bluuebunny/crossref_metadata_2025_split huggingface dataset:
Variation in Outcome Reporting in Cardiac Arrhythmias and Aortopathies in Pregnancy [17K]
Authors: Thurman Robin , Zaffar Nusrat , Sayyar Parastoo , Silversides Candice , Murphy Kellie , D'Souza Rohan 
Published: May 2017

INTRODUCTION:
Variation in outcome reporting undermines the usefulness of research as comparisons cannot be drawn when definitions are not standardized. This study aimed to review outcomes reported in studies on pregnant women with cardiac arrhythmias and aortopathies, with a view to developing a core outcome set for future studies in this area.

METHODS:
A search strategy was designed for MEDLINE, Embase and Cochrane Central databases from 1980 to 2015 to identify studies in pregnant women with arrhythmias and aortopathies. Two reviewers independently assessed titles and abstracts and discrepancies were reviewed by a third reviewer for the final decision on inclusion.

RESULTS:
After removing duplicates, 3118 titles and abstracts were reviewed and 485 articles involving pregnant women with congenital or acquired cardiac disease were identified. Of these, there were 12 studies on aortopathies and ten on arrhythmias. Overall, 77 outcomes were listed in the arrhythmia group, the most common being: cardiac event (7), syncope (4) and spontaneous abortion (3); 83 outcomes were used in studies on aortopathies, preterm delivery (8), increase in aortic root diameter (6), and abortion (6) being the three most common. The definition of outcomes differed significantly between studies.

CONCLUSION:
A large number of inconsistently reported outcomes were identified in studies involving pregnant women with arrhythmias and aortopathies. A core outcome set for cardiac disease in pregnancy, in particularly arrhythmias and aortopathies is in the process of being developed for international use in clinical and research settings.
Expectant Management vs. Induction of Labor in Women With Severe Proteinuria in Preeclampsia [20K]
Authors: Speranza Rosa , Savitsky Leah , Luck Marissa , Burwick Richard , Caughey Aaron B. 
Published: May 2017

INTRODUCTION:
A 2013 report from the American College of Obstetricians and Gynecologists (the College) task force removed greater than 5g proteinuria in a 24-hour urine collection from the severe symptoms list for preeclampsia. We sought to determine the perinatal outcomes following implementation of this guideline.

METHODS:
A decision analytic model was created using TreeAge software. Our study compared induction of labor (IOL) at 34 weeks gestation with expectant management from 34-37 weeks gestation. For each week of expectant management, we calculated the rate of spontaneous delivery and risk of developing severe symptoms. Utilities were included with a discounted life expectancy rate of 3% to produce quality adjusted life years (QALYs). Our theoretical population included 100,000 pregnant women with mild gestational hypertension, greater than 5 g protein in a 24-hour urine collection and no other severe symptoms. We analyzed both neonatal and maternal outcomes.

RESULTS:
Expectant management based on the new guidelines resulted in 23,068 cases of progression to or complications of severe disease, 3 additional maternal deaths, and 10 more stillbirths. Conversely, IOL at 34 weeks resulted in 440 more neonatal deaths and 355 more cases of cerebral palsy.

CONCLUSION:
Our model and analysis support the updated College guideline for expectant management of women with mild hypertension, greater than 5 g proteinuria and no other severe symptoms. Although expectant management leads to higher rates of maternal death, stillbirths, and adverse maternal events, the significant rates of cerebral palsy and neonatal death in preterm delivery at 34 weeks support expectant management over IOL at 34 weeks.
Exploring Racial Disparities in Preterm Neonatal Outcomes in the Neonatal Intensive Care Unit (NICU) [21K]
Authors: Townsel Courtney , Keller Rebecca , Kuo Chia-Ling , Campbell Winston , Hussain Naveed 
Published: May 2017

INTRODUCTION:
Racial disparities exist in pregnancy outcomes and infant mortality. We explored whether in-hospital morbidity or mortality differed by race for preterm neonates admitted to a single academic institution's NICU.

METHODS:
Retrospective cohort analysis of preterm infants, under 37 weeks, within NIS-3 database from 1994-2009. Anomalies and aneuploidy were excluded. Primary outcome was death before discharge. Secondary outcomes were respiratory distress syndrome (RDS), interventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC). Planned sub-analysis of very preterm (VPT) infants, under 28 weeks, was performed. Four racial groups were compared with odds ratio compared to Caucasian neonates (CN). Logistic regression was performed with P-value less than 0.05 significant.

