bluuebunny/crossref_metadata_2025 huggingface dataset:
Brief vs Thong Hygiene in Obstetrics and Gynecology (B-THONG): A Survey Study [1J]
Authors: Hamlin Alyssa , Sheeder Jeanelle , Muffly Tyler
Published: April 2018

INTRODUCTION:

The goal of this study is to determine if thong underwear use is associated with a higher report of urinary tract (UTI) or vaginal infections (bacterial vaginosis; BV and yeast vaginitis; YV).

METHODS:

A national, cross-sectional survey regarding underwear type usage and infectious history was designed and distributed to women via a crowd-sourcing service. Parametric and non-parametric statistical methods were used to compare thong wearers to never-thong wearers. Thong wearers were defined as women who had worn a thong at any point in the last 12 months.

RESULTS:

987 respondents met inclusion criteria and completed the survey; 315 (31.9%) were never-thong wearers and 672 (68.1%) were thong wearers in the last 12 months. Thong wearers were younger, thinner, and had different sexual and hygiene behaviors than never-thong wearers, including being more sexually active. Thong wearers were more likely to report UTIs (20.4% vs 11.4%; OR;95%CI: 1.99;1.23-2.95), yeast vaginitis (22.4% vs.15.6%; OR;95%CI: 1.61;1.13-2.30), and BV (9.7% vs. 5.7%; OR;95%CI:1.77;1.03-3.03) in the last 12 months. However, a logistic regression model found that only oral sex was found to be predictive of UTI (aOR;95%CI:1.61;1.07-2.43) and BV (aOR;95%CI: 2.63;1.39-4.97); further non-cotton crotch underwear (aOR;95%CI:1.75;1.17-2.62) and oral sex (aOR;95%CI:1.51; 1.02-2.25) were predictors of YV.

CONCLUSION:

We found that thong use is not associated with UTI, BV, or VY. Instead, sexual behaviors and hygiene choices are risk factors for these infections. We recommend that providers take a more complete sexual history to identify these risk factors rather than focusing on underwear as a primary risk factor.
Serofast Syphilis and Pregnancy Outcomes [2J]
Authors: Whitham Megan , Bandy Sohini , Eppes Catherine , Rac Martha
Published: April 2018

INTRODUCTION:

Persistent low non-treponemal titers after adequate syphilotherapy, the serofast state, is commonly encountered during pregnancy. We describe the characteristics and pregnancy outcomes of gravidas with serofast syphilis compared to a seronegative general obstetric population.

METHODS:

This is a retrospective chart review from January 2011 to December 2016 of gravidas from our hospital diagnosed with serofast syphilis, defined as <4-fold decline or persistently low non-treponemal titers. These women were compared to our general seronegative obstetric population. Maternal characteristics, non-treponemal titers, delivery and infant outcomes were recorded. Standard statistical analysis was performed.

RESULTS:

38 (40%) of 94 gravidas diagnosed with syphilis were serofast. The median non-treponemal titer was 1:2[1:1,1:2] ranging from non-reactive to 1:16. Compared to our general obstetric population (n=14,407), serofast gravidas were more likely to be black and multiparous (p<0.01). Substance abuse (0.7% vs 24%, p<0.01), mental health disorders (3.5% vs 21%, p<0.10) and other sexually transmitted infections (7.2% vs 37%, p<0.01), including HIV (0.7% vs 11%, p<0.01), were more prevalent in serofast gravidas. Gestational age at delivery, birth weight and pre-term birth rate < 37 weeks was similar between groups. Serofast gravidas were more likely to undergo cesarean delivery and require admission to the Level II nursery or NICU (p=0.03). Two babies were treated for congenital syphilis in the serofast cohort; however, only one met CDC criteria for congenital syphilis

CONCLUSION:

Patients with serofast syphilis during pregnancy remain at risk for adverse outcomes, including congenital syphilis. More information is needed to guide pregnancy management in this high risk population.
Comparison of Nugent Scores and T-cell Markers Within the Female Genital Tract [3J]
Authors: Blackwell Conner O. , Haddad Lisa , Pollak Rebecca M.
Published: April 2018

INTRODUCTION:

Bacterial Vaginosis (BV) has been shown to increase a woman's susceptibility to infections including HIV, but this connection is poorly understood. Although BV is commonly asymptomatic, it can be diagnosed with Nugent scoring. A numerical score 0-10 is assigned to Gram-stained vaginal swabs based on the presence of Gram positive rods, Gram negative rods, and Gram indeterminate curved rods. This study evaluated the association between Nugent score with immune cell phenotypic markers in the female genital tract.

METHODS:

HIV-uninfected normally cycling women were recruited into a prospective contraceptive study. Vaginal swabs and cervicovaginal lavage (CVL) samples were obtained at weeks 0, 2, 14, and 16. Vaginal swabs were scored and separated into 3 categories according to established Nugent score criteria: “No BV”, “Altered”, and “BV”. Leukocytes were isolated from CVL samples and measured using multi-color flow cytometry. Proportions of phenotypic markers on CD4 and CD8 cells were compared to Nugent category using an ordinal mixed regression model with random effect for repeated measures, adjusting for age, race, contraceptive use, and presence of sexually transmitted diseases.

RESULTS:

Among 61 participants, there were 199 total visits with the following Nugent categorizations: 47% “No BV”, 8% “Altered”, and 45% “BV”. Nugent category was significantly associated with increased proportion of CCR7+ CD4 cells, central memory CD4 cells, and central memory CD8 cells.

