bluuebunny/crossref_metadata_2025_split huggingface dataset:
Marijuana Use in Pregnancy and Its Effects on Birth Weight and Gestational Age at Delivery [17R]
Authors: Howard Douglas S. , Dhanraj David , Devaiah Ganga , Lambers Donna 
Published: May 2017

INTRODUCTION:
Prior studies have suggested that marijuana exposure may affect the growth of the fetus and the ultimate birth weight of an infant but have been inconsistent in their methodologies and have shown conflicting results. This study aims to clarify any association between marijuana use and pregnancy outcomes.

METHODS:
A retrospective chart review of electronic medical records for singleton births from September 2013 through January 2015 with available urine drug screens (UDS) at initiation of prenatal care and delivery was conducted. Patients who used drugs other than marijuana were excluded. Patients were grouped into no positive UDS, positive UDS for only tetrahydrocannabinol (THC) at presentation, positive UDS for only THC at delivery, and positive UDS for only THC at both initial presentation and delivery.

RESULTS:
The incidence of marijuana use in pregnancy exclusive of other drugs as evidenced by only tetrahydrocannabinol in the urine of 2173 patients was 22.5%. Infants born to mothers who tested positive at both times during pregnancy were of lower birth weight compared to non-users [2925 gm (IQR 2522-3265) versus 3235 gm (IQR: 2900-3591), P = < 0.001]. This effect cannot be explained by earlier gestational age alone as persistent marijuana users only delivered two gestational days earlier than non-users (39 vs 39.3 weeks). Concomitant tobacco use during pregnancy was not noted to impact infant birth weight using the ANCOVA.

CONCLUSION:
Marijuana use is negatively correlated with fetal birth weight and length at birth. Additional patient education and cessation interventions should be explored.
Neonatal Outcomes by Attempted Mode of Delivery and Obstetric Intervention for Pregnancies Affected by Spina Bifida [19R]
Authors: Spiliopoulos Michail , Iqbal Sara , Reddy Uma , Landy Helain , Huang Chun-Chih 
Published: May 2017

INTRODUCTION:
To evaluate immediate neonatal outcomes of pregnancies affected by spina bifida by attempted vaginal delivery vs. cesarean section and spontaneous compared to induced labor.

METHODS:
This is a retrospective cohort study using data from the Consortium on Safe Labor study, including 228,562 deliveries from 19 hospitals across the U.S. from 2002 to 2008. All singleton pregnancies complicated by spina bifida that resulted in a live birth after 34 weeks of gestation were evaluated. Breech deliveries were excluded from the analysis. Outcomes included NICU admission, respiratory morbidity, sepsis, birth trauma, asphyxia/seizures and mortality and were evaluated according to attempted mode of delivery and spontaneous vs induced labor. Multivariable logistic regression was used to calculate adjusted OR (aOR) and 95% confidence intervals controlling for gestational age and diabetes.

RESULTS:
We identified a total of 51 patients with spina bifida in the database. Women undergoing attempted vaginal delivery were more likely to be nulliparous, less than 35 years of age, white and without a history of previous cesarean delivery (CD) (p value < 0.05) compared to women undergoing planned CD. There was no statistically significant difference in immediate neonatal outcomes between patients attempting vaginal delivery and those scheduled for CD (p=0.07 for NICU admission). No differences in neonatal outcomes of pregnancies affected by spina bifida were identified between the spontaneous labor and scheduled labor induction group.

CONCLUSION:
Neither mode of delivery (attempted vaginal vs scheduled CD) nor scheduled induction of labor had any statistically significant impact on immediate neonatal outcomes of infants with spina bifida.
Neutophil to Lymphocyte Ratio: A Marker for Preterm Labor? [21R]
Authors: Lam Melissa Chu , Hunt Jonathan , Anasti James 
Published: May 2017

INTRODUCTION:
Investigators have postulated that preterm labor may result from inflammation. Neutrophil/lymphocyte ratio (N/L) has been used as marker to determine sub-clinical inflammation and prognosis in several system disorders. The N/L is easy to obtain and inexpensive, which would allow a widespread clinical use in the evaluation of patients. We therefore hypothesis that due to inflammation, preterm patients would have higher N/L ratio compared to term controls.

METHODS:
We randomly selected patients delivered before 37 weeks (PT) and patients that delivered at term (T) during the last 10 years. Only patients in active labor were included. We compared their N/L Ratio at the time of admission to Labor and Delivery. We excluded individuals with known infection, inflammatory diseases, and hematological disorders, as well all those that received steroids at least 3 weeks prior to determining their N/L ratio.

