Evidence-based cesarean delivery: intraoperative management from skin incision until placental delivery (Part 8).

The goal of standardizing the technique of the routine, uncomplicated cesarean delivery (CD) is to decrease maternal morbidity while optimizing neonatal outcomes. During the procedure, a family-oriented CD is recommended. The low transverse cesarean skin incision (created with either scalpel or diathermy) is preferred with either the Joel-Cohen or Pfannenstiel methods being acceptable.

Comparing models that integrate obstetric care and WIC on improved program enrollment during pregnancy: a protocol for a randomized controlled trial.

Background: Low-income, rural pregnant women are at disproportionate risk for adverse pregnancy outcomes as well as future cardiovascular risk. Currently, less than half of eligible women enroll in the Women, Infants, and Children's (WIC) Program. This study aims to evaluate whether integrating clinical care and social care may advance health equity and reduce health disparities by directly linking women receiving obstetric care to the Special Supplemental Nutrition Program for WIC and/or a Registered Dietitian/Nutritionist (RDN).

Evidence-based Cesarean Delivery: Postoperative Care (Part 10).

The following review focuses on routine postoperative care after cesarean delivery (CD), including specific Enhanced Recovery After Cesarean (ERAS) recommendations as well as important postpartum counseling points. Following CD, there is insufficient evidence to support administration of prophylactic multi-dose antibiotics to all patients. Additional antibiotic doses are indicated for the following scenarios: patients with obesity, CD lasting ≥ 4 hours since prophylactic dose, blood loss >1,500 mL, or those with an intra-amniotic infection.

Evidence-based Cesarean Delivery: Intraoperative management following placental delivery until skin closure (Part 9): Evidence based care during cesarean delivery.

This expert review provides recommendations for the cesarean technique after placental delivery to skin closure. Following placental delivery during cesarean, sponge curettage may be omitted as it has not been shown to decrease the risk of retained products of conception. Uterine irrigation and mechanical cervical dilation cannot be recommended.

The impact of prepregnancy body mass index on pregnancy and neonatal outcomes.

Context: The obesity epidemic in the United States is continuing to worsen. Obesity is a known risk factor for pregnancy morbidity. However, many studies use the patient's body mass index (BMI) at the time of delivery, do not stratify by class of obesity, or utilize billing codes as the basis of their study, which are noted to be inaccurate.

Evidence-based cesarean delivery: preoperative management (part 7).

Preoperative preparation for cesarean delivery is a multistep approach for which protocols should exist at each hospital system. These protocols should be guided by the findings of this review. The interventions reviewed and recommendations made for this review have a common goal of decreasing maternal and neonatal morbidity and mortality related to cesarean delivery.

Preeclampsia and Long-term Kidney Outcomes: An Observational Cohort Study.

Rationale & Objective: Preeclampsia is a pregnancy-related complication characterized by acute hypertension and end-organ dysfunction. We evaluated the long-term association between preeclampsia and the risk of developing chronic hypertension and kidney disease.

Study Design: Observational cohort study.

Comparison of three antepartum risk assessment tools to predict significant postpartum hemorrhage in livebirths.

Background: To adequately predict significant postpartum hemorrhage (PPH) at hospital admission, we evaluated and compared the accuracy of three risk assessment tools: 1. California Maternal Quality Care Collaborative (CMQCC), 2. American College of Obstetrics and Gynecology Safe Motherhood Initiative (ACOG SMI) and 3.

Pregnancy Outcomes in Patients Enrolled in the Healthy Beginnings Plus Program.

Objective: To evaluate the effectiveness of enrollment in the Healthy Beginnings Plus Program (HB) on pregnancy outcomes.

Design: Retrospective cohort study of 12,299 singleton pregnancies birthed between January 2007 and December 2018.

Setting/local Problem: Individuals of low socioeconomic status are at increased risk for adverse pregnancy outcomes, such as preterm birth (PTB) and low-birth-weight (LBW) neonates.

