bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inter-delivery Time Interval and the Likelihood of Successful Vaginal Birth After Cesarean Delivery [21P]
Authors: Gulersen Moti , Grunebaum Amos , Bornstein Eran , Chervenak Frank 
Published: April 2020

INTRODUCTION:
The most commonly utilized prediction models to assist in the prediction of vaginal birth after cesarean delivery (VBAC) have not included inter-delivery time interval as a contributing variable. Therefore, we sought to determine the association of inter-delivery time interval and rate of successful VBAC.

METHODS:
This retrospective cohort study utilized the United States Natality Live Births database from the Center for Disease Control and Prevention for the years 2016–2017. Singleton patients at term with their second pregnancy and live birth undergoing a trial of labor after one prior cesarean delivery (TOLAC) were eligible for inclusion. The inter-delivery time interval, defined as the time elapsed between live births, was divided into 7 groups by months: 12–17, 18–23, 24–35, 36–47, 48–59, 60–71, 72 and beyond. Pearson's Chi-Squared test was used to compare rates of successful VBAC across the different inter-delivery time interval groups. Statistical significance was determined as P<.05.

RESULTS:
Of the 60,526 women who underwent TOLAC, 39,948 (66%) had a VBAC. The highest rate of VBAC success was seen with an inter-delivery time interval of 24 to 35 months (12,368/17,760; 69.6%). The differences in rates of VBAC between the different time intervals were statistically significant (P<.0001).

CONCLUSION:
Overall, the rate of successful VBAC in the United States among cases from 2016–2017 was 66%. Our data indicate that the rate of successful VBAC is affected by the inter-delivery time interval, with the optimal time for VBAC being 24–35 months after cesarean delivery. The clinical implication of this statistical finding requires further study.
Induction of Labor at 39 Weeks and the Risk of Perinatal Death [19P]
Authors: Diaz Maria , Rossi Jordan , Burn Sabrina , Contag Stephen , Yao Ruofan 
Published: April 2020

INTRODUCTION:
To investigate the risk of perinatal death associated with induction of labor (IOL) at 39 weeks versus expectant management (EM).

METHODS:
This was a retrospective cohort analysis of singleton non-anomalous liveborn pregnancies in the United States between January 2015 and December 2017. Data was abstracted from the CDC National Center for Health Statistics from the Division of Vital Statistics. Analyses compared IOL at 39 weeks of gestation to EM with delivery between 40 and 42 weeks of gestation. Year over year rates of IOL and perinatal death were calculated and tested for trend over time. The risk of perinatal death associated with IOL compared to EM was estimated using logistic-binomial regression analysis, adjusting for potential confounders.

RESULTS:
There were 1,987,757 pregnancies included for analysis. 499,290 (25.1%) pregnancies were induced at 39 weeks. The year over year risk of IOL was 1.04 (95% CI 1.03–1.04). Conversely, the year over year risk of perinatal death was 0.96 (95% CI 0.94–0.99). There was a year over year decrease in risk of neonatal death, aRR: 0.91 (95% CI 0.85–0.96). In the IOL group there were 184 (0.04%) perinatal deaths compared to 2,421 (0.16%) in the EM group, (P<.001; aRR: 0.22, 95% CI 0.19–0.26).

CONCLUSION:
There was a year over year increase in IOL. Additionally, there was a year over year decrease in perinatal death, primarily due to a decrease in neonatal deaths. IOL at 39 weeks was associated with a decreased risk of perinatal death compared EM.
Efficacy of an Alternative Oxytocin Dosing Regimen for Postpartum Hemorrhage Prevention at Cesarean Delivery [13P]
Authors: Chouinard Sujata , Bronner Baillie , Mulekar Madhuri , Andrews Nicholas L. , Rivera Gabrielle 
Published: April 2020

INTRODUCTION:
In 2013, the University of New Mexico Hospital transitioned from a 20IU oxytocin infusion to a “rule of threes” algorithm (3 IU of oxytocin titrated to uterine tone) for prevention of postpartum hemorrhage (PPH) at time of cesarean delivery. This study seeks to identify whether PPH rates have been affected by this change in oxytocin dosing.

METHODS:
This is a retrospective cohort study comparing PPH rates before and after an institutional shift in oxytocin administration at the time of cesarean delivery. IRB exemption was obtained for this study. Medical records were reviewed for scheduled and unscheduled cesarean section patients before and after the protocol change. 225 patients in each group were randomly selected for the analysis. Our primary outcome was the rate of PPH, determined by estimated blood loss reported by the surgeon. Secondary outcomes included administration of additional uterotonic agents, transfusion, hysterectomy, vasopressor administration, and mortality.

