bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perimenopausal Symptomatology and Menopause-Related Quality of Life [2M]
Authors: Dye Timothy , Demment Margaret , Hyrien Ollivier , Weber Miriam , Morley Christopher , Woods James 
Published: May 2017

INTRODUCTION:
Increasing evidence demonstrates a gap between women's own experience of menopause and practitioners' diagnosis and treatment of menopause-related symptoms (MRS). This study aims to identify subjective symptoms in perimenopausal women and their association with menopause-related Quality of Life (MQOL).

METHODS:
Women aged 45-64 enrolled in Family Medicine- and OBGYN-based primary care settings were approached electronically to participate. Women were excluded if they had past surgical history of oophorectomy, history of breast, or endometrial cancer, or were currently pregnant. In total, 70 women completed the baseline survey which included the Greene Climacteric Scale (measuring MRS) and the Utian Quality of Life Scale (measuring MQOL). Forward stepwise linear regression analyses were used to identify MRS predictors associated with MQOL scores.

RESULTS:
Several MQOL domains were significantly associated with MRS. Psychological symptoms were significantly associated with occupational (-0.66; p < .0001), emotional (-0.48; p < .0001), and overall quality of life (-1.71; p < .0001) MQOL scores. Depression symptoms were strongly associated with menopause health MQOL (-0.95; p < .0001), and vasomotor symptoms were strongly associated with sexual MQOL (-0.40; p 0.036).

CONCLUSION:
Symptomatology significantly correlates with quality of life among women of menopausal age. As psychological and depression symptoms worsen, women report diminished quality of life. Similarly, as vasomotor symptoms increase, sexual quality of life worsens. These symptoms are common, but are often poorly understood clinically. MRS should be addressed within the clinical setting with tools such as the American College of Obstetricians and Gynecologists' Practice Bulletin and EHR-based Best Practice Alerts (BPAs).
A Single Institution Review of Appropriateness of Prophylactic Antibiotics in Hysteroscopy [9M]
Authors: Wallace Erika R. , Nitzsche Brad , Massengill Abbie , Clevenger Nicole , Cotter Thusitha 
Published: May 2017

INTRODUCTION:
To examine our institution's adherence to American College of Obstetricians and Gynecologists guidelines for antibiotic prophylaxis in gynecologic surgeries for which antibiotics are not recommended.

METHODS:
A cross-sectional study of hysteroscopy cases performed at a single tertiary care center from August 2011 to September 2015 was completed. Descriptive statistics summarized patient characteristics. Chi-square tests examined antibiotic use associated with categorical variables; t- test was used for continuous variables. Multiple logistic regressions analyzed the effects of variables on the odds of receiving antibiotics of unproven benefit.

RESULTS:
Among 1,075 women who underwent hysteroscopic procedures for which antibiotics are not recommended, 196 (18.23%) received antibiotics. 770 (71.62%) women had a hysteroscopy alone, and 305 (28.37%) women had additional procedure(s) that also did not warrant antibiotics. The mean age was 45 (SD 13, Range 18-88) years. The odds of having unproven antibiotics increased by 2 percent (OR 1.02) with every one year age increase, adjusted for primary procedure, diagnosis and length of stay [95% CI, 1.76-4.58]. Age (P < .0045), primary procedure (P < .0022), primary diagnosis (P < .0019), admitted year (P < .0302) and length of stay (P < .0005) had statistically significant effects on the impact of having unproven antibiotics. Patients undergoing hysteroscopic ablation were 2.8 times more likely to receive antibiotics than hysteroscopic biopsy (P < .0001).

CONCLUSION:
Non-indicated antibiotic use is high among gynecologic surgeons at our tertiary hospital and the use varies significantly with patient characteristics. This study supports close surveillance of antibiotic administration during gynecologic surgeries for which the drugs are of unproven benefit.
Hepatitis C Infection in Pregnancy: Maternal and Neonatal Complications [17M]
Authors: Clennon Emily , Caughey Aaron B. , Bullard Kimberley , Sharshiner Rita 
Published: May 2017

INTRODUCTION:
Hepatitis C virus (HCV) infection affects thousands of pregnancies in the U.S. each year, yet there is a relative paucity of data on the outcomes of pregnancies complicated by the virus. This study analyzes recent, nationwide data on complications of pregnancy in the setting of HCV infection.

