bluuebunny/crossref_metadata_2025 huggingface dataset:
Screening and Treatment Practices of OB/GYN Providers for Postpartum Depression and Anxiety [4L]
Authors: Hadley Emily E. , Le ViDonna , Swen Tony , Munn Mary , Costantine Maged , Temple Jeff
Published: April 2018

INTRODUCTION:

Prevalence of postpartum depression and anxiety is 20% and 4%–10%, respectively. We sought to identify differences in screening practices among providers and barriers to screening in an obstetric clinic system.

METHODS:

Cross-sectional survey study was performed on obstetrical care providers including certified nurse midwives, nurse practitioners, and OB/GYN residents practicing in a regional clinic system. Surveys were anonymous and voluntary. The survey inquired about provider's frequency of screening, comfort screening, and treatment for postpartum depression and anxiety along with questions about barriers to screening. Residents and mid-level providers (MLP) results were compared using Pearson χ2 test.

RESULTS:

53/85 (62%) health care providers responded including 33 MLPs and 20 residents. The majority of respondents were female (96%). MLPs were significantly older (P=.001) and more likely Caucasian (P=.04). MLPs and residents reported screening for depression 85% and 70% of the time (P=.39) and for anxiety 59% and 20% of the time (P=.006). Significantly more MLPs reported their clinic utilizes a postpartum depression screen as compared to residents (66% versus 10%, P=.001). Sixty-two percent of providers feel their training prepared them to manage postpartum depression, but only 59% and 31% of providers reported feeling confident treating depression and anxiety, respectively. Lack of translation services is a screening barrier significantly more for resident providers (P=.004).

CONCLUSION:

MLPs screen for postpartum anxiety and utilize clinic screening resources more than residents. Results indicate that more postpartum depression and anxiety training should be provided to residents and MLP providers. Translation services are a barrier to screening for some providers.
Maternal Considerations to Termination of Down Syndrome Pregnancies [10L]
Authors: Fanucchi Hannah , Cui Yiwen , Phillips Carolyn , Rijhsinghani Asha
Published: April 2018

INTRODUCTION:

To assess maternal factors that influence a patient's decision to terminate a pregnancy affected by Down syndrome.

METHODS:

This retrospective study included all patients diagnosed with fetal Down syndrome via amniocentesis between 1990 and 2006 at the University of Iowa Hospital and Clinics. Patients were stratified into two groups by maternal age and socio-clinical data were collected from initiation of prenatal care to the end of the pregnancy.

RESULTS:

Total of 261 patients were diagnosed with Down syndrome fetuses, 106 (40.6%) of which belonged to women <35 years old and 155 (59.4%) to >35 year old. Fifty pregnancies (47.2%) in the former group were terminated while 107 (69.0%) were terminated for the latter. Patients >35 yo were diagnosed at a significantly earlier gestational age compared to those <35 yo (16.8+1.9 versus 18.9+2.9, P<.03). Older patients also had a longer time period from diagnosis to termination than younger patients (2.5 versus 2.0 weeks).

CONCLUSION:

Few studies have focused on the patient who must make the ultimate decision on her pregnancy in face of a positive amniocentesis for Down syndrome. We found that the key difference between older women who chose termination compared to those <35 yo is an earlier gestational age at amniocentesis, with a longer period available for decision making. This stresses the importance of availability of screening programs for early karyotyping and diagnosis of Down syndrome and early education.
Does a Comprehensive Multidisciplinary Care Program Impact Utilization of Genetics in Breast Cancer Management? [11L]
Authors: Doe Samfee , Quigg Mary , Bell Myah , Swain Monique
Published: April 2018

INTRODUCTION:

To evaluate the utilization of genetic testing after the implementation of a comprehensive multidisciplinary breast cancer care (cMDC) program: ALL breast cancer cases undergo a mandated, standardized/structured review of treatment options and ongoing care (including clinical trial opportunities).

METHODS:

A retrospective chart review of 542 patients newly diagnosed with invasive breast cancer one year prior to and after the incorporation of a cMDC program was performed for primary outcome: rate of overall appropriate genetic referrals as defined by age, family history, triple negative status, and personal history. Secondary outcomes: compliance and equity in genetic referrals across demographics (race, insurance type and hospital site). SPSS was used for multivariate analysis, (P<.05).

RESULTS:

There were 123 pre-cMDC and 419 cMDC patients. A positive pathologic genetic mutation was seen in 2.2% of patients. Comparison of pre-cMDC and cMDC patients yielded a significant increase in appropriate genetic referrals (34.1%–41.8%), a decrease in withholding genetic referral when indicated (59.3%–21.7%) and an increase in inappropriate referrals (1.9%–11.7%) respectively (P=.001). Amongst both study arms Caucasians were more compliant genetic appointment compared to their African American counterparts (pre-cMDC P=.011, cMDC P=.016). African Americans in the cMDC group demonstrated an 11% increase in attendance compared to a 1% decrease noted among Caucasians in the cMDC group. Genetic referrals were equally offered appropriately before and after the implementation of the MDC across race, insurance type and location.

CONCLUSION:

Utilizing a cMDC approach to breast cancer care may help increase appropriate utilization of genetics, reach more African-Americans and identify those with pathologic mutations.
Predictors of Cervical Cerclage Success in the Prevention of Spontaneous Preterm Birth [13L]
Authors: Enakpene Christopher A. , Jones Tiffany , Marshalla Megan , DiGiovanni Laura , Mastrogiannis Dimitrios , Torre Micaela Della
Published: April 2018

INTRODUCTION:

Cerclage is one of the interventions to prevent spontaneous preterm birth (sPTB). This study aimed to identify predictive factors of cerclage success in preventing sPTB.

