bluuebunny/crossref_metadata_2025_split huggingface dataset:
Age, BMI, and Race as Independent Predictors for 30 Day Readmission After Total Laparoscopic Hysterectomy [8C]
Authors: Le Chi , Elsamadicy Emad A. , Brown Kelsei , Lee Jaclyn 
Published: May 2019

INTRODUCTION:
Readmission after hysterectomy is being used as a proxy for quality of care. We aim to assess the roles of patient age, BMI, and race on 30 days readmission after total laparoscopic hysterectomy (TLH).

METHODS:
Medical records of 168 consecutive patients who underwent TLH at a major academic center between 2010 and 2012 were reviewed. Age, BMI, race, and status of 30-day readmission were collected. Non-readmitted and readmitted group were compared using Welch t-tests and Pearson's Chi-square tests with Yate's continuity correction.

RESULTS:
Among 168 patients reviewed, 15 (8.9%) patients had unplanned readmission within 30 days of TLH while 153 (91.1%) did not. There was a statistically significant difference in age between the two groups, and younger age was observed in the readmitted cohort (Readmitted: 32.6 years vs. Non-readmitted: 38.6 years, p=.00397). No significant difference BMI were identified between the 2 groups (Readmitted: 30.95 vs. Non-readmitted: 31.45, p=0.836). Among 133 Non-Hispanic White and 32 Black patients, readmission rates were higher among Black patients; however, the difference was not statistically significant (Black: 15.6% vs. White: 7.5%, p=0.276).

CONCLUSION:
Our study demonstrated the significance of patient's age in 30-days readmission after total laparoscopic hysterectomy. Moreover, BMI and race were not found to be predictors of readmission. Future studies are necessary evaluate risk factors for readmission to improve surgical outcomes and quality of care.
Assessment of Menstrual Product Financial Burden on Low-Income Patients [9C]
Authors: Trant Amelia A. , Espinal Mariana , Kisanga Edwina , Lee Illuzzi Jessica , Sheth Sangini Shah , Fan Linda L. 
Published: May 2019

INTRODUCTION:
Anecdotal evidence indicates that low-income women in developed countries have difficulty affording menstrual products. Lack of access to menstrual products has been linked to truancy and negative psychosocial effects in school age-females and poor menstrual hygiene practices can increase risk of urogenital infections. This study aims to assess if the expense of menstrual products is a burden for low-income women.

METHODS:
In a cross-sectional study at two outpatient women's health practices at Yale-New Haven Hospital, patients were given an anonymous 21-question questionnaire to complete during their clinic visit. The study protocol was approved by the Institutional Review Board of record at Yale University and informed consent was obtained from all participants. Adult English and Spanish-speaking women of reproductive age were eligible for the study. Access and affordability of menstrual products was assessed on a four-point Likert scale.

RESULTS:
One hundred seventy patients were invited to participate, 155 completed the survey. Participants reported having difficulty affording menstrual products: most of the time 3%, sometimes 19%, rarely 19%, never 59%; 50% of patients reporting menstrual hygiene insecurity (lacking access most of the time or sometimes) had annual family incomes below $20,000. Sixty-seven percent of respondents could not recall any discussions with healthcare professionals about menstrual products.

CONCLUSION:
Menstrual hygiene insecurity is a common issue among women who are low-income and especially those living below the federal poverty level. Healthcare providers serving these populations should ask patients about menstrual product use and affordability to assess need.
Gynecological and Contraceptive Needs of Female Survivors of Sex Trafficking and Sexual Violence [13C]
Authors: Rajeev Pournami , Goddard Brian , Pearson-Ayala Savannah , Bach Sonya Chemouni , Ades Veronica 
Published: May 2019

INTRODUCTION:
Survivors of sexual trauma need trauma-informed care, but their specific gynecologic needs have not been explored. This study aims to examine the gynecological and contraceptive needs among survivors who did present to a specialized gynecology clinic for trauma survivors. This data may help gynecologists who encounter patients with sexual trauma to better understand their medical needs.

METHODS:
This is a retrospective cohort study of patients at the EMPOWER Clinic for Survivors of Sex Trafficking and Sexual Violence. IRB approval and patient informed consent were obtained. Data were abstracted from electronic medical records, and stored and analyzed using REDCap.

