bluuebunny/crossref_metadata_2025_split huggingface dataset:
Puerperal Uterine Necrosis and Pyometrium After Uterine Artery Embolization [27L]
Authors: Chow Stephanie , Van Nguyen Tuong 
Published: April 2018

INTRODUCTION:
Uterine necrosis is a rare complication following uterine artery embolization.

METHODS:
We report a case of uterine necrosis in a 32 year old primigravida patient who underwent uterine artery embolization for postpartum hemorrhage.

RESULTS:
This patient presented in labor at term and had a spontaneous vaginal delivery. Her labor was complicated by chorioamnionitis, which was treated appropriately. Her history was remarkable for a 6.9 × 5.4 × 6.8 cm posterior submucosal fibroid. Postpartum course was significant for hemorrhage secondary to atony and retained placenta, which was manually extracted. Bakri balloon placement was attempted, but unsuccessful due to obstruction from the fibroid. She subsequently underwent an uncomplicated uterine artery embolization, and was discharged on postpartum day 3. She re-presented on postpartum day 10 for fevers to 103°F, and was admitted for presumed endometritis. Appropriate antibiotics were started, however she continued having recurrent fevers through hospital day 9. Computed tomography scan revealed gas and fluid within the uterine cavity, and endometrial biopsy showed heavy growth of E. coli. She underwent an abdominal hysterectomy, and was found to have a 20 weeks sized uterus with a 6 cm submucosal fibroid with blood-tinged purulent contents. Histology was consistent with pyometrium and uterine necrosis.

CONCLUSION:
Uterine necrosis is a rare, but serious complication of uterine artery embolization when used for postpartum hemorrhage. Recognizing risk factors and understanding rare complications can help providers better counsel patients and prevent delays in care when patients re-present with fevers refractory to conventional treatment.
Risk Factors for Placental Abruption Between Singleton and Twin Gestations [28L]
Authors: Dinis Jenifer , Doty Morgen , Sibai Baha M. 
Published: April 2018

INTRODUCTION:
The incidence of placental abruption is increased in twin when compared to singletons, but there is a paucity of data regarding other risk factors that might contribute to this increase. Our aim was to determine whether the incidence of and risk factors for abruption were different between singleton and twin deliveries.

METHODS:
Secondary analysis of a multicenter trial of magnesium sulfate for prevention of cerebral palsy. We included women between 18 and 39 years old, non-anomalous singleton and twin gestations, with placental abruption. Risk factors for placental abruption such as smoking, drug use, premature rupture of membranes (PPROM), chorioamnionitis and preterm labor were evaluated. Chi-square or Fisher exact test were used where appropriate. Adjusted odds ratio (aOR) with 95% confidence intervals (CI) were calculated.

RESULTS:
There were 20 cases of abruption among 203 twin gestations (9.8%) and 162 cases among 2,238 twin gestations (7.2%), P=.17. Of these, 153 were included. The incidence of smoking, alcohol and drug use, preeclampsia and diabetes did not differ between singleton and twin gestations. Twin gestations had significantly higher incidence of preterm labor (44% versus 13%, P<.01) and chorioamnionitis (44% versus 4%, P<.01). Fifty-seven percent (n=8) of women with abruption and chorioamnionitis carried twins. After adjusting for preterm labor, the incidence of chorioamnionitis was still significantly increased for twin gestations (aOR 17.4, CI 5.0–60.4).

CONCLUSION:
Twin gestations have a higher rate of abruption than singletons. However, they both have similar risk factors except that abruption was more likely to be associated with chorioamnionitis in twins.
Retrospective Analysis of IV Flow Capacity in Obstetric Patients at Risk for Postpartum Hemorrhage [30L]
Authors: Olympio Jennie , Cai Bo , Theobald Shannon , Castillo Anastasia , Schrift David , Castleberry Lauren 
Published: April 2018

INTRODUCTION:
Postpartum hemorrhage (PPH) is one of the leading causes of preventable pregnancy-related mortality. However, the risk of PPH can be estimated prior to its occurrence, which allows clinicians to take the necessary precautions to manage high-risk patients. This includes establishing two, 18-gauge (large-bore) intravenous (IV) catheters, an imperative first step in managing hemorrhaging patients. This retrospective study aims to assess how often obstetrical patients at high-risk for PPH received appropriate IV access, defined as two 18-gauge or larger IVs.

METHODS:
A retrospective analysis of 922 obstetrical patients admitted to our institution over a 6-month period was performed. A patient's risk for PPH was determined on admission. Patients were stratified into low, medium and high-risk groups. The number and size of IV catheters inserted upon admission were reviewed.

