bluuebunny/crossref_metadata_2025_split huggingface dataset:
Symptoms of Obstructive Sleep Apnea in Pregnancy [17C]
Authors: Angras Kajal , Lott Melisa , Schulkin Jay , Mackeen A. Dhanya 
Published: May 2017

INTRODUCTION:
Obstructive sleep apnea (OSA) results in increased maternal and pregnancy morbidity including hypertensive disorders, preterm birth and low birth weight. Questionnaires to screen for OSA have been used in the non-pregnant population. As part of the expanded CARN study, our aim was to evaluate patient sleep patterns and presence of risk factors for sleep apnea in pregnant patients without history of OSA.

METHODS:
Women receiving prenatal care at a tertiary care center were given an anonymous survey. We ascertained age, race, pre-pregnancy body mass index (BMI), gestational diabetes, and sleep patterns.

RESULTS:
From December 2015 to May 2016, one hundred eighty-two women completed an anonymous survey. Of participants who completed the survey, 96.1% were Caucasian with a mean age of 25 and 45% were obese based on pre-pregnancy BMI. When questioned about sleep patterns, 93.4% denied a history of sleep apnea, 2.7% were unsure of a diagnosis of sleep apnea, 1.1% had pre-pregnancy diagnosis of OSA, and 2.8% did not answer. Patients reported the following sleep patterns: snoring (36.1%), being told they snore (44.3%), waking from sleep with a choking sensation (6.2%), witnessed apnea (2.2%), and falling asleep while talking to someone (7.3%).

CONCLUSION:
In our survey, more than one-third of patients had risk factors (obesity) and sleep patterns concerning for OSA. Our study highlights the importance of a need for increased awareness among obstetricians to screen for OSA. Evaluation by a sleep medicine specialist should be considered in these patients to decrease the morbidity associated with OSA in pregnancy .
Safety of Routine Use of Pharmacological Thromboprophylaxis in Post Cesarean Section Patients [18C]
Authors: Mustafa Hiba , Fuks Aleksandr , Salafia Carolyn 
Published: May 2017

INTRODUCTION:
To establish the safety of routine use of heparin and low molecular weight heparin (LMWH) for routine in post cesarean section thromboprophylaxis.

METHODS:
A case control study of all cesarean sections performed at Queens Hospital Center, NY, 1/2010 - 12/2013. 1127 patients were studied in which 924 patients were included in the study. Control group: did not receive pharmacological thromboprophylaxis - 481 patients. Case study group: received routine chemoprophylaxis - 444 patient. The primary outcomes included complications of pharmacological thromboprophylaxis: wound hematomas, secondary postpartum hemorrhage, thrombocytopenia and hypersensitivity. Secondary outcomes: other wound complications, not hematomas, and efficacy of routine use of Heparin or LMWH in preventing venous thromboembolism (VTE).

RESULTS:
There was no statistically significant increase in adverse events of grade 2 or more following routine use of heparin or LMWH after cesarean section compared to the control group. 4 cases of wound hematomas were detected in both groups (P: 0.57). No hypersensitivity or delayed postpartum hemorrhage were detected in the case study group. There were 4 cases of thrombocytopenia in the case study group in which the platelets level resolved spontaneously without intervention. Secondary outcomes: there were two VTE cases in the control group while no cases in the case study group (p: 0.68)

CONCLUSION:
Routine administration of Heparin to prevent VTE in post cesarean section patients had no significant increase in complications that would withhold providers from giving it routinely to this group of patients. Prospective studies are needed to prove the efficacy of pharmacological thromboprophylaxis in preventing VTE.
Short Interpregnancy Interval and Obstetric Outcome [22C]
Authors: Holloman Conisha , Guzman Angela , Carlan Steve , Eason Ron , Mcwhorter Jeannie 
Published: May 2017

INTRODUCTION:
The interpregnancy interval (IPI) has been reported to influence pregnancy outcomes. The purpose of this study was to evaluate the obstetrical outcomes of patients with an interval pregnancy less than 12 months compared to an interval of 12 to 43 months.

METHODS:
Retrospective analysis of all deliveries between 1/1/2012 and 9/30/2013. The IPIs were grouped as less than or equal to 12 months (Grp 1) and greater than 12 months and less than 44 months (Grp 2). Primary outcomes included NICU admissions, Cesarean rate, cord pH, Apgars at 1 and 5 minutes, birth weight (BW) and estimated gestational age at delivery (EGA). Statistical analysis included chi-square and student’s t-test (p= < 0.05).

