bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management Strategies for Second Trimester Morbidly Adherent Placenta: An Academic-institution Study [4P]
Authors: Cui Ran , Bai Huimin , Zhang Zhenyu 
Published: April 2018

INTRODUCTION:
To investigate and evaluate the clinical management strategies and outcomes of second trimester morbidly adherent placenta (MAP).

METHODS:
The medical records of patients with MAP who were diagnosed prenatally or after a terminated pregnancy in the second trimester in the past 10 years were retrospectively reviewed.

RESULTS:
A total of 50 patients were included in this analysis. A prenatal diagnosis was suggested in 29 patients, whereas the remaining 21 patients were diagnosed after termination in the second trimester. Expectant management (i.e., extending the gestational period as long as possible) was employed in 29 patients who were diagnosed prenatally. Eight patients failed to prolong their gestation and underwent pregnancy termination in the second trimester, and the remaining 21 (72.4%) women delivered in the third trimester. The neonatal mortality rate was 11%. For the 29 patients who underwent termination in the second trimester, subtotal hysterectomy was performed in 3 patients for life-threatening bleeding during the cesarean operation. Conservative management (i.e., leaving the placenta in situ) was applied in the remaining 26 patients. With the application of adjuvant treatments, including uterine artery embolization and medication, followed by curettage under ultrasound guidance, the implanted placenta passed out 76.6 (range: 19 to 192) days after termination. Uterus preservation was achieved in all 26 patients without severe

CONCLUSION:
Expectant management may be preferred for most patients with second trimester MAP under close monitoring throughout pregnancy. Conservative management may be a feasible therapeutic option for patients who underwent termination in the second trimester to preserve future fertility.
Detection of Non-trisomy Abnormalities in Chromosomes 13, 18, and 21 [6P]
Authors: Cacheris Phillip , Boomer Theresa , McCullough Ron , Caldwell Samantha , Donnenfeld Alan , Almasri Eyad 
Published: April 2018

INTRODUCTION:
Non-invasive prenatal testing (NIPT) has become a mainstay of managing high-risk pregnancies, with the vast majority of testing targeting chromosomes 13, 18, 21, X, Y. NIPT traditionally reports trisomies of aforementioned autosomes; however, other abnormalities are encountered, including but not limited to, partial deletions, duplications, monosomies, many times producing non-reportable results. Presented are five cases showing non-trisomy abnormalities of chromosomes 13, 18, 21 which may have clinical impact.

METHODS:
Maternal blood samples submitted to Sequenom Laboratories® for MaterniT® 21 PLUS testing were subjected to DNA extraction, library preparation, and whole genome massively parallel sequencing.

RESULTS:
Case 1: NIPT demonstrated 13q21.1-q34 deletion. Amnioarray showed contiguous loss of heterozygosity/uniparental disomy: 13q21.1-q34. Case 2: NIPT demonstrated maternal 18p deletion. Maternal karyotype: mosaic deletion 18p11.32-11.21;previous child with 18p deletion. Case 3: NIPT demonstrated 18p duplication. Newborn blood karyotype: 47,XY,+18,i(18)(p10),r(18)(p11.2q23) [17]/46,sl, -r(18) [3]. Case 4: NIPT demonstrated 1 Mb duplication in Down syndrome critical region, likely of maternal origin. Maternal and fetal karyotype with microarray: 21q22.12-q22.13 duplication (900 kb). Case 5: NIPT demonstrated 21q11.2-q21.1 duplication. Amniotic fluid karyotype showed 47,XY,+mar with aCGH showing gain: 21q11.1-21.1.

CONCLUSION:
NIPT findings were communicated to the clinicians with specific recommendations for diagnostic follow-up, as many of these findings would (and did) elude standard karyotype analysis. Most NIPT is limited to whole trisomies of these chromosomes, resulting in non-reportable or misleading reports confounding clinical assessment. Six years into clinical NIPT, the ability to discern subchromosomal events, in addition to trisomy, is essential for providers looking to maximize NIPT clinical utility.
Tdap Vaccine Knowledge and Acceptance Rates during Pregnancy in a Los Angeles Public Teaching-Hospital Clinic [7P]
Authors: Kim Angela , Schiller Andrew , Mellon Michelle , Nelson Anita L. , Stohl Hindi E. 
Published: April 2018

INTRODUCTION:
Though the prevalence of pertussis is on the rise, only 35% of pregnant women in California with public insurance reported receiving the tetanus, diphtheria and pertussis vaccine (Tdap). The Tdap vaccine has been shown to reduce the risk of neonatal pertussis by 78% if mothers received it in the third trimester. This study evaluates pregnant women’s knowledge about the Tdap and its acceptance rate during pregnancy.

