Maternal iron deficiency anemia (IDA) is associated with risk of adverse perinatal outcomes. Oral iron is recommended to reverse anemia, but has gastrointestinal toxicity and frequent non-adherence. Intravenous (IV) iron is reserved for intolerance of, or unresponsiveness to, oral therapy, malabsorption, and severe anemia (1% with hemoglobin [Hgb] levels <7 g/dL). With rare (<100 per one million) adverse events (AEs) ability to infuse a sufficient dose of low molecular weight iron dextran (LMWID) over 60 min, LMWID is an attractive option. This study demonstrated safety and efficacy of rapid IV infusion of 1,000 mg LMWID to gravidas with moderate to severe IDA. An observational treatment study of 1,000 mg LMWID administered over 1 hr for IDA in 189 consecutive, unselected second and third trimester gravidas after oral iron failure was conducted. All received a test dose of 25 mg LMWID and were monitored for AEs during the 60-min infusion. No premedication was administered unless more than one drug allergy or asthma was present in which case IV methylprednisolone was administered. All were followed through pregnancy and delivery. Monitored parameters included Hgb, mean corpuscular volume, serum ferritin, and percent transferrin saturation. About 189 subjects received 1,000 mg LMWID. No serious AEs occurred. About 2% experienced transient infusion reactions. Hgb improved by 1-1.9 g/dL in 82% and 2 g/dL in 24%. Second trimester treatment was not associated with greater Hgb improvement than third trimester treatment. Anemia resolved in 95%. Administration of a single large dose of IV LMWID was effective, safe, and convenient.
Shoulder dystocia continues to challenge obstetrical providers and therefore the management must evolve. The available literature demonstrates clear value in both simulation training and having a clear algorithmic approach. Similarly, the available literature suggests that delivery of the posterior arm should be prioritized. Several new techniques such as the Menticoglou maneuver, Gaskin's maneuver, and the posterior axilla sling traction technique offer obstetrical choices after more traditional techniques have failed.
often utilizing the standard ACOG prenatal genetic history form. This information was then compared to that discovered in the pre-GC intake form and through in-person GC. Missed genetic information was defined as information that was discovered on the pre-GC form or in-person GC that was not present on the initial genetic screening document from the obstetric provider. Missing genetic information that that lead to a change in clinical care, either through additional serum testing, imaging or invasive testing was considered significant. Statistical significance was assessed using Chi-squared testing with p<0.05 identifying significance. RESULTS: 299 patients underwent GC. 57.5% of patients were referred from private providers, 28.1% from academic faculty practice & 14.4% from a federally funded clinic. Missed genetic information was discovered in 171/299 (57.2%) of patients in the GC process. Of these 171 patients, 28.7% were revealed in the pre-GC form and 52.6% in the in-person GC. Of the 171 patients who had new genetic information discovered, 73 (42.7%) were significant. There was no statistical difference in race or referring office setting in the occurrence of new information found. The pre-GC intake form was found to be more likely than the in-person GC to find clinically significant missed genetic history (OR¼1.55; p¼0.037). CONCLUSION: In our population, genetic history obtained in the general obstetrician's office, regardless of practice type, missed over half of patient's genetic information with approximately 40% leading to a change in clinical care. Developing a genetic intake form similar to our pre-GC form may decrease missed genetic information in the general obstetrician's office.
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