bluuebunny/crossref_metadata_2025_split huggingface dataset:
Severe Maternal Morbidity and Mortality During Delivery Hospitalization of Class I, II, III, and Super Obese Women [39I]
Authors: Platner Marissa , Ackerman Christina M. , Xu Xiao , Campbell Katherine , Pettker Christian , Lipkind Heather S. 
Published: April 2018

INTRODUCTION:
Previous studies show that obesity predisposes patients to higher risks of adverse pregnancy outcomes. Data on the relationship between increasing degrees of obesity and risks of severe maternal morbidity, including mortality (SMM), are limited. The purpose of this study was to examine the association of different classes of obesity with SMM during delivery hospitalization.

METHODS:
Using New York City linked birth certificates and hospital discharge data, this study identified delivery hospitalizations for singleton, live births from 2008 through 2012. Women were classified as obese (Class I, II, III or super obesity), as opposed to normal weight or overweight, based on pre-pregnancy body mass index (BMI). Cases of SMM were identified based on ICD-9 diagnosis and procedure codes according to CDC criteria. Multivariable logistic regression was used to evaluate the association between obesity classes and SMM, adjusting for maternal socio-demographic and medical comorbidities.

RESULTS:
There were 539,870 live singleton births with available information on pre-pregnancy BMI. After adjusting for maternal characteristics, women with Class I (adjusted odds ratio (aOR) 1.07; 95% confidence interval (CI) 1.02-1.13), Class II (1.13; 1.05-1.21), Class III (1.26; 1.15-1.38), and super obesity (1.68; 1.32-2.11) were all significantly more likely to have SMM compared to normal and overweight women. Increasing BMI was associated with specific SMM indicators including: renal failure, blood transfusion, and heart failure in the adjusted analysis.

CONCLUSION:
There is a significant dose-response relationship between increasing obesity class and risk of SMM at delivery hospitalization. This relationship persisted even after accounting for potential confounding effects of comorbid conditions.
Brief vs Thong Hygiene in Obstetrics and Gynecology (B-THONG): A Survey Study [1J]
Authors: Hamlin Alyssa , Sheeder Jeanelle , Muffly Tyler 
Published: April 2018

INTRODUCTION:
The goal of this study is to determine if thong underwear use is associated with a higher report of urinary tract (UTI) or vaginal infections (bacterial vaginosis; BV and yeast vaginitis; YV).

METHODS:
A national, cross-sectional survey regarding underwear type usage and infectious history was designed and distributed to women via a crowd-sourcing service. Parametric and non-parametric statistical methods were used to compare thong wearers to never-thong wearers. Thong wearers were defined as women who had worn a thong at any point in the last 12 months.

RESULTS:
987 respondents met inclusion criteria and completed the survey; 315 (31.9%) were never-thong wearers and 672 (68.1%) were thong wearers in the last 12 months. Thong wearers were younger, thinner, and had different sexual and hygiene behaviors than never-thong wearers, including being more sexually active. Thong wearers were more likely to report UTIs (20.4% vs 11.4%; OR;95%CI: 1.99;1.23-2.95), yeast vaginitis (22.4% vs.15.6%; OR;95%CI: 1.61;1.13-2.30), and BV (9.7% vs. 5.7%; OR;95%CI:1.77;1.03-3.03) in the last 12 months. However, a logistic regression model found that only oral sex was found to be predictive of UTI (aOR;95%CI:1.61;1.07-2.43) and BV (aOR;95%CI: 2.63;1.39-4.97); further non-cotton crotch underwear (aOR;95%CI:1.75;1.17-2.62) and oral sex (aOR;95%CI:1.51; 1.02-2.25) were predictors of YV.

CONCLUSION:
We found that thong use is not associated with UTI, BV, or VY. Instead, sexual behaviors and hygiene choices are risk factors for these infections. We recommend that providers take a more complete sexual history to identify these risk factors rather than focusing on underwear as a primary risk factor.
Serofast Syphilis and Pregnancy Outcomes [2J]
Authors: Whitham Megan , Bandy Sohini , Eppes Catherine , Rac Martha 
Published: April 2018

INTRODUCTION:
Persistent low non-treponemal titers after adequate syphilotherapy, the serofast state, is commonly encountered during pregnancy. We describe the characteristics and pregnancy outcomes of gravidas with serofast syphilis compared to a seronegative general obstetric population.

