bluuebunny/crossref_metadata_2025 huggingface dataset:
Preferences of Pregnant Women and Family Members for Health States Arising From Anticoagulant Use in Pregnancy [17N]
Authors: D'Souza Rohan , Tomlinson George , McKelvey Kyra , Krahn Murray , Murphy Kellie , Sander Beate
Published: May 2017

INTRODUCTION:

The aim of this study was to elicit preferences of pregnant women and their family member(s) involved in decision-making, for combined maternal and fetal health-states arising from the use of anticoagulants in pregnancy.

METHODS:

We conducted a cross-sectional study on pregnant women taking medications for chronic medical disorders and their family member(s). Participants–interviewed separately and together–were presented with seven vignettes representing combined maternal and fetal health-states related to anticoagulant use in pregnancy. They were asked to assign values on a visual analogue scale, by the standard gamble and time trade-off methods. Utility values (preferences) were presented on a scale of 0-100.

RESULTS:

Fifty-six pregnant women, 43 family members and 40 pairs completed the interviews. The median age was 32.9 years for pregnant women and 37.1 years for family members, and the median gestational age was 28.9 weeks. Regardless of the method used, values obtained from pregnant women were lower than those obtained from family members and combined interviews. There was a wide variation in utility values obtained from the three interviews and using the three methods. Values obtained from the combined interviews had the smallest confidence limits around point estimates.

CONCLUSION:

This is the first study to determine preferences from pregnant women and family members for combined maternal-fetal health-states. For studies involving pregnancy, utility values that represent the values of both individuals involved in decision-making should probably be used in decision-analysis studies. These findings need prospective validation in different patient populations and different clinical conditions.
Prospective Validation of Formulae for the Estimation of Intrapartum Blood Loss [21N]
Authors: Eckler Rebecca , Rosen Adam , Dunlop Kristyn , Komorowski Adam , Murphy Kellie , D'Souza Rohan
Published: May 2017

INTRODUCTION:

Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality. Improving the accuracy of blood loss estimation is vital to the clinical management of postpartum women. In this study we prospectively validated formulae previously derived to estimate blood loss, that were identified through a systematic review.

METHODS:

Pregnant women over 18 years of age delivering after 24 weeks gestational age were included. Participants had blood loss measured by reference standards that included gravimetric and direct measurement methods and by calculated estimation involving the use of formulae. The test characteristics of each formula (sensitivity, specificity and positive and negative predictive values) were determined against the reference standard.

RESULTS:

These results represent an interim analysis of our data. a total of 172 subjects were recruited, 39 of which delivered vaginally and 133 by caesarean section. after excluding cases with missing data, a total of 138 cases were analyzed. Of the four formulae identified to measure blood loss, two yielded meaningful results. A formula measuring percentage drop in hematocrit had a sensitivity of 73.1% and specificity of 31.4% for identifying PPH and another utilizing maternal height, body weight, and pre-and post-delivery hematocrit had a sensitivity of 44.0% and specificity of 77.9%.

CONCLUSION:

The study's interim analysis demonstrates that the use of formulae incorporating routinely determined variables such as pre- and post-delivery hematocrit, and/or body weight and height may be able to accurately and objectively identify cases of PPH and therefore have application in clinical and research settings.
The Effect of Timing of Removal of Wound Dressing on Surgical Site Infection Rate After Cesarean Delivery [23N]
Authors: Nesrallah Mona , Cole Peter , Kiley Kevin
Published: May 2017

INTRODUCTION:

The objective was to compare the risk of surgical site infection rate with surgical dressing removal between 12-30 hours post-operatively compared with 30-48 hours postoperatively.

METHODS:

Patients with viable pregnancies at 23 0/7 weeks of gestation or greater undergoing scheduled and unscheduled cesarean delivery were randomized to removal of surgical dressing between 12-30 hours post-operatively or removal of surgical dressing between 30-48 hours post-operatively. Standardized wound evaluations were performed at discharge (days 2-4) and at 6 weeks post-operatively. the primary outcome was surgical site disruption or infection.

RESULTS:

Of 602 patients, 300 were randomized to surgical dressing removal between 12-30 hours post-operatively and 302 were randomized to surgical dressing removal between 30-48 hours post-operatively. baseline characteristics including age, body mass index, parity, and prior cesarean delivery were similar by group. All skin incisions were transverse for patients in both groups. the primary outcome incidence at 6 weeks post-operatively was 7% for dressing removal between 12-30 hours and 9.6% for dressing removal between 30-48 hours (p=0.25, odds ratio 1.41, 95% confidence interval [CI] 0.79-2.54).

CONCLUSION:

Surgical dressing removal within 12-30 hours compared with dressing removal within 30-48 hours was not associated with significantly increased composite wound morbidity after cesarean delivery. The presence of asthma and gestational diabetes increased the surgical site infection rate independent of other variables.
Preferred Patient Language and Obstetrical Outcomes [25N]
Authors: Robles Raquel , Takhsh Eden
Published: May 2017

INTRODUCTION:

Obstetrical outcomes as quality of care indicators are coming under increased scrutiny from various stakeholders. patients, regulatory and quality reporting institutions as well as third party payers are demanding reporting and improvements against national and local benchmarks. Three of the most important outcome measures in obstetrics are: cesarean section, episiotomy and operative vaginal delivery rates. Observations in one community teaching hospital unit raised the question of whether patients' preferred language had an adverse impact on these outcomes.

