bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Case Report of Bilateral Subconjunctival Hemorrhages With Orbital Hematoma Following Delivery [13O]
Authors: Riggs McKayla , Teneyuque Nicholas , Keyser Erin 
Published: May 2017

INTRODUCTION:
Subconjunctival hemorrhages are common with trauma to the orbit or in cases with sustained intra-abdominal pressure. Despite the sustained pressures routinely seen in deliveries, subconjunctival hemorrhages are rarely observed in postpartum patients. We describe a case of bilateral subconjunctival hemorrhages and an orbital hematoma.

METHODS:
Chart review; Literature review

RESULTS:
The patient was a 29 year old primiparous African American female at 41 weeks gestation admitted for induction of labor at late term. She had a known fibroid in the lower uterine segment with an otherwise uncomplicated past medical history and antepartum course. She underwent an uncomplicated induction and delivered after an eight minute second stage and three total pushes, experiencing a forty-five second shoulder dystocia. Her postpartum course was complicated by diplopia, blurry vision, and pain with movement of her eyes on postpartum day one. Imaging revealed a retro-orbital hematoma for which ophthalmology was consulted with a workup significant for suspected glaucoma. She was followed outpatient with symptomatic treatment and noted to have resolution of symptoms after four weeks with further workup for glaucoma in six months.

CONCLUSION:
Subconjunctival hemorrhages, though common, are surprisingly rare in the postpartum period even following prolonged or impressive pushing efforts and often point to a medical comorbidity. This case highlights the field of ophthalmology with which most OB/GYNs have little experience though can be clues to alternate diagnoses. Incorporating a multidisciplinary approach for diagnosis of a pregnant patient with ophthalmologic disease is required to optimize management of the patient.
Interconception Health Behaviors Among Women With a Prior Preterm Birth [16O]
Authors: Batra Priya , Scibetta Emily , Celaya Anna K. , Jackson Ashaki , Greenwell Lisa , Saleeby Erin 
Published: May 2017

INTRODUCTION:
Preterm birth (PTB) is a leading cause of infant morbidity and mortality; the strongest risk factor for PTB is a mother's history of preterm delivery. Certain modifiable risk factors for PTB could be addressed between pregnancies to decrease recurrence rates. This study describes associations between previous PTB and select associated interconception health behaviors.

METHODS:
Between December 2013 and August 2016, community health workers conducted intake interviews with pregnant women enrolling into the MAMA'S Los Angeles County prenatal care program. Select interconception health behaviors associated with PTB were assessed in women's current pregnancies, including: trimester of prenatal care initiation, pregnancy intent, and tobacco use at conception. Participants self-reported all outcomes and PTB history. Chi-square tests were performed.

RESULTS:
Analyses included data from 3,259 women, 322 (9.9%) of whom reported a prior PTB. There was no significant association between prior PTB and early (first trimester) initiation of prenatal care in the current pregnancy (chi-square=.40, P=.53). Women reporting a prior PTB were not significantly more likely to report that their current pregnancy was intended (chi-square=.01, P=.92). The proportion of women reporting tobacco use at conception did not differ between women who did (9.7%) and did not (9.9%) report a prior PTB (chi-square=.02, P=.90).

CONCLUSION:
Women reporting a prior PTB did not differ significantly from women without a PTB history with respect to select self-reported interconception health behaviors. Findings suggest that women with a prior PTB could benefit from interventions that could reduce the risk of recurrence by addressing relevant interconception health behaviors.
Length of Stay and Balloon Catheters for Cervical Ripening in the Outpatient Setting in Moderate Risk Populations [18O]
Authors: Gray Kendra 
Published: May 2017

INTRODUCTION:
This study seeks to compare the length of hospital stay between inpatient and outpatient low and moderate risk term patients who underwent cervical ripening using a balloon catheter. Secondary objectives include demonstrating no significant difference in the rates of cesarean section, chorioamnionitis or NICU admissions between groups.

METHODS:
In this retrospective cohort study, 185 women undergoing induction of labor had placement of cervical balloon catheter for cervical ripening. 64 inpatient inductions and deliveries were measured against 121 outpatient inductions and subsequent hospital deliveries. Bivariable and multivariable analyses were performed to determine whether outpatient induction was associated with a shorter length of hospital stay without increasing adverse maternal or neonatal outcomes. T-tests, Pearson Chi-Square tests, linear and logistic regression models were used to determine predictors of the outcomes. A two-tailed p < 0.05 was considered significant.

