bluuebunny/crossref_metadata_2025 huggingface dataset:
The Rate of Cesarean Section Stratified by Maternal Age, Parity and Previous History of Cesarean Section [13Q]
Authors: Luck Marissa , Savitsky Leah , Speranza Rosa , Caughey Aaron
Published: May 2017

INTRODUCTION:

The purpose of this study is to characterize the rate of cesarean sections (CS) in women < 35 years old against women of advanced maternal age (AMA) >35 years old. This data was further stratified by parity and history of cesarean section.

METHODS:

This is a retrospective cohort study of 9,676,773 non-anomalous, singleton deliveries 2012-2014 in the United States. In women with and without GDM, we conducted a chi-squared analysis of women < 35 years old and women of AMA and further stratified by parity and history of a CS.

RESULTS:

Significantly more CS performed on women with GDM than those without GDM in women < 35 years old and of AMA. In women < 35 years old, those with GDM were significantly more likely to have CS than those without GDM (37.0% vs. 26.2%, p < 0.001). Stratifying for nulliparous women < 35 years old with GDM, women were more likely to have CS than those without GDM (36.8% vs. 25.0%, p < 0.001), as well as multiparous women without a history of a CS, and women with a history of CS. Women of AMA with GDM were significantly more likely to have a CS than those without GDM (44.8% vs. 36.8%, p < 0.001).

CONCLUSION:

GDM is associated with increased risk of cesarean section in women who are < 35 years old and women of AMA. This is also shown when considering parity and cesarean section history. Further research is needed to determine etiology of these differences when considering maternal age, diabetes status and parity.
The Impact of Guidelines for the Collaboration Between Obstetricians & Midwives on Provider Satisfaction [15Q]
Authors: Madkour Amr , Smith Patricia , Lyvers Ashlee , Pinger Whitney
Published: May 2017

INTRODUCTION:

Collaborative guidelines were instituted at our academic practice to streamline the existing process of consultation, collaboration, and transfer of care between obstetricians and midwives. We aim to investigate attitudes of providers toward the collaborative model, and how the implementation of an institutional guidelines document influences perceived provider satisfaction, oversight of collaboration, and delivery of patient care.

METHODS:

A qualitative survey of the faculty was administered using an electronic data capture system.

RESULTS:

Thirty-three faculty members were sent surveys, 76% were completed (n = 25, 16 obstetricians, 9 midwives). All respondents perceived collaborative practice improves patient outcomes. Formal guidelines were reported as necessary to direct collaborative practice by 44%, while another 44% reported them to be unnecessary. Respondents either agreed or strongly agreed (100%) that a collaborative model improves vaginal delivery rate, and patient satisfaction. While one respondent was neutral, and another disagreed that a collaborative practice improves provider satisfaction with care, the remaining 91% agreed or strongly agreed that it does. Finally, while 70% of respondents disagreed that collaborative practice increases provider perceived stress associated with patient care, 24% were neutral, 8% agreed, and 4% strongly agreed.

CONCLUSION:

The majority of respondents agree that a collaborative model benefits patients and providers, but equally agree and disagree with formal guidelines to direct collaboration. Subsequent analysis will explore the relationship between responses and the role of the respondent. Additional research investigating such guidelines will be beneficial in understanding collaborative models, and will assist practices interested in implementing similar models.
The Global Burden of Obesity on Pregnancy Outcomes in the Developed World [17Q]
Authors: Quiner Trevor , Perlow Jordan H.
Published: May 2017

INTRODUCTION:

Essentially all major complications of pregnancy are more likely to occur in the obese gravida when compared to women with normal body mass indices. The purpose of this study was to estimate as accurately as possible, the quantitative burden of obesity on pregnancy outcomes in the developed world.

METHODS:

Pooled odds ratios for outcomes of interest related to maternal overweight and obesity were extracted from previously published meta-analyses. Rates of overweight and obesity in adult women in the Group of Eight countries were corrected for the decreased incidence in women prior pregnancy. The prevalence of each adverse outcome was extracted from published literature. Together this information was used to calculate the population attributable fraction that can be attributed to overweight and obesity each year for each outcome.

RESULTS:

Each year an estimated 3,168 stillbirths, 3,610 infant deaths, 570,449 cesarean deliveries, 1,105 neural tube defects, 780 cases of congenital heart defects, and 135,258 cases of preeclampsia can be attributed to maternal obesity in the Group of Eight countries. Calculations were also performed for maternal overweight.

CONCLUSION:

While the negative impact of maternal overweight and obesity is well known, it becomes easy to lose sight of the human cost of these increased odds ratios. By estimating the number of attributable cases this study humanizes the burden of overweight and obesity in the perinatal setting. Furthermore, this detailed estimate assists in the prioritization of public health efforts in the treatment and prevention of obesity and research into its proper management in pregnancy.
The Feasibility of a Patient-Centered Medical Home to Treat Pregnant Women With Opioid Use Disorder: A Pilot Study [19Q]
Authors: Mokhtari Neggin , Bobby Stephanie , Chang Judy C. , Gedekoh Robert , England Michael , Krans Elizabeth E.
Published: May 2017

INTRODUCTION:

The patient-centered medical home (PCMH) is a healthcare model intended to improve healthcare quality while reducing costs. Pregnant women with opioid use disorder (OUD) require intensive healthcare resources. Therefore, a pilot study was conducted to establish the feasibility of a buprenorphine PCMH for pregnant women with OUD.

