bluuebunny/crossref_metadata_2025 huggingface dataset:
What's in a Name? Provider Type and Delivery Outcomes for Nulliparous, Term, Singleton, Vertex Pregnancies in an Urban Hospital [ID 2683515]
Authors: Vorawandthanachai Thammatat , Sher Olivia , Kumar Vani , Ajayi Blessing , Ram Kavitha T.
Published: May 2024

INTRODUCTION:

Few studies have compared the rates of cesarean section of nulliparous, term, singleton, vertex (NTSV) pregnancies between those managed by physicians and those managed by midwives. Our aim was to compare those rates and to determine whether there were any associated differences in neonatal outcomes.

METHODS:

This was a retrospective cohort study of NTSV pregnancies at an urban hospital over 3 months. Two groups were compared: patients who were managed by physicians and those managed by midwives. Our primary outcome was the rate of primary cesarean delivery for each group. Patient demographics and outcomes were compared using a χ2 analysis for categorical variables and Mann–Whitney U test for continuous variables, with significance being alpha <.05. Our study was approved by the Maimonides IRB.

RESULTS:

Between January and March 2023, there were 315 NTSV deliveries. Of these, 230 (73%) were admitted by physicians and 85 by certified nurse-midwives (27%). The NTSV patients admitted and managed by physicians were significantly more likely to undergo cesarean delivery (30.9% versus 16.5%; P=.01). This trend remains significant (P=.04) when adjusted for high-risk maternal comorbidities (ie, diabetes, hypertension, and maternal body mass index). There were no significant differences of neonatal outcomes between physician and midwives groups in Apgar scores (1 minute P=.43, 5 minutes P=.19), neonatal intensive care unit (NICU) admissions (P=.84), or NICU stay length (P=.89).

CONCLUSION:

The NTSV pregnancies managed by midwives resulted in fewer cesarean deliveries with similar neonatal outcomes. Further investigation is needed to assess causes of the difference between provider types and to develop interventions to address the discrepancy.
Association Between Proximity to Delivery Hospital and Postpartum Contraception Choice [ID 2683622]
Authors: Barbee Olivia , Class Quetzal A.
Published: May 2024

INTRODUCTION:

Proximity to prescribers may present a barrier to postpartum contraceptive care. We examine associations between postpartum contraceptive choice and residential proximity to the prescribing, delivery hospital.

METHODS:

After IRB approval, we collected electronic medical record data from 2020 to 2022 at an inner-city, academic hospital and used CDXGeoData to determine residential distance to the hospital. Contraceptive choice at delivery, 2 weeks, and 6 weeks postpartum, focusing on long-acting reversible contraception (LARC) versus other contraceptives, was compared across distance to hospital.

RESULTS:

We identified 3,705 births: 53.5% Black, 30.3% Hispanic, and 73.7% utilizing public health insurance. Residential distance to the hospital was 0–1,724 miles with 74.2% living within 10 or fewer miles. Those residing within 10 miles were more likely to be non-Black (X2 (2)=12.02; P<.01), Hispanic (X2 (2)=83.91; P<.001), single (X2 (3)=33.54; P<.001) and primiparous (X2 (3)=13.09; P<.01). Cesarean section was more frequent (32.5% versus 28.1%; X2 (2)=6.58; P<.01) and gestational age shorter (U=1171108; P<.05) for those living further from the hospital. Postpartum tubal ligation did not differ across groups. LARC uptake at discharge and 2 weeks postpartum trended towards being higher for women who lived further (X2 (1)=3.49; P=.06; aOR 1.15; 95% CI, 0.96–1.39).

CONCLUSION:

There is a trend towards increased LARC uptake if the patient resides further from their delivery hospital after controlling for confounding factors. Our findings add to understanding of patient preferences and barriers to care.
Memorial Regional Hospital Placenta Accreta Spectrum Program: Quality Evaluation of Outcomes [ID 2683637]
Authors: Solis Josselyn , Thompson Safeya , Myers Erin , McCreath Wayne , Kang Julie H.
Published: May 2024

INTRODUCTION:

Placenta accreta spectrum (PAS) affects 1/272 deliveries with a mortality rate of 7%, which is often related to life-threatening hemorrhage. Morbidity related to PAS is often due to complications such as hemorrhage requiring blood transfusion, intensive care unit (ICU) admission, and prolonged hospital stay. The American College of Obstetricians and Gynecologists supports a multidisciplinary approach to management of pregnancies complicated by PAS, and as such our protocol for management of PAS was started in 2016. Our approach to the management of PAS includes a high-risk navigation team, monthly multidisciplinary team meetings, early admission for surgical planning, a dedicated team with 24-hour coverage, blood bank specialist involvement at the time of surgery, the availability of backup surgeons, and coordination with other surgical subspecialties.

METHODS:

This project is a quality review of outcomes of 216 females between 2016 and 2023. Using linear regression analysis, we evaluated four primary outcomes: quantitative blood loss (QBL), blood products transfusion (BPT), length of stay (LOS), and ICU admissions.

RESULTS:

Linear regression outcomes showed that our QBL, BPT, and LOS among non-ICU patients is lower than the national average and within national average among those admitted to the ICU, with the exception of BPT. Finally, placenta pathology and location may not be a major factor negatively affecting surgical outcomes among PAS patients in a structured program and should be a factor considered when developing PAS centers.

