bluuebunny/crossref_metadata_2025_split huggingface dataset:
Conservative Management of Preeclampsia (CMOP): A North Carolina Quality Improvement Project [08L]
Authors: Ollendorff Arthur , Cochran Keith , DeJoseph Jodi , Greenberg Rachel , Gutierrez Susan , McCaffrey Marty 
Published: April 2020

INTRODUCTION:
According to birth certificate data, hypertension in pregnancy is a leading cause of premature births in North Carolina. A quality improvement project was developed using the 2014 Hypertension in Pregnancy guidelines to properly diagnose hypertensive disorders of pregnancy and see which diagnoses led to premature birth.

METHODS:
Birthing hospitals in North Carolina participated in a quality improvement project sponsored by the Perinatal Quality Collaborative of North Carolina. In phase one of the project, hospitals attended a series of monthly webinars, semiannual face-to-face meetings and received periodic support from the PQCNC core team to review best practices to correctly diagnose each of the hypertensive disorders. Hospitals submitted monthly data about their delivered mothers with any hypertension in pregnancy diagnosis through a secure web portal.

RESULTS:
Twenty-two birthing hospitals participated in phase one of the project between March 2015 and March 2016 accounting for 56,743 deliveries (48% of the deliveries in the state). There were 7,550 women (13.3%) with any hypertension in pregnancy diagnosis. 661 of these women delivered prior to 34 weeks and 1254 delivered prior to 37 weeks. The cost common hypertension diagnosis related to prematurity was preeclampsia with severe features (48%).

CONCLUSION:
More than half of the premature infants born to mothers with hypertension in North Carolina were delivered with a diagnosis other than preeclampsia with severe features. With a more complete picture of the severity of hypertension in pregnancy and the role it plays in prematurity in North Carolina, women's health leaders in the state can define potential interventions.
Maternal Near Miss at a Tertiary Teaching Hospital in Mekelle, Ethiopia [21L]
Authors: Yeman Awol , Teka Hale , Zelelow Yibrah Berhe , Mohammednur Sumeya , Goba Gelila , George Jessica 
Published: April 2020

INTRODUCTION:
A peripartum near-miss event occurs when a woman nearly dies, but survives a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy. As maternal deaths are rare occurrences, near-miss cases can be used instead to elucidate the events leading to complications and the obstacles that must be overcome to treat complications, hence providing valuable information on obstetric care. This study aimed to assess maternal near miss at Ayder Referral Hospital (ARH).

METHODS:
Our study was a retrospective chart review of near miss cases seen at ARH between July 1, 2016 and June 30, 2017. WHO near miss criteria was used to select cases.

RESULTS:
Over the study period, there were 3,899 deliveries, 236 near miss, and 13 maternal deaths at ARH. The leading causes of near miss were hemorrhage (41.9%), hypertensive disorders of pregnancy (41.1%), sepsis (9.3%), labor abnormality (4.6%), and medical disorders of pregnancy (3.6%). In terms of timing of near miss diagnosis, 37.7% occurred antenatally, 25% intrapartum, 32% postpartum, and 5.1% post abortion. 86% of cases were referred from other health facilities. Majority of the patients (80%) arrived to our hospital in critical condition. Ninety percent of the near miss cases had antenatal care (ANC) at health center.

CONCLUSION:
Near miss is substantial problem in North Ethiopia. Most referred patients arrived in critical condition, suggesting support and transportation from referring institutions should be improved. Additional research is need to assess the quality ANC given that 90% of the near miss cases had ANC.
Betamethasone-Induced Atrial Fibrillation With Rapid Ventricular Response in Pregnancy: Case Report [05M]
Authors: Verkh Dave , Chalifour Stephanie , Giannina Gregg , Yassin Haidar , Scibetta Craig , Greenspan David L. 
Published: April 2020

INTRODUCTION:
Atrial fibrillation (AF) is a common cardiac arrhythmia but a rare occurrence in obstetrical patients.