METHODS:

Data was retrospectively collected from July 2015 ‒ December 2015 that included patient preferred language, rates of cesarean section, episiotomy and operative vaginal delivery rates.

RESULTS:

Patients were separated into two groups: English speaking and non-English speaking. Data revealed that non-English speaking patients had a higher rate of cesarean section, episiotomy and operative vaginal delivery. Non-English patients had a 46% rate of cesarean section compared to 36% in English speaking patients, 12% rate of operative vaginal delivery compared to 5%, and a 9% rate of episiotomy compared to 6% of English speaking patients.

CONCLUSION:

These data show that non-English speaking patients have higher rates of cesarean section, operative vaginal delivery and episiotomy when compared to English speaking patients. While causation may not deduced purely from these data, it necessitates further investigation into quality of patient care regarding effective communication in non-English speaking patients.
Pulmonary Function and Body Composition in Pregnant Women: A Transversal Study [26N]
Authors: Amorim Melania , Brandao Andrea Carla , de Sales Tavares Jousilene , Sandro Rolland de Souza Alex
Published: May 2017

INTRODUCTION:

This study was conducted to compare the pulmonary function and the body composition between trimesters of pregnancy and, to determine the variables correlated to the peak expiratory flow (PEF) and the expiratory flow between 25% and 75% of vital capacity (FEF25%75%).

METHODS:

A cross-sectional study examined 120 healthy low-risk pregnant women in the three trimesters of pregnancy, measured by spirometry and multisegmental electrical impedance. Women between the fifth and 40th gestational week, ages between 18-35 years, singletons, and sedentary were included. Smokers, individuals with cardio-respiratory diseases, neurological and chest deformities were excluded.

RESULTS:

The vital capacity, the expiratory volume in one second, the peak expiratory flow and expiratory flow between 25% and 75% of vital capacity decreased with the progression of pregnancy, the multiple linear regression analysis showed that height and maternal age were associated with PEF, being responsible for explaining 14.7% of its variability. The prepregnancy weight explained 6.5% of the variability of the FEF25%75%. The multiple linear regression analysis showed that height and maternal age were associated with PEF, explaining 14.7% of its variability.

CONCLUSION:

This study showed that the volumes and lung capacity in healthy pregnant women do not seem to change with the progress of pregnancy. The pre-pregnancy weight was related to the FEF25%75%. Height and maternal age had greater influence on PEF changes, while the body composition and obstetric variables did not influence it.
QT Interval in Pregnant Women on Methadone-Maintenance Therapy [27N]
Authors: Pimentel Veronica Maria , Sia Michelle , Saia Kelley
Published: May 2017

INTRODUCTION:

The upper limit of normal for the QT interval is 450 msec. A prolonged QT is associated with an increase in sudden cardiac death. Female gender, pregnancy and methadone use are risk factors for QT prolongation. This study sought to assess the QT interval in pregnant women undergoing methadone-maintenance therapy (MMT) in the third trimester and the factors that are associated with QT prolongation.

METHODS:

We performed a retrospective review of pregnant women on methadone at Boston University Medical Center between June 2012 and May 2014. Corrected QT (QTc) from a third trimester electrocardiogram (ECG) was calculated using Bazett's formula. The urine toxicity screen (utox) done on the day of the ECG was reviewed. Paired t-test was used to compare QTc of those with cocaine-positive utox to the QTc of those with a negative utox. The relationship between QTc and methadone dose was assessed using Pearson correlation.

RESULTS:

Of the 32 eligible pregnant women on methadone, 21 (65%) had an ECG performed. Their mean QTc was 428.7±33.9 msec. Pregnant women with a cocaine-positive utox had a longer QTc compared to those with a negative utox (476.0±31.7 msec vs. 420.8±28.6 msec, P = .04). There was no correlation between the dose of methadone (range 55 mg to 145 mg) and the QTc interval (p > .05).

CONCLUSION:

The QT interval in pregnant women on methadone was below the upper limit of normal, except for those with a cocaine-positive utox. The concomitant used cocaine place pregnant women on methadone at risk of cardiac arrhythmia.
Rate of Spontaneous Version Following Preterm Premature Rupture of Membranes [28N]
Authors: Banerjee Dipti , Codsi Elisabeth , Borowski Kristi
Published: May 2017

INTRODUCTION:

Malpresentation is a common problem early in pregnancy. The rate of spontaneous version (SV) by gestational age has been studied, but is poorly understood after preterm premature rupture of membranes (PPROM), which complicates 3% of pregnancies in the United States. The objective of our study was to report the rate of SV following PPROM.

METHODS:

We conducted a retrospective cohort study on women age 18 or above with singleton intrauterine pregnancies who experienced PPROM between 22-34 weeks gestation and were delivered at the Mayo Clinic from 01/2010-12/2015. Demographic characteristics, obstetric history, and prenatal care details were abstracted through chart review. Aneuploidy, major fetal anomalies, maternal Müllerian anomalies, and delivery less than 24 hours after PPROM were excluded.

