bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Standardized Nurse Initiated Protocol to Improve Management of Severe Hypertension in Pregnancy [29L]
Authors: Miller Michael J. , Butler Patricia , Drake Elizabeth , Taylor Anne , Lutgendorf Monica A. 
Published: May 2017

INTRODUCTION:
Hypertensive disorders are a leading cause of morbidity and mortality. We developed a standardized nurse driven hypertensive protocol to improve management in pregnancy.

METHODS:
We developed a standardized nurse initiated protocol for management of severe hypertension. The protocol used nifedipine, hydralazine or labetalol sequentially. Data on time from severe blood pressure (BP) to treatment with medication, effect of treatment, and BP monitoring was collected for 3 months prior to the protocol and compared to data after.

RESULTS:
We collected data on patients before (n=47) and after the protocol (n=37). The mean time to treatment of severe BPs was significantly shorter after protocol implementation (19.6 minutes), compared to before (36.9 minutes), t=3.1, p=0.002. There was also a significantly lower mean time to repeat BP (12.8 minutes) after protocol implementation compared to before (15.7 minutes), t=2.3, p=0.02, and the maximum time to repeat BP measurement decreased, from 300 minutes before to 76 minutes after. We also noted more women (89.5%) were treated within 1 hour after the protocol compared to 35% before the protocol and more women were given oral nifedipine (67%) after the protocol compared to only 4% prior to the protocol. However, there was no significant difference in mean time to blood pressure control after protocol implementation (50.3 minutes) comparted to before (67.5 minutes), t = 1.8, p = 0.08.

CONCLUSION:
Implementation of a standardized protocol for the treatment of hypertensive emergency decreased time to treatment, decreased variation and decreased maximum time to repeat BP measurement.
Uterine Leiomyoma Do Not Appear To Be a Risk Factor for Shortened Cervical Length [30L]
Authors: Lam Melissa Chu , Quinn Sara , Wong Christina , Evans Chelsey , Row Kelsey , Wayock Christopher 
Published: May 2017

INTRODUCTION:
Several studies report an increased incidence of preterm delivery (PTD) in patients with uterine leiomyoma (UL). A shortened cervical length (CL) is risk factor for PTD, although universal CL screening is not yet advocated nationally. CL studies in pregnancies complicated by UL have suffered from small sample size or lack of accurate CL measurements. Therefore it is not well known whether the risk of PTD in those women with UL can be appropriately screen utilizing CL. Therefore, we reviewed our data on transvaginal (TVS) CL in those patients with UL.

METHODS:
We performed a retrospective review of patients found to have UL on routine second trimester anatomic survey ultrasounds after establishing a CL screening program. Patient demographics, UL (number and size), TVS-CL and pregnancy outcomes were collected.

RESULTS:
We obtained data on 224 antepartum patients with UL. Mean age was 34.9 ± 4.9 y, and BMI 29.1 ± 6.6 kg/m2. Prior PTD was noted in 21/224 (9.3%). Multiple UL were noted in 67/224 (29.9 %) with an individual's largest UL diameter of 4.5 ± 2.6 cm. Screening occurred at 21 ± 3.2 wks. Mean TVS-CL was 3.9 ± 0.8 cm. Shortened cervix (less than 2.5 cm) occurred in 2/224 (0.9%). Delivery less than 37 weeks occurred in 38/224 (17%) and before 35 weeks in 18/224 (8%). The cesarean delivery was performed in 85/224 (37.9%).

CONCLUSION:
TVS-CL in pregnancies complicated by UL do not appear to be significantly shortened. However, the incidence of PTD in patients with UL remains increased compared to national rates.
Disparities in Postnatal Treatment of Congenital Renal Anomalies [31L]
Authors: Block-Abraham Dana , Seravalli Viola , Miller Jena , Segev Dorry , Baschat Ahmet , Kucirka Lauren 
Published: May 2017

INTRODUCTION:
Congenital renal anomalies (CRAs), including dysplastic kidneys, lower urinary tract obstruction, and infantile recessive polycystic kidney disease, are often identifiable on antenatal ultrasound and generally confer a poor prognosis for the affected fetus. We sought to evaluate social determinants influencing the postnatal course of infants with CRAs.

