bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of Gestational Weight Gain on Neonatal Birth Weight in Obese Women With Type 2 Diabetes [38P]
Authors: Kabacka Julia , LaCoursiere D. Yvette , Laurent Louise , Ramos Gladys 
Published: May 2019

INTRODUCTION:
The Institute of Medicine recommends gestational weight gain (GWG) between 11 and 20 lbs for women with BMI ≥30 kg m-2. It is unknown whether these new guidelines improve outcomes in obese women with type 2 diabetes (T2DM). Objective: To determine the impact of GWG on neonatal birth weight (NBW) in obese pregnant women with T2DM.

METHODS:
Retrospective cohort study of women with initial BMI ≥30 kgm-2 and T2DM treated at UCSD between 2011 and 2016, stratified by GWG category: inadequate, adequate or excessive. The primary outcome was neonatal birth weight. Secondary outcomes included rate of macrosomia, cesarean delivery (CD), SGA infants, low Apgar scores and presence of hypertensive disorders.

RESULTS:
A total of 217 participants were enrolled. The inadequate GWG category had a higher initial BMI than the other two groups (39.8±7.5 vs 37.6±6.2 and 36.0±5.3, P=.001). Mean NBW was not significantly different between the three groups (3516.26±468 g in inadequate vs 3598.42±518 g in adequate vs 3665.75±687 g in excessive GWG groups, P=.34). The rates of CD (69.3% vs 50% and 54.7%, P=.04) and macrosomia (12.3% vs 2% and 3.8%, P=.04) were higher in the excessive GWG group. There were no differences in the rate of low birth weight infants, hypertensive disorders or Apgar scores.

CONCLUSION:
Among women with T2DM with inadequate or excessive GWG, there is no difference in neonatal birth weight. Excessive GWG is associated with higher rates of CD and macrosomia. Inadequate GWG was not associated with SGA infants or low Apgar scores.
The Effect of Method of Induction on Delivery Outcomes in Fetal Growth Restriction [40P]
Authors: Gimovsky Alexis C. , Thomas Janelle , Carter Jene , Sparks Andrew , Ahmadzia Homa K. 
Published: May 2019

INTRODUCTION:
To evaluate whether method of induction used for pregnancies complicated by fetal intrauterine growth restriction has an impact on perinatal outcomes.

METHODS:
Secondary analysis of the Consortium for Safe Labor database. Women were compared by induction method in 3 groups: 1- misoprostol, 2-dinoprostone or 3-mechanical dilation or oxytocin. Inclusion criteria: ≥37 weeks, cephalic presentation. Exclusion criteria: prior cesarean delivery (CD), stillbirth, major congenital anomaly or aneuploidy. Primary outcome was CD due to “non-reassuring” fetal heart rate. Perinatal outcomes were measured secondarily. This study was IRB approved.

RESULTS:
632 women met inclusion criteria: 72 women with misoprostol, 66 women with dinoprostone and 494 women with mechanical dilation/oxytocin. Demographics differed by parity, with higher parity in the mechanical/oxytocin group (p = 0.001). Incidence of CD for “non-reassuring” heart rate was 18.1% in the misoprostol group (13/72), 13.6% in the dinoprostone group (9/66) and 6.5% in the mechanical/oxytocin group (32/494), p = 0.001. Overall incidence of CD was 31.9% (23/72) with misoprostol, 18.2% (12/66) with dinoprostone and 11.1% (55/494) with mechanical/oxytocin induction (p < 0.001). Incidence of operative vaginal delivery did not differ between groups. Resuscitation occurred in 2.8%, 4.6%, and 0.8% of the misoprostol, dinoprostone, and mechanical/oxytocin groups, respectively (p = 0.03).

CONCLUSION:
In term women with fetal growth restriction, induction of labor using misoprostol resulted in the highest incidence of CD for “non-reassuring” fetal heart rate with a 465% increase in comparison to mechanical methods. Newborn resuscitation was more common in the dinoprostone group compared to mechanical, but not increased over misoprostol.
The Impact of Current Smoking on Wound Complications, A Review of the ACS NSQIP Dataset [11Q]
Authors: Hammer Karissa , Fogg Louis , Maurice Joseph Michael 
Published: May 2019

INTRODUCTION:
Smoking is a modifiable risk factor that is associated with cardiac, respiratory, and wound postoperative complications. We investigate the impact of smoking on postoperative wound complications.

