bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality of Care and Communication With Limited English Proficiency (LEP) Obstetric Patients [37J]
Authors: Sanserino Kathryne A. , Papatla Katyayani , Aioub Miriam , Gee Tiffany , Datwani Hema 
Published: April 2020

INTRODUCTION:
Hospital guidelines and standards recommend the routine use of professional interpreters for patients with Limited English Proficiency (LEP). There is no preexisting data on LEP obstetrics patients and their communications with physicians and nurses. Our objective was to review English LEP patients’ communication with physicians and nurses during their delivery hospitalization, including the use of interpreters and language proficient providers, as well as its association with patient satisfaction.

METHODS:
Cross-sectional study with in-person survey methodology and retrospective chart review of patients admitted to our postpartum service after delivery at our institution. IRB exempt.

RESULTS:
148 postpartum patients were screened. After applying inclusion and exclusion criteria, 20 patients participated in the survey. 70% of these patients were admitted by non-language proficient provider. Of these, only 36% documented use of interpreter during admission. 2 of the 3 patients who underwent cesarean section reported that the reason for cesarean was explained to them in English without the use of interpreter. Despite this, there was reported 100% satisfaction with overall physician care, physician communication with respect to medical condition, and physician respect for culture and language.

CONCLUSION:
We hypothesized that the rate of use of interpreters and language-proficient providers would be poor, and this proved to be correct in our internal review. The high reported rates of patient satisfaction with both physician and nursing care, communication, and perception of respect for culture and language was a seemingly discordant finding that warrants further exploration. Patient satisfaction drivers may be somewhat different for obstetric populations. This warrants further investigation.
Rate of Cervical Change During Ripening in Nulliparous Women Using Vaginal or Buccal Misoprostol [38J]
Authors: Grasch Jennifer , Quinney Sara K. , Haas David M. 
Published: April 2020

INTRODUCTION:
Cervical ripening is frequently needed for labor induction in nulliparous women. The objective of this study was to determine if the rate of cervical change and time to active labor were different when misoprostol is administered by vaginal or buccal route.

METHODS:
This was a secondary analysis of nulliparous women enrolled in the IMPROVE Study- A comparison of vaginal versus buccal misoprostol for cervical ripening in women for labor induction at term: a triple-masked randomized controlled trial. Primary outcomes were time to active labor (defined as at least 6 cm cervical dilation) and rate of change of cervical dilation up to active labor. Survival analysis using Product-Limit Survival Estimate and Kaplan-Meier method was utilized for time to active labor. IRB approval was obtained.

RESULTS:
Of the 300 women enrolled in the trial, 124 (41.3%) were nulliparous, with 59 receiving vaginal misoprostol and 65 receiving buccal. Nulliparous women receiving vaginal dosing required fewer doses to reach active labor (2.0 vs 3.0, P=.003). However, this did not result in shorter time to active labor (median 23.1 hrs vs. 25.6, P=.49). The rate of cervical change for the vaginal misoprostol group from trial entry to ≥6 cm was 2.9 (±1.6) mm/hr compared to 2.9 (±1.6) mm/hr for buccal (P=.97).

CONCLUSION:
In nulliparous women undergoing cervical ripening with misoprostol, vaginal dosing may require fewer doses to achieve active labor but the time to active labor and rate of cervical change were similar between dosing groups. There may not be clinically meaningful differences between dosing routes in nulliparous women.
The Association of Maternal Education on Prenatal Care Sufficiency [39J]
Authors: Stephens Kendal K. , Fresch Robert J. , Degrandis Michael , DeFranco Emily 
Published: April 2020

INTRODUCTION:
Low maternal education is an independent risk factor for adverse maternal and neonatal outcomes. We investigated the association between maternal educational attainment and prenatal care quantity to identify an at-risk population who may benefit from public health programs.

METHODS:
Population-based retrospective cohort study of live births in Ohio, 2005-2016. The exposure was maternal education defined as highest educational attainment ≤8th grade, 9-11th grade, or high school graduate. The outcome was adequate care defined as ≥50% of recommended visits for gestational age at birth, inadequate care was <50% of recommended, versus no prenatal care. The Kessner Index was utilized for this calculation. Sociodemographic, maternal, and obstetric characteristics were compared between amount of education and prenatal care. Multivariate logistic regression estimated the relative association of maternal education on prenatal care adequacy after adjusting for coexisting risk factors.

