bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fetal Growth Restriction - Outcome Driven Definition [23H]
Authors: Gonzalez Veronica , Chipman Zachary , Stelzl Patrick , Malone Fergal , D'Alton Mary , Bukowski Radek 
Published: April 2018

INTRODUCTION:
Fetal growth abnormalities are among the main drivers of perinatal mortality and morbidity and a cornerstone of prenatal care. However they are defined based on arbitrary definitions. Our objective was to define fetal growth abnormalities based on increase risk of stillbirth.

METHODS:
In a prospective cohort of 35,251 singleton pregnancies, stillbirth was defined as fetal demise at > 20 weeks without chromosomal or structural abnormalities. Fetal growth was percentile of birth weight for gestational age at delivery. The risk of stillbirth as a function of percentile of fetal growth and gestational age was determined using logistic regression. The threshold in the relationship adjusted for gestational age at delivery was determined using the Bayesian information criterion to identify the point where the relationship’s strength changes.

RESULTS:
There were 61 (0.2%) non-anomalous stillbirths. At the 8.0th percentile of fetal growth the risk of stillbirth increased from 1.5 to 6.5 per 1,000 pregnancies. Risk of stillbirth at or below 8th percentile was 0.0065 (95% CI 0.0060-0.0070) and above the 8.0th percentile the risk of stillbirth was 0.0015 (95% CI 0.0013-0.0017); P<.0001 for both associations.

CONCLUSION:
Definition of fetal growth impairment based on the risk of stillbirth will result in fewer small but normal pregnancies to be misclassified as abnormally grown and thus decreasing unnecessary testing and interventions. Additionally, lower threshold 8th vs 10th percentile for defining fetal growth restriction would decrease by 2% of all pregnancies (80,000 per year in the US) the number of pregnancies requiring further testing and intervention.
Assessing Treatment Effects Using Quality of Life Questionnaires in Pregnant Women with Iron Deficiency Anaemia [26H]
Authors: Shulman Yonatan , Eckler Rebecca , Tomlinson George , D'Souza Rohan 
Published: April 2018

INTRODUCTION:
There is considerable overlap between symptoms related to iron deficiency anaemia (IDA) and a normally advancing gestation, posing challenges to the use of quality of life (QoL) tools to measure treatment effects. Our aim was to determine how best to use two existing QoL tools; short-form 36 (SF36) – a general questionnaire covering eight domains and the multidimensional fatigue symptom inventory: short form (MFSI-SF) – a fatigue-specific questionnaire to assess treatment effect in pregnant women with IDA.

METHODS:
We recruited consecutive women with IDA attending the Obstetric Day Unit at Mount Sinai Hospital, Toronto, for intravenous iron infusions over six months. Consenting participants completed SF36 and MFSI-SF questionnaires at each visit and upon completion of treatment. Scores for the entire questionnaire and individual domains were summed and plotted graphically over time.

RESULTS:
29 women consented and completed at least one SF36 and MFSI-SF questionnaire, while 24 completed two, 12 completed three and four women completed four. The mean maternal age was 34 (24-46) years and the mean gestational age 29 (25-38) weeks. These women represented different ethnic groups and socio-economic strata. Although there was no consistent pattern in scores for 6/8 SF36 domains, there was a significant improvement between visits in the energy/fatigue (37.6 vs 42.8, p=0.044), and emotional wellness (62.7 vs 77.3, p<0.001) domains and in MFSI-SF scores (17.1 vs 12.2, p=0.025).

CONCLUSION:
When assessing treatment effects in pregnant women with IDA, consideration should be given to using QoL tools specifically designed to measure fatigue, such as MFSI-SF or the energy/fatigue domain in SF36.
Pregnancy After 50: Presentation of Two Cases and a Review of the Literature [27H]
Authors: Curcio Erin , Gussman Debra 
Published: April 2018

INTRODUCTION:
To present two cases and review the literature on pregnant post-menopausal women.

