bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Performance Improvement Project for Jehovah's Witness Prenatal Patients [36B]
Authors: Buono Kristen , Bowen Andrea , Lee Jason D. , Lee Kimberly 
Published: May 2017

INTRODUCTION:
Jehovah’s Witnesses (JW) may decline blood products based on religious beliefs. Previous studies have demonstrated that some JW patients may accept blood products during pregnancy. It is important to identify pregnant JW patients and clarify their acceptance of different blood products or alternatives in advance of delivery. This performance improvement project was designed to educate OBGyn providers and create a standardized process to identify JW patients who decline blood products and document their wishes regarding blood products and alternatives.

METHODS:
A department meeting was held to educate providers and a standard blood product preference form was created. A retrospective chart review of all self-identified JW patients who delivered was conducted to assess for identification in the problem list and standardized documentation of preferences regarding blood products.

RESULTS:
Between 2013-2014, 24 of 30 (80%) JW patients were identified in the problem list. Fourteen JW patients (46.6%) had further documentation of preferences, however often the information was incomplete. Between January 1, 2015 and June 30, 2016 after the project had been initiated, 9 of 10 JW patients (90%) who had a delivery were identified in the problem list and 7 of 10 patients (70%) had standardized documentation of preferences.

CONCLUSION:
Education of providers can lead to better identification of JW patients and more comprehensive documentation of their preferences regarding blood products. This workflow could be easily applied to other areas of care, including preoperative management.
Obstetric Outcomes and Interventions Between Low Normal Amniotic Fluid Index Compared to True Oligohydramnios [38B]
Authors: Holloman Conisha , Desai Neeraj , Paradise Courtney , Jodicke Cristiano 
Published: May 2017

INTRODUCTION:
Our goal was to assess obstetric outcomes and interventions in patients with low normal amniotic fluid index versus oligohydramnios.

METHODS:
This was a retrospective study of deliveries between 2010 and 2014. Oligohydramnios was defined as Amniotic Fluid Index less than 5 cm (AF-5) and low normal amniotic fluid of 5 to 8 cm (AF-LN) on ultrasound performed greater than 24 hours before delivery. Outcomes included cesarean section, preterm delivery, Apgars at 1 and 5 minutes, umbilical artery pH, birth weight (BW), and admission to neonatal intensive care unit (NICU). Statistics included chi-square and student t-test.

RESULTS:
76 cases had AF-5 and 398 had AF-LN. Mean gestational age at delivery was 37.62 and 38.18 weeks (P=.005). Preterm birth rates were higher in AF-5 (P=.003), as well as both primary and all c-section delivery rates (P < .05). Our institution’s overall reported primary cesarean section rate for low risk pregnancies was 24%. Neonatal Apgars and BW were significantly lower in AF-5. There was no significant difference in NICU admissions. One fetal death was observed in each group.

CONCLUSION:
As expected, patients with true oligohydramnios have a higher rate of perinatal morbidity than those with low but normal amniotic fluid, with increased interventions in the true oligohydramnios patients. More investigation is warranted to assess whether earlier intervention in the oligohydramnios group may be the cause of the increased perinatal morbidity.
Risk Factors for Shoulder Dystocia at a Community-Based Hospital [4C]
Authors: Kim Tana , Vogel Rachel I. , Das Kamalini 
Published: May 2017

INTRODUCTION:
Shoulder dystocia remains an unpredictable obstetrical emergency with potential for significant neonatal morbidity. Expert opinion recommends consideration of cesarean delivery for suspected fetal macrosomia of greater than 5000 g or 4500 g in diabetic patients, irrespective of other patient characteristics. The objective of this study was to identify risk factors for shoulder dystocia in our patient population.

METHODS:
This retrospective cohort study looked at singleton, term, vaginal deliveries from September 1, 2008 to December 31, 2014 at a single community hospital. Labor and delivery characteristics as well as maternal and fetal outcomes were compared between those with and without a shoulder dystocia. Risk factors were assessed using univariate and multivariate logistic regression models. A classification tree was utilized to identify independent risk factors associated with the highest incidence of shoulder dystocia.

RESULTS:
Our final sample included 8,930 deliveries with 299 (3.3%) shoulder dystocias. Independent risk factors included maternal Asian, African American, or Hispanic descent, diabetes, oxytocin augmentation, operative delivery, and increased fetal birth weight. Furthermore, the combinations associated with the highest incidence of shoulder dystocia were 1) nulliparous, birth weight 4000-5000 g [40.9%], 2) multiparous, diabetes, birth weight 4000-5000 g [30.8%], 3) nulliparous, birth weight 3500-4000 g [15.4%], 4) multiparous, birth weight 4000-5000 g [14.6%].