RESULTS:

Among 120 patients included in the study, 29 were nulliparous. Mean maternal age at PPROM diagnosis was 29.3 years. The median gestational age at PPROM diagnosis and at delivery was 31 1/7 weeks and 32 5/7 weeks, respectively. Intrauterine growth restriction was diagnosed in 10 women following PPROM. Sixty-nine (57.5%) patients delivered vaginally and 51 (42.5%) underwent cesarean section. Twenty-three (19.2%) women experienced SV following PPROM. Of the 21 breech presentations at PPROM diagnosis, 4 (19%) converted to cephalic presentation at delivery.

CONCLUSION:

We determined that approximately 1 out of 5 women experience SV in the setting of PPROM. Data about SV following PPROM is important in order to counsel patients about expectations for the remainder of their pregnancy. This new evidence can better prepare patients and providers for safe delivery.
A Comparison of Characteristics and Outcomes in Typical and Atypical Cases of Morbidly Adherent Placentation [29N]
Authors: Shamshirsaz Amir A. , Bateni Zhoobin H. , Salmanian Bahram , Belfort Michael A. , Fox Karin A.
Published: May 2017

INTRODUCTION:

To compare the characteristics and outcomes of patients with morbidly adherent placenta (MAP) and the typical risk factors of both placenta previa and prior cesarean deliveries (typical group) and patients without at least one of these antenatal risk factors (atypical group).

METHODS:

Patients with confirmed MAP from January 2000 to June 2016 were included in this study. Data were reported using descriptive statistics and appropriate statistical methods were used based on the normality of the data.

RESULTS:

During the study 189 patients had MAP, 157 of whom had singleton gestations and underwent cesarean hysterectomy. Ninety-seven (61.8%) were in the typical group. Baseline characteristics between the two groups were not statistically different. Patients with increta or percreta was significantly higher for the typical group (78.6% v. 41.7% respectively, P < 0.001). Median estimated blood loss was lower in the typical compared with the atypical group (P < 0.01) and the number of patients without a prenatal diagnosis was significantly higher in the atypical group (P < 0.001).

CONCLUSION:

Antenatal recognition of MAP was lower among atypicals. At time of delivery median blood loss was higher in the atypicals despite the fact that the degree of invasion was less confirming that not being prepared for MAP, even when it is accreta rather than percreta, carries increased risk. Failure to recognize MAP in atypicals may be due to greater difficulty in making the diagnosis with ultrasound when there is less invasion, or false reassurance when not all risk factors are present.
Risk Factors Associated with Preterm Delivery After Open Fetal Myelomeningocele Repair [30N]
Authors: Said Heather M. , Vricella Laura K. , Miller Collin , Elbabaa Samer , Vlastos Emanuel
Published: May 2017

INTRODUCTION:

Although open fetal myelomeningocele (MMC) repair increases the risk of preterm delivery (PTD), specific risk factors for this outcome have not been identified. The objective of this study is to determine whether gestational age at the time of open fetal MMC repair is a risk factor for PTD.

METHODS:

A retrospective cohort of 51 consecutive open fetal MMC repairs between 2011-2016 was analyzed by gestational age at time of surgery. Primary outcome was delivery <37w0d. Secondary outcomes were PPROM, delivery < 34w0d, latency from MMC repair to delivery and neonatal outcomes.

RESULTS:

Groups were similar in demographic and intraoperative factors. On univariate analysis, delivery <37w0d was more frequent with earlier MMC repair (94% < 24w0d, 69% 24w0d-24w6d and 57% >25w0d, p=0.031), whereas delivery < 34w0d was not (41% < 24w0d, 23% 24w0d-24w6d and 19% >25w0d, p=0.317). Survival-curve pairwise comparisons demonstrated a difference between the < 24w0d and > 25w0d groups (p=0.027). PPROM was more frequent with earlier MMC repair (71% < 24w0d, 31% 24w0d-24w6d and 30% >25w0d, p=0.041). Mean latency from MMC repair to delivery was similar among groups (73 days for < 24w0d, 73 days for 24w0d-24w6d and 67 days for >25w0d, p=0.727), as were neonatal outcomes. On multivariate analysis, earlier gestational age at MMC repair was associated with delivery before 34 weeks (p=0.039; RR 2.13; 95% CI 1.04-4.36) and 37 weeks (p=0.016; RR 3.47; 95% CI 1.26-9.59).

CONCLUSION:

Earlier gestational age at open fetal MMC repair was associated with preterm delivery before 37 and 34 weeks and PPROM.
Comparative Diagnostic Testing Uptake and Confirmation Rates After High-Risk cffDNA for Trisomy 21, 18, and 13 [32N]
Authors: Suhag Anju , Robbins-Furman Patricia , Hollier Lisa , Monga Manju , Ramin Susan , Van den Veyver Ignatia B.
Published: May 2017

INTRODUCTION:

There is increasing concern that high-risk cffDNA screening results are not always confirmed by diagnostic testing. We hypothesized that the poorer prognosis of trisomy 18 (T18) or trisomy 13 (T13) compared to trisomy 21 (T21) differentially affects the uptake of confirmatory diagnostic testing after a high-risk cffDNA result for these aneuploidies.

METHODS:

A retrospective study of singleton gestations with abnormal cffDNA screening for trisomies 21, 18 and 13 between 10/2012 and 3/2016. We excluded multiple gestations, any unreportable and any other positive cffDNA results. Based on cffDNA results, 3 cohorts were compared: high risk for T21, T18 and T13. Diagnostic testing was offered to all study subjects. Primary outcome was uptake rate of diagnostic testing in the 3 groups. A P-value of < 0.05 was considered significant.

