bluuebunny/crossref_metadata_2025 huggingface dataset:
The Clinical Importance of Postpartum Contraception Upon Hospital Discharge [25J]
Authors: Nguyen Ha Vi , Pan Yangshu , Burke Anne E.
Published: April 2020

INTRODUCTION:

The immediate postpartum period is critical for contraceptive provision due to rapid fertility return but only half of women attend the postpartum visit. Our objective was to examine whether immediate postpartum contraception influenced the likelihood of postpartum follow-up or subsequent pregnancies within 3-years of delivery.

METHODS:

The IRB approval was obtained. We conducted a retrospective chart review of hospital deliveries from April–July 2015 and reviewed follow-up data through 2018. The primary outcome was immediate postpartum contraception (provided before discharge). Secondary outcomes were postpartum visit attendance, follow-up after postpartum visit, and subsequent pregnancies. Chi-square analysis was used for between-group comparisons.

RESULTS:

Among 307 patients, the largest percentage (n=76, 24.8%) received contraceptive implants. Only 44.3% (n=133) of women returned for the postpartum visit; there were no differences by contraceptive method. There were 171 (55.7%) women without follow-up past the postpartum period. Patients who received LARC or permanent contraception immediately postpartum were less likely to follow up after the postpartum visit (n=52, 38.2%) compared to less effective methods (n=84, 61.8%; P<.05). Of 55 women with subsequent pregnancies, 13 (23.6%) had been discharged with LARC, and 42 (76.4%) with less effective methods or no method (P<.001).

CONCLUSION:

Less than half of patients returned for postpartum care. Women discharged with LARC or permanent methods were less likely to have follow-up after the postpartum visit, or have subsequent pregnancies within a 3-year time frame compared to women discharged with less effective or no contraception. Results highlight the importance of offering contraception in the immediate postpartum period.
The Effects of Postpartum Long-Acting Reversible Contraceptive Insertion From the Medicaid Payer Perspective [26J]
Authors: Swiatlo Alison , Miele Kathryn , Morse Jessica E. , Lich Kristen , Krashin Jamie
Published: April 2020

INTRODUCTION:

This Markov model was created to determine the difference in unintended pregnancies, costs, and cost effectiveness with immediate versus standard placement of postpartum long-acting reversible contraception (ppLARC), which includes intrauterine devices (IUDs) and implants.

METHODS:

This Markov model examines a theoretical cohort of 1,000 women whose obstetrical care was paid for by North Carolina Medicaid and who requested ppLARC prior to discharge from their delivery hospitalization from the perspective of NC Medicaid. Probability inputs came from the literature and cost inputs are from NC Medicaid fee schedules. Markov cycles were weekly with an 18 month time horizon. During the time horizon postpartum, a woman could continue with her current contraceptive method, change to a different method, or become pregnant. Pregnancy is an absorbing state with five different outcomes. Probabilistic sensitivity analyses were conducted on key model parameters.

RESULTS:

Immediate ppLARC would result in 182 fewer unintended pregnancies and save North Carolina $624,372 over two years. Immediate ppLARC was cost saving, with an ICER of $3,435 saved per unintended pregnancy prevented. In sensitivity analyses, immediate ppLARC remained cost saving except when parameters were varied widely from expected values.

CONCLUSION:

Immediate post-partum insertion of long-acting reversible contraceptives was found to be associated with cost-savings and fewer unintended pregnancies.
The Impact of Medicaid Reimbursement on Rates of Postpartum LARC Uptake [27J]
Authors: Addante Amy , Koch Susannah , Brubaker Allison , Hillary Duckham , Tepe Melissa , Carter Ebony
Published: April 2020

INTRODUCTION:

There are many barriers to immediate postpartum long acting reversible contraception (LARC) placement, including lack of knowledge, restrictive placement criteria, inadequate reimbursement, and policies banning reimbursement for placement during an inpatient hospitalization. We aimed to determine the impact of a policy change by Missouri Medicaid in October of 2016 allowing reimbursement of immediate postpartum LARC placement.

METHODS:

We completed a retrospective cohort study comparing patients who delivered at Barnes Jewish Hospital (BJH) one year before (September, 2015-September 2016) and after (November, 2016-November, 2017) the Medicaid LARC immediate postpartum reimbursement policy change. Patients who had a contraindication to LARC placement were excluded. The primary outcome was immediate postpartum LARC placement. Demographic characteristics were compared using chi-square and Fisher’s exact test, as appropriate. Pertinent confounders were controlled for using logistic regression and the analysis was stratified by insurance type.

RESULTS:

A total of 6,233 women were included with 3,105 delivering before the postpartum LARC policy change and 3,128 delivering after. Immediate postpartum LARC uptake increased from 0.5% (n=16) to 7.3% (n=229) after the policy change (adjusted odds ratio (aOR) 15.4; 95% CI 9.3-25.8). In stratified analysis, postpartum LARC uptake increased in both women enrolled in Medicaid (0.7% to 9.6%; aOR 14.8; 95% CI 8.6-25.9) and private insurance (0.2% to 2.9%; aOR 13.3; 95% CI 3.2-55.9).

CONCLUSION:

Medicaid reimbursement for inpatient postpartum LARC is associated with an increased uptake among women with both Medicaid and private insurance. This policy change is an important step in reducing the burden of unintended pregnancies.
Complications of Dilation and Evacuation and Induction of Labor for Second-Trimester Fetal Demise [31J]
Authors: McLaren Hillary , Cancino Dominic , McCulloch Megan , Fitzgerald Sharon , French Valerie
Published: April 2020

INTRODUCTION:

We compared the frequency of complications for dilation and evacuation (D&E) and induction of labor (IOL) for treatment of second-trimester intrauterine fetal demise (IUFD).

