In-Person Versus Virtual Instruction and Simulation for Unplanned Out-of-Hospital Births

INTRODUCTION: Unplanned out-of-hospital births are uncommon and associated with serious complications. Most emergency medical services (EMS) personnel receive little or no instruction on emergent vaginal delivery. Our in-person (IP) lecture and simulation training on emergent vaginal delivery for EMS personnel previously demonstrated improvement in knowledge and confidence. With COVID-19 we adapted the same curriculum into a virtual training session (VTS). In-person simulation increases confidence and knowledge, but less is known about virtual simulation training. The purpose of this study was to assess EMS personnel's knowledge and confidence after IP versus VTS in emergent vaginal delivery. METHODS: The IP and VTS participants received the same lecture on emergent delivery either in-person or virtually. The IP group received in-person simulation training using a birth simulator. The VTS group received simulation training via virtual demonstration on the same model. Participants completed pretraining and posttraining surveys to assess knowledge and confidence. Responses were analyzed and compared using Student's t test. RESULTS: Ninety-eight participants (59 IP, 39 VTS) participated with 100% survey completion. Pretraining knowledge scores were similar (IP 45% versus VTS 37%, P =.22). Although both groups showed improvement, the IP group had significantly higher posttraining knowledge scores (IP 99% versus VTS 75%, P <.01). More IP participants reported confidence in performing emergent delivery after training (IP 100% versus VTS 51%, P <.01). CONCLUSION: Live in-person instruction and simulation training of emergent vaginal delivery among EMS personnel results in higher knowledge scores and confidence when compared to virtual instruction and simulation training. Further evaluation is needed to determine generalizability to other learner groups. [ FROM AUTHOR] Copyright of Obstetrics & Gynecology is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Changing Trends of Pregnancy Related Acute Kidney Injury - a Single Centre Prospective Observational Study from Southern India

Introduction: Pregnancy-related acute kidney injury (PR-AKI) in India is largely showing a declining trend due to improved and accessible obstetric care. Nevertheless, PR-AKI continues to cause significant maternal and fetal morbidity and mortality. This study was taken up with the intention to study the incidence and clinical spectrum of AKI in pregnancy in recent times and assess maternal and neonatal outcomes Methods: All pregnant women admitted in the Department of Obstetrics and Gynecology at St John's Medical College Hospital, Bengaluru between January 2018 to June 2020 were screened for AKI with the following criteria 1. Increase in serum creatinine to >0.8mg/dL and/or a sudden increase in serum creatinine by more than 50% when prior renal function was normal. 2. Oligo-anuria 3. Need for renal replacement therapy Women with preexisting CKD were excluded. Patient's clinical and laboratory details recorded. Dialysis support was provided if indicated. The clinical profile and renal outcome of the mother and fetal outcome was assessed at the time of discharge. Mothers' were also followed up at the end of 3 months of postpartum period. Recovery was categorized as Complete recovery- normal serum creatinine (<0.8 mg/dL) or a previously known baseline and no proteinuria /hypertension at the end of 3 months Partial recovery- renal function improved but serum creatinine did not return to normal range and patient was dialysis independent. No recovery- patient continued to require dialysis at the end of 3months. Result(s): Of the 2650 deliveries in the study period 42 women (Mean age 26.9 +/-3.6 years) were diagnosed AKI during pregnancy (1.58%). Baseline characteristics and outcomes are depicted in table 1. Majority of women (n=37) were referred from peripheral hospitals. Hypertension and decreased fetal movements were the common reasons for referral. Third trimester was the most common time of presentation (76.1%). Severe Preeclampsia and HELLP syndrome was the leading cause of AKI (59.5%).ATN secondary to obstetric complications, sepsis and hemolytic uremic syndrome were the other causes. One case each of cortical necrosis, acute fatty liver of pregnancy and COVID 19 associated AKI was seen. Mean duration of hospital stay was 12.1+/-6.9 days. More than one third patients' required ICU stay (35.7%).12 patients (28.5%) required renal replacement therapy. Of them, 3 were dialysis dependent at the end of 3 months and 4 had partial renal recovery. 3 patients expired during hospital stay. Fetal survival was 69.04%.13 babies' required NICU care (44.8%). Neonatal outcomes are summarized in table 2. Close to one third of the pregnancies with AKI were associated with intrauterine fetal demise (28.5%). Low birth weight and prematurity were the common reasons for NICU admission with mean NICU stay of 8.2 +/-2.3 days [Formula presented] [Formula presented] Conclusion(s): Severe preeclampsia was the most common cause of AKI in our study. PR-AKI continues to be a significant problem in the peripheries of developing countries where availability of health care facilities is meager, with late referral to tertiary care centers. One third of the patients required ICU stay & dialytic support. Women who required dialysis had poorer renal prognosis. There was 30% fetal loss seen in PR-AKI and also a higher incidence of low birth weight and prematurity. No conflict of interestCopyright © 2023

