bluuebunny/crossref_metadata_2025 huggingface dataset:
Multiple Concurrent Malignancies Commonly Seen in Immunocompetent Human Immunodeficiency Virus-Infected Women [2N]
Authors: Davis Kelly , Kennedy Kathryn , Robinson William
Published: April 2018

INTRODUCTION:

To determine optimal management strategies for HIV-infected women with HPV-associated invasive and in-situ malignancies. Also, to identify possible interactions between Highly Active Anti-Retroviral Therapy(HAART) and anti-malignancy therapy.

METHODS:

All HIV-infected women diagnosed with an HPV-associated malignancy between 2011-2016 were identified as part of an ongoing Quality-Improvement project. Data collected includes: demographics, HIV treatment/response, malignancy treatment/response, other healthcare utilization, and compliance. The data was analyzed using standard statistical tests.

RESULTS:

17 HIV-infected women were identified with an HPV-related malignancy. The mean age was 39 years and all were African-American. Invasive malignancies included: Cervix-9, Vulva-7, Anal-4, Vagina-3, Urethra/Bladder-2, Oropharyngeal-3. In-situ lesions included: Cervix-4, Vulva-3, Oropharyngeal-1. 4 subjects had 3 separate malignancies, and 2 others had 2 malignancies. Response to HAART and immunocompetence (as measured by CD4 and viral load) correlated strongly with survival. Compliance with HAART correlated strongly with response to anti-malignancy therapy. Compliance also correlated strongly with the use of patient advocate/navigators. Survival at 2 years was similar to that in the general population.

CONCLUSION:

Immunocompetent (high CD4/low viral load) HIV-infected women are at high risk for HPV-associated malignancy. Multiple concurrent cancers are common. However, response to anti-cancer therapy and survival are strongly correlated with immunocompetence, and in turn, compliance with HAART. Careful cancer surveillance should be emphasized, even in immunocompetent HIV-infected women. Once the diagnosis of malignancy has been made, the level of vigilance in screening for other malignancies should increase. The use of patient advocate/navigators influences compliance in these women, who face very complex therapeutic regimens.
Need for Increased Cervical Cancer Screening among HIV Positive African American Women [4N]
Authors: Rochon Hildred , Ranjit Anju , Jalloh Mohamed , Maxwell Celia
Published: April 2018

INTRODUCTION:

BACKGROUND: Black females within the District of Columbia are disproportionately impacted by HIV compared to their non-black counterparts. Ensuring adequate screening for cervical dysplasia among this population is critical to mitigate the incidence of cervical cancer.

OBJECTIVE:

To determine the prevalence of cervical dysplasia among black women and other female patients at the Howard University Hospital(HUH) Center for Infectious Disease Research and Management(CIDMAR).

METHODS:

Data was extracted from HUH-CIDMAR electronic medical records for 464 HIV+ female patients (>17 years of age) from 1998 to 2017. Prevalence of cervical pathology was identified. Variations in abnormal cervical screening results were analyzed using Stata software version 13.0.

RESULTS:

A total of 464 women were included. The mean age was 27.9 years (SD =12.29 years). The majority of patients were African American (n=451, 97.2%) and infected by heterosexual contact (n=344, 74.14%). A total of 293 patients (63.15%) received Pap screenings. Pap screening records for 171 women (36.85%) were incomplete. Of the individuals screened, 146 (49.82%) were found to have a Pap smear abnormality (ASCUS: n=67(14.4%); LSIL CIN1:n=43(9.3%); HSIL CIN2:n=10(2.1 %); HSIL CIS: n=5(1.1%); invasive: n=4(0.8%); other abnormal Pap: n=34(7.3%)).Forty-three women (9.27%) received HPV screening and 24 (55.81%) tested positive for HPV.

CONCLUSION:

The presence of cervical screening abnormalities in a predominantly Black female HIV positive population demonstrates the importance of continued cervical cancer screening to mitigate cervical cancer progression.
Patterns of Fetal Growth in Obese Pregnant Women: an Observational Study [8N]
Authors: Barraza Jorge , Gei Alfredo , Bueno Juan L. , Garza Isabel
Published: April 2018

INTRODUCTION:

The United States is witnessing an obesity epidemic. The maternal body mass index (BMI) and weight gain during pregnancy influence fetal growth. Little is known about fetal growth patterns (FGP) on obese women. The present study was performed to characterize FGPs among obese pregnant women (BMI>30) in a Maternal Fetal Medicine (MFM) practice.

METHODS:

Retrospective review of the ultrasound database of a private MFM practice in Houston. 43 obese patients with 3 or more ultrasounds and with completed pregnancies were included. Demographic, biometric and clinical data were obtained for mothers and neonates. Fetal growth was classified as normal, accelerated or decelerated. Chi square and Student-t test were performed as appropriate. Significance P<.05.

RESULTS:

The average patient was 33 yo (± 4.6) and had a BMI of 36.1 (± 6.3). The fetal growth was accelerated in 51.1%, normal in 46.5% and decelerated in 2.3%. The proportion of fetuses with an AC >95th p/GA increased from 18% at 32 weeks to 38% at 36 weeks. A significant difference (P<.0001) was observed in birth-weight between patients who had EFW accelerations and patients who didn’t (3.52 kg ± 0.47 vs 2.93 kg ± 0.62). An improvement of the fetal growth pattern (in EFW and/or AC) was observed in 31.8% of accelerated growth as a result of interventions (diet and activity) recommended to the mothers.

