Antibiotic Prescribing Practices in Group B Streptococcus Positive Obstetric Patients with Penicillin Allergy.

INTRODUCTION: Group B Streptococcus (GBS) positive patients with penicillin allergies receive intrapartum antibiotics for neonatal sepsis prophylaxis based on recommendations from the American College of Obstetricians and Gynecologists (ACOG). The objective of this study was to determine which antibiotics are used in GBS positive patients with documented penicillin allergies and evaluate for antibiotic stewardship improvements at a tertiary hospital in the Midwestern U.S. METHODS: Retrospective chart review identified GBS positive patients with and without penicillin allergies admitted to the labor and delivery floor. EMR-documented penicillin allergy severity, results of antibiotic susceptibility testing, and all antibiotics administered from admission to delivery were recorded. The study population was divided based on penicillin allergy status with antibiotic choice analyzed using Fisher's exact test. RESULTS: 406 GBS positive patients underwent labor between May 1, 2019, and April 30, 2020. Penicillin allergy was documented in 62 (15.3 percent) patients. Of these patients, cefazolin and vancomycin were prescribed most frequently for intrapartum neonatal sepsis prophylaxis. Antibiotic susceptibility testing was performed on the GBS isolate in 74.2 percent of the penicillin allergic patients. Between penicillin allergy and no penicillin allergy groups, the frequency of ampicillin, cefazolin, clindamycin, gentamicin, and vancomycin use showed statistical differences. CONCLUSION: The study results suggest that antibiotic choice for neonatal sepsis prophylaxis in GBS positive patients with penicillin allergy at a tertiary Midwestern hospital follows current ACOG guidelines. Cefazolin was used most frequently in this population followed by vancomycin and clindamycin. Our results identify room for improvement regarding regular antibiotic susceptibility testing in GBS positive patients with penicillin allergy.

Improving Care for Women Who Experience a First Trimester Loss: Physical and Mental Healthcare and Support Services for Miscarriage Patients.

It is estimated that 25-30 percent of known pregnancies result in early pregnancy loss, which can contribute to significant mental health issues for women. In a local health system, it was identified that there was no standard of care for mental health resources offered to patients experiencing a first trimester miscarriage. To create a model of care and a set of resources that the health system could offer, miscarriage patients nationwide were surveyed about resources and care they received or did not receive, and how that contributed to their satisfaction. This was accomplished with an online, anonymous survey distributed via social media. The survey had 687 responses, with 646 confirming a first trimester miscarriage. Only 13.0 percent (95 percent CI 0.10,0.16) of patients surveyed were offered mental health resources, while a majority desired to receive them. Additionally, only 28.4 percent (0.25,0.32) of patients had a provider well-check, something 84.4 percent (0.81,0.88) of women wanted. Overall, patients reported a mean satisfaction with their care and resources of 5.1 out of 10 (4.89,5.35) and 4.1 out of 10 (3.86,4.32) respectively. Using this data, the goal is to create a standard protocol that health systems can easily implement to improve miscarriage patient satisfaction.

Blepharophimosis-ptosis-epicanthus inversus syndrome and hypergonadotropic hypogonadism.

OBJECTIVE: To describe a woman with blepharophimosis-ptosis-epicanthus inversus syndrome and hypergonadotropic hypogonadism. DESIGN: Case report. SETTING: University medical center. PATIENT(S): One 25-year-old woman. INTERVENTION(S): Pedigree, hormone assays, and donor embryo transfer. MAIN OUTCOME MEASURE(S): Pregnancy. RESULT(S): The patient with hypergonadtropic hypogonadism obtained an ongoing pregnancy after donor embryo transfer. CONCLUSION(S): Blepharophimosis-ptosis-epicanthus inversus syndrome is associated with evidence of premature ovarian failure. The syndrome is a sex-limited, autosomal dominant trait that causes selective loss of ovarian function in affected females. This report emphasizes the importance of a thorough family history and pedigree analysis in the evaluation of a patient with hypergonadotropic hypogonadism.

Uterine leiomyomata necessitating emergency postpartum hysterectomy: a case report.

A 44-year-old woman had an uncomplicated vaginal delivery, immediately followed by severe right upper quadrant abdominal pain and hypotension. An emergency exploratory laparotomy revealed a hemoperitoneum caused by a ruptured blood vessel on a large pedunculated uterine fibroid. An unsuccessful myomectomy was attempted, followed by an emergency hysterectomy. This manuscript includes a review of complications of uterine leiomyomas associated with pregnancy.