Notes

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ith or without FGR deliver vaginally.. · The use of prostaglandins did not increase rates of cesarean for fetal distress in oligohydramnios.. · Prostaglandin use did not increase rate of neonatal intensive care unit admission among pregnancies with oligohydramnios..
· The majority of fetuses with oligohydramnios with or without FGR deliver vaginally.. · The use of prostaglandins did not increase rates of cesarean for fetal distress in oligohydramnios.. · Prostaglandin use did not increase rate of neonatal intensive care unit admission among pregnancies with oligohydramnios..
 The goal of this study was to investigate whether preexisting cardiac arrhythmias are associated with adverse obstetrical outcomes in women with a history of open cardiac surgery.

 This was a retrospective cohort study of women with a history of open cardiac surgery who delivered at MedStar Washington Hospital Center (Washington, DC) from January 2007 through December 2018. Women with the isolated percutaneous cardiac surgical repair were excluded. Maternal and neonatal outcomes were compared between patients with preexisting cardiac arrhythmias and patients without preexisting cardiac arrhythmias. Maternal outcomes studied were intensive care unit admission, postpartum blood loss greater than 1,000 mL, congestive heart failure development, preeclampsia with severe features, postpartum readmission, postpartum cardiac events, and postpartum length of stay >5 days. Neonatal outcomes investigated were low birth weight <2,500 g, Apgar's scores <7 at 5 minutes, and neonatal intensive care unit admissd with women with a history of open cardiac surgery without preexisting cardiac arrhythmias.

· Preexisting arrhythmias after cardiac surgery was associated with a risk of preeclampsia.. · Neonates of women with preexisting cardiac arrhythmias are more likely to be low birth weight.. · Forty-seven percent of women with open cardiac surgery developed subsequent arrhythmias..
· Preexisting arrhythmias after cardiac surgery was associated with a risk of preeclampsia.. · Neonates of women with preexisting cardiac arrhythmias are more likely to be low birth weight.. · Forty-seven percent of women with open cardiac surgery developed subsequent arrhythmias..
 While twin gestations are at increased risk of severe maternal morbidity (SMM), there is limited information about timing and causes of SMM in twins. Furthermore, existing data rely on screening definitions of SMM because a gold standard approach requires chart review. We sought to determine the timing and cause of SMM in twins using a gold standard definition outlined by the American College of Obstetricians and Gynecologists (ACOG).

 We used a perinatal database to identify all twin deliveries from 1998 to 2013 at a single academic medical center (
 = 2,367). Deliveries were classified as screen positive for SMM if they met any of the following criteria (1) one of the Centers for Disease Control and Prevention (CDC) International Classification of Diseases Ninth Revision diagnosis and procedure codes for SMM; (2) a prolonged postpartum length of stay (>3 standard deviations beyond mean length of stay by mode of delivery); or (3) maternal intensive care unit admission. We identified true cases of SMmonary complications were the most common morbidities.. · SMM was most common postpartum..
· Screening approaches for SMM have low positive predictive value in twins.. · Hemorrhage, hypertensive, and pulmonary complications were the most common morbidities.. · SMM was most common postpartum..
 Anemia of pregnancy is a common condition associated with adverse obstetric outcomes. However, little is known about its long-term effect on the offspring. This study aimed to evaluate a possible association between anemia during pregnancy and the long-term incidence of infectious morbidity in the offspring.

 A large population-based retrospective study was conducted at the Soroka University Medical Center, the sole tertiary medical center in the south of Israel. The study included deliveries between the years 1991 and 2014 and compared long-term infectious morbidity of offspring of women with and without anemia during pregnancy (defined as hemoglobin level below 11 g/dL). The long-term incremental incidence of hospitalizations of offspring up to 18 years of age due to infectious morbidity was evaluated using Kaplan-Meier survival curves, while Cox's regression model was used to control for confounders.

 During the study period, 214,244 deliveries met the inclusion criteria, of which 110,775 (51.7%) nefectious morbidity..
· Anemia is highly common in pregnancy.. · Maternal anemia has multiple short-term implications.. · Our study shows anemia of pregnancy is independently associated with long-term offspring infectious morbidity..
 Thromboelastography (TEG), a point-of-care test that measures blood's dynamic viscoelastic properties, is routinely used to guide resuscitation in surgical specialties with high hemorrhage risk. Patients with ongoing postpartum hemorrhage (PPH) often develop coagulopathy and hypofibrinogenemia. Timely assessment of fibrinogen is crucial because cryoprecipitate for repletion requires thawing time prior to administration. TEG may provide rapid assessment of coagulopathy in ongoing hemorrhage but this has not been thoroughly studied. Our objective was to determine if TEG accurately reflects coagulopathy in ongoing PPH when compared with standard assays.

 This was a retrospective cohort study of people with ongoing PPH (quantified blood loss >1,000 mL), from January 1, 2016, to December 31, 2019. TEG variables and standard coagulation parameters were compared in patients who had both assays drawn simultaneously. As a secondary analysis, patients who had TEG were compared with those who did not. The Mann-Wly hemorrhage evaluation and directed resuscitation of coagulopathy.

