Medicine and Health Sciences Commons^™

Delayed Onset Of Neonatal Compartment Syndrome Associated With Compound Fetal Presentation, Nicholas Manini, Hayato Unno

Department of Medicine Faculty Papers

Neonatal compartment syndrome, although rare, has a classic presentation with sentinel skin findings and development of swelling, erythema, and tenderness of the affected extremity. Neonatal compartment syndrome requires prompt surgical intervention to preserve the affected limb and ensure its normal growth and development. Our patient was born at term via vaginal delivery complicated by a compound presentation involving the left upper extremity. No physical exam abnormalities were noted at birth, but she developed signs of neonatal compartment syndrome by 15 h of life. She was surgically treated at 22 h of life and recovered well. At one year of age, …

Recognition Of And Response To Obstetric Emergencies: Developing A Virtual Competency-Based Orientation Program, Susan Morrison

Student Scholarly Projects

In order to improve outcomes in the perinatal setting, the development of a Virtual Competency-Based Orientation Program (CBO) toolkit is vital. Two toolkits, namely the Alliance for Innovation on Maternal Health (AIM) and the California Maternal Quality Care Collaborative (CMQCC), have been identified as effective in enhancing perinatal outcomes. AIM is a national initiative focused on improving maternal health outcomes, promoting safer birth practices, and saving lives through the implementation of best practices. CMQCC is a multi-stakeholder organization in California committed to eliminating preventable morbidity, mortality, and racial disparities in maternity care. Both AIM and CMQCC CBO toolkits incorporate research, …

Effectiveness Of Substance Use Disorder Education On Knowledge And Attitudes Among Entry-Level Obstetric Nurses, Kathryn Hughes

DNP Projects

Background: Substance use disorder (SUD) among pregnant women is a significant public health concern in the United States, particularly in Kentucky. Nursing curriculum has not kept pace with the escalating public health crisis regarding SUD. Graduating nurses joining the obstetric field are often not prepared to meet the unique care needs of this vulnerable population.

Purpose: The purpose of this DNP project was to pilot an educational intervention embedded with content regarding SUD with entry-level obstetric nurses that were enrolled in the nurse residency program at UK HealthCare.

Methods: This project used a quasi-experimental pretest – posttest design. Participants completed …

Sociodemographic And Obstetric Predictors Of Cesarean Section In Ghana, Nana Mireku-Gyimah

Walden Dissertations and Doctoral Studies

The increasing cesarean section (CS) rate in Ghana has severe public health implications as it results in significant maternal and child morbidity and mortality. An assessment of the factors contributing to the increasing CS rate in different settings is imperative to guide the development of interventions. The purpose of this study was to identify the sociodemographic and obstetric predictors of CS in a major referral health facility in Accra, Ghana. This research was grounded in the systems thinking approach and involved the use of a case-control design whereby 2,704 pairs of cases (delivered by CS) and controls (delivered by vaginal …

Effect Of Postpartum Protocols On Maternal Outcomes, Kelsey Grimm, Emily Harnish

Physician Assistant Capstones, 2016 to 2019

Objective: To determine whether postpartum hemorrhage (PPH) protocols lead to decreases in maternal morbidity and mortality.

Design: Systemic literature review.

Methods: The clinical question investigated is whether the implementation of PPH protocols has measurable impact on maternal morbidity and mortality. Searches were done through PubMed using the keywords: “maternal hemorrhage postpartum protocol.” Studies were eliminated if they were more than 10 years old, conducted outside the United States, published in a non-English language, used other animal subjects besides humans, used non-female subjects, if they did not answer the clinical question, or were review articles. Eventually, three cohort …

Obstetric And Neonatal Complications Among Women With Autoimmune Disease, Andrew Williams, Katherine Grantz, Indulaxmi Seeni, Candace Robledo, Shanshan Li, Marion Ouidir, Carrie Nobles, Pauline Mendola

School of Medicine Publications and Presentations

Background: The impact of autoimmune diseases on pregnancy remains understudied on a population level. Examination of obstetric and neonatal outcomes among women with autoimmune disease and their infants can provide important insights for clinical management.