CONCLUSION:

Fetal growth is accelerated in over half of obese women followed with serial ultrasounds. The modification of FGP's suggests that an accelerated fetal growth might be responsive to medical interventions.
Toll-like Receptor 3-mediated Regulation of Drug Transporters in Primary Human Trophoblasts [9N]
Authors: Parrott Jessica , Mason Clifford
Published: April 2018

INTRODUCTION:

Expression of efflux and influx transporters affects drug permeability across the placental barrier. Viral or bacterial challenges alter expression of several placental drug transporters in rodents, suggesting that infection and inflammatory pathways modulate their expression. However, the extent to which these pathways operate in humans are poorly understood. Placenta trophoblasts respond to infectious insults through expression of pattern recognition receptors including the well-characterized Toll-Like Receptors (TLR). The objective of this study was to determine role of TLR3, which recognizes viral RNA, on expression and function of quintessential drug transporters in primary human trophoblasts.

METHODS:

Primary human trophoblast cells were isolated from third trimester placenta and cultured for at least two days prior to treatment with Poly(I:C) (10 μg/ml). Activation of TLR3 signaling by Poly(I:C) was confirmed by measuring phosphorylation of NFkB and IRF3, and expression of pro-inflammatory cytokines. Gene and protein expression of drug transporters ABCB1 and ABCG2, and SLC29A1 and SLC29A2 were evaluated by qRT-PCR and Western blot analysis, respectively. Changes in drug transporter function was determined by measuring cellular accumulation of known substrates.

RESULTS:

Poly(I:C) increased NFkB and IRF3 phosphorylation in primary human trophoblast cells as early as 2hr after treatment and enhanced mRNA expression of TNF-alpha, IL6, and IL8 after 12hr of treatment. Poly(I:C) decreased mRNA and protein expression of drug transporters at 12hr and 48hr, respectively.

CONCLUSION:

Activation of TLR signaling pathways with Poly(I:C) decreases functional expression of drug transporters in primary human trophoblasts suggesting that viral infection may affect placental permeability by altering drug transporter expression.
Patterns of Exercise and Physical Activity in Pregnant Women [11N]
Authors: Moore Iris , Madraswalla Mehnaz , Mason Mikayla , O'Sullivan David , Johnson Amy
Published: April 2018

INTRODUCTION:

In December 2015 ACOG released consensus guidelines recommending that pregnant women participate in a moderate intensity exercise for most or all days of the week. Despite the numerous health benefits, a significant percentage of women continue to avoid physical activity during their pregnancy. Deficiencies in knowledge about the risks and benefits may contribute to the decrease in exercise and overall physical inactivity.

METHODS:

Three hundred postpartum women were given a standardized questionnaire while at Hartford Hospital. The questionnaire gathered information on demographics, physical activity before and during pregnancy, and whether patients discussed exercise with their OB/GYN provider. Chi square tests were used to evaluate differences between those who exercised during pregnancy and those who didn’t.

RESULTS:

64% of patients discussed physical activity with their OB/GYN. Those who did, were more likely to consider exercise to be safe at least 2-3x/wk (75.8% (n=141) vs. 53.6% (n=53), p<0.001). Patients with prior athletic experience were more likely to report exercising at least once a week during the first trimester (55.6% (n=84) vs 36.2% (49), p=0.001) and 2nd trimester (54.6% (n=83) vs 39.1% (n=52), p=0.009).

CONCLUSION:

A majority of providers are discussing physical activity during pregnancy. However, a majority of pregnant women are not exercising enough. There was a correlation between exercise counseling and participation as well as appropriate perceptions about the safety of exercise in pregnancy. Patients with a prior history of participation in competitive athletics were more likely to exercise in pregnancy.
The Effect of Depression on Pregnant Patients with Gestational Diabetes: Maternal and Neonatal Outcomes [13N]
Authors: Chatroux Louisa R. , Shields Michelanne , DeJong Katherine , Caughey Aaron B.
Published: April 2018

INTRODUCTION:

We sought to determine the differences in pregnancy outcomes seen in patients with major depressive disorder and gestational diabetes (GDM) in comparison to women with GDM and no diagnosis of depression.

METHODS:

A retrospective cohort study of 114,483 women with gestational diabetes with singleton, vertex, non-anomalous gestations was performed to assess maternal and neonatal outcomes in women with depression as compared to women without depression. Maternal outcomes included preeclampsia, placental abruption, cesarean delivery, postpartum hemorrhage (PPH) and endometritis. Neonatal outcomes included preterm, respiratory distress syndrome (RDS), jaundice, and neonatal death (NND). Multivariate regression analyses and chi-square tests were employed for statistical comparisons and a p-value of less than 0.05 was used to indicate statistical significance.

RESULTS:

Women with GDM and depression had an increased risk of a range of complications of pregnancy when compared to women with GDM who did not have depression. It was associated with a statistically significant increase in preeclampsia (odds ratio [OR] 1.23), cesarean delivery (OR 1.10), PPH (OR 1.85), Preterm delivery (OR 1.25), and jaundice (OR 1.16).

CONCLUSION:

In women who have gestational diabetes, presence of major depressive disorder is associated with an increased risk of adverse maternal and neonatal outcomes in pregnancy. Whether this increased risk was due to other confounding factors, pharmacologic impact of treatment of depression, or from disease pathophysiology deserves future research. Further, how these risks can be mitigated through health care prior to and during pregnancy needs to be determined. Women should be counseled about these risks and managed accordingly during their pregnancies.
Trust in Physician and Health Agency Impact Postpartum Choices in Women with Gestational Diabetes [20N]
Authors: Spelke Bridget , Has Phinnara , Clark Melissa A. , Kanno Lindsey , Booker Tanya , Werner Erika
Published: April 2018

INTRODUCTION:

Trust in physicians and health agency have been associated with adherence in primary care, but have not been evaluated in the postpartum setting. We assessed the role of these constructs in adherence to postpartum best-practices among women with gestational diabetes mellitus (GDM).

