bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reducing Outpatient Opiate Utilization in the Postpartum Period [32E]
Authors: Conroy Meredith , Altman Alan , Marcotte Michael Paul , Mincarelli Delores , Holbert Michael , Crisp Catrina C. 
Published: April 2020

INTRODUCTION:
The United States is experiencing an epidemic of opiate-related deaths with rates continuing to rise. The majority of postpartum women use only half of opioid tablets prescribed at discharge, and 95% of women do not dispose of excess medication by the postpartum visit. This offers an opportunity to modify physician prescribing habits during the postpartum period.

METHODS:
This is an IRB approved retrospective study at a single, high-volume tertiary healthcare system over four years from January 1, 2015, to December 31, 2018. Women were excluded if they received methadone or buprenorphine during the inpatient postpartum period. The primary outcome was morphine milligram equivalents (MME) prescribed at discharge and within 21 days of discharge.

RESULTS:
Among vaginal deliveries, there was a significant reduction in prescribed MME from 109.4 mg in 2015 to 5.5 mg in 2018 (P<.0001), with an increase in the percentage of patients with no opioids prescribed at discharge or in the immediate postpartum period from 29.5% in 2015 to 93.1% in 2018 (P<.0001, OR 32.3 CI 22.2–41.0). Among cesarean deliveries, there was a reduction in prescribed MME from 235.8 mg in 2015 to 152.6 mg in 2018 (P<.0001), with a decrease in the percentage of patients with no opioids prescribed at discharge or in the immediate postpartum period from 20.0% to 15.5% (P=<.02, OR 0.73 CI 0.57–0.96).

CONCLUSION:
A change in physician prescribing habits can significantly reduce opiate utilization in the postpartum period.
A Retrospective Study of the Associations of Body Weight, BMI and Hypertension With Preeclampsia [01D]
Authors: Power Michael L. , Schulkin Jay 
Published: April 2020

INTRODUCTION:
Preeclampsia is a leading cause of morbidity and mortality for mothers and neonates. We examined births between 2009 and 2018 in the University of Washington medical system (UW) to assess the associations between maternal body weight, body mass index (BMI), blood pressure prior to and early in pregnancy and preeclampsia.

METHODS:
Retrospective data-pull of births at UW. Analysis of variance and Chi Square were used to compare pregnancies with and without preeclampsia for maternal pre-pregnancy weight, BMI, pre- and early pregnancy blood pressure, and birth weight.

RESULTS:
Of the 5,972 births, 1024 (17.1%) were complicated with preeclampsia. Women with preeclampsia were twice as likely to deliver preterm (28.0% versus 13.2%; P<.001); 30.5% of preterm births were complicated with preeclampsia. Women who experienced preeclampsia were heavier (81.6±1.5 kg versus 70.5±0.5 kg) with higher BMI (30.25±0.52 versus 26.22±0.18; P<.001 for both). Obese women were twice as likely to develop preeclampsia (27.5% versus 11.4% for non-obese women). Blood pressure was higher in women who developed preeclampsia at 6–9 months preconception, 0–6 months preconception, and within the first and second trimesters (P<.001 for all). Among women diagnosed with pre-existing hypertension (1,290; 21.6%), 77.3% developed preeclampsia compared to 0.6% in women without pre-existing hypertension (P<.001). The high proportion of preeclamptic pregnancies that were preterm resulted in lower mean birthweight, but term infants did not differ.

CONCLUSION:
Obesity and elevated blood pressure as long as 9 months preconception and during early pregnancy were associated with preeclampsia. A diagnosis of hypertension pre-pregnancy is strongly associated with preeclampsia.
Hemoglobin A1c to Determine the Prevalence of Undiagnosed Carbohydrate Intolerance in Pregnancy [13D]
Authors: Dinglas Cheryl , Cochrane Elizabeth , Umesh Vaibhavi , Bernasko James 
Published: April 2020

INTRODUCTION:
Our objective was to evaluate an antepartum diagnostic approach to differentiate between women who had pre-pregnancy carbohydrate intolerance (pre-diabetes or overt diabetes) versus those who had pre-pregnancy normal carbohydrate tolerance using hemoglobin A1c (HbA1c).

