Background Pregnant women with underlying heart disease ( HD ) are at increased risk for adverse maternal, obstetric, and neonatal outcomes. Methods and Results Inpatient maternal delivery admissions and linked neonatal stays for women with cardiomyopathy, adult congenital HD, pulmonary hypertension ( PH ), and valvular HD were explored utilizing the Statewide Planning and Research Cooperative System (New York), January 1, 2000, through December 31, 2014, with the International Classification of Diseases, Ninth Revision , Clinical Modification (ICD‐9‐CM) . Maternal major adverse cardiac events, neonatal adverse clinical events ( NACE ), and obstetric complications were recorded. Outcomes were compared using multiple logistic regression modeling. Among 2 284 044 delivery admissions, 3871 women had HD ; 676 (17%) had cardiomyopathy, 1528 (40%) had valvular HD, 1367 (35%) had adult congenital HD, and 300 (8%) had PH . Major adverse cardiac events occurred in 16.1% of women with HD , with most in the cardiomyopathy (45.9%) and PH (25%) groups. NACE was more common in offspring of women with HD (18.4% versus 7.1%), with most in the cardiomyopathy (30.0%) and PH (25.0%) groups. Increased risk of NACE was noted for women with HD (odds ratio [ OR ]: 2.8; 95% confidence interval [ CI ], 2.5–3.0), with the highest risk for those with cardiomyopathy ( OR : 5.9; 95% CI , 5.0–7.0) and PH ( OR : 4.5; 95% CI , 3.4–5.9). Preeclampsia ( OR : 5.1; 95% CI , 3.0–8.6), major adverse cardiac events ( OR : 2.3; 95% CI , 1.8–2.9), preexisting diabetes mellitus ( OR : 4.3; 95% CI , 1.5–12.3), and obstetric complications ( OR : 2.9; 95% CI , 1.7–5.2) were independently associated with higher NACE risk. Conclusions Neonatal complications were higher in offspring of pregnant women with HD , particularly cardiomyopathy and PH . Preeclampsia, major adverse cardiac events, obstetric complications, and preexisting diabetes mellitus were independently associated with a higher risk of NACE .
INTRODUCTION: Preeclampsia complicates 2–8% of pregnancies and is a major contributor to maternal and perinatal morbidity and mortality. Aspirin (ASA) is known to decrease rates of preeclampsia in patients at risk for developing the disease. We examined provider compliance with the U.S. Preventive Services Task Force risk-based aspirin prophylaxis guidelines at our institution and identified a need for improvement. METHODS: For quality improvement, we implemented provider education, updated patient history forms, and an embedded ASA checklist within our note template. We retrospectively reviewed demographics, medical/obstetric history, and candidacy/prescription placement for two patient groups at their first prenatal visit. The first was the preintervention group (January 1 to June 30, 2019; N=434) and the second was the postintervention group (July 1 to September 30, 2021; N=284). Preintervention and postintervention data were then compared to determine whether rates of compliance with ASA prophylaxis guidelines improved. RESULTS: A similar proportion of patients met criteria for ASA prophylaxis preintervention (43.1%, 95% CI 38.5–47.8%) and postintervention (46.8%, 95% CI 41.1–52.6%, P=.36), with similar proportions of patients who qualified with one high risk factor versus multiple moderate risk factors. There were significantly more patients who qualified for aspirin and were not identified in the preintervention group (67.9%, 95% CI 60.9–74.2%) than in the postintervention group (18.8%, 95% CI 13.0–26.3%, P<.0001). This improvement was even more pronounced in patients who only qualified by moderate risk factors (preintervention [79.7%, 95% CI 72.5–85.5%] versus postintervention [21.2%, 95% CI 14.7–29.7%]). CONCLUSION: The implementation of provider education, updated patient history forms, and an ASA checklist significantly improved provider adherence to ASA prophylaxis recommendations.
INTRODUCTION:Simulation has rapidly expanded in obstetrics and gynecology for teaching medical knowledge, surgical skills, and maintenance of certification. Low-fidelity simulations are typically lower cost to produce and have been proven beneficial for surgical training.METHODS:The Junior Fellows of the American College of Obstetricians and Gynecologists District X created a competition at their Annual District Meeting in October 2022. All nine residency programs submitted and showcased a low-cost, novel simulation in obstetrics and gynecology at a 1-hour event open to all attendees. After IRB exemption was obtained, a postevent survey was completed by the participants at the event.RESULTS:A total of 77 individuals completed our postevent survey (medical students 12.99%, residents 58.44%, staff or fellows 28.57%). The majority of respondents felt simulation is valuable to ob-gyn training (96.10%). All respondents reported they would like to see the event repeated at future Annual District Meetings. The majority of resident responders reported they would be very likely (79.07%) or likely (18.60%) to use one of the simulations presented at the festival in future teaching or training. Fifteen respondents were involved in creating a simulation for the festival. Most simulations were very easy (60.00%) or easy (33.33%) to make, and all were reported to be very reproducible (100.00%).CONCLUSION:This unique event for Junior Fellows was successful in fostering innovative, low-cost, low-fidelity, highly reproducible simulations in obstetrics and gynecology. Our goals are to continue this event in future years, expand to other districts, foster reproduction of simulations at residency programs and medical schools, and support the publication of novel ideas.
tution in 2020 (P5.000). Applicant perception of a program was felt to be significantly impacted by social media presence in 36% (n515) of those surveyed in 2019, compared to 60% (n529) in 2020 (P5.031). Significantly more applicants felt that a residency program social media presence was an important recruitment strategy in 2020 compared to 2019 (P5.006). The virtual match increased applicant uses of social media in the application process in 80% of respondents (n538).CONCLUSION: Social media is a novel and essential tool for residency programs to showcase their culture. Our study highlights the utility of social media for resident applicant recruitment in the ever changing post-pandemic application milieu.
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INTRODUCTION: Heart Disease (HD) is the leading cause of morbidity and mortality among pregnant women in developed countries. The impact of HD and obstetric complications on outcome requires investigation. METHODS: Statewide Planning and Research Cooperative System database from New York State was used to characterize inpatient singleton deliveries, 2000-2014. Primary outcome was maternal Major Adverse Cardiac Events (MACE), a composite of death, cardiac arrest, myocardial infarction, heart failure, and arrhythmia. Obstetric complications included antepartum and postpartum hemorrhage, eclampsia/preeclampsia, placental insufficiency, and preterm delivery (less than 37 weeks gestation). ANOVA and Pearson's Chi-squared test were used for comparison. RESULTS: We studied 3,871 women with HD and 2,280,173 without HD, with singleton births. 17% had cardiomyopathy (CDM), 40% valvular HD, 35% congenital HD, and 8% pulmonary hypertension (PH). Compared with women without, women with HD had significantly more MACE (16.1 vs 0.4%), more cesarean delivery (45.1 vs 31.0 %), more eclampsia/preeclampsia (11.0 vs 4.2%), more preterm delivery (14.2 vs 5.5%), longer length of stay (4.8±7.3 vs 2.9±2.2 days) and higher total hospital charges ($21,384±47,037 vs 10,175±9,698, all P < .0001). Among women with HD, highest MACE rates were observed in women with CDM and PH (45.9 and 25.0% respectively), and lowest in women with congenital HD (6.1%). Women with CDM and PH also had highest rate of eclampsia/preeclampsia (25.3 and 23.3%, respectively). CONCLUSION: Pregnant women with CDM and PH had the highest rates of MACE during hospitalization for delivery. Eclampsia/preeclampsia was significantly more common in pregnant women with HD, particularly in women with CDM and PH.
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