METHODS:

A prospective cohort of 300 women with GDM completed the validated Trust in Physician Scale (Cronbach alpha 0.81) during their postpartum hospitalization. Participants rated health agency with a 4-point Likert scale evaluating the statement, “I feel that I have little control over risks to my health”. Chart review determined postpartum visit attendance, glucose testing, and sustained breastfeeding. Contraceptive use was collected via telephone interview at 3 months postpartum. Trust and agency were compared with Kruskal-Wallis and Wilcoxon rank sum tests respectively. Confounders were accounted for in multivariable models.

RESULTS:

By 12 weeks postpartum, 83% of participants had attended postpartum visits, 61% of whom were breastfeeding, and 42% had completed postpartum glucose testing. Of 226 participants who completed telephone interviews, 66% reported using contraception. Trust did not differ by demographics or pregnancy outcome. Health agency differed by income and race/ethnicity. Trust and health agency were not associated with postpartum visit adherence, but greater trust was associated with postpartum glucose testing adherence (P<.01), and contraception use (P<.01). Increased health agency was associated with sustained breastfeeding (P<.01). This association persisted after adjusting for income and race/ethnicity.

CONCLUSION:

Strategies that foster trust between clinicians and patients may improve adherence with postpartum glucose testing and contraception use in women with GDM.
Does Buprenorphine Decrease the Risk of Neonatal Abstinence Syndrome in Mothers with Opioid use Disorder? [26N]
Authors: Ly Victoria , Persad Malini D. , Herrera Kimberly , Garry David , Garretto Diana
Published: April 2018

INTRODUCTION:

The objective of this study is to determine if buprenorphine opioid maintenance therapy is associated with a decrease risk of neonatal abstinence syndrome in mothers with opioid use disorder.

METHODS:

A retrospective cohort study of pregnant women with opioid use disorder was performed at a tertiary care hospital from January 2016 to June 2016. Women were identified using the hospital's delivery logs. Women were categorized by opioid maintenance therapy type: buprenorphine or methadone. Maternal demographics, medical history, social history, maintenance therapy type, delivery characteristics and neonatal outcomes were collected from the electronic medical record. A composite adverse neonatal outcome score was created and defined as the presence of any of the following characteristics: preterm delivery, low birth weight <2500 g, Apgar score < 7 at 5 minutes, NICU admission, and neonatal abstinence syndrome. Parametric and nonparametric statistics were used to compared groups as appropriate. A p value of < .05 was considered statistically significant.

RESULTS:

Of 1,927 women who delivered, 37 women qualified for the study. There was no statistically significant difference in demographic characteristics between groups. Additionally, there were no statistically significant differences in neonatal outcomes, including neonatal abstinence syndrome, between women who received buprenorphine maintenance therapy compared to those who received methadone maintenance therapy.

CONCLUSION:

Buprenorphine has a comparable incidence of neonatal abstinence syndrome to methadone in the treatment of opioid use disorder in pregnancy. Providers can consider the use of either agent with treating women with this condition.
Do Psychiatric Medications Exacerbate Neonatal Withdrawal in Pregnant Women Using Opioid Maintenance Therapy? [27N]
Authors: Ly Victoria , Persad Malini D. , Herrera Kimberly , Garry David , Garretto Diana
Published: April 2018

INTRODUCTION:

The objective is to determine if opioid maintenance therapy (OMT) in conjunction with psychiatric medications increases the risk of neonatal abstinence syndrome and adverse neonatal outcomes.

METHODS:

A retrospective cohort study of pregnant women with opioid use disorder was performed at a tertiary care hospital from January 2016 to June 2016. Women were identified from the hospital’s delivery logs. Included in the study were pregnant women on opioid maintenance therapy. Women were categorized by whether or not they simultaneously used psychiatric medication or if they did not. Maternal demographics, medical history, social history, maintenance therapy, delivery characteristics and neonatal outcomes were collected from the electronic medical record. A composite adverse neonatal outcome score was created and defined as the presence of any of the following: preterm delivery, birthweight <2500 grams, Apgar score < 7 at 5 minute, NICU admission, and neonatal abstinence syndrome. Data was compared between the two groups with the use of parametric and nonparametric statistics as appropriate. A p value of < 0.05 was considered statistically significant.

RESULTS:

Of 1,927 deliveries, 37 women qualified for the study. Compared to pregnant women who used opioid maintenance medications alone, pregnant women who used psychiatric medications were significantly more likely to be nulliparous and have a history of psychiatric disorder. There were no differences in adverse neonatal events, including neonatal abstinence syndrome.

CONCLUSION:

Using psychiatric medication in conjunction with opioid maintenance therapy has comparable incidence of neonatal abstinence syndrome to using opioid maintenance therapy alone.
Endometrial Calcifications: A Novel Sonographic Marker of Endometrial Injury [29N]
Authors: Starostanko Andrea , Ayers Jonathan , Keeton Kristie , Green Pooja
Published: April 2018

INTRODUCTION:

Morbidly adherent placenta (MAP) has increased 10-fold in the last fifteen years and is associated with injury to the decidua basalis especially with placental implantation over a previous surgical scar. Transvaginal ultrasound (TVUS) can detect endometrial calcifications (EMC), which pathologically, indicate localized basalis injury. The purpose of this investigation is to determine if ultrasound evidence of EMC is seen more commonly in women with a history of cesarean delivery.

