bluuebunny/crossref_metadata_2025 huggingface dataset:
Extended VTE Prophylaxis in Morbidly Obese Patients Who Underwent Robotic Surgery For Endometrial Cancer [31A]
Authors: Balavage Kristi , Falanga Alexis , Castagno Jacqueline , Cardenas-Goicoechea Joel
Published: April 2018

INTRODUCTION:

Robotic surgery for gynecologic malignancy is associated with a lower rate of venous thromboembolism (VTE) than laparotomy. However, guidelines for extended-duration thromboprophylaxis (e.g. 4 weeks) following robotic surgery for gynecologic malignancy are unclear. Obese patients (BMI >35Kg/m2) represent a particularly high-risk group for VTE, but prior studies regarding extended thromboprophylaxis after robotic surgery tend to focus on patients with a much lower average BMI. This study aimed to examine the role of extended post-operative thromboprophylaxis in morbidly obese patients who underwent robotic hysterectomy for endometrial cancer.

METHODS:

A retrospective chart review of robotic procedures for endometrial cancer performed at the University of Florida from January 2013 to May 2017 was conducted. The primary outcome was a VTE event (e.g. DVT or PE) within the 3- 6 month post-operative period.

RESULTS:

68 robotic cases for endometrial cancer were included in the final analysis based on BMI >35 (median = 42.2 Kg/m2). 91% received pre-operative thromboprophylaxis with heparin or enoxaparin, and 100% used pneumatic compression devices. 14 patients (20.6%) received extended duration prophylaxis (range = 28-30 days). One patient in the group that did not receive extended prophylaxis developed a VTE in the 30-day post-operative period (1.9%), versus 0% in the group that did receive extended prophylaxis (P=1).

CONCLUSION:

In obese patients undergoing robotic surgery for endometrial cancer, extended duration thromboprophylaxis may not be necessary to decrease VTE. The low rate of VTE events in this study could possibly be attributed to the high rate of pre-operative pharmacologic and mechanical thromboprophylaxis.
Developing Sustainable Cervical Cancer Screening in Mwanza, Tanzania: Implementation of a Screen-and-Treat Model [33A]
Authors: Bernstein Megan , Hari Anjali Y. , Farfel Allison , Patel Priya , Raman Kaavya
Published: April 2018

INTRODUCTION:

The purpose of this study is to evaluate the development of a one-week screening campaign and efforts towards the implementation of a sustainable system that addresses cervical cancer in Mwanza, Tanzania with a screen-and-treat model utilizing visual inspection of the cervix with acetic acid (VIA) and cryotherapy.

METHODS:

In partnership with CureCervicalCancer (CCC), a nonprofit organization based in Los Angeles, California, 11 medical students at the University of California, Irvine School of Medicine established a model for sustainable HPV screening practices in Mwanza, Tanzania. This study both quantitatively and qualitatively assesses the successes and limitations of the program model.

RESULTS:

During the 5-day training, a total of 614 women attended the screenings and 556 women were screened with VIA, of which 10.6% (n=59) were VIA positive and 89.4% (n=499) were VIA negative. Of those who for VIA positive, 83.1% (n=49) received cryotherapy while 16.9% (n=10) did not due to suspicions for advanced cancer (n=7), refusal to receive cryotherapy (n=2), or pregnancy (n=1).

CONCLUSION:

The screen-and-treat model for the identification and treatment of pre-cancerous cervical lesions is an effective public health intervention with potential to impact women by both providing the tools and education needed by local healthcare professionals. However, limitations common to resource-poor settings such as continuity of funding, loss to follow-up, and transportation costs, remain barriers to sustainability.
Maximum Cervical Dilation Achieved Prior to Uterine Rupture [38A]
Authors: Nitzsche Brad , King Victor , Zavala Kathryn , Wallace Erika , Reyes Natalie , Elkattah Rayan
Published: April 2018

INTRODUCTION:

Uterine rupture is a catastrophic obstetrical event with high rates of maternal and fetal morbidity and mortality. Uterine rupture occurs most commonly in patients with prior uterine scars, especially those undergoing a trial of labor after cesarean section. It is intuitive that uterine rupture is more likely to occur in the active stage of labor or at advanced cervical dilation, but data on this subject is lacking.

METHODS:

All cases of uterine rupture that occurred at a single institution from 2010-2016 were identified using ICD codes. Inclusion criteria were pregnant women age 18 and greater with a history of a prior low transverse uterine incision who underwent a uterine rupture while in labor. The primary endpoint was the maximum cervical dilation achieved prior to the diagnosis of uterine rupture.

RESULTS:

19 cases were initially identified, but five of these did not meet inclusion criteria. In the remaining 14 cases, the maximum cervical dilation ranged from 0 to 10 cm with a mean of 3.1 cm. In 9 of the 14 cases, uterine rupture occurred at 4 cm dilation or less.

CONCLUSION:

Uterine rupture does not appear to be more likely to occur in active than in latent labor.
Is a 'High Normal' Basal Follicle Stimulating Hormone Level Predictive of IVF Outcomes in Young Women? [1B]
Authors: Persch Paige , Strawn Estil , Alexis Visotcky , Szabo Aniko , Charles David , Schoyer Kate
Published: April 2018

INTRODUCTION:

The purpose of the study was to determine if young women (age 35 or younger) with follicle stimulating hormone (FSH) levels between 8-10 mIu/mL have lower clinical pregnancy rates in their first in vitro fertilization cycle (IVF) compared to young women with FSH levels less than 8.

