bluuebunny/crossref_metadata_2025 huggingface dataset:
Is Mask Ventilation an Acceptable Alternative to Endotracheal Intubation for Pregnant Women Undergoing ECT? [A162]
Authors: Jhaveri Vasanti , Martinez Ramon , Trippensee Arvin , Roussos-Ross Dikea (Kay) , Brennan Meghan , Wendling Adam
Published: June 2022

INTRODUCTION:

Electroconvulsive therapy (ECT) is an evidence-based treatment for severe depression and bipolar disorder in pregnancy. ECT involves induction of general anesthesia with muscle relaxation requiring positive-pressure ventilation. Airway manipulation may lead to complications such as vocal cord injury, aspiration, inability to ventilate, and death. Appropriate airway management for ECT in pregnant patients is unknown. The purpose of this study was to determine if there are differences in incidence of airway complications (AWC) in subjects who underwent mask ventilation (MV) versus endotracheal intubation (ETI).

METHODS:

This was a retrospective case-control study conducted from June 1, 2011, to June 30, 2020, of all adult pregnant patients who underwent anesthesia for ECT. Each ECT treatment on a pregnant patient was matched with two ECT treatments in nonpregnant control patients. Charts were queried for airway management (MV versus ETI), gestational age, and AWCs. Each ECT procedure was considered an independent airway event.

RESULTS:

A total of 13 nonpregnant and 11 pregnant patients met inclusion criteria and received 154 and 76 ECT treatments, respectively. Of the 76 ECT treatments in pregnant patients, 12 occurred in the first trimester, 44 in the second trimester, and 20 in the third trimester. In pregnant patients, airway management consisted of MV in 57 of the 76 treatments: 12 in the first trimester, 33 in the second trimester, and eight in the third trimester. No airway complications were experienced in pregnant or nonpregnant patients.

CONCLUSION:

There were no airway complications observed in pregnant patients undergoing either MV or ETI regardless of gestational age. Our data supports consideration of less invasive airway management during ECT of pregnant patients.
Provider Attitudes and Practice Patterns for Periviable Birth Management [A166]
Authors: George Joshua S. , Swor Katie , Fernandes Nithi , Tremonti Nadia , Gonik Bernard
Published: June 2022

INTRODUCTION:

Periviable birth (PV) is a clinical situation marked by prognostic uncertainty and high maternal and neonatal morbidity and mortality. The objective of this study was to examine obstetric care professional practice patterns in managing PV as a basis for a multidisciplinary exchange.

METHODS:

A cross-sectional survey was administered between February and April 2021 to obstetric (OB) and neonatal (NEO) providers. The survey consisted of nine vignettes with binary questions assessing intrapartum interventions (IPI), resuscitation (RESUS), cesarean delivery (CD), and lethality. Responses were analyzed using a 5-point Likert scale and Fisher's exact test.

RESULTS:

Respondents (N=59) rated their confidence in counseling on IPI and neonatal outcomes as 3.11±1.14 and 3.05±1.11, respectively. A total of 79% would offer IPI at earlier gestational ages (GA) than guidelines suggest, with no difference between groups (76% OB versus 100% NEO; P=.19). At 22 weeks GA, 90% would offer RESUS and 52.5% would offer CD. When confronted with RESUS against maternal wishes at 24 weeks, 57% OB and 50% NEO opined this was an obligation with signs of life at birth (P=.72). In vignettes involving presumed lethality, 92% would want NEO at delivery, 85% would offer RESUS if requested, and 50% would offer CD.

CONCLUSION:

At a center commonly confronted with PV, providers were more likely to offer IPI and RESUS and less likely to offer CD at lower GA. Similar attitudes were observed between OB and NEO providers. The survey identified dichotomous themes involving lethality and patient/provider autonomy. This exercise established ongoing educational efforts to improve patient counseling and provider confidence in decision making.
Does Peripartum Miscalculation of Estimated Fetal Weight Increase Maternal or Fetal Complications? [A181]
Authors: Bharucha Jinai , Rimsza Rebecca , Raghuraman Nandini , Bligard Katherine H.
Published: June 2022

INTRODUCTION:

An estimated fetal weight (EFW) is frequently determined near the time of delivery. We investigated whether discrepancy between EFW and birth weight was associated with increased rates of maternal or neonatal complications.

METHODS:

We performed a secondary analysis of an institutional review board‒approved retrospective cohort study including all women delivering non-anomalous, term singletons via scheduled cesarean delivery from 2004 to 2014. EFW was determined by Leopold maneuvers or recent ultrasound. An accurate EFW was defined as within 20% of BW, while an inaccurate EFW was an EFW >20% or <20% of BW. Neonatal and maternal outcomes were compared based on accuracy of EFW. Neonatal outcomes included Apgar<7, death, hypoxic ischemic encephalopathy, therapeutic hypothermia, intubation, respiratory distress, and seizures. Maternal outcomes included postpartum hemorrhage, transfusion, wound infection, and venous thromboembolism. Multivariable logistic regression was used to adjust for confounders.

RESULTS:

The EFW was inaccurate in 223/1,697 (13.1%) cases. Increasing maternal BMI and abnormal birth weight were associated with inaccurate EFW. The EFW overestimated birth weight in 72/167 (43.0%) of SGA neonates and underestimated birth weight in 47/238 (19.7%) of LGA neonates. Risk of postpartum hemorrhage was two-fold higher when EFW was inaccurate (aOR, 2.09; 95% CI, 1.02–4.31). All other surgical and neonatal outcomes were similar between groups.