RESULTS:
The time from admission to delivery in the outpatient group was decreased by 10 hours and the LOS is decreased by 6 hours. Factors that significantly decreased LOS included gravidity while factors that lengthen hospital stay included cesarean section and increasing BMI. No statistically significant differences were found in the rates of NICU admission, intrauterine infection or cesarean section rate.

CONCLUSION:
Cervical ripening in the outpatient setting with balloon catheters is a reasonable consideration in low to even moderate risk patient populations. Independent predictors for increased length of stay included increased body mass index (BMI) and lower nulliparity. Use of outpatient cervical ripening in this patient population may be most beneficial.
Availability of Zika Virus Information on County and Regional Health Department Websites in the State of Texas [20O]
Authors: Sullivan Adriana , Page-Ramsey Sarah M. , Ireland Kayla , Cuvillier James , Ramsey Patrick S. , Rodriguez Emma 
Published: May 2017

INTRODUCTION:
Zika virus infection is an emerging health threat in pregnant women, particularly in Texas. It is important that obstetric patients and providers can access up-to-date information about Zika. Our objective was to evaluate the availability of information about the Zika virus and perinatal risks on local health department websites in Texas.

METHODS:
We reviewed all Texas county, regional, and metropolitan health department websites for general information available on the Zika virus, pregnancy related risks, prevention measures, mosquito repellent use, sexual transmission, endemic areas, travel guidance, and pregnancy planning. In cases where information was not available on the main webpage, an internal search of the site using the term “Zika” was performed.

RESULTS:
General information about Zika virus was found on only 13.8% of 254 county public health websites, 18.1% of 11 public health region websites, and 51.3% of 39 metropolitan websites. Available county information included patient education (54.3% of sites), health care provider materials (31.4%), details about Zika virus (62.9%), pregnancy risks (37.1%), sexual transmission (40.0%), use of mosquito repellents (34.3%), travel avoidance (42.9%), pregnancy timing (22.9%), and Zika endemic countries (40.0%). Similar rates of information available in these categories were observed on the regional and metropolitan websites.

CONCLUSION:
Despite growing concerns about perinatal risks and Zika virus, local health department websites in Texas have limited information for patients and providers. While state and national level information about perinatal risks from Zika virus is available, enhanced local efforts are needed to improve education and preparedness of patients and providers.
Availability of Provider Information About Zika Virus and Perinatal Risks on State Health Department Websites [21O]
Authors: Gray Jordan , Page-Ramsey Sarah M. , Ireland Kayla , Rivera Joshua , Rodriguez Emma , Ramsey Patrick S. 
Published: May 2017

INTRODUCTION:
Zika virus is an emerging health threat in pregnant women. It is important that obstetric healthcare providers can access up-to-date information about Zika testing, resources, and cases. Our objective was to evaluate the availability of provider-level information about Zika virus on state and US territory health department websites.

METHODS:
We reviewed each U.S. state, District of Columbia, and US territory (Puerto Rico, Guam, US Virgin Islands, American Samoa, North Marianas Islands) health department websites and abstracted provider-level information on Zika testing, testing forms, links to Center for Disease Control (CDC) publications, blood bank/donation guidelines, local cases, and US Zika pregnancy registry information. In cases where information about Zika virus did not appear immediately on the main webpage, an internal search of the site using the term “Zika” was performed.

RESULTS:
Provider-level information about Zika virus was found on 82.1% of 56 websites reviewed. Of those sites with information, information was more common on state websites (88.2%) than on territory sites (20.0%). Information available included Zika testing information (76.9%), access to in-state testing (73.1%), testing forms (59.6%), links to CDC publications (80.8%), blood bank/donation guidelines (25.0%), local cases (76.9%), and US Zika pregnancy registry information (32.7%).