RESULTS:
We compared 137 PT (32.4 ± 4.1 wks) and 145 T (39.2 ± 1.1 wks) patients of similar age. They differed by gravity (PT 2.8 ± 1.9; T 2.0 ± 1.4, p= 0.001), and parity (PT 0.8 ± 1.1; T 1.2 ± 0.8, p=0.001). Preterm patients had higher rates of BMI greater than 35 (PT 13.8%; T 5.5%, p=0.3), tobacco use (PT 24%, T 11%, p=0.001) and hypothyroidism (PT 10.2%; T 2.7%, p=0.001). N/L ratio was significantly elevated in preterm patients compared to those delivered at term (PT 5.9 ± 5.1; T 4.7 ± 3.2, p=0.007).

CONCLUSION:
N/L ratio appears to be elevated in preterm delivery. The clinical utility warrants further study.
Non-Invasive Hemoglobin Monitoring: A Method of Measuring Blood Loss in Cesarean Delivery? [22R]
Authors: Dermaco Amy , Chappelle Joseph 
Published: May 2017

INTRODUCTION:
Obstetrical hemorrhage is a leading cause of maternal morbidity and mortality worldwide. Prompt and accurate estimation of blood loss (EBL) is necessary to expedite the diagnosis and treatment of postpartum hemorrhage. The aim of this study is to investigate the ability of the non-invasive hemoglobin measurement to measure blood loss during a cesarean delivery (CD).

METHODS:
Term, singleton patients undergoing scheduled CD were consented for this prospective, non-blinded, observational study. The Masimo Radical-7 Pulse CO-oximeter recorded non-invasive hemoglobin (SpHb) values at baseline, continuously during the CD, and for 8 hours postoperatively. Values were then compared with hemoglobin (Hb) measurements obtained preoperatively and on postoperative day 1.

RESULTS:
Data were obtained from 13 women. Mean maternal age was 32 (25-41) and mean gestational age was 38.9 (37.6-39.6). Indications were elective repeat (n=5), repeat for > 1 prior (n=6), primary elective (n=2), and prior myomectomy (n=1). Average EBL was 938 (800-1500) and average decrease in Hb was 2.2 (0.6-3.0). EBL was not correlated to calculated blood loss (p=0.37). Average preoperative SpHb was 10.6 (9.2-12.2) and there was no difference in average postoperative SpHb measurements at 0, 1, 4, and 8 hours postoperatively (p-0.9). There was no correlation between SpHb values and blood loss.

CONCLUSION:
This study demonstrates the inability of non-invasive techniques to measure blood loss during CD. SpHb showed poor accuracy and no trending ability compared to laboratory values. These findings are supported by prior studies showing poor performance in conditions involving large changes in intravascular volume, especially during hemorrhage.
Nulliparous, Term, Singleton, Vertex (NTSV): Can We Predict Cesarean Delivery? [23R]
Authors: Seibles Shania , Rikki Baldwin , Kazzi George , Murphy June 
Published: May 2017

INTRODUCTION:
The nulliparous, term, singleton, vertex (NTSV) cesarean delivery rate has become the obstetric quality measure, as it is the most variable portion of the rise in cesarean delivery and represents low risk primary cesarean births. We hypothesize that analysis of previous nulliparous, term, singleton vertex (NTSV) deliveries will yield maternal, fetal, and/or obstetrical characteristics that are associated with increased risk for cesarean delivery.

METHODS:
Retrospective study of all NTSV births that occurred at St. Joseph Mercy Oakland Hospital during the year 2015, with the purpose of identifying factors contributing to cesarean delivery. We compared demographic, obstetrical, and neonatal data. The data were analyzed using SPSS-19 software, with categorical outcomes using the chi square regression analysis and numerical outcomes using the t test.

RESULTS:
A total of 475 cases of NTSV were included analysis. The overall NTSV cesarean delivery rate was 27.08%, with a range of 12.9% to 39.1% amongst obstetrical providers. The most common reasons for NTSV cesarean delivery were abnormal FHR tracing, 53.2%, and labor dystocia, 38.7%. The factors that were statistically significant were diabetes (LHR 7.192, P < 0.004), hypertension (LHR 14.9, P < 0.00), maternal race (LHR 5.42, P < 0.02), age in years (P

CONCLUSION:
The NTSV cesarean delivery rate is influenced by many factors, and a wide variation in incidence can be seen across obstetric providers within the same hospital system. Further research should be performed analyzing variations in obstetrical practices that may contribute to this significant difference.
Obesity and Cell Free DNA Testing [24R]
Authors: Cabrera Camila , Dean Kathryn , Teal Elizabeth , Romero Stephanie T. 
Published: May 2017

INTRODUCTION:
Cell free fetal DNA is first detected in maternal serum at seven weeks gestation and the quantity increases during pregnancy. Non-invasive prenatal testing (NIPT) can be used as a screening test to aid in prenatal diagnosis of fetal aneuploidy. Recommendations for use are limited to women at “high risk.” There are no current guidelines for use in special populations including obese women, “low risk” women, or smokers. In obese women, the amount of maternal cfDNA is greater than in non-obese women. We hypothesize that obese women will have greater rates of “no result” than lean women.

