bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can Body Mass Index Predict Metformin Failure in Women with Gestational Diabetes? [38I]
Authors: Persad Malini D. , Ou Jennie , Bernasko James , Garry David , Garretto Diana , Herrera Kimberly 
Published: April 2018

INTRODUCTION:
To determine if pre-pregnancy body mass index (BMI) predicts metformin failure in the treatment of 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 diabetes mellitus or initiated glyburide or insulin therapy. 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). Metformin failure was defined as the inability to obtain glycemic control despite utilization of the maximum metformin dosage or provider discretion. Maternal characteristics and BMI were collected from the hospital’s electronic medical record and compared between groups. Parametric and nonparametric statistical analyses were performed with a p value of < 0.05 as significant. The sensitivity and the specificity of BMI as a screening test for metformin failure were analyzed and the corresponding ROC curve was plotted to assess the performance of the test.

RESULTS:
A total of 139 women with gestational diabetes were identified, of which 21 (15%) failed metformin therapy. There were no differences in maternal demographics, BMI and BMI classifications between groups. The ROC curve revealed an optimal cut-off BMI to predict metformin failure of 38.7kg/m2 with a sensitivity 38.1 % and specificity 81.4% (AUC 0.56, p=0.236).

CONCLUSION:
Pre-pregnancy BMI may have limited utility in predicting metformin failure.
Obstetric Outcomes Associated with Maternal Syphilis Infection in U.S. Deliveries [4J]
Authors: Hersh Alyssa R. , Skeith Ashley E. , Clennon Emily K. , Caughey Aaron B. 
Published: April 2018

INTRODUCTION:
Syphilis infections affect millions of pregnant women worldwide every year. The recent epidemic in the United States necessitates further investigation into the adverse effects of syphilis infection during pregnancy. Our goal was to examine the association of maternal syphilis infection with adverse pregnancy outcomes.

METHODS:
This was a retrospective cohort study that included 10,483,736 women with singleton gestations delivering in the United States from 2011 through 2013. Simple proportions of obstetric complications were compared between pregnant women infected with syphilis and controls. Chi square tests and multivariable regression were used for statistical analysis, with p<0.05 as the cut-off for significance. Comparisons were controlled for co-infection, parity, congenital abnormality, and maternal race and ethnicity, age, education attainment, cigarette use, and weight.

RESULTS:
A total of 7,148 pregnancies in this analysis were complicated by maternal infection with syphilis. Infection was positively associated with gestational diabetes (adj. OR: 1.33), gestational hypertension (1.36), caesarean section (1.15), maternal ICU stay (2.17), preterm delivery (1.13), NICU stay (1.74), neonate ventilator use for longer than 6 hours (1.37), and congenital abnormality (1.49).

CONCLUSION:
Syphilis infection in pregnancy is associated with increased odds of several adverse obstetric outcomes and increased health care system costs. Although it has been demonstrated that screening pregnant women for syphilis to reduce adverse outcomes is cost-effective, further research is necessary to investigate the detailed mechanisms of morbidity.
Influence of Sexually Transmitted Diseases in Pregnant Adolescents on Preterm Delivery and Chorioamnionitis [5J]
Authors: Fuchs Esther , Dwiggins Maggie , Lokken Erica , Eckert Linda 
Published: April 2018

INTRODUCTION:
Adolescents have increased preterm birth (PTB) and sexually transmitted infections (STIs). However, data of the impact of STIs on PTB and other infectious complications is lacking. We examined the prevalence and impact of STIs (Gonorrhea, Chlamydia and Trichomonas) on PTB and chorioamnionitis in pregnant adolescents.

METHODS:
This retrospective cohort study included patients ≤19 year old at delivery over a 5-year period in an urban hospital. Each adolescents first singleton pregnancy during the study period was included. Logistic regression was used to estimate odds ratio (OR) and 95% confidence intervals (CI) of the association between STIs and pregnancy outcomes. We controlled for potential confounding factors. Chorioamnionitis was diagnosed clinically and histologically.