Features and outcomes of adolescent deliveries during COVID-19 pandemic - a bicentric study

Introduction: adolescent pregnancies represent a global public health problem associated with multiple consequences on the well-being of young mothers, their babies and general population. The biggest prevalence of adolescent pregnancies in Europe can be found in southeastern countries. Objective(s): to analyze the features and outcomes of adolescent deliveries during the COVID-19 pandemic. Material(s) and Method(s): retrospective, descriptive study of adolescent mothers delivered in the period 01.01.2020-31.12.2021 in two university medical centers: the Emergency Clinical County Hospital of Arad (Romania), and Clinic of Gynecology and Obstetrics of University Clinical Center of Vojvodina (Serbia). Demographic and anthropometric parameters of adolescent mothers, number and way of delivery, birth weight and Apgar score of neonate, COVID-19 status and data about pathologies and complications associated with pregnancy and delivery were collected from medical records and analyzed statistically using IBM SPSS. Result(s): there were total of 458 adolescent mothers, aged between 12 and 17 (average 16.07+/-1.07 year). From urban environment there were 182 (60.3%) cases and from rural 276 (39.7%) cases. Number of previous pregnancies and births ranged from 0-3, with majority of mothers being primiparas (76.2%). Cesarean section was performed in 40.8%, vaginal birth in 59.2%. The most common indications for cesarean section were maternal-pelvic disproportion, transverse lie or deflected cephalic presentation, twin pregnancies, severe fetal distress, preeclampsia, scarred uterus with risk of rupture and premature placental abruption. The average fetal weight at birth was 3010.22g ranging from 860 to 4500 g. The average Apgar score was 8.73. There were 9.66% of premature labors. There were 9 (2%) positive COVID-19 cases at birth and additional 4 (0.9%) cases who had COVID-19 during pregnancy. We observed a very high percentage (73.86%) of pregnancies without adequate prenatal care. Conclusion(s): Adolescent mothers are prone to develop complications compared to general population. The COVID-19 pandemic might have additional negative influence on the addressability of underage mothers to medical care, this phenomenon being the basis of most complications during pregnancy. Effective interventions, better sexual education and social programs are needed to reduce the number of adolescent mothers and to help them get a much better social reinsertion and an increase in the general quality of life.Copyright © 2023

SUCCESSFUL DELIVERY OF A COVID-19-POSITIVE PREGNANT WOMAN WHILE SUPPORTED BY VV ECMO

B Description: b We present a case of a 36-year-old patient, G2P1001 at a gestational age of 26 weeks and 4 days with severe acute hypoxemic respiratory failure secondary to COVID-19 infection, requiring extracorporeal membrane oxygenation who underwent successful cesarean section while on ECMO. B Introduction: b Severe Sars-CoV-2 (COVID-19) infection has been reported in both pregnant and postpartum women despite young age and lack of comorbidities. While there are no randomized clinical trials demonstrating improved outcomes in peripartum women, current literature supports the use of ECMO in both pregnant and postpartum patients with severe COVID-19 infection. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)