METHODS:
Case # 1 was a 53 year old with a pregnancy achieved by advanced reproductive techniques (ART) and complicated with twin gestation and pre-eclampsia at 28 weeks. A cesarean delivery was performed. Her post-operative course was complicated by pulmonary edema, hyperglycemia, anemia requiring transfusion, and acute kidney injury.
Case # 2 was a 50 year old with a pregnancy achieved by ART and complicated with Stage 1 breast cancer, gestational hypertension, hypothyroidism, glucose intolerance, and diverticulosis. She had a cesarean delivery at 37 weeks. Data bases were searched to identify studies reporting on women who achieved pregnancy after the age of 50 using ART. Studies were examined for demographics and pregnancy outcomes.

RESULTS:
11 studies were identified reporting on a total of 1070 women 50 or older with successful ART pregnancies. The age range was 51 to 64. Singleton rate was 59% to 89%. Cesarean delivery rate was 67% to 100%. Antenatal maternal hospitalization was 40% to 48%. Gestational diabetes was 5% to 45%. Hypertension in pregnancy was 4% to 59%. Neonate intensive care admission was 11% to 15%. Neonatal death was 2.6%. One maternal death was reported.

CONCLUSION:
With the development of donor oocyte and ART, there have been an increased number of births in post-menopausal women. These pregnancies can have serious complications and require multidisciplinary approach for optimal outcomes. Our experience was consistent with published case reports and case series.
Obesity and Cerclage Efficacy [33H]
Authors: Gill Lisa , Morgan Elizabeth A. , Yamamura Yasuko 
Published: April 2018

INTRODUCTION:
Obese women have an increased risk of preterm birth. Cerclage is used for prevention in a subset of these women with cervical insufficiency. We aimed to quantify the difference in risk of preterm birth in pregnancies treated with cerclage for cervical insufficiency in an obese population compared to a non-obese population.

METHODS:
This is a retrospective cohort study. All cerclage procedures from January 1, 2011 to December 31, 2016 were collected from a single center. Groups were defined as obese (BMI 30.0 or greater) and controls(BMI <30.0). The primary endpoint was defined as preterm birth <23 weeks. Secondary outcomes included preterm birth <28, 32, or 37 weeks. Groups were also compared regarding cerclage type (McDonald vs Shirodkar). Odds ratios with 95% confidence intervals were calculated for each outcome.

RESULTS:
267 cerclage procedures were collected. Delivery documentation was complete for 225 (109 obese, 116 non-obese controls). Gestational age at delivery did not differ significantly (33 weeks in obese vs 34.33 weeks in non-obese, p = 0.14). Risk of preterm delivery for obese women undergoing cerclage was not significantly different from controls. When cerclage type was compared, obese women undergoing Shirodkar cerclage were at increased risk of preterm delivery compared to controls(OR 4.29, 95% CI 1.14-16.2), this difference was not noted in those undergoing McDonald cerclage.

CONCLUSION:
Obesity does not increase the rate of preterm delivery with cerclage, but Shirodkar-type cerclage independently increases the risk of prematurity in this population.
Screening for Obstructive Sleep Apnea during Pregnancy in Rural New Mexico [35H]
Authors: Izquierdo Francisco , Izquierdo Luis A. , Blue Nathan R. , Jaramillo-Huff Ashely 
Published: April 2018

INTRODUCTION:
Obstructive sleep apnea (OSA) is a condition that has been proven to have significant effects on the human body. This study is a pilot study in our State that will seek to identify the prevalence of OSA in pregnancy in New Mexico.

METHODS:
One hundred women in our rural outreach perinatal clinics were given the Berlin questionnaire in order to determine how many of them have symptoms of OSA. Maternal demographics including age, weight, height, and gestational age were analyzed. T tests were used for continuous variables, chi-square for dichotomous variables, and logistic regression analysis to assess for correlation.

RESULTS:
Eighty four patients successfully completed the questionnaire. Sixteen questionnaires were not completed or were missing vital information. The mean age was 30.49 years, the mean height was 1.61 m (SD 0.06 m), the mean weight was 81.51 kg (SD 20.05), and the mean body mass index (BMI) was 31.44 (SD 8.18). In our sample, 26 women (30.9%) had a positive OSA screen. Unexpectedly, there was no correlation between the number of positive screening questions and BMI, (correlation coefficient, r=0.29), or between maternal age and BMI (r=0.10).

