bluuebunny/crossref_metadata_2025_split huggingface dataset:
Induction of Labor at 38 Weeks and Risk of Cesarean Delivery Among Obese Women: A Retrospective Propensity Match Study [21D]
Authors: Eberle Alexa , Czuzoj-Shulman Nicholas , Abenhaim Haim A. 
Published: April 2020

INTRODUCTION:
The objective of this study was to determine if induction of labor (IOL) in obese women at 38 weeks decreases the risk of cesarean delivery (CD) compared to women who are expectantly managed.

METHODS:
We conducted a retrospective propensity match study using the CDC's Period Linked Birth-Infant Death data. The study population included all singleton, nonanomalous and cephalic births to obese women as of 38 weeks that occurred between 2013 and 2017, inclusively. Women who had a previous CD were excluded. The women who underwent IOL at 38 weeks were propensity matched to women, on the basis of CD risk factors, who were expectantly managed. Conditional logistic regression models were used to compare CD rates and maternal outcomes between obese women undergoing an IOL at 38 weeks and those expectantly managed.

RESULTS:
After 1:5 propensity score matching, there were 117,136 obese women induced at 38 weeks and 585,680 obese women expectantly managed. Overall, the risk of CD among obese women who had an IOL at 38 weeks was lower than those of women managed expectantly, 0.76 (0.75–0.77). The decrease in the risk of CD was more significant in multiparas, 0.62 (0.61–0.64), compared to nulliparas, 0.96 (0.94–0.99). When stratified by BMI, the effect of IOL on CD was most pronounced in women with a BMI >40 kg/m2, 0.74 (0.71–0.77). Maternal outcomes were comparable in both groups.

CONCLUSION:
Induction of labor at 38 among obese women appears to lower the risk of CD without compromising maternal outcomes.
Toxicology Testing in Obstetrics: Which Indications Predict Positive Tests? [33C]
Authors: Perlman Nicola C. , Wilkie Gianna L. , Smith Nicole A. 
Published: April 2020

INTRODUCTION:
Universal screening in pregnancy for substance use is currently recommended, however evidence is lacking regarding indications for toxicology testing. We examined documented indications for urine toxicology (UTox) to determine which were associated with a positive result.

METHODS:
We reviewed all UTox sent on obstetric patients in 2018 at a single, tertiary, academic hospital. Charts of all women who underwent UTox were examined for indications for testing and results of tests. Associations were examined with Chi-Square or Fisher's Exact tests.

RESULTS:
Among >6400 births, 178 UTox were sent on mothers. Indications included abruption (9% of ordered tests), PPROM (10%), preterm labor (19%), none (13.5%), affect (4.5%), history of substance use (20%), limited prenatal care (7%), intrauterine growth restriction (5%), pain (4.5%), “other” including stillbirth, seizure (7%). Of these only historic substance use was significantly associated with a positive UTox (P<.01). Preterm labor was associated with negative UTox (P>.01). Six women with history of substance use reported only cannabis, of whom 5 had only cannabis on their UTox. Of the 14 with opioid use disorder, 9 used medication assisted treatment, of whom 3 had a UTox positive only for their prescribed medications.

CONCLUSION:
Few urine toxicology tests sent on obstetric patients resulted in additional data beyond that provided by history alone. Current practice at our institution did not identify any obstetric indications consistently associated with substance use. Evidence based guidelines for UTox testing, particularly in the absence of substance use screening, are needed.
tPregnancy and Heart Disease: Patient and Healthcare Provider Reported Outcomes [30N]
Authors: D'Souza Rohan D. , Hall Chelsea 
Published: April 2020

INTRODUCTION:
Our objective was to conduct focused interviews with patients, family members and healthcare providers to identify and compare outcomes considered important by each group with what is reported in the literature.

METHODS:
Pregnant patients with a cardiac condition and their family members were recruited from the Mount Sinai Hospital, Toronto, Canada and an international group of healthcare providers were contacted through email via contact lists assembled by study investigators. Semi-structured interviews with an emphasis on eliciting outcomes were conducted until no new outcomes were identified.

