bluuebunny/crossref_metadata_2025_split huggingface dataset:
Modifiable Factors Influencing Postpartum IUD Expulsion and IUD String Visualization [35J]
Authors: Jagannathan Samantha , Yu Daohai , Lu Xiaoning , Finch Susan , Jeronis Stacey 
Published: April 2020

INTRODUCTION:
The aim of this study is to identify factors that help prevent unintended and short interval pregnancy. Immediate postpartum IUD insertion should be offered routinely as a safe and effective option for postpartum contraception per ACOG. There is concern, however, that this results in a higher IUD expulsion rate than interval placement, as well increased failure in visualizing IUD strings at subsequent visits. In this study, we assess the effects of the four modifiable factors on both IUD expulsion and IUD string visualization when placed immediately postpartum: mode of delivery (SVD or CS), IUD type (Mirena/levonorgestrel or Paragard/copper), BMI (=35) and number of prior vaginal deliveries (<2 or >=2).

METHODS:
This retrospective study was performed between 7/1/2017 and 1/15/2019 at Temple University Hospital. 193 women ages 15-42 attended a postpartum visit after immediate IUD placement at this hospital. Demographic data, dilation at time of c-section, use of epidural and reasons for IUD removal were noted.

RESULTS:
Results indicate that none of the major factors when considered in isolation affect IUD expulsion. However, string visualization in postpartum visits is affected by two factors considered in this study: IUD type and mode of delivery.

CONCLUSION:
Better understanding of an individual patient’s risk factors for IUD expulsion will help providers to counsel patients appropriately as to when to receive IUD given higher expulsion associated with immediate postpartum IUD insertion. Given string non-visualization involves time and cost to the patient and provider, better counseling guidelines should be developed based on the results of this study.
Priority-Setting for Cochrane Review Updates With Clinicians and Consumers [36J]
Authors: Kumar Nimisha , Grant Sean , Haas David M. 
Published: April 2020

INTRODUCTION:
The US Satellite of the Cochrane Pregnancy & Childbirth Group was launched in March 2019. One of the goals of the US-PCG was to engage both clinicians and consumers in a priority-setting exercise that aimed to (1) identify which systematic reviews to update and (2) reveal any gaps in current knowledge that require a new review.

METHODS:
A series of editorial team evaluations narrowed a list of over 600 relevant review titles down to 97, all of which were in 7 topic categories. A Qualtrics survey was used. Respondents self-identified as a clinician/researcher or consumer and then were asked to rank 10 titles into a “highest priority” area and could rank another 20 in a “medium priority” area. This survey was disseminated through various channels, including ACOG, March of Dimes, Cochrane, and social media networks.

RESULTS:
63 participated in our survey, with 45 clinicians and 18 consumers. Of the 7 categories, maternal medical problems and complications (MMPC) was the topic of most interest overall (79.4%). MMPC was chosen most by clinicians but was tied with psychosocial factors in postpartum care (PFPC) for consumers. Antiplatelet agents for preventing preeclampsia was the only title in the top 3 priority by both clinicians and consumers, but multiple titles overlapped in the top 10 priority.

CONCLUSION:
Clinicians and consumers were able to select priority titles for updating reviews with the groups often sharing some consensus. Stakeholder consensus on review topics will be further refined using Delphi methods to a final priority list by the end of 2019.
Activity Rest Prescription and Compliance in Women With Short Cervix [03K]
Authors: Bitar Ghamar , Sciscione Anthony , Fonge Yaneve 
Published: April 2020

INTRODUCTION:
Despite lack of evidence to support efficacy, activity restriction is one of the most common prescribed interventions used for the prevention of preterm birth. With short cervix being one of the risk factors for preterm birth, the purpose of our study was to determine if women with short cervix are prescribed activity rest and if they are compliant.

METHODS:
This is a single-center retrospective cohort study of women identified with short cervix (<25 mm) prior to 28 weeks gestation of pregnancy who delivered between January 2018 and February 2019. The verified cohort was contacted by phone and administered a questionnaire to identify details regarding activity rest (work restrictions, pelvic rest, lifting restrictions or bed rest) during pregnancy. The primary outcome is rate of activity restriction in women and compliance of prescribed rest.

RESULTS:
Of women questioned, 37% of women with short cervix were placed on activity rest and 83% of these women were placed on rest by an obstetrician. 100% of women reported compliance with prescribed activity rest. 41% of women were prescribed pelvic rest separately from other forms of activity rest. Average gestational age at delivery was comparable for women on activity rest and those not on activity rest (31.2 vs 31.7 weeks gestation).

