Susanna R. Magee

Malabsorption of Oral Antibiotics in Pregnancy after Gastric Bypass Surgery

Gastric bypass surgery, by definition, changes the absorption capabilities of the stomach and small intestine. The use of oral medications in patients post gastric bypass may need to be adjusted by medical providers to account for this absorption change. The following case exemplifies this dilemma in a pregnant patient status post gastric bypass surgery with a complicated urinary tract infection.

Promotion of Family-Centered Birth With Gentle Cesarean Delivery

Purpose: In this commentary we describe our experience developing a “gentle cesarean” program at a community hospital housing a family medicine residency program. The gentle cesarean technique has been popularized in recent obstetrics literature as a viable option to enhance the experience and outcomes of women and families undergoing cesarean delivery. Methods: Skin-to-skin placement of the infant in the operating room with no separation of mother and infant, reduction of extraneous noise, and initiation of breastfeeding in the operating room distinguish this technique from traditional cesarean delivery. Collaboration among family physicians, obstetricians, midwives, pediatricians, neonatologists, anesthesiologists, nurses, and operating room personnel facilitated the provision of gentle cesarean delivery to families requiring an operative birth. Results: Among 144 gentle cesarean births performed from 2009 to 2012, complication rates were similar to or lower than those for traditional cesarean births. Gentle cesarean delivery is now standard of care at our institution. Conclusion: By sharing our experience, we hope to help other hospitals develop gentle cesarean programs. Family physicians should play an integral role in this process.

A pilot randomized controlled trial comparing prenatal yoga to perinatal health education for antenatal depression

We conducted a pilot randomized controlled trial (RCT) comparing a prenatal yoga intervention to perinatal-focused health education in pregnant women with depression. Findings document acceptability and feasibility of the yoga intervention: no yoga-related injuries were observed, instructors showed fidelity to the yoga manual, and women rated interventions as acceptable. Although improvements in depression were not statistically different between groups, they favored yoga. This study provides support for a larger scale RCT examining prenatal yoga to improve mood during pregnancy.

Neonatal Herpes Infection: Case Report and Discussion

Neonatal herpes simplex virus (HSV) infections are often life-threatening. Although sometimes difficult to diagnose, most infections can be treatable when found early. Infection with HSV should be kept high on the differential diagnosis of a febrile newborn younger than 1 month old, and treatment should be strongly considered for infants with certain risk factors, even before definitive culture or polymerase chain reaction results are available. The case presented here exemplifies the benefits of maintaining a high suspicion of and empirically treating for HSV in a 10-day-old febrile infant.

Low Cost, High Yield: Simulation of Obstetric Emergencies for Family Medicine Training

Background: Simulation is now the educational standard for emergency training in residency and is particularly useful on a labor and delivery unit, which is often a stressful environment for learners given the frequency of emergencies. However, simulation can be costly. Purpose: This study aimed to assess the feasibility and effectiveness of low-cost simulated obstetrical emergencies in training family medicine residents. Methods: The study took place in a community hospital in an urban underserved setting in the northeast United States. Low-cost simulations were developed for postpartum hemorrhage (PPH) and preeclampsia/eclampsia (PEC). Twenty residents were randomly assigned to the intervention (simulated PPH or PEC followed by debriefing) or control (lecture on PPH or PEC) group, and equal numbers of residents were assigned to each scenario. All participants completed a written test at baseline and an oral exam 6 months later on the respective scenario to which they were assigned. The participants provided written feedback on their respective teaching interventions. We compared performance on pretests and posttests by group using Wilcoxon Rank Sum. Results: Twenty residents completed the study. Both groups performed similarly on baseline tests for both scenarios. Compared to controls, intervention residents scored significantly higher on the examination on the management of PPH but not for PEC. All intervention group participants reported that the simulation training was “extremely useful,” and most found it “enjoyable.” Conclusions: We demonstrated the feasibility and acceptability of two low-cost obstetric emergency simulations and found that they may result in persistent increases in trainee knowledge.

Breastfeeding and Diabetes

As diabetes becomes more prevalent in younger women, diabetes and maternal-child health issues such as breastfeeding coexist with increasing frequency in clinical practice. Women with diabetes of any kind including type 1 diabetes (DM1), type 2 diabetes (DM2) or gestational diabetes (GDM) should be strongly encouraged to breastfeed because of the maternal and pediatric benefits specific to obesity and diabetes that are above and beyond other known benefits of breastfeeding. Many of the benefits of breastfeeding are dose-dependent. Current infant nutrition recommendations for mother-infant dyads include 6 months of exclusive breastfeeding and continued breastfeeding for at least 12 months. In this chapter, we explore in detail the many relationships between breastfeeding and diabetes in a variety of clinical contexts.