METHODS:
This is a retrospective chart review from January 2011 to December 2016 of gravidas from our hospital diagnosed with serofast syphilis, defined as <4-fold decline or persistently low non-treponemal titers. These women were compared to our general seronegative obstetric population. Maternal characteristics, non-treponemal titers, delivery and infant outcomes were recorded. Standard statistical analysis was performed.

RESULTS:
38 (40%) of 94 gravidas diagnosed with syphilis were serofast. The median non-treponemal titer was 1:2[1:1,1:2] ranging from non-reactive to 1:16. Compared to our general obstetric population (n=14,407), serofast gravidas were more likely to be black and multiparous (p<0.01). Substance abuse (0.7% vs 24%, p<0.01), mental health disorders (3.5% vs 21%, p<0.10) and other sexually transmitted infections (7.2% vs 37%, p<0.01), including HIV (0.7% vs 11%, p<0.01), were more prevalent in serofast gravidas. Gestational age at delivery, birth weight and pre-term birth rate < 37 weeks was similar between groups. Serofast gravidas were more likely to undergo cesarean delivery and require admission to the Level II nursery or NICU (p=0.03). Two babies were treated for congenital syphilis in the serofast cohort; however, only one met CDC criteria for congenital syphilis

CONCLUSION:
Patients with serofast syphilis during pregnancy remain at risk for adverse outcomes, including congenital syphilis. More information is needed to guide pregnancy management in this high risk population.
Comparison of Nugent Scores and T-cell Markers Within the Female Genital Tract [3J]
Authors: Blackwell Conner O. , Haddad Lisa , Pollak Rebecca M. 
Published: April 2018

INTRODUCTION:
Bacterial Vaginosis (BV) has been shown to increase a woman's susceptibility to infections including HIV, but this connection is poorly understood. Although BV is commonly asymptomatic, it can be diagnosed with Nugent scoring. A numerical score 0-10 is assigned to Gram-stained vaginal swabs based on the presence of Gram positive rods, Gram negative rods, and Gram indeterminate curved rods. This study evaluated the association between Nugent score with immune cell phenotypic markers in the female genital tract.

METHODS:
HIV-uninfected normally cycling women were recruited into a prospective contraceptive study. Vaginal swabs and cervicovaginal lavage (CVL) samples were obtained at weeks 0, 2, 14, and 16. Vaginal swabs were scored and separated into 3 categories according to established Nugent score criteria: “No BV”, “Altered”, and “BV”. Leukocytes were isolated from CVL samples and measured using multi-color flow cytometry. Proportions of phenotypic markers on CD4 and CD8 cells were compared to Nugent category using an ordinal mixed regression model with random effect for repeated measures, adjusting for age, race, contraceptive use, and presence of sexually transmitted diseases.

RESULTS:
Among 61 participants, there were 199 total visits with the following Nugent categorizations: 47% “No BV”, 8% “Altered”, and 45% “BV”. Nugent category was significantly associated with increased proportion of CCR7+ CD4 cells, central memory CD4 cells, and central memory CD8 cells.

CONCLUSION:
BV was shown to alter the local immune environment by increasing the central memory and trafficking capacity of T cells. These results help elucidate the relationship between BV and susceptibility to infection.
Does Indication for Induction of Labor Impact the Duration of Induction? [10J]
Authors: Teal E. Nicole , Lewkowitz Adam , Koser Sarah , Tran Carol , Siegel Molly , Gaw Stephanie 
Published: April 2018

INTRODUCTION:
Nearly 25% of pregnancies in the US result in an induction of labor (IOL). The impact of IOL indication on IOL duration is unknown. We aim to assess that impact.

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. There were several IOL indications, listed below. The primary outcome was IOL duration. Secondary outcomes included operative delivery (OD) and cesarean delivery (CD) rates. The data were analyzed using the Kruskal-Wallis test.

RESULTS:
Four hundred and twenty women were included. The most common IOL indications were prolonged gestation (PG) (n=129, 30.7%), hypertensive disorder (HTN) (n=106, 25.2%), diabetes (DM) (n=42, 10%), and non-reassuring fetal status (NRFS) (n=19, 4.5%). The median times to any delivery (cesarean or vaginal) by indication were (in hours): PG 28.8, HTN 30.8, DM 33.3, NRFS 20.8, other 23.6. The median times to spontaneous VD were: PG 26.2, HTN 27.8, DM 24.2, NRFS 31.8, other 21.4. Differences within both groups were statistically significant (p < 0.005). OD rates were: PG 13.7%, HTN 13.6%, DM 9.5%, NRFS 15.8%, other 13.3%. CD rates were: PG 28.2%, HTN 27.1%, DM 38.1%, NRFS 26%, other 29.8%. Differences within these groups were not statistically significant (p > 0.05).

