bluuebunny/crossref_metadata_2025_split huggingface dataset:
Racial Disparities Among Preterm Births Rates in Preeclampsia [25B]
Authors: Speranza Rosa , Luck Marissa , Savitsky Leah , Scrivner Greiner Karen , Caughey Aaron B. 
Published: April 2018

INTRODUCTION:
Preeclampsia complicates 3-5% of deliveries in the United States and is a frequent cause of preterm birth. We sought to characterize the rates of preterm versus term deliveries stratified by race in preeclampsia both with (PE-SF) and without severe features (PE).

METHODS:
This is a retrospective cohort study of singleton, non-anomalous deliveries from 2005-2008 using linked vital statistics and ICD-9 data. Women self-reported into racial categories of white, black, Hispanic/Latina, Asian/Pacific Islander, or other. We used chi-squared tests to compare outcomes by preterm (<37 weeks gestation) or term (≥7 weeks gestation) and multiple logistic regression to adjust for age, race, education, insurance status, chronic hypertension, diabetes, gestational age at delivery, and birthweight.

RESULTS:
There were 58,878 births in our cohort complicated by preeclampsia with 16,073 births from PE-SF and 41,787 from PE. Within each racial category, the preterm versus term delivery rates were statistically significant with a p-value <0.001. Term deliveries were more common in both PE-SF and PE in all races except for Asian/Pacific Islanders which had 52.1% preterm births in PE-SF. The rate of preterm birth was higher in PE-SF compared to PE across all racial categories. Black women had the highest rate of preterm delivery for PE at 26% compared to white women who only had 17.8%.

CONCLUSION:
Rates of preterm deliveries were significantly higher for PE-SF compared to PE an racial disparities were most notable among Black women with PE. Further investigation should be directed at identifying why these disparities exist and how they can be addressed.
Uterine Fibroids in Twin Gestations and Risk of Sonographic Short Cervix [26B]
Authors: Blitz Matthew J. , Rochelson Burton , Greenberg Meir , Vohra Nidhi 
Published: April 2018

INTRODUCTION:
No large studies have evaluated whether the presence of fibroids affects cervical length in twin gestations. The objective of this study was to determine whether uterine fibroids identified on second-trimester ultrasound increase the risk for short cervix and adverse pregnancy outcomes in twin pregnancies.

METHODS:
This retrospective cohort study evaluated all women with twin gestations who had a routine second-trimester ultrasound at 17-23 weeks gestational age from 2010-2016. When fibroids were noted, their presence, number, location and size were recorded. Exclusion criteria included a history of cervical conization or loop electrosurgical excision procedure (LEEP) and uterine anomalies. The primary variable of interest was short cervix (<25 mm). Secondary variables of interest included gestational age at delivery, mode of delivery, indication for cesarean, birth weight and Apgar scores.

RESULTS:
Fibroids were identified in 127/1,260 patients (10.1%). Short cervix was increased in women with fibroids compared to women without fibroids (14.2% vs. 8.2%, OR 1.85, 95% CI 1.07-3.18, P<.03). Women with fibroids were older in age, lower in parity and more likely to have had pregnancies resulting from assisted reproductive technology. There was no difference in the gestational age at delivery, indication for primary cesarean, newborn birth weight or Apgar scores in twin gestations with fibroids compared to those without fibroids. The size and number of fibroids did not affect the frequency of short cervix.

CONCLUSION:
Women with twin gestations and uterine fibroids may be at higher risk for a short cervix. Fibroids are not associated with adverse obstetric and neonatal outcomes in twin pregnancies.
Antepartum Intravenous Iron Reduces Peripartum Blood Transfusions [27B]
Authors: Hamm Rebecca F. , Blauvelt Christine , Wang Eileen , Srinivas Sindhu 
Published: April 2018

INTRODUCTION:
Studies have demonstrated that antepartum intravenous iron sucrose infusion (IVFe) is safe and improves pre-delivery hemoglobin (Hb). Yet, the effect of IVFe on maternal morbidity is unknown. We sought to determine whether antepartum IVFe could reduce peripartum packed red blood cell (pRBC) transfusions.

