bluuebunny/crossref_metadata_2025_split huggingface dataset:
Latinas' Agency and Their Construction of Birthing Knowledge: Implications for Patient Centered Care [1N]
Authors: Masghati Salome , Hayes-Bautista Teodocia Maria , Wohlmuth Cinna 
Published: May 2017

INTRODUCTION:
To provide Patient-Centered Care to Latina women during labor and delivery, a physician must be aware of how she socially constructs the process of birth with reference to her stock of knowledge and sense of agency. Lay constructs of labor and birth provide a foundation for understanding ethnic motherhood in the 21st century. This study observes the properties and dimensions of the categories we term Latina ethnophysiology and ethnic agency related to pregnancy, labor and birth.

METHODS:
This is a qualitative study design. Data were from a subset of focus groups of 42 Latina women (both Spanish and English dominant) who had chosen to give birth at a community-based teaching hospital located in East Los Angeles. Data were analyzed using constructivist grounded theory.

RESULTS:
Latina women constructed mental models of the birthing process along with their ethnic identity and agency, with constructs often unknown to medical professionals. While the medical staff used formal models derived from a narrow, officially sanctioned range of knowledge sources, the patients' models were developed informally, utilizing a wide variety of unsanctioned knowledge sources including information from a relative's advice to stay indoors during a full moon to birthing via YouTube, Baby-R-Us, internet blogs and Jennifer Lopez movies.

CONCLUSION:
For Latina women, knowledge of the female anatomy and physiology related to birthing is socially constructed. Understanding and integrating the social construction of knowledge in specific segments of patient populations, such as low-income Latina women, informs Patient-centered care.
Cesarean Scar Pregnancy: A Three-Year Experience at Yale-New Haven Hospital [2N]
Authors: Deshmukh Uma , Grechukhina Olga , Ozan Bahtiyar Mert , Fan Linda , Sfakianaki Anna 
Published: May 2017

INTRODUCTION:
The incidence of cesarean scar pregnancy (CSP) is rising along with the cesarean delivery rate. Data on the optimal management of the CSP are limited.

METHODS:
This is a series of all CSP cases diagnosed over the period 5/2013–8/2016 at Yale-New Haven Hospital. Data were collected retrospectively and prospectively from electronic medical records with approval from the Institutional Review Board.

RESULTS:
Sixteen cases of CSP were diagnosed in 14 patients, including 2 recurrences. Median number of prior cesarean deliveries was 3 (SD 0.98). Median gestational age at time of diagnosis was 45.5 days (6+3/7 weeks) (SD 11). Fetal cardiac activity was detected in 10 cases. Three patients had spontaneous demise of the CSP and were managed expectantly. Others opted for termination via systemic methotrexate alone (n=4); combined systemic/local methotrexate (n=5); systemic/local methotrexate with bilateral uterine artery embolization (n=1); systemic/local methotrexate with intra-sac KCl injection (n=2); and KCl injection with laparotomy and wedge resection (n=1). Three patients who underwent expectant management or methotrexate therapy had retained products of conception diagnosed 48, 61 and 82 days after initial diagnosis that required hysteroscopy and curettage. One patient opted for hysterectomy after curettage for definitive management. Three patients spontaneously conceived after resolution of CSP. Two patients had recurrences that were managed with methotrexate therapy. One patient has an ongoing viable intrauterine gestation.

CONCLUSION:
This case series highlights the risk of complications associated with expectant management and methotrexate therapy, and demonstrates the potential for spontaneous conception following CSP.
Perinatal Morbidity Among Mothers of Medically Fragile Infants [3N]
Authors: Stuebe Alison , Tucker Christine , Ferrari Renee , Funk Michele Jonsson , Bryant Katherine , Verbiest Sarah 
Published: May 2017

INTRODUCTION:
Mothers of medically fragile infants (MMFI) must recover from birth while attending to an infant in the neonatal intensive care unit (NICU). We hypothesized that, compared with mothers of well babies (MWB), MMFI would have more chronic medical problems and obstetric complications, increasing their need for postpartum follow-up.

METHODS:
Retrospective cohort study of mothers delivering at North Carolina Women's Hospital between 7/1/2014 and 6/30/2015. We defined MMFI as mothers of infants with a NICU length of stay of 3 or more days and MWB as mothers of infants not admitted to NICU. Outcomes were ascertained from the UNC Perinatal Database. We used chi square tests to compare health status and perinatal complications among MMFI, mothers of infants with NICU stays less than 3 days, and MWB. P values less than .05 were considered statistically significant.

