bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does a Large Fetal Abdominal Circumference in Women Without Diabetes Predict Adverse Outcomes? [5P]
Authors: Greenberg Victoria , Jain Vanita 
Published: May 2017

INTRODUCTION:
We sought to determine if fetuses that have a large abdominal circumference (AC) have an increase in adverse outcomes.

METHODS:
This is a retrospective cohort study conducted via chart review of women seen for ultrasound at 28-32 weeks gestation with fetal AC measuring >90th percentile during the study period of 1/1/2014 through 12/31/2015. Women with a known diagnosis of diabetes were excluded. Multivariate logistic regressions were conducted to determine relationships between fetal AC and neonatal and maternal outcomes: neonatal hypoglycemia, birth weight, NICU admission, 5-minute Apgar scores, mode of delivery, development of gestational diabetes, and polyhydramnios. These outcomes were adjusted for presence or absence of gestational diabetes, race, maternal age, and gravidity.

RESULTS:
1715 women were included. Mean gestational age was 31 weeks. Increasing fetal AC is predictive of primary cesarean delivery (OR 1.486, p=0.0023). Fetuses with larger abdominal circumferences on antenatal ultrasounds are more likely to be macrosomic with birth weight >4000 grams (OR 2.496, p < 0.0001). Increasing fetal AC is associated with the later development of gestational diabetes (OR 2.343, p=0.0023) and polyhydramnios (OR 2.938, p=0.0003). Fetal AC does not predict lower Apgar score (OR 0.615, p=0.416), NICU admission (OR 0.824, p=0.167), or neonatal hypoglycemia (OR 1.047, p=0.852). Though none of the patients in this study were initially diagnosed with diabetes, 220 (12.8%) were found to have gestational diabetes by the time of delivery.

CONCLUSION:
Women should be counseled about the increased risks of primary cesarean delivery, polyhydramnios, macrosomia, and gestational diabetes when a large fetal AC is found.
Ultrasound Appearance of the Endometrium Post-Radiofrequency Endometrial Ablation [13P]
Authors: Sara Roper , Crisp Catrina , Buckley William , Devaiah Ganga 
Published: May 2017

INTRODUCTION:
Nearly one third of gynecology visits are related to abnormal uterine bleeding and many are treated with endometrial ablation. Little research describing the impact of ablation on the structure and appearance of the endometrium and uterus post operatively has been done. The primary objective of this retrospective study is to describe and define changes within the endometrium and uterus seen on ultrasound of the post ablated endometrium.

METHODS:
We conducted a retrospective chart review of hospital electronic medical records from 2012 to 2016 to collect data on patients with ultrasound performed after endometrial ablation. Ultrasound reports were manually reviewed to collect quantitative and qualitative data on the post-ablative uterus.

RESULTS:
The mean endometrial thickness of the study sample (n=74) postoperatively was 7.0 mm (SD 3.3), significantly lower than pre operatively (p < 0.001) and the uterine height was 4.7 mm (SD 0.9), significantly lower than pre operatively (p=0.001). The mean endometrial thickness over time trended down from 9.3 (SD 3.4) to 5.5 (SD 2.2). Appearance of heterogeneity, vascularity, and cystic spaces also increased over time.

CONCLUSION:
Endometrial thickness decreases post operatively while presence of heterogeneity vascular or cystic spaces increase but more data is needed to meaningfully compare the trend over time. A prospective study is ongoing to describe the changes of the uterus overtime after ablation to help providers interpret postoperative ultrasound studies.
Is Midtrimester Cervical Length Predictive of an Induction of Labor With an Unfavorable Cervix? [14P]
Authors: Patel Soha S. , Srinivas Sindhu K. , Downes Katheryne L. , Levine Lisa D. 
Published: May 2017

INTRODUCTION:
To assess whether midtrimester cervical length (CL) is predictive of a successful induction of labor (IOL) among women induced at term with an unfavorable cervix.

METHODS:
We performed a retrospective cohort study of women who underwent midtrimester CL assessment during their anatomy ultrasound and subsequently had a term IOL. Women with a term singleton gestation with an unfavorable cervix were included. Outcomes were risk of cesarean delivery (CD) and indication for CD. Student's t-test, Kruskal-Wallis, and Pearson chi-square tests were performed.