METHODS:

Retrospective study of singleton pregnancy at high risk of sPTB in University of Illinois at Chicago between 2013 and 2017. Baseline characteristics, duration of pregnancy, pregnancy outcomes and other predictive factors were analyzed using χ2, student t test, and multiple logistic regression analysis.

RESULTS:

Of the 310 women identified, 90 (29%) had rescue cerclage, and 65 (21%) had prophylactic cerclage. Most statistically significant predictors of sPTB of rescue cerclage were insertions at 17–20 weeks, aOR 2.26 (95% CI: 1.47–3.50, P<.0001), and at 21–22 weeks, aOR 1.81 (95% CI: 1.15–2.87, P<.0001). Cerclages placed at CL <10 mm was associated with increased likelihood of sPTB, aOR 1.60 (95% CI: 1.10–2.34, P<.0001). Cervical length at 21–25 mm and cerclage at GA <16 weeks were associated with decreased rate of sPTB, aOR 0.40 (95% CI: 0.26–0.61, P<.0001), and aOR 0.26 (95% CI: 0.16–0.40, P<.0001). Except for indomethacin in prophylactic cerclage, cervical dilatation, funneling, presence of sludge, prior sPTB, vaginal infections and use of 17-OHPC, these were not statistically significant in preventing sPTB.

CONCLUSION:

The success of cerclage in the prevention of sPTB depends on several factors. The most predictive factors were the degree of short cervix and earlier GA at cerclage placement.
Neonatal Morbidity Associated With Duration of Labor Induction [14L]
Authors: Teal E. Nicole , Lewkowitz Adam , Tran Carol , Koser Sarah , Siegel Molly , Gaw Stephanie
Published: April 2018

INTRODUCTION:

Inductions of labor (IOL) vary in their duration and the effects of that variation are largely unknown. This study assesses the impact of IOL duration on neonatal morbidity.

METHODS:

This retrospective cohort study included all nulliparous women with non-anomalous, singleton, vertex pregnancies who underwent IOL at a tertiary-care academic hospital in 2015. IOL duration was calculated as time from administration of first induction agent to delivery. The primary outcome was neonatal composite morbidity: fetal acidemia, neonatal seizures, hyperbilirubinemia, meconium aspiration with pulmonary hypertension, respiratory distress syndrome, hypoxic ischemic encephalopathy, hypothermic therapy, and/or neonatal readmission. Secondary outcomes were individual components of the composite and neonatal intensive care unit (NICU) admission. We determined the risk of adverse neonatal outcome with increasing length of IOL by logistic regression.

RESULTS:

Four hundred twenty patients were included. Of these, 59 (14.0%) suffered neonatal morbidity. IOL duration exceeding 36 hours was associated with a statistically significant increased risk of neonatal morbidity (odds ratio [OR] 2.14, 95% confidence interval [CI] 1.2–3.8), which was more prominent after 60 hours (OR 3.2, 95% CI 1.4–7.6). Hyperbilirubinemia was the most common complication (37 cases, 62.7%). Fifty-one neonates (12.1%) were admitted to the NICU. IOL duration exceeding 36 hours was associated with increased risk of NICU admission (OR 2.9, 95% CI 1.6–5.3).

CONCLUSION:

In nulliparous women undergoing IOL at term, there is an increased risk of adverse neonatal outcome and NICU admission when IOL duration exceeds 36 hours. Further research is needed to determine additional predictors of adverse neonatal outcome in term inductions.
Pregnancy Outcomes Among Judicially-Involved Commercially Sexually Exploited Youth [16L]
Authors: Kelly Mikaela , Barnert Elizabeth , Thompson Lindsey , Ports Kayleen , Mondal Sangeeta , Bath Eraka
Published: April 2018

INTRODUCTION:

We sought to understand pregnancy rates, outcomes, and pregnancy-related factors among a court-involved commercially sexually exploited youth (CSEY) population.

METHODS:

We conducted an exhaustive chart review of the court files of 363 judicially-involved CSEY within Los Angeles during 2012–2016. Data was summarized using descriptive statistics. Chi-squared tests were performed to explore potential associations between pregnancy and youths' behavioral health profiles.

RESULTS:

Of the 363 CSEY, 70% were African-American, 23% Hispanic, 5% White, 1% Asian, and 1% other. Three hundred fifty-nine participants were female, 2 male, and 2 were transgender male-to-female. Of the biological females, 110 (31%) reported ever being pregnant, including 19 youth who reported 2 pregnancies, and 1 youth who reported 3 pregnancies. Pregnancy outcomes for the 130 pregnancies were as follows: 99 had live births (76%), 6 had miscarriages/stillbirths (5%), 17 had therapeutic abortions (13%), and 8 were still pregnant at the time their court files were closed (6%). The youngest age at first pregnancy was 12-year old-and the average age at first pregnancy was 16-year-old. Mental health and substance use profiles for ever-pregnant versus never-pregnant youth did not significantly differ.

CONCLUSION:

Given the high rates of pregnancy in CSEY, presumably many of which are unplanned, we recommend exploring ways in which family planning education and reproductive care access can be improved for this highly vulnerable youth population. Despite extremely high rates of behavioral health challenges in the CSEY population, the observed lack of relationship between behavioral health profiles and pregnancy further demonstrates that all CSEY are at heightened risk of teen pregnancy.
What Are You Missing? Expanded Genetic Carrier Testing Identifies At-risk Couples [17L]
Authors: Swope Betsy , Tschirgi Matt , Farner Stephanie , Adamski Craig , Terhaar Catherine , Settler Christina
Published: April 2018

INTRODUCTION:

Expanded genetic carrier testing allows couples to determine their reproductive risk for genetic disorders regardless of an individual's ancestral background or geographic origin.

