bluuebunny/crossref_metadata_2025_split huggingface dataset:
Zika Virus in a Non-Endemic Urban Population: Patient Characteristics and Ultrasound Findings [12M]
Authors: Eppes Catherine , Rac Martha , Dempster Carrie , Ballas Jerasimo , Davidson Christina , Aagaard Kjersti 
Published: May 2017

INTRODUCTION:
The global Zika virus (ZIKV) outbreak has led to pregnant women seeking consultation, testing and ultrasound surveillance. We describe patient characteristics and ultrasound findings in a high-risk non-endemic Southern U.S. urban cohort.

METHODS:
This is a retrospective cohort study of women referred to our Obstetrics Infectious Disease Clinic for potential ZIKV exposure between February and September 2016 and tested accordance to Center for Disease Control (CDC) criteria. Patient characteristics, ultrasound findings and testing outcomes were recorded.

RESULTS:
A total of 105 gravidas were evaluated for ZIKV. Mean gestational age at last exposure and testing was 20+9.8 wks and 26.3 +8.9 wks, respectively. Geographic exposure was more common than sexual contact alone (90% vs 10%), though 61 (58%) reported partner co-travel. 95 (90%) were Hispanic and Mexico was the country most often traveled (50%). 21 (20%) women were symptomatic and 8 (11%) had positive test results (1 serum PCR and 7 with IgM and PRNT >10). There were 17 (18%) patients with ultrasound abnormalities; including microcephaly 12 (12%), intracranial abnormalities 3 (3%) and 11 (11%) with fetal growth restriction and/or oligohydramnios. There were 2 (2%) first trimester miscarriages and one stillbirth at 33 weeks. No congenital infection of ZIKV was confirmed either on amniocentesis or at delivery in the 48 (46%) of women delivered thus far.

CONCLUSION:
The prevalence of ultrasound abnormalities was higher than previously reported for as the baseline prevalence in the United States (3-5%). Further research is needed to determine if our findings are related to risk factors independent or dependent on ZIKV exposure or infection.
Home HPV Self-Collection in HIV-Infected Women: Assessing Acceptability and Prevalence [13M]
Authors: Lee Kristen , Ramroop Rosemary , Gaydos Charlotte , Barnes Perry , Anderson Jean , Coleman Jenell 
Published: May 2017

INTRODUCTION:
Up to 55% of women living with HIV (WLHIV) are under-screened for cervical cancer, despite higher risk. Our objective was to examine HPV prevalence, compare home self-collected (SC) to clinician-collected (CC) HPV positivity, and measure acceptability of SC.

METHODS:
A prospective cohort study of WLHIV was conducted from February–September 2016 in Baltimore. IRB approval was obtained. Pregnant and hysterectomized women were excluded. HPV E6/E7 mRNA was detected from SC cervicovaginal and CC cervical cytobrushes using transcription mediated amplification. HPV DNA was detected from a 2nd CC cervical cytobrush using DNA nucleic acid hybridization. Descriptive and Cohen's kappa statistics were performed.

RESULTS:
There were 68 participants with mean age 48 (SD 9.6). The majority (89%) were Black with median CD4 count of 623 (IQR 379-811). Among the 81% of subjects who returned the home SC kits, HPV E6/E7 mRNA prevalence was 50.9% and 41.8% for SC and CC samples, respectively, while DNA prevalence was 34%. Concordance between SC and CC E6/E7 was 76.4% (ĸ=.53, p < .001), and 95.7% (ĸ=.91, p < .001) between CC E6/E7 and DNA. Pap tests were normal among 81.5% of negative home SC tests. The majority (83.3%) would use the swab again and recommend the swab to family/friends (88.2%).

CONCLUSION:
There was moderate agreement between home SC and CC HPV positivity. Home SC was acceptable. Most participants would use the swab again and recommend it to family/friends. Home SC could be used as an alternative method to screen WLHIV who do not regularly visit women's health clinics.
Tobacco Use and High Risk Genital HPV Infection Among United States Females [16M]
Authors: Han Jasmine , Tarney Christopher , Klaric John , Beltra Thomas 
Published: May 2017

INTRODUCTION:
Human Papillomavirus (HPV) is a common sexually transmitted infection which causes cervical cancer that has association with tobacco use. We investigated the associations between objective biomarkers reflective of current tobacco exposures and high risk genital HPV prevalence among adult females in the United States.