METHODS:

We performed a retrospective cohort study of women with an IUFD between 14-24 weeks who underwent D&E or IOL at a university hospital between June 2009 and June 2019. We defined complications a priori as: 1) infection, 2) uterine atony, 3) retained products of conception, 4) hemorrhage, 5) uterine perforation (D&E only), 6) uterine aspiration (IOL only), 7) cervical laceration (D&E only), 8) uterine rupture, 9) unplanned admission, 10) readmission within 14 days, 11) blood transfusion, 12) intensive care unit admission, 13) removal or injury to an organ, 14) uterine rupture, 15) cardiopulmonary arrest, 16) any other unplanned surgery, and 17) death. We also assessed a composite of major complications, defined as complications 8-17. We assessed differences in composite complication frequency with chi-squared and Fisher’s exact tests.

RESULTS:

Of the 119 women who met inclusion criteria, 41 underwent D&E and 78 underwent IOL. In our preliminary analysis, 29.2% (12/41) women in the D&E group and 24.4% (19/78) in the IOL group (P=.56) experienced any complication. No women in the D&E group experienced a major complication and 3 women in the IOL group experienced a major complication (3.8%, P=.55).

CONCLUSION:

D&E and IOL had comparable complication rates for women in our study. Patients should be offered both options in the treatment of a second-trimester IUFD.
Influenza and Tdap Vaccines: Practices and Perception Among Hispanic Women Attending Tertiary Center in Puerto Rico [32J]
Authors: Miranda Angela , Vargas Darlene , Medina Yailis
Published: April 2020

INTRODUCTION:

Explore influenza and Tdap immunization knowledge, attitudes, and practices among Hispanics patients attending prenatal care in a tertiary hospital in Puerto Rico as well as barriers encountered by patients regarding vaccination practices during pregnancy.

METHODS:

Descriptive study conducted at Adult District Hospital prenatal care clinics in the Medical Sciences Campus of Puerto Rico from September 2016 to June 2017.

RESULTS:

A total of 189 were recruited. Regarding Influenza vaccine: 75.6% were offered or oriented about Influenza vaccination, 51.8% had received the vaccine at least once (only 12.2% during current pregnancy) and, 57.1% reported receiving information about influenza infection risks in pregnancy, mainly from health care professionals and media. For Tdap only 20.6% of women were offered or oriented about the vaccine and 23.3% received the vaccine. 55.6% of patient had not been oriented about potential dangers of the pertussis infection; for the few oriented, health professionals were their predominant source. In terms of barriers, lack of information about vaccination and the effects/benefits during pregnancy were the most frequent.

CONCLUSION:

Our study identifies the existing gap of information regarding Influenza and Tdap vaccine. Physicians play a pivotal role in preventive care and new strategies are needed to optimize education to our patients.
Is Screening Positive for Sleep Apnea Associated With a Higher Rate of Miscarriage? [33J]
Authors: Larson Jeannette M. , Bazalakova Mihaela H. , DelBeccaro Melanie , Aagaard Kjersti , Antony Kathleen M.
Published: April 2020

INTRODUCTION:

The purpose of this study was to evaluate whether positive questionnaire-based screening for obstructive sleep apnea (OSA) was associated with higher rates of miscarriage (SAB).

METHODS:

Secondary analysis of a prospective observational study of participants enrolled in an OSA screening study between 2010–2012. This analysis received an IRB exemption. A screening questionnaire with standard Epworth (ESS), Berlin (BQ), and novel items was administered at a prenatal care visit. The results of women who completed the survey in the first trimester (1T) were assessed for association with SAB.

RESULTS:

In a cohort of 213 women screened in the 1T, 30% (n=64) had elevated BQ or ESS scores, 18.8% (n=40) had high ESS scores and 14.6% (n=31) had elevated BQ scores suggestive of risk of OSA. 3.29% (n=7) had high ESS and BQ scores. Women who had both elevated ESS and BQ scores were more likely to experience SAB than those who had elevated scores on one or neither (P=.018). Women who reported snoring (P=.042) or hypertension (P=.013) in the 1T were more likely to experience SAB than women who did not. In contrast, women who reported napping in the 1T were less likely to experience SAB than women who did not (P=.045).

CONCLUSION:

Elevated BQ and ESS scores are statistically significantly associated with SAB. Snoring, naps and hypertension were the only individual questions from the BQ and ESS with statistically significant associations with SAB. Further investigation into this topic is warranted.
Quality of Care and Communication With Limited English Proficiency (LEP) Obstetric Patients [37J]
Authors: Sanserino Kathryne A. , Papatla Katyayani , Aioub Miriam , Gee Tiffany , Datwani Hema
Published: April 2020

INTRODUCTION:

Hospital guidelines and standards recommend the routine use of professional interpreters for patients with Limited English Proficiency (LEP). There is no preexisting data on LEP obstetrics patients and their communications with physicians and nurses. Our objective was to review English LEP patients’ communication with physicians and nurses during their delivery hospitalization, including the use of interpreters and language proficient providers, as well as its association with patient satisfaction.

METHODS:

Cross-sectional study with in-person survey methodology and retrospective chart review of patients admitted to our postpartum service after delivery at our institution. IRB exempt.

