bluuebunny/crossref_metadata_2025_split huggingface dataset:
Falling Insulin Requirements and Adverse Pregnancy Outcomes in Women With Pre-pregnancy Diabetes [10D]
Authors: Vainder Marina , Natt Navneet , D'Souza Rohan D. , Syeda Ambreen , Mitsakakis Nicholas 
Published: April 2020

INTRODUCTION:
A subset of women with pre-gestational diabetes experience a third-trimester fall in insulin requirements (IR). There is no consensus on whether this fall represents placental dysfunction or is a variant of normal third-trimester physiology. Our study sought to determine whether a third-trimester drop in IR is associated with adverse pregnancy outcomes.

METHODS:
This is a retrospective cohort study of women with type 1 and 2 diabetes. We compared outcomes in those with and without a ≥15% drop in basal IR. The primary outcome was a composite of stillbirth, spontaneous preterm birth, preterm premature rupture of membranes and iatrogenic preterm birth or emergency caesarean delivery for fetal wellbeing concerns. The results were adjusted for the effect of maternal BMI, presence of microvascular disease, and pre-pregnancy hemoglobin A1c >7. The study was approved by the research ethics board at Mount Sinai Hospital.

RESULTS:
We included 350 women (146 type 1, 204 type 2), of which 15% had a drop of ≥15% in third-trimester basal insulin requirements. There was no difference in the primary outcome between groups (aOR 0.75 [0.27, 1.81]). In isolation the sensitivity and specificity of a ≥15% drop in basal IR as a diagnostic test for the primary outcome was 13% and 85%, respectively.

CONCLUSION:
A ≥15% drop in third-trimester basal IR is not associated with and is a poor predictor of adverse pregnancy outcomes in women with pre-pregnancy diabetes. It should not be used in isolation as a sole indication for delivery.
Association of Maternal Hypoglycemia on the Glucose Challenge Test and Small for Gestational Age Infants [06D]
Authors: Stivers Stacey L. , Thomas Megan , Devaiah Ganga , Lambers Donna 
Published: April 2020

INTRODUCTION:
To determine if maternal hypoglycemia on the GCT is associated with small for gestational age (SGA) infants. The hypothesis is there will be an increased incidence of SGA in pregnancies with hypoglycemia (<88 mg/dL) as compared to euglycemia (88–129 mg/dL).

METHODS:
IRB approved, retrospective cohort study of singleton pregnancies from January 2015 to December 2017 with a GCT result between 24–28 weeks and delivery information were included. Patients with GCT >129 mg/dL and those with fetal anomalies were excluded. Neonatal and maternal outcomes were collected from the medical record. Growth classification was based on infant gender and gestational age at birth. Parametric and non-parametric tests, Fisher's exact and chi-squared tests were used for statistical analysis.

RESULTS:
2386 patients were euglycemic (88–129 mg/dL) and 966 patients were hypoglycemic (<88 mg/dL) on the GCT results. The cohort gestational age at delivery was 39.1 weeks. Hypoglycemia was associated with increased risk for SGA infants (9.3% vs 7.0%, P=.027) and intrauterine growth restriction (IUGR) (7.9% vs 5.1%, P=.003) and less likely to have large for gestational age infant (5.1% vs 7.3%). Patients with hypoglycemia had a decreased incidence of gestational hypertension (4.8% vs. 6.7%, P=.039) and pre-eclampsia (0.8% vs. 2.2%, P=.006).

CONCLUSION:
Hypoglycemia (GCT level <88 mg/dL) is associated with increased risk of SGA infants and IUGR along with decreased incidence of gestational hypertension and pre-eclampsia. This information can be used to increase fetal growth surveillance by sonography in the third trimester to improve identification of SGA and IUGR.
The Association of Hospital Admission and Postpartum Depression Rates Across Racial and Ethnic Groups [31C]
Authors: Berra Alexandra , Palmer Grace , Stafford Irene A. 
Published: April 2020

INTRODUCTION:
The prevalence of postpartum depression (PPD) is approximately 10% and assessed via the Edinburg Postnatal Depression Score (EPDS). According to most data, these rates do not differ by race and ethnicity. However, there is a lack of data regarding the effect of length of antenatal admission on rates of PPD across women of differing racial and ethnic strata. The aim of this study is to determine if EPDS scores differ according to race and ethnicity across varying lengths of hospital admissions prior to delivery.