METHODS:
An IRB approved retrospective observational study was conducted with women who had HbA1c measured at the initiation of prenatal care between July 2015 and June 2016. Patients with known pre-pregnancy diabetes, or condition affecting HbA1c (ie, hemoglobinopathy) were excluded. The prevalence of undiagnosed overt diabetes (HbA1c>6.5%), pre-diabetes (HbA1c of 5.7- 6.4%) and normal carbohydrate tolerance (HbA1c≤5.6%) was determined. Among those with HbA1c <6.5%, rates of “true gestational diabetes mellitus (GDM)” and their postpartum follow up testing results were evaluated. Maternal characteristics were also extracted.

RESULTS:
205 women were included. 5 (2.4%) had HbA1c >6.5%, 38 (18.5%) had HbA1c between 5.7–6.4%, and 162 (79%) had HbA1c ≤5.6%. Of the women with HbA1c <6.5%, 30 women (15%) were diagnosed with GDM based on IADSPG criteria. GDM was diagnosed in 18% of women with HbA1c between 5.7–6.4% and 14% of those who had HbA1c ≤5.6%. Further, only 8 (26.7%) completed the recommended 4–12 weeks postpartum GTT.

CONCLUSION:
Antepartum HbA1c testing can help identify women who had carbohydrate intolerance before pregnancy. Early identification may capture a high risk population during prenatal care and enable appropriate antepartum management and timely referrals. Pre-delivery identification of pre-existing carbohydrate intolerance proves superior to post-delivery identification because of the persistently poor completion rates of the latter.
The Impact of Peanut Birthing Ball on Cesarean Delivery Rates in the Obese Cohort [37D]
Authors: Staudenmaier Emily K. , White Samantha , Yassa Mark , Tisser Danielle , Vullo John , Gurram Padmalatha 
Published: April 2020

INTRODUCTION:
Obese women are at an increased risk for cesarean delivery (CD) and postoperative complications such as surgical site infections and venous thromboembolism. Recent studies have shown that the Peanut Ball (PB) decreases rates of CD in women laboring with an epidural. The purpose of this study is to evaluate whether PB reduces CD rates in women with body mass index (BMI) greater than 30 compared to non-obese women (BMI<30).

METHODS:
This is a retrospective chart review of women delivered between 2015 to 2017. Women that delivered at term and received epidural anesthesia were included. Preterm deliveries, medically indicated deliveries and anomalies were excluded. Maternal characteristics, duration of labor, mode of delivery, birthweights and Apgar scores were studied. The primary outcome measure is CD rate. Outcomes of women who received PB intervention (PB) were compared to women without the use of PB (NPB). Women were stratified based on BMI and outcome measures were compared. IRB approval was obtained.

RESULTS:
328 PB and 417 NPB patients were included. Maternal age, race/ethnicity, parity and BMI were similar between the groups (P>.05). No difference in CD rates was noted between the PB and NPB groups (P=.225). Obese women were stratified into Class 1, Class 2 and Class 3 Obesity. No difference in CD rates were noted in any of the obesity classes.

CONCLUSION:
Obese women who utilized the PB during labor did not experience lower cesarean delivery rates.
Prediction of Neonatal Birth Weight in Obese Women by Presence of Diabetes [29D]
Authors: McCurdy Rebekah , Gleason Laura 
Published: April 2020

INTRODUCTION:
To design a model that will predict neonatal birth weight within obese mothers by diabetic status.