RESULTS:

148 postpartum patients were screened. After applying inclusion and exclusion criteria, 20 patients participated in the survey. 70% of these patients were admitted by non-language proficient provider. Of these, only 36% documented use of interpreter during admission. 2 of the 3 patients who underwent cesarean section reported that the reason for cesarean was explained to them in English without the use of interpreter. Despite this, there was reported 100% satisfaction with overall physician care, physician communication with respect to medical condition, and physician respect for culture and language.

CONCLUSION:

We hypothesized that the rate of use of interpreters and language-proficient providers would be poor, and this proved to be correct in our internal review. The high reported rates of patient satisfaction with both physician and nursing care, communication, and perception of respect for culture and language was a seemingly discordant finding that warrants further exploration. Patient satisfaction drivers may be somewhat different for obstetric populations. This warrants further investigation.
Rate of Cervical Change During Ripening in Nulliparous Women Using Vaginal or Buccal Misoprostol [38J]
Authors: Grasch Jennifer , Quinney Sara K. , Haas David M.
Published: April 2020

INTRODUCTION:

Cervical ripening is frequently needed for labor induction in nulliparous women. The objective of this study was to determine if the rate of cervical change and time to active labor were different when misoprostol is administered by vaginal or buccal route.

METHODS:

This was a secondary analysis of nulliparous women enrolled in the IMPROVE Study- A comparison of vaginal versus buccal misoprostol for cervical ripening in women for labor induction at term: a triple-masked randomized controlled trial. Primary outcomes were time to active labor (defined as at least 6 cm cervical dilation) and rate of change of cervical dilation up to active labor. Survival analysis using Product-Limit Survival Estimate and Kaplan-Meier method was utilized for time to active labor. IRB approval was obtained.

RESULTS:

Of the 300 women enrolled in the trial, 124 (41.3%) were nulliparous, with 59 receiving vaginal misoprostol and 65 receiving buccal. Nulliparous women receiving vaginal dosing required fewer doses to reach active labor (2.0 vs 3.0, P=.003). However, this did not result in shorter time to active labor (median 23.1 hrs vs. 25.6, P=.49). The rate of cervical change for the vaginal misoprostol group from trial entry to ≥6 cm was 2.9 (±1.6) mm/hr compared to 2.9 (±1.6) mm/hr for buccal (P=.97).

CONCLUSION:

In nulliparous women undergoing cervical ripening with misoprostol, vaginal dosing may require fewer doses to achieve active labor but the time to active labor and rate of cervical change were similar between dosing groups. There may not be clinically meaningful differences between dosing routes in nulliparous women.
The Association of Maternal Education on Prenatal Care Sufficiency [39J]
Authors: Stephens Kendal K. , Fresch Robert J. , Degrandis Michael , DeFranco Emily
Published: April 2020

INTRODUCTION:

Low maternal education is an independent risk factor for adverse maternal and neonatal outcomes. We investigated the association between maternal educational attainment and prenatal care quantity to identify an at-risk population who may benefit from public health programs.

METHODS:

Population-based retrospective cohort study of live births in Ohio, 2005-2016. The exposure was maternal education defined as highest educational attainment ≤8th grade, 9-11th grade, or high school graduate. The outcome was adequate care defined as ≥50% of recommended visits for gestational age at birth, inadequate care was <50% of recommended, versus no prenatal care. The Kessner Index was utilized for this calculation. Sociodemographic, maternal, and obstetric characteristics were compared between amount of education and prenatal care. Multivariate logistic regression estimated the relative association of maternal education on prenatal care adequacy after adjusting for coexisting risk factors.

RESULTS:

Of 1,452,855 live births, 84% achieved high school graduation while 12.2% attended high school, and 3.3% had ≤8th grade education. Furthermore, 6.7% received insufficient and 2.2% received no prenatal care. The adjusted relative risk of obtaining no prenatal care was >2-fold increased for ≤8th grade (aRR 2.5, 95% CI 2.4-2.7) and high school without completion groups (aRR 1.9, CI 1.8-1.9). The risk of inadequate care was also increased, aRR 4.9 (CI 4.8-5.0), and 1.8 (CI 1.8-1.9), respectively, even after adjustment for maternal race and Medicaid.

CONCLUSION:

Low maternal education is associated with lack of prenatal care. Public health initiatives targeting adolescent education on reproductive health may be an opportunity to improve perinatal outcomes.
The Impact of Episiotomy on Adverse Perinatal Outcomes in Operative Vaginal Deliveries [40J]
Authors: Owens Sarah N. , Thayer Sydney Marie , Yanit Keenan , Garg Bharti , Caughey Aaron B.
Published: April 2020

INTRODUCTION:

There has been a large reduction in routine episiotomy, thus many provided today are likely clinically indicated. Thus, we sought to investigate the association between episiotomy and adverse perinatal outcomes in operative vaginal births.

METHODS:

This is a retrospective cohort study of singleton, non-anomalous, term spontaneous vaginal deliveries between 2007 and 2011 using linked vital statistics and ICD-9 data. The neonatal adverse outcomes examined included brachial plexus injury (BPI), clavicular fracture (CVFs), 5-min APGAR score <7, neonatal intensive care unit (NICU) admission, and composite of severe neonatal outcomes (neonatal seizure, APGAR score ≤3, and neonatal death). The maternal adverse outcomes examined included postpartum hemorrhage (PPH), 3rd and 4th-degree perineal lacerations, and maternal blood transfusion (MBTs). Chi-square tests were used to compare rates of perinatal adverse outcomes for births with and without episiotomy. Multivariable logistic regression was used to control for maternal BMI, diabetes status, race/ethnicity, age, education, insurance status, parity, and prenatal care.

