bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of Out-of-Hospital Cardiac Arrests in Births and Neonates: Opportunities to Improve Care [ID: 1377387]
Authors: Guise Jeanne-Marie , Eriksson Carl , Huynh Trang , Meckler Garth , Walker-Stevenson Grace 
Published: May 2023

INTRODUCTION:
Home births have increased 77% from 2004 to 2017 and further increased with the COVID-19 pandemic. While the majority of home births are uneventful, some are complicated and require attendance of emergency medical services (EMS). Understanding characteristics of out-of-hospital births and EMS care is increasingly important to improve care.

METHODS:
We conducted a chart review of pediatric out-of-hospital cardiac arrests (POHCAs) from EMS agencies across the United States to evaluate the care provided by first responders. The study was approved by Oregon Health & Science University and respective IRBs.

RESULTS:
Of 1,020 POHCAs, 54 were responses to births and 43 were for other neonates. While most neonatal POHCAs occurred in a home or residence (84%), some births occurred at other locations such as a health care facility, public or commercial building, and street or highway. Bystander cardiopulmonary resuscitation was performed in less than half of births but more than half of other neonates. Return of spontaneous circulation was twice as likely for births as for other neonates (27% versus 13%). Overall, serious adverse safety events were observed in three-fourths of neonatal resuscitations. Births were more likely to be associated with failure to follow the correct resuscitation algorithm and lack of positive pressure ventilation.

CONCLUSION:
There are unique challenges in the care of out-of-hospital births for the EMS system. There is an opportunity to improve use of neonatal resuscitation protocols and early ventilation.
Qualitative Evaluations of Patient–Provider Interactions and Experience in Obstetric Transport [ID: 1377912]
Authors: Garcia Eliana , Banwarth-Kuhn Brenna , Hong Emily , McGuire Brenna , Quiner Trevor 
Published: May 2023

INTRODUCTION:
Rural patients who require complex obstetric care are dependent on transport services to higher-level facilities. The objective of this study is to describe the efficacy of provider–patient interactions in informed consent, transport processes, and overall quality of care during emergency transport to the University of New Mexico Hospital (UNMH), the only level 1 trauma center receiving complex patients from multiple states.

METHODS:
Participants transported for emergency obstetric indications were recruited at UNMH. Institutional review board approval was obtained for demographic questionnaires, interviews, and surveys graded on a 5-point Likert scale were delivered via in person, telephone, or Zoom software and securely recorded. English interviews were transcribed via Otter.ai. Spanish interviews were manually translated.

RESULTS:
Preliminary results consisted of 10 patients living on average 3 hours from UNMH. While 90% of respondents reported that they had a good overall transport experience, 40% had concerns about personal safety and 50% for their baby's safety during transport. Additionally, 20% felt that their provider did not explain why they required transport and 30% did not understand why they were transported. A strong majority of participants (80%) reported no alternatives to transport being provided.

CONCLUSION:
Overall, rural obstetric patients who required transport to UNMH report a positive experience. However, some patients felt uninformed, did not understand the reason for their transport, and/or had fears about their safety and their baby's safety. Future studies should aim to understand the complex patient and provider factors that contribute to a patient's understanding during the consent process and how this affects patient perceptions and outcomes.
Postpartum Hemorrhage Prevention Quality Improvement Initiatives and Blood Transfusion Utilization [ID: 1378079]
Authors: Berens Michaela , Chisholm Christian , Parsons Laura , Urban Amanda 
Published: May 2023

INTRODUCTION:
The universal implementation of active management of the third stage of labor, quantitative assessment of blood loss, and hemorrhage risk assessment on admission is recommended to reduce the incidence and morbidity of postpartum hemorrhage. We evaluated the effect of these quality improvement (QI) initiatives, in addition to an active management protocol for iron deficiency anemia antepartum, on the use of blood transfusion during delivery hospitalization.

METHODS:
We obtained blood transfusion data for the obstetric service at a tertiary care university hospital from January 1, 2017 to July 13, 2022, as well as data for every delivery during that time period (N=11,101). Institutional review board approval was obtained for the study. Patients whose transfusions were administered for nonobstetric indications were excluded. We compared the frequency of blood transfusions and number of units transfused per patient before and after the implementation of QI initiatives.

RESULTS:
There was a significant downward trend in the frequency of blood transfusions (P=.003) and the number of units transfused per patient (P=.000006) during the study period. The transfusion rate was 3.3% in the year prior to any intervention and 1.78% after implementation of all QI initiatives. No differences were observed in the characteristics of the patient population relevant to hemorrhage risk during the study period.

