OBJECTIVES: The purpose of this study was to minimize unnecessary laboratory services for hospitalized neonates with hyperbilirubinemia by revising a local clinical practice pathway (CPP). METHODS: A retrospective cohort study was performed to compare the number of laboratory tests and blood draws in patients hospitalized with neonatal hyperbilirubinemia before and after implementation of a revised CPP. The study included infants with neonatal hyperbilirubinemia <14 days old admitted after their birth hospitalization between April 2017 and October 2019. Primary outcome measures included the total number of blood draws and the number of laboratory tests obtained per patient and length of stay. Secondary outcome measures included 7-day readmission rate, charges, and discharge bilirubin level. RESULTS: The median number of blood draws per patient after implementation of the CPP decreased to 2 (interquartile range [IQR], 2–3) compared with 3 (IQR, 2–3) before implementation (Poisson model–based estimated mean difference, 1.1; 95% confidence interval, 1.0–1.3; P = .018). The median number of laboratory tests per patient after implementation decreased from 4 (IQR, 3–6) to 3 (IQR, 2–4; Poisson model–based estimated mean difference, 1.3; 95% confidence interval, 1.2–1.5; P < .0001). There was no significant change in length of stay, readmission rate, charges, or discharge bilirubin level. CONCLUSIONS: Implementation of a revised CPP was associated with a significant decrease in the number of blood draws and laboratory tests per patient for infants admitted to the hospital for neonatal hyperbilirubinemia.

INTRODUCTION: To evaluate if the use of a transcervical Foley balloon (TFB) for induction of labor (IOL) increases the risk of preterm delivery in subsequent pregnancies. METHODS: This was a retrospective cohort study evaluating methods of induction and subsequent pregnancy outcomes. RESULTS: 151 women were identified to have a term IOL followed by a subsequent pregnancy within a 10-year span meeting study's criteria. Patients were in the study group if a TFB was used alone or in combination with prostaglandins and/or oxytocin for IOL while the control group did not include TFB. Age, race, BMI (in first pregnancy and subsequent pregnancy), tobacco use, previous LEEP, previous D&C, indication for IOL, and birth weight (in first pregnancy and subsequent pregnancy) were all not significantly different between the groups. Bishop score was significantly higher in the control group (p=0.003). Mode of delivery for the initial pregnancy was significantly different between the two groups (p=0.019) with a higher rate of cesarean section in the study group. Mean gestational age at delivery of the subsequent pregnancy was 39 and 39.1 weeks for the control and study groups respectively (p=0.747). CONCLUSION: The use of TFB for IOL did not have an impact on gestational age of subsequent pregnancy when compared to other modes of induction. The cesarean section rate was higher in the TFB group in the initial pregnancy, which was likely related to the lower bishop score and increased difficulty of IOL which required the TFB in addition to the other methods to begin with.

INTRODUCTION: Pregnant patients’ non-adherence with prescription medications is a challenging problem. The purpose of this study was to investigate factors influencing medication adherence in our urban high risk obstetric clinic. METHODS: This is a prospective cross-sectional study performed February through June 2016 at the Maternal Fetal Medicine clinic at UIC. Participants were ≥24 weeks, English-speaking adults, and taking ≥1 prescription medication. After obtaining consent, study participants were surveyed by questionnaire. Answers were entered into 3 adherence scoring scales: Morisky 8 medication adherence score (MMAS-8), medication adherence reasons scale (MARS), and rapid estimate of adult literacy. RESULTS: A total of 69 patients completed the questionnaire; 60% had unplanned pregnancies, and 45% had health literacy < 8th grade level. Adherence scores were low in 42%, moderate in 38%, and high in 20% of participants. Pregnant women with low adherence score were significantly more likely to be on higher number of medications (p=0.044) and had trended towards missed prenatal visits (p=0.056). 31.9% had asthma, 52.2% had diabetes, 44.9% had hypertension, 11.6% had thyroid disorders, and 4.3% had seizure disorders. Patients with hypertension had higher non-adherence compared to all other categories (p=0.037), and more commonly used marijuana (p < 0.001). Being employed, having a smartphone, dependents, and partner did not affect adherence scores. Women reporting forgetfulness, carelessness, medication side-effects, stopping medication when symptom free, travel, inconvenience, and difficulty calculating dose had low adherence scores. CONCLUSION: Understanding the reasons for medication non-adherence in an urban high risk obstetric population may allow providers to tailor motivational interviewing to improve individual adherence.