bluuebunny/crossref_metadata_2025_split huggingface dataset:
CDC-WONDER Database Analysis of Maternal Morbidity in Florida [ID 2683410]
Authors: Hayes Elisabeth , Wyatt Adam T. M. 
Published: May 2024

INTRODUCTION:
The CDC's WONDER Natality database was updated in 2016 to include comprehensive pregnancy data, encompassing maternal morbidity, a growing concern in the United States. Using the WONDER Natality database, we can better understand risk factors and trends associated with maternal morbidity. The aim of this research is to investigate the variations in maternal morbidity in Florida, focusing on maternal demographics and pregnancy characteristics.

METHODS:
This cross-sectional descriptive study used results from the CDC’s WONDER Natality 2016–2021 expanded-results database. Five categories of maternal morbidity were analyzed. Maternal morbidity and pregnancy characteristics were analyzed for statistical significance using χ2 and unpaired t-tests.

RESULTS:
92,680 (1.04%) births in Census Region 3 (the South) were found to be associated with maternal morbidity. This prompted an in-depth examination of this region, with a particular focus on Florida. Notably, Asian mothers experienced the highest rate of maternal morbidity (1.49%), whereas Black mothers faced the lowest statistical rate (0.67%). Asian mothers experiencing maternal morbidity tended to be older, have lower pre-pregnancy body mass indexes, more prenatal visits, and shorter intervals since their last live births.

CONCLUSION:
This study underscores statistically significant maternal morbidity disparities in Florida, with Asian mothers being particularly vulnerable. It identifies several pregnancy characteristics linked to increased morbidity. Further exploration, including a county-level analysis in Florida and examination of other states in Census Region 3, could reveal or consolidate emerging trends. Moreover, the absence of a universally accepted definition for severe maternal morbidity calls for the establishment of a clear standard to guide future research and obstetric practices.
Low-Lying Placenta and Pregnancy Outcomes in a Large National Cohort [ID 2683532]
Authors: Harrison Rachel , Thomas Jacob , El Helou Yara , Shivashankar Kavya , Holmgren Calla 
Published: May 2024

INTRODUCTION:
We sought to understand the association of low-lying placenta and adverse pregnancy outcomes among those undergoing cesarean delivery.

METHODS:
This was a retrospective cohort study of persons undergoing cesarean delivery using the National Inpatient Sample from 2017 to 2019 through HCUP/AHRQ. Patients with placenta previa were excluded. Rates of adverse maternal outcomes were compared between patients undergoing cesaeran delivery with ICD-10 codes of low-lying placenta and those without. The outcomes included were preterm delivery, hemorrhage, hysterectomy, placenta accreta spectrum (PAS), sepsis, shock, disseminated intravascular coagulation (DIC), and transfusion. Groups were compared using ANOVA, chi-squared analysis, logistic and linear regressions to control for confounders.

RESULTS:
Over 700,000 participants underwent cesarean delivery. 2,664 (0.4%) had low-lying placenta. Affected patients were older, more likely to be anemic, privately insured, undergoing primary cesarean, and deliver at a large/urban teaching hospital. Those with low-lying placenta were more likely to deliver preterm (31.9% versus 14.3%), hemorrhage (27.8% versus 3.8%), undergo hysterectomy (2.0% versus 0.2%), have PAS (2.4% versus 0.2%), receive transfusion (5.4% versus 2.0%) (all P<.001), and experience sepsis, shock, and DIC (all P<.05). Many of these findings persisted after controlling for confounders—preterm delivery (adjusted odds ratio [aOR] 3.07; 95% CI, 2.81–3.35), hemorrhage (aOR 8.87; 95% CI, 8.10–9.73), hysterectomy (aOR 9.42; 95% CI, 7.11–12.47), PAS (aOR 13.41; 95% CI, 10.34–17.39), transfusion (aOR 2.56; 95% CI, 2.14–3.06), and shock (aOR 2.55; 95% CI, 1.44–4.52).