METHODS:

The Pregnancy Recovery Center (PRC) was created by five buprenorphine-licensed obstetricians and one addiction certified nurse in 2014. The PRC provides co-located buprenorphine, prenatal care, counseling, and social services support through a PCMH approach. Feasibility was measured by the ability to enroll, treat and retain patients. Successful completion (retention) was defined by negative drug screens, compliance with prenatal care, buprenorphine and counseling appointments. Additional outcomes were also compared between PRC vs non-PRC buprenorphine patients.

RESULTS:

Of 50 pregnant women enrolled from July 2014 to July 2015, 32 (64%) women successfully completed the program. The mean age was 28.1 years and 95.5% of women were white. Among 32 PRC and 78 non-PRC patients, buprenorphine dose at delivery was significantly higher for PRC vs non-PRC patients (18.4 vs 14.7 mg; P < .01), but neonatal abstinence syndrome (NAS) treatment rates were similar between the groups (46.2% vs 43.8%, P=.82). Fewer hospital charges for antepartum and delivery hospitalizations ($23,554.00 vs $183,703.00) were found for PRC vs non-PRC patients.

CONCLUSION:

A buprenorphine PCMH is feasible and may improve maternal and neonatal outcomes for pregnant women with OUD. Future large-scale clinical trials are needed to compare outcomes associated with alternative healthcare delivery models such as PCMHs for this population.
Reduction of Nulliparous Term Singleton Vertex Cesarean Deliveries With Feedback and Monitoring [23Q]
Authors: Child Reesa , DeCesare Julie
Published: May 2017

INTRODUCTION:

Rates of cesarean deliveries have been increasing, and substantial regional variation for total cesarean delivery rates is 22.6% to 39.7%. The objective of this study is to reduce primary cesarean deliveries in nulliparous term singleton vertex (NTSV) births through a feedback and monitoring program.

METHODS:

This retrospective chart review involves analysis of all nulliparous term singleton vertex cesarean deliveries at Sacred Heart Health System from January 2015 through March 2016. Key components were extracted during chart review based on recommendations by the American College of Obstetricians and Gynecologists/SMFM Obstetrics Consensus. Individual monthly cesarean rates compared to blinded peers were then provided to physicians from June 2016 to present.

RESULTS:

From January 2015 through October 2015, there were a total of 308 NTSV cesarean deliveries. Indications included labor dystocia (28.1%), non-reassuring fetal heart tracing (NRFHT) (21.6%), and suspected fetal macrosomia (4.9%). In cases of suspected fetal macrosomia, an average birth weight of 4,140 grams was noted. Only 16.7% of the 66 cases of NRFHT had interventions documented prior to cesarean delivery. Of the 86 cases involving labor dystocia, only 10.5% met the definition of labor arrest or prolongation as defined by the American College of Obstetricians and Gynecologists/SMFM Obstetrics Consensus. Operative deliveries were attempted in only 2 cases of labor dystocia prior to cesarean delivery.

CONCLUSION:

Based on retrospective chart review, modifiable opportunities for decreasing cesarean deliveries in our institute were identified. Planned monthly feedback from June 2016 to June 2017 will be provided to physicians to trend the overall cesarean rates among nulliparous term singleton vertex deliveries.
The Effect of Body Mass Index on Glyburide Therapy in Pregnancy [26Q]
Authors: Henry Rosanne , Louis-Jacques Adetola , Miladinovic Branko , Nwabuobi Chinedu , Whiteman Valerie
Published: May 2017

INTRODUCTION:

To determine association between glycemic control and body mass index (BMI) in women with gestational diabetes mellitus (GDM).

METHODS:

Retrospective study of women diagnosed with GDM and delivered at a university-affiliated hospital between November 2011 and November 2014. Adequate glycemic control was defined as: Fasting blood glucose less than 95 mg/dL or 1 hour postprandials greater than 140 mg/dL. BMI at delivery was calculated. The primary outcome was glycemic control using blood glucose log closest to the time of delivery. Parametric and non-parametric tests were employed for statistical analyses as appropriate.

RESULTS:

171 women met eligibility criteria: 10.5% overweight (n=18), 62.6% obese (n=107) and 24.6% morbidly (n=42). Four women (2.3%) with BMI in the normal range at delivery were not included in the analyses because of the small number. Gestational age at initiation of glyburide was 32 weeks (p=0.51). The glyburide daily dose at delivery was 5 mg for both the overweight and obese groups and 10 mg for the morbidly obese group. Total weight gain was similar in the three groups (p=0.53). There was no difference in glycemic control amongst the BMI groups (p=0.204), using the blood glucose log, however, there was a significant difference in HgbA1c levels (p=0.01).

CONCLUSION:

Successful treatment of GDM with Glyburide is not affected by BMI, using the blood glucose log as a glycemic control marker. However, HbA1c level was different between the BMI groups. Since HbA1c is a marker for long-term glycemic control, this deserves further study to examine its role in management of GDM amongst obese gravidas.
The Effect of Betamethasone on Middle Cerebral Artery Doppler Flow in Fetuses With Elevated Peak Systolic Velocities [27Q]
Authors: Luffy Katherine , Hoopes Sarah , Nitsche Joshua F.
Published: May 2017

INTRODUCTION:

Administration of betamethasone (BMZ) has been shown to decrease the morbidity and mortality associated with preterm birth, and is given to patients with a variety of complications such as preterm labor, PPROM, fetal growth restriction, and alloimmunization, among others. As middle cerebral artery (MCA) Dopplers are used to monitor fetal hemodynamics in patients with many of these conditions, we sought to determine if administration of betamethasone is associated with changes in MCA Doppler parameters in fetuses with an abnormally elevated MCA peak systolic velocity (PSV).

