bluuebunny/crossref_metadata_2025 huggingface dataset:
The Use of Long-Term Indomethacin Stabilizes Cervical Length in Twin Pregnancies [7Q]
Authors: Shannon Allison , Crimmins Sarah , Hanna David , Kopelman Jerome , Harman Chris , Turan Ozhan
Published: May 2017

INTRODUCTION:

To determine if the use of early onset (less than 25 weeks) long-term indomethacin therapy (greater than 48 hours) (LIT) stabilizes the cervical length (CL) in dichorionic-diamniotic twin gestations (DCDA-T) that are complicated by a short cervix.

METHODS:

DCDA-T pregnancies with short CL (less than 30 mm) after 18 weeks were identified. Serial CL measurements, other treatments (17 OH-P, vaginal progesterone) and outcomes were collected. Patients with cervical cerclage were excluded. The degree of cervical shortening from initial to last examination was compared in patients with a short CL and women with a normal CL at same gestational age (GA). Longitudinal analysis of the change in CL was modeled using mixed-model regression analysis and predicted values were compared using comparisons of the slope analysis.

RESULTS:

Out of 77 patients, 32 (42%) received LIT. The GA at initial ultrasound was similar between groups (P=0.6). Initial and last CLs were shorter in LIT group (21 mm vs 43 mm and 11.5 mm vs 36 mm) (P < .0001 for both). A total of 434 (LIT=191, Normal CL=243) longitudinal CL examinations were used for mixed-model regression analysis. CL improved or did not change in LIT group (0-0.4 mm/week) (CL= 0.0353GA2-1.5458GA+32.399, R2=0.06). However, in normal CL group, CL was declined by 0.8-1.9 mm/w (CL=0.0529GA2-4.1356x+105.25) (P < .00001). There were no reportable antenatal side effects.

CONCLUSION:

Early onset long-term indomethacin therapy in DCDA-T with a short cervix provides an alternative treatment modality to stabilize cervix.
Reliability of Visual Estimation of Intrapartum Blood Loss [10Q]
Authors: Dunlop Kristyn , Eckler Rebecca , Rosen Adam , Komorowski Adam , Murphy Kellie , D'Souza Rohan
Published: May 2017

INTRODUCTION:

Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality. Visual estimation of blood loss (VEBL) is commonly used to diagnose PPH, but its validity remains unknown. This study aimed to determine the accuracy of VEBL in diagnosing PPH.

METHODS:

Pregnant women over 18 years of age delivering vaginally or by caesarean delivery (CD) after 23 completed weeks of gestation were included. Blood loss was measured by weighing pre- and post-delivery sponges and linen (gravimetric method), and direct measurement of blood collected in the suction apparatus at CD. Obstetricians, nurses, and anesthesiologists involved in the delivery were asked to anonymously estimate blood loss. Their role in the delivery and years of experience were noted. Results were presented in numbers and proportions.

RESULTS:

Of 170 cases recruited, 157 were analyzed, including 123 CD and 34 vaginal deliveries. For CD, sensitivity of VEBL was 29.4% for primary surgeons, 16.7% for first assistants, 20% for anesthesiologists, 31.2% for scrub nurses, and 25% for circulating nurses. For vaginal deliveries, the sensitivity was 45.4% for primary obstetricians, and 37.5% for assistants. The specificity was between 89.5% and 100% for all participants with both CD and vaginal deliveries. Although sensitivity increased with years of experience, it remained low even for those with the greatest obstetric experience, at 40% for vaginal deliveries and 25.8% for CD.

CONCLUSION:

This study demonstrates low sensitivity of VEBL in diagnosing PPH. Methods that accurately and objectively quantify intrapartum blood loss are needed for clinical and research purposes.
A Reminder System for Postpartum DM Screening in GDM Patients: A Randomized Controlled Trial (RCT) [20Q]
Authors: Khalifeh Adeeb , Iyer Jayasree , Cantor Eva , Quist-Nelson Johanna , Tumas Jordyn , Berghella Vincenzo
Published: May 2017

INTRODUCTION:

The postpartum period is an opportunity to screen for diabetes mellitus (DM) in pregnancies complicated by gestational diabetes mellitus (GDM). We evaluated whether a reminder system increases DM screening in the postpartum period.

METHODS:

This was a multicenter RCT of women who had pregnancies complicated by GDM and whom we anticipated would undergo postpartum screening for DM. Our intervention was a reminder system comprising of providing the patient with a screening test laboratory requisition prior to discharge from the hospital and of a phone reminder 6 weeks postpartum. Our control group included patients undergoing routine DM screening during their 6 week postpartum visits. The primary outcome was DM screening uptake in the postpartum period. Data was analyzed using Chi squared and Fisher exact tests.

RESULTS:

A total of 75 patients were randomized. 38 were assigned to the reminder system and 37 to the control group. Maternal age, race, insurance and parity were similar between both groups. From the intervention group, 31.6% (n=12) performed postpartum DM screening compared to 24.1% (n=10) in the control group (p=0.1). This increase was significant in patients with public insurance (p=0.04) but not in patients with private insurance (p=0.19). 31.8% (7/22) of patients who completed the screening test were diagnosed with prediabetes but none with DM.