CONCLUSION:

Our findings from our quality review support the use of a multidisciplinary and surgically structured approach for managing patients with PAS.
Racial Disparities in Maternal Blood Transfusion in the United States by Mode of Delivery: A Population-Based Retrospective Cohort Study [ID 2683649]
Authors: Pour Parnian Hossein , Rajasingham Maya , Muraca Giulia M.
Published: May 2024

INTRODUCTION:

Despite well-documented racial disparities in maternal health in the United States, gaps remain in characterizing the distribution of these disparities within specific interventions and outcomes during childbirth, such as blood transfusion. We aimed to assess racial disparities in maternal blood transfusion in the United States overall and stratified by mode of delivery.

METHODS:

We performed a population-based retrospective cohort study of term, live births (2016–2021) using U.S. Natality Files. Regression models were constructed to estimate adjusted odds ratios (aORs) and 95% CIs of maternal blood transfusion (during labor or delivery) by self-identified maternal race in the total population, and among subgroups stratified by mode of delivery. Models were adjusted for maternal and obstetric practice factors.

RESULTS:

The study included 15,936,920 deliveries; maternal blood transfusion occurred in 3.7 per 1,000 deliveries. Compared with White individuals (3.5 per 1,000 transfusion rate), higher odds of transfusion were seen among American Indian and Alaskan Native (AIAN) (aOR 2.31; 95% CI, 2.19–2.44) and Pacific Islander individuals (aOR 1.65; 95% CI, 1.46–1.86). The frequency of transfusion and racial disparities in transfusion rates varied substantially by mode of delivery. For example, among forceps deliveries, compared with White individuals (9.1 per 1,000 transfusion rate), Chinese individuals had a nearly twofold higher rate of transfusion (aOR 1.93; 95% CI, 1.30–2.87), whereas Black individuals had a nearly 30% lower rate (aOR 0.71; 95% CI, 0.56–0.91).

CONCLUSION:

Racial disparities in maternal blood transfusion persist after adjustment for several confounders, particularly within AIAN and Pacific Islander individuals, and vary by mode of delivery.
CDC-WONDER Database Analysis of Maternal Morbidity in Florida [ID 2683410]
Authors: Hayes Elisabeth , Wyatt Adam T. M.
Published: May 2024

INTRODUCTION:

The CDC's WONDER Natality database was updated in 2016 to include comprehensive pregnancy data, encompassing maternal morbidity, a growing concern in the United States. Using the WONDER Natality database, we can better understand risk factors and trends associated with maternal morbidity. The aim of this research is to investigate the variations in maternal morbidity in Florida, focusing on maternal demographics and pregnancy characteristics.

METHODS:

This cross-sectional descriptive study used results from the CDC’s WONDER Natality 2016–2021 expanded-results database. Five categories of maternal morbidity were analyzed. Maternal morbidity and pregnancy characteristics were analyzed for statistical significance using χ2 and unpaired t-tests.

RESULTS:

92,680 (1.04%) births in Census Region 3 (the South) were found to be associated with maternal morbidity. This prompted an in-depth examination of this region, with a particular focus on Florida. Notably, Asian mothers experienced the highest rate of maternal morbidity (1.49%), whereas Black mothers faced the lowest statistical rate (0.67%). Asian mothers experiencing maternal morbidity tended to be older, have lower pre-pregnancy body mass indexes, more prenatal visits, and shorter intervals since their last live births.

CONCLUSION:

This study underscores statistically significant maternal morbidity disparities in Florida, with Asian mothers being particularly vulnerable. It identifies several pregnancy characteristics linked to increased morbidity. Further exploration, including a county-level analysis in Florida and examination of other states in Census Region 3, could reveal or consolidate emerging trends. Moreover, the absence of a universally accepted definition for severe maternal morbidity calls for the establishment of a clear standard to guide future research and obstetric practices.
Low-Lying Placenta and Pregnancy Outcomes in a Large National Cohort [ID 2683532]
Authors: Harrison Rachel , Thomas Jacob , El Helou Yara , Shivashankar Kavya , Holmgren Calla
Published: May 2024

INTRODUCTION:

We sought to understand the association of low-lying placenta and adverse pregnancy outcomes among those undergoing cesarean delivery.

METHODS:

This was a retrospective cohort study of persons undergoing cesarean delivery using the National Inpatient Sample from 2017 to 2019 through HCUP/AHRQ. Patients with placenta previa were excluded. Rates of adverse maternal outcomes were compared between patients undergoing cesaeran delivery with ICD-10 codes of low-lying placenta and those without. The outcomes included were preterm delivery, hemorrhage, hysterectomy, placenta accreta spectrum (PAS), sepsis, shock, disseminated intravascular coagulation (DIC), and transfusion. Groups were compared using ANOVA, chi-squared analysis, logistic and linear regressions to control for confounders.

RESULTS:

Over 700,000 participants underwent cesarean delivery. 2,664 (0.4%) had low-lying placenta. Affected patients were older, more likely to be anemic, privately insured, undergoing primary cesarean, and deliver at a large/urban teaching hospital. Those with low-lying placenta were more likely to deliver preterm (31.9% versus 14.3%), hemorrhage (27.8% versus 3.8%), undergo hysterectomy (2.0% versus 0.2%), have PAS (2.4% versus 0.2%), receive transfusion (5.4% versus 2.0%) (all P<.001), and experience sepsis, shock, and DIC (all P<.05). Many of these findings persisted after controlling for confounders—preterm delivery (adjusted odds ratio [aOR] 3.07; 95% CI, 2.81–3.35), hemorrhage (aOR 8.87; 95% CI, 8.10–9.73), hysterectomy (aOR 9.42; 95% CI, 7.11–12.47), PAS (aOR 13.41; 95% CI, 10.34–17.39), transfusion (aOR 2.56; 95% CI, 2.14–3.06), and shock (aOR 2.55; 95% CI, 1.44–4.52).