METHODS:
A secondary data analysis of an RCT (NCT 02909582) was utilized to create a neonatal birth weight prediction model. Women (n=325) with a BMI >35 kg/m2 from a tertiary academic institution, 2016–2019, were included to estimate the risk of large for gestational age (LGA) infants and neonatal birth weight based on maternal pre-pregnancy BMI and diabetic status. LGA was defined as an infant birth weight >90th percentile. Analysis included Chi-square, t-test, multivariate logistic and linear regression.

RESULTS:
Mean birthweight did not differ in obese mothers based on diabetic status (P>.05). The frequency of large for gestational age infants was significantly greater for diabetic mothers (17% vs 7% without diabetes, P=.024). Total pregnancy weight gain (continuous, lbs) (OR 1.03; 95% CI 1.01, 1.05; P=.016) and pre-pregnancy BMI (continuous, OR 1.08; 95% CI 1.01, 1.15; P=.018) were associated with the risk of LGA infants when accounting for demographics (model R2=0.074). The presence of diabetes (RR 146; 95% CI 24, 268; P=.019), total weight gain (lbs) (RR 4; 95% CI 1, 7; P=.015), and gestational age (RR 197; 95% CI 175, 220; P<.001) were associated with neonatal birth weight when accounting for demographics (model R2=0.550).

CONCLUSION:
These models incorporate the joint effects of maternal obesity and diabetic status in predicting neonatal birthweight, thereby enabling clinicians to counsel their high-risk patients on risk for large for gestational age infants.
Leading Cause of Primary Cesarean Delivery in Diabetic Women Is Failed Induction [23D]
Authors: Roman Tania 
Published: April 2020

INTRODUCTION:
To evaluate mode of delivery in diabetic women compared to non-diabetic pregnant women.

METHODS:
We conducted a retrospective cohort study of pregnant women at our center from 2013 to 2015. Women with singleton pregnancies, who initiated prenatal care at less than 20 weeks, and who completed their delivery at our institution were included. The diabetic cohort consisted of women with pre-gestational (PGDM) and gestational diabetes (GDM). The primary outcome was mode of delivery: cesarean (CD) or vaginal (VD). The secondary outcome was indication for the primary CD. Continuous variables were compared using student t-test and one-way ANOVA for group comparisons. Categorical variables were analyzed using Chi-square test. A P-value of <.05 was considered statistically significant.

RESULTS:
Out of 697 women who met the inclusion criteria, 64 (9.2%) had PGDM, 92 (13.2%) had GDM, and 541 (77.6%) were non-diabetic women. Overall, diabetic women were more likely to have a CD compared to non-diabetic women (58% vs. 41%, P=.0001). In both the diabetic and non-diabetic groups, more than half of the cesarean sections were repeat CD. Women with GDM had the highest rate of primary CD (43%). 50% of women in the PGDM group had primary CD for failed induction, as compared to 14% of the GDM women, and 8.3% of the non-diabetic women (P=.0010).

CONCLUSION:
Failed induction is the leading cause of primary CD in women with pre-gestational diabetes. Studies on induction techniques and assessment in this population are needed.
The Combined Influence of Maternal Medical Conditions on the Risk of Fetal Growth Restriction [34N]
Authors: Fresch Robert J. , DeFranco Emily , Stephen Kendal 
Published: April 2020

INTRODUCTION:
Common maternal medical co-morbidities such as hypertensive disorders, diabetes, tobacco use, and extremes of maternal age, BMI, and gestational weight gain (GWG), are known individually to impact fetal growth restriction (FGR) risk. We aim to examine the risk of FGR in women with multiple maternal medical co-morbidities to determine the cumulative risk imposed on pregnancy.

METHODS:
In this population-based retrospective cohort study we analyzed data from Ohio live birth records from 2006–2015 to estimate the influence of individual and combinations of maternal co-morbidities on rates of FGR (birthweight <10th percentile for gestational age) and severe FGR (<5th percentile). The exposures were individual and combinations of maternal medical conditions (chronic hypertension, gestational hypertension, pre-gestational diabetes, tobacco use, advanced maternal age, underweight, and insufficient GWG) and outcomes were rates and adjusted relative risk (aRR) of FGR.

