bluuebunny/crossref_metadata_2025_split huggingface dataset:
Discharge Analgesics after Vaginal or Cesarean Section Delivery [32D]
Authors: Molero Bravo Ricardo 
Published: April 2018

INTRODUCTION:
The first exposure to opioids for many women is after delivery. We seek to evaluate the rates of opioid prescriptions written at the time of discharge after delivery at Kapi’olani Medical Center for Women and Children (KMCWC) for the year 2016, and how these rates changed after new opioid prescribing guidelines were distributed by the CDC in March 2016

METHODS:
We conducted a review of all deliveries at KMCWC during the months of January and September for the year 2016. Deliveries in which the baby was admitted to the NICU were excluded. Both cesarean and vaginal deliveries were assessed and the quantity of prescribed opioids at the time of discharge.

RESULTS:
There were a total of 907 deliveries that met inclusion criteria, 456 during January and 451 during September. There were 104 (22.8%) cesarean sections during the month of January and 352 (77.2%) vaginal deliveries. In September, there were 90 (20.0%) cesarean sections and 361 (80%) vaginal deliveries. The percentage of vaginal deliveries which received opioids at the time of discharge decreased from January to September (29% vs. 22%, p=<0.05). The mean number of prescribed pills was significantly lower for cesarean sections (30.5 vs. 28.6, p=0.0049) and a decrease for vaginal deliveries (26.5 vs. 25.5, p=0.35).

CONCLUSION:
The numbers of opioids prescribed decreased from January compared to September 2016, showing that behavioral change can occur in the teaching hospital setting. Even though this data is reassuring, more work needs to be done to help alleviate the opioid epidemic.
Sleep Apnea Screening: An Overlooked Aspect of Routine Prenatal Care [33D]
Authors: Saeed Haleema , Chauhan Gaurav , Daklallah Youssef , Attali Ami , Swain Monique , Sangha Roopina 
Published: April 2018

INTRODUCTION:
Obstructive sleep apnea (OSA) in pregnancy can lead to adverse maternal and neonatal outcomes such as pre-eclampsia, intrauterine growth restriction (IUGR), gestational diabetes (GDMA) and preterm birth. Polysomnography screening is “gold standard” for OSA but can be logistically challenging and not cost-effective. In this study, we will investigate simple screening tools such as the Berlin (BQ) and STOP-BANG questionnaires (SBQ) for OSA in pregnancy.

METHODS:
We screened 169 pregnant women using the BQ and SBQ in the third trimester. A chart review was performed for primary outcomes: pre-eclampsia, IUGR and GDMA. Secondary outcomes were gestational age at time of delivery, Apgars, and birth weight. Demographics such as age, race, BMI, gravidity and smoking history were also reviewed.

RESULTS:
Of the 169 women who participated in the study, 58 women(34.3%) were screened as high risk on the SBQ. Of these, 34.5% were subsequently diagnosed with pre-eclampsia(p=<0.01), 22.4% with GDMA(p=0.098), and 8.6% with IUGR(p=0.743). Of the 80 women(47.3%) who screened high risk on the BQ, 30% were diagnosed with pre-eclampsia(p=<0.01), 21.3% with GDMA(p=<0.01) and 7.5% with IUGR(p=0.929). Rate of preterm births were significantly higher in both BSQ and BQ high risk group at 29.3% and 26.3%, respectively(p=<0.01). No significant difference was noted in demographics.

CONCLUSION:
Obstructive sleep apnea is a modifiable risk factor that can be screened at time of first prenatal care visit, using the STOPBANG and Berlin questionnaires. Identifying and treating those with OSA early in pregnancy may lead to a decreased risk of pre-eclampsia, gestational diabetes and subsequent preterm deliveries.
Does Pregnancy Weight Gain Increase the Risk of Metformin Failure in the Treatment of Gestational Diabetes? [35D]
Authors: Persad Malini D. , Ou Jennie , Bernasko James , Garry David , Garretto Diana , Herrera Kimberly 
Published: April 2018

INTRODUCTION:
To determine if maternal weight gain is associated with a higher risk of metformin failure in 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. 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 demographics and weight parameters were collected from the medical records and compared between the 2 groups. Parametric and nonparametric statistical analyses were performed with a p value of < 0.05 as statistically significant.

