IntroductionOpioid exposure during hospitalization for cesarean delivery increases the risk of new persistent opioid use. We studied the effectiveness of stepwise multimodal opioid-sparing analgesia in reducing oxycodone use during cesarean delivery hospitalization and prescriptions at discharge.MethodsThis retrospective cohort study analyzed electronic health records of consecutive cesarean delivery cases in four academic hospitals in a large metropolitan area, before and after implementation of a stepwise multimodal opioid-sparing analgesic computerized order set coupled with provider education. The primary outcome was the proportion of women not using any oxycodone during in-hospital stay (‘non-oxycodone user’). In-hospital secondary outcomes were: (1) total in-hospital oxycodone dose among users, and (2) time to first oxycodone pill. Discharge secondary outcomes were: (1) proportion of oxycodone-free discharge prescription, and (2) number of oxycodone pills prescribed.ResultsThe intervention was associated with a significant increase in the proportion of non-oxycodone users from 15% to 32% (17% difference; 95% CI 10 to 25), a decrease in total in-hospital oxycodone dose among users, and no change in the time to first oxycodone dose. The adjusted OR for being a non-oxycodone user associated with the intervention was 2.67 (95% CI 2.12 to 3.50). With the intervention, the proportion of oxycodone-free discharge prescription increased from 4.4% to 8.5% (4.1% difference; 95% CI 2.5 to 5.6) and the number of prescribed oxycodone pills decreased from 30 to 18 (−12 pills difference; 95% CI −11 to −13).ConclusionsMultimodal stepwise analgesia after cesarean delivery increases the proportion of oxycodone-free women during in-hospital stay and at discharge.

Coronavirus disease 2019 , caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported in New York City (NYC) on 1 March 2020 [1]. NYC was one of the earliest and most profoundly impacted cities in the United States (US) by the COVID-19 pandemic, which continues to be a global crisis. As of 1 December 2020, NYC has recorded more than 290,000 confirmed cases and 19,000 deaths [2].The Bronx is a borough of NYC and has been the most devastated by COVID-19, with case rates considerably higher than its sister boroughs of Manhattan, Brooklyn, Queens, and Staten Island [3]. The borough is also home to the poorest congres-

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Preeclampsia is a multisystemic disorder of pregnancy defined by the presence of hypertension after 20-weeks gestational age in combination with either proteinuria or new onset of 1 of 5 findings (thrombocytopenia, renal insufficiency, pulmonary edema, cerebral or visual symptoms, and impaired liver function). It affects approximately 3% to 4% of pregnant women and ranks among the leading causes of maternal mortality. Although the exact pathophysiology of preeclampsia is not completely understood, its development is likely a consequence of abnormalities in placental growth and implantation leading to vascular hyperreactivity and widespread endothelial dysfunction. Delay in diagnosis can result in intracranial hemorrhage, pulmonary edema, placental abruption, renal failure, and even death. Treatment is largely centered around achieving blood pressure control with antihypertensive therapies, seizure prophylaxis with magnesium sulfate infusion, and expeditious delivery in more severe cases.

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