bluuebunny/crossref_metadata_2025_split huggingface dataset:
Baseline Fetal Heart Rate at Term in Obese and Diabetic Women and Mode of Delivery [23J]
Authors: Kidd Jennifer , Gimovsky Martin Larry , Nazir Munir , Koscica Karen 
Published: April 2018

INTRODUCTION:
Fetal heart rate (FHR) reflects adaptation to environment. Increased baseline FHR at term may be indicative of fetal inability to tolerate labor. This study reviews admission baseline FHR and mode of delivery when non-reassuring FHR is present.

METHODS:
A retrospective cohort study of 1,035 deliveries in obese mothers at term for 2016 was reviewed. Inclusion criteria included: body mass index (BMI) greater than 30, admission baseline FHR, and admission for delivery. Exclusion criteria included multiple gestation, congenital abnormalities, contraindications to labor, prior cesarean delivery and elective cesarean deliveries. Data extracted from medical record included: parity, medical conditions, admission diagnosis, admission baseline FHR, mode of delivery, and indication for cesarean delivery. Statistical analysis utilized Student's t-test and ANOVA for data stratification by BMI and diabetic status.

RESULTS:
Mean admission baseline FHR increased with BMI, diabetic status, and deliveries by cesarean delivery for nonreassuring tracing (NRFHRT). Vaginal delivery rate decreased with increasing BMI and presence of diabetic status. Student t-test of vaginal deliveries versus cesarean deliveries for NRFHRT was significant for diabetics with BMI between 30 and 34 (P<.01). ANOVA analysis of baseline FHR for all groups (P=.013) and all obese non-diabetics (P<.01) was significant; analysis for diabetics alone was not significant (P=.067).

CONCLUSION:
This study suggests baseline admission FHR significantly affects mode of delivery for obese mothers. In addition although not statistically significant, diabetic subgroups demonstrate a similar trend. Increased baseline FHR may be associated with decreased labor tolerance and increased cesarean delivery rate.
The Effect of Low-Molecular-Weight Heparin Added Low Dose Aspirin in the Subsequent Pregnancy of Hypertensive Women [24J]
Authors: Shen Fangrong , Huang Qin , Jiang Na , Yang Weiwen , Chen Youguo 
Published: April 2018

INTRODUCTION:
To investigate the effect of low-molecular-weight heparin (LMWH) added low dose aspirin (LDA) in the subsequent pregnancy of the women who have the previous history of hypertensive disorder of pregnancy.

METHODS:
Prophylactically adding LMWH and LDA in 33 women who has previous hypertensive disorder (HD) of pregnancy compared with 37 cases without administrate. We compared the recurrent rate of hypertensive disorder of pregnancy, the occurrence rate of placental abruption, intrauterine death, fetal growth restriction (FGR), intrapartum and postpartum hemorrhage with the women were not prophylactically adding LMWH and LDA. Also compared with the pregnancy gestational age between the two pregnancies.

RESULTS:
There was no significant differences in recurrent rate of hypertensive disorder of pregnancy, the occurrence rate of placental abruption, intrauterine death, fetal growth restriction intrapartum and postpartum hemorrhage (P>.05). There was significant differences in pregnancy gestational age between two pregnancies (P<.05), the pregnancy gestational age of the subsequent pregnancy were significant longer than the previous pregnancy.

CONCLUSION:
Prophylactically adding LMWH and LDA doesn't reduce the recurrent rate of hypertensive disorder of pregnancy, the occurrence rate of placental abruption, intrauterine death, fetal growth restriction. However, adding LMWH and LDA does prolong pregnancy gestational age, and doesn't increase the risk of the intrapartum and postpartum hemorrhage.
Repeat Antenatal Corticosteroids Decreased Neonatal Morbidity for Preterm Rupture of Membranes [25J]
Authors: Buskmiller Cara , Miller Collin , Vricella Laura 
Published: April 2018

INTRODUCTION:
A second course of antenatal corticosteroids (repeat ANCS) improves composite neonatal morbidity in pregnancies at risk of preterm delivery. Women with preterm premature rupture of membranes (PPROM) have been excluded from some studies of repeat ANCS. This study investigated whether repeat ANCS is associated with decreased neonatal morbidity in PPROM.

