bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postpartum Shock Index as a Predictor of Postpartum Hemorrhage Morbidity [30K]
Authors: Welsh Ann , Savala Michael , Lai Bridget , Kimata Chieko , Soon Reni 
Published: April 2018

INTRODUCTION:
Shock index (SI), or systolic blood pressure/heart rate, can be a marker for trauma morbidity. We sought to explore the utility of this clinical sign in obstetrics by evaluating the relationship between postpartum SI and postpartum hemorrhage morbidity.

METHODS:
To determine if an elevated SI in the first 2 hours after delivery was associated with postpartum hemorrhage morbidity, we conducted a retrospective review of all deliveries occurring at a level III obstetrics hospital in Honolulu, HI from January 1, 2013 to December 31, 2015. The primary outcome was a composite of 1) a decrease in hemoglobin from admission to postpartum of 3 g/dL or more, 2) blood transfusion, or 3) admission to telemetry or ICU. We developed a multivariate regression model to estimate the association between the maximum shock index within 2 hours postpartum and clinically relevant postpartum hemorrhage after adjusting for demographic and clinical variables.

RESULTS:
Among the 17,522 delivery records reviewed, the mean maximum postpartum SI was 0.84±0.18. The composite hemorrhage outcome complicated 1,332 (7.6%) deliveries. A maximum SI of 0.9 or greater occurred in 5,497 deliveries, and 13.0% were found to have the composite hemorrhage outcome, compared to 5.2% of the deliveries in which the maximum SI was less than 0.9 (P<.0001). Women with a maximum postpartum SI of 0.9 or greater were 2.5 times more likely (aOR 2.5 [CI 2.24–2.85]) to experience the composite outcome.

CONCLUSION:
Evaluation of SI, particularly in the immediate postpartum period, may assist in identifying patients at greatest risk for developing adverse hemorrhage-related outcomes.
Maternal Morbidity Associated With Duration of Labor Induction [34K]
Authors: Teal E. Nicole , Lewkowitz Adam , Tran Carol , Koser Sarah , Siegel Molly , Gaw Stephanie 
Published: April 2018

INTRODUCTION:
Inductions of labor (IOL) vary in their duration and the effects of that variation are largely unknown. This study aims to assess the impact of IOL duration on maternal morbidity.

METHODS:
This retrospective cohort study included all nulliparous women with non-anomalous, singleton, vertex pregnancies undergoing IOL at a tertiary-care academic hospital in 2015. IOL duration was calculated as time from administration of first induction agent to delivery. The primary outcome was maternal composite morbidity: third or fourth degree perineal laceration, postpartum hemorrhage, blood transfusion, peripartum infection, uterine rupture, shoulder dystocia, retained placenta, and/or postpartum readmission. Secondary outcome was mode of delivery. The risk of adverse outcomes was stratified by IOL duration.

RESULTS:
Four hundred twenty women were included. IOL duration exceeding 24 hours was associated with increased risk of composite maternal morbidity (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.1–2.7) but that risk did not persist among IOL exceeding 36 hours. One hundred twenty women (28.6%) had a cesarean section. IOL duration exceeding 24 hours was associated with increased risk of CD (OR 3.2, 95% CI 2.0–5.4) which persisted at 36, 48, and 60 hours (OR 2.9 [1.8–4.5], OR 2.8 [CI 1.7–4.8], OR 2.3 [CI 1.1–5.0]). IOL duration was not associated with increased risk of operative delivery.

CONCLUSION:
While increasing IOL duration is associated with increased risk of maternal morbidity at 24 hours, that risk does not persist beyond 36 hours. Conversely, IOL duration longer than 24 hours is associated with increased risk of CD. These data may inform decision-making surrounding prolonged IOL.
Screening and Treatment Practices of OB/GYN Providers for Postpartum Depression and Anxiety [4L]
Authors: Hadley Emily E. , Le ViDonna , Swen Tony , Munn Mary , Costantine Maged , Temple Jeff 
Published: April 2018

INTRODUCTION:
Prevalence of postpartum depression and anxiety is 20% and 4%–10%, respectively. We sought to identify differences in screening practices among providers and barriers to screening in an obstetric clinic system.

METHODS:
Cross-sectional survey study was performed on obstetrical care providers including certified nurse midwives, nurse practitioners, and OB/GYN residents practicing in a regional clinic system. Surveys were anonymous and voluntary. The survey inquired about provider's frequency of screening, comfort screening, and treatment for postpartum depression and anxiety along with questions about barriers to screening. Residents and mid-level providers (MLP) results were compared using Pearson χ2 test.