RESULTS:
There were no significant differences in age, gravidity, parity, prior number of cesarean sections, gestational age, BMI, fetal weight, or induction of labor. Women who received the 20IU oxytocin infusion had a significantly lower rate of PPH (22.2%) compared to “rule of threes” dosing (32.4%, Fishers test P=.0198).

CONCLUSION:
Our data show an increased rate of PPH with a rule of threes oxytocin dosing at the time of cesarean section compared with infusion dosing of oxytocin. These data indicate that rule of threes dosing may not be applicable to a wider patient population.
Correlation of Morbidly Adherent Placentas and Location of Hysterotomy in Cesarean Sections [10P]
Authors: Fox Courtney , Varlamov Anna , Lance Teresa , Feustel Paul 
Published: April 2020

INTRODUCTION:
We evaluated the incidence of classical c-sections associated with morbidly adherent placenta (MAP). Better medical counsel can be provided if there was an association of classical c-section and MAP. We compared other clinical risk factors and outcomes; number of previous c-sections, uterine surgery (D and C), medical co-morbidities (smoking, hypertension, diabetes, advanced age) and other findings encountered.

METHODS:
This study was a case control during 1/1/2014 to 9/15/2018 to review patients' history of hysterotomy location during previous uterine surgery. Case definition and control group were women with MAP and women without MAP with a prior c-section in a 1:4 ratio. Fifty cases and 198 controls reviewed.

RESULTS:
The percent of patients who had MAP had a higher incidence of uterine surgery (32%). The odds of classical c-section with MAP compared to low-transverse with MAP was less than 1 (OR 0.8077, 95% CI 0.28–2.31) and was not statistically significant. We found each increase in prior c-sections by 1, odds of MAP increased by a factor of 2.18 (95% CI 1.59–2.99). D and C increased odds of having MAP (OR 4.05, 95% CI 1.88–8.69). Hypertension appeared to be a protective factor for MAP (OR 0.23, 95% CI 0.07–0.76). Other medical co-morbidities had no correlation.

CONCLUSION:
Findings concluded that there is no statistical significance in the location of hysterotomy and MAP. There is a greater incidence of MAP associated with prior uterine surgery. We can counsel our patients to promote vaginal delivery to decrease uterine surgery and the odds of having a morbidly adherent placenta.
Comparison of Delivery Outcomes in Early Versus Late Amniotomy During Induction of Labor [09P]
Authors: Irvey Teinesha M. , Prieto Jose 
Published: April 2020

INTRODUCTION:
Despite the growing incidence of induction of labor, controversy continues to exist regarding optimal timing of membrane rupture during the induction process. We aim to determine whether early vs late amniotomy contributes to differences in delivery outcomes.

METHODS:
We performed a retrospective cohort study comparing early vs. late amniotomy delivery outcomes in nulliparous, term, singleton, vertex gestations undergoing induction of labor. We defined early amniotomy as rupture of membranes at less than 5 centimeters dilation, and late amniotomy at 5 or more centimeters cervical dilation.

RESULTS:
We reviewed 2,776 charts, 323 were analyzed. Early amniotomy was performed in 228 (70.6%) of patients vs late amniotomy in 95 (29.4%). We found no statistically significant difference in rate of vaginal, operative or cesarean delivery, nor induction method, maternal age, gestational age, maternal comorbidities or neonatal characteristics between groups. The late group had statistically more Caucasian women (P=.008) while the early group had more Hispanic women (P=.038). Lack of descent as an indication for cesarean delivery was higher in patients with late amniotomy (P=.008). Late amniotomy was strongly associated with shorter amniotomy to delivery time, without increasing hospital stay (P=.0001). 71.3% of all patients in the late group were delivered within 6 hours of rupture compared to 32% in the early group (P=.0001).

CONCLUSION:
In our study population, late amniotomy was associated with a statistically significant increase rate of delivery within 6 hours after amniotomy without an increase in the hospital stay. Contrary to many published reports, early amniotomy did not offer any benefit.
Characterizing Relationships Between Prenatal Care and TOLAC Outcomes in an Urban Population [07P]
Authors: Keerthy Madhurima , Smith Jeffery A. 
Published: April 2020

INTRODUCTION:
Several studies have been published on factors predicting success rates of Trial of Labor after Cesarean section (TOLAC). Limited data exists on the relationship between prenatal care provider type and sufficiency of prenatal care. The purpose of this study is to evaluate the relationship between prenatal care provider and TOLAC outcomes.