CONCLUSION:
Here, we identified risk factor combinations with higher incidence for shoulder dystocia than the American College of Obstetricians and Gynecologists' threshold for recommending a cesarean section based on fetal macrosomia alone. Individualized risk assessment should be performed with emphasis on counseling and delivery options particularly in these high risk patients.
System, Provider, Patient, and Placental Factors Associated With Neonatal Hypoxia in a Single Hospital System [10C]
Authors: Friedman Perry , Shah Ishani , Ogunyemi Dotun 
Published: May 2017

INTRODUCTION:
This is a systematic and collaborative review to determine multifactorial correlates of neonatal hypoxic conditions.

METHODS:
A systematic review was performed on all term neonates diagnosed with hypoxic conditions by a designated review team using a published morbidity form with at least 2 different reviewers extracting data from each case followed by a group discussion for consensus.

RESULTS:
Of 16,890 term singleton pregnancies from 2013-2014, 54 cases of neonatal hypoxia were identified, including hypoxic-ischemic encephalopathy (10, 18.5%), meconium aspiration syndrome (9, 16.7%), hypoxemia of the newborn (29, 53.7%), perinatal asphyxia (2, 3.7%), and other acidosis of the newborn (4, 7.4%). Obstetrical risk factors were present in 94.4%, including category 2 fetal heart rate patterns (20, 29%), repeat cesarean delivery (8, 11.6%), chorioamnionitis (5, 7.2%), birth defects (5, 7.2%), labor dystocia (4, 5.8%), IUGR (4, 5.8%), and abnormal biophysical profile (4, 5.8%). Placental pathology was present in 35 cases (64.8%) and absent in 9 cases (16.7%), with another 10 cases (18.5%) where the placenta was not submitted to pathology. The most common findings were thrombus (n = 14, 20.9%), inflammation (16, 23.9%), meconium staining (12, 17.9%), and infarcts (8, 11.9%). From a systems-based view, potential contributors to morbidity were problems with diagnosis (9, 16.7%), treatment (13, 24.1%), documentation (7, 13.5%) and team communication (3, 5.6%). Opportunities to improve care were felt to be present in 19 cases (35.2%).

CONCLUSION:
Neonatal hypoxic conditions are rare and are associated with significant prenatal morbidity. In a minority of cases, opportunities to alter care may be possible.
Rotational Thromboelastometry Use in Obstetric Hemorrhage: A Current Review [11C]
Authors: Kurata Nicole , Schlueter Ryan , Ueno Meryl , Burlingame Janet 
Published: May 2017

INTRODUCTION:
Obstetric hemorrhage is the leading cause of maternal mortality in all countries. Novel technology that accurately and rapidly predicts hematologic status has considerable value in patient care and safety. Rotational thromboelastometry, or ROTEM, is a point of care viscoelastic test which provides results within minutes, making this modality highly useful in acute obstetric care settings.

METHODS:
We performed a database review of PubMed and MEDLINE for all articles regarding the use of ROTEM in obstetric hemorrhage. The search words employed were “ROTEM”, “rotational thromboelastometry”, “obstetric”, “hemorrhage”, “pregnancy”, “PPH” and “coagulation”. A total of 9 articles were identified with the primary outcome. Case studies were excluded. A review of the remaining 5 articles is summarized in Table 1 as collective results with supported conclusions.

RESULTS:
Rotational thromboelastometry has been used in critical care and trauma for many years. The articles report a considerable clinical utility of ROTEM in obstetric hemorrhage, but limited use in the United States. ROTEM is well correlated with conventional laboratory tests and is able to accurately and quickly assess coagulation disruption. The test is able to guide and modify transfusion choices in an acute obstetric setting. Because obstetric data is limited, further need for ROTEM protocols and procedure is necessary to guide physician practice.

CONCLUSION:
ROTEM use is limited in pregnancy and education is needed among obstetric care providers. As point of care test for rapid assessment of coagulation profile there is significant potential for more robust application in obstetric hemorrhage.
Does Prior LEEP and Genital Mycoplasma Co-Infection Increase Preterm Birth Risk? [12C]
Authors: Keller Rebecca , Al-Qaraghouli Mohammed , Kuo Chia-Ling , Townsel Courtney D. , Campbell Winston 
Published: May 2017

INTRODUCTION:
Excisional cervical procedures and genital infections are independent risks for preterm birth (PTB). We evaluated if LEEP history and cervical Mycoplasma/Ureaplasma (Myco/Urea) co-infection increases risk of PTB.

