bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maternal and Neonatal Outcomes of Appendicitis in Pregnancy [19D]
Authors: Shields Michelanne , Chatroux Louisa R. , Hersh Alyssa R. , Caughey Aaron B. 
Published: April 2018

INTRODUCTION:
We sought to determine the differences in pregnancy outcomes seen in women with diagnosed appendicitis when compared to women who do not have this diagnosis.

METHODS:
A retrospective cohort study of 1,853,219 women in California with singleton, vertex, non-anomalous, term gestations was performed to assess the prevalence of maternal and neonatal outcomes in women with appendicitis during pregnancy as compared to unaffected women. Maternal outcomes included chorioamnionitis, placental abruption, cesarean delivery, post-partum hemorrhage, and maternal sepsis. Neonatal outcomes included preterm delivery (divided into <37, <34, and <32 weeks gestational age), intrauterine fetal demise (IUFD), respiratory distress syndrome (RDS), and neonatal death. Multivariate regression analyses and chi-square tests were employed for statistical comparisons.

RESULTS:
Women with appendicitis had an increased risk of adverse outcomes in pregnancy. Appendicitis was associated with a statistically significant increase in cesarean delivery (odds ratio [OR], 7.37; 95% confidence interval [CI], 4.58-11.84), preterm delivery prior to 37 weeks (OR, 11.92; CI, 7.85-18.09), and blood transfusion (OR 20.56, CI, 10.86-38.89). It was also associated with several statistically significant adverse neonatal outcomes, including intrauterine death (OR, 4.16 (CI, .56-30.88), respiratory distress syndrome (OR, 14.78; CI, 7.89-27.64), and neonatal death (OR 19.29, CI (5.70-65.19).

CONCLUSION:
Women with appendicitis in pregnancy are at higher risk of complications than all-comers, with a statistically significant rates of both preterm delivery, cesarean delivery, and neonatal death. Whether this increased risk was due to confounding factors, impact of surgical treatment, or disease pathophysiology, and how these risks can be mitigated through health care practice advancements deserves further consideration.
Intern Bootcamp Cervical Dilation Simulation: Findings and Assessment [34M]
Authors: Chahine E. Britton , Rizk Sara , Young Marisa , Moynihan Aimee , Arluck Jessica , Walker Patrice 
Published: April 2018

INTRODUCTION:
Evaluation of cervical dilation during labor is a learned tactile skill that requires consistency in order to adequately manage laboring patients. Traditionally this skill has been taught by subjecting laboring women to multiple pelvic exams in order to ensure that more junior providers have a similar assessment of a patient’s dilation as compared with more experienced providers. The purpose of this study is to see if simulated cervical dilation models can begin to teach this learned tactile skill and shorten the learning curve to competency.

METHODS:
We modified a cervical dilation simulation model and integrated this into our intern bootcamp. A baseline level of accuracy was obtained on our model and then learners practiced performing simulated cervical exams on our simulation model. On subsequent days, a series of four cervical exam quizzes were given and cervical exam accuracy was assessed for each quiz. A survey of impressions of the model and self-rated confidence regarding cervical exams was also obtained.

RESULTS:
There was a general trend of improving accuracy in the cervical exams with increasing exposure. Prior to the workshop 100% of residents did not feel confident in their cervical exams with 75% of respondents having no experience performing cervical exams on a laboring patient. After the workshop, 100% of the residents felt somewhat confident in their cervical exams.

CONCLUSION:
This simulation provides an innovative way to teach inexperienced providers basic obstetric skills that can be used in immediate practice.
Brainstem Glioma in Pregnancy: A Systematic Review [6N]
Authors: Rosen Adam , Anderson Valerie , Bercovic Eduard , Laperriere Normand , D'Souza Rohan 
Published: April 2018

INTRODUCTION:
Information on pregnancy outcomes in women with brainstem glioma during pregnancy is limited to case reports.

METHODS:
We conducted a systematic review in accordance with PRISMA guidelines and registered with the PROSPERO website (CRD42017060196). Four databases were searched using appropriate indexing terms. Quality assessment was performed in duplicate using the Joanna Briggs Institute Critical Appraisal Checklist for case reports. Outcomes were reported as proportions.

