bluuebunny/crossref_metadata_2025 huggingface dataset:
Change in Shock Index as a Predictor of Transfusion Requirement [07M]
Authors: Schmidt Aidan , Wells Matthew , Hoffman Eva , Ramani Sangeeta , Kunzier Nadia , Vintzileos Anthony
Published: April 2020

INTRODUCTION:

Early identification of PPH is difficult. Shock index (SI) (SI=HR/SBP) of (>0.9) has demonstrated good prediction of PPH, and identify identification of patients requiring massive transfusion. Our objective is to determine if there is a change in SI on admission to postpartum or at time of transfusion after which there is an increased transfusion requirement or morbidity.

METHODS:

IRB approved, retrospective cohort of patients who received blood transfusion at a University based hospital, 2017-2018. SI calculated; at time of admission, after delivery, and prior to transfusion. Patients with invasive carcinoma, with fetus of non-viable gestational age, and incomplete charts were excluded. Spearman correlate coefficient, univariable logistic regression, and ROC analyses were performed.

RESULTS:

160 patients; 117/160 (73%) delivered by cesarean, 37/160 (23%) vaginally, and 6/160 (4%) operative vaginal delivery. Mean admission hemoglobin was 10.8 (± 1.5). Median EBL was 1320 mL (250-6000 mL). 77/160 (48%) of patients received 2 units of PRBC, 26/160 (17%) received 3 units of PRBC, 24/160 (15%) received 4 units of PRBC and 33/160 (20%) received ≥5 units of PRBC. Change in SI from admission to postpartum had a correlation coefficient of 0.022 and a P value of .78. Change in SI from admission to pre-transfusion had a correlation coefficient of 0.128 and a P value of .11.

CONCLUSION:

Changes in SI from admission to immediately postpartum or pre-transfusion do not show any correlation or predictive value for increasing morbidity, or transfusion requirements. This demonstrates change in SI is a poor predictor of morbidity and transfusion requirements.
Does Hemorrhage Risk Stratification Correlate With Need for Intervention and Subsequent Maternal Morbidity? [13M]
Authors: Chu Tina , Rodriguez Aldeboran N. , Kleinmann Whitney , Patel Shivani R. , Horsager Robyn , Morgan Jamie L.
Published: April 2020

INTRODUCTION:

Postpartum hemorrhage (PPH) is a leading cause of preventable maternal morbidity and mortality. In order to identify women prior to delivery at higher risk for hemorrhage, a trinary risk assessment tool has been developed. However, its utility has only been correlated to transfusion need. We sought to compare hemorrhage risk stratification with need for intervention and subsequent maternal morbidity.

METHODS:

We analyzed antepartum and intrapartum hemorrhage risk factors using the California Maternal Quality Care Collaborative’s risk score in all deliveries at our institution between January 1, 2018 and December 31, 2018. Relevant factors were used to stratify women as low, medium, or high risk which was then correlated to uterotonic administration beyond oxytocin and other hemorrhage-related morbidity. PPH was defined as blood loss exceeding 1,000 mL. Data was analyzed using standard methods of rates and proportions with P<.05 considered significant. IRB approval was obtained from the UT Southwestern Medical Center.

RESULTS:

Of 1,868 deliveries, 508 women (27.2%) experienced a PPH. Overall, 178 (9.5%) required uterotonics, 38 (2.0%) required transfusion, 7 (0.4%) needed intensive care unit (ICU) admission, and 12 (0.6%) underwent hysterectomy. Relative to low and medium risk stratifications, high risk women were 2.3 times more likely to require uterotonics. Low risk women were 83% less likely to require transfusion, ICU, or hysterectomy compared to medium and high risk groups. Conversely, high risk women had a 4.1 fold increase in these morbidities.

CONCLUSION:

Women classified as high risk for hemorrhage are indeed more likely to require uterotonics and suffer disproportionately higher maternal morbidity.
Does Increased Time Off Oxytocin Decrease Blood Loss at the Time of Cesarean Birth? [14M]
Authors: Mardy Anne , Reyes Fatima , Rosenstein Melissa
Published: April 2020

INTRODUCTION:

Prolonged periods of oxytocin use during labor can lead to higher rates of postpartum hemorrhage due to oxytocin receptor desensitization. We aimed to determine whether increased time off oxytocin prior to cesarean birth decreased the rate of quantified blood loss (QBL).

METHODS:

This is a retrospective cohort study of women with singleton pregnancies receiving at least 4 hours of oxytocin and delivering via cesarean at the University of California, San Francisco from May 2018 to June 2019. The primary exposure was the time off oxytocin to delivery, in minutes. The primary outcome was QBL, in milliliters. Secondary outcomes included need for blood transfusion, additional uterotonics, additional surgeries needed, and change in hemoglobin.

RESULTS:

338 patients had a cesarean birth after exposure to oxytocin. The mean time from stopping oxytocin to delivery was 119 minutes (IQR 62-133 minutes). The average QBL was 1179 mL (IQR 770-1492 mL). There was no significant difference in QBL based on time off oxytocin (-4.0 mL per 10 min, 95% CI −9.5 to +1.4 mL). There was an increased risk of blood transfusion in those off oxytocin for fewer than 2 hours versus more than 2 hours (14.0% vs. 4.6%, P=.010). This finding persisted after controlling for age, BMI, stage of labor, admission hemoglobin, chorioamnionitis and cumulative oxytocin dose (aOR 2.97, 95% CI 1.06-8.23).