METHODS:
900 infants with CRAs who developed end-stage renal disease (ESRD) in the first 6 months of life between 1995-2012 were identified in the United States Renal Data System. This information was then linked to the Social Security Master Death File and the United Network for Organ Sharing. Cox proportional hazards models were used to examine associations between race, insurance, and 1) survival and 2) receipt of a kidney transplant.

RESULTS:
Survival: Black infants with CRAs who developed ESRD in the first 6 months of life had a 1.34-fold higher hazard of death compared to white infants, even after adjusting for insurance type (p=0.02). Private insurance was associated with a non-significant 0.84-fold lower hazard of death. Receipt of a Kidney Transplant: Black and Hispanic infants had 0.59 and 0.79-fold lower rate of transplant compared to white infants, respectively (p < 0.02), even after adjusting for insurance type. Patients with private insurance had a 1.3-fold higher rate of transplant compared to those with public or no insurance (p < 0.001).

CONCLUSION:
Significant racial disparities exist in the outcomes of CRAs. More research is warranted to discern what patient-level factors are contributory. Outcomes of CRAs by insurance status also suggest a role of system-based factors in postnatal mortality.
Maternal and Neonatal Outcomes in Women With Congenital Heart Disease at a Single Academic Center [32L]
Authors: Pippen Jessica , Koonce Jennifer , Frischhertz Benjamin , Markham Larry , Thompson Jennifer 
Published: May 2017

INTRODUCTION:
Maternal congenital cardiac disease contributes to maternal and neonatal morbidity and mortality. We sought to describe both maternal and neonatal outcomes in women with congenital heart disease delivering at an academic medical center.

METHODS:
We conducted a retrospective review of pregnancies occurring in women with congenital heart disease who received prenatal care and delivered at Vanderbilt University Medical Center between 2009 – 2015.

RESULTS:
A total of 48 women experiencing 52 pregnancies were included. Majority of subjects were Caucasian (76.9%) who utilized public insurance (65.4%). 39 women (75%) had surgically repaired lesions and 14 (26.9%) reported a prior cardiac event. The majority of lesions were WHO class I/II (75%). Maternal ICU admissions occurred in 13.5% of patients and 3.8% of patients had postpartum readmission. 11.5% patients had a cardiac event during peripartum period. Obstetrical complications included preterm birth (15.7%); fetal growth restriction (22%); and admission to NICU (16%). Congenital heart disease was diagnosed in 14% of infants. 49% were delivered via cesarean delivery with an additional 15.7% having operative vaginal deliveries. Epidural anesthesia was administered in 74% of patients.

CONCLUSION:
Pregnancy in women with congenital heart disease is associated with increased maternal and neonatal morbidity and mortality. Our results are similar to previously published data regarding risks of maternal cardiac events, preterm birth, fetal growth restriction and recurrent congenital heart disease. A collaborative care model with adult congenital cardiology, obstetric anesthesia, neonatology, and maternal fetal medicine is necessary to evaluate maternal and neonatal risk in women with congenital heart disease.
Impact of Heart Disease During Pregnancy on Maternal Cardiac and Obstetric Outcomes [33L]
Authors: Owens Amanda , Lima Fabio V. , Nie Lizhou , Yang Jie , Avila Cecilia , Stergiopoulos Kathleen 
Published: May 2017

INTRODUCTION:
Heart Disease (HD) is the leading cause of morbidity and mortality among pregnant women in developed countries. The impact of HD and obstetric complications on outcome requires investigation.

