bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Mode of Terbutaline Administration Improve Success of External Cephalic Version? [34I]
Authors: Razavi Armin , Iftikhar Pulwasha , Chan-Akeley Rosalyn , Skupksi Daniel
Published: May 2019

INTRODUCTION:

There is a high rate of cesarean delivery (CD) for breech presentation and external cephalic version (ECV) is a means to allow for vaginal delivery and thus reduce CD. Our primary objective was to compare the success rate of ECV with subcutaneous versus intravenous (IV) terbutaline.

METHODS:

This was a retrospective cohort of women with singleton fetuses ≥ 36 weeks of gestation undergoing ECV at our institution from May 2007-February 2018. Our protocol from 2007-2013 included a single dose of subcutaneous terbutaline (0.25 mg) followed by ECV. From March 2013 until February 2018, our protocol was a single dose of intravenous terbutaline (0.25 mg) prior to ECV attempt. Statistical analysis included Student t test, Mann-Whitney U, chi-squared and Fisher exact as appropriate. Logistic regression was used to determine which factors affected success.

RESULTS:

Of the 283 patients who underwent an attempted ECV, 111 received subcutaneous and 172 received IV terbutaline. The overall success rate was 65%. The success rate was 71% in the subcutaneous group vs 61.6% in the IV group (p=0.183). Lateral position of the fetal spine (p=0.02) and increasing AFI (p<0.005) were found to be predictive of success by logistic regression analysis. Maternal age, BMI, parity, placenta location, gestational age, head position, breech time and neonatal birth weight did not influence success.

CONCLUSION:

We did not find a difference in success rate of ECV when terbutaline was administered subcutaneously versus intravenously. We found that lateral fetal spine position and increasing AFI were independently associated with version success.
Early Versus Late Onset Preeclampsia: Maternal Characteristics and Severe Features [38I]
Authors: Beeraka Sridivya S. , Rincon Monica , Burwick Richard M.
Published: May 2019

INTRODUCTION:

Early Onset and severe preeclampsia contribute disproportionately to adverse pregnancy outcomes. It remains unclear which maternal characteristics and severe features are associated with early-onset disease. Therefore, we sought to compare specific severe features of early-onset preeclampsia (EOP) vs late-onset preeclampsia (LOP).

METHODS:

Retrospective cohort study among subjects with a diagnosis of preeclampsia (PET) that delivered ≥23 weeks gestation at a single institution (October'13-April'18). Subjects were identified by ICD-9 and 10 codes, followed by chart review to confirm diagnostic accuracy and stratified into two groups by gestational age: 1) EOP <34 weeks; 2) LOP ≥34 weeks. Maternal characteristics and severe features of preeclampsia were abstracted from charts. Data was analyzed by Chi-squared and t-test, and multivariable logistic regression, with α±=.05.

RESULTS:

Among 10,833 deliveries, 781 (7.2%) had PET. Of these, 102 (13.1%) had EOP and 679 (86.9%) had LOP. The following maternal characteristics were significantly more common in EOP: Black race (P=.001), multiple gestation (P<.001), chronic hypertension (P<.001), and diabetes mellitus (P=.001). After multivariable logistic regression, these remained independent risk factors for EOP, with Black race having the strongest association (OR 4.9, CI 1.6-15.4, P=.007). Remarkably, all severe features were more common in EOP. After multivariable regression, the severe features most strongly associated with EOP were: severe systolic blood pressure, aspartate transaminase > 70 U/L, severe headache, and creatinine >1.1 mg/dl.

CONCLUSION:

EOP is characterized by specific maternal and clinical features. Black women have a nearly 5-fold increase in the odds of EOP warranting further attention.
Effect of Labor Analgesia on Fetal Heart Tracing in Term Pregnancies: Nitrous Oxide Versus Epidural [40I]
Authors: Earhart Kimberly Rhea , Cuff Ryan D. , Hebbar Latha , Goodier Christopher , Mateus Nino Julio Fernando
Published: May 2019

INTRODUCTION:

The objective of this study is to determine whether the use of nitrous oxide (N2O) for analgesia is associated with fewer acute fetal heart rate (FHR) abnormalities than epidural analgesia.

METHODS:

This is a prospective cohort study of full-term singleton pregnancies in labor at the Medical University of South Carolina conducted after IRB approval. Women chose their method of analgesia. FHR tracings were compared pre and post analgesia between N2O and epidural groups. Independent investigators interpreted the fetal strips following the NICHD terminology. The primary outcome was acute changes in FHR tracing and the secondary outcomes include short-term maternal and neonatal outcomes.

RESULTS:

The cohort analysis included 68 patients including 19 women in the N2O group and 49 in the epidural group. There were no differences in baseline maternal demographics, parity, maternal BMI, or maternal medical comorbidities between the groups. Admission cervical dilation and membrane status (intact versus ruptured membranes) on admission were similar between the two groups. During the study period 29.4% of women using N2O and 57.4% of women using epidural for analgesia experienced negative acute changes in FHR (P=.04), defined as either a change from moderate or marked variability to minimal or absent, or from an overall Category I to a Category II or III FHR tracing. There were no differences in short-term maternal or neonatal outcomes.