CONCLUSION:

We did not find an association between time off oxytocin before delivery and QBL. However, there was an increased risk of blood transfusion among those off oxytocin for less than 2 hours.
Factors Associated With Hypertension 2-5 Years Postpartum in Women With Hypertensive Diseases of Pregnancy [17M]
Authors: Orr Lauren C. , Hebert Kasey , Hen Eden , Nickerson Ciarra , Leung Katherine , Leftwich Heidi K.
Published: April 2020

INTRODUCTION:

To identify factors associated with hypertension 2-5 years following delivery complicated by a hypertensive disease of pregnancy.

METHODS:

We performed a single-center, retrospective cohort study of women with a hypertensive disease of pregnancy who delivered between 7/2009-1/2014. Women with hypertension predating the incident pregnancy and those discharged on anti-hypertensive medications were excluded. Hypertension was defined as SBP greater than 140 mmHg, and/or DBP greater than 90 mmHg, and/or office visit for management of anti-hypertensive medications. A secondary analysis using SBP greater than 130 mmHg and/or DBP greater than 80 mmHg was also performed. Data was collected through review of electronic medical record. Institutional IRB approval was obtained.

RESULTS:

284 women were eligible for analysis. Of these women, 123 (43%) were considered hypertensive at 2-5 years following delivery. They were more likely to be older (P=.001), have a higher pre-pregnancy BMI (p<.001), be of higher parity (p<.001), undergo cesarean section (P=.002), and to have higher blood pressure immediately postpartum (P=.002, P=.027). When the definition of hypertension outlined by 2017 AHA recommendations (greater than 130/80) was used, 65% of the women were found to have hypertension and the same associations existed.

CONCLUSION:

A large proportion of women with a hypertensive disease of pregnancy had evidence of hypertension at 2-5 years postpartum. This proportion was even greater when the 2017 AHA definition was applied. Some factors associated with developing hypertension were identified in this study and could be considered while addressing importance of long term follow up for women given the magnitude of effect.
Improving Access to HPV Vaccination for Inpatient Postpartum Women at Naval Medical Center San Diego [19M]
Authors: Heye Kristen , Berkley Holly , Heaton Kobjit
Published: April 2020

INTRODUCTION:

Human Papillomavirus (HPV) is the most common sexually transmitted infection in the US and is thought to be the etiologic agent in 99.7% of cervical cancers 1, 2. Despite this, in 2016, only 51.4% of adolescents ages 13-17 have completed the full HPV vaccination series. Vaccination rates at Naval Medical Center San Diego mirror national trends. In our postpartum care, ensuring inpatient vaccination of for diseases (i.e. MMR, Tdap, VZV) is well established, however HPV vaccination was not available on the ward. We sought to develop and evaluate a process improvement program aimed at improving HPV vaccination rates by incorporating screening and administration into an established inpatient postpartum vaccination program.

METHODS:

Women ages 9 to 45 were evaluated for eligibility and offered the nine valent HPV vaccine as inpatients on the postpartum ward. An IRB exempt retrospective chart review pre- and post- intervention was conducted to determine vaccination status and rates of vaccination. The results were stratification based on active duty status and age.

RESULTS:

For all patients prior to intervention, the vaccination rate was 6.4% in the postpartum period when the vaccine was only available in the outpatient clinic. After implementation, the overall vaccination rate rose to 33.3% for postpartum patients (RR 5.2, CI 2.54-10.75, P<.0001). Women 26 years of age or younger were 11.2 times more likely to receive vaccination post-intervention (RR 11.2, CI 2.64-47.29, p=0.001).

CONCLUSION:

An inpatient postpartum HPV vaccination program is associated with increased rates of vaccination.
Making the Case for Expanding Medicaid Coverage to 12 Months Postpartum [23M]
Authors: Kumar Natasha , Quinlan Maura
Published: April 2020

INTRODUCTION:

Efforts to reduce maternal mortality in the U.S. have increasingly focused on the postpartum period. Currently, federally mandated Medicaid provision during pregnancy up to 6 weeks postpartum covers nearly half of the births in the U.S. However, 17.5% of pregnancy-related deaths occur between six-weeks and one-year postpartum, primarily due to cardiomyopathy (32.4%), mental health conditions (16.2%) and embolism (10.8%).

METHODS:

In April 2019, ACOG redefined the postpartum period as the "fourth trimester," recommending care be "an ongoing process rather than a single encounter." In June 2019, the AMA joined ACOG in supporting expansion of Medicaid coverage to 12 months postpartum. The Illinois state legislature approved expansion of Medicaid coverage to 12 months postpartum during its budget reconciliation process in 2019.

RESULTS:

Data from the ACA's Medicaid expansion indicates that postpartum Medicaid expansion would significantly impact health outcomes. By reducing the income eligibility for Medicaid, women who previously only qualified for Medicaid in pregnancy can now remain insured after 6 weeks postpartum. Expansion states had 1.6 per 100,000 fewer maternal deaths than non-expansion states. Postpartum Medicaid expansion will also allow for better birth spacing, improved mental health care, and longer follow-up for medical complications of pregnancy.

