Importance: The environmental impacts of medical practice are becoming more important as the unsustainable activities of global societies continue to damage the environment and contribute to health problems. Life cycle assessment (LCA) is a methodology to quantify a wide range of environmental impacts, including global warming, over the full life cycle of products, processes, and systems, to allow for data-driven environmental decisions.Objective: This article introduces the concepts, terminology, and methodology of LCA using examples from the medical industry. It provides guidance and best practices for the standard steps of an LCA study.Evidence Acquisition: A review of the literature was done to provide examples of the use of LCA and carbon footprints in medicine. Hypothetical medical products were modeled using LCA software to illustrate the capabilities and limitations of this method.Results: Life cycle assessment examples in medicine illustrate the ability of this method to compare environmental impacts for products that perform the same function. They also highlight the relative scale of damage across all life cycle phases for a variety of environmental impact categories. Resources have also been provided for various useful LCA tools.Conclusions and Relevance: Life cycle assessment can provide medical practitioners with quantified environmental metrics in order to make decisions that minimize the environmental impacts of medical products, processes, and systems. Carbon footprints are LCA studies that focus only on the impact of climate change. Life cycle assessment is expected to grow as a tool for environmental decisions in medical practice.Target Audience: Obstetricians and gynecologists, family physicians.Learning Objectives: After completion of this article, the reader should be better able to describe how environment impacts can occur throughout the different phases of the life cycle of a medical product or process; explain how product life cycle inputs/outputs are translated into quantified environmental impacts; identify the concept of a carbon footprint and differentiate it from an LCA; and summarize several of the main environmental impact categories considered in LCA studies.

The objective was to quantify resources devoted to quality and patient safety initiatives, to document the development and use of key performance indicator reports regarding patient outcomes and patient feedback, and to assess the culture of safety within academic obstetrics and gynecology departments. Chairs of academic obstetrics and gynecology departments were asked to complete a quality and safety assessment survey. Surveys were distributed to 138 departments, yielding 52 completed responses (37.7%). Five percent of departments reported including a patient representative on a quality committee. Most committee leaders (60.5%) and members (67.4%) received no compensation. Formal training was required in 28.8% of responding departments. Most departments monitored key performance metrics for inpatient outcomes (95.9%). Leaders scored their departments’ culture of safety highly. Most departments provided no protected time to faculty devoted to quality efforts, generation of key performance indicators for inpatient activities was prevalent and integrating patient and community input remain unrealized opportunities.

OBJECTIVE: Determine the placenta microbiome composition in Type 2 diabetes STUDY DESIGN: A prospective cohort study with two groups: Type 2 Diabetes and Control. Eligible patients were enrolled upon admission. Patients ages 18-40 who delivered between 37-41.6 weeks. Maternal data included Hgb A1c, BMI, weight gain, labor abnormalities, and delivery mode. Fetal/neonatal data included congenital defects, growth abnormalities, gestational age, gender, birth weight, apgars, and NICU admission. With sterile technique, the placenta was collected at delivery. Sterile surgical tools were used to collect four cuboidal sections 3-4 cm from cord insertion. Tissue was immediately frozen in liquid nitrogen. Samples were transferred to a -80C freezer on dry ice. RNA extraction was done with E.Z.N.A RNA Extraction kit. NanoDrop was used to ensure appropriate yield. All samples were sent for 16s rRNA sequencing. RESULTS: Composite features include 34 total patients delivering between 37 to 41.6 weeks. Average hemoglobin A1c was 5.69%, ranging from 4.9-8.1%. Average BMI at admission was 36.5, ranging from 26-59. Average weight gain in pregnancy was 23.7 lbs, ranging from 1-67 lbs. 61% of patients delivered vaginally and 39% via cesarean. 70.6% of fetuses were female and 29.4% were male. Average birth weight was 3248g, ranging from 2010g -4430g. In intergroup analysis, diabetic group had higher Hgb A1c (p-value 0.0025), larger BMI (p-value 0.0168), earlier gestational age (p-value 0.0012), and higher rate of cesarean (p-value 0.0111). No statistically significant difference in APGARs or birth weight. All placentas demonstrated high concentration yields of DNA. Further analysis of the placenta samples for microbial DNA resulted in no yield. The placentas

OBJECTIVE:To determine the neonatal factors that predict histologic chorioamnionitis. STUDY DESIGN: Neonates of women diagnosed with clinical chorioamnionitis at a university hospital between January 2011 and December 2012 were evaluated. Neonatal characteristics were compared in those with histologically confirmed chorioamnionitis (HCC) and those without (non-HCC). Pregnancies with known fetal anomaly or preterm premature rupture of membranes were excluded. Neonatal factors were collected from the electronic medical record. Data was analyzed by parametric and nonparametric statistics with a P value <.05 as significant. RESULTS: Of 383 cases of clinical chorioamnionitis, 261 were confirmed on placental pathology. All neonates were admitted to the NICU and received empiric antibiotic treatment for suspected sepsis. There were no differences in mode of delivery, gender, Apgar scores, umbilical cord gases, birth weight, and neonatal WBC count at 12 and 24 hours of life between neonates born to women with or without HCC. No neonates had positive blood cultures or sepsis. HCC significantly correlated with elevated C-Reactive Protein (CRP) levels >0.5 mg/dL at 12 and 24 hours of life. (Table 1) In those with HCC, CRP levels demonstrated a high sensitivity and negative predictive value. (Table 2) CONCLUSION: When elevated, neonatal CRP is associated with HCC. The high negative predictive value of neonatal CRP in predicting HCC is suggestive that in neonates with normal CRP placental evaluation may not be necessary.