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  • Ovid Technologies (Wolters Kluwer Health)  (2)
  • Bushman, Elisa T.  (2)
  • 1
    Online Resource
    Online Resource
    Evaluation of a Risk-Stratified, Heparin-Based, Obstetric Thromboprophylaxis Protocol
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Obstetrics & Gynecology Vol. 138, No. 4 ( 2021-10), p. 530-538
    Details
    In: Obstetrics & Gynecology, Ovid Technologies (Wolters Kluwer Health), Vol. 138, No. 4 ( 2021-10), p. 530-538
    Abstract: To evaluate outcomes before and after implementation of a risk-stratified heparin-based obstetric thromboprophylaxis protocol. METHODS: We performed a retrospective cohort study of all patients who delivered at our tertiary care center from 2013 to 2018. Deliveries were categorized as preprotocol (2013–2015; no standardized heparin-based thromboprophylaxis) and postprotocol (2016–2018). Patients receiving outpatient anticoagulation for active venous thromboembolism (VTE) or high VTE risk were excluded. Coprimary effectiveness and safety outcomes were postpartum VTEs and wound hematomas, respectively, newly diagnosed after delivery and up to 6 weeks postpartum. Secondary outcomes were other wound or bleeding complications, including unplanned surgical procedures (eg, hysterectomies, wound explorations) and blood transfusions. Outcomes were compared between groups, and adjusted odds ratios (aORs) and 95% CIs were calculated using the preprotocol group as reference. RESULTS: Of 24,229 deliveries, 11,799 (49%) occurred preprotocol. Although patients were more likely to receive heparin-based prophylaxis postprotocol (15.6% vs 1.2%, P 〈 .001), there was no difference in VTE frequency between groups (0.1% vs 0.1%, odds ratio 1.0, 95% CI 0.5–2.1). However, patients postprotocol experienced significantly more wound hematomas (0.7% vs 0.4%, aOR 2.34, 95% CI 1.54–3.57), unplanned surgical procedures (aOR 1.29, 95% CI 1.06–1.57), and blood transfusions (aOR 1.34, 95% CI 1.16–1.55). CONCLUSION: Risk-stratified heparin-based thromboprophylaxis in a general obstetric population was associated with increased wound and bleeding complications without a complementary decrease in postpartum VTE. Guidelines recommending this strategy should be reconsidered.
    Type of Medium: Online Resource
    ISSN: 0029-7844
    URL: Article
    DOI: 10.1097/AOG.0000000000004521
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2012791-1
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  • 2
    Online Resource
    Online Resource
    Occipital Nerve Block Compared With Acetaminophen and Caffeine for Headache Treatment in Pregnancy : A Randomized Controlled Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Obstetrics & Gynecology ( 2023-9-28)
    Details
    In: Obstetrics & Gynecology, Ovid Technologies (Wolters Kluwer Health), ( 2023-9-28)
    Abstract: To evaluate the efficacy of occipital nerve block compared with standard care , defined as acetaminophen with caffeine, for treatment of acute headache in pregnancy. METHODS: We conducted a single-center, unblinded, parallel, randomized controlled trial of pregnant patients with headache and pain score higher than 3 on the visual rating scale. Patients with secondary headache, preeclampsia, or allergy or contraindication to study medications were excluded. Participants were randomized to occipital nerve block or standard care (oral 650 mg acetaminophen and 200 mg caffeine). Crossover treatment was given at 2 hours and second-line treatment at 4 hours to those with worsening visual rating scale score or visual rating scale score higher than 3. The primary outcome was headache improvement to a visual rating scale score of 3 or lower within 2 hours of initial therapy. Secondary outcomes included serial visual rating scale scores, receipt of crossover or second-line therapy, patient satisfaction, and perinatal outcomes. Outcomes were assessed in an intention-to-treat analysis. We estimated that a sample of 62 would provide 80% power to detect a difference from 85% to 50% between groups. RESULTS: From February 2020 to May 2022, 62 participants were randomized to occipital nerve block (n=31) or standard care (n=31). Groups were similar except payer status. The primary outcome, headache improvement to visual rating scale score of 3 or lower, was not significantly different between groups (64.5% vs 51.6%, P =.30). The occipital nerve block group experienced lower median [interquartile range] visual rating scale scores at 1 hour (2 [0–5] vs 6 [2–7], P =.014), and more patients in the occipital nerve block group had visual rating scale scores of 3 or lower at 1 hour. Among patients receiving crossover treatment at 2 hours, the standard care group had a significantly lower visual rating scale score 1 hour after crossover to occipital nerve block than the occipital nerve block group receiving crossover to standard care ( P =.028). There were no significant differences in second-line treatment, refractory headache, satisfaction, or complications. Patients receiving occipital nerve block delivered earlier (36.6 weeks vs 37.8 weeks), but preterm birth did not differ between groups. CONCLUSION: Occipital nerve block is an effective and quick-acting treatment option for acute headache in pregnancy. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT03951649.
    Type of Medium: Online Resource
    ISSN: 0029-7844
    URL: Article
    DOI: 10.1097/AOG.0000000000005386
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2012791-1
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
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