bluuebunny/crossref_metadata_2025 huggingface dataset:
Early Bird or Night Owl? Investigating the Relationship Between Chronotype and Pregnancy Complications [11L]
Authors: Punjala-Patel Advaita , Rowe Dorothea , Singleton Miller , Street Linda
Published: April 2020

INTRODUCTION:

Chronotype or circadian propensity to be a “morning person” or “evening person” has been predictive of adverse health outcomes in the non-pregnant population. Unfortunately, data regarding chronotype and pregnancy complications including diabetes and hypertension remain limited.

METHODS:

IRB approved prospective cohort of patients with a singleton pregnancy and no history of pre-existing diabetes were recruited at Augusta University Medical Center. Patients were consented if they were less than 28 weeks gestation and had not yet had a glucose tolerance test (GTT). Chronotype was assessed by a validated Horne-Ostberg Morningness-Evenings Questionnaire (MEQ). The MEQ consisted of 19 questions about preferred sleep time and daily performances. Scores ranged from 16-86 and based on results patients were categorized as being morning (59-86), intermediate (42-58), or evening (16-41) type. Data was subsequently obtained on pregnancy outcomes.

RESULTS:

Between 11/2018-05/2019, outcome data was obtained from 309 women who completed the MEQ. 34.6%, 45.6%, and 19.8% of women were identified as having morning, intermediate, and evening chronotype respectively. Baseline demographics between groups were comparable. Although, the “evening” type group had a lower proportion of GDM there was no statistical difference between chronotype and development of GDM (P=.457). Furthermore, no statistical significance exists between chronotype and the development of GHTN (P=.813) or PE (P=.768).

CONCLUSION:

To date, this is the first study to examine this association between chronotype and pregnancy complications. While chronotype is not associated with adverse pregnancy outcomes, further studies with larger sample sizes may provide an insight on circadian rhythms in predicting adverse outcomes.
Effects of Sickle Trait on Incidence and Outcomes of Hypertensive Disorders of Pregnancy [13L]
Authors: Hamid Kewan , Moustafa Ahmed , Kalaba Frank , LaChance Jenny , Akinpeloye Atinuke , Saah Elna
Published: April 2020

INTRODUCTION:

Due to a paucity of research and conflicting results in the few published studies, effects of sickle cell trait (SCT) on the incidence & severity of hypertensive disorders in pregnancy and potential adverse perinatal outcomes remain inconclusive. The objective of this research was to examine the risk of hypertensive disorders in pregnancy among SCT carriers compared to non SCT carriers in a single institution, in Flint, Michigan.

METHODS:

This is an IRB-approved, retrospective cohort study. Pregnant women admitted to Labor and Delivery at Hurley Medical Center over a 5-year period (between 06/01/2012 to 06/01/2017) were included if SCT status (presence or absence) was confirmed through laboratory analysis.

RESULTS:

The study included 3,986 patients. 279 patients were carriers of SCT (7%). Maternal age ranged from 13-46 years (mean=25.00, SD 5.12). The majority of our subjects were African American (76.4%, n=3044). 1047 patients were nulliparous (26.4%). Incidence of preeclampsia was higher among patients with SCT (3.9%, n=11) compared to noncarriers [(2.0%, n=75, P=.033, relative risk 1.9487 (95% CI 1.0472–3.6262)]. There was no statistical difference in the incidence of other hypertensive diagnoses among the two groups. There was no statistically significant difference in preterm delivery by SCT status (P=.311).

CONCLUSION:

In our study population, there was a higher incidence of preeclampsia in patients with SCT. However, we were not able to determine if SCT correlated with increased incidence of preeclampsia with severe features or eclampsia. Larger, multi-institutional studies would be required to determine if the SCT may impact severity of hypertensive complications in carriers.
Impact of Delivery-Related Factors on Venous Thromboembolism Risk During Labor [16L]
Authors: Francis Kim Antonia P. , Saleh Mona , Torres Anthony Melendez , Limaye Meghana , Deeb Jessica , Roman Ashley
Published: April 2020

INTRODUCTION:

Pregnancy is a risk factor for venous thromboembolism (VTE). Several VTE risk assessment models (RAM) have been created but not validated in obstetrics. It is unclear which factors confer greater risk of VTE and at what point VTE risk assessment should occur. Our goal was to determine which RAM is most effective at capturing high risk patients while excluding low risk patients and to determine how delivery-related factors (such as mode of delivery, blood loss, transfusion, length of stay) affect RAM scores.

METHODS:

IRB-approved cross-sectional study evaluating 507 deliveries during November 2018 at an urban academic center. 5 VTE cases were identified from 2013-2018. RAM scores (ACOG, CMQCC, ACCP, RCOG, Caprini, Padua) were calculated for all subjects at admission and discharge. Descriptive statistics and T-tests were utilized to investigate the relationships between mode of delivery, blood loss, blood transfusion, length of stay and RAM score.

RESULTS:

The Caprini score stratified 40% of VTE cases as high risk pre-delivery whereas 80% were high risk post-delivery. RCOG stratified 80% of cases as high risk pre-delivery and 100% post-delivery. ACCP stratified 80% of cases as high risk pre-delivery and 100% post-delivery. CMQCC stratified 0% of cases as high risk pre-delivery and 80% of cases post-delivery. Further analysis of Caprini, Padua, and RCOG scores demonstrated a significant association between postpartum hemorrhage and higher score.