CONCLUSION:
Women with short cervix are being prescribed activity rest almost exclusively by obstetricians and are strictly compliant. Women consider activity rest and pelvic rest separate entities. Education to physicians may be needed to reduce unnecessary activity rest in pregnancy as it does not improve preterm birth rate.
Antenatal Steroids in Late Preterm Gestation: Efficacy of One vs Two Doses [05K]
Authors: Wajid Naji A. , Shanahan Lisa K. T. , Staudenmaier Emily K. , Vullo John , Gurram Padmalatha 
Published: April 2020

INTRODUCTION:
Antenatal corticosteroid (ACS) administration in late preterm gestation has been shown to reduce neonatal morbidity and mortality. The objective of the study was to compare the efficacy of antenatal steroids among patients who received zero, one, or two betamethasone injections.

METHODS:
A retrospective review was performed of patients receiving ACS between 34 and 37 weeks gestation. Groups were defined as patients receiving zero doses (Group 0), one dose (Group 1), or two doses (Group 2). Antepartum complications and incidence of the following neonatal outcomes were studied: respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), neonatal hypoglycemia and neonatal ICU (NICU) admission. Exclusion criteria were administration of steroids before 34 weeks, and term deliveries. IRB approval was obtained.

RESULTS:
Groups 0, 1, and 2 consisted of 89 patients, 68 patients, and 57 patients, respectively. Maternal characteristics and antepartum complications were similar (P>.05). Gestational age at ACS administration and delivery was similar. Incidence of RDS was significantly higher in Group 1 (52.9%) compared to Group 2 (29.8%), while similar between Groups 0 and 1. Group 2 (31.6%) demonstrated a significantly higher rate of hypoglycemia compared to Group 1 (4.4%). Group 2 demonstrated higher NICU admission rate (86%) when compared to Group 0 (56.2%), while no significant difference was observed between Group 0 and Group 1.

CONCLUSION:
Incidence of RDS is significantly lowered only in patients receiving two doses of betamethasone. Further studies are needed to determine cost effectiveness of single dose administration when completion of two doses is unlikely.
Bringing Statistics to Life: Developing “Lived-Experience” Family Videos for a Periviable Decision-Support Tool [06K]
Authors: Edmonds Brownsyne Tucker , Hoffman Shelley , Laitano Tatiana , Coleman-Phox Kimberly , Castillo Esperanza , Kuppermann Miriam 
Published: April 2020

INTRODUCTION:
To develop and incorporate ‘lived-experience’ videos of families describing their lives following periviable delivery into the Periviable GOALS (Getting Optimal Alignment around Life Support) decision-support tool.

METHODS:
Through patient-engaged research methodology, patient-partners advocated ‘bringing statistics to life’ by including videos into the tool (IRB-approved). Five videos were created; each contained two families’ stories reflecting: death following comfort care, non-survival following resuscitation, or survival with mild, moderate, or severe neurodevelopmental impairment (NDI). Diverse families represented the spectrum of NDI, using different scripts for bereavement versus survival. Professional videographers filmed and edited the segments (3-5 minutes), which were embedded into the GOALS tool. Focus groups were conducted with pregnant women (20-26 weeks) and women who have delivered periviably to assess the videos’ acceptability.

RESULTS:
Ten families participated in the ‘lived-experience’ videos. Half were African American and half were white; children were age 16 months to 4 years. Bereaved parents were asked about end-of-life experiences and support after loss, while survivor segments described typical days, on-going medical care, and family adjustment. The videos were rated “excellent” (41.7%) or “good” (25%) by focus group participants (n=12). Most (91.7%) thought the tool provided sufficient information and would be useful in helping families make treatment decisions.

CONCLUSION:
Videos provide context for families to make meaning of complex prognostic information on long-term outcomes. They must be developed with caution due to their potential to introduce anchoring, conformity, or optimistic biases. Stakeholder engagement and diverse representation across the spectrum of outcomes and decisions may help to mitigate potential biases.
Cost and Reimbursement for Low Risk Prenatal Care in the United States [10K]
Authors: Baker Mary V. , Butler-Tobah Yvonne , Theiler Regan 
Published: April 2020

INTRODUCTION:
This study calculates the financial margins for delivery of routine antenatal care as reimbursed by Medicaid. Prenatal care cost varies with overhead, provider type, and number of office visits. Antenatal care is only one component of the global obstetric bundle, which also includes intrapartum and postpartum care.

