bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictive Model for Successful Induction of Labor in Early Onset Pre-Eclampsia With Severe Features [24R]
Authors: Fei Yueyang F. , Ware Courtney Abshier , McLaughlin Eric , Hade Erinn , Markham Kara B. 
Published: May 2019

INTRODUCTION:
Hypertensive diseases of pregnancy complicate approximately 10% of pregnancies. Optimal timing and mode of delivery is unclear for pregnancies complicated by early onset pre-eclampsia with severe features (<34 weeks). This study aims to identify characteristics associated with the patient, fetus, and pregnancy that may affect the likelihood of successful vaginal delivery, which may guide future counseling of these patients.

METHODS:
This is a retrospective cohort study of women at a large tertiary medical center from 2012-2016. It included a total of 159 patients who delivered at <34 weeks with pregnancies complicated by pre-eclampsia with severe features. Risk factors for failed induction of labor were compared using various statistical methods. We developed and validated a predictive model using a step-wise procedure to calculate a patient's risk for having a failed induction of labor.

RESULTS:
Of 159 patients who underwent induction of labor, 77 resulted in successful vaginal deliveries. History of prior vaginal delivery, history of preterm labor, and increased parity, were associated with successful induction of labor. Conversely, elevated umbilical artery dopplers, earlier gestational age, lower bishop score, and current smoking were associated with higher rates of cesarean delivery.

CONCLUSION:
Overall, 48.4% of patients delivered vaginally following induction of labor in the setting of early onset pre-eclampsia with severe features. We developed a predictive model to classify patients with regards to risk for cesarean section, which included the following variables: pregnancy history, bishop score, age, smoking status, obesity. Further research can better elucidate the impact of different characteristics in predicting mode of delivery.
Potential Impact of the New Hypertension Criteria on Hypertensive Disorders of Pregnancy [22R]
Authors: Kozakiewicz Melissa L. , White Sarah E. , Burnett Brian A. , Nitsche Joshua , Denney Jeffrey M. , Brost Brian 
Published: May 2019

INTRODUCTION:
In November 2017, the Task Force on Clinical Practice Guidelines of the American College of Cardiology and American Heart Association provided new criteria for the diagnosis of hypertension. We sought to determine if the new diagnostic criteria (>130/80) would impact the diagnosis and potential management of hypertensive disorders of pregnancy.

METHODS:
In a retrospective descriptive study, two groups of mother/fetus pairs were identified: 1) those with a hypertensive disorder of pregnancy diagnosis (gestational hypertension, preeclampsia with or without severe features, eclampsia or HELLP syndrome) 2) no hypertensive disorder of pregnancy diagnosis. 294 consecutive deliveries were reviewed from 2016 following IRB approval.

RESULTS:
31 patients were identified for the hypertensive disorder of pregnancy and 31 for the no hypertensive disorder of pregnancy groups. Baseline demographics of each group were similar except for body mass index. Body mass index was significantly higher in the hypertensive disorder of pregnancy group. In women with a hypertensive disorder of pregnancy diagnosis, 65% met criteria for preexisting hypertension using the new guidelines compared to 19% without a diagnosis of a hypertensive disorder of pregnancy (p=0.0008). Preexisting hypertension would have been diagnosed in 78% of those diagnosed with gestational hypertension using the new criteria.

CONCLUSION:
Our results indicate adopting the new hypertension guidelines would increase the prevalence of chronic hypertension in pregnancy, and in turn the number who require specific antepartum surveillance and intrapartum management. Utilizing the new, more sensitive criteria for diagnosing chronic hypertension would also decrease the number of patients diagnosed with gestational hypertension.
Postpartum Urinary Retention, Identifying Risk Factors to Prevent Injury [21R]
Authors: Tureson Justin R. , Farrell Maureen 
Published: May 2019

INTRODUCTION:
Postpartum urinary retention (PPRT) affects between 2 and 3% of deliveries resulting in increased hospital costs and the potential for long term morbidity including need for prolonged catheter placement, intermittent self-catheterization, and future bladder dysfunction. PPRT is avoidable with medical staff awareness and intervention before bladder distention injuries occur. The project aim is to identify risk factors in patients who develop PPRT and determine the average postpartum diuresis.

