bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changing Transfusion Practice in Obstetrics and Gynecology: The Effect of Hospital-Wide Education [08M]
Authors: Thiel Peter , Lett Christine , Mah Alicia 
Published: April 2020

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CONCLUSION:
Sleep deprivation, falling asleep while driving, and napping are associated with various adverse obstetric outcomes and composite obstetric outcomes. Further research into the effects of sleep deprivation during pregnancy is warranted.
Postpartum Hemorrhage and Very Advanced Maternal Age [28M]
Authors: Freeman H. Austinn , Salmeen Kirsten , Shirazi Aida , Morocco Sarah 
Published: April 2020

INTRODUCTION:
Postpartum hemorrhage (PPH) is an important cause of maternal morbidity. Identifying women at increased risk for PPH can help reduce morbidity. The aim of this study was to determine if women over 45 years (very advanced maternal age, VAMA) are at increased risk for PPH.

METHODS:
Retrospective study of term, nulliparous women with singleton fetuses in vertex presentation who delivered at Kaiser Permanente Northern California Hospitals from 2010-2017 with complete data recorded. Incidence of PPH (estimated blood loss >500 cc for vaginal delivery, >1,000 cc for cesarean delivery, or other definitive chart evidence) among women over 45 years was compared to incidence of PPH among younger women. Logistic regression was used to adjust for confounders.

RESULTS:
There were 98,922 women included, including 177 women over 45 years. PPH occurred in 33.3% of women >45 years as compared to 15.6% of women 45 years had significantly increased odds of PPH as compared to women <35 years (OR 1.88, 95% CI 1.35–2.61).

CONCLUSION:
These data demonstrate that VAMA is an independent risk factor for PPH. This knowledge provides physicians with an opportunity to counsel patients over 45 years regarding the risk for PPH and to prepare for delivery with strategies including optimization of blood count, planning for delivery location and procurement of appropriate blood products before delivery.
Readmission Risk Factors for New-Onset Postpartum Hypertension: A Retrospective Case-Control Study [30M]
Authors: Burns Ralph N. , Has Phinnara , Werner Erika 
Published: April 2020

INTRODUCTION:
Few studies have characterized new-onset postpartum hypertensive disorders of pregnancy (HDP). We sought to identify features associated with newly diagnosed HDP requiring postpartum readmission.

METHODS:
This was an IRB-approved retrospective, single-center, case-control study of women aged 18 years or older, who were discharged after delivery without a diagnosis of HDP, between January 2013 and September 2018. Cases were women readmitted within 42 days of delivery with a new diagnosis of HDP. Non-readmitted controls were matched to cases based on mode of delivery and gestational age at delivery. We hypothesized an increased odds of readmission would be associated with a blood pressure elevation greater than or equal to 130 mmHg systolic or 80 mmHg diastolic in the 24 hours before initial hospital discharge. We targeted a sample of 100 cases, with a 2:1 control-to-case ratio, to identify an odds ratio of 2.0 with 80% statistical power.

RESULTS:
Ninety-one cases of new-onset HDP were identified and matched to 182 controls. Significant differences between cases and controls were older age (33.3 vs 29.4 years, P<.01), black race (26% vs 10%, P<.01), and adherence to IOM weight gain guidelines (27% vs 13%, P<.01), respectively. Amongst cases, 66% had a blood pressure greater than or equal to 130/80 in the 24 hours before discharge, compared to 29% of controls. This difference remained significant after adjusting for potential confounders (aOR 4.31; 95% CI 2.46–7.57).

CONCLUSION:
Among postpartum women without HDP, “subclinical” blood pressure elevations may help identify women at risk of postpartum readmission.
Reducing Postpartum Readmissions Utilizing Different Blood Pressure Interpretation Strategies [31M]
Authors: Mukhtarova Narmin , Chen Yu-Hsin , Alagoz Oguzhan , Hoppe Kara Kjersten 
Published: April 2020

INTRODUCTION:
American College of Obstetricians and Gynecologists (ACOG) recommends blood pressure (BP) greater than 150/100 mmHg, on two occasions at least 4-6 hours apart for initiation of postpartum anti-hypertensive treatment whereas the utility and validity of this strategy for predicting readmission is unknown. This study aimed to determine the impact of different BP interpretation strategies and cutoffs on predicting readmission.

METHODS:
A retrospective cohort of 24,917 women who delivered at a single Midwestern academic center between 1/2009 and 6/2015. BP values measured between delivery and 72 hours postpartum were used to evaluate three different BP interpretation strategies: 1) average BP, 2) maximum BP exceeding the BP cutoff on one occasion, and 3) maximum BP exceeding the BP cutoff on two occasions at least 4 hours apart. Receiver operating characteristic curves (ROC) and the area under the curve (AUC) were used to measure the predictive performance of these strategies. The UnityPoint Health-Meriter IRB approved this study.

