bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing Adverse Neonatal Outcomes Associated With Intrapartum Narcotic Administration [ID 2683477]
Authors: Azar Michelle , Shukr Hassan , Bailey Beth A. 
Published: May 2024

INTRODUCTION:
Approximately 83% of U.S. deliveries include pain control, with 67% incorporating epidural analgesia, and 16% utilizing narcotics. Research suggests intrapartum fentanyl predicts poor neonatal suckling, and thus impaired breastfeeding. Unclear are potential effects of other narcotics. We examined whether use of intrapartum narcotics increases risk of adverse neonatal outcomes.

METHODS:
Charts of patients admitted for delivery at a single academic institution were reviewed for drugs administered in the intrapartum period and neonatal outcomes. Institutional review board approval was obtained with a waiver of informed consent. Data were summarized using logistic regression, controlling for confounders.

RESULTS:
Of the 519 participants, 286 (55.1%) received at least one narcotic in the intrapartum period. Compared to the control group, those who received narcotics were significantly younger, had greater pregnancy weight gain, were less likely to deliver via cesarean section, were less likely to have had preeclampsia, had greater gestational age at delivery, and gave birth to babies that weighed more. Tylenol III predicted a three times higher adjusted risk of neonatal intensive care unit admission (odds ratio [OR] 3.03 [1.06–8.62]). Norco predicted greater than 2.5 times higher risk of 1-minute (OR 2.66 [1.26–5.60]) and 5-minute Apgar scores below 7 (OR 2.61 [1.08–6.31]), and requiring oxygen at birth (OR 2.68 [1.21–5.93]). Morphine predicted a three times higher risk of 5-minute Apgar scores below 7 (OR 3.00 [1.26–7.17]). When adjusting for receipt of epidural analgesia, epidural did not significantly increase risk of any study outcomes.

CONCLUSION:
Adverse neonatal outcomes were observed following intrapartum Norco, morphine, and Tylenol III, and were unrelated to use of epidural analgesia. Findings support growing evidence that intrapartum narcotics pose risk to neonates, and further research is needed to elucidate potential longer-term effects.
Predictive Factors of the Occurrence of Shoulder Dystocia in Diabetic Mothers [ID 2683495]
Authors: Alhousseini Ali , Sharif Nadiya , Polay Madison , Diab Maya , Fawaz Aya 
Published: May 2024

INTRODUCTION:
Maternal diabetes is associated with shoulder dystocia that places the newborn and mother at high risk of morbidity and complications. In the diabetic population, obstetricians lack definitive predictive factors that may improve the counseling, preparation, and management before delivery. This study evaluates prenatal maternal and fetal factors that would predict shoulder dystocia prior to delivery in diabetic mothers.

METHODS:
This is a cross-sectional case–control study of 63 diabetic mothers with shoulder dystocia and 200 diabetic mothers without shoulder dystocia delivered at a single medical center between January 2013 and December 2021. Maternal and neonatal characteristics were obtained. Among the studied maternal characteristics were body mass index, height, weight, ethnicity, age, gestational age, medical comorbidities (including preeclampsia and essential hypertension), hemoglobin A1C, insulin administration, labor type, parity, and health insurance type (public versus private). Neonatal characteristics included weight, height, length, and head circumference. Statistical analysis was performed using univariate and multivariate logistic regression. A value of P<.05 was considered statistically significant.

RESULTS:
There was no statistical difference among most of the maternal and neonatal characteristics between the two groups using univariate and multivariate analysis. We did find a statistically significant association between the incidence of shoulder dystocia and lower maternal gravidity (P=.016), larger neonatal weight (P=.00001), smaller neonatal head circumference (P=.025), smaller head circumference/weight ratio (P=.00001), and smaller head circumference/length ratio (P=.00001).