METHODS:
This was a retrospective cohort study of women with non-anomalous fetuses from 2005 to 2017 admitted for PPROM between 23w0d and 33w6d and latent at least 14 days after a two-dose initial course of ANCS. The standard of care group received no further ANCS; the study cohort received a second two-dose course of ANCS when delivery within 2 weeks was expected. The primary outcome was composite neonatal morbidity including respiratory morbidity, necrotizing enterocolitis, intraventricular hemorrhage, and death. Secondary outcomes were rates of clinical and histologic chorioamnionitis, and neonatal hypoglycemia.

RESULTS:
One hundred eighty-two women and 216 neonates were included. Seventy-seven women received standard of care and 105 received repeat ANCS. Maternal age, demographics, parity, body mass index, and median gestational age at rupture and at delivery were comparable between groups. Repeat ANCS was associated with decreased respiratory morbidity (P<.05). Neonatal hypoglycemia and clinical and histologic chorioamnionitis were similar between groups (P=.06, .14, .82 respectively). When neonates under 28 weeks were analyzed separately, respiratory morbidity remained the only outcome at the level of significance (P=.05).

CONCLUSION:
Repeat ANCS is associated with decreased neonatal morbidity and is not associated with increased rates of chorioamnionitis and neonatal hypoglycemia. Further prospective studies are needed.
Is Acute Intrapartum Fetal Asphyxia Associated With an Increase in Fetal Nucleated Red Blood Cells? [28J]
Authors: Chu Amanda , Divon Michael , Guillaume Stoffels , Kulla Klea , Minior Victoria , Bornstein Eran 
Published: April 2018

INTRODUCTION:
Fetal heart rate abnormalities and elevated nucleated red blood cells (nRBCs) have been suggested as markers of fetal asphyxia. Animal studies suggest that the time between the onset of hypoxia and FHR abnormalities is short. The time interval in humans is unknown. Our study aims to evaluate the association between nRBCs and acute intrapartum fetal asphyxia.

METHODS:
Study patients included consecutive NICU admissions (2013–2017) with cord gases indicating severe fetal asphyxia (n=35). Controls without asphyxia were NICU patients matched for gestational age (n=72). All had a category I FHR tracing on admission. Fetal asphyxia was defined by an umbilical cord pH <7.0 with a base excess <−9. We examined the time interval from the last FHR acceleration to the time of delivery. Fetuses with congenital or genetic abnormalities were excluded. Statistical analysis included χ2 testing, T-testing and Spearman correlations.

RESULTS:
There was no significant association between delta t and nRBCs in either group (P=.70 and P=.71 in study and control patients, respectively). Several additional variables were studied including maternal BMI, gestational age, maternal age, parity, mode of delivery, fetal sex, standardized birth weight. We found that delta T was significantly associated with asphyxia in patients with increased BMI and in Cesarean Sections.

CONCLUSION:
It is highly unlikely that nRBCs can serve as a marker of acute intrapartum fetal asphyxia. We believe that fetal nRBCs are the result of antepartum compensatory mechanisms responding to chronic inadequate fetal oxygenation.
Miscarriage After Noninvasive Prenatal Screening—The Value of Genetic Testing in Pregnancy Loss [34J]
Authors: Maisenbacher Melissa , DiNonno Wendy , Merrion Katrina , Young Michael , Sigurjonsson Styrmir , Hedriana Herman 
Published: April 2018

INTRODUCTION:
Noninvasive prenatal screening (NIPT) is a sensitive screen focusing on common aneuploidies. Products of conception (POC) testing can detect all aneuploidies, uniparental disomy, triploidy and deletions/duplications.

METHODS:
POC and NIPT results for the same pregnancy were reviewed. POC testing was performed using Illumina CytoSNP-12b microarrays. For NIPT, cfDNA was amplified by massively-multiplexed PCR targeting 13,392 SNPs across chromosomes 13, 18, 21, X and Y.

RESULTS:
Of 25,432 POC cases, 22,103 had fetal results (87%): 9,712 normal, 12,391 abnormal (1,630 triploid, 575 deletions/duplications). Two hundred seventy-one POC cases had prior NIPT: 181 (66.8%) low-risk results, 40 (14.8%) high-risk results, and 50 (18.4%) no results (low fetal fraction/uninformative DNA). For low-risk cases, 157/181 (86.7%) had concordant POC results, 23/181 (12.7%) had POC results undetectable by NIPT, including 8 cases of deletions/duplications (4.4%) and 1 triploidy (0.5%). For high-risk cases, 39/40 (97.5%) were concordant. For no result cases, 37/50 (74%) had abnormal POC results, including 14 cases of triploidy (28%), and 2 deletions/duplications (4%).