RESULTS:
Data were available for 232 patients. Most patients presented to the clinic for a routine gynecological exam or due to gynecological symptoms. The most common chief complaints were dysmenorrhea, menorrhagia, and abdominal pain. Seventy percent of childbearing age patients were not on any form of effective contraception at the time of their intake visit. However, more than half of these patients with whom family planning was discussed accepted a new form of contraception, with 50% of these patients choosing oral contraceptive pills.

CONCLUSION:
Trauma survivors often present with routine gynecological complaints, and providers should be prepared to address these in addition to the trauma. Many patients were not using an effective form of contraception at intake, but a majority of patients who discussed family planning with the Ob/Gyn accepted a new form of contraception, suggesting that there may be a high unmet need for contraception in this population.
Predictors of Antenatal Seasonal Influenza Vaccination in an Underserved Population [15C]
Authors: Adams Jenna , Biswas Hope H. , Boulet Sheree L. , Haddad Lisa , Jamieson Denise J. 
Published: May 2019

INTRODUCTION:
Uptake of seasonal influenza vaccination among pregnant women remains low despite recommendations supporting routine vaccination in this population at high risk for severe morbidity. We evaluated predictors of antenatal influenza vaccination in an underserved patient population.

METHODS:
We conducted a retrospective cohort study of all women with deliveries to Emory healthcare providers at Grady Memorial Hospital, a large safety-net hospital, between July 1, 2016 and June 30, 2018. Demographic and clinical characteristics were abstracted from electronic medical records. The Kotelchuk Index was used to assess prenatal care adequacy. Adjusted relative risks (aRRs) and 95% confidence intervals (CIs) for associations between demographic and clinical characteristics and receipt of influenza vaccine were calculated using multivariable log-binomial models. IRB approval was obtained for this study.

RESULTS:
Among 3,727 women with deliveries, most were non-Hispanic black (68.60%) and had Medicaid as their primary insurer for delivery (87.93%). The overall vaccination rate was 49.80% (1,856/3,727). Characteristics significantly associated with influenza vaccination in multivariable models were Hispanic ethnicity (aRR 1.44, 95% CI 1.11-1.88), transferring care between institutions (aRR 0.34, 95% CI, 0.29-0.41), and inadequate prenatal care (aRR 0.70, 95% CI, 0.64-0.75).

CONCLUSION:
Women with inadequate or discontinuous prenatal care were less likely than women with adequate prenatal care to receive a seasonal influenza vaccine. Hispanic ethnicity was associated with increased rates of influenza vaccination, even after controlling for interpretive language services. These findings highlight the importance of continuous, regular prenatal care in recommending and offering antenatal vaccinations to pregnant patients while supporting possible cultural differences in vaccine acceptance.
Influence of Depression on Maternal Outcomes [21C]
Authors: Packer Claire , Valent Amy 
Published: May 2019

INTRODUCTION:
We sought to determine the differences in maternal pregnancy outcomes in patients with pre-existing major depressive disorder compared to unaffected women.

METHODS:
A retrospective cohort study comparing the rate of maternal outcomes among singleton, non-anomalous births in California to women with or without the diagnosis of depression between 2007 and 2011. Maternal outcomes of interest included pregestational diabetes (DM), gestational diabetes (GDM), cesarean delivery, postpartum hemorrhage (PPH), hypertensive disorders of pregnancy (preeclampsia or gestational hypertension), and maternal blood transfusion. Multivariate regression analyses and chi-square tests were employed for statistical comparisons and a p-value of less than 0.05 was used to indicate statistical significance.

RESULTS:
Of the 2,214,533 births in California, 18,775 (0.85%) women were diagnosed with depression. Depression was significantly associated with an increased risk of maternal morbidity and mortality, including DM (Adjusted Odds ratio [aOR] 1.85, 95% CI 1.63-2.10), GDM (aOR 1.33, 95% CI 1.27-1.40), cesarean delivery (aOR 1.05, 95% CI 1.01-1.09), PPH (aOR 1.80, 95% CI 1.68-1.94), maternal blood transfusion (aOR 1.19, 95% CI 0.77-1.84), hypertensive disorders of pregnancy (aOR 1.30, 95% CI 1.23-1.38), and stillbirth (OR 1.49, 95% CI 1.21-1.82) (Table 1).

