bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased Perinatal Morbidity and Mortality Among Asian American and Pacific Islander Women in the Military Health System [A149]
Authors: Grob Patrizia , Tindal Rachel R. , Hamilton Jameaka , Gonzalez-Brown Veronica , Keyser Erin A. , Lundeberg Kathleen R.
Published: June 2022

INTRODUCTION:

Rates of maternal morbidity and mortality experienced by women in the United States have been shown to vary significantly by race, most commonly attributed to differences in access to health care and socioeconomic status. Recent data shows that Asian Pacific Islander (API) have highest rate of maternal morbidity, despite having higher socioeconomic status. In the military, women of all races are granted equal access to health care, irrespective of socioeconomic class. We hypothesized that within the military there would be no racial disparities in maternal outcome due to universal health care.

METHODS:

A retrospective cohort study included data from National Perinatal Information Center report from participating military treatment facilities from April 2019 to March 2020, totaling 36,861 deliveries. We compared racial differences in percentages in each of the following three categories: postpartum hemorrhage (PPH) and severe maternal morbidity (SMM) among women with postpartum hemorrhage including and excluding transfusion.

RESULTS:

MTFs included in the data showed an increased rate of PPH (RR, 1.73; 95% CI, 1.45–2.07), SMM including transfusion (RR, 1.22; 95% CI, 0.93–1.61), and SMM excluding transfusion (RR, 1.97; 95% CI, 1.02–3.8) in API women when compared to women of Black and White race.

CONCLUSION:

Even with equal access to health care in the military, API women experience increased rates of adverse maternal outcomes when compared to Black or White women. This highlights the need to continue to include API as a separate race for data collection and calls for further research into possible causes of this health care disparity.
Risk for Cesarean Delivery by Severity of Hypertension in Women of Advanced Maternal Age [A151]
Authors: Smithson Sarah , Rincon Monica , Burwick Richard M.
Published: June 2022

INTRODUCTION:

Advanced maternal age (AMA) is associated with increased risk for hypertensive disorders of pregnancies (HDP) as well as cesarean delivery (CD). We sought to determine if severity of HDP increases CD risk among AMA women.

METHODS:

Cohort study of women with HDP, delivering at a single institution from 2013 to 2018. Participants were divided into four groups: chronic hypertension (CHTN), gestational hypertension (GHTN), preeclampsia (PE) without severe features, and PE with severe features. The CD rate was compared between AMA and non-AMA women, stratified by HDP group. Differences were evaluated by chi-square test or t test, and logistic regression was utilized to adjust for confounders, with significance at P<.05. This study was institutional review board‒approved.

RESULTS:

We identified 1,625 women with HDP, of whom 450 (28%) were AMA. CD rate was highest in PE with severe features compared to all other groups (P<.001). In AMA women, the CD rate also varied significantly by HDP, with the highest CD rate in PE with severe features compared to all other groups (P=.008). AMA was associated with increased odds of CD (OR, 1.6; 95% CI, 1.3–2.0; P<.001), and this association remained significant after adjustment for race-ethnicity, BMI, gestational age, parity, diabetes, and prior preeclampsia (aOR, 1.7; 95% CI, 1.0–2.7; P=.03).

CONCLUSION:

CD rates vary by severity of HDP and are significantly higher among AMA women with HDP compared to non-AMA women. This data may impact delivery counseling for AMA women, especially those with PE with severe features.
Clinical Application of a Previously Validated Pregnancy-Specific Screening Tool for Sleep Apnea [A165]
Authors: Bajaj Sakshi , Rice Alexandra L. , Jones Nathan , Jacobson Natalie , Bazalakova Mihaela , Antony Kathleen M.
Published: June 2022

INTRODUCTION:

The purpose of this project was to determine the positive predictive value of existing obstructive sleep apnea (OSA) screening tools in clinical use and to explore the development of a new questionnaire for the screening of OSA during pregnancy.

METHODS:

Pregnant women as part of routine clinical practice were administered questionnaires from Facco’s four-variable OSA screening tool, STOP-BANG, and the Epworth Sleepiness Scale. Those who screened positive were referred for diagnostic OSA testing, typically with a type III home monitoring device, in routine use at the sleep clinic. Here we analyzed the screening responses used by those who completed diagnostic testing to determine the positive predictive value of the existing tools. We also sought to develop a new questionnaire for OSA screening during pregnancy. The project was approved by the institutional review board at UnityPoint Health-Meriter (Meriter IRB# 2019-014).

RESULTS:

A total of 159 women completed diagnostic OSA testing and were included in this analysis. The positive predictive value of Facco’s four-variable sleep screening tool was 74%, STOP-BANG was 75%, and the Epworth Sleepiness Scale was 69.8%. Our sample size was insufficient to create a new screening tool.

CONCLUSION:

Here we validated Facco’s four-variable tool for screening of OSA in pregnancy. While we were not able to generate a new screening tool for screening of OSA during pregnancy, both STOP-BANG and Facco’s four-variable tool had positive predictive values over 70% in our population, which was characterized by high BMI and advanced maternal age.
Inter-observer and Intra-observer Reliability for NICE 2017 Interpretation Guidelines for Cardiotopography [A167]
Authors: Ghuman Navdeep Kaur , Singhmor Priya , Singh Pratibha , Kathuria Priyanka , Sharma Charu
Published: June 2022

INTRODUCTION:

The goal to standardize the interpretations of cardiotopography (CTG) graphs by various guidelines has met with a low degree of agreement between the observer and poor reproducibility.