Methods: Autoimmune diseases and outcomes were identified using medical records. Cesarean delivery, preterm birth, preeclampsia, small for gestational age (SGA), neonatal intensive care (NICU) admission, neonatal respiratory distress syndrome (RDS), and perinatal mortality risk was assessed. Poisson regression with robust standard errors estimated relative risks (RR) and 95% confidence intervals (95% CI) with adjustment for maternal characteristics and other chronic conditions.

Results: Women with …

N653_Prospectus_Final_V2_Alternatives To Transfusions .Docx, Donita Rose

Donita Rose

Advanced Cardiovascular Life Support (Acls) And Obstetrical Critical Care (Ob Cc) Education For High Risk Labor And Delivery Nurses In Caring For Growing Population Of High Risk Patients, Tracey E. Mcmillan

Interprofessional Research and Innovations Council

Advanced Cardiovascular Life Support (ACLS) and Obstetrical Critical Care (OB CC) education for high risk Labor and Delivery nurses in caring for growing population of high risk patients

Tracey E. McMillan RNC, BSN

Clinical Nurse III

Labor and Delivery Unit Coordinator

BACKGROUND: Many studies show that an increasing number of pregnant women in the United States have chronic health conditions such as hypertension, diabetes, and chronic heart disease. The factors that place a pregnancy at risk can be divided into four categories: existing health conditions, age, lifestyle factors and conditions of pregnancy. The recent statistics from the Centers for Disease …

Following Epidural Pca Use, Do Obstetric Patients Feel Satisfied With Their Pain Control, James Mcrae

Doctoral Projects

ABSTRACT

Pain is a source of anxiety for many patients, and uncontrolled pain can have deleterious effects on patient outcomes (Patak et al., 2014). Pain associated with labor is a particular concern of obstetric patients. Epidural analgesia is currently the frontline treatment for pain associated with labor, with epidural patient-controlled analgesia (PCA) often being utilized (Braveman, Scavone, Blessing, & Wong, 2013). Little evidence exists that details what factors of epidural PCA that patients considered important (Patak et al., 2014). In this project, a randomized questionnaire was administered to obstetric patients to assess satisfaction levels with their epidural PCA. The questionnaire …

Retrospective Analysis Of Obstetric Sepsis Screening, Holly A. Champagne

Doctoral Projects

This project was designed to evaluate outcomes following implementation of routine screening for sepsis in the obstetric population. A retrospective analysis of the electronic medical record of 204 women who met sepsis criteria using obstetric-adjusted systemic inflammatory response syndrome (SIRS) criteria and a source of infection was the method used. Outcomes were evaluated for neonates born to the women who developed sepsis during labor. The incidence of sepsis was 0.401 per1,000 and included those with antepartum, intrapartum, or postpartum admissions. The setting was a tertiary center with 5,075 deliveries over the study period. There were 92 (45.2%) who had sepsis, …

Anesthesiologists' Preferences Regarding Visitor Presence During Placement Of Neuraxial Labor Analgesia, Sangeeta Kumaraswami, Suryanarayana Pothula, Mario A. Inchiosa Jr, Keshar Paul Kubal, Micah Alexander Burns

NYMC Faculty Publications

Introduction: Neuraxial labor analgesia has become an integral part of modern obstetric anesthetic practice. Presence of a familiar person during its placement may be beneficial to the patient. A survey was sent to anesthesiologists practicing obstetric anesthesia in the USA to determine their views. Methods: The survey queried the following: existence of a written policy; would they allow a visitor; visitor's view, sitting or standing; reasons to allow or not allow a visitor; and influence by other staff on the decision. The responses were analyzed using multiple chi-square analyses. Results: Most practitioners supported allowing a visitor during placement. Reduction of …

Reassessing The Duration Of The Second Stage Of Labor In Relation To Maternal And Neonatal Morbidity., Katherine L. Grantz, Rajeshwari Sundaram, Ling Ma, Stefanie Hinkle, Vincenzo Berghella, Matthew K. Hoffman, Uma M. Reddy

Department of Obstetrics and Gynecology Faculty Papers

OBJECTIVE: To assess the morbidity associated with continuing the second-stage duration of labor, weighing the probability of spontaneous vaginal birth without morbidity compared with birth with serious maternal or neonatal complications.