CONCLUSION:
IOL duration is dependent on IOL indication. Operative and cesarean delivery rates are not. These data may inform provider and patient expectations surrounding IOL duration and outcome.
Preterm Birth among African American Women in a Federal Healthy Start Program: Informing Pay for Success [12J]
Authors: Roman Lee Anne , Luo Zhehui , Meghea Cristian , VanderMeulen Peggy , Fawcett Ken , Leach Richard 
Published: April 2018

INTRODUCTION:
Providers are dependent on community-based, enhanced prenatal care (EPC) and home visiting (HV) programs to augment prenatal care and address health disparities. Given uncertain public resources for EPC/HV, innovative financing models are needed to support effective services. Pay-for-Success, a social impact bond model, partners federal/local governments, private investors, health systems, and providers to fund and deliver effective services to at-risk pregnant women and achieve predetermined health outcomes. If outcomes are achieved, savings repay investors and fund continued services. This comparative study examined baseline preterm birth (PTB) and very preterm birth (VPTB) rates for African American (AA) women enrolled in a federal Healthy Start (HS) program (Strong Beginnings), to explore program effectiveness, guide development of a PFS, and structure financial modeling.

METHODS:
A quasi-experimental study of AA HS participants (n=488; 2009-2014), propensity score matched with non-participants, was conducted using linked HS program, vital record, and Medicaid claims data. The objective was to examine the robustness of the comparison of PTB and VPTB outcomes utilizing multiple statistical methods.

RESULTS:
AA women who enrolled in the HS program were less likely to have a preterm or very preterm birth compared to matched Medicaid-insured AA women in the county (PT: 11% vs. 13.1-18.0%, range p values .003-.465); (VPT: 1.8% vs. 3.0-4.1%, range p values .035-.247). Comparisons excluding women who received other HV programs yielded similar results.

CONCLUSION:
Baseline preterm birth findings were positive, although varied dependent on statistical methods, and supported investment in a five year Pay for Success demonstration project.
Proportion of Abnormal Glucose Values and Perinatal Outcome [13J]
Authors: Merriman Amanda , Wang Laura , Gregory Rebecca , Osmundson Sarah 
Published: April 2018

INTRODUCTION:
Practical targets for glycemic control are unclear. This study examines associations between different proportions of abnormal self-monitored blood glucose (SMBG) values and adverse perinatal outcomes.

METHODS:
We conducted a retrospective cohort study of women undergoing SMBG between 1/1/2011-12/31/2016. Four weeks of SMBG values initiated before 32 weeks with at least 50% of expected values present were required. Women with type 1 diabetes or major congenital anomalies were excluded. The primary outcome was a composite of stillbirth, neonatal death, cesarean for arrest, shoulder dystocia, birth injury, new hypertensive disorder, birth weight >90% (LGA), or treatment for neonatal hypoglycemia. The primary exposure was the total percent abnormal SMBG values, examined by degree of abnormality: <25% (tight), <33% (moderate), or <50% (loose) abnormal.

RESULTS:
120 women met inclusion criteria of whom 47.9% had gestational diabetes (GDM) and 52.1% had type 2 diabetes. Overall, 29.4% had tight control, 37.0% had moderate control, and 33.6% had loose control. Women with tight control were less likely to experience the primary outcome (34.3% vs 69.4%, RR 0.49, 95%CI 0.31-0.80), LGA infants (14.3% vs 34.5%, RR 0.41, 95% CI 0.17-0.98), or neonatal hypoglycemia (11.4% vs 34.1%, RR 0.34, 95%CI 0.13-0.88) than women without tight control. After adjusting for age, parity, and diabetes type, both moderate and tight control were associated with a reduced odds for the primary outcome, however loose control was not.

