bluuebunny/crossref_metadata_2025_split huggingface dataset:
Small for Gestational Age in Women With Different Degrees of Chronic Hypertensive Disease [25C]
Authors: Roman Amanda , Schoen Corina , Moreno Sindy , Duge Leanne , Berghella Vincenzo 
Published: May 2017

INTRODUCTION:
To evaluate the risk of small for gestational age (SGA) in women with chronic hypertension (CHTN) classified by severity of hypertension.

METHODS:
Retrospective cohort of women with CHTN that delivered at Thomas Jefferson University Hospital from January 2008 to June 2016. Women diagnosed with CHTN before pregnancy or during first 20 weeks of gestation, were classified in 3 groups: no antihypertensive medications, severe hypertension requiring antihypertensive medications or CHTN associated with renal disease. Primary outcome was incidence of SGA. Secondary outcomes were superimposed preeclampsia and preterm delivery (PTD).

RESULTS:
We identified 334 women with CHTN without medications, 210 women with severe CHTN requiring medication and 40 women with CHTN and renal disease. Maternal demographics and other comorbidities were not significantly different among the 3 groups. SGA less than 10th% was significantly increased in CHTN requiring medication [odds ratio (OR) 2.1 95% confidence interval (CI) 1.3-3.3] and CHTN and renal disease [OR 2.6 95% CI 1.2-5.8] when compared CHTN without medications. PTD less than 34 weeks was significantly increased in CHTN requiring medication [OR 1.6 95% CI 1.0-2.7] and CHTN and renal disease [OR 3.8 95%CI 1.8-7.9] when compared to CHTN without medications. Superimposed preeclampsia with severe features was increased in CHTN and renal disease [OR 2.0 95%CI 1.1-4.1] when compared to CHTN without medications.

CONCLUSION:
Women with severe CHTN requiring medications and CHTN with renal disease had increased risk of SGA, PTD and superimposed preeclampsia with severe features when compared with CHTN without medications.
Risk Factors for Early Preterm Birth in Women With Short Cervix Treated With Vaginal Progesterone [26C]
Authors: Boelig Rupsa , Villani Michela , Jiang Eva , Orzechowski Kelly , Berghella Vincenzo 
Published: May 2017

INTRODUCTION:
The purpose is to identify risk factors for early preterm birth (PTB), defined as less than 34 weeks, in otherwise low risk women who have a short cervix (less than or equal to 20mm) and prescribed vaginal progesterone.

METHODS:
Retrospective cohort study from 1/2012-12/2014 of singleton gestations without a history of prior spontaneous preterm birth who underwent cervical length (CL) screening between 18 0/7-23 6/7 weeks. Women with a short cervix who took vaginal progesterone were included.

RESULTS:
3,678 women were screened, 38 women (1.0%) were diagnosed with a short cervix, 31 accepted and were started on vaginal progesterone. Of the 31 women included, 11 women (36%) had an early PTB. Among women who had an early PTB, demographic characteristics and obstetric history were similar, however mean CL was significantly lower (11.9 ±4.0 vs 16.5 ±4.1, p=0.005) and the percent of women with a CL less than 15mm was significantly higher (82% vs 15%, p < 0.001) compared to those who delivered after 34 weeks. ROC curve demonstrated that CL was predictive of a PTB < 34 weeks with an area under the curve of 0.81 (p=0.005). CL less than 15mm was associated with an increased risk of PTB < 34 weeks with an odds ratio of 25.5 (95%CI 3.6-181.6).

CONCLUSION:
A cervical length less than 15mm is highly predictive of an early PTB in women with a short cervix, despite vaginal progesterone therapy. Further studies should be done in this subgroup of women to see if they would benefit from additional interventions.
Synthetic Osmotic Dilator Prior to Induction of Labor: Outcomes From International Observational E-Registry [13C]
Authors: Saad Antonio , Gupta Janesh , Maier Josefine , Hruban Lukas , Mehta Priyanka , Baev Oleg 
Published: May 2017

INTRODUCTION:
To determine rate of cesarean delivery (CD) and maternal/neonatal adverse outcomes associated with use of synthetic osmotic dilator prior to labor induction.

METHODS:
This is a multicenter international post-marketing observational study of a synthetic osmotic dilator (Dilapan-S) for cervical ripening prior to labor induction in term pregnancies. Our primary outcome was rate of CD. Data were obtained in a standardized fashion and entered into a centralized electronic data capture system for analysis.

