- Email: [email protected]
Frequency of nursing, physician, and hospital interventions in women at risk for preterm delivery
Frequency of Nursing, Physician, and Hospital Interventions in Women at Risk for Preterm Delivery John Morrison, MD University of Mississippi Medical Center, Jackson, MS
William Roberts, MD, and Gary Stanziano, MD OBJECTIVE: To determine the frequency of nursing intervention, physician intervention, and hospital evaluation (HE) for women receiving outpatient preterm labor management (OPLM) services in addition to routine prenatal care. METHODS: We analyzed data from women with singleton gestations at 20.0 –34.9 weeks receiving OPLM services. OPLM included patient education, daily and PRN nursing assessment of monitored uterine activity (MUA) and patient symptoms, treatment compliance, and physician notification for values exceeding established limits. Frequency of nursing intervention, physician intervention, and HE was analyzed. RESULTS: 307,249 days of OPLM data from 10,660 women were reviewed. 634,983 hours of MUA were assessed (59.6 ⫾ 45.2 hours per patient), with 69,874 hours of PRN tracings (6.5 ⫾ 8.4 hours per patient). On 53,665 (17.5%) of monitored days patients exhibited increased MUA and/or symptoms of preterm labor with nursing intervention and reassessment. Physician notification/intervention was required 7316 (13.6%) times, and HE was ordered for 3163 (43.2%) patients. The most common reason for physician intervention was increased MUA. During HE, 1400 (44.3%) received tocolysis. The mean length of stay for HE was 3.2 ⫾ 7.2 days. 428 (13.5%) of the women with HE remained as inpatients until delivery, and 324 (10.2%) delivered within 48 hours. 137 (42.3%) of the women delivering within 48 hours had ruptured membranes at hospital admission. CONCLUSIONS: Overall, in this population of women receiving OPLM services, 95.1% of increases in MUA or reports of symptoms of preterm labor were managed on an outpatient basis. OPLM allowed for appropriate identification and triage of women needing further HE.
tal evaluation (HE) because of increased uterine activity (UA) and/or subjective symptoms of PTL. METHODS: Inclusion criteria applied to a perinatal database: twin gestation, failed OP physician and nurse intervention, HE because of UA and/or symptoms of PTL persisting at least 2 hours, intact membranes, and gestational age (GA) of 24.0 – 34.0 weeks. Three groups based on reason for HE were identified: 1) PTL symptoms only (Sx only), 2) increased UA only (UA only), and 3) increased UA and PTL symptoms (UA ⫹ Sx). Hospital length of stay (LOS), HA (more than 23 hour LOS), and use of tocolytics were analyzed using ANOVA and the Pearson 2 tests (␣ ⫽ .05). RESULTS: n ⫽ 1532. Overall, the mean GA at HE was 30.4 ⫾ 2.5, 65.9% required HA, and 76.8% had tocolysis initiated or modified (Table 1). Table 1. Sx only (n ⫽ 122)
UA only (n ⫽ 450)
UA & Sx (n ⫽ 960)
P
HA (⬎23 h 68 (55.7%) 293 (65.1%) 649 (67.6%)* .031 LOS) Hospital 1.9 ⫾ 4.6 3.0 ⫾ 6.4* 2.9 ⫾ 6.2* .014 LOS (d) Tocolysis 48 (39.3%) 368 (81.8%)* 760 (79.2%)* ⬍.001 Data presented as mean ⫾ SD or percentage. * ⬍.05 compared with Sx only.
CONCLUSIONS: Women with twin gestations presenting with increased UA are more likely to have extended hospitalization and tocolysis than women with symptoms alone. OP monitoring of UA may provide valuable information for assessing acuity in twin gestations.
Impact of Timing of Diagnosis on Clinical Outcome of Placenta Accreta Ilana Cass, MD Cedars-Sinai Medical Center, Los Angeles, CA
Hospital Evaluation of Twin Gestations Experiencing Uterine Activity and Preterm Labor Symptoms
Luciette Saad, MD, Christine Holschneider, MD, Hyun Shvartzman, MD, Dru Carlson, MD, and Beth Karlan, MD
James Keller, MD
OBJECTIVE: To examine the risk factors for placenta accreta and evaluate clinical outcome according to the timing of diagnosis as antepartum, intrapartum, or postpartum.