RESULTS:
We identified 2726 titles and abstracts of which 89 full texts were screened and 12 articles describing 17 pregnancies in 16 women were included. Most studies had a low or moderate risk of bias. Of the 14 (82.4%) antenatal diagnoses, 10 (58.8 %) were made in the second trimester. Clinical presentation included headaches, nausea and vomiting, focal neurological findings and sudden death. Antenatal treatment included surgical resection in four women, radiation in three and endoscopic third ventriculostomy in one. Postpartum treatment included surgical resection and radiation in two women each. Of the eight maternal deaths (47.1%), five were in the antenatal period, and three were within four months of delivery. Follow up was available for six of the eight survivors, for a median of 24 months, during which time two (33.3%) deteriorated. Fetal outcomes included 4/17 (23.5%) losses secondary to maternal demise, one therapeutic abortion and 5/12 (41.7%) preterm deliveries (median 34 weeks, interquartile range 6).

CONCLUSION:
Prognosis for women with brainstem glioma remains guarded despite multidisciplinary care in tertiary-level centers and prompt attention to diagnosis and treatment. In survivors, fetal outcomes are reassuring.
Weekday Wellness: Integrating Wellness into an Educational Curriculum [5O]
Authors: Chang Katherine , Hall Evelyn , Gorrindo Phillip , Gerber Susan 
Published: April 2018

INTRODUCTION:
Residencies work to balance the demands of training, service, education, and wellness. The ACGME has recognized the importance of trainee wellness, and a new emphasis has been placed on this topic. Prior literature describes burnout rates of >50% among OB/GYN residents. It is important to better quantify the rates of burnout among OB/GYN trainees and develop initiatives to meaningfully impact burnout.

METHODS:
We administered an anonymous, mixed-methods residency-wide survey to obtain opinions about our proposed Wellness Initiative and to gather baseline data using the WHO Well-Being Survey and the Maslach Abbreviated Burnout Inventory. Quantitative results were analyzed with descriptive statistics. Qualitative results were coded by two independent reviewers and relevant themes were developed.

RESULTS:
27/47 residents responded to the survey (57%). Of these, 48% met criteria for burnout and 67% had low mood or depression. Most residents supported this Wellness Initiative (96%), felt it would improve overall resident wellness (74%), and did not feel it would negatively impact education (96%). Themes identified include: optimism among interns, depersonalization and emotional exhaustion attributed to lack of personal time among senior trainees.

CONCLUSION:
Rates of overall burnout increase with each postgraduate year. Within the subscales of burnout, emotional exhaustion is most significantly affected while personal accomplishment remains high. Creative ways of integrating activities that strengthen resilience into an educational curriculum are needed to improve resident wellness and impact high rates of OB/GYN resident burnout.
Perinatal Depression Screening and Treatment in an Obstetrics Clinic with a High Risk Patient Population [8P]
Authors: Koniares Katherine , Fernandez Miguel A. 
Published: April 2018

INTRODUCTION:
Perinatal depression affects 1/7 women in the general population. The prevalence increases to 1/5 women in high risk populations, including those with lower income and education, history of depression, unintended pregnancy, and poor social supports. The Edinburgh Postnatal Depression Scale (EPDS) consists of 10 questions, takes less than 5 minutes to complete, and has been validated in pregnant and postpartum patients.

METHODS:
Between October 24-November 18, 2016, 1st trimester, 2nd trimester, 3rd trimester, and postpartum patients in the obstetrics clinic were screened for perinatal depression using the EPDS. Patients that screened positive for perinatal depression received an immediate intervention and referral for further treatment was made as appropriate.

RESULTS:
The overall prevalence of perinatal depression was 24% (n=63), which is higher than previously reported. 7/18 (39%) patients screened positive for depression in the 2nd trimester. 6/35 (17%) patients screened positive in the 3rd trimester. Of the 10 postpartum patients screened, 2 (20%) patients screened positive for depression. The EPDS is scored on a scale of 0-30. The average score for Spanish speaking patients was 6.3 and the average score for English speaking patients was 8.9.