METHODS:
After IRB approval was obtained, pregnant women receiving prenatal care at a public teaching-hospital clinic were individually interviewed from June to August 2017 about their knowledge of vaccines during pregnancy. Interviews were conducted in English or Spanish. Women who already received the Tdap were excluded. The clinic’s Tdap acceptance rate was obtained through chart review.

RESULTS:
Among 152 pregnant women who had not yet received the Tdap during the current pregnancy, 80(53%) had never heard of the vaccine. An additional 53(35%) had heard of the vaccine but could not identify why the vaccine was recommended in pregnancy. Forty-eight percent of these women were either undecided at the time of their interview or did not plan to get the Tdap. In contrast, the Tdap acceptance rate in the third trimester in this clinic was 84%.

CONCLUSION:
The majority of pregnant women in a low-income clinic have limited understanding of the importance of the Tdap during pregnancy. Interestingly, most pregnant women in this population nonetheless received the vaccine. Educational initiatives about the Tdap may improve patients' knowledge and help them become more informed in their pregnancy-related decisions.
Does a History of IUD Contraceptive Usage Affect Placental Location in Future Pregnancies? [9P]
Authors: Bergh Eric P. , Duncan Sarah , Pan Stephanie , Overbey Jessica , Stone Joanne , Ferrara Lauren 
Published: April 2018

INTRODUCTION:
It is unknown how a history of prior IUD usage affects future pregnancy implantation outcomes. Our objective is to determine the impact of prior IUD usage on placentation and obstetric outcomes in subsequent pregnancies.

METHODS:
Retrospective matched cohort study, where one group of patients had placement of an IUD at Mount Sinai in the last 7 years (2010-2016) prior to a pregnancy and one group with no history of IUD usage. Patients are matched 2:1, two no IUD placements for each IUD patient. They are matched by parity, unit in which they received care, and delivery time (±3 days). Outcomes were obtained via chart review.

RESULTS:
1736 patients underwent IUD placement during the study period, of which 71 subsequently had their device removed, became pregnant and delivered. Four patients were removed from the analysis: 2 delivered at outside institutions, a patient with a 14 week loss and a patient with a twin pregnancy. In all, 67 patients had a subsequent singleton pregnancy outcome beyond 20 weeks. There were no significant differences in placental location nor in the incidence of low lying placenta or placenta previa. Secondary outcomes of EBL, fetal weight, and mode of delivery did not differ. Finally among 43 patients for whom the duration of IUD usage was known, there was no evidence of an association between either duration of IUD usage nor duration of time from removal to delivery on placental outcomes.

CONCLUSION:
History of IUD usage does not appear to affect the location of placentation in future pregnancies.
Late Preterm Steroids and Peripartum Maternal Infection at a Single Center [14P]
Authors: Chen Ellison , Uquillas Kristen , Lee Richard , Ihenacho Ugonna , Cortessis Victoria , Barton Lorayne 
Published: April 2018

INTRODUCTION:
Antenatal corticosteroids (ACS) are commonly administered to pregnant women at risk of delivery before 34 weeks to enhance fetal lung development. Following the Antenatal Late Preterm Steroids (ALPS) trial in 2016, this practice was extended to mothers at risk of delivering in the late preterm period (34 0/7 to 36 6/7 weeks). However, corticosteroid use is known to predispose patients to infection. This study aims to investigate whether women given late preterm ACS at our center were at increased risk of chorioamnionitis or endometritis, or had prolonged postpartum hospitalizations.

METHODS:
A retrospective chart review identified all LAC+USC patients who based on the ALPS trial were eligible for late preterm ACS between February 2015 and July 2017. Maternal outcomes were compared using Student’s t-test for continuous data and Pearson’s chi-squared test for categorical data. Significance was defined as a P-value <0.05.

RESULTS:
Of 194 mothers found to eligible, 67 (34.5%) received ACS. The incidence of chorioamnionitis or endometritis was not significantly different between those who did and did not receive ACS, respectively (1.5% vs. 6.3%, p = 0.13). ACS recipients did not have significantly different postpartum length of stays compared to those who did not receive ACS (3.7 ± 1.1 vs. 3.7 ± 1.1 days, p = 0.88).

