bluuebunny/crossref_metadata_2025_split huggingface dataset:
Approach to Intrapartum Fever During the COVID-19 Pandemic: A New York City Hospital Experience [ID: 1377237]
Authors: Parow Aimee , Cron Julia , Nagy Szilvia , Saiman Lisa , Uppal Nikhil 
Published: May 2023

INTRODUCTION:
At the start of the COVID-19 pandemic, repeat testing for SARS-CoV-2 was added to the management of intrapartum fever. Mother–newborn isolation and separation were implemented until repeat results were available and negative. As few data exist to support or refute repeat testing in this setting, we assessed the yield of repeat testing for intrapartum fever.

METHODS:
We performed a retrospective, IRB-exempt, study from October 2020 to June 2022 of patients who had a negative SARS-CoV-2 test at admission and developed intrapartum fever without an alternative explanation for the fever. Maternal and newborn demographic and clinical variables were extracted from electronic medical records.

RESULTS:
During the study period, among 3,236 deliveries, 151 (4.7%) patients (median age, 34 years) had intrapartum fever; 43%, 11%, and 37% were Asian, Black, and White: 17% were Hispanic. All delivered live newborns (median gestational age, 39 weeks). The median time to fever after admission was 19 hours (range, 0.17–46.17 hours), the median fever was 38.3°C, and median time to repeat test result was 2.07 hours (range, 0.42–12.70 hours). On repeat testing, one (0.7%) patient was positive for SARS-CoV-2 and two had other respiratory viruses detected. Less than 1% had COVID symptoms other than fever. Nine percent of newborns needed transient respiratory support. Two newborns were tested for SARS-CoV-2; both were negative.

CONCLUSION:
Repeat SARS-CoV-2 testing for intrapartum fever management resulted in one additional case, suggesting that routine repeat testing in patients with intrapartum fever and no other symptoms is generally not needed. Additionally, in this setting, mother–newborn isolation and separation are not warranted.
TeamBirth to Enhance Communication and Inpatient Maternity Care Experiences in English and Non-English-Speaking Patients [ID: 1380450]
Authors: Lacroix Tiffany , Ireland Luu , Leung Katherine , Moore-Simas Tiffany , Weiseth Amber , Yeboah Tracy 
Published: May 2023

INTRODUCTION:
Communication affects obstetric experiences. Limited data exist on the effect of speaking a language other than English on birthing persons’ experiences. Few scalable solutions exist to improve communication and mitigate potential poor clinical care experiences. We aimed to understand UMass Memorial Medical Center’s TeamBirth initiative on experiences with health care teams between English and non-English-speaking obstetric patients.

METHODS:
The TeamBirth quality improvement initiative was implemented May 2021. TeamBirth includes structured communication approaches using storyboarding and “huddles” throughout inpatient maternity care. During postpartum stay (May 3, 2021 to May 31, 2022), patients were given an opportunity to complete surveys including validated tools. Data analyses compared experiences between English- and non-English-speaking patients.

RESULTS:
Of 886 respondents, 785 were English-speaking (89%), and 101 were non-English-speaking (11%). English as compared to non-English-speaking patients reported having greater than or equal to 1 huddle in labor (75.1% versus 65.7%, P=.052). Sharing preferences was perceived as making a difference (yes somewhat or definitely) in care (82.0% English- versus 80.9% non-English-speaking, P=.64). There were no statistically significant differences between English- and non-English-speaking patients regarding questions about clinical teams helping patients understand all information (P=.85), providers using words patients did not understand (P=.62), providers talking too fast (P=.29), and providers ignoring what was shared (P=.36). Overall, regardless of preferred language, patients felt their providers were trustworthy (P=.64).

CONCLUSION:
TeamBirth may play a role in improving disparities within clinical care experiences between English and non-English speakers through enhanced communication. Ultimately, this may result in improved health outcomes and a more equitable experience for marginalized obstetric patients.
Advanced Maternal Age Associated With Significantly Increased Cervical Ripening Times and Decreased Vaginal Delivery Rates [ID: 1367634]
Authors: Birchall Courtney , Burns Jamie , Dickinson Taylor , Leftwich Heidi , Nguyen Linh , Taylor Rachel 
Published: May 2023

INTRODUCTION:
With increasing numbers of advanced maternal age (AMA) gravidas, labor characteristics specific to this population are important to understand. The objective of this study was to examine patterns in cervical ripening times and vaginal delivery rates for patients with AMA.

