INTRODUCTION: In 2016, the United States Preventative Task Force recommends screening for depression in adults, including postpartum women. Our purpose was to assess the prevalence of “screen-positive” postpartum women delivering within our system, and to determine if access to prenatal care (PNC) has a measurable influence on depression scale results. METHODS: The ten-question Edinburgh Postnatal Depression Scale was routinely administered to postpartum women in our hospital. A score of 10 or greater triggered physician notification and social services consultation. Multivariate analysis was performed to investigate correlations between positive postpartum depression scale in patients with no PNC (zero office visits), limited PNC (1 to 3 office visits) and adequate PNC (greater than 3 office visits). RESULTS: A total of 970 women from January 2015 to May 2015 were included. The sample distribution consisted of 81% with adequate PNC (n=786), 12.7% no PNC (n=123), and 6.3% limited PNC (n=61). Scores of 10 or greater occurred in 21.1% (n=26/123) with no PNC compared to 10.9% (n=86/786) with adequate PNC (P=.003). A greater percentage of patients with adequate PNC had private insurance compared to those without PNC (23.5% vs 8.1%, P=.0001). Furthermore, significantly more patients with no PNC were self-pay compared to those with adequate PNC (37.4% vs 4.3%, P=.0001). CONCLUSION: Few studies have confirmed inadequate PNC as a measurable variable for positive postpartum depression screen. Financial issues appear to be a confounding variable. Obstetrician surveillance for management of depression in this population is warranted. Further prospective, interventional studies can potentially use this cohort as a base.
INTRODUCTION: Chronic opioid dependence for maternal pain management, methadone maintenance, or suboxone therapy is an increasing phenomenon in obstetrics. Opioids may depress fetal neurobehavioral status and may change reactivity or variability of fetal heart rate patterns. Our primary objective was to determine which fetal assessment modality best identifies the vulnerable opioid exposed fetus. METHODS: A retrospective review from January 2016 through April 2017 at two MFM antenatal centers identified singleton, non-syndromic fetuses with daily opioid exposure. Non-stress tests (NST), biophysical profiles (BPP), amniotic fluid index (AFI), umbilical artery Doppler’s (UAD), and serial biometry were reanalyzed. Test characteristics and frequency of interventions for abnormal monitoring were quantified. RESULTS: Criteria was met in 27 patients (77.8% methadone (n=21), 14.8% prescription opioid (n=4) and 7.4% suboxone (n=2)). There were 112 growth scans, 102 BPP, 112 NST, and 81 UAD measurements. Time to NST first acceleration was <20 minutes in 92.5%. Abnormal testing causing delivery occurred in 6/27 patients (22.2%), all at 36-38 weeks. Isolated oligohydramnios was 2/27 (7.4%, occurring at 37 and 38 weeks), oligohydramnios with IUGR 2/27 (7.4%, both at 36 weeks), nonreactive NST 1/27 (3.7%, 38 weeks), and BPP 6/10 1/27 (3.7%, 36 weeks). UAD did not change management. Earliest IUGR was seen at 32 weeks. CONCLUSION: Antenatal testing of the singleton, chronic opioid exposed fetus should include third trimester serial growth ultrasounds and BPP or NST-AFI scheduled no later than 34-35 weeks. Continuing study on a larger cohort is needed to define optimal monitoring based upon category of opioid dependence.
INTRODUCTION: Hereditary cancer screening performed during routine prenatal care may identify mutation positive women years before disease progression. Our primary goal was to quantify the acceptance and efficacy of a focused cancer screening program initiated during pregnancy intake. Our secondary goal was to determine if at-risk patients who accept gene testing have barriers to obtaining mutation screening. METHODS: In this prospective study, a self-administered cancer history questionnaire was obtained at the first prenatal visit in three urban clinics from February 2015 to April 2016. National Comprehensive Cancer Network criteria identified patients for additional information regarding BRCA or Lynch mutation testing. Patients at increased risk received immediate physician counseling and were also offered genetic counseling. Desire for mutation screening and barriers to completing genetic testing were quantified. RESULTS: There were 942 patients screened. The at-risk prevalence was 11.4% (n=107/942). Acceptance for gene testing was 33.6% (n=36/107). Mean age of at-risk/criteria-positive patients was 27.9 +/- 6.8 years (range 15-43). Among at-risk patients, 33.6% were Non-Hispanic White, 29.0% were Hispanic, and 27.1% were African American. Financial barriers, insurance denials, and poor access to genetic counselors limited testing to less than 5% of those who requested it. CONCLUSION: Obstetrical consultation is a potential “teachable moment” in hereditary cancer screening. A health disparity exists when patients cannot obtain the desired testing due to financial limitations. Future studies should be structured to remove financial barriers to genetic counseling and mutation testing. If successful, the paradigm of screening during obstetrical care could potentially identify at-risk women decades before disease development.
Introduction: Robotic sacrocolpopexy (RSC) has increased dramatically over the last decade. Nationally representative cost estimates of robotic surgery for apical prolapse have yet to be reported. The study determined index and follow-up costs and healthcare utilization up to ninety days after RSC.Methods: Retrospective cohort study was conducted using Truven MarketScan data from 2008 to 2012. Patients were categorized based on route of index procedure and performance of concomitant hysterectomy. Cohorts included RSC (N=2,006), laparoscopic sacrocolpopexy (LSC) (N=10,708), abdominal sacrocolpopexy (ASC) (N=6,126), and vaginal colpopexy (VC) (N=45,808). Index and follow-up costs were calculated using inpatient, outpatient, emergency, and pharmacy services data. Healthcare utilization was determined from readmissions, emergency room visits, and outpatient visits. T-test and z-test were utilized for statistical analyses.
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