CONCLUSION:

BV was shown to alter the local immune environment by increasing the central memory and trafficking capacity of T cells. These results help elucidate the relationship between BV and susceptibility to infection.
Does Indication for Induction of Labor Impact the Duration of Induction? [10J]
Authors: Teal E. Nicole , Lewkowitz Adam , Koser Sarah , Tran Carol , Siegel Molly , Gaw Stephanie
Published: April 2018

INTRODUCTION:

Nearly 25% of pregnancies in the US result in an induction of labor (IOL). The impact of IOL indication on IOL duration is unknown. We aim to assess that impact.

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. There were several IOL indications, listed below. The primary outcome was IOL duration. Secondary outcomes included operative delivery (OD) and cesarean delivery (CD) rates. The data were analyzed using the Kruskal-Wallis test.

RESULTS:

Four hundred and twenty women were included. The most common IOL indications were prolonged gestation (PG) (n=129, 30.7%), hypertensive disorder (HTN) (n=106, 25.2%), diabetes (DM) (n=42, 10%), and non-reassuring fetal status (NRFS) (n=19, 4.5%). The median times to any delivery (cesarean or vaginal) by indication were (in hours): PG 28.8, HTN 30.8, DM 33.3, NRFS 20.8, other 23.6. The median times to spontaneous VD were: PG 26.2, HTN 27.8, DM 24.2, NRFS 31.8, other 21.4. Differences within both groups were statistically significant (p < 0.005). OD rates were: PG 13.7%, HTN 13.6%, DM 9.5%, NRFS 15.8%, other 13.3%. CD rates were: PG 28.2%, HTN 27.1%, DM 38.1%, NRFS 26%, other 29.8%. Differences within these groups were not statistically significant (p > 0.05).

CONCLUSION:

IOL duration is dependent on IOL indication. Operative and cesarean delivery rates are not. These data may inform provider and patient expectations surrounding IOL duration and outcome.
Preterm Birth among African American Women in a Federal Healthy Start Program: Informing Pay for Success [12J]
Authors: Roman Lee Anne , Luo Zhehui , Meghea Cristian , VanderMeulen Peggy , Fawcett Ken , Leach Richard
Published: April 2018

INTRODUCTION:

Providers are dependent on community-based, enhanced prenatal care (EPC) and home visiting (HV) programs to augment prenatal care and address health disparities. Given uncertain public resources for EPC/HV, innovative financing models are needed to support effective services. Pay-for-Success, a social impact bond model, partners federal/local governments, private investors, health systems, and providers to fund and deliver effective services to at-risk pregnant women and achieve predetermined health outcomes. If outcomes are achieved, savings repay investors and fund continued services. This comparative study examined baseline preterm birth (PTB) and very preterm birth (VPTB) rates for African American (AA) women enrolled in a federal Healthy Start (HS) program (Strong Beginnings), to explore program effectiveness, guide development of a PFS, and structure financial modeling.

METHODS:

A quasi-experimental study of AA HS participants (n=488; 2009-2014), propensity score matched with non-participants, was conducted using linked HS program, vital record, and Medicaid claims data. The objective was to examine the robustness of the comparison of PTB and VPTB outcomes utilizing multiple statistical methods.

RESULTS:

AA women who enrolled in the HS program were less likely to have a preterm or very preterm birth compared to matched Medicaid-insured AA women in the county (PT: 11% vs. 13.1-18.0%, range p values .003-.465); (VPT: 1.8% vs. 3.0-4.1%, range p values .035-.247). Comparisons excluding women who received other HV programs yielded similar results.

CONCLUSION:

Baseline preterm birth findings were positive, although varied dependent on statistical methods, and supported investment in a five year Pay for Success demonstration project.
Proportion of Abnormal Glucose Values and Perinatal Outcome [13J]
Authors: Merriman Amanda , Wang Laura , Gregory Rebecca , Osmundson Sarah
Published: April 2018

INTRODUCTION:

Practical targets for glycemic control are unclear. This study examines associations between different proportions of abnormal self-monitored blood glucose (SMBG) values and adverse perinatal outcomes.

METHODS:

We conducted a retrospective cohort study of women undergoing SMBG between 1/1/2011-12/31/2016. Four weeks of SMBG values initiated before 32 weeks with at least 50% of expected values present were required. Women with type 1 diabetes or major congenital anomalies were excluded. The primary outcome was a composite of stillbirth, neonatal death, cesarean for arrest, shoulder dystocia, birth injury, new hypertensive disorder, birth weight >90% (LGA), or treatment for neonatal hypoglycemia. The primary exposure was the total percent abnormal SMBG values, examined by degree of abnormality: <25% (tight), <33% (moderate), or <50% (loose) abnormal.

RESULTS:

120 women met inclusion criteria of whom 47.9% had gestational diabetes (GDM) and 52.1% had type 2 diabetes. Overall, 29.4% had tight control, 37.0% had moderate control, and 33.6% had loose control. Women with tight control were less likely to experience the primary outcome (34.3% vs 69.4%, RR 0.49, 95%CI 0.31-0.80), LGA infants (14.3% vs 34.5%, RR 0.41, 95% CI 0.17-0.98), or neonatal hypoglycemia (11.4% vs 34.1%, RR 0.34, 95%CI 0.13-0.88) than women without tight control. After adjusting for age, parity, and diabetes type, both moderate and tight control were associated with a reduced odds for the primary outcome, however loose control was not.