RESULTS:
Of the 922 patients analyzed, 10% (93) were deemed high-risk for PPH. Of those patients, 93.5% (87) received a single IV catheter on admission, of which 75% were 20-gauge or smaller IVs. Only 1% (1) of the high-risk patients received appropriate IV access (two 18-gauge or larger IVs).

CONCLUSION:
Only 1% of patients at high-risk for PPH received appropriate IV access. Our data represents a single-center experience and should be confirmed. However, these results are concerning and suggest PPH patients may experience under-resuscitation and/or a delay in resuscitation due to inadequate IV access. Based on this data, the authors plan to revise the current Postpartum Hemorrhage Protocol and implement a new policy to ensure appropriate IV access is obtained in patients at high-risk for PPH.
Intrauterine Pressure Catheter Measurements and Body Mass Index [31L]
Authors: Curran Diana , Kappy Michelle , Kobernik Emily , Bell Carrie , Young Stephanie , Marzano David 
Published: April 2018

INTRODUCTION:
Intrauterine pressure catheters are used for varying indications in laboring women. The stages of labor have not accounted for women's changing demographics, especially obesity. This study evaluates the relationship between resting and peak intrauterine tone and BMI, and predictors of intrauterine pressures among laboring women.

METHODS:
We retrospectively examined intrauterine pressure catheter values in women >18 who labored at Michigan Medicine from June 2010 to June 2014. Stage I resting and peak intrauterine pressure catheter measurements were obtained from fetal tracings. Multiple linear regression analyzed independent effects of demographic and labor characteristics on intrauterine pressure catheter measurements.

RESULTS:
Among 588 women with intrauterine pressure catheters, mean (SD) BMI was 33.0 (7.3) kg/m2, mean stage I resting pressure was 23.5 (8.5) mm Hg, and mean peak pressure was 68.0 (16.3) mm Hg. In multivariable models adjusted for age and race, overweight status (β 5.31 [95% CI: 2.66, 7.97]), obesity class I (5.46 [2.75, 8.17]), obesity class II (6.39 [3.54, 9.23]), obesity class III (7.19, [4.36, 10.01]), gestational age (0.10 [0.12, 0.19]), nulliparity (2.84 [0.99, 4.69]), and primiparity (3.21 [1.45, 4.97]) were correlated with increased stage I resting pressure. Only obesity class III status was associated with increased stage I peak pressure (7.30 [1.69, 12.91]).

CONCLUSION:
Resting intrauterine pressure is influenced by demographic characteristics including BMI and parity, but the same correlation was not observed for peak intrauterine pressures. Our findings highlight the need for modern labor guidelines regarding normal intrauterine pressures and their implications on labor outcomes.
Cesarean Delivery Rates Among Nulliparous Women With Advanced Maternal Age Undergoing Labor Induction [32l]
Authors: Khander Amrin , Bigelow Catherine , Robles Brittany , Koo Clara , Klahr Miriam , Stone Joanne 
Published: April 2018

INTRODUCTION:
Optimal antenatal management for women with advanced maternal age (AMA) is not known. Our objective was to determine if induction of labor (IOL) in nulliparous women with AMA (age 35–39) compared to women with very AMA (VAMA, age ≥40) is associated with an increased risk of adverse outcomes, such as rate of cesarean delivery (CD).

METHODS:
A retrospective cohort study of patients ≥35 years who underwent IOL at a single tertiary care center from June 2011 to December 2014. Obstetric and neonatal outcomes were compared after dichotomization into groups 35–39 and ≥40 years.

RESULTS:
From a total 428 patients who met inclusion criteria, 273 (64%) comprised the AMA group and 155 (36%) the VAMA group. The AMA cohort had a higher Bishop score on admission compared to the VAMA cohort. IOL for late term was the most common indication in the AMA group (33.7%) and IOL for AMA in the VAMA group (58.1%). The CD rate was higher in the VAMA group (56.1% versus 44.3%, P=.02). This difference was not significant when controlling for Bishop score <5. The most common indications for CD were arrest of dilation (38.3%) in the AMA group and failed IOL (32.2%) in the VAMA group. When stratified by age, there was a significant increase in CD rate by increasing maternal age (P=.002).