METHODS:

TVUS performed in non-pregnant women were reviewed for the presence of EMC. Women were stratified into 4 groups: 1) nulliparous; 2) one prior vaginal delivery; 3) one prior cesarean delivery (CD) with surgical incision above the internal os; and 4) one prior CD with surgical incision below the internal os.

RESULTS:

TVUS from 518 women were evaluated. EMC were noted in 4% of nulliparous women and 60% of women with one prior vaginal delivery. Sixty percent of patients with a prior CD had evidence of EMC within the surgical scar. Eighty-seven percent of women with a prior CD with a surgical incision below the internal os had localized EMC within the surgical scar.

CONCLUSION:

Parous women are more likely than nulliparous women to have EMC, likely from the placental implantation site. We propose that the combination of localized calcifications within a prior surgical scar, particularly when the incision is below the internal os (area of relatively decreased vascularity), synergistically predisposes patients to increased basalis injury and potentially MAP. This novel marker could be used to predict the risk of MAP in future pregnancies.
Cryopreservation Promotes Sperm DNA Damage Through Oxidative Stress [38N]
Authors: Tran Mai , Uriondo Heydy , Nodar Florencia , Alvarez Sedó Cristian
Published: April 2018

INTRODUCTION:

Sperm cryopreservation may be linked to DNA damage, possibly via oxidative stress. We compared the DNA damage, apoptosis levels, and oxidative stress in semen samples prior to and after slow cryopreservation and evaluated the relationship between these variables.

METHODS:

Semen samples from 60 men who underwent assisted reproductive technology (ART) (experimental group) and 20 normozoospermic sperm donors (control group) were analyzed. DNA fragmentation, apoptosis levels, and plasma membrane lipid peroxidation/oxidative stress were evaluated using TUNEL, Annexin V-FITC Apoptosis Kit, and BODIPY/8OH-DG respectively. These variables were evaluated prior to slow cryopreservation and after thawing. Apoptosis (Annexin V), DNA fragmentation (TUNEL), and oxidative stress (BODIPY and 8OHDG) values were also compared between the group of men who underwent ART and the sperm donor group.

RESULTS:

Annexin V, TUNEL, BODIPY, and 8OHDG values significantly increase after thawing (p<0.05). In the post-thawing group, the BODIPY and 8OHDG levels are significantly greater than the Annexin V level (p<0.05). Moreover, the sperm donor group had significantly lower Annexin V, TUNEL, and BODIPY and 8OHDG values than the group of men who underwent ART (p<0.05).

CONCLUSION:

After slow-freezing thawing, there are higher levels of apoptosis, DNA fragmentation, and oxidative stress in semen samples than prior to cryopreservation. The slow freezing-thawing process induces sperm DNA damage via oxidative stress more so than apoptosis. Semen samples from men who underwent ART are more susceptible to oxidative stress and cell death than normozoospermic sperm donors.
Who Publishes in the Green Journal? [3O]
Authors: Swaim Laurie S. , Davis Beth R. , Limmer Jane , Sangi-Haghpeykar Haleh , Thompson Chesney
Published: April 2018

INTRODUCTION:

Specialists (formerly “generalists”) account for the largest percentage of faculty among medical school departments of obstetrics and gynecology (OBGYN) in the United States (US). First, second or last authorship in a peer-reviewed journal is required for promotion regardless of training. However, academic specialists lack research instruction obtained during subspecialty fellowships. We aim to compare the prevalence of specialist and subspecialist OBGYN and trainee first-authors of original research articles in the journal Obstetrics & Gynecology.

METHODS:

Articles published from 2014-2016 in Obstetrics & Gynecology were evaluated. First authors from US sites were classified as specialists, subspecialists or trainees from the institutional website at the time of publication. Original research articles were categorized as Randomized Controlled Trial (RCT), Cohort, Case-Control, Cross Sectional, or Meta-analysis/Systematic Review based on the description in the materials and methods. The Chi-square test was used to analyze categorical variables. P < .05 was considered significant

RESULTS:

From 2014 to 2016, 339 original research articles were identified. While 66% of first authors were subspecialist (225/339), no significant differences were noted in the portion of subspecialist versus generalist as first authors of RCT (8 vs 11%, P = .41), cohort trials (63 vs 60%, P = .64), or case-control studies (6 vs 4%, P = .44).

CONCLUSION:

Academic OBGYN’s who have completed or are in fellowship subspecialty training programs are more likely to be primary authors of original research than specialist and resident obstetrician-gynecologists. However, specialists are proportionally just as likely to publish original research articles as their subspecialist colleagues.
Assessing Knowledge of Cervical Cancer among Health Care Students in Mwanza, Tanzania [9O]
Authors: Patel Priya , Hari Anjali Y. , Bernstein Megan , Farfel Allison , Raman Kaavya
Published: April 2018

INTRODUCTION:

In many Sub-Saharan African countries, cervical cancer remains the most prevalent cancer among women. The purpose of this study is to empirically characterize levels of knowledge in healthcare students in Mwanza, Tanzania with regards to transmission and risk factors for HPV infection, as well as treatment options and prevention of cervical cancer.

METHODS:

To assess educational needs and awareness, 185 health professions students were surveyed to measure knowledge of cervical cancer.

