bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risks Associated With Arrest of Descent Cesarean Deliveries [28K]
Authors: Mokhtari Neggin , Kawakita Tetsuya , Haddad Andrew , Gold Stacey , Iqbal Sara Naeem 
Published: April 2020

INTRODUCTION:
Cesarean deliveries in laboring women are considered to have higher rates of complications compared to cesarean deliveries for other indications. We sought to evaluate if cesarean delivery for arrest of descent poses more maternal morbidity than other cesarean section indications.

METHODS:
We conducted a retrospective cohort study of women undergoing cesarean delivery from January 2016 to June 2018 at a single hospital. Chart review was performed to evaluate the primary indication for cesarean delivery. Maternal morbidity outcomes analyzed were blood transfusions, deep and superficial incisional surgical site infection (SSI) and postpartum endometritis. Multivariable logistic regression was performed to calculate adjusted odds ratios with 95% confidence intervals. IRB approval: STUDY00000045.

RESULTS:
A total of 2,957 women underwent a cesarean section, of which 165 (5.6%) had a cesarean section for arrest of descent. Women who had arrest of descent cesarean deliveries were more likely to experience SSI (8.5 vs. 2.9%, (aOR 4.48 [95% CI 2.41-8.31]) and postpartum endometritis (6.1% vs. 1.4%, (aOR 5.28 [95% CI 2.50-11.15]) compared to women who had cesarean deliveries due to other indications. There was not an increased risk of blood transfusion between the two groups (7.9% vs. 7. 6%, (aOR 1.34 [95% CI 0.74-2.43]).

CONCLUSION:
No statistical difference in blood transfusion was seen between the arrest of descent group and the control group. The rates of SSI and postpartum endometritis were higher in those with arrest of descent cesarean deliveries compared to other indications for cesarean delivery. Higher vigilance in the postpartum period for infection would be prudent in this population.
The First Prenatal Visit: An Opportunity for Improved Shared Decision-Making for New Prenatal Genetic Tests [31K]
Authors: Farrell Ruth M. , Collart Christina , Pierce Madelyn , Edmonds Brownsyne Tucker , Rose Susannah 
Published: April 2020

INTRODUCTION:
Discussions about prenatal genetic screening and diagnostic testing (PGT) in early pregnancy are challenging, given the complexity of available options and time constraints of the initial prenatal visit (PNV). We examined the impact of a point-of-care shared decision-making (SDM) tool on PGT discussions during PNVs.

METHODS:
We conducted a cluster randomized control trials to assess PGT discussions. We analyzed transcripts from 131 PNV audio recordings. Transcriptions were coded by two independent, blinded coders who measured SDM using the OPTION scale and completed a content checklist. Variables were compared using Chi-square and Fisher exact tests.

RESULTS:
Discussions placed greater emphasis on Trisomy (T) 21 (85.5%) than T18 (60.3%) and T13 (54.2%) and, when addressing diagnostic testing, greater emphasis on amniocentesis than CVS (53.4% vs. 24.4%). Only 21.4% of visits addressed the chance of a false positive, which providers were more likely to discuss with primiparas (P=.03). Providers with ≤10 years in practice were more likely to assess patients’ preferred approach to education (P=.026) and level of involvement in decision making (P=.011). Statistically significant higher OPTION scores were noted among NEST users compared to control for 3 of the 12 SDM items. NEST users were more likely to discuss advantages of all screening options compared to control (P=.025).

CONCLUSION:
Data from this study demonstrates existing challenges in addressing the decision-making needs of pregnant patients engaging with prenatal genomic-based tests. Future educational efforts should focus not just on PGT implementation, but also on efforts to enhance SDM by educating healthcare providers.
Threatened Preterm Labor Admissions: A Population Based Study to Assess Trends and Financial Effect [35K]
Authors: Lavie Anat , Czuzoj-Shulman Nicholas , Spence Andrea , Abenhaim Haim Arie 
Published: April 2020

INTRODUCTION:
Threatened preterm labor (TPTL) is a common hospitalization indication among pregnant women, often for unnecessarily prolonged periods of time. The accurate identification of women not actually in preterm labor avoids unnecessary and costly interventions. The purpose of our study is to describe admissions for TPTL and assess their financial burden.

METHODS:
We carried out a cohort study on all pregnancy admissions using the United States’ Healthcare Cost and Utilization Project-Nationwide Inpatient Sample database between 1999-2015. We identified all TPTL admissions and a comparison was done between length of hospital admission for patients who delivered during that same admission ("Delivery" group) versus those who were discharged without delivering ("Observation" group).

