bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nomogram Use to Predict Obstetric Anal Sphincter Injuries prior to Term Vaginal Delivery [14R]
Authors: Kim Youngwu , Leung Katherine , Leftwich Heidi , Hebert Kasey , Masiero Jessica , Moore Simas Tiffany A. 
Published: April 2018

INTRODUCTION:
Obstetric anal sphincter injuries (OASIs) following vaginal delivery are a significant complication. We previously identified and published significant independent risk factors for OASIs. A validated OASIs prediction model for women with known risk factors planning vaginal delivery is needed to facilitate patient counseling and shared treatment decision-making.

METHODS:
We performed a retrospective cohort study including women having had vaginal deliveries (2006-2015), with demographic and obstetric data abstracted through medical record review. Results were adjusted for potential confounding factors. Nomogram developed using logistic regression analyses that included risk factors taken from published OASIs literature. Dataset was divided into training and test datasets for internal validation. Prediction nomogram was constructed using regression-based coefficient scoring system with a correlated probability of OASIs.

RESULTS:
Among 16,024 included vaginal delivery, 1106 (6.9%) were complicated with an OASIs. Predictors identified in the train cohort were: Asian race, nulliparous status, increased age, birth-weight, birthweight-maternal body mass index ratio (BW:BMI), smoking status, gestational age, parity, episiotomy, trial of labor after cesarean, and operative vaginal deliveries. The constructed nomogram was internally validated.

CONCLUSION:
This study confirmed known OASIs risk factors among women having term vaginal deliveries. Furthermore, we established and validated a novel nomogram for the prediction of OASIs for the women giving vaginal deliveries with known risk factors for severe perineal laceration. If nomogram is externally validated, it would be an excellent counseling tool for women with increased probability of OASIs.
Fetal Myelomeningocele: Antenatal Characteristics and Pregnancy Outcomes [19R]
Authors: Munoz Jessian , Bishop Elaine , Singh Katherine 
Published: April 2018

INTRODUCTION:
Spina bifida is the most common fetal anomaly of the central nervous system, which affect 1:1000 live births in the United States. Myelomeningocele is the most common presentation of spina bifida, representing half of these cases. Given the meningeal membrane sac may contain spinal cord, cerebrospinal fluid and nerve roots, this defect results in significant morbidity to infants and major life-long disabilities. In this study we aimed to identify maternal and fetal characteristics associated with expectant management or termination of pregnancy in the setting of antenatally diagnosed Myelomeningocele.

METHODS:
A retrospective cohort analysis was performed with patients who had presented to the Cleveland Clinic Fetal Care Center between 2005-2017. Live births then followed up at the pediatric Myelomeningocele clinic within our institution.

RESULTS:
Our data showed 40% of patients with antenatally diagnosed Myelomeningocele elected for second trimester terminations vs. 60% who chose to continue either by cesarean section or vaginal delivery. Based off ultrasound findings, there were no significant differences among these two groups. Maternal body mass index was significantly higher in those who continued pregnancies (p<0.05). In addition, the fetal diagnostic methods chosen by patients was significantly different. Those who elected to terminate were more likely to pursue amniocentesis instead of MRI characterization of the fetus (p<0.02).

CONCLUSION:
Taken together, we conclude, in the setting of antenatally diagnosed Myelomeningocele, patients often rely less on the associated ultrasonographic findings and depend more on maternal characteristics as well as fetal diagnostics in determining whether to continue or terminate pregnancy in the second trimester.
Efforts and Interventions for Reducing Cesarean Delivery in China [25R]
Authors: Wang Yue J. , Ayers Charletta , Bachmann Gloria A. 
Published: April 2018

INTRODUCTION:
The rate of cesarean section (CS) delivery, has been generally increasing worldwide. Although the US has been cited for this increasing rate, the trend is more pronounced in areas of China, which has drawn substantial efforts from the Chinese government and health care professionals to try to reduce the CS rate to the WHO recommended level. This abstract will review the major causes associated with high cesarean rate in China and explore effective interventions addressing the issue.

METHODS:
A literature review was conducted in WHO world reports, Chinese government statistics, PubMed and Chinese databases WANFANG and VIP using the key terms “cesarean section”, “intrapartum management”, “psychological intervention”.