RESULTS:
Of the 3,796 patients, group 1 included 396 patients (10.4%) and group 2 included 3400 patients (89.6%). A statistically significant difference was noted in NICU admissions, gestational age at delivery, birth weight, Apgars at 1 and 5 minutes and Cesarean rate (P less than .05). No difference was noted between cord pH (p=0.78). Significant maternal characteristics included age, body mass index), parity, race, marital status, private insurance, and Medicaid (P less than .05).

CONCLUSION:
Short interpregnancy intervals have been linked to increased risk for preterm birth, low birth weight, labor dystocia and maternal morbidity and mortality. Our study showed significant differences between short IPI vs. more prolonged spacing between pregnancies in regards to neonatal outcomes. The differences seen in maternal racial, socio-economic status may also reveal the effects of underlying disparities on this relationship.
An Effective and Practical Non-Narcotic Technique for Controlling Post-Operative Pain After Cesarean Delivery [35C]
Authors: Parker Jennifer Daif 
Published: May 2017

INTRODUCTION:
We present a case series evaluating a non-narcotic technique for controlling Post-Operative Pain after C-section to minimize narcotic usage. Traditional treatments include administration of opiates and high-dose non-steroidal anti-inflammatory medications. The use opioids have unintended consequences. According to the CDC, 47,935 opioid overdose deaths among women occurred between 1999 and 2010. In this study, we use a low level laser therapy (LLLT) device along with traditional oral pain medications to improve patient outcome after surgery.

METHODS:
Twenty patients were offered to wear an LLLT device which was placed in the operating room. This device requires no additional operative time or follow-up visits. Patients received treatment twice daily for 12 post-op days. Patients record pain on a VAS (Visual-Analog-Scale), and narcotics administration is tracked.

RESULTS:
Preliminary findings include: All patients are using less narcotics than prescribed. Overall pain decreased. All treated patients with previous C-sections report less postoperative pain than previous deliveries. Some patients have requested early discharge on postoperative day number 2. All patients are compliant and report easy application. Patients with a previous keloid scar report significantly better cosmetic result despite similar surgical technique.

CONCLUSION:
We believe this method has the potential to improve patient outcomes by reducing pain and decrease the need for narcotics, a national priority. In addition, this method meets key criteria for clinical adoption as it requires minimum training and physician time. A randomized, blinded, placebo-controlled trial is underway.
Advanced Maternal Age and Perinatal and Obstetrical Outcomes – A Population-Based Study [37C]
Authors: Liang Tina C. , Crawford Susan , Chandra Sue 
Published: May 2017

INTRODUCTION:
Our objectives are to update the existing literature on the association between advanced maternal age (AMA) and adverse obstetrical and perinatal outcomes and to determine the effect of parity on this association.

METHODS:
A retrospective cohort study was conducted using the Alberta Perinatal Health Program database including all singleton births without congenital or chromosomal anomalies at greater than 20 weeks gestation from 1998-2013. Maternal age was categorized as less than 20, 20-24, 25-30, 31-34, 35-40, and greater than 40 years. Outcomes were grouped by obstetrical and perinatal. Multinomial logistic regression models were constructed controlling for various confounders.

RESULTS:
105,067 of 690,471 total births (15.2%) were in women 35 years or greater. Compared with those 20-24, women 35-40 have increased risk of various adverse obstetrical outcomes including pre-existing hypertension or diabetes (aOR 3.40 95%CI 3.09-3.74), gestational diabetes (aOR 5.01 95%CI 4.69-5.36), preeclampsia (aOR 1.28 95%CI 1.14-1.43). Controlling for additional relevant obstetrical complications, they have increased risk of adverse perinatal outcomes including preterm birth (aOR 1.33 95%CI 1.26-1.39), low birth weight (LBW) (aOR 1.29 95%CI 1.21-1.38), and low Apgar score at 5 minutes (aOR 1.17 95%CI 1.08-1.26). Women under 20 and over 40 also have increased risk of perinatal mortality (aOR 1.35 and 1.36 95%CI 1.12-1.64 and 1.01-1.82). Compared to multiparas, primiparas have greater risk of adverse outcomes including preeclampsia, preterm birth, LBW, low Apgar score at 5 minutes and NICU admission (P<.05).