CONCLUSION:

Low-lying placenta at time of cesarean is associated with adverse outcomes and should be considered in counseling and delivery planning.
Pregnancy Outcomes at a Safety Net Hospital in Atlanta, Georgia, After Changes to Abortion Legislation [ID 2683629]
Authors: Marcovitch Hannah , Boulet Sheree L. , Haddad Lisa , Wall Kristin
Published: May 2024

INTRODUCTION:

On July 20, 2022, Georgia’s House Bill 481 (HB 481) went into effect for the first time since it passed state legislature in March 2019. House Bill 481 is an abortion ban in the presence of fetal cardiac activity. To date, no study has explored the law’s effects on key clinical indicators of maternal morbidity and mortality. The purpose of this study is to examine whether enactment of HB 481 has been associated with changes pregnancy-related morbidity at a safety net hospital in Atlanta, Georgia.

METHODS:

We are using an interrupted time series retrospective study design to evaluate trends in pregnancy complications at Grady Memorial Hospital between July 2021 and August 2023. The Emory IRB has approved this study.

RESULTS:

Of the 4,886 encounters linked to pregnancy outcomes included, 2,299 occurred in the year prior to enactment of HB 481 versus 2,587 in the year after. Preliminary crude data analysis demonstrated increases in rare outcomes post-enactment period compared to the pre-enactment period, specifically risk of progression to sepsis among those with preterm prelabor rupture of membranes (0.080 versus 0.061) and maternal intensive care unit admission (0.0085 versus 0.0070). There were no significant changes in the overall rate of delivery or encounters for miscarriage and a decrease in overall composite risk of severe maternal morbidity events (0.061 versus 0.074).

CONCLUSION:

In this rapidly changing legal landscape and with many laws similar to HB 481 being enacted in states across the United States, it is essential to continue to document the direct health effects of restrictive abortion policy on pregnancy outcomes.
Rates of Cesarean Delivery and Neurologic Complications in Parturients With Cerebrospinal Fluid Shunts [ID 2683661]
Authors: Howard Erin , Nosova Kristin , Bauer Isabel L. , Kellerhals Sarah , Nakaji Peter , Bina Robert W.
Published: May 2024

INTRODUCTION:

The effect of parturition on neurologic status in CSF shunt-dependent patients is poorly understood. Cesarean delivery has been proposed as a safer alternative to labor in this population based on limited case reports and retrospective data in the literature; however, the true risk of vaginal delivery has not been adequately described. To our knowledge, this is the first study to estimate national incidence of neurologic complications based on delivery mode in shunt-dependent parturients.

METHODS:

The Nationwide Readmissions Database (NRD) was queried for obstetric patients undergoing delivery between 2016 and 2018. ICD-10 codes were used to identify delivery mode, preexisting CSF shunt-dependence, obstetric comorbidities, and neurologic complications. Data were weighted per NRD specifications.

RESULTS:

Of 11,021,188 total deliveries, 1,856 were in shunt-dependent patients. The primary cesarean rate was 41.2% (n=613) versus 20.1% (n=1,823,517) for shunted and non-shunted parturients, respectively. Multivariate analysis confirmed that presence of a shunt independently predicted cesarean delivery (OR 2.4; CI, 2.0–2.9). Intrapartum shunt complication rates were low regardless of delivery mode (vaginal:0.5%, cesarean:0.5%). Additionally, there was no significant difference in rates of brain herniation (P=.82) or CNS infection (P=.15).

CONCLUSION:

There is no difference in neurologic complication rates between CSF shunt-dependent patients undergoing cesarean and vaginal delivery; however, cesarean delivery is performed at more than twice the rate of the general population. CSF-shunt dependence alone may not be an independent indication for cesarean delivery in the absence of other obstetric indications.
Demographics, Morbidity, and Mortality Between Nonpregnant and Pregnant Firearm Injury Victims [ID 2683667]
Authors: Camarena Belia , Brisola Deborah , Moran Gracen K. , Callaghan Lauren , Sellner Allison A. , Naik-Mathuria Bindi
Published: May 2024

INTRODUCTION:

Despite ongoing national efforts to reduce maternal morbidity/mortality, literature on gunshot wounds (GSWs) is limited. We sought to compare demographics, injury severity scores (ISS), and mortality between pregnant and nonpregnant women with GSWs.

METHODS:

Retrospective review of demographics and injury severity in female GSW victims who presented to three Level 1 Trauma Centers between 2018 and 2020. Shapiro–Wilk tests, Wilcoxon-signed-ranks tests, and chi-squared tests were performed. A value of P<.05 was significant.

RESULTS:

We analyzed 575 nonpregnant and 27 pregnant women. Mean age (years) was 32 (30.77–33.33) for nonpregnant women and 27 (24.43–30.13) for pregnant women. For nonpregnant women, 283 (49.39%) were White, 249 (43.46%) Black, and 14 (2.44%) Asian. For pregnant women, 11 (40.74%) were White, 13 (48.15%) Black, and 1 (3.70%) Asian. 9 (23.81%) nonpregnant women and 135 (33.33%) pregnant women were Hispanic. Women publicly insured were 120 (21%) nonpregnant and 11 (41%) pregnant (P<.05). Within a year of shooting, 7% nonpregnant and 27% pregnant women had given birth (P<.05). For nonpregnant versus pregnant women, mean ISS were 11.86 (10.58–13.16) and 14.38 (7.03–21.67), and mortality was 258 (44.87%) and 11 (40.74%), respectively.

