bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic Testing Uptake After High-Risk cffDNA Results for Sex Chromosome Aneuploidy [11B]
Authors: Suhag Anju , Robbins-Furman Patricia , Monga Manju , Hollier Lisa , Ramin Susan , Van den Veyver Ignatia B.
Published: May 2017

INTRODUCTION:

The phenotype of sex chromosome aneuploidy (SCA) is typically mild, except in fetuses with cystic hygroma/hydrops. We hypothesize that because the phenotype of SCA is variable, the uptake of diagnostic testing after positive cffDNA screening varies between different SCA. Our study aim was to describe the uptake of diagnostic testing after a positive cffDNA screen for SCA.

METHODS:

A retrospective study of singleton gestations and abnormal cffDNA results for 45,X, 47,XXY or other SCA from 10/2012 to 3/2016. Any unreportable and other positive cffDNA results were excluded. Based on cffDNA results, 3 cohorts were defined: high-risk for 45,X, 47,XXY or other SCA. Diagnostic testing was offered to all study subjects. Primary outcome was uptake rate of diagnostic testing by abnormal cffDNA SCA results in 3 groups. P-value of < .05 was considered significant.

RESULTS:

109 women met inclusion criteria. Demographics were similar in the 3 groups. The overall uptake of diagnostic testing after abnormal cffDNA for SCA was 22.9%. It was higher in 45,X cohort (36.7%) compared to 47,XXY (14.3%); none of the patients in “other SCA” cohort accepted diagnostic testing (P=.0004). The false positive and confirmation rate of suspected chromosomal abnormality was similar in 45,X and 47,XXY group (P=.68).

CONCLUSION:

Only 23% of women with positive cffDNA for SCA proceed with diagnostic testing. Of all SCA, the uptake is noted to be highest for 45,X. The increased uptake in 45,X may be due to a higher likelihood of abnormal ultrasound findings such as cystic hygroma. Further analysis of this observation is indicated.
Use of Gestational Surrogates for Women With Marfan Syndrome: A Cost-effectiveness Analysis [16B]
Authors: Clennon Emily , Caughey Aaron B. , Teton Zoe , Shaffer Brian , Amato Paula
Published: May 2017

INTRODUCTION:

The potential for morbidity in Marfan Syndrome (MS) increases substantially with pregnancy. Though reproductive decision-making among Marfan patients has been described, costs and effectiveness of their reproductive options have not. This study compares costs and outcomes of pregnancy carried by women with MS to pregnancy carried by gestational surrogates.

METHODS:

A decision-analytic model was built using TreeAge software that compared use of surrogates and pregnancy in women with MS. Outcomes assessed included maternal cardiovascular complication (CVC), intrauterine fetal demise (IUFD), preterm birth, small size for gestational age, and neonatal death. Probabilities and costs were derived from the literature. Utilities were discounted by 3% across the lifespan to generate quality-adjusted life years (QALYs). Univariate and multivariate sensitivity analyses were performed to evaluate robustness of the model.

RESULTS:

In a theoretical cohort of 10,000 women with MS, pregnancy would result in 590 maternal CVCs, 22 IUFDs, 1681 preterm births, and 171 neonatal deaths. Use of surrogates would prevent 92% of maternal CVCs, 94% of neonatal deaths, and all but one stillbirth. Cases of preterm birth are also significantly reduced. Surrogate use would save $786,389 per woman and gain 0.11 QALYs. Cost effectiveness is maintained with high surrogacy cost and low success rate.

CONCLUSION:

Surrogate use for women with MS is cost effective and significantly improves obstetric outcomes. Benefits are robust in the face of high surrogacy costs due to reduction in maternal CVC and preterm birth. These findings should be used to underscore the importance of broadening health care financing for medically-indicated assisted reproduction.
Depression and Social Support During Antepartum Hospitalization: A Needs Assessment [19B]
Authors: Young Danielle , Preyss Melissa , Sipsma Heather , Hair Stephanie , Siddiqui Maryam
Published: May 2017

INTRODUCTION:

Antenatal hospitalization occurs in nearly one million women every year. The overall prevalence of perinatal depression is near 20% and is undefined in this population. We aimed to define rates of depression and social support in a historically understudied, primarily low-income, African-American population.

METHODS:

Fifty women who were hospitalized for at least 48 hours during pregnancy for maternal or fetal indications were screened with the Edinburgh Postnatal Depression Scale (EPDS) and Personal Resource Questionnaire (PRQ). An EPDS score of 10 or higher was considered a positive screen.

RESULTS:

Twelve (24%) participants had an EPDS score of 10 or greater; three (6%) scores were higher than 20. Average PRQ score was 146.5 (±25.97). Approximately 30% of participants disagreed that they belonged to a group to which they felt important, and 16% neither agreed nor disagreed on this item. 30% reported that they could not count on relatives or friends for help, and 66% were indifferent (somewhat agreed, were neutral, or somewhat disagreed) that others have similar problems. Parents (81.63%) were overwhelmingly selected as support for an urgent needs crisis, followed by significant other/spouse/partner (67.35%) and other relative (59.18%).

CONCLUSION:

One in four women who were hospitalized during pregnancy struggled with depressive symptoms. Some women may have difficulty identifying adequate social support, although many reported adequate support networks. Despite the frequency of antenatal hospitalization, nearly two thirds of women were unsure if others had similar problems. More research is needed to identify ways to support pregnant patients and decrease isolation during hospitalization.
Are There Predictable Blood Pressure Patterns After Delivery in Women With Preeclampsia? [20B]
Authors: Hirshberg Adi , Sammel Mary , Srinivas Sindhu K.
Published: May 2017

INTRODUCTION:

There is limited data on blood pressure(BP) patterns after delivery among women diagnosed with preeclampsia. We sought to investigate immediate postpartum BP trajectories and the impact of fluid balance on these patterns.