METHODS:

As part of routine laboratory management, requisitions were reviewed for information on reproductive partners. Our database was queried for names of reproductive partners, and demographic information was cross-referenced to determine validity of the matched sample. A retrospective analysis was performed for known matched reproductive pairs and descriptive analysis regarding ethnicity, test ordered, and results of genetic carrier testing on each matched pair was performed.

RESULTS:

Data was entered for 1,585 reproductive partners; after validation and confirmation of carrier testing performed, 783 known reproductive pairs were confirmed. Forty-six (5.9%) couples were found to be at risk for the same autosomal recessive disorder(s), including: hereditary hemochromatosis (20), cystic fibrosis (10), familial Mediterranean fever (6), hemoglobinopathies (5), spinal muscular atrophy (3), primary congenital glaucoma (2), and phenylalanine hydroxylase deficiency (PKU) (1). An additional 1% were potentially at increased risk for the same genetic disorder due to indeterminate results by enzyme analysis or hemoglobin electrophoresis.

CONCLUSION:

Our study identified 6.9% of couples to be at increased risk to have an affected child, and demonstrates the importance of testing partners to allow for reproductive decision-making. Additionally, 28 (61%) of these couples were found to be carriers of disorders only included on expanded carrier testing panels. Therefore, testing patients with an expanded pan-ethnic panel will identify more couples at risk for disorders that would be missed by current ethnicity-based recommendations.
Complicated Gallstone Disease and Birth Outcomes: A Large-Scale Population-Based Study [20L]
Authors: Bowie Jason , Calvo Richard Y. , Bansal Vishal , Sise Michael J. , Sise C. Beth , Shaw Jennifer G.
Published: April 2018

INTRODUCTION:

Complicated gallstone disease (CGD) is a leading cause of surgery in pregnancy. Studies on the management and outcomes of CGD in pregnancy are limited by small sample size. We evaluated the association between CGD, surgical interventions, and birth outcomes in a large population-based dataset.

METHODS:

Pregnant patients with gallstones were identified in the California Office of Statewide Health Planning and Development 2007–2014 discharge dataset. CGD (acute cholecystitis, cholangitis, gallstone pancreatitis) was compared with uncomplicated gallstone disease (UGD). Adverse (miscarriage, spontaneous abortion, stillborn delivery) or normal (live birth) birth outcomes were identified, as were surgical interventions (cholecystectomy, cholecystotomy, endoscopic retrograde cholangiopancreatography). Preterm delivery, among live births, was a secondary outcome.

RESULTS:

We identified 5,116 eligible pregnancies: 10.6% CGD and 89.4% UGD. CGD patients had longer hospital stays (5.6 days versus 3.2 days), a higher incidence of surgical interventions (83.9% versus 6.7%), and an increased incidence of adverse birth outcomes (16.8% versus 2.6%; OR 3.23, 95% CI 2.13–4.92). CGD patients undergoing surgery had a markedly higher incidence of adverse birth outcomes compared with non-operative management (44.3% versus 7.4%; OR 5.42, 95% CI 3.24–9.08). Among live births, CGD was more frequently associated with preterm delivery when compared with UGD (26.2% versus 11.5%; OR 1.87, 95% CI 1.40–2.51).

CONCLUSION:

There is an increased risk of adverse birth outcomes and preterm delivery in women with CGD. Surgical intervention is also associated with higher risk of adverse outcomes. These findings may assist clinicians in managing and counseling patients and providing informed consent.
Patient-Reported Depression in Women Participating in Remote Patient Monitoring for Postpartum Hypertension [25L]
Authors: Ha Barbara , Thomas Nicole , Zella Julia B. , Fedenia Kris , Williams Makeba , Hoppe Kara
Published: April 2018

INTRODUCTION:

Depression is prevalent in the postpartum period. We evaluated patient-reported symptoms of depression during the 6-week postpartum period, among women at risk for severe hypertension (≥150/100 mm Hg) who were participating in a pilot intervention for remote-monitoring of women with hypertensive disorders following discharge.

METHODS:

This intervention included women with a hypertension-related diagnosis during or after pregnancy. Upon discharge, patients received a table device and equipment to transmit home vital signs daily and answer a series of scheduled questions regarding symptoms associated with hypertension and mood for up to 6 weeks postpartum. Bi-weekly, the patients were asked, if their “mood had been more depressed this week compared with a normal week.”

RESULTS:

11/51 women (22%) reported their mood was more depressed than normal during the first 6 weeks postpartum. Of these patients, 3/11 (27%) had gestational hypertension, 3/11 (27%) chronic hypertension, and 6 (55%) preeclampsia. 6/11 patients reported having a more depressed mood during week 1; this persisted during week 2 or later in only 2 patients. 4/11 patients denied feeling depressed during postpartum week 1, but later endorsed these symptoms.

CONCLUSION:

Preliminary results demonstrated a high proportion of self-reported depressed mood among postpartum patients with a pregnancy-related hypertensive disorder. This was more prevalent in women with preeclampsia, and highest in the early postpartum period. Use of remote monitoring is a promising strategy for monitoring postpartum hypertension as well as other associated symptoms including depressed mood after discharge. Our findings warrant further investigation on effective monitoring and delivery of prompt treatment of postpartum depression.
Medication Assisted Treatment in Pregnancy and Neonatal Anthropometrics [26L]
Authors: Thomas Megan , Alvarado Fernanda , Stark Sydney , Catalano Patrick , O'Tierney-Ginn Perrie , Gibson Kelly S.
Published: April 2018

INTRODUCTION:

Opiate use is an epidemic, and, increasingly, pregnant women are managed with medication assisted treatment (MAT), typically Subutex (SUB) or methadone (MET). MET has been associated with decreased birth length (BL) and head circumference (HC) versus SUB in a small study, but without comparison to normal controls. Decreases in HC at birth are correlated with adverse neurodevelopment later in life. Shorter BL as seen with in utero malnutrition, is associated with hypertension and obesity in adulthood. We hypothesized that MAT treatment with MET negatively affects HC and BL.