METHODS:
All pregnant women admitted to the antepartum unit at our institution from September 2017 to August 2018 were identified. Women with postpartum EPDS scores greater than or equal to ten were identified as having PPD. Antepartum length of stay was recorded by weekly intervals (0–7, 8–14, 15–21, and 22–28 days). Those admitted longer than 28 days were excluded. EPDS scores were compared in each of these groups among different races and ethnicities using chi square analysis.

RESULTS:
Black women (both Hispanic and non-Hispanic) were more likely to have PPD in every time interval. This association was statistically significant for length of stay 0–7 days (P=.03). Overall, black women were 1.7 fold more likely to suffer from PPD. In addition, Hispanic women were significantly less likely to be depressed than non-Hispanic women across all intervals (P=.02).

CONCLUSION:
Demographic information should be taken into consideration when evaluating risk for PPD. While certain racial characteristics may predispose a patient to the development of PPD, others may serve as a protective factor.
Age and Body Mass Index Can Screen for VTE Risk at Labor and Delivery Admission [02D]
Authors: Francis Kim Antonia P. , Saleh Mona , Torres Anthony Melendez , Limaye Meghana , Roman Ashley 
Published: April 2020

INTRODUCTION:
Pregnancy is a risk factor for venous thromboembolism (VTE). VTE risk assessment models (RAM) have been created but not validated in obstetrics. The impact of maternal age and obesity on VTE risk score calculation is unclear. Our goal was to determine how maternal age and body mass index (BMI) affect VTE RAM scores.

METHODS:
IRB approved cross-sectional study evaluating 507 deliveries during November 2018 at an urban academic center. A total of 5 VTE cases were identified from 2013–2018. 6 RAM scores (ACOG, CMQCC, ACCP, RCOG, Caprini, Padua) were calculated for all subjects before and after exclusion of maternal age and BMI. Descriptive statistics and T-tests were utilized to ascertain the relationship between maternal age, BMI and high-risk RAM score (Caprini score of 2 or higher, RCOG score of 2 or higher, Padua score 4 or higher).

RESULTS:
The Caprini score classified 60% of cases as high risk when age and BMI were excluded versus 80% when these factors were included. Similarly, RCOG identified 80% of cases as high risk when BMI and age were excluded but captured 100% of cases when age and BMI were included. Age of 30 years or more and BMI greater than 30 kg/m2 correlated with higher Caprini and RCOG scores.

CONCLUSION:
Caprini and RCOG models were most impacted by age and BMI. If the RCOG and Caprini score are used to stratify patients for VTE risk, we propose using an abbreviated assessment utilizing only age and BMI since these had the most significant impact on final score.
Inadequate Gestational Weight Gain Among Obese Women: Harmful or Protective? [17D]
Authors: Oliva Mariana , Sipe Bradley , Odibo Linda , Odibo Anthony O. 
Published: April 2020

INTRODUCTION:
The risks of inadequate gestational weight gain (IWG) remain controversial, especially among obese women. We aim to compare pregnancy outcomes in this population.

METHODS:
This is a secondary analysis from a prospective study of pregnant women undergoing fetal growth assessment. Obese participants were sorted into cohorts of adequate gestational weight gain (AWG) and IWG as defined by the Institute of Medicine guidelines. The primary outcomes were abnormal fetal growth, both large for gestational age (LGA) and small for gestational age (SGA). Secondary outcomes included: hypertensive disorders of pregnancy, gestational diabetes (GDM), preterm delivery (PTD), and composite adverse neonatal outcomes (CANO, including neonatal ICU admission, neonatal death, seizures, intraventricular hemorrhage, respiratory distress syndrome, necrotizing enterocolitis, and pH<7.10). Chi-square tests were used to compare outcomes. A stratified analysis by obesity class (class 1=BMI 30–34.9, class 2=BMI 35–39.9, class 3=BMI >40) was then performed.

RESULTS:
405 obese women were identified. 81 experienced IWG and 68 experienced AWG. IWG was protective against LGA (RR 0.10, CI 0.03–0.44, P<.01) and against GDM (RR 0.44, CI 0.21–0.93, P=.03). IWG did not affect CANO (P=.63), gestational hypertension (P=.52), preeclampsia (P=.25), PTD (P=.37), and SGA (P=.15). When stratified by obesity class, protection against GDM was seen in class 3 obesity (RR 0.24, 0.07–0.82). The risk of LGA was statistically significantly decreased in class 2 and 3 obesity.

