bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Umbilical Artery Flow Velocity Waveforms with Fetal Perfusion Pressures in Ex Vivo Placenta Cotyledon [5P]
Authors: Pino Daniela , Bednov Andrey , Carillo Maira , Maguire Christopher , Maher James , Schlabritz-Lutsevich Natalia 
Published: April 2018

INTRODUCTION:
The spectral Doppler indices obtained during antenatal sonography are used to evaluate placental resistance in vivo because direct measurement of flow volume in utero is not easily attainable. Placental perfusion pressures obtained from an ex-vivo placental cotyledon can be calculated at standardized flow rates. We sought to compare the ex vivo pressures to in utero Doppler flow indices.

METHODS:
Dual perfused ex vivo human placenta cotyledons from 28 women delivered at 37-39 weeks (IRB #L-014) were cannulated. The inflow pressure (IFP) in the fetal artery at inflow velocity of 4.5 ml/min as well as cotyledon weight were recorded. The umbilical artery flow velocity waveform analysis from routine antenatal sonography was retrospectively collected in twelve women at a mean gestational age of 35.6 +2.5 weeks. The S/D ratio, RI, and PI were obtained.

RESULTS:
The IFP correlated negatively with the cotyledon weight (r=.0485, P=.009) The raw Doppler indices were not significantly correlated with placental or fetal weight, However, if the pressure controlled for cotyledon weight was compared to Doppler index controlled for placenta weight, there was a positive correlation between Doppler RI and placental perfusion pressure. (p=.0086). There was a weak negative correlation between IFP and estimated the fetal weight at the time of ultrasound. (r=.47, p=.06).

CONCLUSION:
Small placental vessels are responsible for the resistance calculated in the umbilical artery. In the dually perfused placenta, our study suggests that the pressure in the functional placental unit of a perfused cotyledon is correlated with the Doppler flow indices on antenatal ultrasound.
When to Deliver Dichorionic Diamniotic Twins in the Setting of Preeclampsia [12P]
Authors: Walker Allison R. , Caughey Aaron B. 
Published: April 2018

INTRODUCTION:
Dichorionic diamniotic (DCDA) twin pregnancies are at increased risk of preeclampsia (PET), intrauterine growth restriction (IUGR) and intrauterine fetal demise (IUFD). Our study compared outcomes of induction of labor (IOL) at 34 through 37 weeks to determine the most favorable gestational age for delivery in DCDA twin pregnancies complicated by mild PET.

METHODS:
A decision analytic model was created using TreeAgePro 2017 software to compare the outcomes of expectant management versus IOL at 34 to 37 weeks of gestational age. Outcomes examined included quality adjusted life years (QALYs), cases of advancement from mild to severe PET, maternal mortality, maternal stroke, IUGR, IUFD, cerebral palsy (CP) and neonatal mortality. Probabilities, utilities, and life expectancies were derived from the literature. Univariate analyses were used to investigate the impact of labor induction at various gestational ages.

RESULTS:
In a theoretical cohort of 10,000 DCDA pregnancies complicated by PET, IOL at 34 weeks resulted in the fewest cases of severe PET (0), maternal stroke (15), maternal mortality (4), IUFD (0), and IUGR (1,183). However, this strategy was also associated with the most cases of neonatal CP (91) and neonatal mortality (87). Neonatal CP was lowest in the 37 week IOL strategy group (46) and neonatal mortality was lowest with IOL at 36 weeks (65). QALYs were highest (868,112) when IOL occurred at 36 weeks.

CONCLUSION:
DCDA twin pregnancies complicated by mild PET should be induced at 36 weeks. When compared to IOL at 37 weeks, this strategy reduces maternal and neonatal morbidity and mortality.
Preconception Cardiac Risk Factors in African American Women with Low Birth Weight Term Deliveries [22P]
Authors: Gold Kellyanne R. , Gold Robert A. , Schilling Mark , McGrady Christopher 
Published: April 2018

INTRODUCTION:
Maternal history of low birth weight (LBW) (<2500 g) delivery is associated with increased maternal cardiovascular mortality. We sought to evaluate cardiovascular risk factors pre-conception in African American (AA) women for term pregnancy LBW.

