bluuebunny/crossref_metadata_2025_split huggingface dataset:
High-Normal Blood Pressure as a Predictor of Preeclampsia in Twin Pregnancies [19C]
Authors: Hill Melissa B. , Connolly Courtney T. , Klahr Rebecca A. , Zafman Kelly B. , Rebarber Andrei , Fox Nathan S. 
Published: May 2019

INTRODUCTION:
Prior research examining blood pressure in twin pregnancies defined the 95th percentile for SBP and DBP for gestational age (120 systolic, 80 diastolic before 30 weeks; 130 systolic, 84 diastolic after 30 weeks). Our objective was to determine if women with twin pregnancies and BP above the 95th percentile (but normal, i.e. <140 SBP and <90 DBP) are at increased risk of preeclampsia.

METHODS:
Retrospective cohort study of all twin pregnancies in a single MFM practice between 2012 and 2018. IRB approval was obtained. We identified all women with SBP or DBP >95th percentile but <140/90, excluding those with chronic hypertension. The primary outcome was development of preeclampsia.

RESULTS:
457 patients met inclusion criteria, of whom 109 (23.9%) had either SBP or DBP >95th percentile (but normal) at any time during pregnancy. These women were significantly more likely to develop preeclampsia than those without any readings >95th percentile (30.3% vs. 12.6%, p<0.001, aOR 3.0 (1.7, 5.1)). Patients with a DBP reading >95th percentile had the highest risk of developing preeclampsia (42.9% vs. 14.2%, p<0.001, aOR 4.2 (2.1, 8.4)). A SBP or DBP >95th percentile was a significant predictor of preeclampsia (AUC 0.61, 95% CI 0.54, 0.69, p=0.002).

CONCLUSION:
In women with twin pregnancies, normal SBP or DBP above the 95th percentile is associated with significantly increased risk of preeclampsia. DBP above the 95th percentile has the strongest association, with 42.9% developing preeclampsia. Women with twin pregnancies and normal BP above the 95th percentile should be observed closely for development of preeclampsia.
Increased Incidence of Small for Gestational Age Neonates Among Hispanic English Only Speaking Women [20C]
Authors: Agarwal Muskan , Dorado Jimmy Espinoza , Yallampalli Chandrasekhar , Banadakoppa Manu 
Published: May 2019

INTRODUCTION:
The association of limited English proficiency and adverse perinatal outcomes is unclear. This study looked at the relationship between maternal language proficiency and birth weight.

METHODS:
Data from all Hispanic/Latino women in the database Peribank were included. The GROW-Centile calculator from the Perinatal Institute categorized neonates into 3 groups: small for gestational age (SGA), normal for gestational age, and large for gestational age (LGA). Logistic regression analysis was used to control for confounding factors (type I/II diabetes, gestational diabetes, maternal smoking, hypertension/preeclampsia, BMI, parity, country of birth, total years living in the US).

RESULTS:
Spanish only speaking patients (n=6248) had a lower incidence of SGA neonates than those with some English proficiency (n=3955) (OR .822; 95% CI .707-.954; P=.012). In contrast, English only speaking patients (n=295) had a higher incidence of SGA neonates than those with some Spanish proficiency (n=9908) (OR 1.452; 95% CI 1.045-2.019, P=.026). Of note, Spanish only speaking patients (n=6248) had a higher incidence of LGA neonates than those with some English proficiency (n=3955) (OR 1.266; 95% CI 1.052-1.523, P=.012). No association was found between English only speaking patients and LGA neonates (P=.937).

CONCLUSION:
Spanish only speaking patients were associated with larger neonates than those who have some English proficiency. One hypothesis is that higher English proficiency may be an indicator of greater assimilation into American culture, and therefore increased adoption of the American diet. As Hispanic/Latino patients become further assimilated into the American culture and diet, they may be at a higher risk of SGA neonates.
Maternal Factors Associated With Compliance in a 2-Year Birth Cohort Study [25C]
Authors: Samaha Mia , Cline Allison , Staat Mary , Morrow Ardythe , DeFranco Emily A. 
Published: May 2019

INTRODUCTION:
There is a paucity of data on predictors of compliance among pregnant women participating in large clinical studies. We aimed to investigate whether socio-demographic factors may accurately identify populations that will comply with the demands of clinical studies.