CONCLUSION:

A reminder system for postpartum DM screening in GDM patients did not increase testing uptake. However, a reminder system may be beneficial in patients with lower socioeconomic status.
The Effects of Tocolysis on Neonatal Septic Death in Women With PPROM: A Retrospective Cohort Study [21Q]
Authors: Chackowicz Ariel , Spence Andrea R. , Abenhaim Haim A.
Published: May 2017

INTRODUCTION:

The use of tocolysis in women with preterm premature rupture of membranes (PPROM) remains uncertain, particularly in suspected chorioamnionitis. The purpose of our study was to evaluate the effect of tocolysis on neonatal septic death in women with PPROM +/- chorioamnionitis.

METHODS:

Using the Linked Birth and Infant Death data files (2009-2013) from the National Center for Health Statistics, we conducted a retrospective cohort study on all registered live births between 24-32 weeks' of pregnancy in order to evaluate the effect of tocolysis on neonatal septic death at 7 and at 28 days among women with PPROM between 24 and 32 weeks' gestation. Logistic regression models were used to evaluate the effect of tocolysis on neonatal septic death at 7 and at 28 days in births with and without chorioamnionitis.

RESULTS:

There were 46,968 births that met study criteria, and of which 6,264 (13.3%) received tocolysis. Tocolysis was more commonly administered to women who were Caucasians, smokers, and with multiple birth pregnancies and previous preterm births. There was no significant association between tocolysis and neonatal septic death at 7 days (OR 0.66, 95% CI 0.39-1.13) and at 28 days (OR 0.85, 95% CI 0.60-1.19). This was consistent in pregnancies complicated by chorioamnionitis and those without chorioamnionitis.

CONCLUSION:

In the setting of PPROM, tocolysis does not appear to increase the risk of neonatal septic death. Therefore, consideration can be given to its administration if clinically indicated.
The Cost-effectiveness of a Trial of Labor After Two Prior Cesareans: Impact on the Subsequent Pregnancy [29Q]
Authors: Sargent James , Worstell Teresa , Griffin Emily , Savitsky Leah , Caughey Aaron B.
Published: May 2017

INTRODUCTION:

The benefits of a trial of labor (TOL) after a single cesarean are generally accepted; this is not true regarding a TOL following two cesareans. Since mode of delivery in the index pregnancy will affect the outcomes in the subsequent pregnancy, we designed a model to examine the cost-effectiveness of a TOL vs elective repeat cesarean (eRCD).

METHODS:

A decision-analytic model was built using TreeagePro and incorporated probabilities, costs, and utilities from the literature. This model was applied to a theoretical cohort of 100,000 women in order to assess the clinical outcomes of uterine rupture, maternal/perinatal death, and neonatal short/long-term disability in both the index and subsequent pregnancy (including future incidence of previa/accreta). A cost-effectiveness threshold was set to $100,000 per quality-adjusted life year, and the robustness of the model was assessed with sensitivity analyses.

RESULTS:

In our model, a TOL following 2 cesareans resulted in 46 fewer maternal demises, 65 additional perinatal demises, and 8 additional cases of cerebral palsy. eRCD resulted in 173 additional cases of placenta previa and 137 cases of placenta accreta. A TOL conferred a cost savings of $3,837 per pregnancy, and was the cost-effective strategy up to a rate of uterine rupture during TOL of 4.4% and down to a successful TOL rate of 20.2%.

CONCLUSION:

When including the outcomes of both the index and subsequent pregnancy, a TOL following two previous cesareans is the cost-effective delivery strategy. Careful counseling regarding the increased rates of neonatal complications (despite an overall low absolute risk) must be addressed.
Accuracy of a Limited vs Expanded cfDNA Platform for the Detection of Fetal Aneuploidy in a High Risk Population [30Q]
Authors: Westover Thomas , Spivack Lauren , Smolinsky Ciaran , Khandelwal Meena
Published: May 2017

INTRODUCTION:

Two types of cell free DNA (cfDNA) platforms are available to screen for fetal chromosome abnormalities. The “limited” platform screens for a fixed number of chromosomal abnormalities while the “expanded” platform screens for abnormalities throughout the entire genome. We sought to compare the accuracy of these two platforms.

METHODS:

We performed a retrospective review of pregnancies undergoing cfDNA, invasive genetic testing, or both, between 2015-2016. Singleton high risk pregnancies were included. Maternal and newborn charts were reviewed to determine which cfDNA platform was performed and whether prenatal or postnatal genetic testing was performed. Appropriate statistical tests were performed for parametric and non-parametric data. Significant chromosome abnormalities were defined as whole chromosome aneuploidy, subchromosomal abnormalities >7 megabases and 22q deletion.

RESULTS:

790 cfDNA assays were performed: 384 limited, 406 expanded. 44 chromosomal abnormalities were found (34 prenatally, 10 postnatally). 75% were common trisomies or sex chromosome aneuploidies while 25% were uncommon chromosomal abnormalities (deletions, duplications, unbalanced translocations, triploidy, rare autosomal trisomy). The expanded platform could potentially have detected 94% of the total number of abnormalities while the limited platform could potentially have detected only 75% (p=.03).

CONCLUSION:

We found that that 25% of chromosomal abnormalities in a high risk population cannot be detected by a limited cfDNA platform. Clinicians should consider usage of an expanded genome wide cfDNA platform that screens for pathogenic, clinically relevant, actionable chromosome abnormalities in patients who prefer non-invasive screening as first line testing.
The “Double Pain” of Childbirth: Immigrant Women's Preference for Female Providers Intrapartum [33Q]
Authors: Aubrey Christa , Mumtaz Zubia , Chari Radha , Mitchell Peter (BF)
Published: May 2017

INTRODUCTION:

Having a male obstetrical provider can be particularly problematic for some immigrant women whose religio-cultural ideals instill a strong preference for female providers. The objective of this study was to gain understanding of the importance and effect of provider gender for immigrant women accessing obstetrical care.