CONCLUSION:
In our study, low-risk cases had a 4.4% rate of deletions/duplications, almost double the overall POC incidence of 2.6%. Importantly, these findings could be due to parental balanced translocations. No results cases had a higher incidence (74%) of chromosome abnormalities than POC studies (56%), particularly triploidy at a rate of 28% compared to 7.4% in POC studies, which carries a risk for gestational trophoblastic disease (GTD). POC testing after NIPT allows providers to streamline the work-up for miscarriage, provide recurrence risks, guide maternal screening for GTD, and allow patients closure.
Pregnancy Intention Screening: Changes in Staff Perceptions With Training [8K]
Authors: Jackson Ashaki , Saleeby Erin , Pietersz Judith Dannelle , Zapata Carmen , Thiel de Bocanegra Heike 
Published: April 2018

INTRODUCTION:
Integrating reproductive life preference (RLP) screening is part of a larger initiative to improve reproductive and sexual healthcare throughout the Los Angeles County Department of Health Services (LACDHS). The LACDHS implemented RLP training among clinic staff and evaluated impact of training on staff perceptions of the RLP questions and their incorporation into routine clinical care.

METHODS:
We collected pre- and post-survey data from training participants from April 2017 to September 2017. Survey items included RLP question knowledge, implementation confidence and attitudes on the importance of reproductive health. We analyzed changes with pre- and post-tests.

RESULTS:
A total of 175 medical staff—largely certified medical assistants (48.6%) and nurses (29.1%)—completed evaluation surveys. Analyses conducted on responses from staff who were already somewhat familiar with RLP questions revealed that by post-survey, staff more often perceived fewer barriers to implementing RLP questions in clinical settings, t(87)=3.34, P=.001; saw inclusion of RLP questions as helpful to their work, t(88)=−3.45, P=.001; and perceived the questions as helpful to information-gathering and the decision-making process, t(88)=−6.40, P=.001. Staff who were unfamiliar with RLP questions more often agreed that RLP questions improved the decision-making process and were useful to information-gathering at post-survey, t(75)=−2.37, P=.02.

CONCLUSION:
Training demonstrated some impact on perceptions of RLP question's value. Future research will include how often staff ask questions prior to and following training to clarify if training also impacts practice.
Patient Opinions on Vaccines and Maternal Vaccination Status [11K]
Authors: Gelvin Brady J. , Morrow Ardythe L. , Staat Mary A. , DeFranco Emily 
Published: April 2018

INTRODUCTION:
To identify opinions that most negatively predict maternal influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination receipt.

METHODS:
Pregnant women >34 weeks were offered enrollment in a prospective cohort study, Pediatric Respiratory & Enteric Virus Acquisition and Immunogenesis Longitudinal Cohort (PREVAIL, www.cdc.gov/surveillance/nvsn/prevail.html). Multivariate logistic regression estimated the association between maternal characteristics and vaccine opinions on not receiving an influenza or Tdap vaccination.

RESULTS:
Of 58 enrolled mothers, 27 (46.6%) declined either an influenza, Tdap, or both vaccinations during their current pregnancy. Vaccine opinions and factors most commonly associated with refusal of an influenza vaccination were prior vaccination refusal (9, 45.0%), believing influenza vaccine is not effective at protecting one from the flu (12, 60%), believing influenza vaccine is not effective at conveying immunity to the baby (9, 45.0%), and believing it is better for a child to develop immunity naturally versus receiving an immunization (8, 40.0%). Vaccine opinions and factors most commonly associated with refusal of a Tdap vaccination were maternal age >34 year old (5, 35.7%), reported hesitancy toward childhood vaccinations (4, 28.6%), not planning on breastfeeding (4, 28.6%), and history of prior vaccine refusal (4, 28.6%).

CONCLUSION:
Our preliminary analysis has elucidated maternal factors and opinions regarding failure to receive recommended prenatal vaccinations. These efforts could help to shape future maternal vaccination education programs, as well as vaccine education programs in general.
Frequency of Neonatal Hypoglycemia After Implementation of Antenatal Late Preterm Steroids Use [19K]
Authors: Alrais Mesk A. , Chen Han-Yang , Sibai Baha M. , Blackwell Sean C. 
Published: April 2018

INTRODUCTION:
Our objective was to evaluate the impact of Antenatal Corticosteroids (ACS) exposure on neonatal hypoglycemia after implementation of Antenatal Late Preterm Steroids (ALPS) protocol.