METHODS:

A retrospective cohort study evaluating neonatal HC and BL was completed with mothers receiving MAT (SUB or MET), and compared to neonates whose mothers were not exposed to opioids (non-MAT). Only neonates born term (>37 weeks) to Caucasian women who smoked were included. HC and BL were converted into z-scores utilizing World Health Organization's growth charts. P<.05 by non-parametric Kruskal-Wallis ANOVA with Dunn's multiple comparison test was considered statistically significant.

RESULTS:

Mean birthweights were 3,163 g in non-MAT, 2,749 g in SUB and 2,846 g in MET groups (P=.0008). Mean HC (±SEM) z-scores were −0.08 (±0.09, n=130) in non-MAT, −0.13 (±0.11, n=80) in SUB and −0.47 (±0.09, n=166) in MET groups. Mean BL z-scores were −0.35 (±0.09, n=135) in non-MAT group, −0.06 (±0.13, n=90) in SUB group and −0.57 (±0.11, n=163) in MET groups. MET treatment lead to significantly smaller HC and BL.

CONCLUSION:

MAT with MET is associated with smaller neonatal HC and BL. While neonates exposed to SUB showed smaller HC but not impaired BL when compared to non-MAT. Long term neurodevelopment issues and adult onset chronic diseases associated with decreased HC and BL may be a reason for recommending SUB for MAT since only HC was decreased. When starting MAT, counseling should include not only short term risks, but also the potential lifelong risks, for the neonate.
Puerperal Uterine Necrosis and Pyometrium After Uterine Artery Embolization [27L]
Authors: Chow Stephanie , Van Nguyen Tuong
Published: April 2018

INTRODUCTION:

Uterine necrosis is a rare complication following uterine artery embolization.

METHODS:

We report a case of uterine necrosis in a 32 year old primigravida patient who underwent uterine artery embolization for postpartum hemorrhage.

RESULTS:

This patient presented in labor at term and had a spontaneous vaginal delivery. Her labor was complicated by chorioamnionitis, which was treated appropriately. Her history was remarkable for a 6.9 × 5.4 × 6.8 cm posterior submucosal fibroid. Postpartum course was significant for hemorrhage secondary to atony and retained placenta, which was manually extracted. Bakri balloon placement was attempted, but unsuccessful due to obstruction from the fibroid. She subsequently underwent an uncomplicated uterine artery embolization, and was discharged on postpartum day 3. She re-presented on postpartum day 10 for fevers to 103°F, and was admitted for presumed endometritis. Appropriate antibiotics were started, however she continued having recurrent fevers through hospital day 9. Computed tomography scan revealed gas and fluid within the uterine cavity, and endometrial biopsy showed heavy growth of E. coli. She underwent an abdominal hysterectomy, and was found to have a 20 weeks sized uterus with a 6 cm submucosal fibroid with blood-tinged purulent contents. Histology was consistent with pyometrium and uterine necrosis.

CONCLUSION:

Uterine necrosis is a rare, but serious complication of uterine artery embolization when used for postpartum hemorrhage. Recognizing risk factors and understanding rare complications can help providers better counsel patients and prevent delays in care when patients re-present with fevers refractory to conventional treatment.
Risk Factors for Placental Abruption Between Singleton and Twin Gestations [28L]
Authors: Dinis Jenifer , Doty Morgen , Sibai Baha M.
Published: April 2018

INTRODUCTION:

The incidence of placental abruption is increased in twin when compared to singletons, but there is a paucity of data regarding other risk factors that might contribute to this increase. Our aim was to determine whether the incidence of and risk factors for abruption were different between singleton and twin deliveries.

METHODS:

Secondary analysis of a multicenter trial of magnesium sulfate for prevention of cerebral palsy. We included women between 18 and 39 years old, non-anomalous singleton and twin gestations, with placental abruption. Risk factors for placental abruption such as smoking, drug use, premature rupture of membranes (PPROM), chorioamnionitis and preterm labor were evaluated. Chi-square or Fisher exact test were used where appropriate. Adjusted odds ratio (aOR) with 95% confidence intervals (CI) were calculated.

RESULTS:

There were 20 cases of abruption among 203 twin gestations (9.8%) and 162 cases among 2,238 twin gestations (7.2%), P=.17. Of these, 153 were included. The incidence of smoking, alcohol and drug use, preeclampsia and diabetes did not differ between singleton and twin gestations. Twin gestations had significantly higher incidence of preterm labor (44% versus 13%, P<.01) and chorioamnionitis (44% versus 4%, P<.01). Fifty-seven percent (n=8) of women with abruption and chorioamnionitis carried twins. After adjusting for preterm labor, the incidence of chorioamnionitis was still significantly increased for twin gestations (aOR 17.4, CI 5.0–60.4).

CONCLUSION:

Twin gestations have a higher rate of abruption than singletons. However, they both have similar risk factors except that abruption was more likely to be associated with chorioamnionitis in twins.
Retrospective Analysis of IV Flow Capacity in Obstetric Patients at Risk for Postpartum Hemorrhage [30L]
Authors: Olympio Jennie , Cai Bo , Theobald Shannon , Castillo Anastasia , Schrift David , Castleberry Lauren
Published: April 2018

INTRODUCTION:

Postpartum hemorrhage (PPH) is one of the leading causes of preventable pregnancy-related mortality. However, the risk of PPH can be estimated prior to its occurrence, which allows clinicians to take the necessary precautions to manage high-risk patients. This includes establishing two, 18-gauge (large-bore) intravenous (IV) catheters, an imperative first step in managing hemorrhaging patients. This retrospective study aims to assess how often obstetrical patients at high-risk for PPH received appropriate IV access, defined as two 18-gauge or larger IVs.