METHODS:
Retrospective comparative analysis was performed on 289 charts. IRB approval was obtained. Criteria included patients delivered between 2013–16 with Singleton gestation, vertex presentation and at least 1 prior cesarean section attempting TOLAC at our institution. Exclusion criteria included multiple gestations, still birth and contraindications to vaginal delivery. ANOVA tests were used for the continuous variables and Chi-square test or Fisher's exact test were used for categorical variables. P-value <.05 considered for statistical significance.

RESULTS:
A total of 289 charts were reviewed. 176 patients achieved Vaginal Birth After Cesarean section (VBAC). Patients who received prenatal care from Physicians had higher VBAC rates when compared to patients who received care from CNMs at our institution (P<.0002). No statistically significance between TOLAC success and sufficiency of prenatal care was noted. There were no statistical differences between the two groups regarding Age, BMI, Race, Co-morbidities, IUGR, Calculated success scores.

CONCLUSION:
This study sheds light on relationship between providers, type of prenatal care and VBAC rates, a rarely explored area in TOLAC research. The results are from a single institution that functions as a staff model. Larger multi institutional prospective trials are necessary to prove or disprove results.
The Patient's Perspective and Patient Satisfaction in Labor and Delivery [35N]
Authors: Day Marilyn , Varghese Elizabeth , Valdes Hannah , Garry David , Garretto Diana 
Published: April 2020

INTRODUCTION:
Clinical and subjective factors affect the patient's perception of labor and delivery, but little is known about how much each factor contributes to patient satisfaction. This study evaluates the correlation between clinical and subjective patient parameters during the intrapartum course and patient satisfaction.

METHODS:
This is a cross-sectional observational study. Participants completed surveys in the immediate postpartum period. Surveys assessed the patient's perception of intrapartum events and patient satisfaction. Survey responses were compared to patient charts. Logistic regressions determined predictors of patient satisfaction.

RESULTS:
332 women completed surveys. Positive subjective factors which predicted patient satisfaction included feeling the provider explained the intrapartum course well (OR 3.47, 95% CI 1.17–10.31, P=.025), patient input into managing labor (OR 2.96, 95% CI 1.46–5.98, P=.002), and increased support during labor (OR 2.45, 95% CI 0.99–6.04, P=.05). Having a birth plan led to less satisfaction (OR 0.49, 95% CI 0.24–0.96, P=.04). Birth classes and feeling pressured by providers in labor were not significant predictors of patient satisfaction. Positive clinical predictors of patient satisfaction included a vaginal delivery (OR 1.97, 95% CI 1.07–3.27, P=.02), but multiparity, advanced maternal age, regional anesthesia, episiotomy, or a postpartum hemorrhage were not significant predictors of satisfaction. Understanding the labor and delivery events predicted high satisfaction (P=.02).

CONCLUSION:
Patient satisfaction is dependent on patient input into labor, adequate explanations of the labor course, increased support in labor, high patient understanding, and achieving a vaginal delivery.
An Enhanced Recovery After Surgery Pathway for Cesarean Delivery May Improve Perioperative Euglycemia [04P]
Authors: Savitsky Leah M. , Hitti Jane , Bollag Laurent A. , Delgado Carlos M. , Mills Elizabeth B. , Fay Emily E. 
Published: April 2020

INTRODUCTION:
Enhanced recovery after surgery (ERAS) pathways are standardized, evidence-based approaches to the care of surgical patients. One component of ERAS pathways is maintaining euglycemia pre- and post-operatively.

METHODS:
We conducted an IRB approved retrospective cohort study evaluating capillary blood glucose (CBG) values among women on the ERAS cesarean delivery pathway (ERAS CD) during the first year of implementation (4/1/2017–3/31/2018, n=531), compared to historical controls (3/1/2016–2/28/2017, n=661) in the year prior. Pregestational diabetics on insulin prior to pregnancy were excluded. ERAS CD pathway patients received preoperative carbohydrate loading as well as a pre-op, 1-hour post-op, and post-op day 1 and 2 CBG. We compared average CBG and percentage of time in-range, defined as any CBG between 70–140 mg/dL for both pre- and post-operative periods between the baseline and implementation groups using chi-square tests and Student t-tests.

