OBJECTIVE: To evaluate the impact of an Enhanced Recovery After Cesarean (ERAC) protocol on the post-cesarean recovery experience using a validated ten-item questionnaire (ERAC-Q). METHODS: This is a prospective cohort study of patients completing ERAC quality-of-life questionnaires (ERAC-Q) during inpatient recovery after cesarean delivery (CD) between October 2019 and September 2020, before and after the implementation of our ERAC protocol. Patients with non-Pfannenstiel incision, ICU admission, massive transfusion, bowel injury, existing chronic pain disorders, acute postpartum depression, or neonatal demise were excluded. The ERAC-Q was administered on postoperative day one and day of discharge to the pre- and post-ERAC implementation cohorts, rating aspects of their recovery experience on a scale of 0 (best) to 10 (worst). The primary outcome was ERAC-Q scores. Statistical analysis was performed with SAS software. RESULTS: There were 196 and 112 patients in the pre- and post-ERAC cohorts, respectively. The post-ERAC group reported significantly lower total ERAC-Q scores compared to the pre-ERAC group, reflecting fewer adverse symptoms and greater perceived recovery on postoperative day one (1.6 [0.7, 2.8] vs. 2.7 [1.6, 4.3]) and day of discharge (0.8 [0.3, 1.5] vs. 1.4 [0.7, 2.2]) (p<0.001). ERAC-Q responses did not predict the time to achieve objective postoperative milestones. However, worse ERAC-Q pain and total scores were associated with higher inpatient opiate use. CONCLUSIONS: ERAC implementation positively impacts patient recovery experience. The administration of ERAC-Q can provide real-time feedback on patient-perceived recovery quality and how healthcare protocol changes may impact their experience.
OBJECTIVE: To sonographically characterize the cervical gland area (CGA) and determine if its evaluation at the time of cervical length (CL) screening can be useful for preterm birth (PTB) prediction. DESIGN: Pilot retrospective cohort study. SETTING: Academic medical center (NYU Langone Health Tisch Hospital). POPULATION: Singleton gestations with universal CL screening performed between 18 – 23 weeks with subsequent live neonate delivery. METHODS: Transvaginal ultrasound (TVUS) cervical images and clinical data were reviewed, comparing sonographically present and absent CGA groups. MAIN OUTCOME MEASURES: Spontaneous PTB <37 weeks and quantitative CGA measurements. RESULTS: The cohort of 772 patients demonstrated similar characteristics when stratified by absent and present CGA. Rates of PTB and absent CGA were 2.6% and 2.3%, respectively. Absent CGA was significantly associated with delivery <37, <34, and <32 weeks (p<0.001), but gland measurements did not correlate with gestational age at delivery. There was good agreement between reviewers for qualitative CGA (PABAK 0.89). Multiple logistic regression modeling demonstrated better performance of CL screening for PTB prediction with the addition of qualitative CGA evaluation (p<0.001). CONCLUSIONS: Qualitative evaluation of the CGA on mid-gestation TVUS may improve CL screening for PTB. Given the biologic activity of the cervical glands, optimal screening in populations with various risk profiles may warrant a multimodal approach that evaluates the mechanical and biological functions of the cervix.
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