bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utility of Intrapartum Fetal Heart Rate Monitoring in a Contemporary Labor and Delivery Unit [4Q]
Authors: Taylor Rachel , Burk Camden , Sugiyama Nathaniel , Friedman Perry , Ogunyemi Dotun 
Published: May 2017

INTRODUCTION:
To evaluate the use of intrapartum electronic fetal heart rate monitoring (EFM) as a screening tool for adverse neonatal outcomes.

METHODS:
This is a retrospective study of 16,980 term, singleton deliveries at a single hospital from 2013-2014. Cases of adverse neonatal outcomes were compared to unaffected controls by the following predictor variables: late, variable, early, and prolonged decelerations; accelerations; tachycardia; bradycardia; and minimal variability. The primary outcome was a composite adverse outcome comprised of five-minute Apgar score less than 4, umbilical arterial pH less than 7.0, sepsis, seizures, encephalopathy, and respiratory failure. Secondary outcomes were neonatal intensive care unit (NICU) admission, hypoxia, hypoglycemia, pH less than 7.0, seizures, and abstinence syndrome. Independent associations were ascertained using logistic regression. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for significant parameters.

RESULTS:
For the composite adverse outcome, prolonged decelerations were positively (OR 2.19) and accelerations were negatively (OR 0.044) associated. For NICU admission, associations included prolonged (OR 1.24) and late (OR 1.39) decelerations, minimal variability (OR 1.17), and tachycardia (OR 1.81). Neonatal hypoxia (OR 0.076), hypoglycemia (OR 0.21) and seizures (OR 0.005) were all negatively associated with accelerations. Low five-minute Apgar score was positively associated with prolonged decelerations (OR 8.69). For the composite adverse outcome, prolonged decelerations had sensitivity, specificity, PPV, and NPV of 0.372, 0.657, 0.00606, and 0.995, while for absence of accelerations were 0.0185, 0.998, 0.0357, and 0.996, respectively.

CONCLUSION:
Standard EFM parameters have excellent NPV but poor PPV when used intrapartum to screen for adverse neonatal outcomes.
The Use of Hemoglobin and Hematocrit Values to Estimate Intrapartum Blood Loss: A Systematic Review [9Q]
Authors: Komorowski Adam S. , Zaffar Nusrat , Shah Prakesh , Murphy Kellie , D'Souza Rohan 
Published: May 2017

INTRODUCTION:
The purpose of this study was to systematically review formulae using hemoglobin (Hb) or hematocrit (Hct) that have been derived, validated or used to objectively estimate intrapartum blood loss and determine their diagnostic accuracy.

METHODS:
MEDLINE, EMBASE, and Web of Science were searched from inception until 29 July 2016 for studies describing the use of Hb or Hct to estimate intrapartum blood loss in pregnant women. Studies were limited to humans, with no other search restrictions. Citation tracking and grey literature searches were performed. Two independent investigators screened titles and abstracts; performed data extraction; and completed risk of bias assessments using a revised tool for quality assessment of diagnostic accuracy studies (QUADAS-2). Disagreement was resolved through discussion or adjudication with a third reviewer. The study protocol was registered with the PROSPERO International Prospective Register of Systematic Reviews (CRD42016043505).

RESULTS:
Of the 6463 identified titles, 63 full-texts were retrieved and 13 studies included in qualitative synthesis. The risk of bias was deemed to be low in five and unclear in eight studies. A total of 12 unique formulae were identified that used Hb or Hct as variables (in addition to height and bodyweight) to estimate peripartum blood loss, of which two were derived and seven were validated. Meta-analysis was not possible due to clinical and methodological heterogeneity between studies.