· TEG significantly correlates with standard laboratory measures of coagulopathy in postpartum hemorrhage, including in patients with hybofibrinogemia (fibrinogen <200).. · TEG is routinely used in nonobstetric hemorrhage, and should be considered in PPH.. · Due to the point-of-care nature, TEG may allow for rapid guided resuscitation, including fibrinogen..
· TEG significantly correlates with standard laboratory measures of coagulopathy in postpartum hemorrhage, including in patients with hybofibrinogemia (fibrinogen less then 200).. learn more · TEG is routinely used in nonobstetric hemorrhage, and should be considered in PPH.. · Due to the point-of-care nature, TEG may allow for rapid guided resuscitation, including fibrinogen..
 We investigated the effect of TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) training on teamwork perceptions and patient safety outcomes in an inpatient obstetrics setting.

 Physicians and nurses from the regional perinatal center were offered TeamSTEPPS instruction and administered a voluntary survey to assess subjective perceptions of team dynamics and patient safety prior to and 6 months following TeamSTEPPS training. Responses were analyzed using analysis of variance (ANOVA) and Chi-square test. Objective measures of patient safety outcomes were the incidence and blood loss of postpartum hemorrhage after vaginal delivery (PPH-VD) or cesarean section (PPH-CS) and incidence of shoulder dystocia (SD). Outcomes were analyzed using Mann-Whitney and Kruskal-Wallis tests.

 Surveys were collected from 20 physicians and 15 nurses prior to training and from 9 physicians and 20 nurses 6 months following training. Survey data showed an overall positive perception of teamwork ry to realize tangible benefits of TeamSTEPPS. Our survey results also highlight important differences between physician and nursing staff perceptions.

· There is value in a comprehensive patient safety program, such as TEAMSTEPPS, with ongoing training.. · Patient safety perceptions may differ between physician and nursing staff in the same unit.. · Health care staff must agree about the situation to improve patient safety..
· There is value in a comprehensive patient safety program, such as TEAMSTEPPS, with ongoing training.. · Patient safety perceptions may differ between physician and nursing staff in the same unit.. · Health care staff must agree about the situation to improve patient safety..
 The American College of Obstetricians and Gynecologists suggests that an electrocardiogram is an acceptable first-line test. We sought to examine whether an electrocardiogram is a sufficient screening tool to identify echocardiogram-diagnosed left ventricular hypertrophy. We also sought to determine risk factors associated with left ventricular hypertrophy.

 This was a retrospective cohort study of pregnant individuals with chronic hypertension who delivered at 20 weeks' gestation or greater at a tertiary care center. Analyses were limited to individuals who had both electrocardiogram and echocardiogram during pregnancy. Left ventricular hypertrophy was diagnosed using the American Society of Echocardiography guidelines. Maternal demographics and electrocardiogram results were compared between individuals with left ventricular hypertrophy and those without left ventricular hypertrophy. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of the electrocardiogram to ident% CI 0.94-7.10).

 Electrocardiogram was not a sufficient test for identifying left ventricular hypertrophy in pregnant individuals with chronic hypertension. We suggest an echocardiogram evaluation for all individuals with chronic hypertension.

· The first-line test for cardiac evaluation is an electrocardiogram.. · In our cohort, the rate of left ventricular hypertrophy was 35%.. · The electrocardiogram was not sensitive to detect left ventricular hypertrophy..
· The first-line test for cardiac evaluation is an electrocardiogram.. · In our cohort, the rate of left ventricular hypertrophy was 35%.. · The electrocardiogram was not sensitive to detect left ventricular hypertrophy..
 Our objective was to evaluate if the use of low-dose aspirin (LDA) among pregnant individuals with chronic hypertension (CHTN) reduces the rate of superimposed preeclampsia or other adverse maternal and neonatal outcomes.

 Our study included single-center cohort of pregnant individuals with CHTN who had a live birth after 23 weeks' gestation, between 2013 and 2018. The primary exposure was the use of LDA in pregnancy and the primary outcome was superimposed preeclampsia. LDA use was also evaluated by the timing of initiation, before or after 16 weeks' gestation. Secondary outcomes included preeclampsia subtypes (e.g., preeclampsia with severe features, early-onset disease), as well as adverse maternal and neonatal outcomes. Differences were analyzed by

, Fisher's exact, or
tests, with logistic regression to adjust for confounders.

 Of 11,825 deliveries during the study period, 494 (4.2%) occurred in women with CHTN. Among those with CHTN, 174 (35%) were prescribed LDA, most often 81 mg daily (1more beneficial at dosages greater than 81 mg daily.

· Superimposed preeclampsia rates are the same regardless of LDA.. · Decreased rate of adverse neonatal outcomes is seen with LDA.. · No decrease in adverse maternal outcomes is seen with LDA..
· Superimposed preeclampsia rates are the same regardless of LDA.. · Decreased rate of adverse neonatal outcomes is seen with LDA.. · No decrease in adverse maternal outcomes is seen with LDA..
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