bluuebunny/crossref_metadata_2025 huggingface dataset:
Can Fetal Head Circumference Assessment on Ultrasound Help Predict 3rd and 4th Degree Perineal lacerations? [40M]
Authors: Ortega Marcus V. , Kim Youngwu , Masiero Jessica , Hebert Kasey , Leung Katherine , Leftwich Heidi
Published: April 2018

INTRODUCTION:

Obstetric Anal Sphincter Injuries (OASIS) occur in 2 to 19% of vaginal deliveries in the United States. Neonatal measurements such as birthweight above 4000g or neonatal head circumference above 37cm are known risk factors for 3rd and 4th degree perineal laceration. Unfortunately, these predictors are identified after the delivery and therefore have very limited practical impact. We hypothesized that fetal Head Circumference (HC) size assessed by ultrasound in pregnancy can aid in predicting Obstetric Anal Sphincter Injuries (OASIS).

METHODS:

Secondary analysis of a retrospective cohort study assessing pregnancies with OASIS between 2005 and 2016. Inclusion criteria for this secondary analysis were third trimester ultrasound head circumference measurements. Antenatal ultrasound Head Circumference (HC) assessment, maternal demographics and labor and delivery data were documented and compared. P less than .05 was considered statistically significant.

RESULTS:

Of 2057 patients that had head circumference assessment, 121 (5.8%) had OASIS. In the unadjusted continuous analysis of the head circumference, an increase of 10% in the HC were associated with OASIS OR 1.12 (1.02-1.23) p=0.015. Although not statistically significant HC above the 90% appears to be associated with OASIS OR 3.37 (0.89-12.74) p=0.073.

CONCLUSION:

In our cohort, fetal head circumference percentile is associated with OASIS, specifically the larger the head circumference percentile, the greater the risk. Severe perineal lacerations significantly impact short and long term health outcomes such as perineal pain, dyspareunia, urinary and fecal incontinence. This piece of information might help clinicians antenatally during counseling of patients about the risk of OASIS and future implications of the injury.
Knowledge of Maternal to Child Transmission and Barriers to ART Adherence among HIV Positive Pregnant Women [3N]
Authors: Zahedi-Spung Leilah , Young Marisa , Haddad Lisa , Badell Martina
Published: April 2018

INTRODUCTION:

Although rare, perinatal HIV transmission still occurs in the United States and most transmissions are preventable. We aim to identify patient barriers to antiretroviral therapy (ART) adherence during pregnancy and assess patient understanding of maternal-to-child transmission (MTCT).

METHODS:

This cross-sectional survey recruited HIV positive postpartum women at Grady Memorial Hospital in Atlanta between January 2016 and July 2017. Survey questions included demographic characteristics, HIV history, knowledge of MTCT and ART adherence. Perinatal and HIV outcomes were assessed using chart abstraction. Results are descriptive.

RESULTS:

Of 52 HIV positive women during the study period, 32 were eligible and consented to participation. Participating women were aged 18 to 40 years, 97% were African American, and 68% had ≥3 pregnancies. Five women had acquired HIV congenitally. Seven women (22%) had a detectable viral load at the time of delivery and three of these reported taking ART few days per week. Eleven women received intrapartum AZT. There were no cases of perinatal HIV. Only 75% of participants reported daily ART adherence and the most frequent reason for missing pills was forgetting (61%). Approximately 1/4 of women either did not know or believed a vaginal delivery, regardless of viral load, would increase their risk of MTCT.

CONCLUSION:

One quarter of women were not compliant with daily ART during pregnancy. Detectable viral load at delivery is the greatest risk factor for transmission, therefore strategies to address ART adherence are needed. Additionally, persistent misunderstanding exists regarding risk of vaginal delivery with maternal HIV.
Case Control Analysis of Fetal Congenital Heart Defects as a Risk Factor for Preeclampsia [10N]
Authors: Bears Breanne , Browne Kathleen , Turan Shifa , Turan Mehmet
Published: April 2018

INTRODUCTION:

Fetal congenital heart defects (fCHD) may indicate an angiogenic imbalance that predisposes mothers to pre-eclampsia (PE.) It is unclear if this is due to other maternal risk factors of PE or from CHD itself. We sought to determine whether fCHD is an independent risk factor for maternal PE.

METHODS:

This was a case control study of singleton births delivered at the University of Maryland Medical Center from 2007 to 2016. Fetuses with CHD diagnosed by a fetal echocardiography were identified. Known chromosomal anomalies were excluded. The primary exposures of interest were known maternal risk factors for PE. Controls were matched 1 to 3 by history of PE, diabetes mellitus (DM,) and chronic hypertension (CHTN). Risk of PE was analyzed in fCHD vs. non-fCHD pregnancies. Data was analyzed using Chi-squared.

RESULTS:

251 fCHD cases met inclusion criteria. These were matched with 753 controls. PE occurred in 15 (6%) deliveries with fCHD and 44 (5.8%) matched controls. Early PE (<34 wks) occurred in 4 (1.6%) fCHD and 10 (1.3%) control pregnancies. Late PE (>34 wks) occurred in 11 (4.4%) fCHD and 34 (4.5%) controls. The presence of fCHD was not associated with PE (OR: 0.98; CI 0.53-1.79; p=0.94). When PE was separated into early and late, CHD was not associated with either early (OR=0.83; CI 0.26-2.67; p=0.75) or late PE (OR: 1.03; CI 0.51-2.07; p=0.93).