RESULTS:

In a cohort of 161,921 operative vaginal births, we found no statistically significant difference for adverse neonatal outcomes for births with and without episiotomy. Interestingly, women with episiotomy had decreased rates of postpartum hemorrhage, a relationship that remained after controlling for confounders of interest (aOR 0.55, 95% CI 0.35-0.84).

CONCLUSION:

Our study demonstrates that episiotomy does not improve neonatal outcomes in the setting of operative vaginal delivery and was not associated with severe perineal laceration, but that it may decrease the odds of maternal postpartum hemorrhage. Careful clinical consideration should be exercised when deciding to use an episiotomy.
A Retrospective Review of Cesarean Deliveries for Suspected Fetal Macrosomia: Were They Indicated? [02K]
Authors: Cate Jennifer , Arkfeld Christopher , Haynes Meagan Campol
Published: April 2020

INTRODUCTION:

For low risk pregnancies, cesarean deliveries have a greater risk of morbidity and mortality than vaginal deliveries. Fetal macrosomia, especially at weights greater than 4500 g, also increases risks of both neonatal and maternal morbidity. Macrosomia, with estimated fetal weight (EFW) greater than 5000 g or greater than 4500 g in women with diabetes mellitus, is the currently accepted ACOG threshold at which cesarean delivery may be offered. This study evaluates current adherence to ACOG guidelines for cesarean deliveries for macrosomia at a large academic medical center.

METHODS:

We analyzed cesarean deliveries performed for suspected fetal macrosomia among individuals undergoing cesarean delivery between September 2018 and August 2019. Using the recorded EFW and actual birthweights, we determined whether criteria for indicated cesarean delivery for macrosomia was met.

RESULTS:

During the study period, 1,716 cesarean deliveries were performed with 24 performed for presumed macrosomia. The average EFW among those 24 undergoing primary cesarean delivery was 4399g. Of the 24 deliveries, 7 pregnancies were complicated by diabetes. Only 4 (17%) met the EFW thresholds, 2 of which had pregnancies complicated by diabetes. The average difference in EFW and actual birthweights was 371g (8%). 13 of the 24 ultrasounds performed for macrosomia had EFWs larger than the actual birth weight.

CONCLUSION:

The majority of primary cesarean deliveries performed for macrosomia did not follow currently accepted ACOG guidelines. Quality improvement initiatives aimed to improve adherence to these guidelines may provide an opportunity to facilitate efforts to decrease primary cesarean delivery rates.
Can We Use Non Invasive Prenatal Testing to Determine Adverse Obstetrics Outcomes? [07K]
Authors: Jackman Janelle , Riccardi Mary Ann , Boisjoli Talya , Azaida Aleena , Robertazzi Robert , Waldron Shervonne
Published: April 2020

INTRODUCTION:

The purpose of this study was to determine if an increased fetal fraction of cell free DNA (cfDNA) in maternal plasma collected during first and second trimester aneuploidy screening is predictive of adverse obstetric complications related to placental dysfunction including preeclampsia, IUGR, preterm birth, PIH and GDM. Therefore possibly implementing early interventions which may reduce the mortality and morbidity associated.

METHODS:

Retrospective study on women with singleton pregnancies who underwent first/second trimester noninvasive Prenatal Testing between 2017 and 2019 at Brooklyn Hospital Center. The fetal fraction of each sample, gestational age and maternal weight was obtained. EMR was used to obtain maternal characteristics/obstetric records such as age, BMI, ethnicity, parity, significant past medical history, social history, antepartum course and gestational age at delivery. Obstetric complications, if any, were identified. Data was transcribed to Microsoft Excel, eliminating any definitive patient identifiers to maintain confidentiality during analysis. Statistical analysis utilized descriptive statistics, the Students t-test for equality of means and linear regression. Probability outcomes <0.05, were statistically significant.

RESULTS:

Patients with preeclampsia had a mean CfDNA fetal fraction of 8.86% +3% which was statistically significant (P=.040) as compared to 11.61% + 5% for the non-preeclampsia group. The BHCG from sequential part 1 was higher in the preeclampsia group (P<.05).

CONCLUSION:

Our results indicated fetal fraction and BHCG (from Sequential Part 1) are predictive of preeclampsia. No other obstetric complications correlated to fetal fraction CfDNA. However there was a narrow sample size of obstetric complications and complete serum marker profiles for sequential screens.
Cervical Length Screening Versus History-Indicated Cerclage in Women With Prior Early Preterm Birth [08K]
Authors: Grantham Lindsey , McLaughlin Eric , Hade Erinn , Smith Devin D. , Samuels Philip , Frey Heather A.
Published: April 2020

INTRODUCTION:

The objective of this study was to compare the rate of recurrent preterm birth (PTB) <37 weeks in women with prior early PTB who underwent history-indicated (HI) cerclage versus cervical length (CL) screening with cerclage when indicated.

METHODS:

This retrospective cohort study included women with a singleton pregnancy and a prior spontaneous PTB between 16w0d and 27w6d weeks. The primary outcome was PTB <37 weeks; secondary outcomes included PTB <34 and <28 weeks, spontaneous PTB, and NICU admission. Fisher exact tests and Wilcoxon rank-sum tests were used to compare baseline characteristics and in unadjusted analyses of the outcomes. Marginal logistic regression was used to adjust for confounders and account for women with multiple pregnancies during the study period.