RESULTS:
Of the 975 babies delivered to adolescent mothers, 739 deliveries were included in our final analysis. Overall prevalence of STIs during pregnancy was 16.5% (Chlamydia 13.1%, Trichomonas 3.7% and Gonorrhea 3.1%). Our PTB rate was high, 18.1%, (15.02% when excluding transfers from outside the two closest counties). Chlamydia, Trichomonas and Gonorrhea were not associated with increased PTB. While Gonorrhea and Chlamydia did not increase the odds of chorioamnionitis, infection with Trichomonas was associated with a statistically significant 3-fold increased likelihood, OR 2.95 (95%CI 1.29, 6.75).

CONCLUSION:
We did not find an association between STI and preterm delivery in adolescent patients who had a high PTB rate, possibly secondary to early detection and treatment. However, Trichomonas markedly increased chorioamnionitis risk, especially diagnosed on pathologic specimens. These data support routine screening of all pregnant teenagers for Trichomonas.
Depression Screening in Early Pregnancy and Associations With Pregnancy Outcomes Among a Diverse Cohort [32J]
Authors: Lundsberg Lisbet , Schwarz Eleanor Bimla , Gariepy Aileen M. 
Published: April 2018

INTRODUCTION:
Depression is a common perinatal occurrence, yet research regarding how early depression can be identified and whether it differs by pregnancy outcome (delivery/abortion) is limited.

METHODS:
English- or Spanish-speaking women, aged 15–44, <24 weeks gestation seeking pregnancy testing or abortion care were enrolled in a prospective cohort study from 2014 to 2015. The Edinburgh Depression Scale (EDS) assessed depression at enrollment and 3 months later. Participants with positive depression screen (EDS ≥13) received mental health referral. Pregnancy outcomes were assessed via phone interviews and medical chart review. Women with miscarriage were excluded from this analysis.

RESULTS:
Among 100 participants with complete EDS data, women averaged 26.8 (±6.3) years and 9.3 (±4.6) weeks gestation. Seventy-nine percent presented for walk-in pregnancy testing; 21% for abortion. Participants were culturally diverse: 48.0% Hispanic, 30.6% Black, non-Hispanic, 14.3% White, non-Hispanic and 7.1% multiracial. Most (66%) continued pregnancy, 44% chose abortion. At enrollment, 21% screened positive for depression, and women choosing delivery (17%) were not statistically different from women choosing abortion (29%) (P=.138). At 3-month follow-up, 18% screened positive for depression; no difference was observed between women choosing delivery (14%) compared to abortion (27%) (P=.114). The overall proportion of women with a positive screen for depression remained stable from enrollment to 3-month follow-up (P=.549), and remained stable among women choosing delivery (P=.727) and abortion (P=>.999).

CONCLUSION:
Antenatal depression is common amongst women early in pregnancy, whether choosing delivery or abortion. Early screening may provide opportunities for early interventions. Future research should test early interventions.
Surgical Management of Placenta Percreta: Outcomes of Immediate Versus Interval Hysterectomy [33J]
Authors: Weidenbaum Emily , Cham Stephanie , Breslin Noelle , Huang Yongmei , Burke William , Perez-Delboy Annette 
Published: April 2018

INTRODUCTION:
To compare the outcomes of women with placental percreta (PP) who underwent immediate hysterectomy (IMM) to those with conservative management with delayed, interval hysterectomy (INT).

METHODS:
A retrospective review with a cohort between 2011 and 2017 of cases with abnormal placentation (AP) diagnosed with US/MRI. Patients were delivered with a massive transfusion protocol and a multidisciplinary accreta team. Estimated blood loss (EBL), length of stay (LOS), and other complications were compared using SAS.

RESULTS:
Of our cohort of 93 patients with AP, 20 (22%) had pathologically confirmed PP. Eleven (55%) women underwent IMM; 9 (45%) underwent INT. The median gestational age at delivery was 35 versus 34 for IMM versus INT (P=.97). The IMM group was more likely to have an emergent procedure compared to the INT group (27.3% versus 11.1%; P=.59). Median EBL for IMM was 2,800 mL (range 1,200–25,000 mL) versus 1,000 mL (range 300–3,700 mL) for INT group (P<.01). Median LOS in IMM versus INT was 15 versus 7 days (P=.34). There was a trend towards a higher rate of transfusion (100% versus 44%; P<.01) and cystotomy (45% versus 11%; P=.16) for IMM versus INT. The rate infection (0% versus 11%; P=.45) were similar for IMM compared to INT.

