bluuebunny/crossref_metadata_2025 huggingface dataset:
Immediate Compared With Deferred Treatment for Gestational Diabetes Mellitus: A Cost-Effectiveness Analysis [ID 2683592]
Authors: Prasad Ruhika , Arora Megha , Doshi Uma , Caughey Aaron B.
Published: May 2024

INTRODUCTION:

Current recommendations for gestational diabetes mellitus (GDM) include screening and treatment at 24–28 weeks’ gestational age. Whether treatment prior to 24–28 weeks improves maternal and infant outcomes is unclear. A recent randomized trial found that immediate treatment of GDM at 20 weeks led to lower incidence of several adverse neonatal outcomes including respiratory distress syndrome (RDS) and shoulder dystocia with brachial plexus injury (BPI). We evaluated the clinical benefits and cost effectiveness of immediate versus deferred treatment in pregnant women with GDM.

METHODS:

We used TreeAge to construct a decision-analytic model comparing outcomes between those who received immediate versus deferred GDM treatment. Our theoretical cohort was 71,679, the approximate number of GDM cases diagnosed early in the United States annually. Outcomes were BPI, RDS with neonatal intensive care unit admission, neurodevelopmental delay (NDD), cost, and quality-adjusted life years (QALYs). Probabilities were derived from a recent randomized trial and other peer-reviewed literature. We used a discount rate of 3% and a willingness-to-pay of $100,000/QALY.

RESULTS:

In our theoretical cohort, immediate treatment led to fewer cases of BPI (25 versus 77), RDS (7,054 versus 12,176). There was no difference between either treatment for NDD. Despite increased costs, immediate treatment was a cost-effective strategy as it resulted in increased QALYs with an incremental cost-effectiveness ratio of $54,434/QALY.

CONCLUSION:

Immediate treatment was a clinically beneficial and cost-effective strategy to reduce cases of BPI and RDS. Given improvement of certain neonatal outcomes, it may be beneficial to screen and immediately treat early-onset GDM.
Fluorescent Imaging Using Indocyanine Green for Intraoperative Detection of Endometriosis [ID 2683620]
Authors: Ward Megan , Tam Maria Teresa , Mabini Christopher-Armand Z.
Published: May 2024

INTRODUCTION:

Endometriosis is characterized by the presence of endometrial-like tissue outside of the uterus. Definitive diagnosis is made by laparoscopic visualization with confirmatory histopathologic biopsy. In some cases, lesions can be ambiguous or difficult to visualize with traditional white light (WL)-illuminated laparoscopy. The study objective is to evaluate whether the use of indocyanine green (ICG) aids in identification and removal of clear or ambiguous endometriosis lesions, not visualized under traditional WL imaging.

METHODS:

This is a retrospective chart review of patients with symptoms suspicious for endometriosis where ICG is used during laparoscopy to assist in identification of suspected endometriosis lesions. Data collection includes patient demographics, medical history, surgical history, preoperative symptoms, and localization of lesions. Data will be collected from hospital electronic health record system and from a private practice.

RESULTS:

In total, 211 suspected lesions were excised, of which 115 had histologically proven endometriosis. 196 lesions were detected using ICG and 112 were confirmed to be endometriosis. These results were statistically significant (P=.024) with a sensitivity of 97.4% and a negative predictive value of 80%, demonstrating that ICG can significantly improve the intraoperative detection of endometriosis lesions. Research is ongoing with more data being collected. Our goal is that the additional data will further strengthen the power of our study.

CONCLUSION:

Our study shows that ICG fluorescence significantly improves the intraoperative detection and resection of ambiguous or clear endometriosis lesions and improves histopathologic diagnosis when compared to WL imaging. Indocyanine green has the potential to increase the detection of endometriosis and improve patient outcomes.
Is Resectoscopic Hysteroscopy a Dying Art? Creation of an Educational Instructional Video [ID 2683474]
Authors: Purmalek Monica , Fielden Aaron , Ramirez Christina I.
Published: May 2024

INTRODUCTION:

Resectoscopic hysteroscopy is a valuable surgical technique for addressing intrauterine pathology. Within our institution, most operative hysteroscopies are performed using newer non-resectoscopic systems, potentially creating a gap in resident surgical education. We developed a novel instructional video demonstrating the components and capabilities of the resectoscopic hysteroscope. Our aim is to assess whether the instructional video increased surgeon comfort using the resectoscopic hysteroscope.

METHODS:

A pilot cohort study was performed with gynecologic surgery and obstetrics (GS&O) residents and staff physicians at Brooke Army Medical Center. Participants were provided access to the resectoscope surgical set throughout the study, completed a baseline survey assessing surgeon comfort, and then repeated the survey after watching the instructional video. The survey used a 5-point Likert scale with 1) very uncomfortable, 3) neutral, and 5) very comfortable.

RESULTS:

Of the 20 participants, 85% lacked formal resectoscope training and 45% had no prior resectoscope experience. Prior experience was limited: 55% used it less than five times and 64% had no use in the last year. At baseline, few were comfortable with setup (15%) and troubleshooting (5%). The instructional video significantly increased surgeon comfort with resectoscope setup (P<.001) and troubleshooting (P<.001). Surgeon comfort supervising a resident doubled after the instructional video (33–66%). All participants felt the video was helpful and would recommend it to others (100%; P<.01). Finally, 80% of participants would like more formal training opportunities for other surgical devices.