CONCLUSION:

RCOG and ACCP models categorized most controls and cases as low- and high-risk, respectively. VTE assessment should be performed at hospitalization and prior to discharge because delivery-related factors affect risk of VTE.
Implementation of Venous Thromboembolism Prophylaxis After Cesarean at a High Volume Military Treatment Facility [17L]
Authors: Saber Barbara
Published: April 2020

INTRODUCTION:

Venous thromboembolism (VTE) is a leading cause of maternal morbidity. In 2016 the National Partnership for Maternal Safety (NPMS) published a Consensus Bundle on Venous Thromboembolism recommending postcesarean dual VTE prophylaxis for a modified Caprini score of 5 or more. The purpose of our study is to determine the impact of policy change from American College of Chest Physicians 2012 guidelines to NPMS in our facility.

METHODS:

Following stepwise implementation of NPMS guidelines, Caprini score calculation became mandatory after cesarean delivery. We reviewed inpatient enoxaparin prescriptions rate of postcesarean patients, comparing the 12 months before implementation with 12 months post-implementation, excluding 5 months of transition period. We also compared the rate of various adverse outcomes including blood transfusion, epidural hematoma, maternal death, wound hematoma or wound separation, re-operation, heparin induced thrombocytopenia, and venous thromboembolism. Student t-test was performed to compare average rate pre and post policy change. A P<.05 was considered significant.

RESULTS:

The analysis included 888 cesarean deliveries pre-implementation and 1,515 post-implementation with no difference in demographics or indication for cesarean. Prior to change in policy, 3.6% (+/- 1.5% SD) of patients received dual prophylaxis. After implementation, this rose to 32.7% (+/- 6.7% SD) (P=.001). The number of cesarean deliveries with adverse outcomes up to 84 days postpartum remained stable. There was no statistically significant difference in VTE in the pre-implementation and post-implementation groups.

CONCLUSION:

Successful implementation of a dual VTE prophylaxis policy postcesarean delivery is possible without adversely affecting complication rates.
Maternal Heart Rate in Labor and the Potential for Confusion With Fetal Heart Rate [20L]
Authors: Oppenheimer Lawrence W. , Faught Emma
Published: April 2020

INTRODUCTION:

A source of error in electronic fetal monitoring occurs where there is confusion between the maternal heart rate (MHR) and the fetal heart rate (FHR). The fetal transducer can detect the MHR rather than the FHR. We studied the MHR during labor to determine the proportion of cases where the MHR was in the fetal range (>110 bpm) and could potentially cause confusion.

METHODS:

Consecutive cases of low risk patients in labor were studied. Cases required a minimum of 2 hours of archived continuous electronic monitoring of both the MHR (by oxygenation saturation probe) and FHR prior to full dilatation. For individual patients, MHR baseline was averaged over each hour in labor and the results express as the proportion of all MHRs >110 bpm during each hour before and after full dilatation.

RESULTS:

There were 80 labors included in the study with data available for a total range of 10 hours. In the first stage only 2.5% of labors had an MHR>110 bpm 7 hours prior to full dilation, rising to 15% at full dilatation. In the second stage this rose to 30% after 2 hours and 45% after 3 hours.

CONCLUSION:

An MHR in the fetal range is common in labor especially in the second stage. The potential for confusion is very significant and this can lead to poor outcomes if an abnormal FHR is misidentified as MHR in the apparently normal range.
Prediction of Clinical Decompensation in an Obstetric Population [26L]
Authors: French Maureen , Loudon Holly , Wagner Brian
Published: April 2020

INTRODUCTION:

Systems assessing the risk of clinical decompensation were developed with the exclusion of pregnant women. While they may identify obstetric patients at risk for severe illness or mortality, the Systemic Inflammatory Response Syndrome (SIRS) criteria may capture many pregnant women with normal physiology, reducing their predictive value.

METHODS:

Institutional Review Board approval was obtained for this retrospective chart review. All patients who triggered the Stop Sepsis Best Practice Advisory (BPA) at a large academic hospital between 1/1/2014 and 10/1/17 were included. Triggering parameters were identified and categorized as SIRS/sepsis, severe sepsis, septic shock, and other. Critical illness was defined as bacteremia, lactic acidosis, intensive care unit (ICU) admission, or mortality. Detailed review of the obstetric cohort included type and time of anesthesia and delivery, estimated blood loss, and presence of infection or hemorrhage. Student t-test, chi-square test, Fisher exact test, and logistic regression were used for analysis.

RESULTS:

8,786 episodes were identified (169 obstetric, 8,617 hospital-wide). Obstetric patients vs. the hospital-wide groups were significantly more likely to trigger the BPA with systolic BP 90 bpm (98% vs 88%), and oxygen saturation <90% (25.4% v 16%). Obstetric patients were less likely to trigger due to sepsis (39% vs 53%) and had more false positives (51% vs 5%). 69% of the hospital-wide cohort and 8% of the obstetric cohort were critically ill (P<.0001).

CONCLUSION:

Application of SIRS criteria to obstetric patients leads to a high false positive rate. Modified parameters and “lock-out” periods surrounding anesthetic administration and delivery could improve the prediction of clinical decompensation.
Preeclampsia as an Independent Risk Factor for Cardiovascular and Metabolic Disease [27L]
Authors: Gore Amartha N. , Hoffman Karlee , Thomas Ronald , Klein-Patel Marcia , Poornima Indu , Gore Amartha N.
Published: April 2020

INTRODUCTION:

Epidemiological studies show an association between preeclampsia and the development of cardiovascular disease. Does an association exist regarding metabolic disease?