RESULTS:
The leading medical indications of CS in China were fetal distress, cephalopelvic disproportion, malpresentation, previous cesarean delivery, elderly primigravida and suspected macrosomia, which were comparable to the US data. Notably, cesarean delivery also occurred in 10-38.4% of the total CS number, largely resulting from sociological and psychological reasons, such as best outcome for one child family. Interventions to reduce CS in China include 1) Government and regional health commissions implementing incentives and regulations to set target CS rate limits for hospitals; 2) Prenatal patient education, focusing on understanding the course and mode of delivery; 3) Full intrapartum accompaniment by an experienced nurse or midwife.

CONCLUSION:
Reducing cesarean deliveries beyond medical necessity is a multifactorial, challenging task, faced by many countries, and is not limited to the US. China also is implementing initiatives to stem the high cesarean delivery rate.
Timely Discharge: Oral Nifedipine is Superior to Labetalol for Postpartum BP Control in Patients with Preeclampsia [27R]
Authors: Beatty Catherine A. , Dangel Alissa 
Published: April 2018

INTRODUCTION:
Postpartum BP is highest on days three to six postpartum, corresponding to the time when most women are preparing for hospital discharge. Elevated BP may delay hospital discharge. There is limited research guiding medication selection in postpartum patients with persistent hypertension in the setting of preeclampsia.

METHODS:
A retrospective study of consecutive patients at Tufts Medical Center from January 1, 2015 through December 31, 2015 with antepartum preeclampsia who were subsequently treated with oral medications for postpartum hypertension was performed. Time to achieve acceptable BP control (defined as sustained BP <160/110 mmHg requiring no further titration or additional medications) and discharge were compared between patients taking oral labetalol and nifedipine. Side effects and reevaluation for reported elevated BP were also evaluated.

RESULTS:
Patients started on oral nifedipine (n=11) had an average time from initiation of anti-hypertensive to acceptable BP control of 7.4 hours compared to 53.5 hours for patients started on labetalol (n=25) (P=0.013). No patients experienced side effects requiring a medication change. Three patients (3/25) in the labetalol group underwent reevaluation after discharge for poor BP control; no patients in the nifedipine group required reevaluation.

CONCLUSION:
Patients started on oral nifedipine in the postpartum period in the setting of preeclampsia achieved optimal BP control in a significantly shorter period of time than those started on labetalol, resulting in a significantly shorter hospital stay. Additional studies are needed to confirm these findings and determine whether nifedipine should be regarded as the preferred agent for postpartum hypertension in patients with preeclampsia.
Cost Effectiveness of Inpatient vs Outpatient Fetal Monitoring in Monochorionic-Monoamniotic Twin Gestations [30R]
Authors: Hickok Ruth A. , Walker Allison R. , Caughey Aaron B. 
Published: April 2018

INTRODUCTION:
To determine the cost-effectiveness of inpatient, continuous fetal monitoring versus outpatient management of monochorionic-monoamniotic (MCMA) twin gestations.

METHODS:
A decision-analytic model was created comparing continuous fetal monitoring versus outpatient daily nonstress test (NST) in a theoretical cohort of 250 MCMA pregnancies. The two arms were broken down based on gestational age beginning at 26 weeks gestation. All probabilities, utilities, and costs were derived from the literature. The primary outcome was the incremental cost per quality-adjusted life year (QALY). Rates of intrauterine fetal demise (IUFD), neonatal death, and cerebral palsy were also investigated. The cost-effectiveness threshold was set at $100,000 per QALY. Univariate and multivariate analyses were used to investigate model robustness.

RESULTS:
Inpatient continuous fetal monitoring results in improved neonatal outcomes and decreased cost. Compared to outpatient management, inpatient management would lead to 43 fewer cases of single IUFD, 7 fewer cases of double IUFD, 34 fewer neonatal deaths and 5 fewer neonates with cerebral palsy. Inpatient management improved effectiveness by 4.500 QALYs and saved $6.6 million (primary strategy improved outcomes). Inpatient management remained the dominant strategy as our estimated cost of per week was doubled to $8,325/week, and remained cost-effective up to five-times our estimated cost.