METHODS:
Revenue was based on 2015 Medicaid reimbursement for the pregnancy global package (CPT 59400). All fifty states were represented. Provider time cost was estimated using mean wages for obstetricians and midwives, or using national mean wage data when state-specific data was unavailable. Staff time for provision of low risk prenatal care was determined prospectively from a study of 133 low risk patients. Sensitivity analysis was performed by varying overhead as a percentage of total revenue. Routine prenatal labs, ultrasounds, intrapartum care, and postpartum care were not included in our analysis.

RESULTS:
Patients received an average of 215 minutes of direct provider time per pregnancy. At the 50th percentile for physician payment and assuming overhead is 40% of revenue, practice margins varied by state from -$1,061 to +$785, with a median of -$161. This does not include the cost of intrapartum or postpartum care. The median margin for antenatal care was negative if overhead exceeded 18% of revenue.

CONCLUSION:
In a majority of states, reimbursement for the global obstetric package reimbursed by Medicaid is less than the actual cost of prenatal care alone. Improving reimbursement or decreasing costs is necessary to make maternity care cost-effective for obstetrics practices.
Early-Onset and Preterm Preeclampsia After Bariatric Surgery [12K]
Authors: Livergood Mary Christine , Harrison Rachel , Allen Katherine , Lak Kathleen , Cruz Meredith 
Published: April 2020

INTRODUCTION:
We sought to determine the rates of early-onset and preterm preeclampsia in women with a history of bariatric surgery compared to controls.

METHODS:
We performed a retrospective cohort study of 189 singleton pregnancies in women who had undergone a bariatric procedure prior to pregnancy and compared them to early pregnancy body mass index (BMI) and delivery date matched controls at a single center between 2005 and 2019. Early-onset and preterm preeclampsia were defined as preeclampsia requiring delivery prior to 34 weeks and 37 weeks, respectively. Pregnancy outcomes were compared using univariate and multivariate analysis.

RESULTS:
Of the 189 pregnant women with history of bariatric surgery, 5 (2.7%) had early-onset preeclampsia and 10 (5.3%) had preterm preeclampsia. Compared to early pregnancy BMI-matched controls, there was no difference between groups in the rates of early-onset preeclampsia (aOR 1.98, 95% CI 0.15-26.85). A subgroup analysis was performed on the rates of these disorders stratified by different types of bariatric surgery. Using gastric sleeve as the reference group, there were lower rates of early-onset preeclampsia and preterm preeclampsia in patients with a Roux-en-Y gastric bypass procedure (aOR 0.02 95% CI 0.00-0.95 and aOR 0.17 95% CI 0.03-0.99, respectively).

CONCLUSION:
Bariatric surgery was not associated with decreased rates of early-onset and preterm preeclampsia. In the subset of patients with a Roux-en-Y gastric bypass procedure, there were lower rates of preeclampsia prior to 34 and 37 weeks of gestation.
Fetal Growth Restriction and Cesarean Delivery for Nonreassuring Fetal Heart Rate Tracing in the Late Preterm Period [15K]
Authors: Bitar Ghamar , Jain Vanita , Ruhstaller Kelly , Mapp Alexandra , Sciscione Anthony 
Published: April 2020

INTRODUCTION:
Women with fetal growth restriction (FGR) are often counseled about the fetus being unable to tolerate induction of labor and the risk for cesarean delivery (CD) for non-reassuring fetal heart tracing (NRFHT), especially in the late preterm period (between 34.0 and 36.6 weeks, LPP). The purpose of our study was to determine the association between FGR and CD for NRFHT in the LPP.

METHODS:
We performed a single-center case control study of women undergoing induction of labor (IOL) in the LPP between January 2010 and January 2017. Women were included if they underwent IOL between 34.0 and 36.6 weeks gestation of pregnancy with a non-anomalous, vertex, singleton gestation. Women with a previous CD and contraindications to IOL were excluded. Rates of FGR in women undergoing CD for NRFHT were compared to those undergoing CD for other indication or vaginal delivery.

RESULTS:
The odds of FGR were statistically significant for women who underwent a CD for NRFHT as compared to those having a vaginal delivery or CD for other indication (AOR 4.0; 95% CI 1.97-8.08) and (AOR 3.08; 95% CI 1.13-8.43). African American women had higher odds of IUGR than their white counterparts (AOR 2.65; 95% CI 1.46-4.82).