CONCLUSION:

This survey demonstrated a gap in surgical experience and comfort using the resectoscope at our institution. The novel instructional resectoscope video improved GS&O resident and staff comfort with setting up and troubleshooting the resectoscope. Staff comfort with supervising a resident using the resectoscope also increased. Future directions include expanding study population to include operating room staff and assessing post-intervention resectoscope utilization rates.
Postoperative Telemedicine Use: Satisfaction and Safety After Benign Gynecologic Surgery: A Randomized Controlled Trial [ID 2683391]
Authors: Norris Vanessa A. , Provost Holly , Smith Chloe , Willard Allison , Knowling Joselyn S.
Published: May 2024

INTRODUCTION:

Telemedicine for postoperative care can be appropriate after minimally invasive surgery, but few studies have examined this option in gynecologic surgery. The objective of this randomized controlled trial was to determine whether virtual, compared to in-person postoperative care, after minimally invasive gynecologic procedures would increase patient satisfaction without negative safety concerns.

METHODS:

Patients were randomized to a telemedicine or in-person visit 2 weeks postoperatively. Eligible participants included women undergoing elective, minimally invasive gynecologic surgery. All participants completed the PSQ-18 form with addendum questions at their 6-week postoperative visit. Chart review was performed to assess frequency of postoperative adverse events. The Wilcoxon rank sum and Fisher exact test were used.

RESULTS:

Of 51 participants enrolled, 29 were randomized to standard (in-person) visits versus 22 randomized to intervention (telehealth). There was no statistical difference in the overall satisfaction with the postoperative care received between the intervention and the standard groups (93.8% agree or strongly agree versus 95.7%; P=1). There was no increase in postoperative complications in the intervention arm of the study, with an overall complication rate of 12.5% in all cases.

CONCLUSION:

It is reasonable to use telemedicine as an option for postoperative care based on shared decision-making with appropriate patients. A virtual postoperative visit is a safe option for patients who may not be able to travel to the office. Future study is ongoing to confirm statistical significance.
Patterns in Female Permanent Contraception After the Dobbs v. Jackson Ruling [ID 2683406]
Authors: Lulseged Bethlehem , Rockwell Tori , Wang Karen C. , Sufrin Carolyn , Stone Rebecca , Frost Anja S.
Published: May 2024

INTRODUCTION:

On June 24, 2022, the Supreme Court reversed the constitutional right to abortion in Dobbs v. Jackson. We aimed to explore changes in interval female permanent contraception procedures before and after the Dobbs ruling.

METHODS:

We performed a retrospective chart review of interval female permanent contraception procedures at a large academic center between June 24, 2019, and May 25, 2023, using relevant CPT codes. Procedure counts pre- and post-ruling were compared. Chi-squared and difference-in-mean-proportions tests were used to explore differences across periods by patient characteristics. Institutional review board approval was waived for this study.

RESULTS:

There were 913 procedures performed during the observation period: 611 in the 3 years pre-ruling (June 24, 2019 to June 23, 2022) and 302 in the 11 months post-ruling (June 24, 2022 to May 25, 2023). There was a 49.5% increase in procedures between the pre-ruling and post-ruling timeframes. A higher proportion of patients who identify as White underwent procedures post-ruling compared to non-White counterparts (P<.001). Chi-squared testing indicated a relationship between insurance status and post-ruling procedures (P<.001). The largest proportion of patients who had procedures post-ruling were privately insured. Patients who had procedures post-ruling had lower gravidity compared to those who had procedures pre-ruling (P<.001).

CONCLUSION:

There was a significant increase in interval female permanent contraception procedures post-Dobbs ruling with significant differences found by race, insurance, and gravidity—notably, in a state without restrictive contraception or abortion legislation. As state abortion and contraception laws evolve, both state and national trends in female permanent contraception should be monitored.
Development and Potential Implementation of Endometrial Cancer Screening in a Poor-Prognosis Endemic Cancer Community [ID 2683642]
Authors: Chavez Thomas , Eiran Ekta , Matthews Roland P. , Leonis Regina , Giuseppe Del Priore
Published: May 2024

INTRODUCTION:

Endometrial cancer incidence and mortality both are increasing in the United States. Certain patient populations are disproportionately affected by this disease. Currently, there is no recommendation from any professional society to screen high-risk patients for premalignancy or cancer. Our patient population is composed of predominantly Black women, a group that experiences worse endometrial cancer outcomes than other demographics. A risk assessment nomogram may be able to be developed using data from this unique patient population that can identify women at high risk of developing endometrial disease.

METHODS:

Endometrial pathology specimens collected at a large safety-net hospital between the years of 2013 and 2022 were analyzed. A retrospective chart review was performed on this data, looking for the patient characteristics of race, age, body mass index (BMI), parity, hemoglobin A1C level, and tamoxifen use history at the time of specimen collection. Odds ratios were calculated for those variables individually as well as collectively to determine whether they could be used to predict risk of endometrial disease in a woman with some of all those characteristics.

RESULTS:

The odds ratios for age, BMI, and parity were statistically significant between benign and abnormal pathologic specimens. The area under the receiver operating characteristic curve was 0.76 when combining age, BMI, and parity.