RESULTS:
53/85 (62%) health care providers responded including 33 MLPs and 20 residents. The majority of respondents were female (96%). MLPs were significantly older (P=.001) and more likely Caucasian (P=.04). MLPs and residents reported screening for depression 85% and 70% of the time (P=.39) and for anxiety 59% and 20% of the time (P=.006). Significantly more MLPs reported their clinic utilizes a postpartum depression screen as compared to residents (66% versus 10%, P=.001). Sixty-two percent of providers feel their training prepared them to manage postpartum depression, but only 59% and 31% of providers reported feeling confident treating depression and anxiety, respectively. Lack of translation services is a screening barrier significantly more for resident providers (P=.004).

CONCLUSION:
MLPs screen for postpartum anxiety and utilize clinic screening resources more than residents. Results indicate that more postpartum depression and anxiety training should be provided to residents and MLP providers. Translation services are a barrier to screening for some providers.
Maternal Considerations to Termination of Down Syndrome Pregnancies [10L]
Authors: Fanucchi Hannah , Cui Yiwen , Phillips Carolyn , Rijhsinghani Asha 
Published: April 2018

INTRODUCTION:
To assess maternal factors that influence a patient's decision to terminate a pregnancy affected by Down syndrome.

METHODS:
This retrospective study included all patients diagnosed with fetal Down syndrome via amniocentesis between 1990 and 2006 at the University of Iowa Hospital and Clinics. Patients were stratified into two groups by maternal age and socio-clinical data were collected from initiation of prenatal care to the end of the pregnancy.

RESULTS:
Total of 261 patients were diagnosed with Down syndrome fetuses, 106 (40.6%) of which belonged to women <35 years old and 155 (59.4%) to >35 year old. Fifty pregnancies (47.2%) in the former group were terminated while 107 (69.0%) were terminated for the latter. Patients >35 yo were diagnosed at a significantly earlier gestational age compared to those <35 yo (16.8+1.9 versus 18.9+2.9, P<.03). Older patients also had a longer time period from diagnosis to termination than younger patients (2.5 versus 2.0 weeks).

CONCLUSION:
Few studies have focused on the patient who must make the ultimate decision on her pregnancy in face of a positive amniocentesis for Down syndrome. We found that the key difference between older women who chose termination compared to those <35 yo is an earlier gestational age at amniocentesis, with a longer period available for decision making. This stresses the importance of availability of screening programs for early karyotyping and diagnosis of Down syndrome and early education.
Does a Comprehensive Multidisciplinary Care Program Impact Utilization of Genetics in Breast Cancer Management? [11L]
Authors: Doe Samfee , Quigg Mary , Bell Myah , Swain Monique 
Published: April 2018

INTRODUCTION:
To evaluate the utilization of genetic testing after the implementation of a comprehensive multidisciplinary breast cancer care (cMDC) program: ALL breast cancer cases undergo a mandated, standardized/structured review of treatment options and ongoing care (including clinical trial opportunities).

METHODS:
A retrospective chart review of 542 patients newly diagnosed with invasive breast cancer one year prior to and after the incorporation of a cMDC program was performed for primary outcome: rate of overall appropriate genetic referrals as defined by age, family history, triple negative status, and personal history. Secondary outcomes: compliance and equity in genetic referrals across demographics (race, insurance type and hospital site). SPSS was used for multivariate analysis, (P<.05).

RESULTS:
There were 123 pre-cMDC and 419 cMDC patients. A positive pathologic genetic mutation was seen in 2.2% of patients. Comparison of pre-cMDC and cMDC patients yielded a significant increase in appropriate genetic referrals (34.1%–41.8%), a decrease in withholding genetic referral when indicated (59.3%–21.7%) and an increase in inappropriate referrals (1.9%–11.7%) respectively (P=.001). Amongst both study arms Caucasians were more compliant genetic appointment compared to their African American counterparts (pre-cMDC P=.011, cMDC P=.016). African Americans in the cMDC group demonstrated an 11% increase in attendance compared to a 1% decrease noted among Caucasians in the cMDC group. Genetic referrals were equally offered appropriately before and after the implementation of the MDC across race, insurance type and location.

CONCLUSION:
Utilizing a cMDC approach to breast cancer care may help increase appropriate utilization of genetics, reach more African-Americans and identify those with pathologic mutations.
Predictors of Cervical Cerclage Success in the Prevention of Spontaneous Preterm Birth [13L]
Authors: Enakpene Christopher A. , Jones Tiffany , Marshalla Megan , DiGiovanni Laura , Mastrogiannis Dimitrios , Torre Micaela Della 
Published: April 2018

INTRODUCTION:
Cerclage is one of the interventions to prevent spontaneous preterm birth (sPTB). This study aimed to identify predictive factors of cerclage success in preventing sPTB.