CONCLUSION:
Compared to IMM, conservative management with INT is associated with decreased EBL and a trend towards lower rates of transfusion and cystotomy than IMM in PP. There was a trend towards increased rate of infection with INT.
Wound Disruption Following Cesarean Delivery in Women With Class III Obesity, a Retrospective Observational Study [36J]
Authors: Sagi Yair , Maxwell Cynthia , Snelgrove John , D'Souza Rohan , Vernon James 
Published: April 2018

INTRODUCTION:
Class III obese women are at increased risk for wound complications following cesarean delivery (CD). We evaluated the CD wound disruption rate in women with class III obesity, and identify underlying risk factors.

METHODS:
Class III obese women who underwent CD >24 weeks of gestation at our hospital, between 2011 and 2015 were included. Data on demographics, clinical history were collected. Information regarding the CD included and also Information regarding the perioperative period. Multivariable logistic regression analysis was performed to identify risk factors likely to contribute to higher wound disruption rates.

RESULTS:
Three hundred thirty-four cases of class III obese women, with mean age 32.96+5.19 and mean BMI of 48.20+7.52. The most frequently used skin incision was Pfannenstiel (75.6%). The subcutaneous tissue was most likely to be closed (65.4%). The skin was most likely to be closed with staples (66%) with the use of a pressure dressing (65%). DVT prophylaxis was administered in 71.7% of cases. We had 18% wound disruption rates. Wound disruption rates were higher if surgical time was >1 hour (odds ratio [OR]=2.03, 95% confidence interval [CI] 1.13–3.65, P=.017) and if DVT prophylaxis was used (OR=2.22, 95% CI 1.08–4.59, P=.031). On multivariable logistic regression, surgical time >1 hour (OR=1.88, P=.050), but not DVT prophylaxis (OR=1.64, P=.22) remained statistically significant.

CONCLUSION:
We found that surgical time >1 hour was the only statistically significant risk factor for wound disruption. We had 18% wound disruption rates. The role of other risk factors, in particular the use of DVT prophylaxis warrants further investigation.
Placenta Previa and Congenital Cardiac Anomalies [37J]
Authors: Aalami-Harandi Pegah , Akinola Damilola , Barton John , Khoury Aldo 
Published: April 2018

INTRODUCTION:
Several studies have shown an association between placental abnormalities and neonatal complications such as major congenital abnormalities, respiratory distress syndrome, intrauterine growth restriction and preterm delivery. With increased incidence of Placenta Previa due to the increase in cesarean deliveries, advanced maternal age and multiparity, we sought to investigate an association between Placenta Previa and congenital heart disease (CHD), which in the general population occurs in 1% of live born infants.

METHODS:
A retrospective chart review was performed to assess possible association between all births with Placenta Previa and infants with congenital heart disease who delivered at St. Joseph Regional Medical Center from 2005 to 2015. In addition, placental location was reviewed for each mother who delivered an infant with CHD, over the past 10 years.

RESULTS:
For the study period, there were 321 mothers with diagnosed Placenta Previa at delivery and 2 infants had CHD (0.6%, P=.497). Furthermore, of the 202 infants with CHD, 13 of the mothers had abnormal placental location (Placenta Previa, marginal or low lying placenta) early in gestation (6.4%).

CONCLUSION:
Placenta Previa at delivery is not associated with newborn diagnosis of congenital heart disease. Abnormal placental location in early gestation however could be associated with CHD. This finding may be due to other confounding factors associated with abnormal placental location in early gestational age.
Using Lean Methodologies to Improve Efficiency in an Outpatient OB/GYN Setting [4K]
Authors: van Nes Jaclyn 
Published: April 2018

INTRODUCTION:
Lean methodologies have been used in business, particularly automotive manufacturing, since the 1980's. Key concepts include just in time inventory, elimination of waste or muda, and quality improvement by focusing on customers and employees. The technique has also been applied in healthcare, particularly emergency rooms, however, data is limited in OB/GYN settings. This article focuses on a lean project in Knoxville, Tennessee.