CONCLUSION:
Inpatient management is a cost-effective strategy for antenatal management of MCMA twin gestations that can reduce perinatal morbidity and mortality. Hospitalization of 5 patients would prevent an IUFD and 8 patients would prevent one neonatal death.
The Effect of Normotensive Antenatal Blood Pressure of Women with Chronic Hypertension on Neonatal Weight [31R]
Authors: Sander Sheigh , Goldkamp Jennifer , Vricella Laura , Rosenberg Henri 
Published: April 2018

INTRODUCTION:
Our objective was to determine if birth weight of infants of women with chronic hypertension is affected by range of antepartum blood pressure.

METHODS:
A retrospective chart review of patients with chronic hypertension at a single tertiary care center was completed. The difference in birth weight between women with mean antenatal blood pressures in the systolic range of <140 mmHg verses >140mmHg was assessed. A second analysis to assess mean antenatal diastolic blood pressure of <90mmHg versus >90 mmHg was completed. Chi squared analysis was utilized, with a P-value of <.05 used to indicate statistical significance.

RESULTS:
Data from 148 women with a diagnosis of chronic hypertension was analyzed. This analysis included both those taking antihypertensive medications and those who were not medicated. There was a significant difference in birth weight in normotensive (<140mmHg systolic or <90 mmHg diastolic) versus hypertensive pregnancies, with normotensive women bearing larger children. Median birth weight for those who had normotensive systolic blood pressures was 3,005g versus 2,450g for those who had hypertensive average systolic blood pressures (P=.008). Median birth weight was 2,997.5g for those with normotensive diastolic pressure averages versus 1,857.5g who were hypertensive (P<.001).

CONCLUSION:
Women with chronic hypertension in pregnancy deliver larger babies when blood pressures are in the normotensive range during the antepartum period.
Predictors of False Negatives in Self-Report Screening for Prenatal Substance Use [34R]
Authors: Blake-Lamb Tiffany , Ondersma Steven , Chang Grace , Gilstad-Hayden Kathryn , Yonkers Kimberly 
Published: April 2018

INTRODUCTION:
Substance use during pregnancy has known harmful effects for both the mother and fetus. Few substance use screening tools have been evaluated in pregnancy and only one has been validated against a biochemical assay. The current study sought to examine predictors of false negative screens using the most sensitive of five tested screeners.

METHODS:
In 2016-2017, women age 18 and over were recruited during prenatal care at three demographically diverse sites. Four existing substance use screeners with published evidence in pregnancy (SURP-P, CRAFFT, WIDUS, and 5Ps), plus the NIDA Quick Screen, were administered to pregnant women in counterbalanced order and followed by collection of urine that was tested for evidence of alcohol, tobacco, marijuana, opiates, cocaine, benzodiazepines, barbiturates, and amphetamines.

RESULTS:
Among 1,220 participating women, 397 (32.5%) had evidence of substance use per urine toxicology or self-report, with the SURP-P having the highest sensitivity (85%) but the lowest specificity (37%) for detecting use. Among women with evidence of substance use by urine toxicology or self-report, the odds of screening negative (false negative) on the SURP-P were higher for women with multiparity, lower educational attainment, Hispanic ethnicity, and those receiving public assistance.

CONCLUSION:
Substance use screening tools with relatively high detection rates during pregnancy may still miss use among clinically important groups of women. This is particularly true among multiparous and low-SES women who may have reason to under-report. Policies allowing safe disclosure to medical providers are desperately needed.
Prior Exam-Indicated Cerclage: Cervical Length Screening or History-Indicated Cerclage in the Next Pregnancy? [36R]
Authors: Roman Amanda , Saccone Gabriele , Pachtman Sarah , Cruz Yury , Rochelson Burton , Berghella Vincenzo 
Published: April 2018

INTRODUCTION:
To evaluate pregnancy outcomes of women with prior physical exam indicated cerclage (PEIC), who in the subsequent pregnancy were either followed by transvaginal ultrasound cervical length (TVU CL) screening or received a planned history-indicated cerclage (HIC).

METHODS:
This was a multicenter cohort study of singleton gestations with prior PEIC. We evaluated two pregnancies in the study subjects: first pregnancy with PEIC for membranes visible or cervical dilatation ≥1.0 cm at speculum exam in asymptomatic women and the subsequent pregnancy in which women received either TVU CL screening with ultrasound-indicated cerclage (UIC) if CL shortened to ≤25mm or planned HIC. The primary outcome was incidence of preterm birth (PTB) <37weeks.