METHODS:
This retrospective cohort study examined 10,457,976 singleton deliveries in the U.S. between 2011-2013. Simple proportions of obstetric complications were compared between pregnancies complicated by Hepatitis C infection 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 of 31,200 pregnancies analyzed were complicated by maternal HCV. Infection was significantly positively associated with gestational hypertension (adj. OR: 1.09), Cesarean section (1.27), and maternal ICU stay (2.61). Many adverse neonatal outcomes were also increased with HCV infection, including overall preterm delivery (1.76), NICU stay (2.67), congenital abnormality (1.59), and neonatal seizure (3.72). Infection was negatively associated with gestational diabetes (0.77), chorioamnionitis (0.82), and macrosomia (0.79).

CONCLUSION:
HCV infection is independently associated with increased odds of many neonatal complications and several maternal complications. However, it also appears to be protective against a minority of adverse outcomes. 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.
Confined Placental Trisomy 18 Mosaicism Detected by Maternal Serum and Prenatal cfDNA Screening [21M]
Authors: Guy Carrie , Maxwell Megan D. , Waurin James L. , Buller-Burckle Arlene , Rabin Douglas S. , Strom Charles 
Published: May 2017

INTRODUCTION:
We describe a case in which maternal serum screening (MSS) and prenatal cell-free DNA (cfDNA) screening were consistent with trisomy 18, later confirmed as confined placental mosaicism (CPM) of trisomy 18. The correlation between MSS and prenatal cfDNA screening, the common relationship of the techniques to placental function, and implications for clinical management are discussed.

METHODS:
A specimen for prenatal cfDNA screening was submitted to our laboratory with an indication of a 1:22 risk for trisomy 18 on first-trimester MSS. Prenatal cfDNA screening using massively parallel shotgun sequencing was performed and outcome information was obtained by laboratory genetic counselors.

RESULTS:
Prenatal cfDNA screening was positive for trisomy 18 in a male fetus; fetal fraction was 6.4% and the Z-score for chromosome 18 was 16. Amniocentesis was consistent with a normal male fetus on routine cytogenetic and microarray analyses. No anomalies were visualized on ultrasound. Delivery was significant for preterm labor, and the neonatal course was unremarkable. Microarray performed on placental tissue revealed mosaic trisomy 18, consistent with CPM.

CONCLUSION:
CPM identification has clinical management implications, such as the associated risk for intrauterine growth restriction (IUGR). The results of MSS and prenatal cfDNA screening in this case were consistent with trisomy 18, but were later revealed to represent CPM. It is well-established that analytes used in MSS are produced by the placenta, and that the cfDNA analyzed in prenatal screening is of feto-placental origin. This case contributes to the understanding of CPM, MSS analytes, feto-placental cfDNA, for improved clinical management.
Umbilical Cord Milking in Term Infants: Blood Volume Associated With Cut and Intact Umbilical Cords [23M]
Authors: Fay Emily , Delaney Shani , McAdams Ryan 
Published: May 2017

INTRODUCTION:
Placental-to-newborn transfusion through delayed cord clamping and umbilical cord milking (UCM) is associated with reduced risk of transfusion, intraventricular hemorrhage, and necrotizing enterocolitis in preterm infants, and increased iron stores in term infants. Total blood volume (BV) transferred during UCM is not well studied. We sought to determine BV associated with both cut UCM (C-UCM) and intact UCM (I-UCM) methods in term infants.

METHODS:
Forty-five term infants were enrolled at a single center. To determine BV with C-UCM, umbilical cords from 30 infants (10 per group) were cut at 10, 20, or 30 centimeters, milked 4 times, and BV recorded. To determine BV with I-UCM, intact umbilical cords of 15 infants were milked 3 times and BV recorded. Demographic data and pregnancy data were obtained. Descriptive statistics were performed.

RESULTS:
In the C-UCM group, BV increased proportional to umbilical cord length, whereas BV/cm of cord decreased with cord length. C-UCM of a 30 cm segment contained a mean BV of 24.8±4.0 mL, or 8.0±1.3 mL/kg of birth weight. Most of the BV was obtained with the first milking (90.1±11.0%). In the I-UCM group, the mean BV was 46.3±24.1 mL, or 13.4±7.1 mL/kg of birth weight. No correlation existed between birth weight, placental weight, or BV.

