bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extending the Effect of Doulas: Digital Health Platforms as an Effective Mechanism for Improving Nonbirth Outcomes [ID 2683473]
Authors: Henrich Natalie , Karwa Smriti , Jahnke Hannah , Brinson Alison , Moss Christa , Shah Neel 
Published: May 2024

INTRODUCTION:
Doulas are nonmedical trained professionals who provide physical, emotional, and educational support to birthing people throughout their pregnancy and postpartum journey including being present at labor and delivery. In this comprehensive role, doulas help patients advocate for their needs and are able to drive effect on birthing and nonbirthing outcomes. Despite their value, there are significant financial, logistical, and geographical challenges to accessing doula services. This analysis evaluated the association between virtual doula use on Maven, a virtual clinic for women’s and family health, with users’ nondelivery outcomes.

METHODS:
This retrospective cohort study used data from 8,989 Maven users who gave birth between January 1, 2020, and April 22, 2023. Logistic regression models estimated the association between total number of doula appointments on the digital health platform with odds of reporting that Maven helped with 1) managing anxiety and/or depression and 2) feeling strongly supported throughout pregnancy. This research was deemed exempt by WCG IRB.

RESULTS:
In adjusted models, attending one or two or more Maven doula appointments was significantly associated with users reporting Maven helped them manage their mental health (one appointment: odds ratio [aOR] 1.28; 95% CI, 1.05–1.56; two or more appointments: aOR 1.78; 95% CI, 1.40–2.26) and helped them feel supported throughout their pregnancy (one appointment: aOR 1.99; 95% CI, 1.74–2.28; two or more appointments: aOR 3.26; 95% CI, 2.70–3.94).

CONCLUSION:
Digitally accessed doulas drive effects beyond labor and delivery outcomes and break down barriers to accessible holistic care.
“She Resolved My Doubts, and I Was a Little Calmer”: A Qualitative Analysis of the HoPE Community-Based Doula Care Program in an Urban Public Hospital [ID 2683480]
Authors: Helm Kaila V. T. , Haq Kanwal L. , Maru Sheela , Rodriguez Alva R. R. , Cooke Caroline , Boychuk Natale A. 
Published: May 2024

INTRODUCTION:
Doula care, or trained lay birth support, represents an evidence-based and cost-effective strategy to improve maternal and child health. However, limited studies have focused on implementing doula care, especially in racial and ethnic minoritized communities. This study assessed HoPE (Helping Promote Birth Equity through Community-Based Doula Care), an intervention within two Queens, New York, public hospitals.

METHODS:
This qualitative analysis is part of a mixed-methods evaluation using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) implementation science framework (IRB 21-01571). We conducted interviews in English or Spanish with HoPE doula clients (n=13), doulas (n=10), and health care providers (n=8) to assess acceptability, feasibility, and satisfaction. Interviews were audio-recorded, transcribed, and translated (if needed). Multiple coders analyzed themes and developed an analytical narrative.

RESULTS:
Preliminary findings suggest that HoPE serves a population in critical need of the support offered by community-based doulas. Regarding reach, doula clients were primarily immigrants and first-time mothers with limited social support and financial resources. We observed doula effectiveness in health care navigation, communication with providers, emotional, mental health, and physical support, infant care, health education, and referrals to social resources. Doula clients, doulas, and providers were generally satisfied with the program and found it acceptable and feasible. Implementation challenges, including language capability and timely client matching, hindered reach and effectiveness.

CONCLUSION:
These preliminary findings demonstrate how community-based doula support can improve health care access and quality of care in diverse, underserved communities. Ongoing evaluation will be used to improve HoPE and contribute to the knowledge of community-centered interventions promoting equity in obstetric care.
The Association of Second-Trimester Cervical Length With Mode of Delivery [ID 2683533]
Authors: Pember Nicolette G. , Thayer Sydney M. , Zofkie Amanda C. 
Published: May 2024

INTRODUCTION:
Second-trimester transvaginal cervical length (TVCL) under 2.5 cm is a well-established risk factor for preterm birth and mid-trimester loss. However, few studies have investigated birth outcomes associated with increasing lengths of “normal” TVCL (2.5 cm or greater). We aimed to evaluate the association of normal TVCL tertiles with mode of delivery.