METHODS:
The National Health and Nutrition Examination Survey (NHANES) sampled a representative cross-section of the non-institutionalized US population. During NHANES 2011-2012 cycle, 2838 adult females with valid HPV results were included in the analysis. DNA was extracted from self-collected vaginal swab specimens, and HPV genotyping was accomplished by PCR amplification. Nicotine metabolites were collected from serum and self-collected urine specimens.

RESULTS:
Nicotine exposure was a significant predictor of high risk (HR) genital HPV infection, p < 0.001. Compared to non-smokers, individuals with second hand nicotine exposure and infrequent smoker were more likely to be HR HPV positive; Odds Ratio (OR) 3.7, (95% Confidence Interval (CI), 1.6-8.5). Active smokers were more likely to test positive for at least one of the quadrivalent HPV vaccine type strains (HPV types 6,11,16,18); OR 2.2; (95% CI, 1.4-3.7) compared to the non-exposure group. The high risk HPV prevalence remained elevated in the nicotine exposure group, although analysis was adjusted for sexual behavior.

CONCLUSION:
In this large cross-sectional, population-based study, we demonstrated significant relationship between current tobacco exposure and high risk genital HPV infection, which causes cervical cancer. These findings highlight the need to examine the role of tobacco in the natural history of genital HPV infection and malignancy progression.
Obstetric Outcomes Complicated by Chlamydia Infection in All U.S. Deliveries Between 2011-2013 [18M]
Authors: Clennon Emily , Caughey Aaron B. , Bullard Kimberley 
Published: May 2017

INTRODUCTION:
Despite recommended routine screening in pregnancy, infection with Chlamydia trachomatis affects thousands of pregnancies in the U.S. each year. This study analyzes recent, nationwide data on complications of pregnancy in the setting of chlamydia infection.

METHODS:
This retrospective cohort study examined 10,490,884 singleton deliveries in the U.S. between 2011-2013. Simple proportions of 14 obstetric complications were compared between pregnancies complicated by Chlamydia trachomatis and controls. Chi squared tests and multivariable regression were used for statistical analysis, with p < 0.05 as the cutoff for significance. Comparisons were controlled for co-infection, parity, congenital abnormality, and maternal race and ethnicity, age, education attainment, cigarette use, and weight.

RESULTS:
A total 194,045 pregnancies analyzed were complicated by maternal chlamydia. Infection was positively associated with gestational hypertension (adj. OR: 1.20), chorioamnionitis (1.24), neonatal ventilator requirement greater than 6 hours (1.18), neonatal antibiotic administration (1.32), and congenital abnormality (1.30). Infection was negatively associated with gestational diabetes (0.95), moderate (0.92) and severe (0.88) preterm delivery, macrosomia (0.87), and Apgar score at 5 minutes less than 4 (0.88). Caesarian section rates overall (0.79) and stratified by parity and previous CS were all lower among infected women. No significant association was found with overall preterm birth, maternal or neonatal ICU stay, or neonatal seizure.

CONCLUSION:
Chlamydia infection is independently associated with increased odds of some of the obstetric complications we analyzed and decreased odds for others. Further investigation is required to determine if these differences are attributable to non-controlled socioeconomic factors, increased monitoring throughout pregnancy, or pathophysiologic mechanisms of infection.
Maternal Human Papillomavirus Infection Increases the Risk of Premature Rupture of Membranes [19M]
Authors: Cotton-Caballero Amaya , Dudley Donald , Ferguson James , Pettit Kate , Boyle Annelee 
Published: May 2017

INTRODUCTION:
Our main objective was to assess the association between maternal human papillomavirus (HPV) infection and premature rupture of membranes (PROM).

METHODS:
We conducted a retrospective cohort study of singleton deliveries from 2010 to 2015. Women with HPV genotyping or cervical cytology results within 3 years were included. Maternal and fetal variables were abstracted from medical records. Chi-squared and logistic regression analyses were used.