CONCLUSION:

Inaccurate estimation of birth weight is more common in LGA and SGA neonates. Increased postpartum hemorrhage, but no other adverse outcomes, were seen when birth weight was inaccurately estimated. Future research should investigate the impact EFW–birth weight discordance has on outcomes after labor.
Size and Number of Placental Lakes on 20-Week Anatomy Ultrasound and Obstetric Outcomes [A190]
Authors: Mansoor Sanaa , Kouba Insaf , Blitz Matthew J. , Bracero Luis A.
Published: June 2022

INTRODUCTION:

Placental lakes are vascular spaces within the placenta filled with maternal blood which appear hypoechoic on ultrasound. They are frequently dismissed as a benign finding despite limited data. The objective of this study was to determine whether large lakes or multiple lakes are associated with an increased risk of adverse pregnancy outcomes.

METHODS:

Retrospective cohort of all pregnant women with placental lakes on 20-week fetal anatomy ultrasound from January 2018 to July 2021 who delivered at one of seven hospitals in a large health system. Exclusion criteria were multiple gestations, placenta previa, and invasive placentation. For each patient, clinical characteristics were obtained and ultrasound images were reviewed to determine whether multiple lakes were present and to measure the lake with the longest dimension. Patients with small placental lakes (<5 cm) were compared to those with large placental lakes (≥5 cm). The outcomes of interest were preterm birth, low birth weight, mode of delivery, and preeclampsia. Institutional review board approval was obtained.

RESULTS:

A total of 210 patients were included for analysis: 23 (11%) had large placental lakes and 187 (89%) had small placental lakes. The mean largest dimensions were 6.3 cm and 3.0 cm in each group, respectively. Multiple lakes were observed in 163 cases (78%). No demographic differences were noted between groups. There was no difference in gestational age at delivery, preterm birth, cesarean delivery, preeclampsia, or birth weight between groups.

CONCLUSION:

Placental lakes identified on 20-week fetal anatomy ultrasound, even when larger than 5 cm or multiple, were not associated with adverse pregnancy outcomes.
Impact of COVID-19 on Pregnancy Outcomes: A Propensity Score Matched Study [A200]
Authors: Patel Mayuri , Mangione Mary , Perreand Elsa , Miyamoto Matthew , Cojocaru Liviu , Chua Joel V.
Published: June 2022

INTRODUCTION:

Available data on the association between COVID-19 and adverse pregnancy outcomes is limited by ascertainment bias. Our objective was to assess the impact of COVID-19 on pregnancy outcomes in a propensity score matching (PSM) study. This allows for balancing of observed baseline covariates and decreases the effect of confounding factors.

METHODS:

We conducted a retrospective, multicenter, case-control study to understand the association between COVID-19 and pregnancy outcomes. We reviewed all consecutive charts of adult females aged 18–45 years with SARS-CoV-2 infection between March 1, 2020, and August 31, 2020. Cases were patients diagnosed with COVID-19 during pregnancy (COVID+), whereas controls were pregnant patients who tested negative for COVID-19 (COVID–). We excluded cases with multiple gestation or incomplete data. PSM was performed using age, race/ethnicity, body mass index, and past medical history. The primary outcome was a compound score of pregnancy complications (pregnancy loss, neonatal demise, fetal growth restriction, hypertensive disorders of pregnancy, preterm premature rupture of membranes, preterm delivery, and placental abruption). Analyses were performed with SAS software.

RESULTS:

A total of 2,474 patients were identified, of which 2,374 were COVID– and 100 COVID+. There was a trend toward higher rate of adverse pregnancy outcomes in the COVID+ group (48 [48%] versus 917 [38.7%], P=.06). The results remained unchanged after optimal one-to-four PSM was applied (48 [48%] versus 151 [37.8%], P=.06).

CONCLUSION:

COVID-19 in pregnancy appears to be associated with an increased risk for adverse pregnancy outcomes. Although our study had a trend toward statistical significance, further research with a large sample size is required.
Trends in Hospitalization for Preterm Labor Without Delivery in the United States, 2007–2014 [A210]
Authors: Sheu Joanne , Al-Haddad Sara , Tran Van , Calixte Rose
Published: June 2022

INTRODUCTION:

Hospitalizations for suspicion of preterm labor are often discharged without delivery, which incurs significant socioeconomic costs. Using the National Inpatient Sample, we seek to describe the epidemiology of these preterm labor admissions that do not result in delivery and evaluate associated trends over time.

METHODS:

The National Inpatient Sample, years 2007–2014, was queried for all discharges containing the ICD-9 code for preterm labor. Data describing age, ethnicity, primary payer, length of admission, and total hospital charges were analyzed. Weighted regression analysis was used to identify trends in continuous variables and regression models were used to evaluate trends in proportion of race and insurance coverage.

RESULTS:

The estimated number of qualifying discharges per year decreased from 88,955 in 2007 to 52,970 in 2014. The ratio of admissions for preterm labor without delivery to admissions for preterm labor resulting in delivery decreased from 1:3.76 to 1:4.32 (P

trend
<.01). Estimated adjusted mean total hospital costs increased from $12,223 to $15,438 (P

trend
<.01). The proportion of discharges with Medicaid and “other” insurance coverage changed significantly from 48.6% to 54.82% (P

trend
=.03) and 9.68% to 7.9% (P

trend
=.05), respectively. Mean length of stay, changes in proportion of race, and changes in coverage by private insurance were not significant.

CONCLUSION:

A decreased ratio of undelivered to delivered preterm labor discharges over time may indicate that identification of true preterm labor is improving. However, increasing hospitalization costs with an increasing proportion of patients covered by Medicaid has concerning implications. Further study on the epidemiology of resolved preterm labor may improve the cost-effectiveness of future patient care.
Pregnancy Outcomes Among Women With Bulimia Nervosa [A217]
Authors: Trahan Marie-Julie , Badeghiesh Ahmad , Baghlaf Haitham , Picado Jennifer , Dahan Michael H.
Published: June 2022

INTRODUCTION:

Bulimia nervosa may be associated with inadequate pregnancy weight gain, nutritional deficiencies, and maternal stress. However, knowledge of maternal and newborn risks associated with bulimia nervosa during pregnancy remains limited. The objective of this study was to evaluate pregnancy outcomes among women with bulimia nervosa using a population database.