METHODS:
This is a retrospective cohort study of patients eligible for vaginal birth with singleton term gestations and normal TVCL (at 16–24 weeks of gestation) delivering at a tertiary care center from June 2022 to June 2023. Mode of delivery was compared by TVCL tertiles: T1, 2.5–3.49 cm; T2, 3.5–4.49 cm; and T3, 4.5 cm or greater. Multivariable logistic regression controlled for potential confounders. Institutional review board approval was obtained.

RESULTS:
Of 1,033 eligible deliveries, 175 (16.9%), 621 (60.1%), and 237 (22.9%) had TVCL in T1, T2, and T3, respectively. Compared to patients with TVCL in T1, those in T2 and T3 were significantly more likely to have an intrapartum cesarean delivery (CD) (T1 3.4% versus T2 8.5%, P=.02; T3 11.8%, P=.002), with odds ratios (ORs) of 2.63 (CI, 1.1–7.6) and 3.77 (CI, 1.5–11.4), respectively. After adjusting for confounders, those with TVCL in T3 remained statistically more likely to undergo CD than those in T1, adjusted OR 6.7 (CI, 2.3–19.2). Of note, no patients with TVCL in T1 had CD for Stage 1 arrest.

CONCLUSION:
Patients with longer TVCL at 16–24 weeks are significantly more likely to undergo an intrapartum CD. This association can be considered during patient counseling on delivery outcome expectations.
Timing of Mifepristone Relative to Misoprostol Critical for Reducing Blood Loss and Need for Surgical Procedure for Induction of Labor in the Second Trimester [ID 2683544]
Authors: Bayer Samantha , Rasmussen Chloe , Pinsky Alana N. , Paul Rachel 
Published: May 2024

INTRODUCTION:
Mifepristone is used in combination with misoprostol to facilitate inpatient induction of labor in the second trimester; however, the optimal interval of time between administration of these drugs is not known. Current practice guidelines recommend an interval of 24–48 hours.

METHODS:
In a single-institution retrospective chart review study, we examined whether mifepristone administration practices at that institution improved loss induction duration or adverse outcomes. This study was determined to be exempt from IRB approval.

RESULTS:
Among 267 loss inductions from 2018 to 2022, 54% received mifepristone. When misoprostol-alone inductions are compared to those that also received mifepristone, results demonstrate no difference in time to delivery (15.1 versus 15.9 hours; P=.62) or adverse outcomes, including blood loss greater than 1 L (8.2% versus 13.1%; P=.24) and need for operating room (OR) procedure (15.6% versus 16.6%; P=.86). Importantly, the average interval in this study between administration of mifepristone and misoprostol was 1.3 hours (median, 0.1 hours). Further analysis of those patients who received mifepristone demonstrated improved outcomes only if mifepristone was given at least 3 hours prior to misoprostol, including blood loss greater than 1 L (17.4% versus 0%; P=.0037) and need for OR procedure (21.4% versus 2.7%; P=.0088). There remained no difference in time to delivery (16.0 versus 15.8 hours; P=.94).

CONCLUSION:
These data demonstrate the importance of the timing of mifepristone and misoprostol administration for loss induction and strongly suggest that at least a 3-hour interval is required to improve adverse outcomes. Further prospective study is warranted to broaden the scope of these findings.
Umbilical Cord Blood Collection During Cesarean Section: Effect on Maternal Blood Loss and Morbidity [ID 2683610]
Authors: Lederer Madeline , Coon Aidan , Hopkins Maeve 
Published: May 2024

INTRODUCTION:
Umbilical cord blood collection (UCBC) for stem-cell banking is routinely performed during cesarean sections (CS). Few studies have examined the maternal effect. This study's objective is to evaluate whether UCBC during CS is associated with increased maternal blood loss and morbidity.