METHODS:
A retrospective review was performed evaluating all pregnant women at our institution who had NIPT drawn From 1/1/11-1/1/15 (n=805). Women with BMI between 25.0-29.9 at initial prenatal visit were excluded. Categorical variables were compared using chi square or Fisher's exact test, continuous variables were assessed using a student t test.

RESULTS:
A total of 473 women met inclusion criteria (277 obese, 196 normal weight). A larger proportion of obese women had “no result” than lean women but this was not statistically significant (3.2% vs 1.5%, p=0.24). The mean BMI in those with “no result” was 36.2+/-13.0. One obese woman had a female result on NIPT and male genitalia on ultrasound and confirmed at birth to be 46, XY.

CONCLUSION:
There was a trend toward more “no result” in obese vs lean women. A larger study is needed to further elucidate the differences in performance of NIPT for lean vs obese women.
Outcomes in Oligohydramnios: The Role of Etiology in Predicting Pulmonary Morbidity/Mortality [28R]
Authors: Hesson Ashley , Langen Elizabeth 
Published: May 2017

INTRODUCTION:
Early-onset oligohydramnios is most commonly secondary to renal-urinary anomalies (RUA) or preterm premature rupture of membranes (PPROM). We compared pulmonary outcomes between these etiologies.

METHODS:
A single tertiary care center's ultrasound database was searched for women with decreased amniotic fluid before 24 weeks gestation due to either PPROM or suspected RUA. Patients were excluded if they delivered elsewhere or if there were other major congenital anomalies or aneuploidy. Obstetrical/neonatal outcomes were recorded. Respiratory morbidity was assessed by need for oxygen at 36 corrected weeks or at hospital discharge if this occurred prior to 36 corrected weeks, or respiratory cause of neonatal death.

RESULTS:
118 identified patients included 56 with oligohydramnios secondary to PPROM and 62 with RUA. 54 women elected to terminate their pregnancies. 36.4% of PPROM and 35.0% of RUA pregnancies that remained experienced an IUFD or pre-viable delivery (n=16/44 vs.7/20; χ2=6.23e-32, p=1.00). 18.2% of the PPROM pregnancies (n=8/44) resulted in neonatal respiratory mortality, as opposed to 40.0% (n=8/20) of the RA pregnancies (χ2=2.42, p=0.12). 25.0% of prior PPROM infants required oxygen at 36 weeks/discharge (n=11/44), while 10.0% of the RUA infants did (n=2/20; χ2=2.00, p=0.25). The collective incidence of respiratory morbidity/mortality was not different between etiologies (χ2=0.06, p=0.81).

CONCLUSION:
This analysis suggests that the prognoses for oligohydramnios due to pre-viable PPROM vs. ultrasound-identified renal anomalies are similarly grave. The trend towards increased respiratory mortality in neonates with RUA warrants further investigation.
Patient Reported Experiences Associated With Mode of Delivery [37R]
Authors: Brousseau E. Christine , Danilack Valery , Matteson Kristen 
Published: May 2017

INTRODUCTION:
Patient perceived experience during labor and delivery is not often considered as a birth outcome, but a better understanding could help strengthen the physician-patient relationship and improve the experience for many women.

METHODS:
We recruited equal numbers of women with a vaginal or cesarean delivery to complete a survey during their post-delivery hospital stay and obtained additional clinical information from medical records.

RESULTS:
Among 200 postpartum women, 99 had a vaginal delivery and 101 had a cesarean delivery (59 planned and 42 unplanned). Endorsing that delivery experience was similar to what was expected differed by delivery type (p < 0.001) with more women delivered by cesarean completely disagreeing. Delivering by cesarean section was associated with increased feelings of fear (64% compared to 37%, p < 0.001), but was not associated with believing that there were any problems encountered during the labor or delivery process (19% compared to 12%, p=0.191). Compared to planned cesarean deliveries, unplanned cesarean deliveries were more likely to report that their delivery experience was not what they expected (p < 0.001), and more likely to think they had problems during labor and delivery (p=0.029), but were not more likely to report increased feelings of fear (p=0.211). Intention to breastfeed differed by delivery type and was higher in women who had a vaginal delivery (88% compared to 74%, p=0.045).