METHODS:

A retrospective cohort study was conducted using data from the Healthcare Cost and Utilization Project–Nationwide Inpatient Sample from 2004 to 2014. ICD-9 code 307.51 was used to identify deliveries among women with bulimia nervosa. Multivariate logistic regression analyses were performed, adjusting for confounding effects.

RESULTS:

Of the 9,096,788 pregnancies included in the cohort, 260 were among women with bulimia nervosa (2.86/100,000 pregnancies). Infants born to women with bulimia nervosa were more likely to be small for gestational age (SGA) compared to infants born to women without bulimia nervosa (aOR, 3.35; 95% CI, 1.85–6.09). There were no statistically significant differences in the risk of gestational hypertension, preeclampsia, gestational diabetes, or preterm delivery between groups.

CONCLUSION:

Contrary to previous smaller studies, we found an increased risk of SGA among pregnant women with bulimia nervosa. Therefore, we recommend increased surveillance for fetal growth restriction among women with eating disorders in pregnancy.
The Obstetric Response to the Opioid Epidemic [A218]
Authors: Tuller Molly , Miller Edward E. , Frazier La-Tisha , Engelbrecht Allison B. , De La Paz Melisa Noa
Published: June 2022

INTRODUCTION:

Daily, 136 Americans die from an opioid overdose. One of the areas hardest hit by this epidemic is the Appalachian region. To combat this crisis, Congress and the American College of Obstetricians and Gynecologists recommend a multifaceted approach in identifying, monitoring, and managing patients. Medication-assisted treatment (MAT) with methadone or buprenorphine is a cornerstone of therapy. Despite the acceptance of MAT as standard of care, opioid related maternal and neonatal morbidity rates continue to rise.

METHODS:

A telephone survey of obstetric care professionals in highly affected counties (as determined by Centers for Disease Control and Prevention analysis) in West Virginia, Kentucky, Ohio, Tennessee, Indiana, and South Carolina was performed. Providers were asked if they: 1. Prescribe methadone or buprenorphine; 2. Manage patients who obtain the medications from other prescribers; 3. Had a preferred provider where they referred these patients. Additional variables included average distance to the referral center and average wait time on phone.

RESULTS:

Our data show that pregnant women experience limited access as well as significant barriers in obtaining MAT compared to nonpregnant patients. Data analysis will be displayed graphically as well as illustratively using state mapping data highlighting the limited options that pregnant women face when seeking MAT.

CONCLUSION:

Our data show a wide gap in both the quantity and the accessibility of obstetric providers willing to prescribe MAT to pregnant patients. The burden of management has fallen disproportionately on academic centers and non-obstetric providers which makes accessing this potentially life-saving treatment in a timely manner out of reach in this high-risk population.
The Utility of Rescue Antenatal Corticosteroids in Patients With Preterm Prelabor Rupture of Membranes [A222]
Authors: Gulersen Moti , Gyamfi-Bannerman Cynthia , Peralta Patricia , Li Xueying , Rochelson Burton , Bornstein Eran
Published: June 2022

INTRODUCTION:

The benefit of rescue antenatal corticosteroids (ACS) in patients with preterm prelabor rupture of membranes (PPROM) is unknown. We investigated whether rescue ACS is associated with a lower rate of adverse neonatal outcomes in patients with PPROM.

METHODS:

Retrospective cohort of all patients admitted with PPROM within a university health system from October 2015 to May 2020. Patients with singleton gestations and PPROM between 23 0/7 and 32 6/7 weeks of gestation who remained undelivered seven days after admission, and thus were eligible for a second course of ACS, were included. Missing outcome data were excluded. Cases were stratified into two groups based on the number of ACS courses administered: one course (n=52) versus a second, rescue course (n=20). The primary outcome was the incidence of respiratory distress syndrome (RDS). Secondary outcomes included mechanical ventilation (MV), neonatal intensive care unit (NICU) length of stay, and composite neonatal morbidity. Statistical analysis included use of chi-square and Wilcoxon rank sum tests.

RESULTS:

Patient characteristics such as gestational ages at PPROM and delivery, time interval from PPROM to delivery, rate of chorioamnionitis, magnesium exposure prior to delivery, and mode of delivery were similar between the two groups. The incidence of RDS in neonates was similar between the two groups. Secondary outcomes were also similar between the two groups.

CONCLUSION:

Our data did not show improvement in respiratory morbidity in neonates exposed to rescue ACS following PPROM. This remains an understudied clinical scenario, and future studies with larger cohorts are needed before determining clinical guidelines regarding rescue ACS for this select population.
Impact of a Multidisciplinary Team Approach on the Diagnosis and Management of Placenta Accreta Spectrum Disorder [A228]
Authors: Yao Ruofan , Nguyen Hoang Yen , Hong Linda , Martin Courtney , Balli Kevin , Ioffe Yevgeniya
Published: June 2022

INTRODUCTION:

Patients with suspected placental accreta spectrum (PAS) are recommended to be referred to specialized centers for antepartum management and cesarean hysterectomy. Previously, it was shown that multidisciplinary approach could improve outcomes, but evidence on referral volume and antenatal diagnostic accuracy were sparse. Our goal is to evaluate the impact of a multidisciplinary team on referral volume, diagnostic accuracy, and surgical outcomes.

