bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medicaid Patients With Immediate Postpartum Contraceptive Implants: Continuation & Rapid Repeat Pregnancy Rates [38A]
Authors: Garza Elizabeth de la , Mazzoni Sara , Krull Mona , Stickrath Elaine 
Published: May 2017

INTRODUCTION:
To determine the 6 and 12-month rates of contraceptive continuation and rapid repeat pregnancy (RRP) for publicly insured patients receiving an immediate postpartum etonogestrel contraceptive implant.

METHODS:
This prospective cohort study recruited Medicaid insured women, who delivered between April 2014 and 2015, and received a postpartum etonogestrel contraceptive implant prior to discharge from a safety-net institution. Patients were surveyed at placement regarding contraceptive decision-making and counseling. Medical records were reviewed at 6 and 12 months to assess implant continuation and if RRP had occurred. If this information was unable to be ascertained by medical record review, the participant was contacted by telephone.

RESULTS:
Of the 413 eligible participants, 223 (54%) enrolled. Data were available for 198 patients (89%) at 6 months where 14 (7%) discontinuations and 1 RRP (0.5%) occurred. Data were available for 168 participants (75%) at 12 months, where 40 (24%) discontinuations and 7 RRPs (4.2%) occurred. There were not any pregnancies among participants who retained their implant. Overall, black participants were more likely to discontinue the implant and have a RRP than non-black women (16% versus 2%, p < 0.009). Participants who continued their implant at 12 months were more likely to report at enrollment prior use of a hormonal implant (OR 2.91, CI 1.04-8.17) and plans to keep the implant for all 3 years (OR 2.42, CI 1.04-5.66).

CONCLUSION:
Among Medicaid patients receiving an immediate postpartum etonogestrel implant at a safety-net hospital, continuation rates were high and rapid repeat pregnancy rates were low.
Uterine Anomalies and Hypertensive Disorders of Pregnancy: A Retrospective Study [1B]
Authors: Kurtz Jillian , Stempel Laurence 
Published: May 2017

INTRODUCTION:
Pregnancies associated with uterine anomalies have higher rates of recurrent pregnancy loss, preterm delivery and malpresentation necessitating cesarean delivery. Smaller studies have suggested the link between hypertensive disorders and uterine anomalies as well but thus far, there still remains little data regarding the subject. The purpose of this study was to compare rates of hypertensive disorders in pregnant women with a known uterine anomaly and compare it to the rate in the normal pregnant population.

METHODS:
Demographic and clinical characteristics of patients who were gravid for more than 20 weeks, had an uterine anomaly, and were seen at OhioHealth facilities from January 1, 2010 to October 7, 2015 were examined. The rate of hypertensive disorders among women with uterine anomalies was calculated and compared to the rate of hypertensive disorders among women without uterine anomalies (i.e., the normal pregnant population).

RESULTS:
From January 1, 2010 to October 7, 2015, there were 80 women seen at OhioHealth facilities who were gravid for more than 20 weeks and had a uterine anomaly. A greater proportion of women with a uterine anomaly had a hypertensive disorder (15.0%) than women without a uterine anomaly (5.0%) (p=0.001).

CONCLUSION:
A greater proportion of women with a uterine anomaly had a hypertensive disorder (15.0%) than women without a uterine anomaly (5.0%) (p=0.001). With increasing use of assisted reproductive technology, the OB/GYN community will begin seeing a greater number of these pregnancies. Understanding the specific pregnancy outcomes that are associated with these high risk pregnancies will be crucial for appropriate management.
Diamine Oxidase Deficiency as a Proposed Mechanism for Anaphylaxis After the Third Stage of Labor: A Case Report [2B]
Authors: Whittaker Naomi , Asam-Jensen Teresa , Stalling Jillian , Jimenez Catherine , Dunniway Diane 
Published: May 2017

INTRODUCTION:
Previous case reports have demonstrated post-partum anaphylaxis associated with breast-feeding, thought to be due to destabilization of mast cells, but none associated with delivery of the placenta. The histamine-degrading enzyme diamine oxidase is produced in large amounts by the placenta as a metabolic barrier preventing bioactive histamine from entering the maternal or fetal circulation.

METHODS:
Case report.

