Improving Perinatal Mental Health Care for Women Veterans: Description of a Quality Improvement Program.

Purpose We describe results from a quality improvement project undertaken to address perinatal mental healthcare for women veterans. Description This quality improvement project was conducted in a single VA healthcare system between 2012 and 2015 and included screening for depressive symptoms with the Edinburgh Postnatal Depression Scale (EPDS) three times during the perinatal period, a dedicated maternity care coordinator (MCC), an on-site clinical social worker, and an on-site obstetrician/gynecologist (Ob/gyn). Information on prior mental health diagnosis was collected by the MCC or Ob/gyn. The prevalence of perinatal depressive symptoms and receipt of mental healthcare among those with such symptoms are reported by presence of a pre-pregnancy mental health diagnosis. Assessment Of the 199 women who used VA maternity benefits between 2012 and 2015, 56% (n = 111) had at least one pre-pregnancy mental health diagnosis. Compared to those without a pre-pregnancy mental health diagnosis, those with such a diagnosis were more likely to be screened for perinatal depressive symptoms at least once (61.5% vs. 46.8%, p = 0.04). Prevalence of depressive symptoms was 46.7% among those with a pre-pregnancy mental health diagnosis and 19.2% among those without. Among those with a pre-pregnancy mental health diagnosis and depressive symptoms (n = 35), 88% received outpatient mental healthcare and 77% met with the clinical social worker. Among those without a pre-pregnancy mental health diagnosis and depressive symptoms (n = 8), none received outpatient mental healthcare, but 77.8% met with the clinical social worker. Conclusion Improving perinatal mental healthcare for women veterans requires a multidisciplinary approach, including on-site integrated mental healthcare.

A novel approach for resection of a vaginal septum.

BACKGROUND: The resection of a vaginal septum using the Harmonic Scalpel in a patient on anticoagulation is described. CASE: A 21-year-old female with bicollis didelphys uterus and a 4-cm vaginal septum underwent resection of the vaginal septum using the ultrasonic scalpel. Hemostasis was noted both during and after the procedure. The patient was given thombophylaxis for 2 weeks perioperatively secondary to her medical history of anti-thrombin III deficiency and deep venous thrombosis. SUMMARY AND CONCLUSION: The use of the Harmonic Scalpel appears to be a safe and effective method for resection of vaginal septa. Patient healing time may vary and may take longer than with traditional techniques.