CONCLUSION:

Based these findings, the use of N2O for analgesia during labor was associated with fewer acute FHR abnormalities than epidural analgesia and neither was associated with adverse short-term maternal or neonatal outcomes.
Technology-Driven Prenatal Screening Results Disclosure and Management [9J]
Authors: Arjunan Aishwarya , Ben-Shachar Rotem , Kostialik Jamie , Taber Katie Johansen , Denne Elizabeth , Haverty Carrie
Published: May 2019

INTRODUCTION:

Non-invasive prenatal screening (NIPS) and expanded carrier screening (ECS) have widened the scope of information available to patients and providers alike, underscoring the importance of timely results delivery. We describe an automated system utilizing online education and tele-genetic counseling to aid women's health professionals in effectively delivering genetic testing results.

METHODS:

Providers are notified upon availability of results. For ECS results indicating a high reproductive risk, patients receive an automated email directing them to schedule a consultation with a laboratory-based genetic counselor. Screen-positive NIPS results are delivered to the ordering provider, who may request that a laboratory-based genetic counselor contact the patient. All other results can be viewed directly by the patient in an online portal with educational resources. Regardless of result type, patients can speak to a genetic counselor, either on-demand or by scheduling an appointment. This study was IRB exempt.

RESULTS:

Through December 2017, 278,318 ECS results and 67,122 NIPS results were issued via the system. Of these, 41,050 patients (15%) ECS patients and 4,673 (7%) NIPS patients elected genetic counseling, resulting in a total of 47,793 consultations. A number of patients electing genetic consultations received negative results (∼50% ECS, 95% NIPS). Patients frequently utilized on-demand services (32% ECS, 70% NIPS). Median consultation duration times were ten minutes and nine minutes for ECS and NIPS results, respectively.

CONCLUSION:

We describe a system that can provide large-scale prenatal genetic testing results delivery, education, and counseling congruent with clinical guidelines; imperative to quality care as uptake grows among the obstetric population.
Opioid Utilization Following Endometriosis Diagnosis: Retrospective Analysis of More Than 100,000 Women [17J]
Authors: Estes Stephanie Jean , Soliman Ahmed M. , Johns Beverly , Lamvu Georgine
Published: May 2019

INTRODUCTION:

Endometriosis is a chronic gynecologic disorder associated with several pain symptoms. This research evaluated opioids utilization following endometriosis diagnosis.

METHODS:

Women aged 18 to 49 who had one inpatient or 2 outpatient claims with endometriosis ICD-9 or ICD-10 diagnosis codes (617.x or N80.x) between 2013 and 2016 were selected from Symphony Health Claims database. Study sample included women who were not diagnosed with cancer and had continuous medical and pharmacy plan eligibility (at least one pharmacy claim activity per quarter) in 12 months before and after their earliest recorded diagnosis for endometriosis (index date). Descriptive statistics were used to describe the following outcomes in the post-index period (12-months following index date): proportion of women receiving an opioid prescription, number of opioids prescriptions, days of opioids supply, prescriber specialty and opioid initiation and its relationship to receiving surgeries.

RESULTS:

Final analysis included 114,151 patients. Average age at index date was 36.7 (7.9) years. In the post-index period, 60.8% of patient received an opioid prescription. Among opioid users, mean number of opioids prescriptions received was 4.6 (6.7), average days of opioids supply was 64.1 (128.6) and the proportion of patients who received 90+ days of opioid supply were 18.1%. Top physician specialties prescribing opioids were Obstetrics/Gynecologists (27.6%), family practice (23.4%) and internal medicine (9.2%). Among opioids initiators (27%), 2.8% received 90+days of opioids supply and 75.7% had an endometriosis-related surgery in the post-index period.

CONCLUSION:

A significant proportion of women diagnosed with endometriosis used opioids following endometriosis diagnosis.
Transcervical Radiofrequency Ablation of Uterine Fibroids: US Experience From the SONATA Pivotal IDE Trial [22J]
Authors: Hudgens Joseph , Johns D. Alan , Lukes Andrea S. , Forstein David , Delvadia Dipak
Published: May 2019

INTRODUCTION:

The SONATA Pivotal IDE Trial was a prospective trial in the United States (US) and Mexico of the safety and effectiveness of transcervical radiofrequency (RF) ablation for symptomatic uterine fibroids. This is a subanalysis of the US cohort (125 patients at 21 centers).

METHODS:

Transcervical RF ablation with the Sonata® System was performed on eligible patients with symptomatic fibroids. The 12-month co-primary endpoints were reduction in menstrual blood loss and freedom from surgical reintervention. Symptom severity, quality of life, satisfaction, safety and reductions in fibroid volume were also evaluated.

RESULTS:

125 patients were enrolled in the US cohort. Both co-primary endpoints were met: 65.3% of patients reported ≥50% reduction in menstrual bleeding and 99.2% of patients were free from surgical reintervention. 95% of patients reported reduced menstrual bleeding at 12 months. Significant mean improvements were realized in both symptom severity and health-related quality of life (33.8 points and 45.8 points, respectively; all P<.0001). Mean maximal fibroid volume reduction per patient was 63.8%. There were no device related adverse events. Mean length of stay was 2.5 hours and 50% of patients returned to normal activity within 1 day. Symptom improvement was noted by 97.4% of patients and 98.3% were satisfied, both at 12 months.

CONCLUSION:

Results for US patients in the SONATA Pivotal IDE Trial were identical to, or exceeded, those from the binational cohort. These results support the efficacy and safety of the Sonata System as a new treatment standard for women affected by symptomatic uterine fibroids.
5% Monolaurin Vaginal Gel for the Treatment of Bacterial Vaginosis: A Randomized, Placebo-Controlled Trial [23J]
Authors: Mancuso Abigail Catherine , Widdice Lea , Hughes Brenna L. , Stockdale Colleen K. , Bernstein David , Winokur Patricia
Published: May 2019

INTRODUCTION:

Bacterial vaginosis (BV) is the most common cause of abnormal vaginal discharge and standard medical treatment is associated with a high recurrence rate. Monolaurin has antimicrobial effects on vaginal pathogens without affecting lactobacilli sp. We assessed the effectiveness and safety of 5% Monolaurin vaginal gel for treatment of BV.