METHODS:

Retrospective cohort study of young women undergoing their first IVF attempt between 1/1/2010 and 12/19/2016. All subjects had a day 2/3 FSH and estradiol drawn within one year of their IVF cycle. The probability of clinical pregnancy was compared between the two groups using Pearson’s chi-squared test at a 5% significance level. Logistic regression analysis was used to assess the effect of confounding factors. An ROC analysis was conducted to evaluate other potential cutoffs.

RESULTS:

Three hundred fifty two women age 35 or younger with FSH levels less than 10 and normal estradiol levels met criteria. There were no significant differences in age, BMI, gravidity, or parity between groups. Stimulation outcomes were similar. Clinical pregnancy rates were lower in the FSH 8-10 group (28.3% versus 43.8%, P=.035) and remained significant when controlling for potential confounders via logistic regression analysis.

CONCLUSION:

Young women with FSH levels between 8-10 had lower clinical pregnancy rates after IVF than those with FSH levels less than 8. An FSH level of 8 or greater may represent premature ovarian aging in young women. Anticipatory counseling and sooner referral to reproductive endocrinology and infertility may be warranted at a new threshold level in young women.
Is Oocyte Quality During IVF Reduced in PCOS? [2B]
Authors: Scogin Mallory , Kim Beomsu , Yu Taechin , Yeh John , Kiltz Robert , Arroyo Armando
Published: April 2018

INTRODUCTION:

Determine whether oocyte morphology during IVF is different in women with polycystic ovarian syndrome (PCOS) compared to normal controls. (NC).

METHODS:

362 IVF cycles in PCOS women and 268 IVF cycles in normal controls (NC) between the ages of 25-35 were selected from 2012 to 2016. PCOS women were selected using Rotterdam criteria. In addition, all PCOS patients had AMH > 5 ng/mL. Normal controls had normal serum total testosterone < 50 ng/dL, FSH < 12 IU/mL, AMH < 5 ng/mL and normal ovaries on transvaginal ultrasound. Semen analysis was > 14 million/ml with motility. Patients received antagonist or agonist protocol. Oocytes were evaluated by CNY embryologists 4 hours after retrieval. Six categories were defined-metaphase II (MII) good, MII fair, MII poor, metaphase I (MI), germinal vesicle (GV), and degenerated.

RESULTS:

6224 oocytes from PCOS women and 3119 oocytes from NC women were studied. The percentage of MII good (39.3 vs 36.5%; p=0.21), fair (24.5 vs 28.0%; p=0.054), and poor (13.3 vs 12.7%; p=0.67) oocytes was not different in PCOS and NC. The percentage of MI (6.34 vs 5.61%; p=0.33), GV (8.09 vs 8.99%; p=0.35), and degenerated oocytes (8.17 vs 7.25%, p=0.28) was not different in both groups. The fresh cycle live-birth rate (# births/cycle) was not different in PCOS women compared to NC (36.7 vs 31.7%, p=0.19).

CONCLUSION:

Oocyte morphology and live-birth rate during IVF was not different between PCOS women and NC. This suggests that oocyte quality in PCOS women is not reduced.
AMH Serum Level as a Predictor of In Vitro Fertilization (IVF) Parameters [3B]
Authors: Baum Stephanie R. , Or Drorit , Georgia Panagopoulos , Hershlag Avner , Mullin Christine , Singer Tomer
Published: April 2018

INTRODUCTION:

Anti-müllerian hormone (AMH) serum level is a component of the infertility workup to evaluate ovarian reserve. Diminished ovarian reserve is one of the major causes of female infertility. Our study examines the relationship between AMH serum level and IVF success.

METHODS:

We performed a retrospective cohort study at a single academic institution, including 145 patients undergoing 185 IVF cycles. The IVF outcomes were reviewed for completed cycles within 12 months of collected follicle stimulating hormone (FSH) and AMH serum levels, under an exempt IRB in 2012. Data included number of oocytes retrieved, number of mature oocytes, number of oocytes fertilized, number of cleavage stage embryos, number of embryos transferred, number of embryos frozen, and number of embryos discarded. The Shapiro-Wilk test of normality and Spearman’s rank correlation coefficient were used for statistical analysis with p<0.05.

RESULTS:

There is a positive correlation between AMH serum level and the number of oocytes retrieved, the number of mature oocytes, the number of fertilized oocytes, and the number of cleavage stage embryos. These findings are statistically significant. There is no correlation between AMH serum level and embryo quality.

CONCLUSION:

AMH serum level correlates with certain IVF parameters, including oocytes retrieved and the number of cleavage stage embryos. AMH serum level does not predict embryo quality. However, an IVF cycle with an increased number of retrieved and fertilized oocytes is likely to have a higher chance of resulting in embryos preferable for transfer in a current or future cycle.
Successful Pregnancy Outcomes after Septum or no Septum Resection in Patients with Recurrent Pregnancy Loss [4B]
Authors: Whelan Anna , Burks Channing , Stephenson Mary
Published: April 2018

INTRODUCTION:

Acquired uterine malformations caused by incomplete fusion or reabsorption of the Mullerian ducts can lead to reproductive issues including infertility, recurrent pregnancy loss (RPL), malpresentation and/or preterm birth. The septate uterus is the result of partial or complete lack of reabsorption. It is the most common acquired uterine malformation with a prevalence of ∼2.3% in the general reproductive population compared to ∼6% in women with RPL. Surgical management of the septate uterus is controversial and subsequent pregnancy outcomes are based on retrospective studies to date.

METHODS:

Observational cohort study using prospectively collected data from a well-defined RPL Database. Subsequent pregnancy outcomes in subjects with a history of RPL and septate uterus were analyzed, based on whether hysteroscopic metroplasty was performed or not.

