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Is 34 weeks of gestation an acceptable goal for a complicated singleton pregnancy?
Adverse Drug Events of an Inpatient Obstetrical Service Franklyn C. Christensen, MD University of New Mexico, Albuquerque, NM
Jose L. Gonzalez, MD, and William Rayburn, MD Objective: To determine the rate and the drugs most frequently associated with adverse drug events (ADEs) in our inpatient obstetric service. We also compared our rate of ADEs with the reported national benchmark. Methods: We analyzed all reported ADEs occurring in labor and delivery and in the antepartum and postpartum wards from February 1994 to June 2000. Medication errors were classified into three classes depending on the severity of morbidity caused (eg, prolonged hospitalization, death). The medication error rate in our obstetric service was compared with the Mecon Peer-X Benchmark rate, derived from class two and class three errors compiled from academic institutions. Results: There were 255 ADEs reported: 228 class one errors, 27 class two errors, and no class three errors. The error rate at our center was significantly lower than the Mecon Peer-X Benchmark rate (0.00006 versus 0.0001). The majority of cases considered class two errors involved excessive dosing of magnesium sulfate and oxytocin. All cases were managed appropriately, with none resulting in permanent sequelae. Conclusions: A system to track medication errors is useful to establish reliable error rates for comparison between institutions. Magnesium sulfate and oxytocin were the drugs most commonly associated with class two errors at our center.
Intravaginal Misoprostol Versus Cervidil for Cervical Ripening in Term Pregnancies* Konrad Harms, MD Christus–St. Joseph Hospital, Houston, TX
Catherine Nguyen, MD, Eugene C. Toy, MD, and Benton Baker, III, MD Objective: To evaluate the effect of intravaginal misoprostol as compared with Cervidil for cervical ripening in term patients. Methods: This was a prospective randomized study of women at term with intact membranes and Bishop scores less than 6 who presented for induction of labor. Misoprostoltreated women initially received 25 g intravaginally; subsequently they received 25–50 g every 4 hours for a maximum of three doses. Cervidil-treated women received the 10-mg dinoprostone intravaginal insert for a maximum of 12 hours. Intravenous oxytocin was then administered. * This document includes a discussion of use of a product that is unapproved by the U.S. Food and Drug Administration.
36S Tuesday Posters
Results: One hundred twenty women were enrolled, with 60 assigned to each group. The mean times from induction to delivery were similar, but the average time in labor was 1.3 hours shorter for the women who were given misoprostol (4.6 hours versus 5.9 hours, P ⫽ 0.03). There were no significant differences in the rates of hyperstimulation, tachysystole, fetal heart rate abnormalities, or cesarean delivery (overall rate of 18.3 %). Misoprostol-teated women had longer hospital stays (3.3 days versus 2.6 days, P ⬍0.001), longer postpartum courses (39.8 hours versus 33.2 hours, P ⬍0.01), and a trend toward more postpartum complications (20% versus 8.3%, P ⫽ 0.06). Conclusion: Compared with Cervidil, intravaginal misoprostol has similar efficacy in cervical ripening but seems to be associated with longer postpartum stays and hospitalization. The effect of intravaginal misoprostol on postpartum complications needs further study.
Is 34 Weeks of Gestation an Acceptable Goal for a Complicated Singleton Pregnancy? J. Stephen Jones, MD Carolina Perinatal Obstetrics, Greenville, SC
Gary Stanziano, MD, and Niki Bergauer, RN Objective: To assess the incidence of NICU admission, respiratory distress syndrome (RDS), and ventilator use in infants delivering between 34 and 36 weeks of gestation because of preterm labor (PTL). Study design: Singleton gestations with delivery at 34 –36 weeks of gestation because of PTL were identified from a database of women completing an outpatient PTL identification program between May 1995 and March 2000. Inclusion criteria were PTL hospitalization leading to delivery without attempted tocolysis. Excluded were indicated deliveries. Statistics used included ANOVA, Kruskal-Wallis H and Pearson’s X2. Results: A total of 2,849 infants were identified. Risk of NICU admission decreases by 47.4% from weeks 34 to 35 and by 41.9% from weeks 35 to 36 (all P values below are ⬍0.004). Data are presented as mean ⫾ SD, or percentage as indicated.
NICU NICU days RDS Ventilator use
34 weeks n ⫽ 370
35 weeks n ⫽ 783
36 weeks n ⫽ 1,696
54.6% 9.5 ⫾ 10.9 12.2% 9.2%
28.7% 8.1 ⫾ 9.1 9.1% 5.6%
16.7% 7.7 ⫾ 8.1 5.4% 3.1%
Conclusion: Rates of NICU admission, RDS, and need for ventilatory assistance decrease significantly with each advancing week of gestation. These data indicate that benefit is derived in prolonging pregnancy beyond 34 weeks.