METHODS:

Women with a discharge diagnosis of preeclampsia from 2009-2015 were identified from our integrated health care system database. We retrospectively collected demographic and cardiovascular risk factor data by chart review on women with preeclampsia and age/race matched controls from the year 2012. We then assessed 7-year follow-up in these cases and controls. A bivariate matched analysis and logistic regression were used to identify associated factors for preeclampsia while adjusting for other variables.

RESULTS:

The incidence of preeclampsia within our network in 2012 was 10.4%. At 7-year follow-up, we found that the cases group have an increased incidence of new-onset hypertension (30.7% vs 2.6%, p<.0001), hyperlipidemia (13.1% vs 2.3%, P<.0001) and diabetes (8.5% vs 1.9%, P<.0001) compared to controls. Hypertension, hyperlipidemia and diabetes served as markers of metabolic disease. Follow-up with a PCP occurred in 19.5% of preeclamptic patients and 14.9% of controls. Statistical analysis showed that preeclampsia was an independent risk factor for current hypertension (OR 6.7 [95% CI 3.4-10.8]), hyperlipidemia (OR 6.5 [95% CI 3.5-10.3]) and diabetes (OR 3.8 [95% CI 1.8-8.3]).

CONCLUSION:

Our findings support a relationship between preeclampsia and the development of metabolic disease. The diagnosis of preeclampsia serves as an independent predictor for the development of both cardiovascular and metabolic disease. This data highlights the necessity for establishing follow-up guidelines for preeclamptic patients when planning preventative medical interventions as it relates to cardiovascular and metabolic disease.
Preeclampsia With Severe Features: Examining the Phenotype of Disease [28L]
Authors: Savitsky Leah M. , Chandrasekaran Suchitra , Albright Catherine
Published: April 2020

INTRODUCTION:

To characterize the impact of increasing body mass index (BMI) on the likelihood of developing preeclampsia (PE) with severe features (SPE).

METHODS:

We performed a retrospective cohort study using the Consortium on Safe Labor database (CSL). Women without chronic hypertension with a diagnosis of PE delivering a singleton, non-anomalous fetus were included. The odds of developing SPE versus PE without severe features (MPE) between women with a pre-pregnancy BMI in the underweight or normal weight categories (<25 kg/m2) versus those in the overweight (25-29.9 kg/m2) or obese (at least 30 kg/m2) categories were compared. Multiple logistic regression was used to adjust for potential confounders.

RESULTS:

There were 228,438 records in the cohort, of which 6,706 had a diagnosis of PE and a documented pre-pregnancy BMI. Of women with PE, 25% were overweight, 30% were obese. Among all BMIs, 34% of women had SPE. Compared to pregnancies with a normal or underweight BMI, overweight and obese women had a decreased odds of developing SPE when adjusted for race, maternal age, parity, insurance, diabetes, and marital status (adjusted OR [aOR] 0.84, 95% CI 0.72-0.96 and aOR 0.75, 95% CI 0.65-0.87, respectively).

CONCLUSION:

Among women who develop PE, women with an overweight or obese pre-pregnancy BMI are less likely to develop SPE than normal or underweight weight women. Potential differences in the metabolic phenotypes between the two groups may contribute to this finding. Further research is needed to characterize the pathophysiology behind these differences in order to find methods of preventing the development of SPE.
Pregnancy-Adapted YEARS Algorithm for Diagnosing Suspected Pulmonary Embolism: A Cost-Effectiveness Analysis [29L]
Authors: Sievert Alex , Hernandez Miriam , Hersh Alyssa R. , Harmon Duncan , Caughey Aaron B.
Published: April 2020

INTRODUCTION:

A recent large prospective study found the pregnancy-adapted YEARS algorithm to be an effective screening tool for pregnant women with suspected pulmonary embolism (PE) while reducing the number of CT pulmonary angiography (CTPA). We investigated the cost-effectiveness of using the YEARS algorithm compared to the current standard.

METHODS:

A cost-effectiveness model was built using TreeAge software to compare the YEARS algorithm versus the current standard where all women get a CTPA. We used a theoretical cohort of 35,000 women, the estimated number of pregnant women in the US who are evaluated for a PE each year. Outcomes included costs, quality-adjusted life years (QALY’s) for the mother, maternal death, childhood cancer, and missed PE’s. Probabilities were derived from the literature. Cost-effectiveness threshold was set at $100,0000/QALY. Sensitivity analyses were done to evaluate the robustness of the results.

RESULTS:

In our theoretical cohort, the pregnancy-adapted YEARS algorithm resulted in a savings of $5,923,530 per year and higher QALYs. There were 42 fewer cases of childhood cancer and 4 more maternal deaths despite 361 missed PE cases.

CONCLUSION:

In our theoretical cohort, utilizing the pregnancy-adapted YEARS algorithm resulted in lower costs and increased QALYs. These results should be considered as future guidelines regarding the evaluation of pregnant women with suspected PE’s are established.
Prehypertension During Pregnancy as a Risk Factor for Adverse Perinatal Outcome: A Historical Cohort Study [30L]
Authors: González-Valencia Diana P. , Valero-Rubio Soraya Y. , Grillo-Ardila Carlos F.
Published: April 2020

INTRODUCTION:

Hypertension during pregnancy is an important cause of perinatal morbidity and mortality. Prehypertension has been linked to cardiovascular morbidity in non-pregnant women. The objective of this study was to assess the association between prehypertension and adverse perinatal outcomes in apparently healthy women.

METHODS:

Historical cohort study.

SETTING:

High complexity institutions located in Bogotá, Colombia.