RESULTS:
A 29 yo G5P3 admitted at 39w1d with ruptured membranes. Her obstetrical history is significant for 3 vaginal deliveries with subsequent anaphylaxis after delivery of the placenta, unrelated to narcotic administration. Medical history includes sensitive skin, seasonal allergies, and negative allergy testing. During her first two deliveries, she experienced angioedema (eye and lip swelling) after delivery of the placenta. After her third delivery, she required supplemental oxygen, steroids and epinephrine secondary to laryngeal edema refractory to diphenhydramine. With her fourth delivery, the patient was given 125 mg IV Solumedrol 2 hours prior to delivery, in addition to IV diphenhydramine. Two hours after delivery, she complained of eye and lip swelling and throat “itchiness” but remained hemodynamically stable. She did not improve with a second dose of IV Diphenhydramine. Due to her history, 0.3 mg Epinephrine IM was given with full resolution of symptoms.

CONCLUSION:
A proposed mechanism of decreased diamine oxidase after delivery of the placenta may provide insight into the maternal–fetal immune system interface in our unusual case. In retrospect, a proposed prevention of anaphylaxis in this patient would be diamine oxidase supplementation in the third trimester.
Georgia State Obstetrician Counseling Practices Regarding Prenatal Environmental Toxin Exposures [3B]
Authors: Gupta Shabnam , Green Victoria L. , Martinuzzi Kurt 
Published: May 2017

INTRODUCTION:
Recent studies have underscored the adverse effects of prenatal exposure to bisphenol-A (BPA), pesticides, mercury, and lead. The purpose of this pilot study was to assess the counseling practices and level of comfort discussing prenatal environmental exposures among obstetricians in the state of Georgia.

METHODS:
We surveyed 100 practicing obstetricians, including Georgia private practice physicians in addition to residents and faculty from the largest residency training program in the state.

RESULTS:
The majority (72%) of physicians agreed that assessing environmental exposures during prenatal care is important in preventing adverse pregnancy outcomes. While 97.9% felt confident discussing cigarette smoking, few felt confident discussing the impact of other toxin exposures on pregnancy as follows: BPA (48.4%), pesticides (46.2%), mercury (42.1%), and lead (36.8%). Furthermore, less than 1 in 4 obstetricians reported routinely discussing each of these exposures as part of prenatal care: BPA (3.2%), pesticides (16.1%), mercury (22.6%), and lead (8.6%). There was no significant difference in either counseling practices or comfort discussing these topics when stratified by age, years in practice, and percentage of practice dedicated to obstetrics.

CONCLUSION:
Prenatal exposure to environmental toxins can have a significant impact on reproductive and developmental health, yet many obstetricians are not confident discussing the effect of environmental exposures on health outcomes with their patients. Currently most Georgia obstetricians are only evaluating a fraction of the environmental exposures recommended by the American College of Obstetricians and Gynecologists experts. There is a profound opportunity for improvement in counseling patients and educating reproductive health providers on this topic.
Use of Vacuum Extraction During Cesarean Delivery: Is It Safe? [7B]
Authors: Persad Malini D. , Nunziato Jaclyn , Vahanian Sevan , Demishev Michael , Quirk James , Garry David 
Published: May 2017

INTRODUCTION:
The complications of vacuum-assisted vaginal deliveries are well documented; however, complications with its use during cesarean delivery (CD) is limited. The objective of the study is to determine if there is an increased risk of maternal and neonatal morbidity in vacuum-assisted CD.

METHODS:
This is a retrospective cohort study of vacuum-assisted CD identified from a university-based surgical case log from 5/2014–7/2015. Term, singleton gestations with cephalic presentation vacuum-assisted CDs were matched 1:1 with non-vacuum-assisted CDs by CD type (primary or repeat). The 2 groups were compared with respect to maternal composite outcome (hysterotomy extension, postpartum hemorrhage, blood transfusion, SICU admission, hospital stay more than 5 days) and neonatal composite outcome (NICU admission, cephalohematoma, subgaleal hematoma, nerve injury, seizure, respiratory distress syndrome, jaundice, ventilation, fracture). Data was analyzed using parametric and non-parametric tests with a p less than 0.05 considered significant.