METHODS:

A focused ethnography was conducted using purposive and convenience sampling of 38 immigrant women from one hospital in Edmonton, Alberta, Canada. Data collection comprised of semi-structured interviews antenatally (38) and postpartum (21), and observation intrapartum (17). Interviews were audio-recorded and transcribed verbatim. Data was managed by a qualitative data analysis software, and analyzed by thematic analysis.

RESULTS:

Women came from various educational and ethnic backgrounds, but the majority were Muslim (30) and married (36), with a mean age of 27.7 years. All women stated that although they preferred a female, they would accept care from a male provider, as provider competency and desire for a safe birth were most important. A culture of modesty, often interwoven with Islam, informed this preference. Nonetheless, women experienced varying degrees of psychological stress from having received care from a male provider intrapartum, which for a small minority led to considerable, potentially serious consequences.

CONCLUSION:

As a whole, women are accepting of care from a male provider. However, for a small minority of women, it can be quite detrimental. There is a need to identify those women for whom this is a substantial barrier, so that optimal support can be determined.
Adherence to Rh Immune Globulin Prophylaxis Guidelines: An Audit of a Modern Obstetric Cohort [34Q]
Authors: Peterson Ashley , Folker Christin , Bond Brian
Published: May 2017

INTRODUCTION:

There is excellent evidence for postpartum Rh immune globulin (RhIG) prophylaxis efficacy and effectiveness. Continued adherence to RhIG prophylaxis guidelines is essential in preventing Rh alloimmunization and hemolytic disease of the newborn. This study aimed to perform an audit of RhIG prophylaxis practice in a modern obstetric cohort.

METHODS:

A retrospective chart review of 451 consecutive deliveries of Rh-negative women at a single-site tertiary medical center was performed. Fisher exact test was used for statistical analysis.

RESULTS:

The prevalence of Rh negativity was 8.9%. Of the Rh-negative women eligible to receive postpartum RhIG, 97.7% received RhIG and 98.9% were screened for fetomaternal hemorrhage (FMH). Of the Rh-negative women ineligible for RhIG administration, 4.6% inappropriately received RhIG and 91.9% were incorrectly screened for FMH. Evidence of FMH was demonstrated in 26.6% of Rh-negative women. Additionally, 1.7% of Rh-negative women had evidence of excessive FMH requiring additional administration of RhIG. Patients with FMH were more likely to have evidence of maternal acute blood loss anemia (47.8% versus 32.9%, P < .05). Mode of delivery was not associated with increased likelihood of FMH (P=.4).

CONCLUSION:

This audit revealed two key areas for improvement. First, the widespread practice of ordering an unnecessary laboratory test was identified. Second, the rates of failure to order RhIG and FMH screening were determined. Though multiple factors likely contribute to imperfect adherence to guidelines, RhIG prophylaxis has historically been physician-driven at our institution. Implementing a protocol-driven approach may improve adherence; however, further study will be necessary to determine a superior approach.
Maternal and Neonatal Morbidity Among Women With Sickle Cell Anemia and Sickle Cell Trait [4R]
Authors: Brown Jewel , Sinkey Rachel , Steffensen Thora , Louis-Jacques Adetola , Louis Judette
Published: May 2017

INTRODUCTION:

The objective of this study is to investigate maternal and neonatal morbidities among a contemporary cohort of women with sickle cell anemia (SCA) and sickle cell trait (SCT).

METHODS:

This is a retrospective cohort study among women with laboratory confirmed SCA and SCT with placental pathology results. We sought to compare maternal and neonatal morbidity among a contemporary cohort of women with SCT and SCA.

RESULTS:

One hundred thirty-two patients met inclusion criteria: 16 (12%) with SCA and 116 (88%) with SCT. Baseline characteristics including age, gravidity, parity, race, funding source and smoking status were similar between groups. Co-morbidities were similar with the exception of a higher incidence of chronic infectious diseases among patients with SCA (38% vs. 9%, p=0.002). With respect to maternal morbidity, the following were significantly more likely to occur among patients with SCA as compared to SCT: antepartum hospital admission (81% vs. 19%, p < 0.001), antepartum (69% vs. 4%, p < 0.001) and postpartum blood transfusions (38% vs. 5%, p < 0.001), postpartum readmission (19% vs. 3%, p=0.004) and endometritis (6% vs. 0%, p=0.01) (Table 1). With respect to neonatal morbidity, 25% of infants born to mothers with SCA were small for gestational age as compared 6% of infants born to SCT mothers (p=0.02). No other short-term neonatal morbidities were identified among infants born to mothers with SCA as compared to infants born to mothers with SCT.

CONCLUSION:

Maternal morbidity among patients with SCA is significantly greater as compared to mothers with SCT; infants born to SCA mothers also have higher rates of SGA.
Maternal Risk Factors in a Cohort Study of Mexican Americans Living Near the U.S.-Mexico Border [10R]
Authors: Patel Divya , Salahuddin Meliha , Gowen Rose , Fisher-Hoch Susan , McCormick Joseph
Published: May 2017

INTRODUCTION:

Preterm and early term births are higher in border versus non-border regions of Texas, though the prevalence of maternal risk factors contributing to negative birth outcomes in this region is not well understood.

METHODS:

Weighted descriptive analyses were conducted on self-reported medical history and information on first pregnancy collected from 384 women ages 19-49 at enrollment into the Cameron County Hispanic Cohort, a prospective study of Mexican Americans residing in South Texas near the U.S.-Mexico border.