METHODS: In a retrospective cohort, we analyzed singleton, vertex births at 36 weeks of gestation or greater without prior cesarean delivery (n=43,810 nulliparous and 59,605 multiparous women). We calculated rates of spontaneous vaginal birth and composite serious maternal or neonatal complications. Results were stratified by parity (nulliparous or multiparous) and epidural status (yes or no). Competing risks models were created for 1) spontaneous vaginal birth with no morbidity, 2) …

Legionellosis Following Water Birth In A Hot Tub In A Canadian Neonate, Michelle Barton, Brianna Mckelvie, Aaron Campigotto, Tara Mullowney

Paediatrics Publications

No abstract provided.

Obstetric Triage Improvement, Whitney Depaoli

Master's Projects and Capstones

The objective of the obstetric triage improvement project is to decrease the average length of stay for perinatal patients presenting to the obstetric triage. The setting is a university hospital in a large urban city. The population includes pregnant patients with obstetric complaints presenting to triage for further evaluation. Methods used include a root cause analysis, process mapping, lean transformation methodology, and standardization of workflow. The results of the project include reducing the average length of stay in obstetric triage from a baseline of 152 minutes to 120.58 minutes, which represents a 21% decrease. The creation of standard workflows, the …

Why 'Down Under' Is A Cut Above: A Comparison Of Rates Of And Reasons For Caesarean Section In England And Australia, Samantha J. Prosser, Yvette D. Miller, Rachel Thompson, Maggie Redshaw

Dartmouth Scholarship

Background: Most studies examining determinants of rising rates of caesarean section have examined patterns in documented reasons for caesarean over time in a single location. Further insights could be gleaned from cross-cultural research that examines practice patterns in locations with disparate rates of caesarean section at a single time point.

Methods: We compared both rates of and main reason for pre-labour and intrapartum caesarean between England and Queensland, Australia, using data from retrospective cross-sectional surveys of women who had recently given birth in England (n = 5,250) and Queensland (n = 3,467).

The Mcgrath Series 5 Video Laryngoscope Versus The Macintosh Laryngoscope: A Randomized Trial In Obstetric Patients, Semi̇h Arici, Serkan Karaman, Serkan Doğru, Tuğba Karaman, Hakan Tapar, Asker Zeki̇ Özsoy, Zi̇ya Kaya, Mustafa Süren

Turkish Journal of Medical Sciences

Anesthesiologists have encountered various difficulties in securing the airway. Therefore, we compare the intubation times and hemodynamic changes between the McGrath Series 5 video laryngoscope and the Macintosh laryngoscope. Materials and methods: A total of 80 obstetric patients were divided into 2 groups, orotracheally intubated with either the McGrath video laryngoscope or the Macintosh laryngoscope. The intubation times, Cormack-Lehane grade, percentage of glottic opening, mean arterial blood pressure, and heart rates were compared among the groups. Results: Intubation time in the McGrath video laryngoscope group was significantly longer than in the Macintosh laryngoscope group (P < 0.01). The percentage of glottic opening was found to be higher in the McGrath video laryngoscope group (P = 0.002). Conclusion: The McGrath Series 5 video laryngoscope provides excellent views during orotracheal intubation in obstetric anesthesia with normal airways.

Experience With An Adolescent Pregnancy Program. A Preliminary Report, D. Youngs, Jennifer Niebyl, D. Blake, D. Shipp, J. Stanley, T. King

Jennifer R Niebyl

A program has been designed to give comprehensive health care services to pregnant adolescents. The program components include community liason, patient education, counseling and social services, a nurse "on call" program for labor and delivery, and pediatric nurse-practitioner followup. In addition, a drug use identification component screens the patients by interview and urinalysis. Hypertensive disorders of pregnancy occurred in 10% of the first 202 patients. Forty-three percent had anemia (hematocrit less than 35%), and screening cervical cultures for gonorrhea were positive in 3.5%. Cigarettes, alcohol, and marijuana constituted the most common nonmedical drugs used, and aspirin the most common medical …

Human Plasma Prekallikrein And High Molecular Weight Kininogen Decrease During Parturition, B. Alving, Jennifer Niebyl, D. Proud, B. Mason, J. Pisano

Jennifer R Niebyl

Prekallikrein and high molecular weight kininogen were measured in plasma taken from nine women during parturition. Prekallikrein decreased significantly (p less than 0.01) from 1.49 +/- 0.15 S-2302 U/ml (mean +/- SEM) in early labor to 1.26 +/- 0.13 S-2302 U/ml in the immediate postpartum period. Immunoreactive high molecular weight kininogen also significantly decreased from 76 +/- 5 micrograms/ml to 68 +/- 5 micrograms/ml one day postpartum (p less than 0.01). Both proteins rose to normal levels within two days. The data suggest that the kallikrein-kinin system is utilized during parturition.