RESULTS:
Between May 2015 and July 2016, 343 term pregnant women undergoing cervical ripening prior to labor induction were included. Median maternal age was 30 (IQR18-45) years, and average BMI was 27. 68% of participants were nulliparous, 23% had a previous vaginal delivery and 9% had previous cesarean section. The majority (64%) of women received 4-5 dilators and the CD rate was 32%. Bishop score gain was 3.7 (95% CI [3.4-3.9]) with the use of the dilator. There were no cases of uterine tachysystole or FHR abnormalities. Maternal discomfort was reported by 9% of women and the rate of chorioamnionitis was 1.5%. Meconium stained amniotic fluid was present in 11% of patients. All newborns had an Apgar score at 5 minutes ≥ 7. Arterial pH < 7.1 and neonatal intensive care admissions were < 1%.

CONCLUSION:
Compared to other cervical ripening methods, the use of synthetic osmotic dilators appears to be safe and efficient method of cervical ripening for induction of labor in term pregnant women. Randomized clinical trials are needed to compare its efficacy to other methods of cervical ripening.
Screening for Zika Virus in a High-Risk Non-Endemic Urban Population: Patient Characteristics and Testing Outcomes [19C]
Authors: Rac Martha , Eppes Catherine , Dempster Carrie , Ballas Jerasimos , Davidson Christina , Aagaard Kjersti 
Published: May 2017

INTRODUCTION:
We report the characteristics and testing outcomes of women exposed to Zika Virus (ZIKV) in a non-endemic high-risk Southern U.S. urban population.

METHODS:
This is an observational study of women referred for potential ZIKV exposure between 2/2016 to 9/2016. Women were tested according to Center for Disease Control (CDC) testing criteria. Confirmed ZIKV was defined as positive PCR on maternal serum, amniocytes, placenta or cord blood. Patient characteristics and testing outcomes were recorded.

RESULTS:
A total of 105 gravidas were referred for ZIKV exposure. Most consults were for travel or prior residence in endemic areas (90%) versus secondary exposure (10%). Sixty-one (58%) patients reported partner co-travel. Most patients (55%) visited an endemic area. Mexico was the most frequent site visited (50%), followed by Central America (31%), South America, (9,9%), and the Caribbean (13%). Twenty-one (20%) patients reported the following symptoms: fever (55%), rash (55%), conjunctivitis (40%), and malaise (10%). Seventy-five (71%) patients met testing criteria. IgM serology was sent in 72 (69%) patients and PCR in 19(25%) patients. One patient tested positive by PCR, and 7 were IgM positive, for a screen-positive rate of 11%. Ninety-seven (92%) patients underwent ultrasound surveillance. Amniocentesis was performed in 6 patients for ZIKV PCR and all were negative. No neonate has met the criteria for congenital ZIKV infection of the 48(46%) gravidas delivered.

CONCLUSION:
One in 10 women screened positive for ZIKV despite no evidence of vertical transmission. Better diagnostic testing is needed to identify patients at highest risk and decrease unnecessary interventions.
Subsequent Pregnancy Outcomes Following Use of an Intrauterine Tamponade Balloon for Postpartum Hemorrhage (PPH) [24C]
Authors: Carlson Laura , Jackson Christine , Glover Angelica , Webster Carolyn , Dotters-Katz Sarah , Strauss Robert 
Published: May 2017

INTRODUCTION:
Uterine tamponade balloons(UTB) reduce the need for invasive procedures in the setting of PPH; but subsequent pregnancy outcomes are unknown. We sought to examine subsequent pregnancy outcomes among women with PPH treated by UTB.

METHODS:
Retrospective cohort of women with diagnosis of PPH at a tertiary referral center, (1/2010-6/2016). Women with an EBL ≥1000 mL who required use of uterotonic medications, and who had at least one subsequent pregnancy were considered for inclusion. Cases defined as women whose PPH was treated with UTB; the woman immediate preceding and following each case were selected as controls. Simple statistics were used as appropriate.

RESULTS:
8 women had a subsequent pregnancy after an index pregnancy requiring UTB, and were matched to 16 controls. During the index pregnancy, cases had lower median prepregnancy BMI (22.4 vs 33.1,p=0.01), but antenatal characteristics were otherwise similar. No difference between the intrapartum characteristics of cases and controls was noted, except that the EBL was higher for cases (2000 vs 1200 mL, p=0.004), and cases were more likely to require transfusion (88% vs 31%,p=0.027). Interpregnancy intervals were similar. In subsequent pregnancy, 75% of the UTB group had documented counseling regarding risk of recurrent PPH, compared with 31% of controls(p=0.082). PPH was similar between groups(38% vs 31%,p>0.99). No woman required UTB, hysterectomy, ICU admission, or had morbidly adherent placenta in subsequent delivery.