CONCLUSION:

Changing the paradigm of postpartum care provision could drastically impact maternal mortality. The consensus of support from the AMA and ACOG around expansion of Medicaid to 12 months postpartum is a critical step forward for legislative efforts to address maternal mortality. As with Illinois, obstetrician-gynecologists should advocate for policy alternatives that support increased access to postpartum care.
Maternal Satisfaction With Childbirth by Length of Second Stage [24M]
Authors: Gimovsky Alexis C. , Pham Amelie , Sardana Aayushi , Reddy Aarthi , Sparks Andrew
Published: April 2020

INTRODUCTION:

The aim of this study is to quantify patient satisfaction during childbirth by length of the second stage and delivery mode.

METHODS:

Cross-sectional study of nulliparous women who delivered between 4/2018–3/2019. Patients completed 4 questionnaires in the immediate postpartum period: Patient Perception Score (PPS), Consumer Satisfaction Questionnaire (CSQ), Six Simple Questions (SSQ), and Salmon survey. Length of second stage was divided into 2 groups (≤3 hours and >3 hours) and patient satisfaction scores were compared.

RESULTS:

100 patients were enrolled. 71 patients had normal second stage and 29 patients had prolonged second stage. Length of second stage had a statistically significant negative correlation with PPS score (ρ=-0.25, P=0.01). Length of second stage was not correlated with the SSQ (ρ=0.06, P=0.54), CSQ (ρ=-0.18, P=0.07), or Salmon survey (ρ=-0.16, P=0.11). PPS and SSQ scores did not significantly differ by delivery mode or epidural status, although the two lowest PPS scores were women who underwent cesarean delivery with extremely prolonged second stage (372 and 402 minutes, respectively). CSQ and Salmon scores were significantly lower in women who underwent second stage cesarean delivery.

CONCLUSION:

Most patients were satisfied with their childbirth experience independent of length of second stage. Only the PSS demonstrated a correlation of higher satisfaction with shorter second stage. Cesarean delivery during second stage was associated with decreased patient satisfaction. Future studies with larger cohorts of patients are needed to confirm our findings.
Patient Perceived Value of Referral to Maternal and Fetal Medicine Subspecialists [25M]
Authors: Shah Qainat , Dasani Megha , Saad Sarah , Kalkur Roshni , Rijhsinghani Asha
Published: April 2020

INTRODUCTION:

Maternal and fetal morbidity and mortality is a national and public health concern. One of the most critical factors to quality maternal fetal care for high-risk pregnancies is access to specialty tertiary care. Our center serves 25. This study assessed patient satisfaction of high-risk pregnancies referred for consultation to the High-Risk Pregnancy Services at a tertiary care center in the US.

METHODS:

Prospective pre and post surveys were administered to pregnant women referred to the High-Risk antenatal clinics. This study was IRB approved. All patients consented to participate in this study.

RESULTS:

50 women completed the pre-visit and post-visit surveys. The average GA at referral was 21 3/7 weeks. The wait time for scheduled appointment from the initial referral was 2.5 weeks. Patients traveled 57.5 ± 32.3 minutes. 45% of the patients reported not understanding the reason for referral. 60% expressed a desire to see a physician after completion of their ultrasound. On post-visit survey, patient’s perceived anxiety was significantly reduced (P=.007). In 16% the ultrasound findings were different from the local findings. 88% of patients indicated a better understanding of pregnancy issues as well as management of their pregnancy. 67.5% rated their overall satisfaction as excellent, 25% as good and 1% as fair.

CONCLUSION:

Not all referred women fully understand the role of a maternal fetal specialist, nonetheless, following the referral appointment and consultation, majority expressed better understanding and felt reassured regarding their pregnancy care. This survey indicates a need for and easy availability of maternal fetal expertise to all pregnant women.
Patient Preferences for Information Sharing During Pregnancy: A Survey of Postpartum Women [26M]
Authors: Peahl Alex , Novara Alli , Moniz Michelle , Smith Roger , Heisler Michele
Published: April 2020

INTRODUCTION:

Anticipatory guidance on pregnancy, childbirth and parenting is a key component of prenatal care. Our objective was to evaluate patients’ preferences for information sharing during prenatal care.

METHODS:

We performed a cross-sectional survey of postpartum patients admitted for childbirth and postpartum recovery at a tertiary care center from May-June, 2019. We assessed which prenatal care resources patients found most helpful and preferable (i.e. "would use"), including in-person (e.g. provider, nurse), print (e.g. books, handouts), media (e.g. video, website, app), and prenatal classes. Validated demographics items were included. Analyses included simple descriptive statistics.

RESULTS:

Of 332 eligible women, 300 (90%) completed the survey. Average age was 30.4 (5.3), 70% of patients were white and 71% had private insurance. The most helpful and preferred sources of prenatal education were nurses and doctors (helpful: 97%, 89%; preferred: 97%, 89%). Over 50% of patients reported other educational resources were helpful and preferred, including books, booklets, and websites. Though many women reported phone apps and the electronic medical record portal were helpful, fewest women preferred them (46% and 40% respectively). Though many women reported prenatal classes were not helpful, over half of women desired breastfeeding (63%) and prenatal classes. (57%).

CONCLUSION:

Patients prefer prenatal education be delivered by their nurse and provider, but are open to other educational modalities. There is a disconnect between patient preferences for prenatal education materials and the perceived quality of currently available resources. Future work will investigate how to better tailor prenatal care education to patient preferences, clinic workflow, and actual use.
Placenta Accreta Spectrum: The Effect of Establishing a Systematic Program for Diagnosis and Management [27M]
Authors: Skupski Daniel W. , Razavi Armin
Published: April 2020

INTRODUCTION:

Improvements in management of placenta accreta spectrum (PAS) can reduce maternal morbidity and mortality. Our objective was to determine the effect on outcomes following the introduction of a systematic program for diagnosis and management of PAS at our institution.

