bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gonadotropin Dose in Young IVF Population With Low Anti-müllerian Hormone Level: A SART Data Study [23A]
Authors: Sarkar Papri , Lam Clarissa J. , New Erika , Sprague Rachel , Anthony Imudia 
Published: April 2020

INTRODUCTION:
One of the most common causes of infertility is diminished ovarian reserve (DOR). AMH plays a role in determining ovarian reserve and levels <1.05 ng/mL is associated with DOR. Young IVF population even with DOR have modest clinical outcome, however information on the stimulation regimen is limited. The aim of this study was to evaluate the gonadotropin dose required in young IVF patients with low AMH to achieve optimal clinical response.

METHODS:
A retrospective cohort study based on SART database between 2012–2016. The study population included 23,001 fresh autologous IVF cycles in women <35 years old with AMH level <1.05 ng/mL. Based on AMH level, women were stratified into 3 groups: low (<1.05–0.4 ng/mL), very low (<0.4–0.16 ng/mL) and ultralow (<0.16 ng/mL). Student t-test was used to compare continuous variables and chi-squared test to compare clinical outcomes.

RESULTS:
The mean age was 32.4±2.4 and BMI was 25±5.9. Women with ultralow AMH had lowest number of oocytes retrieved (5.2±0.4), followed by very low (6.1±0.1) and low AMH group (9.4± 0.07), P<.001. The total gonadotropin dose required was less in the low AMH group (4,086±13.9 IU) than very low (4,446.5±28.3 IU) and ultralow (4,319.34±66.6 IU) AMH groups (P<.001). Live birth rate was significantly higher in the low AMH (4,735/16,290; 29.1%), followed by very low (1,131/5,375; 21%) and ultralow AMH (159/1,336; 11.9%) groups.

CONCLUSION:
AMH is an independent predictor of live birth during IVF and can be used as a guide to estimate gonadotropin dose in young IVF population with DOR to optimize ovarian stimulation and response.
Improving Access for Patients Undergoing Gonadotoxic Therapy: Creation of a Formal Fertility Preservation Program [25A]
Authors: Willson Bryn , Iko Ljeoma , Cookingham Lisa 
Published: April 2020

INTRODUCTION:
Prior to 2016, patients undergoing gonadotoxic therapies were not routinely directed towards educational resources regarding fertility preservation options. In 2016, a formalized fertility preservation program was initiated to increase education, referrals, and provide treatment options to this uniquely vulnerable patient population.

METHODS:
A database was created following initiation of the fertility preservation program (FPP) to track patient demographics such as diagnosis, treatment plan, referring department, consultation turn-around time, uptake of fertility preservation services, and outcomes (post treatment and post fertility preservation, if applicable). For patients undergoing sperm/oocyte/embryo cryopreservation for fertility preservation needs prior to program initiation (2006–2015), a chart review was performed to obtain the same data. We assessed the overall impact of implementation of FPP as compared to other published data from institutions providing formal fertility preservation services.

RESULTS:
Each year following implementation of FPP, noted statistically significant increase in referrals, consultations, and uptake of fertility preservation services. Similarly, the referring departments and diagnoses on referral expanded beyond oncologic providers and oncologic diagnoses, respectively. We also noted a trend of increased uptake for female patients for fertility preservation as compared to male patients, which is dissimilar from previously published data.

CONCLUSION:
A formalized program for fertility preservation improves access and uptake of services for patients undergoing gonadotoxic therapies. Our program demonstrated significant beneficial impact on multiple parameters of interest, even within the first two years following implementation. Subsequently, fertility preservation for oncology patients is now considered a covered benefit within this health maintenance organization.
Uterine Weight as a Predictor of Surgical Complications [36B]
Authors: Oh Jinhee K. , Ko Emily M. , Latif Nawar A. 
Published: April 2020

INTRODUCTION:
The objective of this study is to investigate the impact of uterine weight on peri-operative hysterectomy outcomes. Risk stratification based on uterine weight may help guide surgical planning and post-operative management.

METHODS:
Hysterectomy patients were identified from the NSQIP Database (2014 – 2017). Uterine weight was evaluated as a categorical variable: Group A (less than or equal to 250 g), Group B (greater than 250 g to less than or equal to 500 g), Group C (greater than 500 g). Univariable and multivariable statistics were performed. IRB approval was waived.