METHODS:
265 pregnant women, >34 weeks, were consented to participate in a 2-year prospective birth cohort study, Pediatric Respiratory and Enteric Virus Acquisition and Immunogenesis Longitudinal Cohort (PREVAIL, www.cdc.gov/surveillance/nvsn/prevail.html). Enrollment compliance was determined by completion of an infant follow-up visit two-weeks post-delivery. Maternal socio-demographic factors were compared between women who completed enrollment and delivery specimen collection. Comparisons with p-value <0.05 were considered significant.

RESULTS:
Among the study population, 50% of women were married, 47% African-American, 9% had <high school education, 53% had public insurance, and 26% used tobacco during pregnancy. Among 265 women who consented prior to delivery, >80% completed the first infant biologic sample collection during delivery hospitalization. Over 95% (N=241) completed the two-week infant follow-up visit. No socio-demographic factors significantly associated with compliance with delivery-specimen collection or 2-week infant follow-up visit, all p-values >0.05.

CONCLUSION:
Among a demographically heterogeneous population of women enrolled in PREVAIL, compliance with delivery sample collection and enrollment-determining follow-up visit was high, 95.3%. No socio-demographic factors were significantly associated with compliance in enrollment study procedures. Women who are socio-economically disadvantaged and exhibit negative health behaviors were equally as likely to be compliant as compared to other participants. These data support a non-biased approach of screening and enrollment in research studies inclusive of women of all backgrounds.
Rates of ICU Admission Among Peripartum Women With Obesity at Urban and Rural Hospitals in the [40Q]
Authors: Antony Kathleen M. , Hsiang-Hui Daphne Kuo , Hartenbach Ellen , Ehrenthal Deborah 
Published: May 2019

INTRODUCTION:
Women with obesity, particularly BMI ≥ 50 kg/m2, have increased risk of peripartum admission to the intensive care unit (ICU). We sought to investigate whether the rate of peripartum ICU admission for women with obesity varied by location of birth (rural versus urban).

METHODS:
We used 2014-2015 geocoded birth records from the National Center for Health Statistics (NCHS) to examine the rural-urban differences in ICU admission among nulliparous women delivering singleton, vertex pregnancies at term. The rates of ICU admission were assessed by geographic category (NCHS urban-rural classification) of the county of delivery. BMI was classified into eight total groups defined by WHO criteria with sub-stratification of class III obesity every 5 kg/m2 up to BMI ≥50 kg/m2.

RESULTS:
Among 2,538,994 eligible births, the overall rate of ICU admission per 1000 live births was higher for women with BMI ≥50 kg/m2 (RR 3.89, 95% CI 2.20-6.90) across all geographic categories. Compared to large metropolitan-central counties, rates of ICU admission were lower for all other counties except non-core, which had a higher ICU admission rate (RR 1.72, 95% 1.24-2.39). When evaluating the interaction of BMI and geography, the rate of ICU admission did not vary by BMI or geography except for an increased rate of ICU admission for women with BMI between 30 and 34.9 kg/m2 delivering in micropolitan areas (RR 1.81, 95% CI 1.14-2.86).

CONCLUSION:
The rate of ICU admission is similar across geographic locations and BMI strata. Whether this rate should be lower in rural areas warrants further investigation.
Time to Delivery Following Induction of Labor in Obese Versus Normal-Weight Women [11S]
Authors: Knutson Karin Britta , Leung Katherine , Allocco Elizabeth Rose , Minor Kathleen , Delpapa Ellen , Lauring Julianne 
Published: May 2019

INTRODUCTION:
Increasing BMI (body mass index) has been associated with a longer first stage and longer total spontaneous labor course, however length of labor induction in obese versus normal weight women has been incompletely described. Our objective was to compare length of labor in obese versus normal weight women undergoing induction.

METHODS:
This IRB-approved secondary analysis of a retrospective cohort study included women 18-40 undergoing induction of labor at University of Massachusetts Medical Center in 2016. Our primary outcome was length of induction in hours, from first intervention to delivery. Demographic information and labor and delivery data were also collected.