Advocate Illinois Masonic Medical Center, Chicago, IL
Suzanne Coleman, MSc, RNC OBJECTIVE: To determine the frequency of hospital admission (HA) and use of tocolytics in women in an outpatient (OP) preterm labor (PTL) management program referred for hospi-
VOL. 101, NO. 4 (SUPPLEMENT), APRIL 2003
MATERIALS AND METHODS: A retrospective review of all deliveries at a tertiary care center from April 1991 to December 2001 with pathologically confirmed placenta accreta. RESULTS: Placenta accreta was diagnosed in 53 of 71,880 deliveries (incidence 0.07%). The incidence rose from 0.06% to
TUESDAY POSTERS
63S
William Roberts, MD, and Gary Stanziano, MD OBJECTIVE: To determine the frequency of nursing intervention, physician intervention, and hospital evaluation (HE) for women receiving outpatient preterm labor management (OPLM) services in addition to routine prenatal care. METHODS: We analyzed data from women with singleton gestations at 20.0 –34.9 weeks receiving OPLM services. OPLM included patient education, daily and PRN nursing assessment of monitored uterine activity (MUA) and patient symptoms, treatment compliance, and physician notification for values exceeding established limits. Frequency of nursing intervention, physician intervention, and HE was analyzed. RESULTS: 307,249 days of OPLM data from 10,660 women were reviewed. 634,983 hours of MUA were assessed (59.6 ⫾ 45.2 hours per patient), with 69,874 hours of PRN tracings (6.5 ⫾ 8.4 hours per patient). On 53,665 (17.5%) of monitored days patients exhibited increased MUA and/or symptoms of preterm labor with nursing intervention and reassessment. Physician notification/intervention was required 7316 (13.6%) times, and HE was ordered for 3163 (43.2%) patients. The most common reason for physician intervention was increased MUA. During HE, 1400 (44.3%) received tocolysis. The mean length of stay for HE was 3.2 ⫾ 7.2 days. 428 (13.5%) of the women with HE remained as inpatients until delivery, and 324 (10.2%) delivered within 48 hours. 137 (42.3%) of the women delivering within 48 hours had ruptured membranes at hospital admission. CONCLUSIONS: Overall, in this population of women receiving OPLM services, 95.1% of increases in MUA or reports of symptoms of preterm labor were managed on an outpatient basis. OPLM allowed for appropriate identification and triage of women needing further HE.
tal evaluation (HE) because of increased uterine activity (UA) and/or subjective symptoms of PTL. METHODS: Inclusion criteria applied to a perinatal database: twin gestation, failed OP physician and nurse intervention, HE because of UA and/or symptoms of PTL persisting at least 2 hours, intact membranes, and gestational age (GA) of 24.0 – 34.0 weeks. Three groups based on reason for HE were identified: 1) PTL symptoms only (Sx only), 2) increased UA only (UA only), and 3) increased UA and PTL symptoms (UA ⫹ Sx). Hospital length of stay (LOS), HA (more than 23 hour LOS), and use of tocolytics were analyzed using ANOVA and the Pearson 2 tests (␣ ⫽ .05). RESULTS: n ⫽ 1532. Overall, the mean GA at HE was 30.4 ⫾ 2.5, 65.9% required HA, and 76.8% had tocolysis initiated or modified (Table 1). Table 1. Sx only (n ⫽ 122)
UA only (n ⫽ 450)
UA & Sx (n ⫽ 960)
P
HA (⬎23 h 68 (55.7%) 293 (65.1%) 649 (67.6%)* .031 LOS) Hospital 1.9 ⫾ 4.6 3.0 ⫾ 6.4* 2.9 ⫾ 6.2* .014 LOS (d) Tocolysis 48 (39.3%) 368 (81.8%)* 760 (79.2%)* ⬍.001 Data presented as mean ⫾ SD or percentage. * ⬍.05 compared with Sx only.
CONCLUSIONS: Women with twin gestations presenting with increased UA are more likely to have extended hospitalization and tocolysis than women with symptoms alone. OP monitoring of UA may provide valuable information for assessing acuity in twin gestations.
Impact of Timing of Diagnosis on Clinical Outcome of Placenta Accreta Ilana Cass, MD Cedars-Sinai Medical Center, Los Angeles, CA
Hospital Evaluation of Twin Gestations Experiencing Uterine Activity and Preterm Labor Symptoms
Luciette Saad, MD, Christine Holschneider, MD, Hyun Shvartzman, MD, Dru Carlson, MD, and Beth Karlan, MD
James Keller, MD
OBJECTIVE: To examine the risk factors for placenta accreta and evaluate clinical outcome according to the timing of diagnosis as antepartum, intrapartum, or postpartum.
Advocate Illinois Masonic Medical Center, Chicago, IL
Suzanne Coleman, MSc, RNC OBJECTIVE: To determine the frequency of hospital admission (HA) and use of tocolytics in women in an outpatient (OP) preterm labor (PTL) management program referred for hospi-
VOL. 101, NO. 4 (SUPPLEMENT), APRIL 2003
MATERIALS AND METHODS: A retrospective review of all deliveries at a tertiary care center from April 1991 to December 2001 with pathologically confirmed placenta accreta. RESULTS: Placenta accreta was diagnosed in 53 of 71,880 deliveries (incidence 0.07%). The incidence rose from 0.06% to
TUESDAY POSTERS
63S