bluuebunny/crossref_metadata_2025_split huggingface dataset:
Defining the Sociodemographic Impact on the Latency Period Following Preterm Premature Rupture of Membranes [37A]
Authors: Lambert Calvin , Ranjit Anju , McDonald Vanessa 
Published: April 2018

INTRODUCTION:
Traditionally antibiotics have been viewed as the primary intervention promoting latency (the period between confirmed rupture and delivery) following preterm premature rupture of membranes (PPROM). While most studies have investigated immediate risks to a shortened latency period, few have elucidated the impact of predisposed social disadvantages. The objective of our study is to establish a sociodemographic predictive model among a cohort of patients with the diagnosis of PPROM and their risk of preterm delivery.

METHODS:
Centers for Disease Control (CDC) birth-certificate data (2012-2013) were used to identify women with PPROM. Sociodemographic and clinical characteristics of women, who delivered <34 weeks, 34-36 weeks, and ≥37weeks of gestation were compared using chi-squared tests. These included health insurance source, number of prenatal visits, and education. Multinomial logistic regression models were used to calculate the relative risk ratios (RRR) of delivery <34 weeks and 34-36 weeks compared to delivery at ≥37 weeks.

RESULTS:
A total of 242,290 women with PPROM were identified; 16.1%, 19.7% and 64.2% delivered at <34weeks, between 34-36 weeks, and ≥37 weeks, respectively. Black race was more likely to have delivery at <34 weeks (28.2%) and 34-36 weeks (19.4%) compared to ≥37 weeks (14.2%)(p<0.001). Black race (<34weeks:RRR:1.99;CI:1.94-2.06; 34-36weeks: RRR:1.35;CI:1.31-1.39), high school education or less(<34weeks:RRR:1.19;CI:1.15-1.23; 34-36weeks: RRR:1.16;CI:1.13-1.19), Medicaid insurance(<34weeks:RRR:1.13;CI:1.10-1.17; 34-36weeks: RRR:1.09;CI:1.05-1.12), and 1-3 prenatal visits(<34weeks:RRR:1.45;CI:1.35-1.56; 34-36weeks: RRR:1.03;CI:0.95-1.12) were more likely to have preterm delivery.

CONCLUSION:
Correlates of social disadvantage were associated with a decreased latency period among those patients with PPROM. Targeted interventions among socially disadvantaged groups could help decrease this incidence of preterm birth.
Time Interval from Delivery to Maternal First Neonatal ICU Contact. Are We Doing a Good Job? [39A]
Authors: Thompson Benjamin , Promecene-Cook Pamela , Byrd Teresa , Adler Michael 
Published: April 2018

INTRODUCTION:
To determine the interval between delivery and first maternal NICU contact, and to correlate this with maternal conditions and therapies.

METHODS:
Mothers delivered at our institution and whose infants were admitted to the NICU were identified. A retrospective chart review was performed to collect demographic data, date and time of delivery, maternal antepartum, intrapartum, and postpartum diagnoses, and therapies. NICU sign-in logs were used to determine the time of first maternal contact. Mother’s admitted to the ICU and/or whose infants were transitioned back to the low-risk nursery were excluded.

RESULTS:
The mean interval time to first maternal NICU contact was 18.3 hours. Factors associated with delayed maternal visitation includes mode of delivery (13.3 hours for vaginal vs. 21.1 hours for cesarean, P<.001), the diagnosis of pre-eclampsia with severe features/HELLP (23.9 hours vs. 16.3 hours, P=.003), medications outside routine orders including I.V. antibiotics (21.3 hours, P=.033), PCA pain control (23.5 hours, P=.024), magnesium sulfate (23.5 hours, P<.001), and blood transfusion (26.8 hours, P=.03). There was no correlation found for delayed maternal visitation for infant gender, nursing shift at time of delivery, or having any diagnosis other than pre-eclampsia with severe features/HELLP.

CONCLUSION:
The interval for first maternal NICU contact at our institution leaves much room for improvement. The highest risks populations for delayed NICU contact include cesarean deliveries, patients diagnosed with pre-eclampsia with severe features/HELLP syndrome, and patients receiving infusions such as magnesium sulfate, PCA delivery pain medications, I.V. antibiotics, or blood transfusions. Quality improvement initiatives are in development to decrease this time interval.
Clomiphene Citrate and Intrauterine Insemination: Analysis of 1,531 Cycles by Time Trying to Conceive [6B]
Authors: Stewart Joshua , Panchap Latha , Spandorfer Steven D. 
Published: April 2018

INTRODUCTION:
Clomiphene citrate and intrauterine insemination (CC/IUI) is often a first-line treatment for infertile couples. While it is well established that fecundity rates decrease with age, outcomes of CC/IUI cycles have not been well stratified by time trying to conceive (TTC).