METHODS:

Prospective cohort of women with preeclampsia from 2005-2009. Group-based trajectories were created using latent-class models based on all individual BPs from delivery to 48 hours postpartum. Fluid balance was defined as input minus output from admission until 24 hours postpartum. Odd ratios were calculated for association between BP group, fluid balance, mode of delivery, length of labor, and disease severity.

RESULTS:

96 women were evaluated. A model identifying four distinct patterns best fit the BP trajectories (class 1 (n=28):initial decrease in BP followed by rise at discharge, class 2(n=11):persistently elevated BPs, class 3(n=25):rising BPs until discharge, class 4(n=32):normal BP control). There was a statistically significant association between maternal age (p=0.0004) and initial weight(p=0.0005), parity(p=0.02), history of hypertension(p=0.035) or preeclampsia(0.024), and gestational age at delivery(p=0.018) with BP group. Women with a fluid balance greater than 500 cc and cesarean delivery after more than 12 hours of labor were more likely to be in group 3 vs 4(OR 3.97, p=0.03; OR 8.4, p=0.001). Severity of disease(p=0.36) was not associated with BP group.

CONCLUSION:

There are distinct patterns of BP immediately postpartum. Persistent hypertension is associated with age, chronic hypertension, fluid balance, length of labor, and mode of delivery. Future investigations should evaluate whether diuresis, as a modifiable factor, can alter patterns of BP and expedite resolution of hypertension in the postpartum period.
Delivery With a Palliative Care Plan: Incidence of Complications at Early Versus Late Gestations [21B]
Authors: Krueger Sarah , Peterson Erika , Piquette Theresa , Saripalli Asheema , Amos Angela
Published: May 2017

INTRODUCTION:

The purpose of this study is to compare the incidence of delivery complications in pregnancies with neonatal palliative care plans at early versus late gestational ages.

METHODS:

A retrospective cohort study was performed at a single center from 2008 to 2015. Patients with lethal fetal diagnoses between 24 and 42 weeks gestational age and a neonatal palliative care plan were identified. Two cohorts were compared based on gestational age: 24-32 weeks, and 32-42 weeks. The primary outcome was identified as the composite outcome of retained placenta, operative intervention, blood transfusion and maternal fever. Other maternal variables collected included: maternal age, weight, gravidity, parity, and the method of delivery. Continuous variables were compared using non-parametric Mann Whitney exact test; categorical variables were compared with a Fisher exact test or chi square.

RESULTS:

Sixty-seven patients with lethal fetal diagnoses delivered with a palliative care plan between 24 and 42 weeks gestational age, 44 patients from 24 to 31 6/7 weeks and 23 patients from 32 to 42 weeks. There were 6 complications in early gestations (13.6%) and 2 in later gestations (9.6%), (P=.705). There was no significant difference in maternal demographics between the groups. There was a significant decrease in complications with increasing gravidity (P=0.01) and parity (P =.001) and an increase in complications with increasing maternal age (P=.091).

CONCLUSION:

More complications occurred in the earlier gestational age group, though this did not reach statistical significance. Complications occurred less often with increasing gravidity and more often with increasing maternal age.
Immediate Postpartum Intrauterine Device Insertion, Implant Insertion and Sterilization, U.S., 2008-2013 [33B]
Authors: Moniz Michelle , Chang Tammy , Heisler Michele , Admon Lindsay , Davis Matthew , Dalton Vanessa
Published: May 2017

INTRODUCTION:

Our objective was to measure trends in immediate postpartum intrauterine device (IUD) insertion, contraceptive implant insertion, and tubal sterilization.

METHODS:

Among all delivery hospitalizations in the 2008-2013 National Inpatient Sample, we identified those with codes for tubal sterilization, IUD insertion, or contraceptive implant insertion. We used multivariate and multinomial logistic regression to examine associations between these outcomes and maternal and hospital characteristics over time.

RESULTS:

While the rate of sterilization remained similar over time, the rate of IUD/implant insertion increased over the study period (1.86 per 10,000 deliveries in 2008-09; 13.5 per 10,000 deliveries in 2012-13). Compared with receiving neither IUD/implant nor sterilization and adjusting for year and sociodemographic factors, IUD/implant insertion was more likely among women with medical comorbidity (adjusted odds ratio [aOR]=1.92; 95% confidence interval 1.72-2.13), with non-private insurance (aOR=5.23; 3.82-7.15), and delivering at teaching hospitals (aOR=19.8; 9.41-41.5). Sterilization was more likely among women with medical comorbidity (aOR=1.17; 1.14-1.20) and non-private insurance (aOR=2.20; 2.10-2.30), and less likely among women receiving care at urban versus rural facilities (aOR=0.59, 0.55-0.63). Comparing only women receiving IUD/implant insertion or sterilization, IUD/implant insertion was more likely among women with non-private insurance (aOR=1.9; 1.38-2.63), delivering at urban (aOR=2.18; 1.01-4.70) or teaching (aOR=17.6; 8.50-36.5) hospitals, and delivering later in the study period (aOR=4.51 in 2010-11; aOR=8.26 in 2012-13, compared to 2008-09).

