The purpose of this study was to assess obstetrician-gynecologist utilization of low-dose aspirin for women at increased risk for hypertensive disorders of pregnancy. Further, the study evaluated prescribing practices in relation to speci c risk factor pro les in order to identify which women are at highest risk of not receiving recommended therapy. Methods:This was a retrospective cohort study reviewed and approved by the local Institutional Review Board. Electronic health records were reviewed to identify risk factors for preeclampsia. Women were eligible for aspirin prophylaxis if they had at least one "high" risk factor or multiple "moderate" risk factors.Associations of interest were addressed using Pearson Chi-squared tests and multinomial logistic regression.Results: 970 patients were included and 301 women (31%) met criteria for low-dose aspirin prophylaxis; of these, 92 (31%) were given this recommendation. Women eligible for prophylaxis by presence of multiple "moderate" risk factors alone were least likely (0-6%) to have a low-dose aspirin prescription. Conclusions for Practice:Low-dose aspirin is an underutilized tool for preventing preeclampsia. Women with a combination of "moderate" risk factors are most likely to not receive indicated aspirin prophylaxis. Efforts should be made to encourage broader uptake of the recommendations for aspirin prophylaxis among obstetriciangynecologists. Signi canceWhat is already known on this subject? Low-dose aspirin has been shown to reduce preeclampsia risk in pregnant women. This preventative measure has been recommended by prominent organizations including the American College of Obstetricians and Gynecologists and the United States Preventive Services Task Force. Yet despite widespread support of this recommendation, uptake is not universal among obstetric care providers. What this study adds?This study identi es those who are most likely to experience a missed opportunity for aspirin prophylaxis, thus providing a suggestion for where provider education or other efforts to increase adherence to this guideline may be most impactful. DeclarationsFunding: There was no nancial support obtained for the conduct of this research or preparation of this article for publication.Con icts of interest: The authors report no con icts of interest.Ethics approval: The project was reviewed and approved by the local Institutional Review Board (IRB) prior to commencement of the project.Consents: Waivers of informed consent or consent for publication were obtained from the IRB due to the retrospective nature of this chart review and since no patient-identifying information will be published.

No abstract

The objective was to determine the effect chorioamnionitis has on the risk of third-and fourth-degree perineal lacerations (3/4 PL).METHODS: This represents a retrospective cohort based on the Centers for Disease Control and Prevention Natality Live Birth database (2016)(2017)(2018)(2019)(2020). We compared the rates of 3/4 PL in term, singleton vaginal births across the United States based on diagnosed intrapartum chorioamnionitis. We used Pearson chi-square and multivariate logistic regression to control for confounding variables. Statistical significance was determined as P,.05, and results were displayed as adjusted odds ratios (aORs) with 95% CI. RESULTS:Of the 11,677,671 who met inclusion criteria, 139,174 (1.2%) women experienced 3/4 PL. Intrapartum chorioamnionitis was associated with a staggering 3.96% rate of 3/4 PL compared to a 1.15% rate in women without chorioamnionitis (aOR 1.85, 95% CI 1.80-1.90). CONCLUSION: Based on this current U.S. database we identified chorioamnionitis as a major risk factor for 3/4 PL. The potential explanation may be due to dysfunctional labor, increased perineal edema secondary to protracted labor, or increased friability of tissue. Understanding this association may assist in better counseling and potentially reduce the rates of 3/4 PL in gravidas with chorioamnionitis.

INTRODUCTION:Use of tranexamic acid (TXA) is beneficial in the setting of obstetric hemorrhage. We sought to understand whether patients with placenta accreta spectrum disorder benefit from TXA administration during cesarean hysterectomy.METHODS:This is an IRB-approved retrospective cohort study of participants with suspected placenta accreta spectrum undergoing cesarean hysterectomy in a single hospital system. Those who received TXA were compared to those who did not. The primary outcome was the rate of blood transfusion. Secondary outcomes included maternal intensive care unit (ICU) admission, massive transfusion, length of postoperative stay, operative time, and a composite of adverse maternal outcomes. Chi-square, t tests, and Fisher’s exact test were used to compare baseline characteristics, and a logistic regression was performed with possible confounders.RESULTS:A total of 87 participants met criteria for the study; among those were 35 (40.2%) who received TXA. Baseline characteristics between groups were similar. Although not statistically significant in univariable analysis, there was a trend for those who received TXA to have lower blood loss overall (∼2,000 mL versus ∼2,300 mL, P=.483) and be less likely to require transfusion (48.6% versus 69.2%, P=.053). Further, they were statistically less likely to undergo ICU admission (22.9% versus 60.4%, P=.001). There was no difference in the other secondary outcomes including the combined adverse maternal outcome (40.0% versus 44.2%, P=.695). After controlling for confounders, TXA administration was independently associated with decreased rates of blood transfusion (adjusted odds ratio [aOR] 0.23, 95% CI 0.08–0.68) and ICU admission (aOR 0.16, 95% CI 0.05–0.48).CONCLUSION:Tranexamic acid use in the setting of cesarean hysterectomy for PAS was associated with decreased risks of transfusion and ICU admission.

No abstract