METHODS:
This was a single-center retrospective cohort study of primary CS (PCS) in 2021. Exclusion criteria were age less than 18, multifetal gestation, gestational age less than 34 weeks, emergency, and infection. Data were compared between participants with and without UCBC during PCS. Extensive demographic data was collected and compared. The primary outcome was quantitative blood loss (QBL). Secondary outcomes were operative time, hemorrhage medication usage, and blood transfusion (BT).

RESULTS:
Eight hundred two PCS were reviewed, and 191 were excluded. Of the remaining 611, UCBC was attempted in 151 (24.7%). The UCBC cohort had higher gestational age (39.1 versus 38.7; P=.007), were less often in labor (P=.004) or on magnesium (P=.022), and were more likely to be scheduled (P=.002). Quantitative blood loss was higher with UCBC (1,091.5 versus 1,007.5 mL; P=.075). In non-labored PCS, the QBL difference was statistically significant (941.8 versus 798 mL; P=.034). Umbilical cord blood collection was associated with increased operative time (62.4 versus 56.8 minutes; P<.001) and postoperative BT (7.2% versus 3.3%; P=.036). There were no associations between UCBC and usage of hemorrhage medications.

CONCLUSION:
Umbilical cord blood collection increases QBL in nonlabored PCS. Umbilical cord blood collection increases operative time and postoperative BT in PCS. Patients should be appropriately counseled and selected for UCBC based on hemorrhage risk factors.
Induction Method Combination in Patients With Hypertensive Disorders of Pregnancy [ID 2683632]
Authors: Price Corley Rachelle , Luceno Lisvet , Givens Florence Osei , Vilchez Gustavo , Louis Judette Marie , Duncan Jose R. 
Published: May 2024

INTRODUCTION:
We aim to evaluate cesarean birth (CB) rates according to induction method combinations in patients with hypertensive disorders of pregnancy (HDP).

METHODS:
We conducted a retrospective study including singleton pregnancies with HDP admitted to labor and delivery at a tertiary center from January 2018 to December 2019. Clinical and sociodemographic data were extracted from electronic medical records. Pregnancies with incomplete data and those who declined a trial of labor were excluded. Hypertensive disorder of pregnancy was defined according to the American College of Obstetricians and Gynecologists classification. Cesarean birth rates were compared among induction agent combinations using binary logistic regression. A value of P<.05 was considered significant.

RESULTS:
A total of 552 pregnancies met inclusion criteria. Of these, 113 were induced with oxytocin, 112 with mechanical agents and oxytocin, 58 with a mechanical method and prostaglandins, 31 received prostaglandins alone, 54 received oxytocin and prostaglandins, 80 received oxytocin, prostaglandins, and a mechanical agent, 35 were induced with mechanical methods, and 69 were in spontaneous labor. Demographic and baseline characteristics were not different by induction agent combination. After logistic regression, the combination of prostaglandins and mechanical agents was associated with a decreased CB rate; odds ratio, 0.4 (95% CI: 0.1–0.9), using those in spontaneous labor as reference. No other agent combination was associated with an increased or decreased in CB rate.

CONCLUSION:
Induction of labor with a combination of prostaglandins and mechanical agents may decrease CB rates compared with other combination methods for induction in pregnancies with HDP.
For Patients Undergoing an Induction of Labor, Does Increased Body Mass Index Necessitate Higher Doses of Misoprostol? [ID 2683640]
Authors: Mason-Otey Akailah T. , Lundsberg Lisbet S. , Culhane Jennifer F. , Merriam Audrey 
Published: May 2024

INTRODUCTION:
Obesity is associated with prolonged induction of labor (IOL). This study aimed to investigate the association between body mass index (BMI) and number of misoprostol administrations in patients undergoing IOL.