CONCLUSION:

During delivery hospitalizations in the US from 2008-2013, the IUD/implant insertion rate increased by an order of magnitude. Immediate postpartum IUD/implant insertion is associated with medical comorbidities, non-private insurance status, and urban/teaching hospital status.
Immediate Versus Standard Postpartum Screening for Diabetes [35B]
Authors: Hsieh Frances , Blitz Matthew , Akerman Meredith , Simmonds Lisa , Rabin Jill , Meirowitz Natalie
Published: May 2017

INTRODUCTION:

Current guidelines recommend women with gestational diabetes undergo diabetes screening 6-12 weeks postpartum, however the compliance rate is only about 50%. Failure to return for care is a major barrier to postpartum screening. We sought to determine whether immediate postpartum screening is as reliable as standard postpartum screening at 6-12 weeks postpartum.

METHODS:

This was a prospective cohort study with women with singleton gestations and gestational diabetes (A1 or A2). Patients underwent a 2-hour 75-g oral glucose tolerance test (OGTT) on postpartum day 2, and were asked to repeat the OGTT at 6-12 weeks postpartum. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of the immediate postpartum OGTT were calculated as compared to the gold standard, the OGTT at 6-12 weeks postpartum. Results were considered abnormal if either the fasting blood glucose (BG) value was greater than 100mg/dL or the 2-hour BG value was greater than 140mg/dL.

RESULTS:

141 patients have been enrolled in the study. At this interim analysis, 70 completed the immediate postpartum screening for diabetes, and 53 returned for screening at the standard timeframe. Only the 53 patients with complete data were included in our analysis. The immediate OGTT had a sensitivity of 82.4%, specificity of 47.22%, NPV of 85.0% and PPV of 42.4%.

CONCLUSION:

Screening for diabetes immediately on postpartum day 2 is not a reliable substitute for screening at the current standard timeframe. Continued research with additional patients, and an analysis of clinical characteristics, may determine for which patients immediate screening is useful.
Impact of an Individualized Weight-Tracking Tool on Gestational Weight Gain Knowledge [37B]
Authors: Reid Allison B. , Berggren Erica K.
Published: May 2017

INTRODUCTION:

Only ∼one-third of US women meet Institute of Medicine (IOM) gestational weight gain (GWG) guidelines. Whether women understand these body mass index (BMI)-specific guidelines and whether additional education could improve knowledge is unclear. We hypothesized that an individualized, GWG-tracking tool would improve patient knowledge about GWG guidelines and BMI.

METHODS:

Women with singleton pregnancies at one outpatient clinic were recruited for a clinical trial. Over eight weeks, women 15 0/7-22 6/7 weeks’ with at least one prior prenatal visit were enrolled in the control group. Women 6 0/7-14 6/7 weeks’ were enrolled in the intervention group at their first prenatal visit and received a GWG card from study staff who helped women record preconception weight, BMI, and BMI-specific GWG guidelines. Women were encouraged to record weight at each prenatal care visit. All women completed a GWG knowledge-based questionnaire at 15 0/7-22 6/7 weeks’. Groups were compared using bivariate analyses.

RESULTS:

Among 125 women, 45 (36%) comprised the intervention group. The intervention and control groups were similar in age, race/ethnicity, education, income, parity, and preconception BMI. Compared with control, intervention group women were not more likely to correctly define “BMI” (52% vs. 63%, p=0.5), correctly classify their preconception BMI (48% vs. 51%, p=0.9), recall their BMI-specific GWG guidelines (51% vs. 67%, p=0.1), or think they would meet GWG guidelines (58% vs. 50%, p=0.5).

CONCLUSION:

Our intervention did not improve GWG or BMI knowledge. These data underscore the deficit in fundamental knowledge among pregnant women, which may contribute to the limited success of GWG interventions.
Risk of Cesarean With Obesity and Advancing Maternal Age [5C]
Authors: Petersen Shariska , Khangura Raminder , Fitzgerald Michael , Sousa Denise , Goyert Gregory
Published: May 2017

INTRODUCTION:

The objective of this study is to examine the impact of obesity on cesarean birth rate in an older group of primigravid women.

METHODS:

This retrospective study analyzed data on nulliparous women over 34 years of age who delivered between January 2013 and July 2016 at a single institution. Abstracted data included: BMI, gestational age at delivery, mode of delivery, spontaneous or induced labor, indication for cesarean, and co-morbidities (chronic hypertension, diabetes, preeclampsia, IUGR).

RESULTS:

One hundred thirty one patients were included. Obesity rate was 48% (BMI greater than 30kg/m2) with a mean maternal age of 37.5 years. The overall C/S rate was 61.8% (81/131). Twenty-seven patients had c/s prior to active labor, 31 were associated with labor induction, and 23 were associated with spontaneous labor. Obese patients had a 122% increase odds of cesarean birth, compared to those with a BMI at or below 30. For every one unit increase in BMI, there was a 7% increase in the odds of cesarean birth. Obese African American patients had a 141% increase odds of cesarean birth when compared to all other groups. For all groups, the most common indication for cesarean section was non-reassuring fetal status.

CONCLUSION:

This population confirms the association of increasing BMI with higher C/S rates and this is exaggerated in older nulliparous women. The further increase in rate in African American patients may be related to the increased incidence of clinically significant fibroids associated with malpresentation or obstruction and warrants further study to enhance our counseling for these patients.
An Abnormal 1 Hour Glucose Screen and Ultrasound Evidence of Hyperglycemia Should Be Managed as Gestational Diabetes [6C]
Authors: Crimmins Sarah , Mo Cecilia , Nassar Yomna , Harman Chris , Turan Ozhan
Published: May 2017

INTRODUCTION:

To investigate the risk of impaired glucose metabolism (IGM) and ultrasound findings consistent with hyperglycemia on maternal and neonatal outcomes.