POPULATION:

Women with less than 20 weeks of gestation, single live fetus, with two or more abnormal blood pressure measurements (systolic 120-139 mmHg/diastolic 80-89 mmHg) six hours apart. Patients with prior diseases, assisted reproduction pregnancies, or with a diagnosis of fetal abnormality were excluded. Analysis: Baseline characteristics and pregnancy outcomes were retrieved from the electronic medical record. Gestational age was determined by last menstrual period and confirmed by ultrasound. Exposed and non-exposed cohorts were compared. Exploratory univariate regression analysis and multiple logistic regression were performed, adjusting for the presence of confounding variables. The study protocol was approved by the Ethics Committee of the participating institutions.

RESULTS:

The two groups were similar in terms of sociodemographic and clinical characteristics. Adjusted and non-adjusted odds ratios with 95% confidence intervals were reported. Controlling for maternal age, education, socioeconomic and civil status, social security, parity, drug abuse and weight gain, it was found that prehypertension was associated with the development of pre-eclampsia (aOR 3.54, 95% CI 1.83–6.83) and hospital admissions during pregnancy (aOR 2.35, 95% CI 1.16–4.76).

CONCLUSION:

Although women with prehypertension are currently classified as normal, prehypertension in the first half of pregnancy increases the likelihood of adverse perinatal outcomes.
Prophylactic Anticoagulation While Hospitalized for Premature Prelabor Rupture of Membranes: A Decision Analysis [31L]
Authors: Dahl Carly M. , Iroz Cassandra , Wescott Annie , Cassimatis Irina , Miller Emily S.
Published: April 2020

INTRODUCTION:

Premature prelabor rupture of membranes (PPROM) necessitates hospital admission thus limiting activity and theoretically increasing the risk for venous thromboembolism (VTE). While prophylactic anticoagulation decreases the risk of VTE, it may increase the risk for postpartum hemorrhage (PPH) and affect the ability to obtain neuraxial analgesia. This study analyzed the use of prophylactic anticoagulation during hospitalization for PPROM with a decision analysis model.

METHODS:

The designed decision-analytic model compared the use of unfractionated heparin (UFH), low molecular weight heparin (LMWH) or no anticoagulation in women with a singleton pregnancy admitted to the hospital for PPROM after 24 weeks who remained hospitalized until delivery. Assumptions included: induction of labor at 34 weeks or earlier spontaneous labor; therapeutic use of LMWH in the setting of new onset VTE; and universal desire for neuraxial analgesia. The outcomes of VTE, PPH, spontaneous labor, route of delivery, and type of anesthesia attained were assessed. One and two way sensitivity analyses were performed to interrogate model assumptions and a Monte Carlo probabilistic sensitivity analysis was performed using uniform distributions.

RESULTS:

No prophylactic anticoagulation is the chosen strategy based on the highest expected value and sensitivity analyses. No prophylaxis was the preferred choice 78% of the time, UFH 20% of the time, and LMWH 2% of the time.

CONCLUSION:

Our results do not support the routine use of prophylactic anticoagulation in women admitted to the hospital for PPROM. These findings can be used to inform clinical decisions when admitting low risk singleton pregnancies with PPROM.
Provider Specific Nulliparous, Singleton, Vertex, Term Cesarean Rates Impact on Maternal and Neonatal Outcomes [33L]
Authors: Fiori Catherine , Altman Alan , Marcotte Michael Paul , Holbert Michael
Published: April 2020

INTRODUCTION:

Recent national initiatives have proposed to reduce cesarean delivery rates. Institutions have reported increased neonatal and maternal morbidity secondary to these initiatives. This study evaluated the impact of provider level nulliparous, singleton, vertex, term cesarean section rates on maternal and neonatal outcomes for all laboring patients.

METHODS:

This was an IRB approved retrospective study of deliveries at a tertiary healthcare system over four years from January 1, 2015 to December 31, 2018. Nulliparous, singleton, vertex, term cesarean rates were calculated for each provider. Providers that were one standard deviation above and below the mean were grouped into high NSVT providers and low NSVT providers. All laboring patients of these two provider groups were then compared for maternal and neonatal outcomes.

RESULTS:

Of the 5465 deliveries, there were significant differences in cesarean section rates among high NSVT providers and low NSVT providers, 22.5% vs 6.0%, P<.0001. High NSVT providers had higher rates of maternal fever, 6.1% vs 4.2% (P=.0018 OR 1.47 CI 1.16-1.88), and maternal readmission, 1.6% vs 0.9% (P=.0268 OR 1.73 CI 1.07-2.83). High NSVT providers had lower rates of 3rd or 4th degree lacerations, 1.6% vs 2.4% (P=.0326 OR 0.65 CI 0.44-0.97), shoulder dystocia, 1.8% vs 2.6% (P=.0289 OR 0.66 CI 0.46-0.96), and fetal macrosomia, 0.7% vs 1.3% (P=.0250 OR 0.52 CI 0.29-0.92). All other measures were not significant.

CONCLUSION:

Providers with relatively high and low primary cesarean section rates exhibit different risk profiles for maternal and neonatal morbidity when examining all their laboring patients.
Redefining Hypertension: The Impact of New Risk Stratification on Pregnancy Outcomes [34L]
Authors: Chatterton Carolyn , Mover Kelly , Del Pozzo Jaclyn , Khan Sameer , Vullo John , Gurram Padmalatha
Published: April 2020

INTRODUCTION:

In 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) redefined blood pressure (BP) categories in non-pregnant adults: Normal (140/90). In pregnancy, patients with BP>140/90 before 20 weeks gestation are considered to have chronic hypertension, correlating to S2. Unlike S2, pregnant women in Elevated and S1 cohorts receive no increased antepartum surveillance. The purpose of this study is to compare pregnancy outcomes between normal, elevated, and S1 cohorts to ascertain risk for hypertensive disorders of pregnancy (HDP), including gestational hypertension and pre-eclampsia.

