bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Clinical Characteristics and Prognosis of Cerebral Venous Thrombosis During Pregnancy and Puerperium in China [32Q]
Authors: Liang Zhuwei , Gao Wanli 
Published: May 2017

INTRODUCTION:
Cerebral venous sinus thrombosis (CVT) has a relatively low incidence among young women, although both pregnancy and delivery can substantially increase the risk. Due to the specific physiology of pregnancy and puerperium, CVT may manifest different characteristics. This study aimed to identify the clinical manifestations and prognosis of CVT during pregnancy and puerperium.

METHODS:
A total of 43 pregnancy-associated CVT patients were identified and enrolled in the present study. We analyzed the relevant risk factors and clinical presentations of the disease.

RESULTS:
Our descriptive results showed that 1) the incidence of pregnancy-associated CVT was 202 per 100,000 deliveries, and the mortality rate was 11.63%; 2) the most frequent symptom of pregnancy-associated CVT was headache (zs > 3.97, ps < .0001); 3); and 4) the superior sagittal sinus and transverse sinus were the most frequent locations for CVT during pregnancy and puerperium (zs > 2.58, ps < .01). Moreover, the results of univariate regression analyses indicated that an increased modified Rankin Scale score was positively associated with infection, seizure, intracerebral hemorrhage (ICH) and hypertensive disorder complicating pregnancy (ps = .000, .010, 000, .010). Comparably, the results of a chi-square test demonstrated that the occurrence of death was positively and significantly associated with infection, seizure and ICH (ps = .000, .034, 020).

CONCLUSION:
Amongst patients with CVT during pregnancy and puerperium, infection, seizure, ICH and hypertensive disorder complicating pregnancy were independently associated with a worse prognosis. Patients with infection, seizure and ICH who exhibit pregnancy-associated CVT have a greater risk of death.
Advanced Maternal Age and Incidence of Non-Chromosomal Congenital Anomalies: A Population-based Study [35Q]
Authors: Grossi Matt , Crawford Susan , Chandra Sue 
Published: May 2017

INTRODUCTION:
Advanced maternal age (AMA), is associated with an increased risk of aneuploidy, adverse pregnancy outcomes, and infertility. Our study's objective is to assess whether AMA increases the risk of non-chromosomal congenital anomalies.

METHODS:
A retrospective cohort study was conducted using a linked dataset from Alberta Perinatal Health Program and the Alberta Congenital Anomalies Surveillance System databases. All singleton births and pregnancy terminations greater than 20 weeks gestational age from 2005 to 2013 were included. Pregnancies with aneuploidy were excluded. Maternal age was categorized as less than 35 years and 35 years and greater. Descriptive statistics of maternal demographic characteristics were generated. Multinomial logistic regression models controlled for parity, use of assisted reproductive technology, smoking, and socioeconomic status.

RESULTS:
There is a significant association between AMA and congenital anomalies in the kidney (P=.004), and reproductive tract (P=.021). The rate of anomalies in the kidney was 2.6 per 1,000 births for women under 20 and rose to 3.0 per 1,000 births for women 35 and older. The rate of anomalies in the reproductive tract was 3.5 per 1,000 births in women under 20, and rose to 4.6 per 1,000 births in women 35 and up. Analysis of the type of anomaly revealed a significant association between AMA and congenital obstructive defects of the renal pelvis (P=.025), other malformations of the kidney (P < .001), undescended testicle (P=.032), congenital deformities of the hip (P < .001) and congenital deformities of the feet (P=.001).

CONCLUSION:
Advanced Maternal Age appears to be associated with an increased incidence of specific non-chromosomal congenital anomalies, particularly of the renal and genitourinary systems.
An Unusual Case of Venous Lymphatic Malformation and Hypoplastic Left Heart Diagnosed on Virtual Autopsy [38Q]
Authors: Jackson Jessica , Cheliiah Anushka , Patrick Kathryn , Duff Patrick 
Published: May 2017

INTRODUCTION:
Venous lymphatic malformations are slow-flow vascular malformations that are generally benign in nature. However, they can be associated with aneuploidy and functional impairment of nearby organs and structures. Here, we report an unusual case of lymphatic malformation in association with hypoplastic left heart.

METHODS:
Case Study.