RESULTS:

Women in the sample were predominantly Hispanic (89.8%), married (69.5%), and born outside the U.S. (57.5%), with average age of 36.7 years. Nearly one-quarter (23.1%) smoked 100 cigarettes or more in their lifetime. A majority (83.3%) of participants were obese or overweight, and sizeable proportions reported having high blood pressure (22.4%) or high cholesterol (11.1%). During their first pregnancy, most participants (79.0%) reported attending at least 6 prenatal visits. Prevalence of high blood pressure, diabetes, and preeclampsia during pregnancy was 7.6%, 3.2%, and 7.1%, respectively. Approximately 27% had cesarean delivery for the first pregnancy. Self-reported outcomes of the first pregnancy included preterm delivery (11.3%), miscarriage (9.7%), abortion (3.9%), and infant death (3.0%).

CONCLUSION:

Findings from this study indicate a higher burden of overweight/obesity and hypertensive disorders, as well as cesarean and preterm delivery, among Mexican American women of reproductive age in the South Texas border region compared to state averages. Interventions aimed at mitigating maternal risk factors may help improve birth outcomes and the long term health of women in this population.
Meconium Stained Amniotic Fluid: 10 Years After [12R]
Authors: Tilstra Matthew , Guzman Angela , Peart Mishka , Carlan Steve , McWhorter Jeannie
Published: May 2017

INTRODUCTION:

Meconium stained amniotic fluid (MSAF) occurs in 10-20% of deliveries, and, in the past, was considered a reason to alter obstetric and newborn management. Over the past decade, however, otherwise uncomplicated pregnancies characterized by MSAF have been managed regardless of the presence of MSAF. Whether the changes in hospital protocol regarding MSAF have resulted in poorer pregnancy outcomes have not been studied. The purpose of this study was to compare the outcomes of MSAF versus no MSAF pregnancies since hospital protocol removed MSAF as a risk factor for modifying management.

METHODS:

This was a retrospective study of all 45,961 singleton deliveries from 12/2009 to 12/2013. MSAF occurred in N=4,917.

RESULTS:

Newborn weight and gestational age at delivery were higher in the MSAF group (3344 ± 539 versus 3185 ± 645 grams, and 39 ± 1.8 versus 38 ± 2.5 weeks, respectively, P less than .05. The incidence of Cesarean delivery, and NICU admission were higher and Apgars lower in the MSAF, but umbilical cord pH was similar.

CONCLUSION:

This study suggests that MSAF influences subjectively assigned Apgar scores, but umbilical cord pH, an objective measure of fetal wellbeing is not different. Abandoning hospital protocols that included obstetric management changes when MSAF was present did not influence umbilical cord pH.
Mitochondrial Myopathy, Encephalomyopathy, Lactic Acidosis, Stroke-like Episodes Syndrome: Pregnancy Outcomes [14R]
Authors: Kfouri Julia , Gundy Serena , Faghfoury Hannah , D'Souza Rohan
Published: May 2017

INTRODUCTION:

The purpose of this study was to systematically review the literature on pregnancy outcomes in women with MELAS syndrome, one of the commonest mitochondrial disorders, and summarize strategies for their preconceptional, antepartum and intrapartum care.

METHODS:

MEDLINE, EMBASE, Web of Science, and PubMed were searched from inception to January 2016 for publications describing pregnancies with MELAS syndrome. Studies were only restricted to humans. The grey literature and references of relevant articles were hand-searched. Authors were contacted for missing data or eligibility inquiries. Article selection, data extraction and risk of bias assessment were performed in duplicate with discrepancies resolved by a third reviewer. Articles were excluded if MELAS syndrome was not confirmed or pregnancy outcomes were not described.

RESULTS:

Of 1412 identified titles and abstracts, 53 full texts were retrieved; 12 case reports were retained for final analysis, including one from our institution. In 2/12 (17%) cases, MELAS syndrome was diagnosed in pregnancy. Up to 11/12 (91%) women experienced severe maternal or obstetric complications such as admission to the intensive care unit, stroke-like episodes, or hypertensive disorders of pregnancy. Adverse fetal or neonatal outcomes, such as pregnancy loss or intrauterine growth restriction, were seen in 8/16 (50%) and 4/11 (36%) pregnancies respectively. Adverse outcomes occurred even when women were in complete remission pre-pregnancy. There were no maternal or neonatal deaths.

CONCLUSION:

MELAS syndrome is a multi-organ disorder associated with significant adverse medical and obstetric outcomes. Patients with this diagnosis should have preconception counseling and multidisciplinary pregnancy management in a tertiary center to optimize outcomes.
Neonatal Hypoglycemia in Women Controlled Intrapartum With Insulin Pump as Compared to Subcutaneous Insulin & Drip [18R]
Authors: Soni Shelly , Shah Nikita , Rochelson Burt , Simmonds Lisa
Published: May 2017

INTRODUCTION:

To evaluate the incidence of neonatal hypoglycemia in women with diabetes whose intrapartum insulin management is controlled with continuous insulin pump as compared with those managed with subcutaneous insulin as well as drip.

METHODS:

Retrospective review of patients with pregestational Type 1 and 2 diabetes. Primary outcome was neonatal hypoglycemia, defined as neonatal blood glucose levels of < than 40 mg/dl in the first 24 hrs. Patients were categorized into groups — those receiving intrapartum subcutaneous insulin as well as drip and those with intrapartum insulin pumps. Elective cesarean sections were excluded.