Obstetrics & Gynecology
Jose L. Gonzalez, MD, and William Rayburn, MD Objective: To determine the rate and the drugs most frequently associated with adverse drug events (ADEs) in our inpatient obstetric service. We also compared our rate of ADEs with the reported national benchmark. Methods: We analyzed all reported ADEs occurring in labor and delivery and in the antepartum and postpartum wards from February 1994 to June 2000. Medication errors were classified into three classes depending on the severity of morbidity caused (eg, prolonged hospitalization, death). The medication error rate in our obstetric service was compared with the Mecon Peer-X Benchmark rate, derived from class two and class three errors compiled from academic institutions. Results: There were 255 ADEs reported: 228 class one errors, 27 class two errors, and no class three errors. The error rate at our center was significantly lower than the Mecon Peer-X Benchmark rate (0.00006 versus 0.0001). The majority of cases considered class two errors involved excessive dosing of magnesium sulfate and oxytocin. All cases were managed appropriately, with none resulting in permanent sequelae. Conclusions: A system to track medication errors is useful to establish reliable error rates for comparison between institutions. Magnesium sulfate and oxytocin were the drugs most commonly associated with class two errors at our center.
Intravaginal Misoprostol Versus Cervidil for Cervical Ripening in Term Pregnancies* Konrad Harms, MD Christus–St. Joseph Hospital, Houston, TX
Catherine Nguyen, MD, Eugene C. Toy, MD, and Benton Baker, III, MD Objective: To evaluate the effect of intravaginal misoprostol as compared with Cervidil for cervical ripening in term patients. Methods: This was a prospective randomized study of women at term with intact membranes and Bishop scores less than 6 who presented for induction of labor. Misoprostoltreated women initially received 25 g intravaginally; subsequently they received 25–50 g every 4 hours for a maximum of three doses. Cervidil-treated women received the 10-mg dinoprostone intravaginal insert for a maximum of 12 hours. Intravenous oxytocin was then administered. * This document includes a discussion of use of a product that is unapproved by the U.S. Food and Drug Administration.
36S Tuesday Posters
Results: One hundred twenty women were enrolled, with 60 assigned to each group. The mean times from induction to delivery were similar, but the average time in labor was 1.3 hours shorter for the women who were given misoprostol (4.6 hours versus 5.9 hours, P ⫽ 0.03). There were no significant differences in the rates of hyperstimulation, tachysystole, fetal heart rate abnormalities, or cesarean delivery (overall rate of 18.3 %). Misoprostol-teated women had longer hospital stays (3.3 days versus 2.6 days, P ⬍0.001), longer postpartum courses (39.8 hours versus 33.2 hours, P ⬍0.01), and a trend toward more postpartum complications (20% versus 8.3%, P ⫽ 0.06). Conclusion: Compared with Cervidil, intravaginal misoprostol has similar efficacy in cervical ripening but seems to be associated with longer postpartum stays and hospitalization. The effect of intravaginal misoprostol on postpartum complications needs further study.
Is 34 Weeks of Gestation an Acceptable Goal for a Complicated Singleton Pregnancy? J. Stephen Jones, MD Carolina Perinatal Obstetrics, Greenville, SC
Gary Stanziano, MD, and Niki Bergauer, RN Objective: To assess the incidence of NICU admission, respiratory distress syndrome (RDS), and ventilator use in infants delivering between 34 and 36 weeks of gestation because of preterm labor (PTL). Study design: Singleton gestations with delivery at 34 –36 weeks of gestation because of PTL were identified from a database of women completing an outpatient PTL identification program between May 1995 and March 2000. Inclusion criteria were PTL hospitalization leading to delivery without attempted tocolysis. Excluded were indicated deliveries. Statistics used included ANOVA, Kruskal-Wallis H and Pearson’s X2. Results: A total of 2,849 infants were identified. Risk of NICU admission decreases by 47.4% from weeks 34 to 35 and by 41.9% from weeks 35 to 36 (all P values below are ⬍0.004). Data are presented as mean ⫾ SD, or percentage as indicated.
NICU NICU days RDS Ventilator use
34 weeks n ⫽ 370
35 weeks n ⫽ 783
36 weeks n ⫽ 1,696
54.6% 9.5 ⫾ 10.9 12.2% 9.2%
28.7% 8.1 ⫾ 9.1 9.1% 5.6%
16.7% 7.7 ⫾ 8.1 5.4% 3.1%
Conclusion: Rates of NICU admission, RDS, and need for ventilatory assistance decrease significantly with each advancing week of gestation. These data indicate that benefit is derived in prolonging pregnancy beyond 34 weeks.
Obstetrics & Gynecology