bluuebunny/crossref_metadata_2025_split huggingface dataset:
Making the Case for Expanding Medicaid Coverage to 12 Months Postpartum [23M]
Authors: Kumar Natasha , Quinlan Maura 
Published: April 2020

INTRODUCTION:
Efforts to reduce maternal mortality in the U.S. have increasingly focused on the postpartum period. Currently, federally mandated Medicaid provision during pregnancy up to 6 weeks postpartum covers nearly half of the births in the U.S. However, 17.5% of pregnancy-related deaths occur between six-weeks and one-year postpartum, primarily due to cardiomyopathy (32.4%), mental health conditions (16.2%) and embolism (10.8%).

METHODS:
In April 2019, ACOG redefined the postpartum period as the "fourth trimester," recommending care be "an ongoing process rather than a single encounter." In June 2019, the AMA joined ACOG in supporting expansion of Medicaid coverage to 12 months postpartum. The Illinois state legislature approved expansion of Medicaid coverage to 12 months postpartum during its budget reconciliation process in 2019.

RESULTS:
Data from the ACA's Medicaid expansion indicates that postpartum Medicaid expansion would significantly impact health outcomes. By reducing the income eligibility for Medicaid, women who previously only qualified for Medicaid in pregnancy can now remain insured after 6 weeks postpartum. Expansion states had 1.6 per 100,000 fewer maternal deaths than non-expansion states. Postpartum Medicaid expansion will also allow for better birth spacing, improved mental health care, and longer follow-up for medical complications of pregnancy.

CONCLUSION:
Changing the paradigm of postpartum care provision could drastically impact maternal mortality. The consensus of support from the AMA and ACOG around expansion of Medicaid to 12 months postpartum is a critical step forward for legislative efforts to address maternal mortality. As with Illinois, obstetrician-gynecologists should advocate for policy alternatives that support increased access to postpartum care.
Maternal Satisfaction With Childbirth by Length of Second Stage [24M]
Authors: Gimovsky Alexis C. , Pham Amelie , Sardana Aayushi , Reddy Aarthi , Sparks Andrew 
Published: April 2020

INTRODUCTION:
The aim of this study is to quantify patient satisfaction during childbirth by length of the second stage and delivery mode.

METHODS:
Cross-sectional study of nulliparous women who delivered between 4/2018–3/2019. Patients completed 4 questionnaires in the immediate postpartum period: Patient Perception Score (PPS), Consumer Satisfaction Questionnaire (CSQ), Six Simple Questions (SSQ), and Salmon survey. Length of second stage was divided into 2 groups (≤3 hours and >3 hours) and patient satisfaction scores were compared.

RESULTS:
100 patients were enrolled. 71 patients had normal second stage and 29 patients had prolonged second stage. Length of second stage had a statistically significant negative correlation with PPS score (ρ=-0.25, P=0.01). Length of second stage was not correlated with the SSQ (ρ=0.06, P=0.54), CSQ (ρ=-0.18, P=0.07), or Salmon survey (ρ=-0.16, P=0.11). PPS and SSQ scores did not significantly differ by delivery mode or epidural status, although the two lowest PPS scores were women who underwent cesarean delivery with extremely prolonged second stage (372 and 402 minutes, respectively). CSQ and Salmon scores were significantly lower in women who underwent second stage cesarean delivery.

CONCLUSION:
Most patients were satisfied with their childbirth experience independent of length of second stage. Only the PSS demonstrated a correlation of higher satisfaction with shorter second stage. Cesarean delivery during second stage was associated with decreased patient satisfaction. Future studies with larger cohorts of patients are needed to confirm our findings.
Patient Perceived Value of Referral to Maternal and Fetal Medicine Subspecialists [25M]
Authors: Shah Qainat , Dasani Megha , Saad Sarah , Kalkur Roshni , Rijhsinghani Asha 
Published: April 2020

INTRODUCTION:
Maternal and fetal morbidity and mortality is a national and public health concern. One of the most critical factors to quality maternal fetal care for high-risk pregnancies is access to specialty tertiary care. Our center serves 25. This study assessed patient satisfaction of high-risk pregnancies referred for consultation to the High-Risk Pregnancy Services at a tertiary care center in the US.

METHODS:
Prospective pre and post surveys were administered to pregnant women referred to the High-Risk antenatal clinics. This study was IRB approved. All patients consented to participate in this study.