CONCLUSION:
Our preliminary results indicate that most available maternal and neonatal characteristics were not able to predict perinatal injury. Our sample size and the complexity of etiologies behind neonatal injury are possible reasons behind our non-statistically significant results. Over the coming 2 months, based on the association between shoulder dystocia and neonatal weight and head circumference, we will evaluate third-trimester ultrasound head circumference/abdominal circumference ratio and the ability to predict shoulder dystocia with and without neonatal injury.
Artificial Intelligence-Powered Sentiment Analysis of Water Births on YouTube via ChatGPT [ID 2683505]
Authors: Fleming Erika G. , Chen Jamie , Collamore Katherine , Oladipo Antonia F. 
Published: May 2024

INTRODUCTION:
YouTube is a popular platform for sharing information regarding experiences during pregnancy, including water births. Thus, it is beneficial for health care providers to be aware of the sentiment towards water birth in the most popular videos on the topic. ChatGPT, an artificial intelligence natural language processing tool was utilized to assess sentiments expressed by pregnant individuals and their loved ones through YouTube videos.

METHODS:
A YouTube search query on “water birth” was conducted. English transcripts from the top 100 “most viewed” videos were extracted and analyzed using ChatGPT, which categorized sentiments as positive, negative, neutral, or mixed. Chi-squared goodness-of-fit and independence tests were performed to assess significance of differences between groups.

RESULTS:
Of the 63 YouTube videos that met criteria, 52.4% were positive, 17.5% were mixed, 15.9% could not be assessed, 12.7% were neutral, and 1.6% were negative (P<.0001). Videos were uploaded from North America (84%), Australia (5%), Europe (5%), Asia (4%), Africa (1%), and South America (1%). When comparing North America to other regions, results are as follows: positive (54.7% versus 50% [P=.3173]), negative (8% versus 0% [P=.0032]), neutral (17.2% versus 16.7% [P=.6716]), and mixed (9.4% versus 8.3% [P=.2074]).

CONCLUSION:
As the trend of sharing labor and delivery experiences online gains traction, it is important to understand the sentiment surrounding water births on social media platforms such as YouTube. Over half of all sentiments on water birth were positive, whereas only a small amount were found to have a negative sentiment. While a majority of the most popular videos on water births are from North America, it is important to note that North American videos expressed more negative sentiment compared to other continents. Ongoing efforts should be undertaken to gain insights into the sentiments associated with nontraditional labor and delivery methods.
Estimated Incidence, Mortality, and Costs of Neonatal Herpes Simplex Virus Infections in the United States, 2019 [ID 2683519]
Authors: Pooser Matthew , Yuan Yan , Karki Saugat , O’Callaghan Kevin P. , Hufstetler Kaitlin , Kreisel Kristen 
Published: May 2024

INTRODUCTION:
Neonatal herpes simplex virus (nHSV) infection is rare but can cause serious morbidity and mortality. This study assessed the incidence, mortality, and costs of nHSV infections in the United States in 2019.

METHODS:
Inpatient records of neonates aged 28 days or less at admission were examined using the 2019 Healthcare Cost and Utilization Project Kids' Inpatient Database, a nationally representative sample of U.S. pediatric discharges. Neonatal herpes simplex virus cases were defined as those with ICD-10-CM codes for herpes simplex virus (B00.xx, A60.xx, or P35.2), and hospital stays greater than 5 days or resulting in death. Cases involving readmission or transfer from another hospital were excluded. Incidence, mortality, and costs were estimated by sociodemographic factors including race, U.S. region, primary payer, and median household income.

RESULTS:
In 2019, there were an estimated 561 nHSV cases in the United States (15.7 per 100,000 births), with a 4.6% mortality rate. Incidence rates were highest in neonates of Black race (27.3), in the South (21.3), with public insurance coverage (25.2), and born into a household with a median income less than $48,000 (24.5). The incidence rate of nHSV in preterm (41.8) was three times that of term neonates (13.0). The median hospital stay was 15 days with a median cost of $109,562.

CONCLUSION:
We found disparities in nHSV incidence, with infants in the South and born to Black birthing parents disproportionately affected. Higher incidence rates were also found in infants with public insurance coverage and lower household income. Prevention efforts and early detection are crucial to mitigate these disparities.
Maternal and Fetal Outcomes Among Pregnant Women With Endometriosis [ID 2683578]
Authors: Abdessamie Sara , Czuzoj-Shulman Nicholas , Abenhaim Haim A. 
Published: May 2024

INTRODUCTION:
Endometriosis, a prevalent disorder affecting around 10% of reproductive-aged women, has been linked to obstetric complications during pregnancy. This study aims to evaluate endometriosis prevalence in pregnancy and its effect on maternal and newborn outcomes.