RESULTS:
2,153 women were included. 38.5% were HPV positive. The prevalence of PROM (term and preterm) was 3.4%. HPV infection (p=0.01), history of PROM (p < 0.001), drug use or smoking (p=0.01), and ethnicity (p=0.05) were associated with PROM. HPV infection (OR=2.07, 95%CI: 1.21-3.55) remained associated with PROM when adjusting for history of PROM, cervical conization, drug use or smoking, ethnicity, and insurance. Adjusting for these covariates, HPV infection was associated with preterm PROM (OR=2.23, 95%CI: 1.12-4.43) but not term PROM (OR: 1.87, 95%CI: 0.81-4.34). PPROM was associated with preterm delivery (OR=129.01, 95%CI: 35.59-467.66) after adjusting for HPV infection, PIH, diabetes, placenta previa, placenta abruption, cervical conization, smoking or drug use, ethnicity, and history of PROM. HPV infection was associated with preterm delivery (p=0.04) in univariate analysis, but not in multivariable analysis (p=0.14). HPV infection had a univariate association with newborn septicemia (p=0.02), respiratory distress (p=0.01), NICU admission (p=0.001), and low birth weight (p=0.03).

CONCLUSION:
HPV infection is associated with an increased risk of preterm PROM. Preterm delivery resulting from PPROM is associated with an increased risk of adverse neonatal outcomes, but maternal HPV infection does not independently increase this risk.
The Effects of Zika in Pregnancy: The Miami Experience [20M]
Authors: Tse Colette , Picon Michelle , Rodriguez Patricia , Gonzalez Ivan , Starker Rebecca , Curry Christine 
Published: May 2017

INTRODUCTION:
Zika virus infection in pregnancy is a global health concern. Obstetric providers in Miami care for a large numbers of pregnant women with suspected or confirmed infection from Zika-affected countries, as well as the first cases of local transmission in the United States. We are uniquely positioned to contribute data on the characteristics of Zika-infected pregnant women delivering in the US.

METHODS:
After receiving IRB approval a retrospective chart review was conducted. Using laboratory records of Zika testing (PCR and IgM) performed from January through September 2016 at multiple tertiary care centers in Miami, we extracted demographic data from all pregnant women with PCR and/or IgM tests positive for Zika virus. Testing was based on CDC guidelines at the time of testing, leading to heterogeneity in testing. Routine obstetrics parameters and presence of fetal or neonatal abnormalities were noted.

RESULTS:
A total of 997 pregnant women were tested for Zika. Of those screened, 32 had positive Zika IgM or PCR testing in serum or urine. At the time of writing, 23 had delivered. 2 had microcephaly based on CDC diagnostic criteria. 1 had abnormal intracranial findings and 6 had abnormal fetal ultrasounds prior to delivery. Of those who were still pregnant at the time of writing, 1 had fetal ultrasounds with abnormalities.

CONCLUSION:
In Miami we have a large population of women with Zika virus exposure in pregnancy. With a mix of local and remote infections, our group represents a diverse cohort from whom we can contribute a broad understanding of pregnancy implications.
Breast Feeding Rates in in Centering Pregnancy® Versus Traditional Certified Nurse Midwife Prenatal Care [27M]
Authors: Hahn Petra , Hoff Tara , Sharma Deepti , Huntly Jaimie , Hardy-Fairbanks Abbey , Stockdale Colleen 
Published: May 2017

INTRODUCTION:
Centering Pregnancy® (CP) is a standardized interdisciplinary approach to prenatal care characterized by group visits of women with similar estimated delivery dates. Other forms of group prenatal care has been associated with increased rates of breastfeeding and decreased cesarean deliveries in adolescent and low-income women, however these outcomes have not been studied in a generalizable population.

METHODS:
IRB approved, retrospective chart analysis was conducted for women that participated in (1) CP care between March 2012 and May 2016 and (2) traditional individualized certified nurse midwifery (CNM) prenatal care during the same time period. Breastfeeding status was recorded on all discharging women and at a scheduled 6-8 week postpartum visit. Descriptive and comparative statistics were performed with P < 0.05 considered significant.

RESULTS:
126 women who participated in group CP care and 847 who were involved in individual CNM prenatal care were reviewed. Rates of vaginal delivery (including operative) were not statistically different between CP vs CNM groups (77.0% vs 83.2%, p=0.085). Breast feeding rates at discharge were higher among CP, but not significantly so (97.5% vs 93.1%, p=0.061). More women attended their postpartum visit in the CP group (94.4% vs 83.2%, p=0.001), and rates of breast feeding reported at the postpartum visit were higher in this group, though again, not significantly (89.1% vs 84.1% p=0.163).

