INTRODUCTION: The numerical pain rating scale (NPRS) is a validated measure to quantify acute pain; however, its utility after vaginal delivery is unclear. Poorly controlled postpartum pain can increase rates of complications; therefore, pain control is paramount. We investigated how subjective pain relates to objective pain in the postpartum period. METHODS: A prospective, observational study at a single academic hospital included patients with vaginal deliveries February to October 2021. Women with opioid use disorder, wound complication, hysterectomy, or readmission were excluded. Subjective pain assessment and NPRS were completed 2 weeks postdischarge. Subjective pain was recorded as “well controlled” versus “poorly controlled.” The numerical pain rating scale was scored 0–10. RESULTS: Two hundred thirty-eight patients were included, and 174 (73%) followed up. One hundred twenty (69%) reported “well-controlled” pain, and 54 (31%) reported “poorly controlled.” There was no significant difference in delivery mode, laceration, or nonopioid medication use ( P >.05). Patients who used oxycodone were significantly more likely to report “poorly controlled” pain ( P =.02). “Poorly controlled” pain was associated with higher median NPRS score (5 [interquartile range (IQR) 4–6] versus 2 [IQR 0–3], P <.001). Among patients with “poorly controlled” pain, 11 (20.4%) had NPRS scores of 0–3. Of those who reported “well-controlled” pain, 22 (18.3%) had NPRS scores of 4–10. CONCLUSION: While NPRS scores were higher for patients with “poorly controlled” pain, this was not universal. It is critical to accurately respond to postpartum pain for the nearly 20% of patients whose subjective experience did not correlate with their objective score. Titrating pain control to subjective and objective goals may improve patient experience and outcomes.
In March 2020, the World Health Organization (WHO) declared that a novel coronavirus (COVID-19) had reached pandemic status. The United States experienced a rapid increase in cases that prompted statewide shutdowns, and hospitals quickly became overwhelmed with critically ill patients. Patient
Complete hydatidiform mole with coexisting fetus (CHMCF) is rare, and diagnosis is challenging due to limited data. Here, we present the case of a patient with noninvasive prenatal test (NIPT) resulting in "likely molar pregnancy" in the second trimester. Subsequent ultrasound confirmed a cystic appearing portion of the placenta. At 22 weeks, the patient delivered a demised fetus and two placentas. Pathology was consistent with CHMCF. This case is the first to show primary detection of a CHMCF with single-nucleotide polymorphism (SNP)-based NIPT prior to ultrasound identification. Our case suggests the use of SNP-based NIPT as an alternative noninvasive method to guide shared decision-making and clinical management for patients with this diagnosis.
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