CONCLUSION:
IWG is protective against LGA for class 2 and 3 obesity and protective against GDM for class 3 obesity. IWG did not increase risks of adverse pregnancy outcomes in obese patients.
Toxicology Testing of Neonates: Do a Mother's Demographics Influence Decisions to Test? [35C]
Authors: Perlman Nicola C. , Smith Nicole A. 
Published: April 2020

INTRODUCTION:
Toxicology testing of newborns carries substantial consequences to families, with implications for social service involvement, limitations on breast milk administration, and custody concerns. Clear guidelines for testing of neonates do not exist, and obstetric providers may have opportunities to influence practices of our pediatrician colleagues. We aimed to evaluate whether patterns concerning for implicit bias could be seen in toxicology testing of newborns.

METHODS:
We reviewed charts of all babies born at a single tertiary academic center between 1/1/18 and 12/31/18 on whom toxicology testing was sent. Demographic data was taken from mothers' charts as newborn demographics are not routinely recorded, and compared to sociodemographic data of all mothers with infants born in 2018, including age, race, marital status, ZIP code. Data was analyzed with Wilcoxon Rank Sum test, Chi Square test, or ANOVA where appropriate.

RESULTS:
Of 6438 births in 2018, Tox was sent on infants of 86 mothers (1.3%). Mothers of babies with toxicology testing sent were younger (P<.0001), less likely to be white (P<.0001), reported “single” as marital status (P<.0001), and lived in the lowest income ZIP code (P<.0001).

CONCLUSION:
Maternal age, race, marital and socioeconomic status appeared to significantly impact pediatricians' decisions to order toxicology testing on neonates. Evidence based guidelines may decrease implicit bias in neonatal toxicology testing, and better identify babies at risk of substance exposures.
Rural Women in the United States Burdened by High Maternal Transfer Rates [28C]
Authors: McDowell Laura , Hartenbach Ellen , Daphne Kuo Hsiang-Hui , Ehrenthal Deborah 
Published: April 2020

INTRODUCTION:
To describe obstetrical transfer patterns concerning maternal characteristics and outcomes.

METHODS:
Using 2014–2016 birth records from the National Center for Health Statistics (NCHS) we examined antepartum transfer based on maternal resident county: large metropolitan center (LMC), large metropolitan fringe (LMF), medium metropolitan (M metro), small metropolitan (S metro), micropolitan (Micro) and non-core/rural (Non-core). We examined the association between transfer and sociodemographic, health, and peripartum characteristics.

RESULTS:
59,399 transfers occurred among 11,233,882 hospital births (0.53%). More were living in Micro (OR 3.68, CI 3.59–3.77) and Non-core counties (OR 5.05, CI 4.92–5.19), <18 (OR 1.40, CI 1.33–1.48), non-Hispanic American Indian/Alaskan Native (NH-AIAN) (OR 8.31, CI 8.06–8.56), without prenatal care (OR 4.29, CI 4.14–4.45) and Medicaid (OR 1.47, CI 1.44–1.49) or self-pay (OR 1.67, CI 1.60–1.74). Associated characteristics included smoking (OR 2.40, CI 2.35–2.46), BMI >40 (OR 1.77, CI 1.71–1.83), diabetes (OR 1.63, CI 1.59–1.67), hypertension (OR 3.67, CI 3.59–3.75), multiparity (OR 4.98, CI 4.87–5.10), breech (OR 3.84, CI 3.77–3.93), chorioamnionitis (OR 2.42, CI 2.32–2.53), cesarean (OR 2.04, CI 2.00–2.07) and preterm (OR 21.5, CI 21.1–21.9). Morbidity was high with increased blood transfusion (OR 5.21, CI 4.87–5.58), ICU admission (OR 9.64, CI 8.98–10.36), uterine rupture (OR 3.93, CI 3.07–5.02) and hysterectomy (OR 7.08, CI 4.87–5.57).

