bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Hyponatremia in Preeclamptic Patients With Severe Features [ID 2683491]
Authors: Endres Kodi , Roberts Catherine M. , Krawiec Conrad , Fang Xinying , Wright Tonya , Zhou Shouhao 
Published: May 2024

INTRODUCTION:
Hyponatremia, although common in expectant women with preeclampsia, has not been well studied in a multicenter fashion, and it is unknown whether it is associated with adverse events related to severe preeclampsia. Our primary objectives are to assess the clinical characteristics and emergency therapy applied to participants diagnosed with preeclampsia. We hypothesize that hyponatremia present in preeclamptic patients with severe features is associated with greater use of emergency hypertensives, antenatal steroids, and cesarean delivery.

METHODS:
This is a retrospective cohort study utilizing a multicenter electronic health record database (TriNetX). We collected and evaluated the following data of participants aged 15–54 years with a diagnosis of preeclampsia with severe features: demographics, diagnostic codes, medication codes, procedure codes, deaths, and laboratory results.

RESULTS:
A total of 2,901 participants (215 [7.4%] with a sodium level below 134 mEq/L and 2,686 [92.6%] with a sodium level above 135 mEq/L) were included. A higher proportion of participants in the below 134 sodium group received emergency antihypertensives (165 [76.7%] versus 1,811 [67.4%]; P=.01), antenatal steroids (103 [47.9%] versus 953 [35.5%]; P=.001), and cesarean section (27 [12.6%] versus 97 [3.6%]; P<.001).

CONCLUSION:
We found that hyponatremia may be associated with emergency antihypertensive use, antenatal steroid use, and cesarean section in patients with preeclampsia with severe features. Future research is needed to determine whether routine sodium levels assessed in preeclamptic subjects with severe features identify subjects at risk of receiving these treatments.
Use of a Menstrual Cup to Assist in Diagnosis of Preterm Premature Rupture of Membranes [ID 2683492]
Authors: Fadadu Priyal P. , Chen Valerie , Torbenson Vanessa , Theiler Regan N. 
Published: May 2024

INTRODUCTION:
Several methods exist for diagnosis of preterm premature rupture of membranes (PPROM), including pooling on speculum exam, nitrazine test, arborization under microscopy, immunoassay, and amnio-dye test. Diagnostic accuracy is particularly important for PPROM because a missed diagnosis may result in life-threatening maternal and fetal consequences. We present a novel method for evaluating PPROM in equivocal cases using a menstrual cup.

METHODS:
Written informed consent was obtained for submission of a case report. A 36-year-old G6P5005 at 29 2/7 weeks presented with leakage of fluid. She was found to have negative pooling on speculum exam, negative arborization on microscopy, a maximum vertical pocket (MVP) of 4.0 cm, and a negative urinalysis. She was discharged with precautions and returned 2 days later with persistent symptoms. Workup again showed no pooling, no arborization, and a normal MVP. The patient suggested using a menstrual cup to capture her intermittent leakage of fluid. She wore a menstrual cup for 30 minutes in triage. A sample of the fluid tested positive for arborization. She was admitted to labor and delivery for latency antibiotics, betamethasone, and fetal and maternal monitoring.

CONCLUSION:
Preterm premature rupture of membranes can occur without overt vaginal pooling due to small volume leakage. Conventional testing is less sensitive when pooling is absent. In these cases, a menstrual cup may help facilitate diagnosis and avoid invasive tests such as the amnio-dye test. Care must be taken to use a clean menstrual cup without gel, limit the duration of menstrual cup use to avoid infection, and to distinguish arborization of amniotic fluid from that of cervical mucus.
Expectations for Paternity Leave Among Male Partners in the Postpartum Setting: A Cross-Sectional Survey at a Public Hospital in Los Angeles, California (2023) [ID 2683493]
Authors: Hong Christian E. , Huang Elaine , Nguyen Brian T. 
Published: May 2024

INTRODUCTION:
Early paternal involvement in childcare benefits both birthing mothers and their children. Unfortunately, paid paternity leave is neither mandated nor protected at the state and federal levels, leading to wide variations in early paternal involvement.

METHODS:
As a part of this IRB-approved study, we conducted interviewer-facilitated surveys with English- and Spanish-speaking male partners encountered in the postpartum ward at Los Angeles General Medical Center. The survey queried general sociodemographic factors, employment status, and access to, as well as, planned utilization of paternity leave (both paid and unpaid). We conducted bivariate analyses and multivariable logistic regressions to identify factors linked to fathers not taking paternity leave.