CONCLUSION:

Keeping SMBG to less than 33% abnormal is associated with a reduced risk of adverse perinatal outcomes. These data may help clinicians set targets for glycemic control.
Breastfeeding in a Baby Friendly Hospital: Preliminary Findings [14J]
Authors: Formoso Agatha , Lipori Gigi , Spiryda Lisa Beth
Published: April 2018

INTRODUCTION:

The Baby-Friendly Hospital Initiative (BFHI) was created to improve maternity and breastfeeding practices globally. Increased “Baby-Friendly” practices improves the chances of breastfeeding beyond 6 weeks. UF Health was designated a baby-friendly hospital in 2015. The aim of this study was to determine if the percentage of infants breastfed under the new BFHI policy at UF Health and determine if it is projected to meet the Healthy People 2020 goal both in initiation and continuance of breastfeeding at 6 weeks.

METHODS:

IRB approval was obtained for this retrospective chart review. Charts were identified by CPT codes for both vaginal and cesarean deliveries. Data was abstracted from EMR; women were excluded if they received prenatal care outside UF Health since BFHI program has a significant prenatal educational component. Initial review abstracted data from 150 eligible charts approximately 2 years after BFHI (2/2017-3/2017). Data was analyzed with GraphPad and JMP statistical software.

RESULTS:

Mothers initiated breastfeeding 91.4% of the time at UF Health. Factors that made a mother more likely to breastfeed at 6 weeks were: white versus black (75 v 43%, p = 0.45), private insurance versus Medicaid (82 v 40%, p=0.0001), and married versus single (83 v 41%, p=0.0001).

CONCLUSION:

UF Health’s breastfeeding policies are currently projected to meet the 2020 goal for all infants who have ever been breast fed, but despite the BFHI there were still deficits at 6 weeks. Future studies will explore specific barriers to breastfeeding in these populations.
Obesity and Risk for Infectious Morbidities in Women Delivered by Cesarean Section after Induction of Labor [19J]
Authors: Colihan Sarah , Lynch Tara , Walia Jennifer , Zelig Craig
Published: April 2018

INTRODUCTION:

Obesity is a known risk factor for infectious morbidity after cesarean delivery. Nulliparous women often require prolonged inductions of labor, which increases the length of membrane rupture and risk for chorioamnionitis. Therefore, we sought to evaluate if the risk for chorioamnionitis was increased in obese women based on length of membrane rupture.

METHODS:

This study was conducted on a retrospective cohort of term, nulliparous patients with singleton gestations requiring non-elective cesarean sections after induction of labor at a single academic institution from 2008 to 2015. The primary outcome was the incidence of chorioamnionitis. Secondary outcomes included endometritis and cesarean wound infection. Maternal obesity, defined as body mass index (BMI) >30 kg/m2, and duration of amniotic membrane rupture, were evaluated as the primary risk factors.

RESULTS:

A total of 297 patients met inclusion criteria. Increased duration of membrane rupture was associated with increased risk of chorioamnionitis (Odds ratio [OR] 1.08 95% Confidence Interval [CI] 1.05-1.11). However, increasing BMI was not associated with increased risk of chorioamnionitis, and regression analysis showed there was no significant relationship between BMI and the interval between rupture of amniotic membranes and delivery (R-sq 1.2%). Secondary analysis did reveal significantly higher risk of chorioamnionitis with IUPC use ([OR] 3.12 [CI] 1.4258, 6.7918).

CONCLUSION:

Maternal obesity does not appear to independently increase the length of ruptured membranes and the rate of chorioamnionitis during induction of labor. However, obese patients undergoing a prolonged induction of labor are more likely to be monitored with an IUPC, which increases their chorioamnionitis risk.
Automated Quantification of Blood Loss Compared to Qualitative Estimation in 300 Vaginal Deliveries [20J]
Authors: Rubenstein Andrew , Zamudio Stacy , Al-Kahn Abdulla , Douglas Claudia , Sledge Sharon , Thurer Robert
Published: April 2018

INTRODUCTION:

Under estimation of blood loss and delayed diagnosis of obstetric hemorrhage are leading causes of maternal morbidity and mortality. Failure to visually recognize significant hemorrhage early is often responsible. Accurate quantification of blood loss during delivery is therefore recommended to facilitate rapid recognition and implementation of hemorrhage protocols and improve outcomes.

METHODS:

We assessed quantified blood loss (QBL) using an automated system (Triton L&D™, Gauss Surgical, Los Altos, CA) compared to the attending physician’s clinical estimates during 300 vaginal deliveries. The system batch weighs all blood containing sponges, towels, pads and other supplies and automatically subtracts their dry weights. It also facilitates measurement of blood collected in the under-buttocks drape and subtracts the measured amount of amniotic fluid. Each method was performed independently and clinicians were blinded to the device’s results.

RESULTS:

Mean QBL (405.8 ± 275.2 ml) was significantly greater than visually estimated blood loss (304.9 ± 135.2 ml) (P<.0001). Critically, QBL detected hemorrhage (blood loss > 500 ml) in 27.7% of patients compared to 5.1% of patients using visual estimation (P<.0001). Visual estimation of ≥1,000 ml was recorded in only 1 patient, whereas 13 patients (4.3%) had a blood loss > 1,000 ml by QBL (P<.0001).

CONCLUSION:

Our data demonstrate that QBL facilitated by an automated system recognizes more patients with excessive blood loss than visual estimation. The value of QBL as a public health safety initiative requires clinicians to accept the long-known inadequacy of qualitative estimation. Further studies of clinical outcomes related to implementation of QBL are needed.
Low PAPP-A Levels and Pregnancy Outcomes [21J]
Authors: Shand Muhammed F. , Gimovsky Alexis , Macri Charles
Published: April 2018

INTRODUCTION:

Pregnancy-associated plasma protein A (PAPP-A) is associated with adverse pregnancy outcomes: preterm birth, growth restriction, stillbirth and preeclampsia. Because PAPP-A affects placental function, it may affect labor. The objective of this study was to determine if low PAPP-A is associated with labor dysfunction.