CONCLUSION:
At LAC+USC, mothers who received late preterm ACS did not appear to experience greater risk of peripartum maternal infections, and ACS administration in the late preterm period did not appear to alter postpartum recovery time.
Periviable Preterm Birth: A Descriptive Study of Deliveries from 2011-2017 [16P]
Authors: Lynch Tara , Drennan Kathryn 
Published: April 2018

INTRODUCTION:
The rate of preterm birth in 2015 was 9.63% in the United States, which includes a smaller subset of periviable pregnancies. These neonates have a wide range of morbidity and mortality resulting from severe prematurity.

METHODS:
We performed a descriptive study of neonates delivered at an academic hospital with a level IV NICU from 2011 to 2017. All neonates delivered at 22-25 6/7 weeks gestation were included. Subjects were identified using NICU and birth certificate databases.

RESULTS:
A total of 212 neonates were included. 21.7% did not have active resuscitation and 2.4% of neonates did not require intubation in the delivery room. Survival was 0% at 22 weeks, 47.5% at 23 weeks, 76.4% at 24 weeks and 88.1% at 25 weeks. (p<0.0001). When stratified based on exact gestational age of delivery there was a linear trend that was observed with survival increasing and neonatal death decreasing with increasing gestational age but this did not reach statistical significance (p=0.31). Finally, there was a decreasing rate of vaginal delivery (100.0% at 22 weeks, 60.0% at 23 weeks, 32.8% at 24 weeks and 29.8% at 25 weeks) and increasing rate of cesarean delivery (0.0% at 22 weeks, 40.0% at 23 weeks, 67.2% at 24 weeks and 70.3% at 25 weeks) with increasing gestational age (p<0.0001).

CONCLUSION:
We observed a high rate of survival with periviable preterm birth. As the survival rate of periviable neonates continues to increase, further information on the prediction of survival and risks associated with mode of delivery are needed.
Management of Perinatal Iron Deficiency Anemia: A Retrospective Review of a Community Based Intervention [18P]
Authors: Fernandes Samantha , Darbinian Jeanne , Postlethwaite Debbie , Shirazi Aida , Mandel Sarah 
Published: April 2018

INTRODUCTION:
Unresolved iron-deficiency anemia in pregnancy contributes to maternal and neonatal morbidity, which may be preventable by iron administration. Kaiser Permanente San Francisco (KPSF) Perinatal Anemia Management Program (PAMP) developed a comprehensive algorithmic approach to identify and treat iron-deficiency anemia. A retrospective observational study was conducted to assess the impact of PAMP on peripartum anemia prior (1/2012-6/2013), during (9/2013-2/2015) and after (3/2015-8/2016) its implementation.

METHODS:
Iron-deficient anemic pregnant women delivering at KPSF were identified during the above time periods and divided into cohorts who received prenatal care at KPSF, exposed to PAMP versus KPSF satellites, not exposed to PAMP. Data for 2nd, 3rd trimester and delivery hemoglobin values, parenteral iron administrations and blood transfusions were electronically extracted and analyzed using Chi-square statistics, t-tests, ANOVA, and non-parametric tests to compare differences among groups.

RESULTS:
The mean % change in hemoglobin was significantly higher during-PAMP and post-PAMP among women receiving prenatal care at KPSF compared to women who received prenatal care at satellites (PAMP: 14.6 vs. 12.7, p<0.01; post-PAMP: 15.2 vs. 13.1, p<0.01). The number of KPSF women receiving parenteral iron was highest during PAMP (n=63) and remained constant for satellite women for the three time periods (n=4). Finally, the number of blood transfusions sequentially decreased by period regardless of place of prenatal care (pre-PAMP: n=25, PAMP: n=13, post-PAMP: n=11).

CONCLUSION:
The PAMP comprehensive approach was associated with improvements in peripartum iron-deficiency anemia, increased parenteral iron administration and a decrease in blood transfusions. Implementation of similar programs may in turn lower maternal and neonatal morbidity.
Does Mode of Delivery Impact Cervical Dysplasia Progression? [25P]
Authors: Baur Anna R. , Isaacs Christine 
Published: April 2018

INTRODUCTION:
For many women, prenatal care represents the most likely opportunity to access health care and thus, is an ideal time to screen for cervical dysplasia and counsel appropriately. Prior studies show that delivery can increase the rates of regression of cervical dysplasia, however, few studies have looked into whether the mode of delivery (vaginal vs. cesarean) impacts the course of cervical intraepithelial neoplasia (CIN).

