bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of Trial of Labor After Cesarean Delivery With Adverse Outcomes Among Late Preterm Births [05P]
Authors: McLaren Rodney Anthony , London Viktoriya , Fisher Nelli , Minkoff Howard 
Published: April 2020

INTRODUCTION:
Delivery is recommended for PPROM at 34 weeks of gestation or greater, however guidance on the mode of delivery for women with one prior cesarean delivery (CD) at late preterm gestation is not clear. The objective of this study was to evaluate the association of induction in trial of labor after cesarean delivery (TOLAC) with adverse outcomes among late preterm births (LPB).

METHODS:
A retrospective cohort study of women with one prior CD who had a LPB. The study group was women who underwent TOLAC with induction and the control group was women who had a repeat CD without TOLAC. Data was extracted from the U.S. Natality Database from 2016 to 2017. Multivariate regression analysis was used.

RESULTS:
A total of 2,060 women had an induction and 42,167 had a repeat CD. The VBAC rate among inductions was 71.6%. Women undergoing an induction had risks of adverse maternal outcomes that were similar to those of women without TOLAC. However, the risks of neonatal respiratory problems were decreased among women undergoing TOLAC. Women who had failed induction and underwent CD had a higher risk of uterine rupture and receiving transfusion than women who had a repeat CD without TOLAC.

CONCLUSION:
Women at late preterm with one prior CD who undergo an induction have less respiratory problems and similar risks of adverse maternal outcomes compared to women who have a repeat CD. Patients at late preterm should be counseled about their options and the safety and risks of induction after one CD.
A Retrospective Study of Low-Risk Cesarean Delivery by Midwife Versus Obstetrician Service [02P]
Authors: Damiano Ella A , Auty Samantha , Gerjevic Kristen 
Published: April 2020

INTRODUCTION:
To evaluate the variation in low risk cesarean delivery rate between the midwife and obstetrician-led services at a rural tertiary care center.

METHODS:
A retrospective cohort study of 1787 term, singleton, and vertex (TSV) deliveries without a history of cesarean delivery at a rural academic tertiary care center was performed. The primary outcome was rate of cesarean delivery among midwife and obstetrician-led services. Statistical comparisons were performed using student t-tests, chi-square tests, and multivariable logistic regression.

RESULTS:
Between January 2015 and December 2017, 1787 deliveries were analyzed with 956 (53%) managed by the midwife service and 831 (47%) managed by the obstetrician-led service. Midwife patients had significantly lower odds of having a cesarean delivery after adjustment for all maternal and delivery characteristics (aOR 0.56, 95% CI 0.30–0.82). Other factors favoring cesarean delivery include older maternal age, higher body mass index at delivery, and nulliparity. Midwife patients had higher odds of presenting in spontaneous labor (63.0% vs 53.3%, P<.001), while obstetrician patients had increased odds of receiving neuraxial anesthesia (72.3% vs 56.1%, P<.001) and were more likely to be nulliparous (56.4% vs. 50.3%, P=.01). There were no differences in frequency of APGAR scores less than 7 at five minutes between the two groups (2.5% for obstetrician vs. 1.7% for midwife, P=.204).

CONCLUSION:
In this rural academic tertiary care center, patients cared for by the midwife service have significantly lower odds of cesarean delivery than patients cared for by the physician-led service after adjustment for patient demographics and maternal medical conditions.
Use of Hand Expression of Breastmilk Within First Hour of Delivery to Increase Exclusive Hospital Breastfeeding Rate [40O]
Authors: Crowe Susan Diana , Miller Hayley , Faulkner Bethan , Lee Henry C. 
Published: April 2020

INTRODUCTION:
Although most mothers in the United States initiate breastfeeding, formula supplementation during the hospital stay after delivery is common. Formula use may reflect a limited breastmilk supply. The impact of hand expression of breastmilk within 60 minutes of delivery as a means of improving breastfeeding outcomes in full term infants has not been studied.

METHODS:
Physicians and nurses were taught to instruct mothers on hand expression techniques during the first hour after delivery. Breastfeeding rates within the first hour of delivery and exclusive breastfeeding rates were determined via retrospective chart review of eligible patients admitted over a 7-month time frame. Patients were excluded if the infant was admitted to the neonatal intensive care unit. IRB waiver was obtained.

RESULTS:
Hand expression improved exclusive breastmilk feeding, even if there was no skin-to-skin care or breastfeeding within the first 60 minutes (53.3% vs 34.4%, P=.05). Hand expression resulted in significant improvements in actual breastfeeding within the first 60 minutes for both cesarean (90.1% vs 50.0%, P<.001) and vaginal deliveries (93.0% vs 68.5%, P<.001). Breastfeeding within 60 minutes of delivery was associated with a 62.2% rate of exclusive breastfeeding vs 46.3% (P<.0001) if first breastfeed took place after 60 minutes.