METHODS:

A retrospective longitudinal study was conducted including women with a fetal MCA PSV greater than 1.3 MoM that had an MCA Doppler assessment within one week before and one week after betamethasone administration. Pre- and post-BMZ MCA PSV were compared using a repeated measures t-test.

RESULTS:

20 fetuses met inclusion criteria with diagnoses of alloimmunization (13), parvovirus infection (3), fetal growth restriction (2), and twin-twin transfusion (2). The pre-BMZ PSV of 1.60±0.16 MoM was significantly lower than the post-BMZ PSV of 1.41±0.16 MoM (p < 0.0001). 13 of the 20 fetuses had a second post-BMZ MCA Doppler performed with a PSV of 1.5±0.24 MoM which was not significantly different from the initial post-BMZ MCA PSV (p=0.231).

CONCLUSION:

Our data suggest that maternal betamethasone administration lowers the MCA PSV in fetuses with an initially elevated MCA PSV. This should be taken into account when using MCA Dopplers to monitor fetal hemodynamics in patients receiving BMZ.
The Cost-effectiveness of Tenofovir Prophylaxis to Prevent Mother-to-Child Transmission of Hepatitis B Infection [28Q]
Authors: Sargent James , Sharshiner Rita , Caughey Aaron B.
Published: May 2017

INTRODUCTION:

In the setting of maternal Hepatitis B (HBV) antigen positivity and a HBV DNA level greater than 200,000 IU per milliliter there is increased risk of vertical transmission to the neonate. Infected infants are at risk for chronic HBV infection and its complications (cirrhosis, hepatocellular carcinoma, death). Tenofovir (with standard postpartum HBV immunoprophylaxis) has safely prevented vertical transmission of HBV infection without the risk of viral resistance seen with alternative therapies. We designed a model to examine the cost-effectiveness of Tenofovir prophylaxis when compared to postpartum immunoprophylaxis alone.

METHODS:

A decision-analytic model was built using TreeagePro and incorporated probabilities, costs, and utilities from the literature. This model was applied to a theoretical cohort of 100,000 women in order to assess the outcomes of maternal side effects and consequences of neonatal HBV transmission. A cost-effectiveness threshold was set to $100,000 per quality-adjusted life year; the robustness of the model was assessed with sensitivity analyses.

RESULTS:

In our model, Tenofovir prophylaxis resulted in 12,845 fewer cases of vertical HBV transmission, 3,468 fewer cases of cirrhosis, 1,387 fewer cases of hepatocellular carcinoma, and 388 fewer liver transplants. The use of Tenofovir conferred a savings of $232.77 per pregnancy, and—on sensitivity analysis—was the cost-effective strategy to a baseline transmission risk of 5.4% or up to a 17.7% transmission risk with the use of Tenofovir.

CONCLUSION:

In high-risk pregnancies with HBV infection, Tenofovir administration—in addition to standard postpartum immunoprophylaxis—is the cost-effective strategy to reduce the risk of vertical HBV transmission.
The Clinical Characteristics and Prognosis of Cerebral Venous Thrombosis During Pregnancy and Puerperium in China [32Q]
Authors: Liang Zhuwei , Gao Wanli
Published: May 2017

INTRODUCTION:

Cerebral venous sinus thrombosis (CVT) has a relatively low incidence among young women, although both pregnancy and delivery can substantially increase the risk. Due to the specific physiology of pregnancy and puerperium, CVT may manifest different characteristics. This study aimed to identify the clinical manifestations and prognosis of CVT during pregnancy and puerperium.

METHODS:

A total of 43 pregnancy-associated CVT patients were identified and enrolled in the present study. We analyzed the relevant risk factors and clinical presentations of the disease.

RESULTS:

Our descriptive results showed that 1) the incidence of pregnancy-associated CVT was 202 per 100,000 deliveries, and the mortality rate was 11.63%; 2) the most frequent symptom of pregnancy-associated CVT was headache (zs > 3.97, ps < .0001); 3); and 4) the superior sagittal sinus and transverse sinus were the most frequent locations for CVT during pregnancy and puerperium (zs > 2.58, ps < .01). Moreover, the results of univariate regression analyses indicated that an increased modified Rankin Scale score was positively associated with infection, seizure, intracerebral hemorrhage (ICH) and hypertensive disorder complicating pregnancy (ps = .000, .010, 000, .010). Comparably, the results of a chi-square test demonstrated that the occurrence of death was positively and significantly associated with infection, seizure and ICH (ps = .000, .034, 020).

CONCLUSION:

Amongst patients with CVT during pregnancy and puerperium, infection, seizure, ICH and hypertensive disorder complicating pregnancy were independently associated with a worse prognosis. Patients with infection, seizure and ICH who exhibit pregnancy-associated CVT have a greater risk of death.
Advanced Maternal Age and Incidence of Non-Chromosomal Congenital Anomalies: A Population-based Study [35Q]
Authors: Grossi Matt , Crawford Susan , Chandra Sue
Published: May 2017

INTRODUCTION:

Advanced maternal age (AMA), is associated with an increased risk of aneuploidy, adverse pregnancy outcomes, and infertility. Our study's objective is to assess whether AMA increases the risk of non-chromosomal congenital anomalies.

METHODS:

A retrospective cohort study was conducted using a linked dataset from Alberta Perinatal Health Program and the Alberta Congenital Anomalies Surveillance System databases. All singleton births and pregnancy terminations greater than 20 weeks gestational age from 2005 to 2013 were included. Pregnancies with aneuploidy were excluded. Maternal age was categorized as less than 35 years and 35 years and greater. Descriptive statistics of maternal demographic characteristics were generated. Multinomial logistic regression models controlled for parity, use of assisted reproductive technology, smoking, and socioeconomic status.

