Pub Date : 2023-05-01DOI: 10.1097/01.aog.0000930920.33049.bb
Isabelle Crary, Chloe Koski, Asha Rijhsinghani
INTRODUCTION: The objective of this study was to assess the utility of screening ferritin (<20 weeks of gestation) in pregnant patients on hemoglobin (Hgb) and hematocrit (Hct) later in gestation. METHODS: Pregnant patients who received nondiagnostic ferritin labs at less than 20 weeks of gestation from 2019 to 2021 were retrospectively identified. Patients were excluded if ferritin testing was conducted for diagnostic purposes or if the patient had a history of anemia. Labs at the time of registration, 28 weeks of gestation, and at delivery were analyzed. Anemia was defined as Hgb less than 11 g/dL. This study was approved by the University of Washington IRB, and patient consent was waived. RESULTS: Forty-four patients underwent routine ferritin screening at registration, with ferritin levels ranging from 10 to 136 ng/mL (average 52.5 ng/mL). Average Hgb/Hct at registration were 12.6 g/dL and 37.3%, respectively. At 28 weeks of gestation, Hgb/Hct were obtained on 42 patients, of whom 9 patients were diagnosed with anemia. Patients diagnosed with anemia had a screening ferritin level of 33.6 ng/mL, and nonanemic patients had a ferritin level of 57.4 ng/mL ( P =.1). When a cutoff of 50 ng/mL was studied to compare patients with “low” versus “normal” ferritin, ferritin less than or equal to 50 ng/mL had significantly lower Hgb levels at 28 weeks compared to those with ferritin greater than 50 ng/mL ( P =.013). On labor and delivery (L&D), Hgb/Hct was obtained on 44 patients, and 14 were diagnosed with anemia. Anemic patients on L&D had significantly lower screening ferritin compared to nonanemic, 31.9 and 62.2 ng/mL, respectively ( P =.016). CONCLUSION: Ferritin screening in early pregnancy may help predict lower Hgb in later gestation. Using a higher ferritin cutoff of 50 ng/mL in early pregnancy for identifying patients at risk for anemia in the third trimester may be warranted. Larger prospective studies are needed to evaluate further the utility of ferritin screening.
{"title":"Utility of Ferritin at Registration as a Screen for Development of Anemia in Third Trimester [ID: 1362276]","authors":"Isabelle Crary, Chloe Koski, Asha Rijhsinghani","doi":"10.1097/01.aog.0000930920.33049.bb","DOIUrl":"https://doi.org/10.1097/01.aog.0000930920.33049.bb","url":null,"abstract":"INTRODUCTION: The objective of this study was to assess the utility of screening ferritin (<20 weeks of gestation) in pregnant patients on hemoglobin (Hgb) and hematocrit (Hct) later in gestation. METHODS: Pregnant patients who received nondiagnostic ferritin labs at less than 20 weeks of gestation from 2019 to 2021 were retrospectively identified. Patients were excluded if ferritin testing was conducted for diagnostic purposes or if the patient had a history of anemia. Labs at the time of registration, 28 weeks of gestation, and at delivery were analyzed. Anemia was defined as Hgb less than 11 g/dL. This study was approved by the University of Washington IRB, and patient consent was waived. RESULTS: Forty-four patients underwent routine ferritin screening at registration, with ferritin levels ranging from 10 to 136 ng/mL (average 52.5 ng/mL). Average Hgb/Hct at registration were 12.6 g/dL and 37.3%, respectively. At 28 weeks of gestation, Hgb/Hct were obtained on 42 patients, of whom 9 patients were diagnosed with anemia. Patients diagnosed with anemia had a screening ferritin level of 33.6 ng/mL, and nonanemic patients had a ferritin level of 57.4 ng/mL ( P =.1). When a cutoff of 50 ng/mL was studied to compare patients with “low” versus “normal” ferritin, ferritin less than or equal to 50 ng/mL had significantly lower Hgb levels at 28 weeks compared to those with ferritin greater than 50 ng/mL ( P =.013). On labor and delivery (L&D), Hgb/Hct was obtained on 44 patients, and 14 were diagnosed with anemia. Anemic patients on L&D had significantly lower screening ferritin compared to nonanemic, 31.9 and 62.2 ng/mL, respectively ( P =.016). CONCLUSION: Ferritin screening in early pregnancy may help predict lower Hgb in later gestation. Using a higher ferritin cutoff of 50 ng/mL in early pregnancy for identifying patients at risk for anemia in the third trimester may be warranted. Larger prospective studies are needed to evaluate further the utility of ferritin screening.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"127 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135096034","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.0000930448.60219.0b
Elizabeth Cochrane, Angela Bianco, Chelsea DeBolt, Tahera Doctor, Sarah Roger, Kelly Wang
INTRODUCTION: Delivery rates among patients of advanced maternal age (AMA) are increasing. Prior studies have shown that AMA is associated with increased pregnancy risks and adverse outcomes. This study’s objective was to evaluate whether AMA is associated with an increase in obstetric anal sphincter injury (OASIS) rates among patients who undergo forceps-assisted vaginal deliveries (FAVDs). METHODS: This was an IRB-approved, retrospective cohort study of singleton gestations with FAVD at a single institution between 2017 and 2021. Primary outcome was rate of OASIS among patients with and without AMA. Secondary outcomes included quantitative blood loss (QBL), neonatal composite of subgaleal and cephalohematoma (adverse neonatal composite), and neonatal intensive care unit (NICU) admission. Quantitative blood loss was assessed using Mann-Whitney U test. Remaining outcomes were assessed using multivariate logistic regression models while adjusting for provider clustering and confounding patient characteristics including episiotomy and birth weight. RESULTS: Nine hundred eighty-three records were included, 704 non-AMA and 279 AMA. Patients of AMA were more likely to be Caucasian and were less likely to be Hispanic, nulliparous, experience spontaneous labor, and undergo episiotomy. Patients of AMA did not demonstrate increased odds of OASIS compared to non-AMA patients (odds ratio [OR] 1.21 [0.78, 1.89]). When age was assessed continuously, there was no association between increasing age and rates of OASIS (OR 1.02 [0.98, 1.06]). There was no statistically significant difference in QBL among the two groups (357.0 versus 350.0 cc, P =.20), NICU admission or adverse neonatal composite. CONCLUSION: Advanced maternal age does not appear to be a risk factor for OASIS or other adverse outcomes in patients undergoing FAVD.