RESULTS:

102 patients were included. 71 had type 2 diabetes and 30.4% had type 1 diabetes. There was a greater rate of neonatal hypoglycemia in patients receiving subcutaneous/insulin drip, the difference was not statistically significant (28.6% vs 15.6%, p=0.2). There was no difference in the other perinatal outcomes; cesarean deliveries, birth weights, NICU admissions and the need of neonatal intravenous glucose. There were more patients with Type 1 diabetes in the pump group. Periconception HbA1C was similar. Though birth weights were higher in the pump group, the rate of hypoglycemia as well as the need of intravenous glucose was lower. Our data may have been biased because of more Type 1 diabetics in the pump group.

CONCLUSION:

We found no statistical difference in neonatal outcomes of patients receiving intrapartum continuous subcutaneous insulin infusion pump and those on subcutaneous insulin or drip. Continuing these patients on pump is a reasonable option, especially with lower rates of neonatal hypoglycemia and need of intravenous glucose.
Neonatal Outcomes of Infants at the Threshold of Viability in a Tertiary Care Center [20R]
Authors: Tonismae Tiffany , Lord Megan , Durica Allison
Published: May 2017

INTRODUCTION:

The goal of this study is to analyze outcomes of periviable deliveries at a tertiary care center in Southwest Virginia from January 2010 to 2016 of those infants delivered from 22 to 25 weeks.

METHODS:

This is a retrospective case series of 76 infants delivered between 22 0/7 and 24 6/7 weeks from 2010-2015. Infant and maternal charts were reviewed for data from admission until NICU discharge or in hospital death. Outcomes included death prior to discharge and major morbidities associated with prematurity.

RESULTS:

Seventy-six patients were identified, with none less than 23 0/7 weeks. Three patients were excluded due to life-limiting genetic or anatomic abnormalities diagnosed antenatally. Mean gestational age at delivery was 24 0/7 weeks (22 6/7-24 6/7 weeks) with mean birth weight 610 g (342-907 g). Demographic information was obtained including maternal age/race, receipt of betamethasone and magnesium sulfate, and causes for delivery. Placental pathology reports were also reviewed. Overall survival was 63% (57% at 23 weeks, 70% at 24 weeks), with a mean length of stay of 159 days (77-167 days). Seventy-four percent of survivors were diagnosed with major morbidity including: stage 3-4 retinopathy of prematurity (15%); late onset sepsis (28%); necrotizing enterocolitis (20%); grade 3-4 intraventricular hemorrhage (15%); periventricular leukomalacia (9%); and spontaneous bowel perforation (22%). 70% of survivors were discharged with home oxygen requirements.

CONCLUSION:

Our survival rate is above national benchmark data for this gestational age. However, the majority of survivors experienced significant morbidity, which should be considered when making decisions regarding resuscitation at the threshold of viability.
Obstetric Delivery Practices and Malpractice Claims: Is There a Correlation? [26R]
Authors: Baja Angela , Miller Lauren , Mills Emily , Clarke Bayley , Zarlengo Gerald
Published: May 2017

INTRODUCTION:

This study assesses the correlation in trends between obstetric delivery practices and liability claims over 30 years.

METHODS:

A retrospective chart review was performed at a single Colorado hospital, averaging 4,690 deliveries per year, from alternating years between 1978 and 2012. The number of cesarean sections (CS), operative vaginal deliveries (OVD) and vaginal lacerations (3rd and 4th degree) were recorded. A database of obstetrics liability claims, provided by COPIC Insurance, was tabulated and correlated with delivery data. All liability data was occurrence based and aggregated per year. Analysis was performed with Pearson correlation coefficients.

RESULTS:

The CS rate for singletons increased from 13% to 25% from 1978 to 2012. OVDs decreased from 14% to 2.5%. Lacerations decreased from 10.2% to 1.5%. The number of obstetric claims increased steadily until 2006 and then decreased. There was a significant positive correlation between CS rates and obstetrics claims (P =.006). No significant correlation was found between OVD rates and liability claims (P =.073) or lacerations and liability claims (P = .052).

CONCLUSION:

A positive correlation between CS rates and liability claims was noted, while no correlation in OVD or laceration rates to liability claims was found. Together, these trends suggest that abandonment of OVD has not been protective from a liability perspective. The decreasing rates of CS and malpractice claims starting in 2006 are likely explained by Colorado's medical tort reform in 2003. Undoubtedly fear of malpractice affects obstetricians' management, however abandoning OVD in favor of CS has not proven to be a protective solution.
Outcomes in Women With Chronic Hypertension but Normal Blood Pressures in Pregnancy [29R]
Authors: Youngstrom Mallory , Tang Ying , Gardner Meg , Biggio Joseph , Tita Alan , Harper Lori
Published: May 2017

INTRODUCTION:

Many women with chronic hypertension (HTN) have normal blood pressure (BP) without medication during pregnancy. We sought to assess outcomes in this group compared to women with no hypertension diagnosis, and those who require antihypertensives.

METHODS:

Retrospective cohort of singletons with HTN at UAB from 2000-2014. Exclusions were fetal anomalies, medical problems other than HTN and diabetes. For the same time period, a random group without HTN was chosen. Outcomes were compared between normotensive women with HTN with no medications (noMeds), normotensive women on medications (Meds), and those without HTN (NML). Primary outcome was a neonatal composite of stillbirth, neonatal death, respiratory support, seizures, cord pH less than 7, 5-minute Apgar less than 3. Secondary outcomes were preeclampsia (PE), preterm birth (PTB), and small for gestational age (SGA). Groups were compared using Student's t-test and χ2 test for trend. Logistic regression was used to adjust for confounders.