METHODS:

This was a single-center retrospective cohort study, based in the only university-affiliated tertiary referral center within the region. Patients who underwent cesarean hysterectomy for suspected PAS from January 2014 to April 2021 were divided based on pre- and post-exposure of the multidisciplinary team in January 2019. The outcomes of interest were quantitative blood loss, blood transfusion, diagnostic accuracy, ICU admission, bladder injury, and postoperative length of stay. This study was approved by the institutional review board (#520052).

RESULTS:

A total of 114 patients were included in the cohort: 59 patients were from January 2014 to December 2018 and 55 patients were from January 2019 to April 2021. Since the establishment of the multidisciplinary center, there was a 1.4-fold increase in referral volume. Patients undergoing cesarean hysterectomy since the establishment of the multidisciplinary team had less quantitative blood loss (P=.005) and required less units of packed red blood cell transfusion (P<.001). In addition, the diagnostic accuracy improved from 35.6% to 83.6% (P<.001).

CONCLUSION:

Since the establishment of the multidisciplinary team, our center experienced an increase in referral volume, improvement in antenatal diagnostic accuracy, and surgical outcomes.
Loving Mothers’ Hearts: Screening for Undiagnosed Cardiomyopathy in Peripartum Women [A229]
Authors: Warkus Erica , Glaze Danielle , Castro Monica , Dowd Anne , Drafahl Bridget , Hill Washington C.
Published: June 2022

INTRODUCTION:

Peripartum cardiomyopathy (PPCM) is a leading cause of pregnancy-related maternal mortality, but it is easily treated if diagnosed early. Better screening allows earlier treatment, which can decrease maternal mortality. Prognosis is closely linked to left ventricular ejection fraction (LVEF) at time of diagnosis and treatment. There are no consensus screening guidelines for PPCM.

METHODS:

To address this need, we have created a PPCM screening questionnaire (PSQ), which is used to calculate a PPCM Severity Index (PSI). The PSQ was distributed on social media to women with PPCM (N ∼4,900), preeclampsia (N ∼3,000), uncomplicated pregnancies, and participants enrolled from a cross-sectional sample of peripartum patients presenting to a single maternity center. Peripartum participants in this ongoing, Institutional review board‒approved study (n=1,500) are screened for PPCM using bedside echocardiography. The LVEF measurements are paired with PSI scores and N-terminal pro b-type natriuretic peptide (NT-proBNP) levels for analysis. Study participants are offered free serial echocardiographic assessments at 0–2 weeks, 4–6 weeks and 5–12 months postpartum.

RESULTS:

Preliminary data show that PSI scores are correlated with degree of LV dysfunction and can differentiate between women with PPCM (n=178), healthy pregnant controls (n=32), and women with preeclampsia (n=43). Postpartum PSI scores were more specific for PPCM than pregnant PSI scores. The most frequent symptoms reported by PPCM patients are dyspnea (94%), orthopnea (84%), and fatigue (79%).

CONCLUSION:

The PSQ is an effective screening tool for PPCM and, if used in conjunction with BNP testing and echocardiography, may significantly reduce pregnancy-related maternal mortality.
Should Women With Diabetes Be Counseled Differently If Nephropathy Was Detected? [A242]
Authors: Baghlaf Haitham , Aldhaheri Sarah , Badeghiesh Ahmad , Dahan Michael H.
Published: June 2022

INTRODUCTION:

The prevalence of diabetes mellitus (DM) has increased tremendously in the last two decades mainly due to the pandemic of obesity. Diabetes is a well-known cause of complications during pregnancy. Diabetic nephropathy (DN) is a marker of severe diabetes and resultant organ damage. Despite that, only small studies have evaluated the implications of DN on pregnancy complications. The objective of this study was to explore the effect of nephropathy on obstetric and perinatal outcomes among women with DM using a population database.

METHODS:

This was a retrospective cohort study utilizing data from the Healthcare Cost and Utilization Project–Nationwide Inpatient Sample including women who delivered between 2004 and 2014. Multivariate logistic regression was used to control for confounding effects.

RESULTS:

Among 86,615 pregnancies that were complicated by DM, 1,241 (1.4%) had DN. Women with DN were more likely to smoke during pregnancy; have chronic hypertension, neuropathy, retinopathy, peripheral circulatory disorders, and thyroid diseases; and experience diabetic ketoacidosis compared to diabetic patients without nephropathy (all P<0.05). After adjusting for confounding factors, DN was associated with preeclampsia (aOR, 2.26; 95% CI, 1.90–2.68), superimposed preeclampsia or eclampsia (aOR, 4.21; 95% CI, 3.53–5.01), preterm birth (aOR, 1.83; 95% CI, 1.59–2.1), and blood transfusion (aOR, 3.55; 95% CI, 2.82–4.46).

CONCLUSION:

DN is associated with increased obstetric and perinatal morbidity than DM alone. These patients may benefit from vigilant antenatal surveillance, rigorous screening and prevention methods for hypertensive disorders and delivery in a tertiary-care center.
Outcomes in Adolescent Pregnant Patients Infected With SARS-CoV-2 [A249]
Authors: Murrin Ellen M. , Nguyen Anh Q. , Hitchings Laura , Nasrallah Sebastian , Wang Jenny , Gomez Luis M.
Published: June 2022

INTRODUCTION:

Pregnancy carries increased risk factors for severe COVID-19 and adverse obstetric outcomes. Yet, it has not been evaluated whether increased risk during pregnancy varies with age. We sought to evaluate the risk of severity and adverse obstetric outcomes in SARS-CoV-2 positive adolescent patients compared to both non-infected adolescent and infected non-adolescent subjects.

