bluuebunny/crossref_metadata_2025_split huggingface dataset:
Provider Attitudes, Experiences, and Practices on Childbirth Education and Birth Plans [39M]
Authors: Afshar Yalda , Fahey Jacqueline , Mei Jenny , Saeb Samia , Gregory Kimberly D. 
Published: May 2017

INTRODUCTION:
Attendance at childbirth education classes (CBE) has declined, while the rate of birth plans has increased. We sought to describe the perception and practices of obstetric providers on CBE and birth plans.

METHODS:
A national online-survey was distributed through professional societies and social-media. We collected provider and patient demographics, practice-settings, and perceptions. Responses were on a Likert scale from 1 (not important) to 5 (very important).

RESULTS:
Of 567 eligible surveys, 75.7% were physicians. This cohort believed prenatal care (mean ± SD, 4.4±0.9) and CBE (3.6±1.0) are predictors of patient satisfaction. Most providers routinely recommend (69.7%) and have favorable views on CBE (84%). They had neutral views on doulas (2.9±1.2). With increasing age, providers were more likely to recommend CBEs (0.159, p=0) and birth plans (0.174, p=0). Increasing provider age correlated with believing that prenatal care (0.111, p=0.01), CBE (0.190, p=0) and birth plans (0.108, p=0.012) were predictors of satisfaction and favorable obstetrical outcomes (0.149, p=0.001). Only 26% of providers had favorable views on birth plans and most providers (66.5%) did not recommend birth plans and 31% felt they were predictors of poor obstetrical outcomes. Increasing practice-years correlated with favorable views on CBEs (0.167, p=0) and birth plans (0.205, p=0). Providers with higher obstetrical clinical volume more likely recommend birth plans (0.118, p=0.009).

CONCLUSION:
Providers view CBE as an important predictor of patient satisfaction while they have unfavorable view of birth plans. Further research is needed to understand how to improve childbirth related patient satisfaction and birth experience.
Peripartum Blood Transfusions in a High Risk Maternity Center [5N]
Authors: Patel Krunal , Martimucci Kristina , Guirguis George , Apuzzio Joseph , Gittens Lisa , Williams Shauna 
Published: May 2017

INTRODUCTION:
Peripartum blood transfusions may be urgent and unpredictable. The purpose of this study is to review risk factors associated with transfusion in obstetric patients.

METHODS:
A retrospective study was performed of gravidas at gestational age 23 weeks or more, from 1/1/2012 to 12/31/2015 who delivered at a tertiary care hospital and received blood transfusion. Demographic and obstetric data, indication for transfusion and estimated blood loss (EBL) were reviewed. Student's t-test and Mann-Whitney tests were used.

RESULTS:
177 (2.74%) of 6542 obstetric patients received blood transfusion during this time period. 118 (66.7%) delivered by CD, and 6 (3.4%) had an operative vaginal delivery. Of those who had a CD, 60 (51%) were primary, 28 (24%) had one prior CD and 30 (25%) had 2 or more prior CD. 53 (88.3%) of primary CD and 26 (45%) of repeat CD patients were in labor. Indications for transfusion were acute blood loss in 58 (32.7%), predelivery anemia in 11 (6.2%), and postdelivery symptomatic anemia in 108 (61%). 57% had an admission hemoglobin of less than 10.5 g/dl, of these 44 (43%) received iron prenatally. When comparing patients who were symptomatic postpartum to the rest of the group, preadmission hemoglobin was higher (10.3+1.6 vs 9.7+1.7, p=0.04), nadir was lower (6.7+0.7 vs 7.3+1.5, p=0.0004), and discharge hemoglobin was the same (8.5+0.98 and 8.5+1.4, p=0.8).

CONCLUSION:
There is a high rate of patients who presented with anemia in this cohort. Aggressive treatment of their anemia may decrease the rate of transfusion and associated maternal morbidities. Early recognition and treatment of postdelivery symptomatic anemia may decrease morbidities in this group of patients.
Point-of-Care vs Laboratory Based Urine Protein-Creatinine Ratio as an Indicator of Proteinuria in Pregnancy [9N]
Authors: Sinno Omar , Rood Kara M. , Jones Megan , Thung Stephen , Samuels Philip , Buhimschi Irina A. 
Published: May 2017

INTRODUCTION:
Proteinuria is a hallmark finding in preeclampsia and a value of 300 mg or more in a 24 hour urine collection aids the diagnosis. A random urine protein-creatinine ratio (UPCR) of at least 0.3 mg/dL has emerged as a surrogate indicator of proteinuria. Point-of-care (POC) UPCR tests have been developed and may provide a convenient and timely extrapolation of proteinuria at the bedside. Although such testing has demonstrated excellent correlation with central laboratory methods in studies of non-pregnant patients, its validity and clinical utility have yet to be established in the pregnant population. Our objective was to evaluate POC UPCR as an indicator of proteinuria in pregnancy and compare it to the central laboratory method.