CONCLUSION:
Keeping SMBG to less than 33% abnormal is associated with a reduced risk of adverse perinatal outcomes. These data may help clinicians set targets for glycemic control.
Breastfeeding in a Baby Friendly Hospital: Preliminary Findings [14J]
Authors: Formoso Agatha , Lipori Gigi , Spiryda Lisa Beth 
Published: April 2018

INTRODUCTION:
The Baby-Friendly Hospital Initiative (BFHI) was created to improve maternity and breastfeeding practices globally. Increased “Baby-Friendly” practices improves the chances of breastfeeding beyond 6 weeks. UF Health was designated a baby-friendly hospital in 2015. The aim of this study was to determine if the percentage of infants breastfed under the new BFHI policy at UF Health and determine if it is projected to meet the Healthy People 2020 goal both in initiation and continuance of breastfeeding at 6 weeks.

METHODS:
IRB approval was obtained for this retrospective chart review. Charts were identified by CPT codes for both vaginal and cesarean deliveries. Data was abstracted from EMR; women were excluded if they received prenatal care outside UF Health since BFHI program has a significant prenatal educational component. Initial review abstracted data from 150 eligible charts approximately 2 years after BFHI (2/2017-3/2017). Data was analyzed with GraphPad and JMP statistical software.

RESULTS:
Mothers initiated breastfeeding 91.4% of the time at UF Health. Factors that made a mother more likely to breastfeed at 6 weeks were: white versus black (75 v 43%, p = 0.45), private insurance versus Medicaid (82 v 40%, p=0.0001), and married versus single (83 v 41%, p=0.0001).

CONCLUSION:
UF Health’s breastfeeding policies are currently projected to meet the 2020 goal for all infants who have ever been breast fed, but despite the BFHI there were still deficits at 6 weeks. Future studies will explore specific barriers to breastfeeding in these populations.
Obesity and Risk for Infectious Morbidities in Women Delivered by Cesarean Section after Induction of Labor [19J]
Authors: Colihan Sarah , Lynch Tara , Walia Jennifer , Zelig Craig 
Published: April 2018

INTRODUCTION:
Obesity is a known risk factor for infectious morbidity after cesarean delivery. Nulliparous women often require prolonged inductions of labor, which increases the length of membrane rupture and risk for chorioamnionitis. Therefore, we sought to evaluate if the risk for chorioamnionitis was increased in obese women based on length of membrane rupture.

METHODS:
This study was conducted on a retrospective cohort of term, nulliparous patients with singleton gestations requiring non-elective cesarean sections after induction of labor at a single academic institution from 2008 to 2015. The primary outcome was the incidence of chorioamnionitis. Secondary outcomes included endometritis and cesarean wound infection. Maternal obesity, defined as body mass index (BMI) >30 kg/m2, and duration of amniotic membrane rupture, were evaluated as the primary risk factors.

RESULTS:
A total of 297 patients met inclusion criteria. Increased duration of membrane rupture was associated with increased risk of chorioamnionitis (Odds ratio [OR] 1.08 95% Confidence Interval [CI] 1.05-1.11). However, increasing BMI was not associated with increased risk of chorioamnionitis, and regression analysis showed there was no significant relationship between BMI and the interval between rupture of amniotic membranes and delivery (R-sq 1.2%). Secondary analysis did reveal significantly higher risk of chorioamnionitis with IUPC use ([OR] 3.12 [CI] 1.4258, 6.7918).

CONCLUSION:
Maternal obesity does not appear to independently increase the length of ruptured membranes and the rate of chorioamnionitis during induction of labor. However, obese patients undergoing a prolonged induction of labor are more likely to be monitored with an IUPC, which increases their chorioamnionitis risk.
Automated Quantification of Blood Loss Compared to Qualitative Estimation in 300 Vaginal Deliveries [20J]
Authors: Rubenstein Andrew , Zamudio Stacy , Al-Kahn Abdulla , Douglas Claudia , Sledge Sharon , Thurer Robert 
Published: April 2018

INTRODUCTION:
Under estimation of blood loss and delayed diagnosis of obstetric hemorrhage are leading causes of maternal morbidity and mortality. Failure to visually recognize significant hemorrhage early is often responsible. Accurate quantification of blood loss during delivery is therefore recommended to facilitate rapid recognition and implementation of hemorrhage protocols and improve outcomes.

METHODS:
We assessed quantified blood loss (QBL) using an automated system (Triton L&D™, Gauss Surgical, Los Altos, CA) compared to the attending physician’s clinical estimates during 300 vaginal deliveries. The system batch weighs all blood containing sponges, towels, pads and other supplies and automatically subtracts their dry weights. It also facilitates measurement of blood collected in the under-buttocks drape and subtracts the measured amount of amniotic fluid. Each method was performed independently and clinicians were blinded to the device’s results.

