Risk of third-trimester amniocentesis: a case-control study.

Risks of third-trimester amniocentesis are considered minimal; however, only case series have been reported. We performed a case-control study in which women undergoing third-trimester amniocentesis were matched with controls undergoing antenatal testing for similar indications to determine adverse outcomes associated with the procedure. Cases undergoing amniocentesis at > 32 weeks for fetal lung maturity assessment followed by antepartum testing with nonstress test and amniotic fluid index determination were matched with controls undergoing only antepartum testing based on gestational age at testing and maternal age. The main outcome variable was a composite occurrence of obstetric complications within 48 hours of testing, including urgent delivery, placental abruption, premature rupture of membranes (PROM), perinatal death, or Apgar score at 5 minutes < 7. Statistical analysis included Fisher's exact test and Student T-test, with P < 0.05 considered significant. A total of 167 matched pairs of patients fulfilled the study criteria. Indications for both amniocentesis and antepartum testing, which included diabetes, preterm labor, and cholestasis, were similar in the two groups. As expected, gestational age at sampling/testing (36.4 +/- 1.4 [mean +/- standard deviation] versus 36.6 +/- 1.7 weeks; P = 0.2) and maternal age (31.4 +/- 5.8 versus 31.5 +/- 6.3 years; P = 0.9) were not different between cases and controls. The rate of the main outcome variable within 48 hours of testing was 0 of 167 among cases and 1 of 167 among controls. Amniocentesis in the third trimester is not associated with increased risk of urgent delivery, placental abruption, PROM, Apgar score at 5 minutes < 7, or perinatal death within 48 hours of the procedure.

Additional training with an obstetric simulator improves medical student comfort with basic procedures.

OBJECTIVE: To determine if an obstetric birthing simulator can improve medical student understanding of and comfort with basic obstetric procedures. STUDY DESIGN: Medical students were surveyed at the end of their obstetrics rotation regarding their knowledge and comfort with basic obstetric procedures. A group of students was trained on basic procedures utilizing an obstetric simulator. Survey results were compiled and analyzed with the Mann-Whitney U test. RESULTS: In all, 60 untrained students and 18 simulator trained students completed surveys. Trained students were significantly more comfortable with fundal height measurements (P = 0.003), Leopold maneuvers (P < 0.001), fetal scalp electrode placement (P < 0.001), intrauterine pressure catheter placement (P < 0.001), and artificial rupture of membranes (P = 0.001) and reported better understanding of the indications for placement of a fetal scalp electrode (P = 0.01) and intrauterine pressure catheter (P = 0.03). CONCLUSIONS: Additional training with an obstetric simulator improved medical student self-reported comfort with and understanding of basic procedures compared with standard resident and staff-directed instruction.

The impact of first-trimester screening on AMA patients' uptake of invasive testing.

OBJECTIVE: Prenatal testing for AMA includes invasive procedures such as CVS and amniocentesis, which have risks. We sought to determine the effects of first-trimester screening (FTS) on referrals for genetic counseling and patients' decisions to pursue invasive testing after FTS was offered in 2002. METHODS: We compared AMA patients presenting for prenatal care who underwent early genetic counseling (<13 weeks' gestation) from 2001 to those from 2003. Charts were reviewed for maternal age, gestational age, past obstetric history, prior CVS or amniocentesis, abnormal ultrasound findings and decision to proceed with invasive testing. The two groups were compared using Student t-test and chi-square tests. RESULTS: In 2001, 552 AMA women enrolled in prenatal care; 68 presented for early genetic counseling. In 2003, 728 AMA women enrolled in prenatal care; 172 presented for early genetic counseling. More counseled women chose genetic testing in 2003 than in 2001 (95% vs 79%, p<0.01). More patients elected an invasive procedure in 2001 compared to 2003 (71% vs 26%, p<0.01). CONCLUSION: Availability of FTS results in more AMA women having early prenatal genetic counseling and choosing some form of genetic testing. Such women are less likely to choose invasive tests than those without access to FTS.

Evaluation of residents' delivery notes after a simulated shoulder dystocia.

OBJECTIVE: To describe and analyze delivery notes after a shoulder dystocia drill with a birthing simulator METHODS: A total of 33 residents from 2 university training programs underwent testing on a standardized shoulder dystocia scenario with an obstetric birthing simulator. After the completion of the delivery, each resident was informed of the infant's Apgar scores and birth weight and told that the infant was moving all extremities. The resident was then given a blank progress note and asked to write a delivery note. The notes were evaluated for 15 key components. RESULTS: Seventy-six percent (n = 25) of residents recorded less than 10 of 15 key components of a delivery note after a shoulder dystocia. The majority of residents (91%, 30/33) included the correct order of the maneuvers used during the delivery, but most did not note which shoulder was anterior (18%, 6/33) or how long the head-to-body interval was during delivery (45%, 15/33). CONCLUSION: Residents' delivery notes after a shoulder dystocia simulation often lacked critical elements. Training in documentation is needed in residency training. The addition of the delivery note and feedback regarding the note represents a simple innovation in this teaching scenario that may help identify deficiencies in documentation. LEVEL OF EVIDENCE: III