepatte, Vatche Minassian, Stephanie Schatzman-Bone","doi":"10.1097/01.aog.0000931084.89174.ad","DOIUrl":"https://doi.org/10.1097/01.aog.0000931084.89174.ad","url":null,"abstract":"INTRODUCTION: The objective of this study was to describe sociodemographic and clinical characteristics of patients who “no-show” urogynecology appointments and identify risk factors for “no-show” appointments. METHODS: We conducted an IRB-approved prospective chart review study of women aged 18 years or older scheduled for a urogynecology appointment at four outpatient clinical sites associated with an urban academic tertiary care referral center over 4 months. Patients were included in the no-show group if they did not show up for their appointment or cancelled their appointment the same day. For a comparison group, the patient immediately prior to or after the one who “no-showed” with the same visit type was included. Logistic regression was used to identify risk factors for “no-show” appointments. RESULTS: Four hundred twenty-six women were included, 213 in both the no-show and show groups. Women who “no-showed” were younger (median age 60 [interquartile range (IQR) 47–72] versus 69 [IQR 59–78], P <.001). More women in the no-show group were Hispanic (24.4% versus 13.1%) and non-Hispanic Black (7.51% versus 3.76%, P =.0093), had Medicaid (17.4% versus 6.57%, P =.0006), no-showed a previous appointment (24.9% versus 11.7% P =.0005), had to wait longer for an appointment (median 39 days [IQR 23.5–55.5] versus 30.5 days [IQR 12.8–47.0], P =.002), and made appointments for urinary incontinence (44.1% versus 26.8%, P =.0002). On multivariate logistic regression, women with Medicaid had significantly higher odds of “no-showing” their appointment (adjusted odds ratio, 2.11 [1.04–4.48], P =.0440). CONCLUSION: Women with Medicaid are particularly likely to “no-show” urogynecology appointments. Further research is needed to identify and address potential barriers this group faces when accessing care.","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":"135095430","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: Guidelines for toxicology screening in pregnancy are lacking. Studies suggest provider bias in implementation and potential serious consequences for patients. We examined the effect of a novel hospital policy. METHODS: A protocol was outlined for verbal screening, counseling, and toxicology screening by a hospital task force on cannabis use in pregnancy. Institutional review board approval was obtained for study. A retrospective chart review and analysis of practices on admission for delivery was performed 6 months pre- and post-policy implementation in resident low-risk and maternal–fetal medicine clinics. RESULTS: There were 2,373 deliveries during the study period and 129 mother–infant dyads underwent toxicology screening. The rate of maternal screening did not significantly differ pre- and post-policy implementation (2.6% versus 3.4%, P =.23). In those screened, the rate of maternal cannabinoid positivity increased significantly post-policy (13.8–42.9%, P =.005). Similarly, the rate of neonatal screening did not significantly differ pre- and post-policy implementation (3.4% versus 3.6%, P =.88), while the neonatal cannabinoid positivity rate increased significantly post-policy (7.7–31.8%, P =.005). There were no significant differences in demographics of those screened pre- versus post-policy. CONCLUSION: Implementing a hospital policy did not change the rate or demographics of screening but did correlate with an increased cannabinoid detection rate. The effects of the policy should be cautiously considered. The benefit of standardized verbal screening and discussion of risks is clear, but potential harm from toxicology screening remains.