CONCLUSION:
AMA is independently associated with various pregnancy complications while primiparas have greater risk of these complications.
Postpartum Oral Glucose Tolerance Test: Predictors of Testing and Abnormal Results in a Community Hospital [39C]
Authors: Ake-Uzoigwe Rukeme , Arora Anubha , Zhang Dongping , Salafia Carolyn , Akinnawonu Kolawole , Fuks Aleksandr 
Published: May 2017

INTRODUCTION:
To evaluate the predictors of compliance to postpartum oral glucose tolerance testing (OGTT) and factors predicting diabetes mellitus or impaired glucose tolerance( IGT) postpartum

METHODS:
A retrospective cohort study of gestational diabetic patients’, who delivered from January 2013 to December 2015. Factors predicting compliance to postpartum OGTT and abnormal results was determined using logistic regression analysis.

RESULTS:
Of the 514 patients included, 178 (35%) had a postpartum OGTT; of those 7(4%) had diabetes mellitus and 16 (9%) had impaired glucose tolerance. Predictors of postpartum OGTT included: Gestational age at GDM diagnosis: 24 - 30 weeks vs. less than 24 weeks (OR=0.64 , p = 0.065), greater than 30 weeks vs. less than 24 weeks (OR= 0.54,p= 0.007); Gestational age at initiation of care: greater than 24 weeks vs. less than 24 weeks (OR = 0.58,p = 0.016); Any adverse perinatal outcome vs. none (OR= 0.63,p= 0.014); Race: Black/African vs Asian and Hispanic vs. Asian;(OR = 0.53 p= 0.009; OR= 0.63 p= 0.12 respectively). Predictors of DM and IGT were : requirement for pharmacological vs. diet control (OR = 2.9, p = 0.036); Gestational-age at diagnosis of GDM: greater than 24 weeks vs. less than 24 weeks (OR = 0.21, p= 0.001).

CONCLUSION:
Early diagnosis of GDM and early initiation of prenatal care increased odds of OGTT. Black race and having any adverse perinatal outcome predicted poor postpartum OGTT compliance. GDM patients diagnosed early antepartum and requiring medication are at higher risk of DM and IGT.
Evaluation of Clinical Simulation Curriculum to Improve Resident Performance During Maternal Code Simulation [4D]
Authors: Zimbrunes Shawn E. , Auguste Tamika C. , Duong Vi 
Published: May 2017

INTRODUCTION:
Physicians in training see far fewer code blue events than their predecessors. Structured simulation-based curricula for OBGYN residents managing obstetrical emergencies have not been thoroughly evaluated. Maternal code blue scenarios, specifically, are an area in which little educational research exists. This is a retrospective cohort study of 40 residents that were evaluated during unannounced maternal code scenarios. A simulation-based curriculum was established that included group-based simulation scenarios and small-group instructional sessions with specified objectives. Resident performance was again evaluated in the same unannounced maternal code scenarios post-curriculum.

METHODS:
Cohort A: Individual’s scores from the pre-curriculum scenarios were compared to their post-curriculum scores in order to measure the change in skill evaluations during maternal code scenarios after completing the curriculum. Cohort B: Individual’s scores from the pre-curriculum scenarios were compared to the post-curriculum scores from the same class level in order to account for the difference in skill at each class level after completing the curriculum. Pre- and post-curriculum scores were compared using non-parametric tests, such as Wilcoxon signed-rank test.

RESULTS:
Data has been submitted for statistical analysis, and final results are pending. We expect that residents completing the simulation curriculum will perform significantly better in post-training assessments when compared to baseline performance prior to establishment of a simulation-based curriculum.

CONCLUSION:
There are unique differences in responding to maternal codes specifically. Since this is an area in which there exists a deficit. this research has great opportunity to further the education of OBGYN residents in terms of preparation for management of maternal codes.
A Step Towards Optimizing Antimicrobial Utilization in Gynecologic Surgery at a Tertiary Care Center [17D]
Authors: Wallace Erika R. , Cotter Thusitha 
Published: May 2017

INTRODUCTION:
We partnered with our local Antibiotic Stewardship Program to improve evidence based utilization of antimicrobials at our institution.