METHODS:

This multicenter, double-blinded, randomized trial compared 5% Monolaurin vaginal gel to vehicle placebo gel self-administered twice daily for three days. Healthy, non-pregnant, non-breastfeeding women ages 18 to 50 with BV diagnosed by Amsel criteria were enrolled and randomized 2 to 1 (Monolaurin to placebo). The Modified Intent To Treat (mITT) population had Nugent Scores ≥4. Clinical efficacy was defined as resolution of all four Amsel Criteria and therapeutic cure as Nugent Score ≤ 3. Solicited urogenital symptoms and adverse events were collected.

RESULTS:

109 women participated, with 73 randomized to treatment arm and 36 to placebo arm. Although lactobacilli sp. counts increased in the Monolaurin group compared to placebo (1.0x10^7 vs -5.2x10^6), there was no significant difference in achieving clinical cure (P=.42) or therapeutic cure (P=.99) with only 17% of the Monolaurin group and 25% of the placebo group achieving clinical cure, and only 3% of both groups achieving therapeutic cure (mITT population). There was no difference between groups in solicited urogenital symptoms (P=.24) and all were mild to moderate in nature. No serious adverse events were reported.

CONCLUSION:

Short course 5% Monolaurin was well tolerated but no more effective than placebo in curing BV; however, longer courses should be evaluated.
Potential HPV Vaccine Coverage According to Type Specific Papillomavirus Present in Open Population in Mexico [26J]
Authors: Tiran-Saucedo Jose , Garza Humberto , Leon Yvette , Godinez-Burgos Jesus Alfonso
Published: May 2019

INTRODUCTION:

HPV genotyping is an essential tool for screening of patients with potential risk of developing cervical cancer. Information on the prevalence of genotypes of HPV in Mexico is still limited. The purpose of the study was to evaluate the usefulness of different vaccines against HPV by identifying the most prevalent serotypes in our population.

METHODS:

The study was conducted at the Mexican Institute of Infectious Diseases, Gynecology and Obstetrics in Monterrey, Mexico. The kits used were Innolippa HPV Genotyping Extra I and II, Linear Array HPV Genotyping Test, Seeplex HPV 18 ASE DPO and Abbot Real Time. Patients from 2008 to 2018, who requested an HPV test and patients with positive HPV infection were included.

RESULTS:

We included 816 samples, 524 positives for HPV infection. A total of 957 serotypes were isolated, of which 56.2% are high risk serotypes, 11.7% of probable high-risk, 28.5% low risk and only 3.55% could not be typed. The most prevalent high-risk serotypes were HPV-16 (8.78%), HPV-51 (8.67%), HPV-52 (7.84%), HPV-33 (7.75%), HPV-31 (5.54%). The most prevalent low risk serotype was HPV-6 (6.79%). The coverage of the different types of vaccine was determined according to the serotypes found.

CONCLUSION:

We found that of the first 6 most prevalent serotypes, 5 are high risk and 1 low risk, and of those 5 are included in the HPV9 vaccine, confirming a greater strategic benefit over the other vaccines available to reduce the risk of cancer caused by HPV in our country.
Results of Comprehensive Sexually Transmitted Disease Testing Utilizing an At-Home Kit Over One Year [27J]
Authors: Francis Marra Stankus , Ashley Kristin , Bruno Trudie
Published: May 2019

INTRODUCTION:

This data set review examined rates of positive sexually transmitted disease (STD) results in women utilizing a consumer-initiated, self-collected STD kit over a twelve-month period.

METHODS:

De-identified data was obtained using SQL queries of EverlyWell's® database for women who took a Women's STD Panel Test from September 2017 through September 2018. A total of 1,003 tests were resulted from 951 unique women, 1 test was excluded for inadequate specimen, and 1,002 tests were analyzed in this study. Age range for this data set is 18 to 76.

RESULTS:

Overall, 21% of women received at least one positive STD result and 1.7% received more than one positive result. The most common STD resulted was Herpes Simplex Type 2 at 17% followed by Chlamydia trachomatis at 3.2%. The largest age group utilizing this platform for testing was 25 to 29 years, 23% of total tests taken. The highest proportion of positives within a single age group was found in 55 to 59 years, 54% of the total women in that group.

CONCLUSION:

In a single review of 1002 at-home STD panel test results, approximately 1 out of 5 women screened positive for at least one STD. At-home STD testing may allow women who would otherwise potentially be under-screened for a variety of reasons, such as age, to easily manage their sexual health testing. Self collected STD testing can easily be utilized by women of all ages to identify infections and seek care between routine gynecological visits.
Are OB/GYN Residents Receiving Adequate Training for Shoulder Dystocia? [29J]
Authors: Choi Jennifer , Mehta Shobha , Bell Theodore , Gherman Robert Brian
Published: May 2019

INTRODUCTION:

Data are lacking to determine whether residents are competent to manage shoulder dystocia, as the ACGME does not track this condition. We sought to ascertain whether OB/GYN residents felt that they had received adequate training to independently handle shoulder dystocia.

METHODS:

A 25-question web-based survey was electronically disseminated to program directors of all accredited US OB/GYN residency programs. The survey was sent four times on a weekly basis. A Likert scale was used to query the residents with regards to clinical and didactic training experience. Survey monkey and IBM SPSS Statistics were used to analyze the responses.