RESULTS:
Among the 3,502 women who delivered a live-born infant, 10.5% were MMFI, 4.9% had an infant with a NICU stay less than 3 days, and 84.6% were MWB. MMFI were more likely than MWB to deliver by c-section (53.3 vs 24.4%, P < .01), be transfused with packed Red Blood Cells (5.7 vs 2.2%, P < .01) or Fresh Frozen Plasma (1.4 vs 0.37%, P=.04), and have chronic hypertension (16.0 vs 5.1%, P < .001), severe preeclampsia (24.7 vs 2.6%, P < .01) or HELLP syndrome (4.4 vs 0.3%, P < .01).

CONCLUSION:
MMFI have a greater burden of chronic disease and perinatal morbidity than MWB. Targeted approaches are needed to support the wellbeing of MMFI.
Perinatal Outcomes in Pregnancies With a Low Fetal Fraction on Non Invasive Prenatal Testing [4N]
Authors: Ali Marwan , Pryor Katherine , Chasen Stephen 
Published: May 2017

INTRODUCTION:
Placental-origin cell-free maternal DNA is known as the fetal fraction (FF). Low FF is a risk factor for aneuploidy, and may be a risk factor for poor perinatal outcome. Our objective was to evaluate the relation between low FF, and perinatal outcome.

METHODS:
This is a retrospective review of singleton pregnancies who had NIPT. We compared the maternal BMI, gestational age of delivery (GA), birth weight (BW), and composite perinatal morbidity (CPM) between patients with a FF < 4% on NIPT (LFF), and those with a normal FF on their NIPT (NFF). The CPM was defined as the presence of any of the following complications: spontaneous abortion, hypertensive disorders of pregnancy, abruption, IUFD, preterm birth, low BW, NICU admission, or neonatal death.

RESULTS:
256 patients were included. 28 (10.9%) had LFF, while 228 (89.1%) had NFF. Median age was 35-years, and median GA was 39 weeks. The rate of CPM in the entire cohort was 26.5%. Median BMI was significantly higher in the LFF group (27.4 vs. 22.1 kg/m2; p< .001). There were no significant differences in CPM, gestational age at delivery or BW. Among the 28 patients in the LFF group, median FF in cases with CPM was significantly lower than in cases without CPM (2.0% vs. 3.2%; p=.04).

CONCLUSION:
There were no significant differences in obstetric outcomes between the two groups. Within the LFF group, lower FFs were associated with a higher rate of CPM. Larger studies are necessary to evaluate the association between uncommon outcomes and FF.
Postnatal Hospital Utilization Among U.S. Women With Intellectual and Developmental Disabilities [10N]
Authors: Mitra Monika , Parish Susan L. , Akobirshoev Ilhom , Moore Simas Tiffany A. 
Published: May 2017

INTRODUCTION:
Women with intellectual and developmental disabilities (IDD) are at high risk for pregnancy and delivery related complications. However, there are no population-based studies about postnatal hospital utilization among U.S. women with IDD. We sought to examine the risk of postnatal hospital utilization and emergency department (ED) visits among women with and without IDD.

METHODS:
We conducted population-based retrospective cohort study using the 2002-09 Massachusetts Pregnancy to Early Life Longitudinal data and identified women with (N=541) and without IDD (N=1,623). The primary outcome measures were postnatal hospitalization and ED visits during the one-year postnatal period.

RESULTS:
Women with IDD have significantly higher risk of hospitalization and emergency department visit than the general obstetric population during the one-year postnatal period. Namely, women with IDD have 3.4 times higher odds (OR; 95% CI, 2.61–4.40; p < 0.001) of being hospitalized and 2.3 times higher odds (OR; 95% CI, 1.82–2.87; p < 0.001) of being admitted to emergency department during the one-year postnatal period compared to the general obstetric population.

CONCLUSION:
The findings of the study add to the emerging body of research on postnatal hospitalizations among women with IDD. Development, testing and implementation of evidence-based interventions that effectively support women with IDD during their postnatal period are critical. Furthermore, there is critical need for future research to develop postnatal care guidelines for women with IDD, understand the underlying mechanisms driving the increased postnatal hospitalizations, and educate health care professionals about the postnatal needs of women with IDD.
Cesarean Sections for Abnormal Fetal Heart Tracings: Setting Appropriateness Indicators Based on Neonatal Outcome [11N]
Authors: Ahken Stephanie , Peprah Mary Kwakye , Chen Innie , Wen Shi Wu , Black Amanda 
Published: May 2017

INTRODUCTION:
Fetal distress is often suspected solely on atypical/abnormal cardiotocography which is subject to inter-individual variability. We identified C-sections performed for atypical/abnormal cardiotocography and compared neonatal outcomes to C-sections performed for labor dystocia. Indicators of C-section appropriateness were developed and applied.

