bluuebunny/crossref_metadata_2025_split huggingface dataset:
QT Interval in Pregnant Women on Methadone-Maintenance Therapy [27N]
Authors: Pimentel Veronica Maria , Sia Michelle , Saia Kelley 
Published: May 2017

INTRODUCTION:
The upper limit of normal for the QT interval is 450 msec. A prolonged QT is associated with an increase in sudden cardiac death. Female gender, pregnancy and methadone use are risk factors for QT prolongation. This study sought to assess the QT interval in pregnant women undergoing methadone-maintenance therapy (MMT) in the third trimester and the factors that are associated with QT prolongation.

METHODS:
We performed a retrospective review of pregnant women on methadone at Boston University Medical Center between June 2012 and May 2014. Corrected QT (QTc) from a third trimester electrocardiogram (ECG) was calculated using Bazett's formula. The urine toxicity screen (utox) done on the day of the ECG was reviewed. Paired t-test was used to compare QTc of those with cocaine-positive utox to the QTc of those with a negative utox. The relationship between QTc and methadone dose was assessed using Pearson correlation.

RESULTS:
Of the 32 eligible pregnant women on methadone, 21 (65%) had an ECG performed. Their mean QTc was 428.7±33.9 msec. Pregnant women with a cocaine-positive utox had a longer QTc compared to those with a negative utox (476.0±31.7 msec vs. 420.8±28.6 msec, P = .04). There was no correlation between the dose of methadone (range 55 mg to 145 mg) and the QTc interval (p > .05).

CONCLUSION:
The QT interval in pregnant women on methadone was below the upper limit of normal, except for those with a cocaine-positive utox. The concomitant used cocaine place pregnant women on methadone at risk of cardiac arrhythmia.
Rate of Spontaneous Version Following Preterm Premature Rupture of Membranes [28N]
Authors: Banerjee Dipti , Codsi Elisabeth , Borowski Kristi 
Published: May 2017

INTRODUCTION:
Malpresentation is a common problem early in pregnancy. The rate of spontaneous version (SV) by gestational age has been studied, but is poorly understood after preterm premature rupture of membranes (PPROM), which complicates 3% of pregnancies in the United States. The objective of our study was to report the rate of SV following PPROM.

METHODS:
We conducted a retrospective cohort study on women age 18 or above with singleton intrauterine pregnancies who experienced PPROM between 22-34 weeks gestation and were delivered at the Mayo Clinic from 01/2010-12/2015. Demographic characteristics, obstetric history, and prenatal care details were abstracted through chart review. Aneuploidy, major fetal anomalies, maternal Müllerian anomalies, and delivery less than 24 hours after PPROM were excluded.

RESULTS:
Among 120 patients included in the study, 29 were nulliparous. Mean maternal age at PPROM diagnosis was 29.3 years. The median gestational age at PPROM diagnosis and at delivery was 31 1/7 weeks and 32 5/7 weeks, respectively. Intrauterine growth restriction was diagnosed in 10 women following PPROM. Sixty-nine (57.5%) patients delivered vaginally and 51 (42.5%) underwent cesarean section. Twenty-three (19.2%) women experienced SV following PPROM. Of the 21 breech presentations at PPROM diagnosis, 4 (19%) converted to cephalic presentation at delivery.

CONCLUSION:
We determined that approximately 1 out of 5 women experience SV in the setting of PPROM. Data about SV following PPROM is important in order to counsel patients about expectations for the remainder of their pregnancy. This new evidence can better prepare patients and providers for safe delivery.
A Comparison of Characteristics and Outcomes in Typical and Atypical Cases of Morbidly Adherent Placentation [29N]
Authors: Shamshirsaz Amir A. , Bateni Zhoobin H. , Salmanian Bahram , Belfort Michael A. , Fox Karin A. 
Published: May 2017

INTRODUCTION:
To compare the characteristics and outcomes of patients with morbidly adherent placenta (MAP) and the typical risk factors of both placenta previa and prior cesarean deliveries (typical group) and patients without at least one of these antenatal risk factors (atypical group).

METHODS:
Patients with confirmed MAP from January 2000 to June 2016 were included in this study. Data were reported using descriptive statistics and appropriate statistical methods were used based on the normality of the data.