RESULTS:
There were 1,463,506 live births in Ohio during the study period, of which 734,672 (50.2%) had one or more maternal medical condition. Pregnancies complicated by multiple co-morbidities had higher rates of FGR compared to those with a single medical condition. The rate and aRR range of FGR <10%ile and FGR <5%ile ranged from 8.8–18.4% (aRR 0.91–1.51) and 4.3–9.3% (aRR 0.84–2.22), respectively in pregnancies with single medical conditions, which increased to 10.4–57.9% (aRR 1.03–3.16) and 5.9–36.9% (aRR 1.11–7.03), respectively in pregnancies complicated by multiple medical co-morbidities.

CONCLUSION:
A greater number of maternal medical co-morbidities during pregnancy is associated with increasing cumulative risk of fetal growth restriction, which may be useful in patient counseling and screening for FGR.
The Role of Hospital Specific Labor Curves in Promoting a Culture of Intended Vaginal Birth [37N]
Authors: Neale Donna M. , Yenokyan Gayane 
Published: April 2020

INTRODUCTION:
To describe the labor curve in nulliparous women at term with a singleton fetus in the vertex presentation (NTSV) at a community hospital.

METHODS:
IRB approved, retrospective cohort study of NTSV presenting for labor management from January 1, 2016 – December 31, 2017 (N=1,638). Cervical examination upon admission and every cervical examination until delivery were extracted from the labor flow sheet and delivery summary in the electronic medical record. A linear mixed effect model with random intercept for each woman and random slope for time was used for modeling of cervical exam trajectories with time since first examination. Within-woman correlation and variability of trajectories across women were determined.

RESULTS:
1,084 women delivered vaginally (VD) and 554 women delivered via cesarean section (CD). For the cohort, dilation increased 0.39 cm/hour in the first 12 hours, 0.46 cm/hour between 12–24 hours and 0.41 cm/hour after 24 hours. When comparing delivery type, rate of progression in the first 12 hours for the VD group was 0.45 cm/hour vs 0.26/hour (P<.001) for the CD group. Rate of progression at 12–24 hours in the VD group was 0.53 cm/hours vs 0.34 cm/hour (P<.001) in the CD group.

CONCLUSION:
The change in cervical dilation needed to achieve vaginal delivery in a nulliparous woman is slower than was previously suggested by the Friedman curve. Furthermore, the labor curve in women who delivered vaginally is markedly different from the curve of women who delivered via cesarean section as early as the first 12 hours of labor.
Comparison of Outcome Measures in a US Birth Cohort Against Those in the National Maternity and Perinatal Audit Report [09O]
Authors: Souter Vivienne , Painter Ian , Nethery Elizabeth , Sitcov Kristin 
Published: April 2020

INTRODUCTION:
The aim of this study was to compare outcome measures in a US birth cohort against those reported in the 2019 National Maternity and Perinatal Audit (NMPA) Clinical Report.

METHODS:
This retrospective cohort study evaluated outcome measures for hospital births between 04/01/2016 and 03/31/2017 in a multicenter perinatal quality collaborative (OB COAP) based in the Northwest US, and compared them to rates in Great Britain's 2019 publically available NMPA Clinical Report. Outcome measures included mode of delivery, episiotomy, low Apgar (<7 at 5 minutes), 3rd/4th degree laceration, vaginal birth after cesarean (one previous cesarean only), and neonatal unit admission, for term singleton births, and neonatal unit admission for late preterm births (34+0–36+6 weeks).