导读:高龄产妇(AMA)的分娩率正在上升。先前的研究表明，AMA与妊娠风险增加和不良后果有关。本研究的目的是评估AMA是否与产钳辅助阴道分娩(FAVDs)患者产科肛门括约肌损伤(OASIS)发生率的增加有关。方法:这是一项经irb批准的回顾性队列研究，研究对象是2017年至2021年在单一机构发生的单胎妊娠伴FAVD。主要结局是有或无AMA患者的OASIS发生率。次要结局包括定量失血量(QBL)、新生儿galeal下和头血肿复合(不良新生儿复合)和新生儿重症监护病房(NICU)入住情况。定量失血量采用Mann-Whitney U试验。在调整提供者聚类和混淆患者特征(包括外阴切开术和出生体重)的同时，使用多变量逻辑回归模型评估其余结果。结果:共纳入983例，其中非AMA 704例，AMA 279例。AMA患者多为白种人，西班牙裔、无产、自然分娩和会阴切开术患者较少。与非AMA患者相比，AMA患者的OASIS发生率没有增加(比值比[OR] 1.21[0.78, 1.89])。当持续评估年龄时，年龄的增加与OASIS发生率之间没有关联(OR为1.02[0.98,1.06])。两组间QBL (357.0 vs 350.0 cc, P = 0.20)、新生儿重症监护病房入院或新生儿不良综合情况均无统计学差异。结论:高龄产妇似乎不是FAVD患者发生OASIS或其他不良结局的危险因素。
{"title":"The Effect of Advanced Maternal Age on Adverse Outcomes Among Forceps-Assisted Vaginal Deliveries [ID: 1355950]","authors":"Elizabeth Cochrane, Angela Bianco, Chelsea DeBolt, Tahera Doctor, Sarah Roger, Kelly Wang","doi":"10.1097/01.aog.0000930448.60219.0b","DOIUrl":"https://doi.org/10.1097/01.aog.0000930448.60219.0b","url":null,"abstract":"INTRODUCTION: Delivery rates among patients of advanced maternal age (AMA) are increasing. Prior studies have shown that AMA is associated with increased pregnancy risks and adverse outcomes. This study’s objective was to evaluate whether AMA is associated with an increase in obstetric anal sphincter injury (OASIS) rates among patients who undergo forceps-assisted vaginal deliveries (FAVDs). METHODS: This was an IRB-approved, retrospective cohort study of singleton gestations with FAVD at a single institution between 2017 and 2021. Primary outcome was rate of OASIS among patients with and without AMA. Secondary outcomes included quantitative blood loss (QBL), neonatal composite of subgaleal and cephalohematoma (adverse neonatal composite), and neonatal intensive care unit (NICU) admission. Quantitative blood loss was assessed using Mann-Whitney U test. Remaining outcomes were assessed using multivariate logistic regression models while adjusting for provider clustering and confounding patient characteristics including episiotomy and birth weight. RESULTS: Nine hundred eighty-three records were included, 704 non-AMA and 279 AMA. Patients of AMA were more likely to be Caucasian and were less likely to be Hispanic, nulliparous, experience spontaneous labor, and undergo episiotomy. Patients of AMA did not demonstrate increased odds of OASIS compared to non-AMA patients (odds ratio [OR] 1.21 [0.78, 1.89]). When age was assessed continuously, there was no association between increasing age and rates of OASIS (OR 1.02 [0.98, 1.06]). There was no statistically significant difference in QBL among the two groups (357.0 versus 350.0 cc, P =.20), NICU admission or adverse neonatal composite. CONCLUSION: Advanced maternal age does not appear to be a risk factor for OASIS or other adverse outcomes in patients undergoing FAVD.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"100 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135096233","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.0000930132.97206.72
A. Hirsch, Laura C. Ha, M. Naqvi
INTRODUCTION: Updated guidelines from the Society for Maternal-Fetal Medicine (SMFM) define severe fetal growth restriction (sFGR), or an estimated fetal weight (EFW) less than 3rd percentile, as a distinct entity due to higher perinatal morbidity in this group. Whether an isolated abdominal circumference (AC) less than 3rd percentile similarly portends adverse outcomes remains unclear. METHODS: This is a single-institution, retrospective cohort study of singleton gestations with late-onset FGR and normal Doppler studies from 2012 to 2022. Pregnancies affected by AC less than 3rd percentile (but EFW≥3rd percentile) and EFW less than 3rd percentile were compared using univariable analysis and multivariable logistic regression. The primary outcome was neonatal intensive care unit (NICU) admission. RESULTS: Among eligible participants, 78 (63%) had an isolated AC less than 3rd percentile and 45 (37%) had sFGR. Neonates prenatally diagnosed with sFGR were more likely to be admitted to the NICU than those with isolated AC less than 3rd percentile (68.9% versus 23.1%, P<.001). After adjusting for gestational age, birth weight, race, maternal age, and medical comorbidities, sFGR was still associated with an increased odds of NICU admission (adjusted odds ratio 4.9, 95% CI 1.37–17.48, P=.014). Rates of cesarean delivery (46.7% versus 26.9%; P=.03), small for gestational age (86.7% versus 67.9%, P=.02), and 5-minute Apgar score less than 7 (6.7% versus 0.0%, P=.02) were also higher in the sFGR group. There were no significant differences in NICU length of stay or perinatal death between groups. CONCLUSION: Adverse neonatal outcomes were more prevalent in pregnancies affected by sFGR compared with isolated AC less than 3rd percentile, providing support for the updated SMFM guidelines.