RESULTS:

3 out of 181 students identified all of the correct causes of cervical cancer and none of the incorrect causes. 11 students out of 181 identified all of the correct HPV prevention methods and none of the incorrect methods. None of the students were able to identify all correct responses without selecting any incorrect responses for cervical cancer risk factors, HPV transmission, or cervical cancer treatment options. Almost two-thirds of participants in this study reported being dissatisfied with their current level of cervical cancer knowledge, and the most common source of information indicated by students was the media, not school.

CONCLUSION:

Many policy changes are needed to curtail the high incidence and prevalence of cervical cancer in Tanzania. Low levels of demonstrated knowledge call for the implementation of additional HPV, cervical cancer prevention, and cervical cancer treatment educational lessons. These lessons may improve the knowledge base of the future healthcare workforce, who may in turn be more equipped to address the high rates of cervical cancer in Tanzania.
Pediatric Gynecology: Improving Ob/Gyn Resident Training by Using a Short Interactive Curriculum [13O]
Authors: Medina Yailis
Published: April 2018

INTRODUCTION:

Ob/Gyn residency programs are not providing enough training time to pediatric gynecology education, and residents experience limited exposure in clinics. By graduation, most residents feel less than competent in managing pediatric evaluations. Multiple authors have published their concern and possible solutions to improve training during residency. Most interventions have been limited to independent study or simulations for technical skill development in pediatric pelvic examination. This study will integrate the individual solutions provided in the literature to develop a structured and interactive curriculum to achieve resident competence in all phases of the encounter.

METHODS:

A prospective pre-post cohort study to evaluate effects in knowledge, skills and attitudes (KAS) in 20 Ob/Gyn residents from University of Puerto Rico. The curriculum included 4 interactive, independent sessions of 60 minutes on bleeding patterns, pelvic pain, pelvic masses and vulvovaginal disease. Followed by a 120-minute workshop on examination, procedural and communication skills. To evaluate the areas, the data was collected in a pre and post tools for knowledge, skills and attitudes.

RESULTS:

Data was collected from 14 residents who completed the pre and post-tests. Descriptive statistics comparing all residents who responded pre and post-tests showed a 85% improvement in medical knowledge, 100% for procedural skills and 75% in attitudes.

CONCLUSION:

A short curriculum, with limited resources can be implemented in all interested programs. Providing more time and specific training in pediatric gynecology will improve KSA of Ob/Gyn residents leading to improvement in care for Ped/Gyn population. Study was limited by poor response of residents to web instruments.
Level of Nursing Experience and its Link to Cesarean Birth Rate [20O]
Authors: Adkins Christen B. , Dziadosz Margaret
Published: April 2018

INTRODUCTION:

High cesarean birth rates are a concern both in the United States and around the world. There is limited research on the role of nursing care in contributing to cesarean births in patients who have the potential to deliver vaginally. Our study investigated an association between level of nursing experience and risk of cesarean birth by analyzing an existing data set.

METHODS:

We obtained a sample of women giving birth at a community hospital in New Jersey with approximately 6,000 births per year. Data were extracted from records of every eligible birth over a 2-month period, including experience of the nurse providing care, maternal and infant characteristics, obstetrical procedures, and type of birth. Pregnant patients were selected based on inclusion criteria: ages 18-40 years old, carrying singletons, at 37 weeks or more. Exclusion criteria included: prior uterine surgery, prior cesarean, and planned cesarean. After controlling for maternal age, race, body mass index, parity, infant weight, gestational age, type of rupture, and epidural analgesia, the association between cesarean birth and years of nursing experience was analyzed by a chi-square test. Total amount and maximum rates of Pitocin administered were compared with nurse experience by a Student t-test.

RESULTS:

Associations between nursing experience and cesarean section rate, total amount of Pitocin administered, and maximum Pitocin rate administered during labor were found with statistical significance (P<.05).

CONCLUSION:

Based on these results, this study concludes that more experienced nurses have higher cesarean section rates, and administer lower total amounts and lower maximum rates of Pitocin during labor.
When to Deliver Monochorionic Diamniotic Twins in the Setting of Preeclampsia [21O]
Authors: Walker Allison R. , Caughey Aaron B.
Published: April 2018

INTRODUCTION:

Monochorionic diamniotic (MCDA) twin pregnancies are at increased risk of preeclampsia (PET), intrauterine growth restriction (IUGR) and intrauterine fetal demise (IUFD). Our study compared outcomes of induction of labor (IOL) at 34 through 37 weeks to determine the most favorable gestational age for delivery in MCDA twin pregnancies complicated by mild PET.

METHODS:

A decision analytic model was created using TreeAgePro 2017 software to compare the outcomes of expectant management versus IOL at 34 to 37 weeks of gestational age. Outcomes examined included quality adjusted life years (QALYs), cases of advancement from mild to severe PET, maternal mortality, maternal stroke, IUGR, IUFD, cerebral palsy (CP) and neonatal mortality. Probabilities, utilities, and life expectancies were derived from the literature. Univariate analyses were used to investigate the impact of labor induction at various gestational ages.

RESULTS:

In a theoretical cohort of 10,000 MCDA pregnancies complicated by PET, IOL at 34 weeks resulted in the fewest cases of severe PET (0), maternal stroke (15), maternal mortality (4), IUFD (0), and IUGR (1,183). However, this strategy was also associated with the most cases of neonatal CP (91) and neonatal mortality (90). Neonatal CP and mortality were lowest in the 37 week IOL strategy group at 47 and 67, respectively. QALYs were highest (867,342) when IOL occurred at 36 weeks.