{"title":"Cannabis Use in Pregnancy: Effects of a Hospital Policy on Toxicology Screening Practices [ID: 1377573]","authors":"Florence DiBiase, Erin Brousseau, Lindsey Pileika, Neha Reddy","doi":"10.1097/01.aog.0000929748.73989.74","DOIUrl":"https://doi.org/10.1097/01.aog.0000929748.73989.74","url":null,"abstract":"INTRODUCTION: Guidelines for toxicology screening in pregnancy are lacking. Studies suggest provider bias in implementation and potential serious consequences for patients. We examined the effect of a novel hospital policy. METHODS: A protocol was outlined for verbal screening, counseling, and toxicology screening by a hospital task force on cannabis use in pregnancy. Institutional review board approval was obtained for study. A retrospective chart review and analysis of practices on admission for delivery was performed 6 months pre- and post-policy implementation in resident low-risk and maternal–fetal medicine clinics. RESULTS: There were 2,373 deliveries during the study period and 129 mother–infant dyads underwent toxicology screening. The rate of maternal screening did not significantly differ pre- and post-policy implementation (2.6% versus 3.4%, P =.23). In those screened, the rate of maternal cannabinoid positivity increased significantly post-policy (13.8–42.9%, P =.005). Similarly, the rate of neonatal screening did not significantly differ pre- and post-policy implementation (3.4% versus 3.6%, P =.88), while the neonatal cannabinoid positivity rate increased significantly post-policy (7.7–31.8%, P =.005). There were no significant differences in demographics of those screened pre- versus post-policy. CONCLUSION: Implementing a hospital policy did not change the rate or demographics of screening but did correlate with an increased cannabinoid detection rate. The effects of the policy should be cautiously considered. The benefit of standardized verbal screening and discussion of risks is clear, but potential harm from toxicology screening remains.","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":"135096062","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: Recent studies have demonstrated an association linking the cervicovaginal microbiome with susceptibility to infectious diseases and overall cervical health. We aimed to evaluate the effect of contraceptive methods used by Hispanic females living in Puerto Rico on their cervical microbiome. METHODS: An analysis of 85 women, aged 21–45, grouped by the contraceptive method used at time of sampling, was performed. The methods included birth control pills, intrauterine devices (IUDs), injectable progesterone, male condoms, and female sterilization. The control group did not use any contraception. Swabs collected from the posterior fornix underwent DNA extraction and sequencing of the 16S rRNA gene, being characterized for microbial diversity, and taxonomic composition. IRB approval was obtained. RESULTS: Women using male condoms or sterilization had the highest microbiome richness, and those using IUDs and female sterilization had the highest microbiome diversity. Birth control pills and male condoms had the least effect on the microbiota as participants had a dominance of Lactobacillus . Injectable progesterone and IUDs use were associated with increased levels of Gardnerella . The IUDs group has a noticeable presence of Clostridium when compared to other groups. The female sterilization group is copious in Atopobium and Streptococcus . The injectable progesterone group has an elevated abundance of Megasphaera . CONCLUSION: Preliminary analyses indicate that contraceptive methods may affect the cervicovaginal microbiome, injectable progesterone and IUDs being the methods most associated with vaginal dysbiosis. These findings allow information about the microbiome of Hispanic women living in Puerto Rico to guide further investigations that could contribute to better gynecologic care.
{"title":"Association of the Cervicovaginal Microbiome With Contraceptive Methods in Hispanic Women Living in Puerto Rico [ID: 1376364]","authors":"Nicole Oliveras-Alsina, Marilís Navarrete-Cortés, Josefina Romaguera, Eduardo Tosado-Rodríguez","doi":"10.1097/01.aog.0000929800.76612.51","DOIUrl":"https://doi.org/10.1097/01.aog.0000929800.76612.51","url":null,"abstract":"INTRODUCTION: Recent studies have demonstrated an association linking the cervicovaginal microbiome with susceptibility to infectious diseases and overall cervical health. We aimed to evaluate the effect of contraceptive methods used by Hispanic females living in Puerto Rico on their cervical microbiome. METHODS: An analysis of 85 women, aged 21–45, grouped by the contraceptive method used at time of sampling, was performed. The methods included birth control pills, intrauterine