bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oxytocin Versus Misoprostol for Augmentation After Prelabor Rupture of Membranes [32Q]
Authors: Freret Taylor S. , Chacon Kelly M. , Bryant Mantha Allison S. , Kaimal Anjali J. , Clapp Mark A. 
Published: May 2019

INTRODUCTION:
Data are limited regarding the use of misoprostol vs oxytocin for augmentation after prelabor rupture of membranes (PROM). As nulliparas with unfavorable cervices benefit from cervical ripening for induction, our objective was to determine if admission-to-delivery times varied between nulliparas with PROM who initially received oxytocin vs misoprostol for labor augmentation.

METHODS:
This retrospective cohort comprised all term, nulliparous women with PROM from July 2016 to December 2017 at a single institution. Women were excluded if they presented in labor, had cervical dilation >2 cm, or were expectantly managed. The primary exposure was oxytocin vs misoprostol as the initial augmentation medication. The primary outcome was time from admission to delivery. Secondary outcomes included: full dilation reached, cesarean delivery, chorioamnionitis, and neonatal intensive care unit admission. Linear regressions with log transformation were used to estimate the effect of misoprostol vs oxytocin on time to delivery, controlling for patient factors. IRB approval was obtained.

RESULTS:
130 patients were included. Women receiving oxytocin had faster admission-to-delivery times than women receiving misoprostol (median 16.9 vs 19.9 hours, P=.013). There were no significant differences in the secondary outcomes between the misoprostol and oxytocin groups. In the adjusted model, women who received misoprostol for their initial augmentation agent had a 20.9% longer time from admission to delivery (95% CI 5.8%-36.0%) compared to women receiving oxytocin.

CONCLUSION:
In term, nulliparous women with PROM and an unfavorable cervix, those who received oxytocin had a shorter admission-to-delivery interval than women who received misoprostol as their initial augmentation agent.
Spiking in the Second Stage: What are the Neonatal Implications? [19D]
Authors: Daifotis Helen , Smith Megan , Denoble Anna Elisabeth , Dotters-Katz Sarah Kathleen 
Published: May 2019

INTRODUCTION:
Recent ACOG guidelines don't specify management of isolated maternal fever (IMF). Infectious signs and symptoms may be challenging to interpret in the 2nd stage of labor, with some patients less likely to receive treatment. We compared rates of severe neonatal morbidity between women treated with antibiotics and those untreated for IMF in the 2nd stage.

METHODS:
Retrospective cohort of term singleton vaginal deliveries with new-onset, isolated maternal fever (38.0 to 38.9C) during 2nd stage of labor. Primary outcome was severe neonatal morbidity (necrotizing enterocolitis, sepsis, intubation/respiratory distress and death). NICU admission and length of stay (LOS) also assessed. Neonates whose mothers received antibiotics were compared to untreated women. Bivariate statistics were used to analyze data. This study obtained IRB approval.

RESULTS:
IMF was seen in 116 women, with 75 (64.7%) receiving antibiotics. Demographics, antepartum complications, and delivery characteristics did not differ between groups. Maternal treatment affected neonatal antibiotics receipt (98.7% vs 48.8%, P<0.01). A total of 10 neonates (8.6%) had a severe morbidity 6 (8.0%) among treated women and 4 (9.8%) among untreated women (P=0.71). Invasive respiratory support was required more frequently in untreated group (9.8% vs 5.3%, P=0.45). No differences observed in NICU admission (15.1% vs 7.5%, P=0.37) or median NICU LOS. Among infants who received post-natal antibiotics, severe morbidity occurred in 20% of those untreated in-utero and 8.1% of treated (P=0.21).

CONCLUSION:
Severe neonatal morbidity occurred in approximately 1/12 infants born after IMF in the 2nd stage. Neonates of treated mothers were more likely to receive postnatal antibiotics, but not more likely to experience severe neonatal morbidity.
The Utility of the ACOG Mobile Application's Indicated Delivery Calculator for Obstetrics Resident Physicians [25D]
Authors: Sridhar Aparna , Morikawa Erika , Nguyen Tina , Sridhar Aparna 
Published: May 2019

INTRODUCTION:
The ACOG mobile application includes an IDC to provide evidence-based decision-making support when considering conditions that may necessitate early delivery.