RESULTS:

Nearly all (97%) of the 116 residents who responded had received formal lecture training and underwent simulation drills (87%), and most (89%) felt that they had received appropriate didactic training. 64% of residents had participated in < 10 total cases of shoulder dystocia. Only 51.7% and 48.3% agreed that they could currently independently perform delivery of the posterior fetal arm and fetal rotational maneuvers, respectively. Approximately half of residents (47%) responded that they had never independently managed a shoulder dystocia from start to finish. Slightly more than one third of residents strongly agreed that after completion of residency training they would feel comfortable independently managing a shoulder dystocia.

CONCLUSION:

Residency programs have incorporated simulation and didactic lectures into shoulder dystocia teaching. This does not appear to have translated into clinical competence in handling this obstetrical emergency.
Characterization of Mobile Applications for Patient Participation in Prenatal Care [33J]
Authors: Garchar Elizabeth , Quiner Trevor Elisha , Rayburn William
Published: May 2019

INTRODUCTION:

There is great potential for obstetricians to educate and engage patients in using pregnancy-related mobile applications (apps). However, there is no standard method to evaluate the hundreds of applications currently available to identify accurate and complete apps for use prenatally.

METHODS:

We developed a method to systematically search and characterize the primary function of each pregnancy-related app from the Apple App Store. When present, the abilities of each app to allow data entry associated with specific monitoring tasks were listed. Consumer rating of each app, integration of social media, and cost were noted for each app.

RESULTS:

This search resulted in 915 patient-directed apps for use in pregnancy-of which one-third (321, 33.8%) had functions that permitted patient participation in prenatal care through monitoring specific tasks. These apps included the following monitoring functions: fetal movement (74, 8.1%), weight gain (208, 22.7%), contractions (95, 10.4%), diabetes (18, 2.0%), prenatal care (129, 14.1%), and blood pressure (28, 3.1%). Many apps (63, 6.9%) combined multiple monitoring functions with educational material which we characterized as “all-in-one” pregnancy apps.

CONCLUSION:

Obstetricians can use appropriately evaluated mobile apps to encourage patient participation in prenatal care through personalized, self-directed monitoring between prenatal visits. This allows for prospective information gathering and may aid in facilitating shared decision-making and individualized care. This report gives obstetricians an awareness of available apps and their functions, and provides a novel characterization framework for future evaluation of mobile apps. We intend to evaluate the “all-in-one” pregnancy to identify those best suited to introduce to patients.
Clinical Utility of Expanded Carrier Screening: Actionability and Outcomes [35J]
Authors: Taber Katie Johansen , Beauchamp Kyle , Lazarin Gabriel , Arjunan Aishwarya , Goldberg Jim
Published: May 2019

INTRODUCTION:

Expanded carrier screening (ECS) facilitates reproductive and pregnancy management, such as in vitro fertilization (IVF) with preimplantation genetic testing (PGT) and prenatal diagnosis. Here, we describe the impact of ECS results on planned and actual pregnancy management in the largest sample of at-risk couples (ARCs) studied to date.

METHODS:

Couples who elected ECS and were found to be at high risk of having a pregnancy (ARCs) affected by at least one of 176 genetic conditions were invited to complete a survey about the impact of ECS results on planned and actual pregnancy management.

RESULTS:

391 ARCs completed the survey. 77% of ARCs who received results before they were pregnant reported that they altered or were planning to alter pregnancy management to reduce the risk of an affected pregnancy, including IVF with PGD, use of donated gametes, adoption, avoidance of pregnancy altogether, and prenatal diagnosis if/when they became pregnant. 37% of ARCs who received results while they were pregnant elected to undergo prenatal diagnosis. Approximately one-third of pregnancies were found to be affected, and 42% of affected pregnancies were terminated. Among all ARCs, 166 pregnancies occurred subsequent to receiving ECS results; 35% of these pregnancies were achieved through IVF with PGT. Prenatal diagnosis was pursued in approximately 30% of pregnancies, with 29% of these pregnancies found to be affected and 75% of affected pregnancies terminated.

CONCLUSION:

ECS results impacted couples' reproductive decision-making and led to altered pregnancy management that reduced the risk of an affected pregnancy.
Age-Based Interpretation of Anti-Mullerian Hormone (AMH) Levels in Non-infertile Women [37J]
Authors: Maslow Bat-Sheva L. , Guarnaccia Michael , Hennessy Dayna , Klein Joshua U.
Published: May 2019

INTRODUCTION:

Data related to AMH levels in non-infertile women are scarce, making interpretation for this population difficult. We aimed to characterize age-based AMH levels in a non-infertile population to simplify interpretation of AMH results. This study represents the largest analysis to date of AMH levels in non-infertile women.

METHODS:

This retrospective cohort study includes all women undergoing fertility assessments at Extend Fertility Medical Practice, a large oocyte cryopreservation practice, from 3/1/2016 to 9/30/2018. The study was granted IRB exempt status. AMH levels were abstracted from electronic medical records. AMH levels were measure by an independent laboratory using the Gen-II ELISA platform. To simplify clinical interpretation of AMH levels, age was categorized according to the Society for Assisted Reproductive Technologies standard. Association between age and AMH was made using Kruskal-Wallis.

