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629: Variation in obstetrical anesthesia services and complications in California community hospitals
Poster Session IV
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629 Variation in obstetrical anesthesia services and complications in California community hospitals Samia El Haj Ibrahim1, Moshe Fridman2, Lisa M. Korst3, Daniele S. Feldman1, Lisa D. Bollman4, Arlene Fink5, Kimberly D. Gregory1 1
Department of Obstetrics & Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, 2AMF Consulting, Los Angeles, CA, 3Childbirth Research Associates, North Hollywood, CA, 4Community Perinatal Network, Yorba Linda, CA, 5Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA
OBJECTIVE: To determine whether anesthesia resources are associated
628 Comparison of Celox and Bakri balloon in management of primary atonic postpartum hemorrhage Anne-Karen von Beckerath1, Holger Maul1, Ahmed M. Elmohandes2, Mamdouh Shaaban2, Dina M. Habib2, Ahmed Nasr2, Ahmed F. Abdel-Kawi2 1
Marienkrankenhaus, Hamburg, Germany, 2Assiut University, Assiut, Egypt
OBJECTIVE: Postpartum hemorrhage is a leading cause of maternal
death in developing countries. Mechanical compression techniques as bakri balloon and the recently introduced chitosan gauze (celox) were used in the management of primary atonic postpartum hemorrhage in cases where medical uterotonic agents failed. This study was designed to show the effectiveness of intrauterine insertion of celox in comparison to the standard application of the Bakri Balloon. STUDY DESIGN: Un-blinded randomized parallel prospective study. Primary endpoint was any need for further surgical interventions (e.g. peripartum hysterectomy) as a failure of the mechanical method. Secondary endpoints (e.g. post insertion fever, admission to the intensive care unit) were also recorded. RESULTS: Preliminary data showed failure rate which lead to peripartum hysterectomies were 9.7 % (3/31) in the celox group compared to 40 % (12/30) in the bakri balloon group. Low grade fever (38-38.5 C) was recorded in 19.35 % (6/31) in the celox group compared with none in the bakri balloon group. Admission to the intensive care unit (ICU) was 41.9 % (13/31) (average stay 5 days) in the celox group compared to 33.3 % (10/30) (average stay 7 days) in the bakri balloon group. CONCLUSION: Celox appears to be a potentially effective method in the management of atonic PPH. It further is inexpensive, easy to use and has well manageable side effects compared to the standard intrauterine bakri balloon.
with obstetrical (OB) anesthesia complications in women laboring in California community hospitals. STUDY DESIGN: We developed a structured survey regarding the services provided by childbirth hospitals in California. The survey was administered to labor and delivery nurse managers via telephone interviews in 2013. These data were linked to 2012 hospital discharge data, and used to calculate childbirth-specific anesthesia complication rates based on a modification of the related Patient Safety Indicator defined by the Agency for Healthcare Research and Quality. Hierarchical linear regression models were constructed to estimate the adjusted effects of anesthesia service characteristics (24-hour inhouse coverage yes/no, nighttime anesthesia skill mix [physicians only vs. physicians and nurse anesthetists vs. nurse anesthetists only vs. no in-house coverage], and the presence of a “dedicated” OB service [i.e., no coverage of other hospital areas]) on the occurrence of anesthesia complications. Models were adjusted for OB high-risk status, history of prior cesarean delivery, multiple gestation, preterm, maternal age, and race/ethnicity. RESULTS: Of 193 non-military community hospitals providing childbirth services, 187 (97%) responded. A total of 182 hospitals reported individual discharge data, of which 179 (237,889 deliveries) hospitals had complete data. Overall, OB anesthesia complications were rare (473 complications; [0.20%]). A non-dedicated anesthesia service was associated with an increased risk of complications: OR 1.42 (95% CI 1.11, 1.82), and predicted complication rates of 0.26% vs. 0.18%. No 24-hour in-house coverage: OR 1.11 (0.86, 1.43) and skill mix were not statistically significant albeit the OR for nurse anesthetist only vs. physicians only was 1.49 (0.99, 2.22). CONCLUSION: In community hospitals, a dedicated OB anesthesia service appeared to have fewer anesthesia complications among laboring women; anesthesia skill mix and 24-hour in-house availability were not significant predictors. These findings may help hospitals focus their efforts to further reduce rates of anesthesia complications during childbirth.
630 Lateral asymmetric decubitus for rotation of occiput posterior position: multicenter randomized controlled trial EVADELA camille le ray1, flavie lepleux2, Aure´lie De la Calle1, Jessy gue´rin3, nathalie sellam4, Michel Dreyfus2, Anne Chantry5 1
Port Royal Maternity- Assistance Publique Hôpitaux de Paris -, Paris, France, CHU Côte de Nacre, Caen, France, 3CH Avranches-Granville, Avranches, France, 4Les Bluets Maternity, Paris, France, 5INSERM U1153, Paris, France
2
OBJECTIVE: When the fetal head is in occiput posterior position, the maternal postures aim to lead the flexion of the fetal head to favour its rotation in anterior position. Our objective was to study whether Lateral Asymmetric Decubitus favour rotation of fetal occiput posterior positions.