CONCLUSION:
Use of UTB for PPH does not appear to increase risk for recurrent PPH or abnormal placentation. Until larger studies can be performed, this information offers some reassurance regarding the use UTB.
Comparing Pregnancy Outcomes in Obese Diabetic and Obese Non Diabetic Women - A Retrospective Study [33C]
Authors: Hahn Shannon , Bahamon Camila , Kuffskie Martha , Varlamov Anna 
Published: May 2017

INTRODUCTION:
The purpose of this study was to compare the pregnancy outcomes between obese pregnant women with and without diabetes.

METHODS:
Data from labor and delivery records gathered between 1/1/2010 and 9/1/2013 were studied. Women with BMI greater than 40 and with either gestational or type I diabetes mellitus (DM) were included and separated into two groups: Obese with DM (Group 1) and Obese without DM (Group 2).

RESULTS:
Compared to group 2: 23% of Group 1 delivered prematurely vs 14% (P < .05). Group 1 had cesarean deliveries 94% of the time vs 55% (P < .05). NICU admissions occurred in 14% of Group 1 vs 8% (P < .05) Neonates had a lower neonatal weight (3409 g ± 811 vs 3270 g ± 703 P < .05), slightly lower Apgar scores (7.0 ± 2.0 vs 7.4 ± 1.6) and neonatal pH (7.23 ± 0.9 vs 7.26 ± 0.18) compared to Group 2. 14 % of Group 1 patients developed preeclampsia vs 8% (P < .05). There was no significant difference in intrauterine fetal demise rates or shoulder dystocia rates between the two groups.

CONCLUSION:
In our study, women who are obese with DM had a higher risk of undergoing a cesarean section, delivering prematurely, developing preeclampsia, having a NICU admission, low fetal weight, low Apgar scores, and pH compared with obese women with no DM. This highlights the importance of recognizing and treating both obesity and DM in pregnancy as it has a large impact in both maternal and neonatal morbidity, as well as healthcare cost.
The Effectiveness of Teaching Obstetrical Respiratory Emergency Management Using Simulation [1D]
Authors: Patel Neil , Marko Emily , Nieves Kelsey 
Published: May 2017

INTRODUCTION:
The management of amniotic fluid embolism and maternal cardiac arrest requires coordinated time-sensitive teamwork skills. The study objective was to determine the effectiveness of teaching amniotic fluid embolism and maternal cardiac arrest management to residents using simulation.

METHODS:
Obstetrics and gynecology residents received instruction using a highly interactive team-based simulation curriculum for the management of amniotic fluid embolism and maternal cardiac arrest with perimortem Cesarean-Section. The curriculum consisted of a didactic session followed by high-fidelity simulations of two scenarios. A 21-point checklist was used for baseline teamwork performance assessments. Outcomes were measured using pre-post knowledge tests and confidence surveys in the management of obstetrical respiratory emergencies. Paired t-tests and repeated measures were used for data analysis.

RESULTS:
Twenty-one residents participated in the four-hour curriculum. Mean pre-post knowledge test scores demonstrated statistically significant improvement (75.0%, 94%, p less than 0.0001). Mean pre-post confidence levels rose in the management of amniotic fluid embolus (52.33%, 78.33%, p less than 0.0001) and maternal cardiac arrest (56.0%, 81.67%, p less than 0.0001). Incidentally, residents involved in the simulation curriculum experienced a real life maternal cardiac arrest with perimortem Cesarean-Section the same afternoon and commented that their experience in simulation contributed to the clinical outcome.

CONCLUSION:
Training in both amniotic fluid embolism and maternal cardiac arrest with perimortem Cesarean-Section management is essential for obstetrical providers. Interactive team-based simulation training of these events improves knowledge, performance and confidence even when exposure to real-life obstetrical respiratory emergencies is rare.
Utilizing 3D Printing Model of Placenta Percreta to Guide Obstetric Operation [3D]
Authors: Chen Jingsi , He Hong , Song Ting , Su Chunhong , Chen Dunjin 
Published: May 2017

INTRODUCTION:
Accurate antenatal diagnosis of placenta percreta condition has been employed to optimize delivery management and minimize the risk of associated complication.

METHODS:
We will report two cases about utilizing 3D printing model of placenta percreta to guide obstetrical operation. We performed magnetic resonance imaging of anatomical structures, digital 3D reconstruction, and fabrication via 3D printing. According to the 3D printing model, a multidisciplinary team planned a cesarean hysterectomy and simulated surgery operation before the operation.