CONCLUSION:

Our data suggest that at-risk patients can be reliably identified using simple characteristics. Strengths of our study include a unique patient population and large database. Future directions include refinement of the model and prospective application in the clinical setting.
Trends in Overactive Bladder Prescriptions From 2020 to 2022: A Single Institution Review [ID 2683593]
Authors: Ashmore Sarah , Sarkar Prottusha , Brown Oluwateniola
Published: May 2024

INTRODUCTION:

Anticholinergic (AC) and beta-3 agonist (B3) medications are the mainstay of pharmacotherapy to treat overactive bladder (OAB). Recent clinical guidelines recommend cautious use of ACs in elderly patients as ACs are associated with cognitive side effects. The primary objective of this study was to examine OAB prescribing patterns from 2020 to 2022.

METHODS:

This is an IRB-approved retrospective study at a single academic center between January 2020 and December 2022. Women aged at least 18 years, diagnosed with OAB, and newly prescribed ACs or B3s were included. Overactive bladder diagnosis was identified using ICD-9 and -10 codes and the electronic medical record queried for new OAB medication prescriptions in our system. Patient demographics and clinician specialty were abstracted from the medical record. Group comparisons were conducted using Student's t-test, and χ2, Fisher's exact tests were used as appropriate.

RESULTS:

Five thousand six hundred forty-eight women were prescribed an AC or B3 between 2020 and 2022. Anticholinergic medications were more commonly prescribed, comprising 58.3% of OAB prescriptions compared to B3s (41.7%). Beta-3 agonist prescriptions increased by 127% over the study period. In contrast, AC prescribing remained stable. Women prescribed B3 agonists were more likely to be older (P<.001). There were significant differences in OAB prescription trends by prescriber specialty (P<.001). Urogynecologists were the leading prescribers of B3s (38.3%), whereas primary care clinicians prescribed the most ACs (57.9%).

CONCLUSION:

Beta-3 agonist prescriptions increased while AC prescriptions were relatively unchanged from 2020 to 2022. Despite growing concern regarding AC risks, our study shows that ACs are still prescribed at high volume.
How Did the Recent Infant Formula Shortage Affect Breastfeeding Rates in Northeast New York [ID 2683397]
Authors: Gojayev Anar , Gifford Jamie , Zelig Craig M.
Published: May 2024

INTRODUCTION:

To determine the effect of the recent infant formula shortage on breastfeeding rates in the northeast New York area.

METHODS:

This was a retrospective analysis of the Northeast New York (NENY) Regional Birth Registry database from January 2021 to June 2022. Breastfeeding rates of patients in the first 6 months of 2022 were compared to those from 2021. Maternal demographics, obstetrical history, breastfeeding, and delivery information were collected. We wanted to determine whether the recent infant formula shortage in the United States affected the breastfeeding rates. Statistical analyses were performed using STATA software (Stata/SE 12.1). A P value of <.05 was considered statistically significant. This study was approved by the IRB at Albany Medical Center. We controlled for maternal marital status, education level, ethnicity, and employment status during pregnancy in our statistical analysis.

RESULTS:

We identified 19,610 patients in the NENY database from January 2021 to June 2022. 170 (0.87%) were excluded from our study due to breastfeeding data not being available. The exclusive breastfeeding rate increased from 55.97% to 57.25%. However, this was not statistically significant (P<.104). The formula-only rates essentially stayed the same, 17.94% versus 17.54%. The rates of the infants who were supplemented with formula had a nonsignificant decrease from 25.23% to 24.33% (P<.185). We did a secondary analysis in which the data were excluded for those infants who were admitted to the neonatal intensive care unit and the differences were even smaller with an overall P value of 0.949.

CONCLUSION:

Although the recent infant formula shortage in the United States led to a slight increase in exclusive breastfeeding rates and decrease in formula feeding in a first 6 months of 2022, none of these were statistically significant. These differences were not statistically significant even after controlling for demographic factors such as marital status, race, and education level and BMI.
Gestational Weight Gain Is Not Associated With Risk of Fetal Acidosis in Scheduled Cesarean Deliveries [ID 2683603]
Authors: Dubois Bethany , Sarker Minhazur , Bianco Angela , DeBolt Chelsea A.
Published: May 2024

INTRODUCTION:

Obesity is associated with fetal acidosis at time of scheduled cesarean delivery (CD). Although excessive gestational weight gain (GWG) is associated with adverse pregnancy outcomes, it is not known whether GWG is associated with fetal acidosis at time of scheduled CD.

METHODS:

This was an IRB-approved retrospective cohort study of term, singleton, non-anomalous deliveries by scheduled cesarean under neuraxial anesthesia at Mount Sinai Hospital from 2013 to 2019. Gestational weight gain was the difference between pre-pregnancy or first-trimester weight and delivery weight. Gestational weight gain appropriateness was defined by Institute of Medicine recommendations: insufficient, appropriate, excessive. Primary outcome was fetal acidosis defined as umbilical arterial pH less than 7.1. Demographics were compared using chi-squared analysis and the association between GWG and fetal acidosis was evaluated with multivariable logistic regression.

RESULTS:

Of 2,435 individuals included, 1,046 (43%) had excessive, 749 (31%) had appropriate, and 640 (26%) had insufficient GWG. Incidence of fetal acidosis was 0.8%, 1.7%, and 1.9% among populations with insufficient, appropriate, and excessive GWG, respectively (P=.2). Across groups, rates of insurance status, history of cesarean delivery, and anesthesia type were similar. Compared to appropriate GWG, the excessive GWG group had higher rates of early pregnancy obesity (P=.001). After adjusting for early pregnancy weight, age, cesarean history, insurance type, and anesthesia type, excessive GWG was not associated with increased odds of fetal acidosis (adjusted odds ratio [aOR] 1.01 [0.49, 2.14]).