RESULTS:

There is a significant association between AMA and congenital anomalies in the kidney (P=.004), and reproductive tract (P=.021). The rate of anomalies in the kidney was 2.6 per 1,000 births for women under 20 and rose to 3.0 per 1,000 births for women 35 and older. The rate of anomalies in the reproductive tract was 3.5 per 1,000 births in women under 20, and rose to 4.6 per 1,000 births in women 35 and up. Analysis of the type of anomaly revealed a significant association between AMA and congenital obstructive defects of the renal pelvis (P=.025), other malformations of the kidney (P < .001), undescended testicle (P=.032), congenital deformities of the hip (P < .001) and congenital deformities of the feet (P=.001).

CONCLUSION:

Advanced Maternal Age appears to be associated with an increased incidence of specific non-chromosomal congenital anomalies, particularly of the renal and genitourinary systems.
An Unusual Case of Venous Lymphatic Malformation and Hypoplastic Left Heart Diagnosed on Virtual Autopsy [38Q]
Authors: Jackson Jessica , Cheliiah Anushka , Patrick Kathryn , Duff Patrick
Published: May 2017

INTRODUCTION:

Venous lymphatic malformations are slow-flow vascular malformations that are generally benign in nature. However, they can be associated with aneuploidy and functional impairment of nearby organs and structures. Here, we report an unusual case of lymphatic malformation in association with hypoplastic left heart.

METHODS:

Case Study.

RESULTS:

A 33 year old multiparous woman was evaluated because of an abnormal Quadscreen (1/47 risk of trisomy 21) and a large left cranio-facial mass detected on a 21 week anatomy scan. This lesion was thought to be an unresectable teratoma. The remainder of the anatomic survey was limited due to the mass effect. The patient experienced preterm labor and delivered at 25 weeks gestation. The infant was liveborn but died shortly after birth despite resuscitative efforts. The neonate had massive hydrops and disfigurement of the face, head, and neck from the mass. The family declined autopsy and genetic testing but agreed to a “virtual autopsy” in the form of a postmortem MRI. MRI identified a large veno-lymphatic malformation, occupying nearly the entire left face/neck, accompanied by hypoplastic left heart and hydrops.

CONCLUSION:

To our knowledge, there are no prior reports of the association of this severe veno-lymphatic malformation and hypoplastic left heart. We were unable to confirm the presence of aneuploidy, but we found the virtual autopsy to be of great value in establishing the correct etiology of the craniofacial mass and previously undiagnosed hypoplastic left heart.
Mapping Collaboration Across Birth Settings in the United States: Access, Equity, and Outcomes [2R]
Authors: Vedam Saraswathi , MacDorman Marian , Declercq Eugene , Fisher Timothy J. , Cheyney Melissa , Leeman Lawrence
Published: May 2017

INTRODUCTION:

Lack of coordination of care across birth settings (home-hospital, rural-urban) has been associated with adverse maternal-fetal outcomes. The US Birth Place Mapping Study examines associations between regulation, scope of practice, interprofessional collaboration with maternal-newborn outcomes, and equitable care for at-risk populations.

METHODS:

We populated a 50-state database with published regulatory data on scope of practice across birth settings. A nationwide survey of 92 regulatory experts verified the “on the ground” relevance, importance, and realities of collaboration. Content validation led to a 49-item weighted integration scoring system (item scores range 1-4). Composite summary scores were then used to rank states on the regulatory and practice environment for midwives and physicians across home, birth centers and hospitals. Higher scores indicate more integration and collaboration across all providers and all settings. Using CDC, Area Resource and CMS data, we calculated correlation coefficients between integration scores and selected outcomes (eg. SVD, VBAC, breastfeeding, cesarean, induction, neonatal mortality, LBW) in each state, controlling for race and type of provider.

RESULTS:

Integration scores ranged from 17-59, (North Carolina lowest – 17, Washington highest – 59). We report results through 4 interactive data maps, displaying quartiles for level of integration, linked to optimal and adverse outcomes, and access to care, by state. Rates of birth by race, Medicaid coverage, and location are displayed both by region and by individual states.

CONCLUSION:

This scoring system identifies barriers to collaboration in maternity care, and can inform health human resource planning and policy to improve regional access to high quality maternity care.
Neonatal Abstinence Syndrome Among Infants Born to Mothers With Sickle Cell Hemoglobinopathies [3R]
Authors: Brown Jewel , Sinkey Rachel , Steffensen Thora , Louis-Jacques Adetola , Louis Judette
Published: May 2017

INTRODUCTION:

The objective of this study is to examine risk factors for neonatal abstinence syndrome (NAS) among infants born to mothers with sickle cell hemoglobinopathies (SCH).

METHODS:

This is a retrospective case-control study of non-anomalous, singleton infants born to mothers with laboratory confirmed SCH and placental pathology results. Infants were included if they were diagnosed with NAS prior to hospital discharge. The outcome of interest was the association of maternal variables with NAS.

RESULTS:

The occurrence of NAS was 4% (n=5). Mothers with NAS were more likely to have SC disease (80%) compared to other SCH (20%). Mean weeks gestational age (wga) at delivery was 37 ± 2; and did not differ among NAS affected infants compared to infants without NAS (p=0.51). Likewise, the infant's hospital length of stay (LOS) did not differ between infants with NAS (11 ± 4 days) compared to unaffected infants (8 ± 18 days), p=0.3. A preterm birth rate of 21% associated with prolonged NICU admissions may contribute to similar neonatal LOS. Fifteen women had antepartum (AP) admissions for pain and/or sickle crisis. Of these patients, 4 infants (29%) were diagnosed with NAS. The median maternal AP LOS for women with infants diagnosed with NAS was 132 (61, 164) days compared to women who were admitted for pain but whose infants were not diagnosed infants with NAS: 7.5 (4, 12) days (p < 0.001).