METHODS:
Retrospective study of singleton pregnancy at high risk of sPTB in University of Illinois at Chicago between 2013 and 2017. Baseline characteristics, duration of pregnancy, pregnancy outcomes and other predictive factors were analyzed using χ2, student t test, and multiple logistic regression analysis.

RESULTS:
Of the 310 women identified, 90 (29%) had rescue cerclage, and 65 (21%) had prophylactic cerclage. Most statistically significant predictors of sPTB of rescue cerclage were insertions at 17–20 weeks, aOR 2.26 (95% CI: 1.47–3.50, P<.0001), and at 21–22 weeks, aOR 1.81 (95% CI: 1.15–2.87, P<.0001). Cerclages placed at CL <10 mm was associated with increased likelihood of sPTB, aOR 1.60 (95% CI: 1.10–2.34, P<.0001). Cervical length at 21–25 mm and cerclage at GA <16 weeks were associated with decreased rate of sPTB, aOR 0.40 (95% CI: 0.26–0.61, P<.0001), and aOR 0.26 (95% CI: 0.16–0.40, P<.0001). Except for indomethacin in prophylactic cerclage, cervical dilatation, funneling, presence of sludge, prior sPTB, vaginal infections and use of 17-OHPC, these were not statistically significant in preventing sPTB.

CONCLUSION:
The success of cerclage in the prevention of sPTB depends on several factors. The most predictive factors were the degree of short cervix and earlier GA at cerclage placement.
Neonatal Morbidity Associated With Duration of Labor Induction [14L]
Authors: Teal E. Nicole , Lewkowitz Adam , Tran Carol , Koser Sarah , Siegel Molly , Gaw Stephanie 
Published: April 2018

INTRODUCTION:
Inductions of labor (IOL) vary in their duration and the effects of that variation are largely unknown. This study assesses the impact of IOL duration on neonatal morbidity.

METHODS:
This retrospective cohort study included all nulliparous women with non-anomalous, singleton, vertex pregnancies who underwent IOL at a tertiary-care academic hospital in 2015. IOL duration was calculated as time from administration of first induction agent to delivery. The primary outcome was neonatal composite morbidity: fetal acidemia, neonatal seizures, hyperbilirubinemia, meconium aspiration with pulmonary hypertension, respiratory distress syndrome, hypoxic ischemic encephalopathy, hypothermic therapy, and/or neonatal readmission. Secondary outcomes were individual components of the composite and neonatal intensive care unit (NICU) admission. We determined the risk of adverse neonatal outcome with increasing length of IOL by logistic regression.

RESULTS:
Four hundred twenty patients were included. Of these, 59 (14.0%) suffered neonatal morbidity. IOL duration exceeding 36 hours was associated with a statistically significant increased risk of neonatal morbidity (odds ratio [OR] 2.14, 95% confidence interval [CI] 1.2–3.8), which was more prominent after 60 hours (OR 3.2, 95% CI 1.4–7.6). Hyperbilirubinemia was the most common complication (37 cases, 62.7%). Fifty-one neonates (12.1%) were admitted to the NICU. IOL duration exceeding 36 hours was associated with increased risk of NICU admission (OR 2.9, 95% CI 1.6–5.3).

CONCLUSION:
In nulliparous women undergoing IOL at term, there is an increased risk of adverse neonatal outcome and NICU admission when IOL duration exceeds 36 hours. Further research is needed to determine additional predictors of adverse neonatal outcome in term inductions.
Pregnancy Outcomes Among Judicially-Involved Commercially Sexually Exploited Youth [16L]
Authors: Kelly Mikaela , Barnert Elizabeth , Thompson Lindsey , Ports Kayleen , Mondal Sangeeta , Bath Eraka 
Published: April 2018

INTRODUCTION:
We sought to understand pregnancy rates, outcomes, and pregnancy-related factors among a court-involved commercially sexually exploited youth (CSEY) population.

METHODS:
We conducted an exhaustive chart review of the court files of 363 judicially-involved CSEY within Los Angeles during 2012–2016. Data was summarized using descriptive statistics. Chi-squared tests were performed to explore potential associations between pregnancy and youths' behavioral health profiles.