RESULTS:
50 women completed the pre-visit and post-visit surveys. The average GA at referral was 21 3/7 weeks. The wait time for scheduled appointment from the initial referral was 2.5 weeks. Patients traveled 57.5 ± 32.3 minutes. 45% of the patients reported not understanding the reason for referral. 60% expressed a desire to see a physician after completion of their ultrasound. On post-visit survey, patient’s perceived anxiety was significantly reduced (P=.007). In 16% the ultrasound findings were different from the local findings. 88% of patients indicated a better understanding of pregnancy issues as well as management of their pregnancy. 67.5% rated their overall satisfaction as excellent, 25% as good and 1% as fair.

CONCLUSION:
Not all referred women fully understand the role of a maternal fetal specialist, nonetheless, following the referral appointment and consultation, majority expressed better understanding and felt reassured regarding their pregnancy care. This survey indicates a need for and easy availability of maternal fetal expertise to all pregnant women.
Patient Preferences for Information Sharing During Pregnancy: A Survey of Postpartum Women [26M]
Authors: Peahl Alex , Novara Alli , Moniz Michelle , Smith Roger , Heisler Michele 
Published: April 2020

INTRODUCTION:
Anticipatory guidance on pregnancy, childbirth and parenting is a key component of prenatal care. Our objective was to evaluate patients’ preferences for information sharing during prenatal care.

METHODS:
We performed a cross-sectional survey of postpartum patients admitted for childbirth and postpartum recovery at a tertiary care center from May-June, 2019. We assessed which prenatal care resources patients found most helpful and preferable (i.e. "would use"), including in-person (e.g. provider, nurse), print (e.g. books, handouts), media (e.g. video, website, app), and prenatal classes. Validated demographics items were included. Analyses included simple descriptive statistics.

RESULTS:
Of 332 eligible women, 300 (90%) completed the survey. Average age was 30.4 (5.3), 70% of patients were white and 71% had private insurance. The most helpful and preferred sources of prenatal education were nurses and doctors (helpful: 97%, 89%; preferred: 97%, 89%). Over 50% of patients reported other educational resources were helpful and preferred, including books, booklets, and websites. Though many women reported phone apps and the electronic medical record portal were helpful, fewest women preferred them (46% and 40% respectively). Though many women reported prenatal classes were not helpful, over half of women desired breastfeeding (63%) and prenatal classes. (57%).

CONCLUSION:
Patients prefer prenatal education be delivered by their nurse and provider, but are open to other educational modalities. There is a disconnect between patient preferences for prenatal education materials and the perceived quality of currently available resources. Future work will investigate how to better tailor prenatal care education to patient preferences, clinic workflow, and actual use.
Placenta Accreta Spectrum: The Effect of Establishing a Systematic Program for Diagnosis and Management [27M]
Authors: Skupski Daniel W. , Razavi Armin 
Published: April 2020

INTRODUCTION:
Improvements in management of placenta accreta spectrum (PAS) can reduce maternal morbidity and mortality. Our objective was to determine the effect on outcomes following the introduction of a systematic program for diagnosis and management of PAS at our institution.

METHODS:
This was a retrospective cohort study of deliveries complicated by PAS at New York Presbyterian Queens (NYPQ) from November 2011 to July 2019. NYPQ implemented a systematic program for diagnosis and management of PAS in January 2015. The program included an emphasis on antenatal diagnosis, required scans for all repeat cesarean deliveries and multidisciplinary team management. Group 1 is designated as before and Group 2 is after establishment of the program. A composite outcome which included unplanned hysterectomy, ICU admission, return to the operating room or transfusion of ≥4 units of blood) was also examined. Chi square and Mann Whitney U tests were used in statistical analysis. IRB approval was obtained.

RESULTS:
Of 124 cases eligible cases, 35 (28%) had confirmed PAS (6 cases in Group 1, 29 cases in Group 2). The two groups were similar in terms of maternal age, parity, BMI and number of prior cesarean deliveries. There was no difference in composite morbidity between Groups 1 and 2 (66.7% vs 48.3%, P=.42). There was a trend toward improvement in unplanned hysterectomy and blood transfusion in Group 2.