CONCLUSION:

MCDA twin pregnancies complicated by mild PET should be induced at 36 weeks. When compared to IOL at 37 weeks, this strategy reduces maternal and neonatal morbidity and mortality.
Vitamin C Supplementation and Risk for Preterm Premature Rupture of Membranes and Preterm Birth: A Meta-Analysis [23O]
Authors: Souryal Abigail , Galindo Megan , Roman Tania , Ireland Kayla E. , Ramsey Patrick S. , Boyd Angela R.
Published: April 2018

INTRODUCTION:

Strong evidence has linked perturbations of vitamin C levels and collagen integrity with risk for preterm premature rupture of membranes (PPROM). We sought to evaluate the literature and perform a meta-analysis using available data from randomized clinical trials (RCT) which evaluated the use of vitamin C supplementation to prevent PPROM and preterm birth (PTB).

METHODS:

A systematic literature review was conducted using PUBMED and MEDLINE 1966-2017 using relevant search terms. Secondary citations from retrieved papers were also reviewed. Outcome data from RCT were abstracted and meta-analysis performed using Mantel-Haenszel fixed effects model with test of heterogeneity (Comprehensive Meta-Analysis - Version 2.2.064).

RESULTS:

Ten randomized placebo controlled trials, conducted 2004-2013, assessing Vitamin C supplementation and relationship to PPROM or PTB were identified. These studies included at total cohort of 14291 women who received vitamin C supplementation and 14307 women who received placebo. PPROM and/or PTB were the primary outcome in 4 of the 10 studies. The remainder of studies evaluated PPROM and/or PTB as a secondary outcome. Eight studies included data for PPROM<37 weeks and/or PTB<37 weeks. Five studies included data for PTB<34 weeks. Vitamin C was not associated with reduction in risk of PPROM<37 weeks (OR 1.05, CI 0.91-1.21, p=0.55), PTB<37 weeks (OR 1.02, CI 0.95-1.10, p=0.62) or PTB<34 weeks (OR 1.15, CI 0.97-1.36, p= 0.10).

CONCLUSION:

Vitamin C supplementation during pregnancy is not associated with prevention of PPROM or PTB.
Impact of ACOG Guideline Regarding Low Dose Aspirin for Prevention of Superimposed Preeclampsia [27O]
Authors: Banala Chaitra , Cruz Yury , Moreno Cindy , Schoen Corina , Berghella Vincenzo , Roman Amanda
Published: April 2018

INTRODUCTION:

In July 2016, an American College of Obstetricians and Gynecologists (ACOG) guideline recommended that pregnant women with chronic hypertension (CHTN) be offered low dose aspirin to prevent superimposed preeclampsia (SIP). This study aimed to evaluate the incidence of SIP in women with CHTN before and after the ACOG guideline.

METHODS:

This retrospective cohort study included CHTN patients who delivered at Thomas Jefferson University Hospital from 1/2008 to 7/2017, excluding multiple gestations. The cohort was divided into 2 groups, before and after the ACOG recommendation. We offered daily 81 mg aspirin. The cohort was stratified by other risk factors for SIP, including history of preeclampsia and pre-gestational diabetes. The primary outcome was incidence of SIP. Secondary outcomes were incidence of SIP with severe features (SIPSF), small for gestational age, and preterm birth.

RESULTS:

We identified 715 pregnant CHTN patients, comprised of 80 post-ACOG and 635 pre-ACOG patients. The incidence of SIP in all women with CHTN was 20 (25%) vs 232 (37%), OR 0.43 (95% CI 0.26-0.73). SIP and SIPSF were significantly decreased in the subgroup of women with CHTN without other risk factors: 4/41 (10%) vs 106/355 (30%), OR 0.25 (95% CI 0.08-0.73); and 2/41 (5%) vs 65/355 (18%), OR 0.22 (95% CI 0.54-0.97), respectively. Maternal demographics and secondary outcomes were not significantly different.

CONCLUSION:

After the ACOG guideline, low dose aspirin decreased SIP by 57% in all women with CHTN. The benefit was higher in women with CHTN without other risk factors, with decreases of 75% in SIP and 78% in SIPSF.
Screening Rates, Elevated Risk, and Correlates of Postpartum Depression in an Obstetric Population [28O]
Authors: Long Molly M. , Morgan Franklin G. , Wilkes Charles A. , Fontanares Arlene J. , MacFarlane Beth , Cramer Robert J.
Published: April 2018

INTRODUCTION:

Postpartum depression (PPD) affects approximately 1 in 9 women. However, screening rates for PPD are inconsistent and low among physicians. Physicians most often rely on clinical assessment to evaluate PPD but this method is often inaccurate or inconsistent in evaluating or diagnosing PPD. The current study had 3 objectives: 1) to assess overall screening rates of PPD; 2) to examine elevated PPD score rates; 3) to identify correlates of elevated PPD.

METHODS:

Archival data from an obstetrician/gynecology practice provided data for the current study. A total of 557 medical records were examined for the following: demographics, mental health history, PPD screening tools, elevated PPD screen recommendations and adherence. PPD screening frequency was assessed at 2 time points: intake appointment and 6-week post-delivery follow-up.

RESULTS:

The screening rates were relatively high at intake (335/557, 60.1%) and at 6-week follow-up (476/557, 85.5%). Elevated PPD score rates at intake were 18.2% (n = 61/335) and 13.0% (n = 62/476) at 6-week follow-up. The following bivariate correlates of elevated PPD risk were observed: history of depression, history of anxiety, younger age, Medicaid/Medicare health insurance, and single marital status. Full regression models will be presented at the conference.