METHODS:
Women's Specialty Care, a group of general OB/GYN academic specialists, needed to increase physician numbers in 2015. Four additional physicians were hired doubling the number of the physicians in less than 6 months. An issue arose with how to accommodate eight physicians with resources designed for four. A lean project began in early 2016. Inventory storage was organized and evaluated for overstocking. A standardized restocking system was implemented for exam rooms. Front office space was cleaned and waste eliminated. A patient flow analysis was performed and the office restructured. As staff became more involved in the process, they developed an improved check in system saving staff about 2 hours per day.

RESULTS:
After the 10 month project, all physicians could see patients in the existing space with no additional staff. Patient throughput at the main office improved from approximately forty to seventy patients per day. Additionally, staff morale improved.

CONCLUSION:
In this example, lean techniques were used to improve efficiency in an outpatient OB/GYN setting with excellent results. Lean events should be used and evaluated in other OB/GYN settings to see if the concept is effective in this specialty.
Impact of a Novel Protocol for Management of Pregnancy-Related Iron Deficiency Anemia [7K]
Authors: Reimers Rebecca , Achebe Maureen , Cortes Sarai , Smith Nicole 
Published: April 2018

INTRODUCTION:
Iron deficiency anemia is associated with risk of transfusion, preterm delivery, and cesarean birth. We aimed to optimize management of iron deficiency anemia with a novel protocol.

METHODS:
A multidisciplinary team developed an evidence-based treatment protocol for anemia in pregnancy. Resident and maternal fetal medicine (MFM) practices in a tertiary care center implemented this in October 2016. Two weeks of iron supplementation without 1g/dL hemoglobin increase prompted hematology consultation. Protocol adherence in five fields and rates of anemia in the third trimester and at delivery were compared between sites using Fisher exact and χ2 tests.

RESULTS:
Rates of third trimester anemia were significantly higher in the resident practice (29%) than MFM (15%), P=.03. Term anemia rates were similar (31% and 27%). Rates of iron supplementation in resident patients varied from 50% to 100%, and in MFM from 75% to 100%. Referral to hematology for consideration of iron infusion rates were similar between groups (20% versus 30%), P=.68, as were rates of iron infusion (11% versus 25%). Protocol adherence was inconsistent.

CONCLUSION:
Adherence to a novel pregnancy-related anemia protocol was inconsistent and did not result in a decline in iron deficiency anemia at term. Further investigation is necessary to determine whether protocol adherence could improve rates of anemia.
Does Labor Induction in Nulliparous, Term, Singleton and Vertex Pregnancies Increase the Risk of Cesarean Delivery? [12K]
Authors: Gulersen Moti , Bornstein Eran , Baum Stephanie R. , Krantz David , Minior Victoria , Divon Michael 
Published: April 2018

INTRODUCTION:
Efforts have been made to reduce the rate of cesarean delivery in nulliparous, term, singleton, vertex (NTSV) pregnancies. We set out to evaluate whether labor induction in this patient population is associated with an increased risk of cesarean delivery.

METHODS:
A meta-analysis was performed analyzing fourteen randomized controlled trials that met inclusion criteria. These included all randomized controlled trials of NTSV patients with intact or ruptured membranes that were randomized to induction of labor or control (i.e. expectant management). The primary outcome was the incidence of cesarean delivery. Secondary outcomes included incidence of cesarean delivery after induction of labor in ruptured versus intact membranes, as well as incidence of NICU admission. Results were reported as odds ratio (OR) with 95% confidence interval (CI).

RESULTS:
A total of 2,706 patients were analyzed. NTSV gestations undergoing induction of labor had a similar incidence of cesarean delivery compared to controls (24.6% versus 24.6%; OR 1.095; 95% CI 0.89–1.34). Rates of cesarean delivery in patients with intact membranes (28.7% versus 30.2%; OR 1.041; 95% CI 0.81–1.32) and ruptured membranes (15.1% versus 11.9%; OR 1.321; 95% CI 0.88–1.98) undergoing induction were also similar. Likewise, the incidence of NICU admission associated with labor induction was not statistically different compared to control group (6.3% versus 6.9%; OR 0.928; 95% CI 0.59–1.46).