CONCLUSION:
Transport disproportionately affects rural women. These moms are more likely rural, younger, NH-AIAN, without prenatal care, and utilize Medicaid or self-pay. Numerous individual and health systems factors led to increased morbidity for mothers and infants suggesting areas for future quality initiatives.
Reducing Postpartum Oxycodone Usage at University Hospitals [33E]
Authors: Cossler Nancy , Liu James H. , Albertini Megan , Porter Steven , Niemi Marcie , Katz Tyler Jessica 
Published: April 2020

INTRODUCTION:
Opioid analgesics are among the most common medications employed for postpartum pain management. However, opioid side effects such as nausea, vomiting, urinary retention, and sedation are problematic and can adversely impact postpartum recovery. In addition, the national opioid crisis has prompted enhanced vigilance around narcotic usage in healthcare settings. Non-steroidal anti-inflammatory medications and acetaminophen are an effective complement to opioid analgesia. We describe a systematic approach to reducing postpartum oral narcotic use at MacDonald Women's Hospital (MWH), a northeast Ohio-based hospital providing obstetric services and delivering approximately 4000 women/year.

METHODS:
Beginning on June 5, 2018, we implemented a postpartum care bundle comprised of the following interventions: 1) Providing scheduled PO acetaminophen and PO ibuprofen every six hours after vaginal delivery; and 2) Providing scheduled IV ketorolac every 6 hours for twenty four hours after cesarean delivery, followed by scheduled PO acetaminophen and PO ibuprofen until discharge.

RESULTS:
From May 2017—May 2018, oxycodone usage at MacDonald Women's Hospital averaged 181.6 doses per 100 patient days. From June 2018—May 2019, average rates of oxycodone usage decreased to 153.3 doses per 100 patient days. Following the rollout of the postpartum care bundle, there was no significant change in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPS) patient satisfaction scores related to pain communication (77.9% 6 months pre-bundle vs. 92.2% 6 months post-bundle).

CONCLUSION:
This intervention was associated with a decrease in postpartum in-hospital oxycodone usage without a negative impact on patient satisfaction scores.
Factor V Deficiency in Pregnancy: Could This Mean One and Done? [14N]
Authors: Varma Shruti , Christie Alexandra C. , Aikman Noelle Marie 
Published: April 2020

INTRODUCTION:
Post-partum hemorrhage is the leading cause of maternal mortality worldwide. Our case outlines the importance of recognition of the risks of post-partum hemorrhage including the possibility of permanent sterility.

METHODS:
Case Presentation: A 32-year old G0 @ 39 2/7 weeks presented in labor with minimal prenatal care and congenital Factor V deficiency. Maternal Fetal Medicine and hematology consultants recommended fresh frozen plasma (FFP) to a goal INR of <1.5 mg/dL. Her level on admission was 3 mg/dL. Her Factor V assay was <1%; (nml>70%). She successfully delivered a female neonate and received tranexamic acid, FFP, Cytotec, packed red blood cells, and platelets secondary to heavy bleeding. After delivery, she was hemodynamically unstable and was transferred to SICU for monitoring. Her hemoglobin was 5.2 g/dL with continued bleeding. Ultrasound revealed a distended lower uterine segment with large blood within the cavity. She was unresponsive to blood products and was taken to the OR for exploratory-laparotomy with postpartum hysterectomy.

CONCLUSION:
Factor V deficiency is a rare coagulopathy which leads to a high hemorrhage risk in pregnancy. The incidence is one in one million. We identified multiple reports documenting successful management of Factor V deficiency in pregnancy with FFP given prior to delivery. These patients had deliveries without bleeding complications. However, as our case emphasizes, this coagulopathy can lead to detrimental outcomes in the intrapartum and post-partum period, even with FFP. It is crucial to identify and counsel patients extensively on the risks of hemorrhage during labor including the possibility of permanent sterilization.
Conservative Management of Placenta Accreta Using Helium Plasma Focused Radio Frequency Energy [11N]
Authors: Khamvongsa Peter , Rodriguez Anthony , Patel Naiya 
Published: April 2020

INTRODUCTION:
Abnormal placentation, including placenta accreta, have been occurring at a higher incidence than before due to the increase in cesarean sections. The gold-standard treatment if uncontrolled bleeding occurs is peripartum hysterectomy, depriving woman of future fertility. The purpose of this case was to apply a conservative management by using a helium plasma device to fulgurate the placenta accreta at the uterine site.

METHODS:
Patient informed consent was obtained for submission of a case report. Cesarean delivery with low-vertical incision and manual extraction of the placenta was performed. The uterus was exteriorized and the helium plasma radio frequency (RF) device (J-Plasma system) was used to fulgurate the retained placental tissue, confirming hemostasis with a radius of 3 cm from the site. Hemabate was given to the site to maintain uterine contraction.