简介:来自母胎医学协会(SMFM)的最新指南将严重胎儿生长受限(sFGR)或估计胎儿体重(EFW)低于第三个百分位数定义为一个独特的实体，因为该组围产期发病率较高。孤立腹围(AC)小于3个百分位数是否同样预示着不良后果尚不清楚。方法:这是一项2012年至2022年单胎妊娠迟发性FGR和正常多普勒研究的单机构、回顾性队列研究。采用单变量分析和多变量logistic回归对AC小于第3百分位数(但EFW≥第3百分位数)和EFW小于第3百分位数的妊娠进行比较。主要结局是新生儿重症监护病房(NICU)入住情况。结果:在符合条件的参与者中，78人(63%)的孤立性AC小于第3百分位，45人(37%)患有sFGR。产前诊断为sFGR的新生儿比单独AC小于第3百分位数的新生儿更有可能被送入新生儿重症监护病房(68.9%比23.1%，P< 0.001)。在调整胎龄、出生体重、种族、母亲年龄和医疗合并症后，sFGR仍与新生儿重症监护病房入院的几率增加相关(调整优势比为4.9,95% CI 1.37-17.48, P= 0.014)。剖宫产率(46.7% vs 26.9%;P=.03)，小于胎龄(86.7% vs . 67.9%， P=.02)， 5分钟Apgar评分小于7 (6.7% vs . 0.0%， P=.02)在sFGR组也较高。两组新生儿重症监护病房住院时间和围产儿死亡率无显著差异。结论:与孤立性AC相比，受sFGR影响的妊娠中不良新生儿结局更为普遍，低于3个百分位数，为更新的SMFM指南提供了支持。
{"title":"Late-Onset Severe Fetal Growth Restriction and Isolated Severely Small Abdominal Circumference: Do Neonatal Outcomes Differ? [ID: 1377666]","authors":"A. Hirsch, Laura C. Ha, M. Naqvi","doi":"10.1097/01.aog.0000930132.97206.72","DOIUrl":"https://doi.org/10.1097/01.aog.0000930132.97206.72","url":null,"abstract":"INTRODUCTION: Updated guidelines from the Society for Maternal-Fetal Medicine (SMFM) define severe fetal growth restriction (sFGR), or an estimated fetal weight (EFW) less than 3rd percentile, as a distinct entity due to higher perinatal morbidity in this group. Whether an isolated abdominal circumference (AC) less than 3rd percentile similarly portends adverse outcomes remains unclear. METHODS: This is a single-institution, retrospective cohort study of singleton gestations with late-onset FGR and normal Doppler studies from 2012 to 2022. Pregnancies affected by AC less than 3rd percentile (but EFW≥3rd percentile) and EFW less than 3rd percentile were compared using univariable analysis and multivariable logistic regression. The primary outcome was neonatal intensive care unit (NICU) admission. RESULTS: Among eligible participants, 78 (63%) had an isolated AC less than 3rd percentile and 45 (37%) had sFGR. Neonates prenatally diagnosed with sFGR were more likely to be admitted to the NICU than those with isolated AC less than 3rd percentile (68.9% versus 23.1%, P<.001). After adjusting for gestational age, birth weight, race, maternal age, and medical comorbidities, sFGR was still associated with an increased odds of NICU admission (adjusted odds ratio 4.9, 95% CI 1.37–17.48, P=.014). Rates of cesarean delivery (46.7% versus 26.9%; P=.03), small for gestational age (86.7% versus 67.9%, P=.02), and 5-minute Apgar score less than 7 (6.7% versus 0.0%, P=.02) were also higher in the sFGR group. There were no significant differences in NICU length of stay or perinatal death between groups. CONCLUSION: Adverse neonatal outcomes were more prevalent in pregnancies affected by sFGR compared with isolated AC less than 3rd percentile, providing support for the updated SMFM guidelines.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"48 1","pages":"32S - 33S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76243222","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.0000931248.08942.68
Carolyn S. Sinow, A. Bowen, Anh Nguyen, E. Zaid
INTRODUCTION: Resident duty hour restrictions have resulted in improved resident safety with mixed results on patient safety. There are limited data about 24-hour shifts in obstetrics and gynecology. This project studies resident wellness and performance after eliminating 24-hour call shifts. METHODS: This is a preliminary analysis of a quality improvement project. Physicians were surveyed before and after implementation of a call schedule that reduced 24-hour shifts to 14-hour shifts. Resident performance was assessed by self-reported and attending-reported ability to perform tasks. RESULTS: At preintervention survey, 13 out of 16 residents and 8 out of 17 attendings favored eliminating 24-hour call shifts. Attendings had more confidence in residents' performance on 24-hour shifts than residents did (P<.02) when stratified by task and residency year. At 3-month follow-up, all residents (19/19) preferred 14-hour shifts. Residents reported improvements in wellness (13/13), sleep (13/13), and burnout (10/13). Residents felt more confident in their ability to perform a vaginal delivery (11/13), cesarean birth (12/13), or communicate effectively (11/13) with 14-hour compared to 24-hour shifts. Thematic analysis showed that residents felt happier and better able to care for patients. Two residents cited improved ability to learn, while only one resident cited lost learning opportunities. CONCLUSION: Data suggest that obstetrics and gynecology residency programs should eliminate 24-hour shifts to improve resident wellness and performance, while decreasing burnout. Final follow-up data (to be collected March 2023) will assess whether attendings see a change in resident performance.