RESULTS:
A total of 146 women with GDM were identified, of which 21 women (14%) failed metformin therapy. There were no differences in maternal demographics. Although the overall weight gain in pregnancy was not statistically significant between the 2 groups, mothers who failed metformin therapy had significantly less weight gain from pre-pregnancy to GDM diagnosis and higher weight gain from GDM diagnosis to delivery compared to those who did not fail metformin therapy.

CONCLUSION:
Women who were successfully treated with metformin, gained less weight after GDM diagnosis. Providers should consider weight gain in pregnancy in counseling women regarding their risk of metformin failure in the treatment of GDM.
Effectiveness of a Patient Decision Aid in Postpartum Contraceptive Counseling [1E]
Authors: Cha Sandolsam , Levi Erika , Findley Molly , Leung Wendy , Tarrash Miriam , Benfield Nerys 
Published: April 2018

INTRODUCTION:
Effective postpartum contraceptive counseling helps patients meet their reproductive life goals. Patient decision aids (PtDA) can facilitate counseling but the optimal structure and medium for a PtDA is unknown.

METHODS:
On postpartum day 1, women who had not received a postplacental LARC were randomized to: 1) a paper-based PtDA that featured contraceptive options for side-by-side comparison, 2) standard contraception brochure, or 3) website with comparison of contraceptive options. All patients received counseling utilizing their assigned tool. The concordance between a patient’s decision and their values (“decision quality”) and the extent to which she is clear about her values and feels informed (“decision-making process quality”), were evaluated using validated surveys.

RESULTS:
126 patients were enrolled. The average age of participants was 28.9, half were Latina, 69% had public insurance, 42% were primiparous, and 60% had a vaginal delivery. There were no statistical differences among the groups except for counseling time (6.4 min for PtDA, 6.6 min for the website, and 4.9 min for the standard brochure, p=0.0152). The primary outcomes of “decision quality” and “decision-making process quality” were not statistically different. Regardless of the material, women found them helpful and would recommend to a friend. Although none of the materials highlighted LARC methods, half of all participants chose a LARC method.

CONCLUSION:
Women were satisfied with all approaches to postpartum contraception counseling in this study, which on average took only seven minutes. Our PtDA offer a low-tech solution that women find helpful. Further research is needed to determine its impact in the long-term.
Post-Partum LARC Utilization Among Group Prenatal Care Participants in Atlanta, Georgia [4E]
Authors: Patberg Elizabeth , Young Marisa , Haddad Lisa 
Published: April 2018

INTRODUCTION:
CenteringPregnancy (CP) is a model of group prenatal care (PNC) that reduces preterm birth and increases patient satisfaction. Less is known about post-partum outcomes. This study was conducted to determine whether CP participants have increased utilization of long-acting reversible contraception (LARC) post-partum in comparison to those in traditional PNC.

METHODS:
We conducted a retrospective cohort study of 422 women who received PNC and delivered at Grady Memorial Hospital in Atlanta, Georgia between 2011 and 2015. Participants were eligible if enrolled in Medicaid and received at least three PNC visits with a Certified Nurse Midwife in either CP (n=248) or traditional PNC (n=174). Demographic and clinical data were abstracted from the electronic medical record. Unadjusted relative risk (RR) and adjusted incidence rate ratios (aIRR) with 95% confidence intervals (CI) were generated to compare CP with traditional PNC.

RESULTS:
One quarter of women (26%) chose LARC for post-partum contraception. CP participants were more likely to use LARC by 12 weeks post-partum in comparison to those who received traditional PNC (aIRR 1.89; p=0.01), adjusting for age, mode of delivery, number of prenatal visits and primiparity. Short inter-pregnancy interval was similar between the CP and traditional PNC groups (RR 0.95, p=0.57).

CONCLUSION:
Women in CP groups may be more likely to choose LARC post-partum contraception but were no less likely to have a short inter-pregnancy interval.
Long Acting Reversible Contraceptive Uptake in a Student Health Center Following the 2016 Presidential Election [9E]
Authors: Sridhar Aparna , Baker Zoe , Elias Sam 
Published: April 2018

INTRODUCTION:
In the context of recent political changes and concerns regarding the potential repeal of mandated contraception coverage in the United States (U.S.), the media reported a sudden increased interest in long acting reversible contraceptives (LARCs), such as intrauterine devices (IUDs) and etonogestrel implants (Nexplanon). Data compiled from 2500 Aetna Health physicians similarly revealed an abrupt increase in IUD-related appointments from October-December 2016.