METHODS:
108 urine samples from pregnant women presenting to triage for preeclampsia evaluation were collected prospectively from January to June 2015. For clinical purposes, a urine specimen was collected and sent to the laboratory for standard measurement of protein, creatinine and PC ratio using a Beckman Coulter Au5800, measuring turbidimetry by immunocomplexation with an anti-albumin antibody. A sample of the collected urine was tested via POC UPCR using Multistix Pro 11 reagent strips. Utilizing the manufacture interpretation guide, a “normal” strip ratio was defined as urine containing less than 300 mg protein/g creatinine.

RESULTS:
There was moderate agreement between POC UPCR and laboratory UPCR (k=0.512). After triage evaluation was complete, 31 women had a clinical diagnosis of preeclampsia.

CONCLUSION:
Results indicate that the POC UPCR is not reliable for the diagnosis of proteinuria when compared to the central laboratory UPCR.
Patterns of Oxytocin Use in Those Undergoing Trial of Labor After Cesarean (TOLAC) [19N]
Authors: Abraham Cynthia , Adeyekun Moyosore , Demissie Seleshi 
Published: May 2017

INTRODUCTION:
Oxytocin use in the management of TOLAC is controversial. Data assessing the relationship between oxytocin use and adverse outcomes is scant.

METHODS:
Chart review of 159 patients with one prior cesarean undergoing TOLAC divided into those who were: (1) induced with oxytocin (IND, n=44), (2) augmented with oxytocin (AUG, n=37) and (3) managed expectantly after presenting in labor (SPON, n=78). Following obtained: maternal baseline characteristics, amount administered and duration of oxytocin use if used, incidence of adverse outcomes. Chi-square and ANOVA were used for statistical analysis.

RESULTS:
Baseline characteristics between groups were similar. Two cases of uterine ruptures and one of hemorrhage occurred in the IND group. All three cases had an initial Bishop score less than 5. Average total amount of oxytocin administered and duration of oxytocin use in this subgroup were 4412 milliunits and 12.7 hours. Five patients underwent cervical ripening balloon placement followed by oxytocin for induction. In this subgroup, none experienced adverse outcomes and three of the five had a successful TOLAC. Average total amount of oxytocin administered and duration of oxytocin use were 1988 milliunits and 7.3 hours. One case of uterine dehiscence necessitating surgical intervention occurred in the SPON group. There were no complications in the AUG group. No significant differences were noted among the groups regarding other outcomes including cesarean delivery rate.

CONCLUSION:
Induction of labor in the presence of an unfavorable cervix and prior cesarean is associated with adverse outcomes. Cervical ripening balloon has a role in achieving a successful TOLAC.
Preferences of Pregnant Women With Cardiac Disease for Maternal-Fetal Outcomes Related to Their Pregnancies [20N]
Authors: D'Souza Rohan , Thomas Hannah , Wuebbolt Danielle , Nguyen Vanessa , Murphy Kellie , Silversides Candice 
Published: May 2017

INTRODUCTION:
The trade-offs pregnant women with cardiac disease are willing to make in order to optimize pregnancy outcomes is undetermined. This study aimed to elicit preferences of these women for maternal and fetal outcomes related to cardiac disease in pregnancy.

METHODS:
A cross-sectional study was conducted on pregnant women with cardiac disease. participants were then presented with 19 vignettes describing combined maternal and fetal outcomes related to cardiac disease. Maternal outcomes included cardiac events (arrhythmias and cardiac failure), blood clots, a combination of the two and no cardiac events; while fetal outcomes included perfect health, minor or major malformations, small-for-gestational-age (SGA) infants and fetal demise. Participants were asked to assign values to these outcomes on a visual analogue scale (VAS), by the standard gamble (SG) and time trade-off (TTO) methods. Utility values (preferences) for each state obtained from all three methods were presented on a scale of 0-100.

