Prevention of Preeclampsia: Is it Still a Disappointment?

Preeclampsia is a major cause of maternal mortality worldwide, with many preventive strategies tested. In this review we intend to provide a synthesis of available studies of these strategies that have been tested, including systematic reviews. We will not be performing systematic review of the studies here. Of these strategies tested only low dose acetyl salicylic acid (ASA) and calcium can be considered helpful for prevention at this time. A recent meta-analysis showed a benefit of low dose ASA for both high (RR 0.75, 95% CI 0.66 to 0.85) and moderate risk groups (RR 0.86, 95% CI 0.79 to 0.95). Therefore, low dose ASA in high risk groups may be useful, with a possible smaller benefit in moderate to low risk women. Another meta-analysis looking at calcium shows benefit for both high and low risk groups with an overall reduction in the risk of preeclampsia (RR 0.48, 95% CI 0.33 to 0.69). As a result, prenatal supplementation of calcium may be beneficial for the prevention of preeclampsia. However, vitamins C and E, zinc, fish oil, and magnesium supplementation have been discounted as potential preventive strategies. Nitric oxide, folic acid, and antithrombotics have not been well studied and there is insufficient data for reliable conclusions to be made. Areas of ongoing research that appear promising in the prevention of preeclampsia include modifiable metabolic factors, angiogenic proteins, angiotensin receptor antibodies, and syncytiotrophoblast microparticles. Strategies targeting these areas may provide opportunities for therapeutic interventions.

The Effects of Regular Tanning Bed Use and Increased Vitamin D Status on Serum Markers of Bone Turnover in Healthy Adult Women

Background Vitamin D is a key nutrient in bone health and the vitamin D status of individuals with regular exposure to solar or artificial ultraviolet B (UVB) radiation is generally superior to those with limited exposure. Objective By means of a cross-sectional, observational design, explore the association of serum 25-hydroxy vitamin D (25(OH)D) concentrations and biochemical markers of bone turnover across a spectrum of vitamin D status by comparing women who regularly use tanning beds with women of minimal UVB exposure. Methods A total of 69 healthy women, ages 25–82 y, were recruited. Serum concentrations of 25(OH)D, intact parathyroid hormone (iPTH), leptin, bone-specific alkaline phosphatase (BAP), osteocalcin (OC), and C-terminal telopeptides of Type I collagen (CTx) were measured. Results There were no significant differences in age, height, weight, BMI and dietary intakes between groups. Serum 25(OH)D concentrations were significantly higher in tanners (n = 20) compared with non-tanners (n = 49) (p < 0.0001). Serum iPTH concentrations were lower in tanners than in non-tanners (p < 0.0001) and were negatively correlated with serum 25(OH)D concentrations (r = –4571, p < 0.0001). Of the bone turnover markers, only serum OC concentrations were lower in tanners compared with non-tanners (p = 0.0002). After adjusting for age and menopausal status, osteocalcin was negatively correlated (r = –0.0178; p = 0.04) with 25(OH)D and positively correlated with iPTH (r = 0.035; p = 0.05). Conclusions Our results show healthy women with regular UVB exposure via tanning beds have significantly greater vitamin D status and lower serum osteocalcin concentrations than those without and that there is a significant inverse relationship between serum serum 25(OH)D and osteocalcin concentrations which appears to be PTH-dependent.

Patient Handoffs in Obstetrics and Gynecology: A Vital Link in Patient Safety

Inadequate patient handoffs have been an area of focus for patient safety improvement. Insufficient communication and risks or “shortcuts” taken by staff members during handoffs could negatively affect the safety of patients in a department of obstetrics and gynecology. Other factors that contribute to inadequate handoffs are the caregiver feeling fatigued or stressed, level of urgency, volume of information, language barriers, noise, lighting, ambiguity of describing treatment, not allotting enough time for questions asked, and/or interruptions from other staff members. There have been several methods developed for improving the handoff process, such as the mnemonic devices SBAR, SHARQ, I PASS THE BATON, and the 5 P's. A new method for improving the quality of patient handoffs has been developed and presented in this article. It is a mnemonic device entitled “HANDOFFS”. It covers key aspects of what a handoff process should entail. Teamwork is essential to effective communication, and by using a mnemonic such as this, team members can work together in a more positive and accessible environment that will result in improved patient safety.