We evaluated change in MJ detection by urine toxicology screening (UTOX), self-reported use, and the agreement between the two before and after the January 2014 recreational MJ legalization in Colorado. STUDY DESIGN: Retrospective chart abstraction for self-reported and UTOX-detected substance use among women delivering at a single institution in September and October 2013 prior to legalization of MJ, and September and October 2014 after legalization. Per hospital protocol, UTOX is only ordered if requested by the provider in the setting of suspected substance use or the presence of a medical condition associated with substance use such as preterm labor. Twenty-six women were excluded for having neither UTOX nor selfreport data recorded. A Pearson's exact chi-square was used to test differences in rates before and after legalization. Among the MJ positive subset (self-report or UTOX), the % who self-reported use was also compared between groups. UTOX and self-reported MJ use agreement is summarized overall, before and after legalization, with a Kappa coefficient and 95% confidence interval. RESULTS: Among 743 women (n¼371 before legalization, n¼372 after legalization), self-reported use during pregnancy trended upward after legalization: 4.3%, 7.5%, p¼0.06. Among 60 UTOX (either antepartum or delivery admission) before and 61 after legalization, rate of MJ detected increased from 16.7% to 27. 9%, p¼0.14 (Figure). Agreement between UTOX and self-report was fair before legalization (kappa 0.31 (<0.0-0.63), and improved to moderate after legalization (0.46 (0.21-0.71) Table ). The overall rate of MJ users self-reporting was not different before and after legalization (60% vs 70%, p¼0.54). The rate of detection of other illicit drugs by self-report or UTOX did not change over the same time points. CONCLUSION: After the legalization of recreational marijuana, both self-reported and UTOX-detected MJ use among pregnant women trended upward, and the agreement between UTOX-detected and self-reported marijuana use improved indicating that pregnant women may be more willing to disclose use in a legalized environment.
RESULTS: Three cases of MERS in pregnancy have been reported. One led to stillbirth at 20 weeks, the second resulted in maternal death immediately after cesarean section, and the third delivered and recovered without any long term complications. Because of limited numbers of MERS cases, SARS cases were examined. In the twelve reported cases of SARS in pregnancy, the case fatality rate of 25%, ICU admission (50%) and mechanical ventilation (33%), compared with the non-pregnant population (20%). Also, 57% of patients had spontaneous miscarriage, and 84% who presented after 24 weeks were delivered preterm. CONCLUSION: MERS has the potential to be a serious epidemic. Our recommendations for pregnant patients with MERS include: 1) Standard supportive measures for critically ill respiratory infection 2) Early delivery to better permit ventilation 3) Preventive measures at delivery, including nasopharyngeal suction and cleansing to reduce the viral load. Cesarean section at this time is not encouraged 4) Isolation of the mother from neonate until incubation period (14 days) is completed 5) Delay breast feeding until antibodies are detected in breastmilk.
The incidence of unsuspected uterine sarcoma during myomectomy or hysterectomy for benign indications is low at our institution, and is similar for open and MIS cases. Patients should be counseled on the risks and benefits of both open surgery and MIS approaches.
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