Poster Session I
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individuals. In the United States, racial disparities contribute to
higher maternal mortality among non-Hispanic black women.
Pregnancy complications often progress from a continuum of health
to severe morbidity and eventually death. Severe maternal morbidity
(SMM) are more common, preventable events that have not been
fully quantified in pregnant women with SCD. We examined the
association between SCD and the risk of SMM in a contemporary
cohort of pregnant women.
STUDY DESIGN: This is a retrospective cohort study of pregnancy
deliveries between 2011-2020 at a single, urban institution in
Atlanta, Georgia, examining the risk of SMM in women with SCD
compared to women without disease. SMM were defined by Centers
for Disease Control and Prevention (CDC) indicators with Inter-
national Classification of Diseases 9 and 10 codes. Using multivar-
iable generalized linear models, we estimate risk ratios and 95%
confidence intervals for the association between SCD and SMM. All
analyses were done with SAS 9.3.
RESULTS: Among 25,275 deliveries during the study period, 137
deliveries met the inclusion criteria for SCD. Of those deliveries, 89
(64.5%) had sickle cell crisis, 37 (27%) sepsis, 25 (18%) acute renal
failure, 19 (13.9%) acute respiratory distress syndrome (ARDS), and
14 (10%) air or thrombotic embolism. Among the deliveries with
SCD, 92 (67%) experienced SMM. Compared to those without
disease, deliveries with SCD had increased risk of cardiac arrest (RR
39.5, 95% CI 11.5-136.0), air and thrombotic embolism (RR 31.1,
95% CI 18.1-53.4), puerperal cerebrovascular disorders (RR 28.8,
95% CI 15.1-54.9), shock (RR 23.1, 95% CI 12.6-42.2) and ARDS
(RR 22.1 95% CI 14.21-34.6).
CONCLUSION: SCD in pregnancy is significantly associated with SMM
during delivery hospitalization. Further identification and evaluation
of factors contributing to SMM are critical for implementing pre-
vention strategies to reduce pregnancy-related mortality in black
women.
203 Implementation of an Enhanced Recovery After
Cesarean protocol improves patient satisfaction: the
ERAC questionnaire
1 2
Autusa Pahlavan , Martha K. Coghlan , Suzanne Alton , 2 bacteria vaginosis compared with gonorrhea and
Liviu Cojocaru3, Ariel Trilling4, Hyunuk Seung5,
Bhavani Kodali2, Sarah Crimmins6,
Katherine Goetzinger2
1 2
Johns Hopkins University School of Medicine, Baltimore, MD, University of
Maryland Medical Center, Baltimore, MD, 3University of Maryland School of
S144 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2022
ajog.
Medicine, Baltimore, MD, 4UPMC Magee-Womens Hospital, Pittsburgh, PA,
5
University of Maryland, Baltimore, Baltimore, MD, 6University of Maryland,
Baltimore, MD
OBJECTIVE: The impact of Enhanced Recovery After Cesarean
(ERAC) pathways on patient satisfaction has not been well studied.
We aimed to evaluate if the implementation of an ERAC protocol
would improve patient satisfaction in the postoperative period using
a validated 10-item questionnaire (ERAC-Q).
STUDY DESIGN: This is a prospective cohort study of patients older
than 18 undergoing an uncomplicated cesarean delivery (CD) before
(October 2019-February 2020) and after (May 2020-September
2020) implementation of our ERAC protocol. We excluded CD done
under general anesthesia, those complicated by massive transfusion
events, bowel injury, intensive care unit admission, and skin incision
other than Pfannenstiel. Additionally, we excluded patients with
chronic pain disorders, chronic opioid use, acute postpartum
depression, or neonatal demise prior to discharge. Patients in both
cohorts were administered ERAC-Q to assess satisfaction with
various aspects of their recovery experience on postoperative day 1
and day of discharge. Items were scored on a scale of 0 to 10, with
0 representing highest satisfaction. Baseline demographics and dif-
ferences in ERAC-Q scores were compared between pre-ERAC and
post-ERAC cohorts using c2 test or Fisher’s exact and Wilcoxon
rank-sum test or Student’s t-test as appropriate.
RESULTS: Of the 308 patients undergoing CD during this period, 196
were in the pre-ERAC group and 112 in the post-ERAC group.
Patients in the post-ERAC group had higher overall satisfaction on
postoperative day 1 [1.6(0.7, 2.8) vs. 2.7(1.6, 4.3), p< 0.001] and day
of discharge [0.8(0.3, 1.5) vs. 1.4(0.7, 2.2), p< 0.001]. Patients in the
post-ERAC group also had significantly higher satisfaction with
specific elements of care, including pain control, comfort, inde-
pendent ambulation, care for newborn and self without assistance,
and feeling in control.
CONCLUSION: Implementation of our ERAC protocol was associated
with higher patient satisfaction in the postoperative period. The
ERAC-Q can be used as a component of ERAC pathways to evaluate
patient satisfaction.
204 Preterm complications associated with
chlamydia infection
Ruofan Yao1, Alicia M. Cryer2, Hoang Nguyen3, Bo Park4
1
Loma Linda University, Loma Linda, CA, 2Loma Linda University Health
System, Loma Linda, CA, 3Loma Linda, Loma Linda, CA, 4Cal State
Fullerton, Cal State Fullerton, CA