RESULTS:
Sixteen participants (13 pregnant women and three partners) completed the interviews. Cardiac conditions included arrhythmias (n=5), complex congenital heart disease (n=5) and valvular heart disease (n=3). Ten healthcare providers primarily from Europe and North America, representing cardiology (n-5), obstetrics (n=3), nursing (n=1) and anesthesiology (n=1) were also interviewed. Patients and family members reported 17 unique outcomes, the most frequent of which were: general health and well-being of baby (n=13); congenital defects (n=6); outcomes related to maternal mental health, stress and fatigue (n=5) and appropriate healthcare management (through medications, follow up, continuity of care) (n=4). Healthcare providers reported 65 outcomes, which included maternal mortality (n=7), prematurity (n=7), arrhythmias (n=6), thrombosis, mode of delivery (n=5) and heart failure (n=5). These reflected those encountered in published literature.

CONCLUSION:
Outcomes considered important by patients and their family members differ from those considered important by clinicians and researchers . Including these outcomes in a core outcome set could improve outcome reporting in studies on cardiac disease in pregnancy.
The Development of a Prediction Model for Vaginal Birth After Cesarean Section (VBAC) [34P]
Authors: Frimer Leora 
Published: April 2020

INTRODUCTION:
Pregnant women who have had a previous cesarean section face the decision to either undergo a repeat elective cesarean or to attempt vaginal birth after cesarean (VBAC). The goal of this project was to determine the factors that predict success of VBAC in women with one prior cesarean section in the population of British Columbia, Canada.

METHODS:
Data were drawn from the British Columbia Perinatal Data Registry. We performed a retrospective analysis of 8291 cephalic term singleton planned vaginal births in British Columbia to women with a previous cesarean. Using block multivariate logistic regression, we analyzed the variables, both modifiable and non-modifiable, most predictive of successful VBAC. A result was considered statistically significant if its p value was <.05.

RESULTS:
Of the 8291 planned VBAC births, 5960 were successful, while 2331 resulted in cesarean deliveries. Predictive variables were: maternal age, height and BMI, whether or not she had a vaginal birth within 2 years of the planned VBAC, whether she had a recurrent indication for the prior cesarean, whether she was administered oxytocin or prostaglandins for labor augmentation or induction, whether she was given an epidural, and the size of hospital in which she gave birth.

CONCLUSION:
A prediction model, incorporating eight variables has been developed. This model can inform shared decision-making and guide individualized counselling for eligible women on the chance of VBAC success. We hope that this prediction model will contribute to the literature and ultimately lower the probability of complications and adverse outcomes in childbirth.
Indications for Primary Cesarean Deliveries and Their Association With Maternal Medical Comorbidities [17P]
Authors: Izewski Joanna , Morgan Jessica C. , Whelan Anna R , Wheatley Catherine , Buhimschi Catalin , Ford Catherine E. 
Published: April 2020

INTRODUCTION:
Abnormal fetal heart tracing (FHT) remains one of the most common indications for primary cesarean delivery (PCD) in the United States. Literature suggests a possible association between maternal medical comorbidities and increased risk of cesarean delivery. This study aims to examine PCD for abnormal FHT stratified by various chronic and pregnancy-related medical comorbidities.

METHODS:
We used a retrospective cohort study design. Following IRB approval, electronic medical records were queried for all cesarean deliveries (n=666) performed at a single University hospital from January 1, to December 31, 2018. Data collected included maternal demographic, medical, and delivery information. Parametric and non-parametric tests were used for data analysis.

RESULTS:
Out of all cesarean deliveries, 357 surgeries were identified as PCDs. Most common maternal medical comorbidities included chronic hypertension (HTN) (11%, 39/357), pre-gestational diabetes mellitus (DM) (2.5%, 9/357), gestational HTN (9.5%, 34/357), preeclampsia without severe features (SF) (5%, 18/357), preeclampsia with SF (15%, 53/357), gestational DM (9.5%, 34/357). Subjects with chronic HTN (P=.003) and pre-gestational DM (P=.006) had a statistically significant higher rate of PCD for abnormal FHT. No difference was found for all other medical comorbidities.