CONCLUSION:

Neither excessive nor insufficient GWG are associated with increased risk for fetal acidosis in term, scheduled CD. Association between obesity and fetal acidosis are likely unrelated to GWG.
Prediction of Expected Fetal Weight From Fetal Limb Soft Tissue Measurements [ID 2683393]
Authors: Kim II Dong
Published: May 2024

INTRODUCTION:

This study was to investigate a combination of new formulas that predict birth weight in full-term pregnancy by measuring the thickness of the humerus soft tissue and femur soft tissue in fetuses using three-dimensional (3D) ultrasound.

METHODS:

There were a total of 110 mothers and newborns who were hospitalized with selective cesarean section, induced delivery, or natural delivery between April 2019 and August 2021. We retrospectively investigated fetal biometric parameters (BPD, HC, AC, FL, partial arm volume [Avol], and partial thigh volume [Tvol]), as measured by 4D View 9.0 and GE Healthcare Ultrasound while the mother was admitted to the delivery ward before delivery. The study was approved by the ethics board of the National Medical Center (NMC-2022-03-026).

RESULTS:

Among the several combinations that showed the expected weight, the weight predicted by AC/BPD/Tvol gave the strongest correlation (0.780) with the actual weight of the newborn, with an error rate of 6.4%. In boys, among the several combinations indicating the predicted body weight, AC/Avol/BPD had the highest correlation coefficient with the actual body weight (0.791), with an error rate of 5.0%. In girls, among several combinations, AC/Tvol/BPD had the highest correlation coefficient with actual body weight (0.878), with an error rate of 5.3%.

CONCLUSION:

The fetal weight predicted using Tvol and Avol measured using 3D ultrasound as parameters had a lower error rate for birth weight than the predicted weight measured by conventional 2D ultrasound. The parameters highly correlated with birth weight; however, differences were seen between the sexes.
Decreased Sonographic Head Circumference Is Found in Buprenorphine-Exposed Fetuses [ID 2683396]
Authors: Benton Brooke , Condra Alex , Lewis Nicole , Olsen Martin
Published: May 2024

INTRODUCTION:

Neonates diagnosed with neonatal opioid withdrawal syndrome (NOWS) have decreased head circumference compared to non-exposed newborns. This is the first study to evaluate fetal head circumference over time in a group of fetuses with intrauterine buprenorphine exposure.

METHODS:

Fetal anatomic surveys are commonly performed at around 20 weeks of gestation. Patients treated with medication-assisted therapy (MAT) for opioid use disorder commonly receive estimated fetal weight scans at around 32 weeks of gestation due to the risk of intrauterine growth restriction. Retrospective review of ultrasound reports for three groups of patients were performed. Group 1 (75 patients) was low-dose MAT; group 2 (73 patients) was traditional higher-dose MAT. Group 3 (104 patients) was a control group. The IRB approval was 1220.9e-ETSU, entitled “Effect of Maternal Buprenorphine on Fetal Head Circumference.”

RESULTS:

At the time of the approximately 20-week scan, no statistical difference was found between the groups. At the approximately 32-week growth scan, however, a comparison of the two buprenorphine groups together versus control group showed a statistically significant difference (P=.018) in head circumference. Although the low-dose group had larger head circumferences than the higher-dose group in the 32-week scan, the difference was not significant.

CONCLUSION:

Previous studies have shown decreased head circumference in newborns in association with maternal MAT. This is the first study to provide ultrasound confirmation of decreased head circumference in fetuses exposed to buprenorphine. Effects are pronounced in the third trimester; the possibility exists that interventions during pregnancy might preserve fetal brain volume. Further research is needed.
Intravenous Iron Supplementation in Pregnancy: A Quality Improvement Project on Maternal Transfusion Reduction [ID 2683469]
Authors: Pfeiffer Alixandria F. , Chang Nathalie H. , Cheng CeCe , Byrne John J. , Doyle Nora M.
Published: May 2024

INTRODUCTION:

Intravenous (IV) iron supplementation for patients with iron deficiency anemia in pregnancy has been shown to improve hemoglobin (Hb) levels in the peripartum period and ultimately lead to a decrease in severe maternal morbidity (SMM), specifically blood transfusion. The objective of this study was to analyze the effects of IV iron supplementation on maternal pre-delivery Hb levels after the implementation of an institution-based protocol focused on maternal red blood cell transfusion reduction.

METHODS:

We performed a retrospective review of patients who received IVFe supplementation after the implementation of a maternal transfusion reduction bundle at our Level IV maternal care center in 2020. We reviewed changes in maternal Hb pre-infusion and pre-delivery over a 3-year period (2020–2023), along with rates of postpartum blood transfusion. Patients were excluded if they received an antepartum blood transfusion. Maternal demographics, ferritin and Hg levels were compared between the two groups using GraphPad Prism software.

RESULTS:

Two hundred ninety-five patients met inclusion criteria; most patients were Hispanic (71.9%), had Medicaid (51.9%), and underwent a vaginal delivery (76.9%). Mean gestational age at time of infusion was 34.2 weeks (95% CI, 33.7–34.7) The average Hb pre-infusion and pre-delivery were 8.9 (95% CI, 8.8–9.0) and 10.6 (95% CI, 10.4–10.8), respectively. The change in maternal Hb at time of delivery increased by 2 points (P<.0001). Only two patients received a blood transfusion postpartum.