METHODS:
This was a retrospective cohort analysis of patients undergoing IOL at a single institution from June 2012 to January 2023. Singleton, term patients receiving at least one dose of misoprostol were included (n=4,780). Body mass index at admission was defined as normal (18.5 to <25.0), overweight (25 to <30), Class I obesity (30 to <35), Class II obesity (35 to <40), and Class III (≥40). The primary outcome was the number of misoprostol doses. Demographics were compared by BMI category using chi-square and ANOVA. Crude and multiple linear regression was used to generate parameter estimates and 95% CIs.

RESULTS:
Among the cohort, 4.6%, 23.9%, 31.3%, 21.0%, and 19.2% were normal, overweight, Class I, Class II, and Class III, respectively. Public insurance, cHTN, HDP, and pre-gestational diabetes were positively associated with increasing BMI (P<.0001). Mean misoprostol doses significantly increased across BMI categories (from normal 3.3 [SD 2.4] to Class III 5.0 [SD 3.6]; P<.0001). Compared to normal BMI, model estimates increased for overweight, 0.75 (CI, 0.29–1.22); Class I, 1.03 (CI, 0.57–1.48); Class II, 1.40 (CI, 1.93–1.87); and Class III, 1.75 (CI, 1.28–2.22). After adjustment for aforementioned demographics, these estimates were attenuated but still significant.

CONCLUSION:
Increasing BMI is associated with increased average dose of misoprostol during IOL. This highlights the need to investigate safety of increased misoprostol dosing for IOL among obese patients.
Antepartum and Intrapartum Characteristics Associated With Neonatal Encephalopathy [ID 2683510]
Authors: Denisova Elizabeth , Gurram PadmaLatha , Khan Sameer A. , Livatova Katherine , White Abbigail , Reynolds Katherine 
Published: May 2024

INTRODUCTION:
We aim to identify antepartum and intrapartum characteristics associated with neonatal encephalopathy (NE).

METHODS:
This is a retrospective cohort study from 2013 to 2023. Neonates greater than 34–35 weeks of gestation with NE were identified based on ICD-9/ICD-10 codes. Each case was matched to three controls. Neonates (>34–35 weeks of gestation, cord pH >7, no NE) next to index case were identified as controls. Congenital anomalies, chromosomal abnormalities, and less than 34 weeks were excluded. The outcome measures are incidence and trends of NE in last 10 years and antepartum and intrapartum risk factors associated with NE. This study was IRB approved.

RESULTS:
Twenty cases were included and matched with 60 controls. The number of cases increased since 2013. 1 in 6,000 neonates delivered was identified as NE in 2014, versus 4 of the 5,700 births in 2016, versus 3 of the 2,114 neonates delivered in 2023. Mean maternal age, race/ethnicity/insurance are similar between groups. Cases are more likely to have obesity class 3 (P=.05) and nulliparous (P=.01), class A2 gestational diabetes mellitus (GDMA2) (P=.05), preterm prelabor rupture of membranes (PPROM) (P=.0.01), and tobacco use (P=.00). There is statistically significant difference in Category 3 fetal heart tracing (P=.00), meconium (P=.03), placental abruption (P=.00), and general anesthesia (P=.00) between groups. Mode of delivery, breech, shoulder dystocia cord prolapse, chorioamnionitis, uterine rupture, amniotic fluid embolism, and maternal cardiovascular collapse were similar between groups. Gestational age at delivery, birth weight, and gender were similar between groups.