METHODS:
After IRB exemption, obstetric residents at our tertiary academic center (n=28) were asked to determine delivery timing for fifteen obstetric scenarios, with and without use of the IDC. A mixed effects logistic regression model assessed the change in proportion of test items correct. We conducted semi-structured interviews of the residents' experience utilizing the calculator.

RESULTS:
Residents' ability to identify the correct gestational age at delivery for the obstetric scenarios significantly improved after use of IDC (47% pre to 86% post; p<0.01). Differences in the amount of change by year of residency were assessed using a time-by-group interaction term and no significant difference was noted. Positive feedback included the calculator being “user-friendly,” “convenient,” and “well-organized.” The ability to enter multiple co-morbidities was thought to be the best feature of the application. Residents expressed desire to incorporate this tool into their practice. Criticism about the calculator included desire for more robust yet streamlined complication list, more evidence-based references and elimination of prompt for estimated due date/gestational age.

CONCLUSION:
ACOG's IDC was effective in improving accuracy of residents' clinical decisions regarding delivery timelines for complex obstetric scenarios. Users quickly adapted to the tool and successfully navigated the features. Streamlining the input prompts and complication choice list may improve efficiency and increase use. Future studies can focus on identifying the effect of IDC on a national sample of residents as well as providers in practice.
Demographics and Outcomes Associated With End Stage Renal Disease After Pregnancy Related Acute Kidney Injury [3E]
Authors: Angarita Africano Ana Milena , Segev Dorry L , Johnson Clark , Kucirka Lauren Marie 
Published: May 2019

INTRODUCTION:
Pregnancy related acute kidney injury (AKI) remains an important cause of maternal and fetal morbidity and mortality, which can result in end-stage renal disease (ESRD) requiring life-long renal replacement. Little is known about the characteristics of those who develop ESRD after pregnancy related AKI.

METHODS:
The United States Renal Data System (USRDS) national registry between 1990 and 2015 was used to analyze the frequency of postpartum renal failure and associated risk factors. We used Cox proportional hazards models to evaluate risk factors for mortality and access to transplant among those with post-partum ESRD.

RESULTS:
There were 224 cases of ESRD due to post-partum renal failure vs 151,974 reproductive age women who developed ESRD secondary to other causes. Minorities were disproportionately affected: African-American women comprised 28.6% of those with post-partum renal failure but only represented 15.7% of births over the same time period. Similarly, Hispanic women represented 28.0% of those with post-partum renal failure but only 20% of live births. African-Americans with ESRD due to post-partum renal failure had a 2.15-fold higher hazard of mortality. Women with post-partum renal failure had better overall survival compared other causes of renal failure (HR=0.38, p<0.001). Despite this, women with post-partum renal failure had 0.45 lower hazards of receiving a kidney transplant, even after adjusting for demographic characteristics (P<.001).

CONCLUSION:
There are racial disparities in development of post-partum ESRD, with African-American and Hispanic women disproportionately affected. Women with post-partum ESRD are significantly less likely to receive a transplant despite having better overall survival.
Differences in Metabolic Profiles Among Women of Differences Races With Diabetes in Pregnancy [8E]
Authors: Martingano Daniel , Patel Nishant Pravinchandra , Tse Jaqueline , Shah Tanay , Singh Shailini 
Published: May 2019

INTRODUCTION:
The purpose of the study is to evaluate the racial differences in metabolic profiles among pregnant women with gestational (GDM) and pregestational (T2DM) diabetes and its impact on management.

METHODS:
We conducted a 3-year retrospective study on all pregnant women who were diagnosed as GDM or T2DM during the third trimester of pregnancy. Fasting C-peptide, fasting blood sugar (FBS), total cholesterol (TC), triglycerides (TG), and high density lipoprotein (HDL) were drawn prior to insulin use.

RESULTS:
This study included 200 patients, 68% GDM and 32% T2DM. Difference in fasting C-peptide values for Asian (A), Hispanic (H), African Black (AB), and Caribbean/Haitian Black (CHB) pregnant women and FBS were noted, p<0.01 and p=0.91, respectively. After adjusting for BMI respective to race, C-peptide values still differed significantly, p<0.01. Differences in insulin sensitivity by ISHOMA (C peptide) also demonstrated this effect, p<0.01. TG were higher on average for A and CHB versus H and AB p=<0.01. Differences in HDL and TC differ between race groups, p=0.05 and p=0.03, respectively. A and CHB required insulin therapy more often than H and AB, p=0.04.

