bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vaginal Preparation Prior to Planned Cesarean Delivery to Reduce Postpartum Endometritis: A Quality Improvement Study [ID: 1378331]
Authors: Howse Brittany , Adefisoye James , Cicero Andra , Kram Jessica , Michelson Elizabeth 
Published: May 2023

INTRODUCTION:
Infection prophylaxis is an important part of perioperative care. Studies have demonstrated that incorporation of pre-cesarean vaginal preparation reduces postoperative rates of endometritis in laboring patients or those with ruptured membranes. Our study aimed to identify whether vaginal preparation decreases the risk of postpartum endometritis among scheduled cesarean deliveries.

METHODS:
We retrospectively reviewed all pregnant people with scheduled cesarean deliveries in one urban, teaching hospital between April 2018 and November 2020. Deliveries were excluded if they were laboring, had ruptured membranes prior to surgery, had known iodine allergy, or had other intraoperative complications. Deliveries were divided into three groups based on vaginal preparation protocol implementation: preimplementation (April 2018 to March 2019), implementation (April 2019 to November 2019), and postimplementation (December 2019 to November 2020). Only deliveries in the preimplementation versus postimplementation group were compared given implementation learning curve. Descriptive and inferential statistics were computed; χ2 or Fisher’s exact test was used to assess differences in rates of endometritis or other postpartum complications.

RESULTS:
Overall, 320 scheduled cesarean deliveries were included (N=162 preimplementation; N=158 postimplementation). Rates of endometritis was not different between groups (1.2% versus 2.5% postimplementation; P=.44). Similarly, postpartum complication rates for fever (1.2% versus 3.8% postimplementation, P=.17), wound infection (3.7% versus 3.2% postimplementation, P=.79), sepsis (0% versus 0.6% postimplementation, P=.49), and 30-day readmission unrelated to preeclampsia (3.7% versus 3.3% postimplementation, P=.12) were not different between groups.

CONCLUSION:
While there was no reduction in postpartum endometritis in patients undergoing planned cesarean delivery, universal implementation may still be a reasonable intervention given its low cost and known benefit in laboring patients or those with ruptured membranes.
Tailored, Just-in-Time Education and Resources for Birthing Individuals and Newborn Caregivers After Hospital Discharge: Developing a Chatbot Experience [ID: 1376023]
Authors: Arem Hannah , Auguste Tamika , Danielson Aimee , Ganacias Karen , Patchen Loral , Rethy Janine 
Published: May 2023

INTRODUCTION:
The District of Columbia has some of the highest rates of maternal mortality in the United States, which disproportionally affects Black birthing individuals. Chatbots are a particularly promising platform as they can offer tailored, just-in-time information to birthing individuals and newborn caregivers through active outreach.

METHODS:
We developed an interactive chatbot experience to focus on warning signs (physical and mental health), education, and reconnecting with health care teams in the 42 days after discharge. We solicited input from expert stakeholders with expertise in obstetrics, pediatrics, social work, psychiatry, mHealth, and health equity to develop content for a clinical setting where patients mostly utilize public insurance. Feedback was also solicited from end users through virtual and in-person testing and feedback sessions. The chatbot experience was launched on August 30, 2022, whereby all birthing individuals at a large, urban hospital in Washington, DC, began to receive messaging 24 hours after discharge. The IRB protocol was approved by MedStar Health Research Institute.

RESULTS:
In the first 60 days, 418 messages were sent out, and 230 individuals engaged with the chatbot. 66% of users engaged through SMS, while 34% engaged through email. Nine users (not all of whom engaged) were recruited to provide in-depth feedback. Positive feedback included ease of navigation, enthusiasm for resources, and checkup reminders. Users suggested additional content on barriers to care and community-based resources.

CONCLUSION:
Digital platforms may be an additional channel to offer birthing individuals information about warning signs and connect them to care where needed. Next steps include testing effect on health disparities.
Postpartum Mood Assessment and Intervention Using a Smartphone-Based Application [ID: 1376272]
Authors: Varma Deepthi , Dhillon Karamveer , Goodin Amie , Maguire Michael , Roussos-Ross Dikea , Wen Tony 
Published: May 2023

INTRODUCTION:
Postpartum depression affects up to 15% of women after childbirth, and those with a history of depression are at higher risk. Depression symptoms may develop at any time postpartum, but the current postdelivery follow-up schedule typically accommodates only one examination in the immediate 6 weeks after birth. Gator MOMitor, a smartphone application, was developed to provide real-time assessment of postpartum mental health and to facilitate early intervention.