METHODS:
This is a retrospective review of medical records, comparing the number of women presenting for LARC insertions at the UCLA Arthur Ashe Student Health Center in Los Angeles in the 8 weeks preceding and following the 2016 U.S. presidential election. The volume of LARC insertions during this timeframe was also compared to the volume of LARC insertions during the same 16-week period in the previous year.

RESULTS:
The total number of LARCs inserted increased from 53 in the eight weeks prior to the 2016 presidential election, to 118 in the eight weeks after the election, representing a 123% increase in LARC uptake (p-value=0.02). Over the same 16-week period in the previous year, there was no statistically significant change in number of LARC procedures. No other major changes occurred in the clinic over the 8-week period after the election to account for an increased volume of LARC insertions.

CONCLUSION:
LARC intake increased significantly in our patient population following the 2016 presidential election. We will continue to monitor LARC uptake patterns to determine whether an increased volume of LARC insertions is sustained over a larger timeframe.
Pregnancy Success via Intrauterine Insemination and Effect of Sperm Morphology: Systematic Review & Meta-Analysis [10E]
Authors: Kohn Jaden R. , Kohn Taylor , Ramasamy Ranjith 
Published: April 2018

INTRODUCTION:
Couples in which the man has abnormal sperm morphology are often counseled that natural conception and intrauterine insemination are ineffective and that in vitro fertilization is the only option. Our objective is to determine the effect of sperm morphology on pregnancy success using intrauterine insemination (IUI).

METHODS:
We systematically searched for studies published prior to January 2017 that 1) reported ultrasound-verified clinical pregnancies per IUI cycle; 2) assessed sperm morphology using the Kruger Strict Criteria; and 3) reported morphology at the >4% and ≤4% and/or ≥1% and <1% thresholds. For all studies, mean female age was between 25 and 40 years and mean total motile sperm count (TMC) was greater than 10 million. Estimates were pooled using random effects meta-analysis.

RESULTS:
Data were extracted from 20 observational studies involving 41,018 cycles of IUI. Comparing men with >4% and ≤4%, the rate of ultrasound-verified pregnancy per cycle of IUI was not statistically or clinically different (14.2% vs. 12.1%, p=0.06) and the risk difference was 3.0% (95% CI 1.4–4.6%), indicating three additional pregnancies per 100 IUI cycles. Comparing men with ≥1% and <1%, there were no statistical or clinical differences in the rate of ultrasound-verified pregnancy per cycle of IUI (14.0% vs. 13.9%, p=0.97) or in the risk difference (1.6%, 95% CI -4.5–7.6%).

CONCLUSION:
There appears to be no clinical difference in IUI pregnancy success among those with normal and abnormal sperm morphology, when accounting for total motile sperm count and female age. Abnormal sperm morphology alone should not exclude couples from attempting IUI.
Randomized Trial Comparing Three Methods of Perineal Skin Closure at the Time of Second Degree Repair [12E]
Authors: Swenson Carolyn W. , Low Lisa K. , Kowalk Katie , Seiler Kristian , Fenner Dee 
Published: April 2018

INTRODUCTION:
We aimed to test the null hypothesis that there is no difference in patient pain among three different methods of perineal skin closure during second-degree repair: 1) suture, 2) no suture, and 3) surgical glue.

METHODS:
A single-blind randomized controlled trial of women post vaginal birth with a second-degree perineal laceration was conducted at a tertiary care teaching hospital August 2014-April 2017.Following repair of the deep tissues per standard fashion, women were randomized to perineal skin closure with suture, no suture or surgical glue using a 1:1:1 allocation. Pain was assessed using the McGill, 100-mm VAS and Present Pain Index at 1 day, 2 weeks and 6 weeks postpartum.

RESULTS:
35 women were randomized: 14 received suture, 11 no suture and 10 had surgical glue. Demographics were similar between groups. At 2 weeks, women with suture had higher pain scores than those with surgical glue or no suture (McGill: suture vs glue vs no suture, 16.2 ± 9.9 vs 6.4 ± 8.4 vs 4.7 ± 5.8, ANOVA p = .021; VAS: 50.6 ± 31.7 vs 17.7 ± 25.7 vs 10.9 ± 12.2, ANOVA p=.009). At 6 weeks, pain scores remained higher with suture versus glue (McGill, p = .045) and no suture (VAS, p = .047). No difference in pain was seen between women with glue vs no suture.