METHODS:

This is a retrospective review of women who received prenatal care and delivered at our institution. Patients were classified according to the new guidelines based on BP readings prior to 20 weeks gestation. S2 patients were excluded, as these patients are already known to have increased risk for HDP. The primary outcome measure is incidence of HDP. IRB approval was obtained.

RESULTS:

342 patients were included: normal (n=177), elevated (n=73), and S1 (n=76). Maternal characteristics were similar (P>.05). The incidence of HDP for patients with Elevated BP is 9.59% (P=.048) and S1 is 13.83% (P=.002), compared to normal (3.43%). The incidence of small for gestational age, preterm delivery, and NICU admissions were similar (P>.05).

CONCLUSION:

Women with S1 per the new guidelines are at increased risk for HDP of pregnancy. Further studies are warranted to determine if S1 patients will benefit from antepartum surveillance and prophylactic low dose aspirin.
Social Determinants of Health and Severe Maternal Morbidity During Delivery Hospitalizations in Texas [36L]
Authors: Eppes Carey , Salahuddin Meliha , Ramsey Patrick S. , Davidson Christina , Patel Divya A.
Published: April 2020

INTRODUCTION:

The American College of Obstetricians and Gynecologists now recommends that healthcare providers screen for and document social determinants of health (SDOH) to improve patient-centered care and decrease inequities. The objective of the study was to examine utilization of available SDOH International Classification of Diseases codes and the relationship between SDOH and severe maternal morbidity (SMM).

METHODS:

Using Texas all payer inpatient hospitalization data from 2011 to 2018, delivery-related hospitalizations (n=2,920,079) were classified as having SMM, following Centers for Disease Control and Prevention’s coding scheme. Deliveries were classified as having any SDOH based on documented codes for problems related to upbringing, circumstances (psychosocial, housing, economic, legal, family), employment, social environment, education and occupational exposures. Regression analysis examined the association between SDOH and SMM adjusted for age, payment source, race/ethnicity, and medical comorbidities.

RESULTS:

Only .2% of Texas deliveries between 2011-2018 had a documented SDOH, with problems related to psychosocial circumstances most commonly documented. In that time period, SMM prevalence remained consistent (146.0-161.0 per 10,000 deliveries). Deliveries with a documented SDOH had increased odds of SMM (1.26 95% CI 1.06-1.51).

CONCLUSION:

The low utilization of SDOH codes in all-payer inpatient hospitalization data represents a missed opportunity, given the wide use of these data for population-based estimates of maternal health outcomes, including SMM. In addition to medical conditions, healthcare providers should be encouraged to screen for and document SDOH to better understand contextual factors that may influence a patient’s health as a step towards addressing patient needs in a fuller, more effective way.
The Potential Impact of Aspirin Prophylaxis on Pregnancy Outcomes for Women With Severe Preeclampsia [37L]
Authors: Nelson Sasha , Krishnan Vidhya
Published: April 2020

INTRODUCTION:

Preeclampsia affects 3-5% of pregnancies with significant morbidity and mortality. Aspirin may reduce the risk of developing preeclampsia by up to 24%. Several organizations have created guidelines for initiation of aspirin therapy, each using different criteria. This study was designed to assess the impact of differing guidelines for aspirin use on maternal and fetal outcomes.

METHODS:

A retrospective cohort study of women who delivered between January 2009 and September 2010 with a diagnosis of preeclampsia with severe features was performed. Guidelines from six different OBGYN societies were applied to these patients to identify the percentage who met criteria for aspirin administration. Published risk reduction rates for preeclampsia, intrauterine growth restriction (IUGR), and preterm birth were applied to estimate adjusted maternal and fetal outcomes.

RESULTS:

Of 153 deliveries with 173 neonates, 31 cases of IUGR (20%) and 107 cases of preterm births (70%) were identified. The Canadian society (SOGC) guideline identified 97% of our patients for aspirin therapy, while the remaining guidelines identified between 4-46% (P<.001) The SOGC was the only guideline to meet the published 24% reduction in cases of preeclampsia and 14% reduction of preterm birth with 35.3% and 14.3% reduction respectively. None of the guidelines reduced IUGR by the published 20% rate.

CONCLUSION:

The Canadian society’s guideline is comprehensive and captures more women who should start aspirin therapy. While these guidelines are beneficial for initiation of aspirin therapy, few of the published guidelines will effectively reduce rates of preeclampsia. Development of a more effective preventive treatment remains essential.
Barriers to Blood Transfusions During Post-Partum Hemorrhage in Northern Ethiopia: Preliminary Data [04M]
Authors: Eluobaju Debra , Yeman Awol , Lee Gina , Goba Gelila , Cavanaugh Erin
Published: April 2020

INTRODUCTION:

Post-partum hemorrhage (PPH) remains the leading cause of maternal mortality in Ethiopia; the country experiences 412 maternal deaths per 100,000 births, exceeding the global average. Delays in-transit time and inefficient blood transfusions are linked to maternal death. This study aims to evaluate the effects of centralized Ethiopian blood banks on timely blood transfusion and the impact of comprehensive patient education on transfusion refusal.

METHODS:

As part of a mixed-method study, blood transfusion log books at Ayder Comprehensive Specialized Hospital were analyzed to assess the common reasons for transfusions at tertiary care centers. Focus groups of residents from the Tigray region were conducted to explore the social acceptance of blood transfusions.