RESULTS:
We made a precise operation plan and had an adequate preoperative preparation. Our operative time and the blood loss were less than the other studies. The neonatal outcome was well. For the patients, they also more easily to understand what operation was performed on them and the dangerousness of the operation before operations.

CONCLUSION:
3D printing model is a useful tool to accurate assay the placenta percreta and plan a complex operation, which is helpful for decreasing complication and improve material and fetal outcome. In the future, it maybe will be a useful tool to preoperative assessment or guiding the obstetric and gynecological complex operation.
The Effect of Surges in Patient Volume on Resource Management of an Academic Labor and Delivery Unit [5D]
Authors: Molina Rose , Gombolay Matthew , Jonas Jennifer , Shah Julie , Golen Toni , Shah Neel T. 
Published: May 2017

INTRODUCTION:
Clinical managers in charge of labor and delivery units are challenged by the need to allocate scarce resources, such as beds and nursing staff, when there are surges in patient volume. When particularly busy, managers may resort to a variety of strategies, such as calling in additional staff or delaying new admissions. The thresholds for applying strategies that preserve labor floor resources have not been previously well defined and may have significant implications for patient safety.

METHODS:
We developed a virtual labor floor environment in JAVA to simulate dynamic labor floor conditions, including the expected waxing and waning of patient acuity and volume over the course of a nursing shift. We recorded an inter-professional cohort of clinicians making resource allocation decisions over multiple simulated shifts. Using logistic regression, we determined the odds of delaying admission for patients in early labor when labor floor occupancy varied.

RESULTS:
Eight nurses played the game for 20 minutes on average, which translates to 64 simulated hours of decision-making. In a logistic regression model, we found there is an increased odds of delaying admissions for early labor as the percent of labor and delivery bed occupancy increases (unadjusted odds ratio 1.11, 95% confidence interval 1.03, 1.19).

CONCLUSION:
Early labor admissions were more often delayed with increasing bed occupancy, indicating that the care of patients on labor and delivery units may be sensitive to the total occupancy of the unit. Additional research is needed to understand the impact of resource management on patient safety.
A Novel High Fidelity Multidisciplinary Simulation Exercise to Improve Team Response to Postpartum Hemorrhage [6D]
Authors: Lutgendorf Monica A. , Miller Michael J. , Spalding Carmen N. , Morocco Kristina V. , Heaton Jason O. , Deering Shad 
Published: May 2017

INTRODUCTION:
Postpartum hemorrhage affects 4-7% of all deliveries, and remains a leading cause of maternal morbidity and mortality. Our goal was to assess provider experience with peripartum hysterectomy and improve team responses with a novel postpartum hemorrhage simulation trainer.

METHODS:
As part of an ongoing quality improvement project, we conducted a high fidelity multi-disciplinary in situ simulation exercise using a novel operative postpartum hemorrhage trainer with the capability of simulating a peripartum hysterectomy. Participants completed didactic training prior to the simulation. Simulation scenarios included an emergent cesarean delivery followed by a postpartum hemorrhage requiring activation of the massive transfusion protocol, medical and operative interventions including a hysterectomy. Participants were surveyed on their experience and comfort (using a 5-point Likert scale) with managing postpartum hemorrhage and peripartum hysterectomies.

RESULTS:
We trained 135 participants over 2 days, with 40% nurses, 34% obstetric providers, 14% anesthesia, 10% corpsmen, and 3% emergency medicine. Over 60% of obstetric participants had performed less than or equal to 5 peripartum hysterectomies. Following the simulation exercise, providers reported increased comfort managing postpartum hemorrhage, scores improved by 0.43 points, from 3.64 to 4.08, p = 0.001, 95%CI 0.33-0.54. Providers also reported increased comfort managing peripartum hysterectomies, with scores improved by 0.86 points, from 2.48 to 3.34, p = 0.002, 95%CI 0.7-1.02.

CONCLUSION:
In conclusion, peripartum hysterectomies are rarely encountered in clinical practice. A high fidelity operative simulator provides a high degree of realism, can be used to teach communication and teamwork, and improves participant comfort in managing peripartum hysterectomies.
Validation of an Affordable and Accessible Alternative Simulation Technology [7D]
Authors: Auguste Tamika C. , Benda Natalie C. , Kellogg Kathryn , Fairbanks Rollin 
Published: May 2017

INTRODUCTION:
The aim of this study was to determine the effectiveness of serious game computer simulation training in teaching electronic fetal monitoring (EFM) interpretation skills and the clinical action decisions associated with each abnormality. The use of novel technology like virtual reality, e-learning, and serious gaming can offer improvement in the learning outcomes.