METHODS:

This was a retrospective cohort study of deliveries complicated by PAS at New York Presbyterian Queens (NYPQ) from November 2011 to July 2019. NYPQ implemented a systematic program for diagnosis and management of PAS in January 2015. The program included an emphasis on antenatal diagnosis, required scans for all repeat cesarean deliveries and multidisciplinary team management. Group 1 is designated as before and Group 2 is after establishment of the program. A composite outcome which included unplanned hysterectomy, ICU admission, return to the operating room or transfusion of ≥4 units of blood) was also examined. Chi square and Mann Whitney U tests were used in statistical analysis. IRB approval was obtained.

RESULTS:

Of 124 cases eligible cases, 35 (28%) had confirmed PAS (6 cases in Group 1, 29 cases in Group 2). The two groups were similar in terms of maternal age, parity, BMI and number of prior cesarean deliveries. There was no difference in composite morbidity between Groups 1 and 2 (66.7% vs 48.3%, P=.42). There was a trend toward improvement in unplanned hysterectomy and blood transfusion in Group 2.

CONCLUSION:

The establishment of our accreta program allowed us to demonstrate improvement in several outcome measures that did not achieve statistical significance due to small numbers.
Predicting Blood Loss for Vaginal Deliveries: When Are Quantitative Measures More Accurate? [29M]
Authors: Liew Zi-Qi , Mai Anne , Giacobbo Alexa , Qureshey Emma , Flicker Amanda , Quinones Joanne
Published: April 2020

INTRODUCTION:

Hospitals have been adapting quantitative blood loss (QBL) techniques over traditionally estimated blood loss (EBL), which has been shown to underestimate large volumes of blood loss. Our purpose was to determine the milliliters of blood loss where QBL better approximates EBL in vaginal deliveries.

METHODS:

Retrospective cohort study was conducted at a tertiary center examining blood loss from singleton term vaginal births. EBL and QBL groups each contained 6 separate months of deliveries and compared to a standard: calculated blood loss (CBL), determined by maternal size and hematocrit decrease. Absolute differences between calculated and recorded blood loss were computed and modeled against CBL. Multiple linear regression was used to control for confounders.

RESULTS:

CBL between EBL (n=1085) and QBL (n=1076) groups were not significantly different (P=.051), with a median of 685 (interquartile range 426-948) mL vs 697 (457-967) mL. Absolute difference between CBL and recorded blood loss was smaller in the EBL group [402 (178-644) mL] than QBL group [497 (268-716) mL]. Absolute differences were plotted: EBL (r^2 .84, P<.001) and QBL (r^2 .63, P<.001) groups exhibited linear relationships. Intersection of the linear models corresponded to 370 mL; beyond this value, QBL group demonstrated a smaller difference in comparison to EBL group.

CONCLUSION:

QBL measurements are not more accurate than EBL for uncomplicated vaginal deliveries with little blood loss. However, when blood loss measures greater than 370 mL, QBL is a better approximate. Further studies need to be done to validate role of CBL in determining blood loss for all delivery types.
Relationship Status and Self-Reported Experiences During Pregnancy Are Related to Medication Use [32M]
Authors: Satti Mohamed A. , Mackeen A. Dhanya , Reed Eda G. , Schulkin Jay , Power Michael L.
Published: April 2020

INTRODUCTION:

The study assessed factors associated with women’s medication use during pregnancy.

METHODS:

Pregnant women who were fluent in English and received prenatal care at Geisinger answered 11 questions on their experiences and thoughts during pregnancy. Principal component analysis reduced answers to three axes: overwhelmed/exhausted, happy/optimistic, and health concerns. Self-reported medication use for nausea, insomnia, anxiety and pain during pregnancy was examined.

RESULTS:

Of the 284 women who returned surveys, most (86.6%) were white and 49.3% were married. Many (44.4%) reported being medicated for nausea, insomnia, anxiety or pain; 6.3% reported self-medicating. Married women were least likely to report feeling overwhelmed/exhausted (20.9%) and most likely to report being happy/optimistic (94.1%). Married women were least likely to have been medicated (35.7%), in comparison to 48.6% of unmarried women living with a partner and 64.7% of women not living with a partner (P=.013). Other demographics were not significant. Pregnant women who used medication were more likely to report feeling overwhelmed/exhausted (37.4% versus 21.1%, P=.003), have health concerns (20.3% versus 11.1%, P=.001), and were less likely to be happy/optimistic (85.5% versus 93.3%, P=.033). Women who self-medicated were more likely to not be living with a partner (17.6% versus 4.8%, P<.001), more likely to report feeling overwhelmed (41.2% versus 27.7%, P=.045) and less likely to be happy/optimistic (66.7% versus 91.4%, P=.001) but did not differ in health concerns (22.2% versus 15.2%).

CONCLUSION:

Not living with a partner, feeling overwhelmed, and being less optimistic are associated with being medicated and self-medicating for nausea, insomnia, anxiety and pain during pregnancy.
Risk Factors for Postpartum Readmission: An Obstetric Quality Measure [33M]
Authors: Erfani Hadi , Salmanian Bahram , McKinney Jennifer , Detlefs Sarah , Sangi-Haghpeykar Haleh , Aagaard Kjersti
Published: April 2020

INTRODUCTION:

The rate of postpartum (PP) readmission reflects both pre-existing and pregnancy-specific morbidities and contributes to the maternal mortality rate. We aimed to investigate the PP readmission rate, associated risk factors, and indicators of healthcare disparities within two hospitals affiliated with our academic institution.

