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REFERRAL TO CARDIOLOGY FOLLOWING POSTPARTUM ASSESSMENT FOR CARDIOVASCULAR RISK SCREENING
SOGC MEETING ABSTRACTS
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P-GYN-JM-115..........................................................................
PRE-OPERATIVE MEDICAL OPTIMIZATION OF WOMEN UNDERGOING MYOMECTOMY: A RETROSPECTIVE COHORT STUDY Pavan Gill, Alysha Nensi, Andrea Simpson, Deborah Robertson St. Michael's Hospital, 61 Queen Street East, Toronto, Ontario, Canada, M5C 2T2 Objectives: The purpose of this study was to determine the proportion of women who were medically optimized prior to undergoing myomectomy with interventions to correct anemia and reduce fibroid volume. Myomectomy has been associated with significant blood loss. Pre-operative medical optimization can improve surgical outcomes including minimizing transfusions rates and associated complications. Methods: For this retrospective chart review, all patients undergoing myomectomy (open, laparoscopic and robot-assisted) between February 2015 and June 2018 at a large academic, university-affiliated hospital in Toronto were included. Results: 225 myomectomy surgeries were completed between February 2015 and June 2018. 158 (70%), 25 (11%) and 42 (19%) of myomectomies were completed using open, laparoscopic and robot assisted approaches, respectively. Across all approaches, 68 (30%) of patients had a hemoglobin<120g/L prior to surgery and 115 (51%) were on a form of medical pre-optimization three months before surgery. The most common medications used for pre-optimization were Ulipristal Acetate(30%), oral iron supplementation (19%), GnRH agonist (12%). 32 (20%) of patients who had an open myomectomy required a perioperative transfusion. None of laparoscopic myomectomy patients required a transfusion. Five (12%) robotic-assisted patients had a post-operative transfusion. Conclusions: At the time of myomectomy, a third of women in our study were anemic yet only half were medically optimized within 3 months of surgery. 20% of open myomectomy patients required a perioperative transfusion. More efforts should be directed at optimizing patients prior to myomectomy in the hope of decreasing rates of perioperative transfusions, particularly when an open procedure is planned. Key Words: pre-operative medical optimization, fibroids, anemia, transfusion
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O-OBS-MFM-S-016..................................................................
REFERRAL TO CARDIOLOGY FOLLOWING POSTPARTUM ASSESSMENT FOR CARDIOVASCULAR RISK SCREENING Rachel Gladstone, Jessica Pudwell, Raveen Pal, Graeme Smith Queen's University, 76 Stuart St., Kingston, Ontario, Canada, K7L 4V7 Objectives: Cardiovascular disease (CVD) is the leading cause of death among women, and certain pregnancy complications can be the earliest indicators of increased CVD risk. Nonetheless, there are no recommendations for follow-up of cardiovascular risk factors identified through postpartum screening programs. This study describes current cardiovascular follow-up practices after referral from the postpartum Maternal Health Clinic (MHC). Methods: We investigated the cohort of women referred from the postpartum MHC to cardiology for further assessment and management, specifically examining timing and recommended intervention (s) to reduce CVD risk.
Results: The median time to cardiology appointment was 12 months. Women referred to cardiology differed significantly from those not referred in regards to a history of hypertensive disorders of pregnancy (p<0.05) and demonstrated significantly worse CVD risk profile at 6 months postpartum (p<0.0001). Life expectancy by cardiometabolic model for women referred was 5 years shorter (p<0.0001). Over 60% of women seen by cardiology were recommended to return to clinic, with nearly 58.3% of women deemed eligible for cardiac rehabilitation. From delivery to the cardiology visit, BMI and blood pressure significantly decreased. Conclusions: Although women at highest risk for CVD are being identified and referred to cardiology, the existing system is not designed to target this demographic. Too many women are either missing their cardiology appointments or scheduling appointments beyond 1 year postpartum. To initiate lifestyle changes and/or therapeutic interventions prior to the end of maternity leave and to potentially prevent future pregnancy complications, we suggest CVD prevention programming begin within 1 year of delivery. Key Words: Cardiovascular disease, hypertensive disorders of pregnancy, pre-eclampsia, prevention
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O-OBS-JM-043 ..........................................................................