CONCLUSION:
This study provides evidence that in addition to reducing postpartum hemorrhage and its morbidity, these QI initiatives also help reduce blood transfusion utilization.
Prediction of Severe Postoperative Anemia After Low-Risk Cesarean Delivery [ID: 1370554]
Authors: Onishi Kazuma , Kawakita Tetsuya 
Published: May 2023

INTRODUCTION:
Postoperative laboratory tests after cesarean delivery are routinely performed. With an accurate prediction of individuals at an increased risk of severe postoperative anemia, we may safely reduce the number of routine postoperative laboratory tests. We aimed to develop a scoring system that predicts severe postoperative anemia (hemoglobin less than 7.0 g/dL) after low-risk cesarean delivery.

METHODS:
This was a retrospective case–control study. Individuals with placental abruption, placenta accrete, placenta previa, preeclampsia, HELLP, and blood loss greater than or equal to 1,000 mL were excluded. Predictive variables with P value less than .05 in simple and multivariate logistic regression models were used in the scoring system. Weighted points based on the logarithm of odds ratio in the multivariate logistic regression model were allocated to each factor, and the score was calculated as a summation of those points. Our IRB approved this analysis.

RESULTS:
Of 1,955 individuals analyzed, 35 (1.8%) had severe postoperative anemia. The predictive factors included preoperative Hb less than or equal to 10.0 g/dL (4.0 points), blood loss greater than or equal to 816 mL (1.0 point), body mass index less than or equal to 30.5 kg/m2 (1.0 point), and preoperative platelet greater than or equal to 194×1,000/mL (1.0 point). The area under a curve of the model was 0.92 (95% CI 0.88–0.97). Using score 3.0 as a cutoff, sensitivity, specificity, and positive and negative predictive values were 91.4%, 83.9%, 9.4%, and 99.8%.

CONCLUSION:
We created a scoring system for severe postoperative anemia with high discriminative ability.
Real-Time Assessment of Symptoms for Postpartum Care via a Smartphone Application: Pilot Evaluation [ID: 1376090]
Authors: Goodin Amie , Dhillon Karamveer , Jennings-Coulibaly Alexis , Roussos-Ross Dikea , Varma Deepthi , Wen Tony 
Published: May 2023

INTRODUCTION:
Leading causes of morbidity and mortality in women occur in the postpartum period and include postpartum mood disorders, substance use disorders, hypertensive disorders, and infection. This study pilots Gator MOMitor, a smartphone application utilizing ecological momentary assessment (EMA) technology, which allows clinicians to monitor symptoms in at-risk postpartum women in real time.

METHODS:
Gator MOMitor used a HIPAA-compliant EMA platform to send tailored assessments through the app to postpartum women with health risks in the initial 6 weeks postpartum, including mood disorder (n=401), cesarean infections (n=162), preeclampsia (n=154), and diabetes (n=9). Nonresponsiveness or critical responses submitted by patients in the app generated a trigger based on assessment algorithms, prompting a call from a nurse for follow-up and/or referral.

RESULTS:
A total of 401 participants were enrolled. 60% identified as White race, 22% Black race, and 14% identified as Hispanic ethnicity. Half (52%) were enrolled in Medicaid, and most (84%) had a term delivery. A total of 3,778 assessments were completed in the app: 1,599 for postpartum mood, 620 for cesarean incision, 1,536 for hypertension, and 24 for diabetes. There were 52, 103, and 39 positive screenings, respectively, in mood assessments (≥12 on the Edinburgh Postnatal Depression Scale), hypertension (BP≥140/90), and cesarean incision concerns, and zero positive screens in the diabetes group. The assessment-based triggers from positive screens resulted in 209 nurse follow-ups, 35 face-to-face visits, and 8 hospital admissions.

CONCLUSION:
GatorMOMitor may be an effective tool for extended assessment and monitoring of postpartum women that could reduce maternal mortality and morbidity.
Diagnosis of Fetal Congenital Malformation as Risk Factor for Postpartum Depression [ID: 1377045]
Authors: Doroskin Tatiana , Broome Sidney , Dallas Madison , Kinzer Carly , Roussos-Ross Dikea , Razavi Mehrsa Sadat 
Published: May 2023

INTRODUCTION:
Annually, more than 7.9 million children, or 6% of all neonates worldwide, are diagnosed with fetal congenital malformations (FCMs). This diagnosis is the second largest cause of infant mortality and is an important cause of maternal vulnerability during pregnancy. This study aims to determine whether the incidence of postpartum depression (PPD) is increased in mothers with FCM, in comparison to mothers without such diagnosis.