METHODS:
A retrospective cohort study was conducted using data from Ontario's Perinatal database. Primary outcomes were C-section rates for fetal distress and neonatal outcomes (arterial pH, Apgars, neonatal resuscitation, NICU admission). A C-section for abnormal/atypical cardiotocography was “appropriate” if one or more of these outcomes occurred: 1-minute Apgar < 3, 5-minute Apgar < 7, arterial pH < 7.20, resuscitation required, or NICU admission.

RESULTS:
Between 2006-2014, 146,676 primary C-sections were performed; 20% were performed for atypical/abnormal cardiotocography. Compared with C-sections for labor dystocia, there were significant differences in maternal age, parity, induction of labor, and level of care (p < 0.001). Odds of newborn resuscitation (ORadj 1.48, CI 1.41-1.54) and NICU admission (ORadj 2.21, CI 2.08-2.34) were higher when indication was atypical/abnormal cardiotocography. Less than half (42.3%) of these neonates had at least one of the criteria used to determine C-section “appropriateness.” Rate of “appropriate” C-sections differed by size of center (p < 0.001), induction of labor (p=0.0027), oxytocin use (p < 0.001), level of care (p < 0.0001), and fetal surveillance method (p=0.004).

CONCLUSION:
In the absence of objective measures of intrauterine fetal well-being, C-sections may be performed for fetal distress when they are not required. Developing indicators for C-section appropriateness may guide strategies to reduce C-section rates.
Pre-Delivery Hemoglobin Is a Modifiable Prenatal Target in Reducing Postpartum Transfusion [12N]
Authors: Hamm Rebecca F. , Srinivas Sindhu K. , Bastek Jamie A. , Wang Eileen Y. 
Published: May 2017

INTRODUCTION:
Postpartum hemorrhage (PPH) is a major cause of morbidity and mortality. One modifiable factor is pre-existing anemia. Our objective was to identify a threshold admission hemoglobin (aHgb) below which the risk of postpartum transfusion would be significantly increased.

METHODS:
This is a retrospective study of all women who delivered at the Hospital of the University of Pennsylvania between October 15, 2013 and December 15, 2013. Deliveries were included if both admission and 12 hour postpartum blood count (12hCBC) were available. Medians and distributions were calculated. Chi-Square, Mann-Whitney, and logistic regression were used.

RESULTS:
592 of 626 (95%) women were analyzed. Twenty (3.4%) women were transfused. The overall group 5th percentile and median aHbg were 9.3 g/dL and 11.7 g/dL respectively. The 5th percentile (7.7 vs. 9.5 g/dL, p < 0.001) and median aHgb (9.7 vs. 11.7 g/dL, p < 0.001) were both significantly lower among those who were vs. were not transfused. Admission Hgb cut points are associated with different test characteristics in predicting transfusion. Progressively lower aHgb led to incrementally improved specificity with only minimally decreased NPV.

CONCLUSION:
Our data suggests that, despite poor sensitivity, an aHgb of 9.5 was associated with a 98% NPV and a < 5% false positive rate, making it an excellent antenatal tool to screen women at risk for receiving postpartum transfusion. Achieving this aHgb may serve as an antepartum target in anemic patients to potentially decrease transfusion risk and improve maternal outcomes.
Predicting Perinatal Outcomes With an Obstructive Sleep Apnea Screening Tool [13N]
Authors: Bracero Luis A. , Chaffin Samantha , Calhoun Byron , Seybold Dara , Power Peter , Bush Stephen 
Published: May 2017

INTRODUCTION:
The objective was to determine if a screening tool for obstructive sleep apnea (OSA) can be used to predict adverse perinatal outcomes.

METHODS:
Prospective observational study of patients receiving prenatal care (June 1 2013-May 31 2014) at a tertiary care center clinic. Patients were universally screened for OSA with the STOP questionnaire, a concise tool with four questions related to snoring, tiredness during daytime, observed apnea, and high blood pressure. It has been validated in surgery patients. Positive and negative screens and several confounding variables were included in a backwards logistic regression model to predict the following adverse perinatal outcomes: cesarean delivery, preeclampsia, preterm delivery (PTD) (<37 weeks), low birth weight (LBW) (<2500 g), Intra Uterine Growth Restriction, and Neonatal Intensive Care Unit (NICU) admission.