METHODS:
A retrospective cohort study was conducted using data from the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS) database from the United States between 1999 and 2019. Multivariate logistic regression analysis, controlling for diverse baseline maternal characteristics, was used to investigate pregnancy and newborn outcomes in births to women diagnosed with endometriosis as compared to those without.

RESULTS:
The cohort consisted of 16,911,497 births to women without endometriosis and 14,956 pregnant women diagnosed with endometriosis. Over the 20-year period, there was a significant upward trend in prevalence of endometriosis among births, rising from 34.9 to 160.6/100,000 births. Births to women with endometriosis exhibited distinctive demographic characteristics: being of advanced maternal age, predominantly of Caucasian ethnicity, belonging to higher income quartiles, obese, smokers, and having private insurance coverage. Births to women with endometriosis were at heightened risk of experiencing obstetric complications, including gestational diabetes, preeclampsia, preterm birth, and postpartum hemorrhage. Neonates born to mothers with endometriosis also demonstrated an elevated likelihood of growth restriction and congenital anomalies.

CONCLUSION:
The study highlights the evolving prevalence of endometriosis among pregnant women and establishes a strong connection between endometriosis and adverse maternal and newborn outcomes. These findings emphasize the importance of vigilant monitoring to enhance obstetrical and fetal outcomes in pregnant women with endometriosis.
Maternity Care Deserts and Postpartum Outcomes: Bridging the Gap in Maternal Health Care in Florida [ID 2683485]
Authors: Kendall Alexis 
Published: May 2024

INTRODUCTION:
Over 2.2 million women of reproductive age live in areas, referred to as maternity care deserts (MCD), with inadequate access to postpartum care services. Furthermore, deaths occurring during the postpartum period account for over half of all pregnancy related deaths. This analysis serves to provide an overview of the intricate relationship between health care access and postpartum health while exploring the increased risk of delayed detection of postpartum complications and the association to increasing maternal mortality rates.

METHODS:
Data provided by the Area Health Resource File were used to identify counties in Florida that met the criteria of a designated MCD. Data collected on all pregnancy-related deaths verified by the Florida Department of Health (2020–2021) and geographic codes for MCD were used to identify significant associations.

RESULTS:
This study collected data from a total of 1,938 pregnancy related deaths. A significant increase in the number of postpartum related deaths was during that time (75%). More than a quarter were in MCD (26%). An association of postpartum related deaths with MCD showed an increase (22%). 1 in 10 women living in MCD reported to not receive a postpartum care visit, these counties were also noted to be more likely to have limited telehealth access (30%).

CONCLUSION:
Maternity care desert limitations to postpartum care reduce prevention efforts, increase risk for delayed complications to go undetected, and contribute to the maternal mortality rates. Potential solutions include policy revisions to expand telehealth access and efforts to increase the awareness of the importance of postpartum care.
The Development and Evaluation of the Mobile Obstetric Referral Emergency System (MORES) in Bong County, Liberia [ID 2683571]
Authors: Perosky Joseph , Edson Claire , Reynolds Christopher W. , Nyanplu Aloysius B. , Sieka Joseph M. , Lori Jody R. 
Published: May 2024

INTRODUCTION:
Liberia and much of sub-Saharan Africa lacks a standard triage system for obstetric emergencies. Research conducted in low- and middle-income (LMICs) has shown that maternal mortality is directly related to inadequate triage systems. This study aimed to implement a novel mobile obstetric referral emergency system to improve obstetric triage in Liberia.

METHODS:
Ninety-seven midwives were recruited from 18 rural health facilities (RHFs) and two referral hospitals in Bong County, Liberia. The study utilized WhatsApp, an encrypted messaging platform, to enable communication between providers at RHFs and referral hospitals. Training sessions at RHFs on sending patient referral data including indication, age, gravidity/parity, gestational age, method of transportation, and delays were conducted. Midwives at referral hospitals were instructed to send messages confirming arrival and outcome.