RESULTS:
A total of 278 women met inclusion criteria. The CD rate for this cohort was 29.9%. There was no difference between the mean CL for those with a vaginal delivery compared to those with a CD (3.48 ± 0.61 vs. 3.43 ± 0.55 cm, p=0.6). Quartiles of midtrimester CL were created based on distribution of data. When assessing quartiles of CLs, there was no difference by quartile in overall CD rate (p=0.2), which was true regardless of parity (p=0.4 nullips, p=1.0 multips). However, when evaluating indications for CD, there was a higher rate of CD for failed IOL among women with a longer cervix (p=0.03) without a difference noted in rate of CD for arrest of dilation (p=0.6), arrest of descent (p=0.07), or NRFHT (p=0.9).

CONCLUSION:
While the rate of CD for failed IOL was higher for those with a longer CL, the overall CD rate was no different. Therefore, midtrimester CL has limited predictive utility when counseling women undergoing an IOL at term with an unfavorable cervix regarding likelihood of success.
Should We Offer PGS to Poor Prognosis Patients Undergoing IVF? [20P]
Authors: Tulay Pinar , Gultomruk Meral , Findikli Necati , Bahceci Mustafa 
Published: May 2017

INTRODUCTION:
A number of complex entities, advanced maternal age (AMA), recurrent miscarriages (RM) and recurrent IVF failures (RIF), may increase the risk of numerical chromosomal abnormalities of the embryos. The aim of study was to analyze if use of aCGH for PGS improves implantation and pregnancy rates in poor prognosis patients and to analyze aneuploidy rates between embryos cultured in all-in-one time-lapse incubation (TLI) systems and standard incubators (SI) in PGS cycles.

METHODS:
PGS was performed for couples with at least one of the following factors; maternal age of 36 years or more, at least three previous miscarriages, at least three RIF and normal karyotype. A total of 205 embryos were biopsied at blastocyst stage. Whole genome amplification and aCGH was performed. The implantation and pregnancy rates for each group were analyzed.

RESULTS:
PGS results showed that 78% of the embryos obtained from poor prognosis patients were aneuploid. The implantation rate for PGS group was 11% higher compared to control group (p=0.1). The pregnancy loss rates for both PGS (28%) and control groups (23%) were similar. The rate of aneuploidy was the same for the embryos cultured in a TLI system (72%) and in a conventional incubator (72%).

CONCLUSION:
In this study, we have shown that poor prognosis patients develop a higher number of chromosomally abnormal embryos. We have shown that applying PGS to these patients to select a euploid blastocyst eliminates the unnecessary embryo transfer that may not result in pregnancy or lead to a miscarriage as well as improving the IVF outcome.
Is Progesterone Deficiency Associated With Early Pregnancy Loss? A Study of 718 High-Risk and Normal Pregnancies [23P]
Authors: Xian Yeap Valerie Shu , Tan Thiam Chye , Ku Chee Wai , Lek Sze Min , Allen John , Tan Nguan Soon 
Published: May 2017

INTRODUCTION:
Progesterone is a hormone critical to the maintenance of early pregnancy, yet there is a lack of an established distribution of progesterone levels in early pregnancy. This study aims to establish the distribution of maternal serum progesterone in normal pregnancies and pregnancies complicated by threatened miscarriage. We hypothesize that progesterone deficiency is associated with threatened miscarriage.

METHODS:
This is a single center, prospective cohort study of 718 women. Women from the normal pregnancy group were recruited from routine antenatal clinics and those in the threatened miscarriage group were recruited from emergency walk-in clinics.
Quantile regression was used to characterize serum progesterone levels in these two groups by estimating the 10th, 50th and 90th percentiles from 5 to 13 weeks gestation. Pregnancy outcome was determined at 16 weeks. Subgroup analysis within the threatened miscarriage group, to compare progesterone levels of women who miscarried with those with viable pregnancies was performed.

RESULTS:
Serum progesterone demonstrated an increasing linear trend in the normal pregnancy group, with trend gradient of bN = 4.62 (P < .0001). In the threatened miscarriage group, a linearly increasing trend with reduced gradient of bT= 4.55 (P< .0001) was observed. Median progesterone levels were consistently lower in this group by 10 nmol/L.

CONCLUSION:
Maternal serum progesterone concentration increased linearly with gestational age from 5 to 13 weeks in normal pregnancies. In women with threatened miscarriage, a downward displacement of this linear association was observed. This highlights the association between progesterone deficiency and threatened miscarriage.
Evidence of the Need for Communication Among Obgyns and Gamete Providers for Management of Offspring's Health [29P]
Authors: Callum Pamela 
Published: May 2017

INTRODUCTION:
To illustrate how fetal abnormalities in pregnancies conceived through gamete donation can help to identify inherited risks from gamete donors, and to document how communication among gamete providers and obstetric practices can be beneficial to donor management and patient care.