RESULTS:
Most respondents (N=100) identified as Hispanic or Latinx (76.0%), reported English as their primary language (58.0%), and had an average age of 30.6 years. Ninety-three respondents reported being employed; more than half either reported that their workplace did not have a paternity leave policy (39.1%) or being unsure of their workplace’s policy (17.4%). Only 15.2% reported anticipating paternity leave with full pay. Respondents who knew their workplace policies planned to take no more than 3 weeks of leave on average. Respondents had greater odds of not taking paternity leave if non-English speaking (adjusted odds ratio [aOR] 2.39; 95% CI, 0.93–6.16), uninsured (aOR 5.01; 95% CI, 1.26–20.35), or publicly insured (aOR 2.86; 95% CI, 0.95–8.65).

CONCLUSION:
Male partners in our primarily Hispanic, publicly insured patient population anticipated taking minimal paternity leave, raising questions regarding the role of employee protections or the lack thereof in the face of socioeconomic pressures and cultural differences.
Patient Acceptability of Social Needs Screening at an Ambulatory Prenatal Practice [ID 2683516]
Authors: Wang-Koehler Eileen , Bailey Grover N. , Mills Lisa A. , James Abike , Graseck Anna S. , Clement Elizabeth G. 
Published: May 2024

INTRODUCTION:
Social determinants of health (SDOH) influence maternal–child health outcomes, but standardized social needs screening for prenatal patients is rare, and obstetric practices lack guidance for implementation and tool selection. Our objective was to evaluate patient acceptability of and preferences for SDOH screening during prenatal care.

METHODS:
A paper-based patient survey regarding acceptability of SDOH screening was distributed during a pilot of two different validated screening tools at an ambulatory prenatal practice. Pregnant patients were given the survey during prenatal visits. Demographic data were abstracted from chart review. Descriptive analysis was employed to interpret the findings.

RESULTS:
A total of 84 patients were surveyed. Of these, 67% of patients identified as Black or African American, and 84% had Medicaid or emergency medical assistance. Our patients viewed screening favorably: 82% believed that our team would be able to provide helpful resources, 75% would welcome our assistance if faced with social challenges, and 77% would use resources if provided. Only 11% of patients disagreed that social needs screening was relevant to their prenatal visit. Just 15% of patients preferred the questions to be asked verbally compared to self-administered.

CONCLUSION:
Social needs screening is acceptable to prenatal patients and can be feasibly self-administered. Patients felt that the SDOH questions were relevant to their care and would be open to resources and referrals if they had social needs. Future goals will be to universalize screening in prenatal practices, identify acceptable screening tools, and ensure social needs are addressed effectively once identified.
Social Determinants of Health Needs Among Immigrant and U.S.-Born Pregnant Persons in Central Brooklyn: A Cross-Sectional Survey [ID 2683549]
Authors: Pardo Christina , Bhattacharjee Moyouri , Bruening Sandra , Calixte Rose , Clare Camille A. , Afable Aimee 
Published: May 2024

INTRODUCTION:
Social determinants of health (SDOH) have been linked to poor health outcomes in maternal and infant populations. An epicenter of the maternal health crisis in New York City, Central Brooklyn has a disproportionately high population of immigrants. This cross-sectional survey assesses demographic distributions and SDOH needs of immigrant and U.S.-born pregnant individuals in Central Brooklyn.

METHODS:
The American Academy of Family Practitioners (AAFP) SDOH screening tool was given to 700 pregnant persons with immigrant status defined by country of origin. Institutional review board-approved data were collected through REDCap, and associations were evaluated via χ2, Fisher's exact tests, and logistic regression in STATA.

RESULTS:
Compared to U.S.-born pregnant persons, immigrants tended to be older (P=.000), married (P<.000), and more educated (P=.028). Social determinants of health needs differed significantly by nativity status for housing instability (P=.039), food worry (P=.000), and food inadequacy (P=.018), all of which were higher for immigrants. After adjusting for age and education level, immigrant pregnant persons were significantly more likely to report five or more SDOH needs. Rates of food insecurity (39.86% among immigrants and 27.02% among U.S.-born) were much higher than the national average of 10.2%. Rates of all other SDOH needs were higher for immigrants, except for transportation, but these differences were insignificant.