CONCLUSION:
Women with depression are at increased risk for adverse maternal outcomes in pregnancy. The influence of pharmacologic and behavioral based interventions on these outcomes need to be explored.
Integrating Doulas Into Hospital Births: Provider Perceptions of Doulas and Doula Care [22C]
Authors: Neel Kira , Goldman Roberta , Nothnagle Melissa 
Published: May 2019

INTRODUCTION:
A birth doula provides continuous informational, physical and emotional support during pregnancy, labor and immediately postpartum. Existing published data on the health benefits of birth doulas, especially for low-resource, high-need patients, do not address how and why individual providers decide to utilize or encourage this model of care. This research project aims to fill a gap in the literature describing best practices of integrating doulas into hospital based maternity care teams in order to facilitate access to this evidence-based service for improving maternal health outcomes.

METHODS:
Semi-structured interviews using open-ended questions were conducted in person with 47 maternity care providers across 3 hospitals. A purposive sampling approach included OB/GYN and family medicine physicians, RNs, and nurse midwives. Interviews were audio-recorded, professionally transcribed, and analyzed using the Template Organizing style qualitative analysis approach. The organizing framework was the doula model of care.

RESULTS:
The codebook was based on the doula model of care framework, existing literature on doulas and doula care, and topics in the interview guide. Results demonstrated varied support for doula care given providers' experiences. Suggestions to facilitate good working relationships centered on three overlapping themes: education, role clarification, and mutual respect.

CONCLUSION:
Preliminary findings suggest that doula care may be well-received in hospital settings with adequate staff training on the doula model of care, explicit definition of roles, and doulas working closely with providers. Findings will inform the development of evidence-based trainings and education on how to facilitate good working relationships to incorporate doulas into maternity health care teams.
Interdisciplinary Implementation of Quantification of Blood Loss During Vaginal and Cesarean Delivery [23C]
Authors: Savoie Marissa B. , Gomez Axel , Bernstein Laurel , Delgado Ana , Newmann Sara Jeanette 
Published: May 2019

INTRODUCTION:
Delayed recognition of blood loss is associated with preventable post-partum morbidity and mortality. Visual estimation of blood loss is inaccurate. Quantification of blood loss (QBL), a weight and volume-based method, was incorporated into the California Maternal Quality Care Collaborative Obstetric Hemorrhage Toolkit. We implemented QBL recommendations for vaginal and cesarean deliveries in an urban hospital-based birth center and followed compliance data over 9 months.

METHODS:
First-year medical students, as part of an interdisciplinary quality improvement team, championed the implementation of QBL for vaginal deliveries (starting December 2017), then for cesarean deliveries (starting March 2018). QBL protocols were designed by the team. Adoption of QBL was supported and evaluated by a multi-component intervention consisting of in-service and online trainings, worksheets, visual aids, surveys, and qualitative interviews. Documentation of QBL at all deliveries was assessed weekly, with a goal of 80% QBL.

RESULTS:
The average QBL compliance for vaginal and cesarean deliveries was 90% over 9 months and 85% over 6 months, respectively (772 births total). While most providers and nurses indicated that QBL was important, key issues raised included how QBL changes management during post-partum or intra-operative hemorrhage, feasibility during an emergency, and nursing workflow.

CONCLUSION:
Our multi-component intervention and evaluation process resulted in successful implementation of QBL at an urban hospital-based birth center. Medical students played a key role in the project illustrating benefits of student involvement in quality improvement work. The effect of QBL on post-partum morbidity and mortality has yet to be explored.
Management of Intraamniotic Infection After Spontaneous Vaginal Delivery: Is Nothing Really Enough? [24C]
Authors: Daifotis Helen , Smith Megan , Denoble Anna Elisabeth , Dotters-Katz Sarah 
Published: May 2019

INTRODUCTION:
Current guidelines for management of intraamniotic infection (IAI) call for intrapartum antibiotic therapy, without further treatment after spontaneous vaginal delivery (SVD) except in high-risk women. High-risk criteria are not well-defined. We aim to describe the incidence of and identify risk factors for postpartum infectious complications (PPI) after SVD complicated by IAI.