METHODS:
After obtaining signed consent, the study participants downloaded the Gator MOMitor application to their phones before hospital discharge after delivery. The app prompted participants to complete a mood assessment via the Edinburgh Postpartum Depression Scale (EPDS) sent through the app daily in the first 2 weeks and once per week in postpartum weeks 3 through 6. Assessments could be completed within a 1-hour window, after which they were flagged as incomplete. Participants received two reminders. A greater than or equal to 12 score on EPDS or three consecutive nonresponses triggered a phone call from a nurse for follow-up.

RESULTS:
Among 401 women enrolled, 1,599 mood assessments were completed. Seventy-six of these were positive screens triggering calls from the nurse, where the same participant could have multiple positive screens. Fifty-six participants with positive screens were successfully contacted by a nurse, 11 were referred for a wellness check, 5 were referred to a specialist, and 2 were admitted to the hospital for further evaluation.

CONCLUSION:
Smartphone applications such as Gator MOMitor are effective tools for real-time mood assessment, early symptom recognition, and intervention for postpartum women.
Association Between Mode of Delivery and Abnormal Scores on Psychometric Scales After Stillbirth [ID: 1379988]
Authors: Dang Dung , Ayala Nina , Cersonsky Tess , Dudley Donald , Lewkowitz Adam 
Published: May 2023

INTRODUCTION:
Those who deliver a stillborn infant are at increased risk of postpartum depression (PPD), postpartum anxiety (PPA), and lower post-trauma recovery. We aimed to explore whether PPD, PPA, or post-traumatic growth (PTGI) scores differed among women who had stillborn infants via vaginal delivery (VD) versus cesarean delivery (CD).

METHODS:
This is a secondary analysis of case–control study from the Stillbirth Collaborative Research Network. Longitudinal pregnancy, delivery, and postpartum data were collected between people who had stillbirth and live birth between 2006 and 2009. Those with stillborn infants who completed psychological assessments for PPD (Edinburg Postpartum Depression Scale), PPA (State-Trait Anxiety Inventory), and PTGI were included. The primary outcome was screening positive for PPD (score >10 on the Edinburgh Postnatal Depression Scale). Secondary outcomes were screening positive for PPA (score >40 on the State-Trait Anxiety Inventory), and PTGI score, measured continuously. Outcomes were compared between those who had VD versus CD. Multivariable analysis controlling for demographic or obstetric differences between groups was conducted.

RESULTS:
Of 982 stillbirths, 269 patients (27.4%) completed postpartum psychological assessments and were included. Of these, 41 (15.2%) had CD. Those who had CD were more likely to be Hispanic (48.8% versus 27.2%, P=.006) and have older gestational age (34.4±4.3 weeks versus 26.9±6.5 weeks, P<.001). Mode of delivery (MOD) was not associated with differences in screening positive for PPD (CD odds ratio [OR] 1.62 [95% CI 0.79–3.27]) or PPA (CD OR 1.52 [95% CI 0.75–3.05]). However, MOD was associated with lower PTGI score. This difference persisted after controlling for confounders (beta coefficient −0.17 [standard error 0.07, P=.0141]).

CONCLUSION:
After stillbirth, MOD is not associated with differences in screen-positive rates for PPD or PPA. However, delivering a stillborn infant via CD was associated with lower PTGI score, which suggests additional support resources may be needed in this population to promote positive psychological growth.
Postpartum Titration of Antihypertensives in Patients With Hypertensive Disorders of Pregnancy [ID: 1380430]
Authors: Lafferty Ashlyn , Duryea Elaine , Garner William , Nelson David , Reddy Meghana , Spong Catherine 
Published: May 2023

INTRODUCTION:
Postpartum hypertension is observed in up to 20% of patients within 6 weeks of delivery. While blood pressure evaluation is an integral component of prenatal care, effective blood pressure follow-up postpartum is uncertain. The objective of this study was to evaluate the use of antihypertensive medications and subsequent dosage adjustments in the postpartum period.

METHODS:
This was a retrospective qualitative observational study of patients with hypertensive disorders of pregnancy who delivered at a single quaternary care safety net hospital from July to December 2021. Patients with at least one of the following diagnoses: chronic hypertension (cHTN), gestational hypertension (gHTN), and/or severe preeclampsia (SPE), were included. Data collected included initiation and/or titration of antihypertensives during delivery admission, postpartum visit attendance, outpatient antihypertensive dose adjustments, and emergency department visits.