RESULTS:
218 women met inclusion criteria, 97 (44.5%) normal weight and 121 (55.5%) obese. The mean length of induction in normal-weight women was 14.1 hours (SD=10.2) and 20.2 hours (SD=18.1) in obese women (p=0.047). Obese women were also more likely to be delivered by cesarean section (p=0.002). When adjusting for potential confounders including demographics, parity, birth weight percentile, gestational age, gestational weight gain adherence, obese women had an induction time that was on average 5.0 hours longer than normal weight women (p=0.026). However, when adjusting for misoprostol use there was no significant difference in length of induction.

CONCLUSION:
Obesity was associated with increased length of time to delivery during induction of labor. Induction of labor is a complex, multifactorial process which may be affected by patient characteristics and provider bias which may be difficult to predict or control for in study.
Virtual Reality for Pain Control During Labor: Patient Preferences [14S]
Authors: Cowles Steven , Norton Taylor Jeffery , Hannaford Karen Elaine , Foley Michael 
Published: May 2019

INTRODUCTION:
Immersive virtual reality (VR) has recently been shown to be a valid method to treat pain and anxiety. This modality is very new to the childbirth process. One objective of this study was to show if, during labor, there is a pain level or time of day where virtual reality is less effective or desired, and what VR applications subjects enjoy using most.

METHODS:
This is a randomized control trial intended as a pilot study with 2 different arms of 10. Nurses periodically recorded information every 4 hours during latent labor and every 1 hour during active labor. VR arm patients were asked to use VR for at least 15 minutes and record pain scores again. Patients were allowed access to all standard forms of analgesia throughout labor. A brief survey was completed after delivery. IRB approval/informed consent was obtained.

RESULTS:
100% of patient stopped using VR as labor progressed, even after getting epidurals with the average pain score of 8 in non-epiduralized patients. The average number of VR uses per patient was 3.1 +/- 0.99. 80% of patients' last use of VR prior to refusal was before 2300 hrs. The most enjoyed VR experience was playing games with 67%, and nature/meditation scenes were also preferred options.

CONCLUSION:
This study suggests that VR in labor has some parameters to optimal use. Patients tend to not desire VR use with pain scores >8, or at night time. When implementing VR during labor, patient preferences should be kept in mind to optimize its effectiveness.
Up to a Third of Scheduled Labor Inductions Are Potential Candidates for Outpatient Cervical Ripening [17S]
Authors: Sverdlov Deanna , Dangel Alissa 
Published: May 2019

INTRODUCTION:
Labor induction is the commonest obstetric procedure, often beginning with cervical ripening. In select patients, performing cervical ripening in the outpatient setting has the potential to reduce costs, and benefit patient satisfaction. This study aimed to assess whether the patient population in a tertiary care hospital could benefit from implementation of an outpatient cervical ripening protocol.

METHODS:
We performed a retrospective analysis of data from all 112 scheduled labor inductions over a 6 month period in 2017-18 at Tufts Medical Center, a hospital performing 1,200 deliveries annually. We collected data regarding indication for induction, maternal/fetal comorbidities, gestational age, and intake cervical exam. A poll of providers was performed to ascertain which maternal and fetal factors were generally considered contraindications to outpatient ripening.

RESULTS:
Of 112 scheduled inductions, 74 patients (66.1%) were ineligible for outpatient cervical ripening. These included 19 patients (17%) who had a favorable Bishop score at intake and did not require cervical ripening. 26 patients (23.2%) were disqualified due to fetal conditions that were perceived by providers as requiring continuous fetal monitoring during all phases of labor induction, e.g., fetal growth restriction, oligohydramnios, and fetal anomalies. 29 patients (25.9%) were disqualified due to maternal comorbidities, including preeclampsia and preexisting medical problems. Ultimately, the remaining 38 patients (33.9%) were identified as candidates for outpatient cervical ripening.

CONCLUSION:
In a tertiary care center, 33.9% of patients undergoing scheduled labor induction may be suitable candidates for outpatient cervical ripening. Further research should be aimed at establishing the safety and benefits of outpatient cervical ripening.
Utility of First Trimester Maternal Serum Alpha Fetoprotein to Predict Placental Ischemic Disease [18S]
Authors: Dinglas Cheryl , Cochrane Elizabeth , Ram Bebu , Akerman Meredith , Heo Hye Jung , Vintzileos Anthony M. 
Published: May 2019

INTRODUCTION:
While elevated second trimester maternal serum alpha fetoprotein (msAFP) has been associated with adverse pregnancy outcomes, the utility of first trimester msAFP for prediction of placental ischemic disease is not known. We sought to investigate whether first trimester msAFP correlates with pathology findings suggestive of ischemic placental disease.