RESULTS:

Of 830 women with HTN, 212 (25%) were noMeds, and 618 (75%) were Meds. These groups were compared to 476 NML. Women with HTN were older, had a higher BMI, PIH in a prior pregnancy, renal disease, and diabetes compared to NML. The composite was more common in both HTN groups (AOR 2.9, 95% CI 1.21-6.85 NoMeds; AOR 5.0, 95% CI 2.38-10.54 Meds). The risk of PE, PTB, and SGA was not increased in NoMeds compared to NML.

CONCLUSION:

In spite of normal BP without medications, women with HTN have an increased risk of adverse neonatal outcomes compared to NML. Further research is needed to elucidate whether this is related to baseline characteristics of HTN or the HTN process.
Outcomes of Twin Pregnancies in Women Age 45 or Older [30R]
Authors: Gerber Rachel , Fields Jessica , Barberio Andrea , Bodenlos Kimberly , Fox Nathan
Published: May 2017

INTRODUCTION:

Singleton pregnancies in well-selected women 45 and older undergoing assisted reproduction have a high likelihood of successful pregnancies with an increased risk of hypertensive disorders of pregnancy. Our objective was to investigate outcomes of twin gestations in women age 45 or older.

METHODS:

Historical cohort of 97 women age 45 or older with twin gestations cared for by 2 referral centers between 2005-2016. Analysis included baseline demographic and clinical characteristics. Pregnancy outcomes included gestational age at delivery, hypertensive disease in pregnancy, gestational diabetes, and IUGR. Univariate analysis of association between patient characteristics and outcomes were performed using student t-test and chi square.

RESULTS:

Mean maternal age at delivery was 47.7 +/- 2.0 with 99% undergoing IVF and 95.9% using donor egg. Patients have low baseline rates of hypertension (6.2%), obesity (8.0%) and pre-gestational diabetes (1%). 40.2% of women developed preeclampsia, 45.8% developed IUGR, 14.5% developed gestational diabetes, and 13.4% had an indicated preterm birth prior to 34 weeks. On univariate analysis, No baseline risk factors were associated with the development of preeclampsia or IUGR. Women of white race had a decreased risk of indicated preterm birth < 34 weeks (8.2% vs. 29.2%, p=0.009) and a decreased risk of gestational diabetes (9.6% vs. 30.4%, p=0.014).

CONCLUSION:

Twin pregnancy in women age 45 or older is associated with high rates of hypertensive disease in pregnancy and IUGR but overall outcomes are reassuring. Twin pregnancy should not be discouraged in well-selected, healthy women age 45 or older simply due to age alone.
Over a Half Million Noninvasive Prenatal Tests: A Clinical Laboratory Experience [31R]
Authors: Khanna Adity , Almasri Eyad , Boomer Theresa , Wardrop Jenna , McCullough Ron , Cacheris Phillip
Published: May 2017

INTRODUCTION:

We describe the clinical laboratory experience with the MaterniT® 21 PLUS test, including autosomal/sex aneuploidies and select subchromosomal deletions.

METHODS:

Over 500,000 samples from pregnant patients were submitted for NIPT at our CLIA-certified, CAP-accredited, appropriately state-licensed clinical laboratories in Morrisville, NC and San Diego, CA using genome-wide sequencing. The test includes aneuploidies for chromosomes 13, 18, 21, X, Y and selected subchromosomal events. Statistical analysis of this large patient cohort was undertaken.

RESULTS:

The predominant indication for testing in this large cohort was advanced maternal age, followed by ultrasound findings and positive serum screening. Overall positivity rates were 1.25%, 0.40%, and 0.20% for trisomies of chromosomes 21, 18, and 13, respectively. More than 22,000 cases (∼4.2%) were multifetal pregnancies. In 2015 the average turnaround time was 5.4 calendar days, and the test had a total non-reportable rate, including quantity of DNA not sufficient and technical failures, of 1.75%. Estimated performance based on ad hoc clinical outcome showed that sensitivity and specificity met or exceeded the original clinical validation studies. Additionally, positive predictive values (PPV) of subchromosomal findings for all events ranged from 65.3% - 100%.

CONCLUSION:

MaterniT® 21 PLUS offers pregnant patients accurate and reliable information about fetal aneuploidy status. This laboratory developed test has demonstrated positivity rates for trisomy 21, 18 and 13 that mirror those found in large studies on populations that underwent invasive testing. The addition of subchromosomal events has been shown to perform well, with high PPVs. Operational performance met or exceeded performance from the original clinical validation studies.
Parent Concordance and Fathers' Persistence Through Pregnancy in a Prenatal Program Sample [32R]
Authors: Robinson Nuriya , Jackson Ashaki , Celaya Anna , Saleeby Erin
Published: May 2017

INTRODUCTION:

Single parent households are common and their impact is greatest in underserved communities where racial and ethnic minorities primarily reside. Paternal parental involvement has been shown to improve a child's behavioral, social and mental health, while their absence fuels school dropout, incarceration, violence and drug involvement. This study describes a father's intention for involvement in the pregnancy and the baby's life across different couple types.

METHODS:

Data was collected from interviews with pregnant women enrolling in MAMAs, a prenatal care program at a Los Angeles County Health facility, from December 2013 to August 2016. During the intake visit, demographic information was collected, including maternal and paternal race/ethnicity, relationship status, as well as the expressed or assumed paternal intentions for involvement during pregnancy and in the baby's life. A Chi-Square test examined father's intentions to persist through the pregnancy and the child's life among couples of the same (concordant) and different (discordant) racial and ethnic backgrounds.