CONCLUSION:

This research adds new knowledge regarding screening rates of PPD and elevated PPD screens, thereby enhancing quality of service provision for mothers. This study provides the basic science to inform an educational intervention addressing screening rates and correlates of PPD; such training may enhance provider knowledge, attitudes, and skills regarding PPD.
Prophylactic Uterotonic Use in Grandmultiparas Reduces Recurrent Postpartum Bleeding [32O]
Authors: Misal Meenal , Wong Melissa , Greene Naomi , Aghajanian Paola
Published: April 2018

INTRODUCTION:

Grand multiparity is a risk factor for postpartum hemorrhage (PPH). We evaluated whether prophylactic uterotonics in grandmultiparas reduced the incidence of recurrent postpartum bleeding.

METHODS:

This retrospective cohort study of grandmultiparas who underwent vaginal delivery between January 2011 and December 2015 compared women who received postpartum prophylactic uterotonics (other than routinely given oxytocin) to women who did not. A uterotonic was deemed prophylactic if so recorded by the delivering physician or if given within 1 hour of delivery with no other indication documented. Physician re-evaluation of vaginal bleeding was chosen as the primary outcome as a proxy for clinically significant recurrent bleeding. A multivariable logistic model was used to compare rates of physician re-evaluation between groups receiving prophylactic uterotonics versus none.

RESULTS:

Of the 356 grandmultiparas, 53 (15%) received a prophylactic uterotonic. Women with 7-11 deliveries were more likely to receive prophylactic uterotonics than those with 4-6. Hispanic women were also more likely to receive prophylactic uterotonics. There were no other significant differences in demographic or obstetric factors. PPH rate was similar for both groups (6% vs. 6%, P=.79). However, the adjusted rate of physician re-evaluation was six-fold higher for women who did not receive prophylactic uterotonics (OR: 6.08 [95% CI 1.2 - 29.7] P=0.03). Of those who did not receive prophylactic uterotonics and required physician re-evaluation, 46% subsequently received an additional uterotonic.

CONCLUSION:

The rate of physician re-evaluation for recurrent postpartum bleeding was six-fold higher for grandmultiparas who did not receive prophylactic uterotonics post-delivery. Administration of prophylactic uterotonics may benefit this high-risk population.
Maternal Perception of Fetal Movements Near Term: The Problem of Maternal Compliance [33O]
Authors: Ghidini Alessandro , Newman Anne M. , Cacace Marietta , Han Sacha , Chongasing Kaci
Published: April 2018

INTRODUCTION:

Women's compliance with counting of fetal movements (FM), a key issue for the success of such a screening test, has been poorly studied as non-compliant women have traditionally been excluded from studies on FM count.

METHODS:

Prospective cohort study of all women with risk factors for fetal death undergoing fetal testing via weekly modified biophysical profile started at 36 weeks. Excluded were multiple gestations, decreased fetal movements, delivery indicated at 37 weeks, severe maternal medical conditions or severe fetal anomalies. Risk of stillbirth in last month of pregnancy was explained and women were taught in a consistent way on FM count-to-10 with recording of time to the 10th movement. Log sheets were verified weekly at the time of fetal testing, when instructions on FM counts were reinforced by dedicated nurses.

RESULTS:

8% of candidate women declined FM count. Among women consenting to participate in the study, those compliant (52%) had similar maternal age, race, ethnicity, obesity, and indications for testing as those non-compliant, but were more frequently nulliparous (P<.001). Rates of induction of labor, mode of delivery, birth weights and Apgar scores were similar in the 2 groups. All neonates requiring NICU admission were from the non-compliant group (P=0.001).

CONCLUSION:

Compliance with FM count is low even among high risk women consenting to FM count and receiving specific and reinforced instructions by dedicated nurses. Non-compliant women tend to be multiparous and their babies have higher rates of NICU admission.
Placental Histopathologic Findings Associated with Antepartum Eclampsia [1P]
Authors: DuBois Molly , Ambia Anne M. , Wells C. Edward
Published: April 2018

INTRODUCTION:

The aim of this study was to describe placental pathology among women with antepartum eclampsia.

METHODS:

This was a retrospective cohort study of placental pathology of women with antepartum eclampsia who delivered from May 2009 to December 2016 at Parkland Hospital. Placentas were processed using an institutionalized standardized examination. Placental pathology lesions were grouped into categories including inflammation (vasculitis, funisitis, amnionitis), vasculopathy (infarcts, atheroma), meconium exposure, placenta hypoplasia/hyperplasia, and no pathologic abnormality. Each placenta may have had numerous findings in different categories.

RESULTS:

There were 44 women with antepartum eclampsia at our institution during the study period. Of these, 31 women had placental pathology examined according to institutional protocol. These women were majority Hispanic (83%), primagravidas (65%), and the average age as 23 +/- 7 years. Eclampsia developed at an average gestational age of 36 +/-4 weeks. Sixteen women (52%) had cesarean deliveries, eight (26%) had vaginal deliveries, and seven (22%) had forcep-assisted vaginal deliveries. Overall, the finding of inflammatory lesions was observed in 61%, meconium staining in 55%, and vasculopathy in 42%. Placental hypoplasia was noted in 29% and hyperplasia in 19%. Only one placenta was found to have no histopathologic abnormality.

