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1.
Semin Perinatol ; 48(3): 151906, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38664078

RESUMEN

Parental mental health is an essential sixth vital sign that, when taken into consideration, allows clinicians to improve clinical outcomes for both parents and infants. Although standards exist for screening, referral, and treatment for perinatal mood and anxiety disorders (PMADs), they are not reliably done in practice, and even when addressed, interventions are often minimal in scope. Quality improvement methodology can accelerate the implementation of interventions to address PMADs, but hurdles exist, and systems are not well designed, particularly in pediatric inpatient facilities. In this article, we review the effect of PMADs on parents and their infants and identify quality improvement interventions that can increase screening and referral to treatment of parents experiencing PMADs.


Asunto(s)
Salud Mental , Padres , Atención Perinatal , Mejoramiento de la Calidad , Humanos , Femenino , Padres/psicología , Embarazo , Recién Nacido , Atención Perinatal/normas , Atención Perinatal/métodos , Trastornos de Ansiedad/terapia , Trastornos del Humor/terapia
2.
Ochsner J ; 24(1): 22-30, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38510223

RESUMEN

Background: Whether remote blood pressure (BP) monitoring can decrease racial disparities in BP measurement during pregnancy and the postpartum period remains unclear. This study evaluated whether Black and White patients enrolled in the Connected Maternity Online Monitoring (CMOM) program showed improvements in BP ascertainment and interval. Methods: A retrospective cohort of 3,976 pregnant patients enrolled in CMOM were compared to matched usual care patients between January 2016 and September 2022 using electronic health record data. The primary outcomes were BP ascertainment (number of BP measurements) and BP interval (time between BP measurements) during pregnancy and the postpartum period. The proportion of patients with a hypertensive disorder of pregnancy who checked their BP within 7 days of discharge following delivery was also assessed. Results: Enrollment in CMOM was lower among Black patients than White patients (42.1% vs 54.7%, P<0.0001). Patients in the CMOM group had more BP measurements than patients in the usual care group during pregnancy (rate ratio=1.78, 95% CI 1.74-1.82) and the postpartum period (rate ratio=1.30, 95% CI 1.23-1.37), with significant improvements for both Black and White patients enrolled in CMOM compared to patients in usual care. The CMOM intervention did not result in an improvement in 7-day postpartum adherence to checking BP for Black patients (risk ratio=1.03, 95% CI 0.94-1.11) as it did for White patients (risk ratio=1.09, 95% CI 1.01-1.17). Conclusion: Remote BP monitoring programs are a helpful tool to improve the frequency of BP measurements and shorten intervals between measurements during the prenatal and postpartum periods for all patients. Future evaluation is needed to determine the barriers to offering the program to and enrolling Black patients.

3.
Obstet Gynecol ; 139(4): 692, 2022 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-35594125
4.
J Womens Health (Larchmt) ; 31(5): 698-705, 2022 05.
Artículo en Inglés | MEDLINE | ID: mdl-34582715

RESUMEN

Objective: To assess outcomes of women with uterine fibroids (UFs) and heavy menstrual bleeding (HMB) treated with 300 mg elagolix twice daily plus add-back therapy (E2 1 mg/NETA 0.5 mg once daily) or placebo who were not considered responders in pooled analysis of two phase 3, 6-month randomized clinical trials (Elaris UF-1 and UF-2). Methods: Responders were defined as women who met both primary end point bleeding criteria (<80 mL menstrual blood loss [MBL] during the final month and ≥50% reduction in MBL from baseline to the final month) and either completed the study or discontinued due to predefined reasons. Thus, women termed nonresponders who were analyzed in this study who met neither or one bleeding end point or met both criteria but prematurely discontinued treatment because of adverse events, perceived lack of efficacy, or required surgical or interventional treatment for UFs were analyzed in this study. This post hoc analysis assessed mean changes from baseline in MBL, as well as adverse events. Results: Among 367 women receiving elagolix with add-back with observed data, 89 (24%) were not considered responders. Within this subset, 17 (19%) women met both bleeding criteria but prematurely discontinued treatment for the reasons mentioned above, while 23 (26%) met one bleeding criterion and 49 (55%) met neither bleeding criteria, regardless of discontinuation status. Among all nonresponders, a numerical trend toward greater mean reductions in MBL was observed in those receiving elagolix with add-back, compared with placebo group nonresponders. No differences in adverse events were observed between responders and nonresponders. Conclusion: Forty of 89 (45%) women with HMB and UFs who were classified as nonresponders in the UF-1 or UF-2 trials may have had a clinically meaningful response to elagolix with add-back therapy because they met at least one of the objective bleeding criteria. Clinical Trial Registration: Clinicaltrials.gov, NCT02654054 and NCT02691494. (NEJM 2020; 382:328-340) DOI: 10.1056/NEJMoa1904351.