RESULTS:

Of the 3259 women interviewed, 87.2% (n=2841) stated the father of the baby intended to be involved during and after the pregnancy. In pregnancies with discordant parents (16.4%), the fathers were less likely to want to be involved than in pregnancies with concordant parents (Chi-Square =10.15, P=0.001).

CONCLUSION:

Intentions for paternal involvement during and after pregnancy differ significantly based on parental race and ethnic concordance. Children with discordant parents are at higher risk for absent fathers. Pregnant women with discordant partners may benefit from increased social support during prenatal care and throughout the child's life.
Patient Attitudes Toward Exercise During Pregnancy [34R]
Authors: Lott Melisa , Schulkin Jay , Power Michael , Mackeen A. Dhanya
Published: May 2017

INTRODUCTION:

Maintaining a healthy lifestyle during pregnancy includes engaging in 30 minutes of moderate activity most days of the week. We sought to determine the attitudes of pregnant patients towards exercise and their access to counseling regarding safe exercise options.

METHODS:

From December 2015 to May 2016, women receiving prenatal care completed an anonymous survey that included questions about their exercise habits and their exposure to counseling regarding physical activity recommendations.

RESULTS:

One hundred eighty women completed the survey: 96.1% were Caucasian and 45.0% were obese. Most women (80.3%) planned to do low-impact cardiovascular exercise during pregnancy. The average number of days/week that patients exercised regularly during pregnancy were quantified: zero days (21.2%); 1-2 (47.5%); 3-4 (20.1%); 4-5 (6.1%) and 5+ (5.0%). Nineteen percent of patients reported they were not counseled regarding exercise in pregnancy; 32% of patients that did not exercise prior to pregnancy reported they did not receive counseling. Approximately 32% of patients who exercised and 12% of those who did not exercise pre-pregnancy expressed interest in meeting with a personal trainer for an exercise counseling session. Of women that expressed interest in a personal training session, 20% reported not receiving any exercise counseling.

CONCLUSION:

Twenty percent of pregnant women were not adequately counseled regarding exercise. Twelve percent of patients who did not exercise prior to pregnancy expressed interest in a personal training session. This illustrates a population of women that is interested in and would benefit from further efforts, encouragement and education regarding physical activity that may not otherwise exercise regularly.
The Shrek Test: A Proxy for the Smurf Test? [36Q]
Authors: Conger Jason , Olney Alexandra , Browne Paul , Street Linda M.
Published: May 2017

INTRODUCTION:

Preterm premature rupture of membranes (PPROM) is a significant contributor to preterm birth. Amnio-dye test is diagnostic. Indigo carmine is typically used but is currently unavailable. Indocyanine green has been safely used in neonatal invasive studies and may be a viable alternative.

METHODS:

Case report. 19 year old G1 presented at 26 3/7 weeks gestation with an amniotic fluid index (AFI) of 5.6 cm with report of minimal vaginal discharge. The fetus had normal anatomy and an estimated weight of 813 grams (33rd percentile). She was hydrated with no change in AFI, and evaluated for PPROM with speculum exam negative for fluid pooling, nitrazine reaction, and ferning. The patient was counseled, confirmed to have no iodide allergies and an amniocentesis was performed instilling dilute indocyanine green without complication. PPROM was confirmed with vaginal leaking of green fluid. Continuous electronic fetal monitoring following the procedure was reassuring.

RESULTS:

The patient and fetus remained stable until preterm labor ensued with delivery 23 days post-procedure. A viable male infant was born via spontaneous vaginal delivery at 30 3/7 weeks gestation with Apgar scores of 6 and 9 at 1 and 5 minutes respectively. Umbilical cord arterial blood gas was normal. The infant was admitted to the NICU due to prematurity and did require intubation. At submission, the infant is 4 days of age and requiring minimal ventilatory support with no additional complications.

CONCLUSION:

Indocyanine green may be an acceptable dye when diagnosis of PPROM is inconclusive via non-invasive testing.
Prevalence of Zika Virus Cases in the State of Texas [37Q]
Authors: Sullivan Adriana , Ramsey Patrick S. , Adesomo Adebayo , Cuvillier James , Ireland Kayla , Page-Ramsey Sarah
Published: May 2017

INTRODUCTION:

Zika virus is an emerging national health concern due to its potentially devastating effects on pregnancy. It is of particular concern in Texas because it shares a physical border with Mexico where Zika virus is endemic. Additionally, the Aedes mosquito vector capable of transmitting Zika virus can be found in Texas. Our objective was to determine the prevalence of Zika virus infection in Texas.

METHODS:

We accessed the Texas Department of State Health Services publicly available information on current Zika virus cases through the Texaszika.org website. The information was analyzed for trends and patterns in geographic location and mode of transmission.

RESULTS:

As of September 22nd 2016, one hundred and ninety-six cases of Zika virus have been identified in Texas. Two cases were transmitted via sexual transmission, but all remaining cases were acquired from travel to endemic countries. No locally acquired mosquito-borne cases have been identified. Cases are most prevalent in Harris county (fifty-five cases), Dallas county (thirty-five cases) and Tarrant county (twenty-one cases), all of which are in metropolitan areas with international airports. There are six cases in counties that share the physical border with Mexico. A significant association was found between Zika cases and factors including metropolitan counties (P < .0001), counties with an international airport (P < .0001) and increased birth rate (P < .0001).