RESULTS:
Of 32 singletons with PEIC in a prior pregnancy who met the inclusion criteria, 8 (25%) were followed with TVU CL screening, while 24 (75%) received HIC. Of the 8 women in the TVU CL group, 7 (87.5%) underwent UIC for CL≤25mm. There was no significant difference between the two groups in the incidence of PTB <37 weeks (37.5% vs 29.2%; aOR 1.46, 95% CI 0.27 to 7.82) and in the secondary outcomes in the TVU CL screening versus the HIC groups, respectively.

CONCLUSION:
Women with prior PEIC have similar outcomes if they receive either TVU CL screening with UIC for CL ≤25mm or planned HIC in the subsequent pregnancy. 87.5% of the women in TVU CL screening require a repeat UIC in the subsequent pregnancy.
Association of Antepartum Blood Pressure and Angiogenic Profile in Women With Chronic Hypertension [3OP]
Authors: Minhas Ruby , Perdigao Joana , Nasim Rabab , Mueller Ariel , Young Danielle , Rana Sarosh 
Published: April 2018

INTRODUCTION:
This pilot study explored the association between antenatal blood pressure (BP) and angiogenic biomarkers (sFlt and PlGF) at delivery among women with chronic hypertension (cHTN).

METHODS:
Blood samples were collected within 96 hours of delivery. Mean outpatient BP was stratified as controlled (cBP<140/90) or uncontrolled (uBP≥140/90). Angiogenic factors were measured on an automated platform. Descriptive statistics were assessed with Wilcoxon Rank Sum or chi-square tests, as appropriate. Logistic regression was employed to assess for adverse pregnancy outcomes.

RESULTS:
Of the 78 women enrolled, 58 (74.3%) were African American and 22 (28.2%) had uBP. There was no difference between cBP and uBP in age, race, ethnicity, BMI, smoking/substance abuse, parity, or previous preeclampsia (preE) diagnosis. A higher proportion cBP patients did not use a HTN agent (46.4% vs 13.6%, P=.01), although aspirin usage did not differ. Women with uBP had higher levels of sFlt1 and sFlt1/PlGF (sFlt: 4218.5 vs 3056.0 pg/mL, P=.046; sFlt/PlGF: 62.5 vs. 25.0, P=.04). A greater proportion of uBP vs. cBP patients had superimposed (SI) preE with severe features (preE-SF) (54.6% vs. 25.0%; P=.01), preterm delivery (40.9% vs. 10.7%; P=.002), and more admissions to rule out preE (77.3% vs. 30.4%; P=.0002). In the multivariable model, women with uBP had greater odds of preterm delivery (OR: 6.78; P=.01), SI preE (OR: 3.20; P=.03) and SI preE-SF (OR: 3.27; P=.04).

CONCLUSION:
Antepartum control of BP is associated with a favorable angiogenic profile at delivery and improved outcomes among women with cHTN. Larger studies are needed to confirm these findings.
Targeted Educational Interventions Increase Human Papillomavirus Vaccine Acceptability and Knowledge [7OP]
Authors: Cory Lori , Bogner Hillary , Burger Robert , Chu Christina , Ko Emily 
Published: April 2018

INTRODUCTION:
We sought to determine if targeted educational interventions can increase human papillomavirus (HPV) vaccine acceptability and knowledge among young women.

METHODS:
A randomized controlled trial of 256 women aged 12 to 26 at a single institution was completed. Women were randomized to one of three study arms: control (n=85), educational handout (n=84) or educational video (n=87). All subjects completed a survey collecting data on demographics, HPV vaccine preferences and HPV vaccine knowledge following completion of their randomization assignment. Student t test and chi-square tests were applied.

RESULTS:
Baseline age, race, socioeconomic status and gynecologic history were similar between arms. Post intervention, those who watched the video had higher acceptability for vaccination (51.7%) than the handout (33.3%) or control arms (28.2%) (P<.01). Those in the video arm also had higher mean HPV vaccine knowledge scores than those in the handout and control arms, respectively, post-intervention (5.7 vs 5.0 vs 2.8, P<.01). Vaccine acceptors were more likely to try to obtain all vaccinations (91.5% vs 75.3%, P<.01) and to recommend HPV vaccination to acquaintances (92.8% vs 43.3%, P<.01) than decliners. Both the video and handout arms reported that the interventions helped them learn (97.7% vs 93.1%, P=.15), but the video arm was more likely to be helpful for deciding about vaccination (86.4% vs 70.5%, P<.01).