METHODS:
A retrospective chart review was conducted between January 1, 2015, and April 1, 2022. Inclusion criteria required a) at least one prenatal visit, b) a postpartum visit, c) completion of Edinburgh Postpartum Depression Scale (EPDS), and d) prenatal diagnosis of FCM. The control group required a–c with absence of significant perinatal complications. Two hundred FCM and 200 control participants were included. An EPDS score of greater than 12 was considered positive and at risk of PPD. Independent-samples t test and χ2 analysis were conducted.

RESULTS:
Independent-samples t test, comparing the study and control participants, noted a statistically significant difference in at-risk EPDS scores. Mothers with FCM diagnosis scored higher on questions 3, 7, and 8. Chi-square analysis noted a statistically significant difference in risk of PPD between mothers with FCM and those without such diagnosis.

CONCLUSION:
Mothers with a diagnosis of FCM are more likely to score higher on EPDS and be at-risk for PPD, thereby revealing the importance to closely monitor their psychiatric status. Future studies should analyze the incidence of maternal psychiatric diagnoses based on the severity of newborn intervention required postpartum.
Does a Lower Target of Postpartum Blood Pressure Reduce Readmission Rates in Patients With Hypertensive Disorders of Pregnancy? [ID: 1377089]
Authors: Ge Christina , Brathwaite Coryse , Grover Jennifer , Karpman Mitchell 
Published: May 2023

INTRODUCTION:
The classification of normal blood pressure in the general population, as determined by multiple organizations including the American Heart Association, American College of Cardiology, and National Institutes of Health, has been evolving. In the pregnant and postpartum population, the threshold of normal blood pressure is higher. Postpartum hypertension has been estimated to affect 20% of women and plays a large role in maternal readmissions. In those with hypertensive disorders of pregnancy, the target postpartum blood pressure should be reevaluated in light of the lower thresholds of the general population.

METHODS:
This study included pregnant patients with singleton fetuses and a diagnosis of chronic hypertension, gestational hypertension, preeclampsia, and eclampsia who delivered at Luminis Health Anne Arundel Medical Center from January 2019 to 2022. The primary outcome was hospital readmission for a hypertensive diagnosis or related sequelae within the first 30 days of delivery. This study was approved by IRB ID 1735193-1.

RESULTS:
Out of 1,433 patients with hypertensive disorders of pregnancy, 55 patients (3.8%) were readmitted because of hypertensive disorders or related complications. Patients with a maximum blood pressure after delivery of greater than or equal to 150/100 mm Hg were significantly more likely to be readmitted (odds ratio 1.99 [1.06, 3.75]). The maximum blood pressure on the day of discharge and oral antihypertensive initiation were not significantly associated with readmission.

CONCLUSION:
For postpartum patients with mild hypertension, a target blood pressure of below 150/100 mm Hg should be considered. Next steps include examining the effect of magnesium sulfate, furosemide, and discharge medication compliance in this population.
Subjective Versus Objective Pain Assessment in the Postpartum Period: Improving Pain Control After Vaginal Delivery [ID: 1378006]
Authors: Stewart Kali , Hincker Alexander , Holroyd Lauren , Rimsza Rebecca , Veade Ashley 
Published: May 2023

INTRODUCTION:
The numerical pain rating scale (NPRS) is a validated measure to quantify acute pain; however, its utility after vaginal delivery is unclear. Poorly controlled postpartum pain can increase rates of complications; therefore, pain control is paramount. We investigated how subjective pain relates to objective pain in the postpartum period.

METHODS:
A prospective, observational study at a single academic hospital included patients with vaginal deliveries February to October 2021. Women with opioid use disorder, wound complication, hysterectomy, or readmission were excluded. Subjective pain assessment and NPRS were completed 2 weeks postdischarge. Subjective pain was recorded as “well controlled” versus “poorly controlled.” The numerical pain rating scale was scored 0–10.