METHODS:

The study was commenced following approval of the Institutional Research Committee & Institutional Ethics Committee (AIIMS/IEC/2019-20/824). Intrapartum CTG traces from 165 consecutive women were independently interpreted by six clinicians (three consultants and three residents in training) twice. Inter-observer and intra-observer agreement were calculated by SPSS software version 26 by calculating Fleiss's kappa and Cohen’s kappa coefficient, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of CTG for neonatal metabolic acidosis were computed.

RESULTS:

Among all CTG parameters, observed agreement for baseline was substantial (k=0.678) but the congruence for variability was only slightly above chance (k=0.196). Observers had moderate inter-observer reliability for the presence of decelerations among themselves (k=0.595). The intra-observer agreement was greatly influenced by the experience of observers (k for classifying CTG category was 0.552 for the senior consultant versus 0.473 for the junior resident). For detecting moderate metabolic acidosis (pH≤7.10), CTG had sensitivity 75%, specificity 77.78%, positive predictive value 14.6%, and negative predictive value 98.39%.

CONCLUSION:

The findings emphasize the role of training to improve inter-observer reliability. The higher degree of non-congruence in certain CTG parameters like variability and type of decelerations may perhaps point to the need for further objectivity in defining these parameters. CTG is a good screening tool in a high-risk population and owing to its high negative predictive value provides reassurance to patients and clinicians for fetal wellbeing.
Impact of Insurance Status on Outcomes in Patients With Placenta Accreta Spectrum [A173]
Authors: Hussein Nada , Rigaud Rachelle A. , Edwards Sara , Harrison Rachel , Holmgren Calla
Published: June 2022

INTRODUCTION:

Placenta accreta spectrum (PAS) leads to significant maternal morbidity and mortality. We hypothesized that women with public insurance diagnosed with PAS have increased complications compared to those with private insurance.

METHODS:

This was a retrospective cohort study drawn from the Healthcare Utilization Project–National Inpatient Sample database from across the U.S. between January and December 2018. Inclusion criteria were those with an antepartum diagnosis of PAS, and we compared those with private to those with public insurance. The primary outcome was a composite of surgical complications, including organ/vascular injury or need for repair, ileus or bowel obstruction, IR intervention, or pelvic hematoma. The secondary outcomes were each individual component of the composite. Groups were compared via t tests, chi-square, and logistic regression analyses.

RESULTS:

A total of 1,401 women were eligible for analysis; of these, 709 had public insurance. Women with public insurance were more likely to be Black or Hispanic, of lower socioeconomic status, obese, tobacco users, and be diagnosed with placenta percreta (all P<.05). Those with public insurance had higher rates of the primary composite outcome of any surgical complication (17.0% versus 12.5%, P=.040). However, multivariable logistic regression showed no statistically significant difference in the composite of surgical complications (aOR, 1.19; 95% CI, 0.77–1.84) when adjusted for race, obesity, tobacco use, prior cesarean deliveries, and income, although women with public insurance were 2.5 times more likely to have an ileus or small bowel obstruction (aOR, 2.52; 95% CI, 1.05–6.05).

CONCLUSION:

In this cohort of women with PAS, insurance status was associated with higher rates of ileus or bowel obstruction.
Postpartum Readmission Rates for Hypertensive Disorders of Pregnancy During the COVID-19 Pandemic [A179]
Authors: Griffin Myah , Black Mara , Deeb Jessica , Hoskins Iffath A.
Published: June 2022

INTRODUCTION:

To compare the postpartum (PP) readmission rates of patients with hypertensive disorders of pregnancy (HDP) before and after implementation of an early discharge policy due to the COVID-19 pandemic.

METHODS:

This is a retrospective, quality improvement study of patients with HDP who delivered and were readmitted at NYU Langone Health from March 1, 2019, to February 29, 2020 (Pre) and from April 1, 2020, to March 31, 2021 (Post). The primary outcome was comparison of PP readmission rates between groups. Data were analyzed using ANOVA, Fisher’s exact test, and chi-square test, with significance defined as P<.05.

RESULTS:

There was no statistical difference in readmission rates for PP HDP after implementation of an early discharge policy (19 readmissions of 1,851 deliveries with HDP [1.03%] versus 23 readmissions of 1,847 deliveries with HDP [1.25%]; P=.53). Demographics in each group were similar, as were mean times to readmission (6.4±5.4 days versus 6.4±5.4 days; P=.88) and mean readmission lengths of stay (3.0±1.04 days versus 3.3±1.2 days; P=.45). There was one ICU readmission in the post-group versus none in the pre-group (P=.45). There were no maternal deaths.

CONCLUSION:

These findings support reducing postpartum lengths of stay without increasing readmissions for HDP. The reduction of postpartum length of stay was accompanied by the continuation of a home blood pressure monitoring and introduction of outpatient HDP management guidelines. Further investigation into best practices to support early discharge is warranted.
Training Emergency Department Residents in the Management of Postpartum Hemorrhage: Comparison of Two Approaches [A183]
Authors: Casper Scott , Ray Jessica M. , Galerneau France , Evans Leigh , Slade Martin , Pal Lubna
Published: June 2022

INTRODUCTION:

Postpartum hemorrhage (PPH) is a major contributor to maternal mortality, accounting for 15% of all maternal deaths in the United States. Mortality and morbidity from PPH can be prevented with recognition and rapid intervention. The emergency department (ED) is the first place where women with postpartum hemorrhage present, particularly in areas where obstetric care is limited. Maternity care deserts are defined as counties without a hospital offering obstetric care and no obstetric providers. A total of 34.9% of the counties in the United Sates qualify as maternity care deserts, accounting for 146,451 births. It is critical that ED physicians be trained in the management of PPH.