METHODS:

A retrospective analysis of a prospective, population-based cohort (2011-2019) was performed. Any readmission within 30 days of delivery was included. A random sample of patients with no PP readmission was selected as controls. Characteristics, comorbidities, and labor course were compared. Multivariate logistic regression analyses were performed with appropriate adjustments.

RESULTS:

Among 42,458 subjects delivered in our affiliated hospitals, 248 (0.6%) had PP readmission. A control group of 1248 was randomly selected in a 5:1 control: case ratio. After controlling for potential confounders identified on univariate analysis, postpartum readmission was more common in women who delivered via cesarean after labor regardless of whether spontaneous or induced (adjusted OR [aOR] 1.38, 95% CI 1.02-1.87). Similarly, pregnancy-related hypertensive disorders or chorioamnionitis increased readmission risk (aOR 1.45, 95% CI 1.04-2.04 and aOR 1.86, 95% CI 1.08-2.04 respectively). Interestingly, among subjects delivered vaginally, induction of labor was associated with a higher risk of PP readmission compared to spontaneous or augmented labor (aOR 2.02, CI 1.37-2.98).

CONCLUSION:

Pregnancy-related hypertensive disorders, infection, and cesarean delivery are the most significant risk factors associated with PP readmission, as well as induction of labor in those with a vaginal delivery. Current standards of labor-management should continue to consider all factors potentially related to morbidity and mortality.
Risk Factors for Readmission Due to De Novo Postpartum Hypertension [34M]
Authors: Downs Sarah G. , Kawakita Tetsuya
Published: April 2020

INTRODUCTION:

De novo postpartum hypertension is defined as the development of hypertension without antepartum hypertension. We sought to examine risk factors for readmission due to de novo postpartum hypertension.

METHODS:

This was a retrospective cohort study of all women who delivered at 23 weeks gestation or greater at a single academic center. Women with antenatal hypertension were excluded. Our primary outcome was postpartum readmission for severe hypertension from de novo postpartum hypertension. Outcomes were compared between women readmitted for de novo postpartum hypertension and those who were not using bivariable analyses. Variables that were significant with bivariable analyses were included in a multivariable logistic regression model to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI).

RESULTS:

Of 28,593 women, 113 (0.4%) were readmitted with de novo postpartum hypertension. Women readmitted for de novo postpartum hypertension compared to those who were not were more likely to be older, black, and multiparous; have undergone cesarean delivery (CD); have a higher body mass index (BMI kg/m2); and have a mean blood pressure (BP) >130/80 mmHg on postpartum days 1 and 2. After multivariable logistic regression, outcomes significantly associated with readmission for de novo postpartum hypertension included BP >130/80 mmHg on postpartum day 2 (aOR 2.02; 95% CI 1.32-3.09), age (aOR 1.06; 95% CI 1.03-1.10), BMI (aOR 1.04; 95% CI 1.02-1.07), and CD (aOR 2.60; 95% CI 1.73-3.91).

CONCLUSION:

We found that age, BMI, CD, and BP >130/80 mmHg on postpartum days 1 and 2 were associated with readmission for de novo postpartum hypertension.
Self-Reported Non-Steroidal Anti-Inflammatory Drug Allergy and Postpartum Pain Management [36M]
Authors: Beetham Kristine , Blitz Matthew J.
Published: April 2020

INTRODUCTION:

Patients with a self-reported NSAID allergy (SRNA) are limited in the medications available to treat postpartum pain. Our objective was to determine the frequency of SRNA, how it affects the medications administered for inpatient postpartum analgesia, and whether it is associated with obstetrical outcomes.

METHODS:

Retrospective cohort study of singleton deliveries at ≥37 weeks of gestation at a tertiary university hospital from 2013-2016. Patients were excluded for self-reported opioid allergies, drug abuse history, positive urine toxicology, general anesthesia for delivery, and incomplete records. The primary outcomes evaluated were the postpartum pain medications received, including the total amount in milligrams. Demographic and clinical characteristics were reviewed to identify any associations with SRNA.

RESULTS:

A total of 20,920 deliveries were included: 235 with SRNA and 20,685 without SRNA. SRNA was documented in 1.12% of the study population. After cesarean delivery, median oxycodone use was 19.4 (IQR 6.6-36.7) and 15.4 (IQR 2.6-28.6) mg/day among women with and without SRNA, respectively (P<.04). After vaginal delivery, median oxycodone use was 10.4 (IQR 0-32.9) and 0 (IQR 0-17.9) mg/day among women with and without SRNA, respectively (P<.001). Acetaminophen use (P<.0001) and total postpartum days (P<.05) were also increased in women with SRNA compared to women without SRNA. No demographic or clinical factors differed between groups.

CONCLUSION:

SRNA is documented in approximately 1% of obstetrical patients and affects the medications administered for inpatient postpartum analgesia; both oxycodone and acetaminophen use are increased among SRNA patients, regardless of mode of delivery.
Systematic Treatment and Management of Postpartum Hypertension (STAMPP-HTN) [38M]
Authors: Duncan Colleen , Kaur Harjot , Mueller Ariel , Solache Macaria , Naseem Heba , Rana Sarosh
Published: April 2020

INTRODUCTION:

Hypertensive disorders of pregnancy are a leading cause of morbidity during pregnancy. The postpartum (PP) period is equally morbid, however attendance at recommended PP blood pressure (BP) follow-up appointments is poor. Strategies to bridge this gap are needed.