METHODS:
Retrospective cohort study (1/2005 to 6/2016) of patients delivered under 37 weeks. Patients were selected by Myco/Urea admission cervical culture results. Medical record abstractions: demographics, cervical procedures history, pregnancy outcome. Exclusions: cerclage, knife cone, cryotherapy, multifetal gestations. CASES: LEEP history and positive Myco/Urea result, CONTROL GROUP A: LEEP history and negative Myco/Urea result, CONTROL GROUP B: without LEEP history and positive Myco/Urea result. Primary outcome: delivery gestational weeks (GW). Data analyzed by Fisher's exact, chi-square and Wilcoxon rank-sum tests. A linear regression model for comparison of CASES vs CONTROLS was adjusted for potential confounders. A p-value less than 0.05 (two-tailed) was significant.

RESULTS:
We identified 1755 patients with Myco/Urea results: 37 CASES, 17 GROUP A , 47 GROUP B. Delivery GW: Cases 32±3.8, Control A 30.6 ±4.4, Control B 31.6±3.3 (p more than 0.05 Cases vs Controls). No significant difference in percentage of PPROM, smoking, antibiotic use between Cases vs Controls (p more than 0.05). A history of PTB was greater in Cases (32%) vs Control A (18%, p=0.34) or Control B (13%, p= 0.04). However, cases delivered earlier than controls. Antibiotic use was not different in CASES (51%) vs CONTROL B (48%); p=0.95.

CONCLUSION:
LEEP history and co-infection with genital Myco/Urea is not associated with increased risk for PTB compared to patients with LEEP history alone or Myco/Urea infection alone.
Safety and Efficacy of the Foley Balloon for Cervical Ripening During Induction of Labor in Women With Prior Cesarean [15C]
Authors: Ralph Jessika , Neuman Elizabeth , Zhang Liyun , Wenzlaff Miranda , Simpson Pippa , Hibbard Judith 
Published: May 2017

INTRODUCTION:
Induction of labor in women with prior cesarean is a safe alternative to repeat cesarean. Current evidence has not determined the best method for women who require cervical ripening. We sought to determine whether the use of the Foley balloon is comparable in safety and efficacy to oxytocin.

METHODS:
We conducted a retrospective chart review of all women with prior cesarean undergoing induction between 1990 and 2015. We compared the vaginal delivery rate, maternal adverse event composite, and neonatal adverse event composite. The maternal composite included hemorrhage, infection, uterine rupture, and maternal death. The neonatal composite included 5m Apgar < 7, umbilical artery pH < 7, NICU admission, and neonatal death. Confounding variables, including Bishop score, previous vaginal delivery, gestational age, and presence of PROM, were identified by logistic regression.

RESULTS:
66 women were induced by Foley balloon and 405 by oxytocin. The vaginal delivery rate was significantly less in the Foley balloon group compared to the oxytocin group (55% vs 75%, p=0.001). The rates of maternal and neonatal adverse events were equivalent (24% vs 15%, p=0.070; 11% vs 10%, p=0.86). Logistic regression determined that women with 3 or more deliveries (odds ratio 0.22 (CI 0.01, 0.05)) and gestational age greater than 36 weeks (OR 0.30 (CI 0.11, 0.80)) were associated with decreased likelihood of maternal adverse events; premature rupture of membranes (OR 3.91 (CI 1.93, 7.92)) was associated with increased likelihood of neonatal adverse events.

CONCLUSION:
With careful patient selection, Foley balloon is an acceptable induction method in women with prior cesarean.
Agreement Between Postnatal Meconium Drug Screen and Maternal Urine Drug Screen for Drug Use During Pregnancy [16C]
Authors: Debbink Michelle , Smith Shannon , Langen Elizabeth 
Published: May 2017

INTRODUCTION:
Postnatal meconium drug screen (MDS) is the test of choice for suspected fetal exposure to drugs, theoretically revealing exposures up to 3-6 months antenatally. The degree to which MDS correlates with maternal urine drug screens (UDS) is not well understood. Both test results have significant implications for families. We sought to assess agreement between antenatal UDS and postnatal MDS.

