Pregnancy and the Postpartum Period as an Opportunity for Cardiovascular Risk Identification and Management.

Cardiovascular disease (CVD) is the leading cause of death in women. Because women generally present with more atypical symptoms of CVD than do men and because underlying CVD risk factors are often present for years before the onset of CVD, it is important to use innovative ways to identify women who should undergo CVD risk screening at a younger age. Pregnancy and the postpartum period afford us that opportunity, given that the development of certain pregnancy complications (hypertensive disorders of pregnancy, gestational diabetes, preterm birth, delivery of a neonate with fetal growth restriction, and significant placental abruption) can reliably identify women with underlying, often unrecognized, CVD risk factors. Women with one or more of these pregnancy complications should be identified at the time of delivery and referred for regular follow-up. This would ideally take the form of a multidisciplinary clinic including clinicians and allied health specialists to carry out physical and biochemical screening and counseling regarding lifestyle modification and possible therapeutic interventions. Longer-term follow-up and recommendations should be individualized based on findings and risks. There is also an opportunity for future pregnancy counseling and discussion about the importance of weight loss between pregnancies, initiation of a routine involving physical activity, use of preconception folic acid, and the potential initiation of low-dose aspirin for those women at risk for future preeclampsia and fetal growth restriction or the use of progesterone for women at risk for preterm labor. The link between pregnancy complications and future CVD affords us with the earliest opportunity for CVD risk assessment for health preservation and disease prevention.

Effect of using silver nylon dressings to prevent superficial surgical site infection after cesarean delivery: a randomized clinical trial.

BACKGROUND: Surgical site infections are associated with significant healthcare cost and burden. Silver-impregnated dressings have been associated with a decrease in surgical site infections in select populations, but it is unknown whether the benefit can be observed after cesarean deliveries. OBJECTIVE: We sought to evaluate the impact of silver nylon dressings in reducing superficial surgical site infections after cesarean delivery. MATERIALS AND METHODS: A blinded randomized clinical trial of women undergoing scheduled or unscheduled cesarean delivery at a single site was conducted. Women were recruited for participation from September 2013 to June 2016. Women with vertical skin incisions were excluded. Enrolled participants were randomized to silver nylon dressing or an identical-appearing gauze wound dressing. Wounds were evaluated in the outpatient office at 1 week and 6 weeks after delivery. The primary outcome was superficial surgical site infection as defined by Centers for Disease Control criteria at any time within the first 6 weeks after cesarean delivery. A sample size of 330 per group (n = 660) was planned to compare the 2 arms. Data were analyzed using the χ2, Fisher exact test, Student t test, Mann-Whitney U test, and logistic regression where appropriate, and a value of P < .05 was considered significant. RESULTS: Among the 657 participants, overall, the primary outcome was similar between the 2 groups (4.6% in the silver nylon group vs 4.2% in the gauze group, P = .96). Women allocated to silver nylon, when compared to those who were allocated to gauze, had similar rates of superficial surgical site infection within 1 week (1.2% vs 0.9%) and within 6 weeks ( 4.6% vs 4.2%) after delivery (P >.99). The 2 groups were similar in age (30.9 ± 5.6 vs 31.0 ± 5.5 years, P = .95), body mass index (36.2 ± 8.7 vs 35.3 ± 8.2 kg/m2, P = .19), pregestational diabetes (6.2% vs 3.4%, P = .14), gestational diabetes (7.9% vs 7.3%, P = .88), cesarean delivery after labor (31.9% vs 31.1%, P = .86), presence of chorioamnionitis (5.2% vs 2.1% P = .06), and operative time (56.4 ± 20.6 vs 55.9 ± 17 minutes, P = .69). After adjusting for clinical and sociodemographic confounding variables, current smoking (adjusted odds ratio, 4.9; 95% confidence interval, 1.8-13.4) body mass index ≥40 kg/m2 (adjusted odds ratio, 3.08; 95% confidence interval, 1.3-6.8), and surgery length (minutes) (adjusted odds ratio, 1.02; 95% confidence interval, 1.002-1.04), but not use of gauze dressing, were associated with superficial surgical site infections. CONCLUSION: Among women undergoing cesarean delivery, silver nylon dressing was not more effective than gauze in reducing the risk of superficial surgical site infections.

Interpregnancy Care.

Interpregnancy care aims to maximize a woman's level of wellness not just in between pregnancies and during subsequent pregnancies, but also along her life course. Because the interpregnancy period is a continuum for overall health and wellness, all women of reproductive age who have been pregnant regardless of the outcome of their pregnancies (ie, miscarriage, abortion, preterm, full-term delivery), should receive interpregnancy care as a continuum from postpartum care. The initial components of interpregnancy care should include the components of postpartum care, such as reproductive life planning, screening for depression, vaccination, managing diabetes or hypertension if needed, education about future health, assisting the patient to develop a postpartum care team, and making plans for long-term medical care. In women with chronic medical conditions, interpregnancy care provides an opportunity to optimize health before a subsequent pregnancy. For women who will not have any future pregnancies, the period after pregnancy also affords an opportunity for secondary prevention and improvement of future health.