CONCLUSION:

Fetal CHD was not an independent risk factor for PE, early PE, or late PE. Further monitoring does not appear warranted in women with antenatal diagnosis of fCHD.
Temporal and Quantitative Associations of Electronic Fetal Monitoring with Outcomes [12N]
Authors: Taylor Rachel , Friedman Perry , Kim Sun Kwon , Wozniak Amy , Jovanovski Andrew , Ogunyemi Dotun
Published: April 2018

INTRODUCTION:

To evaluate the use of intrapartum electronic fetal heart rate (FHR) monitoring (EFM) as a screening tool for adverse neonatal outcomes

METHODS:

This is a retrospective study of 22,126 term, singleton deliveries excluding repeat cesarean sections at a hospital system from 2013-2016. EFM data using standardized NICHD nomenclature was reviewed. Data was analyzed as discrete, quantitative, and tabulated as a) any FHR documentation during labor, b) first 60 minutes and c) last 60 minutes of labor. Primary outcome was a composite adverse outcome comprised of five-minute Apgar score < 4, umbilical arterial pH < 7.0, sepsis, seizures, encephalopathy, and respiratory failure. Secondary outcome was NICU admission. Independent associations were ascertained using logistic regression. Sensitivity, specificity, PPV and NPV were calculated.

RESULTS:

Any abnormal EFM was independently significantly associated with NICU (aOR=1.20 p=0.043) and primary outcome (aOR=1.98 p=0.018). Both first and last 60 minutes had independent associations with NICU. Last 60 minutes but not first 60 minutes was independently associated with the primary outcome, Accelerations and early decelerations were protective against NICU admissions and primary outcomes, while late and prolonged decelerations, bradycardia and tachycardia increased risk for both (Table). Negative predictive values for all EFM parameters ranged from 0.897-0.989 while the PPV ranged from 0.009-0.226.

CONCLUSION:

Both admission and terminal FHR are independently associated with NICU admissions but only terminal FHR is predictive of composite neonatal outcome. Accelerations and early decelerations are protective of adverse neonatal outcomes. FHR has high NPV but low PPV when used as screening for adverse neonatal outcomes.
Do Maternal Sociodemographic Factors Explain Race/Ethnic Differences in Neonatal Anthropometry in Low Risk Women? [14N]
Authors: Lambert Calvin , Pugh Sarah , Liu Aiyi , Ayele Fasil Takola , Grantz Katherine
Published: April 2018

INTRODUCTION:

Racial/ethnic differences in birthweight exist. It is unclear to what extent these differences are due to correlates of social disadvantage. Our objective was to evaluate whether relationships between maternal race/ethnicity and neonatal anthropometry varied by maternal socio-demographic characteristics in a cohort of healthy, low-risk women.

METHODS:

In a prospective cohort of 1,645 low-risk singleton pregnancies included in the NICHD Fetal Growth Studies (2010-2013), neonatal anthropometry was measured by trained personnel using a standard protocol. Sociodemographic characteristics were ascertained by interview and included full-time employment/student status (yes/no), marital status, health insurance source (private/managed vs Medicaid/other), income, and education. Separate generalized linear models were used to test the effect of race/ethnicity and the combined effect of race/ethnicity and sociodemographic characteristics (with two-way interaction terms) on neonatal anthropometry adjusting for days from birth (except birthweight) infant sex, and maternal characteristics: age, height, pre-gravid weight, parity, and the other sociodemographic factors.

RESULTS:

Mean birthweight, and neonatal weight, length, head circumference and abdominal circumference at examination differed significantly by race (p<0.001 for all comparisons). No statistically significant interactions occurred between race/ethnicity and full-time employment/student status, marital status, insurance, or education in association with birthweight, neonatal weight, length, or head or abdominal circumference at examination. The interaction of income with race/ethnicity was marginally significant for abdominal circumference (p=0.027). There were no significant interactions of income with other neonatal parameters and the observed significance may have occurred by chance (1 of 25 models).

CONCLUSION:

Racial/ethnic differences in neonatal anthropometry were not explained by sociodemographic factors in low-risk women.
Is Cerclage Height Associated with the Incidence of Preterm Birth in Women with Physical Exam Indicated Cerclage? [16N]
Authors: Roman Amanda , Pachtman Sarah , Cruz Yury , Rochelson Burton , Fleischer Adiel , Berghella Vincenzo
Published: April 2018

INTRODUCTION:

To determine whether there was a cerclage height threshold associated with spontaneous preterm birth in patients with physical exam indicated cerclage (PEIC).

METHODS:

We performed a retrospective multicenter cohort study of women with a PEIC. Functional cervical length and the cerclage height (distance from cerclage to the external cervical os) were obtained. Our cohort was grouped into thirds, based on cerclage height percentile. Our primary outcome was spontaneous preterm birth (SPTB) less than 34 weeks.

RESULTS:

113 women had PEIC and TVCL measurement after cerclage. There were 34 women with cerclage high 0-14mm, 42 women with cerclage high 15-18mm and 37 women with cerclage high 19-28mm. There were no differences in the incidence of SPTB < 34 weeks (44.1% vs 42.9% vs 40.5% respectively) (p=0.9). There were no differences at other gestational ages: SPTB < 24, <28, <32 or <37 weeks. The interval from cerclage to delivery was not significantly different: 11.5±6.8 vs 11.1 ±6.4 vs 13.4±6.8 weeks (p=0.2). It remained none significantly different after controlling for cervical dilation or degree of membrane prolapse into the endocervical canal.