CONCLUSION:
Pregnant A and CHB women likely have beta cell defects resulting in low fasting insulin levels as measured by fasting C-peptide but higher insulin sensitivity on ISHOMA (C peptide) and higher TC, HDL, TG, whereas women of AB race appear to have metabolic profiles more similar to H women.
Associations Between Racial Bias and Adverse Perinatal Outcomes [10E]
Authors: Johnson Jasmine D. , Vuletich Heidi A. , Stuebe Alison M. 
Published: May 2019

INTRODUCTION:
Race disparities in health outcomes are pervasive. Using the Implicit Association Test (IAT) as a marker of structural racism, studies have shown that racial bias among White individuals is associated with negative outcomes for minorities; however, this dataset may not be representative. We investigated both the IAT and the rate of racially charged internet search terms by state - and their relationship to adverse perinatal outcomes. We hypothesized that states with greater racial bias would have worse perinatal outcomes among non-Hispanic Black (NHB) populations compared with non-Hispanic White (NHW) populations.

METHODS:
We performed a secondary analysis of state-level data quantifying racially charged internet search rates and IAT results. We modeled the association between these measures of racial bias and publicly available Vital Statistics data on the rates of preterm birth, low and very low birth weight, infant mortality, and breastfeeding initiation by race. Multivariate regression was used for statistical analyses.

RESULTS:
Data from all 50 states were included. Higher state rates of racially charged internet search terms were correlated with higher rates of adverse outcomes for both NHW and NHB populations. Anti-White bias among Black IAT participants was associated with worse perinatal outcomes for both NHB and NHW populations, with a greater disparity in outcomes between NHW and NHB (P=<.05) populations.

CONCLUSION:
Structural racism, whether indexed by racially-charged internet search terms or IAT results, was associated with worse perinatal outcomes. These results suggest that efforts to address racial bias have the potential both to reduce disparities and improve population health.
Postpartum Hemorrhage After Vaginal Delivery [12E]
Authors: Peleg David , Nofal Mais Abu , Ben Shachar Inbar 
Published: May 2019

INTRODUCTION:
The incidence of postpartum hemorrhage (PPH) following vaginal delivery, an estimated blood loss of 500 mL or more, has been reported to occur in 1 to 5 percent of all vaginal deliveries. In our practice, blood loss after vaginal delivery is estimated using the bedpan technique. Our objective was to determine the incidence of PPH after vaginal delivery using the bedpan technique.

METHODS:
This was a retrospective study of 4510 women who gave birth vaginally between March 2015 and September 2016 at Ziv Medical Center, Zefat, Israel. Following delivery of the baby, the umbilical cord was clamped and cut, and a cardboard bedpan was placed under the buttocks of the woman. Blood was continually collected in the bedpan during delivery of the placenta and until the uterus was firmly contracted and bleeding was minimal. Uterotonics were routinely used during and after the third stage. The bedpan was then weighed without the placenta, and the net weight gain was recorded as blood loss.

RESULTS:
Although the mean blood loss using the bedpan technique was 305.64 ml±210.3 ml, 486 of the 4510 women had blood loss >500 ml, indicating the incidence of PPH was 10.3%. Also, 2.4% of women had blood loss >1000 ml.

CONCLUSION:
Compared to visual estimation, the bedpan technique appears to be a more accurate method for determining blood loss following vaginal delivery. The incidence of PPH using this method was twice as high as that reported in the literature.
Does Implementation of Universal Cervical Length Screening Increase Antepartum Resource Utilization? [15E]
Authors: Hogg James P. , Temming Lorene A. , Stephenson Courtney , Pollack Rebecca E. 
Published: May 2019

INTRODUCTION:
Concern has been raised regarding “intention creep” and increased resource utilization with implementation of universal cervical length (CL) screening. We compared the incidence of antepartum interventions before and after implementation of screening.

METHODS:
Retrospective cohort study of singleton gestations who underwent anatomic ultrasound between 16w0d and 20w6d for two years pre and post implementation of screening. Excluded multiples, fetal anomalies, aneuploidy, and missing records. Interventions included ≥2 repeat CL measurements, vaginal progesterone, 17-OHP, cerclage, pessary, admission for preterm labor, betamethasone administration, and NICU consultation. Multivariable logistic regression was used.