CONCLUSION:
At our institution, incorporating CP group prenatal care improved the rates of women attending their postpartum visit but led to comparable rates of breastfeeding and vaginal delivery to individual CNM prenatal care.
Improving Compliance With Preeclampsia Guidelines Through an Electronic Medical Record Alert [29M]
Authors: Scott Dana M. , Rauk Phillip , Bangdiwala Ananta 
Published: May 2017

INTRODUCTION:
Hypertensive disorders occur in 12-22% of all pregnancies, and account for 17% of maternal mortality in the US. In 2012 and 2013, the American College of Obstetricians and Gynecologists and the California Maternal Quality Care Collaborative released comprehensive guidelines for the diagnosis and treatment of preeclampsia. Electronic health records likely offer an opportunity to improve compliance with these guidelines via automated alerts.

METHODS:
A retrospective review of 289 patients admitted to the University of Minnesota Medical Center in 2015 with preeclampsia or similar disorder was completed. Compliance with the national guidelines for administration of rapid-acting antihypertensives, IV magnesium for seizure prophylaxis, oral antihypertensives, and appropriate timing of outpatient follow up was evaluated. A similar review will be performed six months after the implementation of an automated alert in the electronic health record notifying providers of severe-range blood pressures.

RESULTS:
Data collection for phase 1 is currently in process, and data collection for phase 2 will begin in January 2017. It is expected that 85% of patients with sustained severe-range blood pressures admitted to the antepartum and labor and delivery units will receive rapid-acting antihypertensives within 60 minutes, but only 65% of those patients located on the postpartum unit will receive appropriately timed antihypertensive therapy. Compliance with appropriately timed antihypertensives will improve in all locations following implementation of the automated alert.

CONCLUSION:
The electronic health record has the potential to improve patient care and compliance with American College of Obstetricians and Gynecologists and CMQCC preeclampsia guidelines. More work is needed to optimize the electronic health record's benefit.
The Efficacy of Antepartum Testing in Pregnancies Complicated by Fetal Gastroschisis [32M]
Authors: Bhagat Neha , Gimovsky Martin , Koscica Karen , Nazir Munir 
Published: May 2017

INTRODUCTION:
Our objective was to determine if our approach to antepartum testing is effective at reducing perinatal mortality in fetuses with gastroschisis.

METHODS:
This retrospective case series analyzed fetuses with gastroschisis that underwent intensive fetal surveillance from 2008 to 2016. Data collected included maternal demographics, antenatal fetal testing, influence of testing on timing of delivery, gestational age at delivery, indication for delivery, and perinatal complications. The antenatal fetal surveillance was guided by the following testing protocol: monthly growth scan, twice weekly fetal testing with BPP/NST, consultation with a perinatologist, and strict maternal kick counting.

RESULTS:
This study had 11 patients, majority of which were young primiparous Hispanic women. IUGR complicated 59.5% of our pregnancies with gastroschisis. Bowel dilation greater than 18mm was noted in 31.8% of fetuses with gastroschisis; one was delivered due to bowel dilatation greater than 25 mm. Fourteen patients were sent to L&D from ATU, of which 9 were for nonreassuring fetal testing and 2 related to ultrasound findings. All patients sent from ATU for fetal compromise diagnosed on testing were delivered within 48 hours. Eleven patients were delivered for compromised fetal status as determined by abnormal fetal testing and/or decreased fetal movement. Prevalence of IUFD in fetal gastroschisis in our case series was 0%, as compared to 4.48% reported in the literature.

CONCLUSION:
Our protocol for antenatal fetal surveillance was effective in identifying the compromised fetus with gastroschisis leading to timely delivery. Increased awareness of IUFD and our comprehensive fetal testing protocol resulted in survival of all fetuses in this study.
Trends in Prenatal Care Among the Ngöbe Population of Panama [34M]
Authors: Matsuo Marie-Claire , Gottlieb Jillian , Goodrich Leigh , Ewald Ivy , Velasco Alyssa , Steller Jonathan 
Published: May 2017

INTRODUCTION:
Maternal and infant mortality rates in Panama are reported as being within the best in Latin America, however there is a sharp contrast between rates reported in urban and rural populations. Maternal death rates among indigenous populations, such as the Ngöbe, reach as high as 658 per 100,000 live births. This study assesses the impact of poverty and geographic isolation on women's decisions to deliver at home versus a healthcare facility in this understudied population. Additionally, the use of prenatal vitamins and contraception are evaluated.