RESULTS:
A 33 year old multiparous woman was evaluated because of an abnormal Quadscreen (1/47 risk of trisomy 21) and a large left cranio-facial mass detected on a 21 week anatomy scan. This lesion was thought to be an unresectable teratoma. The remainder of the anatomic survey was limited due to the mass effect. The patient experienced preterm labor and delivered at 25 weeks gestation. The infant was liveborn but died shortly after birth despite resuscitative efforts. The neonate had massive hydrops and disfigurement of the face, head, and neck from the mass. The family declined autopsy and genetic testing but agreed to a “virtual autopsy” in the form of a postmortem MRI. MRI identified a large veno-lymphatic malformation, occupying nearly the entire left face/neck, accompanied by hypoplastic left heart and hydrops.

CONCLUSION:
To our knowledge, there are no prior reports of the association of this severe veno-lymphatic malformation and hypoplastic left heart. We were unable to confirm the presence of aneuploidy, but we found the virtual autopsy to be of great value in establishing the correct etiology of the craniofacial mass and previously undiagnosed hypoplastic left heart.
Mapping Collaboration Across Birth Settings in the United States: Access, Equity, and Outcomes [2R]
Authors: Vedam Saraswathi , MacDorman Marian , Declercq Eugene , Fisher Timothy J. , Cheyney Melissa , Leeman Lawrence 
Published: May 2017

INTRODUCTION:
Lack of coordination of care across birth settings (home-hospital, rural-urban) has been associated with adverse maternal-fetal outcomes. The US Birth Place Mapping Study examines associations between regulation, scope of practice, interprofessional collaboration with maternal-newborn outcomes, and equitable care for at-risk populations.

METHODS:
We populated a 50-state database with published regulatory data on scope of practice across birth settings. A nationwide survey of 92 regulatory experts verified the “on the ground” relevance, importance, and realities of collaboration. Content validation led to a 49-item weighted integration scoring system (item scores range 1-4). Composite summary scores were then used to rank states on the regulatory and practice environment for midwives and physicians across home, birth centers and hospitals. Higher scores indicate more integration and collaboration across all providers and all settings. Using CDC, Area Resource and CMS data, we calculated correlation coefficients between integration scores and selected outcomes (eg. SVD, VBAC, breastfeeding, cesarean, induction, neonatal mortality, LBW) in each state, controlling for race and type of provider.

RESULTS:
Integration scores ranged from 17-59, (North Carolina lowest – 17, Washington highest – 59). We report results through 4 interactive data maps, displaying quartiles for level of integration, linked to optimal and adverse outcomes, and access to care, by state. Rates of birth by race, Medicaid coverage, and location are displayed both by region and by individual states.

CONCLUSION:
This scoring system identifies barriers to collaboration in maternity care, and can inform health human resource planning and policy to improve regional access to high quality maternity care.
Neonatal Abstinence Syndrome Among Infants Born to Mothers With Sickle Cell Hemoglobinopathies [3R]
Authors: Brown Jewel , Sinkey Rachel , Steffensen Thora , Louis-Jacques Adetola , Louis Judette 
Published: May 2017

INTRODUCTION:
The objective of this study is to examine risk factors for neonatal abstinence syndrome (NAS) among infants born to mothers with sickle cell hemoglobinopathies (SCH).

METHODS:
This is a retrospective case-control study of non-anomalous, singleton infants born to mothers with laboratory confirmed SCH and placental pathology results. Infants were included if they were diagnosed with NAS prior to hospital discharge. The outcome of interest was the association of maternal variables with NAS.

RESULTS:
The occurrence of NAS was 4% (n=5). Mothers with NAS were more likely to have SC disease (80%) compared to other SCH (20%). Mean weeks gestational age (wga) at delivery was 37 ± 2; and did not differ among NAS affected infants compared to infants without NAS (p=0.51). Likewise, the infant's hospital length of stay (LOS) did not differ between infants with NAS (11 ± 4 days) compared to unaffected infants (8 ± 18 days), p=0.3. A preterm birth rate of 21% associated with prolonged NICU admissions may contribute to similar neonatal LOS. Fifteen women had antepartum (AP) admissions for pain and/or sickle crisis. Of these patients, 4 infants (29%) were diagnosed with NAS. The median maternal AP LOS for women with infants diagnosed with NAS was 132 (61, 164) days compared to women who were admitted for pain but whose infants were not diagnosed infants with NAS: 7.5 (4, 12) days (p < 0.001).

