No abstract

There is a gap in the literature regarding fetal radiation exposure from interventional cardiac procedures. With an increasingly large and complex cohort of pregnant cardiac patients, it is necessary to evaluate the safety of invasive cardiac procedures and interventions in this population. Here we present a case of a patient with multiple medical comorbidities and non-ST elevation myocardial infarction (NSTEMI) at 15 weeks’ gestation, managed with percutaneous coronary intervention (PCI). We were able to minimize the maternal and estimated fetal absorbed radiation dose to <1 milliGray (mGy), significantly less than the threshold dose for fetal adverse effects at this gestational age.

Objective: To assess whether concordance with our proposed labor induction algorithm is associated with an increased rate of vaginal delivery within 24 hours. Study Design: We conducted a retrospective review of 287 IOLs at a single urban, tertiary, academic medical center which took place before we created an evidence-based induction of labor (IOL) algorithm. We then compared the IOL course to the algorithm to assess for concordance and outcomes. Patients age 18 or over with a singleton, cephalic pregnancy of 36 6/7 to 42 0/7 weeks’ gestation were included. Patients were excluded with a Bishop score >6, contraindication to misoprostol or cervical Foley catheter, major fetal anomalies or intrauterine fetal death. Patients with 100% concordance were compared to <100% concordant patients, and patients with 80% concordance were compared to <80% concordant patients. Adjusted hazard ratios (AHRs) were calculated for rate of vaginal delivery within 24 hours, our primary outcome. Competing risks analysis was conducted for concordant vs. non-concordant groups, using vaginal delivery as the outcome of interest, with cesarean delivery as a competing event. Results: Patients with 100% concordance were more likely to have a vaginal delivery within 24 hours, n = 66/77 or 85.7% vs. n = 120/210 or 57.1% (p<0.0001), with an AHR of 2.72 (1.98, 3.75, p<0.0001) after adjusting for delivery indication and scheduled status. Patients with 100% concordance also had shorter time from first intervention to delivery (11.9 vs. 19.4 hours). Patients with 80% concordance had a lower rate of cesarean delivery (11/96, 11.5%) compared to those with <80% concordance (43/191 = 22.5%) (p=0.0238). There were no differences in neonatal outcomes assessed. Conclusion: Our IOL algorithm may offer an opportunity to standardize care, improve the rate of vaginal delivery within 24 hours, shorten time to delivery, and reduce the cesarean delivery rate for patients undergoing IOL.

BACKGROUND: Tocodynamometry is a common, noninvasive tool used to measure contraction frequency; however, its utility is often limited in patients with obesity. An intrauterine pressure catheter provides a more accurate measurement of uterine contractions but requires ruptured membranes, limiting its utility during early latent labor. Electrical uterine myography has shown promise as a noninvasive contraction monitor with efficacy similar to that of the intrauterine pressure catheter; however, its efficacy has not been widely studied in the obese population. OBJECTIVE: This study aimed to validate the accuracy of electrical uterine myography by comparing it with tocodynamometry and intrauterine pressure catheters among laboring patients with obesity. STUDY DESIGN: This was a prospective observational study from February 2017 to April 2018 of patients with obesity, aged 18 years or older, who were admitted to the labor unit with viable singleton pregnancies and no contraindications for electromyography. Patients were monitored simultaneously with electrical myography and tocodynamometry or intrauterine catheter for more than 30 minutes. Two blinded obstetricians reviewed the tracings. The outcomes of interest were continuous and interpretable tracing, number of contractions, and timing and duration of contractions, interpreted as point estimates and associated 95% confidence intervals. RESULTS: A total of 110 patients were enrolled (65 tocodynamometry, 55 intrauterine catheter). Electrical myography was significantly more interpretable during a 30-minute tracing (P=.001) and detected 39% more contractions than tocodynamometry (P<.0001; 95% confidence interval, 23%−57%), whereas there was no difference in the interpretability of tracings or number of contractions between electrical myography and an intrauterine catheter (P=.16; 95% confidence interval, −0.19 to 1.19). Patients who underwent simultaneous monitoring preferred the electrical myography device over tocodynamometry. CONCLUSION: Electrical uterine myography is superior to tocodynamometry in the detection of intrapartum uterine contraction monitoring and comparable with internal contraction monitoring.