RESULTS:

278 women met inclusion criteria. Demographics were similar in the 3 groups, except for higher rate of AMA in T21 group compared to T18 and T13 (P=.04). The uptake of diagnostic testing was similar in the 3 groups (P=.79). The confirmation of diagnosis by karyotype or CMA was significantly higher for T21 group compared to T18 and T13 (P=.0001). The rate of false positive cffDNA result was significantly higher in T13 group compared to T18 and T21 (P=.0001).

CONCLUSION:

There is no difference in uptake of diagnostic testing in women with a cffDNA screening result indicating high risk for Trisomy 21, 18 or 13. Diagnostic testing is more likely to confirm diagnosis of T21 and T18 compared to T13 in women with abnormal cffDNA screening.
Clinical Outcomes of Term Elective Induction of Labor With Unripe Cervix [34N]
Authors: Harward Lindsey , Nino Julio Mateus , Christensen Colleen , Ebeling Myla
Published: May 2017

INTRODUCTION:

Elective induction of labor has increased over time resulting in higher cesarean delivery rates. Maternal and neonatal outcomes of pregnancies undergoing pre-induction cervical ripening at 39 weeks were compared with those induced at later gestational ages.

METHODS:

Retrospective cohort study of singleton pregnancies induced without a medical indication and a Bishop score less than 8 or simplified Bishop score less than 5 at 39 0/7-6/7, 40 0/7-6/7, and 41 0/7-6/7 weeks between 2006 and 2015. Specific individual maternal and neonatal outcomes were compared. Chi-square, One-way ANOVA, and Fisher exact test were used for statistical analysis.

RESULTS:

Of the 718 identified pregnancies, 143 (19.9%) were induced at 39 weeks, 240 (33.4%) at 40 weeks, and 335 (46.6%) at 41 weeks. Nulliparity was significantly higher in the 41-week group than in the 40-, and the 39-week groups (78.8%, 64.5%, and 37.7%, respectively; P < .00001). Among nulliparous women, cesarean delivery was significantly lower at 39 weeks (27.7%) than at 40 weeks (34.4%), and at 41 weeks (47.7%) (P=.0003). Conversely, cesarean delivery rate was low and not significantly different among multiparous women at each of the gestational age groups. Postpartum hemorrhage and chorioamnionitis rates were significantly higher at 41 weeks compared with the other groups (all P < .0001). NICU admission, 5-minute Apgar scores less than 7, respiratory distress syndrome, and neonatal death rates did not differ significantly among the groups.

CONCLUSION:

Elective induction of labor at 39 weeks with unfavorable cervix was associated with favorable maternal outcomes and low cesarean delivery rate.
Chronic Disease Prevalence Among Mothers Delivering in the United States, 2004-2013 [38N]
Authors: Admon Lindsay , Winkelman Tyler , Moniz Michelle , Davis Matthew , Heisler Michele , Dalton Vanessa
Published: May 2017

INTRODUCTION:

Reasons for nationwide increases in delivery-associated maternal morbidity and mortality are poorly understood. Pre-existing chronic disease increases the risk of obstetric complications, and there is a need to understand trends in chronic disease burden among the childbearing population.

METHODS:

We conducted a serial cross-sectional analysis of the National Inpatient Sample between 2004 and 2013. We used multivariable logistic regression, adjusted for age, income, and insurance status, to examine trends in chronic disease among delivery hospitalizations. Chronic disease was measured with ICD-9CM codes for 8 common conditions known to impact obstetric outcomes.

RESULTS:

Our sample was comprised of 8,307,761 delivery hospitalizations between 2004-2013. The mean age of delivering mothers was 27.7. The most prevalent conditions were respiratory disease, hypertension, and drug abuse (3.0, 1.9 and 1.4 per 100 delivery hospitalizations, respectively). In adjusted analyses, records in 2012/2013 were more likely than those in 2004/2005 to include diagnoses of diabetes, hypertension, respiratory disease, liver disease, kidney disease, and drug use (all P less than 0.001) and less likely to have diagnoses of heart disease (P less than 0.001) or HIV (P equal to 0.02). Delivery hospitalizations in 2012/2013 were also more likely than those in 2004/2005 to be complicated by at least one or at least two chronic conditions (both P less than 0.001).

CONCLUSION:

Chronic disease burden increased significantly among delivering mothers between 2004/2005 and 2012/2013. Higher proportions of women with chronic conditions and higher numbers of chronic conditions per patient may contribute to increases in delivery-associated morbidity and mortality.
Determining the Impact of External Stressors on Laparoscopic Skills Among Obstetrics and Gynecology Residents [1O]
Authors: Moawad Gaby , Tyan Paul , Kumar Dipti , Krapf Jill , Abi-Khalil Elias
Published: May 2017

INTRODUCTION:

Given the lack of a standardized laparoscopic surgery curriculum we designed a study to evaluate the impact of stress on laparoscopic skills among obstetrics and gynecology residents.

METHODS:

We conducted an observational prospective cohort study in a single urban teaching university hospital. Participants included 31 Obstetrics and Gynecology Residents, Post Graduate Years 1-4. We assessed four basic laparoscopic skills at two sessions. The first session was the baseline; six months later the same skills were assessed under audiovisual stressors. We compared the effect of stress on accuracy and efficiency between the two sessions.