CONCLUSION:
This systematic review identified 12 formulae that could provide an objective method for estimating intrapartum blood loss. These formulae need to be validated by adequately powered, prospective studies.
The Risk of Preterm Birth in Pregnancies With Fetal Anomalies [11Q]
Authors: Berger Victoria , Moghadassi Michelle , Gosnell Kristin , Sparks Teresa , Velez Juan Gonzalez , Norton Mary 
Published: May 2017

INTRODUCTION:
To examine the relationship between congenital fetal anomalies and rates of preterm birth (PTB).

METHODS:
Retrospective study of singleton pregnancies with fetal anomalies, delivered at greater than or equal to 24 weeks at our institution between 2007 and 2015. Our primary outcomes were any PTB and spontaneous PTB (both less than 37 weeks). Anomalies were classified as: cardiac, congenital diagrammatic hernia (CDH), gastrointestinal (GI, including abdominal wall defects), genitourinary (GU), central nervous system (CNS), sacrococcygeal teratoma (SCT), musculoskeletal (MSK), neck mass, and multiple. Chi square and Fisher's exact tests were used to compare proportions, and multivariate logistic regression adjusted for potential confounders.

RESULTS:
Among 728 pregnancies, the mean gestational age at delivery was 36.8 ± 3.3 weeks. Twenty-nine percent were delivered preterm, and 15.0% were delivered after spontaneous preterm birth (sPTB) specifically. GI anomaly was associated with a 2.62 fold increased odds of sPTB (95% CI 1.52-4.53), while SCT anomaly was associated with 4.50 fold increased odds of the same (95% CI 1.26-16.05). Considering any PTB, there was a 4.81 fold increased odds (95% CI 2.86-8.09) with GI anomaly, and a 3.66 fold increased odds (95% CI 1.06-12.64) with neck mass, adjusting for maternal age, race, BMI, tobacco and substance use.

CONCLUSION:
Nearly one third of pregnancies with fetal anomalies do not reach term, and the risk of preterm birth varies by anomaly. Increased odds of sPTB were seen with GI anomalies and SCT, and increased odds of any PTB were seen with GI anomalies and neck masses.
The Giving Voice to Mothers Study: Measuring Respectful Maternity Care in the United States [18Q]
Authors: Vedam Saraswathi , Declercq Eugene R. , Monroe Shafia M. , Joseph Jennie , Rubashkin Nicholas 
Published: May 2017

INTRODUCTION:
Adverse perinatal outcomes among immigrants, refugees, and women of colors in the US are well-documented and persist even when socio-economic background is considered.

METHODS:
Community members and researchers designed a survey to capture patient-oriented data on maternity care experiences among communities of color. Items included previously validated instruments including the Mothers Autonomy in Decision Making (MADM) scale, the Mothers on Respect index (MORi); and the Perceptions of Racism (PR) scale. The final instrument was content validated, piloted, and distributed across the US. Descriptive statistics describe access, experience, and outcomes; and regression analyses link MADM and MORi scale scores to respectful care and autonomy (adjusting for differences in sociodemographics, risk profile, type of provider, and place of birth).

RESULTS:
Of the total sample (N=2260), 37.3% were women of color (Black, Hispanic, Native, other), and 18% Medicaid recipients. Women of color had significantly lower MADM scores, and 20.5% were not satisfied with their role in decision making. Women with low MORi scores reported pressure by health professionals to accept interventions [(6.8%) epidurals, (15.8%) inductions, (11.1%) cesarean]. Reported discrimination due to a difference in opinion with providers was more common (17%) among women of color. MADM, MORi, and PR scores varied significantly by place of birth and type of provider.

CONCLUSION:
Persons of color in the US report receiving less respectful maternity care, and reduced access to options for physiologic birth care. Data suggest that type of provider or place of birth modulates outcomes, and institutional racism may be a contributing factor.
The Effects of Continuous Local Anesthetic After Cesarean Delivery on Pain and Narcotic Use [22Q]
Authors: Yaklic Jerome , Maxwell Rose , Urschel Kiera , Lindheim Steven , Griffiths Kara 
Published: May 2017

INTRODUCTION:
Studies of the effectiveness of continuous local anesthetic administration for pain reduction after Cesarean delivery have provided inconsistent results. This study evaluated the effectiveness of this mode of administration on post-surgical pain and narcotic use.

