bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prediction of Clinical Decompensation in an Obstetric Population [26L]
Authors: French Maureen , Loudon Holly , Wagner Brian 
Published: April 2020

INTRODUCTION:
Systems assessing the risk of clinical decompensation were developed with the exclusion of pregnant women. While they may identify obstetric patients at risk for severe illness or mortality, the Systemic Inflammatory Response Syndrome (SIRS) criteria may capture many pregnant women with normal physiology, reducing their predictive value.

METHODS:
Institutional Review Board approval was obtained for this retrospective chart review. All patients who triggered the Stop Sepsis Best Practice Advisory (BPA) at a large academic hospital between 1/1/2014 and 10/1/17 were included. Triggering parameters were identified and categorized as SIRS/sepsis, severe sepsis, septic shock, and other. Critical illness was defined as bacteremia, lactic acidosis, intensive care unit (ICU) admission, or mortality. Detailed review of the obstetric cohort included type and time of anesthesia and delivery, estimated blood loss, and presence of infection or hemorrhage. Student t-test, chi-square test, Fisher exact test, and logistic regression were used for analysis.

RESULTS:
8,786 episodes were identified (169 obstetric, 8,617 hospital-wide). Obstetric patients vs. the hospital-wide groups were significantly more likely to trigger the BPA with systolic BP 90 bpm (98% vs 88%), and oxygen saturation <90% (25.4% v 16%). Obstetric patients were less likely to trigger due to sepsis (39% vs 53%) and had more false positives (51% vs 5%). 69% of the hospital-wide cohort and 8% of the obstetric cohort were critically ill (P<.0001).

CONCLUSION:
Application of SIRS criteria to obstetric patients leads to a high false positive rate. Modified parameters and “lock-out” periods surrounding anesthetic administration and delivery could improve the prediction of clinical decompensation.
Preeclampsia as an Independent Risk Factor for Cardiovascular and Metabolic Disease [27L]
Authors: Gore Amartha N. , Hoffman Karlee , Thomas Ronald , Klein-Patel Marcia , Poornima Indu , Gore Amartha N. 
Published: April 2020

INTRODUCTION:
Epidemiological studies show an association between preeclampsia and the development of cardiovascular disease. Does an association exist regarding metabolic disease?

METHODS:
Women with a discharge diagnosis of preeclampsia from 2009-2015 were identified from our integrated health care system database. We retrospectively collected demographic and cardiovascular risk factor data by chart review on women with preeclampsia and age/race matched controls from the year 2012. We then assessed 7-year follow-up in these cases and controls. A bivariate matched analysis and logistic regression were used to identify associated factors for preeclampsia while adjusting for other variables.

RESULTS:
The incidence of preeclampsia within our network in 2012 was 10.4%. At 7-year follow-up, we found that the cases group have an increased incidence of new-onset hypertension (30.7% vs 2.6%, p<.0001), hyperlipidemia (13.1% vs 2.3%, P<.0001) and diabetes (8.5% vs 1.9%, P<.0001) compared to controls. Hypertension, hyperlipidemia and diabetes served as markers of metabolic disease. Follow-up with a PCP occurred in 19.5% of preeclamptic patients and 14.9% of controls. Statistical analysis showed that preeclampsia was an independent risk factor for current hypertension (OR 6.7 [95% CI 3.4-10.8]), hyperlipidemia (OR 6.5 [95% CI 3.5-10.3]) and diabetes (OR 3.8 [95% CI 1.8-8.3]).

CONCLUSION:
Our findings support a relationship between preeclampsia and the development of metabolic disease. The diagnosis of preeclampsia serves as an independent predictor for the development of both cardiovascular and metabolic disease. This data highlights the necessity for establishing follow-up guidelines for preeclamptic patients when planning preventative medical interventions as it relates to cardiovascular and metabolic disease.
Preeclampsia With Severe Features: Examining the Phenotype of Disease [28L]
Authors: Savitsky Leah M. , Chandrasekaran Suchitra , Albright Catherine 
Published: April 2020

INTRODUCTION:
To characterize the impact of increasing body mass index (BMI) on the likelihood of developing preeclampsia (PE) with severe features (SPE).

METHODS:
We performed a retrospective cohort study using the Consortium on Safe Labor database (CSL). Women without chronic hypertension with a diagnosis of PE delivering a singleton, non-anomalous fetus were included. The odds of developing SPE versus PE without severe features (MPE) between women with a pre-pregnancy BMI in the underweight or normal weight categories (<25 kg/m2) versus those in the overweight (25-29.9 kg/m2) or obese (at least 30 kg/m2) categories were compared. Multiple logistic regression was used to adjust for potential confounders.