METHODS:
A 24-year-old G6P2032 without significant medical history presented at 32 3/7 weeks gestation for routine obstetrical care. The fetus was suspected to have a hypoplastic right heart via fetal echocardiography at 24 5/7 weeks of gestation. She reported decreased fetal movement and audible fetal decelerations were noted during her exam. The patient was referred to the hospital and was noted to have category II fetal heart rate tracing (FHR). Considering the possibility of delivery before 37 weeks, she was given 12 mg betamethasone intramuscular injection at 32 3/7 weeks, which was repeated in 24 hours. The FHR improved to category I throughout prolonged monitoring. The following day, the patient returned complaining of severe palpitations, shortness of breath and was noted to have a pulse of 159 BPM while in AF with rapid ventricular response. She was started on an esmolol drip for rate control and failed to spontaneously convert to normal sinus rhythm (NSR). A transesophageal echocardiogram was performed, followed by direct current cardioversion (DCCV) with 150 J. The patient remained symptom-free in NSR after the DCCV and was discharged on 40 mg enoxaparin. Patient informed consent was obtained for submission of this case report.

CONCLUSION:
This case illustrates the uncommon, yet acknowledged risk of corticosteroid-induced AF. There have been reported cases of AF in pregnant patients receiving both betamethasone and beta-mimetics; however, these case reports attribute the AF to the beta-mimetics. This is believed to be the first reported case of betamethasone-induced AF in pregnancy.
Differences in Post-Delivery Blood Pressures Between Women Who Will Develop Postpartum Preeclampsia and Controls [12M]
Authors: Brubaker Laura H. , Brawley Amalia M. , Williamson Mary H. , Stetter Christy M. , Kunselmanl Allen R. , Pauli Jaimey M. 
Published: April 2020

INTRODUCTION:
Postpartum preeclampsia (with first clinical manifestation after delivery) is poorly understood but has the potential for catastrophic consequences for patients. Predictive variables in the postpartum period may improve outcomes. The purpose of this study was to determine if there is a difference in blood pressure in the immediate postpartum period (delivery to discharge) in women readmitted with postpartum preeclampsia and controls.

METHODS:
Deliveries in a 5-year interval (2014-2019) at a university hospital were included in this retrospective cohort study (n=3,621 unique patients). IRB committee waiver was obtained for the study. Exclusion criteria were diagnosis of preeclampsia, eclampsia, or Hemolysis Elevated Liver Enzymes Low Platelets (HELLP) prior to delivery. Cases included readmissions for preeclampsia, eclampsia, or HELLP diagnosed after delivery (n=26). Controls were randomized from remaining patients (3:1 controls to cases, inflated by 10% to account for prevalence of exclusion criteria) (n=78). Each subject’s highest systolic (SBP) and diastolic blood pressure (DBP) from delivery until discharge was recorded. Two sample t-tests were used, significance set at 0.05.

RESULTS:
The mean peak SBP for cases was significantly higher than controls at 147.4 mmHg (SD 13.4 mmHg) compared to 133.3 mmHg (SD 12.0 mmHg) (P<.001). Mean peak DBP for cases was also higher than controls at 91.6 mmHg (SD 8.7 mmHg) compared to 82.9 mmHg (SD 8.0) (P<.001).

CONCLUSION:
Blood pressure in the immediate postpartum period was higher in women readmitted for postpartum preeclampsia compared to controls. This information may be a first step in developing a predictive model to better understand and predict postpartum preeclampsia.
Effectiveness of Maternal Safety Bundle for Obstetric Hemorrhage at a Large U.S. Military Hospital [15M]
Authors: Joseph Katherine , Wilson Karen L. 
Published: April 2020

INTRODUCTION:
Postpartum hemorrhage is one of the leading causes of maternal deaths worldwide. Attempts to remedy this problem have led to the implementation of multiple maternal safety bundles, of which one was recently implemented at Womack Army Medical Center at Fort Bragg, NC. The goal of our study is to determine the effectiveness of this bundle in predicting postpartum hemorrhage in a military population.

METHODS:
Our study included patients that delivered from March through December 2017, who were deemed either moderate or high risk for postpartum hemorrhage. We looked at blood transfusion rates and risk factors for receiving transfusions. Numerical variables were compared using Student’s t or Wilcoxon Rank Sum as appropriate. Categorical variables were compared with the χ2 Test of Independence or Fisher’s Exact.

RESULTS:
There were 423 patients who were considered ‘moderate’ risk (78.7%) or ‘high’ risk (21.3%) for postpartum hemorrhage. Of patients considered high risk, 11.1% required a blood transfusion, whereas significantly fewer patients classified as moderate risk required a transfusion (3.9%, P=.0150). The only significant risk factors for blood transfusion in this sample were patients with history of a prior postpartum hemorrhage (P=.0027, assessed antepartum) and less than 70,000 platelets assessed intrapartum (P=.0082).