CONCLUSION:
Hand expression of breastmilk within the first hour of delivery was associated with increased rates of breastfeeding within that hour. Hand expression of breastmilk in the first hour was also associated with higher exclusive breastmilk feeding rates during the hospital stay. This practice could be a beneficial tool to improve breastfeeding outcomes.
Unmet Social Needs in the Prenatal Period: Effects on Birth Outcomes and Child Health [39O]
Authors: Sandoval Vida , Saleeby Erin , Jackson Ashaki , Smith Lynn , Schickedancz Adam 
Published: April 2020

INTRODUCTION:
The impact of prenatal social needs, including food insecurity, on both perinatal and child health is not fully understood. It is clear that childhood social needs negatively impact child developmental and health outcomes. This study examines the extent to which prenatal social needs are associated with adverse pregnancy and child health outcomes.

METHODS:
We conducted a retrospective chart review of 268 mother-child dyads receiving prenatal and pediatric care at a large public, academically affiliated safety net medical center. All mother-child dyads who completed any pediatric clinic social need screening between October 2018 and July 2019 were included in the study. IRB approval obtained from LA-Biomed.

RESULTS:
Mothers who experienced prenatal food insecurity had higher odds of experiencing various social needs in the pediatric setting (odds ratio [OR] 3.57; 95% confidence interval [CI] 1.52–8.35, P=.003). Mothers experiencing prenatal food insecurity had 4.45 higher odds of having a child that was born premature at fewer than 36 weeks gestation (95% CI 1.33–14.91, P=.016). Mothers who had prenatal food insecurity also had children with higher counts of inpatient visits (incidence rate ratio [IRR] 2.49, 95% CI 1.07–5.82, P=.035) and missed immunizations (IRR 1.25, 95% CI 0.15–2.35, P=.026) in the first 6 months of life.

CONCLUSION:
Prenatal social needs, especially food insecurity, were found to be associated with adverse perinatal and pediatric outcomes, including prematurity, inpatient hospitalizations, and missed vaccinations. Social needs in the prenatal period may offer opportunities to intervene and reduce their impact on both perinatal and child health as well as family well-being.
The Influence of an Academic Hospitalist Model on Neonatal Outcomes [36O]
Authors: Pineles Beth , Corey Joey , Cuartas Karen , Wagner Stephen 
Published: April 2020

INTRODUCTION:
Previous research has failed to demonstrate improved neonatal outcomes following implementation of a laborist model. Our goal was to examine if there was a difference in neonatal outcomes when labor and delivery was staffed with a private or academic hospitalist practice.

METHODS:
This retrospective cohort study was of a high volume community hospital labor and delivery unit. Institutional Review Board approval was obtained for this research. All deliveries by the laborist service over a six month period in 2018, three months by a private hospitalist group and three months by an academic hospitalist group, were examined. The primary outcome was a composite of neonatal morbidity that included: Apgar <3 at five minutes, shoulder dystocia, birth trauma, seizure, sepsis, necrotizing enterocolitis, intraventricular hemorrhage or mechanical ventilation Differences in outcomes were examined using chi-square tests. The results were presented as relative risk (RR) with 95% confidence interval (CI).

RESULTS:
245 patients were delivered by private physicians and 447 by academic physicians over the study period. There was no difference in a composite neonatal morbidity (9% vs 8%: 0.85 (0.49–1.46). NICU admissions were unchanged between the groups (8% vs 11%: 1.49 [0.85–2.62]). Transient tachypnea of the newborn (5% vs 7%: 1.30 [0.67–2.55]), hyperbilirubinemia (9% vs 14%: 1.52 [0.92–2.53]) and hypoglycemia (6% vs 10%: 1.68 [0.92–3.09]) were likewise similar.

CONCLUSION:
There was no difference in neonatal outcomes in patients delivered by private laborists or academic hospitalists.
Stillbirth and Fetal Autopsy Rates in the United States: Analysis of Fetal Death Certificates [35O]
Authors: Oliver Emily A , Rood Kara M. , Ma'ayeh Marwan , Berghella Vincenzo , Silver Robert R. 
Published: April 2020

INTRODUCTION:
Fetal autopsy is recommended by ACOG as an important part of the evaluation of stillbirth. Stillbirth Collaborative Research Network data show that it can yield a probable or possible cause of stillbirth in approximately 80% of cases and is singularly useful in 42%. Rates of perinatal autopsy approach 100% in countries with similar resources. Our aim was to identify national rates of fetal autopsy and maternal and fetal characteristics related to consent to autopsy.

