bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adherence to New Definitions of Labor Arrest and Failed Induction Decreases Primary Cesareans [16F]
Authors: Greenberg Jessica , Cross Sarah Newbold , Pettker Christian Michael , Lee Illuzzi Jessica 
Published: May 2019

INTRODUCTION:
To examine the use of cesarean delivery over time for labor arrest and failed induction and identify predictors of meeting criteria for these indications.

METHODS:
We analyzed rates of primary cesareans due to arrest of dilation, arrest of descent and failed induction among live births at Yale New Haven Hospital from 2010 through 2013. Criteria for labor arrest and failed induction were based on 2012 guidelines, and the proportions of deliveries meeting these criteria were calculated annually. Multiple logistic regression was used to assess cesarean delivery over time and identify predictors of meeting criteria. IRB approval was obtained.

RESULTS:
The total primary cesarean delivery rate decreased from 23.5% to 21.1% (<.03). The rate of primary cesarean delivery for arrest of dilation decreased from 5.1% to 3.4% (P<.0005), while the rate of meeting criteria for this indication increased from 18.8% to 34.9% (P<.003). Primary cesarean delivery for arrest of descent and failed induction remained stable; the percent of cases meeting criteria for arrest of descent increased from 57.8% to 71.0% (P<.007). Increased cervical dilation on admission increased the likelihood of meeting criteria for arrest of dilation and descent, and epidural use decreased the likelihood of meeting criteria for arrest of descent. As of 2013, 65.1% of primary cesareans for arrest of dilation, 29.0% for arrest of descent, and 50.0% for failed induction did not meet criteria.

CONCLUSION:
A decrease in the primary cesarean rate was associated with meeting new criteria for labor arrest. Increased adherence to these criteria could further reduce the cesarean rate.
Chronic Histiocytic Intervillositis: A Proposed Algorithm for Management of Subsequent Pregnancies [18F]
Authors: D'Souza Rohan D. , Zaffar Nusrat , Syeda Ambreen , Keating Sarah , Koby Lawrence , Malinowski Ann Kinga 
Published: May 2019

INTRODUCTION:
Chronic histiocytic intervillositis (CHI) of the placenta is associated with serious adverse pregnancy outcomes not only in the index pregnancy but also in subsequent pregnancies. This study's aim was to propose an algorithm for the management of pregnancies following a histopathologic diagnosis of CHI.

METHODS:
We conducted a retrospective cohort study at a tertiary-level hospital that included CHI cases and controls matched by age, ethnicity, body mass index and pre-existing medical comorbidities, in a 1:2 ratio. We compared first- and second-trimester biomarkers for fetal aneuploidy, serum alkaline phosphatase (ALKP) and antenatal ultrasound findings, considering a p-value of <0.05 as statistically significant.

RESULTS:
We included 33 cases of CHI and 66 matched controls. The two groups were comparable except with regard to prior (92.6% vs. 43.3%, p<0.001) and current (87.9% vs. 42.2%, p<0.001) adverse obstetric outcomes. There were significant differences between groups in terms of abnormal first-trimester biomarkers in general (55.6% vs. 16.2%, p=0.003), and PAPP-A in particular (46.7% vs. 7.1%, p=0.005), second-trimester alpha-fetoprotein (25% vs. 0%, p=0.006), third-trimester ALKP levels (38.5% vs. 0%, p=0.045); second-trimester placental ultrasound findings (abnormal dimensions in 40% vs. 5.6%, p=0.02 and abnormal echotexture in 25% vs. 0%, p=0.047); third-trimester placental morphology (44% vs. 16.7%, p=0.009), umbilical artery Doppler studies (76% vs. 11.1%, p<0.001) and oligohydramnios (40% vs. 3.7%, p<0.001).

CONCLUSION:
The differences in biomarker and ultrasound findings between cases and controls was used to propose an algorithm for management of subsequent pregnancies, in terms of maternal and fetal surveillance, administration of antenatal corticosteroids and timing of delivery.
Emergency Department Usage Prior to Pregnancy is Associated With Use Postpartum [30F]
Authors: Williams Nayo Shepard , De La Guerra Justin , Borgida Adam F. 
Published: May 2019

INTRODUCTION:
Improvement of care during the 90 days postpartum (“4th trimester”) is needed. Fifty percent of women return for their postpartum office visit; 10% use the emergency department (ED). We evaluated what factors might be associated with postpartum ED usage

METHODS:
This retrospective cohort study from an urban hospital-based clinic compared women who visited the ED within 90 days postpartum (Group 1) to women who did not visit the ED (Group 2). Variables assessed: age, marital status, race, delivery gestational age, parity, ED visits during the year prior to conception. We performed regression analysis to determine independent variables associated with ED usage 90 days postpartum. A P<.05 was significant. IRB approval was obtained for this study.