METHODS:
Case control study of SVDs with clinically diagnosed IAI at a single academic center. Cases were defined as women who developed PPI, including endometritis, perineal infection, sepsis, urinary tract infection (UTI), or pyelonephritis. Cases were compared to those who did not develop PPIs (controls) using bivariate statistics. IRB approval was obtained prior to commencement of this study.

RESULTS:
Between 01/01/2014 and 12/31/2017, 346 women underwent SVD complicated by IAI. Of these, 23 (6.2%) developed PPI (endometritis n=7, UTI/pyelonephritis n=6, sepsis n=4, perineal infection n=6) within 6 weeks of delivery. No differences in demographic data or antepartum complications were observed. Women with PPI were not more likely to receive antibiotics intra- or postpartum, however were more likely to deliver prior to 32 weeks (17.4% vs 4.9%, P=.04). When controlling for antibiotic use intra- and postpartum, delivery at <32 weeks was associated with 3.8-fold increased (95% CI 1.07, 13.7) odds of PPI.

CONCLUSION:
Postpartum infectious complications occur in approximately 1/15 women delivering vaginally with IAI, with those who deliver at <32 weeks' gestation being at increased risk. Though no specific guidelines for postpartum antibiotic therapy in the setting of IAI exist, women delivering before 32 weeks may warrant consideration of postpartum antimicrobial therapy.
Maternal Weight Gain and Neonatal Outcomes in Women With Class III Obesity [29C]
Authors: Reiff Emily S. , Adkins Lamani , Tucker Ann Robin , Gatta Luke , Brown Haywood L. , Dotters-Katz Sarah Kathleen 
Published: May 2019

INTRODUCTION:
Class III obesity is an independent risk factor for neonatal morbidity. Institute of Medicine (IOM) guidelines recommend 11-20 lbs of gestational weight gain (GWG) in women with obesity. We evaluated the association between GWG and neonatal outcomes in women with Class III obesity.

METHODS:
Retrospective cohort of women delivering a liveborn neonate at term at a single institution between 7/2013-12/2017 with a baseline BMI ≥40 in the first trimester. Pregnancies complicated by multiple gestation or fetal anomalies were excluded. Primary outcome was a neonatal composite including 5 m apgar <7, intubation, grade 3/4 IVH, sepsis or intensive care unit (NICU) admission. Secondary outcomes included NICU admission >7 days. Demographic, pregnancy & delivery characteristics of women who gained >20 lbs (mIOM) were compared to those that gained <20 lbs (lIOM) using bivariate statistics. Stepwise backward regression was used to estimate odds ratios.

RESULTS:
Of 374 women, 144 (38.5%) gained mIOM, who were less likely to be multiparous, use tobacco or have a lower BMI at delivery. The neonatal composite occurred in 30 (8.0%) neonates, 16 (11.1%) in mIOM versus 14 (6.1%) in the lIOM group (p=0.12, OR=1.93, 95% CI 0.91,4.08). When adjusted for multiparity and BMI at delivery, the aOR was 1.55 (95% CI 0.85-2.82). Neonates in the mIOM group were more likely to be admitted to the NICU (10.4% v 4.4%, p=0.03, OR=2.56, 95% CI 1.12-5.86) and have an admission >7days (6.9% v 2.2%, p=0.03, OR=3.36, 95% CI 1.12-10.03).

CONCLUSION:
In women with class III obesity, excess GWG was associated with increased odds of NICU admission and admission >7 days.
Normal Reference Values for Percent Body Fat at Term [30C]
Authors: Stark Sydney , Weatherborn Megan , Landau Daphne 
Published: May 2019

INTRODUCTION:
Birth weight percentiles provide limited information on neonatal nutritional status. Body composition may be a better indicator as it provides estimates of percent lean and fat mass. We sought to create a normal reference range for percent body fat (%BF) at term.

METHODS:
On admission, all term infants in our nursery undergo assessment of percent body fat by a validated Anthropometric Model. For this analysis, infants were grouped by sex then categorized by completed gestational age (GA). Subjects with incomplete data were excluded. Data was examined for equal variance and then analyzed using the appropriate Student t test. One way ANOVA was used to compare %BF between 5 gestational age groups (37, 38, 39, 40, and 41 completed weeks) for each sex. Data was expressed by mean and SD. P<.05 was considered significant.