METHODS:

The study design is a blinded randomized control trial. Thirty ED residents from Yale New Haven Hospital enrolled completed a pre-intervention survey assessing their baseline knowledge and confidence in managing PPH. Residents received a lecture on the management of PPH. Participants were then randomized into a group that received no further intervention and a group that participated in a simulation and debriefing. One week later, the residents’ clinical skills were evaluated in a simulation and repeated the survey. Clinical skills evaluation and survey test scores of the two groups were compared using t test. Covariates were analyzed by linear regression.

RESULTS:

All participants improved their knowledge and confidence regardless of the method used. Simulation did not appear to confer additional benefit.

CONCLUSION:

This study demonstrated that through delivery of a curriculum, we can improve the confidence and the knowledge of ED residents in the management of PPH.
Intra-amniotic Instillation of Indocyanine Green in Uncertain Cases of Preterm Prelabor Rupture of Membranes [A185]
Authors: VanHise Katherine , Dellapiana Gabriela , Silverman Neil S.
Published: June 2022

INTRODUCTION:

Amniocentesis with intra-amniotic dye instillation can be used to determine membrane status in clinically equivocal cases of preterm prelabor rupture of membranes (PPROM). Indigo carmine dye has been traditionally utilized for this purpose, with leakage of blue fluid from the vagina considered diagnostic of PPROM. However, with recent national shortages of this agent, alternates such as indocyanine green need to be considered.

METHODS:

This is a case series of four patients with suspected PPROM who underwent intra-amniotic dye instillation of indocyanine green dye during the years 2019–2021. Patients ranged between 31 0/7 and 32 4/7 weeks of gestation at time of dye instillation. Three milliliters of a 2.5 mg/mL solution of indocyanine green were instilled; following the procedure, patients were observed for leakage of green fluid from the vagina. Written consent was obtained from each patient for publication. Institutional review board approval for a case series consisting of less than five cases is not required at our institution.

RESULTS:

In all four cases, membranes were found to be intact, and all patients went on to have uncomplicated deliveries at or near term. We observed transient fetal premature atrial contractions following indocyanine green instillation in one patient that resolved spontaneously within 12 hours. No other maternal, fetal, or neonatal adverse events were identified in our patients either following the intra-amniotic dye instillation or at the time of delivery.

CONCLUSION:

Indocyanine green should be considered as a safe alternative to indigo carmine for use in intra-amniotic dye instillation to establish or exclude a diagnosis of PPROM.
Trial of Labor and Vaginal Birth After Cesarean Delivery: Racial Disparities Modified by Payment Source [A187]
Authors: Vila Irigoyen Ana I. , Hollinger Ruby C. , Schreiber Marina , Rodriguez Pura , Cherry Sheldon H. , Pelaez Juan Ruiz
Published: June 2022

INTRODUCTION:

The cesarean delivery rate in the United States is three times that recommended by the World Health Organization and contributes excessively to maternal morbidity and mortality, especially in Black women. Vaginal birth after cesarean delivery (VBAC) is a proposed solution, given that the primary indication for cesarean delivery is a previous cesarean delivery. Barriers to VBAC not only include medical contraindications, but also race/ethnicity and social factors, such as payment source. This study explored the associations between maternal race/ethnicity, attempt of trial of labor after cesarean delivery (TOLAC), and successful VBAC.

METHODS:

A retrospective cohort study examined 262,946 deliveries in the U.S. in 2019 after prior cesarean delivery; 68,912 underwent TOLAC. Multiple logistic regression assessed associations between maternal race/ethnicity and outcomes adjusting for confounders and effect modification from payment source.

RESULTS:

Among women with Medicaid, Black women had the highest odds of TOLAC (OR, 1.52; 95% CI, 1.46–1.58), but lower odds of VBAC (OR, 0.72; 95% CI, 0.67–0.77). White women with Medicaid had the lowest odds of TOLAC (reference group), but the highest odds of VBAC. With private insurance, Black women had the highest odds of TOLAC (OR, 1.22; 95% CI, 1.16–1.27), but the lowest odds of VBAC (OR, 0.60; 95% CI, 0.55–0.65). White women with private insurance had the highest odds of VBAC.

CONCLUSION:

Racial/ethnic disparities exist in whether TOLAC is attempted and VBAC is successful. Further, these disparities are modified by payment source. Future directions should examine these associations in the context of location, resources, patient education, and provider attitudes to elucidate the source of this difference and address inequality in VBACs.
Food Desert Residence and the Effect on Breastfeeding Initiation [A199]
Authors: Smith Mary Ann , Tanner Jean Paul , Campos Adriana , Wilson Ronee , Fryer Kimberly , Jacques Adetola Louis
Published: June 2022

INTRODUCTION:

A myriad of social determinants of health (SDH) impact breastfeeding initiation (BFI). Prior research by this group using ecological data demonstrated that food desert residence (FDR) is associated with lower rates of BFI. This study uses individual level data to examine the effect of FDR on BFI.

METHODS:

Florida Department of Health birth data from 2019 were linked to the 2019 United States Department of Agriculture (USDA) Food Access Research Atlas. Food desert census tracts were defined per the USDA definition. Adjusted risk ratios (aRR) and 95% CIs were calculated using modified Poisson regression models. Models were adjusted for known SDH.