METHODS:
Fifty women who had a Cesarean delivery were enrolled into a randomized double-blind, placebo controlled trial. The On-Q continuous abdominal wall and intraperitoneal wound irrigation system for local anesthetic administration was placed at the time of closure. Total post-operative narcotic use and patient reported pain scale scores were used to evaluate efficacy of treatment at 6, 12, 24 and 48 hours postoperatively.

RESULTS:
Forty patients completed the study. Repeated measures ANOVA revealed no significant difference in narcotic use or reported pain scores between the control group and those receiving local anesthetic for all time points. There was a trend towards reduced pain and narcotic use in the study group at the 6, 12, and 48-hour time points (group*time interaction p < 0.09). Regardless of group assignment, women who had a prior Cesarean section, versus primigravid women, had an increased total narcotic use (58.06 mg vs. 38.28 mg, respectively; p < 0.03).

CONCLUSION:
Dual catheter placement and infusion of bupivacaine has potential to decrease the use of narcotics and pain following Cesarean delivery; however, given the small sample size of the study, a significant difference between groups could not be delineated. Further study is indicated to investigate catheter placement and effects on pain control, narcotic use and other potential benefits such as shorter length of stay.
A Widening Gap: The Obstetric Response to the Opioid Epidemic [25Q]
Authors: Miller Edward , McDonald Vanessa , Lambert Calvin , Wongk Ashley , Nunes Vanessa 
Published: May 2017

INTRODUCTION:
78 Americans die daily from an opioid overdose. One of the areas hardest hit by this epidemic is the Appalachian region. To combat this crisis, Congress and the American College of Obstetricians and Gynecologists recommend a multifaceted approach in identifying, monitoring, and managing patients. Medication assisted treatment (MAT) with methadone or buprenorphine is a cornerstone of this therapy. Despite the acceptance of MAT as standard of care, opioid related maternal and neonatal morbidity rates continue to rise.

METHODS:
A survey of all obstetric providers in highly affected counties (as determined by CDC analysis) in West Virginia, Kentucky, Ohio, Tennessee, Indiana, and South Carolina was performed. Providers were asked if they: 1. Prescribe Methadone or buprenorphine. 2. Manage patients who obtain the medications from other prescribers 3. Where did they refer their patients for treatment.

RESULTS:
In West Virginia, 47 practices comprising 208 physicians were surveyed. 6.3% of practices (2 Academic, 1 Community) prescribed methadone/buprenorphine. At one academic institution, a sole provider prescribed methadone/buprenorphine. 2.45% of obstetric providers in West Virginia prescribe methadone/buprenorphine. 77% of community practices referred to academic centers for management. 10% were unsure where to refer their patients. Final data is pending for the remaining states and will be displayed numerically and graphically by county.

CONCLUSION:
Our data shows a wide gap both in the quantity and the accessibility of obstetric providers prescribing MAT. The burden of management has fallen disproportionately on academic centers creating a log jam which makes accessing this potentially life-saving treatment in a timely manner out of reach in this high risk population.
The Collaborative Laborist and Midwife Model at Sanford Health: An Accepted and Sustainable Model [31Q]
Authors: Landeen Laurie , Krolikowski Keely , Watson Trevor 
Published: May 2017

INTRODUCTION:
To examine the effects of a Collaborative Laborist and Certified Nurse Midwife (CNM) Model on the rates of induction, primary and repeat cesarean sections, vaginal birth after cesarean (VBAC), and nursing staff satisfaction with this model of care.