CONCLUSION:
Compared to no suture and surgical glue, suturing the perineal skin was associated with the highest pain scores 6 postpartum weeks. Pain with surgical glue and no suture was similar.
Can the 2-hour Glucose Tolerance Test (GTT) Values Predict Metformin Failure in Women with Gestational Diabetes? [14E]
Authors: Persad Malini D. , Ou Jennie , Bernasko James , Garry David , Garretto Diana , Herrera Kimberly 
Published: April 2018

INTRODUCTION:
To determine if the GTT values have utility in predicting metformin failure in 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 DM, or were started on glyburide or insulin therapy initially. 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). Maternal demographics and GTT values were collected. The sensitivity and the specificity of the GTT values as a screening test for metformin failure were analyzed and the corresponding ROC curves were plotted to assess the performance of the test. Parametric and nonparametric statistical analyses were performed with a p value of <0.05 as significant.

RESULTS:
A total of 118 gestational diabetics were identified, 19 (16.1%) women failed metformin therapy. There were no significant differences in maternal demographics between groups. A ROC curve of the fasting GTT value revealed that a value of 103mg/dL was best predictive of metformin failure (AUC 0.653; p 0.04, with a sensitivity and specificity of 42% and 90% respectively. The ROC curves of the 1 hour value and 2 hour value on the GTT were not statistically significant (AUC 0.578, p 0.28; and AUC 0.579, p0.28 respectively).

CONCLUSION:
An elevated fasting GTT value may help predict metformin failure in women with GDM.
Progesterone Effects on Vaginal Cytokines in Women with a History of Preterm Birth [15E]
Authors: Demishev Michael , Persad Malini D. , Peresleni Tatyana , Baker David , Hilsenroth Jessica , Garry David 
Published: April 2018

INTRODUCTION:
To evaluate the vaginal immune response of intramuscular progesterone supplementation in pregnant women at risk for preterm birth compared to normal healthy pregnant controls.

METHODS:
A prospective, cohort study from June 2016 to August 2017 included women at a gestational age 11-16 weeks, >18 years of age, and a singleton pregnancy after IRB approval. Women in the progesterone arm had a history of preterm birth and received intramuscular 17-hydroxyprogesterone caproate. Controls were comprised of healthy, uncomplicated pregnancies. Exclusion criteria were vaginitis, diabetes mellitus, hypertension, and other chronic diseases affecting the immune response. A vaginal wash was performed on entry to the study, at 26 to 28 weeks, and at 35-36 weeks. Samples underwent semi-quantitative detection of human inflammatory markers. Immunofluorescence pixel density data was analyzed and P value <0.05 was considered significant.

RESULTS:
There were 39 women included, 10 with a prior preterm birth and 29 controls. The baseline demographics and pregnancy outcomes for both groups were similar in age, parity, race, BMI, gestational age at delivery, mode of delivery, and birth weight. Enrollment cytokines in women with a prior preterm birth, including IL-1 alpha (39.2+25.1% versus 26.1+13.2%; P=0.04), IL-1 beta (47.9+26.4% versus 24.9+17%; P<0.01), IL-2 (16.7+9.3% versus 11.3+6.3%; P=0.03), and IL-13 (16.9+12.4% versus 8.2+7.4%; P=0.01), were significantly elevated compared with controls. In the third trimester the cytokine densities for IL-1 alpha (26.0+18.2% versus 22.3+12.0%; P=0.49), IL-1 beta (31.8+15.9% versus 33.1+16.8%; P=0.84), IL-2 (10.0+8.4% versus 10.9+5.9%; P=0.71), and IL-13 (9.1+5.9% versus 10.0+6.5%; P=0.71) were all statistically similar between the prior preterm birth group and the healthy controls, respectively.

CONCLUSION:
There is an increased cytokine presence in vaginal washings of women at risk for preterm birth which appears to be modified following administration of 17- hydroxyprogesterone caproate compared with healthy controls.
Qualitative Analysis of Challenges Managing Staff and Bed Availability on Labor and Delivery Units [34E]
Authors: Plough Avery , Henrich Natalie , Galvin Grace , Shah Neel T. 
Published: April 2018

INTRODUCTION:
Mangers of labor and delivery units need to ensure that their limited supply of beds and nursing staff are adequately available, despite uncertainty regarding future patient needs. The ability to address this management challenge has been associated with patient outcomes, however best practices for managing labor and delivery unit resources have not been defined.