RESULTS:
During the study 189 patients had MAP, 157 of whom had singleton gestations and underwent cesarean hysterectomy. Ninety-seven (61.8%) were in the typical group. Baseline characteristics between the two groups were not statistically different. Patients with increta or percreta was significantly higher for the typical group (78.6% v. 41.7% respectively, P < 0.001). Median estimated blood loss was lower in the typical compared with the atypical group (P < 0.01) and the number of patients without a prenatal diagnosis was significantly higher in the atypical group (P < 0.001).

CONCLUSION:
Antenatal recognition of MAP was lower among atypicals. At time of delivery median blood loss was higher in the atypicals despite the fact that the degree of invasion was less confirming that not being prepared for MAP, even when it is accreta rather than percreta, carries increased risk. Failure to recognize MAP in atypicals may be due to greater difficulty in making the diagnosis with ultrasound when there is less invasion, or false reassurance when not all risk factors are present.
Risk Factors Associated with Preterm Delivery After Open Fetal Myelomeningocele Repair [30N]
Authors: Said Heather M. , Vricella Laura K. , Miller Collin , Elbabaa Samer , Vlastos Emanuel 
Published: May 2017

INTRODUCTION:
Although open fetal myelomeningocele (MMC) repair increases the risk of preterm delivery (PTD), specific risk factors for this outcome have not been identified. The objective of this study is to determine whether gestational age at the time of open fetal MMC repair is a risk factor for PTD.

METHODS:
A retrospective cohort of 51 consecutive open fetal MMC repairs between 2011-2016 was analyzed by gestational age at time of surgery. Primary outcome was delivery <37w0d. Secondary outcomes were PPROM, delivery < 34w0d, latency from MMC repair to delivery and neonatal outcomes.

RESULTS:
Groups were similar in demographic and intraoperative factors. On univariate analysis, delivery <37w0d was more frequent with earlier MMC repair (94% < 24w0d, 69% 24w0d-24w6d and 57% >25w0d, p=0.031), whereas delivery < 34w0d was not (41% < 24w0d, 23% 24w0d-24w6d and 19% >25w0d, p=0.317). Survival-curve pairwise comparisons demonstrated a difference between the < 24w0d and > 25w0d groups (p=0.027). PPROM was more frequent with earlier MMC repair (71% < 24w0d, 31% 24w0d-24w6d and 30% >25w0d, p=0.041). Mean latency from MMC repair to delivery was similar among groups (73 days for < 24w0d, 73 days for 24w0d-24w6d and 67 days for >25w0d, p=0.727), as were neonatal outcomes. On multivariate analysis, earlier gestational age at MMC repair was associated with delivery before 34 weeks (p=0.039; RR 2.13; 95% CI 1.04-4.36) and 37 weeks (p=0.016; RR 3.47; 95% CI 1.26-9.59).

CONCLUSION:
Earlier gestational age at open fetal MMC repair was associated with preterm delivery before 37 and 34 weeks and PPROM.
Comparative Diagnostic Testing Uptake and Confirmation Rates After High-Risk cffDNA for Trisomy 21, 18, and 13 [32N]
Authors: Suhag Anju , Robbins-Furman Patricia , Hollier Lisa , Monga Manju , Ramin Susan , Van den Veyver Ignatia B. 
Published: May 2017

INTRODUCTION:
There is increasing concern that high-risk cffDNA screening results are not always confirmed by diagnostic testing. We hypothesized that the poorer prognosis of trisomy 18 (T18) or trisomy 13 (T13) compared to trisomy 21 (T21) differentially affects the uptake of confirmatory diagnostic testing after a high-risk cffDNA result for these aneuploidies.

METHODS:
A retrospective study of singleton gestations with abnormal cffDNA screening for trisomies 21, 18 and 13 between 10/2012 and 3/2016. We excluded multiple gestations, any unreportable and any other positive cffDNA results. Based on cffDNA results, 3 cohorts were compared: high risk for T21, T18 and T13. Diagnostic testing was offered to all study subjects. Primary outcome was uptake rate of diagnostic testing in the 3 groups. A P-value of < 0.05 was considered significant.