METHODS:
This was a prospective cohort study at the largest birthing center in South Dakota between 2008-2016. Rates of induction, primary and repeat cesarean section, VBAC, and nursing staff satisfaction were compared over three 2 year time periods: before and after Laborist Model initiated and with the addition of CNM to the model. Linear regression and two-way ANOVA were used to compare trends of primary cesarean, repeat cesarean, VBAC, and induction. A two-tailed t-test compared values of nursing satisfaction.

RESULTS:
The primary cesarean delivery and induction rate decreased from 15.9% to 13.5% (P < .005 95% CI 0.67–0.22) and 49.38% to 30.75% (P < .006 95% CI 7.24–1.23) respectively. VBAC success rates increased from 1.55% to 2.21% (P < .017 95% CI .07-.23) of all deliveries. There was a significant increase in respect between physician and staff (P < .01 8.9% difference), NICU communication (p < .001 16.2% difference), and provider involvement in triage (P < .001 27.9%) This difference was shown following addition of CNM's.

CONCLUSION:
The rates of primary cesarean section and induction are significantly decreasing at the same time as the rate of VBAC is increasing. These results represent an overall positive outcome of employing the Laborist and CNM Collaboration Model.
Male Fetal Sex: A Risk Factor for Gestational Diabetes Mellitus in Chinese Ethnicity [1R]
Authors: Rebolos Mark , Faris Basma , Schubert Finn 
Published: May 2017

INTRODUCTION:
About 6-7% of pregnancies are complicated by Gestational Diabetes Mellitus (GDM); these pregnancies are at a higher risk for gestational hypertension, preeclampsia, cesarean section and other potential comorbidities. This study's objective is to determine whether Chinese mothers carrying male fetuses are at a higher risk of GDM compared with Chinese mothers carrying female fetuses.

METHODS:
We conducted a retrospective review of women of Chinese ethnicity who were admitted to NYU Lutheran for a delivery during calendar year 2015. This work in progress report covers all data for women with GDM and data for women without GDM from November 22, 2015 through the end of the year. Patients were excluded if they had late prenatal care initiation (>28 weeks), or missing data on key variable. Data collected included: Age, BMI, delivery type, birth weight, gestational age, fetal sex, and glucose values. We used the chi-squared test to compare the proportion of mothers with GDM among those with male versus female babies.

RESULTS:
We analyzed data for 141 women with GDM and 110 women without GDM. Diabetic women were significantly older than non-diabetic women (mean 28.8 vs 31.0, p < .001). Seventy-nine women with GDM (56%) had a male baby, while 56 (51%) non-diabetic women had a male baby, the difference was not statistically significant.

CONCLUSION:
This study did not show a difference between diabetic and non-diabetic women in terms of fetal sex, however, it was not adequately powered and a larger study may show a different result.
Modified B-Lynch Suture Technique for Prevention of Postpartum Hemorrhage [16R]
Authors: Hall Evelyn , Djordjevic Miroslav , Mazzullo Lisa 
Published: May 2017

INTRODUCTION:
In 1997 B-Lynch described a technique using a continuous suture to mechanically compress the uterus in cases of failed medical management of uterine atony. Subsequently several have described modifications to the procedure in order to make it more simple and effective.

METHODS:
In this surgical case series, we describe a technique where 3 side-by-side B-lynch sutures are placed during postpartum hemorrhage at cesarean. Using a modified B-lynch technique, an initial suture is placed and secured in the middle third of the uterus. Two additional B-lynch sutures are placed lateral to the middle suture. The increased compression of these sutures will cause the initial suture to loosen. To avoid bowel complications such as strangulation, the first suture is retied under tension to either one of the B-lynch ties or an additionally placed stitch. Finally, the uterus is measured to ensure it is not expanding. The purpose of the technique is to provide greater amount of compression to the uterus than a solitary B-lynch suture.

RESULTS:
From 2008-2016, we used this technique in over 150 women with postpartum hemorrhages at cesarean that did not respond to conservative treatment. Over this period, there were 2 failures resulting in hysterectomy. No cases of uterine necrosis were noted.