{"title":"Elimination of 24-Hour Call Shifts in an Obstetrics and Gynecology Residency Training Program [ID: 1375098]","authors":"Carolyn S. Sinow, A. Bowen, Anh Nguyen, E. Zaid","doi":"10.1097/01.aog.0000931248.08942.68","DOIUrl":"https://doi.org/10.1097/01.aog.0000931248.08942.68","url":null,"abstract":"INTRODUCTION: Resident duty hour restrictions have resulted in improved resident safety with mixed results on patient safety. There are limited data about 24-hour shifts in obstetrics and gynecology. This project studies resident wellness and performance after eliminating 24-hour call shifts. METHODS: This is a preliminary analysis of a quality improvement project. Physicians were surveyed before and after implementation of a call schedule that reduced 24-hour shifts to 14-hour shifts. Resident performance was assessed by self-reported and attending-reported ability to perform tasks. RESULTS: At preintervention survey, 13 out of 16 residents and 8 out of 17 attendings favored eliminating 24-hour call shifts. Attendings had more confidence in residents' performance on 24-hour shifts than residents did (P<.02) when stratified by task and residency year. At 3-month follow-up, all residents (19/19) preferred 14-hour shifts. Residents reported improvements in wellness (13/13), sleep (13/13), and burnout (10/13). Residents felt more confident in their ability to perform a vaginal delivery (11/13), cesarean birth (12/13), or communicate effectively (11/13) with 14-hour compared to 24-hour shifts. Thematic analysis showed that residents felt happier and better able to care for patients. Two residents cited improved ability to learn, while only one resident cited lost learning opportunities. CONCLUSION: Data suggest that obstetrics and gynecology residency programs should eliminate 24-hour shifts to improve resident wellness and performance, while decreasing burnout. Final follow-up data (to be collected March 2023) will assess whether attendings see a change in resident performance.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"40 1","pages":"101S - 101S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76352122","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.0000930040.32483.66
Tooba Z. Anwer, S. Little, R. Reddy, Emily S. Reiff
INTRODUCTION: The Society for Maternal-Fetal Medicine (SMFM) proposed a new quality metric in 2022 to increase the rate of antenatal corticosteroid (ACS) provision for early preterm deliveries and minimize ACS for pregnancies ending in term deliveries. This study evaluates compliance with this quality metric and examines which delivery indications are associated with suboptimal ACS timing. METHODS: This is a single-center retrospective cohort of patients receiving ACS from January 2017 to September 2022. The primary outcome, measuring compliance with the SMFM ACS quality metric, is the proportion of all early preterm deliveries that received optimally timed ACS (one dose of ACS within 6 hours–7 days before birth). The secondary outcome is the proportion of term deliveries that had previously received ACS compared to all patients who received ACS. A sample of convenience of 500 patients was investigated to determine the indication for ACS. RESULTS: Of the 36,080 deliveries between 2017 and 2022, 2,022 patients received ACS (initial or rescue) and delivered at this center. There were 3,720 early preterm deliveries. Of early preterm deliveries, 14.67% received ACS in the optimal window. Of all the patients that received ACS, 20.9% delivered at term. ACS were more optimally dosed for hypertension relative risk (RR) 1.71 (95% CI 1.36–2.14) and preterm prelabor rupture of membranes RR 2.08 (95% CI 1.67–2.59). CONCLUSION: Based on the SMFM quality metric, rates of optimal ACS administration remain lower than minimum realistic benchmarks. Continuing efforts are needed to optimize ACS administration for preterm deliveries. In order to meet these goals, institutions may examine which clinical situations lead to suboptimal ACS.