RESULTS:
Of 1297 women, there were 190 (14.8%) in Group 1. This group visited the ED 252 times (48.0% for non-emergent diagnoses). Three variables were significant. Group 1 women with cesareans (OR 1.77, 95% CI 1.29-2.42), women who visited the ED in the year prior to conception (OR 2.00, 95% CI 1.45-2.75) and frequent (≥3 visits/year) ED users (OR 2.94, 95% CI 1.84-4.62) were more likely to visit the ED in the 4th trimester versus Group 2.

CONCLUSION:
We found that women who visit the ED and were frequent users prior to pregnancy are more likely to continue that usage during the postpartum. Understanding risk factors for maternal ED usage is important as initiatives and care plans are developed during pregnancy for preemptive education and postpartum care.
Impact of an Integrated, Comprehensive Perinatal Substance Use Disorders Program for an At-Risk, Rural Population [34F]
Authors: Nathan Alyssa , Galvin Shelley , Coulson Carol Catherine , Ramage Melinda , Mullins Nathan Herman , Gannon Marie 
Published: May 2019

INTRODUCTION:
The perinatal substance use disorders (PSUDS) program in Western North Carolina (WNC) began in 2014 and expanded into an integrated, comprehensive program utilizing the stages of change model. The program offers access to behavioral health, social services, and substance use treatment within enhanced obstetrical care visits. Our objective was to compare antenatal care utilization and obstetrical outcomes, through the fourth trimester, over time.

METHODS:
An IRB-approved, retrospective cohort study compared outcomes from 2014 and 2017. Primary outcomes included engagement in: antenatal care, behavioral health, and substance use treatment. Maternal socio-demographics, concurrent diagnoses, and birth outcomes were examined. Comparisons utilized Chi square or Fisher exact and Mann-Whitney or t-tests for categorical and continuous variables, respectively.

RESULTS:
The proportion of patients attending ACOG-based, expected number of prenatal visits increased 25.3% (P=.016). The 14.7% increase in postpartum attendance was not significant. Utilization of in-house substance misuse therapy increased 800% (P<.001); external referral uptake increased 1290% (P<.001). Utilization of pharmacotherapy increased 61% (P=.003) for psychological disorders and 34% (P=.005) for opioid use disorders. Prevalence of illicit drugs on maternal urine drug screen at delivery decreased from 67% to 43% (P<.001). Preterm delivery, cesareans and birthweight remained stable (P>.05).

CONCLUSION:
The implementation of a full spectrum PSUDS model of care improved maternal engagement across obstetrical care, behavioral health and substance misuse treatment; fewer babies were exposed in utero to harmful illicit drugs. Further research examining outcomes of WNC's PSUDS is ongoing; improvements in access and engagement in care by pregnant women with substance use disorders are encouraging.
From “Disappointing” to “Fantastic”: Patient Experiences With Labor Induction [02OP]
Authors: Danilack Valery A. , Siegel-Reamer Leah , Varela Natacha , Brousseau Erin Christine , Guthrie Kate M. 
Published: May 2019

INTRODUCTION:
While over 20% of deliveries in the U.S. involve labor induction, there is a dearth of evidence regarding patient perceptions of their experiences and preferences about the process of care. We conducted postpartum qualitative interviews to elucidate women's expectations and experiences of the labor induction process.

METHODS:
We recruited women who underwent labor induction during their most recent delivery from our hospital's postpartum ward, aiming to enroll equal numbers with vaginal and cesarean deliveries. We conducted semi-structured qualitative interviews within two months of delivery. Research questions included expectations and lived experiences of the labor induction process, side effects and health outcomes of concern, reflections on personal tolerance of different interventions, and thoughts about an ideal process.

RESULTS:
From April-September 2018, we interviewed 36 women; 18 with a vaginal delivery and 18 with a cesarean delivery. The labor induction process involved a wide range of experiences, from unexpected, exhausting, stressful, overwhelming, and frustrating, to fast, smooth, and simple. Preliminary data show that women often perceived their induction to be longer than they expected. The medical intervention with the most adverse opinions was the Foley balloon catheter. Women's concerns regarding side effects and the need for intrapartum cesarean delivery largely centered on the health of their baby.

