bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early-Onset Severe Hypertensive Disease in Pregnancy: Who Is Screened for Antiphospholipid Syndrome? [19H]
Authors: Sobhani Nasim , Shulman Rachel , Washburn Erin , González Juan M. 
Published: April 2018

INTRODUCTION:
Although a history of early preterm delivery (PTD) due to severe hypertensive disease of pregnancy is a clinical criterion for diagnosing antiphospholipid syndrome (APS), there is currently no consensus regarding screening for APS in these women. Therefore, our aim was to determine frequency of APS screening in this population and to identify characteristics that affect likelihood of screening.

METHODS:
Retrospective cohort study of iatrogenic deliveries before 34 weeks for preeclampsia with severe features, superimposed preeclampsia with severe features, HELLP syndrome, or eclampsia, at a single institution from 2012 to 2017. Charts were reviewed for APS testing, as well as gestational age (GA) at delivery, fetal complications, and severity of maternal disease. Fisher exact test and chi-squared tests were used for univariate analyses of categorical variables, rank sum for univariate analyses of continuous variables, and multivariate logistic regression for adjusted odds ratios.

RESULTS:
Among 133 cases, 19 (14.3%) received APS screening. Compared to unscreened patients, screened patients were older (32 vs 29 years, P=.04), delivered earlier (28.9 vs 31.7 weeks, P <.001), and had a higher rate of intrauterine fetal demise (15.8% vs 1.8%, P =.021). In multivariate analysis, each additional week GA was associated with a 25% decrease in the odds of screening (aOR 0.75, P <.01).

CONCLUSION:
Among women with severe hypertensive disease requiring PTD, APS screening was more likely in those with earlier PTD or intrauterine fetal demise. These patients have contraceptive, obstetrical, and long-term risks that require deviations from typical patient counseling, which may prompt changes in screening recommendations.
Impact of Texas Breastfeeding Learning Collaborative on Obstetric Related Aspects of 10 Steps [24H]
Authors: Berens Pamela D. , Stagg Julie , Erickson Tracy , Hamilton-Spence Erin , Butts-Dion Sue , Ustianov Jennifer 
Published: April 2018

INTRODUCTION:
Our objective is to evaluate the effectiveness of the Texas Breastfeeding Learning Collaborative (TBLC) on performance improvement of maternity care practices supporting breastfeeding most relevant to obstetricians.

METHODS:
Funded by Texas Department of State Health Services and facilitated the National Institute for Children’s Health Quality (NICHQ), TBLC included three 2-day learning sessions, technical support and the use of Plan, Do, Study, Act (PDSA) cycles for learning and performance improvement. Seventy-four Texas hospitals were enrolled in three consecutive cohorts from 2012 to 2017.

RESULTS:
Run chart rules revealed favorable shifts from baseline median and/or trends in all Cohorts for prenatal education, breastfeeding support, feeding on cue, skin-to-skin (vaginal and cesarean delivery (CD)), rooming-in, pacifiers and artificial nipple education and referral to community supports at discharge. Prenatal education, skin-to-skin, and rooming-in emerged as process measures with the most opportunity for additional improvement with median performances ranging 52-72% whereas median performance for remaining process measures ranged 77-92%. All Cohorts maintained high median rates of overall breastfeeding (87%, 86%, 84%) and Cohorts A&B had favorable shifts from baseline median for Exclusive Breastfeeding and Supplementation measures.

CONCLUSION:
The Texas Breastfeeding Learning Collaborative changed maternity practices that impacted process and outcome measures despite regional differences in baseline uptake of practices. Obstetricians can influence steps with greatest opportunity for additional improvement at project completion (prenatal education, skin-to-skin, and rooming-in). We encourage obstetricians continued support of these steps and enlist their assistance with future improvement.
Do Self-Help-Style Activity Sheets Promote Breastfeeding Among Pregnant Mothers? [22H]
Authors: Massa Katherine , Amorado Patricia , Miller Collin , Gavard Jeffrey A. , Shyken Jaye 
Published: April 2018

INTRODUCTION:
Studies examining the role of antenatal education in improving breastfeeding rates have produced modest results. We designed a low-cost intervention that could be widely implemented to improve breastfeeding self-efficacy and behavior.

METHODS:
This is a randomized trial using activity sheets to prepare pregnant women for breastfeeding. Subjects completed assessments of their breastfeeding intent and self-efficacy prior to and after an intervention of three activity sheets. Postpartum surveillance assessed breastfeeding 6 weeks postpartum.