METHODS:
This is a population-based retrospective cohort study using United States Fetal Death certificates of stillbirths (20 weeks or over) delivered between January 2014 and December 2016. Multiple gestations were excluded. Fetal autopsy rates were calculated by gestational age, maternal age, race, education, and having at least one living child.

RESULTS:
There were 60,328 stillbirths meeting inclusion criteria. Fetal autopsy was performed in 20.9%. Increasing gestational age positively correlated (r=0.55; P=.003), while increasing maternal age negatively correlated with autopsy (r=-0.66; P <.001). Hispanic women had the lowest rates (17.8%), compared to non-Hispanic black (22.9%) and non-Hispanic white (20.5%) women (P<.001). Higher levels of maternal education were associated with increased rates, women with a Doctorate degree had twice the fetal autopsy rate (32.0%) than women with an educational level of 8th grade (15.3%) (P<.001). Women with at least one living child had lower rates of fetal autopsy (P<.001).

CONCLUSION:
Fetal autopsy rates are quite low throughout the US. The reasons for low autopsy rates warrant further exploration in order to inform strategies to increase availability and uptake.
Severe Fetal Acidemia Was Poorly Predicted by the Three-Tiered Fetal Heart Rate Interpretation System [33O]
Authors: Brendel Katelyn , Gan Sarah , White Chase , Goldberg Jay 
Published: April 2020

INTRODUCTION:
The purpose of this study was to evaluate EFM during the hour prior to birth in babies born with an umbilical cord arterial pH <7 for predictors of severe acidemia.

METHODS:
A retrospective cohort study was performed on babies with umbilical cord arterial pH <7. The last hour of EFM was reviewed. Maternal, neonatal, labor and delivery characteristics were compared using the Chi-squared test for independence and the Fisher's Exact Test. IRB approval was obtained.

RESULTS:
30 babies were identified with umbilical cord arterial pH <7. 27%, 73%, and 0% of FHTs during the last hour of EFM of babies with severe acidemia were Category I, II, and III, respectively. 85% and 54% of the severely acidemic babies had moderate variability and accelerations, respectively. Only 8%, 8%, 19%, and 15% of severely acidemic babies had fetal tachycardia, fetal bradycardia, recurrent variable decelerations or recurrent late decelerations, respectively. Delivery was expedited only in the presence of recurrent late decelerations. The presence of a Category I tracing, moderate variability or accelerations was falsely reassuring such that delivery was less likely to be expedited.

CONCLUSION:
Usage of the three-tiered fetal heart rate interpretation system (Category I, II, and III) was not helpful in identifying babies born with umbilical arterial pH of <7. The majority of FHTs of these severely acidemic babies had moderate variability and accelerations, while less than 20% had fetal tachycardia, fetal bradycardia, recurrent variable decelerations or recurrent late decelerations.
Placental Abruption Is Not Associated With Clinically Significant Fetomaternal Hemorrhage [29O]
Authors: Boller Marie , Navarrete Emily , Hung Yun-Yi , Weintraub Miranda Ritterman , Moore Gaea S. , Schauer Galen M. 
Published: April 2020

INTRODUCTION:
Fetomaternal hemorrhage (FMH) and placental abruption may both result in adverse fetal and neonatal outcomes but have differing pathophysiology. Abruption reportedly can lead to small volume FMH, but a positive test for FMH does not indicate a diagnosis of abruption.

METHODS:
We performed a case-control study within Kaiser Northern California (2008–2017), first identifying all cases of FMH within this time period (defined as a positive flow cytometry for fetal hemoglobin and adverse fetal or neonatal outcomes related to hypovolemia). Cases of FMH were compared to matched controls from the same delivery cohort. We reviewed delivery records and placental pathology reports to identify whether placental abruption was clinically suspected.

RESULTS:
Our study included 56 women in the FMH group and 132 in the control group. Concern for placental abruption was noted in 10.6% of those without FMH and in 12.5% of those with FMH, with no significant difference between the two groups (P=.71). The adjusted odds ratio was 1.33 (95% CI .49–3.62) after adjusting for maternal age and maternal race/ethnicity.