CONCLUSION:

Implementation of a standardized antenatal IV iron infusion protocol can improve maternal pre-delivery Hb levels and reduce morbidity associated with blood transfusion.
Intravenous Iron Supplementation Timing in Pregnancy: A Quality Improvement Project on Maternal Transfusion Reduction [ID 2683470]
Authors: Pfeiffer Alixandria F. , Chang Nathalie H. , Zarudskaya Oxana M. , Boyd Angela R. , Doyle Nora M.
Published: May 2024

INTRODUCTION:

Intravenous iron supplementation (IVFe) for pregnant patients with iron deficiency anemia improves hemoglobin (Hb) levels in the peripartum period. Optimal timing of this therapy, however, is unknown. We analyzed the effects of IVFe as part of an institution-based protocol on maternal Hb levels, stratifying by gestational age (GA).

METHODS:

We reviewed changes in maternal Hb pre-infusion and pre-delivery over a 3-year period (2020–2023) after the implementation of a maternal transfusion reduction bundle was incorporated at our Level IV maternal care center in 2020. Pregnant patients who received IVFe and delivered at our institution were included and compared by gestational age (<34 or ≥34 weeks) at time of IVFe. We excluded patients with known antepartum blood transfusion. Maternal demographics, ferritin and Hg levels were compared between the two groups using GraphPad Prism software.

RESULTS:

Of 295 patients who met inclusion criteria, maternal age, body mass index, nulliparity, and ferritin levels were similar in both groups. Mean GA for the cohorts at time of IV iron transfusion were 29.6 ± 4.9 weeks (early third trimester) and 36.6 ± 2.4 weeks (late third trimester), respectively (P<.0001). Higher delta Hb (2.5 g/dL at <34 weeks versus 1.3 g/dL at ≥34 weeks) and improved mean pre-delivery Hb were seen when IV iron was given in the early third trimester (P<.0001).

CONCLUSION:

Early third-trimester IVFe improves maternal pre-delivery Hb levels and may reduce significant maternal morbidity hemorrhage complications.
Effect of Hyponatremia in Preeclamptic Patients With Severe Features [ID 2683491]
Authors: Endres Kodi , Roberts Catherine M. , Krawiec Conrad , Fang Xinying , Wright Tonya , Zhou Shouhao
Published: May 2024

INTRODUCTION:

Hyponatremia, although common in expectant women with preeclampsia, has not been well studied in a multicenter fashion, and it is unknown whether it is associated with adverse events related to severe preeclampsia. Our primary objectives are to assess the clinical characteristics and emergency therapy applied to participants diagnosed with preeclampsia. We hypothesize that hyponatremia present in preeclamptic patients with severe features is associated with greater use of emergency hypertensives, antenatal steroids, and cesarean delivery.

METHODS:

This is a retrospective cohort study utilizing a multicenter electronic health record database (TriNetX). We collected and evaluated the following data of participants aged 15–54 years with a diagnosis of preeclampsia with severe features: demographics, diagnostic codes, medication codes, procedure codes, deaths, and laboratory results.

RESULTS:

A total of 2,901 participants (215 [7.4%] with a sodium level below 134 mEq/L and 2,686 [92.6%] with a sodium level above 135 mEq/L) were included. A higher proportion of participants in the below 134 sodium group received emergency antihypertensives (165 [76.7%] versus 1,811 [67.4%]; P=.01), antenatal steroids (103 [47.9%] versus 953 [35.5%]; P=.001), and cesarean section (27 [12.6%] versus 97 [3.6%]; P<.001).

CONCLUSION:

We found that hyponatremia may be associated with emergency antihypertensive use, antenatal steroid use, and cesarean section in patients with preeclampsia with severe features. Future research is needed to determine whether routine sodium levels assessed in preeclamptic subjects with severe features identify subjects at risk of receiving these treatments.
Use of a Menstrual Cup to Assist in Diagnosis of Preterm Premature Rupture of Membranes [ID 2683492]
Authors: Fadadu Priyal P. , Chen Valerie , Torbenson Vanessa , Theiler Regan N.
Published: May 2024

INTRODUCTION:

Several methods exist for diagnosis of preterm premature rupture of membranes (PPROM), including pooling on speculum exam, nitrazine test, arborization under microscopy, immunoassay, and amnio-dye test. Diagnostic accuracy is particularly important for PPROM because a missed diagnosis may result in life-threatening maternal and fetal consequences. We present a novel method for evaluating PPROM in equivocal cases using a menstrual cup.

METHODS:

Written informed consent was obtained for submission of a case report. A 36-year-old G6P5005 at 29 2/7 weeks presented with leakage of fluid. She was found to have negative pooling on speculum exam, negative arborization on microscopy, a maximum vertical pocket (MVP) of 4.0 cm, and a negative urinalysis. She was discharged with precautions and returned 2 days later with persistent symptoms. Workup again showed no pooling, no arborization, and a normal MVP. The patient suggested using a menstrual cup to capture her intermittent leakage of fluid. She wore a menstrual cup for 30 minutes in triage. A sample of the fluid tested positive for arborization. She was admitted to labor and delivery for latency antibiotics, betamethasone, and fetal and maternal monitoring.