METHODS:
All CC/IUI cycles performed under a single physician from January 1, 2010 to December 31, 2016 were included, totaling 1,531 cycles in 536 unique couples. The following data were collected from an electronic medical record: age, obstetrical history, semen parameters, time TTC at cycle start, and cycle outcome. Stata IC 15 was used to calculate pregnancy rates. Chi-squared test was used to calculate p-values.

RESULTS:
The positive pregnancy rate (PPR) for couples TTC <1 year was 16.5%; 14.7% when TTC for 1-2 years, 15.4% when TTC for 2-3 years, and 8.6% when TTC for >3 years (p<0.05). The corresponding ongoing pregnancy rates (OPR) were as follows: 11.2%, 9.8%, 7.5%, 3.7% (p<0.05). In women <35 years old at cycle start, the corresponding OPRs were as follows: 13.1%, 11.3%, 8.6%, 4.3% (p<0.05); for women >35 years old at cycle start: 7.4%, 6.1%, 5.9%, 1.7% (p<0.05).

CONCLUSION:
Patients TTC with CC/IUI for <1 year have a higher PPR and OPR as compared to patients TTC for >1 year. Ongoing pregnancy rates further decline with each additional year TTC, and by 3 years of TTC, success rates dramatically decrease at all ages. This data provides important information to the clinician counseling infertile patients regarding when referral to a specialist and more aggressive treatments may be warranted.
Serum IL-1RA Levels Predict IVF Outcome in Caucasian But Not African American Women [10B]
Authors: Elder Simone , Irani Mohamad , Witkin Steven S. , Spandorfer Steven D. 
Published: April 2018

INTRODUCTION:
A growing body of evidence has shown that some cytokines are implicated in embryo development and implantation. Previous studies have suggested that serum levels of interleukin-1β (IL-1β) and interleukin-1 receptor antagonist (IL-1RA) can predict IVF outcome. However, the majority of included patients were Caucasian (C). Therefore, we investigated whether IL-1β and IL-1RA are expressed differently and have different predictive values of IVF outcome between C and African American (AA) women.

METHODS:
A retrospective study including 129 C and 88 AA women undergoing fresh IVF cycles. Serum levels of IL-1β and IL-1RA on cycle day (CD) 2 (before starting ovarian stimulation) and CD28 (14 days after oocyte retrieval) were compared between those who did or did not become pregnant. Values were expressed as mean±SEM. t-test was used as appropriate.

RESULTS:
C women had higher serum IL-1β levels compared to AA patients on CD2 (23.3±8.1 vs. 15.3±12.9 pg/mL, P=0.02). The IL-1RA level on CD 28 in C women, who achieved a pregnancy was higher as compared to those who did not become pregnant (488.2±83.9 vs. 183.4±45.3 pg/mL, P=0.02). In contrast, IL-1RA levels on CD28 were comparable between AA women who did or did not become pregnant (343.8±83.9 vs. 627.4±404.9, P=0.5).

CONCLUSION:
C women have different levels of IL-1 family cytokines as compared to AA women. Serum IL-1RA levels can predict IVF outcome in C but not in AA women. We are currently conducting a prospective study to examine the racial differences in additional cytokines among women undergoing IVF.
IVF Pregnancy after Cytoreductive Surgery and HIPEC of Diffuse Malignant Peritoneal Mesothelioma [12B]
Authors: de Assis Viviana , Adams Jaye , Saunders Rhiana 
Published: April 2018

INTRODUCTION:
Diffuse malignant peritoneal mesothelioma (DMPM) is a rare yet aggressive neoplasm arising from mesothelial cells of the peritoneum. It spreads extensively within the abdominal cavity with substantial associated morbidity and mortality. Expertise in cytoreductive surgery (CRS) and hyperthermic intraoperative peritoneal perfusion chemotherapy (HIPEC) has led to increased overall survival for patients. With improving survival rates and possibility of cure, it is unknown what impact CRS and HIPEC have on the future fertility of reproductive-aged women. We report the case of a successful pregnancy achieved with in-vitro fertilization (IVF) following CRS and HIPEC treatment for epithelioid subtype DMPM.

METHODS:
Data collected from Essentris and Altha, Department of Defense Electronic Medical records for outpatient and inpatient care.