CONCLUSION:
Incidence of NAS among mothers with sickle cell hemoglobinopathies is low; severe disease requiring prolonged AP admission for pain control significantly increases the risk of NAS.
Maternal and Neonatal Outcomes by Mode of Delivery in Obese Women With a Previous Cesarean Section [5R]
Authors: Coviello Elizabeth , Clark-Ganheart Cecily A. , Huang Chun-Chih , Landy Helain , Iqbal Sara , Reddy Uma 
Published: May 2017

INTRODUCTION:
To compare maternal and neonatal outcomes for obese women with a prior cesarean delivery by attempted mode of delivery.

METHODS:
In the Consortium on Safe Labor, 4,840 singleton deliveries greater or equal to 37 weeks with a prior cesarean delivery and eligible for vaginal delivery were classified by body mass index (BMI) class I, II, III. Maternal and neonatal outcomes between planned repeat cesarean delivery (rCD, n=2,364) and trial of labor after cesarean delivery (TOLAC, n=2,506) were compared using chi-square. Maternal outcomes included postpartum deep vein thrombosis/pulmonary embolism (DVT/PE), postpartum hemorrhage (PPH), maternal ICU admission and chorioamnionitis. Multivariable logistic regression was used to calculate adjusted OR (aOR), adjusting for maternal age, race, insurance status, hypertensive disorders, diabetes mellitus, and obesity class.

RESULTS:
TOLAC was attempted by 51.5% of women. Less women attempted VBAC with increasing obesity class, 54.8%, 50.7%, 45.4%. The VBAC success rate decreased with increasing class of obesity, 58.7%, 53.5%, 40.6%. There was an increased likelihood of chorioamnionitis and postpartum DVT/PE with TOLAC compared to rCD (aOR 5.72; 95% CI 3.22-10.15 and aOR 3.03; 95% CI 1.18-7.76), respectively. Women with successful VBAC were 6.95 times more likely to have a DVT/PE compared to failed TOLAC with rCD after adjusting for confounders (95% CI 1.56-30.92). There was no association between mode of delivery and PPH, maternal ICU admission or neonatal outcomes.

CONCLUSION:
Among obese women with a prior cesarean delivery, increasing BMI was associated with lower TOLAC attempts and success rates. Postpartum DVT/PE and chorioamnionitis occurred more frequently in those undergoing TOLAC.
Maternal and Neonatal Outcomes in Multiple Gestations With Elevated Antenatal Edinburgh Depression Scale (EDS) [6R]
Authors: Hamlin Alyssa , Herrero Tiffany , Fratto Victoria , Driebe Amy , Ramos Gladys A. 
Published: May 2017

INTRODUCTION:
The purpose of this study was to determine the association of elevated antenatal Edinburgh Depression Scale (EDS) and maternal and neonatal outcomes in multiple gestations, in particular the rate of preterm delivery.

METHODS:
This is a retrospective study examining multiple gestations delivering at UC San Diego between 2010-2014. Patients were included if they completed an antepartum EDS. An EDS score of >10 was considered positive. The primary outcome was rate of preterm delivery (GA at delivery of < 37 weeks). Other maternal and neonatal outcomes of interest included history of preterm delivery, birth weight percentage and discordance, Apgar score, and maternal weight gain. Data was analyzed using SPPS v.23.

RESULTS:
102 women with multiple gestations completed an antepartum EDS. 22.5% (23/102) had a positive EDS score and 77.5% (79/102) had a negative score. Preterm delivery rate in the entire cohort was 61.8% (N=63). Women with an elevated EDS score had a trend toward higher preterm delivery rate (73.9%, N=17) compared to women with lower EDS scores (58.2%, N=46), p-value=0.23. A higher proportion of neonates born to mothers with elevated EDS had an Apgar score less than 7 at 5 minutes (27.3% vs 12.1%, p-value=0.1) although this was not statistically significant. No differences were noted in maternal weight gain or birth weight discordance.