METHODS:
This is a retrospective cohort study involving postpartum patients at Naval Medical Center San Diego. The study group was patients that delivered between 01JAN2017 and 01JAN2018 who had PPRT. Patients delivering between 01MAY2017 and 30MAY2017 were analyzed as the control group. Data collected included demographic information, delivery type, parity, length of second stage, infant weight, obstetric laceration, anesthesia type, comorbid conditions (hypertension, diabetes, obesity, postpartum hemorrhage), time to first void/bladder drainage and the volume.

RESULTS:
58 patients were identified as having suffered PPRT. In the study group, the average time to noting bladder over distention was 3.88 hrs with an average volume of 1142cc (353cc/hr). The control group included 244 patients with average time to void of 2.92 hrs and an average volume of 454cc (194cc/hr). Common risk factors for PPRT included primiparity, operative delivery (12.3% of PPRT versus 2.9% of controls), prolonged second stage of labor, and neuraxial analgesia.

CONCLUSION:
PPRT is an avoidable morbidity among obstetric patients. Identifying average diuresis rates and common risks factors as noted in this study will help better hone postpartum voiding trial protocols.
Does Antepartum Vitamin D3 Supplementation Prevent Gestational Diabetes Mellitus? [18R]
Authors: Persad Malini D. , Staszewski Cara , Khan Farzana , Perseleni Tatyana , Herrera Kimberly , Garretto Diana 
Published: May 2019

INTRODUCTION:
To determine the if Vitamin D3 supplementation in prevents gestational diabetes (GDM).

METHODS:
A subgroup analysis of the efficacy of Vitamin D3 to prevent GDM was completed on a trial performed from 10/2016 - 5/2018. Inclusion criteria: confirmed intrauterine pregnancy 12-16 weeks gestation. Exclusion criteria: women taking Vitamin D3 supplements, or a malabsorption disorder, or carrying anomalous fetus. Women were assigned to receive daily Vitamin D3 3000IU or no supplement in addition to prenatal vitamins. Maternal demographic factors, maternal serum Vitamin D (25(OH)D) levels, and incidence of GDM were collected from charts. GDM was defined as a positive 2 hour 75 g GTT or 3 hour 100 g GTT. Parametric and nonparametric statistics were calculated with a p value of <0.05 as significant.

RESULTS:
The cohort consisted of 210 women with 103 in the Vitamin D3 supplementation group and 107 in the no supplementation group. There were no significant differences in baseline characteristics between the groups. The third trimester maternal serum 25(OH)D levels were significantly increased in the Vitamin D3 supplementation group (28.9 +/- 11.1 ng/dl vs 23.3 +/- 8.8 ng/dl, p=0.001). The overall incidence of GDM was 10.4% (22/210) and the incidence of GDM was similar between groups (7.8% Vitamin D3 supplementation vs 13.0% no supplementation, RR 0.78, 95% CI 0.79-2.46).

CONCLUSION:
Antepartum Vitamin D3 supplementation raises baseline maternal serum 25(OH)D levels, but does not reduce the incidence of GDM.
Risk Factors for Surgical Site Infection After Cesarean in the Era of Extended Spectrum Preoperative Antibiotics [13R]
Authors: La Rosa Mauricio , Costantine Maged , Babazade Rovnat 
Published: May 2019

INTRODUCTION:
To determine risk factors associated with surgical site infections (SSI) after cesarean delivery (CD) using a contemporary cohort after the introduction of azithromycin.

METHODS:
Retrospective cohort study of women who underwent cesarean delivery (CD) in 2017 at a single university medical center, after the introduction of adjunctive azithromycin prophylaxis protocol. We excluded women younger than 18 years of age and those in which documentation of postpartum clinic follow up was not available. Our primary outcome was SSI defined according to the CDC criteria. Univariable and multivariate logistic regression analysis was performed and a P<0.05 was considered statistically significant.

RESULTS:
1365 women were included in the study. Out of 172 who developed SSI, 85% had superficial SSI. The use of preoperative antibiotics was almost universal and did not differ between the two groups. Women who developed SSI were heavier and more likely to be African American, have chronic hypertension, to have their CD done non-electively and after the onset of labor, and to receive blood transfusion. The duration of CD was longer in the group who developed SSI, their skin closed with staples, and prolonged hospital length of stay. On multivariable analysis, BMI (aOR 1.07, 95% CI 1.04-1.09, P<0.001), blood transfusion (aOR 4.37, 95% CI 2.07-9.22, p<0.001), and undergoing a CD non-electively after the onset of labor (aOR 1.58, 95% CI 1.10-2.28, p=0.01) remained significantly associated with SSI.

