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comorbidities. Spearman rank correlation was used to evaluate correlations between continuous variables. RESULTS: 105 ultrasounds from 49 women were included. Mean maternal age was 34.5 years (19-51) with a mean gestational age of 35.1 weeks (12-41). 17% of the women had underlying hypertensive disease and 16.6% had a fetus with growth restriction. Maternal age correlated with time-averaged maximum velocity (r¼-0.6, p<0.05), as well as the mean aortic valve (AV) peak gradient (r¼-0.7, p<0.05). When comparing the group with hypertensive disease to all others, the systemic vascular resistance index (SVRI) is significantly higher (1324 vs 1149 dyn d s/cm 5 ,p¼0.03). However, stroke volume index (SVI) and cardiac index (CI) were not different. When comparing group with growth restriction to the rest there was no significant difference in CI, SVI nor SVRI versus controls. CONCLUSION: Maternal hemodynamic profiles are obtained through the descending aorta. The SVRI is significantly elevated with hypertensive disease. However, there was no evidence of decreased systemic perfusion. Components of the descending aorta cardiac profile may allow identification of the pregnancy at risk for adverse outcome prior to manifesting traditional markers of severe disease.

L&D outcome measures collected over the 26 month period demonstrated significant change.CONCLUSION: This study demonstrates that targeted improvements can make a difference in overall safety culture particularly in areas around safety, management of errors, and safety practices, but even extending to staff perceptions of job satisfaction and working conditions.

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