METHODS:

Retrospective case-control study of singleton, non-anomalous fetuses with IGM and gestational diabetes (GDM). IGM was defined as a one hour GST of greater than 134 but less than 2 abnormal values on 3 hour GTT. Ultrasound evidence of hyperglycemia was defined as abdominal circumference greater than 95th percentile and/or polyhydramnios. Individuals with IGM were divided into those with ultrasound evidence of hyperglycemia (IGM-US) and those without (IGM). Maternal demographics, delivery (gestational age (GA) at delivery, delivery mode, shoulder dystocia, lacerations), postpartum hemorrhage (PPH), and neonatal outcome (birth weight percentile (BW%), NICU admission, hypoglycemia, respiratory complications, glucose, and length of stay) were recorded. Composite morbidity was tabulated. Delivery and neonatal outcome variables were compared in individuals with IGM-US, IGM, and GDM. Odds ratios were calculated and adjusted with maternal age, race and gestational age at delivery.

RESULTS:

A total of 324 individuals with an abnormal 1-hour were included (96 with IGM-US, 108 with IGM, and 120 with GDM). In comparison to the IGM group, IGM-US had higher rates of induction, cesarean delivery, BW% > 90th percentile at delivery, and respiratory complications in the neonate (p less than 0.05 for all). Individuals with IGM-US had significantly larger neonates by birth weight and percentile than individuals with GDM (67.04[3.9-99.9 v 59.9[1.7-99.9](p = 0.001). The remaining outcomes were similar.

CONCLUSION:

Women with IGM and ultrasound markers of hyperglycemia should be identified and managed as a gestational diabetic.
Amniotomy Affects the Urine Protein Creatinine Ratio Accuracy in the Diagnosis of Preeclampsia [9C]
Authors: Quinn Sara , Lennon Jessica , Gonzalez Aaron Herrera , Dierking Elizabeth , Anasti James
Published: May 2017

INTRODUCTION:

Preeclampsia is a leading cause of obstetric related morbidity and mortality, making prompt diagnosis crucial. While the gold standard for evaluation of maternal urinary protein is a 24 hour urine collection, the spot urine protein creatinine ratio (Up/Ucr ratio) greater than 0.3 g/gcr has been instituted as an alternative. No studies have evaluated the effect of amniotomy, spontaneous or artificial, on the accuracy of the Up/Ucr ratio. We hypothesize the proteins and creatinine found in amniotic fluid may erroneously alter the test result leading to an incorrect diagnosis of preeclampsia.

METHODS:

We performed a case-control trial where each patient served as their own control. An initial random catch urine was obtained for Up/Ucr ratio in women with intact membranes. Following amniotomy a second random catch Up/Ucr ratio was obtained. The urine samples were analyzed in the hospital chemistry department and results compared for consistency.

RESULTS:

The 49 study patients had the following characteristics; Age: 28.8 ± 5.8y, Gravid: 2.7 ± 1.5, Gestational age: 39.1 ± 1.8wks, and BMI: 31.2 ± 6.6 kg/m2. Co-morbidities included 3 gestational diabetic, 2 chronic hypertensive and one preeclamptic patient. Post-amniotomy Up/Ucr ratio was significantly higher than Pre-aminotomy (1.1±2.1 vs 0.23 ± 0.15, p=0.001). The prevalence of Up/Ucr greater than 0.3 g/gcr was higher post amniotomy than pre-amniotomy (28 vs 8, p =0.001).

CONCLUSION:

Amniotomy results in false elevation of the Up/Ucr ratio. Obtaining urine via straight catheterization may be necessary to reduce false positive results.
Adverse Pregnancy Outcomes Among Women With Urinary Tract Infections: Comparing Sensitive and Resistant Organisms [27C]
Authors: O'Malley Katharine , Suharwardy Sanaa , Sie Lillian , Lee Henry C. , Gibbs Ronald S. , Aziz Natali
Published: May 2017

INTRODUCTION:

The primary aim of this study was to examine whether uropathogen resistance affects the rate of preterm birth. Second, to examine whether uropathogen resistance affects the rate of perinatal maternal or neonatal infectious morbidity.

METHODS:

Retrospective cohort study of pregnant women who (1) received obstetric care and delivered at Stanford Children’s Hospital/Lucile Packard Children’s Hospital on the university teaching service and (2) had at least one positive urine culture (≥ 100,000 colony-forming units (cfu) per milliliter (mL)) performed through the Microbiology Lab between January 1, 2010 and August 31, 2014. Urine cultures that yielded likely contaminants were excluded from our analysis. We categorized organisms as “sensitive” or “resistant” based on reported antimicrobial resistance. The primary outcome was preterm birth at < 37 weeks of gestation. Secondary outcomes were composite maternal and neonatal infectious morbidities.

RESULTS:

197 women with UTI were eligible for analysis - 68 (34.5%) had pregnancies complicated by “sensitive” uropathogens and 129 (65.5%) had pregnancies complicated by “resistant” uropathogens. In univariate analysis, the rate of preterm birth was not statistically different; 19.1% among women with sensitive uropathogens and 22.5% among women with resistant uropathogens (P=0.58). UTI with a “resistant” uropathogen was not associated with an increased risk of preterm birth in multi-factorial analysis that included risk factors for preterm birth (aOR 1.2, 95% CI 0.58-2.69). We found no statistical difference in composite maternal and neonatal infectious morbidities.

CONCLUSION:

UTI with a “resistant” uropathogen was not associated with an increased risk for preterm birth nor with composite maternal and neonatal infectious morbidities.
Allostatic Load During the Interconception Period in Women Who Had Gestational Diabetes Mellitus [14C]
Authors: Herrman Sarah , Hobel Calvin , Shalowitz Madeleine , Ramey Sharon
Published: May 2017

INTRODUCTION:

Gestational diabetes mellitus (GDM) is a condition disproportionately affecting racial/ethnic minorities, but the reasons for this disparity remain unclear. GDM in one pregnancy also greatly predicts GDM in future pregnancies. Allostatic load (AL) measures cumulative effects of physical and psychological stress on multiple body systems. Directly measuring and monitoring AL presents a novel way of assessing health risk biomarkers in mothers. We aim to determine the relationship between maternal AL and GDM in the interconception period.

