bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chemotherapy and Optimal Timing of Delivery for Women with Triple Negative Breast Cancer [16D]
Authors: Senz Kayli , Kuo Kelly , Caughey Aaron B. 
Published: April 2018

INTRODUCTION:
Data are limited regarding the optimal management of breast malignancy in pregnancy, particularly for the more aggressive subtype of triple negative breast cancer (TNBC). We sought to compare strategies for the management of TNBC and to determine the optimal gestational age for induction in regards to chemotherapy status and maternal-fetal outcomes.

METHODS:
A decision-analytic model was designed for women with TNBC at 20 weeks electing to continue their pregnancies, comparing 32 different strategies for scheduled delivery between 24-39 weeks gestation, with chemotherapy induction either at 24 weeks or delayed until after delivery. Baseline estimates of stage-specific mortality and the impact of delayed cancer treatment on 5-year survival rates were obtained from the literature. Outcomes factored into the model included the risk of intrauterine fetal demise, spontaneous delivery, respiratory distress syndrome, cerebral palsy, and neonatal demise at each gestational age.

RESULTS:
For women assigned to antepartum chemotherapy, overall QALYs were maximized with delivery at term, with minimal additional benefit beyond 37 weeks. For women with TNBC deferring chemotherapy until the postpartum period, 5-year survival was maximized by immediate delivery, although maternal QALYs were maximized with delivery at 36 weeks for stage I, 31 weeks for stage II, and 26 weeks for stage III disease. Our model was heavily driven by the baseline probability of maternal death within 5 years, in addition to the expected progression of disease and decrease in survival rates with each week of non-treatment, and remained robust across reasonable ranges for all variables of interest.

CONCLUSION:
For women with TNBC diagnosed in early pregnancy, initiation of chemotherapy and delivery at 37 weeks should be considered.
Familial Dysautonomia: Rare Disease or More Common than You Think? [20D]
Authors: Bardos Jonah D. , Terhaar Catherine , Echeverri Natalia , Longman Ryan 
Published: April 2018

INTRODUCTION:
Familial Dysautonomia (FD) is an autosomal recessive disorder affecting the sensory and autonomic nervous systems causing life threatening autonomic crises, hypotonia, and progressive neuronal degeneration. Currently, carrier testing for FD is recommended for the Ashkenazi Jewish (AJ) population. A joint ACOG/ACMG statement highlighted the increasingly multi-ethnic society as consideration for pan-ethnic carrier testing, and recent ACOG committee opinion states that pan-ethnic carrier testing is a reasonable strategy. This study assesses how many non-AJ individuals screened positive for FD when pan-ethnic carrier screening was implemented.

METHODS:
Retrospective database analysis of individuals that received expanded carrier testing utilizing a genotyping panel for two pathologic variants of FD (c.2204+6T>C, R696P) was performed. Expected number of positive carriers for FD in AJ and non-AJ groups were calculated and compared to observed rates. Chi-square analysis was performed to assess for statistical significance (p < 0.01).

RESULTS:
A total of 71,243 individuals were tested for FD. A higher than expected number of non-AJ individuals screened positive for FD (38 observed vs 14.05 expected, p<0.001). The number of AJ individuals that screened positive was consistent with expected values (33 observed vs 32.08 expected, p<0.86).

CONCLUSION:
Non-AJ carriers of FD were more common than expected in this cohort. Pan-ethnic expanded carrier testing will increase the detection of carriers for FD compared with current ethnicity based screening recommendations. Importantly, carriers of FD, who would be missed by ethnicity based testing convention, will be identified allowing for more complete genetic counseling and family planning options for those who choose testing.
Is Participation in CenteringPregnancy Associated with Decreased Postpartum Depression in Black Women? [21D]
Authors: Watson Amelia K. , Roussos-Ross Dikea , Goodin Amie , Prieto Autumn 
Published: April 2018

INTRODUCTION:
Postpartum depression (PPD) occurs in approximately 15% of women. CenteringPregnancy (CP) not only allows for greater social support compared to Traditional Care (TC), it also focuses one group session on PPD. The purpose of this study was to determine whether there was a decreased incidence of PPD in black women enrolled in CP versus TC.