RESULTS:
There were 228,438 records in the cohort, of which 6,706 had a diagnosis of PE and a documented pre-pregnancy BMI. Of women with PE, 25% were overweight, 30% were obese. Among all BMIs, 34% of women had SPE. Compared to pregnancies with a normal or underweight BMI, overweight and obese women had a decreased odds of developing SPE when adjusted for race, maternal age, parity, insurance, diabetes, and marital status (adjusted OR [aOR] 0.84, 95% CI 0.72-0.96 and aOR 0.75, 95% CI 0.65-0.87, respectively).

CONCLUSION:
Among women who develop PE, women with an overweight or obese pre-pregnancy BMI are less likely to develop SPE than normal or underweight weight women. Potential differences in the metabolic phenotypes between the two groups may contribute to this finding. Further research is needed to characterize the pathophysiology behind these differences in order to find methods of preventing the development of SPE.
Pregnancy-Adapted YEARS Algorithm for Diagnosing Suspected Pulmonary Embolism: A Cost-Effectiveness Analysis [29L]
Authors: Sievert Alex , Hernandez Miriam , Hersh Alyssa R. , Harmon Duncan , Caughey Aaron B. 
Published: April 2020

INTRODUCTION:
A recent large prospective study found the pregnancy-adapted YEARS algorithm to be an effective screening tool for pregnant women with suspected pulmonary embolism (PE) while reducing the number of CT pulmonary angiography (CTPA). We investigated the cost-effectiveness of using the YEARS algorithm compared to the current standard.

METHODS:
A cost-effectiveness model was built using TreeAge software to compare the YEARS algorithm versus the current standard where all women get a CTPA. We used a theoretical cohort of 35,000 women, the estimated number of pregnant women in the US who are evaluated for a PE each year. Outcomes included costs, quality-adjusted life years (QALY’s) for the mother, maternal death, childhood cancer, and missed PE’s. Probabilities were derived from the literature. Cost-effectiveness threshold was set at $100,0000/QALY. Sensitivity analyses were done to evaluate the robustness of the results.

RESULTS:
In our theoretical cohort, the pregnancy-adapted YEARS algorithm resulted in a savings of $5,923,530 per year and higher QALYs. There were 42 fewer cases of childhood cancer and 4 more maternal deaths despite 361 missed PE cases.

CONCLUSION:
In our theoretical cohort, utilizing the pregnancy-adapted YEARS algorithm resulted in lower costs and increased QALYs. These results should be considered as future guidelines regarding the evaluation of pregnant women with suspected PE’s are established.
Prehypertension During Pregnancy as a Risk Factor for Adverse Perinatal Outcome: A Historical Cohort Study [30L]
Authors: González-Valencia Diana P. , Valero-Rubio Soraya Y. , Grillo-Ardila Carlos F. 
Published: April 2020

INTRODUCTION:
Hypertension during pregnancy is an important cause of perinatal morbidity and mortality. Prehypertension has been linked to cardiovascular morbidity in non-pregnant women. The objective of this study was to assess the association between prehypertension and adverse perinatal outcomes in apparently healthy women.

METHODS:
Historical cohort study.

SETTING:
High complexity institutions located in Bogotá, Colombia.

POPULATION:
Women with less than 20 weeks of gestation, single live fetus, with two or more abnormal blood pressure measurements (systolic 120-139 mmHg/diastolic 80-89 mmHg) six hours apart. Patients with prior diseases, assisted reproduction pregnancies, or with a diagnosis of fetal abnormality were excluded. Analysis: Baseline characteristics and pregnancy outcomes were retrieved from the electronic medical record. Gestational age was determined by last menstrual period and confirmed by ultrasound. Exposed and non-exposed cohorts were compared. Exploratory univariate regression analysis and multiple logistic regression were performed, adjusting for the presence of confounding variables. The study protocol was approved by the Ethics Committee of the participating institutions.

RESULTS:
The two groups were similar in terms of sociodemographic and clinical characteristics. Adjusted and non-adjusted odds ratios with 95% confidence intervals were reported. Controlling for maternal age, education, socioeconomic and civil status, social security, parity, drug abuse and weight gain, it was found that prehypertension was associated with the development of pre-eclampsia (aOR 3.54, 95% CI 1.83–6.83) and hospital admissions during pregnancy (aOR 2.35, 95% CI 1.16–4.76).