CONCLUSION:
Our study suggests that patients with pre-existing medical comorbidities may have a statistically significant higher rate of PCD for abnormal FHT than other pregnancy-related medical comorbidities. Further prospective studies are needed to confirm this potential association and possibly aid in improving preventative measures for reducing PCD.
Agreement Between Providers When Determining Primary Cesarean Deliveries for Fetal Heart Tracings [03P]
Authors: Whelan Anna , Morgan Jessica C. , Izewski Joanna , Wheatley Catherine , Buhimschi Catalin , Ford Catherine E. 
Published: April 2020

INTRODUCTION:
The most common indications for primary cesarean delivery (PCD) in the US are labor dystocia and abnormal fetal heart tracing (FHT). Category II tracings make up the majority of intrapartum tracings and management may differ among providers (Obstetricians [OB], midwives [CNM], and family medicine physicians [FM]). This study aims to determine the characteristics of FHT which resulted in PCD at UI Health (UIH) by provider type.

METHODS:
IRB approved, retrospective cohort study of primary CD at UIH during 2018. Data was abstracted from electronic medical records and analyzed in SPSS.

RESULTS:
357 PCD occurred during the study period. The most common indication for PCD was abnormal FHT (45.1%), malpresentation (18.2%), followed by labor dystocia (18.1%). When stratifying for provider type, FM had more CD for labor dystocia, while OB and CNM had more for FHT. However, when removing other objective indications, such as placenta previa and malpresentation, FHT was the most common regardless of which service managed antepartum and intrapartum care (45.1%, P=.12). The majority of tracings at the time of decision for CD were category II (84%). Minimal variability was present in (56%, P=.16). Late decelerations were most common at time of CD (46.6%, P=.17), followed by variable (41%, P=.55) and prolonged (15%, P=.14).

CONCLUSION:
Since standardization of categories of FHT by NICHD, there seems to be agreement among providers in terms of the management of category II tracings. More data is needed to confirm this trend, while continuing efforts to improve intrauterine resuscitation in order to decrease the PCD rate.
The Influence of Intrapartum Events on Patient Understanding in Labor [37O]
Authors: Varghese Elizabeth , Day Marilyn , Valdes Hannah , Garry David , Garretto Diana 
Published: April 2020

INTRODUCTION:
There is a paucity of research about how much clinical and subjective variables influence a woman's understanding of the labor process. This study evaluates the correlation between intrapartum variables and patient understanding.

METHODS:
This is a cross-sectional observational study. Women completed surveys in the immediate postpartum period which assessed patient understanding of intrapartum events and patient satisfaction. Survey responses were compared to patient charts to determine patient understanding. Logistic regressions determined predictors of patient understanding.

RESULTS:
332 women completed surveys. 62% had vaginal deliveries, 57% were multiparous, 88% had regional anesthesia, and birth classes were attended by 84% of participants. 20% of women had postpartum hemorrhages. 74% of women self-reported maximum satisfaction, but 30% of women had 100% understanding of their intrapartum course. A significantly greater percentage of women who had 100% patient understanding reported maximum satisfaction (P=.006) with a correlation coefficient of 0.13 (R=0.13, 95% CI 0.03–0.24, P=.02). Patient satisfaction was higher in women with a vaginal delivery (P=.006), but vaginal deliveries, multiparity, advanced maternal age, regional anesthesia, feeling the doctor explained the labor course well, confidence in their doctor, support in labor, and having a birth plan/birth classes were not predictors of patient understanding. Women who felt they had high input into managing their labor increased patient understanding (OR 2.75, 95% CI 1.35–5.59, P=.005) and postpartum hemorrhage decreased it (OR 0.35, 95% CI 0.16–0.75, P=.008).

CONCLUSION:
Patient understanding in labor is decreased in postpartum hemorrhages but improved in women who felt they had input into their labor course.
Sex-Specific Differences in Neonatal Morbidity at Term [34O]
Authors: Bailey Erin , Raghuraman Nandini , Woolfolk Candice , Palanisamy Arvind , Macones George , Cahill Alison 
Published: April 2020

INTRODUCTION:
Male sex is associated with worse outcomes among preterm neonates, but it is unclear if such sex discordant morbidity occurs in term infants. The aim of this study was to investigate the relationship between fetal sex and neonatal morbidity at term gestation.

METHODS:
This is a secondary analysis of a prospective cohort of women admitted for labor at term within a single institution from 2010 to 2015. The primary outcome was composite neonatal morbidity that included death, respiratory distress, mechanical ventilation, meconium aspiration syndrome, suspected sepsis, hypoxic-ischemic encephalopathy, therapeutic hypothermia, and seizure. Multivariable logistic regression was used to estimate the association between infant sex and neonatal morbidity.