母胎医学协会(SMFM)于2022年提出了一项新的质量指标，以提高早期早产的产前皮质类固醇(ACS)供应率，并最大限度地减少足月妊娠的ACS。本研究评估了对这一质量指标的依从性，并检查了哪些分娩指征与次优ACS时间相关。方法:这是一项单中心回顾性队列研究，纳入2017年1月至2022年9月接受ACS治疗的患者。衡量SMFM ACS质量指标依从性的主要结果是所有早期早产儿接受最佳时间ACS(出生前6小时至7天内一剂ACS)的比例。次要结果是以前接受过ACS的足月分娩与所有接受过ACS的患者的比例。为了确定ACS的适应症，我们调查了500例方便患者的样本。结果:在2017年至2022年期间的36,080例分娩中，2,022例患者接受了ACS(初始或抢救)并在该中心分娩。有3720例早产。在早期早产患者中，14.67%在最佳窗口期接受ACS治疗。在所有接受ACS治疗的患者中，20.9%足月分娩。ACS治疗高血压的相对危险度(RR)为1.71 (95% CI 1.36-2.14)，早产产前胎膜破裂的RR为2.08 (95% CI 1.67-2.59)。结论:基于SMFM质量指标，最佳ACS给药率仍然低于最低现实基准。需要继续努力优化ACS对早产的管理。为了达到这些目标，机构可能会检查哪些临床情况导致次优ACS。
{"title":"Examining Antenatal Corticosteroid Administration at a Single Center via a New Proposed Quality Metric [ID: 1375947]","authors":"Tooba Z. Anwer, S. Little, R. Reddy, Emily S. Reiff","doi":"10.1097/01.aog.0000930040.32483.66","DOIUrl":"https://doi.org/10.1097/01.aog.0000930040.32483.66","url":null,"abstract":"INTRODUCTION: The Society for Maternal-Fetal Medicine (SMFM) proposed a new quality metric in 2022 to increase the rate of antenatal corticosteroid (ACS) provision for early preterm deliveries and minimize ACS for pregnancies ending in term deliveries. This study evaluates compliance with this quality metric and examines which delivery indications are associated with suboptimal ACS timing. METHODS: This is a single-center retrospective cohort of patients receiving ACS from January 2017 to September 2022. The primary outcome, measuring compliance with the SMFM ACS quality metric, is the proportion of all early preterm deliveries that received optimally timed ACS (one dose of ACS within 6 hours–7 days before birth). The secondary outcome is the proportion of term deliveries that had previously received ACS compared to all patients who received ACS. A sample of convenience of 500 patients was investigated to determine the indication for ACS. RESULTS: Of the 36,080 deliveries between 2017 and 2022, 2,022 patients received ACS (initial or rescue) and delivered at this center. There were 3,720 early preterm deliveries. Of early preterm deliveries, 14.67% received ACS in the optimal window. Of all the patients that received ACS, 20.9% delivered at term. ACS were more optimally dosed for hypertension relative risk (RR) 1.71 (95% CI 1.36–2.14) and preterm prelabor rupture of membranes RR 2.08 (95% CI 1.67–2.59). CONCLUSION: Based on the SMFM quality metric, rates of optimal ACS administration remain lower than minimum realistic benchmarks. Continuing efforts are needed to optimize ACS administration for preterm deliveries. In order to meet these goals, institutions may examine which clinical situations lead to suboptimal ACS.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"40 1","pages":"26S - 26S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80058497","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.0000931000.56844.2d
C. Russell, T. Beyuo, E. Lawrence, S. Oppong, R. Owusu-Antwi
INTRODUCTION: Despite maternal and perinatal mortality disproportionately occurring in low- and middle-income countries, there are limited data on the emotional toll these losses have on obstetric providers. In a series of focus groups discussions (FGDs), this study delves into the experiences of physicians and midwives in Ghana after maternal and perinatal losses. METHODS: Participants were obstetrician/gynecologists and midwives at the two largest tertiary hospitals in Ghana. Five FGDs were conducted by a trained facilitator, using a semi-structured guide. Questions explored experiences after patient deaths and perspectives on supportive interventions for providers. FGDs were audio-recorded and transcribed verbatim. Using an iteratively developed codebook, transcripts were thematically analyzed with NVivo. Written informed consent and IRB approvals were obtained. RESULTS: Twenty obstetricians and 32 midwives participated in five FGDs in Accra and Kumasi, Ghana. Most providers (84%) had completed training, and almost half (46%) had been in practice for above 10 years. Three major themes emerged: 1) pervasive stigma about seeking mental health services, especially from psychiatrists, rooted in cultural norms; 2) skepticism about departmental and peer confidentiality if providers seek support after poor outcomes; 3) profound sense of blame, both from self and peers, that resulted in poor mortality audit attendance and effects on workplace performance. Despite numerous barriers, providers expressed a strong need for improved departmental and institutional support systems. CONCLUSION: This study uncovers key barriers for providers to access mental health care and support after experiencing maternal and perinatal mortalities. Findings should inform interventions to better support struggling providers.
{"title":"Stigma, Confidentiality, and Blame: Qualitative Focus Groups of Ghanaian Obstetric Providers After Maternal and Perinatal Losses [ID: 1377293]","authors":"C. Russell, T. Beyuo, E. Lawrence, S. Oppong, R. Owusu-Antwi","doi":"10.1097/01.aog.0000931000.56844.2d","DOIUrl":"https://doi.org/10.1097/01.aog.0000931000.56844.2d","url":null,"abstract":"INTRODUCTION: Despite maternal and perinatal mortality disproportionately occurring in low- and middle-income countries, there are limited data on the emotional toll these losses have on obstetric providers. In a series of focus groups discussions (FGDs), this study delves into the experiences of physicians and midwives in Ghana after maternal and perinatal losses. METHODS: Participants were obstetrician/gynecologists and midwives at the two largest tertiary hospitals in Ghana. Five FGDs were conducted by a trained facilitator, using a semi-structured guide. Questions explored experiences after patient deaths and perspectives on supportive interventions for providers. FGDs were audio-recorded and transcribed verbatim. Using an iteratively developed codebook, transcripts were thematically analyzed with NVivo. Written informed consent and IRB approvals were obtained. RESULTS: Twenty obstetricians and 32 midwives participated in five FGDs in Accra and Kumasi, Ghana. Most providers (84%) had completed training, and almost half (46%) had been in practice for above 10 years. Three major themes emerged: 1) pervasive stigma about seeking mental health services, especially from psychiatrists, rooted in cultural norms; 2) skepticism about departmental and peer confidentiality if providers seek support after poor outcomes; 3) profound sense of blame, both from self and peers, that resulted in poor mortality audit attendance and effects on workplace performance. Despite numerous barriers, providers expressed a strong need for improved departmental and institutional support systems. CONCLUSION: This study uncovers key barriers for providers to access mental health care and support after experiencing maternal and perinatal mortalities. Findings should inform interventions to better support struggling providers.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"59 1","pages":"83S - 83S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81107471","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.0000929876.54020.ad
Aurora M. Phillips, R. Flink-bochacki, Sofia Rachad
INTRODUCTION: Miscarriage is common, and treatment modalities overlap with those used for induced abortion. In places where abortion is heavily regulated, clinicians managing miscarriages may cautiously rely on the strictest criteria to differentiate early pregnancy loss from potentially viable pregnancy and may not offer certain treatments commonly associated with abortion. METHODS: From November 2021 to January 2022, we conducted a cross-sectional study of all 296 U.S. obstetrics and gynecology residency programs, surveying each about their institution’s miscarriage practices. We compared miscarriage care by program characteristics, institutional abortion restrictions, and state legislative policies. RESULTS: Of 149 programs who responded (50.3% response rate), 74 (49.7%) reported strict reliance on conservative imaging criteria before offering any intervention for suspected early pregnancy loss, despite patient-centered society recommendations, while the remaining 75 (50.3%) reported incorporation of imaging guidelines with other factors. After controlling for other factors, institutional abortion restrictions were the only independent predictor of strict reliance on imaging guidelines (odds ratio 12.3, 95% CI 3.2–47.9). Mifepristone was used less at programs in states with hostile abortion legislation (32% versus 75%, P<.001) or with institutional abortion restrictions (25% versus 86%, P<.001). Similarly, office-based aspiration was lower in hostile states (48% versus 68%, P=.014) and with institutional abortion restrictions (40% versus 81%, P<.001). CONCLUSION: Academic institutions with restricted access to induced abortion are less likely to holistically incorporate clinical evidence and patient priorities in determining when to intervene for miscarriage and are less likely to offer the full range of treatment options. With abortion bans proliferating nationwide, evidence-based education and patient-centered care for miscarriage may also be imperiled.