RESULTS:
Our total cohort included 1336 infants, 715 male and 621 female, analyzed separately. Birthweight was 3.302 kg (±0.45) in males and 3.138 kg (±0.45) in females. There was no significant difference between the mean %BF for males 12.77% (±3.53) and females 12.705% (±3.57), (P=0.72). There was a significant difference in %BF at each completed week of gestational age; this was true for both male and female infants (P<.00001).

CONCLUSION:
The results of this pilot study establish a normative reference curve for gender and gestational age-specific %BF at term. These data have potential clinical and research applications for understanding newborn nutritional status.
Osteosarcoma During Pregnancy: Case Report and Review of the Literature [32C]
Authors: Urbina Josephine Paula , Scott Elizabeth , Aikman Noelle Marie 
Published: May 2019

INTRODUCTION:
To present a case report and review the literature on osteosarcoma during pregnancy

METHODS:
31 year old para 1 female with a prior history of cesarean delivery complained of dull pain in her right knee not relieved with rest during her 2nd trimester. Both x-ray and MRI revealed “abnormal appearance of distal femur,” possibly secondary to tumor or osteomyelitis. After multiple biopsies, she was diagnosed with high grade osteosarcoma. A subsequent CT chest showed nodules possibly representing metastasis. She underwent delivery by repeat cesarean at 29 weeks gestation after receiving antenatal steroids, as recommended by a multidisciplinary team. Her postpartum course was uncomplicated and she was discharged on post-op day 3. She began neoadjuvant chemotherapy with doxorubicin, cisplatin and ifosfamide within 4 weeks of delivery.

RESULTS:
5 studies were identified reporting on a total of 16 patients diagnosed with osteosarcoma during pregnancy. The age range was 16 to 38. Most common presenting symptoms were pain, enlarging mass and fractures. Metastasis were identified in 9 patients. Most patients underwent vaginal delivery at term. Four patients underwent surgical resection during pregnancy. Most patients underwent chemotherapy. 6 patients eventually succumbed to the disease. Of those, one patient was diagnosed postmortem and never received treatment.

CONCLUSION:
Osteosarcoma in pregnancy is rare. Risks and benefits of early delivery versus delaying maternal therapy have to be weighed in an aggressive malignancy such as this. Long term maternal and neonatal outcomes have to be considered. Our experience was consistent with more recently published case reports and case series.
Rates of Cesarean Conversion in Planned Vaginal Twin Deliveries: Do We Need the Operating Room? [39Q]
Authors: Mei Jenny Y. , Szlachta-McGinn Alec W. , Munoz Hector Enrique , Rao Rashmi , Datkhaeva Ilina , Afshar Yalda 
Published: May 2019

INTRODUCTION:
We aimed to investigate rates of cesarean conversion for planned twin VDs and identify predictors and outcomes of conversion.

METHODS:
A retrospective cross-sectional study of women who underwent planned twin VD at a large academic hospital over four years (IRB#18-000872). Demographic and outcome data were chart abstracted. Logistic regression was used to analyze predictors of conversion and Welch two-sample t- test was used to compare outcomes.

RESULTS:
405 twin deliveries were identified; 60 (14.8%) were planned VD. Of these, 40 (66.7%) were cephalic/cephalic and 20 (33.3%) cephalic/breech presentation. Median maternal age was 33.9 years (IQR 31.6-35.9). Median gestational age (GA) was 36 weeks (IQR 35-38). Conversion to cesarean delivery (CD) occurred in 4 planned VDs (6.7%). Of these, 1 (1.7%) was emergent for fetal bradycardia and 3 (5%) were for malpresentation of Twin B, 2 of which involved providers inexperienced with breech extractions of second twin. There were no significant predictors of conversion to CD, including BMI, maternal age, antepartum length of stay (LOS), GA at delivery, parity, presentation, or type of OB provider. There was no correlation between conversion to CD and postpartum LOS (P=0.12). There were no correlations with neonatal APGARs at 1 and 5 minutes for twin A (P=0.26, P=0.75) or twin B (P=0.86, P=0.51).

CONCLUSION:
Successful VD is achieved in 93.3% of planned VD of twins. Need for emergent conversion to CD, requiring immediate OR availability, is very low. Planned vaginal twin deliveries can be safely performed in Labor and Delivery rooms to optimize costs and resource utilization.