devices (IUDs), injectable progesterone, male condoms, and female sterilization. The control group did not use any contraception. Swabs collected from the posterior fornix underwent DNA extraction and sequencing of the 16S rRNA gene, being characterized for microbial diversity, and taxonomic composition. IRB approval was obtained. RESULTS: Women using male condoms or sterilization had the highest microbiome richness, and those using IUDs and female sterilization had the highest microbiome diversity. Birth control pills and male condoms had the least effect on the microbiota as participants had a dominance of Lactobacillus . Injectable progesterone and IUDs use were associated with increased levels of Gardnerella . The IUDs group has a noticeable presence of Clostridium when compared to other groups. The female sterilization group is copious in Atopobium and Streptococcus . The injectable progesterone group has an elevated abundance of Megasphaera . CONCLUSION: Preliminary analyses indicate that contraceptive methods may affect the cervicovaginal microbiome, injectable progesterone and IUDs being the methods most associated with vaginal dysbiosis. These findings allow information about the microbiome of Hispanic women living in Puerto Rico to guide further investigations that could contribute to better gynecologic care.","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":"135096132","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.0000930028.31044.3e
Thomas Hale, Yu Bagger, Teresa Baker, Carina Holmqvist, Daniel Jonker, Lorien Urban
INTRODUCTION: Establishing lactation after preterm birth is challenging, and there are no approved therapies. Merotocin (FE 202767) is a potent, short-acting, selective oxytocin-receptor agonist in clinical development for induction and support of lactation. This phase 1, open-label, parallel-group study of early postpartum women and women with established lactation investigated possible transfer of merotocin from plasma to breast milk. METHODS: Merotocin was administered as a single 90-minute intravenous (IV) infusion mimicking the intranasal pharmacokinetic profile. In part A, 12 early postpartum women received doses of 5 micrograms (n=6) or 20 micrograms (n=6) merotocin within 4 days of delivery. In part B, 6 women with established lactation received 20 micrograms of merotocin. The total amount of merotocin excreted in breast milk was determined, as well as the presence of metabolites of merotocin in breast milk, and adverse events. The IV route was chosen to minimize the variability in bioavailability often observed with nasal sprays. Institutional review board approval was obtained for the study. RESULTS: In all women (mean age, 26.3 years; 83.3% Caucasian) and at all time points, merotocin in breast milk was below the limit of quantification (25 pg/mL). Merotocin metabolites were not detected in any milk samples. Sixteen treatment-emergent adverse events occurred in early postpartum women only: including seven uterine spasms, and three breast engorgements. All events were mild except one moderate. CONCLUSION: Merotocin is not transferred into breast milk at quantifiable amounts, and is well tolerated. This study supports the evaluation of merotocin in an ongoing phase 2 study in women with preterm delivery (NCT02545127).
{"title":"No Transfer of Merotocin (FE 202767) to Breast Milk in Postpartum Women: A Novel Short-Acting Oxytocin Receptor Agonist for the Induction and Support of Lactation [ID: 1370662]","authors":"Thomas Hale, Yu Bagger, Teresa Baker, Carina Holmqvist, Daniel Jonker, Lorien Urban","doi":"10.1097/01.aog.0000930028.31044.3e","DOIUrl":"https://doi.org/10.1097/01.aog.0000930028.31044.3e","url":null,"abstract":"INTRODUCTION: Establishing lactation after preterm birth is challenging, and there are no approved therapies. Merotocin (FE 202767) is a potent, short-acting, selective oxytocin-receptor agonist in clinical development for induction and support of lactation. This phase 1, open-label, parallel-group study of early postpartum women and women with established lactation investigated possible transfer of merotocin from plasma to breast milk. METHODS: Merotocin was administered as a single 90-minute intravenous (IV) infusion mimicking the intranasal pharmacokinetic profile. In part A, 12 early postpartum women received doses of 5 micrograms (n=6) or 20 micrograms (n=6) merotocin within 4 days of delivery. In part B, 6 women with established lactation received 20 micrograms of merotocin. The total amount of merotocin excreted in breast milk was determined, as well as the presence of metabolites of merotocin in breast milk, and adverse events. The IV route was chosen to minimize the variability in bioavailability often observed with nasal