CONCLUSION:
When performing C-UCM, cutting a long cord segment and milking 1 to 2 times delivers the highest BV. Compared to C-UCM, I-UCM provided greater average BV to newborn term infants. Future research should compare the clinical outcomes of infants who undergo C-UCM and I-UCM.
Correlation of BMI to Magnesium Levels in Patients With Preeclampsia [24M]
Authors: Dickerhoff Lindsay A.M. , Madden Heather , Simpson Pippa , Hibbard Judith , Cruz Meredith 
Published: May 2017

INTRODUCTION:
To determine the relationship between BMI and magnesium blood levels following a 4 or 6 gram bolus of IV magnesium in preeclamptic women.

METHODS:
Retrospective chart review from 2005 to 2015 analyzing magnesium levels in preeclamptic women. Patients received IV magnesium bolus (4 or 6 grams) followed by a basal rate of 2 grams/hour. Magnesium levels were then drawn approximately 4 hours after the bolus dose. Magnesium levels from 4.8 to 8.4 mg/dL were considered therapeutic. BMI and labs (creatinine, ALT, AST, platelets) were compared between therapeutic and sub-therapeutic groups.

RESULTS:
508 patient charts reviewed; 207 met inclusion criteria. Patients with BMI less than or equal to 30 had fewer sub-therapeutic levels than therapeutic levels (Sub-therapeutic: 38.5%; Therapeutic: 61.5%; P-value less than 0.001). Patients with a BMI less than 30 had more sub-therapeutic levels than therapeutic (Sub-therapeutic: 76%; Therapeutic: 24%; P-value less than 0.001). In patients with BMI greater than 35, there were more patients in the sub-therapeutic group (Sub-therapeutic: 83%; Therapeutic: 17%; P-value 0.024). Creatinine was lower in the sub-therapeutic group compared to therapeutic group (Subtherapeutic: 0.66; Therapeutic: 0.73; P-value: 0.003). ROC curve demonstrated 4 gram magnesium bolus with BMI greater than or equal to 30 likely will not reach a therapeutic level (Sensitivity: 0.84, Specificity: 0.51), nor will 6 gram magnesium bolus with BMI greater than or equal to 35 (Sensitivity: 0.74, Specificity: 0.38).

CONCLUSION:
There is an inverse relationship between BMI and blood magnesium levels. When BMI reaches above 30, patients are more likely to be sub-therapeutic than therapeutic.
Impact of Trendelenburg Positioning During Active Labor on Mode of Delivery [25M]
Authors: Milton Sarah , Hempel Amy , Hylton Jordan , Sima Adam , DiPace Brian 
Published: May 2017

INTRODUCTION:
Upright maternal position in labor has been associated with improved obstetrical outcomes. Little is known regarding the impact of alternative maternal positions on maternal and fetal outcomes. The primary aim of this study was to show a decrease in the incidence of cesarean delivery with the use of Trendelenberg position in pregnant women with a prolonged active phase of labor.

METHODS:
This study is a retrospective chart review of women admitted to the VCU Labor and Delivery Unit from 2013-2015 with a prolonged active phase of labor. A total of 2,816 subjects with a singleton viable pregnancy at term were included in the analysis. In addition to demographic data, information was collected from the medical record regarding maternal history, mode of delivery, and fetal outcomes.

RESULTS:
Of 2,816 subjects who met inclusion criteria, 768 (29.4%) were placed in Trendelenburg position. Overall, 441 (16.9%) patients in the study had a cesarean section. The rate of cesarean section in the Trendelenburg group was higher (30.7%) than in the non-Trendelenburg group (14.3%), p < 0.001. Apgar scores were lower in the Trendelenberg group than in the non-Trendelenberg group (1 minute 7.7 vs 8.3, 5 min 8.7 vs 8.9, p < 0.001).