CONCLUSION:
The high prevalence of perinatal depression in this population demonstrates the need for regular screening and the provision of interventions during obstetrics appointments. Support for the Bringing Postpartum Depression Out of the Shadows Act, which aims to increase funding for screening and treatment of perinatal depression, is essential to decrease the detrimental impact perinatal depression can have on mothers and their newborns.
Management of Cervical Ectopic Pregnancies: A Systematic Review [9Q]
Authors: Chia Victoria , Handal-Orefice Roxane , LaTortue-Albino Paula , Mulekar Sujata , White Katharine 
Published: April 2018

INTRODUCTION:
Cervical pregnancies are 0.01% of ectopic pregnancies and pose a considerable risk of hemorrhage. There is currently no consensus on management. This is a systematic review of published cases in the last decade.

METHODS:
PubMed and other databases were searched on July 2, 2017 using variations of the terms “cervical ectopic pregnancy” and “cervical pregnancy” for peer-reviewed citations published in English, Spanish, or French between 2007 and 2017.

RESULTS:
One-hundred-and-eleven articles representing 209 patients were included. Initial interventions included expectant management (3); vaginal removal of lesion (2); uterine artery embolization (UAE) (1); UAE and curettage (34); curettage (42); UAE and methotrexate (22); methotrexate alone (79); hysteroscopic resection (12), UAE and laparoscopy (5), and hysterectomy (6). Sixty patients failed initial intervention, including 38 who received methotrexate alone (58%), 5 who underwent methotrexate with UAE (26%), and 10 who underwent curettage (23%). Thirty-seven patients experienced hemorrhage, including 21% who initially received methotrexate; 40% who initially underwent curettage; and 12% of those initially managed with curettage and UAE. These patients were managed with hysterectomy (6); cerclage (4); curettage (7); UAE (7), and UAE and curettage (3). Overall patients did well with conservative management.

CONCLUSION:
For stable cervical ectopic patients, conservative management with methotrexate (including intraamniotic feticide if fetal cardiac activity is present) may be considered. Importantly, uterine artery embolization is worth considering prior to either surgical or medical management, and is recommended in any unstable patient.
Reproductive Outcomes After Laparoscopic Radiofrequency Ablation of Symptomatic Myomas [12Q]
Authors: Berman Jay M. , Shashuoa Abraham , Olson Christopher , Brucker Sara , Thiel John , Bhagavath Bala 
Published: April 2018

INTRODUCTION:
More than 2,000 cases of laparoscopic intrabdominal ultrasound-guided radiofrequency ablation (Lap-RFA) of symptomatic myomas have been performed in the United States and internationally. Safe conception and childbearing following Lap-RFA are of great interest to patients, obstetrician-gynecologists, and reproductive endocrinologists and surgeons. Our purpose is to study the safety and gestational outcomes among reported pregnancies post Lap-RFA.

METHODS:
Gynecologic surgeons, who perform Lap-RFA, complete standardized data collection forms that capture specific details describing their consenting patients’ preoperative, intraoperative, and postoperative data as well as any pregnancy data. Reproductive outcomes have been collected and analyzed using descriptive statistics.

RESULTS:
Twenty-seven women (age range, 30-43 years old) conceived 28 times after Lap-RFA treatment. Of the 28 gestations, 23 (82.1%) resulted in full-term deliveries of healthy infants, 2 (7.1%) pregnancies are ongoing (due October and November), 2 (7.1%) pregnancies terminated in first-trimester spontaneous abortions, and 1 (3.6%) pregnancy terminated spontaneously in the second trimester. Time from treatment to conception ranged from 1 month to 28 months. Eleven (47.8%) of the births were by vaginal delivery. No cases of abnormal placentation or endometrial defect were observed.

CONCLUSION:
Accumulating evidence indicates that safe childbearing with full-term gestation can be achieved after Lap-RFA of symptomatic myomas. Continued collection of obstetric data from commercial Lap-RFA cases and Lap-RFA clinical trials are needed to support these preliminary findings.
Physical Therapy is an Effective Treatment for Vulvodynia [30Q]
Authors: Hoerle Tess , Dominguez Sarah , Fitzgerald Sharon , Ault Kevin 
Published: April 2018

INTRODUCTION:
Vulvodynia is a chronic pain disorder of the vulva, with an unknown cause. It effects between 3-15% of women, but is underreported and many times misdiagnosed. Definitive treatment options are limited due to lack of research and data collected. The purpose of this study is to show that physical therapy is the appropriate treatment for women with vulvodynia.