CONCLUSION:

Longer cerclage height in women with physical exam indicated cerclage is not associated with a reduction in spontaneous preterm birth.
Quantitative Blood Loss is a More Accurate Measure of Blood Loss Compared to Estimated Blood Loss. [17N]
Authors: Ladella Subhashini , Nguyen Lynsa , O’Byrne Hollee , Cortez Cynthia
Published: April 2018

INTRODUCTION:

Postpartum Hemorrhage (PPH) is the leading cause of maternal deaths worldwide. Visual estimation of blood loss (EBL) can result in underestimation of blood loss, causing delay and failure of early interventions for PPH, thus adversely affecting maternal morbidity and mortality. The California Maternal Quality Care Collaborative (CMQCC) hemorrhage toolkit suggests Quantitative Blood Loss (QBL) is a more accurate measure. The purpose of this study is to determine if QBL is a more accurate measure of blood loss than EBL at Community Regional Medical Center (CRMC) in order to standardize PPH management.

METHODS:

A retrospective cross sectional study was performed at CRMC on postpartum patients from February to June 2016. The variables investigated were pre- and post-delivery hemoglobin, EBL and QBL. The blood loss calculated from the difference between pre- and post-delivery hemoglobin levels was compared to the blood loss given by QBL and EBL.

RESULTS:

A total of 303 cases were reviewed. The mean QBL was 310.57mL and the mean EBL was 255.39mL. The difference was statistically significant (p=0.036). The Pearson correlation coefficient between change in hemoglobin and QBL was 0.28. For EBL, the correlation was 0.25. Both correlation coefficients were statistically significant (p<0.05).

CONCLUSION:

In our study, QBL appears to be a more accurate measure of blood loss than EBL. Additional data from deliveries at CRMC in 2017 are being reviewed given that the process of QBL has continued to improve with better education, compliance and changes in available resources. We hope to find a stronger correlation between QBL and blood loss.
Are Vitamin D Levels Lower in the Breast Milk of Bariatric Surgery Patients? [18N]
Authors: Persad Malini D. , Perseleni Tatyana , Baker David , Pimentel Veronica , Buckley Ayisha , Garretto Diana
Published: April 2018

INTRODUCTION:

To determine if bariatric surgery is associated with lower levels of vitamin D in breast milk.

METHODS:

A prospective cohort study of pregnant women was conducted at a university hospital between June 2014 to July 2015. Included in the study were pregnant women with singleton gestations who had a history of bariatric surgery (gastric bypass group) and pregnant women with no history of malabsorption (controls). Samples collected included maternal postpartum blood, colostrum, transitional milk, and mature milk. Each sample was analyzed for 25-hydroxyvitamin D (25(OH)D) level. Parametric and nonparametric statistics were used to compare groups, with a p value < 0.05 as statistically significant.

RESULTS:

A total of 110 women were included in the study. Women that had undergone bariatric surgery were more likely to be white, Hispanic, and have higher pre-pregnancy and pregnancy BMIs. Vitamin D levels in breast milk decreases with increasing time from delivery regardless of surgical history (Table 2). Women in the bariatric surgery group had significantly higher 25(OH)D levels in transitional milk but similar levels in colostrum and mature milk when compared to

CONCLUSION:

Vitamin D levels in breast milk decreases with increasing interval from delivery. Interestingly enough, vitamin D levels were higher in transitional milk of women that had undergone bariatric surgery. Neonatal vitamin D supplementation should be considered when transitional and mature milk is utilized as the primary nutritional source regardless of maternal bariatric surgery history.
Term Meconium Stained Amniotic Fluid: Maternal and Neonatal Risks [19N]
Authors: Kim Sun Kwon , Friedman Perry , Madan Ichchha , Haltigin Christopher , Awrow Mirna , Ogunyemi Dotun
Published: April 2018

INTRODUCTION:

To determine the independent associations of meconium stained amniotic fluid

METHODS:

This is a retrospective review of 4085 (12.2%) women at 37-42 weeks with meconium staining compared to 29397 (87.8%) women who delivered at a single hospital system from 1/2013-12/2016. The primary outcome was a composite neonatal adverse outcome comprised of five-minute Apgar score < 4, umbilical arterial pH < 7.0, sepsis, seizures, encephalopathy, and respiratory failure. Secondary outcome was neonatal intensive care unit (NICU) admission. Logistic regression and hierarchical regression analysis were used.

RESULTS:

Prenatal factors which positively independently correlated with meconium staining were African-Americans, nulliparity, BMI and public insurance but negatively associated with male fetal gender and multiple pregnancies. For intrapartum factors, vaginal delivery, epidural analgesia, chorioamnionitis and abnormal fetal heart rate patterns were associated with increased risks while abruption and opioid use were associated with decreased meconium staining. Meconium staining was significantly positively correlated with both neonatal composite adverse outcomes and NICU admission. Hierarchical analysis showed that meconium staining significantly increased albeit by a small percentage the variability accounted for both NICU admission (R2=0.015, R2Adjusted=0.017; p<0.001, β=0.037) and the primary outcome (R2=0.004, R2Adjusted=0.005; p<0.001, β=0.021) when controlled for accelerations, late, variable, and prolonged decelerations, tachycardia, bradycardia and minimal variability.

CONCLUSION:

Amniotic fluid meconium staining during labor indicates a slightly increased neonatal risk beyond what is explained by abnormal fetal heart rate patterns.
Implementing a Universal Perinatal Depression Screening and Treatment Program in a Community Setting [21N]
Authors: Lau Kiger , Pardanani Setul
Published: April 2018

INTRODUCTION:

Depression is one of the most common perinatal conditions, and fewer than half of cases are recognized. ACOG and USPSTF recommend that all pregnant women be screened during perinatal care. This is a quality improvement approach to implementing a universal perinatal depression screening and treatment program at Stamford Hospital, as well as a validity test of Patient Health Questionnaire-2 and -9 (PHQ2/9).