RESULTS:
There were a total of 15,337,934 pregnancy admissions during our study period, of which 1,307,934 were for TPTL. The rate of total TPTL admissions decreased over the 16-year period, with a mutual increase in rate of "delivery" and decrease in rate of "observation" admissions over time. Of the total TPTL admissions, 70.5% and 29.5% were in the "delivery" and "observation" groups, respectively. Within 48 hours of admission, 82% of the "delivery" group delivered, whereas 60.8% of the "observation" group were discharged. Of the remaining total- 52.2% delivered eventually, with more than half of them after more than 6 days of admission. In subset analyses, total cost for the "observation" admissions group was 4,059,004,590$ with mean cost of 10,782$ per patient per admission.

CONCLUSION:
Despite improvement in rate of total TPTL admissions throughout the years, and more specifically decline in rates of unnecessary admissions, given their high cost, consideration should be taken for discharging more patients no later than 48 hours, after which our clinical ability to discriminate those who will deliver is sparse.
Type 2B Von Willebrand Disease in Pregnancy: A Systematic Literature Review [36K]
Authors: Pierce-Williams Rebecca , Karl Taylor , Delgado Natalie , Lackritz Katherine , Al-Kouatly Huda B. 
Published: April 2020

INTRODUCTION:
Type 2B Von Willebrand Disease (VWD) is a rare hereditary bleeding disorder that is associated with thrombocytopenia. Our objective was to review obstetric complications in women with Type 2B VWD.

METHODS:
A systematic literature search was conducted using PubMed, Scopus, and Cochrane Central Register of Controlled Trials to include all publications that address Type 2B VWD in pregnancy. Our primary and secondary outcomes were incidence of postpartum hemorrhage (PPH) and incidence of thrombocytopenia in pregnancy, respectively.

RESULTS:
20 studies met inclusion criteria. There were 32 pregnancies with Type 2B VWD in 27 women. Primary PPH was reported in 9/20 (45%) and secondary PPH was reported in 6/13 (46%) and occurred between 5-32 days. Factor concentrate treatment was administered before delivery and postpartum in 16 and 18 pregnancies, respectively. 17 pregnancies required blood products postpartum. Platelet transfusion was given in 13/17 (76%) pregnancies. Red blood cell transfusion was performed in 6/17 (35%) pregnancies. Thrombocytopenia in pregnancy was reported in 27/28 (96%). 23/27 (85%) were severe thrombocytopenia with mean platelet count of 33.7±22.7 × 103/ul and 4/27 (15%) were mild thrombocytopenia (range, 126-150 × 103/ul). No maternal mortality was reported.

CONCLUSION:
Type 2B VWD in pregnancy has significant morbidity, with high incidence of primary and secondary PPH. The majority of patients required the use of factor concentrate before and after delivery in addition to postpartum blood products. The incidence of severe thrombocytopenia was also high, indicating that Type 2B VWD should be considered in the differential diagnosis of severe thrombocytopenia in pregnancy.
Use of a Kinyarwanda-Based Edinburgh Postpartum Depression Screen in a Maternity Ward of a Major Referral Hospital [37K]
Authors: Mushi Juliet , Uwayo Francine , Irakoze Magnifique , Nathan Lisa , Rulisa Stephen 
Published: April 2020

INTRODUCTION:
Maternal mental health has often been relegated to the margins of global women's health discourse despite mounting evidence of the disproportionate burden of common mental health problems among pregnant women in low-and middle-income countries. The Edinburgh Postnatal Depression Scale (EPDS) is a validated tool used to screen for perinatal depression. We developed a version of this screening tool in Kinyarwanda and administered it to 105 women receiving prenatal and postnatal care at the University Teaching Hospital of Kigali (CHUK).

METHODS:
IRB approval was obtained for this prospective study was obtained at Albert Einstein College of Medicine and CHUK from 2016 to 2017. An English version of the EPDS tool was translated to Kinyarwanda and administered to 105 women who consented to participate in this survey project. Descriptive and comparative analysis was performed using STATA 16.

RESULTS:
The majority of women completing our survey were young, multiparous, with at least a primary school education (59%). Most of the women completed the EPDS while postpartum and 85% had an EPDS score less than 10. Higher levels of educational attainment were significantly associated with an EPDS score less than 10 (P<.05). 55% of women surveyed felt that postpartum depression is an issue affecting their communities, with over 60% of women agreeing that stigma prevents pregnant women from seeking help for mental wellness.