RESULTS:

A linear model was used to analyze time. Under stress, residents were more efficient in three out of the four modules. Ring transfer (Hand-eye coordination, bimanual dexterity), P=0.0304. Ring of Fire (Bimanual dexterity, measure of depth perception), P=0.0024 and Dissection Glove (Respect of delicate tissue planes), P=0.0002. Poisson regression was used to analyze the total number of penalties. Residents were more likely to acquire penalties under stress. Ring transfer, P=0.0184 and Cobra (Hand-to-hand coordination), P=0.0487 yielded a statistically significant increase in penalties in the presence of stressors. Dissection Glove P= 0.0605 yielded a non-significant increase in penalties.

CONCLUSION:

Our work confirmed that while under stress residents were more efficient, this translated into their ability to complete tasks faster in all the tested skills. Efficiency, however, came at the expense of accuracy. Taking the current residency-teaching model into consideration, we encourage surgeons to create a less stressful environment when operating with residents.
Readability Assessment of Online Obstetrics and Gynecology Patient-Oriented Literature [2O]
Authors: Richards Elliott , Trinidad Mari Charisse
Published: May 2017

INTRODUCTION:

As the Internet has become the primary source of health information for most patients, there is limited information regarding the readability of available online information for patients in obstetrics and gynecology.

METHODS:

Twenty-four phrases from “Top Searches on ACOG” were used as search terms, using search engine optimization tools, mirroring likely patient search patterns. Contents were then analyzed for readability using four validated readability formulas, including Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning Fog Index (GFOG).

RESULTS:

A total of 214 webpages were evaluated and majority had readability scores higher than currently recommended for patient-directed information. The mean FRES was 56.0 (range, 26.6 to 97.0), with majority (99%) of the sites scoring less than 80, correlating with a “difficult” level of reading. Mean readability grade levels were as follows: 6.86 for FKGL; 8.39 for SMOG; and 8.28 for GFOG. Of the 24 topic areas, only 11 (45.8%) had easily accessible patient related documents published by the American College of Obstetricians and Gynecologists.

CONCLUSION:

To our knowledge, this is the first study providing a broad assessment of readability of currently available online patient related information in obstetrics and gynecology. Consistent with other specialties, the readability of most online obstetrics and gynecology patient materials is unsatisfactory. While readability level is only one component of useful patient-oriented literature, there is a great need for effective and easily accessible online patient-oriented websites as health literacy can impact outcomes.
How Capable Are Ob/Gyn Residents in Counseling Patients at Risk for Periviable Delivery? [4O]
Authors: Byrne John , Siddiqui Maryam , Robinson Barrett , Young Danielle , Plunkett Beth
Published: May 2017

INTRODUCTION:

To understand the current state of resident education in periviability counseling and assess Ob/Gyn resident capacity to counsel patients at risk for periviable delivery.

METHODS:

A cross-sectional, web-based survey developed at the University of Chicago was deployed to Ob/Gyn residents from 13 ACGME accredited residency programs across the US. The survey included questions about program/resident demographics, periviability education content/format, and periviability counseling. Descriptive statistics were used to analyze responses, and Chi-square or Fischer's Exact tests were used to analyze categorical variables.

RESULTS:

Of 374 eligible Ob/Gyn residents, 151 (40.3%) completed the survey. Most respondents came from university-based programs (85.3%), larger residency programs (68.5%), and non-religiously affiliated hospitals (86.7%). Most respondents (n=123, 83.6%) identified spending 0-5 hours annually on periviability education. 63% of respondents felt somewhat capable (SC) or very capable (VC) in counseling patients at risk for periviable delivery regarding neonatal outcomes, with 14 (9.3%) feeling VC. A greater proportion of PGY-4 compared to PGY-1 respondents (86.1% vs. 51.5%; p=0.0018) and those trained in a community vs. university based hospital (90.5% vs.57.9%; p=0.003) reported feeling SC or VC in counseling patients regarding neonatal outcomes. The majority of respondents had never used/were not aware of the NICHD Extremely Preterm Birth Calculator (52.1%). No respondent correctly identified the 5 predictive characteristics that form the framework for the NICHD calculator.

CONCLUSION:

The majority of residents do not feel capable of counseling patients at risk for periviable delivery. These findings point to targeted areas to improve Ob/Gyn resident education and patient care during the periviable period.
Abnormal Pap Tracking in Resident Clinics – What Is Our Standard and Can We Do Better? [6O]
Authors: Miller Jill , Landry Mary
Published: May 2017

INTRODUCTION:

Screening tests are only as valuable as the quality of the system in which they are performed. To reduce cancer rates, tracking patients' care after pap testing is fundamental. Electronic health records (EHR) have made reporting of abnormal test results more efficient and reliable, but how are they being used? We investigated current protocols for tracking abnormal cytology results in Obstetrics & Gynecology resident clinics to better understand how future physicians are trained in this important quality assurance task.

METHODS:

A brief survey designed using REDCap, a secure, web-based application, was sent out to all 249 Obstetrics & Gynecology residency programs within the FRIEDA database.

RESULTS:

Of the 249 residency programs, 54 (22%) responded, 51 (94%) perform colposcopy, and 47 (87%) programs provide treatment. Twenty-five (46%) of respondents have a tracking system for abnormal results with 21 (45%) of the 47 programs providing treatment, tracking post-treatment follow-up care. Follow-up is confirmed by chart review in 18 (72%) of the 25 programs who perform tracking, while 6 (24%) use EHR reports or disease management capability.