METHODS:

Retrospective study of pregnant women between July 2013 and July 2016. Women with PAPP-A in the 5 percentile were compared to women with PAPP-A ≤1 percentile. Primary outcome: cesarean delivery (CD) rate. Secondary outcomes: indication for CD, perinatal outcomes. Exclusion: women with fetuses with known or suspected aneuploidy.

RESULTS:

One hundred thirty-nine women were included; 91 women with PAPP-A in 5 percentile and 48 women with PAPP-A ≤1 percentile. Demographics were similar except for gestational age at delivery (38.6±3.6 weeks in the 5 percentile group versus 35.9±7.4 in the 1 percentile group, P=.004). There was no difference in CD rate (27/91 [29.7%] versus 12/48 [25%], P=.6), fetal indication for CD (8/27 [29.6%] versus 4/12 [33.3%], P=.8). Birth weight was significantly higher in the 5 percentile group versus the 1 percentile group (3,264.6±580.8 versus 2,935.4±715.3, P=.004). Neonatal morbidity composite score was different between groups; (18/91 [19.8%] in the 5 percentile group versus 18/48 [37.5%] in the 1 percentile group P=.02).

CONCLUSION:

PAPP-A ≤1 percentile does not seem associated with delivery mode or indication for cesarean delivery in comparison to <5 percentile. PAPP-A ≤1 percentile may be associated with increased neonatal morbidity during labor, as well as lower birth weight and preterm birth in comparison to PAPP-A <5 percentile.
Serotonin Syndrome in Obstetrics: A Case Report and Review of Clinical Management [22J]
Authors: Asusta Heisy , Keyser Erin , Dominguez Patricia , Odedokun Tolulope
Published: April 2018

INTRODUCTION:

Serotonin syndrome (SS) is a life-threatening condition, usually precipitated by a combination of serotonergic agents. Data regarding the incidence and management of SS in obstetrics are limited. This study presents a case of SS provoked by an atypical antipsychotic in a second trimester, singleton gestation, and reviews the management of SS.

RESULTS:

We present a case of a schizophreniform, pregnant patient with a singleton gestation admitted to a community, military hospital for serotonin syndrome. The patient was admitted to the intensive care unit (ICU) by the obstetrics team, where she was managed conservatively. The cornerstones of therapy were as follows: discontinuation of offending agent, intravenous fluids, supplemental oxygen, telemetry, and hourly neurological assessments. Fetal status was monitored twice daily. After stabilization, the patient was transferred from the ICU to inpatient psychiatry for continued care.

CONCLUSION:

Although serotonin syndrome is infrequently encountered in obstetrics, it is paramount that all obstetricians are familiar with its recognition and management, particularly in community hospital settings. The low incidence of reported SS is largely attributed to under-recognition. Given the increasing prevalence of mental health disorders, it is essential for well-rounded obstetricians to be aware of the potential for SS in our patient population.
Baseline Fetal Heart Rate at Term in Obese and Diabetic Women and Mode of Delivery [23J]
Authors: Kidd Jennifer , Gimovsky Martin Larry , Nazir Munir , Koscica Karen
Published: April 2018

INTRODUCTION:

Fetal heart rate (FHR) reflects adaptation to environment. Increased baseline FHR at term may be indicative of fetal inability to tolerate labor. This study reviews admission baseline FHR and mode of delivery when non-reassuring FHR is present.

METHODS:

A retrospective cohort study of 1,035 deliveries in obese mothers at term for 2016 was reviewed. Inclusion criteria included: body mass index (BMI) greater than 30, admission baseline FHR, and admission for delivery. Exclusion criteria included multiple gestation, congenital abnormalities, contraindications to labor, prior cesarean delivery and elective cesarean deliveries. Data extracted from medical record included: parity, medical conditions, admission diagnosis, admission baseline FHR, mode of delivery, and indication for cesarean delivery. Statistical analysis utilized Student's t-test and ANOVA for data stratification by BMI and diabetic status.

RESULTS:

Mean admission baseline FHR increased with BMI, diabetic status, and deliveries by cesarean delivery for nonreassuring tracing (NRFHRT). Vaginal delivery rate decreased with increasing BMI and presence of diabetic status. Student t-test of vaginal deliveries versus cesarean deliveries for NRFHRT was significant for diabetics with BMI between 30 and 34 (P<.01). ANOVA analysis of baseline FHR for all groups (P=.013) and all obese non-diabetics (P<.01) was significant; analysis for diabetics alone was not significant (P=.067).

CONCLUSION:

This study suggests baseline admission FHR significantly affects mode of delivery for obese mothers. In addition although not statistically significant, diabetic subgroups demonstrate a similar trend. Increased baseline FHR may be associated with decreased labor tolerance and increased cesarean delivery rate.
The Effect of Low-Molecular-Weight Heparin Added Low Dose Aspirin in the Subsequent Pregnancy of Hypertensive Women [24J]
Authors: Shen Fangrong , Huang Qin , Jiang Na , Yang Weiwen , Chen Youguo
Published: April 2018

INTRODUCTION:

To investigate the effect of low-molecular-weight heparin (LMWH) added low dose aspirin (LDA) in the subsequent pregnancy of the women who have the previous history of hypertensive disorder of pregnancy.

METHODS:

Prophylactically adding LMWH and LDA in 33 women who has previous hypertensive disorder (HD) of pregnancy compared with 37 cases without administrate. We compared the recurrent rate of hypertensive disorder of pregnancy, the occurrence rate of placental abruption, intrauterine death, fetal growth restriction (FGR), intrapartum and postpartum hemorrhage with the women were not prophylactically adding LMWH and LDA. Also compared with the pregnancy gestational age between the two pregnancies.