RESULTS:
From July to December 2021, 1,232 pregnancies were complicated by hypertensive disorders: gHTN only, 577 (46.8%); both gHTN and cHTN, 34 (2.8%); both gHTN and SPE, 499 (40.5%); and all three, 122 (9.9%). Of these, 256 (20.8%) required initiation and/or titration of antihypertensives during delivery admission with over 90% of these complicated by SPE. Of the 197 (77.0%) attending at least one follow-up, medication was stopped in 26 (13%), increased in 9 (5%), decreased in 22 (11%), and continued unchanged in 140 (71%). The majority of medication adjustment occurred in the first 2 weeks postpartum.

CONCLUSION:
Postpartum hypertensive therapy management occurs predominantly within 2 weeks postpartum, with nearly one-fourth decreasing and only 5% requiring increased medication.
Pilot Program to Assess Effectiveness of a Meal Supplementation Program in Addressing Food Insecurity in Pregnancy [ID: 1376240]
Authors: Murphy Lauren , Duckworth Megan , Griffin Laurie , Lefkowitz Janet , Lewkowitz Adam 
Published: May 2023

INTRODUCTION:
Food insecurity (FI) has been associated with adverse pregnancy outcomes including hypertension, decreased birth weight, and increased prenatal depression, and can be reduced by meal supplementation programs. However, screening for FI is not universal during pregnancy, and few studies address the feasibility of screening and implementation of interventions such as meal supplementation programs within prenatal clinics.

METHODS:
A novel pilot program was designed in collaboration with Meals on Wheels (MoW) to provide meal supplementation to positively screened pregnant individuals and their households. Universal FI screening for all patients occurred during their obstetrical intake visit using the “Hunger Vital Sign.” Those screening positive were offered enrollment in the program. To address the feasibility of incorporating enrollment into routine obstetric care, clinic practitioners were surveyed anonymously on the program and its potential effect on clinic workflow.

RESULTS:
In the first 3 months of the program, one in five (42/211 [20%]) of new prenatal patients screened positive for FI; of these, more than half (23/42 [55%]) of those with FI desired enrollment in the program. Nearly all clinic practitioners (35/36 [97%]) felt the program was beneficial to patients and 91% (32/35) agreed the program “does not significantly interfere” with their work. 97% (35/36) felt the program should continue.

CONCLUSION:
Food insecurity is prevalent among pregnant patients, but more than half of eligible patients declined meal supplementation program enrollment. Although incorporating such a program into a prenatal clinic is feasible from a provider perspective, feedback on the program from eligible participants is urgently needed to increase uptake rates.
Comparison of Pregnancy and COVID-19 Complications Stratified by Maternal Vaccination Status [ID: 1363064]
Authors: Abuzeid Omar , Garretto Diana , Garry David , Heiselman Cassandra , Pattanaik Rakasa , Shinder Eliane 
Published: May 2023

INTRODUCTION:
COVID-19 vaccination has been shown to reduce disease severity. However, it is unclear how vaccination status may affect complications of both pregnancy and COVID. This study aims to determine whether maternal vaccination status affects COVID-19 and pregnancy complications.

METHODS:
This was a retrospective study of pregnant women diagnosed with SARS-CoV-2 during the Alpha/Delta or Omicron wave (February 1, 2021 to April 1, 2022) at a single academic tertiary care center. Study was approved by the IRB. Women were divided into groups based on vaccination status. The primary outcome was COVID-19 complications (venous thromboembolism, stroke, myocardial infarction, pneumonia [PNA], acute respiratory failure [ARF], renal or hepatic failure, transaminitis). Pregnancy complications (pregnancy-induced hypertension, postpartum hemorrhage, fetal demise, preterm labor, blood transfusion, pyelonephritis, preterm prelabor rupture of membranes [PPROM]) and maternal characteristics were collected from chart review. Statistical analysis was performed using SPSS using chi-square tests and Student t tests with significance defined as P<.05.

RESULTS:
A total of 463 pregnant patients were included in this study. One hundred fifty-nine were fully or partially vaccinated, while 304 were not vaccinated. There was a significantly higher incidence of COVID-19 complications in patients who did not receive the vaccine (3.3%) compared to those who received the vaccine (0%) (P=.02). No patients who were vaccinated had PNA or ARF. Chronic hypertension and pregestational diabetes were also significantly associated with COVID complications. Vaccination status was not associated with any pregnancy complication. Incidence of preeclampsia without severe features was higher in vaccinated women (5.7 versus 1.6, P=.02). Of the patients who received the booster, 10.4% (5/48) had PPROM compared to 3.5% (13/372) who did not receive the booster (P<.05).