METHODS:
This is a retrospective cohort study. In 6/2015, our institution began recommending IVFe for patients with Hb<9.5 g/dL who failed oral ferrous sulfate, as determined by persistent severe anemia in the third trimester. Patients who obtained prenatal care and delivered at our institution from 10/1/2015-10/1/2016 with third trimester Hb<9.5g/dL were included. Hemoglobinopathies were excluded. Decision to proceed with IVFe, timing, and number of doses was left up to patient and provider. Patients receiving ≥1 antepartum dose of 300mg of IVFe at least 48 hours before delivery were included in the IVFe group. Our primary outcome was rate of blood transfusions among those who did vs. did not receive IVFe. Fisher’s exact test was used to compare proportions.

RESULTS:
389 of 3961 (9.8%) delivering patients met Hb criteria and were included. Of those, 25 (6.4%) were in the IVFe group. Third trimester Hb was lower in the IVFe group compared to the No IVFe group (8.6g/dL vs. 9.4g/dL; p<0.0001). Patients in the IVFe group significantly increased their Hb from third trimester to pre-delivery compared to those in the No IVFe group (Δ1.6g/dL vs Δ-0.1g/dL, p<0.0001). 57 of 389 (14.7%) received ≥1 unit of pRBCs during delivery admission. IVFe decreased the rate of peripartum blood transfusion compared to those who did not get IVFe (0% vs. 15.7%, p=0.035). The 57 transfused patients, none of whom received IVFe, required an average of 2.39 units of pRBCs per person.

CONCLUSION:
Despite lower starting Hb in the IVFe group, antepartum IVFe reduced transfusions in patients with a third trimester Hb<9.5g/dL. Future hemorrhage bundle work should highlight the use of IVFe to reduce peripartum pRBC transfusion and maternal morbidity.
Mode of Delivery in Stillbirth Pregnancies [30B]
Authors: Rossi Robert , Hall Eric , DeFranco Emily 
Published: April 2018

INTRODUCTION:
Stillbirth complicates 1 in 160 deliveries in the United States. Vaginal delivery (VD) is the desirable route of delivery even in the setting of a prior cesarean delivery (CD). ACOG recommends CD only for unusual circumstances because of associated maternal morbidity without any fetal benefit, however some patients prefer CD to avoid the experience of a vaginal birth of a demised fetus. We sought to determine the rate of CD in pregnancies complicated by stillbirth and to identify characteristics associated with CD.

METHODS:
Population-based retrospective cohort study of all stillbirths in the United States during the year of 2014. Frequency of CD in stillbirths was stratified by gestational age (16-46 weeks). Maternal, obstetric, and fetal characteristics were compared between women who underwent CD compared to VD. Multivariate logistic regression estimated the relative influence of maternal, obstetric, and fetal factors on the outcome of CD.

RESULTS:
There were 17,701 non-laboring women diagnosed with stillbirth during 2014 in the United States in which mode of delivery was recorded. Of the 17,701 stillbirths, 2,951 (16.7%) underwent a CD. Between 20-23, 24-27, 28-31, 32-36, and >36 weeks of gestation, the CD rate was 4.0, 16.2, 23.7, 30.8, and 28.8% respectively. Among this cohort, 1,727 women (58.5%) had a primary CD. Factors associated with CD included obesity (aOR 1.3, 95% CI 1.1-1.5), pre-existing diabetes (aOR 1.6, 95% CI 1.1-2.2), gestational diabetes (aOR 1.6, 95% CI 1.2-2.1), gestational hypertension (aOR 1.7, 95% CI 1.3-2.1), cigarette smoking (aOR 1.5, 95% CI 1.2-1.8), infertility treatment (aOR 1.9, 95% CI 1.2-3.0), diagnosis of stillbirth in 3rd trimester, (aOR 5.0, 95% CI 4.1-6.0), and large for gestational age (>10th%) birthweight (aOR 2.4, 95% CI 0.1.8-3.1). Younger women (<20 yo) and those with small for gestational age birthweight (<10th%) were less likely to have a CD. Women who underwent a CD were more likely to be admitted to an ICU (aOR 6.1, 95% CI 4.1-6.5).