CONCLUSION:

Demographics, ISS, and mortality did not differ between pregnant and nonpregnant women. Although pregnant women were more likely to be insured, they had similar morbidity/mortality as nonpregnant women. There is a need to determine whether maternal health care access affects outcomes and evaluate methods of primary prevention.
Comparing Clark’s 2017 Category II Electronic Fetal Monitoring Algorithm to Actual Management When Umbilical Cord Arterial pH Was Less Than 7 [ID 2683452]
Authors: Silvino Daniella , Goldberg Jay , Brendel Katelyn
Published: May 2024

INTRODUCTION:

Our previously published study reported that, in only 47% of labors resulting in a baby with severe acidemia (defined as umbilical cord arterial pH less than 7), intrapartum electronic fetal monitoring (EFM) was interpreted as concerning, with delivery expedited. We compared Clark’s EFM Category II algorithm to EFM interpretation and actual management of these deliveries.

METHODS:

Institutional review board approval was obtained. A retrospective cohort study was performed on deliveries with umbilical cord arterial pH less than 7. Two groups were identified in actual management: 1) expedited delivery (urgent/emergent operative vaginal delivery or cesarean section) and 2) nonexpedited delivery. We then reviewed all fetal heart tracings (FHTs) to determine whether the algorithm would have recommended expedited delivery or not. Data were analyzed using chi-squared test for independence and Fisher's exact test.

RESULTS:

Thirty deliveries were identified with severe fetal acidemia. Forty-seven percent were delivered in expedited fashion. The Clark algorithm recommended expedited delivery in 30%. The algorithm was not applicable to 3 out of 30 deliveries. Of actually expedited deliveries, the algorithm agreed with expediting 75% of the time, 78% of which should have been delivered even earlier. Of actually nonexpedited deliveries, the algorithm would have only expedited 7% of those.

CONCLUSION:

The Clark 2017 Category II FHT algorithm had a lower sensitivity for predicting severe fetal acidemia and recommending expedited delivery. Although only 47% of babies with severe acidemia were delivered in expedited fashion, the Clark algorithm would only have expedited delivery in 30% overall.
Exploring Effect of Patient Counseling on Mode of Delivery After Cesarean Section [ID 2683575]
Authors: Pondugula Nishita , Greenberg Jessica , Illuzzi Jessica L. , Adeyemo Oluwatosin
Published: May 2024

INTRODUCTION:

Increasing vaginal birth after cesarean (VBAC) may help lower national cesarean delivery rates in the United States. This study aims to evaluate factors that affect counseling practices and trial of labor after cesarean (TOLAC).

METHODS:

All term repeat cesarean deliveries (rCDs) and VBACs from September 2018 to February 2020 were reviewed. Antepartum counseling on mode of delivery, demographic, and obstetrical data were collected. Patients who were not TOLAC candidates were excluded. This study was IRB approved.

RESULTS:

Six hundred thirty-five patients met inclusion criteria. 304 (47.72%) of these patients had rCD, 65 (10.20%) attempted TOLAC with subsequent rCD, and 268 (42.07%) had VBAC. Of the 635 patients, 470 (74.02%) patients had documentation of TOLAC counseling prior to admission for delivery, whereas 165 (25.98%) did not. TOLAC counseling documentation was not associated with age, race, ethnicity, body mass index (BMI), insurance type, or history of vaginal delivery (VD). Prior VBAC increased the odds of documented TOLAC counseling (odds ratio [OR] 2.36; 95% CI, 1.29–4.63). Medicaid insurance (OR 2.18; 95% CI, 1.29–3.73), history of VD (OR 2.28; 95% CI, 1.16–4.68), history of VBAC (OR 269.0; 95% CI, 50.2–5079), and documented TOLAC counseling (OR 21.12; 95% CI, 11.0–45.10) increased the odds of TOLAC. Increasing BMI decreased the odds of TOLAC (OR 0.91; 95% CI, 0.89–0.95).

CONCLUSION:

Documented TOLAC counseling increased the odds of attempting TOLAC. As only 74.02% of patients had documented counseling prior to admission for delivery, an effort to increase TOLAC counseling and documentation may increase TOLAC and subsequent VBAC rates, decreasing the cesarean delivery rate.
Post-Traumatic Stress in the Pregnancy-to-Postpartum Transition Among Birthing People With Opioid Use Disorder [ID 2683444]
Authors: Shi Chengxian , Eglovitch Michelle , Parlier-Ahmad Anna Beth , Salisbury Amy L. , Martin Caitlin E.
Published: May 2024

INTRODUCTION:

Postpartum people with opioid use disorder (OUD) face unique challenges; post-traumatic stress may trigger substance use recurrence and disrupt the parent–infant dyad. However, the effects of traumatic stress in the pregnancy-to-postpartum transition for birthing people with OUD are not well investigated. Our study characterizes post-traumatic stress after birth among people in OUD treatment during the fourth trimester.

METHODS:

This a priori secondary study uses longitudinal data investigating recovery among postpartum people with OUD receiving buprenorphine. Participants were enrolled during the third trimester and assessed within 2 weeks postpartum. Scores greater than 29 on the PTSD Checklist-Civilian at 2 weeks postpartum identified post-traumatic stress. Other measures included the following: maternal attachment, perceived control in childbirth, trauma history questionnaire, and child welfare involvement. VCU IRB #HM20017030 approved this study.