RESULTS:

Of 209,087 live singleton births, 16% resided in a food desert. FDR birthers had decreased BFI compared to non-FDR birthers (aRR, 1.23). Risk of decreased BFI was highest among Black birthers (aRR, 1.26) and lowest among Hispanic (aRR, 0.58) and Asian/Pacific Islander birthers (aRR, 0.74). Lower education level was associated with decreased BFI compared to college-educated birthers (aRR, middle school, 5.42; high school, 3.46; some college education, 1.95). History of diabetes and preterm or low-birth-weight infants (aRR, 1.14, 1.47, and 1.38, respectively) were also associated with reduced BFI.

CONCLUSION:

After adjustment for known SDH impacting BFI, FDR remains an important risk factor for decreased BFI. Level of education was the SDH most strongly associated with decreased BFI. Understanding how FDR impacts BFI allows better tailoring of interventions to increase BFI.
Does Preferred Spoken Language Affect Time to Epidural for Nulliparous Patients? [A203]
Authors: Bonilla Kevin , Kouba Insaf , Nguyen Anthony , Blitz Matthew J.
Published: June 2022

INTRODUCTION:

Some studies have observed sociodemographic disparities in administration of intrapartum epidural anesthesia. Our objective was to determine whether preferred spoken language was associated with time to epidural administration.

METHODS:

This was a retrospective cohort study of all nulliparous patients admitted for labor or induction at one academic hospital in New York who received intrapartum epidural analgesia prior to delivery from January to December 2019. The outcome was time to epidural, which was evaluated for English-speaking and non-English-speaking patients. For patients undergoing scheduled induction, time to epidural was defined as the interval from induction agent to epidural administration. For patients admitted in spontaneous labor, time to epidural was defined as the time interval from hospital presentation to epidural administration. Demographic and clinical data were collected. Patients in the induction and spontaneous labor groups were analyzed separately.

RESULTS:

A total of 417 patients were included: 215 (52%) inductions and 202 (48%) presenting in spontaneous labor. Overall, 264 (63%) patients preferred English and 153 (47%) preferred another language (primarily Spanish). In the spontaneous labor group, there was no difference in time to epidural between English-speaking and non-English-speaking patients (307 versus 272 minutes, respectively). Among scheduled inductions, time to epidural was lower for English speakers than non-English speakers (869 versus 1,100 minutes, respectively; P<.01). English-speaking patients were more likely to be induced (56% versus 43%, P<.01). Sociodemographic factors such as age, race/ethnicity, and marital status were not associated with time to epidural.

CONCLUSION:

Preferred language was not associated with time to epidural in the spontaneous labor group, but a significant difference was noted for patients undergoing induction. Non-English-speakers may experience delayed analgesic interventions.
Initial Screening Results for Gonorrhea and Chlamydia in Pregnancy and the Association With Subsequent Test Results [A216]
Authors: Kairis Kelsey , Holbert Michael , Von Hoene Amanda , Mitchell Ashley
Published: June 2022

INTRODUCTION:

Gonorrhea and chlamydia infections during pregnancy are associated with adverse perinatal outcomes. The Centers for Disease Control and Prevention recommends screening for gonorrhea and chlamydia at the first prenatal visit and again in the third trimester for high-risk patients. The objective of this study is to determine rates of subsequent positive gonorrhea/chlamydia tests in pregnant patients based on their initial screening results.

METHODS:

This is an institutional review board‒approved multicenter observational study including patients who delivered from January 1, 2014, to December 31, 2020, with more than one gonorrhea/chlamydia test during pregnancy. Patients whose initial tests were negative were compared with patients whose initial tests were positive. Fisher’s test and multiple logistic regression were performed.

RESULTS:

There were 8,163 pregnancies with multiple gonorrhea tests and 8,213 pregnancies with multiple chlamydia tests. There was a significant difference in subsequent gonorrhea-positives in pregnancies with an initial positive test (33/194, 17.0%) compared to an initial negative test (10/7,969, 0.1%); odds ratio (OR), 163.2; 95% CI, 76.5–378.2; P<.001. Likewise, there was a significant difference in subsequent chlamydia-positives in pregnancies with an initial positive test (266/1,003, 26.5%) compared to an initial negative test (37/7,210, 0.5%); OR, 69.9; 95% CI, 48.9–102.3; P<.001. These associations remained significant following logistic regression to control for confounders.

CONCLUSION:

Among pregnancies with an initial negative gonorrhea/chlamydia screening result, subsequent positive results were unlikely. This may be a simple differentiator for the need for subsequent testing in pregnancy, leading to significant cost savings.
Head-to-Body Interval and Neonatal Outcomes After Shoulder Dystocia [A225]
Authors: Antelo Leonardo F. , Williams Shauna , Krishnamoorthy Kaila , Powell Kimone A. , Apuzzio Joseph , Gittens-Williams Lisa
Published: June 2022

INTRODUCTION:

Shoulder dystocia (SD) is a potentially devastating emergency. Complications may result from maneuvers, yet delivery delay can result in hypoxic-related injury. Awaiting the next contraction is reported to assist in shoulder rotation. We hypothesized that shorter head-to-body delivery interval (HBI) is associated with an increase in neonatal injury without an increase in hypoxia-related sequelae.

METHODS:

This is a retrospective, institutional review board‒approved review of records of patients with singleton pregnancies at a tertiary-care hospital (January 1, 2015, to May 31, 2021). Patients were included if SD was documented in the delivery summary. Neonatal injury was defined as brachial plexus injury, clavicular fracture, or humerus fracture, and were compared based on HBI.

