bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of a Maternal Early Warning System Quality Improvement Initiative in Texas Hospitals [20N]
Authors: Patel Divya A. , Salahuddin Meliha , Wagner Amanda , Ramsey Patrick S. , Davidson Christina , Eppes Carey 
Published: April 2020

INTRODUCTION:
Delayed response to abnormal maternal vital signs is a leading cause of preventable maternal death. Maternal early warning systems (MEWS) that alert providers to impending critical illness can improve maternal outcomes. Texas Department of State Health Services partnered with the Alliance for Innovation on Maternal Health (AIM) to launch the TexasAIM maternal safety initiative. The Texas perinatal quality collaborative (PQC) is implementing a quality improvement (QI) initiative to augment TexasAIM with a goal of integrating MEWS in a subset of Texas birthing hospitals by December 2019.

METHODS:
Reinforcement cohort (RC) hospitals were identified in January 2019 based on self-reported stage of MEWS implementation (n=15). The implementation framework uses the Institute for Healthcare Improvement Breakthrough Series modified to include the mentor model, and the AIM MEWS toolkit was adapted. Monthly data collection including process, structure and outcome measures began in June 2019.

RESULTS:
Most RC hospitals were urban (80%) and non-academic (53%), with at least 1,000 annual deliveries (73%). In 2017, the mean severe maternal morbidity rate in the RC hospitals and Texas overall was 196 and 170 per 10,000 deliveries, respectively. By August 2019, most providers (82%) and nurses (94%) were educated on the MEWS protocol. Three RC hospitals have fully integrated MEWS, with two serving as peer mentors to remaining RC hospitals.

CONCLUSION:
Implementation of MEWS, in conjunction with AIM bundles, may augment improvements in maternal health. Future work of the Texas PQC includes scaling the MEWS initiative to additional hospitals to support ongoing TexasAIM efforts to reduce maternal morbidity and mortality.
Oral Health Care in Pregnancy, ACOG Fellow Perspectives [27N]
Authors: Roussos-Ross Kay , LaPorte Amanda , Bright Melissa , Villanueva Kara Mia 
Published: April 2020

INTRODUCTION:
The American College of Obstetrics and Gynecology recommends routine oral health care during pregnancy. Despite this recommendation, many pregnant women do not receive routine dental care. The reasons for discordance are complex. This study, conducted in conjunction with the ACOG District XII Committee on Healthcare of Underserved Women, surveyed ACOG District XII Fellows regarding their perceptions of factors that impact oral health care in pregnancy.

METHODS:
Between May and October 2019, ACOG District XII Fellows were asked to participate in an anonymous electronic survey on their practices regarding oral health in pregnancy. IRB approval was obtained. Descriptive statistics were estimated using SPSS (V25).

RESULTS:
107 ACOG Fellows completed this survey. Twenty-one percent of Fellows reported receiving education/training related to oral health in pregnancy. Less than half (48%) of Fellows reported asking oral health screening questions, 60% recommend that women undergo routine dental cleaning, and 65% reported counseling patients on the importance of oral health in pregnancy. Seventeen percent (17%) reported insufficient clinic time and 17% of Fellows reported lack of accepting dentists as reasons for not discussing oral health during prenatal care. However, 55% of Fellows reported patients would easily find an accepting dentist.

CONCLUSION:
District XII ACOG Fellows acknowledge the importance of routine oral health care in pregnancy. However, they perceive barriers to recommending care such as limited clinic time and patient access. Offering oral health education during provider training could improve screening rates and counseling. Additionally, increasing access to dental care could improve overall oral health in pregnant women.
Outcomes of Placenta Accreta Cases Managed via a Placenta Accreta Protocol Versus Without a Protocol [29N]
Authors: Juusela Alexander , Javadian Pouya , Gimovsky Martin Larry , Nazir Munir 
Published: April 2020

INTRODUCTION:
Placenta accreta spectrum (PAS) is a collection of conditions of abnormal placentation that when undiagnosed at the time of delivery, can lead to massive hemorrhage, disseminated intravascular coagulopathy, hypovolemic shock, and maternal mortality. The purpose of our project was to evaluate outcomes before and after the creation and implementation of our institution's placenta accreta protocol.

METHODS:
After IRB approval was obtained, a retrospective chart review of all deliveries at our institution from January 1st 2007 until December 31st 2015 was performed. Cases were grouped based on those managed following our institution's placenta accreta protocol and those not managed according to the protocol. The data was analyzed using a Student T-test and Chi-Squared (X2) analysis.