RESULTS:
Of 1,452,855 live births, 84% achieved high school graduation while 12.2% attended high school, and 3.3% had ≤8th grade education. Furthermore, 6.7% received insufficient and 2.2% received no prenatal care. The adjusted relative risk of obtaining no prenatal care was >2-fold increased for ≤8th grade (aRR 2.5, 95% CI 2.4-2.7) and high school without completion groups (aRR 1.9, CI 1.8-1.9). The risk of inadequate care was also increased, aRR 4.9 (CI 4.8-5.0), and 1.8 (CI 1.8-1.9), respectively, even after adjustment for maternal race and Medicaid.

CONCLUSION:
Low maternal education is associated with lack of prenatal care. Public health initiatives targeting adolescent education on reproductive health may be an opportunity to improve perinatal outcomes.
The Impact of Episiotomy on Adverse Perinatal Outcomes in Operative Vaginal Deliveries [40J]
Authors: Owens Sarah N. , Thayer Sydney Marie , Yanit Keenan , Garg Bharti , Caughey Aaron B. 
Published: April 2020

INTRODUCTION:
There has been a large reduction in routine episiotomy, thus many provided today are likely clinically indicated. Thus, we sought to investigate the association between episiotomy and adverse perinatal outcomes in operative vaginal births.

METHODS:
This is a retrospective cohort study of singleton, non-anomalous, term spontaneous vaginal deliveries between 2007 and 2011 using linked vital statistics and ICD-9 data. The neonatal adverse outcomes examined included brachial plexus injury (BPI), clavicular fracture (CVFs), 5-min APGAR score <7, neonatal intensive care unit (NICU) admission, and composite of severe neonatal outcomes (neonatal seizure, APGAR score ≤3, and neonatal death). The maternal adverse outcomes examined included postpartum hemorrhage (PPH), 3rd and 4th-degree perineal lacerations, and maternal blood transfusion (MBTs). Chi-square tests were used to compare rates of perinatal adverse outcomes for births with and without episiotomy. Multivariable logistic regression was used to control for maternal BMI, diabetes status, race/ethnicity, age, education, insurance status, parity, and prenatal care.

RESULTS:
In a cohort of 161,921 operative vaginal births, we found no statistically significant difference for adverse neonatal outcomes for births with and without episiotomy. Interestingly, women with episiotomy had decreased rates of postpartum hemorrhage, a relationship that remained after controlling for confounders of interest (aOR 0.55, 95% CI 0.35-0.84).

CONCLUSION:
Our study demonstrates that episiotomy does not improve neonatal outcomes in the setting of operative vaginal delivery and was not associated with severe perineal laceration, but that it may decrease the odds of maternal postpartum hemorrhage. Careful clinical consideration should be exercised when deciding to use an episiotomy.
A Retrospective Review of Cesarean Deliveries for Suspected Fetal Macrosomia: Were They Indicated? [02K]
Authors: Cate Jennifer , Arkfeld Christopher , Haynes Meagan Campol 
Published: April 2020

INTRODUCTION:
For low risk pregnancies, cesarean deliveries have a greater risk of morbidity and mortality than vaginal deliveries. Fetal macrosomia, especially at weights greater than 4500 g, also increases risks of both neonatal and maternal morbidity. Macrosomia, with estimated fetal weight (EFW) greater than 5000 g or greater than 4500 g in women with diabetes mellitus, is the currently accepted ACOG threshold at which cesarean delivery may be offered. This study evaluates current adherence to ACOG guidelines for cesarean deliveries for macrosomia at a large academic medical center.

METHODS:
We analyzed cesarean deliveries performed for suspected fetal macrosomia among individuals undergoing cesarean delivery between September 2018 and August 2019. Using the recorded EFW and actual birthweights, we determined whether criteria for indicated cesarean delivery for macrosomia was met.

RESULTS:
During the study period, 1,716 cesarean deliveries were performed with 24 performed for presumed macrosomia. The average EFW among those 24 undergoing primary cesarean delivery was 4399g. Of the 24 deliveries, 7 pregnancies were complicated by diabetes. Only 4 (17%) met the EFW thresholds, 2 of which had pregnancies complicated by diabetes. The average difference in EFW and actual birthweights was 371g (8%). 13 of the 24 ultrasounds performed for macrosomia had EFWs larger than the actual birth weight.