RESULTS:

36 subjects with RPL and septate uterus were identified, with 82 subsequent pregnancies. Mean maternal age and body mass index were 34.6 years (SD 3.6) and 28.5 kg/m2 (SD 8.2). Analysis of subsequent pregnancy outcomes revealed no significant difference in live birth rate ≥4 weeks of gestation, 36.8% (21/58) with surgery versus 45.3% (11/24) without surgery, OR 1.14 (P = 0.74, 95% CI 0.43 - 3.25). No significant difference in rate of subsequent miscarriage, fetal demise or preterm birth were noted, χ2 = 1.67 (df=3, P =0.65).

CONCLUSION:

The outcomes of this study highlight the need for a randomized controlled trial to evaluate the management of septate uterus in RPL.
Increased Likelihood of Pregnancy from Sex on the Two Days Before Ovulation [5B]
Authors: Johnson Sarah , Marriott Lorrae , Zinaman Michael
Published: April 2018

INTRODUCTION:

Home ovulation tests are a convenient method to maximize chances of becoming pregnant naturally. This study examined intercourse patterns in women using tests and likelihood of pregnancy in relation to timing.

METHODS:

Women seeking to conceive used Clearblue Advanced digital ovulation tests to time intercourse, kept an intercourse diary and collected daily urine samples for 1 cycle. The home ovulation tests detect estrogen rise to identify the onset of the fertile period (approximately 4 days prior to ovulation) and Lutenising hormone (LH) surge (24h prior to ovulation). LH was also measured using AutoDELFIA to assign ovulation day. From the wider population of 1925 volunteers with sufficient data, comparative analysis was conducted on all viable pregnancies (n=288), and a random selection of ovular cycles from not pregnant volunteers (n=677).

RESULTS:

One cycle conception rate was 15%. Women were able to effectively target intercourse to their fertile period using home tests, with >60% having sex on day of LH surge compared to <30% in the luteal phase. More women who became pregnant had sex on the day -1 (p=<0.0001) and -2 (p=0.001) prior to ovulation; with an increased likelihood of pregnancy of 18.5% for day-1 and 23.6% for day -2. The day after the LH surge saw a marked decrease in pregnancy rates.

CONCLUSION:

Women using home tests do target intercourse effectively to the fertile window, and there is an increased likelihood of pregnancy with successful timing. Sex on the day preceding the LH surge, which identifiable only by home tests that measure estrogen, significantly increases likelihood of pregnancy.
Impact of Employer Coverage on Elective Oocyte Cryopreservation: A Study of Graduate Students [9B]
Authors: Turocy Jenna , Cardozo Eden , James Kaitlyn , Freeman Marlene , Toth Thomas
Published: April 2018

INTRODUCTION:

Our aim is to assess female graduate student's attitudes toward elective oocyte cryopreservation (OC) and the potential impact of employer coverage on their family planning decisions.

METHODS:

This cross-sectional study was performed via an online survey distributed to 2,314 female graduate students enrolled in 5 graduate degree programs including masters, doctorate, MBA, law and dental programs from May through October 2016. Survey answers were stratified by demographic factors including relationship status and graduate degree.

RESULTS:

171 female graduate students completed the survey. The majority of respondents were between the ages of 21 and 30 (80%) and had no children (95%). The most common reasons for deferring childbearing were professional goals (63%), followed by no partner (18%) or financial (11%). The majority of participants (97%) have heard of elective OC, citing their largest concern was cost (59%) and success rates (14%). Without employee coverage, only 10% would consider elective OC. However if offered employer coverage for OC, an additional 39% would consider OC and 20% would delay when they planned to have children. Participants enrolled in Dental and Law programs were more likely to delay childbearing if provided employer coverage for OC compared to all other programs (p<0.05).

CONCLUSION:

Among female graduate students surveyed, more women would consider OC and delay childbearing if financial coverage were provided by their employer. As more companies offer coverage for OC, further research is needed to better understand how employer coverage for OC may impact a woman’s family planning decisions and potentially lead to a delay in childbearing.
The Association of Relationship Status and Fertility Awareness [14B]
Authors: Hammer Karissa , Kahan Alyssa N. , Fogg Louis , Walker Mark , Hirshfeld-Cytron Jennifer
Published: April 2018

INTRODUCTION:

Women worldwide are delaying childbearing. Technological advances, such as oocyte cryopreservation (OC) and in vitro fertilization (IVF), allow women to achieve pregnancy despite age related fertility decline. This paper seeks to investigate whether relationship status plays a role in fertility knowledge in order to understand which populations should be targeted for fertility education.

METHODS:

Primary analysis of a national online survey of 1213 nulliparous patients from March 4- March 9, 2016. A linear regression model and ANOVA tests were performed. Results were stratified based on relationship status: partnered (married, living with domestic partner) or unpartnered (single, widowed, divorced).

RESULTS:

Of the 1213 women who completed the survey, 98.8% were analyzed. The majority of participants identified as white, heterosexual, and from urban locations. Partnered women were more likely to report they would have made different life choices had they been more knowledgeable about fertility (p=0.01), and also more likely to “know a lot” about the age-related decline in fertility (p<0.01). When asked about familiarity with oocyte cryopreservation, majority of the survey population responded that they have “heard of it, but don’t know much about it.”