CONCLUSION/IMPLICATIONS:
Nulliparous women ≥35 year old who undergo IOL have a high likelihood of CD, with increasing rates as maternal age increases. This information can guide clinicians when discussing delivery options with nulliparous patients age ≥35.
Obstetric Hemorrhage Management and Maternal Morbidity Among Non-Hispanic Black Women [34L]
Authors: Jayaprakash Pooja , Curry Tierra , Brown Alyssa , Louis Judette 
Published: April 2018

INTRODUCTION:
Non-Hispanic Black women (NHB) have higher rates of severe maternal morbidity and mortality. We sought to evaluate the racial differences in maternal hemorrhage management and associated morbidity.

METHODS:
We conducted a retrospective cohort study including all women who delivered at a tertiary center during February 1, 2013–December 31, 2014. Medical charts were reviewed for hemorrhage, race/ethnicity and relevant clinical data. Hemorrhage related severe morbidity indicators included blood transfusion, shock, acute renal failure, transfusion related lung injury, cardiac arrest and use of interventional radiology procedures. The data was analyzed using χ2, student t-test, Mann Whitney U test, and logistic regression where appropriate. P<.05 was considered significant.

RESULTS:
There were 9,890 deliveries and 2.9% were complicated by obstetric hemorrhage. NHB women when compared to other women with obstetric hemorrhage had a lower admission hemoglobin (10.6±1.6 versus 11.5±1.3 g/dL, P<.001), lower drop in hemoglobin (2.4±1.5 versus 2.9±1.6 g/dL, P=.03) and higher blood loss (1,328±1,014 versus 1,113±602 mL, P<.001). They were equally likely to be treated with uterotonic medications. There was no difference in the time to initiate medication and time to stabilization but NHB were more likely to need a blood transfusion (37.1% versus 23%, P=.03) and more likely to have severe morbidity (41.4% versus 24.4%, P=.001). After controlling for confounding variables, cesarean delivery (aOR 3.59 [1.7–7.9]) and low admission hemoglobin (aOR 1.69 [1.3–2.1]) were predictors of severe morbidity.

CONCLUSION:
Despite similar management, NHB had more maternal morbidity. However, cesarean delivery and low admission hemoglobin but not race were predictive of maternal morbidity.
Fetal Macrosomia: Exploring the Impact of Pre-pregnancy Body Mass Index and Gestational Weight Gain [38L]
Authors: Srinivasan Aarthi , Williams Corrine M. , McDaniel Honour , Chavan Niraj R. 
Published: April 2018

INTRODUCTION:
This study was undertaken to evaluate the relationship between pre-pregnancy body mass index (PPBMI), gestational weight gain (GWG) and fetal macrosomia.

METHODS:
Vital statistics (birth) data collected by the National Center for Health Statistics (NCHS) was utilized. Using the 2015 data, GWG was calculated and the birth cohort consisting of singleton gestations was classified into inadequate, adequate and excess GWG categories under each PPBMI stratum, as per the 2009 Institute of Medicine guidelines. Multivariate logistic regression analyses were used to predict the risk for fetal macrosomia (>4,500 g) in each PPBMI and GWG group while adjusting for age, race/ethnicity, education, marital status, insurance and smoking status.

RESULTS:
Birth certificate data from 3,618,822 patients were reviewed. In comparison to women with normal PPBMI, overweight (OR 1.87; 95% CI 1.82–1.92) and obese (OR 3.25; 95% CI 3.17–3.33) women had higher odds for fetal macrosomia. Excess GWG significantly increased the risk for fetal macrosomia in women who were underweight (OR 3.55; 95% CI 2.72–4.65), normal weight (OR 3.01; 95% CI 2.96–3.94), overweight (OR 2.66, 95% CI 2.52–2.81) and obese (OR 1.93; 95% CI 1.86–2.01) as compared to respective PPBMI matched cohorts with adequate GWG. Notably, inadequate GWG in overweight (OR 0.56, 95% CI 0.53–0.66) and obese (OR 0.72; 95% CI 0.68–0.76) women showed a risk reduction compared to PPBMI matched controls with adequate GWG.

CONCLUSION:
Excess GWG, especially in the setting of higher PPBMI predicts an increased risk for fetal macrosomia.
Repeat External Cephalic Version Under Regional Anesthesia: Is it Worth the Attempt? [22I]
Authors: Ha Thoa K. , Blat Cinthia , González Juan M. , Thiet Mari-Paule , Rosenstein Melissa 
Published: April 2018

INTRODUCTION:
Breech presentation occurs in 4% of term pregnancies with high cesarean delivery rate for persistent breech. External cephalic version (ECV) is a technique used to reduce incidence of cesarean due to malpresentation. Regional anesthesia increases ECV success rates in the first attempt. We assessed the effects of regional anesthesia in repeat ECV.