RESULTS:
278 women met inclusion criteria. Demographics were similar in the 3 groups, except for higher rate of AMA in T21 group compared to T18 and T13 (P=.04). The uptake of diagnostic testing was similar in the 3 groups (P=.79). The confirmation of diagnosis by karyotype or CMA was significantly higher for T21 group compared to T18 and T13 (P=.0001). The rate of false positive cffDNA result was significantly higher in T13 group compared to T18 and T21 (P=.0001).

CONCLUSION:
There is no difference in uptake of diagnostic testing in women with a cffDNA screening result indicating high risk for Trisomy 21, 18 or 13. Diagnostic testing is more likely to confirm diagnosis of T21 and T18 compared to T13 in women with abnormal cffDNA screening.
Clinical Outcomes of Term Elective Induction of Labor With Unripe Cervix [34N]
Authors: Harward Lindsey , Nino Julio Mateus , Christensen Colleen , Ebeling Myla 
Published: May 2017

INTRODUCTION:
Elective induction of labor has increased over time resulting in higher cesarean delivery rates. Maternal and neonatal outcomes of pregnancies undergoing pre-induction cervical ripening at 39 weeks were compared with those induced at later gestational ages.

METHODS:
Retrospective cohort study of singleton pregnancies induced without a medical indication and a Bishop score less than 8 or simplified Bishop score less than 5 at 39 0/7-6/7, 40 0/7-6/7, and 41 0/7-6/7 weeks between 2006 and 2015. Specific individual maternal and neonatal outcomes were compared. Chi-square, One-way ANOVA, and Fisher exact test were used for statistical analysis.

RESULTS:
Of the 718 identified pregnancies, 143 (19.9%) were induced at 39 weeks, 240 (33.4%) at 40 weeks, and 335 (46.6%) at 41 weeks. Nulliparity was significantly higher in the 41-week group than in the 40-, and the 39-week groups (78.8%, 64.5%, and 37.7%, respectively; P < .00001). Among nulliparous women, cesarean delivery was significantly lower at 39 weeks (27.7%) than at 40 weeks (34.4%), and at 41 weeks (47.7%) (P=.0003). Conversely, cesarean delivery rate was low and not significantly different among multiparous women at each of the gestational age groups. Postpartum hemorrhage and chorioamnionitis rates were significantly higher at 41 weeks compared with the other groups (all P < .0001). NICU admission, 5-minute Apgar scores less than 7, respiratory distress syndrome, and neonatal death rates did not differ significantly among the groups.

CONCLUSION:
Elective induction of labor at 39 weeks with unfavorable cervix was associated with favorable maternal outcomes and low cesarean delivery rate.
Chronic Disease Prevalence Among Mothers Delivering in the United States, 2004-2013 [38N]
Authors: Admon Lindsay , Winkelman Tyler , Moniz Michelle , Davis Matthew , Heisler Michele , Dalton Vanessa 
Published: May 2017

INTRODUCTION:
Reasons for nationwide increases in delivery-associated maternal morbidity and mortality are poorly understood. Pre-existing chronic disease increases the risk of obstetric complications, and there is a need to understand trends in chronic disease burden among the childbearing population.

METHODS:
We conducted a serial cross-sectional analysis of the National Inpatient Sample between 2004 and 2013. We used multivariable logistic regression, adjusted for age, income, and insurance status, to examine trends in chronic disease among delivery hospitalizations. Chronic disease was measured with ICD-9CM codes for 8 common conditions known to impact obstetric outcomes.

RESULTS:
Our sample was comprised of 8,307,761 delivery hospitalizations between 2004-2013. The mean age of delivering mothers was 27.7. The most prevalent conditions were respiratory disease, hypertension, and drug abuse (3.0, 1.9 and 1.4 per 100 delivery hospitalizations, respectively). In adjusted analyses, records in 2012/2013 were more likely than those in 2004/2005 to include diagnoses of diabetes, hypertension, respiratory disease, liver disease, kidney disease, and drug use (all P less than 0.001) and less likely to have diagnoses of heart disease (P less than 0.001) or HIV (P equal to 0.02). Delivery hospitalizations in 2012/2013 were also more likely than those in 2004/2005 to be complicated by at least one or at least two chronic conditions (both P less than 0.001).