METHODS:
Patients from our tertiary care center were sent to a physical therapy office where the Vulvar Pain Functional Status Questionnaire (VQ) was collected on patients who met the diagnostic criteria for vulvodynia. The VQ is a validated survey that consists of 11 questions and has a total of 33 points with the more points received correlating to higher levels of pain. The VQ was collected when physical therapy started and then on the last day of treatment. A paired samples t-test was completed to detect differences in pre and post VQ scores for patients who completed both surveys.

RESULTS:
Thirty-six patients were eligible for inclusion in the study. Prior to starting physical therapy the mean VQ result was 11.11 (SD: 4.21) and after physical therapy was 6.78 (SD: 4.83) (P <.0001). A significant decrease in the mean score indicates that women improved after receiving physical therapy for vulvodynia.

CONCLUSION:
We conclude that physical therapy is an effective treatment for women who have been diagnosed with vulvodynia.
Hypertensive Disorders of Pregnancy among Mothers of Medically Fragile Infants [38R]
Authors: Stuebe Alison M. , Tucker Christine , Bryant Katherine , McClain Erin , Ferrari Renee , Verbiest Sarah 
Published: April 2018

INTRODUCTION:
We sought to quantify the prevalence and early postpartum (PP) follow-up for hypertensive disorders of pregnancy among mothers of medically fragile infants (MMFI).

METHODS:
We conducted a retrospective cohort study of mothers delivering at North Carolina Women's Hospital between 7/1/2014 and 6/30/2016. We defined MMFI as mothers of infants with a NICU length of stay ≥3 days and mothers of well babies (MWB) as mothers of infants not admitted to the NICU. We ascertained hypertensive disorders using blood pressures (BP) measured in routine clinical care between 20 weeks of pregnancy and PP discharge from Electronic Medical Records. Rates of mild and severe hypertension and completion of recommended follow-up among MMFI and MWB were compared with chi square test.

RESULTS:
Among 6,851 women who gave birth to one or more liveborn infants, 34.4% met criteria for mild hypertension, and 9.0% for severe hypertension. Hypertension was more common among MMFI; 38.2% met criteria for mild hypertension and 26.1% for severe hypertension. Among women with an indication, MMFI were more likely than MWB to have a PP BP check between discharge and 10 days PP (22.0% vs. 14.2%, p=0.01). MMFI whose infants were still hospitalized at 10 days PP were no more likely than MMFI whose infants had been discharged to have had a PP BP check (23.2 vs 22.8%, p=0.93).

CONCLUSION:
The prevalence of hypertensive disorders among MMFI is high, and few received indicated PP BP follow-up assessment. Evaluation of maternal health at the infant's bedside may improve follow-up and reduce maternal morbidity.
Treatment of Iron Deficiency Anemia in Pregnancy With Intravenous Versus Oral Iron: A Meta-Analysis of RCTs [10OP]
Authors: Govindappagari Shravya , Burwick Richard M. 
Published: April 2018

INTRODUCTION:
According to the World Health Organization, anemia affects 42% of pregnancies globally. Oral (PO) iron is standard of care, but poor absorption limits efficacy. Thus, intravenous (IV) iron has been compared to PO iron in randomized control trials (RCTs). We performed an RCT meta-analysis to assess the benefits of IV iron in pregnancy.

METHODS:
This meta-analysis was performed according to Meta-analysis of Observational studies in Epidemiology (MOOSE) guidelines. We searched PUBMED, clinicaltrials.gov, Google scholar, and Cochrane library. 297 articles were reviewed, and after exclusions, 10 RCTs comparing IV to PO iron in pregnancy were included. Studies confirmed iron-deficiency anemia before treatment. Endpoints were: 1) Subjects achieving target hemoglobin; 2) Hemoglobin increase at 4 weeks and; 3) Subjects experiencing adverse effects. Meta-analyses were performed with Stata (College Station, TX), with summary odds ratios by Mantel-Haenszel method and pooled risk difference by Cohen's method.

RESULTS:
Data from 10 RCTs were utilized for pooled meta-analysis. Pregnant women were more likely to achieve target hemoglobin with IV versus PO iron (7 studies), summary OR 2.7 (95% CI 2.0–3.6), P<.001. Hemoglobin levels increased more at 4 weeks with IV iron (8 studies), mean difference 1.2 g/dL (95% CI 1.0–1.3), P<.001. Adverse reactions were lower with IV versus PO iron (10 studies), summary OR 0.54 (95% CI 0.41–0.72), P<.001.

