bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adequate Weight Gain during Pregnancy by Pre-Pregnancy Body Mass Index: Who Gets It Right? [19C]
Authors: Williams Corrine M. , McDaniel Honour , Chavan Niraj R. 
Published: April 2018

INTRODUCTION:
In 2009, the IOM issued new guidelines for gestational weight gain (GWG), based on pre-pregnancy body mass index (PPBMI). This study was conducted to understand who is currently meeting these recommendations, exploring sociodemographic characteristics.

METHODS:
Using 2015 vital statistics (birth) data collected by the National Center for Health Statistics, GWG was calculated using pre-pregnancy weight and delivery weight to determine inadequate, adequate, and excess GWG categories by PPBMI, per the new guidelines. Chi-square tests and multivariate logistic regression analyses were used to assess the 12-category GWG/PPBMI variable by age, race/ethnicity, education, marital status, insurance at delivery, WIC receipt, trimester prenatal care began and smoking status.

RESULTS:
Of 3,404,491 singleton deliveries with complete information on PPBMI and GWG, 3.6% were underweight, 45.2% were normal weight, 25.9% were overweight, and 25.3% were obese pre-pregnancy. Percentages of meeting the IOM guidelines ranged from 23.7% among obese women to 42.9% among underweight women; among obese women, 54.1% gained more than the recommended weight during pregnancy. All socio-demographic variables were significantly associated with not meeting the GWG recommendations. Compared to obese women who followed the recommendation, those who gained more were more likely to be younger [OR = 1.355 (95% CI: 1.317-1.394] and were less likely to have entered prenatal care in the first trimester [OR = 0.808 (95% CI: 0.787-0.829].

CONCLUSION:
In this study, GWG outside of the IOM recommendations was associated with key demographic risk factors. Additional resources may be needed to help these populations better achieve healthy weight gain during pregnancy.
Antepartum Monitoring of the Fetus Chronically Exposed to Opioids: What To Expect and Why Do We Intervene? [22C]
Authors: Brar Bobby , Hom Katherine , Nat Manita , Lua Lannah L. , Iriye Brian , Jackson David 
Published: April 2018

INTRODUCTION:
Chronic opioid dependence for maternal pain management, methadone maintenance, or suboxone therapy is an increasing phenomenon in obstetrics. Opioids may depress fetal neurobehavioral status and may change reactivity or variability of fetal heart rate patterns. Our primary objective was to determine which fetal assessment modality best identifies the vulnerable opioid exposed fetus.

METHODS:
A retrospective review from January 2016 through April 2017 at two MFM antenatal centers identified singleton, non-syndromic fetuses with daily opioid exposure. Non-stress tests (NST), biophysical profiles (BPP), amniotic fluid index (AFI), umbilical artery Doppler’s (UAD), and serial biometry were reanalyzed. Test characteristics and frequency of interventions for abnormal monitoring were quantified.

RESULTS:
Criteria was met in 27 patients (77.8% methadone (n=21), 14.8% prescription opioid (n=4) and 7.4% suboxone (n=2)). There were 112 growth scans, 102 BPP, 112 NST, and 81 UAD measurements. Time to NST first acceleration was <20 minutes in 92.5%. Abnormal testing causing delivery occurred in 6/27 patients (22.2%), all at 36-38 weeks. Isolated oligohydramnios was 2/27 (7.4%, occurring at 37 and 38 weeks), oligohydramnios with IUGR 2/27 (7.4%, both at 36 weeks), nonreactive NST 1/27 (3.7%, 38 weeks), and BPP 6/10 1/27 (3.7%, 36 weeks). UAD did not change management. Earliest IUGR was seen at 32 weeks.

CONCLUSION:
Antenatal testing of the singleton, chronic opioid exposed fetus should include third trimester serial growth ultrasounds and BPP or NST-AFI scheduled no later than 34-35 weeks. Continuing study on a larger cohort is needed to define optimal monitoring based upon category of opioid dependence.
A Two-Delivery Model Utilizing Doula Care: A Cost-Effectiveness Analysis [25C]
Authors: Greiner Karen Scrivner , Hersh Alyssa R. , Gallagher Alexandra C. , Tilden Ellen , Caughey Aaron B. 
Published: April 2018

INTRODUCTION:
Multiple studies have demonstrated the benefits of receiving doula care during labor and delivery, although analyses elucidating the cost-effectiveness of a doula’s presence are limited. We sought to study the cost-effectiveness and outcomes associated with doula care during the first delivery on the first and second deliveries.