METHODS:
An IRB-approved, multi-site retrospective cohort study was performed among patients with first trimester msAFP as part of routine aneuploidy screening and subsequent placental evaluation from April 2015-August 2016. Pathology report findings were reviewed and classified according to placental diagnostic criteria by the Perinatal Section of the Society for Pediatric Pathology. This classification included 1) amniotic fluid infection 2) maternal underperfusion 3) fetal vascular thrombo-occlusive disease and 4) inflammatory changes (ie. chronic villitis). Spearman correlation coefficient determined the relationship between first trimester msAFP and placental weight. Chi-square and Fisher exact test determined whether an elevated first trimester msAFP is associated with placental pathologic findings.

RESULTS:
We evaluated 368 patients with first trimester msAFP and placental pathology reports available for review. First trimester msAFP >2.0 MoM is predictive of a placental weight <10th percentile and is suggestive of placental ischemic disease 81.6% vs 57.7% (OR 3.24, 95% CI 1.37-7.66). First trimester msAFP > 2.0 is also associated with pathology findings consistent with fetal vascular occlusive disease 21.4% vs 6.1% (OR 4.17, 95% CI 1.76-9.91).

CONCLUSION:
Elevated first trimester msAFP is predictive of placental insufficiency and placental ischemic disease which can help identify at risk pregnancies in the first trimester.
Validation of the MFMU Network VBAC Calculators at an Academic Institution [19S]
Authors: Rasiah Stephen S. , Reilly Devin M. , Maines Jaimie L. , Thomas Holly J. , Pauli Jaimey M. , Ural Serdar H. 
Published: May 2019

INTRODUCTION:
The MFMU Network has developed two calculators to help predict the vaginal delivery success rate of a trial of labor after cesarean section. The purpose of this study was to validate the use of these calculators at an academic institution.

METHODS:
This retrospective cohort study compared actual and predicted VBAC success rates with the online MFMU VBAC calculators. Participants were then divided into two groups based on low (<70%) and high (>70%) predicted success.

RESULTS:
Preliminary data analysis included 299 patients. 223 (75%) patients had a successful VBAC. The VBAC success rate based on information at the initiation of prenatal care was 59% (predicted=58% P=.92) in the 'low success' cohort and was 82% (predicted=83% P=.69) in the 'high success' cohort. The VBAC success rate based on information from admission for delivery was 26% (predicted=44% P=.12) in the 'low success' cohort and was 78% (predicted=96% P<.001) in the 'high success' cohort.

CONCLUSION:
The model was accurate when it incorporated data at the initiation of prenatal care. However, based on information from admission for delivery, the 'low success' cohort showed a non-significant trend towards lower observed success rates, while the 'high success' cohort showed a statistically significant trend towards lower observed success rates. The next step in this project is to determine what factors may be contributing to the decreased accuracy of the 'admission for delivery' calculator. In addition, further studies are needed to see if there may be a role for changing counseling to incorporate information from these calculators.
Whole Genome Sequencing and Gene Editing of Embryos: Are Infertility Patients Ready? [22S]
Authors: Lee Siwon , Vaughan Denis , Erlinger Adrienne , Hacker Michele , Penzias Alan , Neuhausser Werner 
Published: May 2019

INTRODUCTION:
Clinical application of whole genome sequencing (WGS) appears near. In addition, gene editing using clustered regularly interspaced short palindromic repeats (CRISPR) has been applied successfully in human embryos under experimental conditions. We sought to explore the understanding and acceptance of these technologies among patients with infertility.

METHODS:
We administered a cross-sectional survey to infertile couples at a large university-affiliated IVF practice, with centers in 5 states, from April to September 2018. Approved by BIDMC IRB.

RESULTS:
There were 587 respondents, yielding an 80% response rate. The median age was 37; 68% were female and 32% were male. Respondents' political views were: 45% liberal; 36% moderate and 12% conservative. Most (73%) were Caucasian; 57% were Christian; and 65% had household income >$100,000. Whereas 45% had heard of WGS, 60% had heard of gene editing. Most did not object to research on human embryos (87%) or gene editing of embryos (75%) and most reported they would be interested in utilizing WGS and gene editing. Respondents who reported conservative political view were significantly less likely to be interested in utilizing WGS (p=0.006) or gene editing (p=0.01). History of miscarriage did not influence respondents' opinions (p=0.48).

