bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Suture Material in History-Indicated Cerclage on Spontaneous Preterm Delivery Risk [ID: 1370506]
Authors: Sweeney Heather , Ghadiali Tejal , Hong Christian , Lee Richard , Nguyen Michelle , Sriprasert Intira 
Published: May 2023

INTRODUCTION:
This study aimed to determine whether suture material in history-indicated cerclage is associated with spontaneous preterm delivery (sPTD).

METHODS:
We conducted a retrospective cohort study of patients with singleton pregnancies who underwent history-indicated transvaginal cerclage at a tertiary care center from June 2015 to January 2022. The primary outcome was sPTD before 24 weeks of gestation. Secondary outcomes included sPTD at less than 26, 28, 32, and 34 weeks of gestation, chorioamnionitis, days in neonatal intensive care unit, and various adverse neonatal outcomes. Baseline characteristics and outcomes were compared using chi-square and Fisher’s exact tests according to type of suture material: 5-mm braided polyester fiber (Mersilene tape) versus monofilament suture (Prolene). Odds ratios (ORs) for sPTD were estimated using multivariable logistic regression.

RESULTS:
A total of 64 patients were included in the study, with 50 (78%) patients receiving Mersilene and 14 (22%) receiving Prolene. Mersilene, compared to Prolene, was associated with significantly lower rates of sPTD at less than 24 weeks (6% versus 29%, P=.02) and less than 26 weeks (8% versus 29%, P=.04). At more advanced gestational ages, Mersilene still resulted in lower rates of sPTD compared to Prolene, but statistical significance was lost. After adjusting for race and ethnicity, body mass index, use of postoperative progesterone, and gestational age at cerclage placement, patients with Prolene had increased odds of delivery less than 24 weeks (OR 7.69, 95% CI 1.04–56.6). Secondary outcomes were similar between the two groups.

CONCLUSION:
In patients undergoing history-indicated cerclage, Mersilene compared to Prolene was associated with a significantly lower risk of previable pregnancy loss.
The Effect of Implementing a Colorimetric Quantitative Blood Loss System for Identification of Postpartum Hemorrhage [ID: 1377803]
Authors: Gallo Mary , Caliendo Martin , Lardy Meghan , Nims Sarah 
Published: May 2023

INTRODUCTION:
Maternal mortality rates have increased to 23.8 per 100,000 live births in 2020, with the rate for non-Hispanic Black patients 2.9 times greater than non-Hispanic White patients in 2020. Postpartum hemorrhage (PPH) is responsible for approximately half of maternal morbidity. Many PPHs are preventable, and are due to delay in recognition. Disparities in health care outcomes are related to systemic racism, and implicit bias. Improvement requires developing and implementing standardized protocols. The California Maternal Quality Care Collaborative (CMQCC) developed a hemorrhage tool kit, featuring accurate quantitative assessment of blood loss (QBL) as a cornerstone to address these issues. Our main objective was whether implementation of a colorimetric-based QBL would identify PPH at earlier stages and improve maternal outcomes.

METHODS:
This is a retrospective case–control study comparing incidence of PPH, stage of PPH, maternal morbidity and length of stay, stratified by race and ethnicity, 1 year before and after implementation of a colorimetric-based QBL system.

RESULTS:
There was a 178% increase in overall identification of PPH from 5.1% to 14.2%. There was an increase in identification of stage I PPH, and decrease in stage II and stage III PPH. Total intensive care unit (ICU) admissions decreased from nine to zero. In non-Hispanic Black patients, PPH increased from 3.6% to 13.8%, with increased identification of stage I PPH.

CONCLUSION:
An unbiased colorimetric-based system for QBL during delivery and postpartum leads to earlier identification of postpartum hemorrhage in all patients regardless of ethnicity or race, a decrease in total ICU admissions, and shorter length of stay, overall increasing maternal outcomes.
The Effect of Implementation of a Standardized Multidisciplinary Placenta Accreta Spectrum Team: A Quality Improvement Initiative [ID: 1377806]
Authors: Lardy Meghan , Caliendo Martin , Gallo Mary , Nims Sarah 
Published: May 2023

INTRODUCTION:
Placenta accreta spectrum (PAS) is associated with significant morbidity and mortality. A multidisciplinary team and standardized protocol for identified PAS cases were created to provide a clear preoperative plan for mitigation of intraoperative blood loss, and surgical and postoperative complications.

