Rivera‐Chiauzzi, Enid Y.

Abstract BACKGROUND: It is estimated that one third of women in the United States opt for permanent tubal sterilization at the time of cesarean delivery. Evidence suggests that ovarian cancer begins in the fallopian tubes. Ovarian cancer has the highest mortality of all gynecologic malignancies. There is no proven effective screening for ovarian cancer. In view of this, the Royal College of Obstetricians & Gynecologists and the American College of Obstetricians and Gynecologists recommend considering counseling patients about prophylactic salpingectomy as an effective method of sterilization. There are limited well designed clinical trials that compare the safety and feasibility of total salpingectomy to that of traditional partial salpingectomy for tubal sterilization at the time of cesarean delivery. METHODS: We conducted a non-inferiority randomized controlled trial at the Mayo Clinic, Rochester, Minnesota. Women age 21 years and older who were undergoing cesarean delivery and desired concomitant sterilization were enrolled between May 17, 2017 and July 16, 2018. Stratified randomization was performed based on number of previous cesarean deliveries and their Basal Metabolic Index, into a bilateral total salpingectomy group and bilateral partial salpingectomy group. All salpingectomies were performed using clamps and suture. The primary outcome was to compare the mean peri-operative hemoglobin change for both groups. Secondary objectives included sterilization completion time, postoperative length of stay, estimated blood loss, postoperative pain and adverse events. RESULTS: Of the 111 women screened, 40 were enrolled and randomized. Of these, 38 underwent the assigned procedure (18 BTS, 20 BPS). There were no demographic differences between groups. No difference in Mean ±SD hemoglobin drop between groups (1.4±0.7 g/dl for the BTS group and 1.8±1.0 g/dl for the BPS group, p=0.08). Mean time to completion of sterilization procedure was significantly longer in the BTS group (16.3±5.6 minutes for the BTS group vs 5.1±1.6 minutes for the BPS group, p < .01). No significant differences for other outcome measures.CONCLUSIONS: Bilateral total salpingectomy at the time of cesarean delivery does not increase the risk for blood loss and has similar peri-operative outcomes, with a small increase in operative time when compared to traditional bilateral partial salpingectomy. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03135431, 27/04/2017

INTRODUCTION: Adverse patient events inevitably occur in OB/GYN practice. Health care provider who are “second victims” experience psychological trauma and progress through defined stages of recovery as they process the event. This experience is believed to be an under-recognized, yet prevalent phenomenon. Study aims were to determine the prevalence of second victims and the risk factors for feeling like a second victim among staff caring for OB/GYN patients to guide the implementation of new resources for second victims. METHODS: We administered the validated Second Victim Experience and Support Tool (SVEST) supplemented with non-validated questions to multidisciplinary team members caring for OB/GYN patients at Mayo Clinic in Rochester, MN. Respondents to the self-administered, anonymous survey included physicians, nurse practitioners, physician assistants, certified nurse midwife, registered nurses, allied health professionals, and desk staff. RESULTS: The survey was completed by 205 staff (117 OB only, 73 GYN only, 15 both). During their career, 44.8% felt like a second victim while 18.8% had this experience in the last 12 months. Residents and fellows had the highest percentage of second victims (41.7%). Respondents who reported greater psychological distress were more likely to report that they felt like a second victim after an adverse patient safety event within the preceding 12 months (p-value<0.001). The same finding was observed for measures of physical distress. CONCLUSION: OB/GYN team members report significant differences in physiological and physical symptoms after adverse events. Understanding and screening for psychological and physical symptoms may be useful in identifying second victims and guiding support following adverse events.

Objective: A retrospective cohort study was performed to evaluate whether birthweight was less among infants of women taking amphetamine–dextroamphetamine during pregnancy at our academic institution. Method: We identified mother–infant pairs with documented exposure to amphetamine–dextroamphetamine in pregnancy from 2005 through 2015. Patients were matched 2:1 with unexposed controls. Charts were reviewed for known causes of intrauterine growth restriction. Analysis of birthweight used generalized estimating equation blocking on matching. Medical histories were analyzed with χ 2 test or Fisher’s exact test. Results: We identified 53 exposed mother–infant pairs. The difference in mean birthweight of infants exposed to amphetamine–dextroamphetamine versus those not exposed was 26.9 g, which is not significant (95% confidence interval [CI] = [−141, 195 g]; p = .75). A significant difference was noted for exposed versus unexposed mothers for comorbid psychiatric illness and history of substance abuse ( p < .001). Conclusion: With a limited sample size, our study suggests no significant difference in birthweight.

INTRODUCTION: Increasing numbers of pregnant women are being treated for ADHD. The safety of ADHD medications in pregnancy have not been well studied, although studies suggest that methylphenidate use may lower birthweight compare to unexposed newborns. Our primary outcome was to evaluate if birthweight was lower among infants of women utilizing Adderall in our academic institution. METHODS: Maternal and infant pairs exposed to Adderall between January 2005 and December 2015 was identified in EMR based on active medication list during pregnancy. Patients were matched 2:1 with unexposed controls of similar age, gestational age at delivery, parity, infant sex and date of delivery. All charts were reviewed for known causes of IUGR or low birthweight. Statistical analysis of infant birthweight was done using generalized estimating equation blocking on matching. Medical histories were analyzed using Chi-Square test or Fishers exact test as appropriate. RESULTS: We identified 53 exposed pairs. The difference in mean birthweight for exposed vs unexposed infants was 26.9g which is not statistically or clinically significant (95% CI, P-value: (-141, 195), 0.75). A statistically significant difference was noted for exposed vs unexposed mothers for comorbid psychiatric illness and history of substance abuse (p = <0.0001). CONCLUSION: As Adderall use increases among childbearing women, understanding the risk to infants is crucial. With a limited sample size, our study suggests no significant difference in birthweight, which is a concern for women requiring medication in pregnancy. Women using Adderall may have higher rates of comorbid psychiatric disorders and substance use and may benefit from early screening.