bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outpatient Cervical Ripening Program Evaluation: A Comparison of Osmotic Cervical Dilators and Foley Balloon [ID: 1377400]
Authors: Sidebottom Abbey , Colicchia Laura , Drake Kelly , Goering Mary , Vacquier Marc , Wunderlich Whitney 
Published: May 2023

INTRODUCTION:
With increased demand for elective and medically indicated inductions of labor, outpatient cervical ripening programs have the potential to increase clinical efficiency, decrease costs, and promote patient satisfaction. This study describes patient characteristics, process, and outcome measures for an outpatient cervical ripening program.

METHODS:
This retrospective cohort study examined low-risk women (39–40 6/7 weeks) undergoing outpatient cervical ripening with osmotic cervical dilators (Dilapan-S) or Foley balloon from March 2020 to March 2022. Outcomes included mode of delivery, obstetric complications, and changes in cervical dilation and simplified Bishop score (SBS) (a 0- to 9-point scoring system based on dilatation, effacement, and station).

RESULTS:
One hundred twenty patients completed outpatient cervical ripening (80 osmotic dilators, 40 Foley). Foley patients were less likely to be White and had higher SBS at insertion. 16.7% (n=20) of patients returned before scheduled induction, primarily because of contractions. Device expulsion prior to admission was more common among Foley patients (27.5%) than osmotic dilators (6.3%). Mean time from insertion to admission was 17.5 hours for osmotic dilators and 13.6 hours for Foley. The mean SBS change was 1.78, and mean dilation change was 1.83 cm with no differences by device type. Mean time from admission to delivery was 20.96 (15.36) hours, and 74.2% of patients delivered vaginally, with no difference by device type in adjusted models. Rates of infection (4.2%), and postpartum hemorrhage (2.3% vaginal, 32% cesarean) did not differ by device.

CONCLUSION:
Outpatient cervical ripening with osmotic cervical dilators or Foley improves SBS on admission with low complications and no significant differences in outcomes by device.
Inpatient Versus Outpatient Induction of Labor in Low-Risk Pregnancies: A Retrospective Cohort Study [ID: 1377456]
Authors: Dong Zi Yang (Susan) , Alavifard Sepand , Ashraf Rizwana , D’Souza Rohan , Huszti Ella 
Published: May 2023

INTRODUCTION:
To determine whether outpatient induction of labor (OP-IOL) using balloon catheters improved outcomes and resource utilization when compared with inpatient (IP)-IOL.

METHODS:
Outcomes in low-risk singleton pregnancies from April 2016 to December 2018 after introduction of an OP-IOL protocol were compared with those that underwent IP-IOL between April and December 2016 at the same institution.

RESULTS:
We included 225 IP- and 850 OP-IOL cases. Prostaglandin was more commonly employed in operator-determined IP-IOL (78.7%), while balloon catheters were almost exclusively used in OP-IOL (95.4%), consequent to a unit policy. There was no difference in caesarean deliveries (CDs) (adjusted odds ratio [aOR], 1.25 [95% CI, 0.76, 2.08]), neonatal intensive care unit admission, 5-minute Apgar scores less than 7, or maternal adverse events after onset of labor. Those undergoing OP-IOL were less likely to need a second induction agent (aOR 0.19 [95% CI 0.11, 0.33]) but experienced more maternal adverse events related to the induction (aOR 3.72 [95% CI 1.24, 11.75]), a longer median IOL-to-delivery interval (19.13 versus 30.14 hours [7.28, 11.80]), although a median of 13.83 of these 30.14 hours were spent outside the hospital. There were no differences in the admission-to-delivery (−1.45 hours [–3.29, 0.38]) and total hospitalization time (0.66 hours [–3.93, 5.25]).

CONCLUSION:
Although IP- and OP-IOL had comparable CD and neonatal outcomes, operator-determined IP-IOL had significantly shorter IOL-to-delivery. A universal policy of OP balloon catheters did not shorten duration of hospitalization, but increased IOL-to-delivery and maternal adverse events. Whether an individualized approach to OP-IOL could reduce resource utilization needs to be explored.
Diabetes and Hypertensive Disorders of Pregnancy and the Risk of Third- and Fourth-Degree Perineal Lacerations: A Large United States Cohort 2016–2020 [ID: 1377605]
Authors: Gobioff Samantha , Bar-El Liron , Bornstein Eran , Chervenak Frank , Grunebaum Amos , Lenchner Erez 
Published: May 2023

INTRODUCTION:
The objective of this study was to assess the effect diabetes and hypertensive disorders of pregnancy have on the rate of third- and fourth-degree perineal laceration (3/4 PL).