RESULTS:
Mean QBL (405.8 ± 275.2 ml) was significantly greater than visually estimated blood loss (304.9 ± 135.2 ml) (P<.0001). Critically, QBL detected hemorrhage (blood loss > 500 ml) in 27.7% of patients compared to 5.1% of patients using visual estimation (P<.0001). Visual estimation of ≥1,000 ml was recorded in only 1 patient, whereas 13 patients (4.3%) had a blood loss > 1,000 ml by QBL (P<.0001).

CONCLUSION:
Our data demonstrate that QBL facilitated by an automated system recognizes more patients with excessive blood loss than visual estimation. The value of QBL as a public health safety initiative requires clinicians to accept the long-known inadequacy of qualitative estimation. Further studies of clinical outcomes related to implementation of QBL are needed.
Low PAPP-A Levels and Pregnancy Outcomes [21J]
Authors: Shand Muhammed F. , Gimovsky Alexis , Macri Charles 
Published: April 2018

INTRODUCTION:
Pregnancy-associated plasma protein A (PAPP-A) is associated with adverse pregnancy outcomes: preterm birth, growth restriction, stillbirth and preeclampsia. Because PAPP-A affects placental function, it may affect labor. The objective of this study was to determine if low PAPP-A is associated with labor dysfunction.

METHODS:
Retrospective study of pregnant women between July 2013 and July 2016. Women with PAPP-A in the 5 percentile were compared to women with PAPP-A ≤1 percentile. Primary outcome: cesarean delivery (CD) rate. Secondary outcomes: indication for CD, perinatal outcomes. Exclusion: women with fetuses with known or suspected aneuploidy.

RESULTS:
One hundred thirty-nine women were included; 91 women with PAPP-A in 5 percentile and 48 women with PAPP-A ≤1 percentile. Demographics were similar except for gestational age at delivery (38.6±3.6 weeks in the 5 percentile group versus 35.9±7.4 in the 1 percentile group, P=.004). There was no difference in CD rate (27/91 [29.7%] versus 12/48 [25%], P=.6), fetal indication for CD (8/27 [29.6%] versus 4/12 [33.3%], P=.8). Birth weight was significantly higher in the 5 percentile group versus the 1 percentile group (3,264.6±580.8 versus 2,935.4±715.3, P=.004). Neonatal morbidity composite score was different between groups; (18/91 [19.8%] in the 5 percentile group versus 18/48 [37.5%] in the 1 percentile group P=.02).

CONCLUSION:
PAPP-A ≤1 percentile does not seem associated with delivery mode or indication for cesarean delivery in comparison to <5 percentile. PAPP-A ≤1 percentile may be associated with increased neonatal morbidity during labor, as well as lower birth weight and preterm birth in comparison to PAPP-A <5 percentile.
Serotonin Syndrome in Obstetrics: A Case Report and Review of Clinical Management [22J]
Authors: Asusta Heisy , Keyser Erin , Dominguez Patricia , Odedokun Tolulope 
Published: April 2018

INTRODUCTION:
Serotonin syndrome (SS) is a life-threatening condition, usually precipitated by a combination of serotonergic agents. Data regarding the incidence and management of SS in obstetrics are limited. This study presents a case of SS provoked by an atypical antipsychotic in a second trimester, singleton gestation, and reviews the management of SS.

RESULTS:
We present a case of a schizophreniform, pregnant patient with a singleton gestation admitted to a community, military hospital for serotonin syndrome. The patient was admitted to the intensive care unit (ICU) by the obstetrics team, where she was managed conservatively. The cornerstones of therapy were as follows: discontinuation of offending agent, intravenous fluids, supplemental oxygen, telemetry, and hourly neurological assessments. Fetal status was monitored twice daily. After stabilization, the patient was transferred from the ICU to inpatient psychiatry for continued care.

CONCLUSION:
Although serotonin syndrome is infrequently encountered in obstetrics, it is paramount that all obstetricians are familiar with its recognition and management, particularly in community hospital settings. The low incidence of reported SS is largely attributed to under-recognition. Given the increasing prevalence of mental health disorders, it is essential for well-rounded obstetricians to be aware of the potential for SS in our patient population.