RESULTS:

Focus group data illuminates that women are receptive to receiving blood transfusions, especially in the context of delivery. Hospital transfusion log books show a transfusion rate of 3% for PPH; comprising of 1.95% of total transfusions recorded during our 3-month preliminary data collection period.

CONCLUSION:

Despite research indicating the average rate of blood transfusions during PPH is 1.4%; Ayder Comprehensive Specialized Hospital has a transfusion rate of 3.0%. Women should be fully counseled on blood transfusions risks and benefits; our data indicates that comprehensive education does not influence women’s transfusion decisions. High transfusion rates may indicate that women are suffering from complications and are being transferred instead of stabilized at general hospitals. Research should focus on exploring the effectiveness of blood distribution and storage in the general hospitals after screening, eliminating the need to transfer women during obstetric emergencies.
Cervical Length Monitoring in Placenta Previa to Predict Emergency Cesarean Section for Antepartum Hemorrhage [06M]
Authors: Chitkara Aarti , Siwatch Sujata , Bagga Rashmi , Chandra Saha Subas , Singh Tulika
Published: April 2020

INTRODUCTION:

Placenta previa can cause significant obstetric hemorrhage and present as grave emergency, leading to adverse maternal and perinatal outcome. We conducted a prospective observational study to determine if cervical length (CL) ≤3 cm correlates with emergency Cesarean section (CS) for Antepartum hemorrhage (APH).

METHODS:

Transvaginal sonographic CL was measured for women with placenta previa beyond 26 weeks and then at two weekly intervals. Emergency CS due to APH, APH episodes, gestation at delivery and baby’s birth weight were compared between women with CL ≤3 cm (group 1) and CL >3 cm (group 2), measured at the time of recruitment. The study was approved by the local Institutional Ethics Committee.

RESULTS:

Seventy-one women were included, out of which seven delivered vaginally and 64 underwent CS. More women required emergency CS in group 1 (19/32, 59.4%) than in group 2 (14/32, 43.8%) (P=.211). With serial monitoring, short CL ≤3 cm was significantly associated with emergency CS within two weeks (21/32 (65.6%) vs. 12/32 (37.5%), P=.024). Women with short CL ≤3 cm delivered earlier (35.4±2.0 weeks vs. 36.1±2.3 weeks in group 1 &2 respectively, P=.005). Number of APH episodes was higher in group 1 as compared to group 2 (2.2±1.4 vs. 1.5±1.4, P=.024). Women with CL >3 cm delivered neonates with higher birth weight as compared to those with CL ≤3 cm (2.56±0.6 kg vs. 2.3±0.5 kg, P=.046).

CONCLUSION:

Cervical length ≤3 cm is associated with more APH episodes, lower gestation and baby weight at birth in women with placenta previa. Serial monitoring of CL may predict need for emergency CS and help plan admission and delivery.
Changing Transfusion Practice in Obstetrics and Gynecology: The Effect of Hospital-Wide Education [08M]
Authors: Thiel Peter , Lett Christine , Mah Alicia
Published: April 2020

INTRODUCTION:

Red blood cell (RBC) transfusions are a potentially life-saving intervention in Obstetrics and Gynecology (O&G). With limited guidelines outlining appropriate use of RBC transfusions, clinicians often transfuse based solely on low hemoglobin values and habit. Our aim was to assess transfusion practices at a Canadian tertiary care center before and after a hospital-wide blood management educational campaign based on the Choosing Wisely toolkit.

METHODS:

Following approval from our Institutional Review Board, we conducted a retrospective chart review of all patients who received a RBC transfusion while admitted under an O&G provider in two 12-month periods, before and after the intervention. The campaign consisted of Grand Rounds presentations, formal and informal teaching, and posters placed around the hospital. Appropriateness was determined from a set of criteria composed of the presence or absence of active bleeding, initial hemoglobin, and number of units ordered at a time.

RESULTS:

Before and after transfusion rates were 1.8% and 1.2% respectively (83/4,610 vs 55/4,618 P=.016). There was a 52% reduction in total number of RBC units transfused (229 vs 111 P<.001), a 33% reduction in number of patients transfused (83 vs 55 P=.016), and fewer multiple unit transfusions without reassessment (39 vs 13 P=.005). The rate of transfusion appropriateness was low in both the pre and post intervention periods (46.5% vs 50.7% P=.59).

CONCLUSION:

Following a hospital-wide education campaign, there was a marked decrease in overall use of transfusion reflecting adoption of a more restrictive transfusion practice. The low rate of transfusion appropriateness represents an opportunity for further improvement.
Characteristics of Postpartum Patients Readmitted for Management of Hypertensive Disorders of Pregnancy [09M]
Authors: Bump Jennifer M. , Denning Stacie , Harris Tara , Gandhi Manisha , Davidson Christina
Published: April 2020

INTRODUCTION:

To identify risk factors of patients who are readmitted in the immediate postpartum period for management of hypertensive disorders.

METHODS:

Retrospective cohort study from 2012-2019 at a tertiary care academic center of all women with a diagnosis of hypertensive disorders during the delivery admission. Maternal characteristics for women readmitted within 30 days postpartum were compared to those not readmitted.

RESULTS:

Of 40,124 deliveries, 8361 were identified as having a hypertensive disorder (20.8%). 85 were subsequently readmitted for management of hypertension in the postpartum period (1%). Maternal age was significantly correlated with a higher rate of readmission (P<.001). No differences were noted among BMI, gestational age, race/ethnicity, chronic hypertension diagnosis, nulliparity, or multiple gestations. Readmitted patients showed a significantly higher rate of antihypertensive use during the delivery admission (1.33% vs 0.95%, P=.049) and those discharged on labetalol had a higher rate of readmission when compared to those discharged on nifedipine (1.51% vs 0.63%, P=.058). Patients with private insurance were more likely to be readmitted versus those with Medicaid insurance (1.25% vs 0.59%, P=.012).