RESULTS:

2623 subjects were included in the study. AMH was inversely associated with age (P<.0001). Median [IQR] AMH values by age group were as follows: <30; 2.91 [1.79-4.82] ng/mL (n=107); 30-34; 2.42 [1.38-4.22] ng/mL (n=770); 35-37; 2.03 [1.14-3.54] (n=937); 38-40; 1.50 [0.77-2.69] (n=570); 41-42; 0.92 [0.32-2.19] (n=137); >42; 0.59 [0.25-1.2] (n=101).

CONCLUSION:

Accurate representation of physiologic AMH ranges in non-infertile women is a critical element of counseling women regarding their reproductive goals. Median AMH levels in our population were generally lower than prior published reports and more likely represent physiologic levels. Data from infertility cohorts may be confounded by anovulatory subjects with preferentially higher AMH levels. Additional studies are needed to assess what thresholds in each age group constitute a pathologic AMH level.
Insomniacs in Late Pregnancy are Clinically Depressed: Exploring the Role of Nocturnal Rumination [1K]
Authors: Kalmbach David A. , Castelan Andrea Cuamatzi , Atkinson Rachel , Sangha Roopina , O'Brien Louise , Drake Christopher L.
Published: May 2019

INTRODUCTION:

Depression afflicts 13% of pregnant women. Insomnia complaints often increase across pregnancy. As insomnia often triggers depression, women with insomnia in late pregnancy may be at high depression-risk. Cognitive-emotional dysregulation is thought to underlie both insomnia and depression. We proposed nocturnal rumination (negative repetitive thinking in bed at night) to be a key form of cognitive-emotional dysregulation linking these disorders.

METHODS:

A cross-sectional analysis of women (29.6±4.7 years) in late pregnancy (gestational weeks 26-33) receiving prenatal OB care at a large Midwestern health system completed online surveys of insomnia, depression, and nocturnal rumination. This study was IRB-approved.

RESULTS:

Of 163 women, 59.5% of women endorsed clinical insomnia. Women with insomnia reported greater depression than good sleepers (t=4.93, p<.001). A higher proportion of insomniacs were depressed (24.7%) compared to 4.5% of good sleepers (chi-squared=11.59, p<.001). Insomniacs also reported higher nocturnal rumination than good sleepers (t=6.59, p<.001). Importantly, nocturnal rumination appeared to amplify the depressogenicity of insomnia such that 36.1% of insomniacs with high rumination were depressed compared to just 5.6% of insomniacs with low rumination (chi-squared=27.20, p<.001). Indeed, ruminating insomniacs were at 26.51-fold greater odds for depression than good sleepers without rumination (p<.01). Pregnant women with insomnia or nocturnal rumination alone were not at elevated depression-risk.

CONCLUSION:

Insomniacs in late pregnancy endorse high rates of depression. Nocturnal rumination may amplify depression-risk in these women. Assessing insomnia and stress in routine prenatal care may allow opportunity for prevention or early intervention of perinatal depression through the timely deployment of treatments improving sleep and stress management.
A Retrospective Look at Fetal Growth Restriction at St. Damien Hospital in Haiti: Neonatal Outcomes [3K]
Authors: Buckley Ayisha , Persad Malini D. , Milone Gina F. , Pardo Christina , Davilmar Inolson , Garretto Diana J.
Published: May 2019

INTRODUCTION:

Haiti is impoverished and stricken by malnutrition and adverse pregnancy outcomes. Characterization of pregnancies complicated by fetal growth restriction (FGR) has not been performed in Haiti. We sought out to characterize the outcomes of pregnancies complicated by FGR in Haiti.

METHODS:

IRB-approved, retrospective cohort study from January 2017 to May 2017 of all deliveries at St. Damien Hospital. FGR was defined as <10%ile estimated fetal weight for gestational age. Charts were documented in French. A French and Creole-speaking provider translated charts and collected data. No patients were excluded. Parametric and non-parametric statistics were used to analyze the data with P-value of <0.05.

RESULTS:

423 charts were reviewed. 8 cases (1.89%) of FGR were identified. There were no differences in maternal demographics. Patients with FGR were more likely to have preeclampsia with severe features (50% vs. 14% P=.02). FGR neonates were more likely to deliver preterm (average gestational age 32.8 weeks, vs. 37.6 weeks, P<.001), and have 5-minute Apgars <7 (37.5% vs. 8.9% P=.03). Only 87.5% of FGR neonates were classified as small for gestational age (SGA) (P<.001).

CONCLUSION:

This was the first study to evaluate FGR in Haiti. FGR neonates were more likely to deliver preterm, be SGA, and have lower Apgar scores. Due to poor documentation and inability to locate charts, long-term neonatal outcomes were not tracked. In the future, standardized patient charts and linking infant and maternal charts may help to better assess these variables. This study provides novel insight into characteristics of FGR in the Haitian population.
Evaluation of Racial Differences in the Quantity of Disialyllacto-N-tetraose (DSLNT) in Human Breast Milk [2O]
Authors: Dimoff Megan Bloomeyer , Miller Richard Charles , DiSabatino Daniel Justin , Falcone Bianca Anjelica , Hassinger Denise
Published: May 2019

INTRODUCTION:

Premature infants are at risk of developing a diverse array of diseases and health problems. Breast milk seems to be protective against neonatal diseases such as necrotizing enterocolitis (NEC), a disease characterized by damage to the infant's intestinal tract. In the US, NEC is more common in African American infants compared to every other ethnicity. One protective factor seems to be oligosaccharides, specifically disialyllacto-N-tetraose (DSLNT). Therefore, this study examined the effect of ethnicity on DSLNT levels.