RESULTS:
There was a statistically significant difference in outcomes between cases managed with the protocol versus without the protocol for estimated blood loss (P=0.009), units of blood transfused (P=0.002), and intensive care unit admission (P=0.001).

CONCLUSION:
Establishing a suspected diagnosis of PAS before delivery allows for a scheduled delivery and pre-operative planning with a multidisciplinary team based on the severity of the PAS. No randomized controlled trials exist to guide management; therefore management varies between institutions and practitioners. Our retrospective study supports ACOG Committee Opinion No. 529's conclusion in that there was a statistically significant difference in outcomes between unplanned and planned cesarean hysterectomy. As this study demonstrated a clear decrease in adverse outcomes, since this study was performed, all patients with a high suspicion for PAS have been managed using our new protocol.
Acceptability of Using Newborns' Given Names at Birth: Survey in Postpartum and Antepartum Units [01O]
Authors: Besagar Sonya , Robles Patrick Louie , Rojas Chanel , Applebaum Jo R. , Adelman Jason S. , Goffman Dena 
Published: April 2020

INTRODUCTION:
Wrong-patient orders present a significant patient safety risk to newborns during delivery hospitalization. Adopting a distinct newborn naming convention (Wendysboy vs Babyboy) significantly reduced the risk of wrong-patient orders in neonatal intensive care units. However, multiple-birth infants remain at high risk, attributable to errors between siblings with nearly identical names (Wendysboy 1, Wendysboy 2). Using newborns' given names at birth may reduce this risk, but acceptability to parents is unknown.

METHODS:
Research personnel surveyed a convenience sample of women in postpartum and antepartum units, in English or Spanish, at a large academic medical center. Data collected included: timing of newborn name selection, willingness to use given names for identification in the hospital at birth, demographics, and pregnancy-related information.

RESULTS:
A total of 253 women were surveyed postpartum (mean age 32.1±5.7 years; mean gestational age [GA] at delivery 38.5±1.7 weeks, 4.0% multiple gestation) and 25 antepartum (mean age 33.2±6.1 years; mean GA 30.3±3.2 weeks; 28.0% multiple gestation). Postpartum, 84.6% (214/253) of women had selected names and would have been willing to use them on the day of delivery; of those, 71.5% (153/214) had selected names before the 3rd trimester. Antepartum, 64% (16/25) had selected names that they would be willing to use at birth. The survey is ongoing; final results will be presented.

CONCLUSION:
The majority of parents have given names available for use at birth. Assigning given names rather than temporary names in the hospital is a feasible systems-level strategy to reduce wrong-patient errors among multiple-birth infants.
Characteristics of Patients Intending to Breastfeed in a Tertiary Obstetric Hospital in Louisiana [07O]
Authors: LeMoine Felicia , Chapple Andrew , Sutton Elizabeth , Pam Lakedra 
Published: April 2020

INTRODUCTION:
Increasing the rates of breastfed infants has become a national health objective. Louisiana's breastfeeding initiation and continuance rates remain below the national average, ranking 49th of 50. Our goal is to identify demographic predictors of initial and continued intent to breastfeed.

METHODS:
We conducted a retrospective cohort study of electronic health records from deliveries at Woman's Hospital, a tertiary hospital in South-Central Louisiana, between July 2015 and June 2016 (n=6689; approved and monitored by Woman's IRB). Patients were asked upon admission for delivery if they intended to breastfeed. Their feeding plan (breast, formula, combination) was reassessed at discharge. Logistic regression was used to describe the populations most likely to intend to breastfeed prior to delivery and those that were breastfeeding successfully at the time of discharge.

RESULTS:
Between July 2015 and June 2016, 6,689 patients met criteria for analysis. Patients reporting intent to breastfeed prior to delivery were more likely Caucasian (P<.0001), married (P<.001), nulliparous (P<.01), privately-insured (P<.0001), educated (P<.0001), and older (P<.01) compared to patients not intending to breastfeed. These characteristics were similar in those with continued breastfeeding at discharge, however the strongest predictor of breastfeeding at discharge was intent to breastfeed prior to delivery (P<.0001). African American race was the strongest predictor of non-breastfeeding intent (P<.0001).

