INTRODUCTION: The aim of the current study is to develop and validate a prediction model for postpartum hemorrhage (PPH) based on antenatal and intrapartum risk factors in a diverse patient population at a tertiary safety-net center. METHODS: In this observational cohort of 10,025 pregnant women who delivered at Denver Health Medical Center (DHMC) between April, 2016 and March, 2019, ante- and intrapartum characteristics were compared between women with PPH and those without. A predictive multivariable model was estimated using logistic regression with a backwards stepwise approach eliminating variables when P>.05 among the prediction cohort of women delivering before April 2018. The model was validated among women, who delivered after April, 2018. RESULTS: A total of 9,774 women met inclusion criteria, 6,525 in the prediction cohort and 3,249 in the validation cohort. The prevalence of PPH in the prediction and validation cohorts was 6.1% and 6.8%, respectively. Maternal age, maternal body mass index (BMI, kg/m2), parity, gestational age, history of prior cesarean, history of PPH, abnormal placentation, neonatal weight, chorioamnionitis, platelet count on admission and intrapartum magnesium administration were included in the final prediction model. The area under the curve (AUC) for the prediction model was 0.81 (95% CI 0.79-0.84) and the AUC for the validation cohort was 0.89 (95% CI 0.86-0.91). CONCLUSION: The model performed well and can be used to identify women at risk for PPH. Further studies are necessary to evaluate the effect of the model use on decreasing PPH and associated maternal morbidity.

Context: Homeless individuals have comparatively poorer health, however few gender specific assessments exist. Purpose: This cross-sectional survey of homeless individuals assesses gender-specific health needs. Procedure: 68 Homeless adults were surveyed at a shelter from March to April, 2015 in Iowa City, IA. Descriptive statistics were computed to compare gender-subgroup responses. Main Findings: The study population was predominately male (45, 67.2%), white (37, 54.4%), and averaged 42.35 years old (range 21-74). Males were more likely to be veterans (13, 28.9% vs. 1, 4.5%, p=0.025). Women were more likely to have dependents (9, 47.4% vs. 1, 4%, p=0.001) and access to dental coverage (16, 80% vs. 12, 30.8%, p=0.001). Similar rates of chronic disease, primary care access, and unmet health needs were noted. Conclusions: Homeless women and men have unique needs and would benefit from gender-specific health interventions. Resources for child-care may be important for women who are homeless, while dental health care may be particularly beneficial for men.

Objectives: Medical scribes may offer a route to improve physician productivity and workflow efficiency with reduced physician time for documentation. To our knowledge, there is no prior literature on medical scribe impact on outpatient pediatric gastroenterology clinic operations. The primary aim of our study was to address this knowledge gap. Methods: Data were collected on encounters conducted by pediatric gastroenterology physicians at a tertiary center, during a summer scribe program. Scribes were trained and attended clinics in a nonrandomized fashion. Clinic efficiency was assessed by patient flow, tracked via the electronic medical record system. Medical note complexity codes, associated work relative value units (wRVUs), and note delinquency were compared between encounters with and without scribes. Patient satisfaction survey scores were compared between groups. Results: One thousand nine hundred seventy encounters were included. Documented medical note complexity (and wRVUs), note delinquency, patient satisfaction, and perceived overall quality of service were similar between groups. Clinic time for established encounters was statistically shorter with scribes (median 18 vs 21 minutes, P = 0.01), a 14% reduction. No significant difference was noted in new encounter clinic time. The time to note completion was shorter for new encounters with scribes (2 vs 3 days, P = 0.048). More notes were finalized by the third day postencounter when a scribe was present (63% vs 57%, P = 0.02). Conclusions: The presence of medical scribes was associated with significantly more efficient clinic flow for established encounters and modest improvements in note completion rate. There were no measurable negative effects on documented medical note complexity or patient satisfaction scores.

No studies exist to determine the optimal timing to counsel women regarding postpartum contraception which means opportunities for immediate postpartum contraception are often missed. Women between the gestational ages of 250/7 and 356/7 weeks, meeting inclusion criteria and attending an outpatient clinic were offered to participate in the study. Subjects completed surveys querying readiness, capability and confidence in discussing and committing to a postpartum contraceptive plan. Two hundred and forty-three patients were enrolled in the study. Sixty-three percent of patients responded they considered that the best time for contraception discussion was the second or third trimester. More women reported a contraception plan was important or very important postpartum than prenatally (78% vs. 56%; p<.0001). More women reported feeling ready or very ready to discuss (82% vs. 66%; p<.0001), and ready or very ready to choose (84% vs. 64%; p<.007), capable or highly capable of choosing (90% vs. 79%; p=.0009) postpartum than prenatally. Postpartum, more women felt confident or very confident (98% vs. 90%; p=.0006) in their ability to use effective contraception after delivery. Women reported higher levels of readiness and capability to choose and discuss contraception postpartum than prenatally. Most women felt ready and capable to choose a contraceptive option prior to postpartum discharge. IMPACT STATEMENT What is already known on this subject? Short interpregnancy interval is associated with increased maternal and neonatal morbidity and mortality. Effective postpartum contraception can be decided upon and administered, thereby increasing the interval between subsequent pregnancies. What do the results of this study add? The results of this study demonstrate that women report high levels of readiness and capability to choose and discuss contraception before postpartum discharge. What are the implications of these findings for clinical practice and/or further research? These findings imply that further research is needed to determine how to use motivational interviewing to encourage pregnant women to make a postpartum contraception decision prior to the postpartum period to facilitate uptake of their contraceptive choice.