RESULTS:

Among 357 women, 49 (14%) underwent HI cerclage and 308 (86%) underwent CL screening. HI cerclage patients presented to prenatal care earlier, delivered earlier in their prior pregnancies, and were more were more likely to have had a previous cerclage. Only 84 (27%) women who underwent CL screening required cerclage. Of the 49 women with HI cerclage, 26 (53%) had recurrent PTB versus 43% (n=132) in the CL screening group. The odds of PTB were not significantly different between the two groups (aOR 0.92, 95% CI 0.44-1.92, P=.82). Secondary outcomes did not differ significantly.

CONCLUSION:

Our results support preferential use of cervical screening for most women with prior early PTB, as it may avoid cerclage in 2/3 of women. This information is useful when counseling high-risk patients about management options.
Cervical Length Surveillance After 24 Weeks in Women With a History of Spontaneous Preterm Birth [09K]
Authors: Jones Eboni , Whitley Kari , Quinones Joanne , Durie Danielle , Fradeneck Katherine
Published: April 2020

INTRODUCTION:

Cervical length surveillance (CLS) can identify women at increased risk for recurrent spontaneous preterm birth (sPTB) based on transvaginal ultrasound (TVUS). CLS between 24 and 28 weeks is at times performed to administer corticosteroids to women considered at risk of recurrent sPTB. Primary objective was to evaluate the relationship between cervical shortening between 24 and 28 weeks and recurrent sPTB.

METHODS:

Retrospective cohort study of women with history of singleton sPTB between 24 and 32 weeks, who underwent CLS between 24 and 28 weeks at Lehigh Valley Hospital from 2012-2018. IRB approval was obtained. Exposure of interest was cervical shortening less than 2.5 cm. Primary outcome was delivery less than 37 weeks. Secondary outcomes included rate of antenatal interventions and interval between betamethasone administration and delivery.

RESULTS:

3,545 women underwent TVUS for CLS. 118 (3.3%) with CLS between 24 and 28 weeks met inclusion criteria. Cervical shortening was identified in 16 (13.6%) women. Primary outcome was similar among women with short versus normal cervical length. After adjustment, sPTB less than 37 weeks did not correlate with cervical shortening between 24 and 28 weeks, but with clinical preterm labor (AOR 4.02, 95% CI 1.2–13.4; P=.02).

CONCLUSION:

In our population, the risk of sPTB less than 37 weeks was not predicted by the diagnosis of cervical shortening between 24 and 28 weeks. Our data suggest that the clinical presentation of spontaneous preterm labor, not CLS, is the significant risk factor for sPTB in a subsequent pregnancy for women with a history of sPTB.
Dancing During Labor: Are Women Down to Boogie? [11K]
Authors: Kram Jessica J. , Horter Drew , Heslin Kayla , Forgie Marie M. , Malloy Emily
Published: April 2020

INTRODUCTION:

Dancing during the final weeks of pregnancy and in the first stage of labor are recent social media trends. Few studies have evaluated the effects of low-impact dance during the first stage of labor, particularly for pain management and impact on labor duration. As enrollment is often a challenge when conducting prospective studies, we conducted a feasibility study to gauge the willingness of pregnant patients to participate in a future study that would involve low-impact dance during labor.

METHODS:

During June-July 2019, we anonymously surveyed English speaking/reading pregnant women who were receiving prenatal care at one of three clinics. Data for questions related to demographics, current activity level, pregnancy history, and interest in future participation were collected. Women who did not meet eligibility criteria were excluded from descriptive analyses. The study was approved by local Institutional Review Board.

RESULTS:

Overall, 132 of the 177 (74%) women approached completed the survey; 89% indicated that they would hypothetically participate in a future study of low-impact dance. Regardless of demographic characteristics, current activity level, and pregnancy history, there was a high rate of interest in future participation. Only 48% and 34% of interested women preferred that dance moves or music were provided, respectively. However, over 70% wanted either a video clip or photo of themselves dancing.

CONCLUSION:

As 89% of pregnant women would be interested in participating in a future study on low-impact dance during labor, enrollment may be less problematic than previously expected. Such a study is warranted to identify alternative methods for pain management.
Experiences of Women Receiving Failed Non-Invasive Prenatal Testing (NIPT) Results [13K]
Authors: Murphy Kady , DeLoria Madeline , Fanos Joanna , Turocy John , Weil Jon , Barr Kimberly
Published: April 2020

INTRODUCTION:

Non-invasive prenatal testing (NIPT) usually returns a result; however, a small percentage of samples are reported as “no results”. This study aimed to understand the experiences of women who received failed NIPT results and identify strategies to guide clinicians.

METHODS:

A retrospective questionnaire collected responses from 91 women who received a failed NIPT result in a current or recent pregnancy. Questions assessed the women’s knowledge of NIPT, understanding of the failed result and increased risk of chromosomal anomaly, emotional impact, and follow-up testing decisions. Semi-structured telephone interviews expanded on initial questions and were completed by 47.3% (43) of respondents.

RESULTS:

Only 27.5% (25/91) of women knew that NIPT could show no result prior to testing and 78.0% (71) reported a moderate to high worry score of 6 or higher (10-point scale) upon receiving the failed result. 98% chose to repeat NIPT after the initial failed result. A post-test counseling time of less than 10 minutes was considered insufficient (P<.1). Participants suggested that clinicians should provide more pre-test information about possible failed results, communicate results by direct contact versus email, and convey more details when reporting failed results.