CONCLUSION:
The establishment of our accreta program allowed us to demonstrate improvement in several outcome measures that did not achieve statistical significance due to small numbers.
Predicting Blood Loss for Vaginal Deliveries: When Are Quantitative Measures More Accurate? [29M]
Authors: Liew Zi-Qi , Mai Anne , Giacobbo Alexa , Qureshey Emma , Flicker Amanda , Quinones Joanne 
Published: April 2020

INTRODUCTION:
Hospitals have been adapting quantitative blood loss (QBL) techniques over traditionally estimated blood loss (EBL), which has been shown to underestimate large volumes of blood loss. Our purpose was to determine the milliliters of blood loss where QBL better approximates EBL in vaginal deliveries.

METHODS:
Retrospective cohort study was conducted at a tertiary center examining blood loss from singleton term vaginal births. EBL and QBL groups each contained 6 separate months of deliveries and compared to a standard: calculated blood loss (CBL), determined by maternal size and hematocrit decrease. Absolute differences between calculated and recorded blood loss were computed and modeled against CBL. Multiple linear regression was used to control for confounders.

RESULTS:
CBL between EBL (n=1085) and QBL (n=1076) groups were not significantly different (P=.051), with a median of 685 (interquartile range 426-948) mL vs 697 (457-967) mL. Absolute difference between CBL and recorded blood loss was smaller in the EBL group [402 (178-644) mL] than QBL group [497 (268-716) mL]. Absolute differences were plotted: EBL (r^2 .84, P<.001) and QBL (r^2 .63, P<.001) groups exhibited linear relationships. Intersection of the linear models corresponded to 370 mL; beyond this value, QBL group demonstrated a smaller difference in comparison to EBL group.

CONCLUSION:
QBL measurements are not more accurate than EBL for uncomplicated vaginal deliveries with little blood loss. However, when blood loss measures greater than 370 mL, QBL is a better approximate. Further studies need to be done to validate role of CBL in determining blood loss for all delivery types.
Relationship Status and Self-Reported Experiences During Pregnancy Are Related to Medication Use [32M]
Authors: Satti Mohamed A. , Mackeen A. Dhanya , Reed Eda G. , Schulkin Jay , Power Michael L. 
Published: April 2020

INTRODUCTION:
The study assessed factors associated with women’s medication use during pregnancy.

METHODS:
Pregnant women who were fluent in English and received prenatal care at Geisinger answered 11 questions on their experiences and thoughts during pregnancy. Principal component analysis reduced answers to three axes: overwhelmed/exhausted, happy/optimistic, and health concerns. Self-reported medication use for nausea, insomnia, anxiety and pain during pregnancy was examined.

RESULTS:
Of the 284 women who returned surveys, most (86.6%) were white and 49.3% were married. Many (44.4%) reported being medicated for nausea, insomnia, anxiety or pain; 6.3% reported self-medicating. Married women were least likely to report feeling overwhelmed/exhausted (20.9%) and most likely to report being happy/optimistic (94.1%). Married women were least likely to have been medicated (35.7%), in comparison to 48.6% of unmarried women living with a partner and 64.7% of women not living with a partner (P=.013). Other demographics were not significant. Pregnant women who used medication were more likely to report feeling overwhelmed/exhausted (37.4% versus 21.1%, P=.003), have health concerns (20.3% versus 11.1%, P=.001), and were less likely to be happy/optimistic (85.5% versus 93.3%, P=.033). Women who self-medicated were more likely to not be living with a partner (17.6% versus 4.8%, P<.001), more likely to report feeling overwhelmed (41.2% versus 27.7%, P=.045) and less likely to be happy/optimistic (66.7% versus 91.4%, P=.001) but did not differ in health concerns (22.2% versus 15.2%).

CONCLUSION:
Not living with a partner, feeling overwhelmed, and being less optimistic are associated with being medicated and self-medicating for nausea, insomnia, anxiety and pain during pregnancy.
Risk Factors for Postpartum Readmission: An Obstetric Quality Measure [33M]
Authors: Erfani Hadi , Salmanian Bahram , McKinney Jennifer , Detlefs Sarah , Sangi-Haghpeykar Haleh , Aagaard Kjersti 
Published: April 2020

INTRODUCTION:
The rate of postpartum (PP) readmission reflects both pre-existing and pregnancy-specific morbidities and contributes to the maternal mortality rate. We aimed to investigate the PP readmission rate, associated risk factors, and indicators of healthcare disparities within two hospitals affiliated with our academic institution.