METHODS:
This represents a retrospective cohort based on the Centers for Disease Control and Prevention Natality Live Birth database (2016–2020). We compared the rates of 3/4 PL in term, singleton vaginal births across the United States based on maternal gestational hypertension, preeclampsia, pregestational diabetes, and gestational diabetes. We used Pearson χ2 and multivariate logistic regression to control for confounding variables. Statistical significance was determined as P<.05, and results were displayed as adjusted odds ratios (aORs) with 95% CI.

RESULTS:
Of the 11,677,671 who met inclusion criteria, 139,174 (1.2%) women experienced 3/4 PL. Gestational hypertension and preeclampsia were associated with increased rates of 3/4 PL (1.53% with aOR 1.28, 95% CI 1.25–1.30, and 1.61% with aOR 1.31, 95% CI 1.06–1.17, respectively). Additionally, both pregestational diabetes and gestational diabetes were associated with higher rates (1.44% with aOR 1.45, 95% CI 1.35–1.56, and 1.44% with aOR 1.27, 95% CI 1.25–1.30, respectively).

CONCLUSION:
Based on this current U.S. database, we identified several medical complications of pregnancy that are associated with an increased risk for 3/4 PL. Specifically, hypertensive disorders of pregnancy (gestational hypertension and preeclampsia), pregestational as well as gestational diabetes were all associated with significantly increased risks. Understanding these associations may contribute to reduction in the rates of 3/4 PL in gravidas with these conditions.
Chorioamnionitis Is an Independent Risk Factor for Third- and Fourth-Degree Perineal Lacerations in the United States [ID: 1377609]
Authors: Gobioff Samantha , Bar-El Liron , Bornstein Eran , Chervenak Frank , Grunebaum Amos , Lenchner Erez 
Published: May 2023

INTRODUCTION:
The objective was to determine the effect chorioamnionitis has on the risk of third- and fourth-degree perineal lacerations (3/4 PL).

METHODS:
This represents a retrospective cohort based on the Centers for Disease Control and Prevention Natality Live Birth database (2016–2020). We compared the rates of 3/4 PL in term, singleton vaginal births across the United States based on diagnosed intrapartum chorioamnionitis. We used Pearson chi-square and multivariate logistic regression to control for confounding variables. Statistical significance was determined as P<.05, and results were displayed as adjusted odds ratios (aORs) with 95% CI.

RESULTS:
Of the 11,677,671 who met inclusion criteria, 139,174 (1.2%) women experienced 3/4 PL. Intrapartum chorioamnionitis was associated with a staggering 3.96% rate of 3/4 PL compared to a 1.15% rate in women without chorioamnionitis (aOR 1.85, 95% CI 1.80–1.90).

CONCLUSION:
Based on this current U.S. database we identified chorioamnionitis as a major risk factor for 3/4 PL. The potential explanation may be due to dysfunctional labor, increased perineal edema secondary to protracted labor, or increased friability of tissue. Understanding this association may assist in better counseling and potentially reduce the rates of 3/4 PL in gravidas with chorioamnionitis.
Risk Factors for Worsening Placental Invasion Within a Cohort of Placenta Accreta Spectrum Patients [ID: 1380333]
Authors: Hussein Nada , Harrison Rachel , Holmgren Calla , Phelps Alexandra , Steinberg Guy , Steinberg Guy 
Published: May 2023

INTRODUCTION:
Risk factors for placenta accreta spectrum (PAS) are overall well understood. We sought to evaluate whether those with more severe disease (increta/percreta) have a subset of patient-specific risk factors that could assist in preoperative planning.

METHODS:
Institutional review board-approved case–control study of patients diagnosed with PAS who underwent cesarean hysterectomy with pathology confirmed findings. Those with final pathology of placenta increta or percreta were compared to those whose final pathology demonstrated placenta accreta. Baseline characteristics and pregnancy histories were compared between groups via Student’s t tests and χ2 analysis, and a backwards logistic regression was performed to evaluate individual factors associated with more severe PAS invasion.