RESULTS:
A total of 380 referral messages were sent, with significantly more referrals completing the referral process than not (60%). Both hypertension and hemorrhage accounted for 12% of referrals. Nonemergent obstetric causes accounted for 34%. Of women who arrived, 31% delivered via cesarean section. Significantly more women transported via ambulance arrived compared to self-transport or taxi. When money was identified as a barrier, only 45% of women arrived.

CONCLUSION:
This is the first study to introduce a real-time two-way mobile-phone obstetric triage platform for use in Liberia. Strengthening the obstetric triage system is critical to prevent delays in reaching care and improve obstetric outcomes. Addressing socioeconomic barriers is vital to increasing access to maternal health care. Future work includes country-wide scale-up in Liberia and assessment of the sustainability of the MORES intervention.
Implementation of Thromboelastography on the Labor and Delivery Floor for Postpartum Hemorrhage [ID 2683574]
Authors: Kumar Aarti , Noriega Dominique , Clay Carson E. , Taye Abigail , Roman Ashley , Limaye Meghana 
Published: May 2024

INTRODUCTION:
Postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality. Thromboelastography (TEG) is a rapid test that has been shown to improve outcomes in PPH by guiding resuscitation quickly and in a targeted manner. We incorporated TEG into our hemorrhage response protocol (HRP), a robust algorithm focused on facilitating immediate response to PPH, in a pilot study at our high-volume academic medical center. The objective of this quality improvement project was to evaluate the feasibility of incorporating TEG as part of our HRP.

METHODS:
We identified key HRP stakeholders and appointed team leads including obstetricians, anesthesiologists, nurses, and lab/blood bank staff and developed team-appropriate education including 30-minute teaching sessions, badge reference cards, and workflow posters. We then evaluated the TEG utilization rate over time.

RESULTS:
Thromboelastography was utilized in 4/9 (44%) PPHs during the first week after implementation, 4/7 (57%) the second week, and 28/28 (100%) during the following 4 weeks. After an HRT was called, the median time to order TEG was 4.0 minutes (interquartile range [IQR] 13), the median time to collect TEG was 8.5 minutes (IQR 11.8), and the median time for TEG to result was 7.0 minutes (IQR 7.7).

CONCLUSION:
We observed 100% uptake of TEG within 3 weeks of implementation, and rapid workflow completion (<10 minutes per step). The strengths of our implementation approach were its multidisciplinary nature, structuring the workflow into the electronic health record, and appointing team leads to facilitate buy-in. Future studies are needed to assess clinical implications and provider comfort with TEG.
Universal Screening for Syphilis at University of California, Davis, Labor and Delivery: A Response to National Trends [ID 2683426]
Authors: Shirazi Elizabeth 
Published: May 2024

INTRODUCTION:
The number of congenital syphilis cases have been rapidly increasing in the United States despite prenatal screening. In Sacramento County, the rates of congenital syphilis are among the highest in the California. In response to the rapid rise in syphilis rates, there is universal syphilis screening on admission to University of California, Davis, labor and delivery.

METHODS:
Syphilis IgG was added to the admission order set for patients admitted to University of California, Davis, labor and delivery. To assess the effect of this intervention, charts were reviewed from the electronic medical record 6 months prior to and 6 months after the intervention was implemented.

RESULTS:
In the 6 months prior to implementing routine screening, there were nine individuals who screened positive for syphilis. Of those individuals, eight had scant or no prenatal care. Seven had a history of syphilis with prior treatment. Three required re-treatment based on follow-up titers. There were no false-positive screens. Four patients had concomitant sexually transmitted infection (STI) diagnoses, and seven had a history of or current drug use. Five had unstable housing. In comparison, after 6 months of routine syphilis screening, there were six individuals who screened positive for syphilis. Two had scant prenatal care. Three of the patients had history of syphilis and two required re-treatment based on follow-up titers. There were three false-positive screens. One patient had concomitant STI diagnosis. Two patients had unstable housing. The two groups had similar demographics in regard to age, gravidity, and parity.