RESULTS:
50,333 patients were included, 82.6% in Group A (n=41,581), 12.7% in Group B (n=6,369), and 4.7% in Group C (n=2,383). The majority of the patients were white (71.5%). Median age and BMI were 48 (IQR 42, 59) and 30.5 (IQR 25.7, 36.8). There was an association between race and the proportion of patients in Group C: white 3.3%, AA 11.6%, Asian 9.0%, Other 4.8% (P=.000). Uterine weight was moderately correlated (R2=0.038) with operative time. Group B had nearly 3 times the likelihood of blood transfusion (OR 2.82, 95% CI 2.34, 3.40). Likelihood increased to 4 times for Group C (OR 4.08, 95% CI 3.22, 5.18). Group C was associated with increased conversion from MIS to open (OR 4.93, 95% CI 1.91, 12.71). There was no association with LOS, infection, dehiscence, urinary injury, VTE, readmission/re-operation.

CONCLUSION:
Increased uterine weight is associated with transfusion and conversion to open approach. Uterine weight may assist with pre-operative risk stratification and serve as a predictor of complications.
Composite Adverse Endpoints in Obstetric Studies: A Systematic Review [10N]
Authors: Herman Dylan , Qadree Abdul , Lor Kar Yee , D'Souza Rohan D. 
Published: April 2020

INTRODUCTION:
The Composite Adverse Obstetric Outcome Study (CAOOS) is currently in the process of standardizing the use of composite outcomes in obstetric trials. This study aims to determine how composite outcomes have been reported and defined, as a preliminary step towards their standardization.

METHODS:
We conducted a systematic review of English-language randomized controlled trials (RCTs) published between 1999 and 2019 that involved an obstetric condition and reported on a composite outcome. We searched MEDLINE, EMBASE, CENTRAL, www.clinicalTrials.gov and reference lists of included studies. We screened studies and extracted data in duplicate, on study characteristics, and reported on variations on composite outcomes, their components, definitions and/or measurements.

RESULTS:
Of the 4170 results screened, 156 RCTs, reporting on 183 composite outcomes, were included in the final analysis. Of the composite outcomes, 115 were related to the fetus/neonate, 46 to the mother and 22 to adverse pregnancy outcomes which included maternal and perinatal morbidity. Composites comprised between 2 and 16 components. Maternal composite outcomes included components related to mortality and morbidity (17/46), general morbidity alone (4/46), system-specific morbidity (11/46) and wound-related morbidity (14/46). Perinatal composites did not always include components related to in-utero and neonatal morbidity and mortality. Composite pregnancy outcomes included maternal and perinatal morbidity and mortality components in various combinations.

CONCLUSION:
There is considerable variation in how composite outcomes are reported and defined in obstetric RCTs. Patients and stakeholders will be invited to participate in a multi-step mixed-methods research project to determine which components should comprise composite adverse obstetric outcomes.
Nausea and Vomiting of Pregnancy and HG Risk Genes Associated With Blood Levels, Sleep, Stomach Pain, and Other Traits [23N]
Authors: Fejzo Marlena S. , Burch Kathryn , Mullin Patrick , MacGibbon Kimber W. , Pasaniuc Bogdan 
Published: April 2020

INTRODUCTION:
Our genome-wide association study (GWAS) and replication study of nausea and vomiting of pregnancy (NVP) and Hyperemesis Gravidarum (HG) implicates the placenta and appetite hormone gene GDF15, its receptor GFRAL, PGR, and IGFBP7. The purpose of this study was to determine whether these genes and summary statistics overlap with other traits.

METHODS:
The GWAS catalog was searched for risk genes. The database and web interface platform, LD Hub, was used for genetic correlation analysis of summary statistics.

RESULTS:
Among 4220 GWASes, the HG risk locus GDF15 was associated with GDF15 protein levels, periodontitis, and lupus. GFRAL was associated with glomerular filtration rate, blood urea nitrogen levels, insomnia, body mass index, periodontal inflammation, blood protein levels, osteoporosis, and HIV-1 infection. IGFBP7 was associated with IGFBP7 protein levels, IgG glycosylation, diastolic blood pressure, brain volume in infants, heel bone mineral density, alcohol consumption, itch intensity from mosquitoes, and cotinine glucuronidation. PGR was associated with diastolic blood pressure, endometriosis/endometrial cancer, menstrual cycle length, lung adenocarcinoma, height, and adolescent idiopathic scoliosis. Among 855 pairs of traits, the leading findings showed variants increasing HG also increase stomach pain (P=.0004) and variants increasing NVP also increase sleeplessness/insomnia (P=1.37E-14).