CONCLUSION:
The use of multiple B-lynch sutures is an effective, easy, safe and fertility preserving technique for treating uncontrollable postpartum hemorrhage.
Obesity Effect on Induction of Labor Duration [25R]
Authors: Fitzgerald Garrett , Crimmins Sarah , Kopelman Jerome , Harman Chris , Turan Ozhan 
Published: May 2017

INTRODUCTION:
Obesity and associated morbidity significantly impacts obstetric management, including increased indication for induction of labor (IOL). Retrospective studies report obesity prolonging labor course. We aim to investigate duration of IOL stratified by body mass index (BMI). We hypothesize obesity prolongs IOL.

METHODS:
Prospective cohort study of singletons undergoing IOL. Obstetric management was per provider's discretion (vaginal misoprostol, cervical balloon, intravenous oxytocin). The primary outcome was interval from starting IOL to latent labor. Secondary outcomes include duration to active labor and delivery. Labor was considered prolonged if greater than 24 h to latent labor, and greater than 36 h to active labor. Patients were analyzed by BMI category (under 30, between 30 and 39.9, over 40 kg/m2). Cesarean delivery outcomes were excluded. Non-parametric and chi-square test were used for analysis.

RESULTS:
Total of 99 enrolled, 23 were delivered by cesarean, leaving 76 analyzed. The median BMI was 36 kg/m2 (19-75); 17 BMI under 30, 37 BMI between 30 and 39.9, 22 BMI over 40. The parity and Bishop's score were not significantly different. The BMI group median duration to latent labor (10.6 v 9.6 v 12.7 h, P=.5), to active labor (14.1 v 15.0 v 19.2 h, P=.5), and to delivery (18.5 v 17.8 v 20.6 h, P=.5) were not significantly different. The time to achieve active labor trended longer with increasing BMI (P=.049).

CONCLUSION:
Prospectively analyzed induced labor curves were not significantly different between normal weight, obese, and severely obese women. This provides evidence that, regardless of BMI, IOL is a viable management option.
Early Onset Severe IUGR: Waiting to Deliver Does Not Appear to Improve Outcome and May Be Harmful [35R]
Authors: Fore Matthew S. , Quinn Kristen H. , Street Linda M. , Nitsche Joshua F. , Denney Jeffrey M. 
Published: May 2017

INTRODUCTION:
Preterm delivery of IUGR fetuses prior to 32 wks is rarely indicated, occurring in < 1.9% of all pregnancies. We sought to determine if delaying delivery until non-reassuring fetal heart tracing (NRFT) increases adverse outcomes.

METHODS:
In a cohort of IUGR < 32 wks, two groups were compared: those delivered for abnormal UAD studies and those delivered for NRFT. Fetuses with persistent absent (AEDF) or reversed end diastolic flow (REDF) were placed on continuous monitoring until delivery. Pregnancies were excluded when delivered for maternal deterioration. T-test and Chi-square were performed where appropriate.

RESULTS:
43 singletons with IUGR < 32 weeks gestation and abnormal UAD from 2012-2015. Mean GA at diagnosis 24.7 +/-3.1 wks (range 18-30.3 wks). 30 delivered for abnormal UAD and 13 for NRFT. Pregnancy characteristics were similar between groups. Women progressing to urgent delivery due to NRFT were more likely to undergo cesarean (CD) than SVD (p=0.01). 83.9% of both groups were delivered via CD and were significantly smaller compared to those able to be born via SVD (p=0.026). Women with HTN, preeclampsia or GHTN were also more likely to undergo CD than SVD (p=0.04). Expectant management until NRFT of abnormal UAD did not decrease requirement for CPR at delivery or incidence of IVH, RDS, or death. Length of stay was 50.9 days in those delivered for Doppler while 61.2 days in the group delivered emergently (p=0.23).