CONCLUSION:

Preterm premature rupture of membranes can occur without overt vaginal pooling due to small volume leakage. Conventional testing is less sensitive when pooling is absent. In these cases, a menstrual cup may help facilitate diagnosis and avoid invasive tests such as the amnio-dye test. Care must be taken to use a clean menstrual cup without gel, limit the duration of menstrual cup use to avoid infection, and to distinguish arborization of amniotic fluid from that of cervical mucus.
Expectations for Paternity Leave Among Male Partners in the Postpartum Setting: A Cross-Sectional Survey at a Public Hospital in Los Angeles, California (2023) [ID 2683493]
Authors: Hong Christian E. , Huang Elaine , Nguyen Brian T.
Published: May 2024

INTRODUCTION:

Early paternal involvement in childcare benefits both birthing mothers and their children. Unfortunately, paid paternity leave is neither mandated nor protected at the state and federal levels, leading to wide variations in early paternal involvement.

METHODS:

As a part of this IRB-approved study, we conducted interviewer-facilitated surveys with English- and Spanish-speaking male partners encountered in the postpartum ward at Los Angeles General Medical Center. The survey queried general sociodemographic factors, employment status, and access to, as well as, planned utilization of paternity leave (both paid and unpaid). We conducted bivariate analyses and multivariable logistic regressions to identify factors linked to fathers not taking paternity leave.

RESULTS:

Most respondents (N=100) identified as Hispanic or Latinx (76.0%), reported English as their primary language (58.0%), and had an average age of 30.6 years. Ninety-three respondents reported being employed; more than half either reported that their workplace did not have a paternity leave policy (39.1%) or being unsure of their workplace’s policy (17.4%). Only 15.2% reported anticipating paternity leave with full pay. Respondents who knew their workplace policies planned to take no more than 3 weeks of leave on average. Respondents had greater odds of not taking paternity leave if non-English speaking (adjusted odds ratio [aOR] 2.39; 95% CI, 0.93–6.16), uninsured (aOR 5.01; 95% CI, 1.26–20.35), or publicly insured (aOR 2.86; 95% CI, 0.95–8.65).

CONCLUSION:

Male partners in our primarily Hispanic, publicly insured patient population anticipated taking minimal paternity leave, raising questions regarding the role of employee protections or the lack thereof in the face of socioeconomic pressures and cultural differences.
Patient Acceptability of Social Needs Screening at an Ambulatory Prenatal Practice [ID 2683516]
Authors: Wang-Koehler Eileen , Bailey Grover N. , Mills Lisa A. , James Abike , Graseck Anna S. , Clement Elizabeth G.
Published: May 2024

INTRODUCTION:

Social determinants of health (SDOH) influence maternal–child health outcomes, but standardized social needs screening for prenatal patients is rare, and obstetric practices lack guidance for implementation and tool selection. Our objective was to evaluate patient acceptability of and preferences for SDOH screening during prenatal care.

METHODS:

A paper-based patient survey regarding acceptability of SDOH screening was distributed during a pilot of two different validated screening tools at an ambulatory prenatal practice. Pregnant patients were given the survey during prenatal visits. Demographic data were abstracted from chart review. Descriptive analysis was employed to interpret the findings.

RESULTS:

A total of 84 patients were surveyed. Of these, 67% of patients identified as Black or African American, and 84% had Medicaid or emergency medical assistance. Our patients viewed screening favorably: 82% believed that our team would be able to provide helpful resources, 75% would welcome our assistance if faced with social challenges, and 77% would use resources if provided. Only 11% of patients disagreed that social needs screening was relevant to their prenatal visit. Just 15% of patients preferred the questions to be asked verbally compared to self-administered.

CONCLUSION:

Social needs screening is acceptable to prenatal patients and can be feasibly self-administered. Patients felt that the SDOH questions were relevant to their care and would be open to resources and referrals if they had social needs. Future goals will be to universalize screening in prenatal practices, identify acceptable screening tools, and ensure social needs are addressed effectively once identified.
Social Determinants of Health Needs Among Immigrant and U.S.-Born Pregnant Persons in Central Brooklyn: A Cross-Sectional Survey [ID 2683549]
Authors: Pardo Christina , Bhattacharjee Moyouri , Bruening Sandra , Calixte Rose , Clare Camille A. , Afable Aimee
Published: May 2024

INTRODUCTION:

Social determinants of health (SDOH) have been linked to poor health outcomes in maternal and infant populations. An epicenter of the maternal health crisis in New York City, Central Brooklyn has a disproportionately high population of immigrants. This cross-sectional survey assesses demographic distributions and SDOH needs of immigrant and U.S.-born pregnant individuals in Central Brooklyn.

METHODS:

The American Academy of Family Practitioners (AAFP) SDOH screening tool was given to 700 pregnant persons with immigrant status defined by country of origin. Institutional review board-approved data were collected through REDCap, and associations were evaluated via χ2, Fisher's exact tests, and logistic regression in STATA.

RESULTS:

Compared to U.S.-born pregnant persons, immigrants tended to be older (P=.000), married (P<.000), and more educated (P=.028). Social determinants of health needs differed significantly by nativity status for housing instability (P=.039), food worry (P=.000), and food inadequacy (P=.018), all of which were higher for immigrants. After adjusting for age and education level, immigrant pregnant persons were significantly more likely to report five or more SDOH needs. Rates of food insecurity (39.86% among immigrants and 27.02% among U.S.-born) were much higher than the national average of 10.2%. Rates of all other SDOH needs were higher for immigrants, except for transportation, but these differences were insignificant.

