Obstetrical Providers’ Comfort and Knowledge of Screening, Brief Intervention, and Referral to Treatment
Dennis J. Hand, Aasta Mehta, Emily Rosenthal, Alice C. Fischer, Tamara Tatevosian, Carrie Malanga, Laura Hart, Debra Dalessandro, and Kristin Walker
Rates of substance use during pregnancy have continued to rise through 2017. It is likely that obstetrical providers are encountering many pregnant persons who use substances either during prenatal care or postpartum. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based model that has been successfully implemented in some obstetrical settings, but its implementation has been sporadic. The objective of this study was to determine the baseline level of familiarity and use of SBIRT elements among obstetrical providers to identify needs for future SBIRT implementation efforts.
Participants were physicians, medical students, nurses, and other staff attending Grand Rounds presentations on SBIRT at six delivering academic medical centers with maternity services in Philadelphia. Throughout the Grand Rounds presentation, before each topic was discussed, the audience was asked to rate on a 5-point Likert scale their disagreement/agreement with statements like “I am comfortable managing pregnant patients with substance use disorder.” Participants responded anonymously through an online polling platform via their personal mobile device. Participants also provided demographic information anonymously. Responses and demographics were analyzed with descriptive statistics overall and at each medical center.
Less than 29% of participants reported being comfortable managing a pregnant patient with a substance use disorder. One third was familiar with substance use screening methods, 30% were comfortable providing brief interventions, and 48% were comfortable referring patients to substance use disorder treatment. 33% reported being familiar with substance use disorder treatment programs in the area. Generally, medical centers that also had substance use treatment programs were more comfortable and knowledgeable about SBIRT elements.
Very few obstetrical providers were comfortable or knowledgeable about SBIRT elements, even at medical centers with specific programs for treating substance use disorder among pregnant individuals. Efforts to implement SBIRT are sorely needed, and will require significant training given these results.
Hypertensive Disorders of Pregnancy (HDP) and Infertility Treatment: A Population-Based Survey Among U.S. Women
Brent Monseur, MD, ScM; Jerrine Morris, MD, MPH; Heather Hipp, MD; and Vincenzo Berghella, MD
To explore associations between infertility treatment and hypertensive disorders of pregnancy using a nationally representative sample of women
Impact of New “Triple I” Classification on the Incidence of Clinical Chorioamnionitis and Antibiotic Use in Neonates
Amanda Roman, Yury Cruz, Amy J. Sloane, David Carola, Dorothy McElewee, Vincenzo Berghella, and Zubair H. Aghai
To evaluate the impact of the new classification “Triple I” on the incidence of chorioamnionitis during labor, need of antibiotics and diagnosis of neonatal sepsis.
Amanda Roman, Gabriele Saccone, Yury Cruz, Giuseppe Maruotti, Mohamed Satti, Pasquale Martinelli, and Vincenzo Berghella
Objective: To identify the incidence of spontaneous preterm birth (SPTB) and indications for delivery in women with twin pregnancy stratified by chorionicity (monochorionic diamniotic and dichorionic diamniotic pregnancy).
Study Design: Multicenter retrospective cohort of all consecutive twin gestations from 2010 to 2017. They were stratified by chorionicity monochorionic diamniotic and dichorionic diamniotic pregnancy: Primary outcome was SPTB < 37 weeks. Secondary outcome was SPTB at <34, 32, and <28 weeks, gestational age at delivery and indications for delivery: maternal and fetal. Analysis: t-test, Fisher’s exact test and multivariable logistic regression.
Results: 510 women with twin pregnancies were identified. 158 (30.9%) were monochorionic diamniotic pregnancies, and 352 (69.0%) were dichorionic pregnancies. The gestational age at delivery was significantly shorter in the monochorionic compared to the dichorionic group of about 2 weeks (MD -2.20 weeks, 95% CI -2.76 to -1.64). Twins with a monochorionic pregnancy had a significantly higher risk of SPTB <37, <34 and <32 weeks. They also have higher incidence of fetal indication for delivery and increased spontaneous onset of labor at any given gestational age. Maternal complications were similar on both types of twin pregnancies
Conclusion: Twins with monochorionic pregnancy had a higher rate of SPTB <37, <34 and <32 weeks and fetal indications for preterm delivery compared with dichorionic pregnancies. This information will assist in counseling patients with twin pregnancy regarding their individual, maternal, fetal and SPTB risk at different gestational ages.
Midtrimester transvaginal ultrasound cervical length in diamniotic twin pregnancies according to chorionicity
Amanda Roman, Gabriele Saccone, Carolynn M. Dude, Danielle A. Peress, Giuseppe Maria Maruotti, Andrew Ward, Hannah Anastasio, Lorraine Dugoff, Pasquale Martinelli, and Vincenzo Berghella
To compare the mean and additional midtrimester TVCL screening cut offs in monochorionic diamniotic (MC/DA) twins and dichorionic diamniotic (DC/DA) twins and to assess the relationship between the TVCL values and spontaneous preterm birth (SPTB).
Amanda Roman, Gabriele Saccone, Sarah Pachtman, Yury Cruz, Burt Rochelson, Adiel Fleischer, Pasquale Martinelli, and Vincenzo Berghella
To evaluate the predictors of preterm birth <32 weeks in women that underwent physical exam indicated cerclage>(PEIC) in singleton pregnancy.
Maternal activity level in patients with preterm premature rupture of membranes: A Prospective Observational Cohort Study
Amanda Roman, Nathan Watters, Denise Moses, Jenny Reisner, Andrea French, Alexis Gimovsky, Caroline Pessel, Burton Rochelson, Neil Seligman, and Vincenzo Berghella
Objective: To evaluate the level of maternal physical activity effect on the perinatal outcomes of women with preterm premature rupture of membranes (PPROM)
Study Design: This is a pilot, prospective, observational multicenter cohort study. We approached patients admitted between 23 0/7 weeks to 32 0/7 weeks gestation with confirmed PPROM between January of 2014 and June of 2017 All patients received corticosteroids and latency antibiotics. Enrollment was done on third day of admission. Delivery occurred at 34 weeks per protocol via induction of labor or cesarean section as obstetrically indicated; or sooner if chorioamnionitis was diagnosed or spontaneous preterm labor occurred. Patients were provided a pedometer to wear for the duration of their antepartum course and they have maternal activity at lib and were encouraged to go to the physical therapy gymnasium.
Results: We enrolled 32 women. We stratified them in two groups: low activity as less than 500 step a day and higher maternal activity more than 500 steps a day, There were no significant differences in the demographics. Latency from PPROM to delivery were significantly prolonged in women with maternal activity > 500 steps a day: 11.0 ± 8.42 vs 21.18 ± 4.26 days p = 0.004. No maternal or fetal adverse outcomes were identified.
Conclusion: Maternal activity more than 500 steps a day showed a significant association with prolongation of latency
Obesity-induced Endoplasmic Reticulum Stress Causes Lung Endothelial Dysfunction and Promotes Acute Lung Injury
Dilip Shah, Freddy Romero, Zhi Guo, Jianxin Sun, Jonathan C. Li, Caleb Kallen, Ulhas P. Naik, and Ross Summer
- Lung endothelial dysfunction in DIO mice coincides with increased endoplasmic reticulum (ER) stress.
- Fatty acids in obese serum induce ER stress in the pulmonary endothelium leading to pulmonary endothelial cell dysfunction.
- Reducing protein load in the endoplasmic reticulum of pulmonary endothelial cells might protect against ARDS in obese individuals.
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