CONCLUSION:
Intent to breastfeed prior to delivery was the strongest predictor of breastfeeding at discharge; thus, prenatal breastfeeding education within the at-risk population is crucial to increasing breastfeeding rates. Future studies should assess factors influencing breastfeeding discontinuation and breastfeeding rates through six months postpartum.
Comparison of Doppler Indices in Patients With Umbilical Vein Varix (UVV) to Standard Doppler Indices [08O]
Authors: Rivera Patricia , Heslin Kayla , Forgie Marie M. , Stone Ryan , Kram Jessica J. 
Published: April 2020

INTRODUCTION:
There is little consensus on antenatal management of umbilical vein varices (UVV). Our study reviewed biophysical profile (BPP) scores, Doppler indices, and maternal/neonatal demographics.

METHODS:
Following approval by our Institutional Review Board, we retrospectively reviewed singleton pregnancies with UVV from 1/1/2012 to 6/1/2019. Of those with Doppler studies, we compared middle cerebral artery (MCA), umbilical artery (UA), and ductus venosus (DV) values to the 50th percentile of standard indices. We reviewed BPP scores, fetal abnormalities, mode of delivery, maternal comorbidities, neonatal intensive care unit (NICU) admission, and APGARs. Basic descriptive statistics were conducted.

RESULTS:
Overall, 84 women were identified with UVV at an average gestational age of 32 weeks. Notably, 40.5% had used tobacco. Of the fetuses, 13.1% had intrauterine growth restriction, 6% tricuspid regurgitation, 31% anatomic abnormalities. No abnormal BPPs and fetal demises were identified. Sixty-two percent had an abnormal doppler value, with the MCA Doppler differing most from standard indices. Average gestational age at time of delivery was 37 weeks and the cesarean section rate was 26% with a minority due to non-reassuring fetal status (27%). There were three indicated preterm deliveries secondary to umbilical vein thrombus. For the neonates, 31% were admitted to the NICU. Only one had a 5-minute APGAR score <5.

CONCLUSION:
Doppler abnormalities are common in pregnancies affected by UVV with MCA being the most commonly abnormal. None had abnormal BPPs and few required interventions such as indicated cesarean section due to fetal status. This raises the question: is antenatal testing and Doppler testing of any utility?
Cost Analysis and Diagnostic Yield of Histopathology Versus Genetic Testing for Evaluation of Pregnancy Loss [10O]
Authors: Maisenbacher Melissa , Merrion Katerina , Kutteh William 
Published: April 2020

INTRODUCTION:
Miscarriage evaluations, including histopathology studies and genetic testing, are performed to determine the cause of the loss and provide maternal medical management guidance. This study examined the cost and diagnostic effectiveness of histopathology and single nucleotide polymorphism (SNP) array-based genetic testing to identify molar pregnancies, defined as conceptions with excess paternal genetic contribution, or another cause of the loss.

METHODS:
Products of conception cases from a single institution (Recurrent Pregnancy Loss Center, Fertility Associates of Memphis, Memphis, TN), are routinely sent for histopathological examination and genetic testing. Retrospective analysis of the results and cost of both evaluations were compared. (IRB E&I 15148-03).

RESULTS:
Fifty-nine cases were examined. SNP array-based testing showed 27 normal (46%) and 32 abnormal cases (54%), including 3 molar (diandric triploidy). Histopathology identified three molar cases; only one was confirmed by SNP microarray. In this cohort, the self-pay cost for histopathology was $241 and for SNP array was $349. The rate of correctly identifying molar pregnancy by histopathology was 1/59 or $14,219/case identified, and by SNP array was 3/59 or $6,864/case identified. Similarly, the rate of identifying a cause of the loss by histopathology was 1/59 or $14,219/case identified and by SNP array was 32/59 or $643/case identified.

CONCLUSION:
Comparison of the cost of SNP array analysis with histopathology evaluation results in a similar expense to the patient. SNP array is an alternative to identifying patients with a molar pregnancy and provides additional clinical information to providers at a significantly lower cost per case for cause of loss identified.
Does Food Access Impact Neonatal Birth Weight? [11O]
Authors: Sawangkum Peeraya , Tanner Jean , Campos Adriana , Fryer Kimberly , Wilson Ronee , Louis-Jacques Adetola 
Published: April 2020

INTRODUCTION:
Food deserts are typically found in low-income, low-resource areas that can impact health outcomes. A population-based study in Florida was conducted to determine if living in a food desert was associated with a higher prevalence of low birth weight (LBW, <2500 grams).