CONCLUSION:
Women's experiences with the overall process of labor induction, as well as specific medical interventions, influence their perceptions of quality of care during labor and delivery. Patient education, management of expectations, and shared decision-making throughout the process may improve patient experience and satisfaction.
Effects of Maternal Psychological Status Post Cancer Diagnosis in Pregnancy on Early Childhood Development [17OP]
Authors: Betchen Melanie , Gringlas Marcy , Grunberg Victoria , Cardonick Elyce 
Published: May 2019

INTRODUCTION:
Approximately 1 in 1,000 women experience cancer during pregnancy. Evidence indicates that maternal psychological distress can negatively influence a child's language and cognitive development. This study looks at the relationship between child behavior and development and maternal psychological distress among women experiencing cancer during pregnancy.

METHODS:
Women (N=77) who experienced cancer during their pregnancies and enrolled in the IRB approved Cancer and Pregnancy Registry were invited to self-report psychological distress (Basic Symptoms Inventory) and trauma symptoms (Impact of Events Scale-Revised) when their child was at least 18 months of age. Women completed child behavioral functioning (Child Behavioral Checklist). Children underwent developmental testing (Bayley Scales of Infant and Toddler Development Third Edition). Bivariate correlations examined how maternal psychological distress and infant behavior and development were related at the time of assessment.

RESULTS:
When controlling for gestational age at birth, higher levels of maternal depression (r=0.771, P<0.05), anxiety (r=0.904, P<0.01), intrusive trauma symptoms (r=0.953, P<0.001), and avoidant trauma symptoms (r=0.953, P<0.001) was associated with a higher incidence of behavioral problems. This same relationship was not found for cognitive performance on standardized testing.

CONCLUSION:
Maternal psychological stress and depression after cancer during pregnancy can influence their children's development. When controlling for gestational age at birth, maternal distress only influences child behavioral, as opposed to cognitive development. These results highlight the importance of additional support required among women diagnosed with cancer during pregnancy even years after delivery.
Laterality of Single Umbilical Arteries and Associated Fetal Anomalies [05OP]
Authors: Uribe Katelyn A. , Eke Ahizechukwu C. , Witter Frank R. 
Published: May 2019

INTRODUCTION:
Studies have suggested that single umbilical artery (SUA) is associated with adverse obstetric outcomes including growth abnormalities and congenital anomalies. The objective of this study was to determine if laterality of a single umbilical artery (SUA) is associated with specific sonographic findings or other abnormalities.

METHODS:
In this retrospective cohort study, medical records of patients who received an ultrasound at the Johns Hopkins Hospital with identified laterality of the SUA from 1990 to 2017 were reviewed after IRB approval. The primary outcome was the association of isolated left or right SUA with other congenital anomalies. Secondary outcomes included laterality association with intrauterine growth restriction (IUGR) and chromosomal abnormalities. Rates of sonographic abnormalities between fetuses with a right versus left SUA were compared. Multivariate marginal logistic and Poisson regression models were used to investigate the relationship between SUA and IUGR, adjusting for possible confounders. Further analyses were done using propensity score matching.

RESULTS:
Left SUA fetuses had a higher percentage of other fetal abnormalities (51.1% vs. 37.0%; P=0.04). In a multivariate marginal logistic regression analysis, a sonographic left SUA was significantly associated with cardiovascular (aOR 0.43, 95% CI 0.23-0.79; P=0.03) and gastrointestinal (aOR 0.43, 95% CI 0.23-0.79; P=0.03) abnormalities. No other ultrasonographic, doppler, or chromosomal abnormalities were significantly associated with a laterality of the umbilical artery.

CONCLUSION:
Our study identified a significant association between a left SUA and concomitant fetal cardiac and gastrointestinal abnormalities. Laterality of the SUA may be useful in identifying concomitant fetal anomalies, but requires further prospective validation.
FIRST PLACE Heparin Use is Associated With an Increased No-Call Rate of Cell-Free DNA Testing [22OP]
Authors: Lovell Daniel , Nitsche Joshua 
Published: May 2019

INTRODUCTION:
To determine if the no-call rate for cell-free DNA testing is higher in pregnant women with hypertension, diabetes, or those taking aspirin and/or heparin.