METHODS:

Breast milk was collected from 130 breastfeeding mothers that delivered term infants from day of delivery out to 338 days postpartum. Mothers self-reported their race. Breast milk was processed and analyzed by LC/MS (ESI-Q-TOF) to determine DSLNT concentrations. Primary unadjusted analysis was a two-sample t-test. Adjusted analysis by ANOVA (adjusting for days of lactation) with self-reported ethnicity dichotomized to African American or Other. IRB approval was obtained for this study.

RESULTS:

Self-reported race identified 66 African Americans and 64 individuals of other races in our study population. When adjusting for day of lactation, race did not have a significant effect (p-value=0.5770) on DSLNT content in term milk.

CONCLUSION:

DSLNT may be an important human milk oligosaccharide in preventing devastating neonatal disease. Although past studies have postulated that geographical differences in the oligosaccharide may exist, our study did not identify racial differences in the oligosaccharide in the breast milk of term neonates at our center.
Exosome Profiles for Normal and Complicated Pregnancies—A Longitudinal Study [3O]
Authors: Nakahara Angela , Elfeky Omar , Garvey Cathryn , Guanzon Dominic , Longo Sherri Anne , Salmon Carlos
Published: May 2019

INTRODUCTION:

Exosomes are small nanovesicles which play a key role in cell-to-cell communication during pregnancy by transferring bioactive molecules to other cells and modifying their biological functions. Little is known about the changes in the concentration of circulating exosomes throughout gestation in normal and complicated pregnancies.

METHODS:

A prospective cohort of patients approved by IRB was recruited during pregnancy and retrospectively stratified based on normal (n=30), gestational diabetes mellitus (GDM) (n=10) and preeclampsia (PE) pregnancy outcomes (n=15). Total exosomes and specific placental-derived exosomes (PdE) were determined by Nanoparticle Tracking Analysis using quantum dots coupled with CD63 or PLAP antibodies. Linear mixed modeling was performed on normalized total and PdE across gestation using the lme4 package in R. Using likelihood ratio tests, statistically significant differences were found in exosome concentration across gestation.

RESULTS:

Significant factors contributing to variations in total and PdE were gestational age and pregnancy outcomes (ANOVA, p<0.05). Post-hoc analyses established that PdE concentrations increased during gestation in normal, GDM and PE pregnancies. The increase was significantly greater in GDM and PE compared with normal pregnancies. Our linear mixed modeling analysis showed that PdE increased ∼2.1-fold in PE and GDM compared to normal through gestation. Interestingly, maternal BMI, glucose concentration and fetal weight significantly affect the concentration of PdE across gestation.

CONCLUSION:

This study provides evidence of the changes exosomes present in maternal circulation across gestation, suggesting that exosomes may be involved in maternal metabolic adaptation to pregnancy. Further, exosomes can be an early predictor of adverse outcomes, including GDM and PE.
Introduction of a Novel Tool in the Management of Postpartum Hemorrhage [8O]
Authors: Miller Whitney , Hanson Sarah Jean , Groen Reinou Sybrecht
Published: May 2019

INTRODUCTION:

Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality. A standardized approach to PPH can decrease the impact of this obstetric emergency. Simulation-based team training addresses response to medical or obstetrical emergencies. Tools such as algorithms can facilitate teamwork leading to more effective communication and performance.

METHODS:

The authors WM and RSG are part of a PPH committee at the Alaska Native Medical Center. They developed an algorithm (HEART) consisting of 5 team actions in response to PPH: (H) Help, (E) Equipment, (A) Assessment, (R) Resuscitation, and (T) Treatment. The algorithm was tested in simulation scenarios. Pre and post simulation evaluations and feedback on the algorithm were obtained.

RESULTS:

A total of 18 care givers were included in the simulation training in August 2018 and 15 completed training evaluations of the HEART tool (response rate 83%). The responses indicated that there was an increased confidence to manage PPH, (1) as a team 15% increase (from 60 to 69 points), (2) being part of a team 25% increase (from 55 to 69 points) and (3) 25% increase of confidence in actual role you have in the team to manage PPH (55 to 69 points).

CONCLUSION:

The HEART algorithm for PPH management is a team-based tool that aims to improve response of this common obstetric emergency. The HEART tool was found to be helpful in simulated scenarios. More study is needed in actual PPH events to determine tool effectiveness in improving communication, teamwork and outcome.
Monosomy X and Parental Origin of the Retained X Chromosome in Pregnancy Loss [11O]
Authors: Font Guillermo , Pombar Xavier F. , Maisenbacher Melissa
Published: May 2019

INTRODUCTION:

To evaluate the origin of the retained X chromosome using SNP microarray in patients with monosomy X presenting with pregnancy loss. Monosomy X is a one of the most common sex chromosome anomalies found in pregnancy loss, as a result of missing X chromosome in the sperm or egg of a parent. Parental origin of the X chromosome may influence future reproductive decisions for the couple. Studies using SNP microarray have not been done to evaluate the parental origin of the retained X chromosome in patients with pregnancy loss found to have Monosomy X.

METHODS:

Miscarriage specimens from 35,615 losses shipped with maternal blood samples were sent to a single reference laboratory for cytogenetic analysis. Genotyping was performed using Illumina CytoSNP-12b microarrays and informatics.

RESULTS:

Fetal results were obtained in 30,755 cases (86.4%). Abnormal findings were identified in 17,725 fetal cases (57.6%). Of those, Monosomy X was present in 1605 cases (9.1%). The parental origin of the missing X chromosome was paternal in 1251 cases (78%) and maternal in 354 cases (22%).