METHODS:
We conducted a retrospective cohort study of women admitted at 34–36 weeks gestation and had a late preterm birth from April 2016 to March 2017 (after publication of SMFM and ACOG guidelines). ALPS protocol was defined as: administration of Betamethasone (BMZ) for the first time to a live, singleton, non-pregestational diabetic pregnancy with a high probability of delivery between 12 hours and 7 days, in the absence of risk factors necessitate immediate delivery. Hypoglycemia was defined as any blood sugar <40 mg/dL within the first 72 hours of life. Perinatal outcomes were compared between those received ALPS versus those did not receive.

RESULTS:
Out of 484 births, 220 (45.5%) infants developed hypoglycemia irrespective to gestational age. Rate of hypoglycemia was higher in neonates exposed to BMZ compared to those did not (54% versus 43%, P=.049). Among hypoglycemic infants, the total rate of NICU admission was higher in infants exposed to BMZ compared to those not exposed (68% versus 52%, P=.028), but no significant difference was found in their length of stay in NICU. In addition, 34% had spontaneous onset of labor and 58% went into a trial of labor.

CONCLUSION:
In late preterm birth infants, ACS administration was associated with neonatal hypoglycemia which supports the finding in ALPS trial.
Continuous Glucose Monitoring in Pregnancies Complicated by Type 1 Diabetes Mellitus [20K]
Authors: Herrero Tiffany , Coleman Todd , Laurent Louise , Moore Thomas , Ramos Gladys 
Published: April 2018

INTRODUCTION:
Continuous glucose monitors (CGM) is recommended for use in type 1 diabetes mellitus (T1DM) but studies in pregnancy are limited. We compare the number of hypoglycemic and hyperglycemic episodes on CGM to traditional self-monitoring blood glucose (SMBG) in women with T1DM.

METHODS:
Patients with T1DM presenting for care at UC San Diego <20 weeks were approached for participation. Patients underwent routine diabetes care and wore a blinded CGM (Dexcom G4) for 7 days every 4 weeks. Dexcom provided CGM. The primary outcome was the number of hours of hypoglycemia and hyperglycemia detected by each modality. Missed episodes of hypoglycemia/hyperglycemia were those not detected by one testing modality or the other. Mann Whitney-U, χ2 analysis, and Kruskal Wallis Test were performed where appropriate.

RESULTS:
Ten patients were recruited for this study. Two terminated their pregnancies. Two withdrew their participation. Thirty nine thousand five hundred seventy two glucose values (3,625 hours of glycemic data) were collected through CGM. Per day, the mean hours of reported hypoglycemia (4.3±1.9 for CGM versus 0.9±0.4 for SMBG, P<.01) and hyperglycemia (10.8±2.3 for CGM versus 2.7±0.9 for SMBG, P<.01) were significantly higher for the CGM group. For hypoglycemic and hyperglycemic hours, CGM demonstrated a lower mean proportion of missed hypoglycemia (3.7 versus 0.2 by CGM [P<.01]) and hyperglycemia (9.2 versus 0.1 by CGM [P<.01]). There was no correlation between A1c or trimester and missed hypoglycemic/hyperglycemic events.

CONCLUSION:
CGM detected a significant amount of time of unreported hypoglycemia/hyperglycemia over SMBG. Further study is needed to see if CGM can improve glycemic control and perinatal outcomes.
Etiologies and Timing of Stillbirth at a Tertiary Teaching Hospital in Mekelle, Ethiopia [24K]
Authors: Yeman Awol , Cavanaugh Erin , Whelan Anna , Zelelew Yibrah , Miller Emily Stinnett , Goba Gelila 
Published: April 2018

INTRODUCTION:
Stillbirth remains a tragic event. The overwhelming majority globally (98%) occurs in low- and middle-income countries (LMICs), though data is limited. Ayder Referral Hospital (ARH), a tertiary hospital in northern Ethiopia, utilizes a World Health Organization (WHO) form to record stillbirth. This study aimed to determine the etiology and timing of stillbirths delivered at ARH.

METHODS:
Our study was a retrospective chart review of stillbirths delivered at ARH between January 1, 2013 and December 31, 2015. We used delivering obstetricians' notes using the WHO form and physical examination of fetus and placenta to determine etiology and timing of stillbirths.