METHODS:
Reviewed reports of health issues in fetuses and offspring from sperm donors in our program from 2012 through September 2016. Two cases were selected for elaboration to illustrate how inherited risks are identified and how donor management and patient care were affected.

RESULTS:
Two reports of abnormalities in fetuses led to significant changes in donor management due to evidence of significant inherited disease risks to donor-conceived individuals. In one case, a chromosome abnormality in a fetus led to identification of a cryptic translocation in a sperm donor. In another case, ultrasound findings in a fetus led to identification of gonadal mosaicism for tuberous sclerosis in a donor. Knowledge of these findings, and internal documentation systems, allowed our facility to identify the inherited risks and communicate risk information to other clients who had used specimens from these donors.

CONCLUSION:
Genetic risks cannot be eliminated through prospective donor screening practices. The knowledge of abnormalities in fetuses conceived through gamete donation can aid in ongoing risk assessment, changes in donor management, and communication to clients when significant risks are identified. Patients are not always able to accurately communicate the findings in their pregnancies to gamete providers. Collaboration and communication among gamete facilities and healthcare providers allows for enhanced patient care.
MEF2 Transcription Factors Regulate Human Trophoblast Invasion and Differentiation [33P]
Authors: Li Lucy , Gong Xiaoming , Rubin Lewis P. 
Published: May 2017

INTRODUCTION:
Adverse pregnancy outcomes, including preeclampsia and preterm birth, two significant causes of maternal and fetal morbidity and mortality, are associated with placental trophoblast dysfunction. Myocyte enhancer factor 2 (MEF2) transcription factors play an important role in cell differentiation and invasion in various cell types and tissues. The objective of our study is to explore the role of MEF2 in the invasion/differentiation of trophoblasts in normal placental development and preeclampsia.

METHODS:
Human cytotrophoblasts (CTBs) were isolated from term placentas and used to analyze the expression of MEF2 transcription factors and MEF2-dependent cell signaling. The effect of MEF2 on human trophoblast invasion/differentiation and its underlying mechanisms were examined in two trophoblast cell lines: HTR8/SVneo (first trimester human villous-derived) and BeWo (choriocarcinoma CTB-like) cells.

RESULTS:
MEF2 isoforms are differentially expressed in the CTBs of first and third trimester human placentas. MEF2D and 2B are highly expressed in first trimester trophoblasts. Introduction of MEF2D into HTR8/SVneo promotes cell invasion and migration. The invasive capacity is impeded by exogenous expression of dominant negative MEF2. MEF2A is a major isoform of MEF2 in term CTBs and is required for proper CTB differentiation into syncytiotrophoblasts. During in vitro CTB differentiation, p38 MAPK activity was detected for days 1-4, and diminished for days 5-6 suggesting that p38 MAPK signaling is essential for CTB differentiation but not for the maintenance of syncytiotrophoblasts.

CONCLUSION:
Our studies suggest individual MEF2 family members differentially regulate trophoblast invasion/differentiation. Dysregulation of MEF2 signaling may be associated with placenta-related pregnancy disorders, including preeclampsia.
Hysterectomy as Gender-Affirmation Surgery in Female-to-Male Transgender Persons [37P]
Authors: Makhija Neeta , Mihalov Linda 
Published: May 2017

INTRODUCTION:
Persons assigned female gender at birth may seek hysterectomy as part of their gender affirmation. Little is known about the characteristics and outcomes of this population.

METHODS:
Retrospective chart review of 15 trans men (female-to-male transgender persons), age 16-43, who underwent hysterectomy by a single surgeon at our academically-affiliated community hospital from 2012-2016. Three patients participated in a focus group aimed at optimizing perioperative care.

RESULTS:
All patients were nulliparous, 93% had been on testosterone therapy and most had previously undergone bilateral mastectomy (“top surgery”). 66% underwent surgery solely for gender affirmation, the remainder had additional gynecologic indications. Most had robotic laparoscopic hysterectomy, with or without removal of the cervix, tubes and ovaries. Mean duration of surgery was 121.5 minutes (SD 18.75) and EBL was 43 cc (SD 21.9). Mean uterine weight was 91.7 g (SD 47.69). Forty percent of patients had pelvic pathology noted intra-operatively and 46% stayed overnight with mean length of stay of 15.75 hours (SD 1.75). One patient had postoperative vaginal bleeding from introital lacerations requiring two separate re-operations. Access to the vagina was frequently challenging due to absence of prior vaginal intercourse and marked vaginal atrophy due to high dose testosterone. Focus group discussion identified opportunities for creating a welcoming, trans-competent atmosphere for this population.