CONCLUSION:
Low-lying placenta at time of cesarean is associated with adverse outcomes and should be considered in counseling and delivery planning.
Pregnancy Outcomes at a Safety Net Hospital in Atlanta, Georgia, After Changes to Abortion Legislation [ID 2683629]
Authors: Marcovitch Hannah , Boulet Sheree L. , Haddad Lisa , Wall Kristin 
Published: May 2024

INTRODUCTION:
On July 20, 2022, Georgia’s House Bill 481 (HB 481) went into effect for the first time since it passed state legislature in March 2019. House Bill 481 is an abortion ban in the presence of fetal cardiac activity. To date, no study has explored the law’s effects on key clinical indicators of maternal morbidity and mortality. The purpose of this study is to examine whether enactment of HB 481 has been associated with changes pregnancy-related morbidity at a safety net hospital in Atlanta, Georgia.

METHODS:
We are using an interrupted time series retrospective study design to evaluate trends in pregnancy complications at Grady Memorial Hospital between July 2021 and August 2023. The Emory IRB has approved this study.

RESULTS:
Of the 4,886 encounters linked to pregnancy outcomes included, 2,299 occurred in the year prior to enactment of HB 481 versus 2,587 in the year after. Preliminary crude data analysis demonstrated increases in rare outcomes post-enactment period compared to the pre-enactment period, specifically risk of progression to sepsis among those with preterm prelabor rupture of membranes (0.080 versus 0.061) and maternal intensive care unit admission (0.0085 versus 0.0070). There were no significant changes in the overall rate of delivery or encounters for miscarriage and a decrease in overall composite risk of severe maternal morbidity events (0.061 versus 0.074).

CONCLUSION:
In this rapidly changing legal landscape and with many laws similar to HB 481 being enacted in states across the United States, it is essential to continue to document the direct health effects of restrictive abortion policy on pregnancy outcomes.
Rates of Cesarean Delivery and Neurologic Complications in Parturients With Cerebrospinal Fluid Shunts [ID 2683661]
Authors: Howard Erin , Nosova Kristin , Bauer Isabel L. , Kellerhals Sarah , Nakaji Peter , Bina Robert W. 
Published: May 2024

INTRODUCTION:
The effect of parturition on neurologic status in CSF shunt-dependent patients is poorly understood. Cesarean delivery has been proposed as a safer alternative to labor in this population based on limited case reports and retrospective data in the literature; however, the true risk of vaginal delivery has not been adequately described. To our knowledge, this is the first study to estimate national incidence of neurologic complications based on delivery mode in shunt-dependent parturients.

METHODS:
The Nationwide Readmissions Database (NRD) was queried for obstetric patients undergoing delivery between 2016 and 2018. ICD-10 codes were used to identify delivery mode, preexisting CSF shunt-dependence, obstetric comorbidities, and neurologic complications. Data were weighted per NRD specifications.

RESULTS:
Of 11,021,188 total deliveries, 1,856 were in shunt-dependent patients. The primary cesarean rate was 41.2% (n=613) versus 20.1% (n=1,823,517) for shunted and non-shunted parturients, respectively. Multivariate analysis confirmed that presence of a shunt independently predicted cesarean delivery (OR 2.4; CI, 2.0–2.9). Intrapartum shunt complication rates were low regardless of delivery mode (vaginal:0.5%, cesarean:0.5%). Additionally, there was no significant difference in rates of brain herniation (P=.82) or CNS infection (P=.15).