CONCLUSION:

These results indicate how clinicians might better inform patients concerning failed NIPT results. Given the strong preference for more pre-test information and the intense emotional response of receiving a failed NIPT result, we recommend pretest counseling include discussion about a possible failed NIPT result and its consequences, and that sufficient time is allotted for post-test counseling when providing failed results.
Factors Associated With Failed Routine Aneuploidy Cell-Free DNA Screening: A Systematic Review [14K]
Authors: Gomez Julie , Oliver Emily A. , Al-Kouatly Huda B.
Published: April 2020

INTRODUCTION:

Cell free DNA (cfDNA) is the recommended screening test for aneuploidy in women age 35 and over. We conducted a systematic review of factors associated with a failed cfDNA result following routine aneuploidy screening.

METHODS:

PubMed, Scopus, Clinicaltrials.gov and Cochrane were searched for articles from inception to October 2018. Patients undergoing routine cfDNA aneuploidy screening at ≥ 10 weeks gestational age and who had a viable pregnancy were included. Cohort studies and randomized controlled trials were included. Case reports and case series with less than five patients were excluded. The outcome was test failure.

RESULTS:

Our search yielded 756 results. 19 studies met our inclusion criteria and included 506,709 patients. Aneuploidy, maternal obesity, Low-Molecular Weight Heparin (LMWH), and IVF were associated with increased rates of test failure. 12 articles reported aneuploidy as an associated factor in inconclusive results, specifically triploidy and trisomies 13, 18, and 21. One study reported trisomy 9 in a result failure. In six studies, obesity was associated with higher failure rates. Failure rates in obese women was reported at 51.5% compared to 0.7% in non-obese women in one study. Two studies reported increased failure rates in women with LMWH. 75% of women who received failed results were on LMWH in one study. One study reported a 3% higher test failure rate in women who underwent in-vitro fertilization.

CONCLUSION:

Fetal aneuploidy, maternal obesity, LMWH, and IVF are associated with increased rates of failure in cfDNA following routine aneuploidy screening.
Identification of Fetal Growth Restriction in Pregnant Women With Prior Bariatric Surgery [16K]
Authors: Cruz Meredith , Harrison Rachel , Allen Katherine , Braun Emilie , Semons-Booker Kia , Wlodarczyk Katarzyna
Published: April 2020

INTRODUCTION:

Scant formal guidelines exist regarding antenatal ultrasounds in pregnant women with prior bariatric surgery. Considering rates of small-for-gestational-age (SGA) infants may be increased, we investigated whether antenatal ultrasounds were predictive in this population compared to controls.

METHODS:

Women with prior bariatric procedures were matched to controls by early pregnancy body mass index (BMI). 182 women with prior bariatric procedures and 190 controls were identified and the frequency of prenatal fetal growth restriction and postnatal SGA were examined. Sensitivity, specificity, and area under the curve (AUC) for diagnosis of SGA were calculated for both groups.

RESULTS:

Among all women with prior bariatric surgery, 116 (63.7%) had two or more ultrasounds after anatomic survey compared to 89 (46.3%) controls. The average BMI in both groups was 35.3 kg/m2. Out of 19 infants found to be SGA at birth in the bariatric procedure group, 7 were diagnosed prenatally. Out of 21 infants with SGA in the control group, 6 were diagnosed prenatally. When analyzing women who had 2 or more ultrasounds after anatomic survey specifically, the sensitivity was 35.3% for prior bariatric surgery and 54.5% for controls. Specificity was greater than 98.5% for both groups. AUC for two or more ultrasounds was 0.766 (95% CI 0.61-0.92) for controls and 0.689 (95% CI 0.57-0.81) for prior bariatric surgery, P=.436.

CONCLUSION:

Sensitivity for diagnosis of SGA is low in women with prior bariatric surgery, but is not different when compared to BMI-matched controls. The low sensitivity is likely a product of elevated BMI in both groups.
Impact of Depression in Teenage Pregnancy [17K]
Authors: Wan Steven , Ancar Farren , Tewari Hena , Kaushal Deepika
Published: April 2020

INTRODUCTION:

Teenage pregnancy remains a public health concern. Maternal complications include increased C-section and instrumental deliveries. Infant complications include preterm births and neonatal death. Societal implications seen in teenage mothers include increased financial burden, unemployment, poor academic achievement, and physical abuse. In this study, we investigated a correlation between a diagnosed adolescent depression and pregnancy during adolescence (<20 years old).

METHODS:

We conducted a retrospective review of female patients, under the age of 20, diagnosed with depression and/or adolescent pregnancy at Texas Tech University Health Sciences Center clinics (including Obstetrics and Gynecology, Pediatric, and Family Medicine clinics) in Amarillo, Texas from January 1, 2013 to December 31, 2016 and conducted Z-test to analyze the statistical significance. IRB approval was obtained.

RESULTS:

Of the 490 teenage girls identified, 171 (34.9%) were pregnant but not depressed, 220 (44.9%) were depressed but not pregnant, and 99 (20.2%) were both depressed and pregnant. Of the 99 teenage girls, 35 (35.4%) of the patients had depression prior to pregnancy, 29 (29.3%) had PPD (postpartum depression), 19 (19.2%) had depression after conception without PPD, and 16 (16.2%) had depression after conception with unknown PPD.