METHODS:
This was an IRB-approved retrospective cohort study conducted at a single academic center. Data were collected by retrospective chart review of deliveries from 2020 to 2021. We included nulliparous patients aged 18 or older with singleton pregnancies, pre-pregnancy body mass index of 18.5 or greater, and gestational age of 37.0 or greater. Patients with pregestational diabetes and lethal fetal anomalies were excluded.

RESULTS:
One thousand twenty-two patients met inclusion and exclusion criteria, 17.7% of whom were AMA. Lower gestational age and less Hispanic ethnicity were noted in the AMA group. Among AMA patients, there was an increase in cervical ripening time as compared to patients aged older than 35 with an average difference of 3.14 hours (CI 1.26–5.01, P=.001). Compared to participants younger than 35, those that are AMA were 36% less likely to have a vaginal delivery (CI 0.46–0.89, P=.008). Median cervical ripening time to vaginal delivery was 15.0 hours for non-AMA and 19.9 hours for AMA patients. At any point of cervical dilation, AMA patients had a 28% less chance to have a vaginal delivery than non-AMA (P<.001).

CONCLUSION:
Patients who were AMA experienced increased cervical ripening times and decreased rates of vaginal deliveries compared to patients younger than 35. Knowing labor characteristics specific to the AMA population is important for counseling and clinical decision-making.
Effect of Prior Cesarean Section Delivery on Intrapartum Cesarean Section Outcomes [ID: 1372249]
Authors: Goodman Bree , Carbonell Katherine , Carter Ebony , Kelly Jeannie , Raghuraman Nandini , Simpson Lucy 
Published: May 2023

INTRODUCTION:
Intrapartum cesarean deliveries (CDs) are associated with higher rates of maternal and neonatal morbidity than scheduled CDs. In patients undergoing trial of labor after cesarean (TOLAC), perceived added difficulty of intrapartum CD may influence provider decisions on labor management. We sought to evaluate the effect of prior CD on operative times and maternal/neonatal outcomes among those undergoing intrapartum CD.

METHODS:
This is a retrospective cohort study of all singleton, nonanomalous fetuses delivered by intrapartum CD at a tertiary care center from June 2018 to April 2019. CD was categorized as intrapartum if it occurred after the patient was admitted in spontaneous labor or received an induction agent. The primary outcome was time from skin incision to delivery. Secondary outcomes were composite measures of maternal (postpartum hemorrhage, bowel or bladder injury, transfusion, endomyometritis, intensive care unit admission, readmission, wound complications) and neonatal (neonatal intensive care unit admission, respiratory support, therapeutic hypothermia, neonatal mortality, and fetal acidemia) morbidity. We compared these outcomes between women with and without history of prior CD. Multivariable logistic regression was used to control for potential confounders.

RESULTS:
Of 374 intrapartum CDs, 270 (72%) were in patients without prior cesarean section and 104 (28%) were in patients undergoing TOLAC. Operative times were significantly longer in women with a prior CD including time from skin incision to delivery (9 [interquartile range (IQR) 7–13] versus 6 minutes [IQR 3–8], P<.001) and total procedure time (63 [IQR 52–79] versus 55 minutes [IQR 45–65], P<.001). Composite maternal (adjusted relative risk [aRR] 1.04, 95% CI 0.62–1.74) and neonatal (aRR 1.01, 95% CI 0.63–1.64) morbidity did not differ between groups.

CONCLUSION:
Although associated with longer operative times, history of a prior CD does not significantly increase maternal or neonatal morbidity among women undergoing intrapartum CD. Therefore, the threshold to perform an intrapartum CD in those undergoing TOLAC should be similar to those without a prior CD.
Rates of Vaginal Delivery With Increasing Cervical Dilation After Cervical Ripening and Advanced Maternal Age [ID: 1372406]
Authors: Loke Rohini , Burns Jamie , Dickinson Taylor , Leftwich Heidi , Nguyen Linh , Taylor Rachel 
Published: May 2023

INTRODUCTION:
Pregnant patients of advanced maternal age (AMA) are at an increased risk for cesarean delivery. Our primary objective was to determine the association between cervical dilation after cervical ripening and vaginal delivery rates for AMA versus non-AMA patients.

