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Learning to play God: a call for training OB-GYN residents in reproductive ethics

Myrick, Olivia Paige; Winkel, Abigail Ford
In this unique time of technological advancement in medicine and the culture of public discourse that surrounds it, trainees in obstetrics and gynecology require more intensive education in medical ethics to appropriately guide patient decision-making and to become more responsible voices in such an ethically complex field.
PMID: 31346918
ISSN: 1573-7330
CID: 3988232

Use of prophylactic antibiotics in women with previable prelabor rupture of membranes

Dotters-Katz, S K; Myrick, O; Smid, M; Manuck, T A; Boggess, K A; Goodnight, W
OBJECTIVE:To measure the effect of prophylactic antibiotics given at time of previable prelabor rupture of membranes (PROM) on latency. METHODS:Single center, retrospective cohort study of singleton pregnancies with previable (<23 0/7weeks) PROM. Antibiotics were given at clinician discretion. The primary outcome was latency, defined as duration of time between previable PROM and delivery. Secondary outcomes included delivery at ≥ 23weeks, infant survival, and maternal morbidity. Bivariate analysis compared maternal covariates between women who did and did not receive antibiotics. Antibiotic effect on latency was modeled using a Cox proportional hazards ratio. RESULTS:213 women with previable PROM were identified; 77 (36%) remained pregnant and thus were included in this analysis. Forty (52%) of 77 received antibiotics. Compared to women who did not receive antibiotics, those who did had PROM at a later median (IQR) estimated gestational age, EGA, (22.2weeks [20.7, 22.5] vs. 19.3weeks [18, 20.7], p < 0.01). Median (IQR) latency was not different between women who did and did not receive antibiotics (2.2 [0.7, 3.9] vs. 1.5 [0.5, 4.6] weeks, p = 0.49). More infants survived to discharge among women who received antibiotics compared to those who did not [17(43%) vs. 3(8%), p < 0.01]. When adjusted for EGA at PROM, antibiotics were associated with longer latency (HR 0.57 [95% CI 0.33, 0.97], p = 0.01). Antibiotic use was not associated with differences in maternal morbidity. CONCLUSION/CONCLUSIONS:After adjusting for EGA at PROM, antibiotic receipt was associated with longer latency. Larger prospective studies are needed to define the utility of prophylactic antibiotics in previable PROM.
PMID: 29286934
ISSN: 1878-4429
CID: 3897102

Prophylactic Antibiotics in Twin Pregnancies Complicated by Previable Preterm Premature Rupture of Membranes [Case Report]

Myrick, Olivia; Dotters-Katz, Sarah; Grace, Matthew; Manuck, Tracy; Boggess, Kim; Goodnight, William
OBJECTIVE:This study aims to determine if antibiotics given for latency to women with twins and previable preterm premature rupture of membranes (PPROM) affect the duration from membrane rupture to delivery. METHODS:A retrospective cohort study of twin pregnancies at a single center from 2000 to 2015 with previable (14 (0/7)-22 (6/7) weeks) PPROM was conducted. Women who were not candidates for expectant management or who elected for immediate delivery were excluded. Pregnancy complications, delivery data, and neonatal outcomes were compared between women who did and did not receive latency antibiotics. The primary outcome was latency. RESULTS:Of 52 eligible women, 30 (64%) elected expectant management; 17 women received antibiotics and 13 did not. No demographic differences existed between the groups. The median gestational age of rupture was 20 and 20.3 weeks in the antibiotic group and no antibiotic group, respectively. Median latency was 0.8 and 2.4 weeks in the antibiotic and no antibiotic groups correspondingly (p = 0.21). Overall, 58.8 and 23.1% of women who did and didn't receive antibiotics developed chorioamnionitis (p = 0.07). Perinatal mortality and maternal complication rates were high, though not different between the groups. CONCLUSION/CONCLUSIONS:Currently, even though in singletons with previable PPROM there is a recommendation to consider administrating antibiotics, in the setting of twins, no evidence exists to support this.
PMID: 27551580
ISSN: 2157-6998
CID: 3897092