CONCLUSION:
In a high risk pregnancy clinics in New Mexico, around 30% of obese, pregnant women had symptoms consistent with OSA at around 20 weeks of gestation. This study provides researchers cause to further investigate the prevalence of OSA in pregnancy in New Mexico and, subsequently, its impact on the mother and fetus.
Paternal Consent and Research During Pregnancy: A Comparison With Dual-Parent Consent in Pediatric Research [2I]
Authors: Little Maggie , Wickremsinhe Marisha , Lyerly Anne 
Published: April 2018

INTRODUCTION:
The US regulation on research with pregnant women, “Subpart B”, requires paternal consent, in addition to the woman’s (i.e. dual-parent consent), if the research offers the prospect of direct benefit (PDB) to the fetus but not to her. We sought to investigate the ethical underpinnings of this requirement by exploring dual-parent consent requirements for research with children in “Subpart D,” which governs pediatric research.

METHODS:
We reviewed the requirements for dual-parent consent in Subparts B and D to analyze the ethical underpinnings of each regulation. Consent requirements were assessed in using conceptual methods from ethical theory and research ethics literature.

RESULTS:
We identified a critical difference between the considerations for dual-parent consent in Subparts B and D. Subpart D requires dual-parent consent when research offers no prospect of direct benefit to the child and presents greater than minimal risk, presumably as an extra measure of protection to the future offspring; research offering the prospect of direct benefit to the child requires only one parent’s consent. Conversely, Subpart B requires dual-parent consent when, and only when, research offers potential benefit to the fetus while not the woman.

CONCLUSION:
The requirement for paternal consent in research with pregnant women does not mirror the requirement for dual-parent consent for research with children. The regulations problematically burden access to the direct benefit that research might offer a future child in a way that they do not burden access to such benefit with born children.
Investigating Industry Payments of OB/GYN Practice Bulletin Committee Members and Contributing Authors [5I]
Authors: Wright Micah , Checketts Jake , Vassar Matt , Guevara Carlos , Smith Larissa , Frye Lance 
Published: April 2018

INTRODUCTION:
Our study evaluates payments received by ACOG Obstetrics and Gynecology practice bulletin committee members, physicians who author the ACOG Obstetrics and Gynecology practice bulletins, and for comparison the authors of an ACOG established Task Force on Hypertension guideline, compares disclosure statements for accuracy, and determines whether the pharmaceutical companies from which authors received payments manufactured products related to the guidelines. We also investigate payments from top contributors and ties to the specialty

METHODS:
We conducted a cross-sectional study of the Open Payments database. We limited our search from 2014 to present (Open Payment data are not available prior to 2014). We included all general payments and research payments reported from 2014-2015, which included direct payments, indirect payments or other transfers of value made to physicians by applicable manufacturers. We calculated total general payments and also research payment averages and ranges and averages within each group of authors separately

RESULTS:
Of the 60 authors evaluated, 34 received at least one reported industry payment. In total general financial payments amounted to $289,407.36 with a mean of 977.73 per author. Of the 34 authors receiving payments, only 2 authors received specific research payments. Top contributing companies were identified and products related to the specialty were listed.

CONCLUSION:
In absence of other factors, such as level of evidence, financial conflicts do not seem to play a large role in ACOG practice bulletin limitations. Evaluation of the structure of practice bulletin committees would suggest that a large amount of influence is controlled by only a select few.
Who Has Syphilis in Pregnancy? Evaluating National Trends and Behavioral Risk Factors, United States, 2012-2016 [9I]
Authors: Trivedi Shivika , Williams Charnetta , Torrone Elizabeth , Kidd Sarah 
Published: April 2018

INTRODUCTION:
Syphilis is associated with significant complications, particularly among pregnant women. Congenital syphilis (CS) can cause stillbirth and long-term health sequelae. CS is avoidable with the timely screening and treatment of pregnant women.

METHODS:
We analyzed national case report data for 2012–2016 to assess trends among pregnant women with all stages of syphilis and evaluated reported behavioral risk factors for syphilis.

RESULTS:
During 2012–2016, the number of syphilis cases among pregnant women increased 61%, from 1,561 to 2,508. CS cases increased 88% from 334 to 628, and syphilitic stillbirths increased 173%, from 15 to 41. The largest increases among pregnant women were observed in the West (292%) and among American Indians/Alaska Natives (420%), non-Hispanic Whites (108%) and Hispanics (92%). However, the majority of cases were reported in the South (56%) and among non-Hispanic Black women (48%).
Many pregnant women with syphilis denied any risk factors. For example, 57% denied ever having had a sexually transmitted disease and 68% denied having multiple sex partners in the past year. Of fifteen queried risk factors, including high-risk sexual behaviors and drug use, 49% of women did not report any in the past year.