METHODS:

Retrospective study across four Inova Health System Hospitals between March 2020 and January 2021. Patients were grouped by age and SARS-CoV-2 status: (i) adolescents (aged 14–19 years) SARS-CoV-2-positive, (ii) adolescents SARS-CoV-2-negative, and (iii) adults (age >20 years) SARS-CoV-2-positive. Statistical pairwise and regression analyses evaluated differences in disease distribution, severity, rates of prematurity, and cesarean delivery (CD) between group (i) and groups (ii) and (iii).

RESULTS:

Compared to SARS-CoV-2-negative adolescents (n=394), SARS-CoV-2-positive adolescents (n=48) were more likely to be Hispanic (91.7% versus 12.2%; adjusted P<.001), be uninsured (50% versus 7.9%; adjusted P<.001), require CD (25% versus 11.9%; adjusted P=.03), and deliver at greater gestational age (39 1/7 versus 38 4/7 weeks; adjusted P=.002). Compared to adult SARS-CoV-2-positive patients (n=695), adolescent SARS-CoV-2-positive patients were more likely to be Hispanic (91.7% versus 74.5%; adjusted P=.006), asymptomatic (79.2% versus 60.7%; adjusted P=.03), and to deliver at greater gestational age (39 1/7 versus 37 6/7 weeks; adjusted P=.004). We found no significant difference in the rates of prematurity, fetal growth restriction, NICU admission, and stillbirth.

CONCLUSION:

SARS-CoV-2 unequally affects Hispanic and uninsured adolescent pregnant patients. Infected adolescents are at high risk for CD compared to their non-infected adolescent counterparts. Infected pregnant adolescents tend to present with fewer COVID-19 symptoms compared to infected pregnant adults. Other obstetric outcomes were comparable among groups.
Effect of Guideline Change on Preconception Counseling for Heart Disease in Pregnancy [A250]
Authors: Berra Alexandra L. , Turrentine Mark A. , Ramirez Mildred A.
Published: June 2022

INTRODUCTION:

There is limited evidence that implementation of guidelines in preconception counseling improves pregnancy outcomes. In 2019, the American College of Obstetricians and Gynecologists’ Pregnancy and Heart Disease Task Force developed a risk assessment score for cardiovascular disease based on symptoms, vital signs, risks factors, and physical examination. Women with a combined score of ≥4 are to be referred to maternal–fetal medicine (MFM) or primary care or cardiology (PCP) plus obtaining an electrocardiogram (EKG) with brain natriuretic peptide (BNP). Our objective was to estimate the effect of guideline changes on risk screening for cardiovascular disease during preconception counseling.

METHODS:

Retrospective chart review of women undergoing preconception counseling 6 months before versus 6 months after guidelines changed. We identified women with a combined score of ≥4 to evaluate if recommendations were followed.

RESULTS:

During the six months pre-publication, 174 women underwent preconception counseling, compared with 187 in the six months post-publication. Most women were screened by a reproductive endocrinology infertility (REI) physician (95% versus 83% in the pre versus post periods). Similar rates of women had a score of ≥4 in the two periods (5% versus 3%, P=.59). Referral to MFM or a PCP physician was high (88% versus 100%, P=.78), but there was no improvement for obtaining an EKG (88% versus 33%, P=.09) or BNP (0% versus 0%).

CONCLUSION:

Women with preconception counseling are being screened primarily by REI and are being referred to MFM/PCP, but are not consistently receiving recommended cardiovascular screening.
The ARRIVE Effect: What Do the Real-World Data Show? [A251]
Authors: Wood Rachel , Clapp Mark A. , Little Sarah
Published: June 2022

INTRODUCTION:

Published in August 2018, the ARRIVE trial found that induction of labor (IOL) of low-risk, nulliparous patients at a gestational age (GA) of 39 weeks decreased the risk of cesarean delivery (CD). We assessed the rate of elective IOL and CD rates post-ARRIVE in the U.S.

METHODS:

The 2018–2020 U.S. Vital Statistics birth certificate database was used. Nulliparous, singleton, low-risk pregnancies at 39 weeks of gestation or greater were included. Data was analyzed by county and quarter, including counties with more than 100 births in all quarters. Comparisons were made between April and June 2018, the quarter just prior to ARRIVE publication, and October and December 2020, the latest available quarter.

RESULTS:

A total of 297 counties were included, representing over 120,000 births per quarter. The rate of all IOL ≥39 weeks GA increased significantly, from 35% (±9%) to 41% (±11%) (paired t test, P<.001), as did the rate of IOL specifically in the 39th week, from 13% (±6%) to 18% (±8%) (paired t test, P<.001). An interrupted time series analysis showed that the rate of IOLs in the 39th week was rising pre-ARRIVE, but the rate of change was significantly greater post-ARRIVE (0.3% increase per quarter in 39-week IOL post-ARRIVE versus 0.19% increase pre-ARRIVE, P<.001). There was no change, however, in the CD rate: 25.1% (±5%) to 24.7% (±5%) (paired t test, P=.054).

CONCLUSION:

Since the publication of the ARRIVE trial, nulliparous, singleton, low-risk ≥39-week inductions have significantly increased across the U.S. at a greater rate than prior to ARRIVE. There has been no change in the rate of CD.
Can Noninvasive Hemoglobin Testing Be Used to Detect Postpartum Anemia? [A253]
Authors: Mills Kienna , Malhotra Radhika , Lett Christine , Karreman Erwin
Published: June 2022

INTRODUCTION:

Noninvasive hemoglobin analyzers measure hemoglobin percutaneously and offer the benefit of a one-time spot check without phlebotomy. The objective of this study was to determine the validity of noninvasive hemoglobin testing for detection of postpartum anemia (hemoglobin <10 g/dL).