METHODS:
Retrospective cohort analysis of term ECVs between 2012-2017. Women failing initial ECV were offered repeat ECVs with or without regional anesthesia, depending on preference. Primary outcome was successful cephalic version and secondary outcome was vaginal delivery. The impact of BMI, maternal age, gestational age, parity, and birthweight were examined in multivariable model.

RESULTS:
304 women underwent initial ECV without regional anesthesia, 91 (30%) converted to cephalic, resulting in 69 vaginal deliveries (22%). Among 213 women with unsuccessful ECV, 81 underwent repeat ECV: 52 without spinal, 10 converted to cephalic (19%) and 9 delivered vaginally (17%); 29 with spinal anesthesia, 9 converted to cephalic (31%) and 7 delivered vaginally (24%). In unadjusted analysis, OR for successful version with spinal anesthesia was 2.74 (95% CI 1.05–7.15). This did not retain statistical significance after controlling for confounders (OR 2.55, 95% CI: 0.92-7.05). There was no statistically significant difference in maternal age, gestational age, or birth weight between the two groups.

CONCLUSION:
Offering repeat ECV to women who fail first attempt is a reasonable option and has a success rate comparable to the first attempt. In this study, regional anesthesia did not have statistically significant effect on the success rate of repeat ECV.
Omega-3 Fatty Acid Supplements and Risk of CHD
Authors: Rosenberg Karen 
Published: April 2018

According to this study:

Supplementation with marine-derived omega-3 fatty acids isn't associated with reductions in risk of fatal or nonfatal coronary heart disease (CHD) or any major vascular events.The findings don't support the American Heart Association's current recommendations for use of omega-3 fatty acid supplements by people with a history of CHD.
Massive Transfusion Protocol: Provider Education to Improve Patient Outcomes [1M]
Authors: Chow Stephanie , Lee Kimberly L. , Lee Jason , Liu Chi-Mei 
Published: April 2018

INTRODUCTION:
Massive Transfusion Protocol (MTP) was implemented at Kaiser Permanente Santa Clara (KPSC) in 2010 to improve the speed of blood component delivery for patients developing massive hemorrhage. With the advent of MTP, a review of the protocol and provider use has been limited. In this Performance Improvement (PI) project, an analysis of past MTP activations revealed an opportunity to improve provider knowledge and utilization of the MTP within the OBGYN Department.

METHODS:
Several PI tools were applied to identify opportunities for improving MTP. An educational intervention was provided at Labor and Delivery physician and nursing meetings. A brief, anonymous quiz with a five-point comfort scale was distributed to assess pre- and post-education understanding and comfort level with our facility’s MTP. Responses were analyzed using descriptive statistics.

RESULTS:
Responses were received from 67 providers (28 physicians and 39 nurses). Following the educational intervention, physicians and nurses showed significant improvement in their understanding of MTP. Total mean quiz score improved from 49.3% to 84.7% (P<.05). Physician comfort level improved from 44.3% to 71.4% (P<.05). Nursing comfort level also improved from 48.3% to 67.2%, with overall comfort level increasing from 46.5% to 68.9% (P<.05).

CONCLUSION:
Our project demonstrates that provider education is an important factor for performance improvement of MTP within the OBGYN department. Future study is needed to evaluate the long-term effectiveness of MTP on postpartum hemorrhage within KPSC.
Effect of AFPep on the Growth of Human Fibroid Xenografts [1OP]
Authors: Denefrio Cassandra , Kiley Kevin 
Published: April 2018

INTRODUCTION:
Fibroids are the most common pelvic tumors and are sensitive to fluctuations in hormones. Alpha fetoprotein (AFP) has demonstrated anti-estrogenic properties. AFPep is an active site peptide that retains the properties of AFP. Here, we investigated the ability to grow human fibroid xenografts in a murine model and the effect of AFPep on the growth of fibroid tumors.

METHODS:
After IRB approval, patients were identified and consent obtained. Pathology was confirmed by frozen section and the fibroid was implanted under the kidney capsule of ICR/SCID mice along with an estrogen implant. Survival surgery was completed to asses for growth. A second generation was completed followed by another fresh sample. After demonstrable growth, control mice were given normal saline injections and experimental group given AFPep injections for 10 days. Animals were sacrificed 1 hour following the last injection and samples were formalin fixed.