METHODS:

A didactic session on perinatal depression was held for OB/GYN and Family Medicine providers. In the following year, a retrospective chart review compared screening rates and management outcomes using the PHQ-2/9 and the Edinburgh Postnatal Depression Screen (EPDS).

RESULTS:

294 of 295 patients seen for a postpartum visit were screened using one or more tools. In this study, the PHQ2/9 had a sensitivity of 33% and specificity of 100%; those for the EPDS were 63% and 90%, respectively. Of the patients with a positive screen, 76% were referred to and seen by a Behavioral Health specialist. The overall prevalence of postpartum depression was 4%; 2 patients were prescribed antidepressant medications.

CONCLUSION:

This study established baseline postpartum depression screening rates, prevalence and treatment trends at Stamford Optimus Clinic. The condition is under-detected and poorly documented in this population; however, there was a high referral rate to behavioral health specialists after positive screens. The PHQ-2/9 was not as effective as the validated EPDS for depression screening. Future initiatives will utilize this data to create protocols to expand screening, standardize diagnoses, and improve management of perinatal depression.
English- and Spanish Speaking Males are Similarly Uninformed about Pregnancy Health Risks [22N]
Authors: Schiller Andrew , Mellon Michelle , Nelson Anita L. , Stohl Hindi E.
Published: April 2018

INTRODUCTION:

Male partners of pregnant women may have a significant impact on the decisions a pregnant woman makes regarding her prenatal care. Understanding male partners’ perceptions of reproductive health may help elucidate some of the influences that impact pregnancy decision-making. This study seeks to evaluate the understanding of pregnancy health risks among English- and Spanish-speaking male partners of pregnant women.

METHODS:

Men were individually interviewed in private areas of a prenatal clinic at a public teaching hospital. IRB approval was granted by LABioMed and Western University of Health Sciences. Statistical significance was identified with a Chi Square test when P<.05.

RESULTS:

125 surveys were analyzed. 18% of respondents were Spanish-speaking, while 62% were Hispanic. 26% of men couldn't name one pregnancy-related health risk in an open-ended question; language preference did not significantly impact risk naming (P=.313). 42% of men knew that the risk for blood clot increases during pregnancy when presented with a list of health problems; no significant impact of language preference was observed (P=.413). 82% of men considered the birth control pill as more hazardous to a woman’s health than pregnancy; no significant impact of language preference was observed on this perception (P=.890).

CONCLUSION:

Men are largely unaware of the health risks of pregnancy regardless of English or Spanish language preference. Educating men about those risks may help both them and their partners make informed decisions before and during pregnancy, potentially increasing the chance of their compliance with healthcare provider recommendations for contraception or pregnancy.
Poor Understanding of Pregnancy-Associated Health Risks Among Indigent Pregnant Women [23N]
Authors: Mellon Michelle , Schiller Andrew , Nelson Anita L. , Stohl Hindi E. , Dong Fanglong
Published: April 2018

INTRODUCTION:

Health risks associated with pregnancy may be poorly understood by pregnant women, placing them at risk of developing these complications, delaying diagnosis, or making poorly-informed decisions. This study evaluates the health literacy among pregnant women to highlight potential gaps that exist in maternal health knowledge.

METHODS:

This study was conducted in the prenatal clinic at a public teaching hospital. Women were individually interviewed, one-on-one, in private areas in the clinic. IRB approval was granted by LABioMed and Western University of Health Sciences. Statistical significance was identified with a Chi Square test when P<0.05.

RESULTS:

Altogether 184 surveys were collected. Five percent of women who were asked about specific pregnancy-related health risks were able to identify all seven correctly from a multiple-choice list; 30.6% correctly answered that the risks of blood clots, diabetes, and high blood pressure increased in pregnancy. These findings were associated with higher education (P=.0171), but independent of age (P=.6588), previous pregnancy (P=.7599), and gestational age (P=.5771). When asked if pregnancy or birth control pills are more hazardous to a woman’s health, 75% of participants noted the latter regardless of age (P=.5689), previous pregnancy (P=.4439), gestational age (P=.8469), and education (P=.994).

CONCLUSION:

Our study highlights that a large percentage of pregnant women are unaware of the health risks associated with pregnancy. As pregnancy has a large impact on a mother’s health, it is crucial to understand where educational gaps exist so they may be appropriately addressed by clinicians.
Patient Perceptions of Clinical Research in Pregnancy [30N]
Authors: Clapp Mark , Mesina Omar , Goldfarb Ilona
Published: April 2018

INTRODUCTION:

In 2017, the Federal Policy for the Protection of Human Subjects removed pregnant women as a “vulnerable” population and the associated restrictions on research. Little is known about the women's attitudes toward research in pregnancy. Our goal was to understand the types of trials in which pregnant women would enroll and to identify barriers to participation.

METHODS:

An anonymous survey was distributed by non-clinical staff on the postpartum units to women who delivered a viable, liveborn fetus from June to September 2017. The survey was designed, tested, and distributed at a single academic center with IRB approval.