CONCLUSION:
The finding that variants in GDF15 and IGFBP7 are associated with blood protein levels supports our study showing abnormal levels of GDF15 and IGFBP7 in women with HG. Overlap of the genes with other conditions provides biological insight. Associations with poor sleep and stomach pain may have implications for treatment strategies for NVP/HG.
Clinical Predictors of Histologic Chorioamnionitis at Term [06N]
Authors: Romagano Matthew P. , Pinho Gabriella , Krishnamoorthy Kaila , George Lea , Williams Shauna F. , Apuzzio Joseph 
Published: April 2020

INTRODUCTION:
The objective of this study was to determine the diagnostic criteria for clinical chorioamnionitis (CC) that best predict histologic chorioamnionitis (HC).

METHODS:
This is an IRB-approved retrospective cohort study of women diagnosed with CC over a 5-year period. Inclusion criteria were: gestational age 37 to 42 weeks, diagnosis of CC as determined and documented by the provider, and available placental pathology records. CC diagnostic criteria (maternal temperature, maternal or fetal tachycardia, leukocytosis, fundal tenderness, and purulent amniotic fluid) were compared between those with and without HC.

RESULTS:
223 women met inclusion criteria; 159 (71.3%) had HC. Prostaglandin use, diabetes, epidural use, and duration from initiation of antibiotics to delivery were similar. Mean maximum body temperature and presence of other diagnostic criteria were similar between the groups. Those with HC were more likely to have a peak white blood cell count greater than or equal to 25.0x10^9cells/L (13.2 vs 3.1%, P=.03). Twenty-one (13.2%) women in the HC group and 12 (18.8%) in the normal pathology group had no documented fever despite a diagnosis of CC. Of the women without a fever, 64% had HC.

CONCLUSION:
Normal placental pathology was found in a large proportion of women with CC. Although none of the assessed clinical findings predicted HC, a significant leukocytosis was more frequent in women with HC. For women diagnosed with CC without fever, the majority had findings of HC. This study highlights the challenge of diagnosing CC. Providers should consider the diagnosis of CC in the absence of fever when other clinical criteria are present.
Pregnancy Outcomes in Patients With Inadequate Gestational Weight Gain [31N]
Authors: Sipe Bradley , Oliva Mariana , Odibo Linda , Odibo Anthony O. 
Published: April 2020

INTRODUCTION:
The objective of this study is to compare the risks for small for gestational age (SGA) neonates and composite adverse neonatal outcomes (CANO) in patients with inadequate gestational weight gain (IWG) versus adequate gestational weight gain (AWG).

METHODS:
This is a secondary analysis of a prospective study of women undergoing fetal growth assessment. Participants were sorted into AWG and IWG cohorts based on IOM guidelines. Primary outcomes were SGA and CANO (neonatal ICU admission, death, seizures, IVH, respiratory distress syndrome, necrotizing enterocolitis, and pH <7.10). Secondary outcomes included: hypertensive disorders of pregnancy, preterm delivery (PTD), gestational diabetes (GDM), and large for gestational age (LGA) newborns. We performed chi square, t-test, and adjusted multivariable logistical regression. A stratified analysis was performed by pre-pregnancy BMI category.

RESULTS:
214 patients experienced IWG and 282 patients experienced AWG. The risk of SGA was increased in patients with IWG, 47 patients (22.0%) compared to 34 patients (12.2%) with AWG (aOR 1.99, CI 1.19–3.33). CANO were similar between groups (14.5% versus 11.8%, P=.384). IWG was associated with decreased risk of LGA (aOR 0.29, CI 0.12–0.71) but did not have an effect on GDM, PTD, gestational hypertension, or preeclampsia. In obese patients, IWG was protective against GDM (RR 0.44, CI 0.21–0.93) and LGA neonates (RR 0.10, CI 0.03–0.44) without increased risk of SGA neonates.