CONCLUSION:

This national survey demonstrates that having a partner significantly increases the likelihood that a woman is knowledgeable about fertility; nevertheless, partnered women are also more likely to wish they had been more knowledgeable about fertility. More effort is necessary to educate all women on ART and the natural age related decline in fertility, specifically young, single women of childbearing age.
Unexplained Infertility: A Biomarker for Decreased Ovarian Reserve in Young Women [15B]
Authors: Starostanko Andrea , Ayers Jonathan
Published: April 2018

INTRODUCTION:

After 12 months of regular intercourse and appropriate evaluation to assure normal ovulation and sperm quality with patent fallopian tubes, no etiology is identified in up to 1/3 of couples. The treatment for Unexplained Infertility (UI), especially for younger couples (<35 years), is largely empiric. Recent IVF data suggests UI in younger women is associated with lower embryo quality and may be related to prematurely Decreased Ovarian Reserve (DOR). In the present study DOR, as measured by Anti-Mullerian Hormone (AMH), was assessed as part of the initial evaluation of young nulligravid couples with >12 months attempting pregnancy.

METHODS:

Three hundred and forty-three nulligravid couples (18-34 yrs) were evaluated with assessment of tubal patency, ovulatory and anatomic status by mid-cycle TVUS, comprehensive semen analysis, and assessment of DOR with serum AMH.

RESULTS:

An infertility diagnosis was confirmed in 142/343 (41%): anovulation 30%; anatomic abnormality 9%; male factor 6%. UI, the default diagnosis, was made in 201/343 (59%). Of the 201 women with UI, AMH was <95% of age appropriate values in 118 (59%). Most surprisingly, 53/201 (26%) UI women <35 had an AMH value of <1.5.

CONCLUSION:

The results of this study suggest 1) In all women with UI, independent of age, assessment of ovarian reserve should be included in the initial evaluation of fertility status; 2) In young women with premature DOR, consultation with a fertility specialist is warranted to discuss appropriate treatment modalities; 3) Beyond fertility concerns, DOR may herald a premature perimenopausal transition with the associated cardiovascular health implications.
Amphetamine Abuse/Dependence Among Pregnant Women, United States 2003-2014 [20B]
Authors: Admon Lindsay K. , Kozhimannil Katy B. , Rowe Meghan E. , Dalton Vanessa K. , Winkelman Tyler
Published: April 2018

INTRODUCTION:

Nearly one million individuals in the United States reported using amphetamines in 2015. Particularly high levels of use have been identified among rural populations in the West and Midwest. Our objective was to characterize the incidence and geographic distribution of amphetamine abuse/dependence among women who give birth in the United States.

METHODS:

We conducted a retrospective, serial cross-sectional analysis using 2003 to 2014 data from the National Inpatient Sample, a nationally representative sample of hospital discharges. The cohort included all obstetric deliveries. Amphetamine abuse/dependence was identified with ICD-9-CM codes 305.7x and 304.4x. Incidence rates were calculated with logistic regression models.

RESULTS:

Amphetamine use disorders were identified in 16,469 of 9,921,691 unweighted delivery hospitalizations. Maternal amphetamine abuse/dependence reached a nadir in 2009-10 and then increased disproportionately in rural compared to urban counties. Incidence in rural Western, Midwestern, and Southern counties was significantly higher in 2013-14 compared to urban counties in those regions (all P<.001). The highest incidence of amphetamine abuse/dependence was identified among pregnant women living in rural, western counties at 9.6 (95% CI 8.2-11.0) per 1,000 hospital deliveries in 2013-14.

CONCLUSION:

Maternal amphetamine abuse/dependence increased in the United States after 2009-10 and disproportionately impacted rural residents and communities in the West. These findings amplify recent calls for policy- and practice-level interventions to facilitate the prevention and treatment of substance use disorders among pregnant women. In contrast to opioid use disorders, evidence-based pharmacologic treatment options for amphetamine abuse/dependence are lacking. Prevention may play a key role in improving outcomes for mothers and their infants.
Racial Disparities Among Preterm Births Rates in Preeclampsia [25B]
Authors: Speranza Rosa , Luck Marissa , Savitsky Leah , Scrivner Greiner Karen , Caughey Aaron B.
Published: April 2018

INTRODUCTION:

Preeclampsia complicates 3-5% of deliveries in the United States and is a frequent cause of preterm birth. We sought to characterize the rates of preterm versus term deliveries stratified by race in preeclampsia both with (PE-SF) and without severe features (PE).

METHODS:

This is a retrospective cohort study of singleton, non-anomalous deliveries from 2005-2008 using linked vital statistics and ICD-9 data. Women self-reported into racial categories of white, black, Hispanic/Latina, Asian/Pacific Islander, or other. We used chi-squared tests to compare outcomes by preterm (<37 weeks gestation) or term (≥7 weeks gestation) and multiple logistic regression to adjust for age, race, education, insurance status, chronic hypertension, diabetes, gestational age at delivery, and birthweight.

RESULTS:

There were 58,878 births in our cohort complicated by preeclampsia with 16,073 births from PE-SF and 41,787 from PE. Within each racial category, the preterm versus term delivery rates were statistically significant with a p-value <0.001. Term deliveries were more common in both PE-SF and PE in all races except for Asian/Pacific Islanders which had 52.1% preterm births in PE-SF. The rate of preterm birth was higher in PE-SF compared to PE across all racial categories. Black women had the highest rate of preterm delivery for PE at 26% compared to white women who only had 17.8%.

CONCLUSION:

Rates of preterm deliveries were significantly higher for PE-SF compared to PE an racial disparities were most notable among Black women with PE. Further investigation should be directed at identifying why these disparities exist and how they can be addressed.
Uterine Fibroids in Twin Gestations and Risk of Sonographic Short Cervix [26B]
Authors: Blitz Matthew J. , Rochelson Burton , Greenberg Meir , Vohra Nidhi
Published: April 2018

INTRODUCTION:

No large studies have evaluated whether the presence of fibroids affects cervical length in twin gestations. The objective of this study was to determine whether uterine fibroids identified on second-trimester ultrasound increase the risk for short cervix and adverse pregnancy outcomes in twin pregnancies.