METHODS:
Birthweight and demographic information were obtained from the Florida Community Health Assessment Research Tool Set. These data were linked to census tract-level food access information obtained from the US Department of Agriculture Food Access Research Atlas. A low-income, low-access tract (LILA) is a census tract with 20% of the population having income less than 80% of the statewide median family income and with at least 500 people, or 33% of the population, living more than 1 mile (urban areas) or more than 10 miles (rural areas) from the nearest supermarket. Prevalence ratios and 95% confidence intervals were calculated using Poisson regression models.

RESULTS:
From 2008 to 2018, there were 2,368,114 live births with nonmissing birthweight and food access designation in Florida. Approximately 8.6% were LBW, and 18.9% of all LBW occurred in LILA tracts. After adjusting for maternal race/ethnicity, the prevalence ratio (PR) for the association between living in a LILA tract and LBW was 1.06 (95% CI 1.05–1.07). Stratifying by race/ethnicity, the PR were as follows: white non-Hispanic 1.13 (95% CI 1.11–1.15), black non-Hispanic 1.05 (95% CI 1.03–1.06), and Hispanic 1.00 (95% CI 0.98–1.02).

CONCLUSION:
Maternal food access is associated with a higher prevalence of LBW infants in Florida, particularly in white non-Hispanic populations.
Effects of Breastfeeding on NAS Symptom Severity, Infant Pharmacologic Use, and Length of Hospital Stay [12O]
Authors: Turkheimer Lena , Valea Fidel A. , Simcox Kimberly , Hays Jacinda 
Published: April 2020

INTRODUCTION:
Prenatal opioid maintenance therapy (OMT) exposure is associated with neonatal abstinence syndrome (NAS) (Finnegan, Connaughton et al., 1975). Our study examines the effects of breastfeeding on NAS symptom severity, pharmacologic use, and length of treatment.

METHODS:
Data was extracted retrospectively from the medical charts of 74 infants born to mothers on OMT at Carilion Roanoke Memorial Hospital (CRMH) and analyzed using propensity score matching, which examines group differences in outcome while controlling for pre-existing differences in background variables (Rosenbaum & Rubin, 1985). IRB approval was obtained.

RESULTS:
Of the sixty infants included, at five days old thirty were being fed formula only, thirteen were breastfed only, and seventeen were fed both breastmilk and formula. Propensity score matching was used to match the thirteen breastmilk only infants to thirteen of the formula-only infants. Mean peak NAS Finnegan scores in the formula and breastmilk groups were 11.54 and 6.54, respectively (P=.03). Mean length of infant pharmacologic treatment was 1.46 months for formula fed infants and .33 months for breastfed infants (P=.02). Among matched pairs with one infant receiving pharmacologic treatment and one not receiving treatment, the formula fed infant was more likely to have received pharmacologic treatment (P=.04).

CONCLUSION:
This study shows that breastfeeding decreases symptom severity, infant pharmacologic use and length of pharmacologic treatment. The use of propensity matching accounts for confounding variables more appropriately than previous studies, likely increasing the reliability of the findings.
Effects of Delayed Cord Clamping on Neonatal Outcomes in Pregestational Diabetes at Term [13O]
Authors: Bennett Carrie , Munoz Jessian Louis , Yao Meng , Singh Katherine 
Published: April 2020

INTRODUCTION:
Placental blood transfusion via delayed cord clamping can increase infant blood volume 10–20%. Hyperbilirubinemia is a well-known sequelae of infants born to diabetic mothers. Our study sought to evaluate the effects of delayed cord clamping on neonatal hyperbilirubinemia in a population prone to this phenomenon.

METHODS:
In January 2016, our institution implemented a thirty-second delayed cord clamping policy for provider-deemed eligible patients. This retrospective cohort study represents infants of pre-gestational diabetics who delivered before and after implementation. 72 patients were selected for each arm to achieve 80% power to detect a 15% difference between groups. Term singleton gestations were included. Study period was October 2014 to August 2017. Primary outcome was neonatal transcutaneous bilirubin. Secondary outcomes included serum bilirubin, jaundice requiring phototherapy, hypoglycemia, polycythemia, neonatal respiratory distress, and NICU admission. Subgroup analysis for outcomes in Type I diabetes and Type II diabetes was also performed.