RESULTS:
Of the 363 CSEY, 70% were African-American, 23% Hispanic, 5% White, 1% Asian, and 1% other. Three hundred fifty-nine participants were female, 2 male, and 2 were transgender male-to-female. Of the biological females, 110 (31%) reported ever being pregnant, including 19 youth who reported 2 pregnancies, and 1 youth who reported 3 pregnancies. Pregnancy outcomes for the 130 pregnancies were as follows: 99 had live births (76%), 6 had miscarriages/stillbirths (5%), 17 had therapeutic abortions (13%), and 8 were still pregnant at the time their court files were closed (6%). The youngest age at first pregnancy was 12-year old-and the average age at first pregnancy was 16-year-old. Mental health and substance use profiles for ever-pregnant versus never-pregnant youth did not significantly differ.

CONCLUSION:
Given the high rates of pregnancy in CSEY, presumably many of which are unplanned, we recommend exploring ways in which family planning education and reproductive care access can be improved for this highly vulnerable youth population. Despite extremely high rates of behavioral health challenges in the CSEY population, the observed lack of relationship between behavioral health profiles and pregnancy further demonstrates that all CSEY are at heightened risk of teen pregnancy.
What Are You Missing? Expanded Genetic Carrier Testing Identifies At-risk Couples [17L]
Authors: Swope Betsy , Tschirgi Matt , Farner Stephanie , Adamski Craig , Terhaar Catherine , Settler Christina 
Published: April 2018

INTRODUCTION:
Expanded genetic carrier testing allows couples to determine their reproductive risk for genetic disorders regardless of an individual's ancestral background or geographic origin.

METHODS:
As part of routine laboratory management, requisitions were reviewed for information on reproductive partners. Our database was queried for names of reproductive partners, and demographic information was cross-referenced to determine validity of the matched sample. A retrospective analysis was performed for known matched reproductive pairs and descriptive analysis regarding ethnicity, test ordered, and results of genetic carrier testing on each matched pair was performed.

RESULTS:
Data was entered for 1,585 reproductive partners; after validation and confirmation of carrier testing performed, 783 known reproductive pairs were confirmed. Forty-six (5.9%) couples were found to be at risk for the same autosomal recessive disorder(s), including: hereditary hemochromatosis (20), cystic fibrosis (10), familial Mediterranean fever (6), hemoglobinopathies (5), spinal muscular atrophy (3), primary congenital glaucoma (2), and phenylalanine hydroxylase deficiency (PKU) (1). An additional 1% were potentially at increased risk for the same genetic disorder due to indeterminate results by enzyme analysis or hemoglobin electrophoresis.

CONCLUSION:
Our study identified 6.9% of couples to be at increased risk to have an affected child, and demonstrates the importance of testing partners to allow for reproductive decision-making. Additionally, 28 (61%) of these couples were found to be carriers of disorders only included on expanded carrier testing panels. Therefore, testing patients with an expanded pan-ethnic panel will identify more couples at risk for disorders that would be missed by current ethnicity-based recommendations.
Complicated Gallstone Disease and Birth Outcomes: A Large-Scale Population-Based Study [20L]
Authors: Bowie Jason , Calvo Richard Y. , Bansal Vishal , Sise Michael J. , Sise C. Beth , Shaw Jennifer G. 
Published: April 2018

INTRODUCTION:
Complicated gallstone disease (CGD) is a leading cause of surgery in pregnancy. Studies on the management and outcomes of CGD in pregnancy are limited by small sample size. We evaluated the association between CGD, surgical interventions, and birth outcomes in a large population-based dataset.

METHODS:
Pregnant patients with gallstones were identified in the California Office of Statewide Health Planning and Development 2007–2014 discharge dataset. CGD (acute cholecystitis, cholangitis, gallstone pancreatitis) was compared with uncomplicated gallstone disease (UGD). Adverse (miscarriage, spontaneous abortion, stillborn delivery) or normal (live birth) birth outcomes were identified, as were surgical interventions (cholecystectomy, cholecystotomy, endoscopic retrograde cholangiopancreatography). Preterm delivery, among live births, was a secondary outcome.

RESULTS:
We identified 5,116 eligible pregnancies: 10.6% CGD and 89.4% UGD. CGD patients had longer hospital stays (5.6 days versus 3.2 days), a higher incidence of surgical interventions (83.9% versus 6.7%), and an increased incidence of adverse birth outcomes (16.8% versus 2.6%; OR 3.23, 95% CI 2.13–4.92). CGD patients undergoing surgery had a markedly higher incidence of adverse birth outcomes compared with non-operative management (44.3% versus 7.4%; OR 5.42, 95% CI 3.24–9.08). Among live births, CGD was more frequently associated with preterm delivery when compared with UGD (26.2% versus 11.5%; OR 1.87, 95% CI 1.40–2.51).