前言:流产是常见的，治疗方式与那些用于人工流产重叠。在堕胎受到严格管制的地方，处理流产的临床医生可能会谨慎地依赖最严格的标准来区分早期妊娠丢失和潜在的存活妊娠，并且可能不会提供通常与流产相关的某些治疗。方法:从2021年11月到2022年1月，我们对所有296个美国妇产科住院医师项目进行了横断面研究，调查了每个机构的流产实践。我们比较了流产护理的项目特点、机构堕胎限制和州立法政策。结果:在149个有应答的项目中(50.3%应答率)，74个(49.7%)报告严格依赖保守的影像学标准，而不考虑以患者为中心的社会建议，而其余75个(50.3%)报告了影像学指南与其他因素的结合。在控制其他因素后，机构流产限制是严格依赖成像指南的唯一独立预测因子(优势比12.3,95% CI 3.2-47.9)。米非司酮在堕胎立法不友好的州(32%对75%，P<.001)或机构堕胎限制(25%对86%，P<.001)的项目中使用较少。同样，在敌对国家，以办公室为基础的妊娠率较低(48%对68%，P= 0.014)，在机构堕胎限制中(40%对81%，P< 0.001)。结论:限制人工流产的学术机构在决定何时干预流产时不太可能全面纳入临床证据和患者优先事项，也不太可能提供全方位的治疗选择。随着堕胎禁令在全国范围内的扩散，以证据为基础的教育和以病人为中心的流产护理也可能受到危害。
{"title":"The Association Between Abortion Restrictions and Patient-Centered Miscarriage Care: A Cross-Sectional Study of U.S. Obstetrics and Gynecology Residency Programs [ID: 1377546]","authors":"Aurora M. Phillips, R. Flink-bochacki, Sofia Rachad","doi":"10.1097/01.AOG.0000929876.54020.ad","DOIUrl":"https://doi.org/10.1097/01.AOG.0000929876.54020.ad","url":null,"abstract":"INTRODUCTION: Miscarriage is common, and treatment modalities overlap with those used for induced abortion. In places where abortion is heavily regulated, clinicians managing miscarriages may cautiously rely on the strictest criteria to differentiate early pregnancy loss from potentially viable pregnancy and may not offer certain treatments commonly associated with abortion. METHODS: From November 2021 to January 2022, we conducted a cross-sectional study of all 296 U.S. obstetrics and gynecology residency programs, surveying each about their institution’s miscarriage practices. We compared miscarriage care by program characteristics, institutional abortion restrictions, and state legislative policies. RESULTS: Of 149 programs who responded (50.3% response rate), 74 (49.7%) reported strict reliance on conservative imaging criteria before offering any intervention for suspected early pregnancy loss, despite patient-centered society recommendations, while the remaining 75 (50.3%) reported incorporation of imaging guidelines with other factors. After controlling for other factors, institutional abortion restrictions were the only independent predictor of strict reliance on imaging guidelines (odds ratio 12.3, 95% CI 3.2–47.9). Mifepristone was used less at programs in states with hostile abortion legislation (32% versus 75%, P<.001) or with institutional abortion restrictions (25% versus 86%, P<.001). Similarly, office-based aspiration was lower in hostile states (48% versus 68%, P=.014) and with institutional abortion restrictions (40% versus 81%, P<.001). CONCLUSION: Academic institutions with restricted access to induced abortion are less likely to holistically incorporate clinical evidence and patient priorities in determining when to intervene for miscarriage and are less likely to offer the full range of treatment options. With abortion bans proliferating nationwide, evidence-based education and patient-centered care for miscarriage may also be imperiled.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"19 1","pages":"14S - 15S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81587783","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.0000930252.58330.98
E. Lyon, Veronica M Gonzalez-Brown, E. Keyser, Katherine Porter, R. Tindal
INTRODUCTION: Maternal morbidity and mortality rates in the United States have increased in the last two decades with a disproportionate effect on women of color. Military Tricare coverage models universal health care access; however, in studies looking at births in military treatment facilities, disparities still exist for women of color. This study analyzes maternal delivery outcomes for all women with Tricare coverage including deliveries in the civilian sector. METHODS: Data from 6.2 million births in the Centers for Disease Control and Prevention WONDER Linked Birth/Infant Death Records for 2017–2019 were analyzed for all-cause morbidity (transfusions, perineal lacerations, uterine rupture, unplanned hysterectomy, and intensive care unit admissions), severe maternal morbidity (SMM) (excludes lacerations), and SMM excluding transfusion. Risk ratios were calculated comparing overall maternal morbidity rates between Tricare, Medicaid, self-pay, and private insurance. In addition, risk ratios were calculated between insurance types stratified by race. RESULTS: Compared to private insurance, Tricare insurance had significantly reduced risk of all-cause maternal morbidity. Compared to White women, Black women with Tricare and all other insurances had a decreased risk of all-cause morbidity, but a significantly increased risk of SMM and SMM without transfusion. Asian women had significant increased risk of all-cause, SMM and SMM without transfusion. There was no significant difference in the risk of morbidity for women of color with Tricare insurance compared to women of color with Medicaid, private, or self-pay insurance. CONCLUSION: The risk of severe maternal morbidity remains elevated for women of color despite access to Tricare health insurance.