CONCLUSION:

In women with antepartum eclampsia, 97% of placentas examined revealed a histopathologic abnormality such as meconium exposure, vasculopathy, or inflammatory lesions. More than half were observed to have evidence of meconium exposure and 65% were noted to have more than one histopathologic finding.
The Association of Latent Labor and Classical Cesarean Delivery [2P]
Authors: Cockrum Richard , Winter Michelle , Young Danielle , Mueller Ariel , Rana Sarosh , Siddiqui Maryam
Published: April 2018

INTRODUCTION:

Labor prior to cesarean delivery is thought to be a protective factor against classical incision at <28 weeks gestation, ostensibly from development of the lower uterine segment. This study aims to determine if latent labor has a similar secondary benefit to reduce classical cesarean deliveries at an early gestational age.

METHODS:

In this retrospective cohort study, patients with a singleton pregnancy between 24 and 31 weeks gestational age undergoing cesarean delivery at a single, tertiary academic medical center were enrolled between January 2011 and December 2015. Stages of labor were defined as none, latent phase (final dilation <6cm), and active phase (final dilation >/= 6cm). The primary outcome was type of uterine incision.

RESULTS:

For 263 eligible patients, the rate of classical cesarean delivery was 53%. This varied significantly by gestational age (77% at 24-27 weeks vs 32% at 28-31 weeks; p<0.0001). Other significant factors associated with classical incision included smaller birthweight, chorioamnionitis, and fetal malpresentation (p<0.05). Labor was not significantly associated with a reduction in the odds of classical incision (OR 0.79, 95% CI 0.49-1.29). Stratification by stage of labor also did not show a significant difference in rate of classical incision for none, latent, and active labor for all patients (55%, 50%, and 49%, respectively) or for 24-27 weeks (78%, 79%, and 71%, respectively). No difference was observed between spontaneous and induced labor or by provider specialty and experience.

CONCLUSION:

In this preliminary analysis, labor, regardless of stage, was not associated with reduction in the odds of classical cesarean delivery.
Clinical Presentation and Outcome of 10 Cases of Mirror Syndrome [3P]
Authors: Mogharbel Hussain , Hunt Jennifer C.
Published: April 2018

INTRODUCTION:

Mirror syndrome, or Ballantyne’s syndrome, is a rare diagnosis with only 113 cases described in the literature. It is mainly characterised by maternal symptoms similar to preeclampsia in the setting of fetal hydrops. We identify 10 additional cases and provide a review of the maternal presentation, biochemical findings and perinatal outcome.

METHODS:

We performed a retrospective chart review of all cases of fetal hydrops from two tertiary centers in Winnipeg, Canada between 2000 and 2016. There were 276 cases of fetal hydrops during this period, of which 10 cases satisfied the criteria for Mirror syndrome.

RESULTS:

We report 10 cases of Mirror syndrome. The majority (80%) of women were multiparous. The mean gestational age at diagnosis was 23 weeks 4 days +/- 4 days and the mean gestational age at delivery was 25 weeks +/- 5 days. The most common clinical findings included hypertension, edema and placentomegaly. The most common laboratory findings included hypoalbuminemia (mean 20 7 gm/L), elevated uric acid level (mean 375 µmol/L) and anemia (mean hemoglobin 10g/dL). Half of the fetuses were stillborn and 40% of pregnancies resulted in neonatal deaths. Congenital anomalies were diagnosed in half of the pregnancies.

CONCLUSION:

Mirror Syndrome is likely under-diagnosed. Acute hemodilution, hypoalbuminemia and hyperuricemia might be early indicators for the diagnosis. Delivery is the treatment of choice and maternal symptoms usually resolve within few days after delivery. Fetal outcome is poor but early recognition may potentially avoid maternal morbidity.
Clinical Experience of Expanded Carrier Testing for Routine Preconception and Prenatal Care [10P]
Authors: Tschirgi Matt , Swope Betsy , Terhaar Catherine , Dohany Lindsay , Settler Christina
Published: April 2018

INTRODUCTION:

Expanded carrier testing is recognized by ACOG as an acceptable testing strategy in women’s healthcare. We report a large OB/GYN practice’s experience with expanded carrier testing including partner testing uptake and reproductive risk.

METHODS:

A retrospective analysis of expanded carrier testing ordered at a multi-provider clinic was performed. Data analyzed included patient demographics, testing outcomes, and reproductive risks.

RESULTS:

Out of 537 female patients tested, 265 (49.3%) were positive; of those, 201 (75.8%) had partner testing. Fourteen (7.0%) couples were at risk to have a child affected with an autosomal recessive disorder (8 hemochromatosis, 3 familial Mediterranean fever, 1 PKU, 1 primary congenital glaucoma, 1 GJB2 non-syndromic hearing loss). Thirty women were carriers of an X-linked disorder (22 G6PD, 7 Fragile X premutation, and 1 GJB1-related Charcot-Marie Tooth disease). Incidentally, 10 patients were found who may have symptoms of a genetic condition based on their genotype (5 G6PD, 4 hemochromatosis, 1 carnitine palmitoyltransferase II deficiency), which could impact patient and pregnancy management.

CONCLUSION:

Implementing an expanded carrier testing protocol including partner testing identifies carriers of many disorders and allows for reproductive risk identification. In this cohort, out of 537 patients who were tested, 43 (8.0%) were identified to have reproductive risk either due to an X-linked disorder or as carriers of the same autosomal recessive disorder. Risk identification empowers patients to make informed decisions with the guidance of their provider. This experience demonstrates the yield of expanded carrier testing when routine testing and partner follow-up is incorporated in a busy obstetrical practice.