CONCLUSION:
Although women with prehypertension are currently classified as normal, prehypertension in the first half of pregnancy increases the likelihood of adverse perinatal outcomes.
Prophylactic Anticoagulation While Hospitalized for Premature Prelabor Rupture of Membranes: A Decision Analysis [31L]
Authors: Dahl Carly M. , Iroz Cassandra , Wescott Annie , Cassimatis Irina , Miller Emily S. 
Published: April 2020

INTRODUCTION:
Premature prelabor rupture of membranes (PPROM) necessitates hospital admission thus limiting activity and theoretically increasing the risk for venous thromboembolism (VTE). While prophylactic anticoagulation decreases the risk of VTE, it may increase the risk for postpartum hemorrhage (PPH) and affect the ability to obtain neuraxial analgesia. This study analyzed the use of prophylactic anticoagulation during hospitalization for PPROM with a decision analysis model.

METHODS:
The designed decision-analytic model compared the use of unfractionated heparin (UFH), low molecular weight heparin (LMWH) or no anticoagulation in women with a singleton pregnancy admitted to the hospital for PPROM after 24 weeks who remained hospitalized until delivery. Assumptions included: induction of labor at 34 weeks or earlier spontaneous labor; therapeutic use of LMWH in the setting of new onset VTE; and universal desire for neuraxial analgesia. The outcomes of VTE, PPH, spontaneous labor, route of delivery, and type of anesthesia attained were assessed. One and two way sensitivity analyses were performed to interrogate model assumptions and a Monte Carlo probabilistic sensitivity analysis was performed using uniform distributions.

RESULTS:
No prophylactic anticoagulation is the chosen strategy based on the highest expected value and sensitivity analyses. No prophylaxis was the preferred choice 78% of the time, UFH 20% of the time, and LMWH 2% of the time.

CONCLUSION:
Our results do not support the routine use of prophylactic anticoagulation in women admitted to the hospital for PPROM. These findings can be used to inform clinical decisions when admitting low risk singleton pregnancies with PPROM.
Provider Specific Nulliparous, Singleton, Vertex, Term Cesarean Rates Impact on Maternal and Neonatal Outcomes [33L]
Authors: Fiori Catherine , Altman Alan , Marcotte Michael Paul , Holbert Michael 
Published: April 2020

INTRODUCTION:
Recent national initiatives have proposed to reduce cesarean delivery rates. Institutions have reported increased neonatal and maternal morbidity secondary to these initiatives. This study evaluated the impact of provider level nulliparous, singleton, vertex, term cesarean section rates on maternal and neonatal outcomes for all laboring patients.

METHODS:
This was an IRB approved retrospective study of deliveries at a tertiary healthcare system over four years from January 1, 2015 to December 31, 2018. Nulliparous, singleton, vertex, term cesarean rates were calculated for each provider. Providers that were one standard deviation above and below the mean were grouped into high NSVT providers and low NSVT providers. All laboring patients of these two provider groups were then compared for maternal and neonatal outcomes.

RESULTS:
Of the 5465 deliveries, there were significant differences in cesarean section rates among high NSVT providers and low NSVT providers, 22.5% vs 6.0%, P<.0001. High NSVT providers had higher rates of maternal fever, 6.1% vs 4.2% (P=.0018 OR 1.47 CI 1.16-1.88), and maternal readmission, 1.6% vs 0.9% (P=.0268 OR 1.73 CI 1.07-2.83). High NSVT providers had lower rates of 3rd or 4th degree lacerations, 1.6% vs 2.4% (P=.0326 OR 0.65 CI 0.44-0.97), shoulder dystocia, 1.8% vs 2.6% (P=.0289 OR 0.66 CI 0.46-0.96), and fetal macrosomia, 0.7% vs 1.3% (P=.0250 OR 0.52 CI 0.29-0.92). All other measures were not significant.