ABSTRACT This study evaluated homeless women’s contraception knowledge and demonstrated improved knowledge following efficacy-based contraceptive counseling. Women were surveyed using a pre-test then post-test following standardized efficacy-based contraceptive counseling. 47 women participated. 13/19 (68.4%) of reproductive-aged women were not using contraception. After education there was significant increase in good-excellent self-rated knowledge (35, 75.5% vs 44, 93.6%; p < .001) and correct identification of most effective contraception OR 5.90 (95% CI = 2.31–15.02; p < .001). In conclusion, homeless women overestimated their understanding of contraception. Following education, there was significantly increased understanding of efficacy. While most did not desire pregnancy, few were using effective contraception and may benefit from education. Abbreviations: SH: Shelter House; LARC: Long-Acting Reversible Contraception; IUD: Intra-Uterine Device; ACOG: American College of Obstetricians and Gynecologists

The degree of cytoreduction at time of initial surgery for epithelial ovarian cancers is correlated with overall survival. Given that surgery can be physically and mentally taxing on the surgeon, we sought to examine if there were temporal and/or team relationships related to primary cytoreduction outcomes.

INTRODUCTION: Determine the optimal time to discuss and formulate a plan for postpartum contraception by using motivational interviewing and stages of change. Determine responses associated with uptake and adherence to long acting reversible postpartum contraception (LARC). METHODS: Adult women between gestational ages of 25 0/7 and 35 6/7 weeks seeking prenatal care and plans to delivery at our facility were offered to participate in the study. Subjects completed surveys querying readiness, capability and confidence in discussing and committing to a postpartum contraceptive plan at a single prenatal visit and again during their postpartum hospitalization. Subjects received a phone survey at 4–6 months postpartum. RESULTS: 243 women recruited from February to July 2015. 63% of patients responded the best time for contraception discussion was the 2nd or 3rd trimester; 90% planned to start contraception after delivery. More women reported prenatally and postpartum that they felt capable to choose LARC (85% v. 87%; P < .0001) compared to other forms of contraception. Additionally more women reported prenatally and postpartum that they felt ready to choose LARC as their postpartum contraception (74% v. 84%; P < .0001) compared again to other forms of contraception. Women who reported being more ready or capable were more likely to choose LARC and to be using that method at 4–6 months postpartum. CONCLUSION: Women report higher levels of readiness and capability to choose and discuss contraception postpartum than prenatally, however, high rates were seen throughout. More women choose LARC when they endorse readiness, confidence and capability to choose a contraceptive option.

Objectives: We aimed to determine the optimal time to discuss and formulate a plan for postpartum contraception and determine factors associated with uptake of and adherence to a postpartum contraception plan. Methods: All women between the gestational ages of 25 0/7 and 35 6/7 weeks meeting inclusion criteria and attending an outpatient clinic were offered the chance to participate in the study. Subjects completed surveys querying readiness, capability and confidence in discussing and committing to a postpartum contraceptive plan at a single prenatal visit and again during their postpartum hospitalization. Subjects received a phone survey at 4–6 months postpartum. Results: The study enrolled 243 patients. Some 63% of patients reported that the best time for discussion of contraception was the second or third trimester, and 90% of women planned to start a method after delivery. More women reported feeling that a contraception plan was important/very important postpartum than prenatally (78% vs. 56%, p<.0001). Significantly more women reported feeling ready/very ready to discuss (82% vs. 66%; p<.0001), ready/very ready to choose (84% vs. 64%, p<.007) and capable/highly capable of choosing (90% vs. 79%; p=.0009) a method postpartum than prenatally. Reasons for not feeling ready to choose an option were similar prenatally and postpartum. Postpartum, more women felt confident/very confident (98% vs. 90%; p=.0006) in their ability to use an effective contraceptive method after delivery. Conclusions: Women report higher levels of readiness and capability to choose and discuss contraceptive methods postpartum than prenatally; however, levels were high during both time periods. Most women feel ready and capable to choose a contraceptive option prior to postpartum discharge.

Objectives: The degree of cytoreduction at time of initial surgery for epithelial ovarian cancers is correlated with overall survival. Given the importance of primary debulking as well as knowing that surgery can be physically and mentally taxing on the surgeon, we sought to examine if there were temporal relationships related to degree of cytoreduction.