bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Twin Pregnancies With Short Cervix in a Single System [5L]
Authors: Buchanan Christopher , Hostetter Sarah , Volkman Emma , Miller Collin , Gavard Jeffrey , Vricella Laura K. 
Published: May 2017

INTRODUCTION:
We aimed to evaluate whether twin pregnancies with cervical length ≤25 mm who received cerclage had different rates of preterm birth (PTB) < 32 weeks compared with other forms of management.

METHODS:
This is a retrospective cohort of twin pregnancies with a cervical length ≤25 mm at 14w0d-27w6d at our academic center (2013-2016). Twin pregnancies with short cervix were eligible for 4 types of management: cerclage, Inflatoball cervical pessary (pessary), vaginal progesterone (VP), or expectant management (EM). Data were analyzed on intent-to-treat basis. Primary outcome was delivery < 32 weeks. Secondary outcome was interval from diagnosis of short cervix to delivery.

RESULTS:
60 patients met criteria for analysis: cerclage (n=19), pessary (n=11), VP (n=11), EM (n=19). Age, race, parity and history of PTB were similar among groups. Group and pairwise comparisons showed similar rates of delivery < 32 weeks for all groups (58% cerclage, 36% pessary, 55% VP, 47% EM; P=0.7). Survival analysis was used to evaluate the interval from diagnosis to delivery, showing similar intervals when comparing all 4 interventions as a group, but pairwise comparison demonstrated greater median interval for cerclage vs EM (61.7 vs 55.0 days; P=0.04) and for VP vs pessary (65.0 vs 48.8 days; P=.01).

CONCLUSION:
No difference in delivery < 32 weeks was found in this cohort of twin pregnancies with cervical length ≤25 mm who underwent different management. Patients receiving a cerclage had a longer interval to delivery compared to expectant management. Randomized controlled trials are needed to determine the optimal management of twin pregnancies with short cervix.
Learning in Pregnancy: Patient Preferences on Education in the Antenatal Period [9L]
Authors: Friedman M. Alexandra , Heyward Quetrell , Gavarkovs Adam , Maher Melissa , Eger Renee 
Published: May 2017

INTRODUCTION:
Pregnancy is a time of vast knowledge acquisition, however, in a busy clinic schedule, providers have limited time to provide anticipatory guidance. Video has been used to provide stereotyped education, however, information is lacking on the acceptability and effectiveness of video education for antepartum patients. This quality improvement project queried sources of education for antenatal patients, the potential role of video education, and the educational impact of a video currently used in a residency outpatient clinic.

METHODS:
A survey was designed to query patient usage and perceived efficacy of commonly utilized resources for information in pregnancy. Surveys were administered during patients' initial prenatal intake appointment. Patients also completed a knowledge quiz before and after watching a 10-minute video on breastfeeding.

RESULTS:
74 patients participated in the survey. Patients reported the most commonly used and most helpful sources of information were family (43), general websites (37), and friends (36). 69% of respondents reported an interest in videos about pregnancy. Patients showed a statistically significant improvement in knowledge of breastfeeding after watching a 10-minute video (2.83, 3.57 p=0.0078). Patient scores on the knowledge quiz did not differ by video preference.

CONCLUSION:
Patients report their most common and helpful sources of information do not come from professionals. Patients are amenable to video as a source of counseling in pregnancy, and show improved knowledge following education through this modality. Future studies will help to clarify specific characteristics of effective antepartum video education tools, as well as potential impacts on antepartum care.
Outcome Comparison Before & After New Protocol of DVT Chemoprophylaxis for Cesarean Section Patients [11L]
Authors: Paquet Amanda , Keerthy Madhurima 
Published: May 2017

INTRODUCTION:
Venous thromboembolism is one of the leading causes of maternal morbidity and mortality. After careful review of the available literature and discussion of the recommendations of multiple national organizations (American College of Obstetricians and Gynecologists, RCOG, American College of Chest Physicians, etc.), the Quality and Safety Committee at our hospital changed the protocol for VTE prophylaxis for obstetric patients. The new policy advocates a more aggressive VTE prophylaxis of 7500U heparin BID for all Cesarean section patients starting 12 hours post-operation. One year has passed since the implementation of the new chemoprophylaxis protocol and this comparison will allow us to analyze if the benefits outweigh the potential risks.