CONCLUSION:
In this RCT meta-analysis, IV iron is superior to oral iron for treatment of iron-deficiency anemia in pregnancy. Women receiving IV iron more often achieve desired hemoglobin targets, faster, with less side effects.
Regional Anesthesia Complications Correlated With Morbid Obesity [34F]
Authors: Rimsza Rebecca R. , O'Brien Megan , Miller Collin , Vricella Laura 
Published: April 2018

INTRODUCTION:
Maternal obesity increases anesthesia complication at Cesarean Delivery(CD). We sought to evaluate the contribution of technical factors to anesthesia complications during scheduled CD.

METHODS:
All patients undergoing scheduled CD under spinal anesthesia at 37-41 weeks from 2015-2017 were included. Exclusion criteria included planned general anesthesia. Primary outcome was total spinal procedure time. Secondary outcomes: number of spinal placement attempts, spinal needle > 3.5 inches, failed placement of spinal with conversion to general anesthesia, high spinal blockade, and additional intravenous analgesics.

RESULTS:
Of 575 included patients, 131 (23%) had BMI <30 kg/m2 (Group I), 275 (48%) had BMI 30.0-39.9 kg/m2 (Group II), and 169 (29%) had BMI > 40.0 kg/m2 (Group III). Total spinal time increased with BMI (I:5±4 min, II:6±9 min, III:8±7 min, P < .01). More than 1 spinal placement attempt was more frequent among obese patients [I:7/122 (6%), II:27/248 (11%), III:36/157 (23%), P < .001], as was needle length > 3.5 cm [I:2/122 (2%) vs. II:13/238(6%), III:39/158(25%), P = .04]. More obese patients required additional intravenous analgesics [I:12(9%), II: 31(11%), III:20(12%), P = .03] to complete the surgery. Failed placement of spinal with conversion to general (n = 3,2,2, P = 1) and high spinal blockade (n = 0,2,2, P = 1) were both uncommon and similar between groups.

CONCLUSION:
Although spinal anesthesia placement was more complicated among obese patients, the incidence of serious anesthesia complications remained low. Spinal anesthesia remains an acceptable choice for scheduled CD in obese patients.
Within-Family Analysis of Interpregnancy Interval and Adverse Birth Outcomes [1G]
Authors: Class Quetzal A. , Oberg Anna S. , Sujan Ayesha C. , Almqvist Catarina , Larsson Henrik , D'Onofrio Brian 
Published: April 2018

INTRODUCTION:
We examined the associations between interpregnancy interval, the duration from the preceding birth to the conception of the next-born index child, and adverse birth outcomes using designs that adjust for measured and unmeasured factors.

METHODS:
We used population-based Swedish registries to study a prospective cohort of children born 1973 to 2009 (n=1,418,820) to estimate the associations between interpregnancy interval and adverse birth outcomes. Analyses included cousin- and sibling-comparisons and postbirth intervals (i.e., the interval between second- and third-born offspring predicting second-born outcomes) to address unmeasured familial confounding.

RESULTS:
Traditional cohort-wide analyses showed higher odds of preterm birth (PTB) [adjusted odds ratio (aOR) 1.51, 99% CI 1.39-1.63] and low birth weight (LBW; aOR 1.25, 99% CI 1.13-1.39) after short interpregnancy interval (0 to 5 months) compared to offspring born after an interpregnancy interval of 18 to 23 months. Except for PTB (aOR 1.72, 99% CI 1.26-2.35), associations were attenuated in cousin- and sibling-comparisons. For interpregnancy intervals of 60 months or more, odds of PTB (aOR 1.51, 99% CI 1.43-1.60), LBW (aOR 1.61, 99% CI 1.50-1.73), and SGA (aOR 1.54, 99% CI=1.42-1.66) were higher when compared with the reference interval. Associations between long interpregnancy interval and adverse birth outcomes, however, remained through cousin- and sibling-comparisons. Postbirth interval analyses showed familial confounding is present for short interpregnancy intervals, but supported independent associations for long interpregnancy intervals.

CONCLUSION:
Familial confounding explains most of the association between short interpregnancy interval and adverse birth outcomes, while associations with long interpregnancy intervals were independent of measured and unmeasured factors.