RESULTS:
Ninety-five vacuum-assisted CD were compared with 95 matched controls. The most common indication for vacuum use was “difficulty delivering the fetal head” (n=26/40). Baseline characteristics were not different. Vacuum-assisted CD was associated with increased adverse maternal composite outcome (OR 3.5; 95% CI 1.44–14.0, p = 0.01) but not adverse neonatal composite outcome (OR 1.89; 95% CI 0.98–3.62, p =0.06); however, neonatal jaundice was increased (18.9% vs 6.3%, p = 0.01). There were no major neonatal injuries or deaths in either group.

CONCLUSION:
Vacuum-assisted CD is associated with increased rates of maternal morbidity and neonatal jaundice.
Use of Intrauterine Pressure Catheters (IUPC) Increases Risk of Post-Cesarean Surgical Site Infection [9B]
Authors: Rood Kara M. , Gee Stephen , Millen Katherine , Kellert Brian , Buhimschi Catalin , Klebanoff Mark 
Published: May 2017

INTRODUCTION:
Surgical site infection (SSI) rates are increasingly being linked to payment incentives for hospitals and represent an important clinical quality indicator of care. Clinical interventions aimed to significantly reduce cost and morbidity can be designed through identification of key predisposing obstetrical risk factors for SSI. Studies conducted in a limited number of subjects suggest an association between IUPC and post-partum endomyometritis. Our objective was to examine the relationship between intra-partum use of IUPC and risk of post-cesarean SSI.

METHODS:
We performed a secondary analysis using data from Maternal-Fetal Medicine Units Network (MFMU) Cesarean Registry (1999-2002). Patients included in this analysis had a singleton viable pregnancy and a cesarean delivery following labor for recognized obstetrical indication from 24 to 42 weeks gestational age (GA). A multivariable logistic regression model was used to control for GA, race, BMI at delivery, smoking, limited prenatal care, length of labor, length of membrane rupture, PPROM, pre-gestational diabetes, hypertensive diseases, physical health status assessed using American Society of Anesthesiologists established categories, and maternal clinical chorioamnionitis.

RESULTS:
25,986 women were included in this analysis. The rate of SSI was 12.9% (1,542 of 11,941) in the patients with IUPC and 7.8% (1,099 of 14,045) in the patients without IUPC (P= < 0.001). The adjusted Odds Ratio for SSI among patients who had IUPC was 1.40, (95% CI=1.26-1.57, P= < 0.001).

CONCLUSION:
We present compelling data that in laboring women undergoing cesarean delivery, the use of IUPC is an independent risk factor for post-cesarean SSI.
Effect of Chronic Kidney Disease Stage on Pregnancy Outcomes [10B]
Authors: Scrivner Karen , Zwerling Blake , Caughey Aaron B. 
Published: May 2017

INTRODUCTION:
This study aims to estimate the risk of adverse pregnancy outcomes in women with stages 1-5 chronic kidney disease (CKD).

METHODS:
This is a retrospective cohort study of 2,039,870 singleton, non-anomalous pregnancies recorded in the California Birth Registry from 2006 to 2010, of which 93 were complicated by CKD. 27 women were classified as stage 1 or 2, 21 as stage 3, 10 as stage 4 and 35 as stage 5 CKD. Outcomes included: preeclampsia, preterm delivery, intrauterine fetal demise (IUFD), small for gestational age neonates (SGA), and mode of delivery. Results were stratified by parity and analyzed with Pearson Chi-squared Tests and multivariable logistic regression analyses.

RESULTS:
Compared to the general population, all stages of CKD resulted in higher rates of adverse pregnancy outcomes. Women with stage 4 CKD experienced the highest rates of preeclampsia, preterm delivery, and IUFD (60.0%, 100.0%, and 10.0% respectively, all P.

CONCLUSION:
Although all stages of CKD are associated with worse pregnancy outcomes compared with the general population, there was a non-linear relationship between the severity of pregnancy outcomes and degree of kidney dysfunction. Those with more progressed disease on renal replacement therapy may account for the improved outcomes. Further research with a larger cohort is needed to better understand the impact of this chronic disease on pregnancy.
Hypertension Is Associated With Depressive Symptoms in Pregnant Women [23B]
Authors: Diaz Nicole M. , Mccarthy Alicia , Adams Marci , Elue Rita , Plunkett Beth 
Published: May 2017

INTRODUCTION:
Hypertension and beta-blocker use have been associated with depression in the non-pregnant population. We evaluated the independent association of hypertension and beta-blocker use on antepartum depression risk.