METHODS:

This retrospective cohort study evaluated all women with twin gestations who had a routine second-trimester ultrasound at 17-23 weeks gestational age from 2010-2016. When fibroids were noted, their presence, number, location and size were recorded. Exclusion criteria included a history of cervical conization or loop electrosurgical excision procedure (LEEP) and uterine anomalies. The primary variable of interest was short cervix (<25 mm). Secondary variables of interest included gestational age at delivery, mode of delivery, indication for cesarean, birth weight and Apgar scores.

RESULTS:

Fibroids were identified in 127/1,260 patients (10.1%). Short cervix was increased in women with fibroids compared to women without fibroids (14.2% vs. 8.2%, OR 1.85, 95% CI 1.07-3.18, P<.03). Women with fibroids were older in age, lower in parity and more likely to have had pregnancies resulting from assisted reproductive technology. There was no difference in the gestational age at delivery, indication for primary cesarean, newborn birth weight or Apgar scores in twin gestations with fibroids compared to those without fibroids. The size and number of fibroids did not affect the frequency of short cervix.

CONCLUSION:

Women with twin gestations and uterine fibroids may be at higher risk for a short cervix. Fibroids are not associated with adverse obstetric and neonatal outcomes in twin pregnancies.
Antepartum Intravenous Iron Reduces Peripartum Blood Transfusions [27B]
Authors: Hamm Rebecca F. , Blauvelt Christine , Wang Eileen , Srinivas Sindhu
Published: April 2018

INTRODUCTION:

Studies have demonstrated that antepartum intravenous iron sucrose infusion (IVFe) is safe and improves pre-delivery hemoglobin (Hb). Yet, the effect of IVFe on maternal morbidity is unknown. We sought to determine whether antepartum IVFe could reduce peripartum packed red blood cell (pRBC) transfusions.

METHODS:

This is a retrospective cohort study. In 6/2015, our institution began recommending IVFe for patients with Hb<9.5 g/dL who failed oral ferrous sulfate, as determined by persistent severe anemia in the third trimester. Patients who obtained prenatal care and delivered at our institution from 10/1/2015-10/1/2016 with third trimester Hb<9.5g/dL were included. Hemoglobinopathies were excluded. Decision to proceed with IVFe, timing, and number of doses was left up to patient and provider. Patients receiving ≥1 antepartum dose of 300mg of IVFe at least 48 hours before delivery were included in the IVFe group. Our primary outcome was rate of blood transfusions among those who did vs. did not receive IVFe. Fisher’s exact test was used to compare proportions.

RESULTS:

389 of 3961 (9.8%) delivering patients met Hb criteria and were included. Of those, 25 (6.4%) were in the IVFe group. Third trimester Hb was lower in the IVFe group compared to the No IVFe group (8.6g/dL vs. 9.4g/dL; p<0.0001). Patients in the IVFe group significantly increased their Hb from third trimester to pre-delivery compared to those in the No IVFe group (Δ1.6g/dL vs Δ-0.1g/dL, p<0.0001). 57 of 389 (14.7%) received ≥1 unit of pRBCs during delivery admission. IVFe decreased the rate of peripartum blood transfusion compared to those who did not get IVFe (0% vs. 15.7%, p=0.035). The 57 transfused patients, none of whom received IVFe, required an average of 2.39 units of pRBCs per person.

CONCLUSION:

Despite lower starting Hb in the IVFe group, antepartum IVFe reduced transfusions in patients with a third trimester Hb<9.5g/dL. Future hemorrhage bundle work should highlight the use of IVFe to reduce peripartum pRBC transfusion and maternal morbidity.
Mode of Delivery in Stillbirth Pregnancies [30B]
Authors: Rossi Robert , Hall Eric , DeFranco Emily
Published: April 2018

INTRODUCTION:

Stillbirth complicates 1 in 160 deliveries in the United States. Vaginal delivery (VD) is the desirable route of delivery even in the setting of a prior cesarean delivery (CD). ACOG recommends CD only for unusual circumstances because of associated maternal morbidity without any fetal benefit, however some patients prefer CD to avoid the experience of a vaginal birth of a demised fetus. We sought to determine the rate of CD in pregnancies complicated by stillbirth and to identify characteristics associated with CD.

METHODS:

Population-based retrospective cohort study of all stillbirths in the United States during the year of 2014. Frequency of CD in stillbirths was stratified by gestational age (16-46 weeks). Maternal, obstetric, and fetal characteristics were compared between women who underwent CD compared to VD. Multivariate logistic regression estimated the relative influence of maternal, obstetric, and fetal factors on the outcome of CD.

RESULTS:

There were 17,701 non-laboring women diagnosed with stillbirth during 2014 in the United States in which mode of delivery was recorded. Of the 17,701 stillbirths, 2,951 (16.7%) underwent a CD. Between 20-23, 24-27, 28-31, 32-36, and >36 weeks of gestation, the CD rate was 4.0, 16.2, 23.7, 30.8, and 28.8% respectively. Among this cohort, 1,727 women (58.5%) had a primary CD. Factors associated with CD included obesity (aOR 1.3, 95% CI 1.1-1.5), pre-existing diabetes (aOR 1.6, 95% CI 1.1-2.2), gestational diabetes (aOR 1.6, 95% CI 1.2-2.1), gestational hypertension (aOR 1.7, 95% CI 1.3-2.1), cigarette smoking (aOR 1.5, 95% CI 1.2-1.8), infertility treatment (aOR 1.9, 95% CI 1.2-3.0), diagnosis of stillbirth in 3rd trimester, (aOR 5.0, 95% CI 4.1-6.0), and large for gestational age (>10th%) birthweight (aOR 2.4, 95% CI 0.1.8-3.1). Younger women (<20 yo) and those with small for gestational age birthweight (<10th%) were less likely to have a CD. Women who underwent a CD were more likely to be admitted to an ICU (aOR 6.1, 95% CI 4.1-6.5).