CONCLUSION:
Providers with relatively high and low primary cesarean section rates exhibit different risk profiles for maternal and neonatal morbidity when examining all their laboring patients.
Redefining Hypertension: The Impact of New Risk Stratification on Pregnancy Outcomes [34L]
Authors: Chatterton Carolyn , Mover Kelly , Del Pozzo Jaclyn , Khan Sameer , Vullo John , Gurram Padmalatha 
Published: April 2020

INTRODUCTION:
In 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) redefined blood pressure (BP) categories in non-pregnant adults: Normal (140/90). In pregnancy, patients with BP>140/90 before 20 weeks gestation are considered to have chronic hypertension, correlating to S2. Unlike S2, pregnant women in Elevated and S1 cohorts receive no increased antepartum surveillance. The purpose of this study is to compare pregnancy outcomes between normal, elevated, and S1 cohorts to ascertain risk for hypertensive disorders of pregnancy (HDP), including gestational hypertension and pre-eclampsia.

METHODS:
This is a retrospective review of women who received prenatal care and delivered at our institution. Patients were classified according to the new guidelines based on BP readings prior to 20 weeks gestation. S2 patients were excluded, as these patients are already known to have increased risk for HDP. The primary outcome measure is incidence of HDP. IRB approval was obtained.

RESULTS:
342 patients were included: normal (n=177), elevated (n=73), and S1 (n=76). Maternal characteristics were similar (P>.05). The incidence of HDP for patients with Elevated BP is 9.59% (P=.048) and S1 is 13.83% (P=.002), compared to normal (3.43%). The incidence of small for gestational age, preterm delivery, and NICU admissions were similar (P>.05).

CONCLUSION:
Women with S1 per the new guidelines are at increased risk for HDP of pregnancy. Further studies are warranted to determine if S1 patients will benefit from antepartum surveillance and prophylactic low dose aspirin.
Social Determinants of Health and Severe Maternal Morbidity During Delivery Hospitalizations in Texas [36L]
Authors: Eppes Carey , Salahuddin Meliha , Ramsey Patrick S. , Davidson Christina , Patel Divya A. 
Published: April 2020

INTRODUCTION:
The American College of Obstetricians and Gynecologists now recommends that healthcare providers screen for and document social determinants of health (SDOH) to improve patient-centered care and decrease inequities. The objective of the study was to examine utilization of available SDOH International Classification of Diseases codes and the relationship between SDOH and severe maternal morbidity (SMM).

METHODS:
Using Texas all payer inpatient hospitalization data from 2011 to 2018, delivery-related hospitalizations (n=2,920,079) were classified as having SMM, following Centers for Disease Control and Prevention’s coding scheme. Deliveries were classified as having any SDOH based on documented codes for problems related to upbringing, circumstances (psychosocial, housing, economic, legal, family), employment, social environment, education and occupational exposures. Regression analysis examined the association between SDOH and SMM adjusted for age, payment source, race/ethnicity, and medical comorbidities.

RESULTS:
Only .2% of Texas deliveries between 2011-2018 had a documented SDOH, with problems related to psychosocial circumstances most commonly documented. In that time period, SMM prevalence remained consistent (146.0-161.0 per 10,000 deliveries). Deliveries with a documented SDOH had increased odds of SMM (1.26 95% CI 1.06-1.51).

CONCLUSION:
The low utilization of SDOH codes in all-payer inpatient hospitalization data represents a missed opportunity, given the wide use of these data for population-based estimates of maternal health outcomes, including SMM. In addition to medical conditions, healthcare providers should be encouraged to screen for and document SDOH to better understand contextual factors that may influence a patient’s health as a step towards addressing patient needs in a fuller, more effective way.
The Potential Impact of Aspirin Prophylaxis on Pregnancy Outcomes for Women With Severe Preeclampsia [37L]
Authors: Nelson Sasha , Krishnan Vidhya 
Published: April 2020

INTRODUCTION:
Preeclampsia affects 3-5% of pregnancies with significant morbidity and mortality. Aspirin may reduce the risk of developing preeclampsia by up to 24%. Several organizations have created guidelines for initiation of aspirin therapy, each using different criteria. This study was designed to assess the impact of differing guidelines for aspirin use on maternal and fetal outcomes.

METHODS:
A retrospective cohort study of women who delivered between January 2009 and September 2010 with a diagnosis of preeclampsia with severe features was performed. Guidelines from six different OBGYN societies were applied to these patients to identify the percentage who met criteria for aspirin administration. Published risk reduction rates for preeclampsia, intrauterine growth restriction (IUGR), and preterm birth were applied to estimate adjusted maternal and fetal outcomes.