METHODS:

A retrospective analysis of 922 obstetrical patients admitted to our institution over a 6-month period was performed. A patient's risk for PPH was determined on admission. Patients were stratified into low, medium and high-risk groups. The number and size of IV catheters inserted upon admission were reviewed.

RESULTS:

Of the 922 patients analyzed, 10% (93) were deemed high-risk for PPH. Of those patients, 93.5% (87) received a single IV catheter on admission, of which 75% were 20-gauge or smaller IVs. Only 1% (1) of the high-risk patients received appropriate IV access (two 18-gauge or larger IVs).

CONCLUSION:

Only 1% of patients at high-risk for PPH received appropriate IV access. Our data represents a single-center experience and should be confirmed. However, these results are concerning and suggest PPH patients may experience under-resuscitation and/or a delay in resuscitation due to inadequate IV access. Based on this data, the authors plan to revise the current Postpartum Hemorrhage Protocol and implement a new policy to ensure appropriate IV access is obtained in patients at high-risk for PPH.
Intrauterine Pressure Catheter Measurements and Body Mass Index [31L]
Authors: Curran Diana , Kappy Michelle , Kobernik Emily , Bell Carrie , Young Stephanie , Marzano David
Published: April 2018

INTRODUCTION:

Intrauterine pressure catheters are used for varying indications in laboring women. The stages of labor have not accounted for women's changing demographics, especially obesity. This study evaluates the relationship between resting and peak intrauterine tone and BMI, and predictors of intrauterine pressures among laboring women.

METHODS:

We retrospectively examined intrauterine pressure catheter values in women >18 who labored at Michigan Medicine from June 2010 to June 2014. Stage I resting and peak intrauterine pressure catheter measurements were obtained from fetal tracings. Multiple linear regression analyzed independent effects of demographic and labor characteristics on intrauterine pressure catheter measurements.

RESULTS:

Among 588 women with intrauterine pressure catheters, mean (SD) BMI was 33.0 (7.3) kg/m2, mean stage I resting pressure was 23.5 (8.5) mm Hg, and mean peak pressure was 68.0 (16.3) mm Hg. In multivariable models adjusted for age and race, overweight status (β 5.31 [95% CI: 2.66, 7.97]), obesity class I (5.46 [2.75, 8.17]), obesity class II (6.39 [3.54, 9.23]), obesity class III (7.19, [4.36, 10.01]), gestational age (0.10 [0.12, 0.19]), nulliparity (2.84 [0.99, 4.69]), and primiparity (3.21 [1.45, 4.97]) were correlated with increased stage I resting pressure. Only obesity class III status was associated with increased stage I peak pressure (7.30 [1.69, 12.91]).

CONCLUSION:

Resting intrauterine pressure is influenced by demographic characteristics including BMI and parity, but the same correlation was not observed for peak intrauterine pressures. Our findings highlight the need for modern labor guidelines regarding normal intrauterine pressures and their implications on labor outcomes.
Cesarean Delivery Rates Among Nulliparous Women With Advanced Maternal Age Undergoing Labor Induction [32l]
Authors: Khander Amrin , Bigelow Catherine , Robles Brittany , Koo Clara , Klahr Miriam , Stone Joanne
Published: April 2018

INTRODUCTION:

Optimal antenatal management for women with advanced maternal age (AMA) is not known. Our objective was to determine if induction of labor (IOL) in nulliparous women with AMA (age 35–39) compared to women with very AMA (VAMA, age ≥40) is associated with an increased risk of adverse outcomes, such as rate of cesarean delivery (CD).

METHODS:

A retrospective cohort study of patients ≥35 years who underwent IOL at a single tertiary care center from June 2011 to December 2014. Obstetric and neonatal outcomes were compared after dichotomization into groups 35–39 and ≥40 years.

RESULTS:

From a total 428 patients who met inclusion criteria, 273 (64%) comprised the AMA group and 155 (36%) the VAMA group. The AMA cohort had a higher Bishop score on admission compared to the VAMA cohort. IOL for late term was the most common indication in the AMA group (33.7%) and IOL for AMA in the VAMA group (58.1%). The CD rate was higher in the VAMA group (56.1% versus 44.3%, P=.02). This difference was not significant when controlling for Bishop score <5. The most common indications for CD were arrest of dilation (38.3%) in the AMA group and failed IOL (32.2%) in the VAMA group. When stratified by age, there was a significant increase in CD rate by increasing maternal age (P=.002).

CONCLUSION/IMPLICATIONS:

Nulliparous women ≥35 year old who undergo IOL have a high likelihood of CD, with increasing rates as maternal age increases. This information can guide clinicians when discussing delivery options with nulliparous patients age ≥35.
Obstetric Hemorrhage Management and Maternal Morbidity Among Non-Hispanic Black Women [34L]
Authors: Jayaprakash Pooja , Curry Tierra , Brown Alyssa , Louis Judette
Published: April 2018

INTRODUCTION:

Non-Hispanic Black women (NHB) have higher rates of severe maternal morbidity and mortality. We sought to evaluate the racial differences in maternal hemorrhage management and associated morbidity.

METHODS:

We conducted a retrospective cohort study including all women who delivered at a tertiary center during February 1, 2013–December 31, 2014. Medical charts were reviewed for hemorrhage, race/ethnicity and relevant clinical data. Hemorrhage related severe morbidity indicators included blood transfusion, shock, acute renal failure, transfusion related lung injury, cardiac arrest and use of interventional radiology procedures. The data was analyzed using χ2, student t-test, Mann Whitney U test, and logistic regression where appropriate. P<.05 was considered significant.