CONCLUSION:

Approximately 16% of women diagnosed with a stillbirth in the United States underwent a CD in 2014. The CD rate rose with increasing gestational age and peaked during the 3rd trimester, where more than 1 in 4 women diagnosed with a stillbirth underwent a CD, despite ACOG guidelines. Our findings support that provider education, patient counseling, and adherence to society guidelines are potential areas of focus for perinatal quality improvement efforts.
Preeclampsia with or without Chronic Hypertension: Differences and Outcomes [32B]
Authors: Rincon Monica , Beeraka Sridivya Spurthi , Burwick Richard M.
Published: April 2018

INTRODUCTION:

It is unclear if women with chronic hypertension (CHTN) and superimposed preeclampsia (siPE) have more severe disease than women with preeclampsia (PE) without CHTN. We sought to compare disease features and outcomes in these groups.

METHODS:

Retrospective cohort study (Oct'13 - May'17) at a single institution, among subjects with hypertensive disease in pregnancy, delivered ≥23 weeks gestation, who were screened using ICD-9 and ICD-10 codes with subsequent chart validation. Subjects were divided: 1) CHTN; 2) Gestational hypertension (GHTN); 3) PE and, 4) PE with severe features (PE-SF). Those with siPE were placed in Group 3 or 4, as determined by labs or symptom criteria. Differences were assessed by Chi-square, Fisher exact or Student t-test.

RESULTS:

Among 1,188 pregnancies with a hypertensive disorder, 626 developed PE; of which 140 (22.4%) had siPE. CHTN was more common in PE-SF than PE without SF (29.3% vs. 15.2%, P<.001). Compared to women with PE, those with siPE were more likely to have severe headache (30.9 vs. 18.5%, p=0.002) and pulmonary edema (5.7 vs. 1.7%, P.007). Other severe features of PE were similar regardless of CHTN including thrombocytopenia, elevated liver enzymes, kidney injury, and eclampsia. Those with CHTN and siPE were more likely to have preterm neonates (53.0 vs. 24.6%) P<.001) with respiratory distress syndrome (RDS) (30.3 vs. 13.5%, P<.001).

CONCLUSION:

Women with CHTN and siPE have more severe disease than women with PE alone. Notably, siPE is associated with more headache, pulmonary edema, preterm delivery, and RDS
Difference in Nuchal Fold Thickness (NFT) in Male versus Female Fetuses [34B]
Authors: Soni Shelly , Rochelson Burton , Blitz Matthew J. , Vohra Nidhi , Pessel Caroline D.
Published: April 2018

INTRODUCTION:

To evaluate if second trimester nuchal fold thickness (NFT) differs in male vs female fetuses. We also assessed if male gender predisposes to an increased NFT.

METHODS:

Case control study of singleton pregnancies receiving second trimester fetal nuchal fold measurements identified from a search of ultrasound and cytogenetic databases. NFT was compared in male versus female fetuses. Data was stratified for fetuses with normal and increased NFT (defined as ≥6 mm from 14 weeks to 21.6 weeks of gestational age) as well as for those with abnormal genetic results. Genetic results were considered abnormal in cases of aberrant karyotype, as well as known pathogenic mutations on microarray or Noonan panel.

RESULTS:

Of the entire study group (N=6483 pregnancies), 51.3% fetuses (3328/6483) were males and 48.7% were females. Male fetuses had an increased mean NFT as compared to female fetuses in the entire cohort (4.2 mm in males versus 4.0 mm in females, p < 0.0001). NFT was higher in male fetuses in the normal NFT group as well as the group with increased NFT. Data was stratified based on gestational age in fetuses with normal NFT without known chromosomal aberrations. Male fetuses had a higher NFT across all gestational ages. Also, male fetuses had a higher incidence of increased NFT of ≥6mm when compared to female fetuses (OR 1.8 [1.3-2.5], P 0.0006).

CONCLUSION:

Male fetuses have a higher mean NFT as compared to female fetuses, and male gender predisposes to a higher likelihood of an increased NFT.
Academic Hospitalist Programs and the Impact on Resident Education [3C]
Authors: Raine Susan P. , Schneider Karen , Sangi-Haghpeykar Haleh , Swaim Laurie S.
Published: April 2018

INTRODUCTION:

Hospitalist programs have increased in prevalence since their introduction in the mid-1990s, doubling over a 5-year period from 114 to 240. While the laborist model increases patient safety and decreases physician fatigue and burnout in general, its impact on resident education is unknown. The purpose of the study was to determine the number of hospitalist programs within an academic setting and to exam the perceived impact of the program on postgraduate training in obstetrics and gynecology.

METHODS:

A validated survey was sent to program directors at all 242 U.S. Obstetrics and Gynecology training programs using an anonymous online survey instrument. The survey included 9 questions and took approximately 3-5 minutes to complete. The email was distributed three times: initial email with follow up emails at one and six months. Groups of interest were compared by chi-square test.

RESULTS:

242 OB/Gyn residency training programs were surveyed. There were 98 respondents for a response rate of 36%. Twenty-eight percent of programs had a hospitalist program. Of these programs, the majority perceived the presence of laborists to have a positive impact on resident education (n=30, 90%) and did not perceive a reduction in the number of patients or procedures available to the residents (n=26, 96.3%). In addition, resident feedback in these programs indicated a hospitalist program was beneficial to their education (n=19, 70%).