CONCLUSION:

In our cohort the parental origin of the missing X chromosome was paternal in 78% of cases and maternal in 22%, which is similar to previously published estimates in live born cohorts ranging from 60-80%, but different than one study in miscarriage which had a more equal ratio of parental origin. The relationship between parental origin in pregnancy losses with Monosomy X requires further study.
Sequencing-Based Carrier Screening for Cystic Fibrosis: Ready for Prime Time? [16O]
Authors: Beauchamp Kyle , Grauman Peter , Spurka Lindsay , Lim-Harashima Jeraldine , Muzzey Dale
Published: May 2019

INTRODUCTION:

Medical-society guidelines recommend offering carrier screening for cystic fibrosis (CF) to all women who are considering pregnancy or already pregnant. Recommended screening tests for 23 common variants, but this targeted-genotyping approach may fail to detect some at-risk couples. Here we evaluate whether a sequencing-based workflow achieves sufficient sensitivity and specificity-both analytically and clinically-to improve screening for CF.

METHODS:

Informed consent and IRB exemption for anonymized research were obtained for this study. Analytical validity was assessed using orthogonal confirmation and reference cell-line samples. Clinical validity was evaluated using concordance to the CFTR2 variant database. Finally, clinical impact (e.g., incidence) was assessed using a cohort of >100,000 screened patients (>15,000 couples). Three screening strategies were compared: genotyping of 23 ACMG common variants (“CF23”), sequencing all single nucleotide variants (SNVs) and short insertions or deletions (“indels”) in CFTR exons (“NGS”), and sequencing with copy-number variant (CNV) identification (“NGS+CNV”).

RESULTS:

Analytical accuracy of NGS+CNV was 100% for SNVs, indels, and CNVs. Among variants present in both the Counsyl and CFTR2 databases, interpretive clinical specificity was 99.4%. As compared to CF23 genotyping, NGS-based screening showed increased detection rate: of the 67 at-risk couples identified with NGS+CNV, 19 would have gone undetected in a CF23 genotyping-only regimen.

CONCLUSION:

Modern NGS, coupled with standardized variant interpretation processes, now enables the accurate implementation of CF screening based entirely on a sequencing platform. Limiting screening to 23 variants will fail to detect approximately 30% of affected pregnancies in the United States, particularly among patients who are not of Ashkenazi Jewish descent.
Value of the Continued Use of the Hexosaminidase A Enzyme Assay for Reproductive Carrier Screening [21O]
Authors: Yu Chunli , Liao Jun , Gross Susan , Chen Hongjie , Edelmann Lisa , Kornreich Ruth
Published: May 2019

INTRODUCTION:

With the trend towards next-generation screening (NGS) for reproductive carrier screening, the value of Hexosaminidase A (HexA) enzyme assays for detecting Tay-Sachs Disease (TSD) and Sandhoff Disease (SD) carriers has been debated.

METHODS:

Results were analyzed for 27,121 individuals of varied self-reported ethnicities who underwent clinical Hex A enzyme testing as well as HEXA/HEXB NGS.

RESULTS:

481 TSD enzyme carriers were identified, of which 55% could be attributed to HEXA pathogenic (P)/likely pathogenic (LP)/pseudodeficiency (PD) variants, with Ashkenazi Jews and African Americans giving the highest and lowest collective yields, respectively. Of 186 identified SD enzyme carriers, 39% could be attributed to HEXB P/LP/PD variants, with Asians and Ashkenazi Jews giving the highest and lowest yields, respectively. The rate of HEXA variants of uncertain significance (VUSes) in TSD enzyme carriers was 11%, which is 5.4X higher than the rate in individuals with normal enzyme levels. For HEXB VUSes, the rate of 34% in SD enzyme carriers was 12.3X higher than in individuals with normal enzyme levels. 30% of TSD and 22% of SD enzyme carriers did not show P/LP/PD variants or VUSes, a phenomenon that may be explained by benign variants with in vitro effects and/or other variants not uncovered by the NGS testing platform.

CONCLUSION:

Until the majority of VUSes are reclassified and additional sources of variation in the HEXA/HEXB genes are explored, there remains a role for Hex A enzyme assays in the identification of putative carriers and TSD/SD detection rates will remain higher for tests that include enzyme analysis.
Variants of INSR rs2963 is Associated With Gestational Diabetes Mellitus and Iron Storage [22O]
Authors: Liu Junxiu , Cheng Yan , Zhang Qingying , He Mulan , Li Tingting , Cheng Haidong
Published: May 2019

INTRODUCTION:

Gestational diabetes mellitus (GDM) was found to be related with iron status, since GDM was a gene related disease, our goal was to find susceptible single nucleotide polymorphisms (SNPs) that related with GDM and iron overload.

METHODS:

We chose 99 pregnant women with GDM and 114 normal glucose tolerance women as controls. We used Haploview software to screen the SNPs that may have stronger correlation with GDM, the SNPs of SLC2A4 (GLUT4), INSR, IRS - 1, AKT1 genes, and Tag SNPs genotype of GDM group and normal glucose tolerance group were detected by MassArray technology. The differences of genotype and allele frequency between GDM and NGT group were compared, and the correlation of SNPs with iron metabolism and GDM were analyzed.

RESULTS:

The level of serum ferritin is significantly higher in GDM group than control (25.7 (25.75) ng/ml vs 18.5 (17.74) ng/m p<0.001). There was significant difference between GDM and control for INSR gene rs2963, CT model of rs2963 was risk factor of GDM (OR 11.42, 95% CI 1.42-91.89, p=0.022, while adjusted OR 9.47, 95% CI 1.13-79.04, p=0.04). The dominant model CT+TT was risk factor of GDM (OR 12.7, 95% CI 1.60-101.05, p=0.016, while adjusted OR 10.32, 95% CI 1.25-84.95, p=0.03).Serum ferritin level in dominant model CT+TT was higher than that in CC genotype, 41.89 (32.76) ng/ml vs 19.22 (20.55) ng/ml, p=0.001.