RESULTS:

There were 9,890 deliveries and 2.9% were complicated by obstetric hemorrhage. NHB women when compared to other women with obstetric hemorrhage had a lower admission hemoglobin (10.6±1.6 versus 11.5±1.3 g/dL, P<.001), lower drop in hemoglobin (2.4±1.5 versus 2.9±1.6 g/dL, P=.03) and higher blood loss (1,328±1,014 versus 1,113±602 mL, P<.001). They were equally likely to be treated with uterotonic medications. There was no difference in the time to initiate medication and time to stabilization but NHB were more likely to need a blood transfusion (37.1% versus 23%, P=.03) and more likely to have severe morbidity (41.4% versus 24.4%, P=.001). After controlling for confounding variables, cesarean delivery (aOR 3.59 [1.7–7.9]) and low admission hemoglobin (aOR 1.69 [1.3–2.1]) were predictors of severe morbidity.

CONCLUSION:

Despite similar management, NHB had more maternal morbidity. However, cesarean delivery and low admission hemoglobin but not race were predictive of maternal morbidity.
Fetal Macrosomia: Exploring the Impact of Pre-pregnancy Body Mass Index and Gestational Weight Gain [38L]
Authors: Srinivasan Aarthi , Williams Corrine M. , McDaniel Honour , Chavan Niraj R.
Published: April 2018

INTRODUCTION:

This study was undertaken to evaluate the relationship between pre-pregnancy body mass index (PPBMI), gestational weight gain (GWG) and fetal macrosomia.

METHODS:

Vital statistics (birth) data collected by the National Center for Health Statistics (NCHS) was utilized. Using the 2015 data, GWG was calculated and the birth cohort consisting of singleton gestations was classified into inadequate, adequate and excess GWG categories under each PPBMI stratum, as per the 2009 Institute of Medicine guidelines. Multivariate logistic regression analyses were used to predict the risk for fetal macrosomia (>4,500 g) in each PPBMI and GWG group while adjusting for age, race/ethnicity, education, marital status, insurance and smoking status.

RESULTS:

Birth certificate data from 3,618,822 patients were reviewed. In comparison to women with normal PPBMI, overweight (OR 1.87; 95% CI 1.82–1.92) and obese (OR 3.25; 95% CI 3.17–3.33) women had higher odds for fetal macrosomia. Excess GWG significantly increased the risk for fetal macrosomia in women who were underweight (OR 3.55; 95% CI 2.72–4.65), normal weight (OR 3.01; 95% CI 2.96–3.94), overweight (OR 2.66, 95% CI 2.52–2.81) and obese (OR 1.93; 95% CI 1.86–2.01) as compared to respective PPBMI matched cohorts with adequate GWG. Notably, inadequate GWG in overweight (OR 0.56, 95% CI 0.53–0.66) and obese (OR 0.72; 95% CI 0.68–0.76) women showed a risk reduction compared to PPBMI matched controls with adequate GWG.

CONCLUSION:

Excess GWG, especially in the setting of higher PPBMI predicts an increased risk for fetal macrosomia.
Repeat External Cephalic Version Under Regional Anesthesia: Is it Worth the Attempt? [22I]
Authors: Ha Thoa K. , Blat Cinthia , González Juan M. , Thiet Mari-Paule , Rosenstein Melissa
Published: April 2018

INTRODUCTION:

Breech presentation occurs in 4% of term pregnancies with high cesarean delivery rate for persistent breech. External cephalic version (ECV) is a technique used to reduce incidence of cesarean due to malpresentation. Regional anesthesia increases ECV success rates in the first attempt. We assessed the effects of regional anesthesia in repeat ECV.

METHODS:

Retrospective cohort analysis of term ECVs between 2012-2017. Women failing initial ECV were offered repeat ECVs with or without regional anesthesia, depending on preference. Primary outcome was successful cephalic version and secondary outcome was vaginal delivery. The impact of BMI, maternal age, gestational age, parity, and birthweight were examined in multivariable model.

RESULTS:

304 women underwent initial ECV without regional anesthesia, 91 (30%) converted to cephalic, resulting in 69 vaginal deliveries (22%). Among 213 women with unsuccessful ECV, 81 underwent repeat ECV: 52 without spinal, 10 converted to cephalic (19%) and 9 delivered vaginally (17%); 29 with spinal anesthesia, 9 converted to cephalic (31%) and 7 delivered vaginally (24%). In unadjusted analysis, OR for successful version with spinal anesthesia was 2.74 (95% CI 1.05–7.15). This did not retain statistical significance after controlling for confounders (OR 2.55, 95% CI: 0.92-7.05). There was no statistically significant difference in maternal age, gestational age, or birth weight between the two groups.

CONCLUSION:

Offering repeat ECV to women who fail first attempt is a reasonable option and has a success rate comparable to the first attempt. In this study, regional anesthesia did not have statistically significant effect on the success rate of repeat ECV.
Omega-3 Fatty Acid Supplements and Risk of CHD
Authors: Rosenberg Karen
Published: April 2018

According to this study:

Supplementation with marine-derived omega-3 fatty acids isn't associated with reductions in risk of fatal or nonfatal coronary heart disease (CHD) or any major vascular events.