METHODS:
OB/GYN nurses and physicians were randomized to either in-lab simulation group or serious game group in Phase 1 and received group-specific education on EFM interpretation and decision-making. After a minimum 3-month decay period participants completed Phase 2, a well-established in-situ team training drill in which they had to interpret EFM tracings and manage the patient accordingly. Participants were scored on their interpretations and decision-making of the EFM tracings during the in-situ team training drill. Participant scores were compared using the Student t test or Wilcoxon rank sum test. Survey results were analyzed with the Chi square test or Fisher's exact test.

RESULTS:
The primary outcome was percent correct in EFM strip interpretation and decision-making recorded during the in-situ team training sessions. In comparing overall performance between the groups, the serious game participants scored 55.8% and the simulation lab participants scored 61.6%. There were no significant differences detected (p = 0.43), however this study was under powered.

CONCLUSION:
The use of serious games in delivery of education to healthcare providers is a viable alternative to delivery of education in large simulation laboratories. Our serious game participants performed similarly to our in-lab simulation participants. Studies with larger numbers of participation are needed.
Correlation of Obstetrical Skills and Confidence Level of Skilled Birth Attendants in Rural Rwanda [8D]
Authors: Pimentel Veronica Maria , Rwab Denis , Gahima John , Rulisa Stephen , Bernstein Peter , Nathan Lisa 
Published: May 2017

INTRODUCTION:
The World Health Organization (WHO) advocates for the presence of skilled birth attendants (SBAs) at every birth to prevent or manage obstetric complications. Still, the WHO acknowledges that challenges exist relating to the education and practice of SBAs. This study aimed to evaluate the spontaneous vaginal delivery (SVD) and postpartum hemorrhage (PPH) competency of rural skilled-birth attendants (SBAs) and to assess correlation of skills scores with their confidence level.

METHODS:
A simulation-based study was conducted with a convenience sample of SBAs in rural Rwanda in September of 2015 to assess communication, evaluation, and management skills in SVD and PPH. Total correct skills scores were calculated. A score of ≥ 75% for each category was considered “competent.” Participants completed a confidence questionnaire prior to the simulation. Spearman rank correlation coefficients were calculated to assess correlation between simulation scores and confidence level.

RESULTS:
Of the 26 SBAs who participated in the study, 26.9% (7/26) were competent in SVD skills, 11.5% (3/26) were competent in PPH skills, 38.5% (10/26) reported knowing how to perform a SVD, 34.6% (9/26) reported feeling comfortable performing a SVD, 26.9% (7/26) reported knowing how to manage PPH, and 34.6% (9/26) reported knowing how to manage PPH. There was no significant correlation between the SBAs’ competency scores and their confidence level in SVD (P>.5, rs=-.14) or PPH (P>.5, rs=.25).

CONCLUSION:
The competency and confidence of SBAs in rural Rwanda appears to be low and their skills do not correlate with their confidence level. Comprehensive training is needed to enhance their skill-set.
Blood Transfusion Trends in Women With Abnormal Uterine Bleeding [14D]
Authors: Sangha Roopina , Keerthy Madhurima 
Published: May 2017

INTRODUCTION:
Blood transfusion continues to pose serious risks to recipients. The role of blood transfusion in management of women presenting with abnormal uterine bleeding is unclear and has not been studied before. The goal of this study is to determine the predictors of existing blood transfusion practice in women with abnormal uterine bleeding.

METHODS:
Retrospective chart review of women who presented to Emergency room between 2011 and 2013 with abnormal uterine bleeding and received blood transfusion. Patients with pregnancy, critical illness, cancer, bleeding diathesis and religious beliefs precluding transfusion were excluded.

RESULTS:
A total of 212 charts were reviewed. Of the women who received transfusion for abnormal uterine bleeding, 163 were between 24-60 yrs (73%), 141 were not on any hormonal therapy for bleeding (67%), 121 had no previous procedures performed (57%). 78 (37%) women were orthostatic, 21 (10%) had a hemoglobin less than 6 gm/dL, 170 (80%) had hemoglobin between 6-8 gm/dL. Patients with cardiac comorbidities were few (8%). Most women were African American (79%) and the most common etiology was Fibroids (71%). 164 (77%) women had chronic bleeding (6 months or more) and 48 (23%) had acute bleeding. 79 (37%) women had no insurance.

CONCLUSION:
Blood transfusion trends in women with abnormal uterine bleeding in the existing practice appear to be liberal. There is a need for prospective studies for implementing blood transfusion guidelines for women with abnormal bleeding and comparing outcomes of liberal versus restrictive transfusion practice in this clinical situation.