CONCLUSION:
Our study shows that this bundle for obstetric hemorrhage was able to predict a higher rate of transfusion for those deemed high risk. Interestingly, our analysis showed only 2 risk factors of 26 were found to be statistically significant for blood transfusion.
Inflammatory Bowel Disease and Biologic Use During Pregnancy and Its Association With Postpartum Disease Activity [20M]
Authors: Rekawek Patricia , Bigelow Catherine , Getrajdman Chloe , Roy-McMahon Christine , Johnson Shaelyn , Mella Maria T. 
Published: April 2020

INTRODUCTION:
Women with inflammatory bowel disease (IBD) have an increased risk of developing a postpartum flare. There is limited data regarding the effects of antepartum biologic use on disease activity postpartum. Our objective was to identify risk factors associated with postpartum flares and evaluate the effect of antepartum biologic use on the rate of postpartum flares.

METHODS:
This was a retrospective study of pregnant patients with IBD who delivered at a single tertiary care institution from 2012 to 2017. Maternal demographics between patients who experienced an IBD flare postpartum versus those who did not were compared using Wilcoxon tests for continuous measures and Fisher’s exact tests for categorical measures. The incidence of postpartum flares was compared between groups defined by exposure and non-exposure to biologics using a Fisher’s exact test.

RESULTS:
Of the 260 patients included in the analysis, 13 (5%) experienced an IBD flare postpartum. Patients who experienced an IBD flare postpartum were more likely to experience a flare during pregnancy (8/13 [61.5%] versus 29/247 [11.7%], P<.001). There was a significantly increased risk of IBD flare postpartum associated with biologic use in pregnancy (8/70 [11.4%] versus 5/190 [2.6%], p=0.008).

CONCLUSION:
Increased severity of IBD measured by flares during pregnancy is associated with an increased rate of postpartum flare. The association of biologic use with a postpartum flare is likely due to increased disease severity. Future studies are needed to further evaluate timing of biologic use in utero and its association with postpartum disease activity in patients with IBD.
Safety of Prophylactic Measures to Decrease Surgical Complications for Pregnancy Complicated by Placenta Accreta [35M]
Authors: Lazaro Jose J. , Rochon Meredith , Quinones Joanne , Giagni Chelsea , Smulian John , Scorza William 
Published: April 2020

INTRODUCTION:
The objective of this study is to determine the safety and efficacy of routine prophylactic measures to prevent surgical complications during peripartum hysterectomy for placenta accreta spectrum, including placement of pelvic vascular occlusion catheters (PVOC) for uterine artery occlusion or embolization (UAE) and ureteral stents (US).

METHODS:
This is a retrospective cohort study of women undergoing peripartum hysterectomy for pathologically confirmed placenta accreta spectrum from December 1, 2007 to June 30, 2019. Medical records were reviewed for intraoperative details and surgical outcomes, including use of, and complications related to PVOC, UAE and US. Women who had any prophylactic procedure were compared with those that had none. Primary outcome was complications related to use of each prophylactic measure. Data were analyzed using univariate and multivariable techniques.

RESULTS:
A total of 71 women underwent peripartum hysterectomy. 45 women had at least one prophylactic measure: 40 had PVOC or UAE and US, and 5 had US only. Use of any prophylactic measure was associated with an increase in total operative time (P<.0001) and a decrease in blood loss (P<.0001), need for transfusion (P<.001) and maternal ICU admission (P<.001). There were no complications related to US placement, and one complication related to PVOC. There were no differences in rates of ureteral injury, bladder injury or bowel injury between women that had prophylactic measures and those that did not.

CONCLUSION:
Routine use of prophylactic measures at cesarean hysterectomy, including PVOC and US appear to be safe and associated with decreased blood loss and maternal ICU admission.
Trauma Informed Care Training in Ob/Gyn Residency Programs [26G]
Authors: DeAndrade Samantha , Pelletier Andrea , Bartz Deborah , Dutton Caryn 
Published: April 2020

INTRODUCTION:
One in six American women experience sexual abuse in their lifetime, which pre-disposes a large percentage of our patients to post-traumatic stress disorder. Patients report being re-traumatized when undergoing exams during childbirth and routine Ob/Gyn visits. Very little is known about whether Ob/Gyn physicians are trained to care for patients who have experienced trauma.

