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The little data that exist on reasons for postpartum readmission after initial hospitalization for delivery have focused primarily on route of delivery rather than specific indications that necessitate readmission. The aim of this study was to investigate indications for postpartum readmission. The study participants were women who delivered during 2007 and were readmitted within 6 weeks of the original delivery discharge date at 114 Hospital Corporation of America hospitals in 21 states. Preliminary data suggested an especially higher rate of readmission than could be expected for pneumonia, cholecystitis, and acute appendicitis. To address this issue, a stratified analysis was conducted for hospital readmission rates among women with these indications who were readmitted within 180 days after their delivery. Curve comparisons were made using linear regression analysis, survival curve fitting, and Gehan-Breslow statistic with Holm-Sidak all pairwise analysis for multiple comparisons.Of the 222,751 women who delivered in 2007, 2655 women (1.2%) were readmitted within 6 weeks. There was a more than 2-fold increase in frequency of readmission for women who had cesarean section delivery compared to those who had vaginal birth (1.8% vs. 0.83%, P Ͻ 0.001). More than 80% of readmittances for pneumonia occurred within the first 6 weeks of delivery, as did more than 40% of readmittances for appendicitis or cholecystitis. Women readmitted during first 6 weeks after delivery had higher cumulative readmission rates for pneumonia, appendicitis, and cholecystitis compared to those who had been readmitted in the next 20 weeks (6 vs. 20 week comparison: pneumonia curve gradient, 3.7 vs. 0.11; appendicitis curve gradient, 1.1 vs. 0.36; cholecystitis curve gradient, 6.6 vs. 1.7).These findings show that the primary cause of postpartum readmission is infection and suggest that recent pregnancy may increase the risk of pneumonia, appendicitis, and cholecystitis. The investigators do not believe that any of these conditions has been causally linked previously to pregnancy or delivery. EDITORIAL COMMENT(Lydon-Rochelle, et al analyzed the risks for hospital readmission in a cohort of 256,795 women who delivered over a 10-year period in Washington state and found that, overall, 1.2% of women were rehospitalized in the 60 days following birth. The risk varied by mode of delivery: 1% after spontaneous vaginal birth, 1.2% after assisted vaginal birth, and 1.7% after cesarean delivery. Many of the diagnoses associated with the increased rate after cesarean were intuitive, and included higher rates of uterine and wound infection, postpartum hemorrhage, and thromboembolic disease. However, some were not, including an increased risk of admis-OBSTETRICS Volume 65, Number 5 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTMaternal ovarian torsion is a very rare complication in pregnant women that may be misdiagnosed because signs and symptoms such as abdominal pain and nausea/vomiting are nonspecific and are present in a number of obstetric and sur...

This study was designed to determine how easily methamphetamine can be removed from clothing and building materials, utilizing different cleaning materials and methods. The study also addressed the penetration of methamphetamine into drywall and the ability of paints to encapsulate the methamphetamine on drywall. Clothing and building materials were contaminated in a stainless steel chamber by aerosolizing methamphetamine in a beaker heater. The amount of methamphetamine surface contamination was determined by sampling a grid pattern on the material prior to attempting to clean the materials. After cleaning, the materials were again sampled, and the degree of decontamination noted. We found that household clothing and response gear worn by first responders was easily decontaminated using a household detergent in a household washing machine. A single wash removed over 95% of the methamphetamine from these materials. The study also indicated that methamphetamine-contaminated, smooth non-porous surfaces can be easily cleaned to below detectable levels using only mild cleaners. More porous surfaces such as plywood and drywall were unlikely to be decontaminated to below regulatory levels even with three washes using a mild cleaner. This may be due to methamphetamine penetration into the paint on these surfaces. Evaluation of methamphetamine contamination on drywall indicated that approximately 40% of the methamphetamine was removed using a wipe, while another 60% remained in the paint layer. Stronger cleaners such as those with active ingredients including sodium hypochlorite or quaternary ammonia and commercial decontamination agents were more effective than mild detergent-based cleaners and may reduce methamphetamine contamination to below regulatory levels. Results from the encapsulation studies indicate that sprayed on oil-based paint will encapsulate methamphetamine on drywall and plywood surfaces up to 4.5 months, while latex paints were less effective.

Objective To determine if decreased resistance (vasodilatation) RI and PI were 0.93 and 0.93, respectively, with optimal sensitivity and specificity of 86% and 93% for both variables. Positive and negative likelihood ratios were 11.8/0.15 (RI) and 12.3/0.15 (PI). Conclusion