BACKGROUND: Strategies to curb overprescribing have focused primarily on the prescriber as the point of intervention. Less is known about how to empower patients to use fewer opioids and decrease the quantity of leftover opioids. Previous studies in nonobstetrical populations suggest that patient counseling about appropriate opioid use improves disposal of unused opioids and overall knowledge about opioid use. Less is known about whether counseling reduces opioid use after hospital discharge. OBJECTIVE: This study examines whether enhanced discharge counseling on optimal analgesic use after cesarean delivery reduces opioid use and improves proper disposal of unused opioids and opioid use knowledge after hospital discharge. STUDY DESIGN: Women who underwent an uncomplicated cesarean delivery were randomized to enhanced counseling on optimal analgesic use or usual care. Enhanced counseling addressed the following 4 points: (1) pain is normal after cesarean delivery; (2) scheduled ibuprofen should be taken to maintain baseline pain control; (3) opioids should be used sparingly and should be tapered over several days; and (4) all unused opioids should be returned to pharmacy or flushed in a toilet. All participants received 30 tablets of 5 mg hydrocodone-acetaminophen and 30 tablets of 600 mg ibuprofen at discharge. They were contacted 14 days later to determine opioid use and location of leftover opioids and to complete a 10-question analgesic strategies quiz with a score of 1 to 10. We estimated that outcome data on 172 women total would provide an 80% power to detect a 30% reduction in postdischarge opioid use with enhanced counseling.RESULTS: Notably, 79% of eligible women consented to the study and 175 of 196 participants (84 enhanced counseling, 91 usual care) completed the follow-up. Compared with usual care, the enhanced counseling group was more likely to follow recommendations for proper opioid disposal (risk ratio, 2.3; 95% confidence interval, 1.3e3.9). They also scored significantly higher on the analgesic strategies quiz (10 points [interquartile range, 9e10] vs 8 points [interquartile range, 7e9]; P<.001) than the usual care group. Although the enhanced counseling group used less opioids (7.5 tablets [interquartile range, 2e15] vs 10.0 tablets [interquartile range, 2e16]; P¼.55) and a smaller proportion of prescribed opioids (25.0% [6.7e50.0] vs 33.3% [6.7e53.3], P¼.55) than the usual care group, differences were not statistically significant. There was no statistically significant evidence of interaction between participant education level and any of the study outcomes. CONCLUSION: Enhanced discharge opioid counseling doubled the frequency of participants reporting proper opioid disposal and improved overall knowledge about the risks associated with opioids. This intervention did not decrease opioid use in a population of women with low overall opioid use. These findings highlight possible methods to intervene on the short-term (misuse and diversion) and long-term (persistent opioid use) consequences ...
BACKGROUND: Gastroschisis and omphalocele are congenital abdominal wall defects in which the bowel and other abdominal contents extrude from the fetal abdominal cavity. Standard formulas for estimated fetal weight using ultrasound include fetal abdominal circumference measurement and have a range of error of approximately 10%. It is unknown whether the accuracy of estimated fetal weight assessment is compromised in fetuses with abdominal wall defects because of the extrusion of abdominal contents. OBJECTIVE: This study aimed to assess the accuracy of standard estimated fetal weight assessment in fetuses with abdominal wall defects by comparing prenatal assessment of fetal weight with actual birthweight. STUDY DESIGN: A retrospective cohort study of fetuses diagnosed with gastroschisis or omphalocele was performed at a single center from 2012 to 2018. Fetuses with additional anomalies or confirmed chromosome abnormalities were excluded. Estimated fetal weight was calculated using the Hadlock formula. Published estimates of fetal growth rate were used to establish a projected estimated fetal weight at birth from the final growth ultrasound, and the percent difference between projected estimated fetal weight at birth and actual birthweight was calculated. The Wilcoxon rank-sum test was used to examine the difference between projected estimated fetal weight and actual birthweight. RESULTS: We had complete data for 112 fetuses with abdominal wall defects, including 85 with gastroschisis and 27 with omphalocele. The median (interquartile range) projected estimated fetal weight was similar to median birthweight, at 2283 g (interquartile range, 2000−2810) and 2306 g (interquartile range, 1991−264), respectively, which did not represent a statistically significant difference between projected estimated fetal weight and actual birthweight (P=.32). The median percent error was 6.8 (3.1−12.8). In addition, we did not find any statistical difference between projected estimated fetal weight and actual birthweight in patients with gastroschisis (P=.52) or omphalocele (P=.35) individually. Estimated fetal weight was underestimated in most cases (n=68 [60.7%]). CONCLUSION: In fetuses with abdominal wall defects, standard measurement of fetal weight shows an accuracy that is at least comparable with previously established margins of error for ultrasound assessment of fetal weight. Standard estimated fetal weight assessment remains an appropriate method of estimating fetal weight in these fetuses.