CONCLUSION:

Incidence of NAS among mothers with sickle cell hemoglobinopathies is low; severe disease requiring prolonged AP admission for pain control significantly increases the risk of NAS.
Maternal and Neonatal Outcomes by Mode of Delivery in Obese Women With a Previous Cesarean Section [5R]
Authors: Coviello Elizabeth , Clark-Ganheart Cecily A. , Huang Chun-Chih , Landy Helain , Iqbal Sara , Reddy Uma
Published: May 2017

INTRODUCTION:

To compare maternal and neonatal outcomes for obese women with a prior cesarean delivery by attempted mode of delivery.

METHODS:

In the Consortium on Safe Labor, 4,840 singleton deliveries greater or equal to 37 weeks with a prior cesarean delivery and eligible for vaginal delivery were classified by body mass index (BMI) class I, II, III. Maternal and neonatal outcomes between planned repeat cesarean delivery (rCD, n=2,364) and trial of labor after cesarean delivery (TOLAC, n=2,506) were compared using chi-square. Maternal outcomes included postpartum deep vein thrombosis/pulmonary embolism (DVT/PE), postpartum hemorrhage (PPH), maternal ICU admission and chorioamnionitis. Multivariable logistic regression was used to calculate adjusted OR (aOR), adjusting for maternal age, race, insurance status, hypertensive disorders, diabetes mellitus, and obesity class.

RESULTS:

TOLAC was attempted by 51.5% of women. Less women attempted VBAC with increasing obesity class, 54.8%, 50.7%, 45.4%. The VBAC success rate decreased with increasing class of obesity, 58.7%, 53.5%, 40.6%. There was an increased likelihood of chorioamnionitis and postpartum DVT/PE with TOLAC compared to rCD (aOR 5.72; 95% CI 3.22-10.15 and aOR 3.03; 95% CI 1.18-7.76), respectively. Women with successful VBAC were 6.95 times more likely to have a DVT/PE compared to failed TOLAC with rCD after adjusting for confounders (95% CI 1.56-30.92). There was no association between mode of delivery and PPH, maternal ICU admission or neonatal outcomes.

CONCLUSION:

Among obese women with a prior cesarean delivery, increasing BMI was associated with lower TOLAC attempts and success rates. Postpartum DVT/PE and chorioamnionitis occurred more frequently in those undergoing TOLAC.
Maternal and Neonatal Outcomes in Multiple Gestations With Elevated Antenatal Edinburgh Depression Scale (EDS) [6R]
Authors: Hamlin Alyssa , Herrero Tiffany , Fratto Victoria , Driebe Amy , Ramos Gladys A.
Published: May 2017

INTRODUCTION:

The purpose of this study was to determine the association of elevated antenatal Edinburgh Depression Scale (EDS) and maternal and neonatal outcomes in multiple gestations, in particular the rate of preterm delivery.

METHODS:

This is a retrospective study examining multiple gestations delivering at UC San Diego between 2010-2014. Patients were included if they completed an antepartum EDS. An EDS score of >10 was considered positive. The primary outcome was rate of preterm delivery (GA at delivery of < 37 weeks). Other maternal and neonatal outcomes of interest included history of preterm delivery, birth weight percentage and discordance, Apgar score, and maternal weight gain. Data was analyzed using SPPS v.23.

RESULTS:

102 women with multiple gestations completed an antepartum EDS. 22.5% (23/102) had a positive EDS score and 77.5% (79/102) had a negative score. Preterm delivery rate in the entire cohort was 61.8% (N=63). Women with an elevated EDS score had a trend toward higher preterm delivery rate (73.9%, N=17) compared to women with lower EDS scores (58.2%, N=46), p-value=0.23. A higher proportion of neonates born to mothers with elevated EDS had an Apgar score less than 7 at 5 minutes (27.3% vs 12.1%, p-value=0.1) although this was not statistically significant. No differences were noted in maternal weight gain or birth weight discordance.

CONCLUSION:

There is a trend toward an increased rate of preterm delivery and lower Apgar score in multiple gestations with a positive antepartum maternal EDS score. Further studies are needed to assess if treating these high-risk patients reduces their rate of preterm delivery.
Fetal Maternal Size Disproportion: Explanation for the Racial Disparity of OASIS? [7R]
Authors: Kim Youngwu , Hebert Kasey , Masiero Jessica , Leung Katherine , Moore Simas Tiffany A. , Leftwich Heidi
Published: May 2017

INTRODUCTION:

Obstetric anal sphincter injuries (OASIS) are a significant complication of vaginal deliveries. Asian race is a known independent predictor of perineal trauma. Limited data demonstrate a plausible explanation of this racial disparity. We aim to assess the relationship between the fetal maternal size disproportion as measured by fetal birth weight to prepregnancy BMI ratio (BW:BMI) and OASIS in mothers of different race groups.

METHODS:

Retrospective cohort study of vaginal deliveries between 2006 and 2015. Demographics and obstetrical data were abstracted and compared. The significance of BW:BMI to OASIS was evaluated. Results adjusted for confounding factors.