METHODS:

A convenience sample of 584 women aged 18 and over were recruited on postpartum day 1 following a singleton delivery. Two noninvasive hemoglobin monitors, Masimo Pronto Pulse CO-Oximeter (Pronto) and Masimo Rad-67 Pulse CO-Oximeter (Rad-67), were evaluated and compared to the postpartum phlebotomy hemoglobin value.

RESULTS:

Of 584 participants, 31% (181) had postpartum anemia by phlebotomy hemoglobin measurement. Bland-Altman plots determined a positive bias of 2.4 (±1.2) g/dL with the Pronto and 2.2 (±1.1) g/dL with the Rad-67. Low sensitivity was observed: 15% for Pronto and 16% for Rad-67. Adjusting for the fixed positive bias, the Pronto demonstrated a sensitivity of 68% and specificity of 84%, while the Rad-67 demonstrated a sensitivity of 78% and specificity of 88%.

CONCLUSION:

A consistent overestimation of hemoglobin by the noninvasive monitors compared to phlebotomy hemoglobin result was observed. Even after adjusting for the fixed positive bias, the sensitivity for detecting postpartum anemia was low. Detection of postpartum anemia should not be based on these devices alone.
Trends in Co-Use Among Pregnant People Admitted for Treatment of Opioid Use Disorder [A255]
Authors: Schmidt Christina N. , Seidman Dominika
Published: June 2022

INTRODUCTION:

Co-use of opioids with other substances in pregnancy increases the risk of adverse perinatal outcomes and complicates substance use treatment. The objective of this analysis was to estimate trends in co-use among pregnant people presenting for opioid use treatment in the U.S.

METHODS:

Using the Treatment Episode Dataset, an administrative database including admissions to federally funded substance use treatment centers, we extracted substance use and demographic data on pregnant people presenting for opioid use treatment between 2000 and 2017 (N=98,444). We performed Joinpoint regression to describe trends in co-use of methamphetamines, benzodiazepines, cocaine, marijuana, and alcohol, stratified by geographic region.

RESULTS:

A total of 61% of pregnant people presenting for opioid use treatment reported co-use of another substance. Nationally, the average annual percent change (AAPC) in opioid admissions with methamphetamine (AAPC: 13.7%; 95% CI, 8.6–19.0%) and benzodiazepine co-use (AAPC: 6.7%; 95% CI, 4.5–9.0%) increased, while admissions with cocaine co-use (AAPC: –5.7%; 95% CI, –7.8% to –3.5%) decreased. Co-use of alcohol (AAPC: –3.5%; 95% CI, –5.5% to 1.4%) and marijuana (AAPC: 2.9%; 95% CI, –0.4% to 6.4%) remained stable. The increasing proportion of admissions with methamphetamine co-use was driven by trends in the West (AAPC: 10.7%; 95% CI, 4.5–17.2%), where admissions for methamphetamine co-use surpassed those for opioid use alone, and co-use with other substances.

CONCLUSION:

Co-use of opioids with methamphetamines increased among pregnant people presenting for substance use treatment between 2000 and 2017. Tailored programming is needed to meet the complex needs of pregnant people with co-use, in order to improve substance use treatment and prenatal services for this growing population.
Medical Students' Knowledge of and Attitudes Towards Oocyte Cryopreservation [A10]
Authors: Santana E'lysse A. , Jeffe Donna B. , Omurtag Kenan , Martin Caitlin E.
Published: June 2022

INTRODUCTION:

Physicians initiate childbearing at older ages and are more concerned about fertility than non-medical professionals. This study aims to assess medical students’ knowledge and attitudes towards fertility and oocyte cryopreservation (OC).

METHODS:

After institutional review board approval, an anonymous survey was administered to second-year students at Washington University School of Medicine in St. Louis assessing knowledge and attitudes towards fertility decline and OC. Descriptive statistics were performed using SPSS v28.

RESULTS:

Of 104 students, 77 (74.0%) participated. The mean (standard deviation, SD) age of participants was 24.0 (SD 1.6) years, with 62.3% female. Approximately half were in committed relationships or married. Over three-quarters were interested in having children; the average age students planned to start childbearing was 30.9 (SD 2.3) years. Over 80% of participants reported delaying childbearing for career or education reasons, and 89.1% responded with “Yes” or “Maybe” when asked if they or their partner would consider OC. Seventy-eight percent of students reported financial concerns as a barrier to OC. The average knowledge score was 42.0% (2.1/5). Most agreed that insurance companies should cover OC (89.1%) and that coverage may play a role in future training decisions (56.8%). Most agreed that education on OC should be included in education for medical students (97.2%) and postgraduate trainees (98.6%).

CONCLUSION:

Almost 90% of surveyed students would consider elective OC, but report finances as a barrier. These findings suggest that insurance coverage for OC is desired and may influence training decisions. Low knowledge scores indicate the need for better education regarding OC and fertility decline.
Immediate Postpartum Hormonal Contraceptives and Their Association With Postpartum Depression [A12]
Authors: Prasad Shailly , Frid Gabriela , Roig Jacqueline , Lunde Britt , Molenaar Nina M.
Published: June 2022

INTRODUCTION:

The purpose of this study is to determine the association between immediate postpartum hormonal contraceptives and postpartum depression (PPD) as represented by the Edinburgh Postpartum Depression Score (EPDS). Immediate postpartum contraception, including long-acting reversible contraception (LARC) placement, is convenient, effective, and becoming more accessible given ongoing reimbursement changes. Some hormonal contraceptives have been suggested to cause mood changes outside of the peripartum period. However, they have not been fully studied in the postpartum period, and postpartum depression is a significant cause of morbidity post-delivery.