CONCLUSION:
Over half of respondents had heard of gene editing technology. Most infertile patients were interested in WGS and open to the idea of editing their gametes to improve the likelihood of having a child unaffected by a heritable, genetic mutation. There are many technical and ethical implications to be considered before these technologies are adopted in clinical practice.
Assessing Adolescent Sexual Health Counseling Among Residents With a Novel Simulated Patient Workshop [23S]
Authors: Kaiser Jennifer E. , Shinn Alyson , Sheinberg Annabel , Sanders Jessica , Gawron Lori , Turok David Keith 
Published: May 2019

INTRODUCTION:
This study evaluates changes in resident knowledge, counseling confidence, and self-efficacy through a novel adolescent-led sexual and reproductive health simulated patient workshop.

METHODS:
This is a prospective pilot study of obstetrics and gynecology (OBGYN), family medicine, and pediatric residents completing a simulated patient encounter with adolescents trained in peer sexuality education from the Planned Parenthood of Utah Association Teen Council. The workshop included an informational presentation from adolescents who then completed 15-minute, one-on-one simulated patient encounters with a resident. We guided adolescents in creating their own unique simulated patients portraying a range of sexual health chief complaints. Residents completed pre- and post-workshop surveys on adolescent sexual and reproductive health knowledge, counseling confidence, and self-efficacy. We completed descriptive analyses of participant demographics and change in knowledge (7 questions), confidence, and self-efficacy. We used Likert scales (5-point) for measuring confidence (6 questions) and self-efficacy (3 questions).

RESULTS:
A total of 16 residents participated in the workshop (n=12 OBGYN). Prior to the workshop, four residents had one or more hours of adolescent sexual health didactic time and one had a simulated patient encounter as part of their residency training. After the workshop, resident adolescent sexual health knowledge improved (mean increase 3.5/7 SDÂ±0.94). Residents also demonstrated increased total counseling confidence (mean pre-workshop 19/30 to post-workshop 24/30) and increased total counseling self-efficacy (mean pre-workshop 9/15 to post-workshop 12/15).

CONCLUSION:
The adolescent-led sexual and reproductive health workshop is a novel approach to increasing knowledge, counseling confidence, and self-efficacy in adolescent sexual health among resident physicians.
Clinical Effectiveness of Simulation in Eclampsia and Obstetrical Hypertensive Emergencies [24S]
Authors: Marko Emily , Anbazhagan Aruna , Donlan Amy 
Published: May 2019

INTRODUCTION:
Simulation prepares teams for rapid response to rare obstetrical emergencies like hypertensive crisis and eclampsia. The study objective was to determine the clinical effectiveness of teamwork simulation training in eclampsia and obstetrical hypertensive emergencies.

METHODS:
A prospective quasi-experimental educational study design was used to assess the effectiveness of a simulation curriculum on eclampsia and hypertensive emergency. A high fidelity manikin was programmed to produce seizures and hypertension. Outcomes were measured using pre/post knowledge tests, performance assessment scores, safety culture surveys and clinical parameters of intensive care unit (ICU) admissions and length of stay. Internal review board exemption was obtained. Paired t-tests and repeated measures were used for data analysis.

RESULTS:
Over one year, 256 obstetrical staff participated in weekly drills in a large obstetrical hospital with over 10,000 deliveries per year. Statistically significant improvement occurred in pre-post scores of knowledge (59.86%, 93.87%, p<0.0001), performance (56.54%, 93.54%, p<0.0001) and safety culture (3.12, 1.45, 1=high 5=low, p<0.0001). Clinical outcomes for patients diagnosed with eclampsia indicated fewer ICU admissions and shorter lengths of stay (pre 4.58 days, post 3.50 days, p=0.048) as compared with the year prior to initiation of the simulation program.

CONCLUSION:
Teamwork simulation training demonstrated improved team knowledge, performance and attitudes for responsiveness to hypertensive emergencies and eclampsia. Fewer ICU admissions and shorter lengths of stay for these rare events suggest improved patient care after initiating teamwork training.