RESULTS:
4,802 neonates were included. There was no difference across racial groups (RGs) in death before discharge (p=0.106). Mixed neonates had a 60% increased risk of in-hospital death (IHD) compared to CNs [OR 1.60 (1.05-2.40), p=0.026]. There was a significant reduction in RDS for all three RGs compared to CNs (p=0.004). There was no difference between RGs for IVH (p=0.280) or NEC (p=0.099). In the VPT cohort IHD, RDS and NEC did not differ across RGs (p=0.151, p=0.538, p=0.905, respectively). There was a significant increase in IVH across VPT RGs (p=0.038). Asian neonates accounted for majority of IVH morbidity compared to CNs [OR 3.21 (1.09-9.07), p=0.029].

CONCLUSION:
IHD does not differ across RGs in preterm neonates admitted to the NICU. CNs have a higher rate of RDS than other RGs.
A Fertility Sparing Surgical Treatment of Cornual Ectopic Pregnancy [22K]
Authors: Sadek Seifeldin , Ravins Claudia , Vallejo Victoria , Dad Nimra 
Published: May 2017

INTRODUCTION:
The mainstay of treatment for cornual pregnancy has been laparoscopic cornuostomy versus cornual resection. The purpose of this study was to achieve a safe and accessible treatment option for patients with cornual ectopic pregnancy, without compromising future fertility.

METHODS:
Two pregnant women diagnosed with cornual ectopic pregnancy were identified by ultrasound (US). Both were initially treated using methotrexate (MTX). After the failure of medical treatment, both underwent fertility-preserving surgery. The pelvis was accessed laparoscopically, 100 ml of vasopressin (dilution of 1:20) was injected into the myometrium at the base of the cornual ectopic pregnancy. After blanching of the cornual pregnancy was observed, using the operative hysteroscope, the cornual pregnancy was dislodged with alligator grasping forceps. A suction curettage was then performed, removing products of conception. A Beta-hCG was measured at postoperative day (POD) 1 and 28.

RESULTS:
Both patients tolerated the procedure well, with an estimated blood loss of less than 50 ml and an average OR time of 1H40 min. Both patients had a decrease in β-hCG by greater than 15% on POD 1 and were discharged the same day. On POD 28, Beta-hCG was less than 5 mIU/ml in both patients.

CONCLUSION:
The simultaneous use of laparoscopic and operative hysteroscopy in the treatment of a cornual ectopic pregnancy have been reported. The use of this technique reduces intra-operative bleeding and theoretically decreases the risk of rupture in future pregnancies. This modality, however, may not be used in all cornual pregnancies, especially in patients who already have hemoperitoneum.
Expression and Regulation of Anti-angiogenic Genes and Pro-angiogenic Genes in Human Trophoblast [23K]
Authors: Amezquita Fernando Aguirre , Smith Trenae , Schroeder Mark , Ismaeel Haneen , Torry Donald 
Published: May 2017

INTRODUCTION:
Placental hypoxia during preeclampsia contributes to high expression of anti-angiogenic genes like sFlt-1 (Soluble fms-related tyrosine kinase-1) and inhibition of pro-angiogenic genes: PGF (Placental growth factor) and VEGF (Vascular endothelial growth factor). Recent studies suggest choline supplementation during pregnancy could decrease levels of sFlt-1 in maternal serum. The aim of this study is to evaluate angiogenic gene expression of human trophoblast under hypoxic conditions and determine if choline supplementation could modify aberrant gene expression.

METHODS:
Human trophoblast cell lines and placental villus explants collected from normal term placentae were cultured under normoxic and hypoxic conditions. Expression of sFlt-1, VEGF, PGF, and GCM1 (Glial cell missing homolog 1) was evaluated with real-time polymerase chain reaction. 5-Aza-2-deoxycytidine (5-AZA) was used to determine the effects of de-methylation on Flt-1 gene expression in the cell lines. Increasing concentrations of choline from 32 µM to 132 µM were used to treat explants.

RESULTS:
Expression of sFlt-1 in human trophoblast cell lines was lower than in primary trophoblast. Culturing cell lines in 5-AZA increased their expression of sFlt1. Treatment of explants with different choline concentrations under hypoxic conditions had limited effects on the expression of sFlt-1, VEGF, PGF and GCM1.