CONCLUSION:
Regardless of their future plans for genital reassignment surgery (“bottom surgery”), trans men frequently pursue hysterectomy as part of their gender affirmation. Future research is needed to characterize this population, educate providers and improve gynecologic care.
Uterine Transplant: Views Among Medical Professionals [5Q]
Authors: Joudi Noor , Zanelotti Austin , Medina Carlos A. 
Published: May 2017

INTRODUCTION:
Since 2014, with successful live-birth following uterine transplant in Sweden, uterine transplant has become a possible future treatment option for absolute uterine factor infertility (AUFI). The objective of this study is to assess acceptability of uterine transplant among medical personnel and determine if it would be more favorable than surrogacy.

METHODS:
After obtaining IRB approval a questionnaire designed to ascertain acceptability of uterine transplant was distributed using Survey Monkey. It consisted of 15 questions assessing demographics and responses to hypothetical questions regarding knowledge of transplant process, perception of surrogacy/transplant, donor type, willingness to donate, etc. The survey was distributed electronically to 891 medical personnel at our institution. The data was analyzed using descriptive and inferential statistics.

RESULTS:
From 891 questionnaires distributed only 22.7% responded. The majority of respondents were younger than 31 years old (93.7%), female (66.5%), and Caucasian (49.0%). No fellows or attending physicians responded. The majority of respondents chose a gestational surrogate (54.9%) over a uterine transplant (45.1%). Uterine transplant was viewed as a complex procedure by most (77.1%), however, 39.4% would attempt uterine transplant. It did not matter if it the transplant was from a living donor or a cadaver. 71.6% of respondents would donate their uterus if they were postmenopausal, and the overwhelmingly majority (95.1%) would donate their uterus as an organ donor.

CONCLUSION:
Although the majority of medical personnel view uterine transplant as a complex procedure, interestingly, the concept of undergoing a hypothetical uterine transplant was well accepted. Almost all survey respondents would consider donating their uterus.
The Use of Long-Term Indomethacin Stabilizes Cervical Length in Twin Pregnancies [7Q]
Authors: Shannon Allison , Crimmins Sarah , Hanna David , Kopelman Jerome , Harman Chris , Turan Ozhan 
Published: May 2017

INTRODUCTION:
To determine if the use of early onset (less than 25 weeks) long-term indomethacin therapy (greater than 48 hours) (LIT) stabilizes the cervical length (CL) in dichorionic-diamniotic twin gestations (DCDA-T) that are complicated by a short cervix.

METHODS:
DCDA-T pregnancies with short CL (less than 30 mm) after 18 weeks were identified. Serial CL measurements, other treatments (17 OH-P, vaginal progesterone) and outcomes were collected. Patients with cervical cerclage were excluded. The degree of cervical shortening from initial to last examination was compared in patients with a short CL and women with a normal CL at same gestational age (GA). Longitudinal analysis of the change in CL was modeled using mixed-model regression analysis and predicted values were compared using comparisons of the slope analysis.

RESULTS:
Out of 77 patients, 32 (42%) received LIT. The GA at initial ultrasound was similar between groups (P=0.6). Initial and last CLs were shorter in LIT group (21 mm vs 43 mm and 11.5 mm vs 36 mm) (P < .0001 for both). A total of 434 (LIT=191, Normal CL=243) longitudinal CL examinations were used for mixed-model regression analysis. CL improved or did not change in LIT group (0-0.4 mm/week) (CL= 0.0353GA2-1.5458GA+32.399, R2=0.06). However, in normal CL group, CL was declined by 0.8-1.9 mm/w (CL=0.0529GA2-4.1356x+105.25) (P < .00001). There were no reportable antenatal side effects.

CONCLUSION:
Early onset long-term indomethacin therapy in DCDA-T with a short cervix provides an alternative treatment modality to stabilize cervix.
Reliability of Visual Estimation of Intrapartum Blood Loss [10Q]
Authors: Dunlop Kristyn , Eckler Rebecca , Rosen Adam , Komorowski Adam , Murphy Kellie , D'Souza Rohan 
Published: May 2017

INTRODUCTION:
Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality. Visual estimation of blood loss (VEBL) is commonly used to diagnose PPH, but its validity remains unknown. This study aimed to determine the accuracy of VEBL in diagnosing PPH.