RESULTS:
145 patients were included in the final analysis. Transcutaneous bilirubin was 10.1 ± 3.4 for immediate cord clamping and 9.5 ± 3.4 for delayed cord clamping (P=.25). There were no statistically significant differences between groups in jaundice requiring phototherapy, hypoglycemia, polycythemia, neonatal respiratory distress, or NICU admission. No differences were observed in neonatal outcome by subgroup analysis of Type I versus Type II pre-gestational diabetes.

CONCLUSION:
In our study, there was no statistically significant increase in transcutaneous bilirubin in term infants of mothers with pre-gestational diabetes after undergoing 30 seconds of delayed cord clamping. Further research is needed to ascertain long-term neonatal effects.
Incidence of Jaundice by Maternal Body Mass Index and Diabetes Status [19O]
Authors: Thayer Sydney Marie , Owens Sarah N. , Garg Bharti , Caughey Aaron B. 
Published: April 2020

INTRODUCTION:
To examine the association between body mass index (BMI) and neonatal jaundice in women with pre-existing diabetes, gestational diabetes, and without diabetes.

METHODS:
This is a retrospective cohort study of women with singleton, non-anomalous, term pregnancies between 2007 and 2011 using linked vital statistics and discharge data. Chi-square tests were used to compare rates of neonatal jaundice in diabetic and non-diabetic women categorized by BMI class. Pre-pregnancy BMI was categorized into underweight, normal weight, overweight, obesity, and morbid obesity. Multivariable logistic regression was used to examine the association of BMI with jaundice by diabetes classification, controlling for maternal race/ethnicity, age, parity, education, and insurance status.

RESULTS:
The cohort of 1,859,198 consisted of 364,392 (19.6%) obese pregnant women. Overall, a higher BMI class was found to be associated with increased odds of neonatal jaundice, independent of diabetes status. Underweight pre-pregnancy BMI was associated with decreased odds of jaundice when compared to normal-weight women. When compared to women without diabetes, those with gestational and pre-existing diabetes have significantly increased odds of neonatal jaundice (aOR 1.15, 95% CI 1.14–1.17 and aOR 1.63, 95% CI 1.57–1.69, respectively). A significant association was demonstrated between BMI category and jaundice for women with gestational diabetes and no diabetes. In contrast, we did not find a statistically significant relationship between BMI class and neonatal jaundice among women with pre-existing diabetes.

CONCLUSION:
Diabetes status and higher BMI category are associated with increasing incidence of neonatal jaundice. Obstetrical education for women in these categories should emphasize the increased potential of this neonatal complication.
Low 5-Minute Apgar Score and Severe Neonatal Outcomes in Preterm Prelabor Rupture of Membranes [21O]
Authors: Hoover Elizabeth A. , Sawangkum Peeraya , Duncan Jose R. 
Published: April 2020

INTRODUCTION:
The Apgar score has limited prediction accuracy of adverse outcomes. We studied the association of a low 5-minute Apgar score with severe neonatal outcomes (SNO) in pregnancies complicated by preterm prelabor rupture of membranes (PPROM).

METHODS:
We conducted a secondary analysis of a prospective cohort study of singleton pregnancies with PPROM at an academic institution from October 2015 to May 2018. Fetal demise and complex anomalies were excluded. The primary exposure was Apgar <7; the primary outcome was SNO. The rate of SNO was compared in neonates with a 5-minute Apgar score <7 to those ≥7. SNO was defined as one or more of the following: RDS; necrotizing enterocolitis; grade III-IV IVH; neonatal sepsis; or neonatal death. Fischer exact test was utilized for statistical analysis.

RESULTS:
Of 105 pregnancies included, 89 were African American and 83 delivered ≥28 weeks gestation. SNO occurred in 42 neonates (41%). 20 newborns received a 5-minute Apgar score <7 (19%); the median gestational age at delivery was significantly less in this group (26 vs. 32 weeks, P<.001). Therefore we compared the association of 5-minute Apgar <7 and SNO after 28 weeks gestation; neonates with Apgars <7 were more likely to develop SNO than those with scores ≥7 (6 (100%) vs. 15 (18%); RR 5.1; 95% CI 3.3–8.0; P<.001).

CONCLUSION:
In pregnancies complicated by PPROM, a low 5-minute Apgar score may be associated with severe neonatal outcomes. We recommend our findings be corroborated in diverse populations.