METHODS:
Given high rates of illiteracy, an oral questionnaire was administered, consisting of: 1. Preferences in delivery location 2. Use of prenatal vitamins 3. Experience with prenatal healthcare and family planning. Surveys were administered in Spanish to participants receiving services through the non-profit organization Floating Doctors.

RESULTS:
101 pregnant Ngöbe women participated. The majority of women preferred to deliver in a healthcare facility if possible (61%) and wished to use contraception (59%). Age was not a significant factor in the interest in using contraceptives (p=0.74), but the number of living children in the household was (p=0.02). The use of prenatal vitamins during pregnancy did not correlate with age (p=0.27) and was as low as 45%.

CONCLUSION:
This data further demonstrate the need for improved access to transportation to hospitals in order to reduce maternal and fetal morbidity and mortality among the Ngöbe population. Prenatal education and family planning could positively contribute to maternal and fetal health outcomes.
Analysis of a Multi-Disciplinary Program to Reduce Perineal Lacerations During Childbirth [36M]
Authors: Marko Emily , Fausett Merlin , Maxwell George , Stormes Stephanie , Deering Shad , Staat Barton 
Published: May 2017

INTRODUCTION:
To analyze the effectiveness of a multidisciplinary simulation program aimed at reducing perineal lacerations during childbirth.

METHODS:
A retrospective analysis of quality metrics was performed for a mixed-modality simulation program that was adapted for a large multi-hospital system and disseminated to nurses, midwives and physicians. This inter-professional educational program included multiple teamwork strategies aimed at reducing perineal lacerations. Outcome measures included laceration rates and length of hospital stay for patients with lacerations. Linear regression was used for statistical analysis.

RESULTS:
Data was examined over a 3-year period including the year prior to and 2 years after the program was initiated. Reductions in laceration rates occurred for spontaneous vaginal deliveries (29.6/1000 to 6.7/1000, R2 = 0.68, p less than 0.001) and operative vaginal deliveries (135.1/1000 to 46/1000, R2 = 0.23, p=0.09). Average hospital length of stay for patients with lacerations was reduced from 1.12 to 0.94 days during the program implementation (R2 = 0.36, p=0.05).

CONCLUSION:
Modest reductions in perineal laceration rates and hospital length of stay were demonstrated through a multifactorial inter-professional educational program. Reducing severe perineal laceration rates benefits patients and hospital systems.
Effect of Obesity on Labor Inductions With Foley Plus Oxytocin Versus Oxytocin Alone [37M]
Authors: Mackeen A. Dhanya , Durie Danielle , Lin Monique , Huls C. , Packard Roger , Sciscione Anthony 
Published: May 2017

INTRODUCTION:
To estimate the effect of body mass index (BMI) on labor and delivery outcomes for women induced with an intracervical Foley catheter plus oxytocin versus oxytocin alone after (near) term premature rupture of the membranes (PROM).

METHODS:
We performed a multicenter, randomized controlled trial of women with singleton gestations greater than or equal to 34 weeks with PROM and an unfavorable cervix (less than or equal to 2 cm dilated/80% effaced). Subjects were randomly allocated to a Foley catheter inflated to 30 mL with concurrent oxytocin infusion or oxytocin infusion alone. Block randomization was employed with stratification by parity, term/preterm and hospital site. Adjusted linear regression analysis revealed a non-significant shorter time to delivery (-55.4 mins, 95% CI -170.8-60.0, P=.349) in the Foley arm as compared to oxytocin arm. This secondary analysis was conducted to evaluate the effect of BMI on outcomes, within treatment groups.

RESULTS:
We enrolled 201 women and BMI was known for 198 patients. Twenty two had a BMI less than 25, 59 were overweight, 50 were class I obese, 40 were class II obese, and 27 were class III obese. Regardless of the treatment arm, the tests of trend across BMI categories were not significant for interval from induction to delivery, delivery within 24 hours, vaginal delivery within 24 hours, and cesarean delivery rate.

CONCLUSION:
Obesity did not appear to affect delivery outcomes for women induced after PROM with an intracervical Foley catheter plus oxytocin versus oxytocin alone.