CONCLUSION:
Our data suggest that vaccination status is not related to obstetrical outcomes; however pregnant women who received the COVID-19 vaccine are protected from COVID-19 complications.
The Effect of the COVID-19 Pandemic on the Management and Telehealth Care of Spontaneous Abortions [ID: 1378351]
Authors: Cucci Ariana , DeAngelo Lydia , Oladeji Temiloluwa , Schwartz Kaia , Seibert Jonathan , Walker Claudia 
Published: May 2023

INTRODUCTION:
The purpose of this study was to explore the influence of the COVID-19 pandemic on the management of early pregnancy loss. Additionally, we aimed to identify differences in the use of virtual health care for the management of spontaneous abortions (SABs) before and after the COVID-19 pandemic.

METHODS:
Retrospective cohort study was conducted of patients aged 18–40 receiving obstetric care at Cleveland Clinic hospitals between March 2019 and September 2019 (pre-COVID-19), and between March 2020 and September 2020 (post-COVID-19). SABs were defined as spontaneous pregnancy losses occurring before the 20th week of pregnancy, excluding induced abortions and ectopic pregnancies. Baseline demographic information, medical history, type of SAB management, and use of virtual visits were compared between the pre-COVID-19 and post-COVID-19 groups.

RESULTS:
Two thousand two hundred eleven patients met inclusion criteria, 1,159 with SAB pre-COVID-19 and 1,052 with SAB post-COVID-19. Demographic factors including race (P=.64) and age (P=.46) did not differ between the two groups. Overall management of SAB differed between the two cohorts, with a higher proportion of post-COVID-19 patients opting for expectant management (49.9%) compared to only 38.1% choosing expectant management in the pre-COVID-19 group (P<.001). Virtual visits for consultation and management of SAB were more prevalent in the post-COVID period with 11.1% of patients choosing to utilize telehealth compared to only 0.09% of patients in the pre-COVID-19 cohort (P<.001).

CONCLUSION:
The COVID-19 pandemic affected many aspects of the delivery of health care, and women's health is no exception. Our study shows that the pandemic changed the way SABs were managed, with a higher proportion of health care providers and patients opting for expectant management as compared to the pre-pandemic time period. We also saw a change in the way health care was delivered with virtual appointments becoming more popular post-COVID-19, emphasizing the growing role of telehealth in women's health care and in the management of SAB.
Maternal Cigarette and Electronic Cigarette Use Before Pregnancy Associated With the Risk of Hypertension and Gestational Hypertension [ID: 1380637]
Authors: Sana Meghana , Hagblom Farrah , Hand Mariana , Pezzino Alexia , Wen Xiaozhong 
Published: May 2023

INTRODUCTION:
Despite the rapid increase in electronic cigarettes (e-cigarette) use, little is known regarding its effects on maternal health. We examined the association between maternal e-cigarette use before pregnancy and hypertension (preexisting and gestational).

METHODS:
We obtained data from phase 8 (2016–2019) of the Pregnancy Risk Assessment Monitoring System (PRAMS; N=153,336). Postpartum mothers reported their e-cigarette and combustible cigarette use within the 3 months before pregnancy. They also reported hypertension status before pregnancy and gestational hypertension. We used multivariable logistic regression models to estimate the adjusted odds ratio (aOR) of hypertension associated with maternal e-cigarette use and cigarette use before pregnancy, controlling for sociodemographic and pregnancy confounders.

RESULTS:
Compared to nonusers, mothers who exclusively used cigarettes (7.0% versus 4.8%, aOR 1.33 [95% CI 1.32–1.35]) and dual users (8.4% versus 4.8%, aOR 1.98 [95% CI 1.95–2.02]) before pregnancy had an increased risk of hypertension before pregnancy, whereas exclusive e-cigarette smokers had a decreased risk of hypertension before pregnancy (4.5% versus 4.8%, aOR 0.95 [95% CI 0.92–0.98]). Exclusive cigarette users (10.1% versus 9.0%, aOR 1.03 [95% CI 1.02–1.04]), exclusive e-cigarette users (11.3% versus 9.0%, aOR 1.22 [95% CI 1.20–1.25]), and dual users (10.4% versus 9.0%; aOR 1.13 [95% CI 1.11–1.15]) in the 3 months before pregnancy had a higher risk of gestational hypertension compared to nonusers.