RESULTS:
Two hundred thirty-eight patients were included, and 174 (73%) followed up. One hundred twenty (69%) reported “well-controlled” pain, and 54 (31%) reported “poorly controlled.” There was no significant difference in delivery mode, laceration, or nonopioid medication use (P>.05). Patients who used oxycodone were significantly more likely to report “poorly controlled” pain (P=.02). “Poorly controlled” pain was associated with higher median NPRS score (5 [interquartile range (IQR) 4–6] versus 2 [IQR 0–3], P<.001). Among patients with “poorly controlled” pain, 11 (20.4%) had NPRS scores of 0–3. Of those who reported “well-controlled” pain, 22 (18.3%) had NPRS scores of 4–10.

CONCLUSION:
While NPRS scores were higher for patients with “poorly controlled” pain, this was not universal. It is critical to accurately respond to postpartum pain for the nearly 20% of patients whose subjective experience did not correlate with their objective score. Titrating pain control to subjective and objective goals may improve patient experience and outcomes.
Postpartum Maternal Echocardiography and Its Effect on Hospital Management in Patients With Severe Preeclampsia [ID: 1378829]
Authors: Rekawek Patricia , Akerman Meredith , Corbo Anthony , Gubernikoff George , Kinzler Wendy , Vintzileos Anthony 
Published: May 2023

INTRODUCTION:
Maternal echocardiography has demonstrated cardiac changes in the setting of preeclampsia; however, its effect on hospital management has not been well studied. The objective of this study was therefore to determine whether abnormal postpartum echocardiography is associated with a change in hospital management in patients with severe preeclampsia.

METHODS:
This was a retrospective cohort study of patients with severe preeclampsia (20–42 weeks) who received postpartum echocardiogram before discharge at a single academic institution from 2019 to 2021. The decision to obtain an echocardiogram was made by the primary physician. Patients with clinical indications for echocardiography (suspicion of heart failure and cardiomyopathy) were excluded. Hospital management outcomes included length of hospital stay, diuretic use, increasing antihypertensives, hospital readmission, and cardiology consultation. Patients with normal versus abnormal echocardiograms were compared using the chi-square test or Fisher’s exact test for categorical data and the two-sample t test or Mann-Whitney test for continuous data, with a value of P<.05 considered significant.

RESULTS:
One hundred forty five patients with preeclampsia who received maternal echocardiograms were included. Twenty-one (14%) had an abnormal echocardiogram, including left ventricle hypertrophy (n=9, 6%), pulmonary hypertension (n=5, 3.4%), moderate pericardial effusion (n=4, 2.7%), and enlarged atrial size (n=3, 2%). Patients with abnormal maternal echocardiograms were more likely to have a longer hospital stay (median stay of 7 days [5, 10] versus 5 days [4, 6], P=.003) and were more likely to receive diuretics (19.1% versus 4%, P=.03). There was no difference in adjustment of antihypertensives (61.9% versus 49.2%, P=.3), cardiology consultation (9.5% versus 6.5%, P=.6), or hospital readmission (4.8% versus 6.5%, P=1).

CONCLUSION:
Abnormal echocardiograms were associated with change in hospital management including longer hospital stay and more diuretic use. Abnormal postpartum echocardiography may be used to identify patients with more severe disease and adverse clinical outcomes. Further clinical utility of abnormal echocardiograms in severe preeclampsia should be evaluated.
What Is the Most Cost-Effective Timing for Postpartum IUD Insertion? [ID: 1379571]
Authors: Leonetti Alexis , Caughey Aaron , Chaiken Sarina , Doshi Uma , Hersh Alyssa 
Published: May 2023

INTRODUCTION:
Postpartum intrauterine device (IUD) insertion is an effective contraception choice for reducing rates of unplanned and short-interval pregnancies. However, timing of placement is controversial, and risk of perforation and expulsion vary with timing. We aim to analyze the cost-effectiveness of postpartum IUD insertion intervals when considering risk of perforation or expulsion.

METHODS:
A decision-analytic model compared four intervals of postpartum IUD insertion: between 0 and 3 days, 4 days and 6 weeks, 6 and 14 weeks, or 14 and 52 weeks postpartum. A theoretical cohort of 600,000 was calculated using the estimate that 15.3% of postpartum people receive a long-acting reversible contraceptive. Probabilities, costs, and utilities were procured from the literature. Primary outcomes included IUD-related uterine perforation, expulsion, unplanned short-interval pregnancy, termination, stillbirth, ectopic pregnancy, and preterm delivery. The cost-effectiveness threshold was $100,000/quality-adjusted life-year (QALY).