CONCLUSION:
Undergoing CD non-electively after the onset of labor, maternal obesity, and the need for pRBC transfusion are risk factors for SSI in women undergoing CD.
Simulation-Based Education for Contraception Counseling: A Crossover Study [10R]
Authors: Jackson Araba A. , Marko Emily , Perez-Visona Sira 
Published: May 2019

INTRODUCTION:
Healthcare providers are responsible for identifying women at risk of unintended pregnancy and providing counseling regarding contraceptive options through shared decision-making. The purpose of this study was to determine if a simulation-based curriculum will improve confidence and competence in contraception counseling compared with traditional instruction.

METHODS:
A randomized prospective crossover study was performed using two groups of third year medical students in the same clerkship rotations. All students received the same curriculum but had competency assessments at different times (group 1=pre-simulation, group 2=post-simulation). All underwent objective structured clinical exams (OSCEs) at the end of the clerkship. Instructional strategies included standardized patients and faculty feedback. Outcomes were measured using pre-post confidence surveys, competency assessment scores, and OSCE results. Institutional review board exemption was obtained

RESULTS:
Seventy-two students participated in the study over 1 year. Significant improvement was noted in pre-post confidence scores of both groups (group 1 pre=3.27, post=1.79, p=0.0005, group 2 pre=3.20, post=1.63, p<0.0001). The post-simulation crossover group demonstrated competency assessments that were significantly higher than the pre-simulation group (group 1 at 48.61% vs. group 2 at 79.40%, p<0.0001). Both groups completed the clerkship with similar OSCE scores (group 1 at 84.38% vs. group 2 at 83.12%) with group 1 demonstrating significant improvement from the pre-simulation competency assessment (48.61% vs. 84.38%, p<0.0001).

CONCLUSION:
Simulation significantly improved contraception counseling competencies in medical students. Providing learners with the ability to practice these shared decision-making skills through a simulated patient encounter may better prepare them to counsel real patients regarding contraception and hopefully prevent unintended pregnancies.
Second Trimester Induction in the Setting of a Prior Cesarean Delivery [9R]
Authors: Uribe Katelyn A. , Nguyen Anh Q. , Burke Anne E. , Johnson Clark 
Published: May 2019

INTRODUCTION:
Second trimester induction is considered an appropriate alternative to dilation and evacuation (D&E) when indicated, although the presence of a uterine scar potentially increases risks. One prior cesarean delivery (CD) is not associated with increased risk of uterine rupture, although insufficient evidence exists when multiple prior CD have occurred. We sought to further evaluate the safety of induction in the second trimester with a prior uterine scar.

METHODS:
We present a retrospective cohort evaluation of 125 women who underwent induction between 14 weeks and 23 weeks at the Johns Hopkins Hospital between 2013 and 2016. Induction was performed with either prostaglandins, Pitocin, osmotic dilators, or a combination of agents. Outcomes evaluated were infection, hemorrhage, blood transfusion, and retained placenta. IRB approval was obtained.

RESULTS:
29 of the patients had a prior CD, with 8 of the patients having multiple prior CD. No uterine ruptures occurred in any group. One prolonged induction required conversion to D&E. The rate of retained placenta was lower in the group with a prior CD, but this finding was not significant. While the rate of hemorrhage is similar in both groups, the rate of transfusion is higher in the women with prior CD, but is not statistically significant. When isolating the patients with two or more prior CD, outcomes are not significantly different.

CONCLUSION:
Our results are consistent with established guidelines that induction in the second trimester with a prior CD is safe and feasible. Multiple prior CD appear to have similar associated risks, but further research is warranted.
Risk Factors for Postpartum Medroxyprogesterone Problematic Bleeding [8R]
Authors: Thiyagarajan Dhanalakshmi , O'Shea Calliope , Mondheim Michael , Anasti James N. 
Published: May 2019

INTRODUCTION:
Medroxyprogesterone acetate is a safe and effective immediate postpartum contraceptive (MPA-PP). However, the resultant irregular bleeding attributed to MPA-PP is problematic. Little is known as to the contributing factors that increase risk of MPA-PP bleeding. Thus we compared patients that complained of MPA-PP bleeding to those who did not.

