Methodius Tuuli

In Reply In our article, we highlighted the opportunity offered by preconception care to assess dietary intake to “ensure that daily allowances are met for micr

Cesarean delivery is the most common major surgical procedure among women in the United States.¹ In 2018, 32% (1.2 million) of the 3.8 million births in the United States were by cesarean delivery.² Despite significant advances in the use of antiseptics, prophylactic antibiotics, and sterile surgical technique, surgical-site infection remains a significant cause of morbidity.^3,4 In addition to the patient-level effects, surgical-site infections increase hospital length of stay and escalate costs 2-fold at the health care system level.⁵ Obesity (body mass index [BMI], calculated as weight in kilograms divided by height in meters squared, ≥30) complicates 25% of pregnancies and exacerbates the problem of surgical-site infection after cesarean delivery.⁶ Quiz Ref ID Obese women are more likely than nonobese women to deliver by cesarean and are also at a higher risk of surgical-site infection.^7-10 Therefore, additional interventions are needed to reduce surgical-site infections after cesarean delivery in obese women.

Duty hour restrictions limit trainee exposure to obstetric emergencies. Additionally, nursing turnover creates an area of need for increased education for preparation for these emergencies. Simulation has been used to improve physician performance, communication, and medical documentation; however, whether these benefits extend to all providers is understudied. We conducted a quasi-randomized prospective educational trial targeted toward L&D nurses with less than 2 years' experience and junior obstetric residents. Participants were exposed to a pretest examining their knowledge (multiple choice, yes/no, free text responses) and comfort level (measured utilizing the Likert scale) with three common obstetric emergencies: shoulder dystocia, emergency cesarean delivery, and eclampsia. Participants underwent a simulation of one of the scenarios, watched their video-taped performance, participated in a debrief and educational session, and then repeated the simulation. Participants were administered a posttest following the simulation. Eighteen L&D nurses and 17 obstetric residents participated. Examination of the pre- and posttest results revealed improvements in the comfort level with shoulder dystocia maneuvers (P=.0178), communication during a shoulder dystocia (P=.0339), medical management of an eclamptic seizure (P=.0190), and knowledge of how to appropriately administer magnesium to an eclamptic patient without an IV (P=.0047). Interdisciplinary collaboration through the use of obstetric simulation can be utilized to improve knowledge and comfort necessary for the management of obstetric emergencies for both obstetric residents and L&D nurses.

Objective Compare labor progression in first and second stages in women < 18 years with those ≥18 years. Study Design Retrospective cohort study of consecutive women at term that reached the second stage of labor between 2004 and 2008. The first stage in women < 18 years was compared with women ≥18 years. Average labor curves were constructed and median time spent to progress 1 cm in dilation and total time from 4 to 10 cm was estimated. Time spent pushing and total duration of second stage were compared between groups. Analyses were then stratified by parity. Results There was no significant difference in progress of the first stage of labor between women < 18 years and those ≥18 years. In the second stage, nulliparous teenage women were less likely to have a duration > 60 or 120 minutes. Conclusion Laboring women < 18 years should be managed with the same expectations of labor as women ≥18 years.