METHODS:
A retrospective chart review was conducted comparing all black CP patients to a matched cohort of TC patients seen at UF Health between March 2015 and March 2017. A score of > 12 on the Edinburgh Postnatal Depression Scale was categorized positive for PPD. Logistic regression estimated the relationship between positive PPD and CP vs TC participation, adjusting for patient characteristics.

RESULTS:
There was a lower incidence of PPD in black CP patients compared to TC patients (8.96% vs 16.67%), although not statistically significant (P=0.183). Overall, patients with a history of depression were 2.17 times more likely to have PPD (95% CI 0.53-8.89), and patients taking any psychiatric medications during pregnancy were 11.56 times more likely to have PPD (95% CI 1.31-101.96).

CONCLUSION:
The incidence of PPD in the CP group was lower than that in the TC group which mirrored the general population. This difference may be related to additional social support received within CP settings and additional time spent discussing signs and symptoms of PPD and ways to access resources. More research is needed to further assess the psychosocial benefits of CP in black women.
Risk Factors for Readmission Due to Infection after Cesarean Delivery [26D]
Authors: Kawakita Tetsuya , Tefera Eshetu 
Published: April 2018

INTRODUCTION:
Postpartum infections are major cause of prolonged hospital stay and burden to health care system. Wound infection or breakdown is a second most common reason for hospital readmission. Data regarding risk factors for hospital readmission due to infection are limited.

METHODS:
This is a retrospective study of women undergoing cesarean delivery at 23 weeks’ gestation or greater at MedStar Washington Hospital Center. The hospital readmission due to infection is defined as hospital readmission due to the following indications: endometritis, deep wound infection, and other infections (abdominopelvic abscess, maternal sepsis, pelvic septic thrombophlebitis, pyelonephritis, pneumonia, or meningitis) occurring after discharge and up to 6 weeks after cesarean delivery. Maternal demographics, maternal comorbidities, and labor and delivery outcomes were compared between women without hospital readmission due to infection and women with hospital readmission due to infection. Multivariable logistic regression analysis was performed to calculate adjusted odds ratio (aOR) with 95% confidence intervals (95%CI), controlling for significant variables in the bivariate analysis.

RESULTS:
Of 3805 women undergoing cesarean delivery, 30 women (0.8%) had hospital readmission due to infection. Increased risks of hospital readmission due to infection were seen with higher body mass index at admission (BMI) (aOR 1.05; 95%CI 1.01-1.10), operative time ≥60 min (aOR 2.52; 95%CI 1.13-5.58), and ruptured membrane (aOR 3.00; 95%CI 1.17-7.68). A lower risk of hospital readmission due to infection was seen with increasing maternal age (aOR 0.93; 0.87-0.996).

CONCLUSION:
Hospital readmission due to infection was associated with younger maternal age, higher BMI, operative time ≥60 min, and ruptured membrane.
Decreasing Narcotic Use After Cesarean Section with Enhanced Recovery: A Quality Improvement Project [28D]
Authors: White Kevin , Bou Zgheib Nadim , Mitchell Brenda 
Published: April 2018

INTRODUCTION:
Prescription drug abuse presents a major problem to society and can impact postoperative pain management. Many patients who struggle with addiction started using while undergoing treatment of acute pain. A retrospective analysis of our patients revealed that patients used 99.9mg of oral morphine equivalents by the end of postoperative day 2 with only 27% achieving adequate pain control. We aimed to reduce opioid use and pain scores after caesarian delivery with enhanced recovery.

METHODS:
We prospectively implemented a protocol using liposomal bupivacaine injected at the time of cesarean delivery. Patients were then given 500mg acetaminophen every 4 hours, 800mg ibuprofen every 8 hours and 5mg oxycodone every 6 hours as needed. In addition, patients were ambulated 4 hours after surgery and had their catheter removed from their bladder as soon as they could safely ambulate.

RESULTS:
Patients in the treatment group utilized 58% less opioids (p<0.05) and reported 20% less pain (p<0.05). 38% achieved adequate pain control. Hospital charges were equivocal between the groups.