{"title":"Racial Differences in Severe Maternal Morbidity Exist for Tricare Beneficiaries [ID: 1377133]","authors":"E. Lyon, Veronica M Gonzalez-Brown, E. Keyser, Katherine Porter, R. Tindal","doi":"10.1097/01.AOG.0000930252.58330.98","DOIUrl":"https://doi.org/10.1097/01.AOG.0000930252.58330.98","url":null,"abstract":"INTRODUCTION: Maternal morbidity and mortality rates in the United States have increased in the last two decades with a disproportionate effect on women of color. Military Tricare coverage models universal health care access; however, in studies looking at births in military treatment facilities, disparities still exist for women of color. This study analyzes maternal delivery outcomes for all women with Tricare coverage including deliveries in the civilian sector. METHODS: Data from 6.2 million births in the Centers for Disease Control and Prevention WONDER Linked Birth/Infant Death Records for 2017–2019 were analyzed for all-cause morbidity (transfusions, perineal lacerations, uterine rupture, unplanned hysterectomy, and intensive care unit admissions), severe maternal morbidity (SMM) (excludes lacerations), and SMM excluding transfusion. Risk ratios were calculated comparing overall maternal morbidity rates between Tricare, Medicaid, self-pay, and private insurance. In addition, risk ratios were calculated between insurance types stratified by race. RESULTS: Compared to private insurance, Tricare insurance had significantly reduced risk of all-cause maternal morbidity. Compared to White women, Black women with Tricare and all other insurances had a decreased risk of all-cause morbidity, but a significantly increased risk of SMM and SMM without transfusion. Asian women had significant increased risk of all-cause, SMM and SMM without transfusion. There was no significant difference in the risk of morbidity for women of color with Tricare insurance compared to women of color with Medicaid, private, or self-pay insurance. CONCLUSION: The risk of severe maternal morbidity remains elevated for women of color despite access to Tricare health insurance.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"64 1","pages":"41S - 41S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89361879","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.0000930512.24906.d7
A. Kostolias, Zia Husnain, Jane A. James, Adolphia Lauture, Maximiliano Mayrink, J. Pérez
INTRODUCTION: Mount Sinai Medical Center (MSMC) in Miami Beach, Florida, is home to a diverse and international obstetric population. In 2017, the state of Florida had a cesarean delivery (CD) rate for nulliparous, term, singleton, vertex (NTSV) of 31.1%, the highest in the nation. Mount Sinai Medical Center had a NTSV CD rate of 38.3%. The national rate of NTSV CD in 2017 was 26%. Mount Sinai Medical Center joined PROVIDE (Promoting Primary Vaginal Deliveries), a statewide initiative by the Florida Perinatal Quality Collaborative with the goal of improving maternal and newborn outcomes by applying evidence-based interventions and reducing NTSV CD rates. METHODS: The implementation of an obstetrics and gynecology residency program and monthly grand rounds contributed to an effort of evidence-based medicine. The interventions implemented were nurse education of labor positioning from Bundle Births and Spinning Babies, nursing recognition as “Vaginal Queen of the Month,” Bishop score documentation added to H&P, obstetric physicians assigned “Badge Buddies” next to their hospital ID cards disclosing their personal NTSV CD rate, and a pre-cesarean checklist for labor dystocia or failed induction. RESULTS: After 2 years of multifaceted interventions, MSMC had decreased its cesarean delivery rate for NTSV patients from 38.3% in 2017 to 27.7% in 2019. The average rate in Florida overall was 29.7% in 2019 and the national rate of CD in NTSV patients was 25.6% in 2019 (data source: FPQC Perinatal Indicator System). CONCLUSION: With continued interventions, we hypothesize that we will meet the healthy people 2030 target CD for NTSV rate of 23.6% as the initiative enters its sustainability phase.
