Objective To define the amount of opioid analgesics prescribed and consumed after discharge after cesarean delivery. Methods We conducted a survey at six academic medical centers in the United States from 9/2014 to 3/2016. Women who had undergone a cesarean delivery were contacted by phone two weeks after discharge and participated in a structured interview about the opioid prescription they received upon discharge and their oral opioid intake while at home. Results A total of 720 women were enrolled; of these, 615 (85.4%) filled an opioid prescription. The median number of dispensed opioid tablets was 40 (interquartile range (IQR) 30 to 40), the median number consumed was 20 (IQR 8 to 30), and leftover was 15 (IQR 3 to 26). Of those with leftover opioids, 95.3% had not disposed of the excess medication at the time of the interview. There was an association between a larger number of tablets dispensed and the number consumed independent of patient characteristics. The amount of opioids dispensed did not correlate with patient satisfaction, pain control, or the need to refill the opioid prescription. Conclusion The amount of opioid prescribed after cesarean delivery generally exceeds the amount consumed by a significant margin, leading to substantial amounts of leftover opioid medication. Lower opioid prescription correlates with lower consumption without a concomitant increase in pain scores or satisfaction.

Maternal severe sepsis and sepsis-related deaths are increasing in the United States. Severe sepsis often occurs in the absence of a recognized risk factor and underscores the need for developing systems of care that increase sensitivity for disease detection across the entire population. Physicians should enhance surveillance in patients with congestive heart failure, chronic liver disease, chronic renal disease, and systemic lupus erythematous and institute early treatment when signs of sepsis are emerging.

PUI = persons under investigation; RANZCOG = xxx; RCOA-OAA = xxx; RCOG = xxx; RNA = ribonucleic acid; RT-PCR = real-time reverse transcriptasepolymerase chain reaction; SMFM-SOAP = xxx; SOAP = xxx; SOGC = xxx; Spo 2 = pulse oximetry; SARS = severe acute respiratory syndrome; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2; SPG = sphenopalatine ganglion With increasing numbers of Coronavirus Disease 2019 (COVID 19) cases due to efficient human-to-human transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the United States, preparation for the unpredictable setting of labor and delivery is paramount. The priorities are 2-fold in the management of obstetric patients with COVID-19 infection or persons under investigation (PUI): (1) caring for the range of asymptomatic to critically ill pregnant and postpartum women; (2) protecting health care workers and beyond from exposure during the delivery hospitalization (health care providers, personnel, family members). The goal of this review is to provide evidence-based recommendations or, when evidence is limited, expert opinion for anesthesiologists caring for pregnant women during the COVID 19 pandemic with a focus on preparedness and best clinical obstetric anesthesia practice.

Background-Several reports indicate that physical activity can reduce the severity of symptoms in depressed patients. Some data suggest that even a single exercise bout may result in a substantial mood improvement. Objective-To evaluate the short term eVects of a training programme on patients with moderate to severe major depression. Conclusions-Aerobic exercise can produce substantial improvement in mood in patients with major depressive disorders in a short time. (Br J Sports Med 2001;35:114-117) Methods-Twelve patients (mean (SD

Objective: To evaluate the short-term effects of exercise in patients with major depression. Design: Prospective, randomised, controlled study. Setting: A university hospital. Patients: A consecutive series of 38 inpatients with a major depression episode undergoing standard clinical antidepressant drug treatment. Interventions: Patients were randomly assigned to an exercise (walking, n = 20) or placebo (low-intensity stretching and relaxation exercises, n = 18) group. Training was carried out for 10 days. Main outcome measurements: Severity of depression assessed with the Bech-Rafaelsen Melancholy Scale (BRMS) and the Center for Epidemiologic Studies Depression scale (CES-D). Results: After 10 days, reduction of depression scores in the exercise group was significantly larger than in the placebo group (BRMS: 36% v 18%; CES-D: 41% v 21%; p for both = 0.01); the proportion of patients with a clinical response (reduction in the BRMS scores by more than six points) was also larger for the exercise group (65% v 22%, p,0.01). Conclusions: Endurance exercise may help to achieve substantial improvement in the mood of selected patients with major depression in a short time.