METHODS:
Statewide Planning and Research Cooperative System database from New York State was used to characterize inpatient singleton deliveries, 2000-2014. Primary outcome was maternal Major Adverse Cardiac Events (MACE), a composite of death, cardiac arrest, myocardial infarction, heart failure, and arrhythmia. Obstetric complications included antepartum and postpartum hemorrhage, eclampsia/preeclampsia, placental insufficiency, and preterm delivery (less than 37 weeks gestation). ANOVA and Pearson's Chi-squared test were used for comparison.

RESULTS:
We studied 3,871 women with HD and 2,280,173 without HD, with singleton births. 17% had cardiomyopathy (CDM), 40% valvular HD, 35% congenital HD, and 8% pulmonary hypertension (PH). Compared with women without, women with HD had significantly more MACE (16.1 vs 0.4%), more cesarean delivery (45.1 vs 31.0 %), more eclampsia/preeclampsia (11.0 vs 4.2%), more preterm delivery (14.2 vs 5.5%), longer length of stay (4.8±7.3 vs 2.9±2.2 days) and higher total hospital charges ($21,384±47,037 vs 10,175±9,698, all P < .0001). Among women with HD, highest MACE rates were observed in women with CDM and PH (45.9 and 25.0% respectively), and lowest in women with congenital HD (6.1%). Women with CDM and PH also had highest rate of eclampsia/preeclampsia (25.3 and 23.3%, respectively).

CONCLUSION:
Pregnant women with CDM and PH had the highest rates of MACE during hospitalization for delivery. Eclampsia/preeclampsia was significantly more common in pregnant women with HD, particularly in women with CDM and PH.
Association Between Preeclampsia and Congenital Heart Defects [38L]
Authors: Bears Breanne , Crimmins Sarah , Harman Chris , Turan Shifa 
Published: May 2017

INTRODUCTION:
Emerging research supports a common dysfunctional angiogenic mechanism that manifests in mothers as preeclampsia (PE) and in fetuses as congenital heart defects (CHD).

METHODS:
CHD fetuses came from patients assessed by UMMC's Fetal Heart Program. Controls were identified retrospectively from our ultrasound database, and those with known chromosomal or non-CHD anomalies were excluded. PE was diagnosed by the American College of Obstetricians and Gynecologists’ 2013 guidelines and categorized as early (delivery < 34 weeks) or late. Contributors to early and late PE were assessed and compared with controls using binary logistics regression and Chi-square analysis.

RESULTS:
Of 2856 meeting inclusion criteria, 215 (7.5%) had CHD. PE occurred in 182 (6.4%) cases, early PE in 28 (1%) and late PE in 153 (5.4%). CHD cases had no increased risk for early PE (OR:2.07 CI:0.71-6.01) or late PE (OR:0.85 CI:0.44-1.64) compared to controls. In the CHD group, developing late PE was significantly increased by diabetes (OR:7 (1.9-26) p=0.0005), or chronic hypertension (CHT) (OR:15 (3.7-63) p< 0.0001). In the CHD group, CHT was the major determinant of late PE (Logistic regression R2=0.23 p < 0.0001). In patients with CHT, CHD significantly determined late PE (OR:3.43 CI:1.3-9.1 p=0.001.) In those without CHD, late PE was not increased by diabetes (OR:1.4 CI: 0.93-2.11 p=0.11) or CHT (OR: 1.4 CI: 0.79-2.32 p=0.26). No maternal characteristics significantly correlated with early PE in either cohort.

CONCLUSION:
Fetal CHD did not solely predict an increased risk of PE. However, in women with CHT, fetal CHD increases risk of PE. Enhanced surveillance and treatment appear warranted in these women.
Sonohysterogram and Uterine Neoplasia: The Significance of the Changes in Endometrial Findings [3M]
Authors: Rotenberg Ohad , Escobar Pamela , Fridman Dmitry , Doulaveris George , Renz Malte , Dar Pe'er 
Published: May 2017

INTRODUCTION:
We assessed the significance of variations in endometrial echo (EE) findings between transvaginal sonogram (TVS) and saline infusion sonohysterogram (SIS).