RESULTS:
A total of 27,267 births were included in the OB COAP cohort. Compared to unadjusted aggregate rates in the NMPA report, OB COAP had higher rates of cesarean birth (29.3% versus 25.7%), spontaneous vaginal birth (65.9% versus 61.6%), and neonatal unit admission (7.0% versus 5.8%) in term births, and neonatal unit admission in late preterm births (50.3% versus 41.9%). OB COAP had lower rates of operative vaginal birth (4.8% versus 12.5%), vaginal birth after cesarean (14.6% versus 24.5%), and episiotomy (3.1% versus 21.9%). The rate of 3rd/4th degree lacerations was slightly lower in OB COAP (2.8% versus 3.5%) and low Apgar rates were similar (1.3% in OB COAP and 1.2% in NMPA).

CONCLUSION:
Striking differences in outcome measures between the US cohort and rates in the NMPA Clinical Report, highlight potential strategies for quality improvement.
External Cephalic Version in Twin Pregnancy [13N]
Authors: Felder Laura , McCurdy Rebekah , Berghella Vincenzo 
Published: April 2020

INTRODUCTION:
Decreasing the primary cesarean delivery rate and associated maternal and fetal complications is a priority for many obstetric providers. External cephalic version is a procedure recommended for women with singleton pregnancies where the fetus is malpresenting as vaginal breech delivery is inherently riskier than either vaginal or cesarean delivery. However, little is known about this procedure in the context of twin gestations. Women with twin gestations where the presenting fetus is not cephalic are instead recommended to undergo scheduled cesarean delivery.

METHODS:
A systematic review of the following electronic databases was performed, searching from their inception until September, 2019: MEDLINE, Ovid, Scopus, and clinicaltrials.gov. All reported cases of external cephalic version in twin pregnancy were included. Maternal demographics, procedure details, and outcomes data were collected. The primary outcome was successful version of the presenting twin to the cephalic presentation. Statistical analysis involved calculating means, standard deviations, frequencies and percentages as appropriate.

RESULTS:
Two case reports and one case series, totaling 22 patients, met inclusion criteria. No randomized controlled trials were identified. All were dichorionic pregnancies. Successful external cephalic version of twin A occurred in 60% (13/22) of women and 50% (11/22) had a successful vaginal delivery. The majority were performed using regional anesthesia and a uterine relaxant (19/22). No serious adverse events occurred in any of the reports.

CONCLUSION:
External cephalic version appears to be safe and effective for dichorionic twins where the presenting twin is malpresenting. Additional randomized controlled trials are needed to further evaluate this intervention for this patient population.
Outcomes of Oophorectomy in Pregnancy: A Retrospective Cohort [28N]
Authors: Bouchelion Ashleigh , Bauer Alison Marie , Phillis Maria , Hackney David , Armstrong Amy 
Published: April 2020

INTRODUCTION:
Adnexal masses are common in pregnancy. Our objective is to evaluate outcomes of oophorectomy in pregnant women.

METHODS:
This is a retrospective cohort study using data from the National Inpatient Sample between 2007 and 2013. Reproductive-aged women undergoing oophorectomy were identified using International Classification of Diseases – 9 diagnosis and procedure codes. Ectopic pregnancies were excluded. The risk of ovarian cancer was compared between pregnant and non-pregnant women undergoing oophorectomy. Secondary outcomes included surgical and pregnancy complications. Univariable analyses and multivariable regression were performed with adjustment for confounding factors.

RESULTS:
203,075 women aged 15–45 years undergoing oophorectomy were identified, of whom 17,285 (8.5%) were pregnant. Pregnancy was associated with a lower frequency of ovarian cancer diagnosis (0.9% vs 2.5%, P<.001, OR 0.4, 95% CI 0.3 – 0.4). This relationship persisted with multivariable regression (P<.001, aOR 0.3, 95% CI 0.3 – 0.4). Pregnant women were significantly less likely to undergo a laparoscopic procedure or to undergo hysterectomy, omentectomy, or lymph node dissection compared with non-pregnant women. Pregnant women were also significantly more likely to die during hospitalization; this relationship persisted in multivariable regression (0.16% vs 0.05%, P<.001, aOR 4.1, 95% CI 2.5 – 6.6). There were no significant differences in frequency of transfusion or venous thromboembolism. Of pregnant women, 82% delivered during hospitalization for oophorectomy, 78% of these delivered by cesarean.

