Scorecard implementation improves identification of postpartum patients at risk for venous thromboembolism.

Objective: To evaluate if an intensive educational intervention in the use of a standardized venous thromboembolism (VTE) risk assessment tool (scorecard) improves physicians' identification and chemoprophylaxis of postpartum patients at risk for VTE.

Methods: After implementation of a VTE scorecard and prior to an intensive educational intervention, postpartum patients (n = 140) were evaluated to assess scorecard completion, risk factors, and chemoprophylaxis. A performance improvement campaign focusing on patient safety, VTE prevention, and scorecard utilization was then conducted.

Breaking Bad News in obstetrics: a randomized trial of simulation followed by debriefing or lecture.

Objective: Although communication skills represent an increasingly important aspect of medical care, little has been done to assess the best method of teaching these skills. Our study was designed to assess simulation-debriefing compared to lecture in teaching skills for Breaking Bad News (BBN) in obstetrics.

Methods: This is a randomized prospective trial of house staff from a large academic medical center.

Is obesity an independent barrier to obtaining prenatal care?

Objective: Obesity is a demonstrated barrier to obtaining health care. Its impact on obtaining prenatal care (PNC) is unknown. Our objective was to determine if obesity is an independent barrier to accessing early and adequate PNC.

Reproductive implications of bariatric surgery: pre- and postoperative considerations for extremely obese women of childbearing age.

Extreme obesity remains a frustrating and formidable disease, with most sufferers requiring surgical intervention in order to achieve long-term, sustained weight loss. Most bariatric procedures today are performed on women, many of whom are of reproductive age; yet minimal evidence exists to guide clinicians in the care of such women before, during, and after pregnancy. This review outlines the fundamental nutritional and surgical alterations of the most commonly performed bariatric procedures with the aim to elucidate a physiologically sound approach to counseling and management of extremely obese women of childbearing age who are either contemplating or have already undergone bariatric surgery.

Re-evaluating the role of the MFM specialist: lead, follow, or get out of the way.

Objective: To assess the effect of sub-specialty prenatal care provided to high-risk obstetrical patients in a community perinatal center as a function of whether consultation and referral to a Maternal-Fetal Medicine (MFM) sub-specialist was at the discretion of the generalist, required by the insurance carrier, or by patient choice.

Methods: Demographics, management, and perinatal outcomes for high-risk patients managed exclusively by MFM were compared with those managed by generalists who were later referred to MFM after problems arose.

Results: Despite similar demographics, high-risk patients managed exclusively by a single MFM had less prematurity, lower cesarean section rates, fewer low 5-minute Apgar scores (1.

Impact of folic acid fortification in the United States: markedly diminished high maternal serum alpha-fetoprotein values.

Objective: Folic acid fortification of breads and grains was implemented in the United States in 1998 in an attempt to reduce the incidence of neural tube defects. Outcome data from birth registries have shown a 20% drop-less than originally predicted. In this study, we ascertain if the impact of folic acid fortification is better seen at the time of midtrimester prenatal diagnosis by looking at incidence of high maternal serum alpha-fetoprotein (MSAFP) values.

Hemoglobinopathy screening in pregnancy: comparison of two protocols.

This study was designed to determine the ability of a hemoglobinopathy screening protocol involving sickle solubility testing and red blood cell (RBC) indices to identify at-risk pregnancies. Retrospective chart review of all patients registering for prenatal care at the New York Hospital/Cornell Medical Center prenatal clinic in 1996 was the study design. All patients had RBC indices as well as hemoglobin electrophoresis.

Critical Issues in Treating HIV During Pregnancy.

When the AIDS Clinical Trial Group (ACTG) broke the code for Protocol 076, researchers discovered that giving zidovudine (formerly called azidothymidine, or AZT) to HIV-infected women during pregnancy (100mg PO 5 times daily) and labor (2mg/kg of body weight IV, given over 1 hour, then 1mg/kg/hr until delivery), plus to the newborn (2mg/kg PO q6h for 6 weeks), could cut perinatal HIV transmission by two thirds. Now, further studies are also adding to the databank of information about HIV in pregnancy. For example, one study has shown that pregnancy does not hasten the progression of HIV; another has indicated that although vertical HIV transmission often occurs late in gestation, it also can occur as early as 8 weeks.

Cardiovascular effects and placental passage of dantrolene in the maternal-fetal sheep model.

Using the chronic maternal-fetal sheep preparation, nine pregnant ewes were studied to determine the effects of intravenous dantrolene sodium on maternal and fetal physiology, with particular reference to its placental passage, and its effects on uterine blood flow and uterine tone. Two doses of dantrolene sodium were studied: 1.2 mg/kg and 2.

Successful management of varicella pneumonia complicating pregnancy. A report of three cases.

Although varicella is a common infection in the United States, pregnant women are infrequently infected. Varicella pneumonia is an even rarer though potentially fatal complication during pregnancy. Fulminant respiratory collapse often ensues and is associated with greater than 40% mortality.

Multiple peripheral pulmonic stenosis in pregnancy.

Multiple peripheral pulmonic stenosis is a rare congenital cardiac disorder. The clinical course of this disease in pregnancy is not established. We report the benign obstetric course of a patient whose pregnancy was complicated by peripheral pulmonic stenosis and pulmonary hypertension.