RESULTS:
There were 8309 patients- 4350 before (unexposed) vs. 3959 after (exposed). In the unexposed group 94 (0.87%) patients had a CL of ≤3 cm vs. 56 (1.41%) in the exposed group (p=0.02). There were no differences in demographics between groups. Of those with short cervix, the median CL was 2.4 cm (unexposed) vs. 2.5 cm (exposed). The exposed were less likely to undergo ≥1 antepartum intervention (58.9% vs. 80.0%, aRR 0.68, 95% CI 0.34, 0.99). There were no differences in the rates of individual interventions (cerclage placement, vaginal progesterone, 17-OHP, PTL admission, NICU consultation or administration of steroids). Chorioamnionitis was less frequent in the exposed (8.9 vs. 26.3%, p=0.02). There were no differences in neonatal outcomes or the rate of preterm birth.

CONCLUSION:
Implementation of universal CL screening identified more people with a short cervix with no difference in the rate of individual interventions. The exposed were less likely to undergo ≥one intervention. Universal CL screening does not unduly increase antepartum resource utilization.
Pregnancy Outcomes in Peri-Menarchal Adolescents [8F]
Authors: Bauer Alison Marie , Lappen Justin , Hackney David 
Published: May 2019

INTRODUCTION:
The birth rate among adolescents has been declining, and is particularly low in peri-menarchal adolescents (age 10-14 years). At extremely young maternal ages that precede full adult stature, there is theoretical concern for an increased risk of cesarean delivery (CD) due to cephalopelvic disproportion. The aim of this study is to evaluate pregnancy outcomes in peri-menarchal adolescents.

METHODS:
A retrospective cohort study was performed using the National Inpatient Sample (NIS) in 2012. Adolescents with pregnancy and delivery International Classification of Diseases (ICD-9) codes were identified, and terminations were excluded. The risk of CD and composite outcome (postpartum hemorrhage, blood transfusion, hysterectomy, intrauterine growth restriction, preterm delivery, and pre-eclampsia) were compared for adolescents age 10-14 years and 14-18 years, using 18-22 years as a reference group. Univariable and multivariable analyses were performed with adjustment for confounding factors.

RESULTS:
839 adolescents age 10-14, and 35,453 adolescents age 14-18 were identified. In univariable analysis, peri-menarche was associated with decreased frequency of CD (p<0.001, aOR 0.57, 95% CI 0.47-0.69) and increased frequency of the composite outcome (p<0.001, aOR 1.42, 95% CI 1.20-1.67). In multivariable regression, adolescents had decreased odds of undergoing CD and increased odds of pre-eclampsia and the composite outcome.

CONCLUSION:
Pregnancy in the peri-menarche age group is associated with an increased risk of hypertensive disorders in pregnancy and the composite outcome, though is associated with a decreased risk of CD. Thus, peri-menarchal patients have a reduced risk of undergoing CD despite not yet having achieved full adult stature. Thus, peri-menarchal patients have a reduced risk of undergoing CD despite not yet having achieved full adult stature.
Contribution of Maternal Factors to Infant Mortality From Extreme Preterm Birth [25F]
Authors: AnneKelly Elizabeth , Plagge Thomas , McKinney David Nelson , Adcock Ryan , DeFranco Emily A. 
Published: May 2019

INTRODUCTION:
Extreme preterm birth (EPB), defined as birth at ≤28 weeks gestation, is a primary driver of infant mortality. This study aims to quantify the impact of maternal characteristics on infant mortality due EPB using attributable risk percentage (ARP).

METHODS:
We performed a statewide population-based retrospective cohort study of all extreme preterm births (n=17,307) and infant deaths in this cohort (n=3,770) using linked Ohio birth and infant death records from January 2006 through December 2015. We excluded infants born with congenital malformations. Births were stratified by gestational age and the prevalence of maternal characteristics were compared between the infants that died and those that lived. The protocol for this study was approved by the human subjects Institutional Review Board of the Ohio Department of Health.

RESULTS:
Maternal factors associated with infant death due to EPB were inadequate prenatal care (ARP 51.5%, CI 45.8-56.7%), obese BMI (ARP 23.0%, CI 13.3-31.7%), not enrolled in WIC (ARP 38.0%, CI 30.4-44.7%), Gonorrhea infection during index pregnancy (ARP 51.8%, CI 22.4-70.0%), inadequate weight gain (ARP 54.7%, CI 49.2-59.6%), interpregnancy interval >60 months (ARP 33.6%, CI 25.2-41.1%), and prior infant mortality (ARP 57.3%, CI 45.8-65.3%).