CONCLUSION:
Targeted educational interventions increase HPV vaccine acceptability and knowledge among young women. Future studies may determine if these interventions also increase rates of vaccine uptake and series completion.
Effect of Delayed Cord Clamping Above Versus Below the Perineum on Preterm Neonatal Hematocrit [13OP]
Authors: Schakett Cassandra , Khan Amir , Berens Pamela D. 
Published: April 2018

INTRODUCTION:
The objective is to determine the difference in neonatal hematocrit when delayed cord clamping is performed above versus below the perineum.

METHODS:
Patients with anticipated preterm delivery between 30–36 6/7 weeks were randomized to 60 second delayed cord clamping either above or below the perineum after vaginal delivery. Primary outcome was difference in twenty-four hour neonatal hematocrit between groups. Secondary outcomes included Neonatal Intensive Care Unit (NICU) admissions, neonate's need for phototherapy or blood transfusion, one minute APGAR<4 and five minute APGAR<7.

RESULTS:
Of 103 patients consented to the study, 29 were ineligible prior to randomization and 13 did not complete to study. Sixty one patients completed the study (31 above and 30 below to perineum). There were no significant differences in maternal demographic characteristics or comorbidities. Mean gestational age was 35.5 (above) and 34.6 (below), P=.119. No statistical difference was found in neonatal hematocrit at 24-hours of life between the two groups; 51.5 above versus 52.6 below (P=.572). Correspondingly, none of the secondary outcomes were statistically different.

CONCLUSION:
When comparing delayed cord clamping above versus below the perineum in preterm deliveries greater than or equal to 30 weeks gestation, there is no difference in the neonatal hematocrit at 24 hrs of life or secondary neonatal outcomes. Delayed cord clamping can safely be performed above the perineum concomitant with skin to skin contact for vigorous preterm infants.
Nonspecific Tumor Markers in the Era of Value Based Medicine: Role of CA 19-9 in the Pelvic Mass Workup [18OP]
Authors: Underwood Jenny , Saeed Haleema , Chopra Vini , Hanna Rabbie 
Published: April 2018

INTRODUCTION:
When encountering an obscure pelvic mass, the usual tumor markers, CA 125 and CEA, are obtained to evaluate for the presence of ovarian and colon cancer. Some physicians order a CA 19-9 level and we do not know if this has clinical importance to assist in the diagnosis. Does this test offer valuable information or does it add confusion and additional workup when found to be elevated? Studies have shown that CA 19-9 elevation is associated with a fat component, and mesodermal tissue derivative, that is present in many various cancers.

METHODS:
3,370 women were retrospectively identified using CPT codes for pelvic mass and CA 19-9. Initial analysis reviewed the subspecialty of the primary investigator using CA 19-9 in their initial workup, and its correlation to a gynecologic pathology. In the cases where an OBGYN was the primary investigator additional tumor markers, age, race, menopausal status, imaging, surgical interventions and final pathology were further analyzed.

RESULTS:
Out of 3,370 women 982 had abnormal CA 19-9. The subspecialties that utilized CA 19-9 the most in their initial work up was Hematology Oncology 29.6%, Gastrointestinal 16%, and Internal Medicine 15.7%. Of the 9% of cases that Gynecologist that ordered CA 19-9, it was noted that 56% additionally ordered ultrasound and CT, while 14% ordered US, CT and MRI at the time of initial workup. Further analysis revealed that in both postmenopausal and premenopausal women with normal CA 19-9, compared to abnormal CA19-9 showed no statistical significance in distinguishing benign versus malignant etiology.

CONCLUSION:
Majority of adnexal masses are benign, the main goal of diagnostic evaluation is to exclude malignancy. Value based medicine is implemented to help improve health care quality, and efficient utilization of health care resources. Based on this retrospective analysis the use of CA 19-9 in evaluation of a pelvic mass does not offer information that directly improves patient outcome, but rather correlates to the increased misuse of health care resources.