sprays. Institutional review board approval was obtained for the study. RESULTS: In all women (mean age, 26.3 years; 83.3% Caucasian) and at all time points, merotocin in breast milk was below the limit of quantification (25 pg/mL). Merotocin metabolites were not detected in any milk samples. Sixteen treatment-emergent adverse events occurred in early postpartum women only: including seven uterine spasms, and three breast engorgements. All events were mild except one moderate. CONCLUSION: Merotocin is not transferred into breast milk at quantifiable amounts, and is well tolerated. This study supports the evaluation of merotocin in an ongoing phase 2 study in women with preterm delivery (NCT02545127).","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":"135096144","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.0000930176.30180.6a
Alyssa Hersh, Aaron Caughey, Uma Doshi, Bharti Garg
INTRODUCTION: To assess whether there is an association between race and ethnicity with recurrence of gestational diabetes mellitus (GDM) among pregnant persons with a history of GDM in a prior pregnancy. METHODS: This was a retrospective cohort study of births between 2000 and 2012 to pregnant persons in California with a history of GDM in a prior pregnancy. We included singleton, nonanomalous births at gestational ages 23–42 weeks and excluded those who developed preexisting diabetes mellitus between pregnancies or with missing data for race and ethnicity. We adjusted for body mass index, age, educational attainment, and insurance type. Statistical analyses were performed using chi-square and multivariable logistic regression with a P value of .05. RESULTS: We included 26,903 births in this analysis. There were significant differences for all sociodemographic characteristics by recurrence of GDM. The highest proportion of pregnant persons with GDM recurrence were non-Hispanic Asian (55%), followed by Hispanic (51%). We found that the adjusted odds of GDM recurrence was higher among Hispanic (odds ratio [OR] 1.24, 95% CI 1.14–1.35) and non-Hispanic Asian (OR 1.93, 95% CI 1.76–2.11) individuals than the referent, while there was no difference in the adjusted odds of GDM recurrence for non-Hispanic Black (OR 0.99, 95% CI 0.83–1.18) or non-Hispanic American Native (OR 0.99, 95% CI 0.58–1.69) individuals. CONCLUSION: We found that among pregnant persons with a history of GDM, there was a higher adjusted odds of GDM recurrence among certain racial and ethnic groups. Future studies should assess this disparity with targeted interventions to mitigate this increased risk among these specific populations.
前言:评估种族和民族与妊娠期糖尿病(GDM)复发之间是否存在关联。方法:这是一项回顾性队列研究，研究对象是2000年至2012年间出生的加利福尼亚州有妊娠期GDM病史的孕妇。我们纳入了胎龄23-42周的单胎、非异常出生，并排除了那些在怀孕期间患有糖尿病或缺少种族和民族数据的人。我们调整了身体质量指数、年龄、教育程度和保险类型。采用卡方和多变量logistic回归进行统计学分析，P值为0.05。结果:我们纳入了26903例新生儿。GDM复发率与所有社会人口学特征有显著差异。妊娠期GDM复发比例最高的是非西班牙裔亚洲人(55%)，其次是西班牙裔(51%)。我们发现西班牙裔(比值比[OR] 1.24, 95% CI 1.14-1.35)和非西班牙裔亚洲人(OR 1.93, 95% CI 1.76-2.11)的GDM复发率高于参照组，而非西班牙裔黑人(OR 0.99, 95% CI 0.83-1.18)或非西班牙裔美洲原住民(OR 0.99, 95% CI 0.58-1.69)的GDM复发率没有差异。结论:我们发现，在有GDM病史的孕妇中，某些种族和民族的GDM复发率较高。未来的研究应通过有针对性的干预措施来评估这种差异，以减轻这些特定人群中这种增加的风险。
{"title":"Association of Gestational Diabetes Mellitus Recurrence With Race and Ethnicity [ID: 1375479]","authors":"Alyssa Hersh, Aaron Caughey, Uma Doshi, Bharti Garg","doi":"10.1097/01.aog.0000930176.30180.6a","DOIUrl":"https://doi.org/10.1097/01.aog.0000930176.30180.6a","url":null,"abstract":"INTRODUCTION: To assess whether there is an association between race and ethnicity with recurrence of gestational diabetes mellitus (GDM) among pregnant persons with a history of GDM in a prior pregnancy. METHODS: This was a retrospective cohort study of births between 2000 and 2012 to pregnant persons in California with a history of GDM in a prior pregnancy. We included singleton, nonanomalous births at gestational ages 23–42 weeks and excluded those who developed preexisting diabetes mellitus between pregnancies or with missing data for race and ethnicity. We adjusted for body mass index, age, educational attainment, and insurance type. Statistical analyses were performed using chi-square and multivariable logistic regression with a P value of .05. RESULTS: We included 26,903 births in this analysis. There were significant differences for all sociodemographic characteristics by recurrence of GDM. The highest proportion of pregnant persons with GDM recurrence were non-Hispanic Asian (55%), followed by Hispanic (51%). We found that the adjusted odds of GDM recurrence was higher among Hispanic (odds ratio [OR] 1.24, 95% CI 1.14–1.35) and non-Hispanic Asian (OR 1.93, 95% CI 1.76–2.11) individuals than the referent, while there was no difference in the adjusted odds of GDM recurrence for non-Hispanic Black (OR 0.99, 95% CI 0.83–1.18) or non-Hispanic American Native (OR 0.99, 95% CI 0.58–1.69) individuals. CONCLUSION: We found that among pregnant persons with a history of GDM, there was a higher adjusted odds of GDM recurrence among certain racial and ethnic groups. Future studies should assess this disparity with targeted interventions to mitigate this increased risk among these specific populations.","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":"135096167","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.0000931060.21278.6a