CONCLUSION:
Waiting to deliver until there was NRFT does not appear to decrease neonatal morbidity/mortality, increases risk for emergency CD, and may increase length of stay in NICU.
Patient Quality Scoring and Its Utility as a Predictor of Pregnancy Outcomes Amongst Gestational Diabetic Patients [36R]
Authors: Ake-Uzoigwe Rukeme , Arora Anubha , Salafia Carolyn , Zhang Dongping , Akinnawonu Kolawole , Fuks Aleksandr 
Published: May 2017

INTRODUCTION:
To assign a quality score to patients based on the quality of care they received and determine if the quality of care a patient received determined pregnancy outcomes.

METHODS:
A retrospective cohort study of gestational diabetic patients', who delivered from January 2013 to December 2015. Patients were given a quality score based on predefined quality of care parameters. Patients were then categorized as having received high or low quality care. High Quality score (HQS) was defined as a score greater than 19/27, while Low quality score (LQS) was defined as less than or equal to 19/27. The association between quality group and pregnancy outcomes was explored using logistic regression.

RESULTS:
Of the 514 patients in the study. 468 (91%) patients were categorized as receiving high quality care based on HQS; 46 (9%) had low quality care based on LQS. Analysis demonstrated the following: Shoulder dystocia: HQS (1%) vs. LQS (7%) (OR 0.18, p = 0.02); Any complication (ie, Neonatal Hypoglycemia, Jaundice, Macrosomia, shoulder dystocia) HQS (47%) vs. LQS (66%) (OR 0.46, p=0.02); Induction of labor: HQS (53%) vs. LQS (37%) (OR 1.99, p = 0.03); Postpartum OGTT compliance: HQS (38%) vs. LQS (16%) (OR 3.87, p= 0.003).

CONCLUSION:
Assigning quality scores to patients allowed us to categorize prenatal care received by GDM patients. Patients with high quality care, had fewer adverse pregnancy outcomes compared to patients with low quality care. Low quality group patients were less likely to be compliant with postpartum OGTT.
Expulsion of Immediate Postplacental Copper IUDs at Six Weeks: A Prospective Cohort Study [5A]
Authors: Gurney Elizabeth , Sonalkar Sarita , McAllister Arden , McClusky Jessica , Frarey Alhambra , Schreiber Courtney 
Published: May 2017

INTRODUCTION:
Postplacental intrauterine device (IUD) placement could improve contraceptive access and child spacing. We sought to report a precise point estimate of the proportion of TCu380A IUDs expelled 6 weeks after immediate postplacental placement, and to assess risk factors for expulsion.

METHODS:
We enrolled women who received a TCu380A IUD after vaginal delivery beyond 33 weeks gestation from April 2015-August 2016. A sample size of 195 enabled us to detect a 15% expulsion proportion with a 95% confidence interval of ±6%. Follow-up to determine IUD status occurred 6 weeks postpartum.

RESULTS:
195 women enrolled. Six weeks postpartum, 155 of 171 (90.6%) telephone survey respondents believed their IUD was in place, and 136 (79.5%) reported high satisfaction. Of the 147 women who completed a pelvic exam, 104 had a correctly positioned IUD and continued its use (70.7% [95% CI 63.4-78.1%]). Mechanical IUD complications included: 10 complete expulsions (6.8%), 14 partial expulsions (IUD in cervix; 9.5%), 5 devices in the lower uterine segment (3.4%), and 8 rotated in the uterus (5.4%). IUD strings were visible on exam for 112 subjects (76.2%); of these, 90 (80.4%) had correctly positioned devices. There were no statistically significant associations between clinical covariates assessed and IUD continuation.

CONCLUSION:
In our cohort, continuation of a correctly positioned IUD was 71% at 6 weeks postpartum. Mechanical complications occurred in 25%, and visualization of IUD strings did not assure fundal placement. The significance of malpositioned IUDs requires further investigation. Participants were satisfied with postplacental IUD access.