CONCLUSION:
Our study underscores the criticality of monitoring SDOH needs in marginalized populations to inform targeted interventions aimed at dismantling systemic barriers to health care access during pregnancy. By doing so, we can foster greater engagement in care and promote more equitable health outcomes for pregnant and postpartum individuals.
The Relationship of Patient/Provider Racial Concordance to Nulliparous, Term, Singleton, Vertex Cesarean Delivery Rates [ID 2683595]
Authors: Ajayi Blessing , Sher Olivia , Vorawandthanachai Thammatat , Kumar Vani , Ram Kavitha T. 
Published: May 2024

INTRODUCTION:
Prior studies have explored factors affecting nulliparous, term, singleton, vertex cesarean (NTSV-C) delivery rates, such as induction, provider type, and racial disparities. Some studies have shown higher NTSV-C rates among non-White patients compared to their White counterparts. Our aim was to study the influence of racial concordance between patient and provider on NTSV outcomes.

METHODS:
A retrospective analysis of 315 NTSV pregnancies at an urban hospital from January to March 2023 was performed. The NTSV outcomes by racial concordance were examined using χ2 and Fisher exact tests with alpha <.05. Logistic regression analysis was used to adjust for high-risk maternal comorbidities. The race of patients and delivering providers was based on self-identification.

RESULTS:
A majority of patient–provider dyads were concordant for race (199/315 [63.2%]). Racial concordance was associated with a lower NTSV-C rates (23.1 versus 33.6%; P=.04). This association persisted after adjusting for maternal comorbidities (P=.003). When NTSV outcomes were stratified by patient race, significant differences in cesarean delivery rates by patient race were observed for White providers (P=.02). No significant differences between races were observed for Asian (P=.93) or Black providers (P=.82).

CONCLUSION:
These results emphasize the significant effect of racial concordance between patients and providers on cesarean delivery rates, highlighting the need for further examination of health care disparities and tailored interventions to promote equitable maternal care.
Hospital Water Birth: Interim Results of a Pilot Randomized Control Trial [ID 2683557]
Authors: Malloy Emily M. , Kram Jessica J. F. , Adefisoye James , Forgie Marie M. , Kleber Diana , Hanson Lisa 
Published: May 2024

INTRODUCTION:
Water birth is a method of pain relief during labor associated with decreased pain and increased satisfaction. Randomized control trials (RCTs) about water birth and safety outcomes are needed. We conducted an RCT of hospital water birth versus land birth to compare maternal/neonatal outcomes, and differences in analgesia/anesthesia use. This is an updated interim analysis of our findings (Clinical trial: NCT05175599).

METHODS:
After IRB approval, low-risk pregnant adults were offered study participation between 25 and 34 weeks of gestation. Enrollment began January 2022 using a computer-generated 2:1 (water birth-to-land birth) allocation ratio. Participants in both arms were offered routine care and all available pain relief, with those in the water birth arm given the additional option of birth in the tub. Participants in both groups were excluded if they developed risk factors, including hypertension, preterm labor, or nonvertex presentation. Descriptive and inferential statistics were computed.

RESULTS:
Overall, n=182 have been enrolled and n=157 have given birth. Following exclusions, n=96 (n=67 water birth, n=29 land birth) remained eligible for the study. Significantly fewer participants had epidural or intravenous narcotic analgesia in the water birth group (37.3% versus 82.8% land birth; P<.0001). Ultimately in the water birth group, n=35 (52.2%) gave birth in water. Using the Birth Satisfaction Scale-Revised Indicator scale, water birth patients expressed a significantly higher level of satisfaction (Mdn=33.0 versus 29.0 land birth; P=.009). To date, no adverse events occurred.

CONCLUSION:
These preliminary findings suggest that when offered to low-risk laboring people, hospital water birth reduces pain and increases satisfaction without leading to adverse events.
Risk Factors for Emergency Department Visits and Readmissions for Postpartum Hypertension [ID 2683548]
Authors: Mei Jenny Y. , Muñoz Hector E. , Murphy Aisling 
Published: May 2024

INTRODUCTION:
Postpartum hypertension is a source of significant maternal morbidity and mortality. We aim to evaluate risk factors for postpartum emergency department (ED) visits and readmissions for hypertensive complications.