METHODS:
The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) dataset was queried for patient who underwent hysterectomy by primary CPT code from 2011 to 2014. CPT codes used included laparoscopic hysterectomy (58570-58573), laparoscopic assisted vaginal hysterectomy (58550-58554), abdominal hysterectomy (58150), vaginal hysterectomy (58260, 58261, 58290, 58291). Smoking was defined by the ACS NSQIP as individuals who have smoked cigarettes within the previous twelve months leading up to surgery. Univariate analysis was used to assess 30 day postoperative wound complications. Wound complications included: superficial surgical site infection (SSI), deep SSI, organ space SSI and wound disruption.

RESULTS:
There were significant differences between number of wound complications and relative risk for smokers compared to non-smokers undergoing hysterectomy. The relative risk for superficial wound complication is 1.5 (p<0.05), deep surgical site infection is 1.89 (P<0.05), organ space infection is 1.59 (p<0.05), and wound disruption 1.61 (p <0.05) for smokers compared to non-smokers undergoing hysterectomy. The risk of a single complication increases by 1.56 (p<0.001) with smoking, risk of two complications increases by 2.12 (p<0.001), and the risk of having three complications increases by 4.88 (p<0.001).

CONCLUSION:
Smoking at the time of hysterectomy greatly increased the risk of wound complications. Future studies should investigate the amount of time from smoking cessation to surgery required to decrease the risk of wound complications.
Utilization and Outcomes of Ovarian Conservation at Hysterectomy for Benign Gynecologic Indications [15Q]
Authors: Mandelbaum Rachel S. , Chen Ling , Shoupe Donna , Roman Lynda D. , Wright Jason , Matsuo Koji 
Published: May 2019

INTRODUCTION:
The long-term benefits of ovarian conservation (OC) in young women have been well-established, however short-term outcomes remain relatively understudied. We examined utilization and outcomes of OC at the time of hysterectomy for benign gynecologic disease.

METHODS:
A population-based retrospective analysis of the Nationwide Inpatient Sample between 2001-2015 was performed. Hospital discharge records for women <50 years undergoing hysterectomy for benign gynecologic disease, without ovarian pathology or malignancy, were extracted and weighted. Women were grouped as elective oophorectomy versus OC. Propensity score matching was performed, and length of hospitalization, total charges, and perioperative complications were compared.

RESULTS:
There were 1,432,046 women who underwent hysterectomy for benign gynecologic disease during the study period, and 1,084,703 (75.7%) women had OC. OC rates varied between 71.5% and 79.9% during the study period (P<0.05). OC was associated with younger age, Black/Hispanic race, non-obese habitus, fewer comorbidities, higher household income, Medicaid insurance, residence in the Northeast, urban-teaching hospital status, and minimally-invasive hysterectomy approach (all, P<0.05). After propensity score matching, the proportion of patients requiring hospital stays >2 days (27.8% vs. 30.9%, relative risk reduction 10.1%, P<0.001) and median total charges ($17,383 vs. $18,419, net difference -$1,036, P<0.001) were significantly lower for women who had OC compared to oophorectomy. Perioperative complication rates were clinically similar (9.0% vs. 9.2%, P=0.004). Similar findings were observed among women <45 and <40 years of age (all, P<0.05).

CONCLUSION:
Our study suggests that OC is associated with modestly decreased length of hospitalization and total charges in young women undergoing hysterectomy for benign gynecologic indications.
Incarceration in Women at Risk for HIV [17Q]
Authors: Knittel Andrea K. , Shook-Sa Bonnie , Rudolph Jacqueline , Edmonds Andrew , Ramirez Catalina , Adimora Adaora A. 
Published: May 2019

INTRODUCTION:
Incarceration is associated with HIV risk behaviors including high-risk sexual behavior and injection drug use among women in the United States.

METHODS:
The Women's Interagency HIV Study is a geographically diverse multicenter cohort study of women, including 970 at risk for HIV. During semiannual study visits, participants were asked about incarceration of themselves (10/2007-09/2017) and of their sexual partners (10/2013-09/2017). We used descriptive statistics to characterize incarceration among the HIV-negative cohort, and multivariable logistic regression to identify baseline predictors of incident incarceration for 602 HIV-negative women followed forward from 10/2007.