CONCLUSION:
Our enhanced recovery protocol is an effective alternative to traditional pain control and significantly reduced both opioid use and pain scores without any significant increase in hospital costs. More prospective research is needed in this area.
The Clinical Characteristics and Prognosis of Cerebral Venous Thrombosis During Pregnancy and Puerperium in China [29D]
Authors: Liang Zhu-Wei , Gao Wan-Li 
Published: April 2018

INTRODUCTION:
Due to the specific physiology associated with pregnancy and puerperium, cerebral venous sinus thrombosis (CVT) may manifest different characteristics. This study aimed to identify the clinical manifestations and prognosis of pregnancy-associated CVT.

METHODS:
A total of 43 pregnancy-associated CVT patients were enrolled. We analysed the clinical presentations of the disease and performed a multivariate logistic regression analysis to determine which variables were associated with prognosis.

RESULTS:
Our descriptive results showed the following: 1) the incidence was 202 per 100,000 deliveries, and the mortality rate was 11.63%; 2) the most frequent symptom was headache; 3) the most frequent abnormal laboratory findings were increased levels of fibrinogen and several serum lipoproteins (including triglyceride, cholesterol, high-density lipoprotein, low-density lipoprotein, apolipoprotein A1, and apolipoprotein B); and 4) the superior sagittal sinus and transverse sinus were the most frequently affected locations. Moreover, an increased modified Rankin Scale score was positively associated with infection, seizure, intracerebral haemorrhage (ICH) and hypertensive disorders of pregnancy (HDP). Comparably, the occurrence of death was positively and significantly associated with infection, seizure and ICH.

CONCLUSION:
Consequently, timely diagnosis and treatment of pregnancy-associated CVT patients with infection, seizure, ICH or HDP are needed. Patients with infection, seizure or ICH have a greater risk of death.
Plasma Profile of Platelet Auto-antibodies in Patients with Thrombocytopenia in Pregnancy [30D]
Authors: Huang Qin , Jia Yufang , Yang Weiwen 
Published: April 2018

INTRODUCTION:
To evaluate plasma levels of platelet auto-antibodies in patients with thrombocytopenia in pregnancy and assess the clinical significance.

METHODS:
A total of 54 pregnant women with thrombocytopenia, 44 normal pregnant women and 28 women with immune thrombocytopenia (ITP), as well as 31 healthy women were enrolled in this study. The plasma levels of platelet auto-antibodies against 5 platelet glycoproteins (GPIX, GPIb, GPIIIa, GPIIb and P-selectin) were detected by flow cytometric immuno-beads array. The difference was analyzed statistically, and the receiver operating curve (ROC) was constructed to assess the diagnostic value.

RESULTS:
Compared with normal pregnant women and healthy controls, the plasma levels of auto-antibodies against glycoprotein GPIX and GPIb were significantly increased in pregnant women with thrombocytopenia (P < .05), while the levels of other 3 auto-antibodies were similar. The positive rate of auto-antibodies in pregnancy women with thrombocytopenia was higher than that in normal pregnant women (59.3% vs 31.8%, P < .01). ROC analysis showed that the auto-antibody anti-GPIX had a high diagnostic value in pregnant women with thrombocytopenia over normal pregnant women with the area under the curve value of 0.779 (P < .001), the sensitivity and specificity were 76.3% and 100%, respectively.

CONCLUSION:
The plasma profile of platelet auto-antibodies in patients with thrombocytopenia in pregnancy was different from that in ITP patients. The auto-antibody anti-GPIX may be served as a biomarker of the disease.
Outcomes in Intrahepatic Cholestasis of Pregnancy Managed via a Multifaceted Protocol [31D]
Authors: Juusela Alexander , Gimovsky Martin Larry , Singh Shailini , Nazir Munir 
Published: April 2018

INTRODUCTION:
Intrahepatic cholestasis of pregnancy (ICP) is characterized by pruritus, elevated bile acids, usually presents in the second or third trimesters, and is associated with Intra-uterine fetal demise (IUFD). Perinatal morbidity is the lowest at 35 weeks and rises after 36 weeks, with a stillbirth rate of 1.2% after 37 weeks. The original studies that prompted early deliveries, there were 4 IUFD among 331 cases. Subsequent meta analyses refuted that. The goal of our study was to identify factors correlated with a reassuring prognosis and permit expectant management beyond 37 weeks.