RESULTS:

There was no significant differences in recurrent rate of hypertensive disorder of pregnancy, the occurrence rate of placental abruption, intrauterine death, fetal growth restriction intrapartum and postpartum hemorrhage (P>.05). There was significant differences in pregnancy gestational age between two pregnancies (P<.05), the pregnancy gestational age of the subsequent pregnancy were significant longer than the previous pregnancy.

CONCLUSION:

Prophylactically adding LMWH and LDA doesn't reduce the recurrent rate of hypertensive disorder of pregnancy, the occurrence rate of placental abruption, intrauterine death, fetal growth restriction. However, adding LMWH and LDA does prolong pregnancy gestational age, and doesn't increase the risk of the intrapartum and postpartum hemorrhage.
Repeat Antenatal Corticosteroids Decreased Neonatal Morbidity for Preterm Rupture of Membranes [25J]
Authors: Buskmiller Cara , Miller Collin , Vricella Laura
Published: April 2018

INTRODUCTION:

A second course of antenatal corticosteroids (repeat ANCS) improves composite neonatal morbidity in pregnancies at risk of preterm delivery. Women with preterm premature rupture of membranes (PPROM) have been excluded from some studies of repeat ANCS. This study investigated whether repeat ANCS is associated with decreased neonatal morbidity in PPROM.

METHODS:

This was a retrospective cohort study of women with non-anomalous fetuses from 2005 to 2017 admitted for PPROM between 23w0d and 33w6d and latent at least 14 days after a two-dose initial course of ANCS. The standard of care group received no further ANCS; the study cohort received a second two-dose course of ANCS when delivery within 2 weeks was expected. The primary outcome was composite neonatal morbidity including respiratory morbidity, necrotizing enterocolitis, intraventricular hemorrhage, and death. Secondary outcomes were rates of clinical and histologic chorioamnionitis, and neonatal hypoglycemia.

RESULTS:

One hundred eighty-two women and 216 neonates were included. Seventy-seven women received standard of care and 105 received repeat ANCS. Maternal age, demographics, parity, body mass index, and median gestational age at rupture and at delivery were comparable between groups. Repeat ANCS was associated with decreased respiratory morbidity (P<.05). Neonatal hypoglycemia and clinical and histologic chorioamnionitis were similar between groups (P=.06, .14, .82 respectively). When neonates under 28 weeks were analyzed separately, respiratory morbidity remained the only outcome at the level of significance (P=.05).

CONCLUSION:

Repeat ANCS is associated with decreased neonatal morbidity and is not associated with increased rates of chorioamnionitis and neonatal hypoglycemia. Further prospective studies are needed.
Is Acute Intrapartum Fetal Asphyxia Associated With an Increase in Fetal Nucleated Red Blood Cells? [28J]
Authors: Chu Amanda , Divon Michael , Guillaume Stoffels , Kulla Klea , Minior Victoria , Bornstein Eran
Published: April 2018

INTRODUCTION:

Fetal heart rate abnormalities and elevated nucleated red blood cells (nRBCs) have been suggested as markers of fetal asphyxia. Animal studies suggest that the time between the onset of hypoxia and FHR abnormalities is short. The time interval in humans is unknown. Our study aims to evaluate the association between nRBCs and acute intrapartum fetal asphyxia.

METHODS:

Study patients included consecutive NICU admissions (2013–2017) with cord gases indicating severe fetal asphyxia (n=35). Controls without asphyxia were NICU patients matched for gestational age (n=72). All had a category I FHR tracing on admission. Fetal asphyxia was defined by an umbilical cord pH <7.0 with a base excess <−9. We examined the time interval from the last FHR acceleration to the time of delivery. Fetuses with congenital or genetic abnormalities were excluded. Statistical analysis included χ2 testing, T-testing and Spearman correlations.

RESULTS:

There was no significant association between delta t and nRBCs in either group (P=.70 and P=.71 in study and control patients, respectively). Several additional variables were studied including maternal BMI, gestational age, maternal age, parity, mode of delivery, fetal sex, standardized birth weight. We found that delta T was significantly associated with asphyxia in patients with increased BMI and in Cesarean Sections.

CONCLUSION:

It is highly unlikely that nRBCs can serve as a marker of acute intrapartum fetal asphyxia. We believe that fetal nRBCs are the result of antepartum compensatory mechanisms responding to chronic inadequate fetal oxygenation.
Miscarriage After Noninvasive Prenatal Screening—The Value of Genetic Testing in Pregnancy Loss [34J]
Authors: Maisenbacher Melissa , DiNonno Wendy , Merrion Katrina , Young Michael , Sigurjonsson Styrmir , Hedriana Herman
Published: April 2018

INTRODUCTION:

Noninvasive prenatal screening (NIPT) is a sensitive screen focusing on common aneuploidies. Products of conception (POC) testing can detect all aneuploidies, uniparental disomy, triploidy and deletions/duplications.

METHODS:

POC and NIPT results for the same pregnancy were reviewed. POC testing was performed using Illumina CytoSNP-12b microarrays. For NIPT, cfDNA was amplified by massively-multiplexed PCR targeting 13,392 SNPs across chromosomes 13, 18, 21, X and Y.