CONCLUSION:

Research suggests that childbearing does not necessarily cause psychological distress among teenagers. However, after filtering out the data for PPD and those with indeterminate history, the result showed that teens were, on average, depressed first, and became pregnant after. This research shows that depression remains an important risk factor for teen pregnancy. Public policy and medical management should be encouraged to address this.
Impact of the 2015 ACOG Screening Guidelines on Prevalence of Postpartum Depression Among Privately Insured Women [18K]
Authors: Leboffe Emily , Pietragallo Helena , Leslie Doug , Goudong Lui , Ba Djibril , Chuang Cynthia
Published: April 2020

INTRODUCTION:

The American College of Obstetricians and Gynecologists Committee on Obstetric Practice (ACOG) released a Committee Opinion on postpartum depression in 2015 recommending that women be screened at least once during the perinatal period. It is estimated that postpartum depression (PPD) is largely underdiagnosed. Without treatment, PPD can negatively affect the mother and infant. We hypothesized that the 2015 ACOG Committee Opinion led to an increase in postpartum depression diagnosis and prevalence.

METHODS:

Data from the Truven Health Analytics MarketScan database was used to analyze PPD prevalence in 244,624 privately insured women ages 13-45 both before and after the 2015 ACOG guidelines. A postpartum depression diagnosis was identified as a PPD ICD-9/10 claim code, other depression ICD-9/10 claim code, or an antidepressant prescription code during the first 12 months following delivery. A subgroup analysis including only women without prior mood disorders was also evaluated. IRB committee approval was obtained.

RESULTS:

Rates of PPD increased after the 2015 guidelines, when controlling for age, year, delivery complications, and geographic region (adjusted odds ratio, 1.04; 95% confidence interval, 1.01-1.07). ACOG guidelines did not significantly increase rates of PPD in a subanalysis of women without prior history of mood disorders (odds ratio, 1.02; 95% confidence interval, 0.98- 1.05).

CONCLUSION:

This study demonstrates that ACOG guidelines are effective in increasing postpartum depression diagnosis. However, the 2015 guidelines did not impact PPD prevalence in women with no history of prior mood disorders. These findings indicate that national committee guidelines can be effective in addressing the underdiagnosed status of postpartum depression.
Is Food Access Associated With Prevalence of Preterm Birth? [19K]
Authors: Fryer Kimberly , Tanner Jean , Sawangkum Peeraya , Salemi Jason , Campos Adriana , Wilson Ronee
Published: April 2020

INTRODUCTION:

Low food access has been associated with an increased risk of obesity and cardiovascular disease, but little is known if food access increases the likelihood of adverse pregnancy outcomes. We aimed to determine if living in an area of low food access is associated with an increased prevalence of preterm birth in Florida.

METHODS:

We linked, at the census tract level, data on food access from the United States Department of Agriculture (USDA) Food Access Research Atlas to pregnancy outcome data from the Florida Community Health Assessment Research Tool Set. We defined a census tract as “low access to healthy food” if the tract was both low income and a significant number (≥500) or proportion (33%) of the population lives more than 1 mile (urban areas) or 10 miles (rural areas) from the nearest supermarket. Prevalence ratios and 95% confidence intervals were calculated using modified Poisson regression models.

RESULTS:

We analyzed 2,368,114 births in the state of Florida from 2008-2018 with nonmissing gestational age and food access designation. The preterm birth rate was 10.9% and 10.1% in areas with and without low food access, respectively. We calculated a prevalence ratio of 1.04 (95% CI 1.03–1.05) for the association between preterm birth and low food access after adjustment for maternal race/ethnicity.

CONCLUSION:

Living in an area of low food access was associated with a slight increase in prevalence of preterm birth in Florida. Food access and other measures of neighborhood deprivation may play a role in the risk of adverse perinatal outcomes.
Multiple Aneuploidy Pattern Detected by Non-invasive Prenatal Screening in Successive Pregnancies [25K]
Authors: Jarvis Erin , Fels Christina , Plonka Shira , Liao Franchesca , Klein Rachel T. , Weisberger James
Published: April 2020

INTRODUCTION:

We present a case where non-invasive prenatal screening (NIPS) detected a similar pattern of multiple aneuploidies in sequential pregnancies.

METHODS:

Case Presentation (with patient consent): A 25 year-old G3P2 patient had NIPS, by massively parallel sequencing (MPS), in her second and third pregnancies. Her first NIPS result was positive for trisomies 18 and 21. Further bioinformatics review revealed possible partial trisomy 13 and complete trisomies 14 and 20, in addition to the previously reported trisomies. NIPS by MPS repeated at another lab was non-reportable. Amniocentesis revealed normal karyotype, microarray, FISH for the chromosomes of interest, and chromosome 14 uniparental disomy testing. Maternal karyotype, microarray, and chromosomal breakage studies were normal. Patient had a negative oncology evaluation. Patient had an insignificant medical and medication history. Patient delivered a healthy girl. Placenta was small with a normal karyotype. Her current pregnancy shows a similar NIPS pattern. Patient declined amniocentesis and further aneuploidy screening. Second trimester ultrasound detected fetal hyperechoic bowel. Repeat maternal chromosomal breakage studies were normal.