METHODS:

A retrospective cohort study was performed on patients presenting for their postpartum visit from January 1, 2016 through June 30, 2019 at a hospital-based outpatient clinic. Patients were divided into three study arms (1) hormonal contraceptive (2) non-hormonal contraceptive, and (3) no contraceptive. The primary outcome, EPDS score, was collected at the postpartum visit (4-10 weeks after delivery). Multivariate analysis was performed to control for confounders including multiparity, history of mood disorders and psychiatric medications, and neonatal outcomes.

RESULTS:

A total of 1,041 patients were included in the analysis. The rate of immediate postpartum hormonal contraceptive use was 14.6%. There was no difference in the mean or median EPDS across the three study groups. There was not enough evidence to conclude that the rate of EPDS>12 or EPDS as a continuous variable was significantly different between the groups.

CONCLUSION:

Patients who received hormonal contraceptives were neither at increased risk nor decreased risk for postpartum depression.
Vomiting and Risk of Intubation Related to Preoperative Doxycycline Use for Dilation and Evacuation [A17]
Authors: Weiss Madeleine E. , Potter Laura A. , Kamboj Rabia , Ponzini Matthew D. , Wilson Machelle D. , Hou Melody Y.
Published: June 2022

INTRODUCTION:

Oral doxycycline is a common prophylactic antibiotic for second trimester dilation and evacuation (D&E) procedures, but recent research reports associated vomiting rates of 25.2-28.3%. Since deep sedation with natural airway is the preferred anesthetic route for D&E, doxycycline-associated vomiting may increase need for general endotracheal tube anesthesia (GETA) to avoid aspiration. We aimed to describe the rate of vomiting from oral doxycycline given the night before D&E, proportions of anesthesia routes, and anesthetic complications.

METHODS:

We conducted a retrospective chart review of patients presenting for second trimester D&E (14-0/7 to 23-6/7 weeks gestation) at our institution 7/1/2019-6/30/2020, identified by billing records. Our institutional review board deemed this study exempt. We recorded vomiting within 30 minutes of ingestion, anesthetic route, and complications. We tested for associations using chi-square analyses for categorical variables and Wilcoxon-rank sum for non-normal numeric variables.

RESULTS:

We reviewed 702 charts, of which 465 (66%) met inclusion criteria and 425 (61%) took doxycycline as prescribed. Thirty-one (31, 7.3%) vomited within 30 minutes of ingestion. Nulliparity and younger age were significantly associated with emesis (P<.001 and P=.03, respectively), but gestational age (P=.36), BMI (P=.94), and gastrointestinal issues (P>.99) were not. All 10 GETA events (2.4%) occurred in patients without emesis. Anesthetic complications (n=5, 1.2%) were rare and observed only in those without emesis.

CONCLUSION:

Our vomiting rates are lower than those previously published. We found no association between doxycycline-associated vomiting and either need for GETA or anesthetic complications.
Surveys of California Family Physicians and LA County Pharmacists: Pill Prescribing and Dispensing Practices [A18]
Authors: Munnangi Meghana , Matlack Abigail , Gedestad Ilish , Nelson Anita L.
Published: June 2022

INTRODUCTION:

Providing women with 13 cycles of oral contraceptives at once (a one-year supply) reduces unintended pregnancy and abortion rates. Family Planning, Access, Care, and Treatment (PACT) is a state-licensed Medicaid family planning program that is legally required to pay for 13 cycles at once if the physician orders them. Physician prescribing and pharmacy dispensing practices are key components to maximizing contraceptive efficacy.

METHODS:

In a two-part institutional review board-approved study, we conducted an online survey of California family physicians about their pill prescribing practices. We also sampled a substantial proportion of pharmacies in Los Angeles County using a secret shopper survey to determine if staff would dispense 13 cycles as the physician ordered and if they would not, how many they would dispense and why.

RESULTS:

Fifty-one family physicians completed the survey; 22 (43.1%) provided care to women on Family PACT. Eighteen of these 22 physicians reported their prescribing practices; only 5.6% prescribed 13 cycles at once. We attempted to contact 582 representative pharmacies but only successfully contacted 432. Of these, 3.2% of pharmacies stated they would dispense 13 cycles at one time, 47% stated they could not dispense 13 cycles at one time, and 49.7% required that women come in to determine prescription and insurance eligibility.

CONCLUSION:

With only 5.6% of physicians and 3.2% of pharmacies stating they would prescribe or dispense 13 cycles, women on Family PACT insurance face a substantial barrier to accessing the legally allowed amount of oral contraceptives, placing them at a higher risk for unintended pregnancies and abortions.
Validation of Chloe SED, a Low-Cost, Reusable Syringe Extension Device for the Provision of Paracervical Analgesia [A21]
Authors: Ramanathan Aparna , Gwer Stephen , Imbamba Javan L. , Odenyo Stella , Omoto Jackton , Bailey Robert C.
Published: June 2022

INTRODUCTION:

Women in Kenya and other low- and middle-income countries often do not receive analgesia during manual vacuum aspiration (MVA). This pilot study evaluated the efficacy of a novel, ultra-low-cost syringe extension device (Chloe-SED) developed by this research team for provision of paracervical block (PCB) during MVA.

METHODS:

A randomized, single-blinded non-inferiority trial of 61 patients was conducted at two facilities in Kisumu between September 2019 and January 2021 comparing PCB administered with Chloe-SED to a standard spinal needle. The primary outcome was non-inferiority of pain score during uterine evacuation within a non-inferiority margin of 2 points on an 11-point visual assessment scale. Secondary outcomes included non-inferiority of pain score at 4 other time points, patient satisfaction, and provider feedback on Chloe-SED. Institutional review board approval was obtained and written consent was obtained from all participants.

RESULTS:

Chloe-SED showed non-inferiority of the primary outcome with mean pain score during evacuation of 3.9 (3.2-4.7) compared with spinal needle at 4.1 (3.5-4.7). Non-inferiority was shown at all time points. In one patient the syringe and device were incompatible. In one case, breakage of the finger-pad of the device after completion of PCB was noted with no injury to patient or provider. Most patients and providers expressed desire for continued use of the device to administer PCB for MVA.