METHODS:
A cost-effectiveness model using TreeAge software was designed to compare outcomes in women with a trained doula vs. no doula. We used a theoretical cohort of 1.8 million women, the approximate number of nulliparous term births in the US annually. The cost of a doula in Oregon is between $600-2,000 with an average of $1,000 for a healthy woman. Outcomes included mode of delivery, maternal death, uterine rupture and hysterectomy, in addition to cost and quality-adjusted life years (QALY). Probabilities were derived from the literature, and a cost-effectiveness threshold was set at $100,000/QALY. Sensitivity analyses were used to investigate the robustness of the results.

RESULTS:
In our theoretical cohort, we found that the presence of a trained doula during the first delivery resulted in 219,530 fewer cesarean deliveries, 51 fewer maternal deaths, 382 fewer uterine ruptures, and 100 fewer hysterectomies, saving $91 million with 7,227 increased QALYs for the first and subsequent delivery. Sensitivity analyses demonstrated cost-effectiveness up to $1,452 per doula.

CONCLUSION:
The presence of a trained doula during a woman’s first delivery leads to improved outcomes, decreased costs and increased QALYs during her first and second delivery. This model argues for increased reimbursement for doula care, thereby promoting improved health for our patients.
Accuracy of Clinical Estimated Fetal Weight at Term and Effect on Clinical Management [30C]
Authors: Omuso Inara , Tell Noor , Hunter Krystal , Khandelwal Meena 
Published: April 2018

INTRODUCTION:
Although Obstetrics/Gynecology residents are faced with learning a wide variety of complex skills during their training, clinical estimation of fetal weight (EFW) via Leopold's maneuvers, despite the surrounding controversy of use, is a relatively simplistic skill. We wanted to determine the correlation of clinical EFW with actual birth weight (BW) in term pregnancies, and determine if this knowledge had an impact on length of labor or mode of delivery.

METHODS:
Retrospective chart review of singleton pregnancies between 37 and 42 weeks, admitted for labor and delivery were randomly selected, between 2013 and 2016. For 80% power, 452 women were needed to detect a difference of 10% between EFW and BW. The statistical tests used were Pearson and Spearman-Rho Correlation, Mann Whitney-U Tests and Chi Square test as appropriate.

RESULTS:
Of 497 women randomly selected, 9 were excluded for missing data. The mean age of was 26.8 (+/- 6.1); 33% were African American, 30% Hispanic, 27.5% White; with macrosomia rate of 7.5%. EFW had a significant, moderate positive correlation with BW (r =.43, p<.001). The accuracy of EFW within 20% of actual BW was 89.2%. A significant relationship between mode of delivery and EFW noted (20.3% cesarean delivery in <8 lbs group while 10.5% in <8 lbs) (p=0.014). However, estimating a larger EFW did not prolong labor (367[219-580] vs 426[223-630] minutes respectively) (p=0.26).

CONCLUSION:
Continued practice and reinforcement of recording EFW, as part of physical examination, provides clinicians with an accurate and important tool that can aid in management of women in term labor.
Active Patient Portal Status Negatively Correlated with Preterm Birth Rate Among Patients Seen in High Risk OB Clinic [32C]
Authors: Cuff Ryan D. , Wineland Rebecca , Carter Jessica , Sullivan Scott , Johnson Donna 
Published: April 2018

INTRODUCTION:
Use of remote computer patient portals is increasing and thought to improve patient satisfaction, engagement in their care, and patient-provider communication. This study sought to evaluate the county-specific correlation between active patient portal status and preterm birth rate amongst patients under high risk obstetric care.

METHODS:
Descriptive population analysis of all obstetrical patients seen by maternal-fetal medicine at a single academic center from July 2016 through July 2017. Distinct patients were categorized according to their county of residence. Patient portal status, whether active or inactive, was then similarly determined by county. Counties were included if there were greater than 20 distinct patients seen within the established time frame. Preterm birth rates were obtained for each representative county from the Center for Disease Community Health Status Indicators database. Pearson’s test was used to determine strength of correlation.

RESULTS:
841 distinct patients representing seven counties met inclusion criteria. Active patient portal status ranged from 40.4% - 73.5%, while representative county-specific preterm birth rates ranged from 13.5% - 15.3%. Patient portal activity was negatively correlated with preterm birth rate, coefficient -0.77 (p. 0.04).

