bluuebunny/crossref_metadata_2025_split huggingface dataset:
Socioeconomic Disadvantage Is Associated With Risk and Severity of Anemia [ID: 1377641]
Authors: Phillips Jaclyn , Hacker Francis , Lemon Lara , Simhan Hyagriv , Simhan Jayanthi , Simhan Uma 
Published: May 2023

INTRODUCTION:
Anemia on admission for delivery is a significant contributor to peripartum transfusion. Risk of maternal morbidity including transfusion has been linked to neighborhood deprivation. We sought to explore the relationship between a composite measure of neighborhood-level deprivation and frequency and severity of anemia on admission for delivery.

METHODS:
We performed an IRB-approved retrospective cohort analysis of delivery admissions in a single health care network from 2015 to 2020. Area deprivation index (ADI) was used to represent neighborhood socioeconomic disadvantage and is a composite index of neighborhood that spans income, education, household characteristics, and housing. The index ranges from 1 to 100 with higher values indicating higher disadvantage. Anemia was defined as hemoglobin less than 11.0 mg/dL and severe anemia less than 9.0 mg/dL. Multivariable binomial regression models assessed the relationship between ADI and anemia.

RESULTS:
Eighty-five thousand five hundred fifty-three delivery admissions were included. A monotonic linear positive relationship was observed between ADI and anemia. Individuals who reside in the most disadvantaged neighborhoods (ADI>95) had 2.2 times the odds (95% CI 2.1–2.3) of anemia on admission for delivery. For example, individuals who live in a less disadvantaged neighborhood (ADI of 5) had a 11% predicted probability of anemia compared to 23% in individuals who lived in a more disadvantaged neighborhood (ADI of 95). Individuals who lived in the most disadvantaged neighborhoods had a higher rate of severe anemia (1% versus 3%, P<.001).

CONCLUSION:
Anemia is more likely and more severe in individuals living in disadvantaged neighborhoods. Neighborhood-level interventions could be used to target populations at high risk for anemia and potentially affect maternal outcomes.
The Effect of the ARRIVE Trial and the COVID-19 Pandemic on Obstetric Practice and Racial Disparities [ID: 1380285]
Authors: Wheeler Malena , Hong Hwanhee , Swamy Geeta , Truong Tracy , Unnithan Shakthi 
Published: May 2023

INTRODUCTION:
Black birthing people are at increased risk for cesarean delivery (CD) and gestational hypertension (gHTN), compared to their White counterparts. In the ARRIVE trial, labor induction at 39 weeks decreased CD and gHTN in low-risk nulliparous patients. Our aim was to determine whether racial differences in labor induction, CD or gHTN changed after ARRIVE and the COVID-19 pandemic.

METHODS:
We conducted an IRB-approved, retrospective cohort study using publicly available birth certificate data from three time periods: pre-ARRIVE (January 1, 2015 to August 31, 2018), post-ARRIVE (September 1, 2018 to February 29, 2020), and post-COVID (March 1, 2020 to December 31, 2020). All non-Hispanic Black (NHB) or White (NHW) nulliparous patients with a singleton gestation who delivered at more than 39 weeks of gestation with no documented high-risk conditions were included. Odds of labor induction, gHTN, and CD were compared by time period and race and ethnicity using an interrupted time series analysis adjusted for seasonality and covariates.

RESULTS:
There were 471,351 NHB and 2,265,018 NHW birth records included in the analysis. Post ARRIVE, the rate of labor induction increased among NHB and NHW birthing people. Non-Hispanic Black patients were less likely to be induced than their White counterparts before and after the publication of ARRIVE and COVID-19. In the adjusted ITS analysis, the odds of induction of labor (IOL) were lower while the odds of gestational hypertension and cesarean birth were higher for NHB compared to NHW in all three time periods.

CONCLUSION:
It is plausible that the racial difference in 39-week IOL may contribute to racial disparities in gestational hypertension and cesarean delivery. The results of the ARRIVE trial suggest that ensuring equitable access to IOL in the 39th week may be one strategy to reduce obstetric racial disparities.
Understanding Afghan Refugee Experiences With Obstetrical Care: A Qualitative Study [ID: 1381425]
Authors: Sekhon Subhjit , Morales Pedro , Smith Lucy 
Published: May 2023

INTRODUCTION:
Providing equitable maternal care to refugees is a challenging task for hosting countries because of differences in personal experiences and health care systems. It is important to understand these unique needs because of the increased risk of poor pregnancy and birth outcomes for refugee patients. The aim of this study was to explore the experiences of obstetrical care among Afghan refugees in their native countries to mitigate that risk.