RESULTS:

Participants (N=19) were predominantly White (74%). Most (94.7%) endorsed a traumatic event history before delivery of this infant. Eight (42%) met criteria for post-traumatic stress postpartum and identified birth (n=2), infant medical issue (n=3), or unrelated event (n=3) elicited the post-traumatic stress response. Of these, approximately 25% experienced food insecurity and limited health care transportation. These participants reported high levels of maternal attachment (28.1 [SD=4.8]) and perceived control in childbirth (44.3 [SD=6.3]). Most participants reported postpartum child welfare involvement.

CONCLUSION:

Nearly half of our sample experienced post-traumatic stress symptoms after birth, and two-thirds attributed symptoms to a traumatic birth or infant medical issue. Qualitative investigations are warranted to better understand the patient perspective of these experiences and their unique intersections with OUD treatment and recovery to ultimately improve trauma-informed care strategies.
Predictors and Outcomes of Expedited Postpartum Discharge in a National Sample [ID 2683489]
Authors: Walia Anjali , Wen Timothy , Friedman Alexander Michael
Published: May 2024

INTRODUCTION:

Expedited postpartum discharge (EPD), defined as less than 2 days and less than 3 days after vaginal and cesarean birth, respectively, has been postulated as a measure to improve hospital utilization. National trends regarding outcomes after EPD are lacking. This study aims to characterize national trends in EPD, identify predictors, and assess safety using 60-day postpartum readmission as a surrogate marker.

METHODS:

Birth hospitalizations and readmissions were extracted from the 2016–2020 Nationwide Readmissions Database. Postpartum length of stay (ppLOS) was calculated and categorized as routine, expedited, and prolonged. Annual EPD and readmission prevalence were calculated. Unadjusted and adjusted logistic regression models were fit to assess predictors of EPD and the association between EPD and readmission, adjusting for demographic, clinical, and obstetric outcomes.

RESULTS:

Of 17.3 million birth hospitalizations, 33% experienced EPD. Expedited postpartum discharge prevalence increased from 29.6% to 44.4% with a higher proportion of EPD in 2020 compared to 2016–2019 (P<.01). Younger and older age, chronic conditions, and obstetric complications were associated with lower likelihood of EPD. The overall 60-day readmission rate after delivery hospitalization discharge was 1.4%, and when stratified by expedited, routine, and prolonged ppLOS were 1.4%, 1.6%, and 3.3%, respectively, with no change in readmission rate during the study period. Hospitalizations with expedited discharge were 14% less likely to be readmitted 60 days after discharge compared to hospitalizations with routine discharge (aOR 0.86; 95% CI: 0.85, 0.88).

CONCLUSION:

Nationwide rates of EPD increased during the study period with no corresponding increase in 60-day readmission rates, suggesting that EPD may be utilized more widely in appropriate-risk patients.
Use-Based Opioid Prescribing Protocol Reduces Opioid Prescriptions After Cesarean Section [ID 2683514]
Authors: Leung Noelle , Stanley Zachary D. , Slade Emily , Lei Feitong , O'Brien John M. , Oyler Douglas R.
Published: May 2024

INTRODUCTION:

Up to 75% of post-cesarean patients report having up to 50% of their discharge opioid prescription left over. We assessed an institutional standardized post-cesarean section pain management and opioid prescribing protocol implemented to decrease unused opioids entering the community while still adequately managing pain.

METHODS:

This was an IRB-approved single-center retrospective comparative cohort study in patients aged 18 years or older, who underwent cesarean section before or after implementation of standardized pain management and opioid prescribing protocol. The intervention group received scheduled acetaminophen and NSAIDs with oxycodone 5 to 10 mg as needed postoperatively. Opioid consumption during the 24 hours prior to discharge was used with set ranges determine the quantity of opioid to prescribe for discharge. Outcomes included opioid prescription receipt, quantity of opioid prescribed, and supplementary opioid prescription within 30 days of discharge.

RESULTS:

Four hundred thirty-three patients were included, with 255 in the intervention group and 208 in the control group. The intervention group used less oxycodone postoperatively (75.1%, 17.8%, and 7.1% of patients using 45 mg, respectively, versus 52.4%, 30.3%, and 17.3%; P<.001), received fewer opioid prescriptions (79.1% versus 89.4%; P=.041), and fewer oxycodone tablets if prescribed (median [interquartile range]: 15 [5–20] versus 30 [20–30]; P<.001). There was no significant difference in number of supplemental post-discharge opioid prescriptions received.

CONCLUSION:

A standardized post-cesarean section pain management and opioid prescribing protocol significantly reduced the number of both opioid prescriptions written and number of tablets prescribed without increasing patients seeking opioid refills in the 30 days following discharge.
Pregnancy Loss: A Comparative Analysis of Information Delivery Between ACOG FAQs and ChatGPT [ID 2683594]
Authors: Cadiente Angelo , Chen Jamie , Adams April , Oladipo Antonia F.
Published: May 2024

INTRODUCTION:

Pregnancy loss is a sensitive topic, and clear, reliable information is crucial. This study compares the readability and accuracy of ChatGPT's responses to ACOG's frequently asked questions (FAQ) sheets on the subject.

METHODS:

Within the five FAQ sheets under “Pregnancy Loss,” 66 questions were assessed using ChatGPT-3.5. Readability scores, ie, Flesch–Kincaid Reading Ease, Flesch–Kincaid Grade Level, Gunning Fog Score, Smog Index, Coleman Liau Index, and Automated Readability Index were computed for each response. The quality of responses were also graded by two maternal–fetal medicine specialists using a 1–4 scale, where 1 represents a comprehensive response and 4 indicates an incorrect response. Statistical analysis utilized a two-tailed t-test. A weighted Cohen’s kappa coefficient evaluated interrater reliability.