RESULTS:
Of the 8578 participants, 51% delivered a male fetus. Birthweight was higher in male infants (3304 g vs 3177 g, P<.01), as were the rates of prostaglandin administration (19.0 vs 11%, P<.01), operative vaginal (4.0 vs 5.6%, P<.01), and cesarean delivery (15.4 vs 18.6%, P<.01). After adjusting for birthweight, male infants had a significantly higher risk of composite neonatal morbidity (aOR 1.21 [95% CI 1.04, 1.40]). This association was driven primarily by a higher rate of respiratory distress in male infants (1.34 [1.07, 1.68]).

CONCLUSION:
Term male infants appear to be at increased risk for neonatal morbidity compared to females even after adjustment for birthweight. This association was partly driven by a higher rate of respiratory morbidity in male infants. Our findings reinforce the current notion that neonatal outcomes can be sex-dependent, and call for further investigation into the physiologic mechanisms driving this association.
Quantitative MRI Measures of In Utero Feto-Placental Trajectories in Healthy Pregnancies [31O]
Authors: Amgalan Ariunzaya , Limperopoulos Catherine , Kapse Kushal , Quistorff Jessica , Bannantine Kathryn , Andescavage Nickie 
Published: April 2020

INTRODUCTION:
The birth weight-placental weight ratio, a metric of placental efficiency in supporting fetal growth, is associated with fetal demise, neonatal and maternal morbidity. However, in vivo measures of placental health remain lacking. This study uses fetal body and placental volume metrics to (1) characterize in utero feto-placental growth patterns using in vivo three-dimensional MRI and (2) explore these associations with neonatal outcomes.

METHODS:
IRB approval was obtained. In a prospective observational study, healthy women with singleton pregnancies greater than 18 weeks gestation were recruited and underwent fetal MR imaging. The fetal body and placenta were manually outlined using ITK-SNAP software, volumes were calculated in mm3 and feto-placental ratio (FPR) was derived. Clinical data including gestational age (GA) at delivery, birthweight (BW) and corrected birthweight (BW z-score) were obtained.

RESULTS:
Thirty-five women underwent fetal MRI between 25 and 38 completed weeks gestation (mean=31.98±4.20). All pregnancies resulted in live births; 3 (8.5%) infants had birth weights less than 10% and 2 (5.7%) delivered before term. There was a positive association between GA and both fetal body volumes (FBV) and placental volumes (PV) (P<.001 for both) and between GA and FPR (P<.001). There was no association between in vivo FPR and GA at delivery or BW z-score, even with controlling for GA at MRI (P=.12–.88).

CONCLUSION:
We describe in utero trajectories for fetal-placental growth in healthy pregnancies using quantitative MRI tools. Understanding normal patterns of fetal-placental development are needed to be able to detect early in utero placental failure prior to the onset of fetal harm.
Predictors of Expedited Delivery in the Presence of Severe Fetal Acidemia (Umbilical Cord Arterial pH <7) [30O]
Authors: Brendel Katelyn , Gan Sarah , White Chase , Goldberg Jay 
Published: April 2020

INTRODUCTION:
The purpose of this study was to determine which characteristics of EFM in babies with severe acidemia (umbilical cord arterial pH <7) affected whether delivery was expedited or not.

METHODS:
A retrospective cohort study was performed on babies with umbilical cord arterial pH <7. Two groups were identified: (1) expedited delivery (either operative vaginal delivery or urgent/emergent cesarean section) and (2) non-expedited delivery (spontaneous vaginal delivery, scheduled or non-urgent cesarean section). The last hour of EFM was reviewed. Maternal, labor, and neonatal characteristics between the groups were compared using Chi-squared test for independence and the Fisher's Exact Test. IRB approval obtained.

RESULTS:
Thirty neonates with umbilical cord pH <7.0 were identified. Of these, 47% were delivered in expedited fashion. There was no statistical difference between groups in average umbilical cord arterial pH or base excess, gestational age, if labor was induced, length of labor, Pitocin usage for labor augmentation, sentinel events, 5 minute Apgar score or neonatal length of stay. Recurrent late decelerations were more likely to be present in the expedited delivery group (31% vs. 0%), while moderate variability (100% vs. 69%), accelerations (77% vs. 31%), and category I tracing (46% vs. 8%) were more common in the non-expedited group.