RESULTS:
A total of 83 participants met criteria with 51 (61.4%) diagnosed on pathology with increta/percreta. Those with increta/percreta had higher body mass index (34.3±7.0 versus 30.8±8.0) and higher number of prior cesarean births (2.2±1.0 versus 1.7±0.9), and were less likely to have undergone in vitro fertilization (3.9% versus 21.9%) or have a previous cesarean birth with two-layer closure compared to single-layer closure (25.0% versus 63.6%) (all P<.05). After controlling for confounders, there was a trend for more prior cesarean births to increase the risk of increta/percreta and for prior cesarean birth with two-layer closure to decrease the risk, but these were not statistically significant (adjusted odds ratio [aOR] 1.18, 95% CI 0.43–3.23, and aOR 0.51, 95% CI 0.18–1.46, respectively).

CONCLUSION:
Our study did not identify patient-specific factors that increased the risk for more severe PAS invasion; however, there was a trend for multiple prior cesarean births and previous cesarean birth with single-layer closure to be associated with increased risk.
Recent Trends in Tranexamic Acid Use During Postpartum Hemorrhage in the United States [ID: 1380480]
Authors: Litman Ethan , Ahmadzia Homa , Ma Phillip , Nelson Stuart 
Published: May 2023

INTRODUCTION:
The United States has one of the highest rates of maternal mortality among developed regions, and postpartum hemorrhage (PPH) accounted for 14% of all pregnancy-related deaths between 2017 and 2019. Several large studies have demonstrated decreased PPH rates with the use of tranexamic acid (TXA). Consensus has not yet been reached on the when to administer use of TXA. Little data exist regarding the prevalence of TXA use in obstetric patients with and without PPH.

METHODS:
Using a national database, we identified over 1.2 million pregnancies between January 1, 2015, and June 30, 2021. Pregnancy and delivery information was abstracted using ICD-10 codes. The GW Institutional Review Board approved the study protocol and waived the requirement for patient informed consent.

RESULTS:
Overall, TXA was used 1% of the time (12,394/1,262,574), and there was a fivefold increase in TXA use (0.5–2.5%) during the study period. Patients had similar demographic characteristics. Tranexamic acid use differed by geographic region. The use of TXA increased in both patients with PPH and those without. There was a greater increase in the number of patients who received TXA for prophylaxis of PPH than those who received it as treatment of PPH.

CONCLUSION:
This is the largest U.S. observational study to examine patterns of TXA use in obstetrics. Tranexamic acid was only administered in approximately 10% (4,586/43,928) of cases of PPH. This represents an opportunity to increase awareness for the role of TXA in management and prevention of PPH.
Effect of Body Mass Index on Adverse Neonatal Outcomes in Patients With Emergency Cesarean Deliveries [ID: 1381091]
Authors: Doshi Uma , Caughey Aaron , Chaiken Sarina , Garg Bharti 
Published: May 2023

INTRODUCTION:
The objective of this study was to evaluate the association of body mass index (BMI) with adverse neonatal outcomes in pregnant patients with emergency cesarean delivery (CD).

METHODS:
This was a retrospective cohort study of singleton nonanomalous pregnancies between 23 and 42 weeks from 2007 to 2012 in California. Pregnancies resulting in an emergency CD were stratified based by ICD-9 codes for cord prolapse, or uterine rupture. Outcomes included neonatal intensive care unit (NICU) admission, Apgar scores less than 3 at 5 minutes, infant death, respiratory distress syndrome (RDS), neonatal seizures, and hypoglycemia. After stratifying by cause of emergency CD, multivariable logistic regression models were used to evaluate associations of BMI at delivery with adverse neonatal outcomes. Models were adjusted for maternal race and ethnicity, age, education level, insurance, parity, smoking status, and prenatal care.

RESULTS:
Of this cohort, 1,368 had an emergent CD in the setting of cord prolapse, and 992 had an emergent CD in the setting of a uterine rupture. Of individuals with cord prolapse, patients whose BMI was classified as obesity class II had decreased odds of NICU admission, and those whose BMI was classified as obesity class III had decreased odds of NICU admission and RDS. Of individuals with a uterine rupture, patients whose BMI was classified as overweight had decreased odds of all neonatal outcomes analyzed. Those with a BMI classified as obesity class I had decreased odds of all neonatal outcomes except for neonatal seizures. Those with a BMI classified as obesity class II had decreased odds of lower Apgar scores, NICU admission, infant death, and RDS. Those with a BMI greater than 50 had increased odds of RDS and hypoglycemia.