METHODS:

A bundled approach to PP management was implemented which included education for obstetric providers, standardized protocols, educational videos, standardized discharge instructions, follow-up appointments and PPHTN clinics. This analysis sought to identify impact of this intervention and predictors of non-compliance.

RESULTS:

Among all 495 patients, 80.4% were African-American (AA), 68% had Medicaid, and the median age was 28 (IQR 23, 33) years. Factors associated with appointment non-compliance included younger maternal age, older gestational age, shorter PP length of stay, primary obstetric providers outside the study hospital, those who experienced spontaneous labor, current smokers and AA race (all P<.01). When comparing the beginning of the study period (September/October 2018) to the last two months (August/September 2019), PP appointments made before discharge increased (49.3% to 98.7%; P<.001) as did the proportion of patients who followed up within six weeks (26.8% to 45.6%; P=.01). Median [IQR] systolic BPs immediately post-delivery were higher in the beginning of the study period as compared to the end (152 [139,161] vs 139 [133,150]; P=.0001). A significant increase in PP antihypertensive use was also observed (34.2% vs 45.6%, P=.04).

CONCLUSION:

The STAMPP-HTN bundle improved PP compliance with BP control however response was not universal. Additional tools are needed to improve PP follow-up and BP control in this population.
Father Involvement During Pregnancy and Maternal Experience of Postpartum Physical Intimate Partner Violence [01F]
Authors: Chen Yu-Fu M. , Olson-Chen Courtney
Published: April 2020

INTRODUCTION:

Nearly 1 in 3 women experience physical intimate partner violence (PIPV). PIPV increases during pregnancy and postpartum, and markers of risk are needed to target interventions. Father involvement (FI) is associated with a reduction in several adverse pregnancy outcomes. Our objective was to investigate the association between FI during pregnancy and PIPV 1 year postpartum.

METHODS:

Data from baseline and 1 year waves of longitudinal cohort Fragile Families and Child Wellbeing Study were analyzed, which included 1,546 mother-child dyads. PIPV was assessed using the Conflict Tactics Scale, and a binary indicator of any vs no PIPV was created. FI was measured by paternal provision of financial or instrumental support (transportation, chores) and visits to the hospital during pregnancy. Chi-square tests were performed to assess the bivariate FI-PIPV association followed by multivariate logistic regression adjusting for parental age, education, insurance, poverty level, and history of PIPV.

RESULTS:

Bivariate analyses showed that father visits to the hospital during pregnancy (OR .43, 95% CI .24-.73, P=.002) and provision of instrumental support (OR .41, 95% CI .22-.81, P=.009) were negatively associated with postpartum PIPV. Only hospital visits remained significant in multivariate analyses (aOR .38, 95% CI .18-.81, P=.012). Deep poverty and prior PIPV were associated with increased odds of postpartum PIPV.

CONCLUSION:

Our results suggest that FI in pregnancy, specifically during hospital stays, may attenuate maternal risk of experiencing postpartum PIPV. Pregnant women lacking paternal engagement may benefit from additional support. Policies and programs to encourage FI during pregnancy could contribute to a reduction in postpartum PIPV.
Improving Screening for Intimate Partner Violence in an Ambulatory Women's Health Clinic [03F]
Authors: Pavicic Meredith , Goodman Daisy J. , Foster Tina C.
Published: April 2020

INTRODUCTION:

The primary objective was to increase the number of women screened for IPV in an ambulatory women's health clinic.

METHODS:

This was a quality improvement project designed to increase the number of women presenting for annual visits who were screened for intimate partner violence with a validated tool. Process observations, stakeholder interviews and chart review were performed to assess baseline levels of screening and plan for implementation of a screening tool that would be useful and acceptable. Training was performed with clinic flow staff and with providers. Clinic flow staff were asked to assign a computerized screener to patients presenting for annual GYN visits with Generalist OB/GYN providers and completion of the screener was documented using a dot phrase built into the electronic medical record. Success of the intervention was assessed by recording rates of screening tool assignment, completion and documentation. Screening, completion and documentation rates over time were compared using control charts. Given lack of any validated screening tool use prior to the study period, no direct statistical comparison was made to the period prior to the study period.

RESULTS:

Of 1427 eligible women, 722 were screened (50.6%). Rates of screener assigned varied over the months assessed, with a median screening rate of 53.6% over the 10 months studied. Documentation rates also varied among providers. Median documentation rate over the study period was 85%.

CONCLUSION:

Introduction of a new screening tool led to increased rates of IPV screening over time, though further intervention is required to improve this process.
Perception of Candidates and Faculty on Maternal Fetal Medicine Fellowship Videoconference Interviewing [19G]
Authors: Nutter Anna , La Rosa Mauricio , Olson Gayle
Published: April 2020

INTRODUCTION:

Videoconference interviewing (VCI) has been associated with efficiency, cost savings, and lack of interference with clinical responsibilities compared to traditional on-site interviews. Our objective was to evaluate the acceptability and impact of VCI for the 2018-2019 Maternal Fetal Medicine fellowship match.