CONCLUSION:
There is a strongly negative correlation between active patient portal status and preterm birth rate amongst patients under high risk obstetrical care in South Carolina. Though descriptive, this finding suggests that the use of technology in medicine or patient connectivity may be an important correlate of disparate outcomes, and may exacerbate health disparities already known to exist for rural and disadvantaged populations.
A Two-Delivery Model Examining Upright Positioning During Labor: A Cost-Effectiveness Analysis [34C]
Authors: Hersh Alyssa R. , Greiner Karen Scrivner , Gallagher Alexandra C. , Tilden Ellen , Caughey Aaron B. 
Published: April 2018

INTRODUCTION:
Studies have demonstrated the benefits of an upright and mobile position during labor, including lower risk for cesarean delivery and shortened time in labor. We sought to examine the cost-effectiveness and outcomes associated with laboring upright during the first delivery and the resultant effects on the second delivery, such that the risks, benefits, and costs are framed within the public health perspective of the average US childbearing woman’s entire reproductive course.

METHODS:
A cost-effectiveness model using TreeAge software was designed using a theoretical cohort of 1.8 million women, the approximate number of nulliparous term births in the US annually, including uncomplicated deliveries with a trial of labor and with all women having a second delivery, reflecting the average number of births per woman in the US. Outcomes included mode of delivery, maternal death, uterine rupture and hysterectomy, in addition to cost and quality-adjusted life years (QALY) for both pregnancies. Probabilities were derived from the literature, and a cost-effectiveness threshold was set at $100,000/QALY.

RESULTS:
We found that allowing women to be upright and mobile during her first labor resulted in fewer cesarean deliveries, reduced costs and improved QALYs for both the first and subsequent delivery. In our theoretical cohort, laboring upright led to 64,890 fewer cesarean deliveries, 15 fewer maternal deaths, 113 fewer uterine ruptures, and 30 fewer hysterectomies, saving $785 million with 7,227 increased QALYs.

CONCLUSION:
Laboring upright is a no-cost intervention that leads to improved outcomes, decreased costs, and increased QALYs during a woman’s first and second delivery.
Adderall and Pregnancy: Neonatal Outcomes Following Prenatal Prescription Mixed Amphetamine Exposure [36C]
Authors: Rose Sherrill , Borowski Kristi S. , White Wendy M. , Hathcock Matthew , Rivera-Chiauzzi Enid 
Published: April 2018

INTRODUCTION:
Increasing numbers of pregnant women are being treated for ADHD. The safety of ADHD medications in pregnancy have not been well studied, although studies suggest that methylphenidate use may lower birthweight compare to unexposed newborns. Our primary outcome was to evaluate if birthweight was lower among infants of women utilizing Adderall in our academic institution.

METHODS:
Maternal and infant pairs exposed to Adderall between January 2005 and December 2015 was identified in EMR based on active medication list during pregnancy. Patients were matched 2:1 with unexposed controls of similar age, gestational age at delivery, parity, infant sex and date of delivery. All charts were reviewed for known causes of IUGR or low birthweight. Statistical analysis of infant birthweight was done using generalized estimating equation blocking on matching. Medical histories were analyzed using Chi-Square test or Fishers exact test as appropriate.

RESULTS:
We identified 53 exposed pairs. The difference in mean birthweight for exposed vs unexposed infants was 26.9g which is not statistically or clinically significant (95% CI, P-value: (-141, 195), 0.75). A statistically significant difference was noted for exposed vs unexposed mothers for comorbid psychiatric illness and history of substance abuse (p = <0.0001).

CONCLUSION:
As Adderall use increases among childbearing women, understanding the risk to infants is crucial. With a limited sample size, our study suggests no significant difference in birthweight, which is a concern for women requiring medication in pregnancy. Women using Adderall may have higher rates of comorbid psychiatric disorders and substance use and may benefit from early screening.
Antenatal Corticosteroids for Lung Maturity: Neonatal vs Obstetric Data and Improvement Opportunities [37C]
Authors: Konitzer Hollis , Fort Amber , Galvin Shelley , Coulson Carol 
Published: April 2018

INTRODUCTION:
Antenatal corticosteroids (ACS) should be considered from 23 through 36.6 weeks’ gestation in women likely to deliver preterm. Two doses of betamethasone, given 24 hours apart, followed by a second 24 hours until delivery constitutes a complete course. Confirmatory data was requested by the Neonatal Chronic Lung Committee of Mission Hospital.

