William Goodnight

Pneumonia in pregnancy

Objective:Historically, pneumonia during pregnancy has been associated with increased morbidity and mortality compared with nonpregnant women. The goal of this article is to review current literature describing pneumonia in pregnancy. This review will identify maternal risk factors, potential complications, and prenatal outcomes associated with pneumonia and describe the contemporary management of the varied causes of pneumonia in pregnancy. Results:Coexisting maternal disease, including asthma and anemia, increase the risk of contracting pneumonia in pregnancy. Neonatal effects of pneumonia in pregnancy include low birth weight and increased risk of preterm birth, and serious maternal complications include respiratory failure. Community-acquired pneumonia is the most common form of pneumonia in pregnancy, with Streptococcus pneumoniae, Haemophilus influenzae, and Mycoplasma pneumoniae accounting for most identified bacterial organisms. Beta-lactam and macrolide antibiotics are considered safe in pregnancy and are effective for most community-acquired pneumonia in pregnancy. Viral respiratory infections, including varicella, influenza, and severe acute respiratory syndrome, can be associated with maternal pneumonia. Current antiviral and respiratory therapies can reduce maternal morbidity and mortality from viral pneumonia. Influenza vaccination can reduce the prevalence of respiratory hospitalizations among pregnant women during influenza season. Pneumocystis pneumonia continues to carry significant maternal risk to an immunocompromised population. Prevention and treatment of Pneumocystis pneumonia with trimethoprim/sulfamethoxazole is effective in reducing this risk. Conclusions:Prompt diagnosis and treatment with contemporary antimicrobial therapy and intensive care unit management of respiratory compromise has reduced the maternal morbidity and mortality due to pneumonia in pregnancy. Prevention with vaccination in at-risk populations may reduce the prevalence and severity of pneumonia in pregnant women.

The use of blunt needles does not reduce glove perforations during obstetrical laceration repair

OBJECTIVE The objective of the study was to compare the rate of glove perforation for blunt and sharp needles used during obstetrical laceration repair. A secondary aim was to assess physician satisfaction with blunt needles. STUDY DESIGN This was an institutional review board-approved, randomized, prospective trial. Patients with obstetric lacerations were randomized to repair with either blunt or sharp needles. Patient demographics, operator experience, and other clinical variables were collected. Physicians reported any percutaneous injuries and were surveyed regarding satisfaction with the assigned needles. Glove perforation was determined using a validated water test method. RESULTS There were 438 patients enrolled in the trial: 221 in the control group and 217 in the study group. There was no statistical difference between groups in patient demographics, clinical variables, severity of laceration, or experience level of the surgeon. There was no difference in the glove perforation rate between blunt and sharp needles (risk ratio, 0.79; 95% confidence interval, 0.2-2.95). There was poor correlation between reported perforations and those detected by water test (R(2) = 0.33). The physicians reported that blunt needles were more difficult to use than sharp needles (P = .0001). CONCLUSION There was no difference in the rate of surgical glove perforation for blunt, compared with sharp, needles used during vaginal laceration repair. Physicians also reported increased difficulty performing the repair with blunt needles.

Pelvic organ prolapse: is there a difference in POPQ exam results based on time of day, morning or afternoon?

OBJECTIVE The purpose of this study was to determine if there is any difference between AM and PM POPQ exam results. STUDY DESIGN Prospective, IRB approved study of women presenting with pelvic organ prolapse symptoms. Initial POPQ exams were performed in the morning or afternoon; a second exam was performed within 4 weeks at the opposite time of day. Statistical analysis included Wilcoxon signed rank test, paired t test, Spearman correlation, and Stuart-Maxwell test. RESULTS The study consisted of 32 subjects. Mean age was 58.8 years, mean BMI 28.6, median parity 2.0, 75% white, 22% black, and 3% Hispanic. The POPQ exam stages were 47% stage II, 50% stage III, and 3.0% stage IV. There was no significant difference for the 9 POPQ exam measures between morning and afternoon exams. There was good agreement between AM and PM POPQ ordinal stages (Stewart Maxwell P = 1.0, kappa 0.76). CONCLUSION There is no difference between AM and PM POPQ exam results.