OBJECTIVE: To evaluate the effect of reducing the amount of asneeded opioids ordered following cesarean delivery (CD) on inpatient opioid consumption and analgesia. STUDY DESIGN: As part of a larger opioid stewardship initiative at our tertiary care institution, our standard as-needed opioid order was reduced from oxycodone 5-10mg every 4 hours to oxycodone 5mg every 6 hours, effective May 1, 2019. Standing orders for non-opioid ajog.org
BACKGROUND: Congenital diaphragmatic hernia is a congenital anomaly in which fetal abdominal organs herniate into the thoracic cavity through a diaphragmatic defect, which can impede fetal lung development. Standard formulas for estimated fetal weight include measurement of fetal abdominal circumference, which may be inaccurate in fetuses with congenital diaphragmatic hernia because of displacement of abdominal contents into the thorax. OBJECTIVES: This study aimed to assess the accuracy of standard estimated fetal weight assessment in fetuses with congenital diaphragmatic hernia by comparing prenatal assessment of fetal weight with actual birthweight. STUDY DESIGN: A retrospective cohort study of fetuses diagnosed with congenital diaphragmatic hernia was performed at a single center from 2012 to 2018. Fetuses with multiple anomalies or confirmed chromosome abnormalities were excluded. Estimated fetal weight was calculated using the Hadlock formula. Published estimates of fetal growth rate were used to establish a projected estimated fetal weight at birth from the final growth ultrasound, and the percentage difference between projected estimated fetal weight at birth and actual birthweight was calculated. A Wilcoxan rank-sum test was used to examine the difference between projected estimated fetal weight and birthweight.RESULTS: We had complete data for 77 fetuses with congenital diaphragmatic hernia. The majority (76.6%, 55 of 77) had left-sided congenital diaphragmatic hernia. The median [interquartile range] projected estimated fetal weight was similar to median birthweight, at 3177 g [2691e3568] and 3180 g [2630e3500], respectively, which did not represent a statistically significant difference between projected estimated fetal weight and birthweight (P ¼ .66). The median absolute percentage difference between projected birthweight and actual birthweight was 6.3% [3.2e7.0]. Estimated fetal weight was overall underestimated in a minority of cases (44.2%, 34 of 77). CONCLUSION: In fetuses with a congenital diaphragmatic hernia, standard measurements of fetal estimated fetal weight show accuracy that is at least comparable with previously established margins of error for ultrasound assessment of fetal weight. Standard estimated fetal weight assessment remains an appropriate method of estimating fetal weight in fetuses with congenital diaphragmatic hernia.
INTRODUCTION:Activity restriction (AR) is commonly recommended to pregnant patients despite lack of evidence demonstrating benefit to this practice. We describe AR recommendation patterns and identify factors associated with a higher likelihood of recommendation for AR.METHODS:This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) prospective cohort. Data were collected on nulliparous singletons at eight sites from September 2010 to September 2013. Patients were surveyed about AR recommendations at 22 weeks 0 days–29 weeks 6 days and delivery. We excluded patients missing data on AR and age. Patients were grouped by history of AR in pregnancy. We assessed characteristics between groups using χ2 and Wilcoxon rank sum tests. Associations between AR and demographic and clinical factors were examined with univariable and multivariable logistic regression.RESULTS:Of 9,312 women, 1,386 (14.9%) were recommended AR. In unadjusted analysis, prevalence of race and ethnicity, obesity, chronic hypertension, renal disease, and short cervix were significantly different between groups. After adjustment for covariates, Black and Hispanic patients were less likely to be placed on AR when compared to White patients (adjusted odds ratio [aOR] 0.81 [95% CI 0.68–0.98], and aOR 0.73 [95% CI 0.61–0.87], respectively).CONCLUSION:Activity restriction was more likely to be recommended in patients with obesity, chronic medical conditions, and short cervix. After adjustment for baseline differences, Black and Hispanic patients were significantly less likely to be recommended AR compared to White patients. While AR is not an evidence-based practice, these findings suggest implicit bias may affect which patients receive advice to limit activity in pregnancy.
The purpose of this study is to determine whether hypertensive disorders of pregnancy (HDP) affect the development of chronic hypertension (HTN) within 5 years postdelivery based on updated guidelines by the American Heart Association (AHA). METHODS:This IRB-approved study evaluated women who delivered at one hospital from 2014 to 2016. Participants were determined to be normotensive or with HDP. Inclusion criteria for the HDP group was diagnosis of gestational HTN or preeclampsia at 20 weeks of gestation or greater. Exclusion criteria were previous diagnosis of HTN and age over 40. Women were followed up to 5 years postdelivery to assess development of chronic HTN, defined by the 2017 AHA guidelines as systolic greater than 130 mm Hg or diastolic greater than 80 mm Hg.RESULTS: Sixty-four participants (30.9%) developed chronic HTN within 5 years of delivery. Of these participants, 6.25% were from the normotensive pregnancy group, while 84.4% were from the preeclampsia with severe features group, with adjusted odds ratio of 11.38 . Compared to the 5-year normotensive group, the 5-year chronic HTN group was associated with higher maternal body mass index (BMI) (P 5.0146), preterm delivery (P 5.0231), and neonatal intensive care unit (NICU) admission (P 5.04). CONCLUSION: The rate of chronic HTN development 5 years postdelivery was significantly higher in participants with HDP, notably preeclampsia with severe features. Participants with development of chronic HTN had increased BMI during pregnancy, preterm delivery, and NICU admission rates as compared to participants with 5-year normotensive pressures. Awareness of the prevalence and risk factors for development of chronic hypertension provides areas of focus for future investigations.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.