METHODS:
We conducted a retrospective cohort study which included women who delivered within our health system between January 1, 2009, and March 31, 2015, who completed an Edinburgh Postnatal Depression Scale (EPDS) during pregnancy. Increased depression risk was defined as EPDS score >10, or an affirmative answer to endorsing self-harm. Hypertension was determined by blood pressure measurements and ICD-9 codes. We compared normotensive to hypertensive pregnancies, and hypertensive pregnancies requiring beta-blocker therapy to those without medication requirement. Multivariate logistic regression analyses were used to examine the influence of beta-blocker use and hypertension on antepartum depression risk.

RESULTS:
Of the 9192 deliveries, 95% were normotensive and 5% were hypertensive. Of the hypertensive group, 22% utilized a beta-blocker and 68% required no medication. Compared to normotensive pregnancies, antepartum hypertension was significantly associated with antepartum EPDS score ≥10 (adjusted OR 1.61, 95% CI 1.17, 2.21) and with endorsement of self-harm (adjusted OR 1.76, 95% CI 1.05, 2.95). In further analyses of hypertensive pregnancies, beta-blocker users demonstrated no difference in depression risk compared to women without medication use (EPDS score ≥10, adjusted OR 1.22, 95% CI 0.56, 2.63; endorsement of self-harm, adjusted OR 0.84, 95% CI 0.32, 2.21).

CONCLUSION:
Women with hypertension in pregnancy are at increased risk for depressive symptoms and thoughts of self-harm. Beta-blocker use does not appear to be associated with further increased risk.
Decisional Regret in Women Receiving High-Risk Results From Non-Invasive Prenatal Genetic Screening [24B]
Authors: Allyse Megan 
Published: May 2017

INTRODUCTION:
Non-invasive prenatal testing (NIPT) panels have expanded rapidly from limited aneuploidy screening for trisomy 21 to expanded screening for aneuploidies and abnormalities, including sex chromosome aneuploidies and, recently, microdeletions. This study sought to understand the experiences of women receiving NIPT results and the effect of high-risk, false, or inconclusive results on maternal anxiety and pursuit of additional testing.

METHODS:
40 semi-structured telephone interviews were conducted with women who were currently or had recently been pregnant and received high risk (n=15), false positive/negative (n=19), or inconclusive (n=5) results from NIPT.

RESULTS:
Many women felt deceived by the advertised “99% accuracy” statistic of NIPT and asserted that much of their post-test anxiety could have been prevented by improved pre-test counseling. Several women felt pressured by providers to terminate, and most felt pressured to pursue invasive diagnostic testing. False results from NIPT had significant lasting effects the remainder of their pregnancies, their willingness to have more children, and their openness to doing NIPT again. Most women would not do NIPT in future pregnancies or would only do it if the panel was smaller.

CONCLUSION:
Findings suggest significant concerns about how clinical practices are integrating NIPT. Study participants indicate problems with the dialogue when NIPT is offered, the return of results, and the positive predictive value of expanded screenings. Given the confusion about NIPT accuracy, the prevalence of follow-up invasive tests, and the large number of women who regret doing NIPT, NIPT offering and the delivery of results need to be carefully approached.
Could Delayed Primary Closure Reduce Cesarean Wound Complications in Obese Women? A Case Study and Meta-analysis [29B]
Authors: Walton Robert , Peterson Logan , Harmon Tess , Napolitano Peter 
Published: May 2017

INTRODUCTION:
Obesity increases the risk of post-cesarean wound complications. Delayed primary wound closure (DPC) is a technique that may prevent wound complications. Our goal was to discuss a case report of DPC in a parturient with extreme obesity (BMI greater than 60) having a cesarean delivery, and review the literature in the OB/GYN and general surgery literature to test our hypothesis.

METHODS:
We searched the MEDLINE and Cochrane Register of Controlled Trials through May 2016 with key words related to DPC and pregnancy. We also report the result of a patient with extreme obesity having DPC after cesarean delivery.

RESULTS:
There were two retrospective studies in the OB/GYN population, showing mixed results. Seven articles were identified in the general surgery literature, all RCTs. The wound complication rate was 32.8% vs. 17.5% (primary closure vs. DPC). A meta-analysis of these RCTs demonstrated a 0.50 relative risk reduction for DPC. In our case, a parturient with BMI of 61 had a cesarean delivery after failed induction of labor. A wound vacuum was placed in the subcutaneous space after fascia closure. On post-operative day two, skin was closed with staples. There were no significant complications.