CONCLUSION:

The implementation of a hospitalist program in the setting of postgraduate training in Obstetrics and Gynecology does not negatively impact resident education and is perceived by program leadership and trainees as beneficial.
Can the Understanding of Professionalism in Medicine be Influenced by the Background of Trainees or Their Roles? [8C]
Authors: Sakhel Khaled , Goodwin Jeff , Owusu-Anti Philipa , Jalalizadeh Mehrsa , Gemeda Mekbib
Published: April 2018

INTRODUCTION:

This was a pilot study to investigate whether one’s background or training influences the understanding of medical professionalism.

METHODS:

An electronic survey was sent out to all trainees at Eastern Virginia Medical School. The survey included 25 questions; 12 background and 13 questions on professionalism related to ACGME.

RESULTS:

329 out of 1229 learners completed the survey for a response rate of 26.7%. 22.8% noted general lack of professionalism in the work place. 4.5% did not know someone who exemplified professionalism. 20 learners reported they had been cited for lack of professionalism, 12 of whom considered themselves to portray good professionalism. Learners with military background were more likely to have had formal leadership training (56% vs 24%, p<0.001). Among all learners, allied health students were more likely to have had formal leadership training (42%) as compared to medical students (24%) and residents/fellows (21%) (p=0.014). Only 60% of responders agreed or strongly agreed that there was a correlation between ones professional behavior and patient outcomes. Most allied health (93%) agreed professionalism impacts patient outcome while only 74% of medical students and 57% of residents fellows agreed (p<0.001). 55% believed that formal training in professionalism is required. Only 16.9% of respondents were familiar with the ACGME guidelines on medical professionalism. Learners scored the competencies in terms of importance 1-5 (5 being most important). SBL and EBC competencies received lower mean scores than other competencies (3.8 and 4.3). Residents/Fellows rated professionalism lower than other learners (4.0 vs 4.3) (p=0.019).

CONCLUSION:

The pilot demonstrated that understanding of Professionalism in the medical field is influenced by the background and role of trainees. Formal training in medical professionalism should be considered.
An Analysis of the Nulliparous, Term, Singleton, Vertex Cesarean Rate in a High-Volume Community Teaching Hospital [12C]
Authors: Wang Tiffany , Kawakita Tetsuya , Fernandez Miguel A. , Tefera Eshetu , Fernandez Stephen , Moxley Michael
Published: April 2018

INTRODUCTION:

In March 2014, the American College of Obstetricians and Gynecologists (ACOG) published its Obstetric Care Consensus guidelines on preventing the first cesarean birth. Virginia Hospital Center (VHC) in Arlington, Virginia adopted these guidelines to decrease its primary cesarean birth rate. The aim of the study was to examine the effects of these initiatives on the nulliparous, term, singleton, vertex (NTSV) cesarean birth rate at VHC.

METHODS:

Interventions began in mid-2014 and included department-wide review of the indications for scheduled and unscheduled primary cesarean birth. A retrospective cohort study of all nulliparous women with singleton term pregnancies in the vertex presentation who delivered between 2014 and August 2017 was then conducted. The NTSV cesarean birth rates were calculated across time. Chi-square tests were used to determine whether NTSV cesarean birth rates were statistically significant after adoption of ACOG's Obstetric Care Consensus guidelines.

RESULTS:

There were 2,339 NTSV pregnancies in 2014, 2,090 in 2015, 1,673 in 2016, and 1,090 in 2017 (January through August). During this time period, the NTSV cesarean birth rate significantly decreased by 33.6% (31.8% in 2014, 27.7% in 2015, 22.0% in 2016, and 21.1% in 2017 (year to date) P<0.01).

CONCLUSION:

Within two years of implementation of the guidelines set forth by ACOG’s Obstetric Care Consensus, VHC significantly decreased its NTSV rate to meet the HealthyPeople 2020 NSTV goal rate of 23.9%. Further studies will examine provider and patient characteristics, along with other quality metrics to identify factors which may have contributed to the decreased NTSV cesarean birth rate.
Obstetric and Delivery Characteristics Associated with Gastroschisis [14C]
Authors: Rossi Robert , DeFranco Emily
Published: April 2018

INTRODUCTION:

Gastroschisis is a congenital abdominal wall defect associated with complications such as cesarean delivery (CD). Previous studies have reported greater than 30% of these pregnancies having fetal intolerance of labor (FIOL). We sought to characterize obstetric factors associated with gastroschisis.

METHODS:

Population-based retrospective cohort study of livebirths in Ohio (2006-2015). Frequency of gastroschisis was obtained from birth certificate data. Obstetric characteristics were compared between women who delivered an infant with gastroschisis compared to those who without gastroschisis. Multivariate logistic regression estimated the influence of gastroschisis on the outcomes of FIOL and CD.

RESULTS:

Of 1,428,125 live births in Ohio during the 10-year study period, 620 (0.04%) women delivered an infant with a isolated gastroschisis. The CD rate was 45.7% vs 31.0% (p<0.001) in women who delivered an infant with gastroschisis compared to those without gastroschisis. Among women who were induced, the rate of FIOL was 13.4% vs 10.3% (p=0.145) in gastroschisis compared to non-gastroschisis pregnancies respectively. After adjusted analysis, women with gastroschisis pregnancies were not more likely to have FIOL (aOR 0.9, 95% CI 0.6-1.2) compared to those without gastroschisis. Among women who underwent CD, 79.4% (n=181/228) had a primary CD without a trial of labor despite being vertex.