RESULTS:

16,024 vaginal deliveries were included. 28.5% had no lacerations, 64.6% had 1st or 2nd degree lacerations, and 6.9% had OASIS. Demographic factors associated with OASIS included Asian race, nulliparity, increased age, increased birth weight, episiotomy, trial of labor after cesarean, and operative vaginal deliveries. Although BMI was not an independent risk factor, BW:BMI showed a significant relationship with OASIS. For every 10 unit increase in BW:BMI, the adjusted odds of having an OASIS increased by 16% (p= < .001). After adjusting for BW:BMI, Asian race had higher OASIS rates. Interaction between race groups and BW:BMI was only significant for 1st and 2nd degree lacerations, not OASIS.

CONCLUSION:

This study verified known risk factors associated with OASIS. Increasing BW:BMI is associated with OASIS. However, BW:BMI does not provide insight into OASIS racial disparities; further investigations are needed to understand why Asian race is an OASIS risk factor.
Fetal Doppler Evaluation and Perinatal Outcomes in the Absence of Fetal Growth Restriction [8R]
Authors: Condon Niamh , Martinez Francis
Published: May 2017

INTRODUCTION:

Antepartum fetal surveillance techniques are used to assess fetal well-being in pregnancies complicated by preexisting maternal conditions, and pregnancies in which complications develop (1). The application of Doppler velocimetry to antepartum fetal assessment allows for evaluation of placental status and helps to determine the relative risk of sudden fetal deterioration (2). The purpose of this study is to determine whether patients with hypertension or preeclampsia and normally grown fetuses yet abnormal Doppler studies are at an increased risk for adverse perinatal outcomes.

METHODS:

This is a retrospective review of 287 high-risk pregnancies with appropriate-for-gestational- age (AGA) fetuses who had ultrasound evaluations between January 2012 and December 2013. Ultrasound evaluation included fetal growth assessments every four weeks with umbilical artery (UA) and middle cerebral artery (MCA) Doppler interrogation. The control group always had normal Dopplers. The study group had at least one abnormal UA Doppler or one abnormal MCA Doppler. Perinatal outcomes were compared between the groups.

RESULTS:

Of the 287 high-risk AGA pregnancies evaluated, 12.5% (n=36) had at least one abnormal UA or MCA Doppler. Pregnancies complicated by hypertension or preeclampsia had a statistically significant increased risk of having an abnormal UA and/or MCA Doppler (p=0.0013 and p=0.0086, respectively), and were significantly more likely to deliver preterm (p=0.0066 and p=0.0001, respectively).

CONCLUSION:

Fetoplacental circulation may be altered in preeclamptic and hypertensive patients, yet the fetus may not be growth restricted. Abnormal umbilical and middle cerebral artery Dopplers in AGA pregnancies may identify those fetuses that are at risk for preterm delivery.
Maternal Outcomes of Prolonged Induction of Labor [9R]
Authors: Triebwasser Jourdan , VanArtsdalen Jamie , Kobernik Emily , Langen Elizabeth
Published: May 2017

INTRODUCTION:

To safely reduce the number of cesarean deliveries (CD), the time allowed for induction of labor (IOL) has increased. There is little data regarding the safety of prolonged labor induction.

METHODS:

We performed a retrospective study of IOL from July, 2014 – June, 2016. Singletons, greater than 36 weeks, with initial cervical dilation 4 or less were included. Bivariate analysis was performed to compare maternal outcomes by induction length. Multivariable logistic regression identified independent predictors of CD and was subsequently stratified by parity.

RESULTS:

We included 2,032 inductions. For IOL less than 24 hours, 24 to 36 hours, and greater than 36 hours the CD rate was 14.9%, 24.5%, and 43.4% (p < .001) for nulliparous women and 5.5%, 11.2%, and 18.7% (p < .001) for multiparous women. After risk adjustment, the odds of CD were significantly higher for women age 30 or greater, (aOR=1.83, 95%CI 1.42-2.38), BMI 35 or greater, (aOR 1.58, 95%CI 1.21-2.06), previous CD (aOR 12.06 95%CI 6.72-21.67), duration of labor 24 to 36 hours (aOR 1.74 95%CI 1.25-2.42), and duration of labor greater than 36 hours (aOR 1.74 95%CI 1.25-2.42). When stratified, age, BMI, and duration of labor for nulliparous and prior CD and duration of labor for multiparous women were significant. Chorioamnionitis also increased by duration, 5.5%, 8.9%, and 14.6% for nulliparous women (p < .001), and 1.4%, 2.0%, and 9.2% for multiparous women (p=.001).

CONCLUSION:

As the length of IOL increases the risk of CD and infection increases. This data can be used to better inform patients of the risks of prolonged IOL.
Measuring Variation in Design Among American Childbirth Facilities [11R]
Authors: Bilazarian Ani , Plough Avery C. , Galvin Grace E. , Rosenberg Deb , Sullivan Brendan , Shah Neel T.
Published: May 2017

INTRODUCTION:

Facility design may either support or hinder patient care. Nonetheless, there is minimal evidence-based guidance in designing childbirth facilities. We validate a novel methodology of measuring and comparing quantitative design data among American childbirth facilities.

METHODS:

We requested annotated floor plans from 12 diverse childbirth facilities across the United States, ranging from birth centers to high-volume tertiary care centers. We redrew these floor plans to allow for comparison of key functional distances and areas. Specific measurements were selected using a modified-Delphi consensus process with experts in obstetrics, nursing, patient advocacy, evidence-based design, and hospital operations.