METHODS:
Data on neonatal steroid exposure compiled by the neonatology team identified infants inborn at 23+0 to 34+6 weeks since 9/1/2015, surviving to discharge, before 10/1/2016, who required respiratory support. Maternal charts were reviewed for steroid exposure, timing of last exposure to delivery, indication for delivery.

RESULTS:
150 inborn neonates were identified initially as failing to complete ACS. 134 maternal charts were reviewed, accounting for 143 neonates. 26 mothers actually completed steroids; 2 declined. Patients delivered prior to completion were most often in fulminant labor (25), required urgent delivery for fetal indications (29) or demonstrated worsening preeclampsia (13)or other maternal indications (9) precipitating delivery. NICU data included gestational age up to 34 weeks 6 days (30 mothers). Local OB practice was to administer steroids prior to 34 weeks until a late preterm steroid protocol was adopted in April 2016.

CONCLUSION:
Maternal chart review provides more robust identification of steroid completion than neonatal data alone. All providers should use the same gestational age standards in assessing ACS completion and other complementary care processes. Some preterm deliveries for maternal hypertensive disorders prior to steroid completion may be potentially preventable through adherence to the indications for delivery advised by ACOG (Hypertension in Pregnancy 2013).
Safety of Flibanserin in Women With Hypoactive Sexual Desire Disorder Taking Antidepressant Medications [1D]
Authors: Simon James A. , Kingsberg Sheryl A. , Yuan James , Kissling Robert , Clayton Anita H. 
Published: April 2018

INTRODUCTION:
Flibanserin is indicated for the treatment of acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women. This post hoc analysis evaluated the safety of flibanserin in women taking antidepressant medications.

METHODS:
Data from 8 randomized, double-blind, placebo-controlled studies of flibanserin in HSDD (premenopausal women, protocol violators from 5 studies and patients treated for depression in 1 study; postmenopausal women, protocol violators from 2 studies) were pooled for patients receiving flibanserin 100 mg qhs or placebo. This analysis evaluated patients taking a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) at study baseline.

RESULTS:
The analysis population included 2379 flibanserin-treated (SSRI/SNRI users, n=131) and 2690 placebo-treated (SSRI/SNRI users, n=91) patients. Incidence of adverse events (AEs) in flibanserin-treated patients was 73.3% of SSRI/SNRI users and 65.4% of nonusers; incidence in placebo-treated patients was 79.1% and 54.9%, respectively. Serious AEs in SSRI/SNRI users vs nonusers occurred in 1.5% vs 1.1% of flibanserin-treated patients, respectively, and 0.0% vs 0.7% of placebo-treated patients, respectively. AEs led to treatment discontinuation in 15.3% of SSRI/SNRI users and 11.2% of nonusers who received flibanserin, and 18.7% of users and 5.3% of nonusers who received placebo. The most common AEs in flibanserin-treated patients (overall incidence ≥10%) were dizziness (6.9% of SSRI/SNRI users vs 10.5% of nonusers) and somnolence (6.1% vs 10.4%, respectively).

CONCLUSION:
In this post hoc analysis of pre- and postmenopausal women with HSDD, SSRI/SNRI use did not appear to change the AE profile of flibanserin. Concomitant use of flibanserin with moderate/strong CYP3A4 inhibitors (eg, fluvoxamine) is contraindicated.
Enhanced Recovery After Surgery (ERAS) for Benign Minimally Invasive Gynecology [3D]
Authors: Suh Christina , Wörndle Natalie , Mollner Magdalena , Balica Adrian 
Published: April 2018

INTRODUCTION:
Enhanced recovery after surgery (ERAS) protocols use evidence based strategies to optimize postoperative recovery. In colorectal surgery, ERAS has been shown to decrease length of stay and narcotic use without increasing complications or readmissions. These principles are now being applied to gynecologic surgery as well. Our objective was to identify literature published regarding ERAS protocols in benign minimally invasive gynecology.

METHODS:
Publications identified using the PubMed database, written in English and published between January 2012 and September 2017, were included for analysis. Searches were conducted using the terms “enhanced recovery after surgery” or “enhanced recovery” in combination with one of the following: gynecologic surgery, benign gynecologic surgery, minimally invasive gynecologic surgery.

