bluuebunny/crossref_metadata_2025_split huggingface dataset:
Suture Material used in Cerclage and Risk of Preterm Delivery [21I]
Authors: Gill Lisa , Yamamura Yasuko 
Published: April 2018

INTRODUCTION:
Several sutures are used in cerclage. Surgical literature shows an increased infection rate with braided suture compared to monofilament, and preterm birth is associated with infection. This study compares preterm delivery rates in cerclage by suture type.

METHODS:
This is a retrospective cohort study. Cerclages performed between January 1, 2011 and December 31, 2016 were collected from a single center. Exposures included use of a monofilament or braided suture. Comparison group was Mersilene tape. Primary outcomes were defined as delivery <23 weeks gestation and < 37 weeks gestation. Secondary outcomes were defined as delivery <28 and <32 weeks gestation. Odds ratios with 95% confidence intervals were calculated for each endpoint.

RESULTS:
267 cerclages were collected. Delivery information was available for 225. Monofilament was used for 83 procedures, braided for 85, and Mersilene tape for 57. Both monofilament (OR 2.47, 95% CI 0.65-9.4) and braided suture (OR 2.4, 95% CI 0.63-9.14) were associated with a non-significant increased risk of birth < 23 weeks gestation. There was no difference in risk of preterm delivery <37 weeks for either suture (OR 1.07, 95% CI 0.54-2.10; OR 1.06, 95% CI 0.52-2.08 respectively). Use of either monofilament or braided suture increased the risk of delivery prior to 28 or 32 weeks gestation. When Shirodkars were excluded, no difference in preterm delivery was noted.

CONCLUSION:
Monofilament and braided suture may be more likely to result in preterm delivery prior to 28 or 32 weeks of gestation. No difference in preterm or previable delivery was noted with differing suture type.
The Utilization of Antenatal Late Preterm Steroids at a Tertiary Care Academic Medical Center [24I]
Authors: Nicol Casey , Monahan Rose , Boyle Annelee , Dudley Donald , Ferguson James , Pettit Kate 
Published: April 2018

INTRODUCTION:
The purpose of this study was to examine the utilization of antenatal late preterm steroids (ALPS) at a single institution following publication of recent evidence suggesting neonatal benefits in the late preterm period.

METHODS:
A retrospective cohort study was performed including all patients with singleton gestations at 34 weeks to 36 weeks 5 days admitted from April 2016 through March 2017.

RESULTS:
During the study period, 102 patients met inclusion criteria. A total of 28 patients (27.5%) received ALPS. Of the entire cohort, 35 (34.3%) patients qualified for ALPS administration. Of these 35 qualifying patients, 21 (60%) received steroids and 14 (40%) did not. Seven (6.9%) patients received steroids and did not meet standard ALPS criteria. Maternal demographic characteristics and indications for admission were similar between groups. Women who received ALPS were admitted at an earlier median gestational age than women not given ALPS (p<0.005). Common contraindications to steroid administration were delivery anticipated in <12 hours (19.6%), pre-gestational diabetes (11.8%), prior steroid administration <34 weeks (11.8%), and gestational diabetes (6.9%). There were no differences in the rate of NICU admission or neonatal length of stay between groups. The rate of NICU admission in the entire cohort was 43.1% (44/102).

CONCLUSION:
One-third of patients admitted in the late preterm period met criteria for administration of ALPS. Only 60% of patients who qualified for ALPS received steroids. The rate of NICU admission in the late preterm period remains high. Increasing the appropriate use of ALPS may help to further improve neonatal outcomes in this population.
Association of Levels of Antepartum Angiogenic Factors with Severe Postpartum Hypertension [25I]
Authors: Perdigao Joana , Minhas Ruby , Chintala Sireesha , Mueller Ariel , Young Danielle , Rana Sarosh 
Published: April 2018

INTRODUCTION:
Postpartum hypertension often arises from an existing hypertensive disorder of pregnancy (HDP). Limited data exists about antecedent presentation and risk factors of PPHTN, especially among African American (AA) women. We studied the association between antepartum angiogenic biomarkers (sFlt1 and PlGF) and severe PPHTN among predominantly AA women.