METHODS:
The CARDIA Study was initiated in 1985 to study the evolution of cardiac risk factors in young adults 18 to 30 years old. We studied first pregnancy after baseline at Years 2 and 5 in AA women. Subjects with chronic health conditions were excluded. An uncontrolled (univariate) analysis was performed with birth weight (BW) as the dichotomous variable (BW<2500 gm, BW>2500 gm) which assessed risk associated with blood pressure (BP), age, body mass index (BMI), glucose, serum lipids, parity, and tobacco usage at baseline. A second analysis with a logistic regression model was designed with BW as the dichotomous response variable as above and systolic-BP/diastolic-BP, age, BMI, smoking status, and gestational age as the explanatory variables.

RESULTS:
The uncontrolled analysis demonstrated systolic-BP 113.3 (BW<2500 gm, N=18) vs systolic-BP 106.7 (BW>2500 gm, N=255) (P<.003, two-tailed-Student-T) and current smokers 61% (BW < 2500 gm) vs nonsmokers 25% (BW>2500 gm) (P<.002). Other variables were non-significant in the uncontrolled analysis. The logistic regression model demonstrated that maternal age and BMI were not significant, whereas gestational period was significant (P<.033), smoking status was significant (P<.018) and systolic-BP was highly significant (P<.006).

CONCLUSION:
Elevated normal range systolic-BP preconception in AA women is associated with subsequent term pregnancy LBW delivery. The results suggest a possible common predisposition to both LBW and subsequent cardiovascular mortality.
Pregnancy outcomes in an obstetrical Type I Diabetic patient population, Insulin pump vs insulin injections. [24P]
Authors: Hernandez Celso , Lesser Karen , Reed Kathryn 
Published: April 2018

INTRODUCTION:
Objective: To analyze pregnancy outcomes between two different methods of insulin delivery in an obstetrical type I diabetic patient population.

METHODS:
Study Design: A retrospective chart review of an obstetrical type I diabetic was analyzed from a single institution. These patients were separated into those utilizing a continuous subcutaneous insulin pump (CSI) and those receiving multiple daily injections of insulin (MDDI). Subsequently, the data pertinent to the different antenatal and postnatal outcomes was collected. Statistical analysis with student t-test and Chi square test was done as applicable.

RESULTS:
There were no statistical differences in the outcomes between these two groups when comparing age, parity, gestational age, BMI, starting weight, weight at delivery, number of years since diagnosis, weight gain during pregnancy., neonatal birthweight, neonatal hypoglycemia, shoulder dystocia, macrosomia, and primary C-section rate. The HgA1C of the CSI was statistical significant lower when compared to MDDI in first trimester(p<.003), second (p<.03) and third trimester (p<.01).The total number of insulin units needed to treat patients in the CSI was statistically significant lower when compared to MDDI in the first(p<.04), second(p<.004) and third trimester(p<.006).The weight retention at 1 year postpartum was statistically significant lower in the CSI when compared to the MDDI (p<.04).

CONCLUSION:
Pregnancy outcomes were comparable between these two methods for many variables. However, CSI appears to offer an advantage in minimizing the insulin quantity needed during pregnancy and reducing weight retention postpartum in the setting of optimal blood sugar control.
Third Trimester Detection of Fetal Growth Abnormalities in Obese Pregnant Women: A Retrospective Cohort Study [31P]
Authors: Razzaq Khadija , Cotton-Caballero Amaya , Pettit Kate , Boyle Annelee , Ferguson James , Dudley Donald 
Published: April 2018

INTRODUCTION:
To determine if, in pregnant obese women, prenatal ultrasonography (US) can accurately predict abnormal birthweight (BW) in newborns.

METHODS:
We conducted a retrospective chart review of singleton deliveries of obese women between January 1, 2014 and March 31, 2015 at UVA. IUGR was defined as an EFW <10% while LGA was defined as EFW > 90%. BW was categorized into normal (2500-3999 grams), low (<2500 grams), and macrosomic (≥4000 grams). Chi squared tests and logistic regression were used for analyses.