RESULTS:

ACOG attained better readability scores over ChatGPT across all six metrics with statistical significance (P<.001). Among grading, ACOG also outperformed ChatGPT in quality of information with a summative mean of 1.53 (SD 0.60) versus 1.85 (SD 0.90) with statistical significance (P<.001). Grading for ACOG possessed a Cohen's kappa coefficient of 0.493, implying moderate agreement between graders. Grading for ChatGPT possessed a Cohen's kappa coefficient of 0.744, implying substantial agreement between graders.

CONCLUSION:

The responses by ACOG to frequently asked questions on pregnancy loss were both clearer and more comprehensive than those of ChatGPT with consistent agreement between graders. Although ChatGPT can be a convenient source of medical queries, further improvements ought to be made to these large-language models to provide clear and accurate information regarding pregnancy loss to patients.
Effect of Extended Postpartum Medicaid on Health Care Utilization in the First Year Postpartum [ID 2683627]
Authors: Markel Lilla , Busho Audrey , Duncan Jose R. , Brandt Kaitlin P. , Louis Judette Marie
Published: May 2024

INTRODUCTION:

Extended postpartum Medicaid has been implemented in some states to increase health care access, optimize maternal health, and reduce mortality. We sought to evaluate the effect of postpartum Medicaid extension on health care utilization in the year after delivery.

METHODS:

We conducted a retrospective cohort study of postpartum patients at an academic center in Florida whose deliveries were funded by Medicaid. The study was approved by the IRB. Health care charges were compared between Cohort I (pre-Medicaid extension 2020–2021) and Cohort II (post-extension 2022–2023). Primary outcomes were between-cohort differences in health care utilization in the year after delivery. Services were categorized by specialty and acuity. Data were analyzed using χ2 and Student's t-test. P<.5 was considered significant.

RESULTS:

There were 3,746 patients in Cohort I and 1,537 in Cohort II. Baseline characteristics were similar. Cohort I had 899 and Cohort II had 528 patients without health care charges (23 versus 34%; P<.001). Charges in Cohort I were more likely to occur on days 7–90 (75 versus 60.6%; P<.001), and Cohort II had more charges days 183–365 (9.9 versus 24.3%; P<.001). After postpartum Medicaid extension, health care encounters were more likely to be ambulatory (87 versus 93%; P<.001) and less likely to be inpatient (11.6 versus 4.2%; P<.001) or emergency services (0.7 versus 0.4%; P<.001).

CONCLUSION:

In the year after postpartum Medicaid extension, health care charges indicate increased overall utilization, with increased ambulatory care but decreased hospitalizations and emergency visits.
Buprenorphine Decreases Fetal Breathing Movements in Fetal Biophysical Profile Assessment [ID 2683456]
Authors: Bulger Caroline , Olsen Martin , Lewis Nicole
Published: May 2024

INTRODUCTION:

Ten percent of pregnant patients in our community receive medication-assisted therapy with buprenorphine during their prenatal course. The American College of Obstetricians and Gynecologists (ACOG) recommends antenatal testing for conditions when risk of stillbirth is greater than 0.8/1,000. Opioid use in pregnancy is associated with modest increased odds of stillbirth (odds ratio 1.3). Our hypothesis was that biophysical profile (BPP) in buprenorphine patients might be different than a control group of high-risk patients due to the effects of buprenorphine.

METHODS:

This retrospective chart review analyzed the BPP assessments of patients receiving buprenorphine compared to patients followed for chronic hypertension. Patients seen between July 1, 2016, and June 30, 2020, were evaluated. 131 patients were in the buprenorphine group and 46 patients were in the chronic hypertension control group.

RESULTS:

Patients receiving buprenorphine were more likely to have a fetal breathing score of zero than patients undergoing BPP for hypertension. There is a significant relationship between buprenorphine dosage and breathing motion assessment. Chi-squared test yielded a value of P=.04269. Patients on high-dose buprenorphine are more likely to have values of 0 on fetal breathing motion assessment than low-dose patients.

CONCLUSION:

This is the first study to show a dose-related effect of buprenorphine on fetal breathing movements. Previous research has shown buprenorphine effects on fetal brain structure. Current guidelines minimize the effects of maternal buprenorphine administration on fetal development. This study adds to prior research; further study on the dose-related long-term and short-term effects of buprenorphine on fetal development is encouraged.
Frequency of Cannabis Use and Female Infertility: A Cross-Sectional Analysis [ID 2683566]
Authors: Dzubay Sarah , Arora Megha , Prewitt Kristin C. , Hernandez Arielle G. , Andrea Sarah B.
Published: May 2024

INTRODUCTION:

With expanding cannabis legalization in the United States, the prevalence of cannabis use is growing. Literature describing the effect of cannabis use on fertility is limited. The purpose of this study is to investigate the association between frequency of cannabis use and infertility.

METHODS:

This study utilized cross-sectional data from the 2013–2018 cycles of the National Health and Nutrition Examination Study (NHANES) for women aged 20–49. We used multivariable logistic regression models to examine the association between frequency of cannabis use (never used, irregular use, regular use) and infertility (inability to conceive within 1 year), adjusting for self-reported sociodemographics and use of other substances. Regular cannabis use was defined as monthly use or more for at least a year. All analyses were conducted using R, version 2022.07.2.