CONCLUSION:
Approximately 16% of women diagnosed with a stillbirth in the United States underwent a CD in 2014. The CD rate rose with increasing gestational age and peaked during the 3rd trimester, where more than 1 in 4 women diagnosed with a stillbirth underwent a CD, despite ACOG guidelines. Our findings support that provider education, patient counseling, and adherence to society guidelines are potential areas of focus for perinatal quality improvement efforts.
Preeclampsia with or without Chronic Hypertension: Differences and Outcomes [32B]
Authors: Rincon Monica , Beeraka Sridivya Spurthi , Burwick Richard M. 
Published: April 2018

INTRODUCTION:
It is unclear if women with chronic hypertension (CHTN) and superimposed preeclampsia (siPE) have more severe disease than women with preeclampsia (PE) without CHTN. We sought to compare disease features and outcomes in these groups.

METHODS:
Retrospective cohort study (Oct'13 - May'17) at a single institution, among subjects with hypertensive disease in pregnancy, delivered ≥23 weeks gestation, who were screened using ICD-9 and ICD-10 codes with subsequent chart validation. Subjects were divided: 1) CHTN; 2) Gestational hypertension (GHTN); 3) PE and, 4) PE with severe features (PE-SF). Those with siPE were placed in Group 3 or 4, as determined by labs or symptom criteria. Differences were assessed by Chi-square, Fisher exact or Student t-test.

RESULTS:
Among 1,188 pregnancies with a hypertensive disorder, 626 developed PE; of which 140 (22.4%) had siPE. CHTN was more common in PE-SF than PE without SF (29.3% vs. 15.2%, P<.001). Compared to women with PE, those with siPE were more likely to have severe headache (30.9 vs. 18.5%, p=0.002) and pulmonary edema (5.7 vs. 1.7%, P.007). Other severe features of PE were similar regardless of CHTN including thrombocytopenia, elevated liver enzymes, kidney injury, and eclampsia. Those with CHTN and siPE were more likely to have preterm neonates (53.0 vs. 24.6%) P<.001) with respiratory distress syndrome (RDS) (30.3 vs. 13.5%, P<.001).

CONCLUSION:
Women with CHTN and siPE have more severe disease than women with PE alone. Notably, siPE is associated with more headache, pulmonary edema, preterm delivery, and RDS
Difference in Nuchal Fold Thickness (NFT) in Male versus Female Fetuses [34B]
Authors: Soni Shelly , Rochelson Burton , Blitz Matthew J. , Vohra Nidhi , Pessel Caroline D. 
Published: April 2018

INTRODUCTION:
To evaluate if second trimester nuchal fold thickness (NFT) differs in male vs female fetuses. We also assessed if male gender predisposes to an increased NFT.

METHODS:
Case control study of singleton pregnancies receiving second trimester fetal nuchal fold measurements identified from a search of ultrasound and cytogenetic databases. NFT was compared in male versus female fetuses. Data was stratified for fetuses with normal and increased NFT (defined as ≥6 mm from 14 weeks to 21.6 weeks of gestational age) as well as for those with abnormal genetic results. Genetic results were considered abnormal in cases of aberrant karyotype, as well as known pathogenic mutations on microarray or Noonan panel.