METHODS:
A retrospective cohort of hysteroscopy cases performed at a single tertiary care center from August 2011 to September 2015 was studied. Descriptive statistics summarized patient characteristics and univariate analyses examined variables associated with antibiotic use. Multiple logistic regressions analyzed effects of variables on the odds of receiving antibiotics of unproven benefit.

RESULTS:
Among 1,075 women who underwent hysteroscopy for which antibiotics are not recommended, 196 (18.23%) received antibiotics. 770 (71.62%) women had a hysteroscopy alone, and 305 (28.37%) women had additional procedure(s) that also did not warrant antibiotics per guidelines from the American College of Obstetricians and Gynecologists or SCIP. At a significance level of 0.05, age (P < .0045), primary procedure (P < .0022), primary diagnosis (P < .0019), admitted year (P < .0302) and length of stay (P < .0005) had statistically significant effects on the impact of having unproven antibiotics. Non-compliance with guidelines decreased with time from 19.2% in 2010 to 11.4% in 2015 (P=.0242). Compliance among providers was 100% for those in practice < 10 years, 11.9% for those in practice >10 years and 1.2% among subspecialists.

CONCLUSION:
Non-indicated antibiotic use is high among gynecologic surgeons at our institution. Patient characteristics had, in most instances, a small effect size in contrast with more robust contributions of providers’ practice preferences. This aggregate data will be shared broadly and rapidly among individual providers with the aim of mitigating their use of antimicrobials of unproven benefit.
Effect of Bilateral Salpingectomy on Total Hysterectomy Cost: A National Inpatient Sample Analysis [18D]
Authors: Sheyn David , Billow Megan , Mahajan Sangeeta , Soriano Alex , El-Nashar Sherif 
Published: May 2017

INTRODUCTION:
Increasing prevalence of bilateral salpingectomy (BS) at time of hysterectomy has led to concern of increasing healthcare cost. A Canadian study found that salpingectomy at time of hysterectomy was associated with a lower lifetime cost than hysterectomy alone. Given the different healthcare system in Canada these findings may not apply in the United States. Our objective was to determine the cost associated with BS at time of hysterectomy based on USA healthcare data.

METHODS:
The 2013 National Inpatient Sample (NIS) was used to identify women over age 18 years who underwent hysterectomy with BS for benign indications. The primary outcome was higher cost defined as cost above the median. Stepwise multivariate regression analysis was used to evaluate the effect of co-variables on cost of hysterectomy. Statistical analysis was performed using JMP 10 (SAS, Carey NC).

RESULTS:
18,717 hysterectomies with BS were identified, of these 17.1% were laparoscopic, 11.2% were robotic, 58% were abdominal and 14.2% were vaginal. For all types of hysterectomy, BS was associated with a median increase in cost of $1193 ($685-$1701). For vaginal hysterectomy, the median increase in cost was $2080 ($1733-$2427). Robotic, abdominal and laparoscopic hysterectomy were all associated with an increase of less than $75 if BS was performed. Only vaginal hysterectomy was associated with a statistically significant increase in risk of hysterectomy cost being above the median (aOR = 1.57, p=0.01).

CONCLUSION:
Bilateral salpingectomy at time of vaginal hysterectomy is more likely to be associated with an increase in cost of hysterectomy.
The Association Between Fibroid Weight and Perioperative Outcomes for Women Undergoing Myomectomy [23D]
Authors: Sappenfield Elisabeth , Miladinovic Branko , Sarkar Papri , Imudia Anthony , Mikhail Emad 
Published: May 2017

INTRODUCTION:
Myomectomy is a preferred surgical approach in reproductive age women desiring to preserve fertility. Fibroid weight impacts the decision making regarding surgical approach. Primary objective is to examine the association between fibroid weight and the 30-day perioperative outcomes for women undergoing myomectomy.

METHODS:
Data for this retrospective review was obtained from the American College of Surgeons-National Surgical Quality Improvement Project database using Current Procedural Terminology and categorized by fibroid weight. Women over the age of 18 who underwent abdominal or laparoscopic myomectomy from 2005-2014 were included. A mixed-effects logistic regression analyses were performed to analyze the effect of fibroid weight on surgical approach and 30-day postoperative outcomes, and to control for confounding factors including age, race, and surgical approach.