CONCLUSION:

Our study underscores the criticality of monitoring SDOH needs in marginalized populations to inform targeted interventions aimed at dismantling systemic barriers to health care access during pregnancy. By doing so, we can foster greater engagement in care and promote more equitable health outcomes for pregnant and postpartum individuals.
The Relationship of Patient/Provider Racial Concordance to Nulliparous, Term, Singleton, Vertex Cesarean Delivery Rates [ID 2683595]
Authors: Ajayi Blessing , Sher Olivia , Vorawandthanachai Thammatat , Kumar Vani , Ram Kavitha T.
Published: May 2024

INTRODUCTION:

Prior studies have explored factors affecting nulliparous, term, singleton, vertex cesarean (NTSV-C) delivery rates, such as induction, provider type, and racial disparities. Some studies have shown higher NTSV-C rates among non-White patients compared to their White counterparts. Our aim was to study the influence of racial concordance between patient and provider on NTSV outcomes.

METHODS:

A retrospective analysis of 315 NTSV pregnancies at an urban hospital from January to March 2023 was performed. The NTSV outcomes by racial concordance were examined using χ2 and Fisher exact tests with alpha <.05. Logistic regression analysis was used to adjust for high-risk maternal comorbidities. The race of patients and delivering providers was based on self-identification.

RESULTS:

A majority of patient–provider dyads were concordant for race (199/315 [63.2%]). Racial concordance was associated with a lower NTSV-C rates (23.1 versus 33.6%; P=.04). This association persisted after adjusting for maternal comorbidities (P=.003). When NTSV outcomes were stratified by patient race, significant differences in cesarean delivery rates by patient race were observed for White providers (P=.02). No significant differences between races were observed for Asian (P=.93) or Black providers (P=.82).

CONCLUSION:

These results emphasize the significant effect of racial concordance between patients and providers on cesarean delivery rates, highlighting the need for further examination of health care disparities and tailored interventions to promote equitable maternal care.
Hospital Water Birth: Interim Results of a Pilot Randomized Control Trial [ID 2683557]
Authors: Malloy Emily M. , Kram Jessica J. F. , Adefisoye James , Forgie Marie M. , Kleber Diana , Hanson Lisa
Published: May 2024

INTRODUCTION:

Water birth is a method of pain relief during labor associated with decreased pain and increased satisfaction. Randomized control trials (RCTs) about water birth and safety outcomes are needed. We conducted an RCT of hospital water birth versus land birth to compare maternal/neonatal outcomes, and differences in analgesia/anesthesia use. This is an updated interim analysis of our findings (Clinical trial: NCT05175599).

METHODS:

After IRB approval, low-risk pregnant adults were offered study participation between 25 and 34 weeks of gestation. Enrollment began January 2022 using a computer-generated 2:1 (water birth-to-land birth) allocation ratio. Participants in both arms were offered routine care and all available pain relief, with those in the water birth arm given the additional option of birth in the tub. Participants in both groups were excluded if they developed risk factors, including hypertension, preterm labor, or nonvertex presentation. Descriptive and inferential statistics were computed.

RESULTS:

Overall, n=182 have been enrolled and n=157 have given birth. Following exclusions, n=96 (n=67 water birth, n=29 land birth) remained eligible for the study. Significantly fewer participants had epidural or intravenous narcotic analgesia in the water birth group (37.3% versus 82.8% land birth; P<.0001). Ultimately in the water birth group, n=35 (52.2%) gave birth in water. Using the Birth Satisfaction Scale-Revised Indicator scale, water birth patients expressed a significantly higher level of satisfaction (Mdn=33.0 versus 29.0 land birth; P=.009). To date, no adverse events occurred.

CONCLUSION:

These preliminary findings suggest that when offered to low-risk laboring people, hospital water birth reduces pain and increases satisfaction without leading to adverse events.
Risk Factors for Emergency Department Visits and Readmissions for Postpartum Hypertension [ID 2683548]
Authors: Mei Jenny Y. , Muñoz Hector E. , Murphy Aisling
Published: May 2024

INTRODUCTION:

Postpartum hypertension is a source of significant maternal morbidity and mortality. We aim to evaluate risk factors for postpartum emergency department (ED) visits and readmissions for hypertensive complications.

METHODS:

This was a retrospective cohort study of all birthing patients with peripartum hypertension at a single tertiary care center over a 5-year period (2017–2022). Maternal baseline and intrapartum characteristics were chart abstracted. Primary outcome of interest was postpartum ED visit or readmission (EDR) due to hypertensive complications. Patients who had EDR within 42 days of delivery were compared to those who underwent routine outpatient surveillance. This is IRB #14-001098.

RESULTS:

Of 16,162 patients who gave birth during the study period, 2,403 (14.9%) patients met the definition of peripartum hypertension. 218 (9.1%) presented to the ED or were readmitted for hypertension. Risk factors for EDR were as follows: maternal age greater than 40 years (22.9% versus 15.3%; P=.003), cesarean delivery (42.7% versus 35.8%; P=.044), chronic hypertension (37.2% versus 31.6%; P=.029), severe preeclampsia (32.6% versus 15.6%), p50% elevated blood pressures within the 24 hours prior to discharge (16.5% versus 11.9%; P=.046).