RESULTS:
We included 307 women in our study. Indicated third trimester growth US for chronic hypertension or diabetes occurred among 17.6% (54/307) of women. Among the remaining women without these indications, 70.4% (178/253) had at least one follow up US. Overall, 22.3% (44/197) of newborns had a discordant prenatal EFW and BW. For macrosomic infants, 13.9% (5/36) were LGA prenatally, while 58.33% (21/36) appeared normal. Among low BW (LBW) newborns, 13.2% (5/38) had IUGR prenatally, while 44.8% (17/38) had a normal EFW. Normal BW infants were rarely diagnosed as IUGR (1/232, 0.5%) or LGA (5/232, 2.2%). A BMI 35-40 (OR=0.41, 95%CI: 0.18-0.96), having 2-3 US (OR=0.31, 95%CI: 0.12-0.76), and diabetes (OR=0.41, 95%CI: 0.18-0.94) reduced the odds of predicting LBW and macrosomia.

CONCLUSION:
In obese women, there is a high rate of discordance between prenatal fetal growth abnormalities and actual BW. Having a higher BMI or another comorbidity reduces the accuracy of predicting abnormal BW. Prenatal prediction of LBW or macrosomia does not improve after the first follow up growth US.
Endometrial Safety of Low Dose Vaginal Estrogens in Menopausal Women [39P]
Authors: Constantine Ginger , Mirkin Sebastian , Bernick Brian , Liu James 
Published: April 2018

INTRODUCTION:
2.3 million women use low dose vaginal estrogen products to treat symptomatic vulvar and vaginal atrophy (VVA) in the US. Most women do not take a concomitant progesterone. A systematic literature search was conducted on the risk of endometrial hyperplasia/cancer and the use of unopposed vaginal estrogen products.

METHODS:
PubMed and EMBASE were searched for journal articles related to the use of vaginal estrogens in postmenopausal women published in the English language. A total of 5,593 abstracts were reviewed; 37 articles reported vaginal estrogen use and endometrial histology.

RESULTS:
There were 20 randomized studies with a total of 2,747 women exposed to vaginal estrogen for up to one year; there was no evidence of an increased risk of endometrial hyperplasia/cancer in association with vaginal estrogen products. Other interventional and observational studies identified during the systematic review do not support an increased risk of endometrial hyperplasia or endometrial cancer with low dose vaginal estrogen. The exception is a registry from Denmark that was inconsistent with other studies evaluated and of limited applicability to the US.

CONCLUSION:
The available evidence from systematic review does not support an increased risk of endometrial hyperplasia or endometrial cancer with low dose vaginal estrogen; however, there are limitations with the applicability of current reports to new lower dose products.
Investigating Antibiotic Usage in Patients Undergoing Gynecologic Surgery [2Q]
Authors: Brunozzi Sabrina C. , Wilcox Brian 
Published: April 2018

INTRODUCTION:
Multiple studies have shown that indiscriminate antibiotic usage is linked to the development of antibiotic-resistant strains of bacteria. For gynecologic surgeries, the American Congress of Obstetricians and Gynecologists (ACOG) recommends the prophylactic usage of antibiotics for hysterectomy, urogynecologic procedures, hysterosalpingogram, and induced abortion. Conversely, ACOG does not recommend antibiotic prophylaxis in patients undergoing clean procedures with fewer risks for infection.

METHODS:
Based on these recommendations, a retrospective chart review was conducted of all women (N=1,338) who underwent gynecologic surgery between April 2015 and April 2016 at Moses Taylor Hospital in Scranton, PA and the use or non-use of antibiotics was analyzed in each case. Data that was collected included age, race, insurance provider, type of gynecologic procedure performed, antibiotic prescribed, and timing of administration.

RESULTS:
The results of this study showed that 161 of 167 patients (96.4%) received antibiotics appropriately when undergoing a procedure in which an antibiotic was indicated. Conversely, 210 of 1,171 patients (17.9%) received inappropriate antibiotic treatment when undergoing procedures where antibiotics were not indicated. Hysteroscopy was the most common procedure in which antibiotics were given inappropriately.

CONCLUSION:
We recently implemented a quality improvement intervention targeted to improve compliance with ACOG recommendations. This includes dissemination of the recommendations in a simplified chart in the pre-operative areas and operating rooms, and re-training of surgeons, surgical staff, and anesthesia staff. The post-intervention phase is about to begin and the results will be presented. Improvement in outcomes and lessons learned from the intervention can potentially be used as a model for other institutions.
Ulipristal Acetate Impact on Fibroid Volume: Integrated Results From VENUS I and II [11Q]
Authors: Lukes Andrea , Simon James A. , Fu Yiyong , Sniukiene Vilma , Catherino William 
Published: April 2018

INTRODUCTION:
Uterine fibroids (UFs) are common benign tumors that can cause heavy menstrual bleeding (HMB). Ulipristal acetate (UPA), an oral selective progesterone-receptor modulator, suppresses uterine bleeding and reduces fibroid cell size by inducing apoptosis and breakdown of the extracellular matrix.