CONCLUSION:
Patient reported experiences differ by delivery type. Future research should evaluate whether patient experience in labor and delivery affects downstream outcomes such as postpartum depression and breastfeeding.
Pattern and Outcome of Obstetric Admissions Into the Intensive Care Unit of a South-east Nigerian Hospital [38R]
Authors: Ozumba Benjamin , Ajah Leonard O. , Obi Vitus 
Published: May 2017

INTRODUCTION:
Although pregnancy and labor are considered physiological processes, the potential for catastrophic complications is constant and may develop rapidly. There is growing evidence that admission of high risk patients into the intensive care unit is associated with a reduction in maternal mortality. This study was aimed at reviewing all obstetric patients admitted into the intensive care unit (ICU) of Federal Teaching Hospital, Abakaliki.

METHODS:
This was a retrospective study of all obstetric patients who were admitted into the ICU between January 1st 2012 and December 31st 2013.

RESULTS:
During the study period, there were 5176 deliveries. Over the same period there were 89 obstetric patients admitted and managed in the ICU, accounting for 1 in 58 deliveries. A total of 53 (59.0%) patients were between 21 and 30 years. The mean age was 28.4±5.8 years and most of the patients were primiparous. Two thirds of the patients were unbooked. The mean duration of admission was 4.5±3.2 days. All the patients were admitted at postpartum period. The most common indication for admission was ruptured uterus 32 (36.0%) with a case fatality rate of 18.8% and contributing 50% of the overall maternal mortality. There were 12 (13.5%) maternal deaths and booking status was significantly associated with maternal death (P = 0.046).

CONCLUSION:
The commonest indication for admission was ruptured uterus. Almost all the maternal mortalities were among unbooked patients. These maternal deaths can be prevented by booking for antenatal care and the presence of skill birth attendants at delivery.
The Impact of Pregnancy on the Work-Up of Chest Pain and Shortness of Breath in the Emergency Department [14Q]
Authors: Wagner Stephen , Waldman Ian , Kunselman Allen R. , Smith Emily , Deimling Timothy 
Published: May 2017

INTRODUCTION:
This study investigates the comparative rates of imaging studies between pregnant and non-pregnant patients who presented for emergent evaluation of angina and dyspnea.

METHODS:
All reproductive age females presenting to the Emergency Department at an academic teaching institution with a chief complaint of “chest pain” or “shortness of breath” from 2010-2015 were identified. Cohorts were divided based on pregnancy status and chief complaint. The rate of utilization was calculated for each imaging study. Rates were compared between cohorts utilizing odds ratios and p-values.

RESULTS:
Over the study period, 4,834 women were included. One hundred and seventy-four were pregnant. Pregnant patients with chest pain were significantly more likely to undergo a venous duplex (9.2% vs 1.5%), but less likely to undergo a chest x-ray (52.3% vs 85%) as compared to non-pregnant patients. The same disparity was present among pregnant patients presenting with shortness of breath: venous duplex 9.2% vs 2.7% and chest x-ray 26.15% vs 76.9% as compared to non-pregnant patients. There was no difference in the rates of chest CT imaging or MRI.

CONCLUSION:
Imaging studies are an integral adjunct for evaluation in patients reporting angina or dyspnea. Pregnancy places patients at an increased risk of severe sequelae requiring prompt diagnosis to prevent harm to the mother and fetus. The American College of Obstetricians and Gynecologists clearly states that, with few exceptions, radiography should not be withheld from pregnant patients. This study suggests that pregnant patients are significantly less likely to undergo radiography, which could place them at increased risk for delayed diagnosis and treatment.
Evaluation of Pain Management During First Trimester Surgical Abortions Using Moderate Sedation [3A]
Authors: Falik Rebecca , Alton Katie , Hathi Sejal , Semere Luwam 
Published: May 2017

INTRODUCTION:
The Green Journal has emphasized that abortions continue to be painful and has called for research into improving the comfort of therapeutic abortions (TABs). Anesthesia literature defines >4 out of 10 on the Pasero Pain Intensity Scale as unacceptable, which we refer to as “significant pain”.

METHODS:
We performed a retrospective observational study evaluating pain scores, moderate sedation dosages, and incidence of anesthetic reversal agents among all patients undergoing TAB aspiration procedures by all sixteen providers at an outpatient procedure center from 2012-2014.