RESULTS:
Of 153 deliveries with 173 neonates, 31 cases of IUGR (20%) and 107 cases of preterm births (70%) were identified. The Canadian society (SOGC) guideline identified 97% of our patients for aspirin therapy, while the remaining guidelines identified between 4-46% (P<.001) The SOGC was the only guideline to meet the published 24% reduction in cases of preeclampsia and 14% reduction of preterm birth with 35.3% and 14.3% reduction respectively. None of the guidelines reduced IUGR by the published 20% rate.

CONCLUSION:
The Canadian society’s guideline is comprehensive and captures more women who should start aspirin therapy. While these guidelines are beneficial for initiation of aspirin therapy, few of the published guidelines will effectively reduce rates of preeclampsia. Development of a more effective preventive treatment remains essential.
Barriers to Blood Transfusions During Post-Partum Hemorrhage in Northern Ethiopia: Preliminary Data [04M]
Authors: Eluobaju Debra , Yeman Awol , Lee Gina , Goba Gelila , Cavanaugh Erin 
Published: April 2020

INTRODUCTION:
Post-partum hemorrhage (PPH) remains the leading cause of maternal mortality in Ethiopia; the country experiences 412 maternal deaths per 100,000 births, exceeding the global average. Delays in-transit time and inefficient blood transfusions are linked to maternal death. This study aims to evaluate the effects of centralized Ethiopian blood banks on timely blood transfusion and the impact of comprehensive patient education on transfusion refusal.

METHODS:
As part of a mixed-method study, blood transfusion log books at Ayder Comprehensive Specialized Hospital were analyzed to assess the common reasons for transfusions at tertiary care centers. Focus groups of residents from the Tigray region were conducted to explore the social acceptance of blood transfusions.

RESULTS:
Focus group data illuminates that women are receptive to receiving blood transfusions, especially in the context of delivery. Hospital transfusion log books show a transfusion rate of 3% for PPH; comprising of 1.95% of total transfusions recorded during our 3-month preliminary data collection period.

CONCLUSION:
Despite research indicating the average rate of blood transfusions during PPH is 1.4%; Ayder Comprehensive Specialized Hospital has a transfusion rate of 3.0%. Women should be fully counseled on blood transfusions risks and benefits; our data indicates that comprehensive education does not influence women’s transfusion decisions. High transfusion rates may indicate that women are suffering from complications and are being transferred instead of stabilized at general hospitals. Research should focus on exploring the effectiveness of blood distribution and storage in the general hospitals after screening, eliminating the need to transfer women during obstetric emergencies.
Cervical Length Monitoring in Placenta Previa to Predict Emergency Cesarean Section for Antepartum Hemorrhage [06M]
Authors: Chitkara Aarti , Siwatch Sujata , Bagga Rashmi , Chandra Saha Subas , Singh Tulika 
Published: April 2020

INTRODUCTION:
Placenta previa can cause significant obstetric hemorrhage and present as grave emergency, leading to adverse maternal and perinatal outcome. We conducted a prospective observational study to determine if cervical length (CL) ≤3 cm correlates with emergency Cesarean section (CS) for Antepartum hemorrhage (APH).

METHODS:
Transvaginal sonographic CL was measured for women with placenta previa beyond 26 weeks and then at two weekly intervals. Emergency CS due to APH, APH episodes, gestation at delivery and baby’s birth weight were compared between women with CL ≤3 cm (group 1) and CL >3 cm (group 2), measured at the time of recruitment. The study was approved by the local Institutional Ethics Committee.

RESULTS:
Seventy-one women were included, out of which seven delivered vaginally and 64 underwent CS. More women required emergency CS in group 1 (19/32, 59.4%) than in group 2 (14/32, 43.8%) (P=.211). With serial monitoring, short CL ≤3 cm was significantly associated with emergency CS within two weeks (21/32 (65.6%) vs. 12/32 (37.5%), P=.024). Women with short CL ≤3 cm delivered earlier (35.4±2.0 weeks vs. 36.1±2.3 weeks in group 1 &2 respectively, P=.005). Number of APH episodes was higher in group 1 as compared to group 2 (2.2±1.4 vs. 1.5±1.4, P=.024). Women with CL >3 cm delivered neonates with higher birth weight as compared to those with CL ≤3 cm (2.56±0.6 kg vs. 2.3±0.5 kg, P=.046).

CONCLUSION:
Cervical length ≤3 cm is associated with more APH episodes, lower gestation and baby weight at birth in women with placenta previa. Serial monitoring of CL may predict need for emergency CS and help plan admission and delivery.