METHODS:
Retrospective chart review of one year before and one year implementation of new DVT chemoprophylaxis protocol for benefits and complications. Rates of wound infections, hematomas, dehiscence, ER visits, readmissions, DVT, and PE were studied. Initial records were collected from February 2015 through January 2016. 288 patients before protocol implementation and 296 patients after were studied. Cohorts were uniform in regards to age, race, BMI, gravidity, parity.

RESULTS:
No statistical significance noted at 6 months with respect to wound complications, ED visits, readmission rates, DVT, or PE from before protocol implementation to after protocol implementation.

CONCLUSION:
Six month data suggest no statistical significance between the before and after protocol implementation groups. Additional data has been collected and is being analyzed out to the one year mark to determine if the policy change has benefited or adversely affected patients.
Early Initiation of 17OHPC Does Not Increase Risk for Gestational Diabetes in Women With Prior Preterm Birth [13L]
Authors: Suhag Anju , Dutta Ritu , Monga Manju , Sangi-Haghpeykar Haleh , Ramin Susan , Hollier Lisa 
Published: May 2017

INTRODUCTION:
17alpha-hydroxy progesterone caproate (17OHPC) is a common intervention to prevent recurrent preterm birth (PTB). The literature is inconsistent regarding an increased risk of gestational diabetes (GDM) in women on 17OHPC. Our objective was to determine the association of gestational age at initiation of 17OHPC and risk of GDM in women with spontaneous prior PTB (sPTB).

METHODS:
A retrospective study of singleton gestations with prior sPTB, who received weekly 17OHPC injections at two large Medicaid clinics from 2/2014- 6/2016. We excluded pre-gestational diabetes, multiple gestations, and women unable to complete glucose screening by 28 weeks. The study cohort was divided into group 1 (early initiation of 17OHPC at 16-20weeks) and group 2 (late initiation of 17OHPC at 21-26weeks). Primary outcome was the rate of GDM. Secondary outcomes included the rate of normal glucose screening and glucose intolerance. P-value of < .05 was considered statistically significant.

RESULTS:
94 women met inclusion criteria. Demographics were similar in both groups, except mean BMI was higher in group 1 compared to group 2 (P=.002). Mean gestational weight gain (GWG) and the rate of excessive GWG were similar in both groups. The total number of doses of 17OHPC was higher in group 1 compared to group 2 (P < .0001). The rate of GDM was similar in both groups, even after adjusting for BMI and race. Secondary outcomes were also similar in both groups.

CONCLUSION:
Initiation of 17OHPC at 16-20 weeks does not increase the risk of gestational diabetes. Further studies with a large sample size, are suggested to confirm this observation.
MAMA'S Neighborhood–Maternity Assessment Management Access & Service Synergy Through the Neighborhood for Health [16L]
Authors: Saleeby Erin , Scibetta Emily , Moini Moraya , Trang Cassandra , Young Carmen Canto , Greenwell Lisa 
Published: May 2017

INTRODUCTION:
MAMA's Neighborhood (MAMAs), funded by the Strong Start for Mothers and Newborns Initiative, aims to evaluate models of prenatal care to reduce preterm (PTB) and low birth weight (LBW). Using a medical home model in high prevalence areas of Los Angeles, MAMAs sought to better assess potential social determinants of PTB and LBW and organize care to address these risks via: 1. Collaborative care teams, 2. Risk stratified case management, 3. Population health management, and 4. Community engagement and care delivery with social-service agencies.

METHODS:
Data were collected December 2013–August 2016. MAMAs implemented a novel initial assessment with evidence-based screening tools for psychosocial risk factors, risk stratification, case management and population health tracking by collaborative care teams at 6 sites. Neighborhood services were linked for individualized care planning.

RESULTS:
A total of 3,214 women enrolled. This cohort exhibited disproportionately high rates of food insecurity (15%), depression (23%), anxiety (31%) and intimate partner violence (32%) when compared to the general obstetric population. All women received risk stratified case management, allocating services weekly to 4%, monthly to 23%, and trimesterly to 74% of the cohort. Neighborhood service referrals averaged 3.7 per participant for psychosocial needs.

