Variations in Postpartum Opioid Prescribing Practices among Obstetrician-Gynecologists

Introduction. Cesarean patients are commonly prescribed opioids when discharged from the hospital. This study aimed to determine if there were differences in prescribing practices based on the postoperative day opioid prescriptions were written, and before and after the publication of the American College of Obstetricians and Gynecologists (ACOG) Committee Opinion 742. Methods. This retrospective chart review study included women who had a live birth via cesarean at a single institution from July 1, 2017, to February 28, 2021, and excluded patients with chorioamnionitis or discharged after more than 4 days. Opioids were converted to oral morphine milligram equivalents (MME) for comparison, and total MME was calculated for each prescription. Patients were grouped based on date of delivery in comparison to the publication of ACOG Committee Opinion 742 (July 2018). IRB approval was obtained for this study. Results. Out of 411 patients, 93.9% (n=386) had opioids prescribed at discharge, 85.5% of whom (330/386) received a prescription written on the day of discharge. There was no difference in the quantity of MMEs in discharge prescriptions between those written on the day of discharge and those written on a prior day. Patients delivering after the new ACOG Opinion (63.9%, n=263) received discharge prescriptions with fewer average MMEs (159.53±61.64) than those who delivered before the publication (36%, n=148) (187.35±53.42), c2 (1, N=411) = 17.71, p < 0.001. Conclusions. Patients delivering via cesarean after the published ACOG Committee Opinion 742 received discharge prescriptions with fewer MMEs. There was no difference between prescriptions written the day of versus before discharge

Diagnostic accuracy of sonohysterography vs hysteroscopy in benign uterine endocavitary findings

OBJECTIVE: To compare diagnostic accuracy of sonohysterography vs hysteroscopy in patients with benign uterine endocavitary findings. PATIENTS AND METHODS: This retrospective study evaluated 202 patients submitted to sonohysterography after transvaginal ultrasound examination suspicious for uterine endocavitary findings. Cytological sample was taken and analyzed from the fluid used to distend the uterine cavity. Of 202 patients enrolled for this study, 86 patients underwent gynaecological surgery, of whom 77 were treated with operative hysteroscopy and 9 with other gynaecological surgical techniques. Statistical analysis was performed to evaluate diagnostic agreement between sonohysterography vs hysteroscopy and cytology vs histology. RESULTS: Diagnostic concordance between sonohysterography and hysteroscopy was significant (k value 0.87). The correlation between cytological and histological findings had a moderate level of concordance (k value 0.49).CONCLUSIONS: Sonohysterography provides a diagnostic accuracy as well as hysteroscopy, therefore, it could be considered an alternative procedure in the diagnosis of benign uterine endocavitary findings

A life threatening uterine inversion and massive post partum hemorrhage caused by placenta accrete during Caesarean section in a primigravida: a case report

Epoxide hydrolases catalyze the cofactor-independent hydrolysis of reactive and toxic epoxides. They play an essential role in the detoxification of various xenobiotics in higher organisms and in the bacterial degradation of several environmental pollutants. The first x-ray structure of one of these, from Agrobacterium radiobacter AD1, has been determined by isomorphous replacement at 2.1-Å resolution. The enzyme shows a two-domain structure with the core having the α/β hydrolase-fold topology. The catalytic residues, Asp107 and His275, are located in a predominantly hydrophobic environment between the two domains. A tunnel connects the back of the active-site cavity with the surface of the enzyme and provides access to the active site for the catalytic water molecule, which in the crystal structure, has been found at hydrogen bond distance to His275. Because of a crystallographic contact, the active site has become accessible for the Gln134 side chain, which occupies a position mimicking a bound substrate. The structure suggests Tyr152/Tyr215 as the residues involved in substrate binding, stabilization of the transition state, and possibly protonation of the epoxide oxygen.

Prenatal care: diagnostics

This issue of eMedRef provides information to clinicians on the care that should be given during and immediately after a pregnancy

Geospatial Variation in Caesarean Delivery

Aim: The purpose of this study was to evaluate the variation in caesarean delivery rates across counties in Georgia and to determine whether county-level characteristics were associated with clusters. Design: This was a retrospective, observational study. Methods: Rates of primary and repeat caesarean by maternal county of residence were calculated for 2008 through 2012. Global Moran\u27s I (Spatial Autocorrelation) was used to identify geographic clustering. Characteristics of high and low-rate counties were compared using student\u27s t test and chi squared test. Results: Spatial analysis of both primary and repeat caesarean rate identified the presence of clusters (Moran\u27s I = 0.375; p \u3c .001). Counties in high-rate clusters had significantly lower access to midwives, more deliveries paid by Medicaid, higher proportion of births for women belonging to racial/ethnic minority groups and were more likely to be rural

Postpartum Contraception Education

The current standard of practice for postpartum contraception in Plattsburgh, NY, as well as much of the United States, is initiation of contraception at the standard 6 week postpartum visit. However, many women may be better suited for immediate postpartum contraception while still hospitalized in labor and delivery. Long acting reversible birth control (LARC), including hormonal IUDs, copper IUDs, and progesterone implants, were the contraception types focused on in this project. Family medicine residents at CVPH reported low confidence in postpartum contraception as a whole. Furthermore, they reported limited knowledge on immediate postpartum contraception. The primary aim of this project was to expand the resident knowledge base on postpartum contraception and encourage them to consider immediate postpartum contraception in certain patients via an educational session.https://scholarworks.uvm.edu/fmclerk/1465/thumbnail.jp

Induction of Labor: Review of Pros, Cons, and Controversies

Although induction of labor (IOL) has increased over the years, corresponding improvements in perinatal outcomes have not occurred. IOL may result in increased risks for mother and baby, due to factors like gestational age (GA), Bishop score of cervix, and the methods used. Failed IOL resulting in increased cesarean sections may be due to unripe cervix, inadequate Pitocin use, and incorrect patient choice. Medically indicated IOL does not require awaiting 39 weeks GA. Nonmedically indicated IOL prior to 39 weeks GA may result in neonatal morbidity. Patients at 39 weeks GA can be induced electively and need not await labor. Cervical ripening methods include vaginal, oral, or IV medications and can be administered as outpatients rather than in hospitals, in order to decrease financial and time constraints. Ethical issues regarding indications, GA, choice of agent, location of cervical ripening, and failed IOL can have an impact on healthcare resources

Ankle fracture surgery on a pregnant patient complicated by intraoperative emergency caesarian section.

We report the case of a woman in the third trimester of pregnancy who sustained an ankle fracture dislocation that could not be adequately closed reduced. After discussions with the patient, her obstetrician, and the anesthesiologists, she was indicated for surgical fixation. A heart tone monitor was used to assess fetal health during the procedure. During surgical incision, the fetus went into distress, and an emergency caesarian section was performed. After delivery of the infant and abdominal closer, surgery was completed. Due to a cohesive team effort, both the patient and her infant had excellent outcomes. There are many important considerations in the surgical management of the pregnant patient with traumatic orthopaedic injuries. Of especial importance to the orthopaedic surgeon is the impact of patient positioning on uteroplacental blood flow. This report discusses factors that should be taken into account by any orthopaedist who plans to operate on a pregnant patient