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Author: search.filters.author.Farber, Michaela K.Has files: No

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    Item type:Publication,
    Second-Line Uterotonics for Uterine Atony
    (Lippincott, Williams & Wilkins, 2024)
    Cole, Naida M.
    ;
    Kim, Jimin J.
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    Lumbreras-Márquez, Mario Isaac  
    ;
    Fields, Kara G.
    ;
    Mendez-Pino, Laura
    Objective: To evaluate the comparative efficacy of two of the most commonly used second-line uterotonics—methylergonovine maleate and carboprost tromethamine. Methods: We conducted a double-blind randomized trial at two large academic perinatal centers in patients undergoing nonemergency cesarean delivery with uterine atony refractory to oxytocin, as diagnosed by the operating obstetrician. The intervention included administration of a single dose of intramuscular methylergonovine or carboprost intraoperatively at diagnosis. The primary outcome, uterine tone on a 0–10 numeric rating scale 10 minutes after study drug administration, was rated by operating obstetricians blinded to the drug administered. Secondary outcomes included uterine tone score at 5 minutes, administration of additional uterotonic agents, other interventions for uterine atony or hemorrhage, quantitative blood loss, urine output, postpartum change in serum hematocrit, transfusion, length of hospital stay, adverse drug or transfusion reactions, and postpartum hemorrhage complications. A sample size of 50 participants per group was planned to detect a 1-point difference (with estimated within-group SD of 1.5) in the mean primary outcome with 80% power at a two-sided α level of 0.05 while accounting for potential protocol violations. © 2024 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
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    Time to antibiotic initiation for suspected chorioamnionitis and factors associated with delayed treatment
    (2023)
    Lumbreras-Márquez, Mario Isaac  
    ;
    Hale, John
    ;
    Rowse, Olivia
    ;
    Villela-Franyutti, Diego
    ;
    Pearson, Jeffrey C.
    Intraamniotic infection can be associated with maternal bacteremia in 10% of cases. Prompt initiation of antibiotic treatment is critical to prevent maternal and fetal complications. At our quaternary center, the primary antibiotic regimen for suspected chorioamnionitis is ampicillin plus gentamicin. A preliminary quality improvement (QI) initiative evaluating the time from fever onset to antibiotic (ie, ampicillin and gentamicin) initiation in laboring patients at our institution suggested frequent delays of ≥1 hour for gentamicin. The aim of the present QI study was to determine the time to gentamicin treatment and specific factors associated with delayed gentamicin administration among patients with a new diagnosis of suspected chorioamnionitis.
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