The findings don't support the American Heart Association's current recommendations for use of omega-3 fatty acid supplements by people with a history of CHD.
End-Of-Life Cancer Care For Veterans Through The VA Vs. Medicare
Authors: Rosenberg Karen
Published: April 2018

According to this study:

Among patients with solid tumors, those who relied on end-of-life care provided by the Department of Veterans Affairs received higher-quality care than those who relied on fee-for-service Medicare.
Massive Transfusion Protocol: Provider Education to Improve Patient Outcomes [1M]
Authors: Chow Stephanie , Lee Kimberly L. , Lee Jason , Liu Chi-Mei
Published: April 2018

INTRODUCTION:

Massive Transfusion Protocol (MTP) was implemented at Kaiser Permanente Santa Clara (KPSC) in 2010 to improve the speed of blood component delivery for patients developing massive hemorrhage. With the advent of MTP, a review of the protocol and provider use has been limited. In this Performance Improvement (PI) project, an analysis of past MTP activations revealed an opportunity to improve provider knowledge and utilization of the MTP within the OBGYN Department.

METHODS:

Several PI tools were applied to identify opportunities for improving MTP. An educational intervention was provided at Labor and Delivery physician and nursing meetings. A brief, anonymous quiz with a five-point comfort scale was distributed to assess pre- and post-education understanding and comfort level with our facility’s MTP. Responses were analyzed using descriptive statistics.

RESULTS:

Responses were received from 67 providers (28 physicians and 39 nurses). Following the educational intervention, physicians and nurses showed significant improvement in their understanding of MTP. Total mean quiz score improved from 49.3% to 84.7% (P<.05). Physician comfort level improved from 44.3% to 71.4% (P<.05). Nursing comfort level also improved from 48.3% to 67.2%, with overall comfort level increasing from 46.5% to 68.9% (P<.05).

CONCLUSION:

Our project demonstrates that provider education is an important factor for performance improvement of MTP within the OBGYN department. Future study is needed to evaluate the long-term effectiveness of MTP on postpartum hemorrhage within KPSC.
Effect of AFPep on the Growth of Human Fibroid Xenografts [1OP]
Authors: Denefrio Cassandra , Kiley Kevin
Published: April 2018

INTRODUCTION:

Fibroids are the most common pelvic tumors and are sensitive to fluctuations in hormones. Alpha fetoprotein (AFP) has demonstrated anti-estrogenic properties. AFPep is an active site peptide that retains the properties of AFP. Here, we investigated the ability to grow human fibroid xenografts in a murine model and the effect of AFPep on the growth of fibroid tumors.

METHODS:

After IRB approval, patients were identified and consent obtained. Pathology was confirmed by frozen section and the fibroid was implanted under the kidney capsule of ICR/SCID mice along with an estrogen implant. Survival surgery was completed to asses for growth. A second generation was completed followed by another fresh sample. After demonstrable growth, control mice were given normal saline injections and experimental group given AFPep injections for 10 days. Animals were sacrificed 1 hour following the last injection and samples were formalin fixed.

RESULTS:

In the first generation of fibroid implantation, 60% of the fibroids demonstrated growth, with the greatest growth noted days 12–30. The second generation of fibroids showed accelerated growth. The percent difference in tumor volume after AFPep treatment was less in the treatment group (46% vs 95%) and one tumor showed 11% volume regression.

CONCLUSION:

Fibroid xenografts demonstrate growth in a mouse model and the rate of growth is faster in second generation xenografts. Additionally, AFPep may display some inhibitory growth properties with a smaller difference in tumor volume in the treatment group. Histologically, the treatment group showed evidence of increased apoptosis, hyalinized fibrosis, and decreased cellularity.
POSTERIOR STAPHYLOMAS IN EYES WITH RETINITIS PIGMENTOSA WITHOUT HIGH MYOPIA
Authors: Xu Xian , Fang Yuxin , Yokoi Tae , Shinohara Kosei , Hirakata Akito , Iwata Takeshi , Tsunoda Kazushige , Jonas Jost B. , Ohno-Matsui Kyoko
Published: April 2018

Purpose:

To describe features of posterior staphylomas in nonhighly myopic eyes with retinitis pigmentosa (RP).

Methods:

The retrospective observational case series study included patients with RP and an axial length of <26.5 mm and searched for eyes with posterior staphylomas. All study participants underwent fundus photography and optical coherence tomography.

Results:

The study identified 13 eyes of 7 patients with a narrow macular staphyloma. Mean age was 40.9 ± 17.9 years (range 9–62 years) and mean axial length was 24.90 ± 0.69 mm. The staphyloma edges corresponded to the margin between the retinal atrophic area in the fundus midperiphery and the relatively unaffected fundus center. On vertically orientated optical coherence tomography images, the staphyloma edges showed a slight inward protrusion of the sclera and a ring-like localized choroidal thinning with choroidal rethickening in direction toward the fovea and toward the periphery of the fundus. The upper and lower staphyloma edges did not differ in steepness. The thickness of the subfoveal choroid (138.6 m ± 50.1 µm) was thinner than the normal range after adjusting for age and axial length in all eyes. Two eyes with advanced RP in the macula showed a subfoveal choroidal thickness of 95 µm and 88 µm.

Conclusion:

Narrow macular staphylomas can occur in nonhighly myopic eyes with RP and, in contrast to staphylomas in highly myopic eyes, show a less marked thinning of the subfoveal choroid. The occurrence of posterior staphylomas in nonhighly myopic eyes with RP may provide hints to unravel the etiology of posterior staphyloma formation.
A bifunctional-biased mu-opioid agonist–neuropeptide FF receptor antagonist as analgesic with improved acute and chronic side effects
Authors: Drieu la Rochelle Armand , Guillemyn Karel , Dumitrascuta Maria , Martin Charlotte , Utard Valérie , Quillet Raphaëlle , Schneider Séverine , Daubeuf François , Willemse Tom , Mampuys Pieter , Maes Bert U.W. , Frossard Nelly , Bihel Frédéric , Spetea Mariana , Simonin Frédéric , Ballet Steven
Published: April 2018