METHODS:
In the randomized, double-blind, placebo-controlled, Phase III VENUS I and II studies, pre-menopausal women (18-50 years of age) with ≥1 UF and HMB were randomized to placebo, UPA 5 mg, or UPA 10 mg once daily for 12 weeks (one treatment course [TC] for VENUS I and two TCs for VENUS II), with a 12-week treatment-free follow up. Efficacy endpoints included mean change from baseline in total volume of (up to) the three largest UFs (measured by transvaginal ultrasound). VENUS I and II results were pooled only for the first TC for analysis of fibroid volume changes.

RESULTS:
Integrated results after the first TC demonstrated significant fibroid volume reduction from baseline with UPA 5 mg (n=170) vs placebo (n=125) (-11.4% and +6.8%, respectively; P=.0037) and UPA 10 mg (n=165) vs placebo (-14.2% and +6.8%, respectively; P<.001). After the second TC of UPA 5 mg (n=70) and 10 mg (n=59), further volume reduction was seen (-11.7% and -23.0%, respectively), which remained reduced at the 12-week treatment-free follow up (-16.0% and -31.5%, respectively).

CONCLUSION:
Both UPA doses, vs placebo, significantly reduce fibroid volume in women with UFs, with greater reduction observed with UPA 10 mg.
The Safety of RT for the Management of FIGO Stages IA-IIA Cervical Cancer: An Updated Meta-Analysis with TSA [27Q]
Authors: Feng Ying , Zhang Zihan , Lou Tong , Wang Shuzhen , Bai Huimin , Zhang Zhenyu 
Published: April 2018

INTRODUCTION:
This study aimed to evaluate the safety of RT for the management of stages IA-IIA cervical cancer and to initiate new investigations based on the findings of previous studies published in the literature.

METHODS:
The PubMed, EMBASE, Web of Science and Cochrane databases were searched to collect correlational, prospective, CCTs published in English from 1984 to April 2017. A meta-analysis and TSA were performed to evaluate the oncologic and reproductive outcomes of patients treated with RT.

RESULTS:
A total of 5 prospective CCTs with 818 patients were ultimately pooled in this analysis. The recurrence and death rates were similar between RT and RH. Patients with a tumor 2-4 cm in diameter were more likely to be treated with RH than RT, which might be a potential contributor to the higher ratio of postoperative adjuvant chemotherapy in this patient group. Additionally, RH was associated with a significantly higher risk of intraoperative blood transfusion. The TSA indicated that the cumulative number of patients failed to fulfill the required sample size. Promising negative section margins were obtained through RAT, but patients with a tumor 2-4 cm in diameter were more likely to be treated with RH. Moreover, the clinical outcomes of RAT were slightly more favorable than those of RVT.

CONCLUSION:
RVT is safe and feasible for early-stage cervical cancer patients with a tumor less than 2 cm in diameter. RAT could be cautiously recommended as an alternative for patients with a tumor 2-4 cm in diameter. However, further CCTs are warranted to validate these results.
Pregnancy After Bone Marrow Transplantation for Aplastic Anemia [37Q]
Authors: Idler Jay , Patwardhan Sanjay , Gonik Bernard 
Published: April 2018

INTRODUCTION:
Patients with a past history of aplastic anemia treated by bone marrow transplantation (BMT) and immunosuppression are rarely seen in pregnancy. As there is limited literature on the role of prenatal screening, and the management of these patients, we are reporting unusual outcomes of a pregnancy in a patient with a remote history of treated aplastic anemia.

METHODS:
A systematic retrospective chart review was performed for a patient identified in our high risk clinic who was noted have aplastic anemia, previously treated with bone marrow transplantation and immunomodulators. We followed her through the entirety of her pregnancy and are now reporting on her outcomes.