CONCLUSION:
The majority of primary cesarean deliveries performed for macrosomia did not follow currently accepted ACOG guidelines. Quality improvement initiatives aimed to improve adherence to these guidelines may provide an opportunity to facilitate efforts to decrease primary cesarean delivery rates.
Can We Use Non Invasive Prenatal Testing to Determine Adverse Obstetrics Outcomes? [07K]
Authors: Jackman Janelle , Riccardi Mary Ann , Boisjoli Talya , Azaida Aleena , Robertazzi Robert , Waldron Shervonne 
Published: April 2020

INTRODUCTION:
The purpose of this study was to determine if an increased fetal fraction of cell free DNA (cfDNA) in maternal plasma collected during first and second trimester aneuploidy screening is predictive of adverse obstetric complications related to placental dysfunction including preeclampsia, IUGR, preterm birth, PIH and GDM. Therefore possibly implementing early interventions which may reduce the mortality and morbidity associated.

METHODS:
Retrospective study on women with singleton pregnancies who underwent first/second trimester noninvasive Prenatal Testing between 2017 and 2019 at Brooklyn Hospital Center. The fetal fraction of each sample, gestational age and maternal weight was obtained. EMR was used to obtain maternal characteristics/obstetric records such as age, BMI, ethnicity, parity, significant past medical history, social history, antepartum course and gestational age at delivery. Obstetric complications, if any, were identified. Data was transcribed to Microsoft Excel, eliminating any definitive patient identifiers to maintain confidentiality during analysis. Statistical analysis utilized descriptive statistics, the Students t-test for equality of means and linear regression. Probability outcomes <0.05, were statistically significant.

RESULTS:
Patients with preeclampsia had a mean CfDNA fetal fraction of 8.86% +3% which was statistically significant (P=.040) as compared to 11.61% + 5% for the non-preeclampsia group. The BHCG from sequential part 1 was higher in the preeclampsia group (P<.05).

CONCLUSION:
Our results indicated fetal fraction and BHCG (from Sequential Part 1) are predictive of preeclampsia. No other obstetric complications correlated to fetal fraction CfDNA. However there was a narrow sample size of obstetric complications and complete serum marker profiles for sequential screens.
Cervical Length Screening Versus History-Indicated Cerclage in Women With Prior Early Preterm Birth [08K]
Authors: Grantham Lindsey , McLaughlin Eric , Hade Erinn , Smith Devin D. , Samuels Philip , Frey Heather A. 
Published: April 2020

INTRODUCTION:
The objective of this study was to compare the rate of recurrent preterm birth (PTB) <37 weeks in women with prior early PTB who underwent history-indicated (HI) cerclage versus cervical length (CL) screening with cerclage when indicated.

METHODS:
This retrospective cohort study included women with a singleton pregnancy and a prior spontaneous PTB between 16w0d and 27w6d weeks. The primary outcome was PTB <37 weeks; secondary outcomes included PTB <34 and <28 weeks, spontaneous PTB, and NICU admission. Fisher exact tests and Wilcoxon rank-sum tests were used to compare baseline characteristics and in unadjusted analyses of the outcomes. Marginal logistic regression was used to adjust for confounders and account for women with multiple pregnancies during the study period.

RESULTS:
Among 357 women, 49 (14%) underwent HI cerclage and 308 (86%) underwent CL screening. HI cerclage patients presented to prenatal care earlier, delivered earlier in their prior pregnancies, and were more were more likely to have had a previous cerclage. Only 84 (27%) women who underwent CL screening required cerclage. Of the 49 women with HI cerclage, 26 (53%) had recurrent PTB versus 43% (n=132) in the CL screening group. The odds of PTB were not significantly different between the two groups (aOR 0.92, 95% CI 0.44-1.92, P=.82). Secondary outcomes did not differ significantly.

