Abstracts – 2008 - Obstetricia Crítica

prophylaxis for RT-positive women and their infants. RESULTS: Overall, 89.2%of eligible women (3671/4117) underwent RT, of whom 90.4% received resultsbefore delivery. HIV seroprevalence among all women who underwent RT was2.7% (100/3671 women); among previously untested women, seroprevalencewas 6.5% (90/1375 women); the incidence of HIV seroconversion among womenwith previous negative tests during pregnancy was 0.4% (10/2296 women). Afteradjustment, the main predictor of receiving RT results after delivery was lateadmission. Among HIV-exposed infants, 97.9% (92/94) received prophylaxis;61.7% (58/94) had available follow-up data, and 8.6% (5/58) met criteria fordefinitive or presumptive HIV infection. CONCLUSION: The RT programachieved timely detection of HIV-infected women in labor with unknown HIVstatus and effectively prevented perinatal HIV transmission.Am J Obstet Gynecol. 2008 Feb;198(2):173.e1-5.Maternal-Fetal Medicine Units Network cesarean registry: impact of shiftchange on cesarean complications.Bailit JL, Landon MB, Lai Y, Rouse DJ, Spong CY, Varner MW, Moawad AH,Simhan HN, Harper M, Wapner RJ, Sorokin Y, Miodovnik M, O'Sullivan MJ, SibaiBM, Langer O;National Institute of Child Health and Human Development Maternal-FetalMedicine Units Network. Department of Obstetrics and Gynecology, CaseWestern Reserve University, Cleveland, OH, USA.OBJECTIVE: This study was undertaken to evaluate the effect of change of shiftfor physicians and nurses on complications associated with cesarean delivery.STUDY DESIGN: 17,996 term women undergoing an unscheduled cesareandelivery in 13 centers from 1999-2000 were included. Maternal and neonatalmorbidities were evaluated by time of infant delivery vis-à-vis nursing change ofshift (6 AM-8 AM, 2 PM-4 PM, 10 PM-12 AM vs all other hours). The sample wasthen limited to weekdays only and physician shift changes were evaluated(physician shift change 6 AM-8 AM, 5 PM-7 PM vs all others). A composite of 30maternal morbidities was also evaluated by logistic regression, controlling forpotentially confounding factors. RESULTS: Physician change of shift had nomeasurable effect on maternal and neonatal outcomes. Neonatal facial nervepalsies were increased at nursing change of shift (5 vs 0) as werehysterectomies (33 [0.24%] vs 23 [0.53%]; P < .007). Nursing change of shift hadno impact on composite maternal morbidity after controlling for age, race,insurance, medical problems, prior incision type, weekend day, and prenatal care(odds ratio = 0.98; 95% confidence interval = 0.89-1.08). CONCLUSION:Physician change of shift does not appear to be associated with an increase inmorbidities. However, cesarean delivery during nursing change of shift isassociated with increased risk of neonatal facial nerve palsy and hysterectomy.Further investigation is needed to understand the cause of this association.Am J Obstet Gynecol. 2008 Feb;198(2):189.e1-6. Epub 2007 Nov 12.