CONCLUSION:
These results suggest that trophoblast cell lines may regulate sFlt-1 gene expression differently than normal tissue. Hypoxic conditions tended to increase sFlt-1 and VEGF expression and inhibited PGF and GCM1 expression in explants. Choline supplementation seems to have limited effect on reversing hypoxic expression patterns of these genes in vitro. Further studies in primary trophoblast are needed.
Does IVF Treatment (Autologous and Donor Oocyte) Improve Pregnancy Outcomes in Women 40 Years and Older? [24K]
Authors: Savasan Zeynep Alpay , Heasley Emily , Abdulahad Aseel , Zeb Amna 
Published: May 2017

INTRODUCTION:
Determine perinatal outcomes in women older than 40 years with IVF treatment (autologous and donor oocyte) compared with spontaneous pregnancy (SP).

METHODS:
Retrospective case control study of singleton pregnancies with maternal age 40 years and older between 2012-2014. Adverse perinatal outcomes included preterm delivery (PTD), hypertensive disorders of pregnancy (HDP), cesarean section (CS), gestational diabetes (GDM), intrauterine growth restriction (IUGR) and fetal loss (IUFD). Composite neonatal outcomes (CNO) included respiratory distress, intraventricular hemorrhage, necrotizing colitis, jaundice, NICU admission and neonatal death.

RESULTS:
Among 249 patients, 102 were IVF conceptions. Median maternal age (years) was 41 (40-50) for SP and 43 (40-52) for IVF (p>0.05). Logistic regression showed OR for PTD 2.3 (95% CI:1.1-4.7; p=0.024), HDP 2.5 (95% CI:1.2-5.1; p=0.016), CS 2.8 (95% CI:1.7- 4.7; p < 0.0001), CNO 3.1 (95% CI:1.7-5.8; p < 0.0001) in IVF pregnancies. These remained statistically significant after adjusting for maternal age. The risk of GDM, IUGR and IUFD was not significantly different between the two groups. Out of 102 IVF conceptions, 47 used donor eggs. These outcomes were not significantly different between donor and autologous oocyte pregnancies.

CONCLUSION:
IVF treatment is associated with adverse maternal and neonatal outcomes whereas oocyte donation does not improve these outcomes in women 40 years and older.
Does HgA1C Correlate With Birth Weight and Other Neonatal Outcomes in Gestational Diabetics? [28K]
Authors: Dinglas Cheryl , Muscat Jolene , Heo Hye , Boryushkina Varvara , Islam Shahidul , Vintzileos Anthony 
Published: May 2017

INTRODUCTION:
Gestational diabetes has been associated with adverse neonatal outcomes. The objective of the study was to determine if third trimester glucose control, determined by HgA1C, is correlated with birth weight or other adverse neonatal outcomes.

METHODS:
A prospective cohort trial was performed at a single institution from 2/2013 to 1/2016. Gestational diabetics were enrolled and had a HgA1C within 4 days postpartum as an indicator of glucose control in the third trimester. Exclusion criteria included multiple gestations, delivery before 34 weeks, and chronic steroid use. Fetal growth was determined by a ratio of observed to expected birth weight (90th %) for gestational age, (O/E BW ratio). Linear regression analysis determined association between HgA1C and O/E BW ratio. Wilcoxon rank sum test assessed the correlation between HgA1C and neonatal intensive care unit (NICU) admission, respiratory distress syndrome (RDS), hypoglycemia, and hyperbilirubinemia.

RESULTS:
Sixty-eight women enrolled had an immediate postpartum HgA1C drawn. Mean pre-pregnancy BMI was 29 +/-6 kg/m2 and mean HgA1C was 5.6% +/- 0.6%. There was a statistically significant correlation between HgA1C values and O/E BW ratio, r= 0.509, p < 0.001. The optimal HgA1C cutoff, corresponding to an O/E BW ratio of 1, was 5.77%. HgA1C did not differ among neonates admitted to the NICU, or with a diagnosis of RDS, hypoglycemia, or hyperbilirubinemia.

CONCLUSION:
In a cohort of well-controlled gestational diabetic women with a normal mean HgA1C, a positive correlation was found between HgA1C and O/E BW ratio. Strict diabetic control with HgA1C less than 5.77% may prevent fetal overgrowth.
Factors Associated With Enhanced Availability of Zika Virus Testing Information on Health Department Websites [29K]
Authors: Rivera Joshua O. , Page-Ramsey Sarah , Rodriguez Emma , Menchaca Ryan , Ireland Kayla , Ramsey Patrick 
Published: May 2017

INTRODUCTION:
Our objective was to evaluate factors associated with increased Zika virus testing information on health department websites in the United States and its territories.