METHODS:
Women with HDP were enrolled upon admission. Biomarkers were measured on an automated platform from maternal blood collected within 96 hours of delivery. PPHTN was severe if systolic blood pressure (SBP) ≥160 or diastolic blood pressure (DBP) ≥110 and mild if SBP ≥140 or DBP ≥90. Descriptive statistics were assessed with a Wilcoxon Rank Sum or chi-square test, as appropriate. Univariate and multivariable logistic regression was used to assess the association between PPHTN and angiogenic factors, reporting the area under the receiver operating curve (AUC).

RESULTS:
375 women were enrolled, with 279 (74.4%) AA and 151 (40.3%) with severe PPHTN. 52.9% of women with severe PPHTN also had antepartum pre-eclampsia with severe features. The sFlt1/PlGF ratio was significantly higher for both severe and mild PPHTN compared to women with normal postpartum BPs (73.5, 46.0 and 13.0 respectively, p<0.0001). Furthermore, the highest tertile of antepartum sFlt1/PlGF ratio was associated with severe PPHTN [OR 2.52, 95% CI: 1.49-4.27; p=0.001] which persisted after adjustment [OR 2.83; p=0.001]. When predicting severe PPHTN, the adjusted AUC for sFlt1/PlGF was 0.71.

CONCLUSION:
A significant association exists between antepartum angiogenic biomarkers and severe PPHTN — a frequent manifestation in women with antepartum HDP. Further studies should evaluate the mechanisms of such association.
Socioeconomic Disparities in Knowledge and Behaviors of Zika virus in Pregnant Women [6J]
Authors: Chandrasekaran Neeraja , Marotta Mabel , Taldone Sabrina , Singh Vivek , Koru-Sengul Tulay , Curry Christine 
Published: April 2018

INTRODUCTION:
Gaps in knowledge and prevention of Zika have been established in pregnant women, though it is unclear whether these gaps are further pronounced in disadvantaged populations. In this study, we aim to identify disparities in knowledge and behaviors of Zika during pregnancy.

METHODS:
A cross-sectional design was utilized. Surveys were distributed to pregnant women in the antenatal clinics of University of Miami Hospital and Jackson Health Systems. Women were divided into two groups based on socioeconomic status(SES):low(income less than $25,000 or education less than high school) and middle/high(income greater than $25,001 or education greater than high school). Data was then recorded onto REDcap and analyzed using SAS studio. Categorical variables were compared using Pearson’s chi-square or Fisher’s exact test.

RESULTS:
The study was carried out between January 17th,2017-May 3rd,2017, and a total of 224 women were surveyed. Low SES group consisted of 107 women, and middle/high SES group consisted of 117 women. Both groups were similar in trimester and parity and differed in age, race, ethnicity, employment status, and number of children. Women in middle/high SES group answered more questions correctly about Zika symptomology and prevention compared to the lower SES group. Women in lower SES group were more likely to answer that they feel doctors should talk to their patients about risks and protection from Zika at every visit compared to women in middle/higher SES group.

CONCLUSION:
There are disparities in knowledge and behaviors regarding Zika in women of lower SES compared to women of middle/higher SES. Interventions to further educate disadvantaged women on Zika.
Cervical Length Surveillance and Optimal Timing of Antenatal Corticosteroid Exposure in Twins [11J]
Authors: Janssen Ashley , Dahlke Joshua , Hultgren Elizabeth , Hamill Neil , Connealy Brendan , Lovgren Todd 
Published: April 2018

INTRODUCTION:
Cervical shortening in twins is associated with spontaneous preterm birth (sPTB), yet there is limited data on whether increased frequency of transvaginal cervical length (TVCL) surveillance in twins impacts timing of obstetric interventions or perinatal outcomes. Our objective was to determine if an association exists between the frequency of TVCL surveillance and optimal timing of antenatal corticosteroids (ACS) administration.

METHODS:
Retrospective cohort analysis of all twin pregnancies delivered in a single-tertiary care-center between 1/1/13 and 4/1/16. Those with ≥6 and <6 TVCL measurements were compared. Outcomes of interest was administration of ACS course within 7 days of delivery, magnesium sulfate for neuroprotection, and composite maternal and neonatal morbidity.