METHODS:
This was a retrospective cohort study of all birthing patients with peripartum hypertension at a single tertiary care center over a 5-year period (2017–2022). Maternal baseline and intrapartum characteristics were chart abstracted. Primary outcome of interest was postpartum ED visit or readmission (EDR) due to hypertensive complications. Patients who had EDR within 42 days of delivery were compared to those who underwent routine outpatient surveillance. This is IRB #14-001098.

RESULTS:
Of 16,162 patients who gave birth during the study period, 2,403 (14.9%) patients met the definition of peripartum hypertension. 218 (9.1%) presented to the ED or were readmitted for hypertension. Risk factors for EDR were as follows: maternal age greater than 40 years (22.9% versus 15.3%; P=.003), cesarean delivery (42.7% versus 35.8%; P=.044), chronic hypertension (37.2% versus 31.6%; P=.029), severe preeclampsia (32.6% versus 15.6%), p50% elevated blood pressures within the 24 hours prior to discharge (16.5% versus 11.9%; P=.046).

CONCLUSION:
Maternal age over 40, chronic hypertension, severe preeclampsia, prescription of antihypertensives on discharge, and elevated blood pressures leading up to discharge are associated with postpartum ED visits or readmissions for hypertension. Attention should be paid to these high-risk groups to reduce ED visits and readmissions.
Blood Loss Matters: Estimated Compared With Quantitative Blood Loss in Vaginal Deliveries [ID 2683415]
Authors: Winograd Deborah , McKenzie Tesia , Baum Jonathan 
Published: May 2024

INTRODUCTION:
Postpartum hemorrhage is the leading cause of maternal mortality worldwide. Quantitative blood loss calculators have been developed to improve recognition of hemorrhage; however, there is a paucity of research comparing their accuracy. The objective of this study is to compare quantitative blood loss and estimated blood loss values during vaginal deliveries with calculated blood loss determined by maternal hematocrit before and after delivery.

METHODS:
This IRB-approved retrospective cohort study included all term, spontaneous vaginal deliveries of singleton infants to patients 18 years or older who delivered at a single community-based tertiary center between August 2019 and December 2020. Estimated blood loss (EBL) or quantitative blood loss (QBL) were obtained from delivery notes. Quantitative blood loss was obtained using the Triton Gravimetric Calculator. Data were abstracted from electronic medical records and de-identified. Calculated estimated blood loss (cEBL) was determined using the formula determined by Stafford et al. in 2008. The associations between EBL and cEBL and between QBL and cEBL were evaluated by using linear regression.

RESULTS:
Of 1,667 deliveries that met inclusion criteria, 670 had a QBL (40.2%) and 997 had an EBL (60.9%). The association between cEBL and QBL using simple linear regression was a poor fit with an R-square of 0.206. Estimated blood loss and cEBL also had a poor association using linear regression with an R-square of 0.0941. By using R-square, QBL can predict better than EBL; however, both are poor predictors of blood loss calculated from pre-delivery and post-delivery hematocrit.

CONCLUSION:
This study demonstrates that both QBL and EBL have poor correlation with the decrease in hematocrit after a vaginal delivery. Both QBL and EBL missed a significant blood loss in one out of three deliveries. A prospective, blinded, cohort study is currently in process to directly compare QBL and EBL at our institution.
Disparities in Postpartum Pain Management After Cesarean Delivery [ID 2683520]
Authors: Tassone Lauren , Gurram PadmaLatha , Livatova Katherine , Chevalier-Horgan Christine , Nyein Andrew 
Published: May 2024

INTRODUCTION:
We evaluated whether postpartum pain management differs by practice setting, ethnicity, insurance, and preferred language in women with cesarean deliveries (CDs).

METHODS:
This is a retrospective cohort study. Participants who underwent CD at term between 2021 and 2022 were included. Participants with history of opioid use, allergies to NSAIDS, general anesthesia, and postpartum stay greater than 5 days were excluded. The outcomes measures include number of oral “as needed” opioids received measured in morphine milligram equivalents, frequency of pain scores done on the postpartum unit, initial pain scores, pain scores at discharge, and the type and amount of opioids prescribed at discharge. The association of these outcomes based on practice setting (federally funded health center [FFHC] versus private practice [PP]), public versus private insurance, preferred language (English versus non-English), and Hispanic versus Non-Hispanic ethnicity were evaluated. Institutional review board approval was obtained.