METHODS:
We included women with singleton pregnancies between 2009-2016 at a specialized clinic for substance use in pregnancy. Exclusions included delivery at another institution. Using MDS as an imperfect reference standard, the overall percent agreement (OPA), positive and negative percent agreement (PPA and NPA), and Cohen’s kappa for UDS were calculated for cannabinoids (THC) and cocaine. Tests positive for multiple drugs were descriptively compared.

RESULTS:
Among 108 pregnancies, most patients were white, with mean age of 28.6y. Approximately 50% had addictive disorders, while the remainder had chronic pain. For THC, the OPA was 83.3%, Cohen’s kappa was 0.58 (95%C.I. 0.40-0.77), PPA was 67.7%, and NPA was 89.6%. For cocaine, OPA was 91.7%, kappa, 0.59 (95%C.I. 0.40-0.78), PPA, 61.5%, and NPA, 61.5%. Thirty-four patients had multiple drugs on MDS or UDS. Of these, 7 (21%) had negative UDS with positive MDS; 2 (6%) had negative MDS with positive UDS. Concordant tests occurred in 11 cases (32.3%), and partially concordant tests in 11 cases (32.2%).

CONCLUSION:
The agreement between postnatal MDS and antenatal UDS is moderate. Disagreement between positive screens affects 30-40% of tests. These inconsistencies should be considered in patient care decisions and policies.
Symptomatology of Zika Virus Infection During Pregnancy [20C]
Authors: Canabal Jorge Acevedo , Cay Carolina , De La Vega Alberto 
Published: May 2017

INTRODUCTION:
This study describes symptoms reported by patients with confirmed Zika virus (ZIKV) infection during pregnancy.

METHODS:
Data were obtained from patients attending our institution with a diagnosis confirmed either by positive real-time reverse transcription–polymerase chain reaction or immunoglobulin M enzyme-linked immunosorbent assay.

RESULTS:
A total of 273 patients with a diagnosis of Zika virus infection were identified with 222 (81.3%) reporting symptoms while 51 (18.7%) were asymptomatic. The average maternal age at diagnosis was 24 y/o (range 17-38) and average pre-pregnancy BMI was 26.48 kg/m2 (range 15.8–48.2) similar to our general low risk population. Reported symptoms included: maculopapular rash in 210 (94.6%), arthralgia 85 (38.3%), fever 46 (20.7%), general malaise 19 (8.6%), headache 29 (13.1%), conjunctivitis 36 (16.2%), hand and/or feet swelling 11 (5.0%), retro-orbital pain 12 (5.4%), itching 18 (8.1%) and vomiting 6 (2.7%). Less common symptoms were myalgia (7), back pain (6), bone pain (2), chills (1), cough (1), nausea (1), hand numbness (1), mild thrombocytopenia (1), ocular itching (1), dizziness (2), pancytopenia (1), and symptoms of upper respiratory tract infection (1). Eight two patients (36.9%) reported only one symptom. Rash was the most common isolated symptom in 79/82 patients (96%).

CONCLUSION:
Symptoms of ZIKV infection are varied. The characteristic rash is not present in 5% of symptomatic patients and conjunctivitis is much less frequent than previously reported. Physician bias may lead to testing patients with certain classic symptoms. Since clinical symptoms may be absent, vague, or varied, physicians must be alert at any sign that could suggest infection.
AFI, SDP and Transvaginal Cervical Length: Parameter of Predictive Delivery Latency in PPROM [21C]
Authors: Lee Young Joo , Kim Yoon Hwa , Jo Hyun Nyung , Kim Seung Chul 
Published: May 2017

INTRODUCTION:
Prediction of delivery latency complicated with preterm premature rupture of membrane (PPROM) is important for reducing maternal and neonatal complications. However, no studies have correlated parameters including amniotic fluid index, single deepest pocket, transvaginal cervical length, and C-reactive protein as predictive of the latency interval to delivery. We investigated the latency period from PPROM to delivery according to above parameters and predicted delivery latency using cutoff values of these parameters.

METHODS:
The retrospective study was performed on 121 PPROM patients enrolled between March 2010 and July 2015. Measurements including amniotic fluid index, single deepest pocket, transvaginal cervical length, and C-reactive protein were made in 99 singleton pregnancies with PPROM. Latency was defined as the period from sonographic measurements to delivery day.