CONCLUSION:
Hospitals are incentivized to reduce the rate of cesarean sections in NTSV pregnancies. Patients, practitioners and hospitals can be assured that labor induction in this population does not increase the risk of cesarean delivery or NICU admission.
The Impact of Perinatal Depression on Breastfeeding Rates [15K]
Authors: Stark Elisabeth , Shim Jessica , Ross Carolyn , Miller Emily Stinnett 
Published: April 2018

INTRODUCTION:
Perinatal depression complicates 1 in 7 pregnancies and has adverse consequences when untreated. These may include failure to breastfeed and its known adverse effects on mother and offspring. This study sought to determine whether maternal antenatal depression was associated with the likelihood of breastfeeding initiation and continuation until the 6-week postpartum visit.

METHODS:
This retrospective chart study included all deliveries after 20 weeks gestation at a single tertiary care institution between 2008 and 2015 with a documented antenatal depression screen using the Patient Health Questionnaire-9 per standard obstetric care. Breastfeeding initiation and continuation until 6 weeks postpartum were compared between women with and without a positive screen using bivariable analyses. Stepwise backwards elimination regressions were used to identify whether antenatal depression was independently associated with breastfeeding initiation and continuation.

RESULTS:
Of 2,871 women meeting inclusion criteria, 302 (10.5%) screened positive for antenatal depression. Women with antenatal depression were more likely to be younger, a racial/ethnic minority, obese, have public insurance or medical co-morbidity, and deliver preterm than women without depression. Women with antenatal depression were less likely to initiate breastfeeding (81.0% versus 86.3% P=.014) and continue breastfeeding at 6 weeks postpartum (54.7% versus 68.9% P<.001). After controlling for confounders, antenatal depression was not independently associated with breastfeeding initiation (aOR 0.78, 95% CI 0.52–1.16) but did remain significantly associated with reduction in breastfeeding continuation (aOR 0.67, 95% CI 0.48–0.96).

CONCLUSION:
Antenatal depression is a significant risk factor for early breastfeeding cessation. Further interventions to improve breastfeeding rates should include evaluation of maternal mental health.
Postpartum Readmissions: What We Can Learn From Numbers? [18K]
Authors: Nasab Susan Hosseini , Moussa Hind N. , Alrais Mesk A. , Sibai Baha M. , Blackwell Sean C. 
Published: April 2018

INTRODUCTION:
Unplanned hospital readmissions can be considered as a quality indicator for hospital care. Our objective was to describe the risk factors and indications for post-partum readmissions.

METHODS:
This is an observational study of prospectively collected data at one tertiary hospital. Patients were identified during obstetric safety rounds and physician board checkouts during 17 months.

RESULTS:
Over period of 17 months, we had 7,126 deliveries, including 4,156 vaginal and 2,970 cesareans. Study group consisted of 106 patients with total 111 post-partum readmissions, with overall readmissions rate of 1.55%. Main indications for readmissions were: hypertensive disorders (43.2%) and wound complications (18.0%). Among 47 women who were readmitted for hypertensive disorders, 19 (40%) had de-novo onset of preeclampsia, versus 28 (60%) who had a history of hypertensive disorders. Among those 19 women with de-novo onset of preeclampsia, risk factors were obesity (BMI>30) (12), history of hypertensive disorders in previous pregnancies (4), nulliparity (4), gestational diabetes mellitus (2) and twin pregnancy (1). Eighteen patients were readmitted for surgical wound complications with 20 total readmissions. Twelve of 18 had repeat cesarean. For these women, risk factors for wound infection were obesity (BMI>30) (13), prolonged labor before cesarean delivery (5), history of diabetes (4), and steroid administration (7).

CONCLUSION:
Developing protocols and improvement strategies that focus on risk factors with close surveillance and postpartum follow-ups in those identified as high-risk patients, might be a valuable key to reduce readmission rate. Reducing readmission rate gives a valuable opportunity to healthcare facilities to improve patient satisfaction and safety.