CONCLUSION:

The majority of residency programs perform colposcopy and treatment, yet less than 50% of the programs track abnormal results to assure appropriate patient follow-up. The majority of programs who perform tracking do so by the time consuming method of chart review, with only 6 programs (11%) leveraging the efficiency and reliability of their EHR to assist with this quality assurance task. Resident clinics and clinical practices of all types might consider this an area for future quality improvement.
Is Use of Misoprostol Associated With Failed Induction in Pregnancies With Suspected Placental Insufficiency? [12O]
Authors: Rossi Robert , Warshak Carri
Published: May 2017

INTRODUCTION:

Although misoprostol (MP) has demonstrated efficacy for cervical ripening, a concern with use of MP is uterine tachysystole, leading to fetal intolerance of labor and cesarean delivery (CD). We sought to determine whether indicators of placental insufficiency were associated with higher rates of failed induction and CD in pregnancies when MP was used for cervical ripening.

METHODS:

Population based retrospective cohort study of patients who underwent MP induction between May 2008-2013. Maternal and labor characteristics were compared between patients with FGR (<10th% estimated fetal weight on ultrasound), oligohydramnios, preeclampsia, and infants born SGA (birth weight less than 10th%). Primary outcome was rate of CD. Secondary outcomes included CD for nonreassuring fetal status (NRFS). Multivariable logistic regression estimated association between indicators of placental insufficiency on the outcome of CD.

RESULTS:

Of 1,617 inductions during the 6 year period, 580 patients were induced using MP. FGR was suspected in 106 (18.2%). FGR was not associated with higher CD rate in MP inductions [22% versus 29%, p=0.11 (aOR 0.89, 95% CI 0.68-1.16)]. Similarly neither SGA nor oligohydramnios were associated with an increased CD rate, however preeclampsia did demonstrate a trend toward increased CD, aOR 1.21 (95% CI 0.97-1.51). The rate of CD for NRFS was similar between those with FGR and those without FGR (16% vs 15%, p=0.7).

CONCLUSION:

Despite a biologically plausible concern that MP induction in the setting of FGR and other indicators of placental insufficiency may increase risk for CD and CD for NRFS, our data does not support this.
A Case Report of Bilateral Subconjunctival Hemorrhages With Orbital Hematoma Following Delivery [13O]
Authors: Riggs McKayla , Teneyuque Nicholas , Keyser Erin
Published: May 2017

INTRODUCTION:

Subconjunctival hemorrhages are common with trauma to the orbit or in cases with sustained intra-abdominal pressure. Despite the sustained pressures routinely seen in deliveries, subconjunctival hemorrhages are rarely observed in postpartum patients. We describe a case of bilateral subconjunctival hemorrhages and an orbital hematoma.

METHODS:

Chart review; Literature review

RESULTS:

The patient was a 29 year old primiparous African American female at 41 weeks gestation admitted for induction of labor at late term. She had a known fibroid in the lower uterine segment with an otherwise uncomplicated past medical history and antepartum course. She underwent an uncomplicated induction and delivered after an eight minute second stage and three total pushes, experiencing a forty-five second shoulder dystocia. Her postpartum course was complicated by diplopia, blurry vision, and pain with movement of her eyes on postpartum day one. Imaging revealed a retro-orbital hematoma for which ophthalmology was consulted with a workup significant for suspected glaucoma. She was followed outpatient with symptomatic treatment and noted to have resolution of symptoms after four weeks with further workup for glaucoma in six months.

CONCLUSION:

Subconjunctival hemorrhages, though common, are surprisingly rare in the postpartum period even following prolonged or impressive pushing efforts and often point to a medical comorbidity. This case highlights the field of ophthalmology with which most OB/GYNs have little experience though can be clues to alternate diagnoses. Incorporating a multidisciplinary approach for diagnosis of a pregnant patient with ophthalmologic disease is required to optimize management of the patient.
Interconception Health Behaviors Among Women With a Prior Preterm Birth [16O]
Authors: Batra Priya , Scibetta Emily , Celaya Anna K. , Jackson Ashaki , Greenwell Lisa , Saleeby Erin
Published: May 2017

INTRODUCTION:

Preterm birth (PTB) is a leading cause of infant morbidity and mortality; the strongest risk factor for PTB is a mother's history of preterm delivery. Certain modifiable risk factors for PTB could be addressed between pregnancies to decrease recurrence rates. This study describes associations between previous PTB and select associated interconception health behaviors.

METHODS:

Between December 2013 and August 2016, community health workers conducted intake interviews with pregnant women enrolling into the MAMA'S Los Angeles County prenatal care program. Select interconception health behaviors associated with PTB were assessed in women's current pregnancies, including: trimester of prenatal care initiation, pregnancy intent, and tobacco use at conception. Participants self-reported all outcomes and PTB history. Chi-square tests were performed.

RESULTS:

Analyses included data from 3,259 women, 322 (9.9%) of whom reported a prior PTB. There was no significant association between prior PTB and early (first trimester) initiation of prenatal care in the current pregnancy (chi-square=.40, P=.53). Women reporting a prior PTB were not significantly more likely to report that their current pregnancy was intended (chi-square=.01, P=.92). The proportion of women reporting tobacco use at conception did not differ between women who did (9.7%) and did not (9.9%) report a prior PTB (chi-square=.02, P=.90).