METHODS:
This is an ongoing quality improvement study. The PAS team was implemented January 2021. All cases of PAS resulting in cesarean hysterectomy from January 2018 through August 2022 at a single regional perinatal center were included. Estimated blood loss (EBL), number of blood products (packed red cells, platelets, fresh frozen plasma), whether surgical complication was incurred, intensive care unit (ICU) length of stay (LOS), and hospital LOS were compared. T tests and χ2 were used to calculate significance.

RESULTS:
Thirty-eight cases were reviewed, 18 cases before implementation of the PAS team, 20 after. Average EBL was 3,800 mL pre-team, 3,191 mL post-team (P=.522). Pre-team average units of packed red cells were 4.67, 3.55 post-team (P=.199); platelets 1.72 versus 1.35 units (P=.424); fresh frozen plasma 0.67 versus 0.55 units (P=.581). Average ICU LOS and hospital LOS pre-team were 0.67 and 3.56 days, 0.30 (P=.121) and 3.35 (P=.434) days, respectively, post-team.

CONCLUSION:
Estimated blood loss, total blood products, occurrence of surgical complication, ICU LOS, and hospital LOS were decreased after implementation of a PAS multidisciplinary team. Statistical insignificance in all parameters was attributable to small sample size necessitating further future analysis with additional cases. A standardized multidisciplinary approach to PAS may demonstrate morbidity reduction.
Provider Adherence to Aspirin Prophylaxis Recommendations in Pregnancy at a Single Military Treatment Facility [ID: 1380223]
Authors: Chatfield Lindsay , Elmezzi Kristen , Owens Amanda 
Published: May 2023

INTRODUCTION:
Preeclampsia complicates 2–8% of pregnancies and is a major contributor to maternal and perinatal morbidity and mortality. Aspirin (ASA) is known to decrease rates of preeclampsia in patients at risk for developing the disease. We examined provider compliance with the U.S. Preventive Services Task Force risk-based aspirin prophylaxis guidelines at our institution and identified a need for improvement.

METHODS:
For quality improvement, we implemented provider education, updated patient history forms, and an embedded ASA checklist within our note template. We retrospectively reviewed demographics, medical/obstetric history, and candidacy/prescription placement for two patient groups at their first prenatal visit. The first was the preintervention group (January 1 to June 30, 2019; N=434) and the second was the postintervention group (July 1 to September 30, 2021; N=284). Preintervention and postintervention data were then compared to determine whether rates of compliance with ASA prophylaxis guidelines improved.

RESULTS:
A similar proportion of patients met criteria for ASA prophylaxis preintervention (43.1%, 95% CI 38.5–47.8%) and postintervention (46.8%, 95% CI 41.1–52.6%, P=.36), with similar proportions of patients who qualified with one high risk factor versus multiple moderate risk factors. There were significantly more patients who qualified for aspirin and were not identified in the preintervention group (67.9%, 95% CI 60.9–74.2%) than in the postintervention group (18.8%, 95% CI 13.0–26.3%, P<.0001). This improvement was even more pronounced in patients who only qualified by moderate risk factors (preintervention [79.7%, 95% CI 72.5–85.5%] versus postintervention [21.2%, 95% CI 14.7–29.7%]).

CONCLUSION:
The implementation of provider education, updated patient history forms, and an ASA checklist significantly improved provider adherence to ASA prophylaxis recommendations.
MomHEART: Utilization of a Web-Based Postpartum Hypertension Platform [ID: 1371438]
Authors: Winsten Mary Taylor , Gold Stacey , Overcash Rachael 
Published: May 2023

INTRODUCTION:
Maternal complications of hypertensive disorders of pregnancy (HDP) extend to the postpartum period. Remote blood pressure (BP) monitoring and online educational platforms may improve a patient's knowledge, accessibility, and adherence to BP monitoring allowing for earlier identification of complications. We sought to compare differences in postpartum hypertension platform utilization based on severity of HDP.

