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  1. Article ; Online: Reducing Opioid Prescribing after Cesarean Delivery by Utilizing a Tailored Opioid Prescribing Algorithm.

    McKenzie, Christine P / Straube, Lacey E / Webster, Carolyn M / Nielsen, Matthew E / Stuebe, Alison M

    American journal of perinatology

    2023  

    Abstract: Objective:  There are increasing efforts among health care systems to promote safe opioid prescribing; however, best practice for minimizing overprescription is not established. Our study aimed to evaluate the effect of a tailored opioid prescribing ... ...

    Abstract Objective:  There are increasing efforts among health care systems to promote safe opioid prescribing; however, best practice for minimizing overprescription is not established. Our study aimed to evaluate the effect of a tailored opioid prescribing algorithm on opioid prescription quantities.
    Study design:  A tailored opioid prescribing algorithm was developed to provide a recommended prescription quantity based on inpatient opioid use. A retrospective analysis of opioid prescribing 3 months before and after implementation was performed. Our primary outcome was the number of oxycodone 5-mg tablets prescribed. Subgroup analysis by oxycodone consumption in the 24 hour prior to discharge was performed. Patient satisfaction and unused opioid tablets were assessed by text message survey 2 weeks' postpartum.
    Results:  We included 627 (
    Conclusion:  Tailored opioid prescribing reduced the number of opioid tablets prescribed and increased the proportion of patients who were discharged without an opioid prescription.
    Key points: · Opioid prescribing should be tailored by inpatient use.. · Tailored prescribing reduced opioid prescription amounts.. · Many patients do not require an opioid prescription..
    Language English
    Publishing date 2023-11-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605671-4
    ISSN 1098-8785 ; 0735-1631
    ISSN (online) 1098-8785
    ISSN 0735-1631
    DOI 10.1055/a-2184-0423
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 1929: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
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  2. Article ; Online: Extracorporeal membrane oxygenation in pregnant and postpartum women: a ten-year case series.

    Webster, Carolyn M / Smith, Kathleen A / Manuck, Tracy A

    American journal of obstetrics & gynecology MFM

    2020  Volume 2, Issue 2, Page(s) 100108

    Abstract: Objective: tExtracorporeal membrane oxygenation (ECMO) is a life-saving therapy for severe, reversible cardiopulmonary failure, but data regarding its use in pregnancy and the postpartum period are limited. We sought to quantify survival of pregnant and ...

    Abstract Objective: tExtracorporeal membrane oxygenation (ECMO) is a life-saving therapy for severe, reversible cardiopulmonary failure, but data regarding its use in pregnancy and the postpartum period are limited. We sought to quantify survival of pregnant and postpartum women necessitating ECMO in a contemporary cohort at a single tertiary institution.
    Study design: All women of reproductive age (14-44 years), who underwent ECMO at our institution between January 1, 2008, and December 31, 2017, were identified using a query of hospital encounters for ECMO-related CPT codes. We manually reviewed all charts of women of reproductive age; women who were pregnant or <6 weeks postpartum at the time of ECMO initiation were included. Clinical characteristics and maternal and fetal outcomes are described.
    Results: In this study, 54 women of reproductive age underwent ECMO for cardiopulmonary failure. Of those, 9 (17%) were pregnant or <6 weeks postpartum at the time of ECMO initiation: 4 antepartum, 1 intraoperative at the time of cesarean delivery, and 4 postpartum (including 2 in whom ECMO was initiated on postpartum day 0 or 1). Overall, maternal survival was 33%. The median maternal age was 24 years (range 19-39 years); most women were nonsmokers without underlying medical comorbidities. The most common indication for ECMO use in pregnant and postpartum women was acute respiratory distress syndrome, which was present in 7 cases (78%), including 5 cases that were due to infectious etiologies and 2 cases that were attributed to preeclampsia. The median number of days on ECMO was 6 (range 1-14). There were no cases of obstetric hemorrhage. Venovenous ECMO was utilized in all but 1 case, in which emergent attempted venoarterial ECMO was unsuccessful in resuscitating a postpartum patient with cardiac arrest and a massive pulmonary embolism. A total of 4 women were initiated on ECMO during pregnancy: their gestational ages at ECMO initiation were 21, 22, 29, and 30 weeks; maternal survival was 50%, and fetal mortality was 50%. A case of ECMO initiated during cesarean section at 29 weeks' gestation resulted in both maternal and fetal survival. Among 4 mothers with ECMO initiation after childbirth, none survived. Finally, we found a tendency toward survival in those patients for whom ECMO was initiated soon after mechanical ventilation, earlier in the disease process. In contrast, in this study, 23 of 45 women of reproductive age (51%) who were not pregnant but underwent ECMO survived.
    Conclusion: When ECMO was initiated during pregnancy or during childbirth, 60% of mothers and fetuses survived, supporting current use of ECMO as a salvage therapy in pregnant and intrapartum women. In this generally young and healthy population, ECMO has the potential to increase the survival rates of both mother and fetus and should be considered a salvage therapy for peripartum women with reversible forms of cardiorespiratory failure.
    MeSH term(s) Adolescent ; Adult ; Cesarean Section ; Extracorporeal Membrane Oxygenation ; Female ; Humans ; Postpartum Period ; Pregnancy ; Respiratory Distress Syndrome ; Respiratory Insufficiency/therapy ; Young Adult
    Keywords covid19
    Language English
    Publishing date 2020-03-25
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ISSN 2589-9333
    ISSN (online) 2589-9333
    DOI 10.1016/j.ajogmf.2020.100108
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Prenatal genetic considerations of congenital anomalies of the kidney and urinary tract (CAKUT).