RESULTS:
34 pregnant women with cardiac disease completed the interviews. The median age was 31.5 [29-34] years and the median gestational age was 24 [19-35] weeks. Participants did not perceive combinations of maternal cardiac events as more severe than a solitary event. Also, they regarded SGA as more severe outcome than minor congenital malformations, but valued major malformations as bad as fetal demise.

CONCLUSION:
This study is the first to obtain preferences of pregnant women with cardiac disease for combined maternal and fetal outcomes related to their condition. These preferences should be incorporated in clinical decision-making.
Prenatal Use of Aspirin and Acetaminophen [22N]
Authors: Wing Adam Bruce , Cisneros Rebecca , Lilo Sara , Henderson Cassandra 
Published: May 2017

INTRODUCTION:
Acetaminophen is widely used in pregnancy for pain management. Recently published data indicates that in-utero acetaminophen exposure may be associated with greater odds that the resulting child will develop ADHD. Aspirin may be a suitable alternative to pain management in the first and second trimesters.

METHODS:
A systematic review of English language publications using the search terms, “salicylates, pregnancy,” “congenital defects, aspirin,” acetaminophen and ADHD” was conducted to describe perinatal outcome of in utero acetaminophen and aspirin exposure studies showing only third trimester adverse effects were excluded.

RESULTS:
The search found the following publications. 1 case report, 1 meta-analysis, 2 systematic reviews, 1 case control, 1 randomized controlled trial, 4 retrospective cohort and 2 prospective cohort studies. Aspirin use during the first trimester was associated with increased risk of miscarriage and gastroschisis. There appears to be a comparable risk of cryptorchidism with both aspirin and acetaminophen use in the second trimester. The increased risk of miscarriage was significant only when the analgesic agent was taken at the time of conception. However, the increased risk of gastroschisis was heterogeneous, in the absence of controls for numerous confounders, may not be clinically significant.

CONCLUSION:
Prior to use of pain relievers during pregnancy, a thorough discussion of the known and potential risks versus the benefits of available analgesic agents should be followed by shared decision making when considering analgesic options. This has ethical and public health implications, given the reports that have associated in-utero acetaminophen exposure with an increased risk of ADHD.
Impact of Anemia on Preterm Labor in Hypothyroid Patients: A Retrospective Study [31N]
Authors: Araji Sarah , Khoury Aldo , Elkafrawi Deena , Miller Jacob , Ching Michael 
Published: May 2017

INTRODUCTION:
Studies have demonstrated that hypothyroidism in pregnancy is associated with an increased risk of preterm delivery. Current literature fails to demonstrate whether the underlying cause is thyroid dysfunction or anemia of thyroid disease. A negative association between anemia and duration of gestation was reported in the majority of studies; however, the exact mechanism of action is not determined. In this retrospective study, we evaluate anemia as a risk factor for preterm labor in pregnant patients with hypothyroidism.

METHODS:
A retrospective chart review of patients delivered before 37 weeks and received prenatal care at our outpatient clinic between January 2013-August 2015 was conducted. TSH, T4, and H/H levels during the course of pregnancy and before delivery was evaluated. We indicated if patients received levothyroxine or iron supplements.

RESULTS:
Our sample size was 373 pregnant women who delivered before 37 weeks--202 of 373 were neither anemic nor hypothyroid (54.2%), 124 of 373 were anemic only (33.2%), 25 of 373 were hypothyroid and anemic (6.70%), and 23 of 373 were hypothyroid only (6.17%). Anemia had no impact on gestational age when stratified by hypothyroidism. Increasing T4 increased risk of preterm delivery starting from 35.6 weeks of gestation (P=0.00; 95% CI, -1.40 to -0.57) regardless of anemic status.

CONCLUSION:
Anemia does not play a significant role in causing preterm delivery in hypothyroid pregnant patients. T4 was directly proportional to preterm delivery in anemic and non-anemic patients. Age was inversely proportional to preterm delivery in anemic and non-anemic patients alike.
Clinical Relevance of Screening for Rare Autosomal Aneuploidies: A Case of Maternal Uniparental Disomy [33N]
Authors: Helgeson Jennifer , Sullenberger Rebecca , Macedonia Christian , Rafalko Jill , Boomer Theresa , Beruti Sue 
Published: May 2017

INTRODUCTION:
Traditionally, fetal aneuploidy screening has focused on autosomal trisomies of chromosomes 21, 18, and 13. Subsequently, cell-free DNA (cfDNA) screening has expanded to include sex chromosome aneuploidies, select microdeletions, and recently genome-wide analysis. Though uncommon after the first trimester, aneuploidy of any autosome can occur in placental and fetal tissues. Some autosomal aneuploidies present at conception are rescued and restored to a euploid state. When this occurs with imprinted chromosomes, it can lead to a euploid fetus with a genetic syndrome due to uniparental disomy (UPD).