RESULTS:
Over the study period, there were 4,582 live births and 322 stillbirths delivered at ARH. The top five causes of stillbirth were unexplained (41.3%), abruptio placenta (15.5%), fetal congenital anomalies (14.9%), birth asphyxia (12.1%), and cord accidents (6.8%). Most (62.2%) stillbirths occurred intrapartum, including during the latent (6.1%), active (6.1%) and second (50.0%) stages of labor. In 70.8% of stillbirths, fetal heart tone (FHT) was absent on admission to ARH, including 28.6% that had no FHT upon arrival at referring institution, 18.0% that occurred en route to ARH, and 24.2% that arrived at ARH directly with no referral.

CONCLUSION:
Stillbirth continues to be significant problem in northern Ethiopia. Additional research is needed given that 41.3% of stillbirths were unexplained. Nearly two-thirds of stillbirths occurred intrapartum and 18.0% in transit from referral institutions, suggesting women need access to care before labor starts and transportation from referring institutions should be improved.
The Impact of Multi-Drug Therapy on Pregnancies of Chronic Hypertensive Women [26K]
Authors: Ambia Anne M. , Rodriguez A. Noel , Morgan Jamie L. , Wells C. Edward , Roberts Scott W. , Nelson David B. 
Published: April 2018

INTRODUCTION:
Our group has previously described the high frequency of preterm birth and superimposed preeclampsia in women treated during pregnancy for chronic hypertension (CHTN). We hypothesized that women with CHTN requiring more than one medication for control may be at increased risk for these adverse perinatal outcomes.

METHODS:
This was a retrospective study of pregnant women with CHTN who delivered from June 2009 to January 2016. These women were treated with a-adrenergic agonists, combined a-B blockers, calcium channel blockers, or a combination thereof. Regimens were adjusted to achieve blood pressures <150 mm Hg systolic and <100 mm Hg diastolic based on recommendations of the ACOG Task Force of Hypertension in Pregnancy. Perinatal outcomes were analyzed by the number of medications needed to achieve the desired blood pressure (BP).

RESULTS:
There were a total of 419 women with treated CHTN. Fifty (12%) required the use of more than one medication for BP control. There were no differences in maternal baseline characteristics other than duration of diagnosis in those requiring more than one medication (P=.037). Requiring more than one anti-hypertensive medication during pregnancy was associated with a greater risk for superimposed severe preeclampsia (P=.011), delivery <34 weeks (P<.001), and birthweight <2,500 g (P<.001). This burden of preterm birth correlated with an increased frequency of admission to neonatal intensive care (P=.037), development of bronchopulmonary dysplasia (P=.003), surfactant use (P=.02), and phototherapy (P=.015).

CONCLUSION:
Women who require more than one medication for BP control have increased frequencies of adverse perinatal outcomes specifically linked to indicated, early preterm birth.
Postpartum Utilization of Narcotics for Analgesia [29K]
Authors: Kim Sara , Chappelle Joseph 
Published: April 2018

INTRODUCTION:
The number of deaths from opioid overdose has dramatically increased in recent years and one factor is the increase in prescription narcotics. This study aims to assess the amount of narcotics women utilize post-Cesarean and identify factors that affect pain control.

METHODS:
Women were contacted via telephone 10–12 days after delivery and verbally consented to participate. They were asked questions ranging from severity of postoperative pain to amount of narcotics used since discharge. At the completion of the survey, demographics, postoperative pain and medication usage were collected. Women using methadone or buprenorphine were excluded.

RESULTS:
There were one hundred women in the study. Mean narcotic usage was 92.4±90.4 mg morphine equivalents inpatient and 15.2±32.2 mg outpatient. More women with commercial insurance felt they had been prescribed too many pills compared to women with Medicaid (40.0% versus 20.0%, P=.002), while women with anxiety and/or depression more often felt that they were not given enough (2.4% versus 22.2%, P=.04). No other factors were significant. Women who used more narcotics inpatient tended to required more outpatient, however no clinically relevant cut-offs could be found. Most commonly prescribed amount was 30 pills and 5.8% of women given 20 pills or less felt that they did not have enough.

CONCLUSION:
The amount of opioids prescribed is likely too much for most patients. Having this information will better guide physicians in our community to minimize amount of opioids prescribed without compromising patient's pain. Pain control in women with anxiety and depression needs further attention.