RESULTS:

Of 25,432 POC cases, 22,103 had fetal results (87%): 9,712 normal, 12,391 abnormal (1,630 triploid, 575 deletions/duplications). Two hundred seventy-one POC cases had prior NIPT: 181 (66.8%) low-risk results, 40 (14.8%) high-risk results, and 50 (18.4%) no results (low fetal fraction/uninformative DNA). For low-risk cases, 157/181 (86.7%) had concordant POC results, 23/181 (12.7%) had POC results undetectable by NIPT, including 8 cases of deletions/duplications (4.4%) and 1 triploidy (0.5%). For high-risk cases, 39/40 (97.5%) were concordant. For no result cases, 37/50 (74%) had abnormal POC results, including 14 cases of triploidy (28%), and 2 deletions/duplications (4%).

CONCLUSION:

In our study, low-risk cases had a 4.4% rate of deletions/duplications, almost double the overall POC incidence of 2.6%. Importantly, these findings could be due to parental balanced translocations. No results cases had a higher incidence (74%) of chromosome abnormalities than POC studies (56%), particularly triploidy at a rate of 28% compared to 7.4% in POC studies, which carries a risk for gestational trophoblastic disease (GTD). POC testing after NIPT allows providers to streamline the work-up for miscarriage, provide recurrence risks, guide maternal screening for GTD, and allow patients closure.
Pregnancy Intention Screening: Changes in Staff Perceptions With Training [8K]
Authors: Jackson Ashaki , Saleeby Erin , Pietersz Judith Dannelle , Zapata Carmen , Thiel de Bocanegra Heike
Published: April 2018

INTRODUCTION:

Integrating reproductive life preference (RLP) screening is part of a larger initiative to improve reproductive and sexual healthcare throughout the Los Angeles County Department of Health Services (LACDHS). The LACDHS implemented RLP training among clinic staff and evaluated impact of training on staff perceptions of the RLP questions and their incorporation into routine clinical care.

METHODS:

We collected pre- and post-survey data from training participants from April 2017 to September 2017. Survey items included RLP question knowledge, implementation confidence and attitudes on the importance of reproductive health. We analyzed changes with pre- and post-tests.

RESULTS:

A total of 175 medical staff—largely certified medical assistants (48.6%) and nurses (29.1%)—completed evaluation surveys. Analyses conducted on responses from staff who were already somewhat familiar with RLP questions revealed that by post-survey, staff more often perceived fewer barriers to implementing RLP questions in clinical settings, t(87)=3.34, P=.001; saw inclusion of RLP questions as helpful to their work, t(88)=−3.45, P=.001; and perceived the questions as helpful to information-gathering and the decision-making process, t(88)=−6.40, P=.001. Staff who were unfamiliar with RLP questions more often agreed that RLP questions improved the decision-making process and were useful to information-gathering at post-survey, t(75)=−2.37, P=.02.

CONCLUSION:

Training demonstrated some impact on perceptions of RLP question's value. Future research will include how often staff ask questions prior to and following training to clarify if training also impacts practice.
Patient Opinions on Vaccines and Maternal Vaccination Status [11K]
Authors: Gelvin Brady J. , Morrow Ardythe L. , Staat Mary A. , DeFranco Emily
Published: April 2018

INTRODUCTION:

To identify opinions that most negatively predict maternal influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination receipt.

METHODS:

Pregnant women >34 weeks were offered enrollment in a prospective cohort study, Pediatric Respiratory & Enteric Virus Acquisition and Immunogenesis Longitudinal Cohort (PREVAIL, www.cdc.gov/surveillance/nvsn/prevail.html). Multivariate logistic regression estimated the association between maternal characteristics and vaccine opinions on not receiving an influenza or Tdap vaccination.

RESULTS:

Of 58 enrolled mothers, 27 (46.6%) declined either an influenza, Tdap, or both vaccinations during their current pregnancy. Vaccine opinions and factors most commonly associated with refusal of an influenza vaccination were prior vaccination refusal (9, 45.0%), believing influenza vaccine is not effective at protecting one from the flu (12, 60%), believing influenza vaccine is not effective at conveying immunity to the baby (9, 45.0%), and believing it is better for a child to develop immunity naturally versus receiving an immunization (8, 40.0%). Vaccine opinions and factors most commonly associated with refusal of a Tdap vaccination were maternal age >34 year old (5, 35.7%), reported hesitancy toward childhood vaccinations (4, 28.6%), not planning on breastfeeding (4, 28.6%), and history of prior vaccine refusal (4, 28.6%).

CONCLUSION:

Our preliminary analysis has elucidated maternal factors and opinions regarding failure to receive recommended prenatal vaccinations. These efforts could help to shape future maternal vaccination education programs, as well as vaccine education programs in general.
Frequency of Neonatal Hypoglycemia After Implementation of Antenatal Late Preterm Steroids Use [19K]
Authors: Alrais Mesk A. , Chen Han-Yang , Sibai Baha M. , Blackwell Sean C.
Published: April 2018

INTRODUCTION:

Our objective was to evaluate the impact of Antenatal Corticosteroids (ACS) exposure on neonatal hypoglycemia after implementation of Antenatal Late Preterm Steroids (ALPS) protocol.

METHODS:

We conducted a retrospective cohort study of women admitted at 34–36 weeks gestation and had a late preterm birth from April 2016 to March 2017 (after publication of SMFM and ACOG guidelines). ALPS protocol was defined as: administration of Betamethasone (BMZ) for the first time to a live, singleton, non-pregestational diabetic pregnancy with a high probability of delivery between 12 hours and 7 days, in the absence of risk factors necessitate immediate delivery. Hypoglycemia was defined as any blood sugar <40 mg/dL within the first 72 hours of life. Perinatal outcomes were compared between those received ALPS versus those did not receive.