CONCLUSION:
Women with a diagnosis of FGR are significantly more likely to have a CD for NRFHT than a CD for other indication or VD in the LPP. This information should be included in counseling women who are undergoing an IOL and have a diagnosis of FGR in the LPP regardless of their indication for induction.
Is In-Utero Marijuana Exposure Associated With Childhood Developmental Delay? [20K]
Authors: Roussos-Ross Kay , Dukharan Victoria , Goodin Amie 
Published: April 2020

INTRODUCTION:
Women are at the highest risk for developing a substance use disorder during their reproductive years. The prevalence of marijuana use in the US during pregnancy is 7%. Data is unclear regarding long-term effects of in-utero marijuana exposure. Given that the endocannabinoid system is present at around day 16 of gestation, it is plausible that maternal marijuana use could affect fetal brain development. This purpose of this study was to determine correlations between in-utero marijuana exposure and childhood developmental delay.

METHODS:
After IRB approval, a retrospective chart review of infants with a history of marijuana exposure in utero was conducted. A total of 230 study subjects met inclusion criteria and were analyzed.

RESULTS:
The majority of subjects, 84 (59.6%) were noted to have feeding problems in infancy. Forty one subjects, 17.8% showed abnormal muscle tone, 39 subjects, 17%, were noted to be small for gestational age (SGA). Speech delay was present with a frequency of 10.0%, 23 subjects. Fine motor delay was seen in 25 subjects, 10.9% and global development delay with noted in 21 subjects, 9.1%.

CONCLUSION:
Results from this retrospective chart review indicate possible risks of short-term (feeding problems, abnormal muscle tone, SGA) and longer-term developmental delays. Further research is necessary to determine whether these effects are due to marijuana alone, or if confounding factors are involved. In order to educate and advise the public about the effects of marijuana use in pregnancy, this relationship must first be understood.
Isolated Leukocytosis to Predict Chorioamnionitis in Preterm Prelabor Rupture of Membranes Between 24 and 33 Weeks [21K]
Authors: Cardenas Carlos , Khoury Aldo 
Published: April 2020

INTRODUCTION:
During Prelabor Premature Rupture of Membranes (PPROM), Chorioamnionitis is an indication for delivery; hence prompt diagnosis is of major relevance for maternal and neonatal outcome. Chorioamnionitis can affect about 40-70% of preterm births with premature rupture of membranes. The objective of this study is to assess the relevance of isolated leukocytosis in predicting Chorioamnionitis during PPROM between 24 and 33 weeks.

METHODS:
In this retrospective study performed at our institution from 2014 to 2017, 161 pregnancies with PPROM where selected. The last white blood cell count (WBC) obtained before delivery was used as an indicator for Chorioamnionitis, which was diagnosed by placental histologic findings. Patients were classified as PPROM without Chorioamnionitis and with Chorioamnionitis with and without Leukocytosis (>15,000 cells/ml). Time of when Celestone was given in relation to the last WBC obtained, indication for delivery and presence of other signs of infection including fever were documented.

RESULTS:
81 patients had PPROM without Chorioamnionitis; only 9 (11%) had leukocytosis. From the patients with Chorioamnionitis, 50 (62.2%) had leukocytosis (Average WBC 17,500) and 30 (37.8%) did not (Average WBC 9,900). 85% of the patients with leukocytosis had Chorioamnionitis. Only 2.5% of patients with Chorioamnionitis had fever and 20% of the patients with Chorioamnionitis were delivered due to suspected infection. Sensitivity for Leukocytosis was 62.5% with specificity of 88.8%. Receiver operating characteristic AUC was 0.723 (p value<0.001, 95% confidence interval 0.6396 to 0.8066).

CONCLUSION:
Isolated leukocytosis can become a strong predictor for Chorioamnionitis if repeated periodically during PPROM between 24 and 33 weeks.
Marijuana Use and Perinatal Outcomes Among Obstetric Patients in a Southern California Safety Net Hospital [22K]
Authors: Sasso Elizabeth , Komatsu Emi J. , Johnson Brittney , Bolshakova Maria , Cortessis Victoria , Mullin Patrick 
Published: April 2020

INTRODUCTION:
Recreational marijuana use is increasing and poses a risk to both mother and the fetus. We aimed to assess marijuana use and perinatal outcomes in the local obstetric population at our hospital.

METHODS:
An IRB approved retrospective chart review identified a cohort of women with singleton gestations who delivered at LAC/USC hospital between 2015 and 2018. Women with self-reported marijuana use were compared with a control group. Demographic characteristics, maternal and perinatal outcomes were evaluated. Associations between these factors and marijuana use were assessed with univariate and multivariate regression.