RESULTS:
359 of 424 twin pregnancies during the study period met inclusion criteria and received a total of 2,305 TVCL measurements. There were no differences in sPTB rates <34 0/7 weeks, magnesium exposure if delivery was <32 0/7 weeks, ACS within 7 days of delivery or composite maternal or neonatal morbidity were lacking. Those with ≥6 TVCL measurements were less likely to receive a first ACS course within 7 days of delivery (11/41 [27%] vs. 19/39 [49%], P=.04).

CONCLUSION:
More frequent TVCL surveillance did not improve timing of obstetric interventions or perinatal morbidity. The utility of cervical surveillance in twins remains unclear.
Primary Cesarean Rates at a Community Hospital: Differences Between Residency and Private Practice [15J]
Authors: Quinn Shantel , Butz Anh , Simpson Barbara , Stovall Dale W. 
Published: April 2018

INTRODUCTION:
Reducing cesarean delivery rates remains a primary objective in obstetrics. Differences in labor management and practice environment likely contribute to variation in the rate of cesarean delivery. This research compares the rate of primary cesarean delivery of an obstetrics & gynecology residency and a private practice at the same community hospital.

METHODS:
In this retrospective cohort study, all deliveries over an 18-month period were reviewed. Demographic information including age, race, gravidity/parity, gestational age, pregnancy complications, maternal comorbidities, and indication for cesarean delivery were obtained.

RESULTS:
The residency performed 1,114 vaginal and 346 cesarean deliveries, for an overall cesarean rate of 23.7%. The private practice performed 1,223 vaginal and 482 cesarean deliveries, for an overall cesarean rate of 28.3%. Considering only primary cesarean deliveries, the residency performed 188 cases (14.4%), while the private practice performed 271 cases (18.1%). The residency performed significantly fewer primary cesarean deliveries (P = 0.009) and had a significantly lower cesarean rate overall (P = 0.004). The cohorts differed significantly in age, gravidity/parity, and indication for cesarean delivery. Delivery was indicated most often by non-reassuring fetal status for the residency cohort (48.9%) and by labor dystocia (arrest of descent or dilation) for the private practice (38.0%) (P < 0.0001). Prevalence of hypertension, diabetes, and other comorbidities did not differ between cohorts.

CONCLUSION:
Residency practice patterns might yield lower cesarean delivery rates. Further study of differences in indication for cesarean and role of age and multiparity could help identify strategies to reduce primary cesarean delivery.
Liposomal Bupivacaine at Cesarean Delivery, Minimizing Opioid use for Post-operative Pain Control [17J]
Authors: Cherot Elizabeth , Kett Atilla , Mauro Rachel 
Published: April 2018

INTRODUCTION:
Cesarean delivery is the most common in-patient surgery performed in the United States. Opioids are frequently prescribed post-operatively; this can lead to misuse or even illegal distribution.

METHODS:
We infiltrated liposomal bupivacaine at the time of fascial closer of a Pfannenstiel incision, during a cesarean section. An 80cc solution was divided into four infiltrates of 5cc of Liposomal Bupivacaine, 6cc of .5% Bupivacaine and 9cc of Normal Saline each. Half of the solution was injected laterally under the fascia and the remaining was distributed evenly subcutaneously. Post-operative management was standardized with intrathecal morphine, scheduled Ketorolac and Ofirmev for the first 24 hours intravenously. Scheduled PO ibuprofen and acetaminophen were continued for forty-eight hours postoperatively. Oxycodone was ordered as needed but not scheduled. We used our SeamlessMD smartphone application to collect data on pain control and patient satisfaction. We reviewed in-patient charts and outpatient EMR records post-operatively for two weeks

RESULTS:
Of the 11 cases, five patients used no narcotics, and one outlier was identified as a potential abuser. The mean morphine equivalent was 7.5mg or one 5mg oxycodone over the inpatient and 2 week post-operative period. The average length of stay was 2.2 days. The response rate was 42% to patient satisfaction questions.

CONCLUSION:
Liposomal Bupivacaine reduces opioid use in the post- operative time period for cesarean section. It increased patient satisfaction and improved pain control, shortening length of stay. Further randomized control studies to determine the best delivery method are warranted.
Comparison of Outpatient Foley Bulb Induction to Traditional Induction of Labor [18J]
Authors: Bull Mary , Hong Christina , Roth Patrick , Washburn Mark 
Published: April 2018

INTRODUCTION:
More than 20% of pregnant women in the U.S. undergo induction. Due to an unfavorable cervix, many of the women presenting for induction experience longer labor times, increased rates of cesarean section and increased healthcare costs. The purpose of the study was to examine the difference in cesarean section rates, maternal and neonatal morbidity and costs for outpatient vs inpatient Foley induction.