    Talati, Asha N / Webster, Carolyn M / Vora, Neeta L

    Prenatal diagnosis

    2019  Volume 39, Issue 9, Page(s) 679–692

    Abstract: Congenital anomalies of the kidney and urinary tract (CAKUT) constitute 20% of all congenital malformations occurring in one in 500 live births. Worldwide, CAKUT are responsible for 40% to 50% of pediatric and 7% of adult end-stage renal disease. ... ...

    Abstract Congenital anomalies of the kidney and urinary tract (CAKUT) constitute 20% of all congenital malformations occurring in one in 500 live births. Worldwide, CAKUT are responsible for 40% to 50% of pediatric and 7% of adult end-stage renal disease. Pathogenic variants in genes causing CAKUT include monogenic diseases such as polycystic kidney disease and ciliopathies, as well as syndromes that include isolated kidney disease in conjunction with other abnormalities. Prenatal diagnosis most often occurs using ultrasonography; however, further genetic diagnosis may be made using a variety of testing strategies. Family history and pathologic examination can also provide information to improve the ability to make a prenatal diagnosis of CAKUT. Here, we provide a comprehensive overview of genetic considerations in the prenatal diagnosis of CAKUT disorders. Specifically, we discuss monogenic causes of CAKUT, associated ultrasound characteristics, and considerations for genetic diagnosis, antenatal care, and postnatal care.
    MeSH term(s) Female ; Humans ; Kidney/abnormalities ; Kidney Diseases, Cystic/diagnostic imaging ; Kidney Diseases, Cystic/genetics ; Pregnancy ; Prenatal Diagnosis ; Urogenital Abnormalities/classification ; Urogenital Abnormalities/diagnosis ; Urogenital Abnormalities/genetics
    Language English
    Publishing date 2019-08-05
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 82031-3
    ISSN 1097-0223 ; 0197-3851
    ISSN (online) 1097-0223
    ISSN 0197-3851
    DOI 10.1002/pd.5536
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    Zs.A 1625: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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    ab Jg. 2022: Lesesaal (EG)

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  4. Article: Reducing Opioid Prescribing after Cesarean Delivery by Utilizing a Tailored Opioid Prescribing Algorithm

    McKenzie, Christine P. / Straube, Lacey E. / Webster, Carolyn M. / Nielsen, Matthew E. / Stuebe, Alison M.

    American Journal of Perinatology

    2023  

    Abstract: Objective: There are increasing efforts among health care systems to promote safe opioid prescribing; however, best practice for minimizing overprescription is not established. Our study aimed to evaluate the effect of a tailored opioid prescribing ... ...