METHODS:
We reviewed the charts of all women receiving MPA-PP and had at least 3 months follow-up during 16 month period at a suburban health network. Age, ethnicity, BMI, Breast feeding status, parity, pregnancy complications and delivery type were collected. All visit between 3 months and 12 months were reviewed for persistent bleeding complaints and continuation rates of MPA. This study was approved by IRB. Those with and without bleeding complaints were compared using chi squared or t-test as appropriate.

RESULTS:
Of the 204 MPA-PP patients studied during the first PP year, 99 switched to alternative contraception or discontinued all contraception, 58 had no MPA bleeding complaints and 47 complained of persistent bleeding. Thirty of the 47 (64%) patients with bleeding stopped MPA. MPA bleeding group did not differ by age, BMI, ethnicity, and pregnancy complications. Although MPA bleeding group had lower cesarean delivery (p=0.06), breast feeding rates (p=0.11), and parity (p=0.07), they did not reach statistical significance.

CONCLUSION:
Of those wishing to continue MPA-PP, 47/58 (63%) complained of persistent bleeding during the first PP year. Although initiation of MPA in the postpartum period is associated with higher rates of bleeding than in the non-postpartum period, risk factors remain elusive.
Reproductive Health Care Knowledge, Needs, and Access Among Transgender Men: A Mixed Methods Study [6R]
Authors: Fein Lydia A. , Zaw Catherine , Wong Adriana , Jhaveri Vasanti , Gerkowicz Sabrina Aleezah , Potter JoNell 
Published: May 2019

INTRODUCTION:
Most transgender men retain their natal reproductive organs and genitalia. Approximately 70% of OB-GYN's report discomfort when providing care for this population. To ascertain the needs and experiences of transgender men who seek reproductive health care we conducted a mixed methods study among transgender men.

METHODS:
Self-identified transgender men participated in focus groups featuring questions about reproductive health care and completed a survey regarding reproductive goals. Descriptive statistical analysis was performed on survey data, and focus group data were transcribed and analyzed to identify emergent themes.

RESULTS:
Nine transgender men participated; mean age was 29, six were on hormone therapy. All had their uterus and ovaries in situ, and four reported recent vaginal receptive intercourse. Only two reported receiving fertility preservation information from a physician; five desired future children. Five reported current or past use of contraception, even after starting testosterone. Two reported history of unintended pregnancy and miscarriage. Themes identified through focus groups: reference to gynecologists as the “necessary evil”; sensing provider uncertainty about or avoidance of reproductive health topics, especially during the patients' reproductive transition'; systemic issues including insurance and financial barriers for gynecologic care and fertility preservation; and avoidance of gynecologic care due to dysphoria and lack of transgender-knowledgeable OB/GYN providers.

CONCLUSION:
These findings indicate that transgender men often retain their reproductive organs, use contraception, and desire childbearing, necessitating reproductive health care from OB/GYN providers. Strategies to increase providers awareness of these findings are needed so transgender men's access to and experiences of reproductive health are improved.
Patients With Mood Disorders Require Higher Doses of Buprenorphine for Management of Opiate Use Disorder [35Q]
Authors: Tonismae Tiffany R. , Lee McDowell Misty , Slaven James E. , Quinney Sara K. , Schubert Frank , Benjamin Tara D. 
Published: May 2019

INTRODUCTION:
The purpose of this study is to compare differences in buprenorphine doses needed to treat Opiate Use Disorder (OUD) in patients with and without mood disorders.

METHODS:
This is a retrospective cohort study of pregnant women treated at Indiana University with OUD. IRB approval was obtained from Indiana University School of Medicine. Charts were obtained via prescription medication search. Patients were included if they had at least one outpatient visit with our center during pregnancy and delivered within the Indiana University Health system. Charts were reviewed for maternal demographics, medical history, prescription use, and delivery data.

RESULTS:
266 patients were treated and 171 patients had a mood disorder: 148 with depression, 130 with anxiety, and 19 with post-traumatic stress disorder (PTSD). Over 40% of the patients had a history of dual diagnoses. Patients with a history of depression or anxiety required a higher dose of buprenorphine during pregnancy (p=0.0217, p=0.0165) compared to those without a history of mood disorder. There was no significant difference in dose in those with PTSD versus those without mood disorder. In those with a diagnosis of mood disorder, there was no difference in buprenorphine dose between women on medication versus those not on medication for depression, anxiety, and PTSD.