CONCLUSION:
Oophorectomy in pregnancy is associated with a lower frequency of ovarian cancer diagnosis, though is associated with higher frequency of laparotomy and death during hospitalization.
Pregnancy Outcomes in Women With Percutaneous Nephrostomy Tube Placement for Renal Colic [32N]
Authors: Tabsch Kareem K. , Starikov Roman , Hirsch Kevin 
Published: April 2020

INTRODUCTION:
Maternal and fetal outcomes in pregnant patients undergoing treatment of renal colic with percutaneous nephrostomy tubes (PCN) have not previously been described. We undertook this study to evaluate pregnancy outcomes in patients who had nephrostomy tubes placement during pregnancy.

METHODS:
Following IRB approval, we retrospectively identified women who had nephrostomy tubes placed during pregnancy at a single tertiary care center. Data were collected from maternal and newborn charts. Descriptive statistics were utilized to characterize pregnancy outcomes.

RESULTS:
During the study period (2014–2018), 41 patients underwent placement of nephrostomy tubes during pregnancy, however maternal and neonatal outcomes were available for only 13 patients. Median gestational age at PCN placement was 28.2 weeks. Prior to PCN placement, renal stones were identified on imaging in 53% of patients and median creatinine was 0.6 (range 0.44–1.06). Urinary tract infection (positive urine culture) was identified in 46% of patients. Median number of hospital days during pregnancy was 9 (range 3–19 days). 31% of patients delivered prior to 37 weeks (median 37, range 32w6d-40w4d). A total of 5 (38%) infants required NICU admission and 2 (15%) were diagnosed with neonatal abstinence syndrome (NAS).

CONCLUSION:
Although limited by follow up data, this is the largest case series to date describing PCN in pregnancy. The underlying renal disease necessitating PCN is associated with prolonged hospital stays, NICU admission, and treatment for NAS. Given these findings, our group is planning to conduct prospective studies to characterize pregnancy outcomes in women with symptomatic renal colic during pregnancy.
Super-utilizers of Inpatient Care in an Obstetric Population [33N]
Authors: Keselowsky Kerri , Rosen Todd , Hadaya Ola , Khan Shama , Ananth Cande 
Published: April 2020

INTRODUCTION:
Super-utilizers (SUs) are patients who use a disproportionate amount of resources. Approximately 1–3% of adult patients account for 30% of hospital spending. Programs have been developed to improve healthcare delivery to SUs and decrease costs. Our objective was to create distribution curves of hospital charges (HC) and length of stay (LOS) in the obstetric population and characterize and compare SUs and typical utilizers (TUs).

METHODS:
We performed a retrospective cohort study of 500 patients at a tertiary center between 2012 and 2014. Data were collected 266 days prior to the estimated date of confinement (EDC) and up to 42 days post-delivery. Medical diagnoses, obstetric details, demographics, HC, and LOS were collected.

RESULTS:
Distribution curves for HC and LOS were positively skewed. SUs were defined as patients with charges greater than $75,000; they comprised 7% of patients (n=36) and accounted for 30% of charges. SUs averaged higher HC ($172,257 vs $30,524, P<.05) and longer LOS (22.6 vs 3.2 days, P<.05). They had earlier deliveries (34.5 vs 38.5 weeks, P<.05), higher cesarean section rates (69% vs 35%, P<.05), more chronic conditions (0.97% vs 0.48%, P<.05), and pregnancy complications (2.08% vs 0.67%, P<.05). The most common complications in SUs were preterm labor (33.3% vs 5.4%, P<.05) and preterm premature rupture of membranes (25% vs 3.9%, P<.05).

CONCLUSION:
There is unequal use of resources in the obstetric population and SUs are at risk for adverse outcomes. These data can guide our community to serve our most vulnerable patients through prevention, research, and care that specifically targets SUs.