{"title":"Reduction of Cesarean Delivery Rates in South Florida: The MSMC Experience [ID: 1370319]","authors":"A. Kostolias, Zia Husnain, Jane A. James, Adolphia Lauture, Maximiliano Mayrink, J. Pérez","doi":"10.1097/01.aog.0000930512.24906.d7","DOIUrl":"https://doi.org/10.1097/01.aog.0000930512.24906.d7","url":null,"abstract":"INTRODUCTION: Mount Sinai Medical Center (MSMC) in Miami Beach, Florida, is home to a diverse and international obstetric population. In 2017, the state of Florida had a cesarean delivery (CD) rate for nulliparous, term, singleton, vertex (NTSV) of 31.1%, the highest in the nation. Mount Sinai Medical Center had a NTSV CD rate of 38.3%. The national rate of NTSV CD in 2017 was 26%. Mount Sinai Medical Center joined PROVIDE (Promoting Primary Vaginal Deliveries), a statewide initiative by the Florida Perinatal Quality Collaborative with the goal of improving maternal and newborn outcomes by applying evidence-based interventions and reducing NTSV CD rates. METHODS: The implementation of an obstetrics and gynecology residency program and monthly grand rounds contributed to an effort of evidence-based medicine. The interventions implemented were nurse education of labor positioning from Bundle Births and Spinning Babies, nursing recognition as “Vaginal Queen of the Month,” Bishop score documentation added to H&P, obstetric physicians assigned “Badge Buddies” next to their hospital ID cards disclosing their personal NTSV CD rate, and a pre-cesarean checklist for labor dystocia or failed induction. RESULTS: After 2 years of multifaceted interventions, MSMC had decreased its cesarean delivery rate for NTSV patients from 38.3% in 2017 to 27.7% in 2019. The average rate in Florida overall was 29.7% in 2019 and the national rate of CD in NTSV patients was 25.6% in 2019 (data source: FPQC Perinatal Indicator System). CONCLUSION: With continued interventions, we hypothesize that we will meet the healthy people 2030 target CD for NTSV rate of 23.6% as the initiative enters its sustainability phase.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"1 1","pages":"59S - 59S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89616862","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.0000931092.06067.d0
Saumya S. Sao, J. Coleman, Lillee Izadi, Runzhi Wang, R. Yu
INTRODUCTION: Youth bear a disproportionate burden of sexually transmitted infections (STIs) and unintended pregnancy. Knowledge about sexual and reproductive health (SRH) is low among this population, and youth face numerous barriers to care. We sought to develop and assess a youth-led intervention to increase youth SRH knowledge, self-efficacy, and autonomy, which are key indicators in developing positive sexual health behaviors and skills to feel confident in accessing health services. METHODS: Nine interactive, youth-led, 2-hour sessions were held virtually or in-person over 9 months. Session topics included human immunodeficiency virus and STIs, contraception, reproductive anatomy, menstrual health, healthy relationships, sexual decision-making, sexual violence, substance use, goal setting, gender identity and sexuality, and navigating health care services as an adolescent. Monetary compensation and transportation were provided. Sexual and reproductive health knowledge, self-efficacy, and autonomy were assessed using validated scales via an electronic questionnaire before and after implementing the intervention (IRB approved). Paired t tests were used to assess intervention effect. RESULTS: Thirty-seven participants with a mean age of 15.8 years (SD 1.13) were enrolled. All lived in the greater Baltimore area, and the majority self-identified as female. 52% were Black/African American, 28% Asian/Asian American, 12% White, and 8% Hispanic/Latino. Average attendance across sessions was 88%. Participants showed improvement in SRH knowledge (P=.02), advocacy and self-efficacy (P<.001), and personal safety and autonomy (P<.01). They reported increased comfort using trusted sites to procure SRH information (P<.01). CONCLUSION: A youth-led SRH intervention effectively increased SRH knowledge, self-efficacy, and autonomy. Further work should be done to explore the effects and expansion of peer-to-peer SRH education.
{"title":"Evaluation of a Youth-Led Intervention to Improve Adolescent Sexual and Reproductive Health Knowledge, Efficacy, and Autonomy [ID: 1377919]","authors":"Saumya S. Sao, J. Coleman, Lillee Izadi, Runzhi Wang, R. Yu","doi":"10.1097/01.aog.0000931092.06067.d0","DOIUrl":"https://doi.org/10.1097/01.aog.0000931092.06067.d0","url":null,"abstract":"INTRODUCTION: Youth bear a disproportionate burden of sexually transmitted infections (STIs) and unintended pregnancy. Knowledge about sexual and reproductive health (SRH) is low among this population, and youth face numerous barriers to care. We sought to develop and assess a youth-led intervention to increase youth SRH knowledge, self-efficacy, and autonomy, which are key indicators in developing positive sexual health behaviors and skills to feel confident in accessing health services. METHODS: Nine interactive, youth-led, 2-hour sessions were held virtually or in-person over 9 months. Session topics included human immunodeficiency virus and STIs, contraception, reproductive anatomy, menstrual health, healthy relationships, sexual decision-making, sexual violence, substance use, goal setting, gender identity and sexuality, and navigating health care services as an adolescent. Monetary compensation and transportation were provided. Sexual and reproductive health knowledge, self-efficacy, and autonomy were assessed using validated scales via an electronic questionnaire before and after implementing the intervention (IRB approved). Paired t tests were used to assess intervention effect. RESULTS: Thirty-seven participants with a mean age of 15.8 years (SD 1.13) were enrolled. All lived in the greater Baltimore area, and the majority self-identified as female. 52% were Black/African American, 28% Asian/Asian American, 12% White, and 8% Hispanic/Latino. Average attendance across sessions was 88%. Participants showed improvement in SRH knowledge (P=.02), advocacy and self-efficacy (P<.001), and personal safety and autonomy (P<.01). They reported increased comfort using trusted sites to procure SRH information (P<.01). CONCLUSION: A youth-led SRH intervention effectively increased SRH knowledge, self-efficacy, and autonomy. Further work should be done to explore the effects and expansion of peer-to-peer SRH education.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":"11 1","pages":"90S - 90S"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88725172","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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