RESULTS:

Out of 484 births, 220 (45.5%) infants developed hypoglycemia irrespective to gestational age. Rate of hypoglycemia was higher in neonates exposed to BMZ compared to those did not (54% versus 43%, P=.049). Among hypoglycemic infants, the total rate of NICU admission was higher in infants exposed to BMZ compared to those not exposed (68% versus 52%, P=.028), but no significant difference was found in their length of stay in NICU. In addition, 34% had spontaneous onset of labor and 58% went into a trial of labor.

CONCLUSION:

In late preterm birth infants, ACS administration was associated with neonatal hypoglycemia which supports the finding in ALPS trial.
Continuous Glucose Monitoring in Pregnancies Complicated by Type 1 Diabetes Mellitus [20K]
Authors: Herrero Tiffany , Coleman Todd , Laurent Louise , Moore Thomas , Ramos Gladys
Published: April 2018

INTRODUCTION:

Continuous glucose monitors (CGM) is recommended for use in type 1 diabetes mellitus (T1DM) but studies in pregnancy are limited. We compare the number of hypoglycemic and hyperglycemic episodes on CGM to traditional self-monitoring blood glucose (SMBG) in women with T1DM.

METHODS:

Patients with T1DM presenting for care at UC San Diego <20 weeks were approached for participation. Patients underwent routine diabetes care and wore a blinded CGM (Dexcom G4) for 7 days every 4 weeks. Dexcom provided CGM. The primary outcome was the number of hours of hypoglycemia and hyperglycemia detected by each modality. Missed episodes of hypoglycemia/hyperglycemia were those not detected by one testing modality or the other. Mann Whitney-U, χ2 analysis, and Kruskal Wallis Test were performed where appropriate.

RESULTS:

Ten patients were recruited for this study. Two terminated their pregnancies. Two withdrew their participation. Thirty nine thousand five hundred seventy two glucose values (3,625 hours of glycemic data) were collected through CGM. Per day, the mean hours of reported hypoglycemia (4.3±1.9 for CGM versus 0.9±0.4 for SMBG, P<.01) and hyperglycemia (10.8±2.3 for CGM versus 2.7±0.9 for SMBG, P<.01) were significantly higher for the CGM group. For hypoglycemic and hyperglycemic hours, CGM demonstrated a lower mean proportion of missed hypoglycemia (3.7 versus 0.2 by CGM [P<.01]) and hyperglycemia (9.2 versus 0.1 by CGM [P<.01]). There was no correlation between A1c or trimester and missed hypoglycemic/hyperglycemic events.

CONCLUSION:

CGM detected a significant amount of time of unreported hypoglycemia/hyperglycemia over SMBG. Further study is needed to see if CGM can improve glycemic control and perinatal outcomes.
Etiologies and Timing of Stillbirth at a Tertiary Teaching Hospital in Mekelle, Ethiopia [24K]
Authors: Yeman Awol , Cavanaugh Erin , Whelan Anna , Zelelew Yibrah , Miller Emily Stinnett , Goba Gelila
Published: April 2018

INTRODUCTION:

Stillbirth remains a tragic event. The overwhelming majority globally (98%) occurs in low- and middle-income countries (LMICs), though data is limited. Ayder Referral Hospital (ARH), a tertiary hospital in northern Ethiopia, utilizes a World Health Organization (WHO) form to record stillbirth. This study aimed to determine the etiology and timing of stillbirths delivered at ARH.

METHODS:

Our study was a retrospective chart review of stillbirths delivered at ARH between January 1, 2013 and December 31, 2015. We used delivering obstetricians' notes using the WHO form and physical examination of fetus and placenta to determine etiology and timing of stillbirths.

RESULTS:

Over the study period, there were 4,582 live births and 322 stillbirths delivered at ARH. The top five causes of stillbirth were unexplained (41.3%), abruptio placenta (15.5%), fetal congenital anomalies (14.9%), birth asphyxia (12.1%), and cord accidents (6.8%). Most (62.2%) stillbirths occurred intrapartum, including during the latent (6.1%), active (6.1%) and second (50.0%) stages of labor. In 70.8% of stillbirths, fetal heart tone (FHT) was absent on admission to ARH, including 28.6% that had no FHT upon arrival at referring institution, 18.0% that occurred en route to ARH, and 24.2% that arrived at ARH directly with no referral.

CONCLUSION:

Stillbirth continues to be significant problem in northern Ethiopia. Additional research is needed given that 41.3% of stillbirths were unexplained. Nearly two-thirds of stillbirths occurred intrapartum and 18.0% in transit from referral institutions, suggesting women need access to care before labor starts and transportation from referring institutions should be improved.
The Impact of Multi-Drug Therapy on Pregnancies of Chronic Hypertensive Women [26K]
Authors: Ambia Anne M. , Rodriguez A. Noel , Morgan Jamie L. , Wells C. Edward , Roberts Scott W. , Nelson David B.
Published: April 2018

INTRODUCTION:

Our group has previously described the high frequency of preterm birth and superimposed preeclampsia in women treated during pregnancy for chronic hypertension (CHTN). We hypothesized that women with CHTN requiring more than one medication for control may be at increased risk for these adverse perinatal outcomes.

METHODS:

This was a retrospective study of pregnant women with CHTN who delivered from June 2009 to January 2016. These women were treated with a-adrenergic agonists, combined a-B blockers, calcium channel blockers, or a combination thereof. Regimens were adjusted to achieve blood pressures <150 mm Hg systolic and <100 mm Hg diastolic based on recommendations of the ACOG Task Force of Hypertension in Pregnancy. Perinatal outcomes were analyzed by the number of medications needed to achieve the desired blood pressure (BP).