Drugs For Inhibition Of Premature Labor, Jennifer Niebyl

Jennifer R Niebyl

Effective inhibition of premature labor depends on prompt initiation of treatment. The author discusses factors initiating parturition, and the benefits and risks for mother and child of administration of alcohol, beta adrenergic agents, magnesium sulfate, and other agents that may counteract them.

Premature Rupture Of The Membranes And Prolonged Latency, J. Johnson, N. Daikoku, Jennifer Niebyl, T. Johnson, V. Khouzami, F. Witter

Jennifer R Niebyl

The aim of this retrospective study in 8320 patients with premature rupture of the membranes (PROM) was to determine the consequences of prolongation of the latent period. Among patients with pregnancies of more than 37 weeks' duration, those with PROM and latent periods of more than 1 day demonstrated an increased incidence of intrapartum fever (IPF), whereas those with latent periods of more than 3 days demonstrated a marked increase in fetal (but not neonatal) deaths. Although IPF and perinatal mortality were more common in preterm pregnancies, neither was found to increase or decrease with prolonged latency, provided differences in …

Prostaglandin F Metabolite Concentration As A Prognostic Factor In Preterm Labor, C. Weitz, R. Ghodgaonkar, N. Dubin, Jennifer Niebyl

Jennifer R Niebyl

Concentration of the 13,14-dihydro,15 keto-metabolite of prostaglandin F2 alpha (PGFM) was measured in women being observed for preterm labor. The mean initial PGFM level was significantly higher in patients who delivered preterm (65.9 +/- 9.7 pg/mL; N = 14) than in patients not in preterm labor (32.1 +/- 4.3 pg/mL; N = 11; P less than .01). Plasma PGFM concentrations decreased significantly during ritodrine therapy only in successfully treated patients (P less than .05). All patients with initial PGFM concentrations greater than or equal to 55 pg/mL delivered preterm. Two of four patients not considered to be in preterm labor …

Asthma In Pregnancy: Pathophysiology, Diagnosis And Management., Abbey Hardy-Fairbanks, Emily Baker

Abbey J Hardy-Fairbanks

Asthma is a common, potentially serious, even life-threatening, chronic medical condition seen amongst nearly all groups of patients, regardless of ethnicity and socioeconomic circumstances. This article addresses the group of pregnant women with symptomatic asthma as well as those whose asthma is asymptomatic as a result of good control. The incidence, the pathophysiologic changes of pregnancy, and the interplay between these changes and asthma are reviewed in this article. The classification of these patients and appropriate management strategies are discussed.

Oestrogen Modulation With Parturition In The Human Placenta., Kimberly Leslie, D. Zuckerman, J. Schruefer, M. Burchell, J. Smith, B. Albertson

Kimberly K. Leslie

An initial group of term (36-41 6/7 weeks), preterm (less than 36 weeks), and post-term (42 or more weeks) placentae were collected from women at delivery to determine the placental levels of important steroids and steroidogenic enzymes involved in the oestrogen synthesis pathway as a function of gestational age. A second group of placentae were obtained from women delivering at term before and after the onset of labour. Placentae were evaluated individually for cytosolic steroid hormone levels and microsomal steroidogenic enzyme activities. Oestradiol (E2), oestrone (E1), progesterone (P), and delta-4-androstenedione (A) were measured by radioimmunoassay in placental cytosols. Aromatase (AR), …

The Effect Of A Low Glycemic Index Diet During Pregnancy On Obstetric Outcomes, Robert G. Moses, M J. Luebcke, Warren S. Davis, K J. Coleman, Linda C. Tapsell, Peter Petocz, Jennie C. Brand-Miller