RESULTS:
Of the entire study group (N=6483 pregnancies), 51.3% fetuses (3328/6483) were males and 48.7% were females. Male fetuses had an increased mean NFT as compared to female fetuses in the entire cohort (4.2 mm in males versus 4.0 mm in females, p < 0.0001). NFT was higher in male fetuses in the normal NFT group as well as the group with increased NFT. Data was stratified based on gestational age in fetuses with normal NFT without known chromosomal aberrations. Male fetuses had a higher NFT across all gestational ages. Also, male fetuses had a higher incidence of increased NFT of ≥6mm when compared to female fetuses (OR 1.8 [1.3-2.5], P 0.0006).

CONCLUSION:
Male fetuses have a higher mean NFT as compared to female fetuses, and male gender predisposes to a higher likelihood of an increased NFT.
Academic Hospitalist Programs and the Impact on Resident Education [3C]
Authors: Raine Susan P. , Schneider Karen , Sangi-Haghpeykar Haleh , Swaim Laurie S. 
Published: April 2018

INTRODUCTION:
Hospitalist programs have increased in prevalence since their introduction in the mid-1990s, doubling over a 5-year period from 114 to 240. While the laborist model increases patient safety and decreases physician fatigue and burnout in general, its impact on resident education is unknown. The purpose of the study was to determine the number of hospitalist programs within an academic setting and to exam the perceived impact of the program on postgraduate training in obstetrics and gynecology.

METHODS:
A validated survey was sent to program directors at all 242 U.S. Obstetrics and Gynecology training programs using an anonymous online survey instrument. The survey included 9 questions and took approximately 3-5 minutes to complete. The email was distributed three times: initial email with follow up emails at one and six months. Groups of interest were compared by chi-square test.

RESULTS:
242 OB/Gyn residency training programs were surveyed. There were 98 respondents for a response rate of 36%. Twenty-eight percent of programs had a hospitalist program. Of these programs, the majority perceived the presence of laborists to have a positive impact on resident education (n=30, 90%) and did not perceive a reduction in the number of patients or procedures available to the residents (n=26, 96.3%). In addition, resident feedback in these programs indicated a hospitalist program was beneficial to their education (n=19, 70%).

CONCLUSION:
The implementation of a hospitalist program in the setting of postgraduate training in Obstetrics and Gynecology does not negatively impact resident education and is perceived by program leadership and trainees as beneficial.
Can the Understanding of Professionalism in Medicine be Influenced by the Background of Trainees or Their Roles? [8C]
Authors: Sakhel Khaled , Goodwin Jeff , Owusu-Anti Philipa , Jalalizadeh Mehrsa , Gemeda Mekbib 
Published: April 2018

INTRODUCTION:
This was a pilot study to investigate whether one’s background or training influences the understanding of medical professionalism.

METHODS:
An electronic survey was sent out to all trainees at Eastern Virginia Medical School. The survey included 25 questions; 12 background and 13 questions on professionalism related to ACGME.

RESULTS:
329 out of 1229 learners completed the survey for a response rate of 26.7%. 22.8% noted general lack of professionalism in the work place. 4.5% did not know someone who exemplified professionalism. 20 learners reported they had been cited for lack of professionalism, 12 of whom considered themselves to portray good professionalism. Learners with military background were more likely to have had formal leadership training (56% vs 24%, p<0.001). Among all learners, allied health students were more likely to have had formal leadership training (42%) as compared to medical students (24%) and residents/fellows (21%) (p=0.014). Only 60% of responders agreed or strongly agreed that there was a correlation between ones professional behavior and patient outcomes. Most allied health (93%) agreed professionalism impacts patient outcome while only 74% of medical students and 57% of residents fellows agreed (p<0.001). 55% believed that formal training in professionalism is required. Only 16.9% of respondents were familiar with the ACGME guidelines on medical professionalism. Learners scored the competencies in terms of importance 1-5 (5 being most important). SBL and EBC competencies received lower mean scores than other competencies (3.8 and 4.3). Residents/Fellows rated professionalism lower than other learners (4.0 vs 4.3) (p=0.019).