CONCLUSION:

The Chloe SED device appears effective and desirable for administration of PCB during MVA. Further study and development of Chloe SED will allow humane pain control during MVA in regions worldwide where this previously was not possible.
The Effect of Immediate Postpartum Implant Use on Breastfeeding or Breast Milk Supply [A28]
Authors: Fleurant Erin , O'Sullivan David , Hazel Kathleen , Crim Mary Marshall , Kuhnly Joan , Johnson Amy
Published: June 2022

INTRODUCTION:

Lactogenesis is triggered by withdrawal of circulating progesterone after birth, thus leading to theoretical concern that progesterone-containing contraception may decrease breast milk production. While current studies show no adverse effects of implant placement on milk supply, there has not yet been a study to evaluate the effects with immediate postpartum implant use.

METHODS:

We performed a prospective cohort study from June 2019 through April 2021. Inclusion criteria were breastfeeding females ages 18 years and older. Exclusion criteria were use of other hormonal contraception, contraindications to breastfeeding, or inability to breastfeed due to neonatal circumstances. Participants were enrolled prior to discharge and assigned to an implant (progesterone-containing contraceptive) or control group. Follow-up data were collected at the 6-week visit or via telephone. Statistics included Student’s t-test and chi square, and were performed using an alpha level of 0.05.

RESULTS:

A total of 151 participants were enrolled. There was no significant difference between breastfeeding rates at 6 weeks postpartum (implant 65.0% vs control 70.5%, P=.537). Cohorts differed in marital status (P<.001) and age (P=.017), with implant users more likely to be younger and single.

CONCLUSION:

Interim analysis indicates that immediate implant use does not have a significant effect on postpartum breastfeeding rates. Due to interruptions during a global pandemic, the study did not reach goal participation of implant users to adequately power the primary outcome. Despite younger age, potential lack of partner support, and a trend toward first-time mothers, immediate postpartum implant use did not appear to affect breastfeeding rates.
“There’s only one use for it”: Stigma as a Barrier to Mifepristone Use for Early Pregnancy Loss [A31]
Authors: Mokashi Mugdha , Boulineaux Christina M. , Janiak Elizabeth , Boozer Margaret , Neill Sara
Published: June 2022

INTRODUCTION:

Mifepristone combined with misoprostol has superior efficacy for early pregnancy loss (EPL) treatment compared to misoprostol alone. Mifepristone access is restricted by the U.S. Food and Drug Administration (FDA) Risk Evaluation and Mitigation Strategy program, and its use may be further limited by logistical and interpersonal barriers due to its association with abortion, especially in states with restrictive policies. Understanding barriers to incorporation of mifepristone in EPL care is key for developing interventions to improve care quality.

METHODS:

We conducted semi-structured interviews with 19 obstetrician-gynecologists in Alabama who manage EPL. Interviews explored participants’ knowledge of and experience with mifepristone use for EPL and abortion, along with barriers to and facilitators of clinical mifepristone use. Interviews were coded by multiple study staff using inductive and deductive thematic coding. This study was deemed exempt by the Harvard Medical School Institutional Review Board.

RESULTS:

Nearly all interviewees identified abortion-related stigma as a barrier to mifepristone use. Interviewees often attributed stigma to a lack of knowledge about the clinical use of mifepristone for EPL. Stigmatization of mifepristone due to its association with abortion was related to religious and politic objections. Many also described stigma associated with misoprostol use. Although providers believed mifepristone use for abortion would not be accepted in their practice, most felt that mifepristone could be successfully used for EPL after practice-wide education on its use.

CONCLUSION:

Mifepristone is strongly associated with abortion stigma, which is a barrier to its use for EPL. Interventions to increase clinical knowledge of mifepristone use and decrease stigma are needed to optimize EPL care.
Risk Factors for IUD Malposition [A36]
Authors: Frisse Ann , Louik Jay , Kachwala Isha , Wu Haotian , Avila Karina , Benfield Nerys
Published: June 2022

INTRODUCTION:

We aimed to identify the risk factors for intrauterine device (IUD) malposition and to develop a model to predict who is at risk for IUD malposition.

METHODS:

We performed a retrospective cohort study of IUD users with ultrasounds performed between July 2014 to July 2017 within a large, urban, academic medical system. Our primary outcome was IUD malposition. The Fisher’s exact test and Wilcoxon rank sum test were used. We used logistic regression, least absolute shrinkage and selection operator (LASSO), and elastic net models to predict the likelihood of having a malpositioned IUD. Institutional review board (IRB) approval was obtained for this study.

RESULTS:

Of 1,759 ultrasound reports with an IUD present, 436 described a malpositioned IUD. Compared to participants with non-malpositioned IUDs, participants with malpositioned IUDs were more likely to be younger (30.7 and 31.9 years old, P=.02), have fibroids (21.6% and 15.9%, P<.01), and have abnormal uterine bleeding (AUB) (19.7% and 14.9%, P=.02). There were no differences between groups in gravidity, parity, uterine surgeries, number of cesarean deliveries, IUD type, or timing of IUD placement relative to abortion or delivery. Reports describing malpositioned IUDs were more likely to have been authored by radiologists than gynecologists (85.1% and 13.5%, P<.01). LASSO model, elastic net model, and logistic regression were unable to identify a meaningfully predictive model for IUD malposition

CONCLUSION:

Fibroids and AUB are associated with IUD malposition. No other risk factors were statistically or clinically significant. No linear combination of factors meaningfully predicted risk of IUD malposition. Radiologists were more likely to author reports describing malpositioned IUDs.