CONCLUSION:
Use of Trendelenburg position during prolonged active labor does not decrease the incidence of cesarean delivery and may be associated with poor fetal outcomes. Prospective, randomized data on the topic of maternal positioning in labor would further elucidate the role, if any, for Trendelenburg position in labor.
Effect of Federal Regulation on Compounding of 17-hydroxyprogesterone Caproate in North Carolina [26M]
Authors: Hoopes Sarah , Nitsche Joshua F. 
Published: May 2017

INTRODUCTION:
Compounding of 17-hydroxyprogesterone caproate (17P) was common until the US FDA approved the drug for sale under the brand name Makena. Although current regulation prohibits compounding of an FDA approved equivalent, safe compounding of 17P was permitted by the FDA in the year following Makena's approval. We sought to report trends in compounding and quality control of 17P across North Carolina (NC) in the year before and after Makena's approval.

METHODS:
All sterile compounding pharmacies registered in NC were called to participate in a survey regarding quality control and history of 17P compounding.

RESULTS:
150 of 210 pharmacies participated. Before Makena's introduction, 18 pharmacies compounded 17P (average cost of $73 per multi-dose vial). In the year after Makena's introduction, only 3 pharmacies continued compounding 17P at a similar rate (average cost of $68 per multi-dose vial), 7 pharmacies discontinued the practice, and 8 compounded 17P significantly less frequently. 8 of the 18 pharmacies (44%) who previously compounded 17P were accredited by the Pharmacy Compounding Accreditation Board, 13 (72%) tested for product purity, and 12 (67%) tested for potency.

CONCLUSION:
Although the cost of compounded 17P was notably lower than current price of Makena ($690/dose), not all of the pharmacies that compounded 17P regularly tested for purity and potency of the drug. Provided the price of Makena does not reduce access to the medication, its stricter quality control should improve its safety and efficacy. Further federal regulation of compounding may improve the quality and safety of compounded 17P.
Improved Estimation of Blood Loss at Time of Cesarean Section Using a Quantitative Approach [28M]
Authors: Conly Bethany , Sylla Ricci , Lee Kimberly , Wei Julia 
Published: May 2017

INTRODUCTION:
In October 2009, the Kaiser Permanente Santa Clara Medical Center implemented a method of standardized, quantitative measurement of blood loss (QBL) at the time of cesarean section. The aim of this study was to determine if this QBL approach was better able to measure actual blood loss compared to the traditional visual estimation of blood loss (EBL).

METHODS:
This was a retrospective cohort study of 564 women who underwent scheduled cesarean section at our facility. The EBL group included 269 women from January 1st to December 31st, 2009 and the QBL group included 295 women from January 1st to December 31st, 2012. Blood loss estimates recorded in operative reports were collected along with the pre and postoperative hematocrits for each subject. Actual blood loss was calculated using the postoperative hematocrit change and compared to the recorded blood loss estimations in both groups using Pearson correlation coefficients (r) and coefficients of determination (r^2).

RESULTS:
QBL was weakly to moderately correlated (r = 0.35, r^2= 0.124) while EBL was very weakly correlated (r = 0.16, r^2 = 0.025) with the calculated blood loss after scheduled cesarean section.

CONCLUSION:
While neither EBL nor QBL methods were strongly correlated with the actual blood loss at time of scheduled cesarean section, the QBL method was more highly correlated. These data suggest that implementation of a standardized, quantitative approach to measuring blood loss at time of cesarean section may improve the immediate postoperative assessment of operative blood loss.
Control of Postpartum Hemorrhage Using Vacuum-Induced Uterine Tamponade [31M]
Authors: Segnitz Jan , Arulkumaran Sabaratnam 
Published: May 2017

INTRODUCTION:
Early arrest of postpartum hemorrhage (PPH) using a simple to use conservative technique, well before coagulopathy sets in, would reduce blood transfusions, unnecessary surgeries including hysterectomies, and maternal deaths. For cases of atonic PPH, a new device that uses vacuum force to collapse the uterus causing rapid tamponade, has been proposed. This may be a better alternative to balloon tamponade as it follows natural physiology, is easy to use, does not depend on guessing the volume of fluid to be introduced, or conceal bleeding behind the balloon. Our study sought to demonstrate safety, effectiveness, and ease of use in the deployment of this new device to treat PPH.

METHODS:
Ten women, with vaginal deliveries in a hospital setting, treated with prophylactic uterotonics plus additional uterotonics for excessive bleeding, were the subjects of the study. When conservative medical therapy was failing and tamponade therapy was indicated, our device, that generates uniform vacuum-induced tamponade within the entire uterine cavity, was used with physiologic vacuum forces of 70 mmHg.