METHODS:
A qualitative study was conducted of 10 Afghan women. Institutional review board approval was obtained (UMKC #2092624). Face-to-face, semistructured, and in-depth interviews were conducted with certified interpreters. Interviews were analyzed using a thematic analytical method.

RESULTS:
All study participants were recent migrants within the past 6 months with no prior care within the U.S. health care system. Patients were pregnant in their second (n=8) or third trimester (n=2). Two were nulliparous. Three major themes were identified: insufficient prenatal and postpartum care, inadequate information, and decreased social support. None of the participants had regular prenatal care, ultrasounds, or labs. Most of the women (n=8) had previously delivered in a hospital, although they noted several differences: lack of private delivery rooms, fetal monitoring, and support during the process. There was no consent process, and the women were unaware of indications for delivery or cesarean delivery.

CONCLUSION:
With better understanding of the background and experiences of Afghan refugee patients, we can develop strategies to improve obstetric care and outcomes. This includes educational efforts geared towards introducing these women to a new health care model that closes the gaps they previously experienced.
Young Birthing Age and Delivery and Neonatal Outcomes [ID: 1356517]
Authors: Jones Cresta , Bader Alexandra , Brumley Caroline , Considine Samantha , Tessier Katelyn , Wanberg Lindsey 
Published: May 2023

INTRODUCTION:
The objective of this study is to examine differences in obstetric delivery and neonatal outcomes between young birthing patients (age 18 years or younger) and a standard risk birthing population (age 25–30 years).

METHODS:
This is a retrospective cohort study of patients delivering between 2012 and 2017 in a single urban academic health system. Outcomes were examined for a young birthing cohort (n=528) and compared with a standard risk cohort age 25–30 years (n=937). This study was identified as exempt by the local IRB.

RESULTS:
When examining delivery outcomes, young birthing age was associated with a lower risk of cesarean section, even after adjusting for a history of prior cesarean section (13.4% versus 30.7%, adjusted odds ratio [aOR] 0.41), and a lower risk of postpartum hemorrhage (8.5% versus 12.85, aOR 0.48), all with P<.05. However, young age was also associated with an increased risk of delivery at less than 37 weeks of gestation (15.2% versus 9.5%, OR 1.96). When examining neonatal outcomes, young birthing age was associated with a lower rate of congenital anomalies at birth (6.6% versus 14.4%, aOR 0.42). After adjusting for covariates, there was no difference in low birth weight or neonatal intensive care unit (NICU) admission.

CONCLUSION:
Young birthing patients have delivery outcomes that vary from those of a standard birthing cohort, with a lower risk of cesarean delivery and postpartum hemorrhage but an increased risk of preterm birth. In addition, younger birthing patients have a lower risk of anomalies identified at birth but no increased risk of lower birth weight or NICU admission. These data may help tailor birthing programs for younger patients to better address their specific delivery risks.
Effect of an Obstetric Enhanced Recovery After Surgery (ERAS) Protocol on Maternal and Neonatal Outcomes [ID: 1375461]
Authors: Powel Jennifer , Chavan Niraj , Childress Katherine , Huber Madeline , Kumanan Krithika Narayana , Peramsetty Nikita 
Published: May 2023

INTRODUCTION:
Enhanced Recovery After Surgery (ERAS) is a protocol initiated in many specialties with the goal of reducing health care costs, postoperative complications, and patient morbidity.

METHODS:
We undertook a retrospective cohort study of pregnant women undergoing nonlaboring, nonurgent cesarean delivery between October 2020 and October 2021. Data pertaining to demographic characteristics, pregnancy comorbidities, and maternal and neonatal outcome measures pertaining to operative and postoperative complications, readmission, length of stay, breastfeeding, neonatal cord gases, and neonatal intensive care unit admission were abstracted from electronic health records and compared across two groups, preimplementation and postimplementation, using Student t-test, Pearson’s χ2, Mann-Whitney U, and/or Fisher’s exact test, as indicated. Statistical significance was set at P<.05. Institutional review board approval was obtained.