METHODS:
A retrospective chart review of women admitted to NBIMC for ICP between January 1st 2013 and December 31st 2016. CPT codes were used to identify cases of ICP. 52 charts met inclusion criteria and a statistical analysis was performed.

RESULTS:
In our series no stillbirth occurred. No single factor was identified that correlated with a reassuring outcome, therefore we conclude that a multifaceted approach with active maternal fetal surveillance and use of ursodeoxycholic acid likely contributed to a lower stillbirth rate, however, it is possible our small data set caused a Type 2 error.

CONCLUSION:
As no RCTs are available to guide management, further case series, meta analyses, or a registry could be the solution. We present our multifaceted approach to management that includes serial bile acids, liver function tests, treatment with ursodeoxycholic acid, monitoring of symptoms, and intensive fetal surveillance, which may allow pregnancy to proceed to 38 weeks or beyond.
Cesarean Hysterectomy and Prophylactic Occlusive Balloons Catheters: Is it Worth the Risk? [34D]
Authors: Mellott Elizabeth , Kram Jessica J. F. , Greer Danielle M. , Dickson Michelson Elizabeth 
Published: April 2018

INTRODUCTION:
Severe hemorrhage during cesarean hysterectomy associated with abnormal placentation is a major cause of maternal morbidity and mortality in the US. Intravascular occlusive balloon catheter placement has been hypothesized to lessen blood loss during planned cesarean hysterectomy. This study explored patterns associated with balloon placement during cesarean hysterectomy

METHODS:
We retrospectively studied women ≥18 years of age who underwent cesarean hysterectomy for abnormal placental implantation within our large, community-based hospital system during 2012-2016. Three patient groups were studied: (1) balloon not placed, (2) balloon placed but not deployed, and (3) balloon placed and deployed. Data were abstracted from the electronic medical record and compared among patient groups using basic descriptive and inferential statistics.

RESULTS:
Of 17 total patients identified (mean age 37.1 years, body mass index 33.8 kg/m2, and gestational age 32.3 weeks), 11 (65%) had balloons placed and 3 (18%) had balloons deployed. Odds of balloon placement (regardless of subsequent deployment) were greater in women with placenta accreta (P=0.01), preoperative anemia (P<0.01), and larger, multidisciplinary teams of providers (P=0.02). Significant complications (thromboembolic events and/or stent placement) were experienced by 2 women who underwent balloon placement but no one in the balloon deployment group. No significant group differences were detected in provider characteristics or other outcomes (e.g., estimated blood loss, transfusion, surgery duration).

CONCLUSION:
In this community-based study, use of occlusive balloon catheters did not improve outcomes but rather increased complications directly related to placement. Prospective multicenter studies are needed to evaluate the efficacy of balloon placement and deployment.
Exercise for the Prevention of Preterm Birth: A Cost-Effectiveness Analysis [37D]
Authors: Speranza Rosa , Sargent James , Savitsky Leah , Caughey Aaron B. 
Published: April 2018

INTRODUCTION:
Preterm birth (PTB) is associated with significant neonatal morbidity and healthcare expenditures. Modest exercise during pregnancy has been found to reduce the risk of PTB in overweight and obese women. We sought to investigate the cost-effectiveness of an exercise-based intervention aimed at reducing PTB.

METHODS:
We built a decision-analytic model using TreeAge Pro and incorporated probabilities, costs, and utilities from the literature to compare a modest exercise regimen with usual care. We then applied this model to a theoretical cohort of 1,000,000 women with a pre-pregnancy body mass index (BMI) ≥26kg/m2. The cost-effectiveness threshold was set at $100,000 per quality-adjusted life year (QALY), and sensitivity analyses were used to assess the robustness of the model.