CONCLUSION:
The pilot demonstrated that understanding of Professionalism in the medical field is influenced by the background and role of trainees. Formal training in medical professionalism should be considered.
An Analysis of the Nulliparous, Term, Singleton, Vertex Cesarean Rate in a High-Volume Community Teaching Hospital [12C]
Authors: Wang Tiffany , Kawakita Tetsuya , Fernandez Miguel A. , Tefera Eshetu , Fernandez Stephen , Moxley Michael 
Published: April 2018

INTRODUCTION:
In March 2014, the American College of Obstetricians and Gynecologists (ACOG) published its Obstetric Care Consensus guidelines on preventing the first cesarean birth. Virginia Hospital Center (VHC) in Arlington, Virginia adopted these guidelines to decrease its primary cesarean birth rate. The aim of the study was to examine the effects of these initiatives on the nulliparous, term, singleton, vertex (NTSV) cesarean birth rate at VHC.

METHODS:
Interventions began in mid-2014 and included department-wide review of the indications for scheduled and unscheduled primary cesarean birth. A retrospective cohort study of all nulliparous women with singleton term pregnancies in the vertex presentation who delivered between 2014 and August 2017 was then conducted. The NTSV cesarean birth rates were calculated across time. Chi-square tests were used to determine whether NTSV cesarean birth rates were statistically significant after adoption of ACOG's Obstetric Care Consensus guidelines.

RESULTS:
There were 2,339 NTSV pregnancies in 2014, 2,090 in 2015, 1,673 in 2016, and 1,090 in 2017 (January through August). During this time period, the NTSV cesarean birth rate significantly decreased by 33.6% (31.8% in 2014, 27.7% in 2015, 22.0% in 2016, and 21.1% in 2017 (year to date) P<0.01).

CONCLUSION:
Within two years of implementation of the guidelines set forth by ACOG’s Obstetric Care Consensus, VHC significantly decreased its NTSV rate to meet the HealthyPeople 2020 NSTV goal rate of 23.9%. Further studies will examine provider and patient characteristics, along with other quality metrics to identify factors which may have contributed to the decreased NTSV cesarean birth rate.
Obstetric and Delivery Characteristics Associated with Gastroschisis [14C]
Authors: Rossi Robert , DeFranco Emily 
Published: April 2018

INTRODUCTION:
Gastroschisis is a congenital abdominal wall defect associated with complications such as cesarean delivery (CD). Previous studies have reported greater than 30% of these pregnancies having fetal intolerance of labor (FIOL). We sought to characterize obstetric factors associated with gastroschisis.

METHODS:
Population-based retrospective cohort study of livebirths in Ohio (2006-2015). Frequency of gastroschisis was obtained from birth certificate data. Obstetric characteristics were compared between women who delivered an infant with gastroschisis compared to those who without gastroschisis. Multivariate logistic regression estimated the influence of gastroschisis on the outcomes of FIOL and CD.

RESULTS:
Of 1,428,125 live births in Ohio during the 10-year study period, 620 (0.04%) women delivered an infant with a isolated gastroschisis. The CD rate was 45.7% vs 31.0% (p<0.001) in women who delivered an infant with gastroschisis compared to those without gastroschisis. Among women who were induced, the rate of FIOL was 13.4% vs 10.3% (p=0.145) in gastroschisis compared to non-gastroschisis pregnancies respectively. After adjusted analysis, women with gastroschisis pregnancies were not more likely to have FIOL (aOR 0.9, 95% CI 0.6-1.2) compared to those without gastroschisis. Among women who underwent CD, 79.4% (n=181/228) had a primary CD without a trial of labor despite being vertex.