RESULTS:
A 28 year old female with primary infertility and recurrent ascites was found to have fleshy- appearing peritoneal nodules on laparoscopy with histologic findings of epithelioid subtype DMPM. She elected ovarian suppression with a GnRH-agonist prior to undergoing CRS, HIPEC, and adjuvant chemotherapy. Spontaneous return of menses occurred 18 months after completion of chemotherapy. After two years of remission, she pursued fertility treatment with IVF, and has an ongoing uncomplicated singleton gestation.

CONCLUSION:
Median survival for patients with DMPM has improved to approximately 50% at five years with CRS and HIPEC treatment. We report the first known case of a successful pregnancy achieved with IVF following CRS, HIPEC, and adjuvant chemotherapy for DMPM. Of interest, GnRH pre-treatment offered an approach to ovarian suppression. In light of urgency to initiate expeditious treatment, this approach possibly optimized fertility preservation and post-treatment childbearing potential.
Accurate Assessment of Blood Loss During Cesarean Delivery Improves Estimate of Postoperative Hemoglobin [17B]
Authors: Rubenstein Andrew , Tully Griffeth , Thurer Robert 
Published: April 2018

INTRODUCTION:
The need for red blood cell transfusion for patients having cesarean delivery is ideally based on an evaluation of both clinical indicators and laboratory studies. In practice, transfusions are often given to women based on estimated intraoperative blood loss (EBL) and/or the postoperative hemoglobin level. Since visual estimation is known to be inaccurate, we postulated that a more accurate determination using a novel colorimetric device would be better correlated with postoperative day one hemoglobin than visual estimation.

METHODS:
A formula incorporating both height and weight was used to estimate blood volume and, by including preoperative hemoglobin, red cell mass. Assuming a constant blood volume either the visual EBL (n=32) or EBL using a novel colorimetric device (Triton System™, Gauss Surgical) that incorporates a mobile application to photograph sponges and canisters and calculate their hemoglobin content (n=53) was used to predict the postoperative day one hemoglobin value in patients where either the visual estimate or colorimetric estimate was >1,000 ml (a common definition of hemorrhage).

RESULTS:
The predicted postoperative day one hemoglobin level using the device was better correlated with the actual value (R squared=0.319) than the predictions using visual EBL (R squared=0.035) (P=.027).

CONCLUSION:
In mothers with high blood loss, EBL using the novel device was a more accurate predictor of the postoperative day one hemoglobin than visually estimated blood loss. Clinical use of this information has the potential to improve transfusion practice in cesarean delivery patients and positively impact maternal health.
Current Inpatient Antenatal Fetal Surveillance Paradigms and the Effect on Clinical Decision Making [23B]
Authors: Racusin Diana , Adimorah Nesochi , Piro Mica , Heye Kristen , Sharp Charlotte , Blackwell Sean C. , Refuerzo Jerrie S. 
Published: April 2018

INTRODUCTION:
While outpatient biophysical profiles (BPPS) are routinely used to prevent intrauterine fetal demise, the clinical utility of BPPs performed inpatient with scheduled electronic fetal monitoring (EFM) is uncertain. Our objective was to determine whether BPPs performed in the hospital on the antepartum unit result in prolonged duration of EFM or in delivery.

METHODS:
A retrospective cohort review was performed among women who had a BPP during their antepartum hospital admission. Women were divided into two groups (BPPs 8/8 or 6/8 or less) and their outcomes compared. The primary outcome was the need for prolonged EFM greater than 2 hours or decision to proceed with delivery. Maternal demographics, pregnancy characteristics, and neonatal outcomes were compared. Indications for hospitalization and delivery were collected. Student-t test and chi-square test were used for statistical analysis.

RESULTS:
Among our high-risk cohort (n=325), delivery management was altered in one case (0.3%) by the BPP findings. There were no BPPs that resulted in need for prolonged monitoring. Need for delivery or prolonged monitoring was primarily dictated by either change in clinical scenario or EFM abnormalities. Compared to women with BPP 8/8, women with BPP 6/8 or less were admitted and delivered at significantly earlier gestational ages, had higher corticosteroid rates, lower birthweight neonates and required more frequent NICU admissions.