CONCLUSION:
Provider-level information about Zika virus is available on most state, but not US territory websites. Testing information, CDC publications, blood bank/donation guidelines, local cases, and US Zika pregnancy registry information are not consistently available. State and territory sites should include such information to assist healthcare providers in optimal care of the obstetric population.
Compliance With Contemporary Guidelines for the Diagnosis of Labor Dystocia by Stage of Labor [22O]
Authors: Wu Erica , Clair Kiran , Chan Kenneth 
Published: May 2017

INTRODUCTION:
The objective of this study was to evaluate the relationship between stage of labor and compliance with contemporary criteria for the diagnosis of labor dystocia.

METHODS:
This was a secondary analysis of a prospective cohort study of cesarean delivery rates following implementation of a labor dystocia checklist at a community hospital. The checklist requested that physicians specify which of the contemporary criteria for the diagnosis of labor dystocia were met prior to performing a cesarean delivery on women in labor. Following implementation, the primary and NTSV cesarean delivery rates decreased from 20.7% to 18.0% and 26.4% to 22.6%, respectively. In this analysis, primary cesarean deliveries performed for labor dystocia were reviewed and categorized based on furthest stage of labor achieved and whether contemporary criteria for labor dystocia were fulfilled. Rates of compliance were compared between each stage of labor.

RESULTS:
During the 6-month study period, 145 cesarean deliveries were performed for labor dystocia. A majority (55.9%) were not compliant with contemporary guidelines for the diagnosis of labor dystocia. A greater proportion of deliveries that occurred in the latent phase (63.6%) and second stage (58.3%) were compliant compared to those that were failed inductions (33.3%) or that occurred in the active phase (38.2%), however, this difference was not statistically significant (P = 0.07).

CONCLUSION:
Most cesarean deliveries performed for labor dystocia did not meet contemporary criteria for the diagnosis of labor dystocia. Interventions designed to increase provider awareness of recent Obstetric Care Consensus guidelines for labor dystocia are needed for all stages of labor.
Compliance With Contemporary Criteria for the Diagnosis of Labor Dystocia by Time of Day [23O]
Authors: Clair Kiran , Wu Erica , Chan Kenneth 
Published: May 2017

INTRODUCTION:
To evaluate the relationship between time of day and compliance with contemporary criteria for the diagnosis of labor dystocia.

METHODS:
This was a secondary analysis of a prospective cohort study of cesarean delivery rates following implementation of a labor dystocia checklist at a community hospital. The checklist requested that physicians specify which of the contemporary criteria for the diagnosis of labor dystocia were met prior to performing a cesarean delivery on women in labor. Following implementation, the primary and NTSV cesarean delivery rates decreased from 20.7% to 18.0% and 26.4% to 22.6%, respectively. Data were then reviewed and categorized as either compliant or noncompliant with contemporary criteria and rates of compliance compared between three time periods: daytime (8AM-6PM), evening (6PM-12AM), and overnight (12AM-8AM).

RESULTS:
Of 145 Cesarean sections performed for dystocia, 52 (35.8%) occurred between 8AM-6PM, 49 (33.8%) occurred between 6PM-12AM, and 44 (30.3%) occurred between 12AM-8AM. Overall, 64 (44.1%) were compliant with contemporary guidelines for the diagnosis of labor dystocia. Compared to the evening and overnight time periods, cesarean deliveries performed for labor dystocia during the daytime were more likely to be compliant with contemporary criteria for the diagnosis of labor dystocia. (P = 0.02).

CONCLUSION:
Cesarean deliveries performed for labor dystocia during the daytime are more likely to satisfy contemporary criteria for the diagnosis of labor dystocia than those performed during the evening or overnight. Additional studies are needed to further evaluate the impact that time of day may have on physicians' decision-making process when diagnosing labor dystocia.
Comparison of Risk Factors and Neonatal Outcomes Among Women With a Spontaneous Versus Iatrogenic Preterm Birth [24O]
Authors: Boelig Rupsa C. , Lamar Christian , Berghella Vincenzo 
Published: May 2017

INTRODUCTION:
While spontaneous preterm birth (sPTB) has been trending down, iatrogenic preterm birth (iPTB) has been trending up. The purpose of this study is to examine the difference in risk factors and neonatal outcomes among women with a sPTB vs iPTB to identify areas for intervention.