METHODS:

Prior to interviews candidates were provided with a link to a power-point presentation and virtual campus tour. Candidates were interviewed by a panel of five interviewers and offered contact information for additional questions and to visit campus at their leisure. After interviews and prior to match results, an anonymous survey using a 5-point Likert scale was sent to candidates and interviewers consisting of 16 and 11 questions respectively and a comment section which queried acceptance and future feasibility of VCI. Questions similar to both groups were analyzed using Student t-test or Mann-Whitney U test.

RESULTS:

Response rate was 78% and 87% for candidates and interviewers. Candidates were all PGY4, ten female, four male and mean age 30.3 years. Candidates found the process easy (82%) and supported the concept (82%) but identified VCI prevented “gut feelings” obtained on-site. Interviewers identified the lack of subjective details from personal interaction. As a sole interview modality, 18% and 29% of candidates and interviewers identified a negative impact to the program. Questions that were similar for candidates and interviewers showed no difference in responses.

CONCLUSION:

Identified benefits of VCI included cost and time savings, but the majority of candidates preferred traditional interviews. VCI may be useful as an adjunct or screening tool for traditional on-site interviews.
Chte-Level Access to Contraception [04J]
Authors: Patel Kriya , Bakk Juliana , Pensak Meredith , DeFranco Emily
Published: April 2020

INTRODUCTION:

To assess the influence of Medicaid on the rate of short interpregnancy intervals. We tested the hypothesis that Medicaid expansion and subsequent access to birth control would be associated with decreased short interpregnancy (IPIs) rates.

METHODS:

Using the US Birth Certificate data, we performed a population-based retrospective cohort study including all multiparous women who had a live birth in the US in 2016, after Medicaid expansion had been implemented. Multivariate logistic regression estimated the relative influence of Medicaid expansion on the outcome of short interpregnancy interval (<12 months).

RESULTS:

There were 3,956,112 live births in the US in 2016: 2,244,158 (56.7%) in multiparous women with data on IPI (n=1,077,411, 48% ME states, n=746,712, 33.3% non-ME states). The rate of short IPI was 18.1% in non-ME states compared to 16.4% in ME states, rate difference 1.68% (95% CI 1.57-1.79%). Living within a state that adopted ME was associated with a modestly decreased risk of a short interpregnancy interval (adjusted relative risk, 0.973; 95% CI 0.966-0.979), even after adjustment for coexisting risks for short IPI. The individual-level factors most strongly associated with short IPI in women who gave birth in states that did not adopt ME were black race, younger maternal age, unmarried, Medicaid enrollment and utilization of WIC, lack of early initiation of prenatal care initiation, and grand multiparity.

CONCLUSION:

The risk of short interpregnancy interval decreases with Medicaid expansion, even after adjusting for coexisting risk factors. This demonstrates the value of expanding Medicaid to women of child bearing ages.
Positive Impact of Online Education on Physicians’ Knowledge and Confidence in Prenatal Screening Methodologies [21G]
Authors: Hurst Simi , Martorano James , Capparelli Catherine , Aboulsaoud Pakinam
Published: April 2020

INTRODUCTION:

Screening for fetal chromosomal abnormalities has become the standard of care for all pregnancies. This study assessed the ability of online continuing medical education (CME) to improve obstetricians/gynecologists (Ob/Gyns) knowledge regarding key considerations and interpretation of analyte and cell-free DNA (cfDNA) prenatal screening tests.

METHODS:

A 30-minute, CME-certified activity featuring a video-based discussion between two faculty and an associated video commentary in French (in partnership with the Collège National des Gynécologues Et Obstétriciens Français) was developed and launched online on 12/24/2018. Educational effectiveness was assessed with a repeated-pairs pre-/post-assessment study design; each individual served as his/her own control. A chi-square test assessed changes pre- to post-assessment. P values<0.05 are statistically significant. Effect sizes were evaluated using Cramer's V (<0.05 modest; 0.06-0.15 noticeable effect; 0.16-0.26 considerable effect; >0.26 extensive effect).

RESULTS:

7,603 HCPs, including 6,788 physicians have participated in the activity. This analysis comprises data from the subset of Ob/Gyns (n=831) who answered all pre-/post-assessment questions through 08/14/19. Following participation, significant improvements were observed overall (P≤.0001, V=.140) and in the following areas: Identifying possible causes for a no-call result (61% pre vs 75% post; 23% relative improvement; P<.0001; V=.144). Recognizing the rationale for screening all pregnancies vs just high-risk pregnancies (61% pre vs 75% post; 21% relative improvement; P<.0001; V=.135). 41% Ob/Gyns reported measurable increases in their ability to interpret cfDNA test results.

CONCLUSION:

This educational activity significantly improved Ob/Gyn’s knowledge of clinical considerations when performing prenatal screening as well as key differentiating characteristics of analyte and cfDNA screening tests.
Provider Selection: Patient Turnover Occurs Nearly Half the Time in Subsequent Pregnancies [22G]
Authors: Bradley Danielle , Blaine Arianna , Wolfberg Adam
Published: April 2020

INTRODUCTION:

The objectives of this study were to understand 1) how common it is to change providers between pregnancies, 2) which sources of information patients use when selecting their provider, and 3) which factors matter most when selecting a provider.

METHODS:

A survey about provider satisfaction and selection was sent to users of the Ovia Pregnancy mobile app. Respondents were age 18 or older, United States residents, and pregnant (n=2,142). IRB exemption was granted.

