Furosemide for Postpartum Management of Hypertensive Disorders: A Randomized Controlled Study

Loop diuretics have been investigated for managing postpartum hypertensive disorders, but there is currently insufficient clinical evidence pointing to any single agent. This study aims to compare blood pressure (BP) outcomes for patients with gestational hypertensive disorders receiving labetalol alone versus labetalol + furosemide during postpartum hospital stay. The primary aim was to learn if loop diuretic incorporation in conjunction with labetalol could lower the need for additional anti-hypertensive agents.https://corescholar.libraries.wright.edu/urop_celebration/1147/thumbnail.jp

Obstetrics Emergency Labor and Delivery Case Simulations with Normal Vaginal Delivery Demonstration: A Hands-on Simulation for Clerkship Students

Introduction: Simulation is rarely used for medical student education in the field of obstetrics. This method is an effective model of learning for topics that are encountered in clinical situations and for topics that pose significant risk to patients when an untrained individual is involved. Methods: A 2-hour obstetric delivery simulation session was developed and incorporated into the third-year obstetrics and gynecology clerkship rotation at Wright State University Boonshoft School of Medicine. Medical students completed self-guided content reviews with resources provided prior to the session. During the session, each medical student conducted a normal vaginal delivery and one of the emergent cases (umbilical cord prolapse, pre-eclampsia/eclampsia, shoulder dystocia, and postpartum hemorrhage). During each case the Resident facilitator followed a script which included asking questions using gamification strategies to promote a low-stress learning environment. Critical action checklists were used to ensure students gained a strong understanding of topics. Simulation sessions were conducted both remotely and in-person. The simulation experience was evaluated using surveys and quizzes completed prior to and after participating in the simulation session. Results: Students reported that the simulation experience increased their comfort with emergent obstetric situations, increased their medical knowledge, and was beneficial to their education. Discussion: Simulation is an untapped learning method in obstetrics. We developed simulations for obstetric events to provide medical students with hands-on exposure to important obstetric experiences. This simulation session provides the framework for other medical schools to incorporate these obstetric simulations into their clerkship curriculum

Instrumental Delivery of the Fetal Head at the Time of Elective Repeat Cesarean: A Randomized Pilot Study

We sought to ascertain whether the routine use of instruments, forceps or vacuum, at the time of elective repeat cesarean delivery, permits a delivery that is as safe for mother and infant and as easy for mother and physician as traditional manual delivery of the fetal head. In this prospective study 44 women undergoing elective repeat cesarean were randomized to deliver by Vacuum (V), Forceps (F), or by Manual (M) means. Groups were compared with regard to demographic variables and maternal and neonatal outcomes. Deliveries were timed from entry into the uterus until full delivery of the infant. Maternal pain scores were assessed using a 10-cm visual analog scale. There were no differences in demographic variables except that the M group had fewer women with up to two cesareans. A large percentage of women in each group were delivered with the randomized instrument. Use of the V did not demonstrate fewer extensions of the uterine incision or lesser amounts of blood loss as measured by serial hemoglobin determinations. There was a trend for the F group to require a longer period of time for delivery (p = 0.061). Women in the V group reported significantly lower pain scores (p = 0.015). There were no serious neonatal injuries. The routine use of instruments at the time of elective repeat cesarean delivery appears safe and effective

Instrumental Delivery of the Fetal Head at the Time of Elective Repeat Cesarean: A Randomized Pilot Study

We sought to ascertain whether the routine use of instruments, forceps or vacuum, at the time of elective repeat cesarean delivery, permits a delivery that is as safe for mother and infant and as easy for mother and physician as traditional manual delivery of the fetal head. In this prospective study 44 women undergoing elective repeat cesarean were randomized to deliver by Vacuum (V), Forceps (F), or by Manual (M) means. Groups were compared with regard to demographic variables and maternal and neonatal outcomes. Deliveries were timed from entry into the uterus until full delivery of the infant. Maternal pain scores were assessed using a 10-cm visual analog scale. There were no differences in demographic variables except that the M group had fewer women with up to two cesareans. A large percentage of women in each group were delivered with the randomized instrument. Use of the V did not demonstrate fewer extensions of the uterine incision or lesser amounts of blood loss as measured by serial hemoglobin determinations. There was a trend for the F group to require a longer period of time for delivery (p = 0.061). Women in the V group reported significantly lower pain scores (p = 0.015). There were no serious neonatal injuries. The routine use of instruments at the time of elective repeat cesarean delivery appears safe and effective