    Abstract Objective: There are increasing efforts among health care systems to promote safe opioid prescribing; however, best practice for minimizing overprescription is not established. Our study aimed to evaluate the effect of a tailored opioid prescribing algorithm on opioid prescription quantities.
    Study Design: A tailored opioid prescribing algorithm was developed to provide a recommended prescription quantity based on inpatient opioid use. A retrospective analysis of opioid prescribing 3 months before and after implementation was performed. Our primary outcome was the number of oxycodone 5-mg tablets prescribed. Subgroup analysis by oxycodone consumption in the 24 hour prior to discharge was performed. Patient satisfaction and unused opioid tablets were assessed by text message survey 2 weeks' postpartum.
    Results: We included 627 ( n  = 313 preimplementation; n  = 314 postimplementation) patients who underwent cesarean delivery. Clinical characteristics were similar between groups. The median number of oxycodone 5-mg tablets prescribed in the baseline group was 20 (interquartile range [IQR]: 20–30), compared with 5 (IQR: 0–10) in the tailored prescribing group ( p  < 0.0001). For patients with no opioid use in the 24 hours prior to discharge, the median number of tablets prescribed decreased from 20 (IQR: 10–20) to 0 (IQR: 0–5) following the intervention ( p  < 0.0001). The proportion of patients discharged without an opioid prescription increased from 7% (23/313) in the baseline group to 35% (111/314) in the tailored prescribing group (odds ratio: 6.9, 95% confidence interval [4.3, 11.1]).
    Conclusion: Tailored opioid prescribing reduced the number of opioid tablets prescribed and increased the proportion of patients who were discharged without an opioid prescription.
    Key Points: Opioid prescribing should be tailored by inpatient use. Tailored prescribing reduced opioid prescription amounts. Many patients do not require an opioid prescription.
    Keywords cesarean delivery ; obstetrics ; opioid ; opioid consumption ; opioid prescription ; opioid stewardship ; quality improvement ; cesarean analgesia
    Language English
    Publishing date 2023-09-29
    Publisher Thieme Medical Publishers, Inc.
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 605671-4
    ISSN 1098-8785 ; 0735-1631
    ISSN (online) 1098-8785
    ISSN 0735-1631
    DOI 10.1055/a-2184-0423
    Database Thieme publisher's database

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    Zs.A 1929: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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    ab Jg. 2022: Lesesaal (EG)

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  5. Article ; Online: Physical activity and pregnancy outcomes: an expert review.

    Gascoigne, Emily L / Webster, Carolyn M / Honart, Anne West / Wang, Penny / Smith-Ryan, Abbie / Manuck, Tracy A

    American journal of obstetrics & gynecology MFM

    2022  Volume 5, Issue 1, Page(s) 100758

    Abstract: This expert review aimed to assess current literature on the effect and tracking of physical activity during pregnancy and associated outcomes. Self-reported physical activity may be inaccurate given the subjective nature of the questionnaires. The ... ...

    Abstract This expert review aimed to assess current literature on the effect and tracking of physical activity during pregnancy and associated outcomes. Self-reported physical activity may be inaccurate given the subjective nature of the questionnaires. The accelerometer ActiGraph is considered the "gold standard" to objectively measure physical activity. However, other more user-friendly wearable devices are now widely available and may accurately track physical activity. Conclusive data from both validated activity questionnaires and accelerometers indicate that physical activity is safe during pregnancy. In addition, studies of physical activity during pregnancy that evaluate pregnancy outcomes have found reduced risks of preterm birth, preeclampsia, and gestational diabetes mellitus and improved mental health among individuals who regularly engage in physical activity. In the United States, approximately 48% of pregnant individuals gain more than the recommended amount of weight during pregnancy; excessive gestational weight gain is associated with an increased risk of maternal and fetal complications, including preterm birth, preeclampsia, and gestational diabetes mellitus, and corresponding higher adverse short- and long-term maternal and offspring health outcomes. Although physical activity is safe during pregnancy and may reduce excessive gestational weight gain and resultant pregnancy complications, further research is needed to determine the frequency and duration of specific types of physical activity during pregnancy. Providers should encourage physical activity before and during pregnancy and educate patients regarding the benefits and safety of physical activity.
    MeSH term(s) Pregnancy ; Female ; Humans ; Infant, Newborn ; Diabetes, Gestational/diagnosis ; Diabetes, Gestational/epidemiology ; Diabetes, Gestational/prevention & control ; Gestational Weight Gain ; Premature Birth/epidemiology ; Premature Birth/etiology ; Premature Birth/prevention & control ; Pre-Eclampsia/diagnosis ; Pre-Eclampsia/epidemiology ; Pre-Eclampsia/prevention & control ; Exercise ; Weight Gain
    Language English
    Publishing date 2022-09-26
    Publishing country United States
    Document type Journal Article ; Review ; Research Support, N.I.H., Extramural
    ISSN 2589-9333
    ISSN (online) 2589-9333
    DOI 10.1016/j.ajogmf.2022.100758
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Seroreduction of syphilis non-treponemal titers during pregnancy for women with and without HIV co-infection.