RESULTS:
We identified 33 relevant publications, including 9 retrospective cohort studies, 3 randomized controlled trials, 2 case control studies, and 1 prospective cohort study. Review articles, including 2 ERAS society recommendations, were excluded from analysis. Four publications assessed benign pathology only, whereas 5 publications included benign and malignant pathology. Of the 3 publications assessing benign minimally invasive gynecology, 2 assessed vaginal hysterectomies only, as opposed to laparoscopic or robotic procedures.
Common interventions included preoperative counseling, nausea prophylaxis, multimodal analgesia, early ambulation, and early feeding. Common outcomes measured included length of stay and readmission rate.

CONCLUSION:
There is limited data evaluating the efficacy of ERAS protocols for gynecologic surgery, and there is nearly no published data for benign minimally invasive gynecology. Given the increasing numbers of minimally invasive procedures, more studies are needed to assess the potential benefits of ERAS in this field.
Dermoid Cyst Management and Pathologic Outcomes: A Review of Over 1,000 Cases at a Single Institution [9D]
Authors: Tankou Joan , Schantz-Dunn Julianna , Liu Christina Young , Melamed Alexander 
Published: April 2018

INTRODUCTION:
Teratomas are the most common ovarian germ cell tumor and have a distinct appearance on imaging. Current practice frequently uses minimally invasive surgery (MIS) for management of suspected mature teratomas. This study aims to describe the clinical management, outcomes and pathologic features of over 1,000 teratomas at a single institution.

METHODS:
A retrospective chart review was performed on all patients with a pathologic diagnosis of a teratoma over an 11-year period at a single academic hospital.

RESULTS:
1,055 patients were included in the study. Mean age at time of surgery was 38 (range 14-82). 72% of cysts were removed via MIS, and 63.8% via cystectomy. Spillage of cyst contents occurred in 37.2% of cases and was associated with MIS and cystectomy but not cyst size. There was 1 case of chemical peritonitis (0.09%) in a patient with spontaneous cyst rupture prior to surgery. There were 3 cases of immature teratoma (0.3%) and 12 cases of malignant transformation of dermoid (1.1%). 100 teratomas were associated with pregnancy with a rate of torsion of 9% compared to 5.2% in non-pregnant patients (p-value 0.16). Cysts larger than 5cm were more likely to undergo torsion compared to cysts < 5cm (83.1% vs 16.9%, p-value < 0.0001).

CONCLUSION:
Minimally invasive surgery and cystectomy are safe management strategies for suspected mature teratomas, and cysts larger than 5cm should be removed due to the increased risk of torsion.
Comparing Different Methods of Patient Education on Preeclampsia [13D]
Authors: Strassberg Emmie R. , Fisher Sarah M. , Mackeen A. Dhanya , Sun Haiyan , Paglia Michael J. 
Published: April 2018

INTRODUCTION:
Preeclampsia is a life-threatening condition unique to pregnancy that contributes to a significant number of maternal deaths worldwide. Delays in diagnosis and treatment are causal factors for maternal deaths from preeclampsia. Patients who are informed regarding this disease process may present earlier for evaluation. We sought identify which method of patient education is most effective.

METHODS:
We compared women’s preeclampsia knowledge retention after exposure to different educational materials in a prospective randomized controlled trial. Singleton primigravid patients at a tertiary care center were given a survey regarding preeclampsia knowledge at 18-25 weeks gestation, then randomized to preeclampsia education with a graphic card, educational video, or no educational tool. They were given the same survey again at 32-37 weeks gestation. We compared the change in preeclampsia knowledge scores for each type of education.

RESULTS:
150 subjects completed both initial and follow up preeclampsia knowledge surveys. 56 received education with the graphic card, 45 were educated with the video and 49 received no further education. There was no difference in preeclampsia knowledge score when the graphic card, video or no further education groups were compared. There was a significant improvement in knowledge score for all subjects, with a mean baseline score of 51.7% and a mean follow up score of 61.4% (P = <0.001).

CONCLUSION:
There is no additional improvement of patient knowledge retention when patients receive education with a graphic card or an educational video compared to routine prenatal counseling without the addition of these educational tools. Patient knowledge regarding preeclampsia appears to improve from the second to third trimester regardless of method of patient education.