CONCLUSION:
There is a trend toward an increased rate of preterm delivery and lower Apgar score in multiple gestations with a positive antepartum maternal EDS score. Further studies are needed to assess if treating these high-risk patients reduces their rate of preterm delivery.
Fetal Maternal Size Disproportion: Explanation for the Racial Disparity of OASIS? [7R]
Authors: Kim Youngwu , Hebert Kasey , Masiero Jessica , Leung Katherine , Moore Simas Tiffany A. , Leftwich Heidi 
Published: May 2017

INTRODUCTION:
Obstetric anal sphincter injuries (OASIS) are a significant complication of vaginal deliveries. Asian race is a known independent predictor of perineal trauma. Limited data demonstrate a plausible explanation of this racial disparity. We aim to assess the relationship between the fetal maternal size disproportion as measured by fetal birth weight to prepregnancy BMI ratio (BW:BMI) and OASIS in mothers of different race groups.

METHODS:
Retrospective cohort study of vaginal deliveries between 2006 and 2015. Demographics and obstetrical data were abstracted and compared. The significance of BW:BMI to OASIS was evaluated. Results adjusted for confounding factors.

RESULTS:
16,024 vaginal deliveries were included. 28.5% had no lacerations, 64.6% had 1st or 2nd degree lacerations, and 6.9% had OASIS. Demographic factors associated with OASIS included Asian race, nulliparity, increased age, increased birth weight, episiotomy, trial of labor after cesarean, and operative vaginal deliveries. Although BMI was not an independent risk factor, BW:BMI showed a significant relationship with OASIS. For every 10 unit increase in BW:BMI, the adjusted odds of having an OASIS increased by 16% (p= < .001). After adjusting for BW:BMI, Asian race had higher OASIS rates. Interaction between race groups and BW:BMI was only significant for 1st and 2nd degree lacerations, not OASIS.

CONCLUSION:
This study verified known risk factors associated with OASIS. Increasing BW:BMI is associated with OASIS. However, BW:BMI does not provide insight into OASIS racial disparities; further investigations are needed to understand why Asian race is an OASIS risk factor.
Fetal Doppler Evaluation and Perinatal Outcomes in the Absence of Fetal Growth Restriction [8R]
Authors: Condon Niamh , Martinez Francis 
Published: May 2017

INTRODUCTION:
Antepartum fetal surveillance techniques are used to assess fetal well-being in pregnancies complicated by preexisting maternal conditions, and pregnancies in which complications develop (1). The application of Doppler velocimetry to antepartum fetal assessment allows for evaluation of placental status and helps to determine the relative risk of sudden fetal deterioration (2). The purpose of this study is to determine whether patients with hypertension or preeclampsia and normally grown fetuses yet abnormal Doppler studies are at an increased risk for adverse perinatal outcomes.

METHODS:
This is a retrospective review of 287 high-risk pregnancies with appropriate-for-gestational- age (AGA) fetuses who had ultrasound evaluations between January 2012 and December 2013. Ultrasound evaluation included fetal growth assessments every four weeks with umbilical artery (UA) and middle cerebral artery (MCA) Doppler interrogation. The control group always had normal Dopplers. The study group had at least one abnormal UA Doppler or one abnormal MCA Doppler. Perinatal outcomes were compared between the groups.

RESULTS:
Of the 287 high-risk AGA pregnancies evaluated, 12.5% (n=36) had at least one abnormal UA or MCA Doppler. Pregnancies complicated by hypertension or preeclampsia had a statistically significant increased risk of having an abnormal UA and/or MCA Doppler (p=0.0013 and p=0.0086, respectively), and were significantly more likely to deliver preterm (p=0.0066 and p=0.0001, respectively).

CONCLUSION:
Fetoplacental circulation may be altered in preeclamptic and hypertensive patients, yet the fetus may not be growth restricted. Abnormal umbilical and middle cerebral artery Dopplers in AGA pregnancies may identify those fetuses that are at risk for preterm delivery.
Maternal Outcomes of Prolonged Induction of Labor [9R]
Authors: Triebwasser Jourdan , VanArtsdalen Jamie , Kobernik Emily , Langen Elizabeth 
Published: May 2017

INTRODUCTION:
To safely reduce the number of cesarean deliveries (CD), the time allowed for induction of labor (IOL) has increased. There is little data regarding the safety of prolonged labor induction.

METHODS:
We performed a retrospective study of IOL from July, 2014 – June, 2016. Singletons, greater than 36 weeks, with initial cervical dilation 4 or less were included. Bivariate analysis was performed to compare maternal outcomes by induction length. Multivariable logistic regression identified independent predictors of CD and was subsequently stratified by parity.