CONCLUSION:

Women reporting a prior PTB did not differ significantly from women without a PTB history with respect to select self-reported interconception health behaviors. Findings suggest that women with a prior PTB could benefit from interventions that could reduce the risk of recurrence by addressing relevant interconception health behaviors.
Length of Stay and Balloon Catheters for Cervical Ripening in the Outpatient Setting in Moderate Risk Populations [18O]
Authors: Gray Kendra
Published: May 2017

INTRODUCTION:

This study seeks to compare the length of hospital stay between inpatient and outpatient low and moderate risk term patients who underwent cervical ripening using a balloon catheter. Secondary objectives include demonstrating no significant difference in the rates of cesarean section, chorioamnionitis or NICU admissions between groups.

METHODS:

In this retrospective cohort study, 185 women undergoing induction of labor had placement of cervical balloon catheter for cervical ripening. 64 inpatient inductions and deliveries were measured against 121 outpatient inductions and subsequent hospital deliveries. Bivariable and multivariable analyses were performed to determine whether outpatient induction was associated with a shorter length of hospital stay without increasing adverse maternal or neonatal outcomes. T-tests, Pearson Chi-Square tests, linear and logistic regression models were used to determine predictors of the outcomes. A two-tailed p < 0.05 was considered significant.

RESULTS:

The time from admission to delivery in the outpatient group was decreased by 10 hours and the LOS is decreased by 6 hours. Factors that significantly decreased LOS included gravidity while factors that lengthen hospital stay included cesarean section and increasing BMI. No statistically significant differences were found in the rates of NICU admission, intrauterine infection or cesarean section rate.

CONCLUSION:

Cervical ripening in the outpatient setting with balloon catheters is a reasonable consideration in low to even moderate risk patient populations. Independent predictors for increased length of stay included increased body mass index (BMI) and lower nulliparity. Use of outpatient cervical ripening in this patient population may be most beneficial.
Availability of Zika Virus Information on County and Regional Health Department Websites in the State of Texas [20O]
Authors: Sullivan Adriana , Page-Ramsey Sarah M. , Ireland Kayla , Cuvillier James , Ramsey Patrick S. , Rodriguez Emma
Published: May 2017

INTRODUCTION:

Zika virus infection is an emerging health threat in pregnant women, particularly in Texas. It is important that obstetric patients and providers can access up-to-date information about Zika. Our objective was to evaluate the availability of information about the Zika virus and perinatal risks on local health department websites in Texas.

METHODS:

We reviewed all Texas county, regional, and metropolitan health department websites for general information available on the Zika virus, pregnancy related risks, prevention measures, mosquito repellent use, sexual transmission, endemic areas, travel guidance, and pregnancy planning. In cases where information was not available on the main webpage, an internal search of the site using the term “Zika” was performed.

RESULTS:

General information about Zika virus was found on only 13.8% of 254 county public health websites, 18.1% of 11 public health region websites, and 51.3% of 39 metropolitan websites. Available county information included patient education (54.3% of sites), health care provider materials (31.4%), details about Zika virus (62.9%), pregnancy risks (37.1%), sexual transmission (40.0%), use of mosquito repellents (34.3%), travel avoidance (42.9%), pregnancy timing (22.9%), and Zika endemic countries (40.0%). Similar rates of information available in these categories were observed on the regional and metropolitan websites.

CONCLUSION:

Despite growing concerns about perinatal risks and Zika virus, local health department websites in Texas have limited information for patients and providers. While state and national level information about perinatal risks from Zika virus is available, enhanced local efforts are needed to improve education and preparedness of patients and providers.
Availability of Provider Information About Zika Virus and Perinatal Risks on State Health Department Websites [21O]
Authors: Gray Jordan , Page-Ramsey Sarah M. , Ireland Kayla , Rivera Joshua , Rodriguez Emma , Ramsey Patrick S.
Published: May 2017

INTRODUCTION:

Zika virus is an emerging health threat in pregnant women. It is important that obstetric healthcare providers can access up-to-date information about Zika testing, resources, and cases. Our objective was to evaluate the availability of provider-level information about Zika virus on state and US territory health department websites.

METHODS:

We reviewed each U.S. state, District of Columbia, and US territory (Puerto Rico, Guam, US Virgin Islands, American Samoa, North Marianas Islands) health department websites and abstracted provider-level information on Zika testing, testing forms, links to Center for Disease Control (CDC) publications, blood bank/donation guidelines, local cases, and US Zika pregnancy registry information. In cases where information about Zika virus did not appear immediately on the main webpage, an internal search of the site using the term “Zika” was performed.

RESULTS:

Provider-level information about Zika virus was found on 82.1% of 56 websites reviewed. Of those sites with information, information was more common on state websites (88.2%) than on territory sites (20.0%). Information available included Zika testing information (76.9%), access to in-state testing (73.1%), testing forms (59.6%), links to CDC publications (80.8%), blood bank/donation guidelines (25.0%), local cases (76.9%), and US Zika pregnancy registry information (32.7%).