METHODS:
We conducted a secondary analysis of 96 interviews with nurse and physician managers from 48 labor and delivery units across the United States. Based on emerging themes, we identified common challenges in managing bed and staff availability. For each management challenge, we assessed specific management practices based on proactiveness (ability to mitigate challenges before they occur) and systematicness (ability to address challenges in a consistent and reliable manner).

RESULTS:
We identified four key challenges common to all labor and delivery units: 1) scheduling planned cases, 2) tracking patient flow, 3) monitoring bed and staff availability in the moment, and 4) adjusting bed and staff availability in the moment. We observed that proactiveness and systematicness represented distinct characteristics of management practices with some units exhibiting proactiveness but not systematicness and vice versa. Units with both proactive and systematic practices appeared best positioned to reliably address resource challenges effectively.

CONCLUSION:
Labor and delivery unit managers should assess both the proactiveness and systematicness of their existing resource management practices and consider how their practices could be modified to improve operations and quality of care.
Obstetrical and Neonatal Outcomes in Pregnancies Affected by Cannabis Abuse or Dependence [36E]
Authors: Petrangelo Adriano , Czuzoj-Shulman Nicholas , Abenhaim Haim Arie A. 
Published: April 2018

INTRODUCTION:
Cannabis is one of the most commonly used illicit drugs during pregnancy in the United States and this prevalence may rise with a growing number of states legalizing its use. We aimed to describe the rate of its use during pregnancy and evaluate its adjusted effect on obstetric and neonatal outcomes.

METHODS:
We performed a retrospective population-based cohort study composed of 12 million births in the United States between 1999 and 2013, extracted from the National Inpatient Sample, compiled by the Healthcare Cost and Utilization Project. Births to mothers abusing or dependent on cannabis were identified using ICD-9 codes and were compared to unexposed women. The adjusted effect of cannabis exposure during pregnancy on various obstetrical and neonatal outcomes was assessed with the use of unconditional logistic regression.

RESULTS:
There were 66,925 births to mothers using cannabis with an incidence rising from 0.28% in 1999 to 0.95% in 2013, p<.05. Compared with the reference population, women reporting cannabis use were at a significantly higher risk of having a preterm premature rupture of membranes (OR 1.46, 95%CI 1.35-1.58) and miscarriage (OR 1.46 95% CI 1.34-1.58). Neonates born to exposed mothers were at a higher risk of being born prematurely (OR 1.40 95% CI 1.36-1.43) and growth restricted (OR 1.35 95%CI 1.30-1.41).

CONCLUSION:
Cannabis use during pregnancy has steadily increased over the study period and is associated with important adverse newborn outcomes. With legalization of cannabis use for recreational purposes, pregnancy may become an important public health concern and should be monitored.
Patterns of Gestational Weight Gain in Relation to Maternal Body Mass Index in Rural Pennsylvania [37E]
Authors: Power Michael L. , Lott Melisa , Mackeen A. Dhanya , DiBari Jessica , Schulkin Jay 
Published: April 2018

INTRODUCTION:
To assess whether the patterns of gestational weight gain (GWG) in a rural population changed after the release of the 2009 Institute of Medicine (IOM) guidance on GWG modified by maternal pre-pregnancy body mass index (BMI).

METHODS:
We examined GWG in 18,217 term singleton births between 2006 and 2015 in which maternal pre-pregnancy BMI and GWG could be calculated from electronic medical records at Geisinger in PA.

RESULTS:
The proportion of births with recorded maternal pre-pregnancy BMI and data to calculate GWG increased after 2010, suggesting greater effort in tracking maternal weight. However, the pattern of GWG did not change between 2006 and 2015, with the proportion of women who gained outside of recommendations remaining constant. Only 26% of women in this population gained within recommendations. More than 50% of overweight and obese women gained above IOM recommendations in all years. Underweight women were the most likely to gain below recommendations (33%). GWG above recommendations was associated with higher birthweight, low Apgars and a greater increase in maternal blood pressure throughout pregnancy. Underweight women who gained below recommendations had the highest proportion of low birth weight babies (10.4%).

CONCLUSION:
Despite the publication of IOM recommendations in 2009 and an apparent increase in tracking maternal weight after 2010, GWG in this population did not change between 2006 and 2015. A majority of overweight and obese women gained above recommendations and one third of underweight women gained below recommendations. GWG outside of IOM’s recommendations was associated with poorer outcomes.