RESULTS:
IUD insertion between 6 and 14 weeks postpartum was the cost-effective strategy despite having 1,978 and 1,982 additional perforations in intervals between 0–3 days and 14–52 weeks, respectively. All other outcomes were reduced. When compared to the intervals of 0–3 days, 4 days–6 weeks, and 14–52 weeks postpartum, this strategy resulted in 3,054, 282, and 3,816 more QALYs and decreased costs by $91 million, $22 million, and $316 million, respectively.

CONCLUSION:
Intrauterine device insertion between 6 and 14 weeks postpartum is the cost-effective strategy despite increased risk of perforation. Appropriately counseling patients on the risks and benefits associated with timing of IUD insertion is an important component of postpartum care.
Implementation of a Postpartum Furosemide Protocol in Patients With Hypertensive Disorders of Pregnancy (HDP) [ID: 1381582]
Authors: Foy Melissa , O'Reilly Geralyn 
Published: May 2023

INTRODUCTION:
Increasing evidence has shown benefits with the use of furosemide for patients with hypertensive disorders of pregnancy (HDP) in the postpartum period. We compared outcomes of patients diagnosed with HDP who received a standard protocol of postpartum furosemide versus those who had routine postpartum care.

METHODS:
In February 2022, a standardized, multidisciplinary postpartum furosemide protocol was instituted for patients with HDP. Exclusion criteria included hypokalemia, receiving concomitant diuretics, creatinine greater than 1.2 mg/dL, stenotic valvular cardiac disease, hemodynamic instability, or body mass index less than 18. We compared patients prior to routine furosemide use (June 2020 to January 2022) to patients treated under the protocol (February 2022 to July 2022). Outcomes included hypertension defined as systolic blood pressure (BP) greater than 139 or diastolic BP greater than 89 at 6–14 days postpartum, need for additional antihypertensive medications, readmissions, and show-rate for postpartum outpatient visits. Nonparametric tests were used to compare outcomes between the groups. Study was exempt from the IRB.

RESULTS:
A total of 129 patients were identified who met inclusion criteria. 80 patients met criteria prior to protocol implementation, and 49 patients met criteria after implementation. The furosemide group had a significant reduction in hypertension at 6–14 days postpartum (22.86% versus 55.26%, odds ratio 0.24, 95% CI 0.09–0.66) compared to the group who did not receive furosemide. No adverse events were noted in the furosemide group.

CONCLUSION:
Administration of a short course of furosemide to postpartum patients with HDP appears to improve BP recovery in the days immediately after delivery. Further studies examining hemodynamic changes after furosemide use are needed.
Prepregnancy Plant-Based Diets and Risk of Hypertensive Disorders of Pregnancy [ID: 1377112]
Authors: Mitsunami Makiko , Chavarro Jorge , Ortiz-Panozo Eduardo , Rich-Edwards Janet , Souter Irene , Wang Siwen 
Published: May 2023

INTRODUCTION:
Plant-based diets have been associated with a lower risk of cardiovascular disease in adults. Specific evidence for their relationship with the risk of hypertensive disorders in pregnancy (HDP) is scarce.

METHODS:
We followed 11,535 healthy women (16,892 singleton pregnancies) participating in the Nurses' Health Study II (1999–2009). Diet was assessed every 4 years using a validated food questionnaire, from which we calculated a plant-based diet index (PBDI; a higher score indicates higher adherence). The women self-reported HDP including preeclampsia and gestational hypertension (GHTN). We estimated the relative risk (RR) of HDP and PBDI (in quintiles) with log-binomial regression using generalized estimating equations with adjustments for potential confounders while considering pregnancies from the same woman.

RESULTS:
The mean age of women at their first in-study pregnancy was 35 years. We identified 495 cases of preeclampsia (2.9%), and 561 cases of GHTN (3.3%). Women in the highest quintile of PBDI had a 28% lower risk of HDP compared to women in the lowest quartile (95% CI: −11%, −42%; P-trend=.007). The association was stronger for GHTN (RR 0.63 [0.47, 0.84], P-trend<.001) than for preeclampsia (RR 0.73 [0.53, 1.02], P-trend=.23). Mediation analysis suggested that body mass index self-reported between dietary assessment and pregnancy explained 39% (95% CI 14–70%) of the relation between PBDI and HDP and 46% (95% CI 12–84%) of the relation between PBDI and GHTN.

CONCLUSION:
Higher adherence to plant-based diets was associated with a lower risk of developing HDP. Much of the benefit appears to be related to improved weight control.