The aim of this study was to evaluate if premature progesterone elevation on the last day of assisted reproduction technique stimulation contributes to racial disparities. A total of 3289 assisted reproduction technique cycles were evaluated in Latino, Asian, African American, and white women. Live birth was more likely in white women (42.6%) compared with Asian (34.8%) and African American women (36.3%), but was similar to Latino women (40.7%). In all racial groups, progesterone was negatively associated with live birth and the negative effect of progesterone persisted when adjusting for confounders. Although the effect of elevated progesterone was similar in all racial groups, the prevalence of elevated progesterone differed. P > 1.5 ng/ml occurred in only 10.6% of cycles in white women compared with 18.0% in Latino and 20.2% in Asian women. P > 2 ng/ml occurred in only 2.3% of cycles in white women compared with 6.3% in Latino, 5.9% in Asian and 4.4% in African American women. The increased prevalence of premature elevated progesterone persisted when controlling for IVF stimulation parameters. In conclusion, premature progesterone elevation had a negative effect on live birth in all racial groups studied. The prevalence of elevated progesterone was higher in racial minorities.
INTRODUCTION: Eclampsia is an obstetrical emergency of hypertensive disorders in pregnancy, which can lead to significant morbidity and mortality. The objective of this study was to demonstrate and quantify the effect of simulation training on knowledge, performance and confidence levels of providers in managing eclampsia. METHODS: A 3 month study was performed using 6 obstetrics and gynecology residents and a standardized simulation program with a high-fidelity manikin. Pre- and post-testing were performed using knowledge tests, validated performance checklists and confidence surveys. An interval performance assessment was conducted at three months to quantify retention of skills. Statistical analysis was performed using chi-squared analyses. RESULTS: Significant improvement was noted in all domains. Knowledge scores increased from 36.67% to 96.67% post simulation, p less than 0.0004. Performance assessment increased from 31.75% to 94.67%, p less than 000.1. Confidence levels demonstrated statistically significant improvements in all areas with the greatest in managing an eclamptic seizure, ordering eclampsia medications and managing magnesium sulfate toxicity, p less than 0.0001. Retention scores at 3 months indicated that performance remained strong at 91.67%, p less than 0.0001. Participant comments included the benefit of practicing this rare event in simulation which then occurred in real life the next day. CONCLUSION: Simulation-based training for eclampsia management improves knowledge, performance and confidence levels. Repeated simulation training demonstrates retention of learning. Simulation is a valuable tool in preparing physicians for managing eclampsia and maintaining knowledge and skills for when these rare emergencies occur in reality.
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