Objective To describe our hospital's experience following expectant management of previable preterm prelabor rupture of membranes (pPPROM). Study Design Retrospective review of neonatal survival and maternal and neonatal outcomes of pPPROM cases between 2012 and 2019 at a tertiary referral center in South Central Louisiana. Regression analyses were performed to identify predictors of neonatal survival. Results Of 81 cases of pPPROM prior to 23 weeks gestational age (WGA), 23 survived to neonatal intensive care unit discharge (28.3%) with gestational age at rupture ranging from 180/7 to 226/7 WGA. Increased latency (adjusted odds ratio [aOR] = 1.30, 95% confidence interval [CI] = 1.11, 1.52) and increased gestational age at rupture (aOR = 1.62, 95% CI = 1.19, 2.21) increased the probability of neonatal survival. Antibiotics prior to delivery were associated with increased latency duration (adjusted hazard ratio = 0.55, 95% CI = 0.42, 0.74). Conclusion Neonatal survival rate following pPPROM was 28.3%. Later gestational age at membrane rupture and increased latency periods are associated with increased neonatal survivability. Antibiotic administration following pPPROM increased latency duration.
INTRODUCTION: The Louisiana State University Obstetric Clinic (LSU-OBGYN Clinic) developed a navigation system to guide patients with diabetes through their prenatal care. We aimed to determine whether participation in the LSU-Diabetes Navigation System (LSU-DNS) could improve adverse maternal and neonatal outcomes associated with diabetes in pregnancy. METHODS: We conducted a retrospective cohort study of LSU-OBGYN Clinic patients with diabetes in pregnancy (n=191, 10/2015–09/2019; approved and monitored by Woman's Hospital IRB). The primary outcome was occurrence of a maternal-neonatal composite compared in patients before (n=148) or after (n=43) implementation of the LSU-DNS using Fisher exact and Wilcoxon Signed-rank tests. Composite variables included: antepartum admission, preterm delivery, pregnancy-induced hypertension, shoulder dystocia, failure of postpartum glucose tolerance testing, fetal demise, NICU admission, NICU length of stay, neonatal birthweight, large for gestational age, and neonatal hypoglycemia. RESULTS: Since 2015, the maternal-neonatal composite occurred in 112 (58.6%) patients; 89 (60.1%) of patients before the LSU-DNS was implemented and 23 (53.5%) patients that participated in the LSU-DNS (P=.48). While the overall composite is not significantly decreased in LSU-DNS participants in this interim analysis (currently n=43 patients have completed LSU-DNS participation), incidence of several individual outcomes were decreased in LSU-DNS patients compared to pre-LSU-DNS patients including: preterm delivery (21.4% vs. 29.7% respectively, P=.33), pregnancy-induced hypertension (20.1% vs. 26.4%, P=.55), shoulder dystocia (0% vs. 4.1%, P=.33), and large for gestational age neonates (19.0% vs. 23.6%, P=.68). CONCLUSION: The LSU-DNS may improve maternal and neonatal outcomes in patients with diabetes in pregnancy, however more patients are needed to adequately assess its effectiveness.
INTRODUCTION: Treatment of diabetes in pregnancy requires coordination of resources by obstetric providers. In a high volume, high acuity, low resource academic practice with multiple providers, gaps in care can occur. The Louisiana State University Obstetric Clinic (LSU-OBGYN Clinic) developed a navigation system to guide patients with diabetes through prenatal and postnatal care. We aimed to test the effectiveness of the LSU-Diabetes Navigation System (LSU-DNS) to improve adherence to ACOG standard of care treatment of diabetes in pregnancy. METHODS: We conducted a retrospective cohort study with LSU-OBGYN Clinic patients with diabetes in pregnancy (10/2015–09/2019; n=191). Receipt of ACOG recommended standard of care treatment of patients with diabetes in pregnancy (assessed by: receipt of diabetes education, Maternal Fetal Medicine consultation, growth ultrasounds, weekly fetal monitoring, postpartum glucose testing, and attendance to prenatal appointments) was evaluated before (n=148) or after (n=43) implementation of the LSU-DNS using Fisher exact and Wilcoxon Signed-rank tests. RESULTS: In our cohort, 60 (31%) patients had preexisting diabetes (n=15 Type 1 DM; n=45 Type 2 DM) and 131 (69%) had gestational diabetes. Patients were on average 31±6 years old with a mean body mass index of 37.0±8.7 kg/m2. 49.7% were African American and 90.0% used government-assisted health insurance. Overall adherence to standard of care was significantly improved with the LSU-DNS (before LSU-DNS 78±15% compliance vs. after LSU-DNS 86±13% compliance; P=.0002), and all individual metrics significantly improved except for prenatal appointment attendance. CONCLUSION: A clinical navigation system for management of diabetes in pregnancy improves adherence to standard of care guidelines.
INTRODUCTION: Increasing the rates of breastfed infants has become a national health objective. Louisiana's breastfeeding initiation and continuance rates remain below the national average, ranking 49th of 50. Our goal is to identify demographic predictors of initial and continued intent to breastfeed. METHODS: We conducted a retrospective cohort study of electronic health records from deliveries at Woman's Hospital, a tertiary hospital in South-Central Louisiana, between July 2015 and June 2016 (n=6689; approved and monitored by Woman's IRB). Patients were asked upon admission for delivery if they intended to breastfeed. Their feeding plan (breast, formula, combination) was reassessed at discharge. Logistic regression was used to describe the populations most likely to intend to breastfeed prior to delivery and those that were breastfeeding successfully at the time of discharge. RESULTS: Between July 2015 and June 2016, 6,689 patients met criteria for analysis. Patients reporting intent to breastfeed prior to delivery were more likely Caucasian (P<.0001), married (P<.001), nulliparous (P<.01), privately-insured (P<.0001), educated (P<.0001), and older (P<.01) compared to patients not intending to breastfeed. These characteristics were similar in those with continued breastfeeding at discharge, however the strongest predictor of breastfeeding at discharge was intent to breastfeed prior to delivery (P<.0001). African American race was the strongest predictor of non-breastfeeding intent (P<.0001). CONCLUSION: Intent to breastfeed prior to delivery was the strongest predictor of breastfeeding at discharge; thus, prenatal breastfeeding education within the at-risk population is crucial to increasing breastfeeding rates. Future studies should assess factors influencing breastfeeding discontinuation and breastfeeding rates through six months postpartum.
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