CONCLUSION:
There is no difference in neurologic complication rates between CSF shunt-dependent patients undergoing cesarean and vaginal delivery; however, cesarean delivery is performed at more than twice the rate of the general population. CSF-shunt dependence alone may not be an independent indication for cesarean delivery in the absence of other obstetric indications.
Demographics, Morbidity, and Mortality Between Nonpregnant and Pregnant Firearm Injury Victims [ID 2683667]
Authors: Camarena Belia , Brisola Deborah , Moran Gracen K. , Callaghan Lauren , Sellner Allison A. , Naik-Mathuria Bindi 
Published: May 2024

INTRODUCTION:
Despite ongoing national efforts to reduce maternal morbidity/mortality, literature on gunshot wounds (GSWs) is limited. We sought to compare demographics, injury severity scores (ISS), and mortality between pregnant and nonpregnant women with GSWs.

METHODS:
Retrospective review of demographics and injury severity in female GSW victims who presented to three Level 1 Trauma Centers between 2018 and 2020. Shapiro–Wilk tests, Wilcoxon-signed-ranks tests, and chi-squared tests were performed. A value of P<.05 was significant.

RESULTS:
We analyzed 575 nonpregnant and 27 pregnant women. Mean age (years) was 32 (30.77–33.33) for nonpregnant women and 27 (24.43–30.13) for pregnant women. For nonpregnant women, 283 (49.39%) were White, 249 (43.46%) Black, and 14 (2.44%) Asian. For pregnant women, 11 (40.74%) were White, 13 (48.15%) Black, and 1 (3.70%) Asian. 9 (23.81%) nonpregnant women and 135 (33.33%) pregnant women were Hispanic. Women publicly insured were 120 (21%) nonpregnant and 11 (41%) pregnant (P<.05). Within a year of shooting, 7% nonpregnant and 27% pregnant women had given birth (P<.05). For nonpregnant versus pregnant women, mean ISS were 11.86 (10.58–13.16) and 14.38 (7.03–21.67), and mortality was 258 (44.87%) and 11 (40.74%), respectively.

CONCLUSION:
Demographics, ISS, and mortality did not differ between pregnant and nonpregnant women. Although pregnant women were more likely to be insured, they had similar morbidity/mortality as nonpregnant women. There is a need to determine whether maternal health care access affects outcomes and evaluate methods of primary prevention.
Comparing Clark’s 2017 Category II Electronic Fetal Monitoring Algorithm to Actual Management When Umbilical Cord Arterial pH Was Less Than 7 [ID 2683452]
Authors: Silvino Daniella , Goldberg Jay , Brendel Katelyn 
Published: May 2024

INTRODUCTION:
Our previously published study reported that, in only 47% of labors resulting in a baby with severe acidemia (defined as umbilical cord arterial pH less than 7), intrapartum electronic fetal monitoring (EFM) was interpreted as concerning, with delivery expedited. We compared Clark’s EFM Category II algorithm to EFM interpretation and actual management of these deliveries.

METHODS:
Institutional review board approval was obtained. A retrospective cohort study was performed on deliveries with umbilical cord arterial pH less than 7. Two groups were identified in actual management: 1) expedited delivery (urgent/emergent operative vaginal delivery or cesarean section) and 2) nonexpedited delivery. We then reviewed all fetal heart tracings (FHTs) to determine whether the algorithm would have recommended expedited delivery or not. Data were analyzed using chi-squared test for independence and Fisher's exact test.

RESULTS:
Thirty deliveries were identified with severe fetal acidemia. Forty-seven percent were delivered in expedited fashion. The Clark algorithm recommended expedited delivery in 30%. The algorithm was not applicable to 3 out of 30 deliveries. Of actually expedited deliveries, the algorithm agreed with expediting 75% of the time, 78% of which should have been delivered even earlier. Of actually nonexpedited deliveries, the algorithm would have only expedited 7% of those.