CONCLUSION:
DPC is a potential technique for reducing wound complications after cesarean delivery. The OB/GYN literature is limited. A meta-analysis of the general surgery literature demonstrated a 0.50 relative risk reduction for DPC. The patient in our study had no significant complications. DPC is a technique that should be further studied to prevent wound complications in women with extreme obesity having cesarean delivery.
Use of a Standardized Algorithm to Decrease the Primary Cesarean Section Rate at a Major Tertiary Care Center [30B]
Authors: Reddy Aishwarya , Vick Tara , Miller Michael S. , Anderson William , Marshburn Paul , Kullstam Susan 
Published: May 2017

INTRODUCTION:
At Carolinas Medical Center, a standardized algorithm was implemented in 2015. The study purpose is to determine if this algorithm decreased the primary C-section rate for PC-02 patients. Subanalysis will determine if primary C-section rate varied by OB practice. Secondary analyses will examine BMI, race/ethnicity and scheduled vs unscheduled admissions.

METHODS:
Retrospective chart review compared PC-02 deliveries during 2014 vs 2015. We hypothesize implementing the algorithm decreased the primary C-section rate. Chi-square was used for statistical analyses. P value less than 0.05 was statistically significant.

RESULTS:
PC-02 deliveries totaled 2,152 in 2014 compared to 2,109 in 2015. In 2014, 516 patients underwent primary C-section (24.0%) vs 455 patients who underwent primary C-section in 2015 (21.6%). There were no significant differences between the 2014 and 2015 populations while comparing race/ethnicity (P=0.47), BMI (P=0.83), or scheduled (P=.50) vs unscheduled admissions (P=.13). After combining 2014 and 2015 data, C-section rates significantly varied by race/ethnicity (P < 0.0001). BMI was significantly higher in patients who underwent primary C-section (P < 0.0001). Scheduled admissions had a significantly higher primary C-section rate (27.3%) vs unscheduled admissions (19.8%) (P < .0001).

CONCLUSION:
The decrease in primary C-section rate in the PC-02 population showed a trend toward statistical significance after implementation of a standardized algorithm (P=.06). Staff OB had the lowest primary C-section rate (19.3%, P < .0001). After combining the data from 2014 and 2015, we noted several significant differences. We propose the current PC-02 criteria be expanded to include additional factors which may significantly influence the primary C-section rate.
Unmasking Valvular Heart Disease in Pregnancy [31B]
Authors: Clevenger Nicole , Hutchison Justin , Hertz Amy 
Published: May 2017

INTRODUCTION:
Hemodynamic changes of the heart during pregnancy including increased stroke volume, heart rate, and cardiac output can result as cardiac decompensation in women with valvular heart disease. These hemodyamic changes can unmask faulty valves in women putting them at an increased risk of acute respiratory distress and heart failure.

METHODS:
We present two cases of previously undiagnosed valvular heart disease that was unmasked in late pregnancy and during labor. The first patient was a previously healthy 27-year-old female who presented at 38 weeks gestation with shortness of breath. She was diagnosed with pneumonia and developed pulmonary edema and acute respiratory failure. She was intubated and an emergency cesarean delivery was performed. Echocardiogram revealed severe mitral stenosis, tricuspid regurgitation, and congestive heart failure with valvular changes consistent with rheumatic heart disease. Patient was extubated on postpartum day 11 and later underwent a mitral valve replacement. Our second patient was a 29-year-old obese gravida 6 para 3 who presented at term in labor. Pregnancy was complicated by chronic hypertension. During labor, she developed acute pulmonary edema. After a spontaneous vaginal delivery, post-delivery echo showed severe mitral and tricuspid regurgitation with cardiomegaly. Patient was scheduled for valve replacement 6 months postpartum, but was non-complaint and eventually became pregnant again. She is scheduled for a mitral valve repair possible replacement 2 months postpartum.

RESULTS:
NA.

CONCLUSION:
The hemodynamic changes of late pregnancy and labor uncovered previously undiagnosed valvular disease in these two patients. Clinicians should have a heightened suspicion for valvular disease in women presenting with respiratory complaints.