RESULTS:
Of 539 patients, 16% experienced significant pain just before TAB from misoprostol placed pre-procedure, 28% experienced significant pain during the TAB procedure, and 18% experienced pain beyond their stated comfort threshold. Half of procedures started with low doses of ≤1mg midazolam and ≤100mcg fentanyl. Additional doses of fentanyl and/or midazolam were received intraoperatively by 54% of patients; these patients were more likely to report significant pain (P < .0001). Reversal agents were never needed.

CONCLUSION:
Over one quarter of patients experienced unacceptable levels of pain in this study of first trimester surgical TABs. Obstetrician-gynecologists administering conscious sedation may not be aware of under-medicating their patients. In over half of TAB cases, the provider recognized part-way through the short procedure that the patient required additional sedation. Obstetrician-gynecologists performing TABs and similar procedures such as diagnostic hysteroscopy may consider administering higher initial sedative doses, with minimal risk of oversedation. Future study of preoperative analgesia, such as ibuprofen administration concomitant with miso placement, is warranted to evaluate improvement in intra-procedural pain.
Evaluation of Postpartum Contraceptive Plan and Actual Use [4A]
Authors: Vuong Elizabeth , Chiu Chiao An , Habib Shaddi , Rafie Sally , Mody Sheila , Bayer Lisa 
Published: May 2017

INTRODUCTION:
Using effective contraception postpartum can help women achieve recommended interpregnancy intervals. This study evaluated women’s postpartum contraception plan and actual use.

METHODS:
Medical record data was retrieved for women with at least one prenatal visit and a live birth between July 1, 2014–June 30, 2015 at a single academic medical center. Of those with a postpartum visit, a random sample of 200 women was selected for retrospective chart review. Records were reviewed up to three months postpartum to identify contraceptive method plan and actual use postpartum.

RESULTS:
Data was retrieved for 2445 women meeting criteria, of whom 23.1% (565/2445) had no postpartum visit. Among the sample of women with a postpartum visit, 33.5% (67/200) of actual contraception used postpartum diverged from the prenatal plan, of whom 59.7% (40/67) changed from higher to lower effectiveness. Prenatally, 47.0% (94/200) planned to use highly effective (tubal ligation, intrauterine device, implant, lactational amenorrhea), 26.0% (52/200) effective (pill, patch, ring, injection), 22.5% (45/200) less effective (barrier), and 4.5% (9/200) no method. Postpartum, 35.0% (70/200) used highly effective, 41.0% (82/200) effective, 23.5% (47/200) less effective, and 0.5% (1/200) no method. Breastfeeding was not included in analysis. There was no difference in effectiveness of contraception used between women seeing Ob/Gyn physicians and Nurse Midwives (P=0.413). Number of prenatal visits did not influence use of highly effective contraception (P=0.945).

CONCLUSIONS:
Most women adhered to the postpartum contraceptive plan made prenatally. Over half the women who deviated from their prenatal contraceptive plan used a less effective method.
Does Age Influence Knowledge and Attitudes About Intrauterine Devices (IUDs)? [7A]
Authors: Edwards Sara , Perriera Lisa , Mercier Rebecca 
Published: May 2017

INTRODUCTION:
The IUD is considered excellent birth control, but United States usage lags behind that of similar countries. Barriers to usage include patient attitudes and lack of education, fueling misperceptions and unawareness. We sought to identify if attitudes and knowledge about the IUD vary by age.

METHODS:
From June 13 to July 18, 2016, all women in an obstetrics & gynecology outpatient office of a large urban academic medical center were asked to participate in a 94 question survey. Women were excluded if they could not read English or were younger than 14 years of age. Surveys included detailed questions about participant demographic characteristics and knowledge and opinions of IUDs. We hypothesized that older women would hold more negative opinions. We performed an exploratory bivariable analysis using t tests and chi square testing to determine which outcomes differed by participant age. For those appearing to differ significantly by age, we performed regression analysis to assess for confounding by other demographic factors.

RESULTS:
Of 1,366 women approached, 521 completed the survey. Few survey items differed significantly by age. Self-reported IUD knowledge (P=.024), having ever used an IUD (P=.009), thinking the IUD is reliable (P=.025), and agreement with the statements “IUD insertion requires surgery” (P=.046) and “Hormonal birth control is safe and effective” (P=.012) were statistically significantly different. After controlling for confounders only responses to the statement “Hormonal birth control is safe and effective” retained significance.

CONCLUSION:
Our results suggest that attitudes and knowledge about IUDs do not differ significantly by age.