RESULTS:
Demographic characteristics and rates of pregnancy comorbidities, including chronic hypertension, hypertensive disorders of pregnancy, and pregestational/gestational diabetes, were similar across pregnant women undergoing cesarean delivery in the preimplementation (N=168) and postimplementation (N=123) groups. Cesarean procedure duration, overall intraoperative and/or postoperative complication rates, readmission, breastfeeding rates, and postoperative length of stay did not change after ERAS implementation and were comparable to the pre-ERAS cohort. Postoperative Foley catheter replacement was more common after ERAS implementation (P=.03). Neonatal outcomes were comparable across both study groups.

CONCLUSION:
Implementation of an ERAS protocol did not significantly alter maternal and neonatal clinical outcomes in our study cohort with the exception of a small increase in Foley catheter replacement rates, which may be attributable to the protocol workflow requiring Foley removal within 6 hours postoperatively.
Evaluating the Effect of Interdisciplinary Simulation Training on Provider Comfort in the Management of Postpartum Hemorrhage (PPH) in a Low-Resource Setting [ID: 1363496]
Authors: Voigt Paxton , Hernandez Sasha , Ramos Beralis , Shirazian Taraneh 
Published: May 2023

INTRODUCTION:
Maternal mortality from postpartum hemorrhage (PPH) can be reduced through timely management. Interdisciplinary simulation-based training (SBT) has been shown to improve team response to PPH, but SBT is not widely available in low-resource settings. The purpose of this study is to assess the acceptability of SBT and its effect on interdisciplinary personnel’s self-efficacy in a low-resource setting.

METHODS:
A pilot low-fidelity PPH SBT program using PRONTOPack was conducted from November 2021 to September 2022 after an initial audit revealed inadequate training at a public teaching hospital with the highest national maternal mortality rate in the Dominican Republic. Thirty interdisciplinary providers were trained in two cohorts. Self-efficacy was assessed via anonymous, postsimulation surveys.

RESULTS:
One hundred percent of providers reported that the SBT was an effective form of training that will help them manage PPH in the future. In the first cohort (n=7), providers reported high comfort with their teamwork (4.57/5 S 0.49) and communication skills (4.29/5 S 0.45) after SBT. In the second cohort (n=23), 100% of trainees agreed that SBT improved their ability to communicate effectively, work in teams, and manage PPH.

CONCLUSION:
Low-fidelity interdisciplinary SBT was found to be useful in improving trainees’ self-perceived nontechnical skills in the management of PPH. Most notably, communication skills were improved between providers that routinely manage real-time PPHs in clinical practice. Next steps are to integrate and standardize SBT into the obstetric department’s workflow to train all personnel managing PPHs.
Identifying Racial Inequities in Respect and Autonomy During Delivery Care [ID: 1378253]
Authors: Amutah-Onukagha Ndidiamaka , Declercq Eugene , Larson Elysia , Macharia AnnLiz , Meadows Audra , Schneider Lily 
Published: May 2023

INTRODUCTION:
Measuring patient experience is core to understanding and addressing inequities in obstetric care quality.

METHODS:
People who gave birth at one of five hospitals in Massachusetts and identified as non-Hispanic Black (NHB) or non-Hispanic White (NHW) were invited to complete a structured survey 7–16 weeks postpartum, from February to September 2022. The survey included two validated patient experience instruments: the Mothers on Respect index, dichotomized as “very respectful” or not and the Mothers Autonomy in Decision Making scale, dichotomized as “high patient autonomy” or not. We report risk ratios of associations between patient characteristics and respectful or autonomous care, adjusting for hospital cluster using Stata v.17. Institutional review board approval was received from the Social and Behavioral Research IRB at Tufts University.