CONCLUSION:

Women with hypertensive disorders discharged home on antihypertensive medication are more likely to be readmitted during the postpartum period and may benefit from increased vigilance during this time period. Further investigation is needed to determine the effect of insurance on readmission rate and if social determinants of health impact postpartum hypertension follow up visits. The use of nifedipine versus labetalol also warrants further investigation as there appears to be a trend towards improved blood pressure control with nifedipine.
Community Triage and Resources for Maternal Hemorrhage in the Marin District of Port-au-Prince, Haiti [10M]
Authors: Marlow Emily , Van Laere Jeffrey
Published: April 2020

INTRODUCTION:

Maternal hemorrhage is a leading cause of maternal mortality in Haiti despite being an entirely preventable cause of death. Few studies have been performed evaluating postpartum hemorrhage (PPH) in Haiti. The goal of this project is to evaluate the current situation surrounding PPH in the Marin district of Port-au-Prince and identify possible areas of intervention.

METHODS:

Health facilities in the Marin area were identified in collaboration with physicians from the Foyer St. Camille Hospital. These participants received a survey covering four aspects of PPH care: prevention, treatment, referral, and prenatal care. Survey items were primarily based on the 2012 WHO Recommendations for Treatment and Prevention of Postpartum Haemorrhage.

RESULTS:

Historically, delays in treatment have been the primary contributors to maternal death from hemorrhage, most commonly delays in 1) seeking treatment after home birth, 2) knowing where to seek emergency obstetric care, and 3) receiving care upon arriving at a facility. The data collected from this survey is expected to elucidate causes primarily for the third delay through comparisons to the WHO guidelines, between facilities, and between rural and urban centers. The results of this study will be available by the time of presentation.

CONCLUSION:

This knowledge has potential to open the door to specific actions that can be taken in the Port-au-Prince community for reducing maternal deaths due to hemorrhage. If successful, these actions can then be extrapolated and adapted to fit other communities in Haiti and possibly in other countries with high rates of PPH.
Developing and Validating a Prediction Model for Postpartum Hemorrhage at a Single Safety-net Tertiary Care Center [11M]
Authors: Goad Lindsay , Fabbri Stefka E. , Rockhill Karilynn , Heyborne Kent
Published: April 2020

INTRODUCTION:

The aim of the current study is to develop and validate a prediction model for postpartum hemorrhage (PPH) based on antenatal and intrapartum risk factors in a diverse patient population at a tertiary safety-net center.

METHODS:

In this observational cohort of 10,025 pregnant women who delivered at Denver Health Medical Center (DHMC) between April, 2016 and March, 2019, ante- and intrapartum characteristics were compared between women with PPH and those without. A predictive multivariable model was estimated using logistic regression with a backwards stepwise approach eliminating variables when P>.05 among the prediction cohort of women delivering before April 2018. The model was validated among women, who delivered after April, 2018.

RESULTS:

A total of 9,774 women met inclusion criteria, 6,525 in the prediction cohort and 3,249 in the validation cohort. The prevalence of PPH in the prediction and validation cohorts was 6.1% and 6.8%, respectively. Maternal age, maternal body mass index (BMI, kg/m2), parity, gestational age, history of prior cesarean, history of PPH, abnormal placentation, neonatal weight, chorioamnionitis, platelet count on admission and intrapartum magnesium administration were included in the final prediction model. The area under the curve (AUC) for the prediction model was 0.81 (95% CI 0.79-0.84) and the AUC for the validation cohort was 0.89 (95% CI 0.86-0.91).

CONCLUSION:

The model performed well and can be used to identify women at risk for PPH. Further studies are necessary to evaluate the effect of the model use on decreasing PPH and associated maternal morbidity.
Establishing Reference Values for Health Related Quality of Life Scores During Pregnancy [16M]
Authors: Nica Alex , Fathi Ariana , Shulman Yonatan , Teshler Lizabeth , Huszti Ella
Published: April 2020

INTRODUCTION:

This study aims to generate gestational-age specific Health-Related Quality of Life (HRQoL) scores from a diverse population of low-risk pregnant women, to provide reference values for future research and clinical practice.

METHODS:

We conducted a prospective longitudinal study at Mount Sinai Hospital in Toronto, Canada. Over a period of three months, we recruited 333 women over the age of 18 with low-risk singleton pregnancies between 12 and 40 weeks of gestation. Participants completed a demographic survey at the first visit and two HRQoL questionnaires - the Short Form-36 (SF-36) and the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) at each visit. The SF-36 was composed of eight domains: physical functioning, role limitations due to physical health, role limitations due to emotional health, energy/fatigue, emotional well-being, social functioning, pain and general health scores. The MFSI-SF produced domains consisting of the general score and the vigor score. Gestational-age-specific mean HRQoL scores and standard deviations were calculated to determine how they changed throughout the course of pregnancy in various domains. Approved by Mount Sinai Hospital Research Ethics Board.

RESULTS:

Although SF36 scores were constant for the general domain, those for the energy domain as well as MFSI-SF scores tended to rise from 12 weeks and peak at 20-27 weeks before dropping slightly again and plateauing between 34 and 40 weeks.