METHODS:

Data collection occurred through the 5-site NIH Community Child Health Network. AL was analyzed as an absolute value plus individual indices to determine associations to GDM at both 6 and 12 months postpartum. ANOVAs were performed to assess relationships between AL, stress, and resiliency in women with and without GDM.

RESULTS:

There are significant differences in AL between the GDM (N=61) and non-GDM (N=1421) groups at 6 and 12 months (P < .001), particularly in the African-American group at both time points (P < .001). There was no significant change in AL from 6 to 12 months postpartum for either group. There were no significant differences between the groups for self-reported measures of stress and resiliency. Total chronic life stress is significantly correlated with AL at both times for both groups (P < .01).

CONCLUSION:

Differences in AL between mothers with and without GDM highlights a worse picture of health postpartum for women with GDM, especially African-American women. Women with increased AL and GDM need more rigorous and focused interconception care in order to prevent GDM and improve overall health.
Adverse Neonatal Outcomes Among Women With Hypertensive Disorders of Pregnancy [28C]
Authors: Rincon Monica P. , Kuo Kelly , Sabol Bethany , Burwick Richard
Published: May 2017

INTRODUCTION:

The American College of Obstetricians and Gynecologists (the College) provided new guidance for diagnosis and management of hypertensive disorders of pregnancy. The impact of these changes is unclear; so we sought to compare adverse neonatal outcomes among women with hypertensive disorders of pregnancy.

METHODS:

Retrospective cohort study of singleton deliveries occurring greater than or equal to 23 weeks gestational age from September 2015 to March 2016 in a single institution. Subjects were screened for hypertension in pregnancy utilizing hospital discharge codes, and diagnoses confirmed by individual chart review. Subjects were placed into 4 groups by College criteria: chronic hypertension (CHTN), gestational hypertension (GHTN), preeclampsia (PE) without severe features (SF), and PE with SF.

RESULTS:

In our cohort of 1,399 consecutive deliveries, 193 women (13.8%) with hypertensive disease met inclusion criteria; CHTN (3.1%), GHTN (3.2%), PE without SF (3.6%) and PE with SF (4.1%). Women with CHTN had higher BMI and were less often nulliparous compared to those with GHTN or PE (BMI p < 0.001; nulliparous p=0.001). Subjects with CHTN delivered earlier than those with GHTN or PE without SF (p=0.003). Rates of adverse neonatal outcomes were increased with CHTN compared to GHTN (preterm birth p=0.040; NICU admission p=0.021; RDS p=0.026), but adverse outcomes were similar between CHTN and PE without SF.

CONCLUSION:

We find that women with CHTN have rates of adverse neonatal outcomes similar to women with PE without SF, but higher than GHTN. Our findings reinforce the College’s recommendation to maintain vigilance in pregnancies complicated by CHTN.
Symptoms of Obstructive Sleep Apnea in Pregnancy [17C]
Authors: Angras Kajal , Lott Melisa , Schulkin Jay , Mackeen A. Dhanya
Published: May 2017

INTRODUCTION:

Obstructive sleep apnea (OSA) results in increased maternal and pregnancy morbidity including hypertensive disorders, preterm birth and low birth weight. Questionnaires to screen for OSA have been used in the non-pregnant population. As part of the expanded CARN study, our aim was to evaluate patient sleep patterns and presence of risk factors for sleep apnea in pregnant patients without history of OSA.

METHODS:

Women receiving prenatal care at a tertiary care center were given an anonymous survey. We ascertained age, race, pre-pregnancy body mass index (BMI), gestational diabetes, and sleep patterns.

RESULTS:

From December 2015 to May 2016, one hundred eighty-two women completed an anonymous survey. Of participants who completed the survey, 96.1% were Caucasian with a mean age of 25 and 45% were obese based on pre-pregnancy BMI. When questioned about sleep patterns, 93.4% denied a history of sleep apnea, 2.7% were unsure of a diagnosis of sleep apnea, 1.1% had pre-pregnancy diagnosis of OSA, and 2.8% did not answer. Patients reported the following sleep patterns: snoring (36.1%), being told they snore (44.3%), waking from sleep with a choking sensation (6.2%), witnessed apnea (2.2%), and falling asleep while talking to someone (7.3%).

CONCLUSION:

In our survey, more than one-third of patients had risk factors (obesity) and sleep patterns concerning for OSA. Our study highlights the importance of a need for increased awareness among obstetricians to screen for OSA. Evaluation by a sleep medicine specialist should be considered in these patients to decrease the morbidity associated with OSA in pregnancy .
Safety of Routine Use of Pharmacological Thromboprophylaxis in Post Cesarean Section Patients [18C]
Authors: Mustafa Hiba , Fuks Aleksandr , Salafia Carolyn
Published: May 2017

INTRODUCTION:

To establish the safety of routine use of heparin and low molecular weight heparin (LMWH) for routine in post cesarean section thromboprophylaxis.

METHODS:

A case control study of all cesarean sections performed at Queens Hospital Center, NY, 1/2010 - 12/2013. 1127 patients were studied in which 924 patients were included in the study. Control group: did not receive pharmacological thromboprophylaxis - 481 patients. Case study group: received routine chemoprophylaxis - 444 patient. The primary outcomes included complications of pharmacological thromboprophylaxis: wound hematomas, secondary postpartum hemorrhage, thrombocytopenia and hypersensitivity. Secondary outcomes: other wound complications, not hematomas, and efficacy of routine use of Heparin or LMWH in preventing venous thromboembolism (VTE).