RESULTS:

100 of the 265 distributed surveys were returned (38%). Of participants, 34% had previously participated in research, and 43% would consider participating in pregnancy. Women were unlikely to participate in trials with medications with no data in pregnancy (80%), experimental vaccinations (68%), trials with a placebo (45%), or research with unknown effects on breastfeeding (79%). Women were willing to participate in studies with more ultrasounds (51%) and additional blood work (60%) prenatally. Women were more accepting of trials involving infection prevention (55%) and pain control (60%) in labor. The effects of demographic variables were assessed on a woman’s likelihood of participation in pregnancy using a univariate logistic regression; race, education, physician visits in the prior year, and employment type were statistically significant (p<0.05).

CONCLUSION:

Even in a population familiar with clinical trials, significant barriers exist to acceptance of participation during pregnancy. This data can help guide project design and strategies to increase enrollment in clinical trials.
Concordance of Self-Reported Weight and Initial Prenatal Weight in an Obese Pregnant Population [31N]
Authors: Ratan Bani M. , Sellner Allison A. , Hollier Lisa M.
Published: April 2018

INTRODUCTION:

The 2009 Institute of Medicine guidelines recommend 11-20 pounds of weight gain during pregnancy for women with BMI ≥30, with 1.1-4.4 of this in the first trimester. However, many women are unaware of this and do not monitor their weight prior to initiating prenatal care. This study compares self-reported pre-pregnancy weight versus first prenatal visit weight in an obese, low-income population.

METHODS:

A retrospective cohort of 1,440 women receiving care at a large Medicaid clinic from 2013-2016 with BMI ≥30 was reviewed. Women who initiated prenatal care before 14 weeks gestation were included. Self-reported pre-pregnancy weight was compared with weight at first prenatal visit using paired t-test. Demographic data was compared using unpaired t-test and ANOVA.

RESULTS:

Inclusion criteria was met by 842 women, with mean gestational age of 9.2 weeks. Pre-gravid weight varied significantly from initial prenatal care weight, with mean absolute difference of 5.4 pounds (P<.001). 30.7% of patients had an increase in weight of greater than 5 pounds. There was no statistical significance between weight difference in planned versus unplanned pregnancies (P=.50). Patients with BMI>40 had a smaller difference between reported and first visit weights than those with BMI 30-34.9 (mean 0.64 vs 2.83 pounds, P<0.01).

CONCLUSION:

In an obese, low-income population, self-reported and initial first-trimester visit weight can differ significantly. It is unclear if this is due to poor recall of pre-pregnancy weight or early weight gain. More awareness of pre-pregnancy weight and the guidelines regarding weight gain are needed prior to the initiation of prenatal care.
Prenatal Magnesium Sulfate and Time to First Stool in Late Preterm Infants [32N]
Authors: Jones Cresta W. , Petrashek Kara , Wenzlaff Miranda , Simpson Pippa , Pan Amy Y.
Published: April 2018

INTRODUCTION:

Reports suggest an increase in bowel obstruction or delayed transit time in preterm infants exposed to magnesium sulfate prior to delivery, but there are limited data in a later preterm cohort. Delayed stooling may be the first sign of more severe bowel dysfunction. Our goal was to examine the effect of magnesium sulfate on time to first stool in infants 32 weeks 0 days and 33 weeks 6 days gestational age.

METHODS:

A retrospective chart review of infants delivered between 32 weeks 0 days and 33 weeks 6 days gestational age at an academic medical center were examined from August 2012 to December 2014. Time to first stool and exposure to magnesium were studied in 120 infants who met study criteria. Indication for magnesium treatment was identified. Neonatal records were reviewed for evidence of adverse bowel events.

RESULTS:

No difference in time to first stool was identified comparing infants not receiving magnesium (time to first stool 0.72 days) with infants receiving magnesium for preeclampsia (0.72 days) and for tocolysis (0.77 days), P = 0.93. Time to first stool was inversely proportional to gestational age (p=0.008). No adverse bowel events were identified in either group.

CONCLUSION:

In infants born at 32w0d - 33w6d, there does not appear to be an increase in time to first stool with exposure to prenatal magnesium sulfate. Therefore, magnesium can be considered as an option for tocolysis, as well as utilized for treatment of preeclampsia with severe features, without delaying bowel transit time in this cohort.
Does Vitamin D Prophylaxis in Pregnancy Decrease the Risk of Adverse Neonatal Outcomes? [33N]
Authors: Persad Malini D. , Ly Victoria , Herrera Kimberly , Demishev Michael , Quirk J. Gerald , Garretto Diana
Published: April 2018

INTRODUCTION:

Maternal vitamin D deficiency has been associated with adverse neonatal outcomes including preterm birth, immunosuppression, infection, low birth weight, neonatal seizures, asthma and fractures. We set out to determine if antepartum vitamin D prophylaxis decreases the risk of adverse neonatal outcomes.

METHODS:

A prospective cohort study was performed at a university hospital between October 2016 to July 2017. Included in the study were women with a confirmed intrauterine pregnancy, between 12-16 weeks gestation. Excluded from the study were women taking vitamin D supplements prior to enrollment, diagnosed with a malabsorption disorder, or carrying a fetus with a known anomaly. Women were assigned to receive vitamin D 3000IU daily or no supplement in addition to prenatal vitamins. Participants were routinely assessed for medication compliance. Neonatal factors were collected and compared between those who were compliant and those who were not. Adverse neonatal events were defined as preterm birth, Apgar score < 5 and 7 at 1 and 5 minutes respectively, NICU admission, or fetal death. Parametric and nonparametric statistics were used to compare groups.

RESULTS:

72 women were included in the study. There was no statistically significant difference in demographic characteristics between groups. Women receiving vitamin D delivered at a statistically significant greater gestational age, with no deliveries occurring prior to 34 weeks gestation. There was no difference in adverse neonatal events.