CONCLUSION:
Higher BMI was associated with decreased risk of many adverse neonatal outcomes in the setting of patients delivering emergently with cord prolapse or uterine rupture. These findings may be useful in appropriately managing patients presenting with emergent CD.
Newborn Outcomes After Maternal COVID-19 Infection in Pregnancy and the Potential Role of Infection Severity [ID: 1373946]
Authors: Elsayed Yosra , Bailey Beth , Oatey Elena 
Published: May 2023

INTRODUCTION:
COVID-19 poses health risks in pregnancy including increased rates of cesarean sections, preeclampsia, and miscarriage. However, less is known about newborn effects and the effect of severity of infection. We evaluated the link between pregnancy COVID-19 infection status and severity, and newborn outcomes.

METHODS:
Participants in this IRB-approved retrospective chart review study were identified via medical records from a single university-affiliated obstetric practice and grouped as COVID-19 positive during pregnancy (n=69), or COVID-19 negative delivering pre-COVID (n=59). Severity of infection was based on emergency department visit, hospitalization, oxygen treatment, steroids, antibodies, or ventilation. Information on socioeconomic factors, medical history, and birth outcomes was also abstracted.

RESULTS:
Compared to controls, and after adjustment for background differences, those with COVID-19 infection during pregnancy had newborns 242 g lighter and were 4.3 times more likely to deliver preterm, 2.6 times more likely to have a newborn with a 1-minute Apgar score less than 8, and 2.9 times more likely to remain hospitalized a week or more. Differences were largely driven by earlier delivery. Finally, severe COVID-19 infection (which occurred for 41% of participants with COVID-19) was a strong predictor of preterm delivery, low birth weight, receipt of oxygen, neonatal intensive care unit admission, and longer hospital stay.

CONCLUSION:
COVID-19 infection during pregnancy predicts adverse newborn outcomes, especially as a result of reduced gestational duration. Additionally, severity of infection may predict worse outcomes. A larger, more diverse sample is needed to confirm findings, and to examine potential effect of vaccination in reducing the effect of COVID-19 infection during pregnancy.
Postpartum Readmission in Maryland by Race and Ethnicity [ID: 1358223]
Authors: Hamilton Sonia , Lawson Shari , Olson Sarah , Voegtline Kristin 
Published: May 2023

INTRODUCTION:
In Maryland, 81% of pregnancy-related deaths occurred in the postpartum period. We sought to compare postpartum readmission by race and ethnicity to better understand disparities in maternal mortality.

METHODS:
In this retrospective study (2016–2019), childbirth hospitalizations from the Maryland State Inpatient Database for childbearing age patients were analyzed. Indication for readmission was described. Multivariable logistic regression models were employed to determine race and ethnicity differences in postpartum readmissions, adjusting for maternal and obstetric characteristics (Johns Hopkins IRB00320807).

RESULTS:
Among total deliveries (n=260,778), 3,914 patients (1.5%) were readmitted within 60 days of delivery. The most common primary diagnoses at readmission were hypertension and infection. The prevalence of readmission was 1.2% for White patients, 2.3% for Black patients, and 1.2% for Hispanic patients (P<.0001). Black patients had the highest rates of readmission for hypertensive disorders (37%, P<.0001). In adjusted models, Black patients were more likely to be readmitted than White patients (odds ratio 1.64, CI 1.52–1.77). The majority of readmissions occurred in the first week after delivery; however, Black patients had higher rates of readmission in the second week relative to all other groups (P<.0001).

CONCLUSION:
Hypertension is a leading factor for postpartum readmission in Maryland. Black patients were more likely to be readmitted for hypertensive disorders of pregnancy and to have delayed readmission relative to other race/ethnic groups. Maryland public health officials should address disparities with interventions targeting racial and ethnic minorities, patients at risk for hypertensive disorders, and barriers to timely care.
Maternal Outcomes in Placenta Accreta Spectrum Disorders Managed With REBOA [ID: 1370002]
Authors: Muller Benjamin , Chang Eugene , Finneran Matthew , McElwee Eliza , Peneva Ralitza , Sullivan Scott 
Published: May 2023

INTRODUCTION:
Pregnancies complicated by placenta accreta spectrum (PAS) are increasing. In PAS, resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used to control life-threatening hemorrhage, although supporting data are conflicting. The aim of this study was to determine the outcomes in pregnancies complicated by PAS managed with REBOA.

METHODS:
This was an IRB-exempt retrospective cohort study of pregnancies complicated by PAS at a single institution. The primary outcome was arterial thrombus. Secondary outcomes were estimated blood loss, operative room time, transfusion risk, and hospital and intensive care unit stays. Demographics and outcomes were compared by univariate analysis. Multivariable logistic regression with a mixed effects model was used to control for confounders.