RESULTS:

There was no statistically significant increase in adverse events of grade 2 or more following routine use of heparin or LMWH after cesarean section compared to the control group. 4 cases of wound hematomas were detected in both groups (P: 0.57). No hypersensitivity or delayed postpartum hemorrhage were detected in the case study group. There were 4 cases of thrombocytopenia in the case study group in which the platelets level resolved spontaneously without intervention. Secondary outcomes: there were two VTE cases in the control group while no cases in the case study group (p: 0.68)

CONCLUSION:

Routine administration of Heparin to prevent VTE in post cesarean section patients had no significant increase in complications that would withhold providers from giving it routinely to this group of patients. Prospective studies are needed to prove the efficacy of pharmacological thromboprophylaxis in preventing VTE.
Short Interpregnancy Interval and Obstetric Outcome [22C]
Authors: Holloman Conisha , Guzman Angela , Carlan Steve , Eason Ron , Mcwhorter Jeannie
Published: May 2017

INTRODUCTION:

The interpregnancy interval (IPI) has been reported to influence pregnancy outcomes. The purpose of this study was to evaluate the obstetrical outcomes of patients with an interval pregnancy less than 12 months compared to an interval of 12 to 43 months.

METHODS:

Retrospective analysis of all deliveries between 1/1/2012 and 9/30/2013. The IPIs were grouped as less than or equal to 12 months (Grp 1) and greater than 12 months and less than 44 months (Grp 2). Primary outcomes included NICU admissions, Cesarean rate, cord pH, Apgars at 1 and 5 minutes, birth weight (BW) and estimated gestational age at delivery (EGA). Statistical analysis included chi-square and student’s t-test (p= < 0.05).

RESULTS:

Of the 3,796 patients, group 1 included 396 patients (10.4%) and group 2 included 3400 patients (89.6%). A statistically significant difference was noted in NICU admissions, gestational age at delivery, birth weight, Apgars at 1 and 5 minutes and Cesarean rate (P less than .05). No difference was noted between cord pH (p=0.78). Significant maternal characteristics included age, body mass index), parity, race, marital status, private insurance, and Medicaid (P less than .05).

CONCLUSION:

Short interpregnancy intervals have been linked to increased risk for preterm birth, low birth weight, labor dystocia and maternal morbidity and mortality. Our study showed significant differences between short IPI vs. more prolonged spacing between pregnancies in regards to neonatal outcomes. The differences seen in maternal racial, socio-economic status may also reveal the effects of underlying disparities on this relationship.
An Effective and Practical Non-Narcotic Technique for Controlling Post-Operative Pain After Cesarean Delivery [35C]
Authors: Parker Jennifer Daif
Published: May 2017

INTRODUCTION:

We present a case series evaluating a non-narcotic technique for controlling Post-Operative Pain after C-section to minimize narcotic usage. Traditional treatments include administration of opiates and high-dose non-steroidal anti-inflammatory medications. The use opioids have unintended consequences. According to the CDC, 47,935 opioid overdose deaths among women occurred between 1999 and 2010. In this study, we use a low level laser therapy (LLLT) device along with traditional oral pain medications to improve patient outcome after surgery.

METHODS:

Twenty patients were offered to wear an LLLT device which was placed in the operating room. This device requires no additional operative time or follow-up visits. Patients received treatment twice daily for 12 post-op days. Patients record pain on a VAS (Visual-Analog-Scale), and narcotics administration is tracked.

RESULTS:

Preliminary findings include: All patients are using less narcotics than prescribed. Overall pain decreased. All treated patients with previous C-sections report less postoperative pain than previous deliveries. Some patients have requested early discharge on postoperative day number 2. All patients are compliant and report easy application. Patients with a previous keloid scar report significantly better cosmetic result despite similar surgical technique.

CONCLUSION:

We believe this method has the potential to improve patient outcomes by reducing pain and decrease the need for narcotics, a national priority. In addition, this method meets key criteria for clinical adoption as it requires minimum training and physician time. A randomized, blinded, placebo-controlled trial is underway.
Advanced Maternal Age and Perinatal and Obstetrical Outcomes – A Population-Based Study [37C]
Authors: Liang Tina C. , Crawford Susan , Chandra Sue
Published: May 2017

INTRODUCTION:

Our objectives are to update the existing literature on the association between advanced maternal age (AMA) and adverse obstetrical and perinatal outcomes and to determine the effect of parity on this association.

METHODS:

A retrospective cohort study was conducted using the Alberta Perinatal Health Program database including all singleton births without congenital or chromosomal anomalies at greater than 20 weeks gestation from 1998-2013. Maternal age was categorized as less than 20, 20-24, 25-30, 31-34, 35-40, and greater than 40 years. Outcomes were grouped by obstetrical and perinatal. Multinomial logistic regression models were constructed controlling for various confounders.

RESULTS:

105,067 of 690,471 total births (15.2%) were in women 35 years or greater. Compared with those 20-24, women 35-40 have increased risk of various adverse obstetrical outcomes including pre-existing hypertension or diabetes (aOR 3.40 95%CI 3.09-3.74), gestational diabetes (aOR 5.01 95%CI 4.69-5.36), preeclampsia (aOR 1.28 95%CI 1.14-1.43). Controlling for additional relevant obstetrical complications, they have increased risk of adverse perinatal outcomes including preterm birth (aOR 1.33 95%CI 1.26-1.39), low birth weight (LBW) (aOR 1.29 95%CI 1.21-1.38), and low Apgar score at 5 minutes (aOR 1.17 95%CI 1.08-1.26). Women under 20 and over 40 also have increased risk of perinatal mortality (aOR 1.35 and 1.36 95%CI 1.12-1.64 and 1.01-1.82). Compared to multiparas, primiparas have greater risk of adverse outcomes including preeclampsia, preterm birth, LBW, low Apgar score at 5 minutes and NICU admission (P<.05).