CONCLUSION:

Vitamin D prophylaxis in pregnancy may decrease the risk of preterm birth.
Behcet’s Disease and Pregnancy: Obstetrical and Neonatal Outcomes in a Cohort of 12 Million Births [34N]
Authors: Lee Seohyuk , Czuzoj-Shulman Nicholas , Spence Andrea , Abenhaim Haim Arie A.
Published: April 2018

INTRODUCTION:

Behcet’s disease (BD) is a rare inflammatory disorder for which limited and contradicting data exists in the context of pregnancy. This study aimed to estimate the prevalence of BD in pregnancy and to evaluate the associated maternal and fetal outcomes.

METHODS:

Using data collected by the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from the United States between 1999 and 2013, we performed a population-based retrospective cohort study consisting of deliveries that occurred during this time period. ICD-9 codes were used to identify deliveries underwent by women with and without BD. We calculated the prevalence of BD in pregnancy and conducted multivariate logistic regression to estimate the adjusted effects of BD on maternal and fetal outcomes.

RESULTS:

We found an overall prevalence of 1.14 cases per 100,000 births between 1999 and 2013, rising from 0.5 to 2.4 per 100,000 births over the 14-year study period. Women with BD demonstrated a more than two-fold greater chance of being admitted to a hospital during pregnancy (p<0.0001), and were more likely to be Caucasian, have private medical insurance, be of the third income quartile, and deliver at an urban teaching hospital. Women with BD were at increased risk for preterm labour (OR5.95, 95%CI1.47-24.12), and venous thromboembolism postpartum (OR15.22, 95%CI7.03-32.92), while their newborns were more likely to be born prematurely (OR1.73, 95%CI1.02-2.93).

CONCLUSION:

BD is associated with a greater risk for adverse maternal and fetal outcomes in pregnancy. Appropriate thromboprophylaxis during pregnancy should be considered given the increased risk for venous thromboembolism.
Preferences of Pregnant Women and Family Members for Maternal-fetal Health States: A Cross-Sectional Study [35N]
Authors: Adesanya Oluwabunmi , Andrejevic Katarina , Wuebbolt Danielle , D'Souza Rohan
Published: April 2018

INTRODUCTION:

Our objective was to determine whether pregnant women and their family members choose differently when making medical decisions in pregnancy.

METHODS:

We conducted a cross-sectional study on pregnant women with chronic medical conditions and their family members involved in medical decision making, seen at Mount Sinai Hospital, Toronto. Participants were presented with seven vignettes related to the maternal and fetal outcomes related to the use of anticoagulants in pregnancy. Preferences values were obtained between 0-100 (zero representing death and 100 representing perfect health), using the visual analogue scale (VAS) and the standard gamble (SG).

RESULTS:

32 pregnant women, 31 family members, and 32 pairs completed the study. The median age for pregnant women and their family members was 32.5 and 35 years respectively. Most were in partnered relationships, Caucasian, of North American descent, educated, employed with combined annual incomes ≥100 000 Canadian Dollars and risk-averse. While preference values obtained from combined interviews by VAS showed no distinct pattern, those obtained by the SG were closer to those of the family member. . The health-state with the highest preference value was “mother ok, minor fetal malformation” while the lowest involved maternal blood clot with either a major fetal malformation or fetal loss.

CONCLUSION:

Preference values for maternal-fetal health-states obtained through shared interviews with pregnant women and their family members are closer to those of the family member than the pregnant woman. Reasons for these differences are being explored as part of a qualitative study.
Adverse Perinatal Outcomes in Mexican Women with Mild Gestational Diabetes Diagnosed by The IADSPG Criteria [39N]
Authors: Cerecedo-Ponce Carmen , Reyes Múñoz Enrique , Martínez Cruz Nayeli , Soriano Ortega Karla , Arce Sánchez Lidia , Ortega González Carlos
Published: April 2018

INTRODUCTION:

Few studies had evaluated the risk of adverse perinatal outcomes among Mexican women with mild gestational diabetes mellitus (GDM) diagnosed by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. The objective of this study is to evaluate the risk of adverse perinatal outcomes (APO) among Mexican women without treatment for mild GDM diagnosed by the IADPSG criteria

METHODS:

Historical cohort study. All participants had universal screening for GDM with a 75g 2h oral glucose tolerance test (OGTT). Group 1:Untreated mild GDM women with one abnormal glucose value during OGTT (fasting 92 and 94 mg/dL,1h <180 or 2h 153 and 154mg/dl) Group 2: Women with normal OGTT (fasting <92 mg/dL, 1h <180 mg/dL and 2h <153 mg/dl) matched by maternal age and pregestational body mass index (BMI). Any type of pregestational diabetes, multiple pregnancy or any other disease were excluded from this research

RESULTS:

We included 282 women per group. The glucose values during OGTT were significantly higher in group 1 in comparison to group 2, (P=0.0001). There were no differences between group 1 and 2, in the incidence of adverse perinatal outcomes as newborn large for gestational age (LGA), preeclampsia, cesarean, preterm birth and premature rupture of membranes. A sub-analysis showed that pregestational BMI >30 kg/m2 was related to higher incidence of LGA

CONCLUSION:

The risk of APO is similar among the Mexican women with mild GDM diagnosed by the IADSPG criteria to those non diabetic pregnant women
Teaching Medical Students About Abortion Through Problem-Based Learning [1O]
Authors: Pomerantz Tali , Patel Pradip , Miller Karen , Ziegler Craig , Hoffmann Jennifer , Bergin Ashlee
Published: April 2018

INTRODUCTION:

Medical students have limited exposure to women’s reproductive health topics in their first two years of training. A problem-based learning (PBL) module was developed to introduce abortion to second year medical students at the University of Louisville School of Medicine. The study’s purpose was to evaluate students’ knowledge and perceptions of abortion before and after the module.