METHODS:
A prospective study of 440 women 50 years and older, who underwent TVS, SIS and pathological sampling for endometrial assessment. Endometrial findings and measurements on TVS and SIS were evaluated and assessed in benign and Cancer/hyperplasia cases.

RESULTS:
Patients median age was 60.1+/-8.1 (range 50-91) and mean BMI was 33.3+/-7.2. The main indication for evaluation was bleeding (87.3%) and 34/440 (7.7%) had either cancer or hyperplasia. In 4/34 (11.8%) cases with cancer or hyperplasia the EE was poorly visualized on TVS and 3/34 (8.8%) had intracavitary fluid. Only 3 (8.8%) had EE between 4-5mm and the rest had “thick EE.” On SIS 23/34 (67.6%) had polyps, 10/34 (29.4%) had focal thickening and only 1/34(2.9%) had diffuse thickening. As for EE thickness on SIS, 13/27 (48.1%) had EE <5mm and in 11/27 (40.7%) cases it was <4mm. The mean EE on TVS was 14.7±8.6mm as compared to 5.9±3.7mm, on SIS (p < 0.0001). In 319/440 (92.3%) of cases with benign pathology, the TVS EE was significantly thicker than sis, even after excluding cases with polyps (n=159), focal thickening (n=62) and submucosal fibroids (n=35): 6.5±4.3mm on TVS vs 3.9±2.4mm on SIS, (n=63, p=0.001). EE conversion formula was created using scatterplot of the measurements with regression line: TVSEE =1.41×SISEE.

CONCLUSION:
SIS EE was significantly thinner than TVS EE both in the cancer/hyperplasia and the benign groups. The EE conversion formula is: TVS EE=1.41xSIS EE. This finding suggests that the current interpretation of thin endometrium on TVS may not be applied in SIS.
Breastfeeding for U.S. Women Living With HIV: A Medical and Ethical Policy Analysis [7M]
Authors: Gross Marielle , Tomori Cecelia , Anderson Jean , Coleman Jenell 
Published: May 2017

INTRODUCTION:
US HIV guidelines recommend against breastfeeding (BF) by women living with HIV (WLHIV), regardless of viral load (VL) and combination antiretroviral therapy (cART), to eliminate risk of breast milk mother-to-child-transmission (MTCT). Cultural stigma may prompt intermittent, non-exclusive BF, further increasing risk. However, BF decreases morbidity and mortality for children and women, and is an important reproductive right. We sought to evaluate the medical and ethical bases of categorically prohibiting BF for WLHIV.

METHODS:
Our empirically informed ethical analysis: (1) reviews MTCT risk; (2) explores unique health risks of HIV-exposed infants and WLHIV; and (3) explores potential harms of universally prohibiting US WLHIV from BF.

RESULTS:
(1) MTCT from short-term exclusive BF is less than 1% with cART, even in low-resource settings. (2) Formula-fed HIV-exposed infants have increased risk of prematurity, low birth weight, sudden infant death syndrome, and necrotizing enterocolitis (all causes of US child mortality); and diabetes, asthma, and obesity. Without BF, WLHIV have increased risk of breast/ovarian cancer, hypertension, diabetes, heart disease, depression and unintended pregnancy. (3) Given low MTCT with cART and BF health outcome data, both groups may be disproportionately harmed by withholding BF. Further, non-exclusive BF without provider knowledge/support increases MTCT risk, and avoiding BF may impair bonding.