METHODS:
Pregnant women over 18 years of age delivering vaginally or by caesarean delivery (CD) after 23 completed weeks of gestation were included. Blood loss was measured by weighing pre- and post-delivery sponges and linen (gravimetric method), and direct measurement of blood collected in the suction apparatus at CD. Obstetricians, nurses, and anesthesiologists involved in the delivery were asked to anonymously estimate blood loss. Their role in the delivery and years of experience were noted. Results were presented in numbers and proportions.

RESULTS:
Of 170 cases recruited, 157 were analyzed, including 123 CD and 34 vaginal deliveries. For CD, sensitivity of VEBL was 29.4% for primary surgeons, 16.7% for first assistants, 20% for anesthesiologists, 31.2% for scrub nurses, and 25% for circulating nurses. For vaginal deliveries, the sensitivity was 45.4% for primary obstetricians, and 37.5% for assistants. The specificity was between 89.5% and 100% for all participants with both CD and vaginal deliveries. Although sensitivity increased with years of experience, it remained low even for those with the greatest obstetric experience, at 40% for vaginal deliveries and 25.8% for CD.

CONCLUSION:
This study demonstrates low sensitivity of VEBL in diagnosing PPH. Methods that accurately and objectively quantify intrapartum blood loss are needed for clinical and research purposes.
A Reminder System for Postpartum DM Screening in GDM Patients: A Randomized Controlled Trial (RCT) [20Q]
Authors: Khalifeh Adeeb , Iyer Jayasree , Cantor Eva , Quist-Nelson Johanna , Tumas Jordyn , Berghella Vincenzo 
Published: May 2017

INTRODUCTION:
The postpartum period is an opportunity to screen for diabetes mellitus (DM) in pregnancies complicated by gestational diabetes mellitus (GDM). We evaluated whether a reminder system increases DM screening in the postpartum period.

METHODS:
This was a multicenter RCT of women who had pregnancies complicated by GDM and whom we anticipated would undergo postpartum screening for DM. Our intervention was a reminder system comprising of providing the patient with a screening test laboratory requisition prior to discharge from the hospital and of a phone reminder 6 weeks postpartum. Our control group included patients undergoing routine DM screening during their 6 week postpartum visits. The primary outcome was DM screening uptake in the postpartum period. Data was analyzed using Chi squared and Fisher exact tests.

RESULTS:
A total of 75 patients were randomized. 38 were assigned to the reminder system and 37 to the control group. Maternal age, race, insurance and parity were similar between both groups. From the intervention group, 31.6% (n=12) performed postpartum DM screening compared to 24.1% (n=10) in the control group (p=0.1). This increase was significant in patients with public insurance (p=0.04) but not in patients with private insurance (p=0.19). 31.8% (7/22) of patients who completed the screening test were diagnosed with prediabetes but none with DM.

CONCLUSION:
A reminder system for postpartum DM screening in GDM patients did not increase testing uptake. However, a reminder system may be beneficial in patients with lower socioeconomic status.
The Effects of Tocolysis on Neonatal Septic Death in Women With PPROM: A Retrospective Cohort Study [21Q]
Authors: Chackowicz Ariel , Spence Andrea R. , Abenhaim Haim A. 
Published: May 2017

INTRODUCTION:
The use of tocolysis in women with preterm premature rupture of membranes (PPROM) remains uncertain, particularly in suspected chorioamnionitis. The purpose of our study was to evaluate the effect of tocolysis on neonatal septic death in women with PPROM +/- chorioamnionitis.

METHODS:
Using the Linked Birth and Infant Death data files (2009-2013) from the National Center for Health Statistics, we conducted a retrospective cohort study on all registered live births between 24-32 weeks' of pregnancy in order to evaluate the effect of tocolysis on neonatal septic death at 7 and at 28 days among women with PPROM between 24 and 32 weeks' gestation. Logistic regression models were used to evaluate the effect of tocolysis on neonatal septic death at 7 and at 28 days in births with and without chorioamnionitis.

RESULTS:
There were 46,968 births that met study criteria, and of which 6,264 (13.3%) received tocolysis. Tocolysis was more commonly administered to women who were Caucasians, smokers, and with multiple birth pregnancies and previous preterm births. There was no significant association between tocolysis and neonatal septic death at 7 days (OR 0.66, 95% CI 0.39-1.13) and at 28 days (OR 0.85, 95% CI 0.60-1.19). This was consistent in pregnancies complicated by chorioamnionitis and those without chorioamnionitis.

CONCLUSION:
In the setting of PPROM, tocolysis does not appear to increase the risk of neonatal septic death. Therefore, consideration can be given to its administration if clinically indicated.