RESULTS:

Among respondents, 979 (46%) were multiparous, of which 437 (45%) reported seeing a different provider during this pregnancy, compared to their previous pregnancy. The most commonly reported reason was geography — either the provider or patient relocated (38%). A combined 34% reported their previous provider being a bad fit or having had a negative experience. Nulliparous women (n=1,163) and multiparous women who kept their same provider (n=542) reported recommendations from friends/family members as the most common influence in provider selection (54% in both groups). Multiparous women who changed their provider depended on recommendations and internet searches most often (47% and 46%, respectively). In-network, ratings and reviews, recommendations, proximity to home/work, and scheduling ease were the five most important factors when selecting a provider among all three groups of women.

CONCLUSION:

Results indicate that patient turnover is common and some causes of this turnover are preventable. With continuity of care being an important aspect of preconception, perinatal, and postpartum health, this degree of patient turnover should be addressed.
Providers Perspectives on Racial Equity: What Is Needed in a Training to Advance Black Women’s Reproductive Health [23G]
Authors: Chambers Brittany D. , Taylor Brianne , Nelson Tamara , Harrison Jessica , Bell Arielle , Scott Karen A.
Published: April 2020

INTRODUCTION:

To explore providers’ perceptions of the need for a racial equity training and recommendations on strategies that can be used to improve black women’s reproductive health outcomes.

METHODS:

January-March 2019 we conducted 25 semi-structured interviews (30-60 minutes) with a diverse group of prenatal care providers practicing in the San Francisco Bay Area. Providers were recruited through email correspondences and department meetings. Culturally concordant qualitatively trained researcher assistants conducted all interviews. Interviews were audio-recorded and transcribed. We used the constant comparative method to analyze data. This study was approved by the University of California, San Francisco Institutional Review Board.

RESULTS:

Most providers were CNM (n=8, 32%) or OB/GYN (n=7, 28%), worked in their current role for 1-5 years (n=10, 40%), and identified as white (n=16, 64%). All providers expressed a need and importance to address racial inequities to improve the care experiences and reproductive health outcomes of black women. Most providers agreed that the proposed components of the racial equity training were important topics to cover: Racism in the US (n=20, 80%), Racial Disparities in Maternal and Neonatal Outcomes (n=23, 92%), Women’s Experiences, (n=24, 96%), Providers’ Experiences (n=16, 64%), and Reflection and Discussion (n=18, 72%). Providers stressed that there is need for an action-oriented racial equity training where they learn how to address racism as well as implement system-level accountabilities (e.g., metrics on patients’ perceptions of care).

CONCLUSION:

Providers desire an action-oriented racial equity training that will provide ongoing skills and practice, and system-level accountabilities to better serve black women.
Twitter and Obstetrics and Gynecology: Where Do the Chirps Stand? A Review of the Literature and Social Media [27G]
Authors: Noureddine Lama , Chappelle Joseph
Published: April 2020

INTRODUCTION:

The media has played an increasing role in medicine in recent years and social media has proven to have an influential power over the public. Physicians, in general, are late adopters of new technology which can lead to the loudest voices being non-professionals.

METHODS:

A search was conducted on Twitter using the keywords “obgyn” and “obstetrics and gynecology” between the dates of September 1st, 2019 and September 30th, 2019. Tweets were classified as posted by medical professionals vs non-professional, and goal of tweet: education, opinion, personal or public announcement.

RESULTS:

A total of 198 tweets are identified. The majority (55.5%) of tweets are posted by non-professional users. The most common category is opinion (40.4%) and the least common is educational (19.2%). Among professional voices 14.9% were opinion tweets and 38.3% were educational tweets. In contrast, among non-professional posts, 85.6% of the posts were opinions while 9.2% were educational.

CONCLUSION:

Social media is a powerful method for interacting with the public. Medical professionals have an opportunity to drive the conversation. We also can provide a higher ratio of education to opinion in order to increase awareness to the public.
Understanding the Second Victim Experience Among Multidisciplinary Providers in OB/GYN [28G]
Authors: Rivera-Chiauzzi Enid , Riggan Kirsten , Long Margaret E. , Allyse Megan A. , Torbenson Vanessa , Weaver Amy
Published: April 2020

INTRODUCTION:

Adverse patient events inevitably occur in OB/GYN practice. Health care provider who are “second victims” experience psychological trauma and progress through defined stages of recovery as they process the event. This experience is believed to be an under-recognized, yet prevalent phenomenon. Study aims were to determine the prevalence of second victims and the risk factors for feeling like a second victim among staff caring for OB/GYN patients to guide the implementation of new resources for second victims.

METHODS:

We administered the validated Second Victim Experience and Support Tool (SVEST) supplemented with non-validated questions to multidisciplinary team members caring for OB/GYN patients at Mayo Clinic in Rochester, MN. Respondents to the self-administered, anonymous survey included physicians, nurse practitioners, physician assistants, certified nurse midwife, registered nurses, allied health professionals, and desk staff.

RESULTS:

The survey was completed by 205 staff (117 OB only, 73 GYN only, 15 both). During their career, 44.8% felt like a second victim while 18.8% had this experience in the last 12 months. Residents and fellows had the highest percentage of second victims (41.7%). Respondents who reported greater psychological distress were more likely to report that they felt like a second victim after an adverse patient safety event within the preceding 12 months (p-value<0.001). The same finding was observed for measures of physical distress.

CONCLUSION:

OB/GYN team members report significant differences in physiological and physical symptoms after adverse events. Understanding and screening for psychological and physical symptoms may be useful in identifying second victims and guiding support following adverse events.