METHODS:
This study was a cross-sectional survey administered to program directors at all US and Canadian Ob/Gyn Residency programs in September of 2019.

RESULTS:
At this time, 58 out of 241 (24%) program directors have responded to the survey and represent all ACOG districts. Over 20% of programs have formal training that occurs every year, 63.8% have had some training occur in the past though not on a regular basis, and 15.5% have never had any training. When asked about the primary barrier to providing this training, 27.6% of respondents cited the lack of facilitators to teach it, followed by lack of time within the residency curriculum (17.2%). About 30% of respondents are satisfied with the current training provided at their program. All respondents agree that Ob/Gyn residents need to be trained in trauma informed care, 60.3% believe it should be a CREOG educational objective, and 88% would be somewhat or extremely likely to implement a training program specifically designed for Ob/Gyn residents if one became available.

CONCLUSION:
Most Ob/Gyn residency programs are providing some training on the care of patients who have experienced trauma, however respondents in our sample are largely unsatisfied with how this occurs.
The Impacts of Obstetrical Simulation Training for Emergency Medical Service Providers [40G]
Authors: Peterkin Veronica C. , Robinson Jaimee , Marko Emily K. 
Published: April 2020

INTRODUCTION:
Obstetrical emergencies in the field require coordinated time-sensitive teamwork between emergency medical services (EMS) and hospital-based teams. Simulation is effective at preparation for emergencies. The study objective was to determine the educational and clinical impacts of simulation training sessions for emergency medical service personnel by obstetrical teams within the same communities.

METHODS:
A multi-center prospective pre/post educational study design was used to assess the effectiveness of a curriculum designed for emergency medical service providers on obstetrical emergencies. Instructional strategies included team-based checklist review and skills coaching using low-fidelity task trainers, taught by interdisciplinary teams. Outcomes were measured using pre/post educational tests, team performance assessments, course evaluations and clinical impacts. Internal review board exemption was obtained. Paired t-tests were used for data analysis.

RESULTS:
Over 18 months, 185 EMS personnel participated in the curriculum taught at 2 community hospitals. Instructors included obstetricians, emergency physicians, nurses, and medical students. Significant improvement in knowledge was achieved (pre 47.8%, post 89.6%, P<.0001). Confidence (1=high, 5=low) improved in managing precipitous delivery (pre 3.77, post 1.52, P<.0001), shoulder dystocia (pre 4.0, post 1.48, P<.0001), eclampsia (pre 2.68, post 1.29, P<.0001), breech (pre 4.68, post 2.21, P<.0001), and PPH (pre 3.68, post 1.33, P<.0001). Team performance assessments demonstrated significant improvement (pre 68.54%, post 93.54%, P<.0001). Qualitative clinical impacts included improvements to EMS protocols, transfer of care and communication between teams.

CONCLUSION:
Simulation training in obstetrical emergencies for emergency medical service providers improves knowledge, skills, and performance. Instruction by obstetrical teams in the same communities enhances communication and collaborative care.
Case Report: Retroperitoneal Abscess After Uncomplicated Spontaneous Vaginal Delivery [19H]
Authors: Score Samantha A. , Gallagher Kristen , Wahl Geneva , Archil Vanessa 
Published: April 2020

INTRODUCTION:
Retroperitoneal abscess following an uncomplicated vaginal delivery is uncommon and may be potentially life-threatening. We present a case of a multiparous 36 year old patient who developed a large retroperitoneal abscess following an uncomplicated vaginal delivery, requiring CT-guided fluid drainage and intravenous antibiotics.

METHODS:
Patient consent was obtained for this case report. Our patient is a 36 year old multiparous female who presented in spontaneous labor. She was febrile to 101.0 and started on empiric antibiotics. She underwent an uncomplicated spontaneous vaginal delivery with intact perineum without anesthesia. She remained afebrile and antibiotics were discontinued. Patient again developed fever to 102.5 prompting consult to infectious disease. Recommendation was made for broad spectrum antibiotics. She presented 3 weeks later with complaint of constipation, abdominal swelling, and pain. A palpable mass was noted, and patient was sent to the emergency department. CT scan showed heterogeneous fluid collection in the retroperitoneal left lower quadrant measuring 14.1 x 6.5 x 13.4 cm. Interventional radiology was consulted and she was taken for CT-guided drainage of fluid collection. Fluid culture resulted as Streptococcus pyogenes. IV antibiotics were adjusted based on culture and continued for 14 days. Follow up imaging demonstrated near-complete resolution of fluid collection.