CONCLUSION:
In our analysis, hospital BPPs alter clinical decision making in less than 1% of cases. An intervention trial is warranted to assess the potential benefits of BPPs in an inpatient antepartum setting.
Prevalence of Chronic and Pregnancy-Induced Cardiovascular Conditions in Severe Maternal morbidity in Texas [24B]
Authors: Salahuddin Meliha , Mandell Dorothy , Lakey David , Patel Divya 
Published: April 2018

INTRODUCTION:
In 2011-2012, the three leading causes of maternal mortality in Texas were cardiac events, drug overdose, and hypertension/eclampsia, with two out of the three being cardiovascular-related conditions. While chronic conditions likely contribute to mortality, severe maternal morbidity (SMM) metrics only include eclampsia and do not include chronic cardiovascular conditions such as preexisting hypertension. To better understand the contribution of both pregnancy-induced and chronic cardiovascular conditions to SMM, the prevalence of comorbid cardiovascular conditions among women with SMM was assessed.

METHODS:
Delivery-related hospitalizations between 2011-2014 were classified as SMM, based on the CDC’s coding scheme. Cardiovascular comorbidities among SMM were classified using the obstetric comorbidity coding scheme identified by Bateman et al (2013). Prevalence was assessed by age to examine whether older women with SMM had higher prevalence of these comorbidities.

RESULTS:
SMM prevalence remained consistent between 2011 and 2014 (19.6-19.8 per 1,000 deliveries, p=0.57). Overall, SMM showed a quadratic relationship with age, with the youngest and oldest age groups having the highest prevalence (p<0.01). Among comorbidities assessed in SMM, the youngest and oldest age groups had the highest prevalence of severe preeclampsia/eclampsia. However, the prevalence of preexisting hypertension increased linearly with age.

CONCLUSION:
Older women with SMM were comorbid for both pregnancy-induced and chronic cardiovascular conditions, whereas younger women had pregnancy-induced conditions. This finding suggests a need to assess the role of chronic cardiovascular conditions in SMM, especially among older women. Results also suggest that the narrowly defined SMM metric may underestimate the contribution of chronic cardiovascular conditions to severe maternal morbidity.
Phase 3 Study Evaluating Brexanolone, a GABAA Receptor Modulator, in Severe Postpartum Depression [29B]
Authors: Meltzer-Brody Samantha , Kanes Stephen , Riesenberg Robert , Rubinow David , Maximos Bassem , Colquhoun Helen 
Published: April 2018

INTRODUCTION:
A double-blind, placebo-controlled Phase 2 study of brexanolone (USAN; formerly SAGE-547 Injection), a positive allosteric modulator of GABAA receptors, demonstrated rapid and durable improvements in postpartum depression (PPD). The current study (NCT02942004) is one of two randomized, double-blind, placebo-controlled Phase 3 studies that evaluated the efficacy and safety of brexanolone in women with PPD.

METHODS:
Approximately 120 women with severe PPD (Hamilton Rating Scale for Depression [HAM-D] total score ≥26) were randomized 1:1:1 to 60-hour infusions of blinded placebo or brexanolone at 60 or 90 µg/kg/h. The primary endpoint was the change from baseline in the mean HAM-D total score at Hour 60 following brexanolone compared with placebo. Durability of effect and safety were assessed through Day 30. Safety and tolerability were assessed by adverse events, vital signs, laboratory evaluations, electrocardiogram, and the Columbia Suicide Severity Rating Scale. Secondary efficacy endpoints included change from baseline in the Montgomery-Åsberg Depression Rating Scale, HAM-D response, HAM-D remission, and Clinical Global Impression-Improvement.

RESULTS:
This Phase 3 study will be completed in 2017. This presentation will be the first comprehensive reporting of primary and secondary endpoints. These data seek to validate and expand upon the Phase 2 results, which showed a rapid reduction in mean HAM-D score (Hour 60, brexanolone -21.0 vs. placebo -8.8, p=0.008) and durability through Day 30 (20.8 vs. -8.8, p=0.010).

CONCLUSION:
This study, along with a companion Phase 3 study with brexanolone in subjects with moderate PPD, seeks to validate and expand upon the earlier Phase 2 data.
Chemotherapy and Optimal Timing of Delivery for Women with Human Epidermal Receptor-2 Positive Breast Cancer [33B]
Authors: Kuo Kelly , Senz Kayli , Caughey Aaron B. 
Published: April 2018

INTRODUCTION:
Data are limited regarding the optimal management of breast cancer in pregnancy, particularly for human epidermal receptor-2 (HER2+) tumors and the potential fetotoxicity of subtype-specific chemotherapy. We sought to compare strategies for the management of HER2+ tumors and to determine the optimal gestational age for induction in regards to chemotherapy status and maternal-fetal outcomes.

