The obstetrical emergency department: need, rationale, and guide to implementation.

The past 2 decades have seen dramatic growth in the number of obstetrics and gynecology hospitalists, and many hospitals have created obstetrical-specific emergency departments. The goals of an obstetrics emergency department are to provide safe and efficient care to the pregnant dyad and postpartum patient, while generating revenue for emergency services provided. In an obstetrics emergency department, all patients must be evaluated in person by a licensed practitioner, whereas historically they may have been evaluated in person by nursing staff or a trainee. We make the argument that formation of an obstetrics emergency department has the potential to improve the safety and quality of patient care. In addition, the financial benefits to institutions are substantial and can subsidize the cost of maintaining obstetrician presence all the time in the hospital. There are various regulatory requirements to become certified, accredited, and licensed as an emergency department. In addition, there are many operational and systems issues that institutions should consider before implementation. We provide a guide for healthcare systems considering creating an obstetrics emergency department.

Use of Obstetric and Gynecologic Hospitalists Is Associated With Decreased Severe Maternal Morbidity in the United States.

OBJECTIVES: This study aimed to evaluate the prevalence of obstetric and gynecologic (Ob/Gyn) hospitalists and determine if an association exists between the presence of Ob/Gyn hospitalists and severe maternal morbidity (SMM). METHODS: This observational study included data from hospitals listed in the USA TODAY 's 2019 article titled, "Deadly deliveries: Childbirth complication rates at maternity hospitals." Telephone and email surveys of staff in these hospitals identified the presence or absence of continuous providers in the hospital 24 hours, 7 days a week (24/7 coverage) and the types of providers who are employed, then compared these responses with the SMM cited by USA TODAY . RESULTS: Eight hundred ten hospitals were contacted, with participation from 614 labor and delivery units for a response rate of 75.8%. Fifty-seven percent of units were staffed with 24/7 coverage, with 46% of hospitals' coverage primarily provided by an Ob/Gyn hospitalist and 54% primarily by a nonhospitalist OB/Gyn provider. The SMM and presence of 24/7 coverage increased with the level of neonatal care and delivery volume. Of hospitals with 24/7 coverage, those that primarily used Ob/Gyn hospitalists had a lower SMM for all mothers (1.7 versus 2.0, P = 0.014) and for low-income mothers (1.9 versus 2.30, P = 0.007) than those who primarily used nonhospitalist OB/Gyn providers. CONCLUSIONS: Severe maternal morbidity increases with delivery volume, level of neonatal care, and 24/7 coverage. Of hospitals with 24/7 coverage, units that staff with Ob/Gyn hospitalists have lower levels of SMM than those that use nonhospitalist Ob/Gyn providers.

Shearing-force injury of a kidney transplant graft during cesarean section: a case report and review of the literature.

BACKGROUND: With an increasing number of reproductive-aged women undergoing renal transplantation coupled with improved fertility post-transplantation, more women are becoming pregnant with a kidney transplant in place. This leads to increased risk of perinatal complications such as pre-eclampsia, gestational diabetes, preterm delivery and Cesarean section. Given that kidney transplants are often placed extra-peritoneally in the iliac fossa, there is also a risk of damage to the transplanted kidney at the time of Cesarean section. CASE PRESENTATION: We present a case of shearing-force injury to a transplanted kidney at the time of repeat Cesarean section due to adherence of the organ to the overlying fascia. This is the first known case of an injury by this mechanism. CONCLUSION: Pre-operative planning with organ mapping and incision planning is imperative, with consideration for a vertical midline incision to avoid direct or shearing forces on the transplant kidney. Preoperative collaboration with the Transplant Surgery team is also important so they are available in case of emergency or need for intraoperative consultation.

Prevalence of interstitial cystitis in young women.

OBJECTIVES: Traditional epidemiologic studies have significantly underestimated interstitial cystitis (IC) prevalence because they surveyed populations for diagnosed cases rather than screening for IC symptoms and evaluating suspected cases. Our earlier data have suggested that IC affects almost 25% of women. To test this hypothesis, we used a validated IC symptom questionnaire and intravesical potassium sensitivity testing (PST), history, and physical examination to determine the prevalence of IC in a fixed population of young women. METHODS: All female members of the University of California, San Diego, third-year medical student class were asked to complete the Pelvic Pain and Urgency/Frequency (PUF) scale. All those scoring 7 or greater were asked to undergo clinical evaluation, including urinalysis, urine culture, and PST. RESULTS: Of 52 potential subjects, 49 (median age 26 years) completed the PUF scale. Of the 49, 15 (30.6%) scored 7 or greater; 5 of those 15 volunteered for PST. All 5 had negative urinalysis findings and were PST positive, for a 10% (5 of 52) rate of positive voluntary PST in the medical student population. All 15 subjects with PUF scores of 7 or greater reported being sexually active. Dyspareunia was present in 13 (87%) of the 15 women, including all 5 PST-positive subjects. CONCLUSIONS: We identified probable IC in 30.6% and documented IC in a minimum of 10% of the female medical students. These data suggest the estimate of IC prevalence in the United States should be vastly increased from approximately 1.5 million to perhaps 25 to 30 million women and that IC is highly prevalent in young women. Screening for IC-specific symptoms is a useful method for identifying undiagnosed IC cases.