CONCLUSION:
CS and syphilis cases among pregnant women are steadily increasing. It is essential that practitioners adhere to CDC recommendations to screen all pregnant women for syphilis at the first prenatal visit. CDC also recommends repeat screening based on risk factors and geography. Our findings emphasize that patient-reported risk factors may not sufficiently identify all those at risk for syphilis in pregnancy.
Maternal Characteristics of Congenital Syphilis [13I]
Authors: Whitham Megan , Bandy Sohini , Eppes Catherine , Rac Martha 
Published: April 2018

INTRODUCTION:
We describe the maternal characteristics and pregnancy outcomes of seropositive gravidas who delivered an infant with and without congenital syphilis.

METHODS:
This is a retrospective chart review of gravidas diagnosed with syphilis at our county hospital system from January 2011 to December 2016. Maternal stage of syphilis was diagnosed according to CDC guidelines and the diagnosis of congenital syphilis was assigned by the managing clinician in the prenatal period and at delivery respectively. Maternal characteristics, stage of syphilis, treatment history, delivery and infant outcomes were recorded. Characteristics of patients who delivered a child that required treatment for congenital syphilis were compared to those who did not. Standard statistical analysis was performed.

RESULTS:
94 gravidas were diagnosed with syphilis and 17 (18%) delivered an infant who required treatment for congenital syphilis. Most women had latent syphilis (n=15, 88%) and 2(11.8%) were diagnosed with serofast syphilis. Eight (47%) did not receive antenatal treatment. For those that did, gestational age at treatment was 26.4 + 11.4 weeks. Women with infants diagnosed with congenital syphilis were more likely to have no prenatal care, be diagnosed and treated later in pregnancy, have less time from treatment to delivery and receive treatment less than 4 weeks prior to delivery (p<0.01). Age, race, prevalence of co-morbidities, gestational age at delivery, and rate of prematurity were similar between the two groups.

CONCLUSION:
Consistent with prior research, poor prenatal care and delayed antenatal treatment confers a higher risk of congenital syphilis. In the prevention of congenital syphilis, time is of essence.
First Report of Cryptogenic Klebsiella Pneumoniae Liver Abscess in Pregnancy [17I]
Authors: Schmiedecke Stacey Stevens , Estrada Sarah , Napolitano Peter 
Published: April 2018

INTRODUCTION:
Pyogenic liver abscesses are a rare clinical entity occurring in an estimated 2.3 per 100,000 of the population. Klebsiella pneumoniae-associated liver abscess syndromes are extremely rare and have not been previously reported in the medical literature during pregnancy.

METHODS:
We had a medical librarian perform a professional search using the key words, “pyogenic liver abscess”, “pregnancy”, “pregnant”, “postpartum”, “pyogenic hepatic abscess”, and “Klebsiella pneumoniae” in the English language. We found that pyogenic liver abscesses (PLA) in the antenatal and postpartum period are rare, finding only five cases that have been previously reported in the puerperium. We discovered no cases of Klebsiella pneumoniae liver abscess in pregnancy.

RESULTS:
We report a 29 year-old G2P1001 who presented at 11 weeks and 1 day for fever, fatigue, body aches and headache. An infectious workup was initiated and preliminary blood cultures returned with gram negative rods; final cultures results confirmed heavy Klebsiella pneumoniae. During her workup for Klebsiella bacteremia of unknown source, an ultrasound of the liver showed a 4 cm abscess, later confirmed with MRI. She subsequently underwent percutaneous drainage of the liver abscess with culture confirming Klebsiella pneumoniae. Following diagnosis, she received an echocardiogram and an ophthalmology evaluation to rule out invasive disease. She was treated with a two week course of intravenous ceftriaxone therapy and oral metronidazole therapy. She was then transitioned to oral cefixime for a total of four weeks of therapy until abscess resolution was confirmed on follow-up imaging. For the remainder of her pregnancy, she was followed in the high-risk obstetric clinic and delivered a viable female infant at term. At approximately two months postpartum, she continues to be followed closely for mild transaminitis and is otherwise well.