CONCLUSION:
In babies born with umbilical arterial pH of <7, expedited delivery was more common in the presence of recurrent late decelerations during the last hour of fetal monitoring. A Category I fetal heart tracing, moderate variability, and accelerations were more common when the delivery was not expedited.
Impact of the Affordable Care Act on Cervical Cancer Trends in New Orleans [32H]
Authors: Masri Amal , Steinmetz Leah , Robinson William R. 
Published: April 2020

INTRODUCTION:
To examine trends among women diagnosed with cervical carcinoma in New Orleans before and after the Affordable Care Act’s (ACA’s) Medicaid expansion was implemented in Louisiana in January 2016. Age at diagnosis, time since last doctor’s visit, progression free survival (PFS), and overall survival (OS) were analyzed between racial groups.

METHODS:
Subjects with Medicaid coverage diagnosed with cervical cancer at an urban medical center between 2005-2019 were identified via hospital databases. Data were reviewed retrospectively and analyzed using SPSS.

RESULTS:
451 subjects (310 black, 103 Caucasian, 38 Hispanic) were identified: 375 pre-ACA (2005-2016) and 76 post-ACA (2016-2019). All comparisons pre- vs post-ACA and results not statistically significant unless specified. Cumulative analysis: age 49.9 vs 53.0 years (P<.001), doctor’s visit 18.7 vs 16.4 months (P<.001), PFS 52.5 vs 71.2 months (P<.001), and OS 57.6 vs 72.9 months (P<.001). Black: age 49.8 vs 49.0 years; doctor’s visit 19.2 vs 15.3 months; PFS 45.2 vs 36.9 months; OS 49.8 vs 39.5 months. White: age 51.9 vs 53.8 years; doctor’s visit 14.9 vs 11.0 months; PFS 50.4 vs 75.7 months (P<.006); OS 56.6 vs 77.3 months (P<.01). Hispanic: age 50.2 vs 42.4 years (P<.001), doctor’s visit 23.0 vs 19.5 months; PFS 54.5 vs 72.4 months; OS 59.0 vs 75 months.

CONCLUSION:
The ACA’s Medicaid expansion was associated with decreased time since last doctor’s visit and increased PFS and OS, notably in Hispanics and Caucasians. Hispanic women were diagnosed at earlier ages post-ACA which likely influenced early treatment and favorable prognoses. Conversely black women had decreased PFS and OS post-ACA which approached statistical significance, and they had the lowest PFS and OS pre-and post-ACA of all groups. This suggests access to care is not the only factor influencing cervical cancer outcomes in this disproportionately affected group.
Analyzing Patient Experiences From Crowd-Sourced Reviews of Crisis Pregnancy Centers in California [05I]
Authors: Chan Elaine , Korotkaya Yelena , Sridhar Aparna 
Published: April 2020

INTRODUCTION:
Crisis Pregnancy Centers (CPCs) are non-profit organizations that claim provision of pregnancy counseling resources. As more patients utilize online reviews to select healthcare providers, we evaluated patient experiences of CPCs through analysis of crowd-sourced review forum, specifically Yelp.

METHODS:
Active CPCs were identified using the Crisis Pregnancy Center Map, derived from directories maintained by CPC national organizations. Yelp listings were identified using business name or address. Reviews were collected from every CPC in California with a Yelp listing. Repeated ideas and concepts were tagged with codes extracted from data.

RESULTS:
We identified 145 active California CPCs. 122 had Yelp listings. 619 total Yelp reviews were extracted by October 1st, 2019. There were 503 5-star reviews, 14 4-star, 3 3-star, 16 2-star, and 83 1-star in total. Among negative reviews (n=102), 6 themes emerged: inadequacy of medical care, lack of transparency, paternalistic approach, poor customer service, psychological harm. Among a positive review set (n=100), patient satisfaction resulted from faith-based care, accessibility of CPCs for uninsured individuals, free services, patient treatment, crisis counseling. 12.5% of reviews voiced financial stress or lack of insurance.

CONCLUSION:
Crowd-sourced review forums may provide data into the quality of care perceived by patients in CPCs. 84% of CPCs in California use Yelp. Patients ambivalent on pregnancy outcome felt their care was inappropriate, whereas patients continuing pregnancy felt supported. Positive reviews were not related to quality of medical care. The results of this study may help explain the wide disparity commonly observed between conventional quality metrics and crowd-sourced online reviews.