CONCLUSION:
MAMAs Neighborhood successfully implemented evidence-based screening tools for psychosocial risk factors into prenatal care, risk stratify and manage population health. MAMAs also developed individualized care plans for pregnant women including services delivered by community-based agencies to meet social needs. This model, involving both health system and community partners, leverages a Neighborhood approach to optimize maternal-child health outcomes.
Association Between Time of Day of Delivery and Perinatal Outcomes [17L]
Authors: Liu Lilly , Miller Emily , Yee Lynn 
Published: May 2017

INTRODUCTION:
Prior work has demonstrated differences in cesarean-associated maternal morbidity based on time of delivery, but it remains unclear whether delivery mode or neonatal outcomes are associated with diurnal patterns. The objective was to determine if there is an association between delivery time and perinatal outcomes.

METHODS:
This is a retrospective cohort study of all nulliparous women delivering singleton, vertex, live births at ≥37 weeks gestation at a single center from 2014-15. Delivery time was dichotomized with nighttime deliveries designated as those occurring between 6pm and 6am. The primary outcome was delivery mode. Secondary outcomes included epidural use, labor augmentation, episiotomy and perineal lacerations, 5 minute Apgar < 7, cord umbilical artery pH < 7.0, and NICU admission. Bivariable and multivariable analyses were utilized for analyses.

RESULTS:
Of 7,691 women eligible for inclusion, 3,707 (48.2%) delivered during the night. Women undergoing night deliveries were marginally more likely to be undergoing induction of labor (20.1% vs 18.4%, p=0.06). Women delivering during the night were less likely to experience augmentation of labor (79.8% vs 81.6%, p=0.05) and had a higher frequency of cesarean delivery (20.6% vs 17.0%, p < 0.001). They were also more likely to have neonates with a 5-minute Apgar score < 7 (aOR 1.57, 95% CI 1.07-2.30) and umbilical artery pH < 7.0 (aOR 1.75, 95% CI 1.17-2.61).

CONCLUSION:
Among nulliparous women, delivery at night is associated with greater odds of cesarean delivery, low 5-minute Apgar score, and low umbilical artery pH.
Prevention and Management of Severe Obstetric Lacerations: A National Survey of Nurse Midwives [21L]
Authors: Diko Sindi , Guiahi Maryam , Carlson Nicole S. , Connell Kathleen , Reeves Shane , Hurt K. Joseph 
Published: May 2017

INTRODUCTION:
There is no detailed information on US obstetric providers' understanding of risks and management of severe obstetric anal sphincter injuries (OASIS). We performed a cross-sectional national survey study to identify OASIS education gaps among certified nurse midwives (CNMs) that could improve obstetric quality.

METHODS:
We invited American College of Nurse Midwives members (ACNM; n=6909) via email, and included active ACNM members performing at least one delivery within the past year. We assessed their understanding of OASIS risks, prevention, repair, and management based on a RedCap survey instrument that was previously created and piloted within a university OB-GYN department.

RESULTS:
We received 1069 (15.5%) completed surveys; 889 (83.2%) met our inclusion criteria. Participant age, race, and gender were statistically representative of ACNM membership. Poor nutrition, nulliparity, forceps and vacuum use, and midline episiotomy were reported as the top OASIS risk factors. CNM prevention techniques included perineal support, guided delivery, avoiding episiotomies, and maternal positioning. 15.1% of respondents reported repairing OASIS personally, 78.8% referred out. Over 85% of respondent reported they did not routinely perform a rectal exam if lacerations were suspected. At discharge, CNMs recommend stool softeners, sitz baths, NSAIDS, lidocaine ointment or spray, and fiber supplements. 30% of respondents reported receiving formal education on OASIS, and 37.5% reported that their delivery sites have protocols or guidelines regarding OASIS management.