METHODS:
Maternal blood samples submitted to Sequenom® Laboratories for MaterniT® GENOME testing were subjected to DNA extraction, library preparation, and whole genome massively parallel sequencing. Data were analyzed using a novel algorithm to detect trisomies and other subchromosomal events.

RESULTS:
A 42 year old patient elected genome-wide cfDNA screening after genetic counseling. Screening was positive, indicating an increased representation of chromosome 15, consistent with mosaic trisomy 15. The patient elected amniocentesis which returned a normal fetal karyotype, 46,XX. Subsequent testing of amniocytes detected maternal UPD of chromosome 15. Maternal UPD15 is a cause of Prader-Willi syndrome.

CONCLUSION:
This case illustrates the clinical relevance of screening for esoteric trisomies with cfDNA. Though the fetus did not have trisomy 15, the cfDNA test detected a trisomy in the placenta, evidently rescued in fetal tissue, which led to maternal UPD of chromosome 15 and a fetal diagnosis of Prader-Willi syndrome. Diagnosing Prader-Willi syndrome prenatally allows patients to make reproductive decisions, including pregnancy termination, adoption, and preparing for a child with disabilities.
Apgar Score and Umbilical Cord Gas as Quality Markers for Identification of Unindicated Cesareans [35N]
Authors: Metz Torri , Hermesch Amy , Allshouse Amanda , Alston Meredith , Babcock Gilbert Sara Ann , Saade George 
Published: May 2017

INTRODUCTION:
To evaluate if either a 1-minute Apgar 7 or greater, or umbilical artery (UA) pH 7.2 or greater can be used as a quality measure to identify unindicated cesarean deliveries (CD) for non-reassuring fetal heart rate (NRFHR).

METHODS:
Retrospective cohort of nulliparas with no contraindication to vaginal delivery. Individual physician CD rates were calculated. Two quality measures were investigated as indicative of normal neonatal status: (1) 1-minute Apgar 7 or greater, (2) UA pH 7.2 or greater. Pearson's correlation was calculated between individual physician CD rates and proportion of CDs performed with a primary indication of NRFHR but normal neonatal status. A random sample of 60 FHR tracings from women who had a CD for NRFHR were reviewed by 3 obstetricians blinded to Apgars and gases to determine if CD was indicated.

RESULTS:
2,224 women were included. Of 537 CDs, 181 (34%) had a primary indication of NRFHR. Individual physician CD rates and rates of CD for NRFHR with normal neonatal status were moderately correlated (Apgar rho=0.53,95%CI 0.12-0.79, UA pH rho=0.53,95%CI 0.11-0.79). CDs were identified by peer review to be unindicated in 65% of cases with a UA pH of 7.2 or greater, compared to only 28% of cases with a pH less than 7.2 (p=0.04). A high proportion of CDs with 1-minute Apgar 7 or greater were also unindicated (70% vs 57%, p=0.42).

CONCLUSION:
Performance of a CD for NRFHR with UA pH 7.2 or greater may help identify physicians with higher CD rates and cases that may benefit from peer review.
Clinical Characteristics & Patient Preferences Among Women Planning Out-of-Hospital Births (OOHB) [36N]
Authors: Afshar Yalda , McCulloch Jeanette , Korst Lisa M. , Fridman Moshe , Saeb Samia , Gregory Kimberly D. 
Published: May 2017

INTRODUCTION:
We describe socio-demographics, clinical characteristics and patient preferences among women who plan OOHB.

METHODS:
We performed a systematic literature review for patient-reported outcomes in childbirth and collaborated with community partners to hold focus groups to determine birth preferences. Nielsen recruited nationally and administered a survey to pregnant women. A multiple logistic model was fitted to examine characteristics associated with planned delivery location. Odds ratios (OR) and 95% confidence intervals are reported.