RESULTS:

A total of 9,044 deliveries occurred during the study period. Of these, 71 patients were identified with SD; one was excluded. Of patients with SD, 71% had HBI <3 minutes, 90% had HBI <4 minutes, and one had HBI >6 minutes. Cord pH was available for 67% of patients, none of whom had pH <7.0. Neonatal injury was documented in 22 deliveries and was similar between HBI ≤3 minutes and >3 minutes (30% versus 42%, P=.67). Cord pH was similar with and without neonatal injury (7.177 versus 7.223, P=.069). Two infants had hypoxic injury, both with HBI >4 minutes.

CONCLUSION:

HBI was not associated with neonatal injury. Hypoxic injury was rare and was only seen with HBI >4 minutes. These data support allowing for maternal effort during the subsequent contraction after delivery of the head when less than 4 minutes.
Initiation of Surveillance for Fetal Growth Restriction: At Time of Diagnosis or at 32 Weeks? [A230]
Authors: Vadlamudi Gayathri D. , Hinge Amita M. , Goyert Gregory , Shaman Majid
Published: June 2022

INTRODUCTION:

Following the 2020 Society for Maternal–Fetal Medicine guideline on management of fetal growth restriction (FGR), our institution began initiating antenatal surveillance at time of FGR diagnosis instead of at 32 weeks of gestation.

METHODS:

This institutional review board‒approved retrospective cohort study included patients with FGR, without absent or reversed end diastolic velocity in umbilical artery Dopplers, from the 12-month periods preceding and following this change in surveillance. Previously, twice-weekly non-stress testing (NST) was initiated at 32 weeks of gestation. Subsequently, surveillance was initiated at time of FGR diagnosis, with weekly biophysical profile (BPP) starting at 26 weeks and additional weekly NST at 32 weeks. The primary outcome was a composite of neonatal intubation, respiratory distress syndrome, intraventricular hemorrhage, and perinatal death. Secondary outcomes were rates of neonatal intensive care unit (NICU) admission, preterm delivery, surveillance visit attendance, and referral for further monitoring.

RESULTS:

A total of 150 patients were studied: 73 with antenatal testing initiated after 32 weeks and 77 with testing starting at time of diagnosis. There was no difference in primary neonatal composite outcome (6.8% versus 9.1%, P=.766), rates of NICU admission (19.2% versus 18.2%, P=.876), preterm delivery (16.4% versus 16.9%, P=.942), surveillance visit attendance (91.7% versus 88.9%, P=.697), or overall referral rate for further monitoring (8.0% versus 8.2%, P=.894). With initiation of surveillance at time of diagnosis, 7.5% of referrals occurred prior to 32 weeks.

CONCLUSION:

In the setting of FGR with normal Dopplers, initiating antenatal surveillance at time of diagnosis led to increased referrals for further monitoring at earlier gestational ages without improvement in neonatal outcomes.
Mobile Integrated Health for Postpartum Blood Pressure Monitoring: Impact on Hospital Readmissions [A237]
Authors: Goebel Anna M. , Abam Cynthia , Dude Carolynn M. , Boulet Sheree , Stanhope Kaitlyn K. , Geary Franklyn H.
Published: June 2022

INTRODUCTION:

Starting in December 2019, Grady Memorial Hospital, a public institution in Atlanta, Georgia, implemented a home visiting mobile integrated health (MIH) program to reduce risk for postpartum complications among women with hypertensive disorders of pregnancy (HDP). We aimed to assess the impact of the MIH intervention on readmission rates.

METHODS:

Using electronic medical record for all deliveries between March 2018 and June 2021 at Grady Memorial Hospital, we calculated monthly rates of all-cause readmissions within 42 days of delivery discharge. We used a controlled interrupted time series design to compare readmission rates before (March 1, 2018, to November 30, 2019) and after (December 1, 2019, to June 30, 2021) the implementation of the MIH program for deliveries with and without HDP, assuming a level and slope change. Deliveries without HDP were not eligible for the MIH intervention and were used as controls. Emory’s institutional review board approved this study.

RESULTS:

There were 3,455 deliveries with HDP and 4,479 deliveries without HDP. Overall rates of readmission for deliveries with and without HDP were 3.7% (95% CI, 2.9–4.7%) and 1.8% (95% CI, 1.3–2.4%) in the pre-MIH period and 3.9% (95% CI, 3.0–5.1%) and 1.9% (95% CI, 1.4–2.6%) in the post-MIH period, respectively. We found no evidence of a sudden change in readmission rates (β, 0.029; P=.96) or a linear trend in readmissions (β, –0.069; P=.17) following the implementation of the MIH intervention among deliveries with HDP compared with deliveries without HDP.

CONCLUSION:

A MIH intervention for women with HDP was not associated with decreased rates of postpartum readmissions in our population.
Obstetrics and Gynecology Resident and Physician Experience With Management of Cesarean Wound Complications [A238]
Authors: Olig Emily M. , Reddy Madhuri
Published: June 2022

INTRODUCTION:

With the increasing BMI of the pregnant population putting women at higher risk for cesarean delivery and subsequent wound complications, it is important to identify where our specialty stands in our ability to manage these complications independently. This study was designed to elicit the general knowledge and comfort level of residents and practicing physicians with respect to managing complex postoperative wound infections after cesarean.

METHODS:

This descriptive study was performed as an anonymous online survey using REDCap database tools. Institutional review board approval was obtained. Links to the online study were sent electronically to program coordinators at U.S. residency programs in obstetrics and gynecology for distribution to their residents and faculty.