CONCLUSION:
The risk factors associated with NE in our study are obesity class 3, nulliparity, tobacco use, GDMA2, PPROM, Category 3 tracing, meconium, and placental abruption.
Effects of COVID-19 Vaccination on Nebraska Maternal Health Outcomes [ID 2683619]
Authors: Wells Brittney , Walsh Marissa , Soares Lauren , Borland Ashley , Becker Ashley , Zeineddine Sami 
Published: May 2024

INTRODUCTION:
When the COVID-19 vaccine was developed, there were many concerns about the risk–benefit profile, especially in pregnancy. The purpose of this study was to elucidate the effect of COVID-19 vaccination on maternal health outcomes.

METHODS:
An IRB-approved, retrospective analysis was performed using data from CHI Nebraska's 2021 EPIC health records to determine whether maternal COVID-19 vaccination prior to delivery in previously healthy, primigravid women aged 18–35 affected maternal health outcomes. The outcomes studied included preterm delivery, eclampsia, gestational diabetes, preeclampsia, placental abruption, placenta previa, and postpartum hemorrhage.

RESULTS:
Of the 7,997 patients analyzed, 1,220 were vaccinated for COVID-19 prior to their delivery date. Compared to patients that were not vaccinated, vaccinated patients had statistically significant increased rates of gestational diabetes and preeclampsia (odds ratio [OR] 1.31; P=.02103; OR 1.47, P=.00589). Vaccinated patients were also found to have increased rates of eclampsia, placenta previa, preterm delivery, and postpartum hemorrhage, but these were not statistically significant. Clinically, these differences between vaccinated and nonvaccinated patients were small for all outcomes tested, all being less than 2%.

CONCLUSION:
Although our research was restricted by accessibility of the vaccine in early 2021, it illustrated that vaccinated individuals did not experience any significant increase in eclampsia, placenta previa, postpartum hemorrhage, or preterm delivery compared to the unvaccinated. We found that history of COVID-19 vaccination correlated with a small, yet significant increased rate of gestational diabetes and preeclampsia. Further research should be done to further elucidate how the vaccination affects health outcomes as they pertain to pregnancy.
Correlation of Peripartum Acute Kidney Injury Severity With Obstetric Comorbidity Index Scores and Maternal Morbidity [ID 2683636]
Authors: Kishkovich Thomas , Kempf Abigail M. , Pelletier Andrea , Patton Nicole , Farber Michaela K. , Smith Nicole A. 
Published: May 2024

INTRODUCTION:
Risk stratification systems are increasingly used to predict obstetric complications. The Obstetric Comorbidity Index (OB-CMI) is one validated prediction tool, applying weighted scores to maternal and obstetric conditions. Although acute kidney injury (AKI) is a severe maternal morbidity, there is limited information on predicting AKI severity. We aimed to investigate the utility of OB-CMI scores and its specific comorbidities in predicting obstetric AKI severity, and the relationship of AKI severity and other maternal morbidity outcomes.

METHODS:
This was an IRB-exempt, retrospective cohort study of AKI cases (ICD-10 code N17.0-17.9) between January 2018 and December 2022 at a single academic institution with ∼6,000 births annually. Information was extracted via chart review. Cases were stratified by those meeting American College of Obstetricians and Gynecologists (ACOG)/Society for Maternal-Fetal Medicine (SMFM) criteria for severe renal injury. Those with unknown baseline Cr were assigned 0.7 (the 95th percentile Cr value at 39–40 weeks). Groups were compared based on admission OB-CMI scores and comorbidities, and maternal morbidity events using independent t-tests, χ2, and Fisher's exact as appropriate.

RESULTS:
Two hundred thirty cases were reviewed: 8.3% (19 cases) met ACOG/SMFM AKI criteria. There was no significant difference in mean OB-CMI scores (mean 3.8 versus 4.1; P=.782) or incidence of individual comorbidities between groups. Regarding other maternal morbidity events, ACOG/SMFM criteria AKI was significantly associated with other severe morbidity events (47.4% versus 12.3%; P<.001), including transfusion, disseminated intravascular coagulation, intubation, and intensive care unit admission.