RESULTS:
Gestational age at delivery, body mass index, amniotic fluid index, single deepest pocket, and transvaginal cervical length had significant differences according to delivery latency at 3 days. The median gestational age at delivery, amniotic fluid index, and single deepest pocket were lower, and transvaginal cervical length was significantly shorter in delivery latency within 3 days. Amniotic fluid index and single deepest pocket had the highest sensitivity (82.2%) and single deepest pocket combined with transvaginal cervical length showed the highest specificity (75.9%) and area under curve value. A predicted median latency period was less than 2 days within the cutoff value of parameter.

CONCLUSION:
Amniotic fluid index and single deepest pocket combined with or without transvaginal cervical length could be useful predictive parameters of the latency period from PPROM to delivery.
Standardizing the Usage of Oxytocin During Induction of Labor With a Checklist: A Cost-effectiveness Analysis [29C]
Authors: Chatroux Louisa R. , Caughey Aaron B. , Savitsky Leah , Sargent James , Zwerling Blake 
Published: May 2017

INTRODUCTION:
Oxytocin is generally considered to be safe and effective for induction and augmentation of labor, but has been implicated in uterine hyperstimulation and adverse fetal outcomes. The management of labor with oxytocin in response to changes in fetal status is in need of additional consensus guidelines. This study sought to assess the cost-effectiveness of implementing an oxytocin in-use checklist.

METHODS:
A decision-analytic model was built using TreeAge with probabilities, costs and utilities derived from the literature. Primary outcomes included: Cerebral Palsy, neonatal mortality, and mode of delivery. Secondary outcomes included: cost per quality-adjusted life year (cost-effectiveness threshold set at $100,000/quality-adjusted life year, NICU admission, and low 5 minute Apgar score (< 7). Sensitivity analyses were performed to determine the robustness of our baseline assumptions.

RESULTS:
In a theoretical cohort of 900,000 women, representing the estimated number of women undergoing induction at term in U.S., implementing the in-use checklist for women undergoing induction with oxytocin at term was a cost-effective strategy. Use of the checklist prevented 13,140 NICU admissions, 1,080 low Apgar scores, 50 neonatal deaths, 27,000 cesarean deliveries, and 30 cases of cerebral palsy. Sensitivity analysis revealed that the strategy is also cost-saving if the checklist costs less than #304 per delivery. Estimated cost of the checklist was $35 per delivery.

CONCLUSION:
Standardizing oxytocin administration with an in-use checklist is both cost-effective and cost-saving. Most importantly, it reduces neonatal and maternal morbidity and mortality. Examination of both how to translate the use of such checklists and improve their impact deserves further attention.
Survival, Resuscitation and Morbidities in Extremely Preterm Infant – A Retrospective Cohort Study [23C]
Authors: Hussaini Sofia , Czuzoj-Shulman Nicholas , Spence Andrea , Abenhaim Haim Arie 
Published: May 2017

INTRODUCTION:
This study aims to evaluate survival to discharge, resuscitation, predictors of survival and short-term morbidities of preterm babies born at less than 24 weeks.

METHODS:
We conducted a retrospective cohort study using the Nationwide Inpatient Sample-Healthcare Cost and Utilization Project database. We evaluated the neonatal outcomes of all live birth admissions of less than 24 weeks from 2003-2011, excluding newborns with known congenital malformation. We used multivariate logistic regression to estimate the predictors of survival and intact survival in (1) all resuscitated newborn less than 24 weeks and in (2) resuscitated and survived infants.

RESULTS:
There were 9,644 live births that met study criteria, of which 76% were not resuscitated and 24% were resuscitated. The survival rate among resuscitated infants was 42.86%, while the overall survival rate to discharge among non-resuscitated infants was 10.27%. Mortality was highest in the first 2 days of life. The incidence of intraventricular hemorrhage was 13.62%, respiratory distress syndrome was 65.79%, and necrotizing enterocolitis was 0.91%. The rate of intact survival was 31.89 % in resuscitated newborn less than 24 weeks of gestation. Birth weight greater than 500g and urban non-teaching hospitals were positive predictors of survival, with an adjusted OR of 1.46 (95% CI 1.12-1.90) and OR of 1.71(95% CI 1.43-2.06), respectively.

CONCLUSION:
Mortality and morbidity of extremely preterm infants born at less than 24 weeks of gestation is high. However, selected extremely preterm newborns can be viable without major short-term morbidity. Providing patient counseling requires up-to-date estimates of the health outcomes in extremely preterm births.