METHODS:
We conducted a retrospective case control study using data from the Kaiser Permanente electronic medical record for the Orange County Service area. Cases were identified using a log of all patients receiving Foley bulb placement. Controls were identified through the electronic health record using Current Procedural Terminology codes and International Classification of Diseases 9th Revision codes for induction of labor from 2013-2015. Cases and controls were matched by advanced maternal age status, parity and race. Patients were excluded if they had a modified bishop score >6 or nonvertex presentation or <37 weeks gestation.

RESULTS:
Between 9/2013 and 12/2015, 283 cases were identified and matched 1:1 to controls. There was no difference between cases and controls for rate of cesarean (P>0.89) or for maternal (P>0.37) or neonatal morbidity (P<0.5). Cases were more likely to have an infant with a higher birth weight (P<0.01), have a shorter length of hospitalization for labor and delivery (P<0.01) and lower costs of hospitalization (P<0.01). Cost was quantified, with average 300 dollars per patient savings for outpatient induction.

CONCLUSION:
Outpatient Foley bulb placement is a safe, cost effective alternative for women undergoing induction of labor.
Racial Disparities in Surgical Outcomes During Peripartum Hysterectomy [26J]
Authors: Martin Kristin L. , Martin Kimberly A. , Chou Betty , Ryan Isa , Lawson Shari M. 
Published: April 2018

INTRODUCTION:
Peripartum hysterectomy (PH) is a lifesaving procedure known to have increased morbidity and mortality over elective hysterectomy. Non-white surgical patients frequently have poorer outcomes than white patients undergoing the same procedure. We sought to analyze patients undergoing PH and compare intraoperative and postoperative outcomes by race.

METHODS:
We performed a retrospective analysis of female patients (age 12–55) who underwent delivery of a newborn in a US hospital and had a subsequent peripartum hysterectomy during the same admission between 2005 and 2014. Data were obtained from the Healthcare Cost and Utilization Project's National Inpatient Sample. Demographic, clinical, socioeconomic and hospital characteristics of patients were compared with respect to patient race/ethnic group.

RESULTS:
Blacks undergoing PH were 3.1 times more likely to have any in-hospital mortality. This trend persisted between both Hispanic and Asian groups (2.1 times and 2.9 times more likely, respectively). After adjusting for covariates, in-hospital mortality and cardiopulmonary complications for Black and Asian women remained significantly higher than for whites. All races (Black, Hispanic, Asian) were more likely to undergo blood transfusion than their white counterparts. Blacks were 95% percent more likely to be diagnosed with sepsis during hospitalization. Additionally, surgical site infection was not statistically significant, however blacks were more likely (69.7%) to have wound dehiscence.

CONCLUSION:
Disparities in both intraoperative and postoperative outcomes following peripartum hysterectomy were observed. Future investigation must be performed in order to identify and eliminate any modifiable contributing factors on the provider or system level.
Racial Disparities in Maternal Outcomes Among Pregnant Women With Major Depressive Disorder [35J]
Authors: Toffey David E. , Chatroux Louisa R. , Caughey Aaron B. 
Published: April 2018

INTRODUCTION:
We sought to determine the differences in pregnancy outcomes among white, black, Hispanic, Asian/Pacific Islander, and Native American women with major depressive disorder (MDD).

METHODS:
A retrospective cohort of 14,489 women with MDD and singleton, non-anomalous gestations was used to examine maternal outcomes, assessed according to race. Maternal outcomes included pre-eclampsia/eclampsia (abbreviated “Any PET”), gestational diabetes (GDM), chorioamnionitis, blood transfusion, endometritis, 3rd or 4th degree lacerations, and postpartum hemorrhage (PPH). Multivariate regression analyses and χ2 tests were employed for statistical comparisons and a P-value of less than 0.05 was used to indicate statistical significance.