METHODS:
A retrospective chart review at an urban academic hospital was preformed from 2009-2014 searching by ICD-9 codes for pregnancy, delivery, and cervical dysplasia. We compared antepartum and postpartum cervical cytology and pathology of 149 patients following cesarean versus vaginal delivery.

RESULTS:
Two statistical analyses were performed. In the first analysis, we used the colposcopy result when available and the pap result only when no colposcopy report existed. Normal and LSIL/CIN 1 was classified as low grade dysplasia while HSIL/CIN 2/CIN 3 was classified as high grade dysplasia. We compared outcomes of pre- and post-delivery pathology with respect to vaginal delivery vs. cesarean delivery. Our results showed no statistical significance with dysplasia changes (regression or progression) based on mode of delivery. Our secondary analysis used mathematical extrapolation of the data when a pap screening or colposcopy result was missing either antepartum or postpartum. Overall, progression of dysplasia was more common than regression, regardless of mode of delivery (p=0.095 for CD, p=0.022 for VD).

CONCLUSION:
Vaginal versus cesarean route of delivery does not impart a statistically significant influence or advantage on overall cervical dysplasia regression rates.
Does an Upward Trend in Fetal Weight Predict Large-for-Gestational Age in Pregnancies Complicated by Diabetes? [30P]
Authors: Beddow Meghan E. , Blue Nathan R. , Savabi Mariam , Katukuri Vivek R. , Chao Conrad R. 
Published: April 2018

INTRODUCTION:
Determine whether an upward trend in estimated fetal weight (EFW) percentile predicts large-for-gestational age (LGA) at birth in women with diabetes.

METHODS:
We reviewed deliveries at our institution from January 1, 2013 to March 31, 2017. We included well-dated, non-anomalous, singleton pregnancies with gestational or pre-gestational diabetes mellitus with ≥2 measured EFWs who delivered at term. EFWs and percentiles were calculated using the Hadlock formulas. The differences in EFW percentiles between two consecutive exams were calculated and receiver-operator characteristics plotted to identify the optimal threshold to predict LGA. LGA was defined as birth weight >90th percentile. We compared the rates of LGA in pregnancies with an upward-trending EFW percentile to those without using Chi square.

RESULTS:
We analyzed 235 pregnancies, with an LGA rate of 12.8% (n=30). Using the receiver-operator characteristics, we defined an “up-trending EFW” as an increase of ≥15 percentile points. To predict LGA, this cutoff had a sensitivity of 70% (95% confidence interval [CI] 50.6-85.3), specificity 51.7% (95% CI 44.6-58.7), positive predictive value 17.5% (95% CI 13.9-21.8), and negative predictive value 92.2% (95% CI 87.0-95.4), with a positive likelihood ratio of 1.45 (95% CI 1.1-1.9). The rate of LGA at birth among fetuses with an up-trending EFW was 17.5%, versus 9% for those without (p= 0.03).

CONCLUSION:
In pregnancies complicated by diabetes, an up-trending EFW percentile indicates an increased risk for LGA at birth.
Late Third Trimester Ultrasound Improves Accuracy of Predicted Birthweight in Women with Class III Obesity [32P]
Authors: Reforma Liberty , Teefey Christina Paidas , Durnwald Celeste P. , Srinivas Sindhu , Sammel Mary , Wang Eileen 
Published: April 2018

INTRODUCTION:
Optimal timing of third trimester (3rd tri) ultrasound in the obese population is unclear. Later scans are technically difficult while earlier scans may not reflect clinical changes closer to term. We compared the accuracy of early versus late 3rd tri ultrasounds in predicting actual birthweight (BW) in women with class III obesity.

METHODS:
A retrospective chart review of women with a pre-pregnancy BMI>40kg/m2 who underwent both an early (28w0d-34w6d) and late 3rd tri scan (35w or greater) was performed. Subjects delivered at two urban tertiary centers. The gestation-adjusted projection method calculated a predicted BW (pBW) using the ultrasound EFW to allow for comparison with actual BW. Paired t-tests compared absolute BW error and percent error. McNemar’s test compared the proportion within 15% of actual BW between scans.