RESULTS:
A 35-year-old patient with a history of aplastic anemia treated with BMT and immunosuppressive therapy presented in her first trimester for prenatal care. Noninvasive prenatal testing (NIPT) was uninterpretable, and QUAD screening was low risk, with the exception of an elevated maternal serum alpha-fetoprotein (MSAFP). Early intrauterine fetal growth restriction (IUGR) was diagnosed at 21 weeks’ gestation which persisted through the rest of her gestation. Cesarean delivery was performed at 28 weeks 3 days gestation, for recurrent fetal heart rate decelerations.

CONCLUSION:
Selective use of cffDNA (cell free fetal DNA) technology for NIPT should be utilized for patients who have undergone BMT in the past. SNP testing relies on hematopoietic derived cells for analysis, which does not reflect the patient’s germline (ova), therefore should not be obtained. The observed fetal growth restriction may have been influenced by the pre-transplant whole body radiation including the maternal pelvic structures.
Post-Operative Pain Control: A Retrospective Study Investigating the Impact of Anesthetic Choice for TAP block [2R]
Authors: Morrison Christopher , Schuler Kevin , Devaiah Ganga , Maetzold Erin , Crisp Catrina 
Published: April 2018

INTRODUCTION:
Transversus abdominis plane (TAP) block has been shown to decrease narcotic requirements, lower pain scores, and decrease length of hospital stay in the post-operative setting. Variation exists regarding choice of anesthetic agent used to perform the block. We investigate the impact of anesthetic choice on TAP block in gynecologic oncology patients undergoing laparotomy via midline vertical incision.

METHODS:
This is a retrospective cohort study involving 70 patients from a large academic referral center from 2014-2017 undergoing TAP block for perioperative pain control. Subjects received either bupivacaine or liposomal bupivacaine for TAP. Narcotic use for post-operative day 0-3 was the primary outcome, with post-operative pain scores and hospital length of stay as secondary outcomes.

RESULTS:
Average age was 56 years with the bupivacaine group being older: 58 vs. 52 years (p=0.012). No significant differences were found among post-operative narcotic requirements. Pain scores at regular intervals up to 72 hours between groups were also not different. When analyzing timing of the TAP, there was no difference in narcotic requirements or pain scores when the TAP was performed before or after the surgical procedure. Lastly, choice of anesthetic did not impact hospital length of stay.

CONCLUSION:
No significant differences were found between bupivacaine and liposomal bupivacaine with regard to post-operative narcotic requirements, pain scores, or length of hospital stay in gynecologic oncology patients undergoing laparotomy. A prospective approach to investigate anesthetic choice and timing would be needed in order to better investigate timing and anesthetic choice.
Characteristics and Outcomes of Unexecuted Postpartum Sterilization in High Risk Low Income Obstetrical Patients [10R]
Authors: Persad Malini D. , Staszewski Cara , Ly Victoria , Garry David , Quirk J. Gerald 
Published: April 2018

INTRODUCTION:
To determine the characteristics and outcomes associated with unexecuted postpartum sterilizations in high risk low income obstetrical patients.

METHODS:
A retrospective cohort study of pregnant women desiring postpartum sterilization from a high risk, Medicaid based, obstetrical practice was undertaken at a university based hospital from January-June 2014. Women who did not undergo postpartum sterilization were compared to those who underwent the postpartum procedure during the hospital stay. Maternal demographic factors, medical history, obstetrical history and mode of delivery were extracted from the medical record. Women who did not undergo sterilization were assessed for contraception utilized, obstetrical follow up, unintended pregnancy rate and subsequent adverse pregnancy outcomes. Groups were compared with the use of parametric and non-parametric tests with a p <0.05 as statistically significant.

RESULTS:
Over the 6-month period, 73 high risk low income women were identified, with 40% failing to undergo postpartum sterilization during their hospital stay. Women were less likely to undergo sterilization if they were younger, single, and had a vaginal birth. In those not undergoing the procedure, 31.0% received an alternative form of contraception, 6.9% received interval sterilization, 27.5% had unintended pregnancies of which 12.5% had a subsequent adverse pregnancy outcome and 31.0% were lost to follow up.

CONCLUSION:
Failure to perform postpartum sterilization results in a high unintended pregnancy rate and adverse subsequent pregnancy outcomes. In those with unfulfilled procedures, efforts should be made to provide alternative contraception and planned follow up prior to discharge.