RESULTS:
Nearly half (n=453, 46.7%) of HIV-negative women were incarcerated during or before the study, and the incarceration rate between 2007 and 2017 was 6.1 per 100 person-years. Women experienced a lifetime median of three incarcerations (IQR 1-6 episodes), and eight months of incarcerated time (IQR 2-26 months). One third of incarcerated women (n=86) reported that one or more male sexual partners were incarcerated during the project period. In the multivariable model, incident incarceration was associated with prior incarceration (OR 7.5, 95% CI 4.3-13.0), non-injection drug use (OR 2.2, 95% CI 1.4-3.6), and housing instability (OR 3.8, 95% CI 1.6-8.9).

CONCLUSION:
Compared with less than one incarceration per 100 person-years in the general population, incarceration is more common for women at risk for HIV. Incarceration is associated with drug use and unstable housing. HIV prevention interventions targeting incarcerated women have the potential to reach a large proportion of women at risk of HIV infection in the US.
Hepatitis C Viral Infection Among Pregnant Women in Utah, 2009–2016 [18Q]
Authors: Smid Marcela Carolina , Maeda Jewel , Stone Nicole , Shakib Julie , Baksh Laurie 
Published: May 2019

INTRODUCTION:
Little is known about women with hepatitis C virus (HCV) infection in pregnancy in Utah. Our objectives were to 1) describe the demographics of women with HCV in pregnancy and 2) assess the trends in HCV infection among pregnant women in Utah.

METHODS:
Population-based retrospective cohort of all livebirths >= 20 weeks gestation in Utah from 2009-2016. We describe demographics of women with HCV compared to women with no infections. We assessed change in prevalence of HCV, HIV, hepatitis B and syphilis from 2009-2016 using linear test of trend.

RESULTS:
From 2009-2013, 411,936 women had a delivery >= 20 weeks in Utah: 595 (0.14%) had HCV, 543 (0.13%) HBV, 103 (0.03%) HIV, and 83 (0.02%) syphilis. Compared to women with no infection, women with HCV were more likely to have less than a high school education (10.7 vs 25.7%), have Medicaid insurance (26.0 vs 64.7%), no prenatal care (0.5 vs 5.1%), smoke in the third trimester (3.0 vs 33.1%) and use illicit drugs during pregnancy (0.8 vs 39%), (all p<0.001). From 2009-2016, the proportion of pregnant women with HCV increased significantly (p=<0.001). There was no significant change in the proportion of pregnant women diagnosed with HBV (p=0.20), HIV (p=0.74) or syphilis (p=0.11).

CONCLUSION:
In contrast to other infection, HCV among pregnant women in Utah is increasing. While there are no current perinatal interventions for HCV, referral and treatment of women with HCV in the postpartum period is in line with recent guidelines encouraging providers to use the “fourth trimester” to improve maternal health.
Depression Risk is Associated With Higher Viral Loads in Women Infected With Human Immunodeficiency Virus [21Q]
Authors: Doehrman Pooja Deb , Willey Alicia S. , Casper Katie , Egbe Thomas Obinchemti , Marcelin Ngowe , Sab Sab Melvin 
Published: May 2019

INTRODUCTION:
Human Immunodeficiency Virus (HIV)-positive patients in Cameroon have a three-fold increased risk of depression compared to non-infected patients. This study identifies the relationship between psychological, social, and economic factors that affect disease progression in this population.

METHODS:
Patient Health Questionnaire (PHQ-9) depression risk assessments, viral load, marriage, religion, occupation, and income data was collected from 237 women in a cross-sectional study, from the Buea and Limbe municipalities of Cameroon. An independent T-test was performed to compare viral loads in patients with high and low-risk depression assessments, as defined as a PHQ-9 score above or below 10. Two-way ANOVA was performed to evaluate the interaction of several social factors and depression risk on viral load.

RESULTS:
A statistically significant difference exists between mean HIV viral load in individuals with low-risk (<10) versus high-risk depression screening (>9) (7,281 vs 206,433, P <.001). Married women high-risk for depression had the highest viral load 465,014, with a statistically significant interaction between marriage and depression on viral load (P<.001).