RESULTS:
Overall, race was associated with a statistically significant increase in the majority of investigated outcomes. Compared to white women, and after controlling for confounders, black women with MDD were more likely to experience PET, develop chorioamnionitis and endometritis, and require a blood transfusion, and trended towards greater rates of PPH. Hispanic women were more likely to develop GDM, chorioamnionitis, and endometritis, and trended towards greater rates of PET and PPH. Asian/Pacific Islander women were more likely to develop GDM, chorioamnionitis, endometritis, 3rd or 4th degree lacerations, and PPH, and trended towards lower rates of PET. Native American women had higher rates of PET and endometritis, and trended towards higher rates of GDM and PPH.

CONCLUSION:
Non-white women with MDD experience higher rates of obstetric complications than white women, with specific complications and rates varying across races. These data suggest disparities may exist in management of pregnant women with MDD across different races.
Optimal Delivery Timing for MoMo Twin Gestations Undergoing Continuous Fetal Monitoring—Cost-Effective Analysis [38J]
Authors: Hickok Ruth A. , Walker Allison R. , Caughey Aaron B. 
Published: April 2018

INTRODUCTION:
To determine the most cost-effective gestational age of delivery for women undergoing inpatient management for monochorionic-monoamniotic (MCMA) twin gestations.

METHODS:
A decision-analytic model was created comparing timing of delivery for MCMA pregnancies undergoing inpatient continuous fetal monitoring beginning at 26 weeks. Each arm of the tree represented a different gestational age at time of induction of labor, ranging from 28 to 34 weeks. Strategies involving expectant management accounted for probabilities of intrauterine fetal demise (IUFD) and spontaneous delivery at each successive week. Examined outcomes included quality adjusted life years (QALYs), IUFD, cerebral palsy and neonatal death. All probabilities, utilities, and costs were derived from the literature. The primary outcome was the incremental cost per QALY. The cost-effectiveness threshold was set at $100,000 per QALY. Univariate and multivariate analyses were used to investigate model robustness.

RESULTS:
In a theoretical cohort of 250 MCMA twin pregnancies, delivery at 34 weeks would save $130 million compared to delivery at 28 weeks. Perinatal mortality was lowest at 30 weeks (12) and highest at 34 weeks (18). QALYs were highest at 31 week (21,146) and lowest at 28 weeks (20,799). Taken together, the most cost-effective strategy was delivery at 32 weeks gestation at $395 per QALY. Sensitivity analysis demonstrated that delivery at 32 weeks remained the optimal strategy until weekly cost of inpatient management was decreased to $4,038, at which point delivery at 33 weeks became the optimal strategy.

CONCLUSION:
Delivering at 32 weeks gestation is the most cost-effective strategy for MCMA twin gestations undergoing continuous fetal monitoring.
Hereditary Cancer Genetic Testing in Community-Based Obstetrics and Gynecology Settings [3K]
Authors: DeFrancesco Mark S. , Karanik Dana , Bernhisel Ryan , Alico Lindsey , Adkins Royce T. , Waldman Richard 
Published: April 2018

INTRODUCTION:
Despite ACOG recommendations, many Obstetricians and Gynecologists (Ob/Gyns) do not routinely screen patients for hereditary cancer risk. Here we evaluate the feasibility of improving screening, genetic risk assessment, and testing services in community Ob/Gyn practices.

METHODS:
This was a prospective, single arm process intervention study at two community Ob/Gyn office sites. Data was collected during a 8 weeks pre-intervention and 8-week post-intervention period. There was a 4-week practice period following process intervention. Surveys were completed by providers and patients who underwent genetic testing.

RESULTS:
During the pre-intervention period, 3,882 patients were seen and 43 (1.1%) had genetic testing for hereditary cancer risk. In the post-intervention period, 4,107 patients were seen and genetic testing was ordered for 219 (5.3%) patients. Of those who completed genetic testing, 5.5% (9/165) were found to carry a pathogenic variant. Regarding their experience with screening and genetic testing, 98.8% (167/169) of patients were able to understand the information provided and 97.6% (165/169) were satisfied with the overall process. All providers (15/15) reported that they would continue to use this process to screen and test patients at risk for hereditary cancer and 93.3% (14/15) were satisfied with the process implementation.

CONCLUSION:
This process intervention resulted in a substantial improvement in the proportion of at-risk patients who had genetic testing, with patients and providers reporting a positive experience. This demonstrates that Ob/Gyns are capable of counseling and ordering hereditary cancer genetic testing and that integration into routine practice is feasible and beneficial in a community Ob/Gyn setting.