CONCLUSION:

Maternal age over 40, chronic hypertension, severe preeclampsia, prescription of antihypertensives on discharge, and elevated blood pressures leading up to discharge are associated with postpartum ED visits or readmissions for hypertension. Attention should be paid to these high-risk groups to reduce ED visits and readmissions.
Blood Loss Matters: Estimated Compared With Quantitative Blood Loss in Vaginal Deliveries [ID 2683415]
Authors: Winograd Deborah , McKenzie Tesia , Baum Jonathan
Published: May 2024

INTRODUCTION:

Postpartum hemorrhage is the leading cause of maternal mortality worldwide. Quantitative blood loss calculators have been developed to improve recognition of hemorrhage; however, there is a paucity of research comparing their accuracy. The objective of this study is to compare quantitative blood loss and estimated blood loss values during vaginal deliveries with calculated blood loss determined by maternal hematocrit before and after delivery.

METHODS:

This IRB-approved retrospective cohort study included all term, spontaneous vaginal deliveries of singleton infants to patients 18 years or older who delivered at a single community-based tertiary center between August 2019 and December 2020. Estimated blood loss (EBL) or quantitative blood loss (QBL) were obtained from delivery notes. Quantitative blood loss was obtained using the Triton Gravimetric Calculator. Data were abstracted from electronic medical records and de-identified. Calculated estimated blood loss (cEBL) was determined using the formula determined by Stafford et al. in 2008. The associations between EBL and cEBL and between QBL and cEBL were evaluated by using linear regression.

RESULTS:

Of 1,667 deliveries that met inclusion criteria, 670 had a QBL (40.2%) and 997 had an EBL (60.9%). The association between cEBL and QBL using simple linear regression was a poor fit with an R-square of 0.206. Estimated blood loss and cEBL also had a poor association using linear regression with an R-square of 0.0941. By using R-square, QBL can predict better than EBL; however, both are poor predictors of blood loss calculated from pre-delivery and post-delivery hematocrit.

CONCLUSION:

This study demonstrates that both QBL and EBL have poor correlation with the decrease in hematocrit after a vaginal delivery. Both QBL and EBL missed a significant blood loss in one out of three deliveries. A prospective, blinded, cohort study is currently in process to directly compare QBL and EBL at our institution.
Disparities in Postpartum Pain Management After Cesarean Delivery [ID 2683520]
Authors: Tassone Lauren , Gurram PadmaLatha , Livatova Katherine , Chevalier-Horgan Christine , Nyein Andrew
Published: May 2024

INTRODUCTION:

We evaluated whether postpartum pain management differs by practice setting, ethnicity, insurance, and preferred language in women with cesarean deliveries (CDs).

METHODS:

This is a retrospective cohort study. Participants who underwent CD at term between 2021 and 2022 were included. Participants with history of opioid use, allergies to NSAIDS, general anesthesia, and postpartum stay greater than 5 days were excluded. The outcomes measures include number of oral “as needed” opioids received measured in morphine milligram equivalents, frequency of pain scores done on the postpartum unit, initial pain scores, pain scores at discharge, and the type and amount of opioids prescribed at discharge. The association of these outcomes based on practice setting (federally funded health center [FFHC] versus private practice [PP]), public versus private insurance, preferred language (English versus non-English), and Hispanic versus Non-Hispanic ethnicity were evaluated. Institutional review board approval was obtained.

RESULTS:

Four hundred seventy-nine participants were included. FFHCs received less “as-needed” opioids than patients of PP (P=.03). Publicly insured received less opioids than privately insured at discharge (P=.03). English-speaking participants were asked about their pain more frequently (P=.05) and received more inpatient opioids than non-English-speaking participants (P=.00). Non-Hispanic participants were asked about their pain more frequently (P=.042) and were more likely to be discharged with opioid-only medications (P=.04) than Hispanic patients who were discharged with combined medications (P=.03).

CONCLUSION:

Women attending FFHC, non-English-speaking, with public insurance, and of Hispanic ethnicity experience disparities in postpartum pain management. Targeted protocols should be developed to eliminate the disparities that exist in postpartum pain management.
Buprenorphine Dosing Through the Pregnancy-to-Postpartum Transition: A Descriptive Analysis [ID 2683589]
Authors: Shadowen Caroline R. , Shadowen Hannah , Thuma Lillia , Martin Caitlin E.
Published: May 2024

INTRODUCTION:

Supporting continuation of life-saving medications for opioid use disorder (OUD), like buprenorphine (BUP), is imperative through the postpartum period. However, no clinical guidelines exist to inform BUP dosing in this transition. Our study describes BUP dose changes in the first 3 months postpartum and associated patient characteristics in an OUD clinical sample.

METHODS:

This is a secondary analysis of an IRB-approved retrospective cohort study of pregnant patients with OUD who delivered at an academic medical center, initiated BUP between January 1, 2018, and March 30, 2020, and remained on BUP until at least 3 months postpartum. The primary outcome was change in BUP dose between delivery and 3 months: a categorical variable with three levels (increase, decrease, or no change) abstracted from medical record. Bivariate analysis assessed the relationship between changes in BUP dosage and patient characteristics.

RESULTS:

In our sample (N=66), about half maintained their BUP dosage through 3 months postpartum (n=36; 55%); the remaining patients decreased (n=22; 33%) or increased their dose (n=8; 12%). 38% of patients incarcerated at delivery increased their dose, whereas 9% of patients not incarcerated increased their dose. 39% of patients who delivered vaginally decreased their dose; 24% of patients who delivered via cesarean section decreased their dose.

CONCLUSION:

Our study takes a crucial first step in developing the evidence base for the individualization of BUP dosing for postpartum people. Ultimately, we aim to use these data to inform a decision aid to facilitate shared decision-making about BUP dose changes in the pregnancy-to-postpartum transition.