CONCLUSION:

NIPS analyzes cell-free DNA in maternal blood originating from maternal and cytotrophoblast cells. The similar NIPS pattern in both pregnancies indicates a likely maternal etiology. When multiple aneuploidies are observed by NIPS, possible etiologies include maternal benign tumor or malignancy and fetal, placental or maternal chromosome abnormalities. However, subsequent fetal and maternal evaluations were normal. This case highlights that NIPS may yield unexpected results that are not representative of the fetal or maternal karyotypes and an extensive multi-specialty work-up may be recommended in these scenarios.
Preterm Birth Risk and Recurrence Among Multiparous Women With Congenital Uterine Anomalies [26K]
Authors: Schwartz Amanda R. , Abdalla Azza , Wheeler Sarahn M. , Dotters-Katz Sarah K.
Published: April 2020

INTRODUCTION:

Women with congenital uterine anomalies (CUA) are known be at high risk for preterm birth (PTB). We sought to determine the risk of PTB among multiparous women with known CUA as stratified by previous pregnancy history.

METHODS:

A retrospective cohort of women with a known CUA who delivered at 2 tertiary health systems, 2013-2019. We included multiparous women who were carrying non-anomalous, singleton gestations. The primary outcome was PTB before 37 weeks; secondary outcomes included PTB before 34weeks and median delivery gestational age (GA). Women with a history of PTB were compared to those without a history of PTB using Wilcoxon rank sum, ANOVA, Fisher’s exact, chi-square, and Kaplan-Meier survival curves.

RESULTS:

122 multiparous women with CUA met inclusion criteria; 48 (39.3%) had a prior PTB. The most common CUA was bicornuate (43.4%) followed by septate (27.9%), unicornuate (11.5%), didelphys (10.7%), and arcuate (6.7%). PTB before 37 weeks was more common among women with a prior PTB (45.8% vs. 25.7%, P=.02), as was PTB before 34 weeks (27.1% vs. 12.2%, P=.04). In addition, women with a prior PTB delivered earlier [median 37.1 (IQR 30.9-38.4) vs. 39.0 (IQR 36.9-39.4), P=.002].

CONCLUSION:

Multiparous women with CUA are at high risk for PTB. While a history of preterm birth increases risk, even women with prior term birth(s) had high rates of PTB. Overall use of prophylactic treatments such as cerclage and progestogen supplementation was low. Future studies should investigate therapeutic options for the prevention of PTB among women with CUA, irrespective of prior pregnancy history.
Risk-Factor Based Lead Screening and Correlation With Blood and Bone Lead Levels in Pregnancy [27K]
Authors: Johnson Katherine , Specht Aaron , Salahuddin Saira , Erlinger Adrienne L. , Wylie Blair , O'Brien Karen
Published: April 2020

INTRODUCTION:

Lead exposure has devastating neurologic consequences for children and may begin in utero. The American College of Obstetricians and Gynecologists recommends prenatal lead screening using a risk factor-based approach rather than universal blood testing. The clinical utility of this approach has not been studied. We evaluated the association of bone and blood lead with a prenatal risk assessment questionnaire.

METHODS:

We enrolled a convenience sample of parturients ≥34 weeks’ gestation, with a singleton pregnancy, who were admitted from the obstetrical triage unit. We measured blood lead before delivery and bone lead ≤4 days postpartum using a portable X-ray spectrometer. We defined detectable blood lead as ≥2 ug/dL and detectable bone lead as ≥10 ug/g. The IRB approved the study.

RESULTS:

We enrolled 102 participants, of whom 100 had lead measured. We identified ≥1 risk factor among 78% of participants; none had clinical blood lead testing. The median blood lead was 0.2 ug/dL (0.2–0.4) and median bone lead was 3.8 ug/g (2.0–6.6). Blood lead, but not bone lead, was significantly higher for parturients born outside the US (P=.01). Two participants (2.2%) had detectable blood lead, while 16 (16.2%) had detectable bone lead. The questionnaire had good sensitivity but poor specificity when using blood (sensitivity 100%, specificity 22%), and bone (sensitivity 94%, specificity 25%) as the gold standard for lead exposure.

CONCLUSION:

This study showed that a risk-based approach for detecting lead exposure identifies parturients with high lead levels, but this approach was infrequently used clinically and has poor specificity.
Second Stage Cesarean Deliveries: Does Amount of Pushing and Fetal Station Increase Maternal Morbidity? [29K]
Authors: Mokhtari Neggin , Gold Stacey , Kawakita Tetsuya
Published: April 2020

INTRODUCTION:

Cesarean deliveries due to arrest of descent are considered to have more complications compared to cesarean deliveries due to other indications. We sought to examine if duration of pushing and fetal station at time of cesarean delivery increases rates of maternal morbidity.

METHODS:

A retrospective cohort study of all women undergoing cesarean delivery from January 2016 to June 2018 at a single hospital was performed. We compared the risks of blood transfusion, superficial and deep incisional surgical site infection (SSI) and postpartum endometritis according to hours of pushing in the second stage (2-4 hours vs. 5 or more hours) and fetal station (≤0 vs. +1 to +5) at time of cesarean delivery. Multivariable logistic regression was performed to calculate adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). IRB approval: STUDY00000045.

RESULTS:

Of 165 (5.6%) who had arrest of descent, 124 (75%) women were pushing for 2-4 hours, while 41 (25%) pushed for five or more hours at time of their surgery. Women who pushed at least 5 hours compared to those who pushed for 2-4 hours had similar rates of blood transfusion, SSI, and endometritis (aOR 0.23 [95% CI 0.03, 1.83], aOR 1.28 [95% CI 0.37, 4.40], aOR 1.25 [0.31, 5.13], respectively). Women who had fetal station of +1 to+5 compared to those who had fetal station of ≤0 had similar rates of blood transfusion, SSI, or endometritis.

CONCLUSION:

Increased length of time of pushing and lower fetal station in the second stage of labor did not significantly increase the rate of maternal complications.