Uterine Leiomyoma and Pregnancy Outcomes

Abstract

reviewed retrospectively. Complications were the primary outcome and were divided into major (i.e., bleeding requiring transfusion or sutures) and minor (bleeding requiring pressure or local hemostatic agents). RESULTS: From January 2012 to December 2014 a total of 1071 medical records were reviewed. Gomco was the more common technique used [55.84% (598/1071)]. The overall complication rate was 3.83% (41/1071), all involving bleeding. Only 3 [7.32% (3/41)] major complications were encounter, requiring suture placement. No transfusions required. The rest were minor bleeding complications, controlled either by pressure [58.54% (24/41)], silver nitrate [26.83% (11/41) or thrombin [7.32% (3/41)]. Use of the Gomco clamp was more likely to result in bleeding than was the Mogen clamp, 5.69% (34/598) vs 2.96% (14/473), P5.03. Statistical significant difference was noted between pediatricians complication rate (11.49%), compared to OB/GYN physicians (3.08%) (P5.0002).CONCLUSION: Neonatal circumcision is a fairly safe procedure when performed in a hospital setting by attendings or proper supervised physicians in training. The most common complication found in our cohort, was bleeding and the majority resolved with either suture or pressure. No significant major complications were found. In our hands, the Mogen clamp was associated with less bleeding than was the Gomco clamp.INTRODUCTION: Hartford Healthcare, a five hospital system in Connecticut, integrated simulation with risk management training into a single educational curriculum to both improve patient safety and mitigate malpractice risk for the specialty of obstetrics. The first year of the curriculum focused on shoulder dystocia and documentation, and will be expanded to other high risk areas in subsequent years. METHODS:A Work Group, comprised of simulation experts, medical malpractice defense attorneys, risk management consultants, and clinicians, was commissioned to construct the program. Both clinical and risk management learning objectives were identified, and an integrated curriculum was developed using an evidence-based approach. This Group was responsible for implementing the program to 350 participants across five sites. RESULTS:The Group developed customized evaluation and assessment tools that were administered to each participant. These tools aimed to measure participant receptivity and overall buy-in of the program. For the simulation session, 100% of participants stated it was worth their time, and 99% indicated the program would change their practice. For the risk management presentation, 97% of participants said it was worth their time, and 93% of participants indicated the program would change their practice.CONCLUSION: This integrated simulation and risk management training was found to be a worthwhile use of participants' time and have an impact on participants' practice. Simulation training offers a safe and controlled environment in which to train obstetrical emergencies. By integrating risk management with simulation, we can impact both patien...