CONCLUSION:

AMA is independently associated with various pregnancy complications while primiparas have greater risk of these complications.
Postpartum Oral Glucose Tolerance Test: Predictors of Testing and Abnormal Results in a Community Hospital [39C]
Authors: Ake-Uzoigwe Rukeme , Arora Anubha , Zhang Dongping , Salafia Carolyn , Akinnawonu Kolawole , Fuks Aleksandr
Published: May 2017

INTRODUCTION:

To evaluate the predictors of compliance to postpartum oral glucose tolerance testing (OGTT) and factors predicting diabetes mellitus or impaired glucose tolerance( IGT) postpartum

METHODS:

A retrospective cohort study of gestational diabetic patients’, who delivered from January 2013 to December 2015. Factors predicting compliance to postpartum OGTT and abnormal results was determined using logistic regression analysis.

RESULTS:

Of the 514 patients included, 178 (35%) had a postpartum OGTT; of those 7(4%) had diabetes mellitus and 16 (9%) had impaired glucose tolerance. Predictors of postpartum OGTT included: Gestational age at GDM diagnosis: 24 - 30 weeks vs. less than 24 weeks (OR=0.64 , p = 0.065), greater than 30 weeks vs. less than 24 weeks (OR= 0.54,p= 0.007); Gestational age at initiation of care: greater than 24 weeks vs. less than 24 weeks (OR = 0.58,p = 0.016); Any adverse perinatal outcome vs. none (OR= 0.63,p= 0.014); Race: Black/African vs Asian and Hispanic vs. Asian;(OR = 0.53 p= 0.009; OR= 0.63 p= 0.12 respectively). Predictors of DM and IGT were : requirement for pharmacological vs. diet control (OR = 2.9, p = 0.036); Gestational-age at diagnosis of GDM: greater than 24 weeks vs. less than 24 weeks (OR = 0.21, p= 0.001).

CONCLUSION:

Early diagnosis of GDM and early initiation of prenatal care increased odds of OGTT. Black race and having any adverse perinatal outcome predicted poor postpartum OGTT compliance. GDM patients diagnosed early antepartum and requiring medication are at higher risk of DM and IGT.
Evaluation of Clinical Simulation Curriculum to Improve Resident Performance During Maternal Code Simulation [4D]
Authors: Zimbrunes Shawn E. , Auguste Tamika C. , Duong Vi
Published: May 2017

INTRODUCTION:

Physicians in training see far fewer code blue events than their predecessors. Structured simulation-based curricula for OBGYN residents managing obstetrical emergencies have not been thoroughly evaluated. Maternal code blue scenarios, specifically, are an area in which little educational research exists. This is a retrospective cohort study of 40 residents that were evaluated during unannounced maternal code scenarios. A simulation-based curriculum was established that included group-based simulation scenarios and small-group instructional sessions with specified objectives. Resident performance was again evaluated in the same unannounced maternal code scenarios post-curriculum.

METHODS:

Cohort A: Individual’s scores from the pre-curriculum scenarios were compared to their post-curriculum scores in order to measure the change in skill evaluations during maternal code scenarios after completing the curriculum. Cohort B: Individual’s scores from the pre-curriculum scenarios were compared to the post-curriculum scores from the same class level in order to account for the difference in skill at each class level after completing the curriculum. Pre- and post-curriculum scores were compared using non-parametric tests, such as Wilcoxon signed-rank test.

RESULTS:

Data has been submitted for statistical analysis, and final results are pending. We expect that residents completing the simulation curriculum will perform significantly better in post-training assessments when compared to baseline performance prior to establishment of a simulation-based curriculum.

CONCLUSION:

There are unique differences in responding to maternal codes specifically. Since this is an area in which there exists a deficit. this research has great opportunity to further the education of OBGYN residents in terms of preparation for management of maternal codes.
A Step Towards Optimizing Antimicrobial Utilization in Gynecologic Surgery at a Tertiary Care Center [17D]
Authors: Wallace Erika R. , Cotter Thusitha
Published: May 2017

INTRODUCTION:

We partnered with our local Antibiotic Stewardship Program to improve evidence based utilization of antimicrobials at our institution.

METHODS:

A retrospective cohort of hysteroscopy cases performed at a single tertiary care center from August 2011 to September 2015 was studied. Descriptive statistics summarized patient characteristics and univariate analyses examined variables associated with antibiotic use. Multiple logistic regressions analyzed effects of variables on the odds of receiving antibiotics of unproven benefit.

RESULTS:

Among 1,075 women who underwent hysteroscopy for which antibiotics are not recommended, 196 (18.23%) received antibiotics. 770 (71.62%) women had a hysteroscopy alone, and 305 (28.37%) women had additional procedure(s) that also did not warrant antibiotics per guidelines from the American College of Obstetricians and Gynecologists or SCIP. At a significance level of 0.05, age (P < .0045), primary procedure (P < .0022), primary diagnosis (P < .0019), admitted year (P < .0302) and length of stay (P < .0005) had statistically significant effects on the impact of having unproven antibiotics. Non-compliance with guidelines decreased with time from 19.2% in 2010 to 11.4% in 2015 (P=.0242). Compliance among providers was 100% for those in practice < 10 years, 11.9% for those in practice >10 years and 1.2% among subspecialists.