METHODS:
We performed a single-center, prospective implementation study of women enrolled in a web-based postpartum hypertension platform called MomHEART. Through MomHEART, women received educational information about BP monitoring, text message reminders or calls from virtual nurses to log their BP daily for 14 days. Primary outcome was utilization defined as logging a BP, viewing educational information, and/or interacting with a virtual nurse. Descriptive statistics were used to analyze our data. A Fisher exact test was used to compare program utilization based on hypertensive severity.

RESULTS:
Sixty-four patients were enrolled from April to July 2022. The mean gestational age at delivery was 37.1 weeks. Participants were more likely to be Black, single, have insurance, and delivery vaginally. Thirty-two participants (50%) had HDP with severe features, and 32 (50%) had HDP without severe features. Forty-nine (76.6%) participants interacted with MomHEART. We found no difference in platform utilization by severity of hypertensive diagnosis.

CONCLUSION:
Utilization of MomHEART did not vary based on hypertension severity. Overall, utilization was high, indicating participants found MomHEART valuable. This is a small pilot study on the utilization of the MomHEART program. Additional analysis will be performed to assess the efficacy of identifying maternal hypertensive complications in the postpartum period.
Improvement in HAMD-17 Subscale Scores With 14-Day Treatment Course of Zuranolone in Postpartum Depression: Results From the SKYLARK Study [ID: 1372313]
Authors: Deligiannidis Kristina , Bullock Amy , Kotecha Mona , Li Sigui , Maximos Bassem , Vera Theresa 
Published: May 2023

INTRODUCTION:
Postpartum depression (PPD) is a serious perinatal complication. SKYLARK (phase 3, randomized, double-blind, placebo-controlled trial [NCT04442503]) evaluated zuranolone, an investigational, neuroactive steroid positive allosteric modulator of both synaptic and extrasynaptic GABA(A) receptors, in adult patients with PPD. The primary endpoint, change from baseline (CFB) in HAMD-17 total score at day 15, was met. Zuranolone was generally well tolerated. The HAMD-17 can be divided into subscales that group specific items from the HAMD-17 scale that measure different aspects of depression presentation. Here, we present HAMD-17 subscale data from SKYLARK.

METHODS:
Patients aged 18–45 years with severe PPD (HAMD 17 total score ≥26) were randomized 1:1 to oral, once-daily zuranolone 50 mg or placebo for 14 days. The secondary endpoint was day 15 CFB in HAMD-17 subscale (Core Depression, Anxiety, Bech-6, Maier) scores. Subscales were analyzed separately by a mixed-effects model for repeated measures. Institutional review board approval was obtained.

RESULTS:
One hundred ninety-five patients (zuranolone, 98; placebo, 97) were randomized, received study drug, and had valid baseline and one or more post-baseline efficacy assessments. At day 15, patients receiving a 14-day treatment course of zuranolone showed nominally significant improvements across all HAMD-17 subscales versus placebo (least squares mean [SE] CFB treatment difference: Core Depression, −5.9 [2.4], P=.0151; Anxiety, −5.7 [2.3], P=.0123; Bech-6, −8.6 [3.0], P=.0040; Maier, −7.6 [2.6], P=.0041). Improvement in all subscales was observed starting at day 3.

CONCLUSION:
In SKYLARK, zuranolone was associated with rapid improvement in depressive and anxiety symptoms in patients with PPD across multiple domains, supporting its development as a potential oral, rapid-acting treatment option for PPD.
Should Severe Preeclampsia Be Considered a Risk Factor for Postpartum Depression and Anxiety? [ID: 1376999]
Authors: Broome Sidney , Dallas Madison , Kinzer Carly , Lowtan Tiffany , Roussos-Ross Dikea , Razavi Mehrsa Sadat 
Published: May 2023

INTRODUCTION:
Postpartum mood disorders are common and seen in approximately 20% of women. It is important to understand risk factors associated with this diagnosis so that earlier interventions can be initiated. To date, the effect of preeclampsia on postpartum mood disorders has not been thoroughly investigated. The purpose of this study was to investigate whether severe preeclampsia (SPE) acts as a risk factor for postpartum depression (PPD) or postpartum anxiety (PPA).