EXPLORING THE SERVICES AND MANAGEMENT AVAILABLE FOR WOMEN EXPERIENCING COMPLICATIONS OF EARLY PREGNANCY: A SURVEY OF ONTARIO HOSPITALS. Robin Glicksman, Catherine Varner, Shelley McLeod, Andrea Page, Jackie Thomas University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada, M5S 1A8 Objectives: This investigation sought to characterize the provision of care for women experiencing first trimester complications in Ontario hospitals. Methods: Obstetrical/gynaecology (OB/GYN) hospital chiefs and emergency department (ED) chiefs (or their delegates) of 71 and 61 Ontario hospitals were invited to complete 55-item and 30-item online questionnaires, respectively, using modified Dillman methodology. Hospitals were included if they had a volume >30,000 ED visits per year, representing 85% of Ontario’s ED visits annually. Results: 43 OB/GYN respondents completed the survey (response rate=70.4%) and 58 ED respondents completed the survey on behalf of 63 hospital sites (response rate=88.7%). Of the ED respondents, 34 (54.0%) reported they did not have access to an early pregnancy clinic (EPC). At hospitals without an EPC, patients followed up in the EDs of 14 (41.1%) for pregnancy of unknown location (PUL) and 14 (41.1%) for threatened abortion (TA). Of the OB/GYN hospital respondents without an EPC, 14 (56.0%) reported previous consideration of creating an EPC with 13 (52%) citing personnel/staffing and finances as barriers to fruition. All sites with EPCs treated women for missed abortions, 16 (88.9%) for TA, ectopic pregnancy and PUL, 15 (83.3%) for molar pregnancy and 5 (27.7%) for other complications. For sites with EPCs, 12 (66.7%) reported less than 2 days between referral and first EPC appointment. Conclusions: Results of this study highlight the reliance of some hospitals on the ED to provide ongoing follow-up care to patients experiencing complications of early pregnancy, which may be mitigated by access to an EPC. Key Words: Early Pregnancy Complications, Emergency Department, Early Pregnancy Clinic
MAY JOGC MAI 2019
717
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P-GYN-JM-115..........................................................................
PRE-OPERATIVE MEDICAL OPTIMIZATION OF WOMEN UNDERGOING MYOMECTOMY: A RETROSPECTIVE COHORT STUDY Pavan Gill, Alysha Nensi, Andrea Simpson, Deborah Robertson St. Michael's Hospital, 61 Queen Street East, Toronto, Ontario, Canada, M5C 2T2 Objectives: The purpose of this study was to determine the proportion of women who were medically optimized prior to undergoing myomectomy with interventions to correct anemia and reduce fibroid volume. Myomectomy has been associated with significant blood loss. Pre-operative medical optimization can improve surgical outcomes including minimizing transfusions rates and associated complications. Methods: For this retrospective chart review, all patients undergoing myomectomy (open, laparoscopic and robot-assisted) between February 2015 and June 2018 at a large academic, university-affiliated hospital in Toronto were included. Results: 225 myomectomy surgeries were completed between February 2015 and June 2018. 158 (70%), 25 (11%) and 42 (19%) of myomectomies were completed using open, laparoscopic and robot assisted approaches, respectively. Across all approaches, 68 (30%) of patients had a hemoglobin<120g/L prior to surgery and 115 (51%) were on a form of medical pre-optimization three months before surgery. The most common medications used for pre-optimization were Ulipristal Acetate(30%), oral iron supplementation (19%), GnRH agonist (12%). 32 (20%) of patients who had an open myomectomy required a perioperative transfusion. None of laparoscopic myomectomy patients required a transfusion. Five (12%) robotic-assisted patients had a post-operative transfusion. Conclusions: At the time of myomectomy, a third of women in our study were anemic yet only half were medically optimized within 3 months of surgery. 20% of open myomectomy patients required a perioperative transfusion. More efforts should be directed at optimizing patients prior to myomectomy in the hope of decreasing rates of perioperative transfusions, particularly when an open procedure is planned. Key Words: pre-operative medical optimization, fibroids, anemia, transfusion
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O-OBS-MFM-S-016..................................................................