METHODS:
This IRB approved, retrospective cohort study included 1395 patients with cell-free DNA testing performed between 2014-2018. Weight, gestational age at collection, cell-free DNA platform, parity, presence/absence of chronic hypertension, pre-gestational diabetes, or autoimmune disease, and use of heparin, aspirin, or immune modulating drugs, was gathered for each patient. Univariate and multivariate logistic regressions were performed to determine if chronic hypertension, pre-gestational diabetes, and use of heparin and/or aspirin affected the no-call rate.

RESULTS:
In the univariate analyses there was a significant increase in the odds of a no-call for chronic hypertension, pre-gestational diabetes, and heparin and/or aspirin use. The unadjusted odds ratios (OR) and 95% confidence intervals were 6.1 (3.3-11.1), 3.3 (1.5-7.3), and 13.9 (7.6-25.2), respectively. After adjustment for confounding factors including weight, gestational age at collection, cell-free DNA platform, autoimmune disease, and use of immune modulating drugs, only heparin and/or aspirin use remained a significant predictor of a no-call. The adjusted ORs were 1.5 (0.7-3.3), 0.7 (0.3-1.8), and 6.1 (3.0-12.6), for chronic hypertension, pre-gestational diabetes, and heparin and/or aspirin use, respectively.

CONCLUSION:
On multivariate analysis heparin and/or aspirin use increased the odds of a no-call following cell-free DNA testing. Based on this result, clinicians should consider other genetic testing options in patients taking heparin and/or aspirin, especially those with other conditions known to decrease cell-free DNA level.
Management of Postpartum Hemorrhage: Transfusion of Blood Products [24OP]
Authors: Menzies Anya V. , Poljak Dijana , Pearl Michael Loran , Gossner Gabrielle , Griffin Todd R. , Burke William M. 
Published: May 2019

INTRODUCTION:
Postpartum hemorrhage causes significant maternal morbidity and mortality. Coordinated care and adherence to standard protocol in these events may improve patient outcomes. Few studies of the obstetric population focus on appropriate transfusion of blood products. Studies in the trauma and anesthesia literature recommend a 1:1:1 transfusion protocol. Adherence to these recommendations among labor and delivery units nationwide remains unclear.

METHODS:
After IRB approval was obtained, we conducted a retrospective analysis examining all pregnant patients greater than 23 weeks gestation who delivered between 2011-2017 and received transfusion of at least 4 units of packed red blood cells (PRBCs) at our institution. Patients were identified by blood bank transfusion records. Data was collected regarding patient demographics, labor course, hemorrhage event and management, postpartum course, and associated complications. Each case was analyzed for adherence to a transfusion protocol.

RESULTS:
There were 23,964 deliveries during the study period. 90 (0.38%) patients who received at least four units PRBCs were identified. The median total EBL was 2800 ml (450ml-9,000ml). The median units transfused were: PRBCs 4.0 (4-22), fresh frozen plasma 2.0 (0-17), platelets 0 (0-7). None of the patients received a transfusion of products in a 1:1:1 ratio. Of the 90 studied patients, 24 (26.7%) required admission to the intensive care unit.

CONCLUSION:
Obstetrical hemorrhage is a rare but serious event. From review of the data, adherence to standardized use of a transfusion protocol at this institution is rare. In order to diminish maternal mortality, utilization of a hemorrhage protocol with a transfusion ratio should be encouraged.
Maternal and Fetal Outcomes in Pregnancies with Long-term Corticosteroid Use: Retrospective Cohort Study [13OP]
Authors: Cai Emmy , Czuzoj-Shulman Nicholas , Abenhaim Haim Arie 
Published: May 2019

INTRODUCTION:
Long-term corticosteroids is administered in pregnant patients with an array of autoimmune and inflammatory disorders. Our objective is to determine whether long-term corticosteroid use is associated with increased maternal and neonatal adverse outcomes.

METHODS:
We performed a retrospective cohort study using the Healthcare Cost and Utilization Project - National Inpatient Sample from the United States. All pregnant patients on long-term corticosteroids were identified using International Statistical Classification of Disease-9 coding from 2003 to 2015. The effect of long-term corticosteroid use on maternal and neonatal outcomes was evaluated using logistic regression.