METHODS:
This was an IRB-approved, retrospective cohort study conducted at a single tertiary care center, which included nulliparous, term deliveries that required cervical ripening from January 2020 to January 2022. We excluded patients with multifetal gestation, pregestational diabetes, lethal fetal anomalies, prior cesarean delivery, and prisoner status.

RESULTS:
Altogether, 964 patients met inclusion/exclusion criteria, of whom 17.7% were AMA. Increasing cervical dilation at the end of cervical ripening was associated with higher rates of vaginal delivery, with a mean of 3.7 cm for patients who underwent vaginal delivery and 3.2 cm for those who delivered via cesarean (P<.001). A logistic regression examined the interaction between AMA status with cervical dilation after ripening and vaginal delivery rates, which was not significant (P=.38). After adjusting for AMA status, the odds of having a vaginal delivery increased by 22% for every 1-unit increase in end cervical dilation after ripening (CI 1.12–1.33, P<.001). Compared to non-AMA, after adjusting for end dilation after ripening, AMA patients were 35% less likely to have a vaginal delivery (CI 0.46–0.91, P=.013).

CONCLUSION:
Advancing cervical dilation after ripening was associated with a higher rate of vaginal delivery overall. However, AMA patients had significantly fewer vaginal deliveries even when controlling for this end cervical dilation.
Early Feasibility Lessons: A Pilot Randomized Trial of Amnioinfusion as a Novel Indication for Intrapartum Neuroprotection [ID: 1374128]
Authors: Polnaszek Brock , Hamel Maureen , Lewkowitz Adam , Murphy Lauren , Rossen Julia , Whelan Anna 
Published: May 2023

INTRODUCTION:
Developing evidence-based management strategies to decrease maternal/neonatal morbidity in labor is essential. However, the barriers/facilitators to executing these trials are underreported. Our objective is to present early feasibility lessons learned after the rollout of a pilot randomized control trial examining amnioinfusion as a novel indication for intrapartum neuroprotection.

METHODS:
Our pilot randomized control trial began recruiting patients in July of 2022. In the first 3 months of our pilot, we followed the Plan, Do, Check, Act (PDCA) cycle to identify barriers and facilitators as a part of our feasibility aim. The PDCA cycle was executed by the primary research team and began with the first patient to be successfully consented and randomized. The barriers and facilitator were tracked by key study personnel and addressed at the weekly research meetings. Using this cycle, we developed the study protocol before widespread recruitment was initiated.

RESULTS:
We identified several barriers including 1) challenging acute and emergent clinical situations inherent to intrapartum care; 2) lack of provider/patient acceptability for novel indication of amnioinfusion; 3) monitoring for the development of intrapartum risk factors, and 4) unanticipated hospital system processes. We implemented several facilitators in direct response to these barriers for the pilot feasibility trial including 1) identification and presence of a research champion on labor and delivery to build rapport with staff and participants; 2) continuous education of the novel therapy; 3) incentivization of care team and participants; and 4) engagement of key stakeholders.

CONCLUSION:
Using a PDCA was invaluable. We identified several barriers and facilitators to be considered when designing/implementing future randomized trials intrapartum, particularly when studying novel indications of therapy.
Understanding the Effect of Expectant Versus Expedited Delivery in the Periviable Period [ID: 1376738]
Authors: Griffin Laurie , Gimovsky Alexis , Gould Alexander , Passarelli Natalie 
Published: May 2023

INTRODUCTION:
Periviable birth accounts for only 0.5% of births but contributes to a majority of neonatal deaths. There is no clear recommendation regarding expediting delivery in periviable patients with advanced cervical dilation (ACD). The objective of this study was to assess whether expectant management versus expedited delivery in patients with ACD affects perinatal outcomes.

METHODS:
This is a single-institution retrospective cohort study of singleton gestations at 20.0–25.6 weeks with ACD (4–6 cm) on admission from 2016 to 2018. Individuals were stratified into two groups: 1) those who progressed spontaneously to delivery (expectant management) and 2) those who underwent augmentation of labor or cesarean delivery at the time of ACD diagnosis (expedited delivery). The primary outcome was neonatal mortality. Secondary outcomes included differences in postpartum hemorrhage and infection rates.