RESULTS:
In the first generation of fibroid implantation, 60% of the fibroids demonstrated growth, with the greatest growth noted days 12–30. The second generation of fibroids showed accelerated growth. The percent difference in tumor volume after AFPep treatment was less in the treatment group (46% vs 95%) and one tumor showed 11% volume regression.

CONCLUSION:
Fibroid xenografts demonstrate growth in a mouse model and the rate of growth is faster in second generation xenografts. Additionally, AFPep may display some inhibitory growth properties with a smaller difference in tumor volume in the treatment group. Histologically, the treatment group showed evidence of increased apoptosis, hyalinized fibrosis, and decreased cellularity.
POSTERIOR STAPHYLOMAS IN EYES WITH RETINITIS PIGMENTOSA WITHOUT HIGH MYOPIA
Authors: Xu Xian , Fang Yuxin , Yokoi Tae , Shinohara Kosei , Hirakata Akito , Iwata Takeshi , Tsunoda Kazushige , Jonas Jost B. , Ohno-Matsui Kyoko 
Published: April 2018

Purpose:
To describe features of posterior staphylomas in nonhighly myopic eyes with retinitis pigmentosa (RP).

Methods:
The retrospective observational case series study included patients with RP and an axial length of <26.5 mm and searched for eyes with posterior staphylomas. All study participants underwent fundus photography and optical coherence tomography.

Results:
The study identified 13 eyes of 7 patients with a narrow macular staphyloma. Mean age was 40.9 ± 17.9 years (range 9–62 years) and mean axial length was 24.90 ± 0.69 mm. The staphyloma edges corresponded to the margin between the retinal atrophic area in the fundus midperiphery and the relatively unaffected fundus center. On vertically orientated optical coherence tomography images, the staphyloma edges showed a slight inward protrusion of the sclera and a ring-like localized choroidal thinning with choroidal rethickening in direction toward the fovea and toward the periphery of the fundus. The upper and lower staphyloma edges did not differ in steepness. The thickness of the subfoveal choroid (138.6 m ± 50.1 µm) was thinner than the normal range after adjusting for age and axial length in all eyes. Two eyes with advanced RP in the macula showed a subfoveal choroidal thickness of 95 µm and 88 µm.

Conclusion:
Narrow macular staphylomas can occur in nonhighly myopic eyes with RP and, in contrast to staphylomas in highly myopic eyes, show a less marked thinning of the subfoveal choroid. The occurrence of posterior staphylomas in nonhighly myopic eyes with RP may provide hints to unravel the etiology of posterior staphyloma formation.
A bifunctional-biased mu-opioid agonist–neuropeptide FF receptor antagonist as analgesic with improved acute and chronic side effects
Authors: Drieu la Rochelle Armand , Guillemyn Karel , Dumitrascuta Maria , Martin Charlotte , Utard Valérie , Quillet Raphaëlle , Schneider Séverine , Daubeuf François , Willemse Tom , Mampuys Pieter , Maes Bert U.W. , Frossard Nelly , Bihel Frédéric , Spetea Mariana , Simonin Frédéric , Ballet Steven 
Published: April 2018

Abstract
Opioid analgesics, such as morphine, oxycodone, and fentanyl, are the cornerstones for treating moderate to severe pain. However, on chronic administration, their efficiency is limited by prominent side effects such as analgesic tolerance and dependence liability. Neuropeptide FF (NPFF) and its receptors (NPFF1R and NPFF2R) are recognized as an important pronociceptive system involved in opioid-induced hyperalgesia and analgesic tolerance. In this article, we report the design of multitarget peptidomimetic compounds that show high-affinity binding to the mu-opioid receptor (MOPr) and NPFFRs. In vitro characterization of these compounds led to identification of KGFF03 and KGFF09 as G-protein–biased MOPr agonists with full agonist or antagonist activity at NPFFRs, respectively. In agreement with their biased MOPr agonism, KGFF03/09 showed reduced respiratory depression in mice, as compared to the unbiased parent opioid agonist KGOP01. Chronic subcutaneous administration of KGOP01 and KGFF03 in mice rapidly induced hyperalgesia and analgesic tolerance, effects that were not observed on chronic treatment with KGFF09. This favorable profile was further confirmed in a model of persistent inflammatory pain. In addition, we showed that KGFF09 induced less physical dependence compared with KGOP01 and KGFF03. Altogether, our data establish that combining, within a single molecule, the G-protein–biased MOPr agonism and NPFFR antagonism have beneficial effects on both acute and chronic side effects of conventional opioid analgesics. This strategy can lead to the development of novel and potent antinociceptive drugs with limited side effects on acute and chronic administration.