The Center for Peripartum Optimization
The Center for Peripartum Optimization
In January 2017 investigators started a Center for Peripartum Optimization (CPO) with the aim
 of optimizing a patient's clinical status in an outpatient setting to minimize unnecessary
 laboratory tests and studies, costly inpatient consultations, the likelihood of post-surgical
 adverse events, escalations in level of care, inpatient admissions and readmissions. This
 research project seeks to evaluate the impact of this innovative concept on patient outcomes
 during the last 12 months. Investigators will accomplish this by collecting retrospective
 data from patients' electronic medical records in the intervention group and comparing it to
 data gathered from a controlled group of patients with similar comorbidities but who were not
 evaluated at the CPO clinic.
Inclusion Criteria:

 -  Records of all female, obstetric patients of child-bearing age who were evaluated in
 the Center for Peripartum Optimization during the period between January 2017 and
 January 2018.

 -  Controlled group will include parturients with match high risk comorbidities or
 history of nonobstetric surgery during pregnancy who delivered at Johns Hopkins
 Hospital (JHH) during July 1, 2016 - Dec 31, 2016

 -  Patients with any one or more of these high risk comorbidities:

 -  Complex spine pathologies (Scoliosis, vertebral fusion, disc disease, spinal canal
 defects, neuropathies, and nerve disease, etc.)

 -  Neurological pathology (Cerebral ischemia, tumor, increased intracranial pressure,
 cerebral vascular disease, etc.)

 -  Cardiac disease (Congenital, valvular, pulmonary hypertension, cardiomyopathy,
 ischemic disease, arrhythmia, etc.)

 -  Pulmonary disease (History of pulmonary embolism, interstitial lung disease, severe
 asthma, cancer, etc.)

 -  Morbid Obesity (Obstructive Sleep Apnea, equipment considerations)

 -  Hematologic Disorders (Thrombophilias, coagulopathies, patients on anticoagulation)

 -  Cancer

 -  Abnormal placentation (Previa, accreta / increta / percreta)

 -  Anesthetic concerns (Airway abnormalities, history of adverse anesthetic reactions or
 experiences (i.e. recall, anaphylaxis))

 -  Fetal therapy patients requiring specialized management (Ex utero intrapartum
 treatment (EXIT), Fetoscopic endotracheal occlusion (FETO), Twin-to-twin transfusion
 syndrome (TTTS), Percutaneous Umbilical Blood Sampling (PUBS), etc.)

 -  Chronic Pain

 Exclusion Criteria:

 -  Records of CPO participating parturients outside the specified timeframe.

 -  Records of obstetric patients of child-bearing age without high-risk comorbid
 conditions described in inclusion criteria.

 -  Records of patients seen in CPO clinic that did not deliver at our institution