CONCLUSION:
IWG increases risk of SGA but did not increase neonatal morbidity. IWG was protective against GDM and LGA without increasing other risks in obese patients, suggesting lower weight gain in this population may be beneficial.
Analysis of a Statewide Maternal Transport System: A Four-Year Review [04N]
Authors: Kogutt Benjamin K. , Morris Bernard D. , Applebaum Jeremy , Hall Valerie , Phillips Michelle , Sheffield Jeanne S. 
Published: April 2020

INTRODUCTION:
Implementing levels of maternal care (LOMC) dictates that certain maternal conditions be centralized to risk-appropriate care centers. However, the feasibility of a LOMC system is dependent on the ability to transport risk appropriate patients in a timely manner. The objective of this study is to describe maternal transports via a robust, state-sponsored maternal transport system.

METHODS:
This is a retrospective cohort study of all maternal transports from Sept ‘15 through Jun ‘19 into the Johns Hopkins Medical system. Data were extracted from maternal transport logs and electronic medical records.

RESULTS:
Of 1,392 maternal transports over the study period, 652 (47%) were for maternal indications. The majority of transports originated from Level I centers (37%). The median distance travelled per transport was 26 miles: 70% by ambulance and 21% by helicopter. 48% of transported mothers delivered during their admission at the receiving hospital. Average maternal age was 29 years, with 48% of mothers being white, 42% black. Average infant weight was 1926 grams, with a 66% NICU admission rate. 18% of transports were suspected preventable if antepartum care was transferred prior to the delivery episode with the most frequent indications for transport being hypertensive disease of pregnancy (34%), infection (8%) and placentation (6%).

CONCLUSION:
Maryland has had an established, regionalized maternal care system since the early-1990s, with clearly defined LOMC and a functioning transport network. Our findings demonstrate utilization patterns within such a program and describe key characteristics of transporting hospitals and patients. Further research is needed to determine the effectiveness of LOMC.
A Retrospective Cohort Study of Maternal and Fetal Outcomes in Pregnancies Complicated by Acute Pancreatitis [02N]
Authors: Cai Emmy , Czuzoj-Shulman Nicholas , Abenhaim Haim A 
Published: April 2020

INTRODUCTION:
Acute pancreatitis is a rare condition that can be associated with significant complications. In pregnancy, pancreatitis can be linked with poor maternal and fetal outcomes. The objective of this study is to better understand the complications associated with acute pancreatitis (AP) in pregnancy.

METHODS:
A retrospective cohort study using the Healthcare Cost and Utilization Project – National Inpatient Sample from the United States was performed. All pregnant women admitted with AP were identified using International Classification of Disease-9 coding from 1999 to 2015. The maternal and neonatal outcomes among women diagnosed with AP in pregnancy were compared to women without acute pancreatitis who delivered using multivariate logistic regression adjusting for baseline maternal characteristics.

RESULTS:
There were 14,258 admissions for AP in pregnancy among 13,815,919 births in our study period for an overall incidence of 10.3 cases per 10,000 births. Women admitted with AP in pregnancy were more likely to require transfusions, OR 2.58 (95% CI 2.32–2.87), develop pre-eclampsia, 3.81 (3.33–4.36), deliver prematurely, 4.27 (3.83–4.77), develop venous thromboembolisms, 3.97 (3.30–4.78), develop acute respiratory failure, 21.99 (19.08–25.34), develop disseminated intravascular coagulation, 7.66 (5.48–10.69), and to suffer from maternal death, 9.15 (6.05–13.85) as compared to women without AP. Acute pancreatitis in pregnancy was also associated with an increased risk of intrauterine fetal demise, 2.60 (1.86–3.62).

CONCLUSION:
Acute pancreatitis in pregnancy is associated with severe maternal and newborn complications and thus should be managed in tertiary level centers capable of providing with adequate maternal care for this condition as well and appropriate fetal and premature neonatal care.
Hemodynamic Changes in Women With Congenital Heart Disease: Effect of the Duration of the Active Second Stage [18N]
Authors: Patterson Jenna , Pippen Jessica , Rood Kara M. , Cakovic Michael 
Published: April 2020

INTRODUCTION:
Women with congenital heart disease (CHD) are a growing population and represent 1% of pregnant women. Due to hemodynamic changes associated with labor, an assisted second stage of labor is recommended for some women with CHD. We investigated the effect of the duration of the active second stage of labor on maternal heart rate and blood pressure.

METHODS:
Retrospective chart review of women with CHD who received prenatal care and delivered at a single academic institution from 2010 – 2018. Maternal demographic, baseline cardiac health and peripartum outcome information was collected. Vital signs were recorded before the active second stage and postpartum. Vitals signs prior to active second stage were compared with vital signs in the postpartum period using appropriate statistical analysis.