CONCLUSION:
There is extremely low MTCT from exclusive BF with cART and undetectable VL. Given potential benefits of BF for WLHIV and their infants, eliminating choice is ethically problematic. We propose a nationwide discussion to critically reevaluate the medical and ethical bases of prohibiting BF for select cART-adherent, virally suppressed WLHIV.
Providers Perspectives on Tdap Vaccination in Pregnancy Patients [8M]
Authors: Vidrine Samantha , DeCesare Julie , Roussos-Ross Dikea , Ashby Mary , Floyd Elizabeth , Peterson Hanna 
Published: May 2017

INTRODUCTION:
The CDC recommends Tdap vaccination during pregnancy to increase infants' protection against pertussis. The best time to vaccinate is between 27 and 36 weeks gestation in order to maximize the maternal antibody response and transfer to the infant. This project looks at the providers prospective as to why women are not receiving the vaccine.

METHODS:
An 8 question survey was sent out to all members of the American College of Obstetricians and Gynecologists District XII. The questions were concerning Tdap vaccination in pregnancy. Responses were received from 139 providers.

RESULTS:
According to the survey, 83.4% of obstetricians universally offer Tdap vaccinations in the third trimester in their office. Of the patients who are offered the vaccine, 51-75% of patients accept the vaccine. Concern for vaccination safety was the most common response for why patients decline, followed by lack of understanding of importance. 55.9% of providers answered that they encounter barriers in trying to offer Tdap in their practice, and identified was lack of point of care availability (70.3%) as the most common barrier. Difference in vaccination rates between insure types were noted and 59% answered that Medicaid patients are less likely to receive Tdap in the third trimester due to lack of reimbursement.

CONCLUSION:
The most common reasons cited for patients to not receive Tdap vaccination in the third trimester is concern for safety and lack of understanding of importance. More than half of the providers answered that Medicaid patients are less likely to receive the vaccine due to reimbursement and point of care issues.
REPLENISH Trial: Combination Capsule of Estradiol/Progesterone (TX-001HR) for Treating Hot Flushes [5M]
Authors: Archer David F. , Graham Shelli , Gasper Gina , Constantine Ginger , Bernick Brian , Mirkin Sebastian 
Published: May 2017

INTRODUCTION:
Many FDA-approved hormone therapies (HTs) combining estrogens and progestins are currently available in the US for treating menopausal symptoms. The use of FDA-approved HT has recently declined, while that of custom-compounded hormone therapy (CHT) with estradiol and progesterone has increased. Current reports suggest that up to 3 million women 40 years and older are using CHT (30 million prescriptions/year). Compounded BHT may be associated with endometrial cancer. No single product combining natural 17β-estradiol and progesterone has been approved yet by the FDA.

METHODS:
REPLENISH (NCT01942668) was a phase 3, randomized, double-blind, placebo-controlled, multicenter trial (∼100 US sites) that evaluated the safety and efficacy of TX-001HR (a 17β-estradiol‒natural progesterone combination capsule) for treating moderate to severe hot flushes in postmenopausal women with an intact uterus. Of the total 1,847 women enrolled, 767 were randomly assigned to one of four TX-001HR daily doses (estradiol 1.0 mg/progesterone 100 mg, 0.5 mg/100 mg, 0.5 mg/50 mg, or 0.25 mg/50 mg) or placebo for 12 months (vasomotor symptom substudy); the remaining 1,080 women were randomly assigned between the active treatments. The four co-primary efficacy endpoints were the mean change from baseline to weeks 4 and 12 in frequency and severity of moderate to severe vasomotor symptoms for active treatments vs placebo. The primary safety endpoint was the incidence of endometrial hyperplasia at 12 months.

RESULTS:
TX-001HR 1.0 mg/100 mg or 0.5 mg/100 mg met all 4 co-primary endpoints, with significant improvements from baseline in frequency and severity of moderate to severe hot flushes at weeks 4 (all, P< 0.05) and 12 (all, P< 0.001) compared with placebo. Women treated with TX-001HR 0.5 mg/50 mg had significant improvements in hot flush frequency and severity at week 12 (both, P< 0.05) vs placebo, while those taking 0.25 mg/50 mg had significant improvements in frequency, but not in severity, at weeks 4 and 12 (both, P≤ 0.001). The incidence of endometrial hyperplasia or malignancy was 0% (by consensus read) with all four TX-001HR doses and placebo after 12 months of therapy. A high incidence of amenorrhea was achieved with all TX-001HR doses.