RESULTS:
Of 2792 women who delivered during the study period, 151 (5.4%) had documented marijuana use. Compared to 192 non-users, marijuana users were more likely to be younger, non-Hispanic, undomiciled, unemployed and use other illicit substances. Marijuana users entered prenatal care later (14.2 vs. 22.1 weeks, P<.001), were more likely to have preeclampsia (P=.046) and cesarean delivery (P=.01) and had infants with average birth weight 106 grams less (P=.02) than controls. After adjusting for confounders, marijuana use was not significantly associated with preterm birth or composite perinatal morbidity, but remained associated with 4.1-fold greater likelihood of delivering a small for gestational age (SGA) infant (95% CI 1.95-8.74).

CONCLUSION:
At a safety net hospital, antepartum marijuana use is significantly associated with SGA at birth. Marijuana users have higher maternal morbidity including preeclampsia and cesarean delivery, and are more likely to enter prenatal care later and report poly-substance use. Healthcare disparities associated with marijuana use make this a population of critical interest.
Maternal Early Warning Signs in Pregnant Women With Trauma [23K]
Authors: Yaghi Alia , Ireland Kayla 
Published: April 2020

INTRODUCTION:
Traumatic events during pregnant are relatively common and remain a leading cause of non-obstetric maternal morbidity. Maternal physiologic changes generate alterations in maternal vital signs (VS). Utilizing maternal early warning criteria of VS (MEWS) may aid in identification and recognition of women with at risk of morbidity from traumatic injury.

METHODS:
Retrospective cohort of pregnant women in Level I trauma center who presented with trauma from 2006-2017 by Emergency Medical Services (EMS). We compared Injury Severity Score (ISS) and TRISS in women with abnormal MEWS and normal MEWS VS from EMS records. Statistical tests included Fischer’s exact test for categorical variables and t test for comparisons of continuous variables. Linear regression models were used to evaluate predicting covariates correlation with ISS and TRISS.

RESULTS:
Of the 460 pregnant women treated for trauma, 240 (52%) arrived by EMS and 56 (12%) women had at least one abnormal MEWs criteria on the scene and only 3 patients had more than 1 abnormal VS. Most common injury mechanism was MVC (75%), Assaults (9%) and falls (7%). ISS (8.3 vs 8.79, P=.45) and TRISS (0.993 vs 0.925, P=.14) were not significantly different between women with normal and abnormal MEWS. However, with multivariate linear regression, scene heart rate (P=.02, 95% CI 0.108 to 0.009) and respiratory rate (P=.013, 95% CI 0.3 to 0.03) significantly correlated with ISS. No scene maternal VS were associated with TRISS.

CONCLUSION:
Although maternal vital signs correlate with injury severity, women with abnormal vitals utilizing MEWS criteria are not associated with more severe injury.
Maternal Morbidity Associated With Cesarean Deliveries Due to Arrest of Dilation [24K]
Authors: Mokhtari Neggin , Kawakita Tetsuya , Nachman Einav , Haddad Andrew , Iqbal Sara Naeem 
Published: April 2020

INTRODUCTION:
It has been suggested that cesarean delivery during labor is associated with increased maternal morbidity compared with cesarean delivery without labor. We sought to examine the morbidity associated with cesarean deliveries due to arrest of dilation.

METHODS:
We conducted a retrospective cohort study of all women undergoing cesarean delivery from January 2016 to June 2018 at a single hospital. Each chart was reviewed to examine the primary indication for cesarean delivery. We examined maternal morbidity including chorioamnionitis, blood transfusion, superficial and deep incisional surgical site infections (SSI), and endometritis. We compared outcomes between women who had cesarean delivery due to arrest of dilation and those for other indications. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). IRB approval: STUDY00000045.

RESULTS:
Of 2957 women who underwent cesarean delivery, 214 (7.2%) had a cesarean delivery due to arrest of dilation. The rate of chorioamnionitis rates was significantly higher with arrest of dilation compared to other indications for cesarean delivery (13.6% vs. 3.6%, P<.01). Women that had cesarean delivery due to arrest of dilation compared to those who had other indications had similar rates of blood transfusion (7.5% vs. 7.6%; aOR 1.31 [95% CI 0.77–2.25]), SSI (4.7% vs. 3.1%; aOR 1.84 (95% CI 0.93–3.67]), and endometritis (2.8% vs. 1.6%; aOR 1.78 [95% CI 0.74–4.30], respectively).

CONCLUSION:
In contrast to theoretical concern, we found that postpartum complications (blood transfusion and postpartum infections) are similar between cesarean delivery due to arrest of dilation and cesarean delivery for other indications.