METHODS:
A retrospective analysis of a prospective, population-based cohort (2011-2019) was performed. Any readmission within 30 days of delivery was included. A random sample of patients with no PP readmission was selected as controls. Characteristics, comorbidities, and labor course were compared. Multivariate logistic regression analyses were performed with appropriate adjustments.

RESULTS:
Among 42,458 subjects delivered in our affiliated hospitals, 248 (0.6%) had PP readmission. A control group of 1248 was randomly selected in a 5:1 control: case ratio. After controlling for potential confounders identified on univariate analysis, postpartum readmission was more common in women who delivered via cesarean after labor regardless of whether spontaneous or induced (adjusted OR [aOR] 1.38, 95% CI 1.02-1.87). Similarly, pregnancy-related hypertensive disorders or chorioamnionitis increased readmission risk (aOR 1.45, 95% CI 1.04-2.04 and aOR 1.86, 95% CI 1.08-2.04 respectively). Interestingly, among subjects delivered vaginally, induction of labor was associated with a higher risk of PP readmission compared to spontaneous or augmented labor (aOR 2.02, CI 1.37-2.98).

CONCLUSION:
Pregnancy-related hypertensive disorders, infection, and cesarean delivery are the most significant risk factors associated with PP readmission, as well as induction of labor in those with a vaginal delivery. Current standards of labor-management should continue to consider all factors potentially related to morbidity and mortality.
Risk Factors for Readmission Due to De Novo Postpartum Hypertension [34M]
Authors: Downs Sarah G. , Kawakita Tetsuya 
Published: April 2020

INTRODUCTION:
De novo postpartum hypertension is defined as the development of hypertension without antepartum hypertension. We sought to examine risk factors for readmission due to de novo postpartum hypertension.

METHODS:
This was a retrospective cohort study of all women who delivered at 23 weeks gestation or greater at a single academic center. Women with antenatal hypertension were excluded. Our primary outcome was postpartum readmission for severe hypertension from de novo postpartum hypertension. Outcomes were compared between women readmitted for de novo postpartum hypertension and those who were not using bivariable analyses. Variables that were significant with bivariable analyses were included in a multivariable logistic regression model to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI).

RESULTS:
Of 28,593 women, 113 (0.4%) were readmitted with de novo postpartum hypertension. Women readmitted for de novo postpartum hypertension compared to those who were not were more likely to be older, black, and multiparous; have undergone cesarean delivery (CD); have a higher body mass index (BMI kg/m2); and have a mean blood pressure (BP) >130/80 mmHg on postpartum days 1 and 2. After multivariable logistic regression, outcomes significantly associated with readmission for de novo postpartum hypertension included BP >130/80 mmHg on postpartum day 2 (aOR 2.02; 95% CI 1.32-3.09), age (aOR 1.06; 95% CI 1.03-1.10), BMI (aOR 1.04; 95% CI 1.02-1.07), and CD (aOR 2.60; 95% CI 1.73-3.91).

CONCLUSION:
We found that age, BMI, CD, and BP >130/80 mmHg on postpartum days 1 and 2 were associated with readmission for de novo postpartum hypertension.
Self-Reported Non-Steroidal Anti-Inflammatory Drug Allergy and Postpartum Pain Management [36M]
Authors: Beetham Kristine , Blitz Matthew J. 
Published: April 2020

INTRODUCTION:
Patients with a self-reported NSAID allergy (SRNA) are limited in the medications available to treat postpartum pain. Our objective was to determine the frequency of SRNA, how it affects the medications administered for inpatient postpartum analgesia, and whether it is associated with obstetrical outcomes.

METHODS:
Retrospective cohort study of singleton deliveries at ≥37 weeks of gestation at a tertiary university hospital from 2013-2016. Patients were excluded for self-reported opioid allergies, drug abuse history, positive urine toxicology, general anesthesia for delivery, and incomplete records. The primary outcomes evaluated were the postpartum pain medications received, including the total amount in milligrams. Demographic and clinical characteristics were reviewed to identify any associations with SRNA.