CONCLUSION:

Non-indicated antibiotic use is high among gynecologic surgeons at our institution. Patient characteristics had, in most instances, a small effect size in contrast with more robust contributions of providers’ practice preferences. This aggregate data will be shared broadly and rapidly among individual providers with the aim of mitigating their use of antimicrobials of unproven benefit.
Effect of Bilateral Salpingectomy on Total Hysterectomy Cost: A National Inpatient Sample Analysis [18D]
Authors: Sheyn David , Billow Megan , Mahajan Sangeeta , Soriano Alex , El-Nashar Sherif
Published: May 2017

INTRODUCTION:

Increasing prevalence of bilateral salpingectomy (BS) at time of hysterectomy has led to concern of increasing healthcare cost. A Canadian study found that salpingectomy at time of hysterectomy was associated with a lower lifetime cost than hysterectomy alone. Given the different healthcare system in Canada these findings may not apply in the United States. Our objective was to determine the cost associated with BS at time of hysterectomy based on USA healthcare data.

METHODS:

The 2013 National Inpatient Sample (NIS) was used to identify women over age 18 years who underwent hysterectomy with BS for benign indications. The primary outcome was higher cost defined as cost above the median. Stepwise multivariate regression analysis was used to evaluate the effect of co-variables on cost of hysterectomy. Statistical analysis was performed using JMP 10 (SAS, Carey NC).

RESULTS:

18,717 hysterectomies with BS were identified, of these 17.1% were laparoscopic, 11.2% were robotic, 58% were abdominal and 14.2% were vaginal. For all types of hysterectomy, BS was associated with a median increase in cost of $1193 ($685-$1701). For vaginal hysterectomy, the median increase in cost was $2080 ($1733-$2427). Robotic, abdominal and laparoscopic hysterectomy were all associated with an increase of less than $75 if BS was performed. Only vaginal hysterectomy was associated with a statistically significant increase in risk of hysterectomy cost being above the median (aOR = 1.57, p=0.01).

CONCLUSION:

Bilateral salpingectomy at time of vaginal hysterectomy is more likely to be associated with an increase in cost of hysterectomy.
The Association Between Fibroid Weight and Perioperative Outcomes for Women Undergoing Myomectomy [23D]
Authors: Sappenfield Elisabeth , Miladinovic Branko , Sarkar Papri , Imudia Anthony , Mikhail Emad
Published: May 2017

INTRODUCTION:

Myomectomy is a preferred surgical approach in reproductive age women desiring to preserve fertility. Fibroid weight impacts the decision making regarding surgical approach. Primary objective is to examine the association between fibroid weight and the 30-day perioperative outcomes for women undergoing myomectomy.

METHODS:

Data for this retrospective review was obtained from the American College of Surgeons-National Surgical Quality Improvement Project database using Current Procedural Terminology and categorized by fibroid weight. Women over the age of 18 who underwent abdominal or laparoscopic myomectomy from 2005-2014 were included. A mixed-effects logistic regression analyses were performed to analyze the effect of fibroid weight on surgical approach and 30-day postoperative outcomes, and to control for confounding factors including age, race, and surgical approach.

RESULTS:

A total of 2,862 women underwent myomectomy; 1203 (42%) patient with fibroids weight less than 250gm, and 1659 (58%) patients with fibroids greater than 250gm. Presence of fibroids weighing more than 250gm was associated with less utilization of laparoscopic route 36.9% versus 63.1% [ORadj (95%CI)] [0.585 (0.471, 0.725)], longer operative time 150m versus 118m [ORadj (95%CI)] [1.006 (1.004, 1.008)], increased likelihood of blood transfusion 67% versus 33% [ORadj (95%CI)] [1.696 (1.231, 2.336)], and total length of hospital stay 2d versus 1d [ORadj (95%CI)] [1.087 (1.012, 1.167)]. There was no significant difference in surgical site infection and readmission rate by fibroid weight.

CONCLUSION:

Increased fibroid weight was associated with increased risk of longer operative time, blood transfusion, and total length of hospital stay. Laparoscopic myomectomy was less likely utilized for fibroids greater than 250gm.
Pre-Surgical Huddles Improve Operating Room Efficiency and Teamwork [25D]
Authors: Hullfish Kathie , Morris Keith , Hall Elizabeth , Rich George
Published: May 2017

INTRODUCTION:

Background: In the operating room (OR), new technologies, space and capacity demands, as well as competing resources place a premium on eliminating waste and improving efficiency. The objective of this quality improvement pilot initiative was to assess the impact of a pre-surgical team huddle on first time starts, turnaround times, and case duration. Our secondary aim was to assess team member satisfaction pre-and post-intervention.

METHODS:

For one urogynecologic surgeon in the outpatient OR, we measured the proportion of first case starts, average turnaround time, and average case length duration ten months before (n=37) and twenty months after (n=101) the implementation of a team pre-surgical huddle. The huddle was led by the attending surgeon at 7am with the entire surgical and anesthesia team, to discuss specific patient and equipment needs, as well as potential safety concerns, for all cases that day.

RESULTS:

The proportion of first case starts improved from pre to post intervention (90% to 100%, p = 0.10), turnaround times decreased (30.5 to 28.4 mins, p = 0.14), and overall case length remained essentially unchanged (92.7 to 93.8 min, p = 0.44). Most importantly, the OR team reported value in the project in terms of enhanced teamwork and communication, and personnel involved in this pilot study have rolled out the project to other service lines at our institution.

CONCLUSION:

Conclusion/Implications: A pre-surgical huddle was associated with modest improvements in OR efficiency and teamwork. Further research is needed to assess the impact of huddles on patient outcomes and provider satisfaction.