RESULTS:
Forty-three of 199 preterm deliveries met eligibility criteria: 21 were expectantly managed and 22 underwent expedited delivery. There was no difference in demographic characteristics or gestational age between the expectant management and expedited delivery groups (23′1 [SD 1.65] versus 24′4 [SD 3.05] weeks, [P=.9]). There was no difference in neonatal mortality (n=13 [61.9%] versus n=10 [45.5%], P=.3), maternal infection (n=1 [4.76%] versus n=4 [18.2%], P=.3) or postpartum hemorrhage (n=2 [9.5%] versus n=1 [4.5%], P=1.0) between the expectant management and expedited delivery groups, respectively.

CONCLUSION:
In this cohort, there were no differences in neonatal mortality, maternal infection, or postpartum hemorrhage between expectant management and expedited delivery in singletons with ACD in the periviable period. Larger studies are needed to inform guidelines for management of these complex cases.
Antepartum and Postpartum Monocyte Distribution Width Values in Patients With Histopathologic Chorioamnionitis [ID: 1376799]
Authors: Vircks Julie , Dahlke Julia , Henricks Christine , Karmarkar Tanvi , Kaufman Eva , O’Brien Devon 
Published: May 2023

INTRODUCTION:
In nonpregnant adults presenting to the emergency department, monocyte distribution width (MDW) progressively increases with infection severity. While studies have shown that chorioamnionitis alters monocyte response, MDW has not been well studied in pregnancy. The primary aim of the study was to examine MDW values antepartum and postpartum in patients with histopathologic chorioamnionitis.

METHODS:
A retrospective electronic chart review was performed from an urban safety net hospital. Patients with an MDW value on admission and postpartum day number 1 (PPD1), in addition to postpartum placental histopathologic examination, were included in the study. Institutional review board approval was obtained (UMKC #2093657). The Mann-Whitney U test was utilized for statistical analyses.

RESULTS:
Of the 419 obstetric patient encounters reviewed, 89 encounters met inclusion criteria, of which 32% were diagnosed with histopathologic chorioamnionitis. There was no difference (P>.05) in median MDW at the time of admission between those with and without chorioamnionitis on histopathology (18.78 U versus 18.53 U, P=.602). However, the median MDW was significantly higher on PPD1 in patients diagnosed with chorioamnionitis compared to those without chorioamnionitis on postpartum histopathology (21.48 U versus 19.56 U, P=.001).

CONCLUSION:
In the setting of histopathologic chorioamnionitis, a significant elevation in postpartum MDW values compared to admission values suggests intrapartum MDW values increase as the infection develops. Additional longitudinal and prospective analysis of intrapartum MDW values may help characterize this rise and establish its potential role as a predictor of adverse pregnancy outcomes.
BMI Had a Negative Effect on Decision-to-Incision Times for Urgent Cesarean Deliveries [ID: 1377147]
Authors: Deal Laura , Gad Mary , Goldberg Jay , Jaspan David , White Chase 
Published: May 2023

INTRODUCTION:
Greater maternal body mass index (BMI) is associated with worse maternal and fetal outcomes. Intrapartum care of patients may be more difficult with higher BMIs. We studied the effect of BMI on decision-to-incision times less than 30 minutes for urgent cesarean sections.

METHODS:
After IRB approval, a retrospective chart review of 186 consecutive urgent cesarean deliveries during 2020 at an academic medical center were examined. Data were abstracted from patient and neonate charts. Statistical analysis was performed using χ2, t test, and Pearson’s r test.

RESULTS:
Seventy-one percent of patients with BMI greater than 30 had decision-to-incision times of more than 30 minutes, compared to 46% with BMI less than 30 (P=.03). The mean time from decision-to-incision with BMI greater than 30 was 44 minutes, and 36 minutes with BMI less than 30 (P=.005). When BMI was greater than 40, the mean time was 50 minutes (P=.03). 16% of patients with BMI greater than 30 had decision-to-incision times of more than 60 minutes, compared to 2% with BMI less than 30 (P=.007). BMIs greater than 30 had longer decision-to-operating room (OR) entry (22 versus 17 minutes, P=.02) and OR entry-to-incision times (22 versus 19 minutes, P=.053). Body mass indexes of greater than 40 had both longer decision-to-OR entry (24 versus 19 minutes) and OR entry-to-incision times (25 versus 19 minutes, P=.005). Mothers with BMI greater than 50 had the longest times from OR entry-to-incision and had babies most likely to go to the neonatal intensive care unit (NICU) (50% versus 16%).