CONCLUSION:
We did not find an association of intrapartum FIOL in gastroschisis pregnancies. Less than 15% of pregnancies with gastroschisis are complicated by FIOL despite having a higher rate and association with CD. Elective CD should be avoided in pregnancies with gastroschisis given the known maternal morbidity and lack of neonatal benefit.
Factors That Affect Weight Gain in an Obese Pregnant Population [16C]
Authors: Ratan Bani M. , Garbarino Abigail H. , Miao Di , Hollier Lisa M. 
Published: April 2018

INTRODUCTION:
The 2009 Institute of Medicine guidelines recommend 11-20 pounds weight gain for pregnant women with BMI ≥30. This study examines factors that affect compliance with weight gain recommendations in an obese, low-income population.

METHODS:
A retrospective cohort of 1,440 women receiving care at a large Medicaid clinic from 2013-2016 with BMI ≥30 was reviewed. Eligible women were non-smokers with a singleton full-term delivery that initiated care before 20 weeks. Linear and multinomial logistic regression analysis was used to compare gestational weight gain to demographic characteristics, nutritional education, participation in group prenatal care, and medical conditions.

RESULTS:
Inclusion criteria was met by 803 women, with mean weight gain of 21.8 pounds. In total, 162 (20%) gained weight within guidelines, 211 (26%) below, and 430 (54%) above. Controlling for pre-pregnancy BMI, multiparous women gained significantly fewer pounds then nulliparous women (19 versus 28, P<.001), with a greater proportion of multiparous women within the recommended guidelines (29% versus 16%, P<.001). In univariate analysis, patients that were married, had prior spontaneous preterm birth, or had chronic hypertension were associated with less weight gain, but none were significant after adjusting for parity. Race, nutritional education, and group prenatal care did not significantly affect weight gain.

CONCLUSION:
Interventions such as group prenatal care and nutrition visits do not significantly affect gestational weight gain in an obese, low-income population. Parity may be an important modifying factor in gestational weight gain. These findings may be useful for targeting policies aimed at attaining healthy weight gain based on parity.
A Prospective Randomized Study Assessing Cesarean Wound Infections Comparing Silver Dressings to Gauze Dressings [18C]
Authors: Connery Sheila , Louis Judette , Downes Katheryne L. , Odibo Linda , Raitano Olivia , Yankowitz Jerome 
Published: April 2018

INTRODUCTION:
Topical antimicrobial dressings which contain silver are used to prevent infection in a wide range of surgical specialties. We sought to evaluate the impact of silver-plated dressings in reducing surgical site infections (SSI) after cesarean delivery.

METHODS:
A double blinded randomized control trial of women undergoing cesarean delivery was conducted. Participants were randomized to two arms: Silverlon dressing (Argentum Medical, Chicago, Illinois) or an identical appearing gauze wound dressing (placebo). The primary outcome was superficial SSI within 6 weeks after delivery. Univariable comparisons were completed with chi-square and Student t-tests. Adjusted odds ratios were estimated with logistic regression. P<.05 was considered significant.

RESULTS:
Among the 618 participants, superficial SSI occurred in 15 women (4.6%) receiving placebo and 14 women (4.3%) receiving the silver plated dressing. [Odds Ratio (OR) 1.06; (95% confidence interval (CI) 0.55-2.20; P=.86]. Overall, 95% of the cohort received a standard preoperative skin prep with chlorhexidine, and 85.6% received standard preoperative antibiotics for SSI prophylaxis. The two groups were similar in age (30±5 vs 31±5 years, P=.86), Body Mass Index, (36±8 vs 35±8.1kg/m2, P=.17), presence of any diabetes (15.4 vs 14.3%, P=.25), cesarean after labor (32.2 vs 31.7%, P=.89), presence of chorioamnionitis (5.2 vs 2.2%, P=.06), and operative time (56±20 vs 55±17 minutes, P=.49). After controlling for confounding variables, use of a silver impregnated dressing were not associated with reduced risk of superficial SSI [OR 1.2 (95% CI 0.46-2.20].

CONCLUSION:
Among women undergoing cesarean delivery, silver plated dressing was not associated with a decrease in SSI.