METHODS:
We reviewed each US state, District of Columbia, and territory (Puerto Rico, Guam, US Virgin Islands, American Samoa, North Marianas Islands) health department websites for information on Zika virus testing. Websites were grouped as either having Zika testing information or not. Factors potentially associated with the presence of testing information on websites were compared between groups, including birth rates, presence of the Aedes mosquito, presence of Zika cases in the state/territory, and designation as a border state/territory.

RESULTS:
71% of 56 state/territory websites had Zika testing information. Mean birth rates were similar between those states with testing information and those without (12.2/1000 vs 13.8/1000, p=0.06). Websites with Zika testing information were more likely to be in areas with Aedes mosquitoes (92.5% vs 62.5%, p=0.01) and to have documented Zika cases (97.5% vs 68.8%, p=0.006) compared to those without information. Designation as a border state/territory did not impact likelihood of Zika testing information on the website (12.5% vs 25.0%, p=0.26).

CONCLUSION:
Zika testing information is more likely to found on state/territory websites where the Aedes mosquito is present and where Zika cases have occurred. Birth rate and border status do not impact the presence of Zika testing information on the state/territory website.
Factors Associated With Induction of Labor Among Primiparous Women Delivering at Term in the LTM III Study [30K]
Authors: Patel Divya , Davidson Christina , Salahuddin Meliha , Lakey David 
Published: May 2017

INTRODUCTION:
Induction of labor (IOL) is an increasingly common obstetrical procedure in the U.S., yet characteristics associated with IOL among primiparous women delivering at term are not well understood.

METHODS:
Data from the Listening to Mothers III study, a survey of women ages 18-45 who delivered singleton babies in U.S. hospitals in 2011-12, were utilized. Weighted logistic regression models examined predictors of IOL among 924 primiparous women with term deliveries. Associations of maternal characteristics with delivery route (cesarean and vaginal delivery) were examined among primiparous women induced at term.

RESULTS:
423 (45.8%) primiparous women who delivered at term underwent IOL; subjective/non-medical reasons were reported by 53% of induced women. Women who were married (OR=1.8), felt pressure from a provider for IOL (OR=3.5), and whose provider was concerned about size of the baby (OR=1.9) were significantly more likely to undergo IOL. Nearly 30% of primiparous women who underwent IOL at term had cesarean delivery. Among induced women, those who were overweight/obese (OR=4.9), felt pressure from a provider for cesarean delivery (OR=9.0), believed that childbirth should only be interfered with if medically necessary (OR=2.2), and whose provider suspected the baby might be getting large near end of pregnancy (OR=2.9) were significantly more likely to have cesarean delivery.

CONCLUSION:
In this study, nearly half of primiparous women with term deliveries underwent IOL, with a sizeable proportion reporting subjective or non-medical reasons for induction. A better understanding of characteristics associated with IOL at term may help reduce unnecessary intrapartum interventions and, ultimately, primary cesarean delivery.
Factors Associated With Multiple Organ Dysfunction Syndrome in Patients With Obstetric Hemorrhage in Critical Care [31K]
Authors: Eliana Montoya , Carrizosa Jorge , Nino Reinaldo , Castro Alejandro 
Published: May 2017

INTRODUCTION:
Obstetric hemorrhage is one of the leading causes of death in obstetric patients in developing countries. Every year, 14 million cases of obstetric hemorrhage occur globally, 1% of them dies. Multiple organ dysfunction syndrome (MODS) occurs between 7% to 15% of patients and has a 90% mortality when three or more organs are affected.

METHODS:
The aim of this study was to determine the risk to develop MODS in patients with obstetric hemorrhage using laboratory results at critical care unit admission. A retrospective case-control study was conducted in four university hospitals in Bogota, Colombia, between 2008 and 2014. Logistic regression analysis was conducted.