RESULTS:
A total of 2,862 women underwent myomectomy; 1203 (42%) patient with fibroids weight less than 250gm, and 1659 (58%) patients with fibroids greater than 250gm. Presence of fibroids weighing more than 250gm was associated with less utilization of laparoscopic route 36.9% versus 63.1% [ORadj (95%CI)] [0.585 (0.471, 0.725)], longer operative time 150m versus 118m [ORadj (95%CI)] [1.006 (1.004, 1.008)], increased likelihood of blood transfusion 67% versus 33% [ORadj (95%CI)] [1.696 (1.231, 2.336)], and total length of hospital stay 2d versus 1d [ORadj (95%CI)] [1.087 (1.012, 1.167)]. There was no significant difference in surgical site infection and readmission rate by fibroid weight.

CONCLUSION:
Increased fibroid weight was associated with increased risk of longer operative time, blood transfusion, and total length of hospital stay. Laparoscopic myomectomy was less likely utilized for fibroids greater than 250gm.
Pre-Surgical Huddles Improve Operating Room Efficiency and Teamwork [25D]
Authors: Hullfish Kathie , Morris Keith , Hall Elizabeth , Rich George 
Published: May 2017

INTRODUCTION:
Background: In the operating room (OR), new technologies, space and capacity demands, as well as competing resources place a premium on eliminating waste and improving efficiency. The objective of this quality improvement pilot initiative was to assess the impact of a pre-surgical team huddle on first time starts, turnaround times, and case duration. Our secondary aim was to assess team member satisfaction pre-and post-intervention.

METHODS:
For one urogynecologic surgeon in the outpatient OR, we measured the proportion of first case starts, average turnaround time, and average case length duration ten months before (n=37) and twenty months after (n=101) the implementation of a team pre-surgical huddle. The huddle was led by the attending surgeon at 7am with the entire surgical and anesthesia team, to discuss specific patient and equipment needs, as well as potential safety concerns, for all cases that day.

RESULTS:
The proportion of first case starts improved from pre to post intervention (90% to 100%, p = 0.10), turnaround times decreased (30.5 to 28.4 mins, p = 0.14), and overall case length remained essentially unchanged (92.7 to 93.8 min, p = 0.44). Most importantly, the OR team reported value in the project in terms of enhanced teamwork and communication, and personnel involved in this pilot study have rolled out the project to other service lines at our institution.

CONCLUSION:
Conclusion/Implications: A pre-surgical huddle was associated with modest improvements in OR efficiency and teamwork. Further research is needed to assess the impact of huddles on patient outcomes and provider satisfaction.
Blood Pressure Trends in Pregnancy: Is There a New Normal? [29D]
Authors: Benham Joshua , Ganju Nihar , Sheth Sheetal , Marko Kathryn 
Published: May 2017

INTRODUCTION:
Few studies have explored blood pressure (BP) trends in pregnancy and the postpartum period. The accepted belief is that BP in pregnancy stays close to non-pregnant values (120/80mmHg). Studies also suggest variance between clinic and home based BP measurements. In this report, we describe the use of digital health technology to gather weekly BP values and better track BP trends in pregnancy.

METHODS:
Retrospective analysis was conducted of pregnant patients enrolled in the first trimester from 12 university-affiliated clinics. Patients received a digital sphygmomanometer and were asked to check home-based blood pressure at least weekly. BP averages were categorized by pre-pregnancy body mass index (BMI).

RESULTS:
381 patient records had complete blood pressure data for the entire pregnancy totaling 8101 data points. Mean systolic BP was 101 mmHg (±11.3) for BMI < 18.5, 106 mmHg (±10.8) for BMI 18.5-24.9, 112 mmHg (±10.6) for BMI 25-29.9, 117 mmHg (±11) for BMI 30+. An ANOVA analysis demonstrated significant differences between weight classes (p < 2.8e-34). Mean systolic BP was higher in clinic vs at home except in the obese class.

CONCLUSION:
Mean systolic BP may be lower in pregnancy and increases significantly with increasing BMI. BP collected at home is frequently lower than clinic measurements and may be a more accurate reflection of “normal” BP. We plan to analyze this data to identify norms for each trimester. Further study of high frequency at-home BP monitoring is needed to improve our understanding of blood pressure trends in pregnancy.