RESULTS:

Of the 65 respondents, 65% were trainees and 35% were practicing physicians. Of those with community or combined community/academic training, 65% felt they did not have enough hands-on training in residency. This was true of 33% of those who trained in a predominantly academic setting. Overall, only 10% of respondents either identified wound care as something they did not desire to participate in or as something that was out of their scope of practice. Over half (55%) of respondents in each training group identified continued education in wound care as an essential part of being able to manage these complications independently.

CONCLUSION:

This preliminary study suggests that training in postoperative wound care is often insufficient in residency, and that a significant portion of obstetrician–gynecologists would provide this care to their postoperative patients independently with access to enhanced educational opportunities.
Perspectives of Postpartum Pain Management Among Patients With Prenatal Opioid Exposure [A252]
Authors: Townsel Courtney , Keer Emma , Irani Sanaya , Nguyen Buu-Hac , Hallway Alex , Peahl Alex F.
Published: June 2022

INTRODUCTION:

Opioid-sparing protocols can reduce postpartum opioid prescribing in opioid-naïve patients; however, patients with a history of opioid use disorder (OUD) and chronic pain are typically excluded from evaluations. We assessed the postpartum pain experience in patients who were not opioid-naïve before delivery.

METHODS:

We conducted a phone survey assessing maternal postpartum pain experiences for all patients with OUD and chronic pain on opioids prenatally who delivered between January 2020 and August 2021 at a single hospital. In this IRB exempt study, verbal informed consent was obtained for all participants. Analyses included simple descriptive statistics.

RESULTS:

Of 24 patients successfully contacted, 17 (71%) participated. Patients were predominantly White (100%, 17/17), publicly insured (76%, 13/17), multiparous (82%, 14/17), had a vaginal delivery (53%, 9/17), and had an average age of 32. Patients were most commonly identified as having OUD (88%, 15/17) followed by chronic pain (12%, 2/17). About a quarter (4/17, 24%) reported poor pain control (7/10 or greater) in the hospital and one week after discharge. Among patients with vaginal deliveries, 11% (1/9) used opioids postpartum, 78% (7/9) used acetaminophen, and 67% (6/9) used ibuprofen. Among cesarean births, 50% (4/8) used opioids postpartum, 100% (8/8) used acetaminophen, and 75% (6/8) used ibuprofen. Of the 69% (11/16) who reported breastfeeding, 45% (5/11) reported some pain interference.

CONCLUSION:

Many patients on maintenance opioids prenatally reported poor postpartum pain control. Non-opioid medications were not optimized in patients undergoing cesarean delivery, suggesting an opportunity for better opioid-sparing pain management strategies.
Estimating In Vivo Levonorgestrel Release Rate and Exposure Over Eight Years With Levonorgestrel Releasing Intrauterine System 52 mg Use With Population Pharmacokinetic Approach [A03]
Authors: Jensen Jeffrey T. , Reinecke Isabel , Lukkari-Lax Eeva , Hofmann Birte M.
Published: June 2022

INTRODUCTION:

To characterize performance of the levonorgestrel releasing intrauterine system (LNG-IUS) 52 mg (Mirena) for 8 years of use (currently approved for 7 years) and facilitate comparisons with LNG-IUS 19.5 mg and LNG-IUS 13.5 mg, we estimated in vivo LNG release rates and LNG plasma/serum concentrations using a population pharmacokinetic (popPK) approach with data from the Mirena Extension Trial (MET) and earlier clinical trials.

METHODS:

Previously, we developed a popPK model based on measured plasma/serum LNG concentrations and residual LNG content from removed 52 mg, 19.5 mg, and 13.5 mg LNG-IUS devices in clinical studies for up to 5 years of use, estimating in vivo LNG release and describing LNG exposure. To estimate release and exposure for years 6–8 of use, we applied the model to data for 6, 7, and finally 8 years from the MET.

RESULTS:

As expected, LNG release rates for LNG-IUS 52 mg were higher than for 19.5 mg and 13.5 mg devices. After 8 years, LNG-IUS 52 mg release rate (7.04 µg/day) was similar to LNG-IUS 19.5 mg after 5 years (7.6 µg/day) and higher than LNG-IUS 13.5 mg after 3 years (5.5 µg/day). Model-based estimated and measured LNG concentrations showed good agreement, with average plasma LNG concentrations after 8 years LNG-IUS 52 mg (100ng/L [CV%: 39.9%]) similar to after 5 years LNG-IUS 19.5 mg (84.8ng/L [39.9%]) and higher than after 3 years LNG-IUS 13.5 mg (58.1ng/L [40.8%]) use.

CONCLUSION:

LNG release rates from LNG-IUS 52 mg at 8 years are similar to 19.5 mg at 5 years and higher than 13.5 mg at 3 years. The 8-year popPK model provides in vivo LNG release rate and concentration estimates, facilitating more direct comparisons between the three LNG-IUSs.
Medical Student-Led Implementation of Preclinical Abortion Didactics [A09]
Authors: Cardall Anna K. , Barker Margot , Rosecrance Katherine G. , Masini Irene , Patibandla Yamini , Patel Jasmine
Published: June 2022

INTRODUCTION:

Although all physicians encounter patients who have had abortions, formal abortion education in medical school is often limited to individual interest. Given that less than 50% of US medical schools formally discuss abortion care, we evaluated a preclinical session for our fellow medical students teaching about abortion care.