Danielle Browning, Eva Fandozzi, Christina Megli, Alexandria Sasaki
INTRODUCTION: Preterm premature rupture of membranes (PPROM) accounts for one-third of preterm deliveries and is associated with significant perinatal morbidity. Neonatal resuscitation has been extended to earlier gestational ages, including for patients with PPROM, but maternal and neonatal outcomes are not well characterized. Our objective is to compare outcomes after PPROM diagnosis prior to viability (23 weeks 0 days) or in the periviable period (23–25 weeks). METHODS: A retrospective cohort of 101 pregnancies and 112 neonates from July 2015 to May 2018 were identified by maternal ICD-9/10 codes for PPROM. Exclusion criteria include PPROM greater than 24 weeks 6 days and neonatal congenital anomalies. Detailed chart review was performed. Patients were stratified by gestational age (GA) at PPROM and groups were compared according to GA. Chi-square test was used for dichotomous variables and t test for continuous variables. Institutional review board approval was obtained for this study. RESULTS: 27.9% of patients who elected for expectant management delivered after viability (23 weeks 0 days or later). Neonatal death was greater after delivery from pregnancies with previable PPROM in comparison to periviable PPROM with similar gestational age at birth, P =.005. The composite adverse neonatal outcomes occurred in 100% of neonates born after previable PPROM. Maternal outcomes were elevated with both previable and periviable PPROM who elected for expectant management (52.4% versus 35.3%, NS). The maternal morbidity rate after termination of pregnancy was significantly less (26.9%) ( P =.047). CONCLUSION: Previable PPROM is associated with higher neonatal death rates, despite similar GA at delivery in comparison to periviable PPROM. Maternal morbidity is high with both previable and periviable PPROM.
{"title":"Maternal and Neonatal Outcomes of Pregnancies With Periviable and Previable Preterm Premature Rupture of Membranes [ID: 1380561]","authors":"Danielle Browning, Eva Fandozzi, Christina Megli, Alexandria Sasaki","doi":"10.1097/01.aog.0000931060.21278.6a","DOIUrl":"https://doi.org/10.1097/01.aog.0000931060.21278.6a","url":null,"abstract":"INTRODUCTION: Preterm premature rupture of membranes (PPROM) accounts for one-third of preterm deliveries and is associated with significant perinatal morbidity. Neonatal resuscitation has been extended to earlier gestational ages, including for patients with PPROM, but maternal and neonatal outcomes are not well characterized. Our objective is to compare outcomes after PPROM diagnosis prior to viability (23 weeks 0 days) or in the periviable period (23–25 weeks). METHODS: A retrospective cohort of 101 pregnancies and 112 neonates from July 2015 to May 2018 were identified by maternal ICD-9/10 codes for PPROM. Exclusion criteria include PPROM greater than 24 weeks 6 days and neonatal congenital anomalies. Detailed chart review was performed. Patients were stratified by gestational age (GA) at PPROM and groups were compared according to GA. Chi-square test was used for dichotomous variables and t test for continuous variables. Institutional review board approval was obtained for this study. RESULTS: 27.9% of patients who elected for expectant management delivered after viability (23 weeks 0 days or later). Neonatal death was greater after delivery from pregnancies with previable PPROM in comparison to periviable PPROM with similar gestational age at birth, P =.005. The composite adverse neonatal outcomes occurred in 100% of neonates born after previable PPROM. Maternal outcomes were elevated with both previable and periviable PPROM who elected for expectant management (52.4% versus 35.3%, NS). The maternal morbidity rate after termination of pregnancy was significantly less (26.9%) ( P =.047). CONCLUSION: Previable PPROM is associated with higher neonatal death rates, despite similar GA at delivery in comparison to periviable PPROM. Maternal morbidity is high with both previable and periviable PPROM.","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":"135096032","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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