RESULTS:
The women on the ERAS CD pathway had a significantly higher percentage of in-range CBGs both in the pre- and post-operative time period (pre-op: 84.9% vs. 95.4%, P<.001; post-op: 77.2% vs. 94.3%, P<.001) compared to historical controls. The average pre- and post-operative CBGs were also significantly lower among women on the ERAS CD pathway (pre-op: 93.3±19.3 mg/dL vs. 87.5±15.7, P=.0033; post-op: 109.5±29.2 mg/dL vs. 90.9±17.8 mg/dL, P<.001).

CONCLUSION:
Women on the ERAS CD pathway had significantly improved CBGs both pre- and post-operatively, as demonstrated by higher percentage of in-range CBGs and lower average CBGs during both time periods. This suggests that ERAS CD pathways may improve perioperative euglycemia, but further studies are needed to evaluate this.
A Randomized Controlled Trial: Do Family-Centered Cesarean Deliveries Improve Patient Satisfaction? [01P]
Authors: Montgomery Michelle O. , Kram Jessica J. , Forgie Marie M. , Perez Moreno Ana C. , Romdenne Taylor 
Published: April 2020

INTRODUCTION:
In comparison to women who deliver vaginally, women who deliver via cesarean section report they are less satisfied with their birthing experience, have later skin-to-skin contact, and delayed mother-newborn interactions. Our study aimed to determine if maternal experiences, as well as maternal and neonatal outcomes, differ between family-centered and traditional cesarean delivery methods.

METHODS:
Pregnant women with singleton pregnancy ≥ 38 weeks' gestation who underwent planned cesarean delivery at one of two delivery units were enrolled June 2016–July 2018. Women were randomized to either family-centered (Method 1; can view birth, baby placed on chest) or traditional cesarean (Method 2; unable to view birth, baby taken to warmer). Satisfaction was recorded using modified Likert scale, ranging from 1 (lowest) to 5 (highest). Baseline characteristics, as well as maternal and neonatal outcomes, were compared using ANOVA and Pearson's chi-squared. This study was approved by local Institutional Review Board.

RESULTS:
Women in Method 1 (n=68) and Method 2 (n=61) did not significantly differ by baseline characteristics, nor maternal and neonatal outcomes. Patients in Method 1 established skin-to-skin contact on average 11 minutes earlier than those in Method 2 (P<.001). Additionally, patients in Method 1 were more satisfied, although not statistically significant (4.6 vs. 4.4 Method 2; P=.27).

CONCLUSION:
Our study found no statistical differences in maternal satisfaction or maternal/newborn outcomes, between methods. Even so, the family-centered cesarean was significantly associated with earlier skin-to-skin initiation, which has proven benefits. Given our findings, women should be allowed to choose either method of cesarean delivery based on personal preference.
The Job of the Obstetrician Does Not End by the Delivery of the Fetus With Non-reassuring Status [38O]
Authors: Ogunyemi Dotun , Farr Carly , Wharton Kurt , Karabon Patrick , Bahado-Singh Ray , Alhousseini Ali 
Published: April 2020

INTRODUCTION:
Research generally focuses on neonatal outcomes when pregnancy is complicated by non-reassuring fetal status. Little attention has been directed to maternal outcomes after such deliveries.

METHODS:
A retrospective cohort study of 27,886 pregnancies at a single health system evaluated fetal status and postpartum maternal characteristics. Fetal heart tracing, arterial cord pH, maternal blood transfusion, and maternal ICU admission were among the evaluated characteristics. Multivariate logistic regression analyses were performed to assess correlation with markers of fetal well-being and maternal outcomes and adjusted odds ratios (AOR) were derived.

RESULTS:
Umbilical artery pH less than 7.0 was associated with transfusion (AOR 6.83 [95% CI 2.22–21.0, P<.001]), cesarean delivery (AOR 5.76 [95% CI 3.63–9.15, P<.0001]), and maternal readmission (AOR 12.6 [95% CI 2.26–69.8, P=.0039]). Fetal bradycardia events were associated with increased maternal ICU admission (AOR 3.22 [95% CI 1.23–8.46, P<.017]), transfusion (AOR 2.13 [95% CI 1.26–3.59, P<.005]) and readmission (AOR 4.17 [95% CI 1.16–15.0, P<.029]). Late decelerations were associated with cesarean delivery (AOR 1.65 [95% CI 1.55–1.76, P<.0001]), maternal readmission (AOR 1.24 [95% CI 1.01–1.53, P=.04]), chorioamnionitis (AOR 2.88 [95% CI 2.46–3.37, P<.0001]), and maternal need for antibiotics (AOR 1.89 [95% CI 1.66–2.15, P<.0001]).