Women's beliefs of pain after childbirth: Critical insight for promoting behavioral strategies to regulate pain and reduce risks for maternal mortality.

Objective: Promoting behavioral strategies to better regulate pain and decrease the use of prescription pain medications immediately after childbirth is an attractive approach to reduce risks for adverse outcomes associated with the maternal mortality crisis. This study aimed to understand women's beliefs and experiences about pain management to identify important insights for promoting behavioral strategies to control postpartum pain.

Methods: N = 32 postpartum women participated in a semi-structured interview about beliefs/experiences with managing postpartum pain.

Retrospective application of algorithms to improve identification of pregnancy outcomes from the electronic health record.

Objective: To improve upon the accuracy of ICD codes for identifying maternal and neonatal outcomes by developing algorithms that incorporate readily available EHR data.

Study Design: Algorithms were developed for gestational hypertension (GHTN), pre-eclampsia (PreE), gestational diabetes mellitus (GDM) and were compared to ICD codes and chart review. Accuracy and sensitivity analyses were calculated with their respective 95% confidence limits for each of the comparisons between algorithms, ICD codes alone, and chart review.

Suture Compared With Staples for Skin Closure After Cesarean Delivery: A Systematic Review and Meta-analysis.

Objective: Absorbable suture is the preferred method of cesarean skin closure compared with metal staples, because it decreases wound complications. Two recently published trials in patients with obesity contradict this evidence. The goal of this meta-analysis was to assess whether suture remains the recommended method of cesarean skin closure, regardless of obesity status.

Factors that shape pregnant women's perceptions regarding the safety of cannabis use during pregnancy.

Background: Cannabis use among pregnant women has increased. We surveyed pregnant women in rural Pennsylvania to examine cannabis use and opinions regarding its safety during pregnancy. We examined associations between challenges of pregnancy (e.

Obstetricians' prescribing practices for pain management after delivery.

To examine postpartum opioid prescribing practices. Obstetricians were interviewed about opioids: choice of opioid, clinical factors considered when prescribing, thoughts/beliefs about prescribing, and typical counseling provided. Inductive thematic analyses were used to identify themes.

A retrospective review of pregnancy outcomes in women with uncomplicated mild to moderate chronic hypertension.

Objective: To examine pregnancy complications in women with uncomplicated mild-moderate chronic hypertension (CHTN) treated with antihypertensives prior to 20 weeks compared to those not on antihypertensives.

Study Design: This retrospective cohort study examined singleton pregnancies of women with mild-moderate CHTN who delivered from 01/2014-3/2019. Pregnancies complicated by hypertension at ≥ 20 weeks, end organ damage, preexisting diabetes mellitus, early-onset gestational diabetes, multifetal gestation, and fetal anomalies were excluded.

Duration of postpartum magnesium sulfate for seizure prophylaxis in women with preeclampsia: a systematic review and meta-analysis.

Objective: Pregnant women diagnosed with preeclampsia are at increased risk of eclampsia. Magnesium sulfate is the standard of care for maternal seizure prophylaxis. Traditional regimens of magnesium sulfate have continued infusions for 24 h postpartum.

Obstetric Physicians' Beliefs and Knowledge on Guidelines and Screening Tools to Reduce Opioid Use After Childbirth.

Objective: To examine obstetric physicians' beliefs about using professional or regulatory guidelines, opioid risk-screening tools, and preferences for recommending nonanalgesic therapies for postpartum pain management.

Methods: A qualitative study design was used to conduct semi-structured interviews with obstetric and maternal-fetal medicine physicians (N=38) from two large academic health care institutions in central Pennsylvania. An interview guide was used to direct the discussion about each physicians' beliefs in response to questions about pain management after childbirth.

Comparison of different methods of patient education on preeclampsia: a randomized controlled trial.

Background: Preeclampsia is a life-threatening condition unique to pregnancy that contributes to maternal mortality worldwide. Delays in diagnosis and treatment are contributing factors for most maternal deaths from preeclampsia. Patients who are educated and knowledgeable regarding this disease process may present earlier for care.