CONCLUSION:
Patients with a mood disorder require higher doses of buprenorphine compared to patients without a mood disorder. Treatment of depression, anxiety or PTSD did not show a difference in buprenorphine dose versus no treatment when a mood disorder was diagnosed.
Differences in Outcomes by Mode of Operative Vaginal Delivery Among Nulliparous Women [21B]
Authors: Packer Claire , Pilliod Rachel , Gallagher Alexandra , Caughey Aaron B. 
Published: May 2019

INTRODUCTION:
We sought to determine the differences in perinatal outcomes in deliveries with forceps compared to vacuum assisted delivery in nulliparous women.

METHODS:
A retrospective cohort study comparing the rate of perinatal outcomes among singleton, non-anomalous births in California to women who had forceps versus vacuum assisted deliveries between 2007 and 2011. Perinatal outcomes of interest included shoulder dystocia, brachial plexus injury (BPI), 3rd or 4th degree perineal laceration, cervical laceration, NICU admission, Apgar scores, facial nerve palsy, scalp injury, clavicular injury, and jaundice. Multivariate regression analyses and chi-square tests were employed for statistical comparisons and a p-value of less than 0.05 was used to indicate statistical significance.

RESULTS:
Of the nulliparous births in California, 4,028 had forceps deliveries and 53,781 had vacuum deliveries. Vacuum delivery was associated with an increased risk of both shoulder dystocia (Adjusted Odds Ratio [aOR] 1.5, 95% CI 1.16-1.93) and scalp injury (aOR 1.21, 95% CI 1.07-1.35), while forceps delivery was associated with an increased risk of adverse perinatal outcomes including 3rd or 4th degree perineal laceration (aOR 0.55, 95% CI 0.51-0.59), cervical laceration (aOR 0.55, 95% CI 0.22-0.51), and facial nerve palsy (aOR 0.30, 95% CI 0.21-1.59).

CONCLUSION:
Perinatal outcomes differ by method of operative vaginal delivery. It is interesting that vacuum deliveries have a higher rate of shoulder dystocia even when controlling for potential confounding factors. Forceps delivery, however, does have higher rates of perineal trauma. These findings can be used by clinicians to guide choices regarding mode of delivery.
Efficacy of Bremelanotide Across Hypoactive Sexual Desire Disorder Duration Subgroups [15M]
Authors: Simon James A. , Clayton Anita H. , Kingsberg Sheryl , Jordan Robert , Williams Laura , Krop Julie 
Published: May 2019

INTRODUCTION:
Bremelanotide, an investigational new drug, demonstrated efficacy in premenopausal women with hypoactive sexual desire disorder (HSDD) in the RECONNECT studies. In this analysis, bremelanotide efficacy was investigated across HSDD duration subgroups.

METHODS:
RECONNECT comprised two replicate, phase 3, double-blind, randomized, placebo-controlled, IRB-approved studies. Subjects self-administered bremelanotide 1.75 mg or placebo using an autoinjector pen, on demand, for 24 weeks. Subjects were evaluated based on HSDD duration at baseline. Efficacy was assessed using RECONNECT co-primary endpoints: change from baseline to end-of-study (EOS) for Female Sexual Function Index-desire domain (FSFI-D) and Female Sexual Distress Scale-Desire/Arousal/Orgasm (FSDS-DAO) Item 13 scores.

RESULTS:
In the integrated population of RECONNECT (N=1202), differences in mean change in FSFI-D and FSDS-DAO Item 13 from baseline to EOS (bremelanotide-placebo) were 0.35 and -0.33, respectively (P<.0001 for both endpoints). Differences in mean FSFI-D changes from baseline to EOS for each duration quartile were 0.42 (6-18 months; N=174-177), 0.41 (>18-33 months; N=118-132), 0.28 (>33-60 months; N=158-167), and 0.33 (>60-360 months; N=131-144). Differences in mean FSDS-DAO Item 13 changes for each duration quartile were -0.46 (6-18 months), -0.43 (>18-33 months), -0.14 (>33-60 months), and -0.29 (>60-360 months). Significantly greater (P≤.0082) changes in FSFI-D were achieved with bremelanotide versus placebo in all HSDD duration quartiles. FSDS-DAO Item 13 was also significantly improved across duration quartiles (P≤.0295) except for the 33-60 months quartile (P=.2449).

CONCLUSION:
Bremelanotide demonstrated efficacy in premenopausal women regardless of HSDD duration. Bremelanotide significantly restored sexual desire across HSDD duration quartiles and showed improvements in decreasing distress.