METHODS:
A retrospective chart review of participants who delivered between January 1, 2015, and April 1, 2022, was conducted after IRB approval. Inclusion criteria required: 1) at least one prenatal visit, 2) a postpartum visit, 3) an Edinburgh Postnatal Depression Scale (EPDS) score, 4) a SPE diagnosis, and 5) no other significant perinatal complications. Control records met #1–3 and #5 criteria. Data analysis was conducted using an independent-samples t test.

RESULTS:
Of 216 SPE participants and 253 control participants queried, 150 and 200 participants respectively met inclusion criteria. An independent-samples t test comparing EPDS scores of SPE and control participants found no significant difference, t(299)=0.40, P=.693. Comparing EPDS anxiety scores (EPDS-3A) likewise found no significant difference between the two groups, t(240)=.85, P=.397.

CONCLUSION:
Results indicate that SPE is not a risk factor for PPD or PPA diagnosis. Despite null findings, those with and without preeclampsia must be screened for PPD because of its prevalence and detrimental effect if left untreated. Future studies should examine PPD and PPA diagnoses within 12 months postpartum instead of the immediate postpartum period.
Healing at Home: Impacting Postpartum Outcomes Utilizing Clinical Practice Changes and Augmented Intelligence [ID: 1379350]
Authors: Leitner Kirstin , Christ Lori , Cutri-French Clare , Levine Lisa , McCabe Meaghan , Scalise Laura 
Published: May 2023

INTRODUCTION:
The fourth trimester is a time of great physical and emotional challenge. To help patients navigate this period, we created the Healing at Home (H@H) program, which combined expedited discharge with a 24/7 bidirectional postpartum support chatbot.

METHODS:
Clinical outcomes, abstracted from medical record and patient report via text message, were evaluated for patients enrolled in H@H (March 2020 to September 2021) compared to patients delivering prior to program implementation (July to December 2019). Enrolled patients had a full-term singleton vaginal delivery of a non-small-for-gestational-age infant without postpartum hemorrhage (>1,000 cc), a low-risk sepsis risk score, a low- to intermediate-risk bilirubin, and lack of significant maternal comorbidities (eg, preeclampsia, preexisting diabetes). Institutional review board waiver for this quality improvement study was obtained.

RESULTS:
There were 490 patients enrolled in H@H versus 309 in preintervention group. The groups were similar in parity, race, ethnicity, and insurance status. There was no difference in the primary outcome, postpartum visit attendance (76.9% versus 76.1%, P=.77). H@H patients had a shorter postpartum length of stay (33.3 versus 46.7 hours, P<.001), higher rates of exclusive breastfeeding at 1 week (59.2% versus 57.0%, P=.02), and a higher rate of contraceptive use (55% versus 44%, P=.01), with no difference in maternal unscheduled visits or hospital readmissions.

CONCLUSION:
This innovative postpartum program was associated with a shorter length of stay and improvement in contraceptive acceptance and breastfeeding without increasing unscheduled visits. Future studies should evaluate the cost-effectiveness of this program and expansion to higher-risk patients including those with cesarean delivery and medical comorbidities.
Do Clinicians Appropriately Screen for Thyroid Disease in Pregnancy Using Targeted Screening Guidelines? A Real-World Retrospective Study [ID: 1368322]
Authors: Dong Allan , Lott Melisa 
Published: May 2023

INTRODUCTION:
Universal screening for thyroid disease in pregnancy is not currently recommended. Guidelines support targeted screening of high-risk individuals. Prior studies have provided some evidence to the cost-effectiveness of universal screening. We aim to evaluate adherence to targeted screening criteria as well as outcome differences between screened and unscreened patients.

METHODS:
All patients presenting for new obstetrical visits in 2020 were reviewed. Institutional review board approval was obtained for this study. Risk factors meeting thyroid screening criteria based on American Thyroid Association (ATA) and/or American College of Obstetricians and Gynecologists (ACOG) guidelines, and pregnancy outcomes were extracted. Pregnancy outcomes were compared between patients meeting ATA and/or ACOG criteria who did or did not receive screening via thyroid function testing (TFT).