METHODS:
Retrospective cohort study from 1/2012-12/2014 of singleton pregnancies without a history of prior sPTB undergoing routine cervical length screening between 18 0/7-23 6/7 weeks. Women were included if they delivered less than 37 weeks.

RESULTS:
Of 3678 women screened, 200 women (5.4%) had a PTB; 114 (57%) sPTB and 86 (43%) iPTB. Women with sPTB were on average younger than those with iPTB (27.3 ±6.2 vs 29.5 ±6.4, p=0.019). Women with iPTB were more likely to have a BMI of at least 30 (39% vs 23%, p=0.021), have a hypertensive disorder of pregnancy (74% vs 9%, p < 0.001), and have fetal growth restriction (14% vs 0%, p < 0.001) than women with sPTB. Women with a sPTB delivered earlier, with a mean gestational age of 32.7±4.9 vs 34.1±2.7 weeks (p=0.015), and an increased incidence of delivery less than 28 weeks (17% vs 4%, p=0.003). However, infants born from an iPTB were more likely to require intensive care admission (71% vs 54%, p=0.016). The incidence of neonatal morbidity was similar.

CONCLUSION:
Although sPTB tends to result in an earlier gestational age of delivery, iPTB is a more significant source of neonatal intensive care admission. Maternal obesity and hypertensive disorders are major modifiable risk factors for iPTB.
Body Mass Index and Adverse Neonatal Outcomes in Women Undergoing Elective Cesarean: A Nationwide Cohort Study [25O]
Authors: Vincent Sophie , Czuzoj-Shulman Nicholas , Spence Andrea R. , Abenhaim Haim Arie 
Published: May 2017

INTRODUCTION:
To examine the association between pre-pregnancy body mass index (BMI) and neonatal outcomes among women who underwent elective cesarean section (CS).

METHODS:
We conducted a retrospective cohort study using data from the Center for Disease Control and Prevention (CDC) for all reported births by elective CS in 2011-2013. Women's pre-pregnancy BMI was categorized as underweight (“less than”18.5), normal (18.5-24.5), overweight (25-29.9), obese (30-39.9) and morbidly obese (“equal or above”40). Odds ratio (OR) and 95% confidence intervals (CIs) adjusted for baseline characteristics were calculated to estimate the neonatal risks in relation to pre-pregnancy BMI, using normal BMI as our reference.

RESULTS:
Our cohort was composed of 737,548 women with available BMI data, of whom 2.8% were underweight, 38.8% had normal BMI, 26.3% were considered overweight, 25.0% obese, and 7.2% morbidly obese. Infant mortality rates were of 4.2/1000 births for normal weight women, and 5.5/1000 births among the morbidly obese group (OR 1.43; 95% CI 1.25-1.64). A dose-dependent relationship between maternal pre-pregnancy BMI and assisted ventilation was seen. Furthermore, infants born to morbidly obese women were at significantly increased risk for assisted ventilation over 6 hours (OR 1.24; 95% CI 1.15-1.35) and admission to intensive care units (OR 1.17; 95% CI 1.13-1.21). Risk for adverse outcomes is higher with elective CS at earlier gestational age, and this effect is intensified with abnormally elevated maternal BMI.

CONCLUSION:
Increasing maternal pre-pregnancy BMI in women undergoing elective CS was found to be associated with progressively higher risks of adverse neonatal outcomes and mortality.
Comparison of Analgesic Efficacy of Paracetamol and Tramadol for Pain Relief in Active Labor [26O]
Authors: Dahiya Krishna 
Published: May 2017

INTRODUCTION:
Labor pain has been described as the most severe pain experienced by women in their lives. To evaluate the efficacy and adverse effects of an intravenous infusion of 1000 mg of paracetamol as compared with an intravenous injection of 50mg of tramadol for intrapartum analgesia.

METHODS:
In a randomized prospective study,200 women in active labor were allocated to received either paracetamol (n=100) or tramadol (n=100). The primary outcome was the efficacy of the drug to supply adequate analgesia as measured by a change in the visual analog scale (VAS) at various times after drug administration. The secondary outcomes included the need for additional rescue analgesia and the presence of adverse maternal or fetal events.