RESULTS:
Of the 680 patients who received prenatal care, 442 (65%) had singleton births and were included in analysis. Patient body mass indexes ranged from 12.8-61.4 with mean of 29.7. This study population had high tobacco (241; 54.5%) and illicit drug use (155; 35.1%). Positive STOP screens (64;14.5%) were associated with two outcomes: PTD and NICU admission. For PTD, history of pre-term labor was the strongest predictor, followed by STOP and nulliparity with odds ratios (OR) of 4.2 (95% CI 2.0-8.8; p < 0.001), 2.8 (95% CI 1.4-5.8; p=0.004), and 2.3 (95% CI 1.2-4.4; p=0.013). For NICU admission, a positive STOP was the only significant predictor with 2.5 OR (95% CI 1.1-5.7; p=0.036).

CONCLUSION:
The STOP screening questionnaire may be useful in predicting PTD and NICU admission.
Preferences of Pregnant Women and Family Members for Health States Arising From Anticoagulant Use in Pregnancy [17N]
Authors: D'Souza Rohan , Tomlinson George , McKelvey Kyra , Krahn Murray , Murphy Kellie , Sander Beate 
Published: May 2017

INTRODUCTION:
The aim of this study was to elicit preferences of pregnant women and their family member(s) involved in decision-making, for combined maternal and fetal health-states arising from the use of anticoagulants in pregnancy.

METHODS:
We conducted a cross-sectional study on pregnant women taking medications for chronic medical disorders and their family member(s). Participants–interviewed separately and together–were presented with seven vignettes representing combined maternal and fetal health-states related to anticoagulant use in pregnancy. They were asked to assign values on a visual analogue scale, by the standard gamble and time trade-off methods. Utility values (preferences) were presented on a scale of 0-100.

RESULTS:
Fifty-six pregnant women, 43 family members and 40 pairs completed the interviews. The median age was 32.9 years for pregnant women and 37.1 years for family members, and the median gestational age was 28.9 weeks. Regardless of the method used, values obtained from pregnant women were lower than those obtained from family members and combined interviews. There was a wide variation in utility values obtained from the three interviews and using the three methods. Values obtained from the combined interviews had the smallest confidence limits around point estimates.

CONCLUSION:
This is the first study to determine preferences from pregnant women and family members for combined maternal-fetal health-states. For studies involving pregnancy, utility values that represent the values of both individuals involved in decision-making should probably be used in decision-analysis studies. These findings need prospective validation in different patient populations and different clinical conditions.
Prospective Validation of Formulae for the Estimation of Intrapartum Blood Loss [21N]
Authors: Eckler Rebecca , Rosen Adam , Dunlop Kristyn , Komorowski Adam , Murphy Kellie , D'Souza Rohan 
Published: May 2017

INTRODUCTION:
Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality. Improving the accuracy of blood loss estimation is vital to the clinical management of postpartum women. In this study we prospectively validated formulae previously derived to estimate blood loss, that were identified through a systematic review.

METHODS:
Pregnant women over 18 years of age delivering after 24 weeks gestational age were included. Participants had blood loss measured by reference standards that included gravimetric and direct measurement methods and by calculated estimation involving the use of formulae. The test characteristics of each formula (sensitivity, specificity and positive and negative predictive values) were determined against the reference standard.

RESULTS:
These results represent an interim analysis of our data. a total of 172 subjects were recruited, 39 of which delivered vaginally and 133 by caesarean section. after excluding cases with missing data, a total of 138 cases were analyzed. Of the four formulae identified to measure blood loss, two yielded meaningful results. A formula measuring percentage drop in hematocrit had a sensitivity of 73.1% and specificity of 31.4% for identifying PPH and another utilizing maternal height, body weight, and pre-and post-delivery hematocrit had a sensitivity of 44.0% and specificity of 77.9%.

CONCLUSION:
The study's interim analysis demonstrates that the use of formulae incorporating routinely determined variables such as pre- and post-delivery hematocrit, and/or body weight and height may be able to accurately and objectively identify cases of PPH and therefore have application in clinical and research settings.
The Effect of Timing of Removal of Wound Dressing on Surgical Site Infection Rate After Cesarean Delivery [23N]
Authors: Nesrallah Mona , Cole Peter , Kiley Kevin 
Published: May 2017

INTRODUCTION:
The objective was to compare the risk of surgical site infection rate with surgical dressing removal between 12-30 hours post-operatively compared with 30-48 hours postoperatively.