METHODS:

We created and presented a didactic session reviewing non-biased pregnancy options counseling and outlining abortion epidemiology, techniques, and safety with an interactive small group case-based discussion. We anonymously obtained pre- and post-intervention surveys which collected demographics and views on the necessity and impact of the session as well as evaluated changes in participants’ knowledge of and attitudes towards abortion. We compared matched results using McNemar’s test for discordant pairs.

RESULTS:

Ninety-two first- and second-year medical students participated in both surveys, for a 76.7% response rate. An overwhelming majority (94.6%) of participants agreed that basic abortion knowledge is necessary for all physicians. In addition, 88% affirmed that the session would affect their future practice. We observed a significant increase in knowledge of abortion epidemiology (OR 13.3, P<.001) and techniques (OR 48, P<.001). Participants felt more comfortable discussing pregnancy options (OR 39, P<.001) and 30.4% cited changes in their attitudes towards abortion after the session. Qualitative feedback demonstrated appreciation of our focus on the medical aspects of abortion care and emphasized the appropriateness of the session.

CONCLUSION:

Abortion education for preclinical medical students is valuable for them and their future patients. Additionally, it can be implemented effectively by a medical student cohort with institutional support.
Satisfaction With Levonorgestrel-Releasing Intrauterine System 12 in North American Women: Findings From the Real-World Kyleena Satisfaction Study [A14]
Authors: Hauck Brian , Baisden Kristie W. , Frenz Ann-Kathrin , Aqua Keith
Published: June 2022

INTRODUCTION:

The real-world Kyleena Satisfaction Study (KYSS) confirmed clinical findings that the levonorgestrel-releasing intrauterine system (LNG-IUS) 12 (Kyleena) is associated with high satisfaction and continuation rates. We report results from North American KYSS participants.

METHODS:

This observational, multinational, multicenter, single-arm cohort study was conducted from 2017 to 2018. All centers obtained institutional review board approval. Women who independently elected to use LNG-IUS 12 were enrolled. KYSS assessed LNG-IUS 12 satisfaction, continuation, and safety.

RESULTS:

LNG-IUS 12 was successfully placed in 99/99 Canadian and 99/100 US women. Clinicians rated placement “easy” in 88 (89%) Canadian and 90 (90%) US women. Sixty-seven (67) (68%) Canadian and 72 (72%) US women rated placement pain as none/mild. For Canadian women, mean age was 24.2±7.0 years and 87/99 (88%) were nulliparous, compared with 26.4±7.3 years and 71/99 (72%) for US women. Motivations for choosing LNG-IUS 12 were most commonly “no need for a contraceptive routine” (31/99 [31%] Canadian and 49/99 [50%] US women) and “high contraceptive reliability” (34/99 [34%] and 23/99 [23%], respectively). At 12 months/premature discontinuation, 69/75 (92%) Canadian and 83/89 (93%) US women reported being very/somewhat satisfied with LNG-IUS 12; 49/74 (66%) Canadian and 64/80 (80%) US women were satisfied with their menstrual bleeding profile. The 12-month continuation rate was 74% (73/99) for Canadian and 82% (82/100) for US women. Most discontinuations were due to loss to follow-up (16/99 [16%] and 7/100 [7%], respectively) or treatment-emergent adverse events (10/99 [10%] and 8/100 [8%], respectively).

CONCLUSION:

Results from North American KYSS participants demonstrate high satisfaction and continuation including among young and nulliparous women.
Effects of the COVID-19 Pandemic on Contraceptive Access at Planned Parenthood of Illinois [A16]
Authors: Young Danielle , Schumm L. Philip , McHugh Ashley , Whitaker Amy K. , Stulberg Debra
Published: June 2022

INTRODUCTION:

Prior to the COVID-19 pandemic, Planned Parenthood of Illinois (PPIL) provided in-clinic contraceptive services to over 10,000 patients/year. At pandemic onset, PPIL rapidly consolidated services to six health centers and launched telehealth. This study aims to understand the disruptions of the pandemic on contraceptive access and to understand the impact of telehealth as measured by changes in time to appointment and method mix.

METHODS:

Retrospective contraceptive service delivery data were analyzed before (March 2019–March 2020) and during (March–October 2020) the pandemic. Time to appointment was defined as days from date appointment was made to originally scheduled appointment date. Method mix was dichotomized as pill/patch/ring or long-acting reversible contraception (LARC). Other methods were excluded. Descriptive and comparative statistics were generated. Institutional review board approval was received from the University of Chicago.

RESULTS:

Before the pandemic, median (IQR) time to in-clinic appointment was 5 (2-9) days compared to 11 (5-15) days during the pandemic. Median time to telehealth appointment was 4 (2-8) days. During the pandemic, 6,615 patients received contraceptive services, 1,701 through telehealth and 4,914 in-clinic, with 91.9% choosing pill/patch/ring or LARC methods. When dichotomized, method mix slightly changed with 57.0% of patients, pre-pandemic, choosing pill/patch/ring methods compared to 54.9% patients during the pandemic (P=.006). During the pandemic, 41.4% of pill/patch/ring visits were through telehealth and 58.6% through in-clinic visit.