CONCLUSION:
The Clark 2017 Category II FHT algorithm had a lower sensitivity for predicting severe fetal acidemia and recommending expedited delivery. Although only 47% of babies with severe acidemia were delivered in expedited fashion, the Clark algorithm would only have expedited delivery in 30% overall.
Exploring Effect of Patient Counseling on Mode of Delivery After Cesarean Section [ID 2683575]
Authors: Pondugula Nishita , Greenberg Jessica , Illuzzi Jessica L. , Adeyemo Oluwatosin 
Published: May 2024

INTRODUCTION:
Increasing vaginal birth after cesarean (VBAC) may help lower national cesarean delivery rates in the United States. This study aims to evaluate factors that affect counseling practices and trial of labor after cesarean (TOLAC).

METHODS:
All term repeat cesarean deliveries (rCDs) and VBACs from September 2018 to February 2020 were reviewed. Antepartum counseling on mode of delivery, demographic, and obstetrical data were collected. Patients who were not TOLAC candidates were excluded. This study was IRB approved.

RESULTS:
Six hundred thirty-five patients met inclusion criteria. 304 (47.72%) of these patients had rCD, 65 (10.20%) attempted TOLAC with subsequent rCD, and 268 (42.07%) had VBAC. Of the 635 patients, 470 (74.02%) patients had documentation of TOLAC counseling prior to admission for delivery, whereas 165 (25.98%) did not. TOLAC counseling documentation was not associated with age, race, ethnicity, body mass index (BMI), insurance type, or history of vaginal delivery (VD). Prior VBAC increased the odds of documented TOLAC counseling (odds ratio [OR] 2.36; 95% CI, 1.29–4.63). Medicaid insurance (OR 2.18; 95% CI, 1.29–3.73), history of VD (OR 2.28; 95% CI, 1.16–4.68), history of VBAC (OR 269.0; 95% CI, 50.2–5079), and documented TOLAC counseling (OR 21.12; 95% CI, 11.0–45.10) increased the odds of TOLAC. Increasing BMI decreased the odds of TOLAC (OR 0.91; 95% CI, 0.89–0.95).

CONCLUSION:
Documented TOLAC counseling increased the odds of attempting TOLAC. As only 74.02% of patients had documented counseling prior to admission for delivery, an effort to increase TOLAC counseling and documentation may increase TOLAC and subsequent VBAC rates, decreasing the cesarean delivery rate.
Post-Traumatic Stress in the Pregnancy-to-Postpartum Transition Among Birthing People With Opioid Use Disorder [ID 2683444]
Authors: Shi Chengxian , Eglovitch Michelle , Parlier-Ahmad Anna Beth , Salisbury Amy L. , Martin Caitlin E. 
Published: May 2024

INTRODUCTION:
Postpartum people with opioid use disorder (OUD) face unique challenges; post-traumatic stress may trigger substance use recurrence and disrupt the parent–infant dyad. However, the effects of traumatic stress in the pregnancy-to-postpartum transition for birthing people with OUD are not well investigated. Our study characterizes post-traumatic stress after birth among people in OUD treatment during the fourth trimester.

METHODS:
This a priori secondary study uses longitudinal data investigating recovery among postpartum people with OUD receiving buprenorphine. Participants were enrolled during the third trimester and assessed within 2 weeks postpartum. Scores greater than 29 on the PTSD Checklist-Civilian at 2 weeks postpartum identified post-traumatic stress. Other measures included the following: maternal attachment, perceived control in childbirth, trauma history questionnaire, and child welfare involvement. VCU IRB #HM20017030 approved this study.

RESULTS:
Participants (N=19) were predominantly White (74%). Most (94.7%) endorsed a traumatic event history before delivery of this infant. Eight (42%) met criteria for post-traumatic stress postpartum and identified birth (n=2), infant medical issue (n=3), or unrelated event (n=3) elicited the post-traumatic stress response. Of these, approximately 25% experienced food insecurity and limited health care transportation. These participants reported high levels of maternal attachment (28.1 [SD=4.8]) and perceived control in childbirth (44.3 [SD=6.3]). Most participants reported postpartum child welfare involvement.