RESULTS:
The estimated cost for an exercise intervention was $1,300 per pregnancy and resulted 1,400 fewer PTBs, 140 fewer neonatal deaths, and 163 fewer cases of neurodevelopmental delay. There were also 35,000 fewer cases of gestational diabetes. At baseline assumptions, standard care was the cost-effective strategy. On sensitivity analysis, the exercise intervention became cost-effective with an exercise regimen of $1,223, and, as the cost of the exercise regimen was lowered to $812, the exercise regimen became the dominant strategy. The exercise regimen was associated with $489 more per pregnancy.

CONCLUSION:
A modest exercise regimen can be a cost-effective method of decreasing PTB and improving pregnancy outcomes if the price of the intervention can be lowered below $1,223 per pregnancy. Future endeavors should focus on reducing the intervention cost without limiting utility or adherence to the program.
Prophylactic Antibiotics at the Time of Bakri Insertion is Associated with a Reduction in Endometritis [38D]
Authors: Wong Melissa , Greene Naomi , Gregory Kimberly D. 
Published: April 2018

INTRODUCTION:
The aim of this study is to determine whether prophylactic antibiotics initiated at the time of placement of an intrauterine balloon tamponade (IBT) is associated with a reduction in the rate of postpartum endometritis.

METHODS:
Retrospective cohort study of patients who received an IBT from 1/1/2012 - 12/31/2016. Patients were included if the IBT remained in place at least 2 hours and were excluded if chorioamnionitis was present prior to delivery. Patients who received prophylactic antibiotics at the time of Bakri placement were compared to those who had not.

RESULTS:
124 subjects received an IBT and 11 were excluded due to chorioamnionitis. Of the remaining 113 patients, 59 received prophylactic antibiotics and 54 did not. Baseline characteristics were similar between the groups except for mode of delivery. The majority (56%) of those who had received prophylactic antibiotics had a vaginal delivery, whereas the majority (65%) of those who did not receive antibiotics had a cesarean delivery (p = 0.03). The incidence of endometritis was 15% and did not differ by mode of delivery. The incidence of endometritis was lower among those patients who received prophylactic antibiotics compared to those who did not (5% vs 26%, p <0.002; OR 6.53 [95% CI 1.76-24.25]). This association remained after adjustment for mode of delivery (OR 5.9 [95% CI 1.58-22.35]).

CONCLUSION:
Prophylactic antibiotics was associated with a reduction in the likelihood of postpartum endometritis among patients receiving an IBT. Prospective trials are needed to determine whether prophylactic antibiotics should be routinely given for IBT placement.
California State Law (SB-999) and Implementation: Dispensing a Year-long Supply of Prescription Birth Control [2E]
Authors: Nikpour Gelareh , Allen Antoinette , Rafie Sally , Rible Radhika , Chen Angela 
Published: April 2018

INTRODUCTION:
Access to birth control is the cornerstone to preventing unplanned pregnancies. In California, women qualifying for state-funded reproductive insurance get yearlong supplies of contraception from participating dispensaries. A 2011 study found a 30% odds reduction in unplanned pregnancies when women received yearlong supplies of birth control as compared to one- or three-month supplies (Foster, 2011). Subsequently, in 2016, California Senate Bill-999 was passed, designating that women could receive yearlong supplies of birth control from pharmacists while requiring insurance companies to fund these prescriptions.
Using secret shopper methods, we will conduct a cross-sectional survey of California pharmacies to inquire whether they are able to comply with SB-999.

METHODS:
19,693 pharmacies met our inclusion criteria: commercial retail pharmacies in California. 13,660 were excluded for revoked/cancelled licenses or because they were affiliated with managed care or publicly funded networks. Based on our pilot study, for a power of 80%, 600 pharmacies were randomly selected from the remaining 6033. Using a secret shopper technique, these pharmacies are called and asked whether they can dispense yearlong supplies of prescription birth control to customers.

RESULTS:
We are currently collecting date. Based on preliminary review of 200 pharmacies called, with approximately 80% completed calls, 44% of pharmacists have not heard of SB-999. The top two obstacles to dispensing yearlong supplies of birth control quoted were insurance coverage (37%) and company policy (16%).

CONCLUSION:
Implementation of new laws take time and require institutional accountability. In revealing obstacles to accessing yearlong supplies of birth control, we aim to expedite implementation of SB-999.