RESULTS:
Out of the 10,491,798 births included in our study, 3,999 were on chronic steroids, for an overall prevalence of 38 per 100,000 births. There was a steady increase in chronic steroid use from 2 to 81 per 100,000 births over the 12-year study period (P<.0001). Women on chronic steroids were more likely to have pregnancies complicated by gestational diabetes mellitus, 1.61 (1.46-1.79) and preeclampsia, 2.50 (2.26-2.77). They were also more likely to have caesarean sections, 1.73 (1.62-1.84), premature preterm rupture of membranes, 2.29 (2.06-2.54), sepsis, 1.77 (0.66-4.73), venous thromboembolisms, 5.25 (4.12-6.69) and uterine rupture, 3.39 (2.10-5.46). Neonates born from mothers on chronic steroids were more likely to suffer from prematurity, 3.02 (2.79-3.28) and congenital malformations, 2.42 (1.88-3.12).

CONCLUSION:
Long-term corticosteroids use in pregnancy is associated with maternal and fetal adverse outcomes. These patients would benefit from close follow-up throughout their pregnancy to minimize complications.
Reducing Postpartum Opioid Use Following Cesarean Delivery: The Impact of an Opioid-Sparing Protocol [11T]
Authors: Peahl Alex Friedman , Harvey Steve , Bradley Andrew , Smith Roger 
Published: May 2019

INTRODUCTION:
Opioid persistence following Cesarean Delivery (CD) is estimated at 1/300 women. Receipt of an opioid prescription and size of the prescription are risk factors for persistence. Opioid-sparing protocols for CD could reduce opioid use during and beyond the postoperative period. Interventions to date have targeted individual patient characteristics rather than hospital-wide protocols.

METHODS:
A single academic institution designed an opioid-sparing protocol for post-Cesarean patients, which was implemented in October 2017. Omnicell automated dispensing data was used to assess the protocol's impact on patterns of non-narcotic and narcotic pain medication use before and after implementation. Patient assessment of pain control was queried through the Press Ganey survey. Descriptive statistics and paired t-tests were used for analysis.

RESULTS:
Women undergoing Cesarean Section between July 2017 and September 2018 were included in the analysis. Patients received more scheduled non-narcotic medications after protocol implementation: acetaminophen (43.3%, 85.5% p=0.005), ketorolac (27.4%, 80.4% p=0.01), and ibuprofen (1.83%, 81.9% p=0.001). Unscheduled oxycodone was prescribed with the same frequency before and after implementation (85.4%, 86.1%, p=0.793). Administration of unscheduled oxycodone doses decreased from 60.45% to 13.28%, with a decrease in morphine milligram equivalents per patient from 25.5 to 10.0. Patient satisfaction remained unchanged over protocol implementation based on patient response to the Press Ganey question “my pain was well controlled during my hospitalization” (84 vs. 87, p=0.60).

CONCLUSION:
Opioid-sparing post-operative protocols for Cesarean Section can be easily implemented to reduce post-operative narcotic use, while maintaining patient satisfaction with pain control.
Using Raman Spectroscopy for Assessing Cervical Change During Labor: An Objective Approach to Labor Management [31T]
Authors: Masson Laura , Elsamadicy Emad A. , Mahadevan-Jansen Anita 
Published: May 2019

INTRODUCTION:
Subjective assessment of digital examination can lead to different interpretations of cervical change and may affect labor management decisions. The aim of this study is to assess using Raman Spectroscopy to identify biochemical signatures associated with cervical change during labor.

METHODS:
At a major medical center, 10 adult pregnant patients were recruited and enrolled. The exclusion criteria were non-English speakers, prior preterm birth, prior LEEP, preterm labor or PROM. A portable Raman system with imaging-spectrograph, 785 nm diode laser, and fiber-optic probe were used. Measurements were taken at each prenatal visit starting at 37 weeks and during labor. The probe was placed at 3-6-9, and 12 o'clock positions and spectra were obtained. Both prenatal and labor peak ratios were compared and analyzed as function of cervical dilation.

RESULTS:
The average age and BMI were 25 years and 35.4 kg/m2 respectively. 40% underwent induction of labor with an average cervical dilation of 2.7 cm on admission. Raman peak amplitudes associated with extracellular matrix (ECM) proteins displayed significant differences between spectra measured at prenatal visits vs. labor. These included amide III band at 1253 cm-1 (P=.004), collagen and lipid-associated band at 1454 cm-1 (p=.001), and amide I band 1654 cm-1 (P=1.05x10-5). The 1454 cm-1band showed a distinct increase as a function of cervical dilation.

CONCLUSION:
Our study demonstrates that Raman spectroscopy is sensitive to biochemical changes in the cervix prior to the onset of labor as well as during labor progress. This may suggest reorganization of the ECM as the cervix remodels during labor.