METHODS:

In February 2017, 159 medical students were divided into 16 small groups and received a case with a woman seeking abortion after diagnosis of Zika infection. Students discussed the case and developed learning objectives in the first session. Groups reconvened after one week to re-evaluate the case. One hundred twenty-seven students completed pre- and post-PBL surveys and 16 facilitators completed post-PBL surveys. Quantitative data were analyzed using SPSS Version 22.0, and qualitative data using Pandit’s version of Glaser and Strauss Grounded Theory.

RESULTS:

Students reported significantly increased knowledge about abortion after the PBL (58% felt informed or very informed after, 30% before. p<0.001). Paradoxically, students’ quiz scores decreased, with mean score dropping from 7.83 to 6.58 (p<0.001). Prevalent themes included professional obligation, patient autonomy, and moral/ethical objections to abortion.

CONCLUSION:

Students appreciated the opportunity to discuss abortion and evaluate the ethical and professional considerations surrounding abortion provision. However, comparison of pre- and post-PBL quiz scores suggest that some foundational content, such as procedural details and gestational limits, were not effectively taught in the PBL setting. Future studies are needed to determine whether didactic education, in addition to PBL, can effectively provide comprehensive abortion education.
Inability to Predict Successful Promotion within 9 Years of Appointment [2O]
Authors: Mastrobattista Joan , Ashton David , Aagaard Kjersti , Monga Manju
Published: April 2018

INTRODUCTION:

Our objective was to determine factors that correlate with successful promotion from Assistant Professor to Associate Professor within 9 years of appointment.

METHODS:

Faculty demographic characteristics were abstracted from the de-identified faculty database of a large academic obstetrics and gynecology department and correlated with successful promotion from Assistant to Associate Professor within nine years of initial appointment. Fisher exact and t-test were used where appropriate, p<0.05 was considered significant.

RESULTS:

Information about 107 full-time clinical faculty was obtained. 79 faculty had initial appointment as Assistant Professor less than nine years ago and were excluded; data from 28 faculty was used for analysis. 21 were promoted within 9 years. Sex, age at initial appointment, sub-specialization, graduation from a US medical school, graduation from an academic residency, advanced degree prior to appointment, number of publications or funding prior to appointment, administrative or committee work or institution change as an Assistant Professor were not associated with likelihood of promotion within 9 years.

CONCLUSION:

Factors traditionally thought to be associated with timely promotion from Assistant to Associate Professor are not predictive of success in the 21st century.
Performance on the Obstetrics and Gynecology In-Training Examination After Implementation of a New Curriculum [7O]
Authors: Madison Shannon , Lo Nancy , Maxwell Rose , Galloway Michael , Massengill Jason
Published: April 2018

INTRODUCTION:

The objective of this study is to determine the impact of a new academic curriculum on the Council on Resident Education in Obstetrics and Gynecology In-Training Examination (CREOG-ITE) scores in an American College of Graduate Medical Education (ACGME) accredited obstetrics and gynecology (OB/GYN) residency program.

METHODS:

This is a retrospective cohort analyzing the results of our scholastic preparation program. After scores from the January 2015 CREOG-ITE were released, all residents with a score one standard deviation below the mean, or <180, were placed into the experimental group and met with the same attending every month to discuss key learning objectives. They were compared to the control group of residents with a score >180 who had no additional formal education. Each resident served as her own matched paired internal control.

RESULTS:

Out of 18 possible residents, five were placed into the scholastic preparation program based on CREOG-ITE score <180; two were PGY1 (post-graduate year), two were PGY2 and one was PGY3. The mean improvement in CREOG-ITE score from 2015 to 2016 for the experimental group was 23.2 points (95% CI 12.4-40.5 with P<.001).

CONCLUSION:

The scholastic preparation program was associated with a substantial and statistically significant improvement in CREOG-ITE scores, even when accounting for PGY level. This demonstrates that improvement was not simply a by-product of inherent academic knowledge of a resident further along in training. Accountability to faculty members also played a large role in the program's success. This scholastic preparation program may serve as a model for improving OB/GYN resident education.
A Quality Improvement Project: Resident Engagement with the Medication Reconciliation Process [8O]
Authors: Clifford Caitlin , Bond Brian , Peterson Ashley
Published: April 2018

INTRODUCTION:

Adverse drug events are injuries resulting from medication use and are associated with increased morbidity and mortality and higher costs. More than 40% of medication errors are believed to result from inadequate medication reconciliation (MR) during admissions and discharges. Historically, MR completion on patient admission to L&D at our institution is estimated to be 50%. Our aim was to evaluate Ob/Gyn resident understanding and compliance with the MR process prior to and following a resident didactics session.

METHODS:

During a didactics session, residents took a multiple choice quiz to evaluate their understanding of MR and then listened to a presentation detailing the process and its significance. MR completion rates for all resident admissions to L&D during the 14 days prior to and the 40 days following the session were calculated. Residents were then emailed individualized report cards detailing their progress. Finally, completion rates for the 26 days following the personalized feedback were calculated.