RESULTS:
The helium plasma device provided adequate hemostasis to the 12.76 cc of retained placenta accreta at 40% power 4 L/min gas flow, reducing lateral and depth damage of normal endometrial tissue. Quantitative blood loss was 560 cc. Obstetric hemorrhage and peripartum hysterectomy were avoided, allowing for future fertility.

CONCLUSION:
The helium plasma RF device provided a high-precision and efficient operative time in conservatively managing placenta accreta. This adds a safer alternative form of managing abnormal placentation and avoiding radical treatment. More research and trials should be done on larger placenta accreta and on other morbidly adherent placentas. It will be able to allow woman of high-risk to maintain their ability of reproducing in the future since a peripartum hysterectomy could be avoided.
Do Lipoid Metabolism Disorders Increase Risks of Maternal and Fetal Complications in Pregnancies? [12N]
Authors: Cai Emmy , Czuzoj-Shulman Nicholas , Abenhaim Haim A. 
Published: April 2020

INTRODUCTION:
The effects of lipoid metabolism disorders (LMD) are not well understood in pregnancy; thus, this study aims at understanding the different maternal and fetal outcomes that can be associated with this condition in pregnancy.

METHODS:
Using the Healthcare Cost and Utilization Project – National Inpatient Sample from the United States, a retrospective cohort study was conducted to determine the risks of complications in pregnant women known to have LMDs. All pregnant patients diagnosed with LMDs between 1999 and 2015 were identified using the International Classification of Disease-9 coding. Maternal and neonatal outcomes in pregnant women with LMDs were analyzed using multivariate logistic regression.

RESULTS:
A total of 13,792,544 pregnant women were included in our study; 9,666 women were diagnosed with LMDs for an overall prevalence of 7.0 per 10,000 births. Births to women with LMDs were more likely to have pregnancies complicated by diabetes and hypertension. Women with LMDs were more likely to have premature births, OR 1.42 (95% CI 1.35–1.53), suffer from myocardial infarctions, 11.97 (6.07–23.58), venous thromboembolisms, 2.03 (1.64–2.51), postpartum hemorrhage, 1.34 (1.21–1.48), and maternal death, 3.52 (1.97–6.32). There was also an increased risk of congenital anomalies, 2.48 (2.09–2.93), intrauterine growth restriction, 1.41 (1.26–1.58), and intrauterine fetal demise, 1.79 (1.51–2.13).

CONCLUSION:
The effects of LMDs on pregnancies are not very well understood, but women with these disorders appear to be at significantly increased risks of poor maternal and fetal outcomes. Better understanding of these risks and complications can allow for better outcomes in pregnant women suffering from lipoid metabolism disorders.
Feasibility of Remote Monitoring to Confirm Exercise Adherence in High Risk Pregnant Women [15N]
Authors: Kogutt Benjamin K. , Sheffield Jeanne S. 
Published: April 2020

INTRODUCTION:
Pregnancy is an ideal opportunity for women to focus on physical health; however, exercise recommendations are rarely met. At-home fitness is more accessible than ever due to technology-based interventions, and with the addition of wearable technology, real-time adherence and intensity feedback is possible. The objective of our study is to determine if contemporaneous, mobile technology can provide an innovative method to monitor exercise in a high-risk pregnant population remotely.

METHODS:
This is a prospective, randomized controlled pilot study with two arms: exercise vs. standard counseling. Exercise was logged and tracked remotely in both groups. Once an exercise session was recorded, participation was confirmed by cross-referencing participant's FitBit activity and heart rate monitor (San Francisco, CA), thus providing a method to confirm participation and monitor degree of exercise intensity.

RESULTS:
Sixteen total patients were enrolled, eight in each arm. 102 exercise sessions were logged: 80 (78%) in the intervention group vs. 22 (22%) in the non. Exercise was confirmed in 79 of the 102 exercise sessions (77%). Interestingly, only 18% of recorded sessions reached moderate intensity based on heart rate parameters, and none reached vigorous intensity.

CONCLUSION:
Connected health technologies can provide a reliable, cost effective, and efficient method to determine adherence to and degree of exercise intensity in a high-risk pregnant population. Providing feedback to patients about their actual vs. perceived exercise intensity may improve the efficacy of their regimens. Additional research is needed to determine which methods are most effective to motivate exercise in pregnancy.