RESULTS:
ACOG’s recommended cutoff of 150/100 mmHg had 38% sensitivity and 95% specificity whereas the same strategy with cutoff of 140/90 mmHg demonstrated 71% sensitivity and 84% specificity. The AUC for the three strategies: AUC 0.81; 95% CI 76.95-85.08 (Strategy 1); AUC 0.79; 95% CI 74.7-82.81 (Strategy 2); AUC 0.83; 95% CI 79.83-87.24 (Strategy 3). The difference between the AUC of Strategy 2 and 3 was significant (P<.0001).

CONCLUSION:
The strategy of using maximum BP exceeding the cutoff on two occasions at least 4 hours apart at lower cutoff can predict readmissions with higher sensitivity and/or specificity.
Stricter Hypertension Guidelines: Should We Be More Concerned Postpartum? [37M]
Authors: Weeks Corinne M. , Leung Katherine , Leftwich Heidi K. 
Published: April 2020

INTRODUCTION:
Studies have shown women with hypertensive disorders of pregnancy have increased risk of hypertension and cardiovascular disease later in life. In 2017, the American College of Cardiology (ACC)/American Heart Association (AHA) developed new hypertension guidelines defining Stage I hypertension as a blood pressure greater than or equal to 130/80. We sought to identify characteristics associated with Stage I hypertension in the 3-24 months postpartum period.

METHODS:
A retrospective, IRB approved cohort study on postpartum hypertension from deliveries from 07/09-07/16. Inclusion criteria were delivery at our institution, presence of a hypertensive disorder of pregnancy, and a documented blood pressure between 3-24 months postpartum. Exclusion criteria were chronic hypertension and discharge home on antihypertensive medication. Postpartum hypertension was defined by the 2017 ACC/AHA definition. Chi-square test was used for categorical variables. Student T-test was used for continuous variables.

RESULTS:
444 women met inclusion and exclusion criteria. Of these women, 349 (79%) were identified as having hypertension 3-24 months postpartum. Women with persistent hypertension were more likely to receive antepartum antihypertensive therapy (P=.04), be older (P=.022), have a higher pre-pregnancy BMI (P=.002), and be multiparous (P=.017). There were no differences amongst other study variables.

CONCLUSION:
Approximately 79% of women in our cohort remained hypertensive. Women that were persistently hypertensive were more likely to be older, have a higher pre-pregnancy BMI, be multiparous, and be treated antepartum with an antihypertensive agent. This large incidence of postpartum hypertension as well as identifying characteristics warrants further study, as identifying these women early may improve follow up and long-term outcomes.
The Utility of Shock Index in Identifying Patients Requiring Blood Transfusions Postpartum [39M]
Authors: Shanahan Lisa K.T. , Sidle Meg Wright , Wajid Naji , Mover Kelly , Vullo John , Gurram Padmalatha 
Published: April 2020

INTRODUCTION:
Early intervention for treating postpartum hemorrhage is often delayed due to compensatory mechanisms. Shock index ({SI} heart rate/systolic blood pressure) is used to predict the effects of hemorrhage in non-pregnant patients. SI>1 (normal=0.5-0.7), indicates shock requiring intervention. The objective is to establish SI threshold for patients requiring blood transfusion (BT) within 24 hours of delivery and to determine the earliest time to identify SI changes.

METHODS:
A retrospective study of patients delivered after 37 weeks between 2014 and 2019. Patients that received BT (Group 1) were compared to patients that did not (Group 2). SI at time of admission and every 4 hours for 24 hours was analyzed. SI and delta SI (change in SI between consecutive time periods) was compared between groups. IRB approval obtained.

RESULTS:
50 patients in Group 1 and 55 in Group 2 were included. Baseline characteristics were similar (P>.05). SI range for Group 1 with vaginal deliveries (VD) is .82-.87 (95% CI), and 0.75 -.80 for Group 2 regardless of time period. SI range for cesarean (CD) is .83-.87 for Group 1 and 0.76-0.80 for Group 2. Delta SI is significant between 8 to 12 hours in VD (P=.02) and 1 to 4 hours postpartum in CD (P=.01) in Group 1.

CONCLUSION:
Patients with SI>0.83 should be further assessed for interventions such as BT and changes can be detected as early as 4 hours for CD and 8 hours for VD. SI can be a valuable tool in early diagnosis of PPH.