CONCLUSION:
Our results support preferential use of cervical screening for most women with prior early PTB, as it may avoid cerclage in 2/3 of women. This information is useful when counseling high-risk patients about management options.
Cervical Length Surveillance After 24 Weeks in Women With a History of Spontaneous Preterm Birth [09K]
Authors: Jones Eboni , Whitley Kari , Quinones Joanne , Durie Danielle , Fradeneck Katherine 
Published: April 2020

INTRODUCTION:
Cervical length surveillance (CLS) can identify women at increased risk for recurrent spontaneous preterm birth (sPTB) based on transvaginal ultrasound (TVUS). CLS between 24 and 28 weeks is at times performed to administer corticosteroids to women considered at risk of recurrent sPTB. Primary objective was to evaluate the relationship between cervical shortening between 24 and 28 weeks and recurrent sPTB.

METHODS:
Retrospective cohort study of women with history of singleton sPTB between 24 and 32 weeks, who underwent CLS between 24 and 28 weeks at Lehigh Valley Hospital from 2012-2018. IRB approval was obtained. Exposure of interest was cervical shortening less than 2.5 cm. Primary outcome was delivery less than 37 weeks. Secondary outcomes included rate of antenatal interventions and interval between betamethasone administration and delivery.

RESULTS:
3,545 women underwent TVUS for CLS. 118 (3.3%) with CLS between 24 and 28 weeks met inclusion criteria. Cervical shortening was identified in 16 (13.6%) women. Primary outcome was similar among women with short versus normal cervical length. After adjustment, sPTB less than 37 weeks did not correlate with cervical shortening between 24 and 28 weeks, but with clinical preterm labor (AOR 4.02, 95% CI 1.2–13.4; P=.02).

CONCLUSION:
In our population, the risk of sPTB less than 37 weeks was not predicted by the diagnosis of cervical shortening between 24 and 28 weeks. Our data suggest that the clinical presentation of spontaneous preterm labor, not CLS, is the significant risk factor for sPTB in a subsequent pregnancy for women with a history of sPTB.
Dancing During Labor: Are Women Down to Boogie? [11K]
Authors: Kram Jessica J. , Horter Drew , Heslin Kayla , Forgie Marie M. , Malloy Emily 
Published: April 2020

INTRODUCTION:
Dancing during the final weeks of pregnancy and in the first stage of labor are recent social media trends. Few studies have evaluated the effects of low-impact dance during the first stage of labor, particularly for pain management and impact on labor duration. As enrollment is often a challenge when conducting prospective studies, we conducted a feasibility study to gauge the willingness of pregnant patients to participate in a future study that would involve low-impact dance during labor.

METHODS:
During June-July 2019, we anonymously surveyed English speaking/reading pregnant women who were receiving prenatal care at one of three clinics. Data for questions related to demographics, current activity level, pregnancy history, and interest in future participation were collected. Women who did not meet eligibility criteria were excluded from descriptive analyses. The study was approved by local Institutional Review Board.

RESULTS:
Overall, 132 of the 177 (74%) women approached completed the survey; 89% indicated that they would hypothetically participate in a future study of low-impact dance. Regardless of demographic characteristics, current activity level, and pregnancy history, there was a high rate of interest in future participation. Only 48% and 34% of interested women preferred that dance moves or music were provided, respectively. However, over 70% wanted either a video clip or photo of themselves dancing.

CONCLUSION:
As 89% of pregnant women would be interested in participating in a future study on low-impact dance during labor, enrollment may be less problematic than previously expected. Such a study is warranted to identify alternative methods for pain management.
Experiences of Women Receiving Failed Non-Invasive Prenatal Testing (NIPT) Results [13K]
Authors: Murphy Kady , DeLoria Madeline , Fanos Joanna , Turocy John , Weil Jon , Barr Kimberly 
Published: April 2020

INTRODUCTION:
Non-invasive prenatal testing (NIPT) usually returns a result; however, a small percentage of samples are reported as “no results”. This study aimed to understand the experiences of women who received failed NIPT results and identify strategies to guide clinicians.

METHODS:
A retrospective questionnaire collected responses from 91 women who received a failed NIPT result in a current or recent pregnancy. Questions assessed the women’s knowledge of NIPT, understanding of the failed result and increased risk of chromosomal anomaly, emotional impact, and follow-up testing decisions. Semi-structured telephone interviews expanded on initial questions and were completed by 47.3% (43) of respondents.

