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Published byDerick Price Modified over 8 years ago
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The Capabilities of Family Medicine Residents Caring for Routine and High- Risk Obstetrical Patients Laird Bell, MD; Logan Banks, DO; Kathryn Geron, DO; Brett Mosberger, MS4
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Disclosures No financial disclosures
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Goals of Database Cox Family Medicine Residency can demonstrate competency in managing routine and high-risk pregnancies Serve as repository for future research
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Project Description 1 year time frame 390 total deliveries Use of EMR and other available records Approximately 50,000 data points entered
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Name DOB MR # Age Insurance Gravida Para Abortus LOS LMP def/approx. LMP Delivery type Csec Ind Initial EGA (est care) Delivery EGA Menarche Planned preg Contracept at concept Contracept type Pre-preg BMI Wt change (lbs) Delivery BMI Admit SVE –Dil –Eff –Station Stage 1 length ROM length How ROM occurred Fluid description Analgesia –Method 1 –Method 2 –Epidural Induction Agent Augmentation Agent Induction indic Scalp monitor IUPC Stage 2 length Presentation (A, B) Position (A, B) Nuchal cord Nuchal cord procedure Shoulder dystocia Cord pH (A, B) Gender (A,B) Birth weight (A,B) APGAR 1 min (A,B) APGAR 5 min (A,B) APGAR 10 min (A,B) Stage 3 length Placenta delivery Episiotomy Laceration Laceration repair EBL Placenta pathology LMP EDD Sono EDD Final EDD Delivery date Labs –Hgb (admit) –Hgb (discharge) –ABO –Rh Rhogam –Antibody screen –RPR –Hepatitis B surface Antigen –Rubella IgG –TSH –GBS –Pap –GC –Chlamydia –HIV –AFP –Quad screen –CF –1 hr GTT –3 hr GTT Feeding plan Final EDD LMP EDD Sono EDD Initial sono (weeks) Del date Current pregnancy complications –Preeclampsia –GDM –UTI –Preterm del –Preterm labor –Steroids –GHTN –PPH –Mec –Macrosomia (>4500) –Mult gest –Induction Prior pregnancy complications –Preeclampsia –GDM –UTI –Preterm del –Preterm labor –GHTN –PPH –Mec –Macrosomia (>4500) –Mult gest –Induction PMH –Misc –HTN –DM FH –Misc –HTN –Heart disease –DM SH –Tobacco –Alcohol use –Drug use –Sexual partners (#) –FOB involvement –Misc Perinatology –Who –# visits # Triage visits # Prenatal visits
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Prenatal Care Family Medical Care Center (52%) Jordan Valley Clinic (FQHC) (19%) Community physicians and regional transfers (22%) Midwife patients (3%) No prenatal care (4%)
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Pregnancy Complications Preeclampsia –13.3% –Compare to rate of 3.4% in United States Preterm delivery –16.2% –Compare to 11.73% of births in United States in 2011
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Placental Pathology 367 placentas submitted for pathology Overall –Histologic Chorioamnionitis 19.7% –Meconium 11.8% Versus rate of 15.9% based on description of fluids
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After the database was done Cox FMR can ably care for routine pregnancies as well as pregnancies with significant complications, with pregnancy complication rates equivalent to or exceeding national average, readying our graduates for excellence in practice
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Future Research
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Thank you Dr. Bell, Dr. Banks, Brett Mossberger Amy Lewis, PhD
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Questions?
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