CONCLUSION:
We identified level of educational attainment as a factor associated with a low EPDS score among women admitted at a maternity ward in a large referral hospital in Rwanda.
Characteristics of Women Diagnosed With Preeclampsia With Severe Features Based on Hypertension Alone [05L]
Authors: Romagano Matthew P. , Flint Matthew , Sachdev Devika , Apuzzio Joseph , Williams Shauna F. , Gittens-Williams Lisa 
Published: April 2020

INTRODUCTION:
The objective of this study was to compare pregnancy and postpartum characteristics amongst women diagnosed with preeclampsia with severe features (PE-SF) based on hypertension alone versus those with additional criteria for PE-SF.

METHODS:
This is an IRB-approved retrospective cohort study of women with a diagnosis of PE-SF, identified by hospital discharge records over a 1-year period. Electronic medical records were reviewed. Women diagnosed with PE-SF based on severe hypertension alone (HTN-A) in the absence of other criteria for preeclampsia were compared to those with PE-SF that had additional criteria for preeclampsia (e.g. proteinuria or clinical/laboratory signs or symptoms).

RESULTS:
105 women had PE-SF or chronic hypertension with superimposed PE-SF over the study period. 22 (21%) of these women were diagnosed based on HTN-A. Maternal demographics, intrapartum/postpartum characteristics, laboratory values, delivery outcomes, and postpartum follow-up rates were similar. Those diagnosed with PE-SF based on HTN-A had a lower mean protein-to-creatinine ratio (0.2 vs 1.5, P=.003). For women who attended a 1-week postpartum blood pressure check, the rate of those with severe hypertension were similar between the HTN-A and other criteria groups (2/12 vs 3/49, P=.233) but the HTN-A group was more likely to have severe hypertension at the 3-4 week postpartum visit (4/13, 31% vs 2/57, 3.5%, P=.009).

CONCLUSION:
Women who receive a diagnosis of PE-SF based on severe hypertension alone in the absence of other abnormal findings still have a significant rate of persistent hypertension postpartum. These women should be followed and managed for persistent hypertensive disease in the postpartum period and beyond.
Contraindications to Magnesium Sulfate and Alternative Seizure Prophylaxis for Severe Preeclampsia [09L]
Authors: Prasannan Lakha , Blitz Matthew J. , Rochelson Burton L. , Gerber Rachel P. 
Published: April 2020

INTRODUCTION:
Intravenous magnesium sulfate is considered first-line seizure prophylaxis for preeclampsia, reducing the risk of eclampsia by half. Absolute or relative contraindications to this medication include myasthenia gravis, severe renal failure, cardiac ischemia, heart block and pulmonary edema. Levetiracetam, an alternative antiepileptic drug considered safe in pregnancy, has been suggested in such cases though its efficacy remains uncertain. Our objective was to determine how frequently alternative anticonvulsant medications are administered for seizure prophylaxis in severe preeclampsia and to identify the documented indications in such cases.

METHODS:
IRB approved, retrospective cohort study of women with a diagnosis of preeclampsia at 34 weeks of gestation or greater who received seizure prophylaxis at a tertiary university hospital from 2014-2017. Demographics, clinical characteristics and contraindications to magnesium sulfate, if present, were evaluated. Patients were excluded if they had a pre-existing seizure disorders or incomplete medical records.

RESULTS:
A total of 1,370 patients were included; 3.2% (n=44) received levetiracetam for seizure prophylaxis. Most of the levetiracetam group (79.5%) initially received magnesium. The most commonly documented contraindication was pulmonary edema (n=14) which was confirmed by imaging (either ultrasound or chest x-ray) in less than half of cases; other reasons included changes in laboratory data (n=11; increasing serum creatinine, serum magnesium >7 mg/dL), development of additional signs/symptoms (n=11; hypotension, headache, vision changes, decreased urine output) and patient refusal (n=3). Five cases did not document any contraindication.

CONCLUSION:
The use of alternative anticonvulsant medications in preeclampsia, which may be less efficacious, must be reserved for true contraindications to magnesium sulfate.
Early Bird or Night Owl? Investigating the Relationship Between Chronotype and Pregnancy Complications [11L]
Authors: Punjala-Patel Advaita , Rowe Dorothea , Singleton Miller , Street Linda 
Published: April 2020

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CONCLUSION:
An MHR in the fetal range is common in labor especially in the second stage. The potential for confusion is very significant and this can lead to poor outcomes if an abnormal FHR is misidentified as MHR in the apparently normal range.