RESULTS:
We included 2,032 inductions. For IOL less than 24 hours, 24 to 36 hours, and greater than 36 hours the CD rate was 14.9%, 24.5%, and 43.4% (p < .001) for nulliparous women and 5.5%, 11.2%, and 18.7% (p < .001) for multiparous women. After risk adjustment, the odds of CD were significantly higher for women age 30 or greater, (aOR=1.83, 95%CI 1.42-2.38), BMI 35 or greater, (aOR 1.58, 95%CI 1.21-2.06), previous CD (aOR 12.06 95%CI 6.72-21.67), duration of labor 24 to 36 hours (aOR 1.74 95%CI 1.25-2.42), and duration of labor greater than 36 hours (aOR 1.74 95%CI 1.25-2.42). When stratified, age, BMI, and duration of labor for nulliparous and prior CD and duration of labor for multiparous women were significant. Chorioamnionitis also increased by duration, 5.5%, 8.9%, and 14.6% for nulliparous women (p < .001), and 1.4%, 2.0%, and 9.2% for multiparous women (p=.001).

CONCLUSION:
As the length of IOL increases the risk of CD and infection increases. This data can be used to better inform patients of the risks of prolonged IOL.
Measuring Variation in Design Among American Childbirth Facilities [11R]
Authors: Bilazarian Ani , Plough Avery C. , Galvin Grace E. , Rosenberg Deb , Sullivan Brendan , Shah Neel T. 
Published: May 2017

INTRODUCTION:
Facility design may either support or hinder patient care. Nonetheless, there is minimal evidence-based guidance in designing childbirth facilities. We validate a novel methodology of measuring and comparing quantitative design data among American childbirth facilities.

METHODS:
We requested annotated floor plans from 12 diverse childbirth facilities across the United States, ranging from birth centers to high-volume tertiary care centers. We redrew these floor plans to allow for comparison of key functional distances and areas. Specific measurements were selected using a modified-Delphi consensus process with experts in obstetrics, nursing, patient advocacy, evidence-based design, and hospital operations.

RESULTS:
Our cohort consisted of nine hospitals and three birth centers. Hospital delivery volumes ranged from 432 to 9,100 deliveries per year, and birth center delivery volumes ranged from 175 to 300 deliveries per year. The ratio of labor and delivery rooms to ORs ranged from 1.0 to 8.5 in hospitals. Annual deliveries per labor room ranged from 86.40 to 361.54 annual deliveries per room in hospitals and 87.50 to 100.00 annual deliveries per room in birth centers.

CONCLUSION:
We observed substantial variation in childbirth facility design and demonstrated the feasibility of collecting design data from diverse facilities. Given limited evidence-based design standards, future work is needed to understand the impact of variation in design on clinical processes in childbirth.
Decision Analysis Studies Involving the Management of Pregnant Women: A Systematic Review [13R]
Authors: D'Souza Rohan , McKelvey Kyra , Murphy Kellie , Sander Beate 
Published: May 2017

INTRODUCTION:
This study systematically reviewed Decision Analysis (DA) and economic evaluation (EE) studies involving the management of pregnant women and described methodological variations and limitations.

METHODS:
Three databases were searched to include articles from inception to December 2014. DA and EE studies describing conditions involving the management of pregnant women were included and screening and data-extraction were conducted in duplicate. Outcomes included type of analysis, model type, input variables (“probabilities,” “utilities” and “costs”) and outcome variables (clinical or cost-based, time horizon). Reporting quality was assessed by a five-point scale.

RESULTS:
6,055 titles were screened and 303 full texts retrieved, of which 57 describing management of clinical conditions were included. Five used Markov Models, while 52 used decision trees. Most studies (45) involved EE. Probabilities were obtained from multiple publications in 48 studies. Utilities were used in 26 studies [maternal and offspring (18), offspring (5) and combined (3)]. Utilities were obtained from physicians (6), physician and patient (3), mother and offspring (2), mother (2), public (2), parents (2) and offspring (1). Costs were obtained from perspectives of society (10), health care system (7), third-party payer (6), hospital (5) and multiple sources (2). 53 studies described clinical outcomes and 4 only described costs. Time-horizon involved maternal and/or offspring lifetime (19), pregnancy duration (19) and other reported time-horizons (6). Only five studies had a high risk-of-bias.

CONCLUSION:
There is considerable variation in the conduct and reporting of DA and EE studies in obstetrics. A consensus statement to standardize conduct of these studies in obstetrics is required.