Objectives To evaluate the concordance between second‐trimester anatomic ultrasound and fetal echocardiography in detecting minor and critical congenital heart disease in pregnancies meeting American Heart Association criteria. Methods We conducted a retrospective cohort study of pregnancies in which a second‐trimester fetal anatomic ultrasound examination (18–26 weeks) and fetal echocardiography were performed between 2012 and 2018 at our institution based on American Heart Association recommendations. Anatomic ultrasound studies were interpreted by maternal‐fetal medicine specialists and fetal echocardiographic studies by pediatric cardiologists. Our primary outcome was the proportion of critical congenital heart disease (CCHD) cases not detected by anatomic ultrasound but detected by fetal echocardiography. The secondary outcome was the proportion of total congenital heart disease cases missed by anatomic ultrasound but detected by fetal echocardiography. Neonatal medical records were reviewed for all pregnancies when obtained and available. Results Overall, 722 studies met inclusion criteria. Anatomic ultrasound and fetal echocardiography were in agreement in detecting cardiac abnormalities in 681(96.1%) studies (κ = 0.803; P < .001). The most common diagnosis not identified by anatomic ultrasound was a ventricular septal defect, accounting for 9 of 12 (75%) missed congenital heart defects. Of 664 studies with normal cardiac findings on the anatomic ultrasound examinations, no additional instances of CCHD were detected by fetal echocardiography. No unanticipated instances of CCHD were diagnosed postnatally. Conclusions With current American Heart Association screening guidelines, automatic fetal echocardiography in the setting of normal detailed anatomic ultrasound findings provided limited benefit in detecting congenital heart defects that would warrant immediate postnatal interventions. More selective use of automatic fetal echocardiography in at‐risk pregnancies should be explored.
INTRODUCTION:The American College of Obstetricians and Gynecologists has recommended that hospitals providing obstetrical care should have the capability to begin cesarean deliveries within 30 minutes. This has been taken out of context in that failure to meet a 30-minute decision-to-incision time for urgent cesarean sections may be criticized litigiously if a poor neonatal outcome occurs.METHODS:After IRB approval, a retrospective chart review of 186 consecutive urgent cesarean deliveries during 2020 at an urban academic medical center was performed. Data were abstracted from patient and neonate charts. Statistical analysis was performed using χ2, t test, and Pearson’s r test.RESULTS:Sixty-seven percent of urgent cesarean section had a decision-to-incision time greater than 30 minutes. Mean time was 42 minutes and median time was 36 minutes (8–194 minutes). Seventy-one percent of patients with body mass index (BMI) greater than 30 had decision-to-incision times greater than 30 minutes, compared to 46% with BMI less than 30 (P=.03). Seventy-eight percent of patients without an epidural took more than 30 minutes, compared to 64% with an epidural (P=.09). Sixty-four percent of urgent cesarean sections occurring between 7 am and 5 pm had decision-to-incision times of greater than 30 minutes, compared to 69% between 5 pm and 7 am (P=.54).CONCLUSION:Sixty-seven percent of urgent cesarean sections had a decision-to-incision time greater than 30 minutes at an academic medical center. Deliveries with BMI greater than 30 were associated with failure to meet a 30-minute threshold. Not having an epidural trended towards failure to meet a 30-minute threshold. Whether delivering during the daytime or nighttime, race, and insurance status did not affect decision-to-incision times. Decision-to-incision time greater than 30 minutes did not affect umbilical cord arterial pH or neonatal intensive care unit admission.
INTRODUCTION:Greater maternal body mass index (BMI) is associated with worse maternal and fetal outcomes. Intrapartum care of patients may be more difficult with higher BMIs. We studied the effect of BMI on decision-to-incision times less than 30 minutes for urgent cesarean sections.METHODS:After IRB approval, a retrospective chart review of 186 consecutive urgent cesarean deliveries during 2020 at an academic medical center were examined. Data were abstracted from patient and neonate charts. Statistical analysis was performed using χ2, t test, and Pearson’s r test.RESULTS:Seventy-one percent of patients with BMI greater than 30 had decision-to-incision times of more than 30 minutes, compared to 46% with BMI less than 30 (P=.03). The mean time from decision-to-incision with BMI greater than 30 was 44 minutes, and 36 minutes with BMI less than 30 (P=.005). When BMI was greater than 40, the mean time was 50 minutes (P=.03). 16% of patients with BMI greater than 30 had decision-to-incision times of more than 60 minutes, compared to 2% with BMI less than 30 (P=.007). BMIs greater than 30 had longer decision-to-operating room (OR) entry (22 versus 17 minutes, P=.02) and OR entry-to-incision times (22 versus 19 minutes, P=.053). Body mass indexes of greater than 40 had both longer decision-to-OR entry (24 versus 19 minutes) and OR entry-to-incision times (25 versus 19 minutes, P=.005). Mothers with BMI greater than 50 had the longest times from OR entry-to-incision and had babies most likely to go to the neonatal intensive care unit (NICU) (50% versus 16%).CONCLUSION:Greater maternal BMIs had longer times for urgent cesarean sections for decision to incision, decision to OR entry, and OR entry to incision. There was a lengthening of decision-to-incision times with increasing BMI. The highest maternal BMIs were most likely to result in NICU admissions. Decision-to-incision time of greater than 30 minutes did not affect umbilical cord arterial pH or NICU admission.
A 20-week abortion ban results in an additional 135 stillbirths, 110 neonatal deaths, and 1,577 children with Down Syndrome per 3,370 women. There would be 1,823 fewer terminations of pregnancy. The presence of a ban results in 13,718 fewer maternal QALYs and costs $1,265,905,483. Among the 2,522 women who would consider termination, 699 would still travel out of state to obtain the abortion. Not having a ban in place remained the costeffective strategy until abortion cost over 700 times its current cost. CONCLUSION: Policies prohibiting termination of pregnancy after 20 weeks' gestation limits options after prenatal diagnoses and are associated with worsened maternal outcomes and increased societal costs.
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