RESULTS:
One hundred seventy-six subjects were randomized to the intervention group and 159 to the control group, with follow up to 6 weeks postpartum in 151 and 137 subjects respectively. Initial feeding plans were similar between groups. There was no difference at six weeks postpartum in breastfeeding rates between intervention and control groups (n=60, 39.7% versus n=57, 41.6%, p=0.747). Baseline self-efficacy scores were similar between the intervention group and control group (median 85.0 [IQR 68.0,94.5] versus 84.0 [IQR 74.0.96.0]) and there was no difference in the change in scores between groups. Median self-efficacy scores were higher among breastfeeding subjects at baseline (92.0 [IQR 77.0,98.0]) and prior to delivery (94.0 [IQR 80.0,99.0]) than among subjects not breastfeeding (80.0 [IQR 66.0,81.5] and 82.0 [IQR 74.5,91.5]), p<0.01).

CONCLUSION:
Our intervention did not impact prenatal breastfeeding self-efficacy, feeding plans or duration of breastfeeding. In spite of sub-optimal breastfeeding, self-efficacy scores were high relative to the study in which the scale was validated. However, self-efficacy predicted success in breastfeeding. Improvement of self-efficacy may be a fruitful focus of breastfeeding promotion.
Racial Disparities in Low PAPP-A Levels and Pregnancy Outcomes [29H]
Authors: Shand Muhammed F. , Gimovsky Alexis , Macri Charles 
Published: April 2018

INTRODUCTION:
Pregnancy-associated plasma protein A(PAPP-A) is associated with adverse pregnancy outcomes: preterm birth, growth restriction, stillbirth and preeclampsia. The association of low PAPP-A and pregnancy outcomes based on race is unknown. The objective of this study was to determine if low PAPP-A is associated with labor dysfunction in different racial populations.

METHODS:
Retrospective study of pregnant women with PAPP-A ≤5%ile between 7/2013-7/2016. Outcomes of non-Hispanic white (NHW) women were compared to non-Hispanic black (NHB) women. Primary outcome: cesarean delivery (CD) rate. Secondary outcomes: indication for CD, perinatal outcomes. Exclusion: women with fetuses with known or suspected aneuploidy.

RESULTS:
114 women were included; 69 NHW women and 45 NHB women. Demographical differences included maternal age at delivery (35.0 ± 4.1 weeks in the NHW group vs.30.5 ± 5.6 in the NHB group, p<0.001), gravidity (1.9 ± 1.3 in the NHW group vs. 3.1 ± 1.9 in the NHB group, p<0.001), parity (0.5 ± 0.7 in the NHW group vs. 1.1 ± 1.3 in the NHB group, p=0.002), and BMI (28.7 ± 4.9 in the NHW group vs. 34.3 ± 9.1 in the NHB group, p<0.001). There was no difference noted in CD rate (18/69(26.1%) vs. 13/45(28.9%), p=0.6) or fetal indication for CD (5/18(29.6%) vs. 4/13(33.3%), p=0.9). Neonatal morbidity composite score was different between groups (12/69, 17.4% in the NHW group vs. 20/45, 44.4% in the NHB group, p=0.002).

CONCLUSION:
No racial association with delivery mode or indication for cesarean delivery. Increased neonatal morbidity during labor noted among NHB women with low PAPP-A.
Risk for Adult Obesity in Offspring of Pregnancies Affected by Hypertensive Diseases of Pregnancy [31H]
Authors: Hammad Ibrahim A. , Meeks Huong , Fraser Alison , Esplin Sean M. , Smith Ken , Varner Michael 
Published: April 2018

INTRODUCTION:
To determine if hypertensive disease of pregnancy (HDP) is associated with adult obesity in offspring.

METHODS:
A retrospective cohort study design was used to identify offspring of pregnancies complicated by HDP (gestational hypertension, preeclampsia, HELLP syndrome, eclampsia) born between 1947-1997 (now >20 years old) and with at least one adult BMI recorded in the Utah Population Database. These offspring (exposed) were matched by maternal age at birth, birth year, gender, and multiple gestation with offspring of women with no history of HDP (unexposed offspring). A second analysis was done matching the exposed offspring to their unexposed sibling in order to assess and control for the familial and environmental possible confounders. Adjusted relative risk (aRR) for obesity among exposed versus unexposed offspring as well as unexposed siblings were estimated using conditional logistic regression models.