CONCLUSION:
Placental abruption is not more likely to occur in clinically significant FMH compared to other deliveries for which placental pathology is obtained. Obstetric providers should consider FMH and abruption as separate clinical entities. Flow cytometry for fetal hemoglobin should be ordered in the setting of clinical suspicion for FMH, unexplained intrauterine fetal death, or adverse outcomes related to fetal or neonatal hypovolemia. The Kleihauer-Betke and flow cytometry tests for fetal hemoglobin do not confirm or refute the possibility of abruption.
Outcome Reporting in Studies on Perinatal Venous Thromboembolism: A Systematic Review [28O]
Authors: King Alexandria , D'Souza Rohan D. , Herman Dylan , Malinowski Ann K. 
Published: April 2020

INTRODUCTION:
The perinatal period places women at risk of developing venous thromboembolism (VTE). This systematic review aims to identify variation in outcome reporting in studies on the prevention and management of VTE in pregnant women, as a preliminary step towards developing a core outcome set to standardize outcome reporting in studies on perinatal VTE.

METHODS:
MEDLINE, EMBASE and www.clinicaltrials.gov were searched for clinical trials, registrations and observational studies with over 10 participants published between 1998 and 2018. Titles and full texts were screened in duplicate. Studies were classified as those focusing on VTE prevention vs. management. Reported outcomes were categorized under mortality, clinical, functional, resource use and adverse events based on a taxonomy of outcomes for medical research. Proportions of studies reporting each outcome were determined. Definitions and measurement tools were noted for each outcome.

RESULTS:
Of 7541 results screened, 69 studies (36 prevention+33 management) were included. Of the 165 outcomes, 25 were related to the fetus. Maternal outcomes mostly represented the clinical domain (96/152), with fewer adverse events (31), resource use (7), mortality (3) and functioning (3). There was very little consistency in how outcomes were defined or measured.

CONCLUSION:
Variation in outcome reporting and measurement in studies on perinatal VTE presents challenges for study comparison and meta-analysis. Outcomes related to fetal wellbeing, adverse events, resource use and functioning are inadequately represented. Qualitative interviews with patients and care providers to determine their perception on these outcomes is an important step in developing this core outcome set.
Obstetric Antecedents of Perinatal Clavicular Fracture [27O]
Authors: Denning Stacie , Clark Steven , Gandhi Manisha , Davidson Christina , Berra Alexandra 
Published: April 2020

INTRODUCTION:
Perinatal clavicular fractures generally heal without sequelae, however their discovery may carry an inference of improper obstetric care. We sought to examine risk factors associated with the largest contemporary U.S. series of perinatal clavicular fractures.

METHODS:
A retrospective cohort study including all newborns with clavicular fracture, identified by coding data, born at our teaching institution between March 2012 and July 2019. The records of newborns with clavicular fracture were linked to their respective maternal charts. Clinical factors of interest were extracted and analyzed. Chi-square analysis was utilized.

RESULTS:
During the study time period, 132 neonatal clavicular fractures occurred in 25,760 infants born vaginally (0.51%). There was no difference in the rate of clavicular fracture when analyzed by parity, maternal diabetes, gestational age, prior cesarean delivery or length of second stage labor. A statistically significant increase in fracture was seen in macrosomic (>4,000 g) vs. non-macrosomic infants (2.13% vs. 0.41%, P<.001), attempted or successful operative vs. spontaneous vaginal delivery (0.99% vs. 0.48%, P=.014) and shoulder dystocia (3.99% vs. 0.44%, P<.001).

CONCLUSION:
Important risk factors for clavicular fracture were identified. However, the overwhelming majority of perinatal clavicular fractures occur in non-macrosomic infants with uncomplicated spontaneous deliveries following a normal second stage of labor. This highlights important biologic variability in the tolerance of infants to contraction-driven passage through the maternal pelvis without sustaining injury.
Neonatal Outcomes and Frequency of Ultrasound in Pregnant Women With Prior Bariatric Surgery [26O]
Authors: Wlodarczyk Katarzyna , Harrison Rachel , Allen Katherine , Semons-Booker Kia , Braun Emilie , Cruz Meredith 
Published: April 2020

INTRODUCTION:
Infants of women who have undergone bariatric surgery are more likely to be born small for gestational age (SGA). We sought to identify whether increased ultrasound surveillance lead to better neonatal outcomes. We hypothesized that women with less than 2 ultrasounds (US) after their anatomical survey were more likely to have poor neonatal outcomes.

METHODS:
IRB approval was obtained. This was a single center, retrospective cohort study of 189 singleton pregnancies after bariatric surgery between 2005–2019. Patients were placed in 2 categories: those with less than 2 ultrasounds after fetal anatomic survey (FAS) or those with greater than or equal to 2 ultrasounds after FAS. US information and neonatal outcomes were compared between these two groups. A neonatal composite was utilized as a measure of adverse neonatal outcome.