RESULTS:
As recorded by the VAS score, there was significant pain reduction at 30 minutes, and at 1 and 2 hours in both groups (P < 0.01). On comparison between group I and II, significantly higher rate of nausea and vomiting in tramadol group (14% vs 8%; P < 0.03) patients. Similarly, drowsiness (0% vs 11%; P < 0.01), dry mouth (0% vs 8%; P < 0.04) and dizziness (0% vs 9%; P < 0.02) was also significant in group II.

CONCLUSION:
Due to difficulty in administering epidural analgesia to all parturients, administration of paracetamol and tramadol infusion for analgesia is simple and less invasive alternative. In the present study both paracetamol and tramadol were equally effective for labor analgesia but paracetamol has emerged as safe alternative as compared to tramadol due to low incidence of side effects.
To Ligate or Not to Ligate: Comparing Outcomes in Cesarean Hysterectomy With or Without Hypogastric Artery Ligation [29O]
Authors: Ballah Deddeh , Kohi Maureen 
Published: May 2017

INTRODUCTION:
To determine if hypogastric artery ligation during cesarean hysterectomy (Chyst) for patients with invasive placentas results in less blood loss and transfusion requirements.

METHODS:
Retrospective review of consecutive patients with invasive placenta who underwent Chyst at one institution between 1/2011 until 5/2016 was performed. Patient characteristics, surgical technique, laboratory parameters and patient outcomes were reviewed.

RESULTS:
A total of 35 patients (median age 35 years range: 22-42 years) were identified. Mean gestation age at Chyst was 34 weeks ± 3 weeks and 6 days. Thirteen of 35 patients underwent hypogastric artery ligation during Chyst. The mean intraoperative estimated blood loss (EBL) for the ligation group was 2,992 ± 2,420 mL and 2757 ± 2131 mL for the non-ligation group, p=0.77. The mean intraoperative transfusion requirements were 4.2 ± 4.7 units of packed red blood cells for the ligation group and 3.9 ± 6.5 units of packed red blood cells for the non-ligation group, p=0.91. The mean intraoperative time for the ligation group was 248 minutes ± 96 minutes and 190 minutes ± 70 minutes for the non-ligation group, p=0.09. The gestational age, length of post-operative intensive care unit hospital stay and total postoperative hospital stay were not significantly different between the two groups (p>0.05).

CONCLUSION:
As hypogastric artery ligation becomes less prevalent in obstetrical and gynecological surgical curriculum, interventional radiology may assume a more prominent role for Chyst in patients with invasive placentas. Furthermore, hypogastric artery ligation during Chyst may not result in different intraoperative estimated blood loss or transfusion requirements.
Transatlantic Air Travel in the Third Trimester of Pregnancy: Does It Affect the Fetus? [31O]
Authors: Petrikovsky Boris , Terrani Michael , Sichinava Lali 
Published: May 2017

INTRODUCTION:
Prolonged air travel has numerous risk factors potentially affecting pregnancy including cosmic radiation, aircraft noise and vibration, decreased partial PO2, etc. Airline policies regarding travel in pregnancy vary. Most airlines allow flying until 36 weeks of pregnancy in low risk patients. Immediate effects of the transatlantic flights on 3rd trimester fetus had not been reported.

METHODS:
112 patients between 34 and 37 weeks of gestation underwent NST before and within 12 hours after the transatlantic flight, and 24 hours later. Patients were asked to report fetal movement (FM) during takeoff, flight itself, and landing. Statistical evaluation was made using SPSS for Windows V 15.0 (SPSS Inc.). Data were shown as frequency (percentage) or mean ± standard deviation.

RESULTS:
NST was reactive in 104 patients (93%) before the flight, in 82 patients (73%) patients within 12 hours after this flight (p < 0.05), and in 110 patients (98%) 24 hours later. Variable decelerations were reported in 7 cases (6%) before the flight, 16 (14%) within 12 hours after (p < 0.05), and in 9 (8%) 24 hours later. Increased FM during take-off was reported by 17 patients (15%), no change in 62 (35%), decreased in 4 (3.6%). During flight itself, increased FM was reported by 6 pregnant passengers (5.4%), no change in 70 (63%), decreased in 8 (7%).

CONCLUSION:
Transatlantic flights are associated with temporary changes in fetal status – increased frequency of non-reactive NST and appearance of variable decelerations as well as maternal perception of FM.