CONCLUSION:
Women at high risk for depression were more negatively affected by the social construct of marriage, with higher mean viral loads. Mental health and social factors seem to influence immunologic resilience and subsequent disease progression in certain at risk populations of HIV- positive women. Strategies to improve treatment outcomes may be more effective with consideration of these psycho-social factors.
Effect of Duration from Diagnosis of Clinical Chorioamnionitis to Delivery on Short Term Neonatal Outcomes [22Q]
Authors: Patel Krunal P. , Rana Rima , Williams Shauna F. , Gittens Lisa Nadine , Apuzzio Joseph 
Published: May 2019

INTRODUCTION:
Clinical chorioamnionitis (CC) is associated with poor neonatal outcomes. It is not well known if the duration from diagnosis of CC to delivery has an impact on neonatal outcome. Our hypothesis is that the duration from diagnosis of CC to delivery at term does not affect the short term neonatal outcome.

METHODS:
This is a retrospective cohort study of patients >37 weeks gestation diagnosed with CC at a single tertiary care hospital from Jan 1, 2015 to December 31, 2017. Medical records were reviewed for maternal demographics and neonatal records were reviewed for length of NICU stay, total hospital stay, 5 minute APGAR score and presence of bacteremia. Patients were grouped by duration of diagnosis of CC to delivery <4 hours and> 4 hours. Mann Whitney test, Fisher's exact test and t-test were performed when appropriate.

RESULTS:
131 patients met inclusion criteria. 94 women delivered within 4 hours of diagnosis of CC and 37 women delivered after 4 hours of diagnosis. There was no difference in length of NICU stay, length of hospital stay, 5 minute APGAR score or neonatal bacteremia. When comparing time of diagnosis to delivery at time points of 1 and 6 hours, there was no difference in neonatal length of hospital stay.

CONCLUSION:
Time to delivery after diagnosis of chorioamnionitis at term does not appear to affect short term neonatal outcomes.
Obstetric Hemorrhage Policies and Practices Among New York State Obstetric Hemorrhage Project Hospitals [23Q]
Authors: Goffman Dena , Roy Amanda , Atallah Fouad , Lawless Kristen , Ghazaryan Lusine , Kacica Marilyn 
Published: May 2019

INTRODUCTION:
The New York State (NYS) Obstetric Hemorrhage Project (NYSOHP) aims to reduce maternal morbidity and mortality by improving management of obstetric hemorrhage. In order to develop a strategy for intervention, a survey of current policies and practices was conducted.

METHODS:
The NYSOHP Current Practices Survey was disseminated to all NYS birthing hospitals. Participating hospitals were asked to complete the survey upon joining the project beginning October 2017. One survey was completed per hospital. Results were analyzed in aggregate and by hospital level.

RESULTS:
84 of 123 NYS birthing hospitals are participating in NYSOHP. 100% of project participants completed the survey. 98% of hospitals have an obstetric hemorrhage protocol. The top three elements addressed in protocols were: obstetric hemorrhage definition (89%), massive transfusion protocol (85%) and hemorrhage risk assessment (83%), while advisement on huddles/debriefs (57%), outcomes monitoring (43%), and information for patients (28%) were identified as areas for improvement. In practice, risk assessments were conducted: 88% on admission, 47% intrapartum, and 28% postpartum. Quantification of blood loss was used exclusively in 23% of hospitals, 20% used visual estimation and 57% used a combination. 86% conduct hemorrhage drills with variable frequency, only 37% are at least quarterly. 88% conduct reviews after serious hemorrhages.

CONCLUSION:
The majority of NYS birthing hospitals fulfill many elements of readiness for obstetric hemorrhage. However, significant variation remains. Better understanding of opportunities for improvement allowed for the development of a State-wide QI intervention launched in November 2017. Further data collection and analysis will allow assessment of impact on outcomes.
Outcome Reporting in Studies on Pregnant Women With Cardiac Disease: A Systematic Review [30Q]
Authors: Hall Chelsea , Shishkina Anna , Pal Ankita , D'Souza Rohan D. 
Published: May 2019

INTRODUCTION:
To systematically review the literature for reported outcomes is studies on pregnant women with cardiac disease.

METHODS:
A search strategy was designed for Medline, Embase, Web of Science and Cochrane Central databases from 1980 to 2015 to identify all experimental and observational studies in pregnant women with cardiac disease. The search was limited to studies describing five patients or more, studies in the English language and excluded conference abstracts. As the intent was to describe reported outcomes, authors were not contacted for clarifications, the grey literature was not searched and no risk of bias assessment was performed.