RESULTS:

Of the 3,166 women included, 12.5% reported infertility, with the prevalence of infertility ranging from 10.8% among irregular cannabis users to 15.4% among regular cannabis users. Compared to women who reported never using cannabis, women who reported regular use had 47% greater odds of infertility (adjusted odds ratio [aOR] 1.47; 95% CI, 0.88, 2.45) and women who reported irregular use had 17% lower odds of infertility (aOR 0.83; 95% CI, 0.54, 1.30).

CONCLUSION:

Our results contribute to a small, but growing body of evidence that regular cannabis use could have a small to moderate association with infertility, signaling that further research is necessary to better characterize the risk to prospective parents.
Patient Understanding of Carrier Screening With an Educational Video Intervention [ID 2683583]
Authors: Legro Nicole , Mccullough Corinne , Kumnick Allison , Mokhtari Neggin , Haizler-Cohen Lylach
Published: May 2024

INTRODUCTION:

Carrier screening allows patients to understand their risk of passing on a recessive genetic disease. Clinical visits have limited time to explain concepts behind carrier screening and access to genetic counseling may not be available. We sought to understand patient's baseline knowledge of carrier screening and whether an educational video intervention can improve understanding of this test.

METHODS:

This was a pilot randomized controlled trial administered between July 1, 2023 and July 31, 2023, where participants were recruited at their first obstetrics visit. They were randomized in 1:1 ratio to watch a short video on carrier screening versus routine care. A 10-question true/false questionnaire on basic concepts of carrier screening was administered to all participants. Demographic data including race, age, ethnicity, gravity, and parity were collected. Two-tailed t-test and Fisher's exact test were used for continuous and categorical variables, respectively.

RESULTS:

In total, 40 participants were recruited and 20 were randomized to view an educational video. The cohort identified as 60% Black or African American; average age, 30.2; and 32.5% completed a graduate degree. There were no significant demographic differences between the groups. The average knowledge score in the video and nonvideo groups was similar (61% versus 63%; P=.69). However, most participants felt that an educational video was helpful (84.6%).

CONCLUSION:

This pilot study did not find a significance in knowledge score after the video intervention. Our results highlight the need for additional patient resources and face-to-face interventions to improve patient education on carrier screening.
Oh My GAD: Evaluating Anxiety in Current Pregnant Patients Who Have Had a Prior Termination Abortion [ID 2683438]
Authors: Or Maya , Kazma Jamil , Alpern Rebecca R. , Folarin-Amode Faridat , Jamshidi Roxanne
Published: May 2024

INTRODUCTION:

An estimated 31.1% of U.S. adults experience anxiety disorders at some point in their lives. Studies have shown that prior pregnancy loss such as miscarriage is associated with increased anxiety in future pregnancies. We aim to look at the effect of abortion on anxiety in future pregnancies carried to term.

METHODS:

This is a cross-sectional study in which current pregnant patients seeking obstetric care at the George Washington Medical Faculty Associates were surveyed via the BabyScripts application. The survey was sent out via the application and text message and included demographics, obstetric history, and the Generalized Anxiety Disorder-7 (GAD-7). The primary outcome was anxiety levels in patients who are currently pregnant and have previously undergone abortion.

RESULTS:

One hundred seventy-nine patients completed the survey thus far; the study is ongoing. Of these, 72 patients reported a history of anxiety. Race distribution between those with a history of anxiety versus those without were similar. Of those who have had a prior pregnancy, those with a history of abortion were more likely to have severe anxiety with a GAD-7 score greater than 15 in this current pregnancy (18.2% versus 4.5%; P=.01).

CONCLUSION:

Our study shows that multiparous patients who have had a prior abortion and are currently pregnant are more likely to have severe anxiety as compared to patients without a history of abortion. Patients who have experienced abortion therefore have specific needs for prenatal care that are currently unmet. Furthermore, as GAD-7 is not routinely administered in pregnancy, these patients may be underdiagnosed with anxiety that then goes untreated.
Trends in Substance Use and Prenatal Care in Pregnant Patients in a Delaware Hospital [ID 2683484]
Authors: Bishop Erin E. , Hoffman Matthew K.
Published: May 2024

INTRODUCTION:

8.2% of pregnancy-associated deaths are attributable to opioid use. In Delaware, the rate of overdose deaths is 60% higher than nationally, and 12/14 pregnancy-associated deaths in 2021 were opioid related. This study examines demographic trends to identify targets for population-level interventions to decrease opioid abuse in pregnancy.

METHODS:

The data for this retrospective study were obtained via chart review, de-identified, and included all women with a positive drug screen who delivered in a Delaware community hospital between January 2018 and December 2021, examined for trends by half year.

RESULTS:

The majority of 677 women identified as White (70.9%), non-Hispanic/Latino (93.6%), and had government-issued insurance (86.6%). We saw high rates of emergency department (ED) utilization, with 66.6% of patients being seen in ED on at least one occasion prior to delivery. 33% of patients had less than five prenatal visits and 11.1% had no prenatal care. Women with government-issued insurance were significantly more likely to have insufficient prenatal care (P<.001). A trend was present showing that women taking medication for opioid use disorder (MOUD) were more likely to have sufficient prenatal care, although this value was not significant (P=.10).