Asunto(s)
Leiomioma , Menorragia , Neoplasias Uterinas , Femenino , Hormona Liberadora de Gonadotropina/uso terapéutico , Humanos , Hidrocarburos Fluorados , Leiomioma/complicaciones , Leiomioma/tratamiento farmacológico , Masculino , Menorragia/tratamiento farmacológico , Pirimidinas , Neoplasias Uterinas/complicaciones , Neoplasias Uterinas/tratamiento farmacológico
5.
Obstet Gynecol ; 138(5): 762-769, 2021 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-34619735

RESUMEN

OBJECTIVE: To estimate the national pregnancy-associated homicide mortality ratio, characterize pregnancy-associated homicide victims, and compare the risk of homicide in the perinatal period (pregnancy and up to 1 year postpartum) with risk among nonpregnant, nonpostpartum females aged 10-44 years. METHODS: Data from the National Center for Health Statistics 2018 and 2019 mortality files were used to identify all female decedents aged 10-44 in the United States. These data were used to estimate 2-year pregnancy-associated homicide mortality ratios (deaths/100,000 live births) for comparison with homicide mortality among nonpregnant, nonpostpartum females (deaths/100,000 population) and to mortality ratios for direct maternal causes of death. We compared characteristics and estimated homicide mortality rate ratios and 95% CIs between pregnant or postpartum and nonpregnant, nonpostpartum victims for the total population and with stratification by race and ethnicity and age. RESULTS: There were 3.62 homicides per 100,000 live births among females who were pregnant or within 1 year postpartum, 16% higher than homicide prevalence among nonpregnant and nonpostpartum females of reproductive age (3.12 deaths/100,000 population, P<.05). Homicide during pregnancy or within 42 days of the end of pregnancy exceeded all the leading causes of maternal mortality by more than twofold. Pregnancy was associated with a significantly elevated homicide risk in the Black population and among girls and younger women (age 10-24 years) across racial and ethnic subgroups. CONCLUSION: Homicide is a leading cause of death during pregnancy and the postpartum period in the United States. Pregnancy and the postpartum period are times of elevated risk for homicide among all females of reproductive age.


Asunto(s)
Homicidio/estadística & datos numéricos , Periodo Posparto , Complicaciones del Embarazo/mortalidad , Adolescente , Adulto , Causas de Muerte , Niño , Etnicidad/estadística & datos numéricos , Femenino , Humanos , Nacimiento Vivo/epidemiología , Mortalidad Materna , National Center for Health Statistics, U.S. , Embarazo , Complicaciones del Embarazo/epidemiología , Factores de Riesgo , Estados Unidos/epidemiología , Violencia/estadística & datos numéricos , Adulto Joven
6.
Obstet Gynecol ; 137(2): 220-224, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33416278

RESUMEN

The evidence of racial health disparities is profound. Much attention has been given to the disparity in maternal morbidity and mortality experienced by Black mothers. The disparity in Black lives lost from coronavirus disease 2019 (COVID-19) has further highlighted the disparity in health outcomes for Black people. Although COVID-19 is a new disease, the reason for the health disparity is the same as in maternal morbidity and mortality: implicit bias and structural racism. Implicit bias among health care professionals leads to disparities in how health care is delivered. Generations of structural racism perpetuated through racial residential segregation, economic suppression, and health care inequality have normalized the poorer health outcomes for Black Americans. It is easy to dismiss these issues as someone else's problem, because health care professionals often fail to acknowledge the effect of implicit bias in their own practices. We all need to be highly critical of our own practices and look introspectively for implicit bias to find the cure. Health care organizations must invest time and resources into investigating the structural racism that exists within our own walls.


Asunto(s)
Negro o Afroamericano/estadística & datos numéricos , COVID-19/mortalidad , Disparidades en Atención de Salud/estadística & datos numéricos , Racismo/estadística & datos numéricos , SARS-CoV-2 , Femenino , Personal de Salud/estadística & datos numéricos , Humanos , Lactante , Mortalidad Infantil/etnología , Mortalidad Materna/etnología , Embarazo , Complicaciones Infecciosas del Embarazo/mortalidad
7.
Ochsner J ; 20(4): 434-438, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33408583

RESUMEN

Background: Surgical site infections (SSIs) are a type of health care-associated infection that can cause significant patient harm. Many are preventable. Postoperative courses complicated by an SSI can equate to longer hospital stays, lost time from work, and the need for reoperation. Methods: This review addresses types of SSIs, risk factors, and best practices for preventing SSIs associated with gynecologic surgery. Results: Best practices to reduce SSIs are divided into preoperative, intraoperative, and postoperative activities. Preoperative considerations include patient showering, hair removal, glycemic control, and hand and forearm scrub. Intraoperative concerns are antibiotic prophylaxis, skin preparation prior to the start of surgery, and the operating room environment. Postoperative concerns are surgical dressing, vacuum-assisted wound closure, and patient instructions. Conclusion: Best practices should be established and followed to reduce the risk of SSI associated with gynecologic surgery.

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