RESULTS:
A total of 18,009 exposed offspring were compared to 30,761 unexposed offspring and 12,579 exposed siblings to 26,251 unexposed siblings. The relative risk of obesity was higher for exposed versus unexposed offspring, aRR=1.44 [95%CI 1.36-1.52]. Maternal obesity increased the relative risk to aRR=2.58 [95%CI 2.41-2.77], whereas higher maternal education decreased it to 0.87 [0.80-0.95]. For the sibling analysis, the risk for obesity was similar, aRR=1.05 [95%CI 0.98-1.11], aside from being a male sibling and first born aRR=1.31 [1.23-1.40] and aRR=1.18 [95%CI 1.09-1.27] respectively, no associated factors significantly increased the risk of obesity.

CONCLUSION:
HDP is independently associated with an increased the risk of obesity in adulthood. However this independent association was not demonstrated in the family, sibling environment.
Risk Factors for Poor Perineal Outcome after Operative Vaginal Delivery [32H]
Authors: Wilkie Gianna L. , Saadeh Michael , Robinson Julian , Little Sarah 
Published: April 2018

INTRODUCTION:
The aim of this study was to identify risk factors for poor perineal outcome (higher order laceration or wound breakdown) after operative vaginal delivery.

METHODS:
A retrospective cohort study was performed including all operative vaginal deliveries during 2016. Multiple gestations and failed operative deliveries were excluded. Analysis was performed with Chi-square test, T-test and a multivariate logistic regression analysis.

RESULTS:
Our cohort included 334 operative vaginal deliveries (70.7% vacuum and 29.3% forceps) and was on average 32.1 ± 4.7 years old and 87.1% were nulliparous. Fifty-four (16.2%) had a higher order perineal lacerations and 7 (2.1%) had a wound breakdown (1 of which occurred after a higher order laceration). The only significant risk factor for a higher order laceration was chorioamnionitis (aOR 2.3; 95% CI 1.1-5.0). Risk factors for perineal wound breakdown included episiotomy (4.2% vs. 0.9%; p=0.01), type of operative delivery (6.1% after forceps vs. 0.4% after vacuum; p<0.01) and the need for narcotic pain control postpartum. Overall, 25.0% of operative deliveries required narcotics postpartum, and 6.0% of those using narcotics subsequently had a perineal breakdown vs. 0.8% who did not (p=0.01). Narcotic use postpartum remained a strong predictor in adjusted analysis (OR 11.2; 95% CI 2.0-63.7). The highest risk group (forceps deliveries with an episiotomy who required narcotic pain control postpartum) had a 30% rate of perineal breakdown.

CONCLUSION:
Narcotic use after an operative vaginal delivery was associated with subsequent perineal wound breakdown. Women requiring narcotic pain control after forceps delivery with an episiotomy may benefit from close follow-up postpartum.
Does Inpatient Postpartum Blood Pressure Correlate With Outpatient Postpartum Hypertension? [36H]
Authors: Lauring Julianne , Wiese Sarah , Mehdizadeh Amir , Majid Sana , Chung Charles , Leftwich Heidi 
Published: April 2018

INTRODUCTION:
We sought to identify factors that correlate with hypertension within 12 weeks postpartum.

METHODS:
This is a retrospective cohort study of women with hypertensive disorders delivering between 2009 and 2016. Comparisons were made between women with one, two or three episodes ≥160 systolic or ≥110 diastolic within 24 hours postpartum vs women with blood pressures <160/110. Comparison were also made between women with one, two or three episodes ≥150 systolic or ≥100 diastolic 24-72 hours postpartum vs women with blood pressures <150/100.

RESULTS:
For women with hypertension ≥160/110 <24 hours postpartum there was no significant difference in hypertension at ≤2 weeks or compliance with a visit at ≤2 and 2-12 weeks. Women with two or three episodes ≥160/110 <24 hours postpartum were 1.9 times more likely to be hypertensive at this 2-12 weeks visit. Women with any episode ≥150/100 24 -72 hours postpartum were more likely to have a visit ≤ 2 and 2-12 weeks than women <150/100. These women were also more likely to be hypertensive at 2-12 weeks. Women with three episodes ≥150/100 24-72 hours postpartum were 3.1 times more likely to have hypertension at the visit <2 weeks postpartum than women <150/100.