RESULTS:
Ninety-one pregnancies (16 REBOA and 75 non-REBOA) were included. REBOA was associated with an increased risk of arterial thrombus, adjusted odds ratio of 1.33 (95% CI 1.05–1.77, P<.001). Patients with an arterial thrombus had longer hospital (P<.003) and intensive care unit stays (P<.001). REBOA use was associated with increased total operative time (249 versus 171 minutes, P=.001). REBOA was not associated with lower total estimated blood loss (EBL, 2,699 versus 3,455 mL, P=.28).

CONCLUSION:
The use of REBOA in PAS is associated with an increased risk of arterial thrombus compared to management without. This risk remains elevated after controlling for demographic and clinical variables. REBOA use was not associated with clinical benefits such as decreased EBL or operative time.
Nonobstetric Maternal Mortality Trends by Race in the United States From 2000 to 2019 [ID: 1376551]
Authors: Huang Ryan , Abenhaim Haim Arie 
Published: May 2023

INTRODUCTION:
Public health interventions to reduce maternal mortality have focused on direct and indirect obstetric causes, while neglecting nonobstetric causes of death. The study objective was to examine recent trends in maternal deaths from nonobstetric causes in the United States.

METHODS:
A population-based cross-sectional study was conducted in the United States using data from the “Birth Data” and “Mortality Multiple Cause” files compiled by the Centers for Disease Control and Prevention from 2000 to 2019. The annual incidence of maternal deaths attributed to nonobstetric causes per 100,00 live births were calculated across racial groups using official death certificates, while the effects of race on the risk of nonobstetric maternal mortality and temporal changes over the study period were examined using logistic regression models.

RESULTS:
From 2000 to 2019, a total of 7,334 women died during pregnancy and childbirth from nonobstetric causes, where 31.3% of these deaths were caused by transport accidents and 27.3% by accidental poisoning. American Indian women were found to be at the highest risk of nonobstetric maternal mortality (odds ratio 2.20, 95% CI 1.90–2.56), and 46.1% of all deaths among pregnant American Indian women were caused by nonobstetric complications. The risk of nonobstetric maternal mortality increased overall during the study period, with a greater increase among Black (1.15, 1.13–1.17) and American Indian women (1.17, 1.13–1.21).

CONCLUSION:
Nonobstetric causes of death have become increasingly prevalent in the United States, overall and especially in American Indian women. Novel interventions to address these nonobstetric factors should especially target American Indian women to improve maternal outcomes.
The Effect of Transverse Skin Incision Location on Wound Morbidity After Cesarean Delivery for Patients With Morbid Obesity [ID: 1377795]
Authors: Baranco Nicholas , Mastrogiannis Dimitrios , Zhang Junchao 
Published: May 2023

INTRODUCTION:
The objective of this study was to assess whether placement of transverse skin incision below or above the panniculus for cesarean delivery in patients with morbid obesity is associated with postoperative wound complications.

METHODS:
We identified a cohort of all women with body mass index (BMI) higher than 40 who delivered by cesarean at our institution from 2016 to 2020, had complete postpartum records, singleton gestation, and transverse skin incision. Medical records were abstracted after IRB exemption. The primary outcome was composite wound morbidity (infection, disruption, or dehiscence). Secondary outcomes included operative time, neonatal outcome, and blood transfusion. Analysis was performed with χ2 and logistic regression including BMI percentile, diabetes, smoking, unscheduled surgery, and prior cesarean.

RESULTS:
Two hundred sixty-three patients had a low transverse incision and 65 had a high transverse incision. 14.6% of patients had wound morbidity. There were two reoperations and no fascial dehiscences or deep site infections. Patients with a high transverse incision had higher mean BMI (53.0 versus 45.9, P<.001) and were less likely to be in labor (relative risk 0.52, 0.28–0.96) but were otherwise similar to patients with a low incision. High transverse incision was associated with composite wound morbidity (adjusted odds ratio 5.12, 2.36–11.09) and increased operative time (61 versus 54 minutes, P=.02) but not other secondary outcomes. Results did not significantly differ when analysis was restricted to patients with BMI greater than 50.

CONCLUSION:
Wound morbidity was more frequent after high transverse skin incision for cesarean delivery. Prospective studies are needed to determine whether incision location or other factors caused this increase.