RESULTS:
3118 titles and abstracts were reviewed and 327 studies were included in this review, stratified under valvular heart disease (78), all cardiac disease (75), cardiomyopathies (68), complex congenital heart disease (49), cardiac interventions in pregnancy (35) and others including aortopathies and arrhythmias (22). There was large variation in the number and nature of reported outcomes. The most commonly reported maternal outcomes included: maternal mortality (n=169), thrombo-embolism (n=118), and mode of delivery (n=190). The most commonly reported fetal/neonatal outcomes included: preterm birth (n=143), miscarriage/abortion (n=119) and neonatal death (n=100). Proportions of studies that provided definitions for outcomes varied, and definitions were highly inconsistent between studies.

CONCLUSION:
Meta-analysis of studies involving pregnant women with cardiac disease requires consistency in the reporting and defining of outcomes for meaningful clinical conclusions to be drawn. To address this issue, a core outcome set, a standardized set of outcomes obtained through consensus between relevant stakeholders, is urgently required.
Parity and Starting Effacement as Predictors of Successful Induction of Labor With Foley Balloon [33C]
Authors: Coghlan Martha K. , Hurvitz Julie , Atkins Kristin L. , Crimmins Sarah D. 
Published: May 2019

INTRODUCTION:
We sought to determine if parity and starting effacement predict successful induction of labor (IOL), defined as achievement of complete cervical dilation (ACD), when utilizing Foley Balloon (FB) for IOL.

METHODS:
A retrospective study with IRB approval was conducted of all singleton pregnancies undergoing IOL between 2013 and 2016 at a single institution. Stillbirths and prior cesarean delivery (CD) were excluded. Primary outcome was ACD. Secondary outcomes were CD, postpartum hemorrhage, chorioamnionitis, and NICU admission. Starting effacement was stratified into quartiles: 0-25%, 26-50%, 51-75%, and 76-100%, and parity divided into nulliparous and multiparous groups. Multivariate logistic regression were performed to assess the effect of parity and starting effacement on the rate of ACD.

RESULTS:
Of the 1,260 patients that met inclusion criteria, 615 had starting effacement between 0-25% with a mean parity of 1.0. In nulliparous women with starting effacement 0-25% receiving FB for IOL, 50.4% (68) ACD, compared to 69.0% (116) in the same group not receiving FB (P<0.001, OR 0.45; 95th CI: 0.28-0.73). The CD rate was also higher in nulliparous women receiving FB (54.8% v 34.9%, P<0.001, OR: 2.3; 95th CI: 1.4-3.6) compared to nulliparous women not receiving FB. In multiparous women with starting effacement 0-25% receiving FB for IOL, 84.8% (56) ACD, compared to 86.2% (219) in the same group not receiving FB (P=0.69, OR 0.86; 95th CI: 0.4-1.8). There were no statistically significant differences in the secondary outcomes.

CONCLUSION:
Nulliparous patients with low starting effacement may benefit from additional medications, rather than placement of FB for IOL.
Prediction Models for Determining the Success of Labor Induction: A Systematic Review [35C]
Authors: Meier Kennedy , Parrish Jacqueline , D'Souza Rohan D. 
Published: May 2019

INTRODUCTION:
The purpose of this study was to systematically identify all derived and/or validated clinical prediction models for labor induction containing universally accessible factors and compare their performance to inform the development of a model that could be recommended for clinical practice.

METHODS:
Four databases were searched from inception to November, 2017 for studies that derived and/or validated clinical prediction models containing antenatal history and cervical examination. Risk-of-bias of included studies was assessed using the Prediction Study Risk of Bias Assessment Tool. In view of anticipated heterogeneity between studies, only descriptive analysis was possible.

RESULTS:
We identified 16 studies describing 14 prediction models derived between 1966 and 2018. Models varied with regard to participant inclusion, sample size, considered and included variables, endpoint definitions, study design and performance. Of the derived models, six were validated internally and three externally. Performance was most commonly measured using the area under the receiver operator characteristic curve, which ranged from 0.68 to 0.79, 0.67 to 0.77 and 0.61 to 0.73 for derived, internally validated and externally validated models, respectively. Studies' risk-of-bias ranged between studies fulfilling 36% to 86% of eligible items.

CONCLUSION:
No published model to determine the success of vaginal birth after labor induction can be currently recommended for clinical use. In order to improve performance and uptake, researchers should incorporate attitudes of women and care providers, assess clinical and resource implications and adhere to recommendations made by this systematic review before deriving and validating prediction models for determining the success of labor induction.