CONCLUSION:

Telehealth appointments were available sooner than in-clinic visits and uptake of telehealth visits for patients obtaining pill/patch/ring was substantial. The small change in method mix is likely not clinically significant.
Postmarketing Safety of a Levonorgestrel/Ethinyl Estradiol Contraceptive Transdermal Delivery System [A24]
Authors: Kroll Robin , Chiodo Joseph , Previtera Michelle , Korner Paul , Kaunitz Andrew M. , Teixeira Beata
Published: June 2022

INTRODUCTION:

TWIRLA is a low-dose contraceptive transdermal delivery system of 120 µg/day levonorgestrel and 30 µg/day ethinyl estradiol (LNG/EE TDS) used in a 28-day cycle. It was approved by the US Food and Drug Administration in February 2020 as a method of contraception for use in women of reproductive potential with a body mass index (BMI) <30 kg/m2. The phase 3 SECURE study showed an acceptable safety profile for the LNG/EE TDS in a clinical trial setting. This assessment provides an update of LNG/EE TDS safety based on real-world postmarketing adverse event reporting.

METHODS:

Data collected from LNG/EE TDS standard postmarketing reporting during December 2020 through September 2021 were assessed and describe serious adverse events (SAEs) to date, including venous thromboembolism (VTE, an event of special interest), and the number of patients who received replacements in a patch-replacement program.

RESULTS:

Approximately 14,600 prescriptions for the LNG/EE TDS were dispensed during this postmarketing period, with additional patches dispensed as samples. No VTEs were reported. Two SAEs (one case each of suicidal ideation and loss of consciousness) were reported; based on spontaneous reporting, no new safety issues were identified. Reports of TDS adhesion issues were rare; only 11 individuals received a replacement over the 10-month period.

CONCLUSION:

In this assessment of real-world usage of the LNG/EE TDS, SAEs and TDS replacements were infrequent and no VTEs were reported. These findings are consistent with the safety profile reported in the SECURE study, where four patients with VTEs were identified, all in women with a BMI >30 kg/m2.
Clinical Outcomes of Incidental, Postplacental Intrauterine Device Placement in the Setting of Chorioamnionitis [A26]
Authors: Bayard Katherine E. , Fabricant Sonya , White Jessica D. , Gordon Brian , Nguyen Brian T.
Published: June 2022

INTRODUCTION:

This case-control study reviews complications and contraceptive outcomes following incidental, immediate post-placental intrauterine device (IUD) placement in the setting of chorioamnionitis (CDC contraindication category 4), versus waiting to receive an interval IUD per standard guidelines.

METHODS:

We conducted an institutional review board (IRB)-compliant retrospective chart review of individuals delivering an infant and desiring an IUD for postpartum contraception in the setting of chorioamnionitis (2015-2020). We collected demographics, histopathologic confirmation of chorioamnionitis, timing of IUD placement, duration of use, short term outcomes/complications (e.g., worsening infection), and long-term outcomes/complications (e.g., IUD retention, IUD expulsion, pelvic inflammatory disease). Data were compared between individuals receiving post-placental IUDs and those waiting to receive outpatient, interval IUDs. We conducted phone interviews to validate and follow-up on medical record data.

RESULTS:

Fifty-five individuals with chorioamnionitis desired an IUD for postpartum contraception (mean age: 27 years, gestational age at delivery: 39 weeks); 25% provided phone interviews. Nearly half (45%) of clinician-diagnosed chorioamnionitis was confirmed on histopathology. Among IUD recipients (22 post-placental, 10 interval), four re-presented with five complaints (one vaginal discharge, three pelvic pain, one IUD malposition). Incidence of re-presentation did not differ by timing (P=.77) or presence (P=.91) of IUD. Individuals who received a post-placental IUD were significantly more likely (P<.01) to have their IUD in place at 12 months than those intending to receive a post-partum interval IUD.

CONCLUSION:

No severe complications occurred among individuals receiving a post-placental IUD in the setting of chorioamnionitis. Recipients of immediate versus interval IUDs were more likely to have an IUD at 1 year follow-up.
Awareness of the Maternal Health Benefits of Lactation Among US Pregnant Women [A30]
Authors: Iwuagwu Caidon , Chen Melissa J. , Hoyt-Austin Adrienne E. , Kair Laura R. , Fix Margaret , Schwarz Eleanor Bimla
Published: June 2022

INTRODUCTION:

Rates of breastfeeding in the US remain suboptimal. Public health campaigns encouraging breastfeeding have focused on health benefits for infants, despite over 60 years of data demonstrating breastfeeding reduces maternal risk of breast cancer with more recent data indicating breastfeeding lowers maternal risk of ovarian cancer, diabetes, hypertension and heart disease.

METHODS:

To assess awareness of the effects of lactation on maternal health, we used social media to recruit a prospective cohort of US-born nulliparous women carrying a singleton pregnancy of 28+ weeks’ gestation in 2021. Participants were compensated a $20 gift card for completing an online survey. Institutional review board (IRB) approval was obtained.

RESULTS:

Of 152 respondents, a family history of breast cancer (9%), diabetes (23%), hypertension (26%), and heart disease (9%) was reported by some; fewer (5%) were diagnosed with gestational diabetes or a hypertensive disorder of pregnancy (2%), and 76% were college educated. Most respondents were aware that breastfeeding benefits infant health; 23% strongly (and 42% somewhat) felt that breastfed babies are healthier than formula fed babies. Most (91%) believed breastfeeding will save their family money. Most strongly (67%) or somewhat (23%) agreed that breastfeeding their baby was important. However, fewer than half were aware that breastfeeding lowers maternal risk of breast cancer (47%), ovarian cancer (32%), diabetes (25%), and hypertension or heart disease (28%).

CONCLUSION:

Few US pregnant women are aware of the maternal health benefits of breastfeeding. Counseling pregnant women about the beneficial effects of lactation on maternal, in addition to infant, health may help increase breastfeeding rates.