CONCLUSION:
Nearly half of our sample experienced post-traumatic stress symptoms after birth, and two-thirds attributed symptoms to a traumatic birth or infant medical issue. Qualitative investigations are warranted to better understand the patient perspective of these experiences and their unique intersections with OUD treatment and recovery to ultimately improve trauma-informed care strategies.
Predictors and Outcomes of Expedited Postpartum Discharge in a National Sample [ID 2683489]
Authors: Walia Anjali , Wen Timothy , Friedman Alexander Michael 
Published: May 2024

INTRODUCTION:
Expedited postpartum discharge (EPD), defined as less than 2 days and less than 3 days after vaginal and cesarean birth, respectively, has been postulated as a measure to improve hospital utilization. National trends regarding outcomes after EPD are lacking. This study aims to characterize national trends in EPD, identify predictors, and assess safety using 60-day postpartum readmission as a surrogate marker.

METHODS:
Birth hospitalizations and readmissions were extracted from the 2016–2020 Nationwide Readmissions Database. Postpartum length of stay (ppLOS) was calculated and categorized as routine, expedited, and prolonged. Annual EPD and readmission prevalence were calculated. Unadjusted and adjusted logistic regression models were fit to assess predictors of EPD and the association between EPD and readmission, adjusting for demographic, clinical, and obstetric outcomes.

RESULTS:
Of 17.3 million birth hospitalizations, 33% experienced EPD. Expedited postpartum discharge prevalence increased from 29.6% to 44.4% with a higher proportion of EPD in 2020 compared to 2016–2019 (P<.01). Younger and older age, chronic conditions, and obstetric complications were associated with lower likelihood of EPD. The overall 60-day readmission rate after delivery hospitalization discharge was 1.4%, and when stratified by expedited, routine, and prolonged ppLOS were 1.4%, 1.6%, and 3.3%, respectively, with no change in readmission rate during the study period. Hospitalizations with expedited discharge were 14% less likely to be readmitted 60 days after discharge compared to hospitalizations with routine discharge (aOR 0.86; 95% CI: 0.85, 0.88).

CONCLUSION:
Nationwide rates of EPD increased during the study period with no corresponding increase in 60-day readmission rates, suggesting that EPD may be utilized more widely in appropriate-risk patients.
Use-Based Opioid Prescribing Protocol Reduces Opioid Prescriptions After Cesarean Section [ID 2683514]
Authors: Leung Noelle , Stanley Zachary D. , Slade Emily , Lei Feitong , O'Brien John M. , Oyler Douglas R. 
Published: May 2024

INTRODUCTION:
Up to 75% of post-cesarean patients report having up to 50% of their discharge opioid prescription left over. We assessed an institutional standardized post-cesarean section pain management and opioid prescribing protocol implemented to decrease unused opioids entering the community while still adequately managing pain.

METHODS:
This was an IRB-approved single-center retrospective comparative cohort study in patients aged 18 years or older, who underwent cesarean section before or after implementation of standardized pain management and opioid prescribing protocol. The intervention group received scheduled acetaminophen and NSAIDs with oxycodone 5 to 10 mg as needed postoperatively. Opioid consumption during the 24 hours prior to discharge was used with set ranges determine the quantity of opioid to prescribe for discharge. Outcomes included opioid prescription receipt, quantity of opioid prescribed, and supplementary opioid prescription within 30 days of discharge.

RESULTS:
Four hundred thirty-three patients were included, with 255 in the intervention group and 208 in the control group. The intervention group used less oxycodone postoperatively (75.1%, 17.8%, and 7.1% of patients using 45 mg, respectively, versus 52.4%, 30.3%, and 17.3%; P<.001), received fewer opioid prescriptions (79.1% versus 89.4%; P=.041), and fewer oxycodone tablets if prescribed (median [interquartile range]: 15 [5–20] versus 30 [20–30]; P<.001). There was no significant difference in number of supplemental post-discharge opioid prescriptions received.