CONCLUSION:
Pyogenic liver abscesses are an uncommon etiology of fever in pregnancy. Cryptogenic PLAs are often associated with non-specific symptoms that overlap common pregnancy complaints. Accurate diagnosis requires a thorough fever workup until a source is identified. Our case is the first report of Klebsiella pneumoniae PLA in pregnancy.
Venous Thromboembolism Prophylaxis After Cesarean Section: A Quality Improvement Project [27I]
Authors: Pierce-Williams Rebecca , Cohen Isabelle , D'Adamo Chris , Ehsanipoor Robert 
Published: April 2018

INTRODUCTION:
To create and implement a venous thromboembolism (VTE) calculator for post-cesarean section patients at a community hospital, and analyze its association with subsequent rates of pharmacologic thromboprophylaxis use.

METHODS:
A risk calculator was developed, with points weighted based on the severity of the risk factor. Use of a paper form of the calculator was initiated in May 2015 (phase 1), and of an electronic form in August 2016 (phase 2). Data from 50 subjects each prior to the intervention (phase 0), during phase 1, and during phase 2 were collected (total n=150). Rates of pharmacologic thromboprophylaxis were compared with risk categories using Fisher exact test. Logistic regression models of these associations adjusting for key covariates (age, body mass index greater than 40, chorioamnionitis) were also constructed.

RESULTS:
There was a statistically significant increase in the use of pharmacologic prophylaxis after the intervention (phase 1 and 2), when compared to phase 0 (p=0.02). There was also a statistically significant decrease in high risk patients not receiving prophylaxis (p <0.0001). The association between phase and use of prophylaxis remained statistically significant after adjustment for covariates.

CONCLUSION:
Use of our calculator has led to a significant increase in prescription of pharmacologic thromboprophylaxis, particularly in moderate and high risk patients. To our knowledge, there have been no thromboembolic events since the start of the intervention.
C-reactive Protein Levels, Waist Circumference, and Pregnancy Outcomes in Overweight and Class 1 Obese Women [37I]
Authors: Rives Ted , Glass Alicia , Robbins Reiesha , Street Linda , Denney Jeffrey M. 
Published: April 2018

INTRODUCTION:
To determine effects of adipose distribution and baseline CRP in 1st trimester on development of pregnancy-related conditions of GDM, GHTN, and preeclampsia in pregnancies with normal BMI compared to BMI 25-35 stratified by waist circumference (WC).

METHODS:
Prospective study including 3 cohorts: Group I Controls (BMI 18.5-25); Group II Subcutaneous Adiposity (BMI 25-35, WC < 35 in), and, Group III Visceral Adiposity (BMI 25-35 with WC> 35 in). Patients were eligible if enrollment <14wks GA and BMI 18.5-35 but excluded for antibiotic/corticosteroid use or rheumatologic/immunodeficiency disorders. Outcome measures included: GHTN, preeclampsia, GDM. Given cost, CRP measurement was limited to 24 patients (9 GI, 5 GII, 10 GIII). Univariate/multivariate analysis used where appropriate.

RESULTS:
134 patients enrolled: GI (n=51), GII (n=24), and GIII (n=57). Mean wks GA at delivery (GI 38.5, GII 38.3, and GIII 38.4; p=0.9) and gestational weight gain lbs (GI 28.0, GII 29.1, and GIII 21.0; p=0.16) were similar by group. GIII patients had a higher likelihood of developing GDM (GI 2.4%, GII 0%, GIII 12.5%; p=0.06, OR 4.5). Controlling for confounders (HTN, DM, smoking) intake CRP correlated with BMI (R=0.85) and was higher with BMI >30 (p=0.01), noting intake mean CRP (GI 1.7, GII 1.4, GIII 4.7). CRP>3.0 in 1st trimester increased risk for GHTN/preeclampsia (OR 3.35).

CONCLUSION:
Visceral adiposity increases systemic inflammation defined by elevated intake CRP and risk for GDM. Increased incidence of complications in obese mothers may be rooted in inflammatory insults to early placental development. Future studies may assess CRP utility as a risk stratification tool.