CONCLUSION:
The OB-CMI score was poorly predictive of AKI severity; however, the occurrence of severe AKI by ACOG/SMFM criteria was associated with a 4-fold increased rate of co-occurring maternal morbidity events and a 2.5-fold increased rate of blood transfusion.
Patient Needs and Perceptions of Doula Care: A Survey Study [ID 2683478]
Authors: Marudo Catherine P. , Nicotra Caroline , Chou Brandon , Fletcher Michelle M. , Amani Jamarah , Antoine Rebekah 
Published: May 2024

INTRODUCTION:
Doulas improve birth outcomes, and doulas that provide culturally congruent care are needed in historically marginalized communities who experience stark disparities in maternal mortality and morbidity. This study characterizes the needs and perceptions of doula care among patients from the same health care system.

METHODS:
This IRB-approved, cross-sectional study, in collaboration with community-based midwives and doulas, administered de-identified surveys in two obstetrics/gynecology clinics in South Florida. Surveys characterized 1) patient demographics, along with 2) patient understanding of, and 3) patient need for doula care.

RESULTS:
One-hundred seventy-six patients were surveyed and an alpha level of 0.05 was utilized for all statistical tests. Multivariate analysis showed that patients with an annual household income between $25,000 and $50,000 (OR = 4.87; 95% CI, [1.02–23.36]) were almost five times more likely than those with an annual household income below $25,000 to have an interest in doula care. Chi-squared analysis found no statistically significant relationship between race and interest in doula care, X2 (4, N = 176) = 2.80, P=.591. Among patients who expressed interest for doula care, χ2 analysis found a statistically significant relationship where Black and/or African American patients were less likely than White/Caucasian patients to be able to pay for doula care, X2 (8, N = 148) = 19.25, P=.014.

CONCLUSION:
Results illustrate an increased need for doula access among patients in a large academic, safety-net hospital, especially those from historically marginalized groups. This study encourages other health care systems to assess the need for increased doula support within their communities.
Single-Dose Azithromycin Prophylaxis in Planned Vaginal Delivery for Sepsis Prevention: A Systematic Review and Meta-analysis of Randomized Controlled Trials [ID 2683483]
Authors: Philip Chris E. , Crosara Laura F. , Orsini Pedro V. B. , Eskandar Karine , Khalil Samira M. 
Published: May 2024

INTRODUCTION:
The use of oral azithromycin as a preventive measure against postpartum infections of planned vaginal births has been the subject of many randomized controlled trials. However, the results from these trials have not been consistent. Therefore, performed a systematic review and meta-analysis to determine whether the use of a single-dose of oral azithromycin is clinically significant.

METHODS:
We systematically searched PubMed, Embase and Cochrane Central for RCTs from May to June 2023, comparing a single dose of oral azithromycin to placebo in patients undergoing planned vaginal delivery at minimum 28 weeks of gestational age. The main outcomes were puerperal and neonatal sepsis. Statistical analyses were performed using Review Manager 5.4.1 (Cochrane Collaboration). Heterogeneity was assessed with I2 statistics.

RESULTS:
Four randomized controlled trials were included (mothers, n= 42,235; newborns n= 42,492). Approximately 49.8% of mothers received a single dose of oral azithromycin for sepsis prophylaxis. Azithromycin significantly reduced the incidence of puerperal sepsis (risk ratio [RR] 0.65; 95% CI; P<.001), mastitis or breast abscess (RR 0.58; 95% CI; P<.001), endometritis (RR 0.65; 95% CI; P<.001), wound infection (RR 0.81; 95% CI; P=.013), infection rate (RR 0.62; 95% CI; P<.001) and fever (RR 0.50; 95% CI, 0.28–0.89; P=.018) in mothers compared to placebo.

CONCLUSION:
Azithromycin shows to be an effective preventive measure against many postpartum infections in mothers but a substantial effect on neonatal outcomes has not yet been conclusively observed.