CONCLUSION:
Diagnosis of a retroperitoneal abscess requires a high level of suspicion. In this case, we highlight the importance of postnatal follow-up and a low threshold for postpartum imaging. A multidisciplinary approach to treatment is important. Initiation of broad-spectrum antibiotics and drainage of the abscess should be arranged if diagnosis is made.
A Preliminary Analysis of a Multidisciplinary Fibroid Clinic Patient Satisfaction and Demographics [10F]
Authors: Josephson Rebecca J. , Hatfield Joanna , Forbes Marci Messerle 
Published: April 2020

INTRODUCTION:
Fibroids are benign growths of the uterine muscle that can cause a variety of symptoms including abnormal uterine bleeding, pelvic pain, and bulk symptoms. Our institution created a dedicated multidisciplinary Fibroid Program to address the needs of patients with symptomatic fibroids. Cases were reviewed with gynecologists, diagnostic radiologists, and interventional radiologists to provide tailored treatment plans and counseling for patients.

METHODS:
Patients seen between 1/2014 and 8/2018 (n=312) completed intake surveys detailing demographic background, prior treatments, most problematic symptoms, and a validated quality of life (UFS-QOL) survey. One-year follow up surveys about treatments, Likert scale rated satisfaction, and updated UFS-QOL were sent out to all patients and responses (n=111) were analyzed. Chart review clarifying fibroid size and locations was also performed.

RESULTS:
The average age of patients was 43.6 ± 0.4 years old. Upon initial presentation, 70.1% reported abnormal bleeding, 80.6% had pain, 44.3% had urinary symptoms, 77.4% had abdominal fullness, and 32.5% had bowel complaints. The average UFS-QOL score prior to treatment was 53.0 (out of 100). After treatment the average UFS-QOL score was 78.3, a difference of 25.3 points after being seen in the Fibroid Program. Patient reported satisfaction was excellent, with 79.2% of patients rating their satisfaction at 5 out of 5.

CONCLUSION:
Patients had a high rate of satisfaction after participation in our multidisciplinary Fibroid Program and UFS-QOL scores improved. We hope that this model can continue to be used to improve the life of patients by demonstrating the success of multidisciplinary informed counseling, tailored treatment, and shared-decision making.
A Comparison Between Obstetrician-Gynecologists Practicing in Rural and Metropolitan Counties in New Mexico [09F]
Authors: Rayburn William , Yoder Katelyn , Quiner Trevor , Blackstone Jacquelyn 
Published: April 2020

INTRODUCTION:
About one-half of all U.S. counties lack obstetrician-gynecologist physicians (ob-gyns) especially in rural areas. The objective of this study was to use experience in our state identify demographic and practice characteristics distinguishing ob-gyns in general practice (general ob-gyns) in rural and metropolitan settings.

METHODS:
This retrospective observational study used self-reported responses by physicians to a mandated survey about demographics and practice patterns at the time of New Mexico medical relicensing. Included in the study were all general ob-gyns in 2016 and 2017. Information about subspecialist ob-gyns and residents who graduated that year was obtained from the American College of Obstetricians and Gynecologists and the Accreditation Council for Graduate Medical Education from 2016 to 2019.

RESULTS:
Nearly 1 in 3 (84 of 273, 30.8%) general ob-gyns practiced in a rural county. Those in rural settings tended to be older (P=.02) and male (P=.04). Most had practices in both obstetrics and gynecology. Compared with those in metropolitan counties, general ob-gyns in rural counties practiced in smaller groups (P=.0003) and worked 40 or more hours weekly (P=.0003). All subspecialists practiced in the most populous metropolitan county. No recent residency graduate practiced rurally in New Mexico.

CONCLUSION:
General ob-gyns in New Mexico’s rural counties practiced in smaller groups and worked longer work hours. Rural ob-gyns tended to be older and male. More training opportunities in rural communities with maternity centers may aid in recruiting resident graduates.