RESULTS:
Of 417 respondents (response rate: 25%), 245 (59%) were NHW and 172 (41%) were NHB. Most had a bachelor’s degree (62%). 241 (60%) of births were vaginal. Very respectful treatment was reported by 78% of respondents, whereas high patient autonomy was only reported by 64%. Non-Hispanic White people were 1.2 times as likely to report high respect compared to NHB (95% CI: 1.1, 1.4). Respect was also significantly lower for those with lower education and those with vaginal birth compared to those with cesarean birth. Differences in respect by race remained significant in multivariable models (1.2, 95% CI: 1.0, 1.4). Autonomy did not differ by any of the assessed demographic or delivery characteristics.

CONCLUSION:
Examining patient experience revealed inequities. To identify opportunities for improvement and monitor change, brief, validated, patient reported experience measures need to be incorporated into routine data collection.
Perceptions of Maternal Mortality in the Missouri Birthing Population [ID: 1380060]
Authors: Johnson Traci , Florio Karen , Kendig Susan , Quay Daniel , Rideout Reggi , Williams Alison 
Published: May 2023

INTRODUCTION:
Missouri ranks ninth worst for pregnancy-related deaths (PRDs). Black women die at a rate threefold that of White women. The etiologies are multifactorial, including lack of awareness. We therefore sought to understand perceptions of PRD among the birthing population in Missouri.

METHODS:
The Perinatal Quality Collaborative (PQC) of Missouri developed a questionnaire assessing baseline knowledge surrounding risk factors, causes, and perceived underlying contribution of discrimination to maternal mortality (MM). A mailing list racially representative of the birthing population was purchased (Dynata) with grant support. Thirty-nine questions were distributed from March to August 2022 to birthing persons aged 18 years or older. Those without a Missouri ZIP code or who identified as male were excluded.

RESULTS:
One thousand seven hundred thirty-eight people met inclusion criteria with a response rate of 89%. Of those, 74.5% identified at White, 14% Black, 3.5% Hispanic, 3.6% Native American, 2.5% Asian, 0.3% as Hawaiian Native or Pacific Islander, and 1.6% as other/unknown. Over 78% reported awareness of MM with 58.2% believing those numbers to be high. Twenty-two percent reported a family member succumbing to MM. When asked about etiologies, 78.8% identified high blood pressure, 30.21% identified heart disease, and 79.63% reported health disorders as contributors. Fifty-seven percent of the cohort believed discrimination or bias have a role to play in MM in Missouri.

CONCLUSION:
The birthing population in Missouri is aware not only of the current maternal mortality crisis but astute to the underlying causes, including discrimination or bias. Our PQC will utilize this information to guide implementation of preventative measures for maternal mortality.
Hand Forceps for Delivery of Floating Fetal Head at Cesarean Section: A Randomized Pilot Study [ID: 1375984]
Authors: Jiang Xuezhi , Rodger Jonathan , Tegos George , Wu Rebecca 
Published: May 2023

INTRODUCTION:
On occasion, obstetricians encounter difficulty delivering the floating fetal head at cesarean section; additional techniques may need to be employed beyond the traditional one-handed delivery technique. We propose a modified two-handed manual delivery method or “hand forceps,” with surgeon’s both hands shaped like a pair of forceps, as an alternative technique for fetal head delivery. The purpose of this study is to compare the efficacy and safety of two-handed technique by comparing with the traditional one-handed technique.

METHODS:
We conducted a randomized pilot study of women undergoing cesarean section (NCT04159857, ClinicalTrials.gov). Inclusion criteria included a singleton in cephalic presentation, at gestational age of 37 weeks or greater, with planned low transverse uterine incision, cervical dilation of 6 cm or lower and station less than −3. Patients were randomized to either the one-handed or two-handed delivery group. The primary outcome was “U-D interval,” defined as the time from entry of the hands into the uterus to the delivery of the fetal head. The secondary outcome was incidence of hysterotomy extension. Neonatal safety data were also collected.

RESULTS:
A total of 40 patients participated in the study; 16 randomized to the one-handed group, 19 randomized to the two-handed group, and 5 patients excluded because of protocol deviation. U-D interval (mean±SD) was significantly shorter in the two-handed group (6.0±7.4 seconds) than in the one-handed group (14.3±9.9 seconds), P<.001. There was no significant difference in incidence of hysterotomy extension, maternal and neonatal outcomes between the two groups.