METHODS:
Patients with viable pregnancies at 23 0/7 weeks of gestation or greater undergoing scheduled and unscheduled cesarean delivery were randomized to removal of surgical dressing between 12-30 hours post-operatively or removal of surgical dressing between 30-48 hours post-operatively. Standardized wound evaluations were performed at discharge (days 2-4) and at 6 weeks post-operatively. the primary outcome was surgical site disruption or infection.

RESULTS:
Of 602 patients, 300 were randomized to surgical dressing removal between 12-30 hours post-operatively and 302 were randomized to surgical dressing removal between 30-48 hours post-operatively. baseline characteristics including age, body mass index, parity, and prior cesarean delivery were similar by group. All skin incisions were transverse for patients in both groups. the primary outcome incidence at 6 weeks post-operatively was 7% for dressing removal between 12-30 hours and 9.6% for dressing removal between 30-48 hours (p=0.25, odds ratio 1.41, 95% confidence interval [CI] 0.79-2.54).

CONCLUSION:
Surgical dressing removal within 12-30 hours compared with dressing removal within 30-48 hours was not associated with significantly increased composite wound morbidity after cesarean delivery. The presence of asthma and gestational diabetes increased the surgical site infection rate independent of other variables.
Preferred Patient Language and Obstetrical Outcomes [25N]
Authors: Robles Raquel , Takhsh Eden 
Published: May 2017

INTRODUCTION:
Obstetrical outcomes as quality of care indicators are coming under increased scrutiny from various stakeholders. patients, regulatory and quality reporting institutions as well as third party payers are demanding reporting and improvements against national and local benchmarks. Three of the most important outcome measures in obstetrics are: cesarean section, episiotomy and operative vaginal delivery rates. Observations in one community teaching hospital unit raised the question of whether patients' preferred language had an adverse impact on these outcomes.

METHODS:
Data was retrospectively collected from July 2015 ‒ December 2015 that included patient preferred language, rates of cesarean section, episiotomy and operative vaginal delivery rates.

RESULTS:
Patients were separated into two groups: English speaking and non-English speaking. Data revealed that non-English speaking patients had a higher rate of cesarean section, episiotomy and operative vaginal delivery. Non-English patients had a 46% rate of cesarean section compared to 36% in English speaking patients, 12% rate of operative vaginal delivery compared to 5%, and a 9% rate of episiotomy compared to 6% of English speaking patients.

CONCLUSION:
These data show that non-English speaking patients have higher rates of cesarean section, operative vaginal delivery and episiotomy when compared to English speaking patients. While causation may not deduced purely from these data, it necessitates further investigation into quality of patient care regarding effective communication in non-English speaking patients.
Pulmonary Function and Body Composition in Pregnant Women: A Transversal Study [26N]
Authors: Amorim Melania , Brandao Andrea Carla , de Sales Tavares Jousilene , Sandro Rolland de Souza Alex 
Published: May 2017

INTRODUCTION:
This study was conducted to compare the pulmonary function and the body composition between trimesters of pregnancy and, to determine the variables correlated to the peak expiratory flow (PEF) and the expiratory flow between 25% and 75% of vital capacity (FEF25%75%).

METHODS:
A cross-sectional study examined 120 healthy low-risk pregnant women in the three trimesters of pregnancy, measured by spirometry and multisegmental electrical impedance. Women between the fifth and 40th gestational week, ages between 18-35 years, singletons, and sedentary were included. Smokers, individuals with cardio-respiratory diseases, neurological and chest deformities were excluded.

RESULTS:
The vital capacity, the expiratory volume in one second, the peak expiratory flow and expiratory flow between 25% and 75% of vital capacity decreased with the progression of pregnancy, the multiple linear regression analysis showed that height and maternal age were associated with PEF, being responsible for explaining 14.7% of its variability. The prepregnancy weight explained 6.5% of the variability of the FEF25%75%. The multiple linear regression analysis showed that height and maternal age were associated with PEF, explaining 14.7% of its variability.

CONCLUSION:
This study showed that the volumes and lung capacity in healthy pregnant women do not seem to change with the progress of pregnancy. The pre-pregnancy weight was related to the FEF25%75%. Height and maternal age had greater influence on PEF changes, while the body composition and obstetric variables did not influence it.