REFERRAL TO CARDIOLOGY FOLLOWING POSTPARTUM ASSESSMENT FOR CARDIOVASCULAR RISK SCREENING Rachel Gladstone, Jessica Pudwell, Raveen Pal, Graeme Smith Queen's University, 76 Stuart St., Kingston, Ontario, Canada, K7L 4V7 Objectives: Cardiovascular disease (CVD) is the leading cause of death among women, and certain pregnancy complications can be the earliest indicators of increased CVD risk. Nonetheless, there are no recommendations for follow-up of cardiovascular risk factors identified through postpartum screening programs. This study describes current cardiovascular follow-up practices after referral from the postpartum Maternal Health Clinic (MHC). Methods: We investigated the cohort of women referred from the postpartum MHC to cardiology for further assessment and management, specifically examining timing and recommended intervention (s) to reduce CVD risk.
Results: The median time to cardiology appointment was 12 months. Women referred to cardiology differed significantly from those not referred in regards to a history of hypertensive disorders of pregnancy (p<0.05) and demonstrated significantly worse CVD risk profile at 6 months postpartum (p<0.0001). Life expectancy by cardiometabolic model for women referred was 5 years shorter (p<0.0001). Over 60% of women seen by cardiology were recommended to return to clinic, with nearly 58.3% of women deemed eligible for cardiac rehabilitation. From delivery to the cardiology visit, BMI and blood pressure significantly decreased. Conclusions: Although women at highest risk for CVD are being identified and referred to cardiology, the existing system is not designed to target this demographic. Too many women are either missing their cardiology appointments or scheduling appointments beyond 1 year postpartum. To initiate lifestyle changes and/or therapeutic interventions prior to the end of maternity leave and to potentially prevent future pregnancy complications, we suggest CVD prevention programming begin within 1 year of delivery. Key Words: Cardiovascular disease, hypertensive disorders of pregnancy, pre-eclampsia, prevention
&
O-OBS-JM-043 ..........................................................................
EXPLORING THE SERVICES AND MANAGEMENT AVAILABLE FOR WOMEN EXPERIENCING COMPLICATIONS OF EARLY PREGNANCY: A SURVEY OF ONTARIO HOSPITALS. Robin Glicksman, Catherine Varner, Shelley McLeod, Andrea Page, Jackie Thomas University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada, M5S 1A8 Objectives: This investigation sought to characterize the provision of care for women experiencing first trimester complications in Ontario hospitals. Methods: Obstetrical/gynaecology (OB/GYN) hospital chiefs and emergency department (ED) chiefs (or their delegates) of 71 and 61 Ontario hospitals were invited to complete 55-item and 30-item online questionnaires, respectively, using modified Dillman methodology. Hospitals were included if they had a volume >30,000 ED visits per year, representing 85% of Ontario’s ED visits annually. Results: 43 OB/GYN respondents completed the survey (response rate=70.4%) and 58 ED respondents completed the survey on behalf of 63 hospital sites (response rate=88.7%). Of the ED respondents, 34 (54.0%) reported they did not have access to an early pregnancy clinic (EPC). At hospitals without an EPC, patients followed up in the EDs of 14 (41.1%) for pregnancy of unknown location (PUL) and 14 (41.1%) for threatened abortion (TA). Of the OB/GYN hospital respondents without an EPC, 14 (56.0%) reported previous consideration of creating an EPC with 13 (52%) citing personnel/staffing and finances as barriers to fruition. All sites with EPCs treated women for missed abortions, 16 (88.9%) for TA, ectopic pregnancy and PUL, 15 (83.3%) for molar pregnancy and 5 (27.7%) for other complications. For sites with EPCs, 12 (66.7%) reported less than 2 days between referral and first EPC appointment. Conclusions: Results of this study highlight the reliance of some hospitals on the ED to provide ongoing follow-up care to patients experiencing complications of early pregnancy, which may be mitigated by access to an EPC. Key Words: Early Pregnancy Complications, Emergency Department, Early Pregnancy Clinic
MAY JOGC MAI 2019
717