CONCLUSION:
The two-handed method for fetal head delivery has a significantly decreased U-D interval compared to the one-handed method, without increasing the incidence of hysterotomy extension. A large-scale multicenter randomized controlled study is needed to further determine whether the “hand forceps” can be considered a safe alternative technique for delivery of the floating fetal head in cesarean sections.
The Use of Virtual Reality During Extraamniotic Balloon Insertion for Pain and Anxiety Relief: A Randomized Controlled Trial [ID: 1376399]
Authors: Kleiner Ilia , Bar Jakob , Barda Giulia , Cartun Zachary , Mor Liat , Weiner Eran 
Published: May 2023

INTRODUCTION:
Induction of labor (IOL) with extraamniotic balloon (EAB) catheter is a procedure commonly associated with maternal discomfort, pain, and anxiety. We aimed to investigate the distractive effect of virtual reality (VR) technology on pain and anxiety in pregnant women who undergo IOL with EAB.

METHODS:
In this randomized controlled trial, pregnant women intended for IOL with EAB at term, were recruited, signed a consent form, and randomized into two groups. The control group received the institutional standard care for EAB insertion, while women in the VR group were exposed to a VR clip during the procedure. Pain scores (expressed by Visual Analog Scale [VAS]) were obtained before, during, and after EAB insertion. Anxiety levels (expressed by validated State-Trait-Anxiety Inventory Scale [STAI-S]) were obtained before and after the procedure. Maternal satisfaction was also recorded. The primary outcome was the VAS score during EAB insertion.

RESULTS:
Total of 145 women were recruited 1:1 ratio. There were no differences between groups in terms of age, body mass index, gestational age at enrollment, indication for IOL, or preprocedural VAS score and anxiety levels. VAS score during the procedure was significantly lower in the VR group compared to the control group (4.62±2.89 versus 5.95±3.18, P=.04). In addition, the VR group benefited from a higher rate of anxiety relief expressed by the difference between preprocedure and postprocedure STAI score (7.09±10.45 versus 2.84±8.65, P=.039). Women in the VR group reported an overall very high (93%) satisfaction score.

CONCLUSION:
In this randomized controlled trial, we demonstrated that the use of VR technology in women undergoing IOL with EAB was associated with lower VAS scores during the procedure, with significant anxiety reduction, and a higher satisfaction score, compared to women who received standard care.
Risk of Cesarean Delivery Varies by Race and Ethnicity Among Pregnancies Complicated by Fetal Growth Restriction [ID: 1377645]
Authors: Nilsen Nichole , Esposito Matthew , Lord Megan 
Published: May 2023

INTRODUCTION:
Cesarean delivery (CD) rates differ between non-Hispanic White (NHW) and Hispanic/non-White (H/NW) patients, although the relationship varies by indication. We examined CD rates among NHW and H/NW patients in pregnancies complicated by fetal growth restriction (FGR).

METHODS:
This was an IRB-approved secondary analysis of a retrospective cohort of singleton live births 2003–2012 with an estimated fetal weight (EFW) less than 10th centile for gestational age on the last ultrasound prior to delivery.

RESULTS:
Of 563 pregnancies, 270 (46.88%) were to NHW patients and 306 (53.12%) to H/NW patients. NHW were older (27.92 versus 26.04 years), taller (160.42 versus 158.58 cm), and more likely to have private insurance (51.30% versus 20.26%) and be admitted to a private practice (70.00% versus 44.41%) (P<.01 for all). There was no difference in umbilical artery Doppler findings, EFW, proportion of CD performed because of nonreassuring fetal status, maternal body mass index, gestational age at FGR diagnosis or delivery, or maternal comorbidities. Apgar scores, arterial cord pH, neonatal intensive care unit admission, hypoglycemia, need for respiratory support, and neonatal death were similar (P>.05 for all). However, NHW patients were more likely to undergo CD (35.71% versus 22.90%, P<.01) including prelabor cesarean (21.48% versus 13.75%, P<.01). After adjusting for maternal age, height, insurance status, and delivering team, risk of CD remained higher among NHW patients (relative risk 1.56, 95% CI 1.20–2.03; adjusted relative risk 1.48, 95% CI 1.12–1.96).

CONCLUSION:
Despite similar neonatal outcomes, NHW are more likely than H/NW patients to deliver by CD, particularly prelabor CD, when the EFW is below the 10th centile.