RESULTS:

Our cohort consisted of nine hospitals and three birth centers. Hospital delivery volumes ranged from 432 to 9,100 deliveries per year, and birth center delivery volumes ranged from 175 to 300 deliveries per year. The ratio of labor and delivery rooms to ORs ranged from 1.0 to 8.5 in hospitals. Annual deliveries per labor room ranged from 86.40 to 361.54 annual deliveries per room in hospitals and 87.50 to 100.00 annual deliveries per room in birth centers.

CONCLUSION:

We observed substantial variation in childbirth facility design and demonstrated the feasibility of collecting design data from diverse facilities. Given limited evidence-based design standards, future work is needed to understand the impact of variation in design on clinical processes in childbirth.
Decision Analysis Studies Involving the Management of Pregnant Women: A Systematic Review [13R]
Authors: D'Souza Rohan , McKelvey Kyra , Murphy Kellie , Sander Beate
Published: May 2017

INTRODUCTION:

This study systematically reviewed Decision Analysis (DA) and economic evaluation (EE) studies involving the management of pregnant women and described methodological variations and limitations.

METHODS:

Three databases were searched to include articles from inception to December 2014. DA and EE studies describing conditions involving the management of pregnant women were included and screening and data-extraction were conducted in duplicate. Outcomes included type of analysis, model type, input variables (“probabilities,” “utilities” and “costs”) and outcome variables (clinical or cost-based, time horizon). Reporting quality was assessed by a five-point scale.

RESULTS:

6,055 titles were screened and 303 full texts retrieved, of which 57 describing management of clinical conditions were included. Five used Markov Models, while 52 used decision trees. Most studies (45) involved EE. Probabilities were obtained from multiple publications in 48 studies. Utilities were used in 26 studies [maternal and offspring (18), offspring (5) and combined (3)]. Utilities were obtained from physicians (6), physician and patient (3), mother and offspring (2), mother (2), public (2), parents (2) and offspring (1). Costs were obtained from perspectives of society (10), health care system (7), third-party payer (6), hospital (5) and multiple sources (2). 53 studies described clinical outcomes and 4 only described costs. Time-horizon involved maternal and/or offspring lifetime (19), pregnancy duration (19) and other reported time-horizons (6). Only five studies had a high risk-of-bias.

CONCLUSION:

There is considerable variation in the conduct and reporting of DA and EE studies in obstetrics. A consensus statement to standardize conduct of these studies in obstetrics is required.
Marijuana Use in Pregnancy and Its Effects on Birth Weight and Gestational Age at Delivery [17R]
Authors: Howard Douglas S. , Dhanraj David , Devaiah Ganga , Lambers Donna
Published: May 2017

INTRODUCTION:

Prior studies have suggested that marijuana exposure may affect the growth of the fetus and the ultimate birth weight of an infant but have been inconsistent in their methodologies and have shown conflicting results. This study aims to clarify any association between marijuana use and pregnancy outcomes.

METHODS:

A retrospective chart review of electronic medical records for singleton births from September 2013 through January 2015 with available urine drug screens (UDS) at initiation of prenatal care and delivery was conducted. Patients who used drugs other than marijuana were excluded. Patients were grouped into no positive UDS, positive UDS for only tetrahydrocannabinol (THC) at presentation, positive UDS for only THC at delivery, and positive UDS for only THC at both initial presentation and delivery.

RESULTS:

The incidence of marijuana use in pregnancy exclusive of other drugs as evidenced by only tetrahydrocannabinol in the urine of 2173 patients was 22.5%. Infants born to mothers who tested positive at both times during pregnancy were of lower birth weight compared to non-users [2925 gm (IQR 2522-3265) versus 3235 gm (IQR: 2900-3591), P = < 0.001]. This effect cannot be explained by earlier gestational age alone as persistent marijuana users only delivered two gestational days earlier than non-users (39 vs 39.3 weeks). Concomitant tobacco use during pregnancy was not noted to impact infant birth weight using the ANCOVA.

CONCLUSION:

Marijuana use is negatively correlated with fetal birth weight and length at birth. Additional patient education and cessation interventions should be explored.
Neonatal Outcomes by Attempted Mode of Delivery and Obstetric Intervention for Pregnancies Affected by Spina Bifida [19R]
Authors: Spiliopoulos Michail , Iqbal Sara , Reddy Uma , Landy Helain , Huang Chun-Chih
Published: May 2017

INTRODUCTION:

To evaluate immediate neonatal outcomes of pregnancies affected by spina bifida by attempted vaginal delivery vs. cesarean section and spontaneous compared to induced labor.

METHODS:

This is a retrospective cohort study using data from the Consortium on Safe Labor study, including 228,562 deliveries from 19 hospitals across the U.S. from 2002 to 2008. All singleton pregnancies complicated by spina bifida that resulted in a live birth after 34 weeks of gestation were evaluated. Breech deliveries were excluded from the analysis. Outcomes included NICU admission, respiratory morbidity, sepsis, birth trauma, asphyxia/seizures and mortality and were evaluated according to attempted mode of delivery and spontaneous vs induced labor. Multivariable logistic regression was used to calculate adjusted OR (aOR) and 95% confidence intervals controlling for gestational age and diabetes.

RESULTS:

We identified a total of 51 patients with spina bifida in the database. Women undergoing attempted vaginal delivery were more likely to be nulliparous, less than 35 years of age, white and without a history of previous cesarean delivery (CD) (p value < 0.05) compared to women undergoing planned CD. There was no statistically significant difference in immediate neonatal outcomes between patients attempting vaginal delivery and those scheduled for CD (p=0.07 for NICU admission). No differences in neonatal outcomes of pregnancies affected by spina bifida were identified between the spontaneous labor and scheduled labor induction group.