RESULTS:
We collected information from 277 cases and 558 controls. Of them, 84.9% was pregnant and 15.1% in the puerperium. The mean age was 27.8 years old (SD 7.3) and mean gestational age was 32.1 weeks (SD 7.1). Hemorrhage was the second most frequent diagnosis (12.2%). Multivariate analysis of hemorrhage diagnosis identified factors associated with MODS: creatinine levels equal or greater than 0.65 mg/dL (OR 1.8 95%CI 1.4-5.3; p < 0.003), platelets equal or less than 200.000 mm3 (OR 2.1 95%CI 1.4-3.2; p < 0.000), aspartate aminotransferases equal or greater than 80 (OR3.3 95%CI 1.7-6.6; p < 0.001), alanine aminotransferase equal or greater than 40 (OR 1.9 95%CI 1.1-3.3; p < 0.019) and total bilirubin equal or greater than 0.8 (OR 1.8 95%CI 1.1-3.0; p < 0.016).

CONCLUSION:
In patients with obstetric hemorrhage, platelet count, serum creatinine, and liver function test can be associated with MODS, even at values considered as normal.
Does Delivery Method Affect Neonatal Outcomes in Diabetic Women? [32K]
Authors: Varvoutis Megan , Shepherd Megan , Borgstadt Ashley , Leaphart Lynn , Baker Arthur 
Published: May 2017

INTRODUCTION:
Prior studies have provided valuable findings regarding neonatal outcomes of diabetic mothers. Research has evaluated delivery methods and neonatal outcomes in the general population. Few studies have combined these factors and analyzed the association between delivery method and neonatal morbidity in pregnancies complicated by diabetes mellitus. We sought to determine whether a difference in neonatal outcome exists in the glucose intolerant patient by the type of delivery method.

METHODS:
This is a retrospective cohort study of glucose intolerant women comparing neonatal morbidity based on delivery method. Inclusion criteria were singleton, ≥37 weeks EGA pregnancies with glucose intolerance (pregestational and gestational). Patients diagnosed with congenital fetal anomalies were excluded. Patients were placed into two primary groups: vaginal delivery and cesarean delivery. The primary outcome was a composite of neonatal complications including hyperbilirubinemia, hypoglycemia, NICU admission, respiratory distress syndrome and birth trauma.

RESULTS:
The analysis included 413 eligible women (NSVD, n= 175; CS, n=238). The composite outcome of neonatal morbidity was not significantly increased in women delivered by cesarean section (33.1% vs. 33.2%; p=0.99). Subgroup analysis showed no significant difference in neonatal outcomes in spontaneous and induced vaginal delivery (40.7% vs 29.9%, p=0.15) or scheduled and failed IOL cesarean section (30.4% vs 37.0%, p=0.29).

CONCLUSION:
No significant increase in neonatal morbidity was observed in a particular delivery method. Failed induction of labor was not associated with worse neonatal outcomes. This information may be used for improved patient counseling. Further prospective studies evaluating delivery methods, failed induction of labor and neonatal outcomes are warranted.
Utilization of Placenta Examination in Extremely Obese Pregnant Women; Would It Assist in Improving Prenatal Care? [33K]
Authors: Mariona Federico , Plymel Tryston , Zoma Melody 
Published: May 2017

INTRODUCTION:
Maternal obesity is associated with suboptimal perinatal outcome. Abnormal placenta structure and function have been reported in association with an inflammatory response present in maternal obesity. Our study explores the clinicians' use of placenta pathology in extremely obese pregnant women (body mass index ≥ 50 Kg/m2 BMI) to improve future prenatal care.

METHODS:
Post-hoc analysis of a limited patient cohort. Prenatal care was provided by Obstetrician Gynecologists and Resident physicians. Institutional Review Board approval was obtained. The placenta was examined at the time of delivery and submitted to the pathology laboratory. Macroscopic and microscopic evaluation was conducted by Board certified pathologists.

RESULTS:
The study was conducted between July 1, 2015 and July 31, 2016 included 4,527 live births; 797 placentas were submitted for evaluation (17.6 %). Two percent (n=58) were in the extreme obese class and 23 placentas of this group were submitted (39.6%). Mean maternal age 29.6 years, mean BMI 56.3 Kg/m2. Gestational age at delivery 27 6/7 to 40 6/7 weeks' gestation. Cesarean delivery 95.6 %. 52% of the placentas were large and 43.7 % small for gestational age. Hypertension in 43% and diabetes in 21.7 %. Preterm birth occurred in 43.4 % where 60% of the placentas were between the 5th and 25th percentile for gestational age. 22 % showed histologic chorioamnionitis. No predominant placenta histologic pathology was reported in the cohort.

CONCLUSION:
The findings reported to the clinicians provided no useful information to modify the prenatal care in a future pregnancy.