CONCLUSION:

Provider-level information about Zika virus is available on most state, but not US territory websites. Testing information, CDC publications, blood bank/donation guidelines, local cases, and US Zika pregnancy registry information are not consistently available. State and territory sites should include such information to assist healthcare providers in optimal care of the obstetric population.
Compliance With Contemporary Guidelines for the Diagnosis of Labor Dystocia by Stage of Labor [22O]
Authors: Wu Erica , Clair Kiran , Chan Kenneth
Published: May 2017

INTRODUCTION:

The objective of this study was to evaluate the relationship between stage of labor and compliance with contemporary criteria for the diagnosis of labor dystocia.

METHODS:

This was a secondary analysis of a prospective cohort study of cesarean delivery rates following implementation of a labor dystocia checklist at a community hospital. The checklist requested that physicians specify which of the contemporary criteria for the diagnosis of labor dystocia were met prior to performing a cesarean delivery on women in labor. Following implementation, the primary and NTSV cesarean delivery rates decreased from 20.7% to 18.0% and 26.4% to 22.6%, respectively. In this analysis, primary cesarean deliveries performed for labor dystocia were reviewed and categorized based on furthest stage of labor achieved and whether contemporary criteria for labor dystocia were fulfilled. Rates of compliance were compared between each stage of labor.

RESULTS:

During the 6-month study period, 145 cesarean deliveries were performed for labor dystocia. A majority (55.9%) were not compliant with contemporary guidelines for the diagnosis of labor dystocia. A greater proportion of deliveries that occurred in the latent phase (63.6%) and second stage (58.3%) were compliant compared to those that were failed inductions (33.3%) or that occurred in the active phase (38.2%), however, this difference was not statistically significant (P = 0.07).

CONCLUSION:

Most cesarean deliveries performed for labor dystocia did not meet contemporary criteria for the diagnosis of labor dystocia. Interventions designed to increase provider awareness of recent Obstetric Care Consensus guidelines for labor dystocia are needed for all stages of labor.
Compliance With Contemporary Criteria for the Diagnosis of Labor Dystocia by Time of Day [23O]
Authors: Clair Kiran , Wu Erica , Chan Kenneth
Published: May 2017

INTRODUCTION:

To evaluate the relationship between time of day and compliance with contemporary criteria for the diagnosis of labor dystocia.

METHODS:

This was a secondary analysis of a prospective cohort study of cesarean delivery rates following implementation of a labor dystocia checklist at a community hospital. The checklist requested that physicians specify which of the contemporary criteria for the diagnosis of labor dystocia were met prior to performing a cesarean delivery on women in labor. Following implementation, the primary and NTSV cesarean delivery rates decreased from 20.7% to 18.0% and 26.4% to 22.6%, respectively. Data were then reviewed and categorized as either compliant or noncompliant with contemporary criteria and rates of compliance compared between three time periods: daytime (8AM-6PM), evening (6PM-12AM), and overnight (12AM-8AM).

RESULTS:

Of 145 Cesarean sections performed for dystocia, 52 (35.8%) occurred between 8AM-6PM, 49 (33.8%) occurred between 6PM-12AM, and 44 (30.3%) occurred between 12AM-8AM. Overall, 64 (44.1%) were compliant with contemporary guidelines for the diagnosis of labor dystocia. Compared to the evening and overnight time periods, cesarean deliveries performed for labor dystocia during the daytime were more likely to be compliant with contemporary criteria for the diagnosis of labor dystocia. (P = 0.02).

CONCLUSION:

Cesarean deliveries performed for labor dystocia during the daytime are more likely to satisfy contemporary criteria for the diagnosis of labor dystocia than those performed during the evening or overnight. Additional studies are needed to further evaluate the impact that time of day may have on physicians' decision-making process when diagnosing labor dystocia.
Comparison of Risk Factors and Neonatal Outcomes Among Women With a Spontaneous Versus Iatrogenic Preterm Birth [24O]
Authors: Boelig Rupsa C. , Lamar Christian , Berghella Vincenzo
Published: May 2017

INTRODUCTION:

While spontaneous preterm birth (sPTB) has been trending down, iatrogenic preterm birth (iPTB) has been trending up. The purpose of this study is to examine the difference in risk factors and neonatal outcomes among women with a sPTB vs iPTB to identify areas for intervention.

METHODS:

Retrospective cohort study from 1/2012-12/2014 of singleton pregnancies without a history of prior sPTB undergoing routine cervical length screening between 18 0/7-23 6/7 weeks. Women were included if they delivered less than 37 weeks.

RESULTS:

Of 3678 women screened, 200 women (5.4%) had a PTB; 114 (57%) sPTB and 86 (43%) iPTB. Women with sPTB were on average younger than those with iPTB (27.3 ±6.2 vs 29.5 ±6.4, p=0.019). Women with iPTB were more likely to have a BMI of at least 30 (39% vs 23%, p=0.021), have a hypertensive disorder of pregnancy (74% vs 9%, p < 0.001), and have fetal growth restriction (14% vs 0%, p < 0.001) than women with sPTB. Women with a sPTB delivered earlier, with a mean gestational age of 32.7±4.9 vs 34.1±2.7 weeks (p=0.015), and an increased incidence of delivery less than 28 weeks (17% vs 4%, p=0.003). However, infants born from an iPTB were more likely to require intensive care admission (71% vs 54%, p=0.016). The incidence of neonatal morbidity was similar.

CONCLUSION:

Although sPTB tends to result in an earlier gestational age of delivery, iPTB is a more significant source of neonatal intensive care admission. Maternal obesity and hypertensive disorders are major modifiable risk factors for iPTB.