CONCLUSION:
In the first 6 months of routine screening, there was no increase in identification of syphilis cases when compared to risk-based screening (P=0.17). This finding suggests that using a risk-based model (for example, screening individuals with scant to no prenatal care) is sufficient for identifying individuals in need of treatment.
Beyond Maternal Health: Examining the Effect of Birth Complications on Unmarried Fathers' Postpartum Well-Being [ID 2683609]
Authors: Chen Michael , Assibey-Mensah Vanessa , Olson-Chen Courtney 
Published: May 2024

INTRODUCTION:
Birth complications (BCs) are known risk factors for maternal postpartum depression, but their effect on paternal postpartum depression (PPD), especially among unmarried fathers, remains understudied.

METHODS:
In this cross-sectional study, we analyzed data from The Future of Families and Child Wellbeing longitudinal birth cohort, focusing on unmarried fathers who were present at their child’s birth (n=1,484). Paternal PPD was assessed using a 12-item CES-D scale, dichotomized into depression present versus absent. Maternal medical records identified seven conditions constituting BC, including excessive bleeding, placental abruption, placenta previa, emergency c-section, seizure during delivery, cord prolapse, or fetal distress. Logistic regression models were estimated, adjusting for parents' demographics, self-reported health status, cohabitation, poverty, substance use, relationship quality, and prior fatherhood experience.

RESULTS:
Postpartum depression affected 132 fathers (9%), while BC occurred in 602 mothers (41%). In the unadjusted model, BC was associated with 42% increased odds of paternal PPD compared to uncomplicated births (95% CI, 1.00–2.04). In multivariable analysis, BC was significantly linked to paternal PPD (aOR 1.46; 95% CI, 1.00–2.12). Fathers in great/very good health had 37% lower paternal PPD odds than those in good/fair/poor health (95% CI, 0.43–0.96), while interparental conflict was linked to higher paternal PPD odds (aOR 2.38; 95% CI, 1.61–3.52).

CONCLUSION:
Our study found birth complications to be associated with increased odds of paternal postpartum depression. Further research is needed to explore how maternal birth experiences affect paternal well-being, particularly among unmarried fathers, and identify novel ways to incorporate fathers into perinatal support systems and interventions.
Does Maternal Asthma Modify the Association Between Placental Hormones and Placental Weight? [ID 2683539]
Authors: Hanson Courtney M. , Saizy Sadia , O'Hare Danielle , Schlichting Regina , Subramaniam Akila , Williams Andrew D. 
Published: May 2024

INTRODUCTION:
Placental endocrine function is essential for placental growth. Maternal asthma may alter placental growth. The relationship between asthma, placental hormones, and placental size remains understudied. We examined the association between placental hormones and placental weight in pregnant participants with and without asthma.

METHODS:
Hormones influencing placenta function, prolactin (in nanograms per milliliter), lactogen (in nanograms per milliliter), placenta growth hormone (PGH) (in picograms per milliliter), IGF-1 (in picograms per milliliter), and IGF-2 (in nanograms per milliliter), were measured from serum drawn at ∼30 weeks (range, 27–36 weeks) of gestation, categorized into quartiles. Placental weight (in grams) was obtained from placental pathology reports. Data were available for 174 women (134 with asthma; 40 without) from the B-WELL-Mom study. Linear regression models estimated associations between placental hormones and placental weight, adjusted for maternal factors. Models were fit overall, and asthma*hormone interaction terms were fit. We then stratified models by asthma. This analysis was approved by the authors’ home institution IRB.

RESULTS:
Participants were, on average, 31 years old, had high income (47%; >$140,000), and were racially diverse (40% White, 40% Black, 15% Hispanic, 5% mixed race). Mean placental weight (overall, 465.56 g) differed between those with (473.43 g) and without asthma (439.20 g; P<.05). Placental hormone levels also varied by asthma status. In overall regression analyses, high levels of PGH (quartile 4 versus quartile 1) were associated with increased placental weight (68.32 g; 95% CI, 24.23, 112.40). The association between high levels of PGH and placental weight was stronger among women without asthma (127.47 g; 95% CI, 19.22, 235.72) than among those with asthma (66.18 g; 95% CI, 16.33, 116.03; P-interaction=.12).

CONCLUSION:
Our findings suggest the association between PGH and placental weight differs by asthma status. Additional research regarding placental function among women with asthma is warranted to better understand adverse outcomes among pregnancies complicated by asthma.