CONCLUSION:
There is an increased risk of adverse birth outcomes and preterm delivery in women with CGD. Surgical intervention is also associated with higher risk of adverse outcomes. These findings may assist clinicians in managing and counseling patients and providing informed consent.
Patient-Reported Depression in Women Participating in Remote Patient Monitoring for Postpartum Hypertension [25L]
Authors: Ha Barbara , Thomas Nicole , Zella Julia B. , Fedenia Kris , Williams Makeba , Hoppe Kara 
Published: April 2018

INTRODUCTION:
Depression is prevalent in the postpartum period. We evaluated patient-reported symptoms of depression during the 6-week postpartum period, among women at risk for severe hypertension (≥150/100 mm Hg) who were participating in a pilot intervention for remote-monitoring of women with hypertensive disorders following discharge.

METHODS:
This intervention included women with a hypertension-related diagnosis during or after pregnancy. Upon discharge, patients received a table device and equipment to transmit home vital signs daily and answer a series of scheduled questions regarding symptoms associated with hypertension and mood for up to 6 weeks postpartum. Bi-weekly, the patients were asked, if their “mood had been more depressed this week compared with a normal week.”

RESULTS:
11/51 women (22%) reported their mood was more depressed than normal during the first 6 weeks postpartum. Of these patients, 3/11 (27%) had gestational hypertension, 3/11 (27%) chronic hypertension, and 6 (55%) preeclampsia. 6/11 patients reported having a more depressed mood during week 1; this persisted during week 2 or later in only 2 patients. 4/11 patients denied feeling depressed during postpartum week 1, but later endorsed these symptoms.

CONCLUSION:
Preliminary results demonstrated a high proportion of self-reported depressed mood among postpartum patients with a pregnancy-related hypertensive disorder. This was more prevalent in women with preeclampsia, and highest in the early postpartum period. Use of remote monitoring is a promising strategy for monitoring postpartum hypertension as well as other associated symptoms including depressed mood after discharge. Our findings warrant further investigation on effective monitoring and delivery of prompt treatment of postpartum depression.
Medication Assisted Treatment in Pregnancy and Neonatal Anthropometrics [26L]
Authors: Thomas Megan , Alvarado Fernanda , Stark Sydney , Catalano Patrick , O'Tierney-Ginn Perrie , Gibson Kelly S. 
Published: April 2018

INTRODUCTION:
Opiate use is an epidemic, and, increasingly, pregnant women are managed with medication assisted treatment (MAT), typically Subutex (SUB) or methadone (MET). MET has been associated with decreased birth length (BL) and head circumference (HC) versus SUB in a small study, but without comparison to normal controls. Decreases in HC at birth are correlated with adverse neurodevelopment later in life. Shorter BL as seen with in utero malnutrition, is associated with hypertension and obesity in adulthood. We hypothesized that MAT treatment with MET negatively affects HC and BL.

METHODS:
A retrospective cohort study evaluating neonatal HC and BL was completed with mothers receiving MAT (SUB or MET), and compared to neonates whose mothers were not exposed to opioids (non-MAT). Only neonates born term (>37 weeks) to Caucasian women who smoked were included. HC and BL were converted into z-scores utilizing World Health Organization's growth charts. P<.05 by non-parametric Kruskal-Wallis ANOVA with Dunn's multiple comparison test was considered statistically significant.

RESULTS:
Mean birthweights were 3,163 g in non-MAT, 2,749 g in SUB and 2,846 g in MET groups (P=.0008). Mean HC (±SEM) z-scores were −0.08 (±0.09, n=130) in non-MAT, −0.13 (±0.11, n=80) in SUB and −0.47 (±0.09, n=166) in MET groups. Mean BL z-scores were −0.35 (±0.09, n=135) in non-MAT group, −0.06 (±0.13, n=90) in SUB group and −0.57 (±0.11, n=163) in MET groups. MET treatment lead to significantly smaller HC and BL.

CONCLUSION:
MAT with MET is associated with smaller neonatal HC and BL. While neonates exposed to SUB showed smaller HC but not impaired BL when compared to non-MAT. Long term neurodevelopment issues and adult onset chronic diseases associated with decreased HC and BL may be a reason for recommending SUB for MAT since only HC was decreased. When starting MAT, counseling should include not only short term risks, but also the potential lifelong risks, for the neonate.