RESULTS:
189 women were included. The difference between pBW and actual BW was similar with 75g (SD 367g) for the late scans versus 83g (SD 446g) for the early scans (p=0.765). However, 82.5% of women had a pBW within 15% of actual BW at the late scan compared to only 73% at the early scan (p-value=0.024). There were 22 cases of fetal growth restriction (FGR) (<10th percentile) at delivery. The late scan detected 9 cases of FGR (41%, p<0.003) not detected at the early scan.

CONCLUSION:
In obese women, the late 3rd tri scan predicted BW more accurately than the early scan and identified additional cases of FGR not previously detected. Consideration should be given to a standard late 3rd tri growth scan in this population.
Comparison of Formulas for Estimation of Fetal Weight in Pregnancies Complicated by Gastroschisis [34P]
Authors: Tonismae Tiffany , Voirol Jenna , Schubert Frank , Shanks Anthony 
Published: April 2018

INTRODUCTION:
Gastroschisis is an abdominal wall defect and it is often difficult to accurately measure the abdominal circumference. The purpose of this study is to compare formulas for estimating fetal weight by ultrasound in these infants.

METHODS:
A retrospective cohort analysis of singleton deliveries complicated by Gastroschisis. Exclusions included fetuses with additional anomalies, fetuses born at < 28 weeks, and those without available delivery data. Biometric measurements (BPD, AC, HC and FL) and estimated fetal weight were extracted from ultrasound reports. The EFW was adjusted based on a correction factor for weight gain in the third trimester. Maternal and fetal charts were reviewed for gestational age at time of delivery and birth weight.

RESULTS:
148 cases of Gastroschisis were identified. 39 were excluded based on unavailable delivery data, additional fetal anomalies, termination, and stillbirths. A total of 41 charts were reviewed with an ultrasound within 14 days of delivery (1-7 days n= 29, 8-14 days n=11). Median birth weight for those infants born within 1-7 days and 8-14 days of delivery was 2250g and 2487g. Average gestational age at time of delivery was 35 weeks 5 days and 35 weeks 6 days for those with an ultrasound between 1-7 days and 8-14 days. Average Pearson Correlation Coefficient was 0.803 (range 0.776-0.832) with the highest correlation found using Hadlock IV, JSUM, and Hadlock II. Percentage of error noted similar findings.

CONCLUSION:
As seen in other studies comparing EFW in pregnancies complicated by Gastroschisis, we noted underestimation of weight in both pregnancies with ultrasounds.
Bremelanotide for Hypoactive Sexual Desire Disorder: Age and Weight Subgroup Efficacy Analyses [1Q]
Authors: Simon James A. , Kingsberg Sheryl A. , Clayton Anita H. , Jordan Robert , Lucas Johna 
Published: April 2018

INTRODUCTION:
Bremelanotide, an investigational new drug, is a melanocortin 4 receptor agonist that has demonstrated efficacy in the treatment of hypoactive sexual desire disorder (HSDD) in women. In this analysis, bremelanotide efficacy was investigated within age and weight subgroups.

METHODS:
Women from two phase 3 studies (RECONNECT) and one phase 2 study were separated into age and weight quartiles. After 4-week placebo run-in period, women self-administered 1.75 mg of bremelanotide via auto-injector pen, as desired, or equal volume placebo for 12 (phase 2) or 24 (phase 3) weeks. Efficacy was assessed using FSFI and FSDS-DAO scoring systems, with FSFI desire domain (FSFI-D) and FSDS-DAO distress resulting from low desire (Item 13) as RECONNECT co-primary endpoints.

RESULTS:
For the total integrated population (N=1337), the difference in FSFI-D mean changes from baseline (bremelanotide-placebo) was 0.38. Differences in mean FSFI-D changes from baseline for each age quartile (n-value range: 150-187) were 0.21 (19-33 y), 0.39 (>33-39 y), 0.56 (>39-44 y), and 0.34 (>44-56 y). Differences in mean FSFI-D changes for each weight quartile (n-value range: 159-181) were 0.30 (39.8-63.1 kg), 0.42 (>63.1-73.5 kg), 0.43 (>73.5-87.6 kg), and 0.34 (>87.6-189.9 kg). Significantly greater (P<0.05) changes in FSFI-D were achieved with bremelanotide vs placebo across all age and weight quartiles. FSDS-DAO Item 13 was also significantly improved across age and weight quartiles with the exception of the 39.8-63.1 kg (P=0.05) weight quartile.

CONCLUSION:
Bremelanotide demonstrated efficacy in women regardless of age. Bremelanotide significantly improved desire across weight quartiles and showed a trend in decreasing distress.