CONCLUSION:
A standardized post-cesarean section pain management and opioid prescribing protocol significantly reduced the number of both opioid prescriptions written and number of tablets prescribed without increasing patients seeking opioid refills in the 30 days following discharge.
Pregnancy Loss: A Comparative Analysis of Information Delivery Between ACOG FAQs and ChatGPT [ID 2683594]
Authors: Cadiente Angelo , Chen Jamie , Adams April , Oladipo Antonia F. 
Published: May 2024

INTRODUCTION:
Pregnancy loss is a sensitive topic, and clear, reliable information is crucial. This study compares the readability and accuracy of ChatGPT's responses to ACOG's frequently asked questions (FAQ) sheets on the subject.

METHODS:
Within the five FAQ sheets under “Pregnancy Loss,” 66 questions were assessed using ChatGPT-3.5. Readability scores, ie, Flesch–Kincaid Reading Ease, Flesch–Kincaid Grade Level, Gunning Fog Score, Smog Index, Coleman Liau Index, and Automated Readability Index were computed for each response. The quality of responses were also graded by two maternal–fetal medicine specialists using a 1–4 scale, where 1 represents a comprehensive response and 4 indicates an incorrect response. Statistical analysis utilized a two-tailed t-test. A weighted Cohen’s kappa coefficient evaluated interrater reliability.

RESULTS:
ACOG attained better readability scores over ChatGPT across all six metrics with statistical significance (P<.001). Among grading, ACOG also outperformed ChatGPT in quality of information with a summative mean of 1.53 (SD 0.60) versus 1.85 (SD 0.90) with statistical significance (P<.001). Grading for ACOG possessed a Cohen's kappa coefficient of 0.493, implying moderate agreement between graders. Grading for ChatGPT possessed a Cohen's kappa coefficient of 0.744, implying substantial agreement between graders.

CONCLUSION:
The responses by ACOG to frequently asked questions on pregnancy loss were both clearer and more comprehensive than those of ChatGPT with consistent agreement between graders. Although ChatGPT can be a convenient source of medical queries, further improvements ought to be made to these large-language models to provide clear and accurate information regarding pregnancy loss to patients.
Effect of Extended Postpartum Medicaid on Health Care Utilization in the First Year Postpartum [ID 2683627]
Authors: Markel Lilla , Busho Audrey , Duncan Jose R. , Brandt Kaitlin P. , Louis Judette Marie 
Published: May 2024

INTRODUCTION:
Extended postpartum Medicaid has been implemented in some states to increase health care access, optimize maternal health, and reduce mortality. We sought to evaluate the effect of postpartum Medicaid extension on health care utilization in the year after delivery.

METHODS:
We conducted a retrospective cohort study of postpartum patients at an academic center in Florida whose deliveries were funded by Medicaid. The study was approved by the IRB. Health care charges were compared between Cohort I (pre-Medicaid extension 2020–2021) and Cohort II (post-extension 2022–2023). Primary outcomes were between-cohort differences in health care utilization in the year after delivery. Services were categorized by specialty and acuity. Data were analyzed using χ2 and Student's t-test. P<.5 was considered significant.

RESULTS:
There were 3,746 patients in Cohort I and 1,537 in Cohort II. Baseline characteristics were similar. Cohort I had 899 and Cohort II had 528 patients without health care charges (23 versus 34%; P<.001). Charges in Cohort I were more likely to occur on days 7–90 (75 versus 60.6%; P<.001), and Cohort II had more charges days 183–365 (9.9 versus 24.3%; P<.001). After postpartum Medicaid extension, health care encounters were more likely to be ambulatory (87 versus 93%; P<.001) and less likely to be inpatient (11.6 versus 4.2%; P<.001) or emergency services (0.7 versus 0.4%; P<.001).

CONCLUSION:
In the year after postpartum Medicaid extension, health care charges indicate increased overall utilization, with increased ambulatory care but decreased hospitalizations and emergency visits.