CONCLUSION:

We did not find an association of intrapartum FIOL in gastroschisis pregnancies. Less than 15% of pregnancies with gastroschisis are complicated by FIOL despite having a higher rate and association with CD. Elective CD should be avoided in pregnancies with gastroschisis given the known maternal morbidity and lack of neonatal benefit.
Factors That Affect Weight Gain in an Obese Pregnant Population [16C]
Authors: Ratan Bani M. , Garbarino Abigail H. , Miao Di , Hollier Lisa M.
Published: April 2018

INTRODUCTION:

The 2009 Institute of Medicine guidelines recommend 11-20 pounds weight gain for pregnant women with BMI ≥30. This study examines factors that affect compliance with weight gain recommendations 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. Eligible women were non-smokers with a singleton full-term delivery that initiated care before 20 weeks. Linear and multinomial logistic regression analysis was used to compare gestational weight gain to demographic characteristics, nutritional education, participation in group prenatal care, and medical conditions.

RESULTS:

Inclusion criteria was met by 803 women, with mean weight gain of 21.8 pounds. In total, 162 (20%) gained weight within guidelines, 211 (26%) below, and 430 (54%) above. Controlling for pre-pregnancy BMI, multiparous women gained significantly fewer pounds then nulliparous women (19 versus 28, P<.001), with a greater proportion of multiparous women within the recommended guidelines (29% versus 16%, P<.001). In univariate analysis, patients that were married, had prior spontaneous preterm birth, or had chronic hypertension were associated with less weight gain, but none were significant after adjusting for parity. Race, nutritional education, and group prenatal care did not significantly affect weight gain.

CONCLUSION:

Interventions such as group prenatal care and nutrition visits do not significantly affect gestational weight gain in an obese, low-income population. Parity may be an important modifying factor in gestational weight gain. These findings may be useful for targeting policies aimed at attaining healthy weight gain based on parity.
A Prospective Randomized Study Assessing Cesarean Wound Infections Comparing Silver Dressings to Gauze Dressings [18C]
Authors: Connery Sheila , Louis Judette , Downes Katheryne L. , Odibo Linda , Raitano Olivia , Yankowitz Jerome
Published: April 2018

INTRODUCTION:

Topical antimicrobial dressings which contain silver are used to prevent infection in a wide range of surgical specialties. We sought to evaluate the impact of silver-plated dressings in reducing surgical site infections (SSI) after cesarean delivery.

METHODS:

A double blinded randomized control trial of women undergoing cesarean delivery was conducted. Participants were randomized to two arms: Silverlon dressing (Argentum Medical, Chicago, Illinois) or an identical appearing gauze wound dressing (placebo). The primary outcome was superficial SSI within 6 weeks after delivery. Univariable comparisons were completed with chi-square and Student t-tests. Adjusted odds ratios were estimated with logistic regression. P<.05 was considered significant.

RESULTS:

Among the 618 participants, superficial SSI occurred in 15 women (4.6%) receiving placebo and 14 women (4.3%) receiving the silver plated dressing. [Odds Ratio (OR) 1.06; (95% confidence interval (CI) 0.55-2.20; P=.86]. Overall, 95% of the cohort received a standard preoperative skin prep with chlorhexidine, and 85.6% received standard preoperative antibiotics for SSI prophylaxis. The two groups were similar in age (30±5 vs 31±5 years, P=.86), Body Mass Index, (36±8 vs 35±8.1kg/m2, P=.17), presence of any diabetes (15.4 vs 14.3%, P=.25), cesarean after labor (32.2 vs 31.7%, P=.89), presence of chorioamnionitis (5.2 vs 2.2%, P=.06), and operative time (56±20 vs 55±17 minutes, P=.49). After controlling for confounding variables, use of a silver impregnated dressing were not associated with reduced risk of superficial SSI [OR 1.2 (95% CI 0.46-2.20].

CONCLUSION:

Among women undergoing cesarean delivery, silver plated dressing was not associated with a decrease in SSI.
Adequate Weight Gain during Pregnancy by Pre-Pregnancy Body Mass Index: Who Gets It Right? [19C]
Authors: Williams Corrine M. , McDaniel Honour , Chavan Niraj R.
Published: April 2018

INTRODUCTION:

In 2009, the IOM issued new guidelines for gestational weight gain (GWG), based on pre-pregnancy body mass index (PPBMI). This study was conducted to understand who is currently meeting these recommendations, exploring sociodemographic characteristics.

METHODS:

Using 2015 vital statistics (birth) data collected by the National Center for Health Statistics, GWG was calculated using pre-pregnancy weight and delivery weight to determine inadequate, adequate, and excess GWG categories by PPBMI, per the new guidelines. Chi-square tests and multivariate logistic regression analyses were used to assess the 12-category GWG/PPBMI variable by age, race/ethnicity, education, marital status, insurance at delivery, WIC receipt, trimester prenatal care began and smoking status.

RESULTS:

Of 3,404,491 singleton deliveries with complete information on PPBMI and GWG, 3.6% were underweight, 45.2% were normal weight, 25.9% were overweight, and 25.3% were obese pre-pregnancy. Percentages of meeting the IOM guidelines ranged from 23.7% among obese women to 42.9% among underweight women; among obese women, 54.1% gained more than the recommended weight during pregnancy. All socio-demographic variables were significantly associated with not meeting the GWG recommendations. Compared to obese women who followed the recommendation, those who gained more were more likely to be younger [OR = 1.355 (95% CI: 1.317-1.394] and were less likely to have entered prenatal care in the first trimester [OR = 0.808 (95% CI: 0.787-0.829].

CONCLUSION:

In this study, GWG outside of the IOM recommendations was associated with key demographic risk factors. Additional resources may be needed to help these populations better achieve healthy weight gain during pregnancy.