CONCLUSION:
CNMs report standard care for OASIS that is similar to the American College of Obstetricians and Gynecologists’ recent practice bulletin recommendations, though additional formal training on OASIS prevention and management appears warranted.
Comparing Induction of Labor With Expectant Management in Pregnancies With Congenital Anomalies [22L]
Authors: Patel Shruti , Quimby Alyssa , Twogood Sara , Pinheiro Meaghan , Brown Niquelle , Cortessis Victoria 
Published: May 2017

INTRODUCTION:
Historically, induction of labor has been associated with higher rates of C-section, particularly when the starting cervical exam is unfavorable. However, recent studies have challenged this idea, showing lower rates of C-section for elective inductions in singleton cephalic pregnancies without anomalies at term compared to expectant management. This study aims to look at the rate of C-section in women with fetal anomalies who were induced at term as compared to those who were expectantly managed.

METHODS:
We conducted a retrospective review of pregnancies prenatally diagnosed with fetal anomalies delivered from 2012 to 2014 at a single referral center. Induction vs expectant management, gestational age, mode of delivery, maternal and fetal factors, and complications were evaluated.

RESULTS:
Of the 117 women included in the study, 64 were induced, while 53 were expectantly managed. 17.2% of the induced pregnancies were delivered via C-section, while 62.2% of the expectantly managed pregnancies were delivered via C-section. Further analysis including only patients delivered beyond 37 weeks, showed induction patients were 83% less likely to deliver via C-section compared to patients who were expectantly managed (95% CI [0.06, 0.48]).

CONCLUSION:
Our data suggests that patients with fetal anomalies, including patients with an “unfavorable cervix,” who are induced at term do not have higher rates of C-section as compared to those who are expectantly managed. This supports the conclusions of previous studies in regard to induction, but now can be expanded to pregnancies complicated by fetal anomalies.
The Association of Labor Induction for Advanced Maternal Age With Cesarean Section [23L]
Authors: Spiegelman Jessica , Connolly Katherine , Khander Amrin , Factor Stephanie , Stone Joanne 
Published: May 2017

INTRODUCTION:
To determine if induction of labor among women ≥ 40 years for advanced maternal age (AMA) at 39 0/7–39 6/7 weeks is associated with an increased risk of cesarean section compared to women who are expectantly managed.

METHODS:
A retrospective cohort study of patients ≥ 40 years who delivered at a single tertiary care center from June 2011 through December 2014. Cesarean section rates of women who underwent induction of labor at 39 0/7-39 6/7 weeks for AMA to those who were expectantly managed were compared using chi-square and multiple logistical regression.

RESULTS:
Of 223 nulliparous women, 76 (34%) were in the induction group, and of the 263 multiparous women, 85 (32%) were in the induction group. Among the nulliparous women, there were no differences in baseline characteristics. Among the multiparous women, those in the induction group were older (median age 42 vs. 41, P=.01) and had a lower admission Bishop Score (median 9 vs. 10, P=.05). Among nulliparous women, the induction group was not at increased risk of cesarean section (OR=1.47, 95%CI 0.84, 2.58, P=.18). Among multiparous women, the induction group was not at increased risk of cesarean section (OR=1.69, 95% CI 0.71, 3.99, P=.23) after controlling for age and admission Bishop Score.

CONCLUSION:
In patients ≥ 40 years old, induction of labor for AMA was not associated with an increased risk of cesarean section. Given the concern for stillbirth in this group, this information may help guide clinicians decide whether to induce labor for AMA in the absence of other indications.
Audit of Management of Gestational Proteinuria [25L]
Authors: Sood Akanksha , Mathen Stephy 
Published: May 2017

INTRODUCTION:
Studies have demonstrated that around 50% of women with isolated proteinuria in pregnancy develop preeclampsia and importantly, even in the absence of hypertension, these women are at significantly increased risk of fetal growth restriction and placental abruption.

METHODS:
Retrospective audit of cases of Isolated gestational proteinuria. A total of 50 patients were identified who had their urine protein creatinine ratio (uPCR) sent in the January to December 2015. Only cases with isolated gestational proteinuria were identified.