CONCLUSION:

Zika virus is a concern in the state of Texas. Nearly all Zika cases have been acquired through travel to endemic countries. The largest number of cases appear to be associated with metropolitan areas containing international airports.
Mobile Phone-Based Perinatal Depression Screening: Feasibility and Acceptance [15R]
Authors: Silver Richard K. , Kim J. Jo , La Porte Laura , Zagorsky Benjamin , Desmarais Elyse , Gibbons Robert D.
Published: May 2017

INTRODUCTION:

Routine depression screening can identify the 10-20% of perinatal women affected by depression. The American College of Obstetricians and Gynecologists recommends screening as a standard of care. However, competing clinical care priorities and lack of standardized protocols have been cited as barriers to universal perinatal depression screening. Delivering outpatient screening via mobile health technology is a promising strategy introduced to bypass these barriers, but feasibility and acceptance must first be evaluated.

METHODS:

This prospective cohort study enrolled 160 pregnant and postpartum women. Participants received a text message prompt to complete the perinatal-calibrated version of the Computerized Adaptive Test-Mental Health™ (CAT-MH™) via a secure portal. Feasibility was defined as the ability to complete CAT-MH™ without technical difficulties. Acceptability was determined by direct survey patient via SMS.

RESULTS:

Overall, 67.5% (108/160) of participants completed the CAT-MH™ via mobile phone, with 57.5% of these completing at the first prompt and 5% of additional participants completing after each of the first and second reminder prompts. CAT-MH™ completion rates did not vary by race, ethnicity or marital status. However, privately-insured women were nearly twice as likely (OR=1.98, CI = 1.03-3.81) to complete the mobile CAT-MH™ as their publicly-insured counterparts. Of 67 women who completed both the mobile CAT-MH™ and the satisfaction survey, 72% described the experience as easy.

CONCLUSION:

Perinatal depression screening via mobile phone using the CAT-MH™ is both feasible and acceptable among perinatal women. To assess barriers to mobile screening prior to recommendation for routine clinical use, stakeholder interviewing, particularly among low-income women, is warranted.
A Review of Hormone-Based Therapies in the Treatment of Adult Acne: Safety and Efficacy [2A]
Authors: Trivedi Megha , Murase Jenny , Anderson Anna
Published: May 2017

INTRODUCTION:

Hormone-based therapies which include combined oral contraceptives and spironolactone have been considered effective alternatives to conventional therapies for adult onset acne which has a high rate of treatment failure. Our objective is to provide a concise and comprehensive overview of the types of hormone therapy available for acne treatment and comment on their efficacy and safety profiles for clinical practice.

METHODS:

A systematic search using the PubMed Database was conducted with the following search terms “contraceptives,” “hormone therapy,” “spirinolactone,” “flutamide,” and “acne treatment.” “Polycystic ovarian syndrome,” “endometriosis,” and “hidradenitis supparativa” were excluded. Filters included human studies published after Jan 1, 2000. 236 results were then manually filtered using a systematic approach to yield 39 relevant studies.

RESULTS:

It was found that OCP’s led to significant reductions in lesion counts across all lesion types compared to placebo. No consistent differences in efficacy between different combined OCPs were found. In terms of risk, OCP users had a three times increased odds of VTE versus non-users in a recent meta-analysis (95% CI 2.46-2.59). OCP’s conferred slightly higher risk of breast cancer but reduced risk of endometrial and ovarian cancer. Spironolactone was also shown to be an effective alternative with few side effects.

CONCLUSION:

Combined oral contraceptives and spironolactone as adjuvant and monotherapies are safe and effective in patients with adult-onset acne that is refractory to conventional treatments. However, appropriate clinical exam, screening, and individual risk assessment especially for VTE risk must be conducted in order to maximize benefits of therapy for each patient.
Abortion Stigma Resulting From State-Mandated Abortion Consent Language: A Randomized Controlled Trial [10A]
Authors: Sonalkar Sarita , Gurney Elizabeth P. , McAllister Arden , Schreiber Courtney
Published: May 2017

INTRODUCTION:

State-mandated abortion counseling requirements may direct women toward continuing a pregnancy. We sought to pilot-test our hypothesis that state-mandated abortion counseling requirements in Pennsylvania increase individual-level stigma.

METHODS:

Women presenting for abortion were randomized to complete the validated Individual Level Abortion Stigma (ILAS) scale either before (unexposed) or after (exposed) hearing the mandatory Pennsylvania Abortion Control Act (PACA) consent language via video. A sample size of 46 (23 per group) allowed us to detect a one standard deviation difference in mean ILAS score.

RESULTS:

From November 2015 to April 2016, 46 participants completed the study. All characteristics but one were balanced among the groups: the unexposed group had a greater proportion of low-income participants. The median ILAS score among all participants was 0.85 [IQR 0.6, 1.4]. Compared to the unexposed group, the exposed group experienced a significantly lower median ILAS score (0.75 [IQR 0.5, 1.05] versus 1.25 [IQR 0.7, 1.9], p=0.016). However, when controlling for participant income category in a multivariate analysis, the effect of the PACA consent language on stigma scores was no longer statistically significant (p=0.068).

CONCLUSION:

In this randomized trial, stigma scores were lower among women who heard the state-mandated abortion consent script when compared with stigma scores among women who had not yet heard the script, but this effect was confounded by participants’ income category. State-mandated consent processes intended to dissuade women from having abortions do not appear to increase perceived stigma; however, the effect of socioeconomic status on abortion stigma deserves further study.