CONCLUSION:
Recurrent severe hypertension <24 hour postpartum and hypertension >150/100 24-72 hours postpartum may predict hypertension 2-12 weeks postpartum. These women may also be more likely to present for postpartum care, but with similar rate of postpartum hypertension at <2 weeks, suggesting the importance of improving compliance with short interval outpatient follow-up.
The Effectiveness of Antenatal Corticosteroids Administration in Women at Risk for Late Pre-Term Delivery [38H]
Authors: La Rosa Mauricio , Kirsch Nathan , Florence Elizabeth , Petruzzi Victoria , Saade George R. , Saad Antonio 
Published: April 2018

INTRODUCTION:
The objective of this study was to determine the effectiveness of antenatal corticosteroid (ACS) administration to late preterm pregnancies, and associated adverse neonatal outcomes, after implementation of this policy at our institution.

METHODS:
Retrospective cohort of women with late preterm delivery during 2015 -2017. We compared patients before and after the implementation of the 2016 recommendations. The primary outcome was a composite of perinatal morbidity defined as: CPAP or high-flow nasal cannula for at least 12 continuous hours, supplemental oxygen with a fraction of inspired oxygen of at least 0.30 for at least 24 continuous hours, ECMO or mechanical ventilation, stillbirth, or neonatal death within 72 hours after delivery. Other neonatal outcomes included respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), apnea, bronchopulmonary dysplasia (BPD), surfactant administration, need for resuscitation at birth, severe respiratory morbidity, and neonatal hypoglycemia (serum glucose ≤ 40 mg/dL). Univariable and multivariable logistic regression analyses were performed and a P<0.05 was considered statistical significant.

RESULTS:
Of 602 patients, 239 received at least one dose of ACS. The composite outcome was not significantly different between those who received versus those who did not receive ACS (1.13 95%CI [0.8-1.6] p=0.46]). All the secondary outcomes were not different between groups. Neonates in the steroid group did not have a significantly higher rate of hypoglycemia (1.28 95%CI [0.77-2.12] p=0.29). The lack of differences persisted after adjusting for potential confounders.

CONCLUSION:
We were unable to find neonatal benefit, nor increased hypoglycemia, after introduction of ACS for late preterm delivery.
Imprisoned and Pregnant: Evaluating the Use of Correctional Restraints [4I]
Authors: Fox Mallory , Best Kelly 
Published: April 2018

INTRODUCTION:
The use of physical restraints in pregnant incarcerated patients is commonplace in many health care institutions. Restraints and shackles have been deemed not only unsafe but also demeaning and unnecessary for this special patient population. The American College of Obstetricians and Gynecologists (ACOG), the National Commission of Health Care standards, as well as Florida State Statues have adopted position statements opposing the use of physical restraints in pregnant patients. My project aimed to assess the baseline knowledge of the correctional guard staff implementing shackles and restraints; as well as provide an educational seminar to the correctional officers. Overall the aim of this study was to educate guard staff in efforts of aligning practices in accordance with ACOG and the state of Florida recommendations.

METHODS:
A brief educational seminar was presented to a group of correctional facility guards and Jacksonville Sherriff’s officers involved in the care of UF Health ambulatory or inpatient obstetric patients. The presentation covered the associated health risks and implications of restraint use in pregnancy. Additionally, the current practice recommendations were presented as outlined by ACOG and the Florida State Statute in FL Senate Bill No. 524. A brief anonymous pre and post IRB approved survey was administered. The rate of correct answers by question was described across time periods using counts and percentages, and analyzed using Fisher’s exact tests. Wilcoxon’s Signed Rank Test was used to compare the difference in overall score from pre to post. All analyses were performed using SAS® Version 9.4 for Windows.

RESULTS:
There were fifteen Jacksonville Sherriff’s officers and correctional guard staff that participated in the educational seminar and completed the pre and post survey. There was no significant relationship between time period (pre/post) and correct responses (p=0.2148-1.0). Additionally, there was no significant change in overall score between time periods (p=0.1052).

CONCLUSION:
Despite clear concise guidelines, the use of shackles and restraints remains commonplace in the field of OBGYN. As such, there is a need for education for patients, correctional guard staff, and health care providers. The current study showed that several guard staff are not familiar the current guidelines set forth by ACOG and the Florida State Statute. While there was not a statistically significant difference in pre and post survey answers, the need for education remains evident. Efforts should be made to limit the use of physical restraints in incarcerated pregnant women to improve quality of care and patient safety.
Informed Consent Experience Among Spanish-Speaking Patients Undergoing Gynecologic Surgery [7I]
Authors: Lo Lydia , Ruiz Maria , Taira Breena , Carranza Leslie 
Published: April 2018

INTRODUCTION:
Obtaining informed consent is an ethical and legal obligation. Our goal was to conduct a pilot study to describe the informed consent experience for gynecologic surgery among Spanish-speaking patients.