METHODS:
A decision-analytic model was designed for women with HER2+ breast cancer at 20 weeks electing to continue their pregnancies, comparing 32 different strategies for scheduled delivery between 24-39 weeks gestation, with chemotherapy induction either at 24 weeks or delayed until after delivery. Baseline estimates of stage-specific mortality and the impact of delayed cancer treatment on 5-year survival rates were obtained from the literature. Outcomes factored into the model included the risk of intrauterine fetal demise, spontaneous delivery, respiratory distress syndrome, cerebral palsy, and neonatal demise at each gestational age. Univariate and multivariate sensitivity analyses were performed to test the robustness of our model.

RESULTS:
For women assigned to antepartum chemotherapy, delivery at 39 weeks yielded the highest maternal and overall QALYs at all cancer stages. For women with HER2+ breast cancer deferring chemotherapy until after delivery, maternal quality-adjusted life years (QALYs) were maximized with induction at 37 weeks for stage I cancer, 32 weeks for stage II cancer, and 28 weeks for stage III cancer. Our model was heavily driven by the baseline probability of maternal death within 5 years, in addition to the expected progression of disease and decrease in survival rates with each week of non-treatment, and remained robust across reasonable ranges for all variables of interest.

CONCLUSION:
For women with HER2+ breast cancer diagnosed in early pregnancy, initiation of chemotherapy and delivery at term is recommended.
Can Initial Glycemic Control Predict Metformin Failure in Women with Gestational Diabetes? [38B]
Authors: Persad Malini D. , Ou Jennie , Bernasko James , Garry David , Garretto Diana , Herrera Kimberly 
Published: April 2018

INTRODUCTION:
To determine if glycemic control prior to medication initiation predicts metformin failure in women with gestational diabetes (GDM).

METHODS:
A retrospective cohort study of women with GDM was conducted from 2013-2016. Included in the study were women with GDM started on metformin after a failed trial of diet therapy. Excluded from the study were women with pre-existing DM. Women were advised to take fasting and 1-hour postprandial finger sticks. Women were categorized as having adequate glycemic control on metformin (metformin success) or requiring the addition of or transition to an insulin regimen (metformin failure). Maternal demographics and average blood glucose (BG) values were collected. The sensitivity and the specificity of BG values as a screening test for metformin failure were analyzed and the corresponding ROC curves were plotted to assess the performance of the test. Parametric and nonparametric statistical analyses were performed with a p value of <0.05 as significant.

RESULTS:
A total of 118 gestational diabetics were identified, 19 (16.1%) women failed metformin therapy. There were no significant differences in maternal demographics in the groups. Compared to the metformin success group, those in the metformin failure group had significantly higher fasting BG values prior to medical management. Postprandial BG values were not different between groups. A ROC curve of the average fasting BGs revealed that a value of 90mg/dl was best predictive of metformin failure (AUC 0.74; p 0.002), with a sensitivity and specificity of 90% and 79% respectively.

CONCLUSION:
Elevated fasting BG values may predict metformin failure in women with GDM.
A Year of Mentored I-Pass Standardized Handoff Application: Observations of Local Versus National Trend [1C]
Authors: Gaspar-Oishi Maria , Saito-Tom Lynne , Hiraoka Mark 
Published: April 2018

INTRODUCTION:
The I-PASS study group has created a nationally recognized standardized patient hand-off system that has been utilized by various residency programs. This study describes the impact of the I-PASS Mentored Implementation Project by comparing our local Ob-gyn residency I-PASS adoption with pooled data from residency programs that implemented I-PASS in the same period.

METHODS:
Patient hand-offs were evaluated on a weekly basis by attending physicians using a standardized observation tool. This data was submitted to the I-PASS study group and our site was provided with monthly run-charts that measured I-PASS core measures. Combined data from the other residency program sites were also provided.

RESULTS:
We compared three core measures: 1) Adherence to all elements of the I-PASS mnemonic: Locally, the average percent adherence was 33.3%, whereas nationally, the average was 50%. 2) Miscommunication: Locally, average occurrence of miscommunication was 23.3% whereas the national average was 8.2%. 3) Omission of important information: The average reported omission of important information was similar at both the local and national levels at 11.1% and 11.7%, respectively.

CONCLUSION:
In one year, the I-PASS Mentored Implementation Project has allowed our residency program to perform similarly to other programs around the country. Our local trend was not dissimilar to the national averages found in the pooled data. Both occurrence of miscommunication and omission of important information were below the core threshold of 25%. However, average adherence was lower than the national average and below the core goal of 75%. We will continue to look for innovative ways to improve handoff.