CONCLUSION:
TX-001HR 1.0 mg/100 mg or 0.5 mg/100 mg effectively treated menopause-related moderate to severe hot flushes and had a safe endometrial safety profile. If approved, TX-001HR – the first combination HT product containing naturally occurring 17β-estradiol and progesterone – may provide an alternative option for the estimated 3 million of women currently using unregulated, unapproved, compounded bio-identical in the US.
Zika Knowledge Among Pregnant Woman in an Inner-City Urban Hospital [10M]
Authors: Bhat Samhita , Gabbur Nagaraj 
Published: May 2017

INTRODUCTION:
Zika virus has been shown to pass vertically during pregnancy. In the US, more than 800 pregnant women have tested positive and 26 infants have birth defects. Many organizations educate about Zika however, the effectiveness is not well known. A national poll of 1,275 individuals revealed that 23% were unaware of the birth defects; 20% believe there is a vaccine; 42% do not realize Zika virus can be sexually transmitted; and 25% think individuals with Zika will always have symptoms. In this study, pregnant women were surveyed to assess their Zika knowledge in an urban inner city setting.

METHODS:
A 14 question survey was administered to pregnant patients at SUNY Downstate Medical Center. 4 questions were demographic and 10 assessed knowledge regarding Zika.

RESULTS:
53 pregnant women were surveyed. 87% were unaware that Zika does not exhibit symptoms in most; 55% did not know there is no specific treatment; 28% were unaware of where Zika is found; and 28% were not aware Zika can be sexually transmitted. Kruskal-Wallis tests for one-way analysis of variance demonstrated greater knowledge regarding Zika in patients with more than one child compared to those with just one child (Mean: 7.90 vs 6.36, p=0.007).

CONCLUSION:
These results show that although the government has tried to educate about Zika, there are still areas of deficiency. Differences in Zika knowledge based on demographics was not noted except between women with one child and women with more than one child which should be investigated further.
Factors Associated With Zika Virus Information on County Health Department Websites in the State of Texas [11M]
Authors: Cuvillier James , Page-Ramsey Sarah M. , Rodriguez Emma , Ireland Kayla , Adesomo Adebayo , Ramsey Patrick S. 
Published: May 2017

INTRODUCTION:
In the United States, Texas has the third highest reported Zika case incidence (218 cases, October 2016), including 13 pregnant women. Thus, prevention is a critical public health concern. Our objective was to evaluate factors associated with availability of Zika virus information on Texas county health department websites.

METHODS:
We reviewed Texas county health department websites for any Zika virus information, using internal searches for “Zika” when necessary. Factors potentially associated with availability of information on the county website (birth rates, “metropolitan” designation, reported Zika cases, and designation as a county bordering Mexico) were compared between groups using a Fisher's exact test and Student t-test where appropriate.

RESULTS:
Of 254 counties, 35 (13.8%) reported information about Zika virus on their county health websites. Mean birth rates in counties with information about Zika were higher than counties without Zika information (14.4/1000 vs 12.5/1000, p < 0.0001). These counties were also more likely to be “metropolitan” designation (77.1% vs 25.1%, p < 0.0001) and have Zika cases (45.7% vs 1.8%, p < 0.0001). Mexican border designation was not associated with increased likelihood of publishing Zika information (2.9% vs 6.4%, p=0.70).

CONCLUSION:
Very few Texas county health department websites contain any information about the Zika virus. Counties with higher birth rates, “metropolitan” designation, and Zika cases are more likely to have Zika information available. Disseminating county-specific resources and instruction on Zika surveillance, prevention, and monitoring of pregnancy and infant outcomes will be vital in preparing for potential future outbreaks or viral entry to local mosquito populations.