    Webster, Carolyn M / Kasaro, Margaret P / Price, Joan T / Stringer, Elizabeth M / Wiesen, Christopher A / Vwalika, Bellington / Stringer, Jeffrey S A

    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics

    2022  Volume 159, Issue 2, Page(s) 427–434

    Abstract: Objective: To evaluate the effect of HIV co-infection on non-treponemal titers during pregnancy in women with syphilis.: Methods: This is a secondary analysis of pregnant women with syphilis in the prospective, observational Zambian Preterm Birth ... ...

    Abstract Objective: To evaluate the effect of HIV co-infection on non-treponemal titers during pregnancy in women with syphilis.
    Methods: This is a secondary analysis of pregnant women with syphilis in the prospective, observational Zambian Preterm Birth Prevention Study (ZAPPS). Treponemal (Treponema pallidum particle agglutination) and non-treponemal (rapid plasma reagin; RPR) testing were performed on serum biospecimens, resulting in 47 participants with serologically confirmed syphilis (27 HIV-positive, 20 HIV-negative). The primary outcome, achievement of RPR titer seroreduction during pregnancy, was analyzed by logistic regression. Secondary outcomes included overall titer reduction, seroreduction rate, serologic cure, and adverse pregnancy outcomes.
    Results: Seroreduction of RPR titer occurred in 78% (21/27) of women with HIV versus 45% (9/20) of women without (adjusted odds ratio 4.66; 95% confidence interval [CI] 1.14 - 19.08). Overall RPR titer reduction, rate of seroreduction per week, and the proportion achieving serologic cure each trended higher among women with HIV compared with those without HIV. There was a trend toward decreased stillbirth incidence in participants achieving seroreduction (odds ratio 0.15, 95% CI 0.01-1.58).
    Conclusion: HIV co-infection in this cohort of Zambian women with syphilis was associated with greater odds of RPR titer seroreduction during pregnancy. Pregnant women with syphilis and HIV may not be at increased risk for a delayed syphilis treatment response compared with women without HIV.
    MeSH term(s) Coinfection/epidemiology ; Female ; HIV Infections/complications ; HIV Infections/epidemiology ; Humans ; Infant, Newborn ; Pregnancy ; Pregnancy Complications, Infectious/epidemiology ; Pregnancy Outcome/epidemiology ; Premature Birth ; Prospective Studies ; Reagins ; Syphilis/complications ; Syphilis/epidemiology ; Syphilis Serodiagnosis/methods
    Chemical Substances Reagins
    Language English
    Publishing date 2022-02-25
    Publishing country United States
    Document type Journal Article ; Observational Study
    ZDB-ID 80149-5
    ISSN 1879-3479 ; 0020-7292
    ISSN (online) 1879-3479
    ISSN 0020-7292
    DOI 10.1002/ijgo.14131
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    Zs.MO 183: Show issues

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  7. Article: Capnocytophaga

    Hopkins, Austin M / Desravines, Nerlyne / Stringer, Elizabeth M / Zahn, Katelin / Webster, Carolyn M / Krajick, Kayla / Vora, Neeta L

    Infectious disease reports

    2019  Volume 11, Issue 3, Page(s) 8272

    Abstract: ... ...

    Abstract Capnocytophaga
    Language English
    Publishing date 2019-12-05
    Publishing country Switzerland
    Document type Journal Article
    ISSN 2036-7430
    ISSN 2036-7430
    DOI 10.4081/idr.2019.8272
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