CONCLUSION:

Because of frequent visits in the antepartum period, pregnancy is a time where women may have increased interaction with the health care system, providing an important opportunity for intervention and care. Encounters in the ED may provide an important occasion to help connect patients to prenatal care resources, and clinics providing substance use-related care and prenatal care in one location would further decrease barriers to access care.
Evaluating the Effect of Intimate Partner Violence on Hypertensive Disorders of Pregnancy [ID 2683517]
Authors: de Pins Agathe M. , DeBolt Chelsea A.
Published: May 2024

INTRODUCTION:

Approximately 5% of pregnant individuals in the United States will experience intimate partner violence (IPV) during their pregnancy. Studies have linked IPV during pregnancy to adverse pregnancy outcomes, but most were either conducted in small datasets, low/middle-income countries, or are outdated. Hypertensive disorders of pregnancy (HDP) have been linked to maternal stress and adverse pregnancy outcomes, but no study to date has looked at the effect of IPV during pregnancy on HDP.

METHODS:

Data from the 2016–2021 Pregnancy Risk Assessment Monitoring System were used to conduct univariate and multivariate logistic regression analyses to assess the relationship between IPV (physical, sexual, and emotional) and HDP, adjusting for maternal age, education, insurance, preexisting hypertension or diabetes, smoking, and no previous live births.

RESULTS:

Of the 41,075 participants, 2,762 (6.7%) reported IPV during pregnancy and were younger with higher rates of public insurance, tobacco use, preexisting hypertension/diabetes, and less likely to have a bachelors degree. Incidence of HDP among individuals reporting IPV was 20.8%. Those who reported IPV had increased odds of HDP compared to those who did not (adjusted odds ratio [OR] 1.13 [1.02–1.26]). This association remained significant in individuals reporting physical abuse (N=863) during pregnancy (adjusted OR, 1.25 [1.05–1.50]) and reporting emotional abuse (N=2,607) during pregnancy (adjusted OR, 1.13 [1.01–1.25]). There was no association between IPV and HDP for individuals reporting sexual (N=490) abuse.

CONCLUSION:

This study provides a current understanding of the effect of IPV during pregnancy on HDP. Its findings provide ground for greater advocacy against IPV and towards IPV screening and support during pregnancy.
Stakeholder Implementation Considerations for PATH (Plan for Appropriate Tailored Healthcare in Pregnancy) Social Needs Recommendations [ID 2683568]
Authors: Rajpurkar Asavari , Zahn Christopher M. , Daniel Yannet , Lott Lauren , Ahmed Lamiya , Peahl Alex
Published: May 2024

INTRODUCTION:

Unmet social needs negatively affect health care access and outcomes, and are disproportionately experienced by groups marginalized by racism, socioeconomic status, and geography. The Plan for Appropriate Tailored Healthcare in Pregnancy (PATH), a consensus-based prenatal care recommendation developed by a multidisciplinary panel of prenatal care experts, includes two recommendations regarding social needs: 1) early screening for medical and social determinants of health; and 2) management of social needs in prenatal care. A national listening tour was conducted to capture stakeholder feedback for implementing social needs recommendations into practice.

METHODS:

We conducted nine, 120-minute virtual focus groups with more than 25 organizations including professional (8), patient advocacy (8), public health (5), and payer groups (4). Focus groups were transcribed, coded by recommendation, and analyzed with matrix coding across patient, clinic, and policy level implementation considerations.

RESULTS:

Focus groups included 110 participants. Patient-level considerations for implementation included the importance of relationship building, shared decision-making, resources-first screening, and delivery of trauma-informed, culturally concordant care. On the clinic level, participants stressed robust clinic-level processes for providing effective social needs care, including multidisciplinary care navigation, social needs toolkit utilization, dynamic patient needs assessments, and provision of closed-loop referrals. Policy-level considerations included the need for improved provider incentives, interprofessional group collaboration, evidence-based research, and social needs infrastructure.

CONCLUSION:

Key considerations for implementing social needs care at the individual, clinic, and policy levels must be operationalized for successful integration into routine prenatal care. Further evidence is needed to identify and test the best approaches to addressing unmet social needs across practice settings.
Exploring Hybrid Prenatal Care: A Qualitative Analysis of Accessibility, Quality of Care, Attitude, and Preference Among Low-Risk Obstetric Patients [ID 2683577]
Authors: Stelmak Daria , Rasmussen Chloe , Azar Michelle , Maben-Feaster Rosalyn E. , Wu Justine P. , Peahl Alex
Published: May 2024

INTRODUCTION:

Patients' experiences with virtual prenatal care options outside of the acute COVID-19 pandemic remain relatively uncharacterized. Our study qualitatively describes obstetric patients’ experiences and general attitudes regarding hybrid care models (in-person and virtual visits) to evaluate strategies for patient-centered care.

METHODS:

At an academic institution, patients consented to this IRB-exempt survey during their postpartum hospitalization. A qualitative content analysis followed by matrix coding of free-responses was used to evaluate patients’ perceptions of hybrid prenatal care.

RESULTS:

Among the 200 patients who participated in the survey, 78 received hybrid prenatal care. Regarding access, patients highlighted the enhanced general access afforded by hybrid care, emphasizing flexibility and reduced travel time and time off work; however, negative aspects included unreliable internet, insurance coverage issues, and availability of home monitoring devices. For quality, virtual care was sometimes viewed favorably, but some respondents expressed concern for impersonal virtual care experiences or missing the fetal heartbeat. One patient stated, “I really needed to be able to hear the heartbeat every visit, so opted out of virtual visits….” Although many participants had a positive attitude towards hybrid care as an option, others stated a preference for in-person visits, driven largely by the desire to hear the fetal heartbeat.

CONCLUSION:

Patients expressed positive attitudes and experiences regarding improved access with virtual prenatal care. Participants stressed hearing the fetal heartbeat when citing concern for virtual care quality and preference for in-person visits. Future studies should explore patient-centric approaches to virtual care, such as incorporating home-based fetal heartbeat assessment.