RESULTS:
A total of 20,920 deliveries were included: 235 with SRNA and 20,685 without SRNA. SRNA was documented in 1.12% of the study population. After cesarean delivery, median oxycodone use was 19.4 (IQR 6.6-36.7) and 15.4 (IQR 2.6-28.6) mg/day among women with and without SRNA, respectively (P<.04). After vaginal delivery, median oxycodone use was 10.4 (IQR 0-32.9) and 0 (IQR 0-17.9) mg/day among women with and without SRNA, respectively (P<.001). Acetaminophen use (P<.0001) and total postpartum days (P<.05) were also increased in women with SRNA compared to women without SRNA. No demographic or clinical factors differed between groups.

CONCLUSION:
SRNA is documented in approximately 1% of obstetrical patients and affects the medications administered for inpatient postpartum analgesia; both oxycodone and acetaminophen use are increased among SRNA patients, regardless of mode of delivery.
Systematic Treatment and Management of Postpartum Hypertension (STAMPP-HTN) [38M]
Authors: Duncan Colleen , Kaur Harjot , Mueller Ariel , Solache Macaria , Naseem Heba , Rana Sarosh 
Published: April 2020

INTRODUCTION:
Hypertensive disorders of pregnancy are a leading cause of morbidity during pregnancy. The postpartum (PP) period is equally morbid, however attendance at recommended PP blood pressure (BP) follow-up appointments is poor. Strategies to bridge this gap are needed.

METHODS:
A bundled approach to PP management was implemented which included education for obstetric providers, standardized protocols, educational videos, standardized discharge instructions, follow-up appointments and PPHTN clinics. This analysis sought to identify impact of this intervention and predictors of non-compliance.

RESULTS:
Among all 495 patients, 80.4% were African-American (AA), 68% had Medicaid, and the median age was 28 (IQR 23, 33) years. Factors associated with appointment non-compliance included younger maternal age, older gestational age, shorter PP length of stay, primary obstetric providers outside the study hospital, those who experienced spontaneous labor, current smokers and AA race (all P<.01). When comparing the beginning of the study period (September/October 2018) to the last two months (August/September 2019), PP appointments made before discharge increased (49.3% to 98.7%; P<.001) as did the proportion of patients who followed up within six weeks (26.8% to 45.6%; P=.01). Median [IQR] systolic BPs immediately post-delivery were higher in the beginning of the study period as compared to the end (152 [139,161] vs 139 [133,150]; P=.0001). A significant increase in PP antihypertensive use was also observed (34.2% vs 45.6%, P=.04).

CONCLUSION:
The STAMPP-HTN bundle improved PP compliance with BP control however response was not universal. Additional tools are needed to improve PP follow-up and BP control in this population.
Father Involvement During Pregnancy and Maternal Experience of Postpartum Physical Intimate Partner Violence [01F]
Authors: Chen Yu-Fu M. , Olson-Chen Courtney 
Published: April 2020

INTRODUCTION:
Nearly 1 in 3 women experience physical intimate partner violence (PIPV). PIPV increases during pregnancy and postpartum, and markers of risk are needed to target interventions. Father involvement (FI) is associated with a reduction in several adverse pregnancy outcomes. Our objective was to investigate the association between FI during pregnancy and PIPV 1 year postpartum.

METHODS:
Data from baseline and 1 year waves of longitudinal cohort Fragile Families and Child Wellbeing Study were analyzed, which included 1,546 mother-child dyads. PIPV was assessed using the Conflict Tactics Scale, and a binary indicator of any vs no PIPV was created. FI was measured by paternal provision of financial or instrumental support (transportation, chores) and visits to the hospital during pregnancy. Chi-square tests were performed to assess the bivariate FI-PIPV association followed by multivariate logistic regression adjusting for parental age, education, insurance, poverty level, and history of PIPV.

RESULTS:
Bivariate analyses showed that father visits to the hospital during pregnancy (OR .43, 95% CI .24-.73, P=.002) and provision of instrumental support (OR .41, 95% CI .22-.81, P=.009) were negatively associated with postpartum PIPV. Only hospital visits remained significant in multivariate analyses (aOR .38, 95% CI .18-.81, P=.012). Deep poverty and prior PIPV were associated with increased odds of postpartum PIPV.

CONCLUSION:
Our results suggest that FI in pregnancy, specifically during hospital stays, may attenuate maternal risk of experiencing postpartum PIPV. Pregnant women lacking paternal engagement may benefit from additional support. Policies and programs to encourage FI during pregnancy could contribute to a reduction in postpartum PIPV.