Opioid analgesics, such as morphine, oxycodone, and fentanyl, are the cornerstones for treating moderate to severe pain. However, on chronic administration, their efficiency is limited by prominent side effects such as analgesic tolerance and dependence liability. Neuropeptide FF (NPFF) and its receptors (NPFF1R and NPFF2R) are recognized as an important pronociceptive system involved in opioid-induced hyperalgesia and analgesic tolerance. In this article, we report the design of multitarget peptidomimetic compounds that show high-affinity binding to the mu-opioid receptor (MOPr) and NPFFRs. In vitro characterization of these compounds led to identification of KGFF03 and KGFF09 as G-protein–biased MOPr agonists with full agonist or antagonist activity at NPFFRs, respectively. In agreement with their biased MOPr agonism, KGFF03/09 showed reduced respiratory depression in mice, as compared to the unbiased parent opioid agonist KGOP01. Chronic subcutaneous administration of KGOP01 and KGFF03 in mice rapidly induced hyperalgesia and analgesic tolerance, effects that were not observed on chronic treatment with KGFF09. This favorable profile was further confirmed in a model of persistent inflammatory pain. In addition, we showed that KGFF09 induced less physical dependence compared with KGOP01 and KGFF03. Altogether, our data establish that combining, within a single molecule, the G-protein–biased MOPr agonism and NPFFR antagonism have beneficial effects on both acute and chronic side effects of conventional opioid analgesics. This strategy can lead to the development of novel and potent antinociceptive drugs with limited side effects on acute and chronic administration.
Feasibility of Dynamic Contrast-Enhanced Magnetic Resonance Imaging Using Low-Dose Gadolinium
Authors: He Dianning , Chatterjee Aritrick , Fan Xiaobing , Wang Shiyang , Eggener Scott , Yousuf Ambereen , Antic Tatjana , Oto Aytekin , Karczmar Gregory S.
Published: April 2018

Objectives

This study investigates whether administration of low doses of gadolinium-based contrast agent (GBCA) for dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) can be as effective as a standard dose in distinguishing prostate cancer (PCa) from benign tissue. In addition, we evaluated the combination of kinetic parameters from the low- and high-dose injection as a new diagnostic marker.

Materials and Methods

Patients (n = 17) with histologically confirmed PCa underwent preoperative 3 T MRI. Dynamic contrast-enhanced MRI images were acquired at 8.3-second temporal resolution with a low dose (0.015 mmol/kg) and close to the standard dose (0.085 mmol/kg) of gadobentate dimeglumine bolus injections. Low-dose images were acquired for 3.5 minutes, followed by a 5-minute gap before acquiring standard dose images for 8.3 minutes. The data were analyzed qualitatively to investigate whether lesions could be detected based on early focal enhancement and quantitatively by fitting signal intensity as a function of time with an empirical mathematical model to obtain a maximum enhancement projection (MEP) and signal enhancement rate (α).

Results

Both low- and standard-dose DCE-MRI showed similar sensitivity (13/26 = 50%) and lesion conspicuity score (4.0 ± 1.0 vs 4.2 ± 0.9; P = 0.317) for PCa diagnosis on qualitative analysis. Prostate cancer showed significantly increased α compared with benign tissue for low (9.98 ± 5.84 vs 5.12 ± 2.95 s−1) but not for standard (4.27 ± 2.20 vs 3.35 ± 1.48 s−1) dose. The ratio of low-dose α to standard-dose α was significantly greater (P = 0.02) for PCa (2.8 ± 2.3) than for normal prostate (1.6 ± 0.9), suggesting changes in water exchange and T2* effects associated with cancer. In addition, decreases in the percentage change in T1 relaxation rate as a function of increasing contrast media concentration (ie, the “saturation effect”) can also contribute to the observed differences in high-dose and low-dose α. Area under the receiver operating characteristic curve for differentiating PCa from benign tissue using α was higher for low dose (0.769) compared with standard dose (0.625). There were no significant differences between MEP calculated for PCa and normal tissue at the low and standard doses. Moderate significant Pearson correlation for DCE parameters, MEP (r = 0.53) and α (r = 0.58), was found between low and standard doses of GBCA.

Conclusions

These preliminary results suggest that DCE-MRI with a low GBCA dose distinguishes PCa from benign prostate tissue more effectively than does the standard GBCA dose, based on signal enhancement rate. Diagnostic accuracy is similar on qualitative assessment. Prostate cancer diagnosis may be feasible with DCE-MRI with low-dose GBCA. In addition, comparison of enhancement kinetics after low and high doses of contrast media may provide diagnostically useful information.
Does an Aerobic Exercise Improve Outcomes in Older Sedentary Nonspecific Low Back Pain Subjects? A Randomized Controlled Study
Authors: Barni Luca , Calabretta Lucrezia , Lepori Luca , Pasquetti Pietro , Gulisano Massimo , Freddolini Marco
Published: April 2018

Purpose:

To demonstrate that a tailored, supervised aerobic exercise after a general back-school rehabilitation program will improve outcomes for older patients with low back pain more than the general back-school program alone.

Method:

Twenty-two older patients with chronic nonspecific low back pain were recruited for this study, and they were randomly assigned to a control or an interventional group. Both groups received a standard back-school program, while subjects in the intervention group received an additional 15 minutes of the aerobic training program. The numerical pain rating scale (NPRS) and the Roland-Morris Questionnaire (RMQ) were used to assess pain intensity and disability before and after the 5-week treatment in both the participants' groups.

Results:

Reduction percentage was found significantly increased in the interventional group when compared with the control group for both the NPRS and the RMQ index (P < .05).

Conclusion:

An adapted aerobic exercise, together with a standard back-school program, was effective in reducing pain symptoms and disability in low back pain subjects rather than the back-school program alone. This should be used as an advice to practitioners while managing low back pain.