CONCLUSION:
The maternal characteristics were associated with 403 infant deaths per year. The potentially modifiable factors of obesity, inadequate prenatal care, gonorrhea infection, inadequate weight gain, and not being enrolled in WIC were associated with 281 infant deaths per year. Understanding the contribution of maternal factors to infant mortality in a cohort of infants born before 28 weeks gestation is important in informing interventions and providing maternal counseling.
Pulmonary Hypertension in Pregnancy: Maternal and Neonatal Trends and Outcomes [01OP]
Authors: Shao Yi-Hong , Czuzoj-Shulman Nicholas , Spence Andrea , Abenhaim Haim Arie 
Published: May 2019

INTRODUCTION:
Pulmonary hypertension (PH) is associated with significant maternal and fetal morbidity and mortality. With recent treatment advances, women with PH are electing to continue their pregnancy to term. Our study compared the demographics, comorbidities and clinical outcomes in parturients with PH and without PH.

METHODS:
We conducted a population-based retrospective cohort study using Nationwide Inpatient Sample (NIS) of Healthcare Costs and Utilization Project (HCUP) database from 2000 to 2014. We used an unconditional logistic regression analyses to estimate the associated risks of maternal and neonatal outcomes.

RESULTS:
We identified 2,087 cases of PH in pregnancy. Compared to non-PH pregnant women, PH in pregnancy was associated with an increase in hypertensive disorders (23.24% vs. 4.99%, P<0.0001), including pre-eclampsia (13.61% vs. 3.47%, P<0.0001) and eclampsia (0.38% vs. 0.08%, P<0.0001). A 1.9-fold increase in cesarean section rate was observed. The most common maternal post-partum complication was cardiomyopathy (5.70% vs. 0.02%, P<0.0001). The maternal mortality rate was 2.64% compared to 0.01% in controls (P<0.001). Mortality rate trends have remained stable, while hospital delivery admission rates have risen significantly (P=0.028). Neonatal outcomes were worse among PH patients, notably higher rates of intra-uterine growth restriction and death, preterm birth and congenital anomalies.

CONCLUSION:
PH in pregnancy is rare and associated with increased risk of adverse pregnancy, maternal and neonatal outcomes. However, our study found a significantly lower maternal mortality rate compared to those previously quoted in the literature. Given significantly higher risk of thromboembolic events, careful consideration should be given to thromboprophylaxis.
In Vitro Activity of Ibrexafungerp (SCY-078) Against Candida spp. (Including Fluconazole-Resistant Isolates) [14OP]
Authors: Borroto-Esoda Katyna , Barat Stephen , Angulo David , Sobel Ryan 
Published: May 2019

INTRODUCTION:
Vulvovaginal candidiasis (VVC) is a common fungal infection caused by Candida spp., with only one oral treatment, fluconazole, currently approved in the U.S. Another oral option is desirable, particularly with azole resistance on the rise among some Candida spp. Ibrexafungerp (IBX, formerly SCY-078) is a first-in-class, broad-spectrum, intravenous and oral, triterpenoid antifungal, a novel class of glucan synthase inhibitors, currently in phase 3 development for the treatment of VVC. The purpose of this study was to evaluate the activity of IBX against Candida spp., including fluconazole-resistant isolates.

METHODS:
In vitro MIC data for IBX against multiple Candida spp. were compiled from 7 independent studies. The combined studies included 242 isolates with fluconazole resistance (FLU-R) and 532 wild-type (WT) isolates of C. albicans, C. glabrata, C. tropicalis and C. parapsilosis. In vitro susceptibility was determined by broth micro-dilution using CLSI methods. Isolates with IBX MIC values >2-fold dilutions as compared to WT MIC50 values were considered resistant. FLU-R was defined for Candida spp. per CLSI M27-S4.

RESULTS:
MIC50 values for IBX against the WT isolates ranged from 0.008 to 0.5 ug/mL. Similar results were obtained against FLU-R strains, for which IBX MIC50 values ranged from 0.06 to 0.5 ug/mL. Overall, IBX was active (MIC within 2 dilutions of WT) against 240/242 (99%) of the FLU-R isolates tested in these studies.

CONCLUSION:
IBX exhibited in vitro activity against FLU-R Candida spp. These results suggest that IBX is a highly-promising, orally bioavailable antifungal agent for the treatment of patients with FLU-R VVC.