CONCLUSION:

Iron storage level is higher in GDM than control group, INSR loci rs2963 C>T was a risk factor for GDM, and for iron supplementation the dominant model CT+TT women would be more likely to develop GDM.
Changes in Length of Stay and 30-Day Readmission Rates After Starting an Advanced Surgical Recovery Program [24O]
Authors: Manahan Kelly J. , Seeley Neil , Geisler John Patrick
Published: May 2019

INTRODUCTION:

Advanced surgical recovery programs have been initiated at many institutions to improve quality and enhance patient safety. The objective of this study was to determine if length of stay in days (LOS) and 30-day readmission rates changed after commencing the program.

METHODS:

Medical records were examined for the last 50 patients before and first 75 patients after the beginning of the program undergoing radical complete debulking for ovarian cancer. No patients using opioids before surgery were included. No patients were knowingly excluded. Demographics, length of postoperative stay in days (LOS) and 30-day readmission rates at any hospital were collected. Two-tailed statistical tests were employed. IRB approval was either obtained or waived for the study.

RESULTS:

The mean age and BMI of the pre- (50.2 years (95% CI 47.5-52.0); 29.7 kg/m2 (95% CI 28.6-30.9) and post-program start (51.5 years (95% CI 49.6-53.4); 31.1 kg/m2 (95% CI 30.2-31.9) were not significantly different. There were no differences in radical procedures required for complete cytoreduction between the groups including bowel resections, diaphragm stripping/resection, liver wedge resections or splenectomies. Mean LOS decreased from 7.1 days (95% CI 5.9-8.3) to 2.6 (95% CI 2.6-2.8). Similarly, the readmission rate at 30-days decreased from 14% to 0% (P<0.001).

CONCLUSION:

When employed in the care of patients with ovarian cancer undergoing complete cytoreductive surgery, advanced surgical recover programs can decrease LOS without increasing 30-day readmission rates.
Pan-Cancer Panel Testing: Variation in Testing and Results by Ancestry [27O]
Authors: Chalas Eva , Cummings Shelly , Larson Katie , Adkins Royce Terrell
Published: May 2019

INTRODUCTION:

Multi-gene panels and reduced costs have allowed for greater access to hereditary cancer genetic testing. Here we assess ancestry-based differences in testing practices for individuals with and without a personal history.

METHODS:

Clinical information was obtained from provider-completed test request forms for women who had pan-cancer panel testing from 2013 to 2018 (N=427,864). The proportion of patients with a pathogenic variant (PV), family cancer history, and age at testing were evaluated for the four most common ancestries in this cohort (White/non-Hispanic, Hispanic/Latino American, Black/African, Asian). Analyses were performed separately based on personal cancer history (affected, unaffected).

RESULTS:

65.5% of individuals were unaffected (White, 64.2%; Black, 65.6%; Hispanic, 67.4%; Asian, 54.7%). Although positive rates were higher among affected individuals (9.2% to 11.5%), a substantial proportion of unaffected individuals had a PV (White, 5.2%; Black, 3.7%; Hispanic, 4.6%; Asian, 4.9%). Regardless of ancestry, family history of cancer was more common among unaffected individuals (99.0 to 99.4%) compared to affected individuals (71.2 to 91.0%). Affected women were older than unaffected women at the time of testing in the full cohort (53.2 vs 41.9 years, P<.0001) and among PV carriers (51.9 vs. 40.0 years, P<.0001). Affected, Hispanic women were the youngest at testing.

CONCLUSION:

These data demonstrate that obtaining a family cancer history for unaffected women is critical to identifying those at increased risk of carrying a PV in a cancer-predisposition gene, regardless of ancestry. The older age at testing observed for affected women may also suggest missed opportunities for earlier testing and subsequent intervention.
LARC: Looking At Retention of Contraception [2P]
Authors: Sandsmark Emilee K. , Garcia Christian , Mercer Laura , Addis Ilana
Published: May 2019

INTRODUCTION:

The American College of Obstetricians and Gynecologists (ACOG) recommends LARC use as first line for all reproductive aged women who desire contraception, including women that are in the immediate postpartum period. There are no studies that describe the preference of Arizona women to use LARC during the immediate postpartum period and their ability to obtain their preferred contraception.

METHODS:

This was a prospective cohort study that used postpartum phone surveys at 2, 6 and 12 months to inquire about postpartum follow up compliance, contraception choice at time of delivery, and ability to achieve and maintain their method of choice.

RESULTS:

79 patients were recruited at Banner University Medical Center Tucson. During their delivery hospitalization, 49% expressed desire for a LARC. 28% received a LARC, 41% definitively did not receive one, and 31% were lost to follow up. Of those not using a LARC at follow up, only 43% were using an effective method. In those who had at least one follow up call, the pregnancy rate was 9 percent (n=5). 4 pregnancies were unintended, and 3 of these patients had desired a LARC but did not receive one. 76% of all patients reported contraception counseling prior to delivery hospitalization. Individuals who received pre-delivery discussion were twice as likely to desire a LARC at time of delivery.

CONCLUSION:

Far more individuals desire LARC than those who receive LARC. Even women who are strongly motivated to avoid pregnancy are at risk of unplanned pregnancy within the first year after delivery.