RESULTS:
Our results showed that 58% of women developed preeclampsia with an average interval of 11 days from first admission with isolated proteinuria. Further, 12% of babies were small for gestational age and 16% delivered less than 37 weeks. A urine culture sensitivity was performed in 76 % women with any degree of proteinuria to exclude urinary tract infection. A urine protein creatinine ratio (uPCR) was requested in 96% when greater than or equal to“+” on urine dipstick. Baseline bloods were done in 98% when urine protein creatinine ratio (uPCR) was greater than 30 mg/mmol or “++” proteinuria dipstick. Only 56% had a management care plan documented by a senior obstetrician. In women with significant proteinuria (even in the absence of hypertension) delivery was discussed and offered after 37 weeks in 86.36%.

CONCLUSION:
There was marked inconsistency in the management of gestational proteinuria. Universal guideline pathway should be made to avoid adverse outcomes like preeclampsia which is increased in this group.
Association of NSAIDs with Postpartum Blood Pressure in Women With Hypertensive Diseases in Pregnancy [26L]
Authors: Workman Pritha , Spinosa Daniel , Su Hui-Chun , Roeder Hilary 
Published: May 2017

INTRODUCTION:
Based on the Hypertension in Pregnancy Task Force guidelines, we examined if NSAID administration adversely affects blood pressures in the immediate postpartum (PP) period in women with HDP (hypertensive disorders of pregnancy).

METHODS:
This cross sectional study examined patients with HDP who delivered at our institution from April 2012 to April 2015. Mean systolic (SBP) and diastolic (DBP) blood pressures over the first 24 hours were compared by NSAID exposure using Student's t-test or Chi-square test of proportions. Multivariable linear regression was used to adjust for confounding. Exploratory repeated measures analyses were performed.

RESULTS:
130 subjects with HDP were identified; 103 (79%) were exposed to NSAIDs. Mean SBP in NSAID exposed and unexposed was 132.5 ± 10.7 vs 140.9 ± 10.4 mmHg, respectively (p < 0.01). Mean DBP in NSAID exposed and unexposed was 79.0 0 ± 7.1 and 84.8 ± 8.4 mmHg, respectively (p = 0.01). In multivariable modeling, only magnesium exposure and earlier gestational age remained significantly associated with higher SBP. Of 46 women with severe preeclampsia, 26 (43.5%) were exposed to NSAIDs. Mean SBP in NSAID exposed and unexposed was 137.7 ± 13.0 and 143.7 ± 9.9 mmHg (p=0.09). Repeated measures analysis of blood pressures showed similar results.

CONCLUSION:
Administration of NSAIDs did not appear to be associated with higher mean SBP or DBP immediately PP. NSAID exposure was associated with significantly lower SBP and DBP. This suggests NSAIDs may not adversely affect BP immediately PP, but a randomized controlled trial is needed to provide higher level evidence.
An Incidence of Chronic Inflammatory Demyelinating Polyneuropathy in Pregnancy [28L]
Authors: Manley Charisma , Geary Franklyn 
Published: May 2017

INTRODUCTION:
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is a long-term form of Guillain-Barre syndrome (GBS), an acute inflammatory autoimmune polyradiculoneuropathy linked to various infectious agents. It is a rare disease process associated with symmetric motor paralysis with or without sensory deficits, affecting between 0.8 and 7.7 per 1,000,000. There is limited representation of antepartum management of CIDP in the literature.

METHODS:
We detail our experience in a primigravid patient with previously diagnosed CIDP during an acute exacerbation in pregnancy. The clinical case was analyzed followed by a literature review of CIDP antepartum management.

RESULTS:
A 29 year old primigravid female at 18 weeks gestation with a past medical history notable for GBS presented with reports of numbness and weakness in bilateral upper and lower extremities for 1 week. The patient was assessed, admitted and underwent evaluation with electromyogram and nerve conduction studies. Studies demonstrated progression of CIDP, with worsened demyelinating features with reduced conduction velocity and axonal involvement. Due to prior poor response to intravenous immunoglobulin, treatment with a limited course of plasmapheresis to prevent disease progression was successfully conducted. The patient subsequently experienced a successful term delivery of a female neonate.

CONCLUSION:
CIDP is an autoimmune neurologic disease process that has been minimally studied in pregnancy due to its low incidence. Our case details the successful evaluation and management of CIDP with plasmapheresis during pregnancy with subsequent successful term delivery. Increased awareness of CIDP and associated management is necessary due to the debilitating nature of the disease with potential fetal and maternal effects.