CONCLUSION:
Combustible cigarette use and dual use before pregnancy was associated with an increased risk of hypertension before pregnancy and gestational hypertension. E-cigarette use before pregnancy was associated with increased risk for gestational hypertension only.
Patient Characteristics Associated With Optimal Telemedicine Experience in Maternal–Fetal Medicine (MFM) [ID: 1368093]
Authors: Rep Miranda , Gillenwater Jordan , Mackeen A. Dhanya , Power Michael , Troy Adam 
Published: May 2023

INTRODUCTION:
Data regarding patient satisfaction with telemedicine use in obstetrics are limited. Our objective was to identify demographics and their effect on patient satisfaction with telemedicine in maternal–fetal medicine (MFM) to better identify patients who may prefer this modality.

METHODS:
An IRB-approved prospective survey was offered to patients in MFM from March 2022 to May 2022. Telemedicine experience was not required. Demographics and responses to statements comparing telemedicine versus in-person appointments were collected via a 5-point Likert scale. Telemedicine was defined as an appointment where provider–patient interaction occurred via telecommunications technology. The primary outcome was patient characteristics associated with telemedicine satisfaction. Exploratory factor analysis was performed to identify components affecting patient satisfaction.

RESULTS:
Surveys were completed by 327 patients. Factor analysis yielded two components from eight statements: “attentiveness” from the provider and “technology” comfort. Telemedicine was viewed neutrally for attentiveness-related questions and favorably for technology-related questions. While both factors were significantly associated with desire for future telemedicine option, the effect of attentiveness was twice as strong as that of technology in multiple regression. Higher education level and being married were significantly associated with lower levels of perceived attentiveness. Employment and telemedicine experience were significantly associated with increased technology comfort. Those with telemedicine experience and higher technology comfort experienced statistically fewer connection problems.

CONCLUSION:
Telemedicine was viewed neutrally or favorably for the factors studied. Perceived provider attentiveness and technology comfort affected patient satisfaction with telemedicine; each is associated with certain patient demographics. Once validated, this scale can be used to identify patients who may prefer telemedicine appointments.
Outcomes of Evidence-Based Stratification of Placenta Accreta Spectrum (PAS) Disorders for Team-Based Management [ID: 1375468]
Authors: Munoz Jessian , Blankenship Logan , McCann Georgia , Ramsey Patrick 
Published: May 2023

INTRODUCTION:
Placenta accreta spectrum (PAS) is characterized by placental invasion and adherence to underlying uterine myometrium resulting in significant maternal morbidity and mortality. Despite knowledge that greater placental depth results in worse outcomes, many centers approach PAS with a single uniform management protocol. We aimed to undercover the effect of surgical planning stratification by antenatal suspicion of placental depth.

METHODS:
This study was a preimplementation and postimplementation of analysis of PAS surgical stratification by suspected depth of placental invasion, accreta (less invasion) or increta/percreta (greater invasion), from 2019 to 2022. Depth of placenta invasion was determined by ultrasonography and/or magnetic resonance imaging. As a control, 4-year (2015–2018) preimplementation group was used to assess the effect of the protocol. This protocol included utilization of a hybrid operating room, uniform uterine artery embolization, as well as staffing by advanced pelvic surgeons. Patient demographics and clinically relevant outcomes were obtained from electronic medical records. Exclusion criteria included pregnancy less than 20 weeks of gestation, fetal demise, and multifetal gestation.

RESULTS:
During the 8-year time period, a total of 93 patients were managed by our PAS team. Forty-six patients were in the preimplementation period, of which 17 (37%) were suspected increta/percreta. During the postimplementation period, 24 of 53 (45%) cases were suspected increta/percreta. In cases of placenta accreta, no significant differences were noted in blood loss, blood transfusion rates, or operative time. When analyzing outcomes of the suspected increta/percreta cohort, our protocol was associated with lower blood loss (2,500 versus 1,500 mL, P=.008), lower blood transfusion rates (88% versus 54%, P=.03), and longer operative time (240 versus 384 minutes, P=.009). Final pathology confirmed increta/percreta suspicion in 23 of the 24 cases (96%).

CONCLUSION:
A protocol for the management of PAS cases by antenatally suspected degree of placenta invasion is not only feasible but results in optimal outcomes for patients with the most complex obstetric conditions.