CONCLUSION:
Chronic disease burden increased significantly among delivering mothers between 2004/2005 and 2012/2013. Higher proportions of women with chronic conditions and higher numbers of chronic conditions per patient may contribute to increases in delivery-associated morbidity and mortality.
Determining the Impact of External Stressors on Laparoscopic Skills Among Obstetrics and Gynecology Residents [1O]
Authors: Moawad Gaby , Tyan Paul , Kumar Dipti , Krapf Jill , Abi-Khalil Elias 
Published: May 2017

INTRODUCTION:
Given the lack of a standardized laparoscopic surgery curriculum we designed a study to evaluate the impact of stress on laparoscopic skills among obstetrics and gynecology residents.

METHODS:
We conducted an observational prospective cohort study in a single urban teaching university hospital. Participants included 31 Obstetrics and Gynecology Residents, Post Graduate Years 1-4. We assessed four basic laparoscopic skills at two sessions. The first session was the baseline; six months later the same skills were assessed under audiovisual stressors. We compared the effect of stress on accuracy and efficiency between the two sessions.

RESULTS:
A linear model was used to analyze time. Under stress, residents were more efficient in three out of the four modules. Ring transfer (Hand-eye coordination, bimanual dexterity), P=0.0304. Ring of Fire (Bimanual dexterity, measure of depth perception), P=0.0024 and Dissection Glove (Respect of delicate tissue planes), P=0.0002. Poisson regression was used to analyze the total number of penalties. Residents were more likely to acquire penalties under stress. Ring transfer, P=0.0184 and Cobra (Hand-to-hand coordination), P=0.0487 yielded a statistically significant increase in penalties in the presence of stressors. Dissection Glove P= 0.0605 yielded a non-significant increase in penalties.

CONCLUSION:
Our work confirmed that while under stress residents were more efficient, this translated into their ability to complete tasks faster in all the tested skills. Efficiency, however, came at the expense of accuracy. Taking the current residency-teaching model into consideration, we encourage surgeons to create a less stressful environment when operating with residents.
Readability Assessment of Online Obstetrics and Gynecology Patient-Oriented Literature [2O]
Authors: Richards Elliott , Trinidad Mari Charisse 
Published: May 2017

INTRODUCTION:
As the Internet has become the primary source of health information for most patients, there is limited information regarding the readability of available online information for patients in obstetrics and gynecology.

METHODS:
Twenty-four phrases from “Top Searches on ACOG” were used as search terms, using search engine optimization tools, mirroring likely patient search patterns. Contents were then analyzed for readability using four validated readability formulas, including Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning Fog Index (GFOG).

RESULTS:
A total of 214 webpages were evaluated and majority had readability scores higher than currently recommended for patient-directed information. The mean FRES was 56.0 (range, 26.6 to 97.0), with majority (99%) of the sites scoring less than 80, correlating with a “difficult” level of reading. Mean readability grade levels were as follows: 6.86 for FKGL; 8.39 for SMOG; and 8.28 for GFOG. Of the 24 topic areas, only 11 (45.8%) had easily accessible patient related documents published by the American College of Obstetricians and Gynecologists.

CONCLUSION:
To our knowledge, this is the first study providing a broad assessment of readability of currently available online patient related information in obstetrics and gynecology. Consistent with other specialties, the readability of most online obstetrics and gynecology patient materials is unsatisfactory. While readability level is only one component of useful patient-oriented literature, there is a great need for effective and easily accessible online patient-oriented websites as health literacy can impact outcomes.
How Capable Are Ob/Gyn Residents in Counseling Patients at Risk for Periviable Delivery? [4O]
Authors: Byrne John , Siddiqui Maryam , Robinson Barrett , Young Danielle , Plunkett Beth 
Published: May 2017

INTRODUCTION:
To understand the current state of resident education in periviability counseling and assess Ob/Gyn resident capacity to counsel patients at risk for periviable delivery.

METHODS:
A cross-sectional, web-based survey developed at the University of Chicago was deployed to Ob/Gyn residents from 13 ACGME accredited residency programs across the US. The survey included questions about program/resident demographics, periviability education content/format, and periviability counseling. Descriptive statistics were used to analyze responses, and Chi-square or Fischer's Exact tests were used to analyze categorical variables.