L. C. Tapsell

Abstract presented at The 2006 Annual Scientific Meeting of the Nutrition Society of Australia, 29 November - 2 December, Sydney, Australia

Development And Evaluation Of An Instrument To Measure Mother-Infant Togetherness After Childbirth, Carol Lawrence

Electronic Theses and Dissertations

No existing measure to date captures mother-infant togetherness. A valid measure of togetherness is essential to engage in evidence-based practice, evaluate obstetric delivery models and nursing interventions, and measure the level of togetherness which promotes optimal maternal-infant outcomes. When together and in close proximity, a women and her infant have access to one another to allow for mutual caregiving or caregiving on cue. A new measure entitled the Mother-Infant Togetherness Scale (MITS) was developed based on a review of the literature and conceptual framework of Mother-Newborn Mutual Caregiving. The MITS is a 35- item instrument composed of four subscales that …

Maternal And Neonatal Outcomes By Labor Onset Type And Gestational Age, Jennifer L Bailit, Kimberly D Gregory, Uma M Reddy, Victor H Gonzalez-Quintero, Judith U Hibbard, Mildred M Ramirez, D Ware Branch, Ronald Burkman, Shoshana Haberman, Christos G Hatjis, Matthew K Hoffman, Michelle Kominiarek, Helain J Landy, Lee A Learman, James Troendle, Paul Van Veldhuisen, Isabelle Wilkins, Liping Sun, Jun Zhang

Journal Articles

OBJECTIVE: We sought to determine maternal and neonatal outcomes by labor onset type and gestational age.

STUDY DESIGN: We used electronic medical records data from 10 US institutions in the Consortium on Safe Labor on 115,528 deliveries from 2002 through 2008. Deliveries were divided by labor onset type (spontaneous, elective induction, indicated induction, unlabored cesarean). Neonatal and maternal outcomes were calculated by labor onset type and gestational age.

RESULTS: Neonatal intensive care unit admissions and sepsis improved with each week of gestational age until 39 weeks (P < .001). After adjusting for complications, elective induction of labor was associated with a lower risk of ventilator use (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.28-0.53), sepsis (OR, 0.36; 95% CI, 0.26-0.49), and neonatal intensive care unit admissions (OR, 0.52; 95% CI, 0.48-0.57) compared to spontaneous labor. The relative risk of hysterectomy at term was 3.21 (95% CI, 1.08-9.54) with elective induction, 1.16 (95% CI, 0.24-5.58) with indicated induction, and 6.57 (95% CI, 1.78-24.30) with cesarean without labor compared to spontaneous labor.

CONCLUSION: Some neonatal outcomes improved until 39 weeks. Babies born with elective induction …

Obstetric Cerebral Venous Thrombosis, Bhojo Khealani, Uzma U Mapari, Rozina Sikandar Sultanali

Department of Obstetrics & Gynaecology

Pregnancy and puerperium are most prevalent prothrombotic states leading to cerebral venous thrombosis. Likelihood of stroke to be of venous origin is greater in stroke associated with pregnancy compared to stroke unrelated to pregnancy. Pregnancy induces several changes in coagulation system, which persists at least during early puerperium, rendering it a prothrombotic state. Hypercoaguability worsens further after delivery as a result of volume depletion and trauma. During puerperium additional risk factors include infection and instrumental delivery or Caesarean section. The management follows general rules as for the venous thrombosis unrelated to pregnancy, however the prognosis is different.

The Effect Of A Low Glycemic Index Diet During Pregnancy On Obstetric Outcomes, Robert G. Moses, M J. Luebcke, Warren S. Davis, K J. Coleman, Linda C. Tapsell, Peter Petocz, Jennie C. Brand-Miller

Faculty of Health and Behavioural Sciences - Papers (Archive)

Abstract presented at The 2006 Annual Scientific Meeting of the Nutrition Society of Australia, 29 November - 2 December, Sydney, Australia

Cytoprotective Agents In Cancer Chemotherapy, N. Voravud, A. Sookprasert

Chulalongkorn Medical Journal

No abstract provided.

Transverse Presentation Of The Fetus, Richard E. Jackson

MD Theses

No abstract provided.