CONCLUSION:

HRQoL scores, especially those related to energy and vigor, fluctuate during the course of pregnancy and these fluctuations need to be considered when comparing the effect of interventions or the progression of disease conditions during pregnancy.
Implementation of Hemorrhage Guidelines Reveals Racial Disparities in Transfusion Requirements [18M]
Authors: Holliman Kerry , Pluym Ilina D. , Wong Thalia , Han Christina , Nguyen Tina , Rao Rashmi
Published: April 2020

INTRODUCTION:

The California Maternal Quality Care Collaborative (CMQCC) released new enhanced risk stratification guidelines for postpartum hemorrhage (PPH) in 2015 aimed at reducing perinatal morbidity and mortality. This study evaluates the effects of the CMQCC PPH guidelines on frequency of PPH and blood transfusion.

METHODS:

With IRB approval, a retrospective study using hospital administrative data of deliveries from 2014-2019 at two large medical centers under one academic institution was performed. The incidences of PPH, defined as estimated blood loss greater than 1,000 mL, and transfusion were compared before and after implementation of the CMQCC PPH guidelines. Multiple logistic regression analysis was performed for PPH patients and transfusion recipients to adjust for clinical covariates, such as method of delivery, pre-delivery length of stay, gestational age, and race.

RESULTS:

There were 3,610 deliveries prior to CMQCC guideline implementation, compared with 13,018 deliveries after. The rate of PPH significantly decreased from 2.6% (94/3,610) before to 0.8% (110/13,018) after (P<.001). In contrast, transfusion frequency did not change (1.9%, 69/3,610 vs 2.1%, 274/13,018, P=.51). Black, Hispanic and Asian patients had a higher rate of transfusion when compared to white (4.4%, 2.9%, 2.4% vs 1.3%, respectively, P<.001 for each), even though rates of PPH did not differ by race. Black women had the highest aOR of transfusion at 2.86 (95% CI 1.95-4.21, P<.001).

CONCLUSION:

Despite a decline in the rate of PPH overall, black, Hispanic and Asian women continue to have increased rates of postpartum transfusion. Further studies are needed to further investigate the cause of this racial disparity.
Is It in Your Blood: Does Blood Type O Increase the Risk of Early Postpartum Hemorrhage? [21M]
Authors: Kelly Amelia G. , Limaye Meghana , Roman Ashley
Published: April 2020

INTRODUCTION:

Patients with type O blood have been demonstrated to have lower von Willebrand levels than other ABO types. We evaluated whether O blood type is associated with an increased risk of early postpartum hemorrhage (PPH).

METHODS:

We performed an Institutional Review Board approved retrospective cohort study of women aged 18-45 who had a vaginal or cesarean delivery of a live-born singleton infant at our institution from January 1, 2018 to December 31, 2018. The quantitative blood loss (QBL) from delivery and rates of early PPH were compared between patients with type O blood and those with non-type O blood. Early PPH was defined as 1,000 mL of blood loss or greater within 24 hours of delivery. Patient characteristics were compared. Chi square tests and student’s t-tests were used to assess for statistical significance.

RESULTS:

There were 9,990 patients included with 4,422 (44.3%) in the O group and 5,568 (55.7%) in the non-O group. The groups were similar with regard to age, parity, gestational age at delivery, mode of delivery, rate of induction, episiotomy use, delivery anesthesia type, and birth weight. There was a higher proportion of grand multiparity (parity of 5 or greater) in the non-O group (6.16% versus 5.01%, P=.02). Rates of early PPH were similar in the type O and non-O groups (7.78% versus 7.22%, P=.29). There was no significant difference in the mean QBL between the groups (450.9 mL versus 434.7mL, P=.75).

CONCLUSION:

In this analysis, O blood type was not associated with an increased risk for early PPH.
Is Sleep Deprivation Associated With Adverse Pregnancy Outcomes? [22M]
Authors: Larson Jeannette M. , Bazalakova Mihaela H. , DelBeccaro Melanie , Aagaard Kjersti , Antony Kathleen M.
Published: April 2020

INTRODUCTION:

The purpose of this study was to evaluate the association between measures of sleep deprivation (SD) and adverse pregnancy outcomes.

METHODS:

A screening questionnaire which included novel items intended to assess sleep deprivation, was administered at the time of prenatal care; this was a secondary analysis of participants enrolled (2010-2012). SD was defined as a 3 hour or more difference between weekday and weekend self-reported sleep duration. This analysis received an IRB exemption.

RESULTS:

Of 1172 women, 17.41% (n=204) had SD. Women with SD were more likely to have large for gestational age (LGA) babies (6.5% vs. 2.99%, P=.015) and babies admitted to the neonatal intensive care unit (NICU) (21.1% vs. 15.4%, P=.048). Women who reported falling asleep while driving were more likely to have gestational hypertension (gHTN) (18.6% vs. 9.3%, P=.030), preeclampsia (PreE) (27.1% vs. 13.8%, P=.010), PreE with severe features (18.8% vs. 8.68%, P=.017) and to experience adverse composite obstetric outcomes (64.7% vs. 50%, P=.040). Women who reported napping were more likely to have PreE with severe features (11.1% vs. 7.59%, P=.049), preterm birth (PTB) (16.6% vs. 9.71%, P=.001), and NICU admission (20.9% vs. 14.4%, P=.005). Women who reported napping more than 3x/week were more likely to have gHTN (12.0% vs. 8.12%, P=.024), PTB (16.0% vs. 10.3%, P=.003), and adverse composite obstetric outcomes (54.0% vs. 48.3%, P=.047).

CONCLUSION:

Sleep deprivation, falling asleep while driving, and napping are associated with various adverse obstetric outcomes and composite obstetric outcomes. Further research into the effects of sleep deprivation during pregnancy is warranted.