RESULTS:

There were a total of 419 women with treated CHTN. Fifty (12%) required the use of more than one medication for BP control. There were no differences in maternal baseline characteristics other than duration of diagnosis in those requiring more than one medication (P=.037). Requiring more than one anti-hypertensive medication during pregnancy was associated with a greater risk for superimposed severe preeclampsia (P=.011), delivery <34 weeks (P<.001), and birthweight <2,500 g (P<.001). This burden of preterm birth correlated with an increased frequency of admission to neonatal intensive care (P=.037), development of bronchopulmonary dysplasia (P=.003), surfactant use (P=.02), and phototherapy (P=.015).

CONCLUSION:

Women who require more than one medication for BP control have increased frequencies of adverse perinatal outcomes specifically linked to indicated, early preterm birth.
Postpartum Utilization of Narcotics for Analgesia [29K]
Authors: Kim Sara , Chappelle Joseph
Published: April 2018

INTRODUCTION:

The number of deaths from opioid overdose has dramatically increased in recent years and one factor is the increase in prescription narcotics. This study aims to assess the amount of narcotics women utilize post-Cesarean and identify factors that affect pain control.

METHODS:

Women were contacted via telephone 10–12 days after delivery and verbally consented to participate. They were asked questions ranging from severity of postoperative pain to amount of narcotics used since discharge. At the completion of the survey, demographics, postoperative pain and medication usage were collected. Women using methadone or buprenorphine were excluded.

RESULTS:

There were one hundred women in the study. Mean narcotic usage was 92.4±90.4 mg morphine equivalents inpatient and 15.2±32.2 mg outpatient. More women with commercial insurance felt they had been prescribed too many pills compared to women with Medicaid (40.0% versus 20.0%, P=.002), while women with anxiety and/or depression more often felt that they were not given enough (2.4% versus 22.2%, P=.04). No other factors were significant. Women who used more narcotics inpatient tended to required more outpatient, however no clinically relevant cut-offs could be found. Most commonly prescribed amount was 30 pills and 5.8% of women given 20 pills or less felt that they did not have enough.

CONCLUSION:

The amount of opioids prescribed is likely too much for most patients. Having this information will better guide physicians in our community to minimize amount of opioids prescribed without compromising patient's pain. Pain control in women with anxiety and depression needs further attention.
Postpartum Shock Index as a Predictor of Postpartum Hemorrhage Morbidity [30K]
Authors: Welsh Ann , Savala Michael , Lai Bridget , Kimata Chieko , Soon Reni
Published: April 2018

INTRODUCTION:

Shock index (SI), or systolic blood pressure/heart rate, can be a marker for trauma morbidity. We sought to explore the utility of this clinical sign in obstetrics by evaluating the relationship between postpartum SI and postpartum hemorrhage morbidity.

METHODS:

To determine if an elevated SI in the first 2 hours after delivery was associated with postpartum hemorrhage morbidity, we conducted a retrospective review of all deliveries occurring at a level III obstetrics hospital in Honolulu, HI from January 1, 2013 to December 31, 2015. The primary outcome was a composite of 1) a decrease in hemoglobin from admission to postpartum of 3 g/dL or more, 2) blood transfusion, or 3) admission to telemetry or ICU. We developed a multivariate regression model to estimate the association between the maximum shock index within 2 hours postpartum and clinically relevant postpartum hemorrhage after adjusting for demographic and clinical variables.

RESULTS:

Among the 17,522 delivery records reviewed, the mean maximum postpartum SI was 0.84±0.18. The composite hemorrhage outcome complicated 1,332 (7.6%) deliveries. A maximum SI of 0.9 or greater occurred in 5,497 deliveries, and 13.0% were found to have the composite hemorrhage outcome, compared to 5.2% of the deliveries in which the maximum SI was less than 0.9 (P<.0001). Women with a maximum postpartum SI of 0.9 or greater were 2.5 times more likely (aOR 2.5 [CI 2.24–2.85]) to experience the composite outcome.

CONCLUSION:

Evaluation of SI, particularly in the immediate postpartum period, may assist in identifying patients at greatest risk for developing adverse hemorrhage-related outcomes.
Maternal Morbidity Associated With Duration of Labor Induction [34K]
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 aims to assess the impact of IOL duration on maternal morbidity.

METHODS:

This retrospective cohort study included all nulliparous women with non-anomalous, singleton, vertex pregnancies undergoing 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 maternal composite morbidity: third or fourth degree perineal laceration, postpartum hemorrhage, blood transfusion, peripartum infection, uterine rupture, shoulder dystocia, retained placenta, and/or postpartum readmission. Secondary outcome was mode of delivery. The risk of adverse outcomes was stratified by IOL duration.

RESULTS:

Four hundred twenty women were included. IOL duration exceeding 24 hours was associated with increased risk of composite maternal morbidity (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.1–2.7) but that risk did not persist among IOL exceeding 36 hours. One hundred twenty women (28.6%) had a cesarean section. IOL duration exceeding 24 hours was associated with increased risk of CD (OR 3.2, 95% CI 2.0–5.4) which persisted at 36, 48, and 60 hours (OR 2.9 [1.8–4.5], OR 2.8 [CI 1.7–4.8], OR 2.3 [CI 1.1–5.0]). IOL duration was not associated with increased risk of operative delivery.

CONCLUSION:

While increasing IOL duration is associated with increased risk of maternal morbidity at 24 hours, that risk does not persist beyond 36 hours. Conversely, IOL duration longer than 24 hours is associated with increased risk of CD. These data may inform decision-making surrounding prolonged IOL.