Supplement to JANUARY 2016 American Journal of Obstetrics & Gynecology
S335
ajog.org
629 Variation in obstetrical anesthesia services and complications in California community hospitals Samia El Haj Ibrahim1, Moshe Fridman2, Lisa M. Korst3, Daniele S. Feldman1, Lisa D. Bollman4, Arlene Fink5, Kimberly D. Gregory1 1
Department of Obstetrics & Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, 2AMF Consulting, Los Angeles, CA, 3Childbirth Research Associates, North Hollywood, CA, 4Community Perinatal Network, Yorba Linda, CA, 5Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA
OBJECTIVE: To determine whether anesthesia resources are associated
628 Comparison of Celox and Bakri balloon in management of primary atonic postpartum hemorrhage Anne-Karen von Beckerath1, Holger Maul1, Ahmed M. Elmohandes2, Mamdouh Shaaban2, Dina M. Habib2, Ahmed Nasr2, Ahmed F. Abdel-Kawi2 1
Marienkrankenhaus, Hamburg, Germany, 2Assiut University, Assiut, Egypt
OBJECTIVE: Postpartum hemorrhage is a leading cause of maternal
death in developing countries. Mechanical compression techniques as bakri balloon and the recently introduced chitosan gauze (celox) were used in the management of primary atonic postpartum hemorrhage in cases where medical uterotonic agents failed. This study was designed to show the effectiveness of intrauterine insertion of celox in comparison to the standard application of the Bakri Balloon. STUDY DESIGN: Un-blinded randomized parallel prospective study. Primary endpoint was any need for further surgical interventions (e.g. peripartum hysterectomy) as a failure of the mechanical method. Secondary endpoints (e.g. post insertion fever, admission to the intensive care unit) were also recorded. RESULTS: Preliminary data showed failure rate which lead to peripartum hysterectomies were 9.7 % (3/31) in the celox group compared to 40 % (12/30) in the bakri balloon group. Low grade fever (38-38.5 C) was recorded in 19.35 % (6/31) in the celox group compared with none in the bakri balloon group. Admission to the intensive care unit (ICU) was 41.9 % (13/31) (average stay 5 days) in the celox group compared to 33.3 % (10/30) (average stay 7 days) in the bakri balloon group. CONCLUSION: Celox appears to be a potentially effective method in the management of atonic PPH. It further is inexpensive, easy to use and has well manageable side effects compared to the standard intrauterine bakri balloon.
with obstetrical (OB) anesthesia complications in women laboring in California community hospitals. STUDY DESIGN: We developed a structured survey regarding the services provided by childbirth hospitals in California. The survey was administered to labor and delivery nurse managers via telephone interviews in 2013. These data were linked to 2012 hospital discharge data, and used to calculate childbirth-specific anesthesia complication rates based on a modification of the related Patient Safety Indicator defined by the Agency for Healthcare Research and Quality. Hierarchical linear regression models were constructed to estimate the adjusted effects of anesthesia service characteristics (24-hour inhouse coverage yes/no, nighttime anesthesia skill mix [physicians only vs. physicians and nurse anesthetists vs. nurse anesthetists only vs. no in-house coverage], and the presence of a “dedicated” OB service [i.e., no coverage of other hospital areas]) on the occurrence of anesthesia complications. Models were adjusted for OB high-risk status, history of prior cesarean delivery, multiple gestation, preterm, maternal age, and race/ethnicity. RESULTS: Of 193 non-military community hospitals providing childbirth services, 187 (97%) responded. A total of 182 hospitals reported individual discharge data, of which 179 (237,889 deliveries) hospitals had complete data. Overall, OB anesthesia complications were rare (473 complications; [0.20%]). A non-dedicated anesthesia service was associated with an increased risk of complications: OR 1.42 (95% CI 1.11, 1.82), and predicted complication rates of 0.26% vs. 0.18%. No 24-hour in-house coverage: OR 1.11 (0.86, 1.43) and skill mix were not statistically significant albeit the OR for nurse anesthetist only vs. physicians only was 1.49 (0.99, 2.22). CONCLUSION: In community hospitals, a dedicated OB anesthesia service appeared to have fewer anesthesia complications among laboring women; anesthesia skill mix and 24-hour in-house availability were not significant predictors. These findings may help hospitals focus their efforts to further reduce rates of anesthesia complications during childbirth.
630 Lateral asymmetric decubitus for rotation of occiput posterior position: multicenter randomized controlled trial EVADELA camille le ray1, flavie lepleux2, Aure´lie De la Calle1, Jessy gue´rin3, nathalie sellam4, Michel Dreyfus2, Anne Chantry5 1
Port Royal Maternity- Assistance Publique Hôpitaux de Paris -, Paris, France, CHU Côte de Nacre, Caen, France, 3CH Avranches-Granville, Avranches, France, 4Les Bluets Maternity, Paris, France, 5INSERM U1153, Paris, France
2
OBJECTIVE: When the fetal head is in occiput posterior position, the maternal postures aim to lead the flexion of the fetal head to favour its rotation in anterior position. Our objective was to study whether Lateral Asymmetric Decubitus favour rotation of fetal occiput posterior positions.
Supplement to JANUARY 2016 American Journal of Obstetrics & Gynecology
S335