RESULTS:
During study period 146 women were identified. There was no difference in demographic or baseline cardiac health between women with active second stage <30 minutes and >30 minutes. For active second stage <30 minutes, pre active second stage and postpartum heart rate (83 vs 87, P=.08), systolic blood pressure (123 vs 123, P=.80) and diastolic blood pressure (69 vs 67, P=.19) were similar. For active second stage >30 minutes, pre active second stage and postpartum heart rate (94 vs 95, P=.48), systolic blood pressure (124 vs 124, P=.73) and diastolic blood pressure (74 vs 66, P=.08) were similar.

CONCLUSION:
Duration of the active second stage of labor is not associated with significant hemodynamic differences between pre and post active second stage.
Comparison of Minimally Invasive and Open Management of Cesarean Wound Complications: A Retrospective Chart Review [08N]
Authors: Qadri Farnoosh , Khan Ayesha , Al-azawi Hind , Sengstock David , Chehab Monzer 
Published: April 2020

INTRODUCTION:
Superficial abscesses are common surgical site infections (SSI) following cesarean sections. Standard of care is open drainage but optimal management is not known. We compared superficial abscess (SA) management by image guided (IG) percutaneous drainage to open surgical (OS) drainage.

METHODS:
We performed a retrospective chart review between 1/1/2010 and 12/31/2018 of SSI following cesarean section. IRB waiver was obtained. All patients with SA measuring >3 cm by CT or ultrasound were included. Endpoints included: length of stay (LOS), opioids on discharge, and need for home health care or readmission (combined outcome).

RESULTS:
Of 2,000 charts, n=8 IG (32%) and n=17 OS (68%) met inclusion criteria. Compared to IG patients, OS were significantly older (27.6±4.2 vs 33±6.0 years, P<.05), but had similar BMI (35.2±10.8 vs 39.8±10.2 kg/m2, P>.1), smoking (25% vs 24%, P>.1), hypertension (38% vs 29%, P>.1), diabetes (13% vs 47%, P>.1), parity (2.8±2.5 vs 1.8±1 births, P>.1). Although antibiotic use was lower in OS group (3±1.9 vs 3.7±1.0, P>.1) and a suggestion of lower LOS (6.0±4.0 vs 5.0±2.3, P>.1), IG patients showed a trend of less home-care or readmissions (38% vs 65%, P>.1). Significantly, IG patients were discharged less frequently on opiates (40% vs 88%, P<.01).

CONCLUSION:
This study suggests that minimally invasive drainage of SA following cesarean section is a viable option and may be preferable in certain situations. Although, limited by small sample size, IG appears less painful than OS drainage. The difference in the outcome of home-care or readmissions was lower, though not statistically significant and deserves further study.
Incidence of Pregnancy Following Uterine Artery Embolization Performed for Uterine Arteriovenous Malformations [22N]
Authors: Kole Monica , Keerthy Madhurima , Fotouhi Audrey , Sangha Roopina 
Published: April 2020

INTRODUCTION:
There are limited data available regarding the rate of success and pregnancy outcomes for women after undergoing embolization for uterine artery arteriovenous malformation (AVM) which mostly comprise of case series and reports with small sample sizes. The purpose of this study is to evaluate fertility and pregnancy outcomes in patients who underwent interventional radiology-guided uterine artery embolization for uterine AVM at our institution.

METHODS:
IRB approval was obtained. A retrospective chart review was performed from 2008 to present looking at patients who had interventional radiology-guided uterine artery embolization. These patients' charts were reviewed for subsequent pregnancy incidence and outcome of those pregnancies.

RESULTS:
37 patients were diagnosed with uterine AVM. 18 chose to undergo UAE. Of those 18 patients, 7 attained subsequent pregnancies. Of the subsequent pregnancies, 4 patients had full-term deliveries and two of these four also had at least one miscarriage. One patient had only a miscarriage without any deliveries, and 1 had a voluntary termination of pregnancy with no other pregnancies documented for the duration of their follow up in our health system. No patients had preterm deliveries. No patients had post-procedure placental abnormalities in their subsequent pregnancies (no documented placenta previa, accreta, or percreta).

CONCLUSION:
Our data show that successful term pregnancies are possible after IR-guided treatment of uterine AVM. Future multi-institutional prospective studies are required to further prove or disprove results shown in this study. This data has the potential to impact counseling and management for patients who present with uterine artery AVM and desire future fertility.