RESULTS:
Of the 189 patients, 165 had documentation of FAS or beyond. 48 patients had less than 2 US and 117 had greater than or equal to 2 US. Women with less than 2 US had their last US at approximately 26.7 weeks (vs 36.5, P<.001), they were more likely to deliver at an earlier gestational age (36.6 vs. 38.2 weeks, P=.005), and had an increased likelihood of a composite adverse neonatal outcome (aOR 0.36, 95%CI 0.15–0.86) including NICU admission, jaundice, hypoglycemia, respiratory distress, and macrosomia, after controlling for confounders.

CONCLUSION:
Less frequent ultrasound surveillance in women with previous bariatric surgery is associated with earlier gestational age at delivery and higher rates of adverse neonatal outcomes.
Multidisciplinary OUD Group Prenatal Care Decreases NICU Admissions and Duration of Treatment for NAS [25O]
Authors: Cleary Erin , McKiever Monique , Gonzales-Brown Veronica , Hess Maryann , Talley Allison , Rood Kara M. 
Published: April 2020

INTRODUCTION:
To compare neonatal characteristics among neonates born to women with opioid use disorder (OUD) on buprenorphine/naloxone medication assisted therapy (MAT) receiving traditional prenatal care (TPNC) or multidisciplinary OUD group (MOG) prenatal care.

METHODS:
A retrospective cohort analysis was performed of dyads treated with OUD on MAT who received TPNC or MOG prenatal care. MOG prenatal care is a comprehensive approach comprising of prenatal care and group counselling, social work, psychiatry, psychotherapy, mindfulness-integrated cognitive behavior therapy, pregnancy and OUD educational topics (breastfeeding, postpartum blues/depression, contraception, hepatitis C and Narcan administration).

RESULTS:
From July 2017 to June 2019, we identified 177 mother-infant dyads; 102 received TPNC and 75 received MOG prenatal care. Continuous data were analyzed for normality using the Shapiro-Wilk test. Student's t-test or Mann-Whitney U test were also employed. Categorical data analyzed with chi-square. Neonates born to mothers receiving MOG prenatal care were significantly less likely to require NICU admission (25.3% vs 41.2%, P=.048). Among neonates requiring NAS treatment, those born to mothers in MOG care had a significantly reduced duration of treatment (6 days vs 9 days, P=.001). Neonates born to mothers receiving MOG care were less likely to be treated for NAS, had a lower peak NAS score, higher birthweight and were less likely to be born prematurely; although these differences did not achieve statistical significance.

CONCLUSION:
Neonates born to mothers receiving MOG care were less likely to require NICU admission and had a shorter duration of NAS treatment.
Identification of Newborns With Birth Weight of 4,500 Grams or More: The Impact of Obesity [16O]
Authors: Blackburn Bonnie , Bicocca Matthew , Le Tran , Zhang Caroline , Sibai Baha M. , Chauhan Suneet P. 
Published: April 2020

INTRODUCTION:
Obesity is a known risk factor for fetal macrosomia (birth weight [BW] greater than or equal to 4,500g), but prior studies examining its effect on sonographic estimated fetal weight (SEFW) have been equivocal. Our objective was to determine the impact of obesity on sonographic detection of macrosomia.

METHODS:
We performed a multicenter retrospective cohort study of all non-anomalous singletons with SEFW greater than or equal to 4,000g. All SEFWs were performed by Registered Diagnostic Medical Sonographers within 14 days of delivery and were calculated using a Hadlock equation. Patients were grouped according to body mass index (kg/m2) at delivery (<30.0 [non-obese], 30.0–39.9 [obese], and ≥ 40.0 [morbidly obese]). The primary outcome was the detection rate (DR) of macrosomic newborns. Secondary outcomes were false positive rate (FPR) and area under the receiver operator curve (AUC).

RESULTS:
Of the 330 women included, 83 (25.2%) were non-obese, 145 (43.9%) were obese, and 102 (30.9%) were morbidly obese. Overall there were 51 (15.5%) macrosomic newborns and its prevalence varied: 8.4% among non-obese, 14.5% among obese, and 22.5% among morbidly obese women. There were no significant differences in DR (42.9%, 52.4%, 60.9%; P=.67), FPR (7.9%, 9.7%, 10.1%; P=.87), or AUC (0.79, 0.77, 0.86; P=.51) for BW greater than or equal to 4,500 g between non-obese, obese, and morbidly obese women, respectively.

CONCLUSION:
Maternal obesity does not influence sonographic detection of newborns with BW of at least 4,500 g. Clinicians should not consider maternal obesity to be a limitation for identification of macrosomic newborns.