RESULTS:
We surveyed 2,757 women; 2,056 planned a vaginal delivery, and 79 (3.8%) planned OOHB. No differences were found in age, race, or gestational age. Women who planned OOHB were more likely to want to avoid interventions (OR 4.7, 2.47-9.05). They were more likely to have multiple gestation (OR 4.27, 1.93-9.47) and to want a choice of laboring positions (OR 3.40, 1.47-7.88). Women who planned OOHB favored use of a shower/tub (OR 6.39, 2.98-13.72) and birthing ball/stool (OR 10.94, 2.19-54.55). Women who planned in-hospital births were more likely to identify their pregnancy as high-risk (OR 1.99, 1.00-3.96), to have previously labored (OR 1.94, 1.07-3.51), to want comfort/reassurance from providers (OR 5.66, 1.70-18.85), and were more likely to describe their mental health as poor/fair (OR 7.72, 1.20-53.28).

CONCLUSION:
Women planning OOHB reported having lower clinical risk, better mental health, and specified distinct birthing preferences relative to women planning hospital birth. Given the increasing rate of planned OOHB, an understanding of the preferences of women who choose this experience is essential to identifying patient-specific strategies for improving inpatient satisfaction and outpatient safety.
Characteristics Associated with Attempted External Cephalic Version– A Descriptive Cohort Study [39N]
Authors: Limaye Meghana , Abdullahi Najma , Has Phinnara , Froehlich Rosemary , Werner Erika 
Published: May 2017

INTRODUCTION:
External cephalic version (ECV) can decrease the rate of cesarean delivery (CD) but is underutilized. We sought to assess the characteristics of women who undergo ECV compared to those who do not.

METHODS:
This was a retrospective cohort study of women with singleton gestations and non-cephalic presentations at term. Women with contraindications to vaginal delivery (VD) were excluded. Women who had attempted ECVs were compared to women who did not. Factors associated with successful ECV were also examined. The study was powered to detect a 20% difference in ECV rate among women with history of VD compared to those without. Fisher's exact test compared categorical variables and Wilcoxon rank-sum test compared continuous variables.

RESULTS:
212 women were included in the study, 52 (24.5%) underwent ECV. Women who had ECV compared to those who did not were more likely to have had prior VDs (67 v 36%, p < 0.001), be multiparous (67 v 49%, p=0.03), have posterior placentas (46 v 24%, p=0.03), and be seen in academic practices (17 v 6%, p=0.02). Among women who had ECV, the success rate was 56%, and 44% went on to have VDs compared to 7% of women who did not have ECV (p < 0.001). There was no difference between successful and unsuccessful ECV with regard to use of terbutaline, IV pain medication, or neuraxial anesthesia.

CONCLUSION:
Nulliparous women and women without a history of VD are less likely to undergo ECV. Education and quality initiatives should specifically encourage discussion of ECV in these groups.
Transgender Health Care: Multi-Disciplinary Team Approach Prior to Female to Male Confirmation Surgery [3O]
Authors: Bachmann Gloria , Baras Jackie , Berner Nicole , Marshall Ian , Salwitz James , Moffa Salvatore 
Published: May 2017

INTRODUCTION:
Healthcare providers and medical centers are often challenged in comprehensively caring for the transgender population in a safe environment. In response to the Affordable Care Act supporting increased access to healthcare, it is important that the appropriate templates are put into place by all medical centers to ensure this community is provided with optimal clinical care and customer service.

METHODS:
An FTM individual was to be admitted to Robert Wood Johnson University Hospital for confirmation surgery (hysterectomy). To ensure the patient's clinical and customer service needs would be met during the hospitalization, it was decided that representatives from all possible points of interaction would meet to formulate a template of care before patient admission. This group included representation from Obstetrics/Gynecology, Urology, Endocrinology, Psychiatry, Anesthesiology, Nursing staff, Security, Registration, Pre-Admission Testing, Perioperative Services, Bio-Ethics, Patient Relations, Food & Nutrition services, and Housekeeping.

RESULTS:
This multi-disciplinary team approach allowed the medical team to prepare a customized care plan, which will now be used for transgender individuals admitted for confirmation surgery. It also was a venue during which the entire team could weigh in on how best to address issues such as continuation of current hormonal therapy (pre and post-operatively) and emotional and social support post-procedure.

CONCLUSION:
The gathering of a multi-disciplinary team assisted in the development of a template of care for transgender services that supports the delivery of quality patient care and exemplary customer service. This multi-disciplinary meeting prior to hospitalization is strongly recommended for all medical centers.