RESULTS:

Prior to the session, only 41% of residents could correctly identify an adverse drug event and their frequency of occurrence (85% response rate). Prior to the session, 64% of MRs were completed while 99% were completed in the following 40 days (p=0.02). Following personalized feedback, 100% of MRs were completed (p=0.01).

CONCLUSION:

Significant improvements in resident participation in quality measures can be achieved with focused peer interventions. Given that the Institute of Medicine estimates that the average hospitalized patient is subject to one medication error a day, such improvements in MR are likely to substantially improve patient care.
A Hands-On Approach to Hysteroscopy Training [16O]
Authors: Galhotra Sheena , Hammer Karissa , Tam Teresa , Fogg Louis
Published: April 2018

INTRODUCTION:

Simulation training is an invaluable tool in learning, especially for surgical techniques. There is little research on hands-on hysteroscopic instruction and its effect on resident education. Our objective is to investigate a standardized curriculum for hysteroscopy to improve resident assembly times and familiarity with instrumentation.

METHODS:

A standardized hysteroscopy course was created per ACOG guidelines entailing a lecture and interactive session on hysteroscopy assembly and use. Knowledge improvement was measured by written test scores. Instrumentation proficiency was measured in assembly times and ability to identify parts of the hysteroscope detailed on a checklist. Pre and post lecture tests scores were compared. Three Chicago residency programs were included in the study from 2013 to 2017.

RESULTS:

Data points were assessed using a repeated measures analysis of variance. A statistically significant difference of 15.18% (N=42, p< 0.001) improvement between pre and post test scores was seen. This increase did not depend on PGY level (p= 0.188) but only exposure to curriculum. Assembly time decreased by 1.15 minutes (N= 38, p= 0.004). Checklist completion increased by 17.22% (N=38).

CONCLUSION:

The standardized curriculum made significant improvement in resident knowledge of hysteroscopy and familiarity with instrumentation. This was demonstrated by improved written test scores, assembly times and checklist completion in all years of training. The impact of such a hands-on learning course can be applied more widely to other residency programs to improve education in hysteroscopy.
First Trimester Fasting Plasma Glucose Screen in Advanced Maternal Age to Detect Pre-existing Glucose Intolerance [22O]
Authors: Waites Bethany T. , Walker Allison R. , Skeith Ashley E. , Caughey Aaron B.
Published: April 2018

INTRODUCTION:

Women of advanced maternal age (AMA) are at increased risk of diabetes in pregnancy. Screening for impaired fasting glucose in the first trimester can result in earlier diagnosis and treatment of pre-existing glucose intolerance. Our study examined the cost-effectiveness of first trimester fasting plasma glucose (FPG) screening in AMA women.

METHODS:

A decision analysis model was created using TreeAge2017 software to compare pregnancy outcomes between AMA women who undergo a first trimester FPG screen versus those who undergo second trimester screening alone. Outcomes examined included intrauterine fetal demise, preeclampsia, preterm delivery, neonatal death, cerebral palsy, cost, and quality adjusted life years (QALYs) of the mother and neonate. Probabilities, utilities, and costs were derived from the literature, and a cost-effectiveness threshold was set at $100,000/QALY. Univariate analyses were used to investigate the impact of screening positivity.

RESULTS:

In a theoretical cohort of 10,000 AMA women, first trimester FPG screening was cost-saving, more effective and more cost-effective than traditional second trimester screening alone, with a cost-effectiveness ratio of $59.96 per QALY. Earlier detection resulted in lower incidence of preeclampsia and fewer preterm deliveries, intrauterine fetal demises, and neonatal deaths. Using a threshold of $100,000 per QALY, sensitivity analysis revealed that early screening was effective even when the cost of screening is increased 300-fold or the incremental cost of initiating diabetes treatment in the first trimester is increased 200-fold.

CONCLUSION:

First trimester FPG screening in advanced maternal age is cost-effective and allows for earlier diagnosis, treatment, and improved neonatal outcomes compared to second trimester screening alone.
Expired Group-B Streptococcus Cultures Among Women Delivering at or After 40 Weeks Gestation [26O]
Authors: Miller Amanda , Brustman Lois , Waldron Carolyn
Published: April 2018

INTRODUCTION:

At term, 10 to 30% of pregnant women have vaginal or rectal colonization with Group-B Streptococcus (GBS). Fetal infection at delivery is associated with significant neurologic morbidity and mortality. The Centers for Disease Control recommends GBS collection between 35 and 37 weeks gestation; if taken within 5 weeks of delivery, GBS status at delivery has a positive predictive value (PPV) of 87 to 100%. However, PPV falls to 43% if the culture is taken 6 weeks or more before delivery. We hypothesize approximately one third of patients at our institution delivering past their estimated due date have expired GBS cultures, defined as greater than 35 days old.

METHODS:

A retrospective chart review from July 2015 to July 2016 included all women who delivered at or after 40 weeks gestation. Demographics, delivery information, GBS status, interval between culture and delivery, and neonatal data were collected. Patients were divided by week of gestational age at delivery, and rates of expired cultures compared by chi-square.

RESULTS:

1,393 patients were included; they delivered between 40 and 42 weeks gestation at Mount Sinai West. 660 (47%) had expired cultures at delivery. Of those delivering during week 40, 328/971 (34%) had expired cultures; during week 41, 296/385 (77%) had expired cultures; this difference in expiration rates was significant (P<.0001). Expiration rate was also significantly greater in week 42 than in week 41. No neonatal GBS infections occurred.

CONCLUSION:

Cultures should be repeated after 35 days, or initially collected at 37 weeks, to improve reliability.