METHODS:
This descriptive study is a retrospective telephone interview of patients who received gynecologic surgery at a safety net hospital in southern California between January and July 2017. Questions included self-rated understanding of the surgery received, risks and benefits, patient description of what was done and why, and details regarding the consent form.

RESULTS:
Seventy-four Spanish-speaking patients completed the survey. All patients signed consents in Spanish. Sixty-one percent thought their consent was signed either in English or they did not recall. Only 15% recalled the name of their surgeon. In 72% of these patient interactions, a hospital certified interpreter was used, most commonly a certified nurse or other staff member (49%) or via telephone (45%). Only 55% of patients responded that they understood all of what was going to be done during surgery, and 52% said that they understood all of the risks and benefits of surgery. Chart review showed 15% of patients had gross errors in understanding what surgery they received. Overall satisfaction with the consent process was rated as 4.49 and satisfaction overall 4.69 out of 5. Comments reflected grateful patients but a desire for native Spanish-speaking providers.

CONCLUSION:
Our study showed than Spanish-speaking patients are at increased risk of undergoing a suboptimal informed consent process. Several workflow processes were identified for areas of improvement.
Provider Comfort With Teaching Patients and Learns about Racial and Ethnic Disparities in Ob/Gyn Outcomes [8I]
Authors: Wheeler Sarahn , Truong Tracy , Brown Haywood L. 
Published: April 2018

INTRODUCTION:
Although racial and ethnic disparities are well documented in ob/gyn outcomes, it is unclear if ob/gyn providers feel adequately trained to counsel patients and teach learners about healthcare disparities.

METHODS:
An electronic survey was distributed to the ACOG District IV membership. Participants were also asked how comfortable they feel with 1) their knowledge, 2) counseling patients and 3) teaching learners about racial and ethnic disparities in ob/gyn. Participants selected a single response from a four-point scale—very or somewhat knowledgeable/comfortable, somewhat or very not knowledgeable/uncomfortable. We compared responses by years out of training using chi-square and Fisher’s exact.

RESULTS:
A total of 462 participants responded to the survey (30% response rate). The majority of respondents reported they were “somewhat knowledgeable” about racial and ethnic disparities in ob/gyn (58%) and “somewhat comfortable” counseling patients about disparities in health outcomes (45%). Only 36% felt “very comfortable” teaching learners about racial/ethnic disparities. Respondents 30 or more years out of training most often reported feeling “very comfortable” counseling patients yet most often to report they “rarely” counsel patients about disparities (table). Only 37.4% of respondents had formal training about racial and ethnic disparities and 75% reported they would like more training.

CONCLUSION:
Our survey reveals the majority of providers lack formal training about racial and ethnic disparities in ob/gyn and feel such training would be beneficial in their practice. Further research is needed to develop evidence-based educational programs to enhance provider abilities to educate patients and learners about disparities in ob/gyn outcomes.
Zika Virus Knowledge, Health Education, and Contraceptive Use Among Rural Dominican Republic Communities [12I]
Authors: Adamian Shant , Bachelor Brooke , Mittra Tricia , Andres Sarah , Hodges Fiona , Shaw Rebecca 
Published: April 2018

INTRODUCTION:
Amidst the Zika virus epidemic, a team from Des Moines University traveled to four rural communities surrounding Monte Cristi, Dominican Republic to provide health services. The team assessed Zika virus knowledge, common contraceptive methods, and current methods of disseminating vital health information over a period of four days.

METHODS:
Ninety men and women provided informed consent to participate in a 12-question, verbally administered survey.

RESULTS:
Most participants had heard of Zika virus and had received their information from charlas, a local term for informal health presentations. Few knew that Zika is present in their communities, can be sexually transmitted, and is incurable. The most commonly cited contraceptive method was condoms, and thirty percent of participants did not use contraception. One patient reported long-acting reversible contraceptive (LARC) usage.

CONCLUSION:
Significant Zika knowledge deficits were present within these communities and accurate knowledge varied. Through identification of specific knowledge gaps, communities can disseminate standardized, unambiguous, and realistic recommendations to prevent infection during similar epidemics. Additionally, the limited usage of LARCs appeared, anecdotally, to be due to lack of access, rather than lack of desire for LARCs. This is particularly concerning in an environment where pregnancy prevention is the primary recommendation to prevent fetal harm. Future research should analyze charlas to identify the most effective methods for disseminating critical information in a timely manner to similar populations. In the context of inevitable future epidemics, results may not only be applicable to Dominican communities, but to rural communities globally.