Labor and Delivery Unit Closures in Rural Georgia from 2012–2016 and the Impact on Black Women: A Mixed-Methods Investigation

Background. Obstetric provider coverage in rural Georgia has worsened, with nine rural labor and delivery units (LDUs) closing outside the Atlanta Metropolitan Statistical Area from 2012–2016. Georgia consistently has one of the highest maternal mortality rates in the nation and faces increased adverse health consequences from this decline in obstetric care.Objective. This study explores what factors may be associated with rural hospital LDU closures in Georgia from 2012–2016.Methods. This study describes differences between rural Georgia hospitals based on LDU closure status through a quantitative analysis of 2011 baseline regional, hospital, and patient data, and a qualitative analysis of newspaper articles addressing the closures.Results. LDUs that closed had higher proportions of Black female residents in their Primary Care Service Areas (PCSAs), of Black birthing patients, and of patients with Medicaid, self-pay or other government insurance; lower LDU birth volume; more women giving birth within their PCSA of residence; fewer obstetricians and obstetric provider equivalents per LDU; and fewer average annual births per obstetric provider. Qualitative results indicate financial distress primarily contributed to closures, but also suggest that low birth volume and obstetric provider shortage impacted closures.Conclusions for Practice. Rural LDU closure in Georgia has a disproportionate impact on Black and low-income women and may be prevented through funding maternity healthcare and addressing provider shortages.

The rate of intrapartum cesarean delivery based on estimated fetal weight in comparison to previous child’s birth weight

Objective: To examine whether an estimated fetal weight of the current pregnancy greater than previous birth weight is associated with increased odds of intrapartum cesarean delivery. Study design: We conducted a retrospective cohort study of all women who had more than one singleton pregnancy at 23 weeks’ gestation or greater at a single Labor and Delivery unit. We only analyzed the second pregnancy in the dataset. We excluded women who had preterm birth in the second pregnancy. Women were categorized according to the difference between estimated fetal weight and previous birth weight - estimated fetal weight close to previous birth weight within 500 grams (Similar Weight Group); estimated fetal weight significantly (more than 500 grams) greater than previous birth weight (Larger Weight Group); and estimated fetal weight significantly (more than 500 grams) lower than previous birth weight (Smaller Weight Group). The primary outcome was intrapartum cesarean delivery. Multivariable logistic regression was performed to calculate adjusted odds ratios (aOR) with 95% confidence interval (95%CI) after adjusting for predefined covariates. Results: Of 1,887 women, there were 1,415 (75%) in the Similar Weight Group, 384 (20%) in the Greater Weight Group, and 88 (5%) in the Smaller Weight Group. Individuals in the Larger Weight Group compared to those in the Similar Weight Group had higher odds of undergoing intrapartum cesarean delivery (11.2% vs. 4.5%; aOR 2.91; 95%CI 1.91-4.45). The odds of intrapartum cesarean delivery in the Smaller Weight Group compared to those in the Similar Weight Group were not increased (3.4% vs. 4.5%; crude OR 0.75; 95%CI 0.23-2.42). Conclusion: The difference between current estimated fetal weight and previous birth weight plays an important role in assessing the risk of intrapartum cesarean delivery.

Ethnic Disparities in Coronavirus Disease 2019 after the Implementation of Universal Screening in Hartford, Connecticut

Objective The aim of this article was to estimate the prevalence of coronavirus disease 2019 (COVID-19) in Connecticut, examine racial/ethnic disparities, and assess pregnancy outcomes in pregnant women following the implementation of universal screening for the virus. Materials and methods This is a retrospective cohort study of all obstetric patients admitted to our labor and delivery unit during the first 4 weeks of implementation of universal screening of COVID-19. Viral studies were performed in all neonates born to mothers with severe acute respiratory syndrome coronavirus 2. We calculated the prevalence of COVID-19, compared the baseline characteristics and pregnancy outcomes between those who tested positive and negative for the virus, and determined the factors associated with COVID-19. Results A total of 10 (4.6%) of 220 women screened positive for the virus. All were asymptomatic. Week 1 had the highest prevalence of infection, nearing 8%. No neonates were infected. Hispanics were more likely to test positive (odds ratio: 10.23; confidence interval: [2.71–49.1], p = 0.001). Obstetric and neonatal outcomes were similar between the groups (p > 0.05). Conclusion Although the rate of asymptomatic COVID-19 was low, ethnic disparities were present with Hispanics being more likely to have the infection. Key Points

Research on Distribution and Inventory Cooperation of Agricultural Means Supply Chain

This paper constructed a biobjective model based on the total cost and time satisfaction to provide a desirable solution to the distribution and inventory cooperation of agricultural means supply chain. The model simulated how the distribution center and retailers collaborate to meet the needs of the order customer in the random lead time and out-of-stock loss costs. By the features of the model, the biobjective genetic algorithm was improved based on elitism selection, aiming to improve the quality of noninferior solution in biobjective model. Finally, the influence degree of the lead time of delivery, unit inventory cost, and unit transport cost on the total cost of the system was quantified through the analysis of examples and sensitivity of model parameters. This research has provided valuable new insights into the distribution and inventory coordination of supply chain.

Awareness of euglycaemic diabetic ketoacidosis during pregnancy prevents recurrence of devastating outcomes: a case report of two pregnancies in one patient

Background Euglycaemic diabetic ketoacidosis (DKA) during pregnancy is a life-threatening obstetric emergency. It requires early identification and prompt action. Obstetricians’ knowledge about symptoms, diagnostic pitfalls and management during pregnancy and delivery need to be improved. We report a case of a young diabetic woman developing severe euglycaemic DKA in two consecutive pregnancies; the first pregnancy resulted in the most deviating outcome (i.e., intrauterine death), while the second pregnancy resulted in the delivery of a healthy newborn. Thus, the novelty of the case presented here is the possibility to demonstrate how the management of DKA in pregnancy can dramatically change outcomes. Case presentation We report a case of a young diabetic woman in whom DKA was concealed by hyperemesis and oesophageal reflux. This woman presented to our delivery unit with severe euglycaemic DKA during her first pregnancy. While the mother’s condition could be successfully stabilized, the foetus died shortly after admission. Two years later, the same woman presented with similar problems. Repeated episodes of mild euglycaemic DKA could be successfully managed with consequent interdisciplinary treatment and close observation, leading to a good pregnancy outcome, i.e., the birth of a healthy child. Conclusion Awareness of euglycaemic DKA needs to be increased to reduce the risk of severe complications during pregnancies in diabetic women. This case report demonstrates that increased awareness of DKA with immediate recognition and a successful multidisciplinary approach are mandatory for an positive pregnancy outcomes.