CONCLUSION:
Non-reassuring fetal status is associated with significant risks to the mother as evidenced by significant increases in transfusions, ICU admissions, and readmissions. Obstetricians should remain vigilant after delivery for non-reassuring fetal status and focus on monitoring and optimization of maternal status.
Gabapentin's Effects on Hyperemesis Gravidarum: A Randomized Controlled Trial [17N]
Authors: Guttuso Thomas , Messing Susan , Mullin Patrick , Strittmatter Chad , Saha Sumona , Thornburg Loralei Lacina 
Published: April 2020

INTRODUCTION:
Hyperemesis gravidarum (HG) is a disabling disease of early pregnancy for which there are no effective outpatient therapies. Because of the severe and persistent physical and psychological distress caused by HG, about 15% of HG pregnancies are terminated in the first trimester.

METHODS:
A randomized, double-blind, multi-center trial was conducted among patients with medically-refractory HG. Subjects were randomized (1:1) to either oral gabapentin (1,800–2,400 mg a day) or an active comparator arm of either oral ondansetron (24–32 mg a day) or oral metoclopramide (45–60 mg a day) for 7 days. Change in Motherisk-PUQE scores from baseline to Days 5–7 served as the primary endpoint.

RESULTS:
Thirty-one patients were enrolled from 10/2014–5/2019. Among the 21 subjects providing any primary outcome data (12 assigned to gabapentin, 9 to the active comparator arm), 18 were enrolled as outpatients and all 21 were outpatients on Days 5–7. Intention-to-treat analysis showed the gabapentin treatment arm to have greater reductions in Motherisk-PUQE scores (P=.005) and increases in oral nutrition (P=.007) from baseline as well as higher global satisfaction (P=.02), relief (P<.05) and desire to continue therapy (P=.04) compared to the active comparator arm. Adverse events and number of subject withdrawals were equivalent between the groups.

CONCLUSION:
Despite the small sample size of this trial and high rate of subject attrition, gabapentin therapy was more effective than standard-of-care therapy for HG symptoms in the outpatient setting. Considering the favorable safety profile of gabapentin use during early pregnancy, gabapentin therapy may be able to provide HG patients and their infants with improved long-term prognoses.
Mother-Baby Errors: A Potential Unintended Consequence of Distinct Newborn Naming Conventions [24O]
Authors: Goffman Dena , Kern-Goldberger Adina , Fernandes Yelstin , Salmasian Hojjat , Applebaum Jo R. , Adelman Jason S. 
Published: April 2020

INTRODUCTION:
To prevent wrong-patient errors, The Joint Commission issued a requirement in 2019 that hospitals use distinct methods of newborn identification, such as incorporating the mother's first name into the newborn' name (eg, Jackson, Wendysgirl). However, since the requirement went into effect, there have been reports of wrong-patient errors between mother-baby dyads as an unintended consequence of having similar names.

METHODS:
The purpose of this study was to quantify the rate of mother-baby errors, using a validated measure of near-miss, wrong-patient orders. The Wrong-Patient Retract-and-Reorder measure identifies orders placed for a patient that are canceled and reordered by the same clinician for a different patient shortly thereafter. We examined all orders placed for women and newborns who were inpatients at the same time after delivery from 1/1/2015–12/31/2018 at a large academic medical center that used the required newborn naming convention over the entire study period.

RESULTS:
The analysis included a total of 5,953,738 orders placed for 59,737 mother-baby dyads. Overall, there were 311 wrong-patient orders (mean 77.8 per year), for a rate of 5.2 per 100,000 orders. Order errors occurred in 84 mother-baby dyads; in 77 dyads, orders placed for the mother were intended for the newborn, most commonly vaccines and newborn screens. Orders placed for the newborn intended for the mother included antihypertensives, anticoagulants, and opioids.

CONCLUSION:
These results provide further evidence of mother-baby errors related to newborn naming conventions. Although these were near-miss errors, the outcome of such errors reaching the patient could be catastrophic in this setting.