RESULTS:
Four hundred seventy-nine participants were included. FFHCs received less “as-needed” opioids than patients of PP (P=.03). Publicly insured received less opioids than privately insured at discharge (P=.03). English-speaking participants were asked about their pain more frequently (P=.05) and received more inpatient opioids than non-English-speaking participants (P=.00). Non-Hispanic participants were asked about their pain more frequently (P=.042) and were more likely to be discharged with opioid-only medications (P=.04) than Hispanic patients who were discharged with combined medications (P=.03).

CONCLUSION:
Women attending FFHC, non-English-speaking, with public insurance, and of Hispanic ethnicity experience disparities in postpartum pain management. Targeted protocols should be developed to eliminate the disparities that exist in postpartum pain management.
Buprenorphine Dosing Through the Pregnancy-to-Postpartum Transition: A Descriptive Analysis [ID 2683589]
Authors: Shadowen Caroline R. , Shadowen Hannah , Thuma Lillia , Martin Caitlin E. 
Published: May 2024

INTRODUCTION:
Supporting continuation of life-saving medications for opioid use disorder (OUD), like buprenorphine (BUP), is imperative through the postpartum period. However, no clinical guidelines exist to inform BUP dosing in this transition. Our study describes BUP dose changes in the first 3 months postpartum and associated patient characteristics in an OUD clinical sample.

METHODS:
This is a secondary analysis of an IRB-approved retrospective cohort study of pregnant patients with OUD who delivered at an academic medical center, initiated BUP between January 1, 2018, and March 30, 2020, and remained on BUP until at least 3 months postpartum. The primary outcome was change in BUP dose between delivery and 3 months: a categorical variable with three levels (increase, decrease, or no change) abstracted from medical record. Bivariate analysis assessed the relationship between changes in BUP dosage and patient characteristics.

RESULTS:
In our sample (N=66), about half maintained their BUP dosage through 3 months postpartum (n=36; 55%); the remaining patients decreased (n=22; 33%) or increased their dose (n=8; 12%). 38% of patients incarcerated at delivery increased their dose, whereas 9% of patients not incarcerated increased their dose. 39% of patients who delivered vaginally decreased their dose; 24% of patients who delivered via cesarean section decreased their dose.

CONCLUSION:
Our study takes a crucial first step in developing the evidence base for the individualization of BUP dosing for postpartum people. Ultimately, we aim to use these data to inform a decision aid to facilitate shared decision-making about BUP dose changes in the pregnancy-to-postpartum transition.
Incidence of Adverse Maternal Outcomes Among Pregnant Health Care Workers [ID 2683462]
Authors: Collins Ana M. , Smith Andrew 
Published: May 2024

INTRODUCTION:
The objective of this study was to examine whether pregnant health care workers at are increased risk for adverse maternal outcomes in pregnancy.

METHODS:
A retrospective cohort study from 2008 to 2023 was conducted using TriNetX Research platform (de-identified patient data from a network of health care organizations) to identify pregnant health care workers. Using ICD codes, CPT codes, and LOINC codes, individuals were diagnosed with the presence or absence of the following conditions: fetal growth restriction, gestational diabetes mellitus, chronic hypertension, gestational hypertension, preeclampsia (with and without severe features), and postpartum depression. Descriptive statistics were used to analyze the data. The University of Texas Medical Branch IRB approved this study as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent.

RESULTS:
Among 1,553,793 patients, 34,099 were health care workers. Health care workers had increased incidences for the following adverse maternal outcomes: diet-controlled gestational diabetes (12.88% versus 9.95%; P<.001), oral hypoglycemic agent-controlled gestational diabetes (1.56% versus 1.02%; P<.001), insulin-controlled gestational diabetes (2.88% versus 1.73%; P<.001), gestational hypertension (3.04% versus 2.73%; P<.001), and preeclampsia with severe features (5.95% versus 4.23%; P<.001). Health care workers were at decreased incidences for fetal growth restriction, preeclampsia without severe features, and postpartum hemorrhage.

CONCLUSION:
Given that health care workers are at increased risk of several adverse maternal outcomes, it may be important for providers to screen health care workers more frequently for these adverse outcomes. Additional studies will need to be conducted using current identifiable electronic medical records.