RESULTS:
One thousand twenty-five records were included. 87/198 patients meeting ACOG criteria for screening (43.9%) and 108/826 patients meeting ATA criteria (13.1%) had TFT. Patients meeting ATA criteria who underwent TFT had higher live-birth rates and lower miscarriage rates compared to unscreened patients meeting ATA criteria, 92.6% versus 83.26% (P=.006) and 4.63% versus 12.41% (P=.009), respectively. No difference was found between patients meeting ACOG criteria who did or did not receive TFT. No differences were observed in preterm delivery rates.

CONCLUSION:
In a real-world study of obstetrical practice, less than 50% of patients were appropriately screened for thyroid disease in pregnancy. ATA criteria identified threefold more patients for screening compared to ACOG criteria. Those screened appropriately per ATA criteria had higher live-birth rates and lower miscarriage rates compared to unscreened patients meeting ATA criteria.
Low Optimism and Social Media Use Characteristics in Pregnancy [ID: 1375605]
Authors: Ayala Nina , Jarell Amelia , Lewkowitz Adam , Mette Makena , Schlichting Lauren , Whelan Anna 
Published: May 2023

INTRODUCTION:
Dispositional optimism (DO) is a resilience factor associated with improved perinatal somatic and mental health outcomes. Low DO has been associated with lower perceived control over labor. Little is known about the relationship between DO and social media (SM) use characteristics, which might provide context for the differences in perceived labor control.

METHODS:
This is a cross-sectional descriptive study of patients from a single tertiary institution. Participants were approached during their postpartum hospitalization and completed a short series of questionnaires including DO (Life-Orientation Test-Revised), perceived labor control (Labour Agentry Scale), and SM use characteristics (frequency, time spent on SM, frequency of posting). Those with low DO (score ≤14) were compared to those with high DO using bivariable analyses. Institutional review board approval was obtained prior to enrollment initiation.

RESULTS:
Two hundred ninety-nine postpartum individuals took part in the study, and 97 (32.4%) had low DO. Those with low DO were younger, had lower education, and were more likely to self-identify as non-White. Overall frequency of SM use did not differ between groups; however, those with low DO were more likely to post information about their pregnancy online (P<.01). They also had nonsignificantly lower rates of posting pregnancy-related questions (37.1% versus 62.9%, P=.25). Lastly, they had lower perceived control over the labor process (47.1 versus 52.9, P<.01).

CONCLUSION:
Recently postpartum individuals with low versus high DO reported using SM differently during their pregnancy, which may have contributed to differences in perceived control over labor, an important predictor for postpartum psychopathology.
Adverse Maternal Outcomes Associated With Gestational Weight Gain in Women With Polycystic Ovarian Syndrome [ID: 1377702]
Authors: Rossi Jordan , Johnson Juliane , Park Bo , Yao Ruofan 
Published: May 2023

INTRODUCTION:
The objective of this study was to investigate maternal complications associated with gestational weight gain (GWG) in women with a history of polycystic ovarian syndrome (PCOS).

METHODS:
This was a retrospective cohort analysis using data abstracted from the California Office of Statewide Health Planning and Development (OSHPD) Linked Birth File with hospital discharge International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses between 2007 and 2012. Pregnancies in women with a history of PCOS were stratified based on the Institute of Medicine 2009 recommendations for GWG as follows: appropriate weight gain, excessive weight gain, inadequate weight gain, or weight loss. The maternal outcomes of interest included preeclampsia, cesarean delivery, blood transfusion, and intensive care admission. Logistic regression analysis was performed to estimate the odd ratio of the outcomes of interest for each GWG stratum in pregnancies with and without PCOS, with adjustments for confounding variables.

RESULTS:
There were 3,161,821 pregnancies, with 4,233 women with history of PCOS. The risk of cesarean delivery for women in the excessive weight gain cohort without PCOS was 1.35% versus 1.68% in the PCOS group (P<.001, 95% CI [1.38–2.04]). There were no significant differences in cesarean delivery rate for women with PCOS in the inadequate weight gain or weight loss groups. There were no statistically significant differences for preeclampsia, blood transfusion, and intensive care admission in pregnancies with and without PCOS based on GWG.

CONCLUSION:
In pregnancies affected by PCOS, excessive weight gain is associated with increased risk of cesarean delivery compared to women without PCOS.