CONCLUSION:

Neither mode of delivery (attempted vaginal vs scheduled CD) nor scheduled induction of labor had any statistically significant impact on immediate neonatal outcomes of infants with spina bifida.
Neutophil to Lymphocyte Ratio: A Marker for Preterm Labor? [21R]
Authors: Lam Melissa Chu , Hunt Jonathan , Anasti James
Published: May 2017

INTRODUCTION:

Investigators have postulated that preterm labor may result from inflammation. Neutrophil/lymphocyte ratio (N/L) has been used as marker to determine sub-clinical inflammation and prognosis in several system disorders. The N/L is easy to obtain and inexpensive, which would allow a widespread clinical use in the evaluation of patients. We therefore hypothesis that due to inflammation, preterm patients would have higher N/L ratio compared to term controls.

METHODS:

We randomly selected patients delivered before 37 weeks (PT) and patients that delivered at term (T) during the last 10 years. Only patients in active labor were included. We compared their N/L Ratio at the time of admission to Labor and Delivery. We excluded individuals with known infection, inflammatory diseases, and hematological disorders, as well all those that received steroids at least 3 weeks prior to determining their N/L ratio.

RESULTS:

We compared 137 PT (32.4 ± 4.1 wks) and 145 T (39.2 ± 1.1 wks) patients of similar age. They differed by gravity (PT 2.8 ± 1.9; T 2.0 ± 1.4, p= 0.001), and parity (PT 0.8 ± 1.1; T 1.2 ± 0.8, p=0.001). Preterm patients had higher rates of BMI greater than 35 (PT 13.8%; T 5.5%, p=0.3), tobacco use (PT 24%, T 11%, p=0.001) and hypothyroidism (PT 10.2%; T 2.7%, p=0.001). N/L ratio was significantly elevated in preterm patients compared to those delivered at term (PT 5.9 ± 5.1; T 4.7 ± 3.2, p=0.007).

CONCLUSION:

N/L ratio appears to be elevated in preterm delivery. The clinical utility warrants further study.
Non-Invasive Hemoglobin Monitoring: A Method of Measuring Blood Loss in Cesarean Delivery? [22R]
Authors: Dermaco Amy , Chappelle Joseph
Published: May 2017

INTRODUCTION:

Obstetrical hemorrhage is a leading cause of maternal morbidity and mortality worldwide. Prompt and accurate estimation of blood loss (EBL) is necessary to expedite the diagnosis and treatment of postpartum hemorrhage. The aim of this study is to investigate the ability of the non-invasive hemoglobin measurement to measure blood loss during a cesarean delivery (CD).

METHODS:

Term, singleton patients undergoing scheduled CD were consented for this prospective, non-blinded, observational study. The Masimo Radical-7 Pulse CO-oximeter recorded non-invasive hemoglobin (SpHb) values at baseline, continuously during the CD, and for 8 hours postoperatively. Values were then compared with hemoglobin (Hb) measurements obtained preoperatively and on postoperative day 1.

RESULTS:

Data were obtained from 13 women. Mean maternal age was 32 (25-41) and mean gestational age was 38.9 (37.6-39.6). Indications were elective repeat (n=5), repeat for > 1 prior (n=6), primary elective (n=2), and prior myomectomy (n=1). Average EBL was 938 (800-1500) and average decrease in Hb was 2.2 (0.6-3.0). EBL was not correlated to calculated blood loss (p=0.37). Average preoperative SpHb was 10.6 (9.2-12.2) and there was no difference in average postoperative SpHb measurements at 0, 1, 4, and 8 hours postoperatively (p-0.9). There was no correlation between SpHb values and blood loss.

CONCLUSION:

This study demonstrates the inability of non-invasive techniques to measure blood loss during CD. SpHb showed poor accuracy and no trending ability compared to laboratory values. These findings are supported by prior studies showing poor performance in conditions involving large changes in intravascular volume, especially during hemorrhage.
Nulliparous, Term, Singleton, Vertex (NTSV): Can We Predict Cesarean Delivery? [23R]
Authors: Seibles Shania , Rikki Baldwin , Kazzi George , Murphy June
Published: May 2017

INTRODUCTION:

The nulliparous, term, singleton, vertex (NTSV) cesarean delivery rate has become the obstetric quality measure, as it is the most variable portion of the rise in cesarean delivery and represents low risk primary cesarean births. We hypothesize that analysis of previous nulliparous, term, singleton vertex (NTSV) deliveries will yield maternal, fetal, and/or obstetrical characteristics that are associated with increased risk for cesarean delivery.

METHODS:

Retrospective study of all NTSV births that occurred at St. Joseph Mercy Oakland Hospital during the year 2015, with the purpose of identifying factors contributing to cesarean delivery. We compared demographic, obstetrical, and neonatal data. The data were analyzed using SPSS-19 software, with categorical outcomes using the chi square regression analysis and numerical outcomes using the t test.

RESULTS:

A total of 475 cases of NTSV were included analysis. The overall NTSV cesarean delivery rate was 27.08%, with a range of 12.9% to 39.1% amongst obstetrical providers. The most common reasons for NTSV cesarean delivery were abnormal FHR tracing, 53.2%, and labor dystocia, 38.7%. The factors that were statistically significant were diabetes (LHR 7.192, P < 0.004), hypertension (LHR 14.9, P < 0.00), maternal race (LHR 5.42, P < 0.02), age in years (P

CONCLUSION:

The NTSV cesarean delivery rate is influenced by many factors, and a wide variation in incidence can be seen across obstetric providers within the same hospital system. Further research should be performed analyzing variations in obstetrical practices that may contribute to this significant difference.