RESULTS:
Of 374 eligible Ob/Gyn residents, 151 (40.3%) completed the survey. Most respondents came from university-based programs (85.3%), larger residency programs (68.5%), and non-religiously affiliated hospitals (86.7%). Most respondents (n=123, 83.6%) identified spending 0-5 hours annually on periviability education. 63% of respondents felt somewhat capable (SC) or very capable (VC) in counseling patients at risk for periviable delivery regarding neonatal outcomes, with 14 (9.3%) feeling VC. A greater proportion of PGY-4 compared to PGY-1 respondents (86.1% vs. 51.5%; p=0.0018) and those trained in a community vs. university based hospital (90.5% vs.57.9%; p=0.003) reported feeling SC or VC in counseling patients regarding neonatal outcomes. The majority of respondents had never used/were not aware of the NICHD Extremely Preterm Birth Calculator (52.1%). No respondent correctly identified the 5 predictive characteristics that form the framework for the NICHD calculator.

CONCLUSION:
The majority of residents do not feel capable of counseling patients at risk for periviable delivery. These findings point to targeted areas to improve Ob/Gyn resident education and patient care during the periviable period.
Abnormal Pap Tracking in Resident Clinics – What Is Our Standard and Can We Do Better? [6O]
Authors: Miller Jill , Landry Mary 
Published: May 2017

INTRODUCTION:
Screening tests are only as valuable as the quality of the system in which they are performed. To reduce cancer rates, tracking patients' care after pap testing is fundamental. Electronic health records (EHR) have made reporting of abnormal test results more efficient and reliable, but how are they being used? We investigated current protocols for tracking abnormal cytology results in Obstetrics & Gynecology resident clinics to better understand how future physicians are trained in this important quality assurance task.

METHODS:
A brief survey designed using REDCap, a secure, web-based application, was sent out to all 249 Obstetrics & Gynecology residency programs within the FRIEDA database.

RESULTS:
Of the 249 residency programs, 54 (22%) responded, 51 (94%) perform colposcopy, and 47 (87%) programs provide treatment. Twenty-five (46%) of respondents have a tracking system for abnormal results with 21 (45%) of the 47 programs providing treatment, tracking post-treatment follow-up care. Follow-up is confirmed by chart review in 18 (72%) of the 25 programs who perform tracking, while 6 (24%) use EHR reports or disease management capability.

CONCLUSION:
The majority of residency programs perform colposcopy and treatment, yet less than 50% of the programs track abnormal results to assure appropriate patient follow-up. The majority of programs who perform tracking do so by the time consuming method of chart review, with only 6 programs (11%) leveraging the efficiency and reliability of their EHR to assist with this quality assurance task. Resident clinics and clinical practices of all types might consider this an area for future quality improvement.
Is Use of Misoprostol Associated With Failed Induction in Pregnancies With Suspected Placental Insufficiency? [12O]
Authors: Rossi Robert , Warshak Carri 
Published: May 2017

INTRODUCTION:
Although misoprostol (MP) has demonstrated efficacy for cervical ripening, a concern with use of MP is uterine tachysystole, leading to fetal intolerance of labor and cesarean delivery (CD). We sought to determine whether indicators of placental insufficiency were associated with higher rates of failed induction and CD in pregnancies when MP was used for cervical ripening.

METHODS:
Population based retrospective cohort study of patients who underwent MP induction between May 2008-2013. Maternal and labor characteristics were compared between patients with FGR (<10th% estimated fetal weight on ultrasound), oligohydramnios, preeclampsia, and infants born SGA (birth weight less than 10th%). Primary outcome was rate of CD. Secondary outcomes included CD for nonreassuring fetal status (NRFS). Multivariable logistic regression estimated association between indicators of placental insufficiency on the outcome of CD.

RESULTS:
Of 1,617 inductions during the 6 year period, 580 patients were induced using MP. FGR was suspected in 106 (18.2%). FGR was not associated with higher CD rate in MP inductions [22% versus 29%, p=0.11 (aOR 0.89, 95% CI 0.68-1.16)]. Similarly neither SGA nor oligohydramnios were associated with an increased CD rate, however preeclampsia did demonstrate a trend toward increased CD, aOR 1.21 (95% CI 0.97-1.51). The rate of CD for NRFS was similar between those with FGR and those without FGR (16% vs 15%, p=0.7).

CONCLUSION:
Despite a biologically plausible concern that MP induction in the setting of FGR and other indicators of placental insufficiency may increase risk for CD and CD for NRFS, our data does not support this.