RESULTS:
The ten women experienced 600-1,000 milliliters of blood loss before vacuum was generated. The vacuum created an immediate seal, 50-250 milliliters of blood were evacuated, the uterus collapsed and regained tone, and hemorrhaging stopped within 2 minutes in all cases. The device remained in place for an average of 2 hours.

CONCLUSION:
This preliminary investigation suggests that a device designed to create vacuum-induced uterine tamponade may be a better alternative than balloon devices used to treat atonic PPH. Additional study is needed and is in progress.
Contribution of Depression and Anxiety to Prenatal, Intrapartum, and Neonatal Outcomes [33M]
Authors: Liu James , Hage Natalie , Sugiyama Nathaniel , Jovanovski Andrew , Madan Ichchha 
Published: May 2017

INTRODUCTION:
To determine independent prenatal, intrapartum, and neonatal correlates of pregnancies affected by depression and anxiety.

METHODS:
Of deliveries occurring in 2013-2014, depression or anxiety was present in 915 (5.1%), including those with depression alone (n = 315, 1.8%), anxiety alone (n = 398, 2.2%), and comorbid depression and anxiety (n = 202, 1.1%). Cases were compared to unaffected pregnancies (n = 17,024, 94.9%) using logistic regression.

RESULTS:
For depression or anxiety, independently associated prenatal factors were unmarried status (OR 1.40), non-Hispanic white race (OR 1.89), smoking (OR 1.98), asthma (OR 1.38), epilepsy (OR 2.49), migraines (OR 3.58), and hypertension (OR 1.35). For intrapartum factors, independent associations were sedative use (OR 2.14), opioid use (OR 1.33), and insulin use (OR 2.94). For neonatal factors, independent associations were neonatal abstinence syndrome (OR 11.6), five-minute Apgar score (OR 0.83), and umbilical vein pH (OR 0.14). Individual regression analysis showed that depression had the most independent associations (n = 11), followed by anxiety (n = 9), and comorbid depression and anxiety (n = 8). Psychotropic medications were used by 280 subjects (31%). The most common were selective serotonin reuptake inhibitors (n = 224, 25%), benzodiazepines (n = 38, 4.2%), other antidepressants (n = 37, 4.0%), and anti-epileptics (n = 13, 1.1%).

CONCLUSION:
Ethnic and social factors, substance use, and medical disorders are associated with depression and anxiety in pregnancy. A minority of women used psychotropic medications during pregnancy. There is a trend for more narcotic and sedative use with a resultant increased risk of neonatal abstinence syndrome.
Is Checking Fasting Plasma Glucose After Delivery a Reasonable Cost Expenditure? [38M]
Authors: Domalakes Ericka , Vircks Julie , Holland Marium 
Published: May 2017

INTRODUCTION:
Gestational Diabetes (GDM) complicates 5-6% of pregnancies in the US. Current recommendations are a fasting plasma glucose (FPG) or 75 g glucose tolerance test (GTT) at 6 weeks postpartum. FPG value is often obtained in the immediate postpartum period to screen for continued hyperglycemia. There is no recommendation for this however, and given the cost of checking FPG, we questioned if this practice would routinely affect clinical outcomes or predict the outcomes of 2 hr GTT.

METHODS:
A retrospective chart review was used to collect FPG and 6 week GTT results. Logistic regression and Chi Square analysis was used to evaluate OR to determine if there was a significant correlation between FPG and 2 hr GTT. An in-patient FPG (cpt 82962) was $28.00. This was applied to the total number of GDMs to calculate cost to the system.

RESULTS:
We found no difference in 6 wk postpartum GTT results based upon FPG (OR 1.01, 95% CI 0.97-1.06). FPG was greater than 99 mg/dL in 15.6% of patients, and the pass rate for GTT was 72.5%. There were no patients who failed GTT, however 27.5% demonstrated glucose intolerance. In our limited sample (n=167), there was a total of $4,676 spent on FPG.

CONCLUSION:
We found no correlation between FPG and 2 hr GTT. Given approximately 4 million births each year with GDM rates of 5%, over $5.5 million may be spent on FPG every year. As the FPG does not appear to add useful information to a patient's care, this provides an opportunity to reduce associated costs.