Kara K. Hoppe

Achieving High Coverage of H1N1 Influenza Vaccine in an Ethnically Diverse Obstetric Population: Success of a Multifaceted Approach

Objective. To report on a multifaceted approach to increase uptake of the H1N1 vaccine in our ethnically diverse obstetrical population. Methods. A review of our obstetric clinic vaccine registry and the approaches used to increase vaccine uptake. We created a real-time vaccine registry, educated patients in their own language via educational videos and use of cultural case workers, facilitated patient appointments and transportation, educated staff, and used other interventions to enhance immunization uptake. Results. Within the first month of H1N1 availability, we vaccinated 120 of our total 157 obstetrics patients. Our overall coverage rate was 76% (number vaccinated/total number eligible.) Of the enrolled patients, the vaccine acceptance rates were similar in our English (59 (78%) of 76) versus non-English (59 (75%) of 79) speaking patients. Conclusions. High vaccine coverage is possible in an ethnically diverse, highly immigrant obstetrics population.

30 mL Single- versus 80 mL double-balloon catheter for pre-induction cervical ripening: a randomized controlled trial

Abstract Objective: To compare the efficacy of an 80 mL double-balloon catheter versus a 30 mL single-balloon catheter for pre-induction cervical ripening. Methods: We performed a randomized controlled trial of women ≥18 years with a singleton, vertex pregnancy, a reactive non-stress test, and a Bishop score ≤5 comparing an 80 mL double- versus a 30 mL single-balloon catheters for cervical ripening. Women were randomly assigned to the two catheter types, stratified 1:1 by nulliparity or multiparity. The primary outcome was achieving a Bishop score ≥6 at the time of catheter expulsion or removal assessed by chi-squared, stratified by parity. Results: A total of 98 women were included in the analysis (50 in the 80 mL double and 48 in the 30 mL single-balloon catheter groups). Among nulliparous women, a greater proportion of those randomized to the 80 mL double achieved a Bishop score ≥6 at time of catheter removal (88.0% versus 28.0%; p ≤ 0.001) and delivered vaginally (60.0% versus 32.0%; p = 0.047) compared to those with the 30 mL single-balloon catheter. We found no difference by catheter type in achieving a Bishop score ≥6 or vaginal delivery among multiparous women. Conclusions: These findings suggest the 80 mL double-balloon catheter is more effective than the 30 mL single-balloon catheter for pre-induction cervical ripening and achieving a vaginal delivery in nulliparous women.

Intrauterine air embolism associated with a rectovaginal fistula in a pregnant woman.

BACKGROUND: Previous case reports have reported maternal and fetal mortality in pregnancies complicated by air emboli induced by various mechanisms. CASE: A 33-year-old multiparous woman with a known rectovaginal fistula presented with symptoms of placental abruption. She subsequently was found to have a large intrauterine air embolus. The patient was treated successfully to term by continuously draining the vaginal air with a Malecot catheter. CONCLUSION: We describe a rare case of an intrauterine air embolism during pregnancy caused by a rectovaginal fistula. Prompt recognition of air within the uterine myometrium and subchorionic space during ultrasonography led to the diagnosis and successful treatment of a potentially fatal complication by using an intravaginal Malecot catheter to release the trapped air.

Duration of Spontaneous Active Labor and Perinatal Outcomes Using Contemporary Labor Curves

Objective Evaluate the association between spontaneous active labor duration utilizing contemporary labor curves and risk of adverse outcomes. Materials and Methods This is a retrospective cohort study from January 2012 to January 2015. Subjects were nulliparous, 18 to 44 years, with a cephalic, singleton ≥37 weeks in spontaneous labor. Subjects were placed into three subgroups, defined by active labor duration from 6 to 10 cm as less than the median, the median‐95th, and >95th percentile based on contemporary labor curves published by Zhang et al. We evaluated the association between subgroups and cesarean delivery, chorioamnionitis, estimated blood loss, Apgar score < 7 at 5 minutes, and neonatal intensive care unit admission using logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI). Results Six‐hundred forty two women met the inclusion criteria. Compared with women whose active labor was less than the median, the risk of cesarean was higher in the median‐95th percentile ([adjusted OR, aOR] 3.1, 95% CI 1.8‐5.5) and the >95th percentile ([aOR] 6.8, 95% CI 3.9‐11.7) subgroups. There was an increased odds of chorioamnionitis in the median‐95th percentile subgroup ([aOR] 2.5, 95% CI 1.1‐5.9). Conclusion Chorioamnionitis and cesarean delivery increased significantly as labor duration exceeded the median. This study provides a better understanding regarding the potential risk of cesarean and chorioamnionitis using contemporary labor curves.

Risks of venous thromboembolism after cesarean sections: a meta-analysis

Считается, что кесарево сечение (КС) ассоциируется с большим риском послеродовой венозной тромбоэмболии (ВТЭ). Цель анализа заключалась в проведении систематического обзора доказательств такой связи и абсолютного риска развития ВТЭ после КС. Методы: был выполнен поиск в базах данных PubMed, Embase и среди результатов конференций 1980–2015 гг. на предмет наличия сообщений о связи способа родов с послеродовой ВТЭ и частоты ВТЭ после КС. Авторы исключили исследования по тромбофилии или рецидивирующей ВТЭ и ограничились перспективными исследованиями, которые оценивали заболеваемость ВТЭ. Совокупные относительные и абсолютные риски были рассчитаны с помощью моделей со случайными эффектами. Результаты: поиск выявил 28 в основном ретроспективных обсервационных исследований, сравнивающих риск развития ВТЭ после КС и после вагинальных родов (ВР) (n > 53 000 случаев ВТЭ) и 32 перспективных исследования, сообщивших о риске ВТЭ после КС (n = 218 случаев ВТЭ). По сравнению с ВР относительный риск развития ВТЭ после КС колебался от 1 до 22, мета-аналитический относительный риск составил 3,7 (95% доверительный интервал (ДИ) 3,0–4,6). Корректировка по возрасту и индексу массы тела незначительно влияла на совокупный относительный риск. Связь была выявлена как для планового, так и для экстренного КС, с более выраженной ассоциацией в последнем случае. Совокупная частота составила 2,6 случая ВТЭ на 1000 КС (95% ДИ 1,7–3,5) и была выше в исследованиях с более длительным и лучшим периодом наблюдения в послеродовом периоде (4,3 случая ВТЭ на1000 КС). Вывод: риск ВТЭ, независимо от других факторов ее развития, после КС в 4 раза выше, чем после ВР, а также является более высоким в случае экстренного КС по сравнению с плановым. В среднем ВТЭ после КС возникнет у 3 женщин из 1000.