CONCLUSION:
Greater maternal BMIs had longer times for urgent cesarean sections for decision to incision, decision to OR entry, and OR entry to incision. There was a lengthening of decision-to-incision times with increasing BMI. The highest maternal BMIs were most likely to result in NICU admissions. Decision-to-incision time of greater than 30 minutes did not affect umbilical cord arterial pH or NICU admission.
The Majority of Urgent Cesarean Sections Had a Decision-to-Incision Time of Greater Than 30 Minutes [ID: 1377172]
Authors: Deal Laura , Gad Mary , Goldberg Jay , Jaspan David , White Chase 
Published: May 2023

INTRODUCTION:
The American College of Obstetricians and Gynecologists has recommended that hospitals providing obstetrical care should have the capability to begin cesarean deliveries within 30 minutes. This has been taken out of context in that failure to meet a 30-minute decision-to-incision time for urgent cesarean sections may be criticized litigiously if a poor neonatal outcome occurs.

METHODS:
After IRB approval, a retrospective chart review of 186 consecutive urgent cesarean deliveries during 2020 at an urban academic medical center was performed. Data were abstracted from patient and neonate charts. Statistical analysis was performed using χ2, t test, and Pearson’s r test.

RESULTS:
Sixty-seven percent of urgent cesarean section had a decision-to-incision time greater than 30 minutes. Mean time was 42 minutes and median time was 36 minutes (8–194 minutes). Seventy-one percent of patients with body mass index (BMI) greater than 30 had decision-to-incision times greater than 30 minutes, compared to 46% with BMI less than 30 (P=.03). Seventy-eight percent of patients without an epidural took more than 30 minutes, compared to 64% with an epidural (P=.09). Sixty-four percent of urgent cesarean sections occurring between 7 am and 5 pm had decision-to-incision times of greater than 30 minutes, compared to 69% between 5 pm and 7 am (P=.54).

CONCLUSION:
Sixty-seven percent of urgent cesarean sections had a decision-to-incision time greater than 30 minutes at an academic medical center. Deliveries with BMI greater than 30 were associated with failure to meet a 30-minute threshold. Not having an epidural trended towards failure to meet a 30-minute threshold. Whether delivering during the daytime or nighttime, race, and insurance status did not affect decision-to-incision times. Decision-to-incision time greater than 30 minutes did not affect umbilical cord arterial pH or neonatal intensive care unit admission.
External Validation of Second-Stage Vaginal Delivery Prediction Model [ID: 1377356]
Authors: Herz-Roiphe Rachel , Little Sarah , Reiff Emily 
Published: May 2023

INTRODUCTION:
We sought to externally validate Gimovsky et al.’s prediction model for spontaneous vaginal delivery (SVD) in the second stage (https://www.pushprescriber.com [PUSH MODEL]) prior to using it for a quality improvement (QI) intervention at our hospital.

METHODS:
This was a retrospective cohort of 2,296 birthing persons delivering at a single hospital over 1 year. Inclusion criteria were similar to the PUSH MODEL: nulliparous, term, without planned cesarean, singleton, vertex, nonanomalous, epidural anesthesia. We calculated the predicted probability of SVD at every hour from the PUSH MODEL to generate receiver–operator curves and analyzed factors associated with second stage duration in our cohort.

RESULTS:
Overall, 1,735 (77%) delivered by SVD, similar to 74% in the PUSH MODEL. Head position had the strongest association with SVD (83% OA versus 39% OP, P<.01). The area under the curve from the PUSH MODEL at the start of the second stage was 0.64 (95% CI 0.62–0.77), as compared to 0.73 in the original population. The model had similar performance at hours 1 (n=1,513), 2 (n=917), 3 (n=522), and 4 or more (n=255). Using a cutoff of 77% (baseline rate of SVD in our population), those who “Screen Positive” at the start of the second stage had an 78.5% rate of SVD as compared to 39.3% for those who “Screen Negative” (P<.01).

CONCLUSION:
The PUSH MODEL performed well on external validation; we similarly found that head position and second-stage duration were strongly associated with the probability of SVD in our cohort, supporting incorporation of this tool in QI work at our hospital.