RESULTS:
Only 27.5% (25/91) of women knew that NIPT could show no result prior to testing and 78.0% (71) reported a moderate to high worry score of 6 or higher (10-point scale) upon receiving the failed result. 98% chose to repeat NIPT after the initial failed result. A post-test counseling time of less than 10 minutes was considered insufficient (P<.1). Participants suggested that clinicians should provide more pre-test information about possible failed results, communicate results by direct contact versus email, and convey more details when reporting failed results.

CONCLUSION:
These results indicate how clinicians might better inform patients concerning failed NIPT results. Given the strong preference for more pre-test information and the intense emotional response of receiving a failed NIPT result, we recommend pretest counseling include discussion about a possible failed NIPT result and its consequences, and that sufficient time is allotted for post-test counseling when providing failed results.
Factors Associated With Failed Routine Aneuploidy Cell-Free DNA Screening: A Systematic Review [14K]
Authors: Gomez Julie , Oliver Emily A. , Al-Kouatly Huda B. 
Published: April 2020

INTRODUCTION:
Cell free DNA (cfDNA) is the recommended screening test for aneuploidy in women age 35 and over. We conducted a systematic review of factors associated with a failed cfDNA result following routine aneuploidy screening.

METHODS:
PubMed, Scopus, Clinicaltrials.gov and Cochrane were searched for articles from inception to October 2018. Patients undergoing routine cfDNA aneuploidy screening at ≥ 10 weeks gestational age and who had a viable pregnancy were included. Cohort studies and randomized controlled trials were included. Case reports and case series with less than five patients were excluded. The outcome was test failure.

RESULTS:
Our search yielded 756 results. 19 studies met our inclusion criteria and included 506,709 patients. Aneuploidy, maternal obesity, Low-Molecular Weight Heparin (LMWH), and IVF were associated with increased rates of test failure. 12 articles reported aneuploidy as an associated factor in inconclusive results, specifically triploidy and trisomies 13, 18, and 21. One study reported trisomy 9 in a result failure. In six studies, obesity was associated with higher failure rates. Failure rates in obese women was reported at 51.5% compared to 0.7% in non-obese women in one study. Two studies reported increased failure rates in women with LMWH. 75% of women who received failed results were on LMWH in one study. One study reported a 3% higher test failure rate in women who underwent in-vitro fertilization.

CONCLUSION:
Fetal aneuploidy, maternal obesity, LMWH, and IVF are associated with increased rates of failure in cfDNA following routine aneuploidy screening.
Identification of Fetal Growth Restriction in Pregnant Women With Prior Bariatric Surgery [16K]
Authors: Cruz Meredith , Harrison Rachel , Allen Katherine , Braun Emilie , Semons-Booker Kia , Wlodarczyk Katarzyna 
Published: April 2020

INTRODUCTION:
Scant formal guidelines exist regarding antenatal ultrasounds in pregnant women with prior bariatric surgery. Considering rates of small-for-gestational-age (SGA) infants may be increased, we investigated whether antenatal ultrasounds were predictive in this population compared to controls.

METHODS:
Women with prior bariatric procedures were matched to controls by early pregnancy body mass index (BMI). 182 women with prior bariatric procedures and 190 controls were identified and the frequency of prenatal fetal growth restriction and postnatal SGA were examined. Sensitivity, specificity, and area under the curve (AUC) for diagnosis of SGA were calculated for both groups.

RESULTS:
Among all women with prior bariatric surgery, 116 (63.7%) had two or more ultrasounds after anatomic survey compared to 89 (46.3%) controls. The average BMI in both groups was 35.3 kg/m2. Out of 19 infants found to be SGA at birth in the bariatric procedure group, 7 were diagnosed prenatally. Out of 21 infants with SGA in the control group, 6 were diagnosed prenatally. When analyzing women who had 2 or more ultrasounds after anatomic survey specifically, the sensitivity was 35.3% for prior bariatric surgery and 54.5% for controls. Specificity was greater than 98.5% for both groups. AUC for two or more ultrasounds was 0.766 (95% CI 0.61-0.92) for controls and 0.689 (95% CI 0.57-0.81) for prior bariatric surgery, P=.436.

CONCLUSION:
Sensitivity for diagnosis of SGA is low in women with prior bariatric surgery, but is not different when compared to BMI-matched controls. The low sensitivity is likely a product of elevated BMI in both groups.