bluuebunny/crossref_metadata_2025_split huggingface dataset:
Size and Number of Placental Lakes on 20-Week Anatomy Ultrasound and Obstetric Outcomes [A190]
Authors: Mansoor Sanaa , Kouba Insaf , Blitz Matthew J. , Bracero Luis A. 
Published: June 2022

INTRODUCTION:
Placental lakes are vascular spaces within the placenta filled with maternal blood which appear hypoechoic on ultrasound. They are frequently dismissed as a benign finding despite limited data. The objective of this study was to determine whether large lakes or multiple lakes are associated with an increased risk of adverse pregnancy outcomes.

METHODS:
Retrospective cohort of all pregnant women with placental lakes on 20-week fetal anatomy ultrasound from January 2018 to July 2021 who delivered at one of seven hospitals in a large health system. Exclusion criteria were multiple gestations, placenta previa, and invasive placentation. For each patient, clinical characteristics were obtained and ultrasound images were reviewed to determine whether multiple lakes were present and to measure the lake with the longest dimension. Patients with small placental lakes (<5 cm) were compared to those with large placental lakes (≥5 cm). The outcomes of interest were preterm birth, low birth weight, mode of delivery, and preeclampsia. Institutional review board approval was obtained.

RESULTS:
A total of 210 patients were included for analysis: 23 (11%) had large placental lakes and 187 (89%) had small placental lakes. The mean largest dimensions were 6.3 cm and 3.0 cm in each group, respectively. Multiple lakes were observed in 163 cases (78%). No demographic differences were noted between groups. There was no difference in gestational age at delivery, preterm birth, cesarean delivery, preeclampsia, or birth weight between groups.

CONCLUSION:
Placental lakes identified on 20-week fetal anatomy ultrasound, even when larger than 5 cm or multiple, were not associated with adverse pregnancy outcomes.
Impact of COVID-19 on Pregnancy Outcomes: A Propensity Score Matched Study [A200]
Authors: Patel Mayuri , Mangione Mary , Perreand Elsa , Miyamoto Matthew , Cojocaru Liviu , Chua Joel V. 
Published: June 2022

INTRODUCTION:
Available data on the association between COVID-19 and adverse pregnancy outcomes is limited by ascertainment bias. Our objective was to assess the impact of COVID-19 on pregnancy outcomes in a propensity score matching (PSM) study. This allows for balancing of observed baseline covariates and decreases the effect of confounding factors.

METHODS:
We conducted a retrospective, multicenter, case-control study to understand the association between COVID-19 and pregnancy outcomes. We reviewed all consecutive charts of adult females aged 18–45 years with SARS-CoV-2 infection between March 1, 2020, and August 31, 2020. Cases were patients diagnosed with COVID-19 during pregnancy (COVID+), whereas controls were pregnant patients who tested negative for COVID-19 (COVID–). We excluded cases with multiple gestation or incomplete data. PSM was performed using age, race/ethnicity, body mass index, and past medical history. The primary outcome was a compound score of pregnancy complications (pregnancy loss, neonatal demise, fetal growth restriction, hypertensive disorders of pregnancy, preterm premature rupture of membranes, preterm delivery, and placental abruption). Analyses were performed with SAS software.

RESULTS:
A total of 2,474 patients were identified, of which 2,374 were COVID– and 100 COVID+. There was a trend toward higher rate of adverse pregnancy outcomes in the COVID+ group (48 [48%] versus 917 [38.7%], P=.06). The results remained unchanged after optimal one-to-four PSM was applied (48 [48%] versus 151 [37.8%], P=.06).

CONCLUSION:
COVID-19 in pregnancy appears to be associated with an increased risk for adverse pregnancy outcomes. Although our study had a trend toward statistical significance, further research with a large sample size is required.
Trends in Hospitalization for Preterm Labor Without Delivery in the United States, 2007–2014 [A210]
Authors: Sheu Joanne , Al-Haddad Sara , Tran Van , Calixte Rose 
Published: June 2022

INTRODUCTION:
Hospitalizations for suspicion of preterm labor are often discharged without delivery, which incurs significant socioeconomic costs. Using the National Inpatient Sample, we seek to describe the epidemiology of these preterm labor admissions that do not result in delivery and evaluate associated trends over time.

METHODS:
The National Inpatient Sample, years 2007–2014, was queried for all discharges containing the ICD-9 code for preterm labor. Data describing age, ethnicity, primary payer, length of admission, and total hospital charges were analyzed. Weighted regression analysis was used to identify trends in continuous variables and regression models were used to evaluate trends in proportion of race and insurance coverage.

RESULTS:
The estimated number of qualifying discharges per year decreased from 88,955 in 2007 to 52,970 in 2014. The ratio of admissions for preterm labor without delivery to admissions for preterm labor resulting in delivery decreased from 1:3.76 to 1:4.32 (P

trend
<.01). Estimated adjusted mean total hospital costs increased from $12,223 to $15,438 (P

trend
<.01). The proportion of discharges with Medicaid and “other” insurance coverage changed significantly from 48.6% to 54.82% (P

trend
=.03) and 9.68% to 7.9% (P

trend
=.05), respectively. Mean length of stay, changes in proportion of race, and changes in coverage by private insurance were not significant.

CONCLUSION:
A decreased ratio of undelivered to delivered preterm labor discharges over time may indicate that identification of true preterm labor is improving. However, increasing hospitalization costs with an increasing proportion of patients covered by Medicaid has concerning implications. Further study on the epidemiology of resolved preterm labor may improve the cost-effectiveness of future patient care.
Pregnancy Outcomes Among Women With Bulimia Nervosa [A217]
Authors: Trahan Marie-Julie , Badeghiesh Ahmad , Baghlaf Haitham , Picado Jennifer , Dahan Michael H. 
Published: June 2022

INTRODUCTION:
Bulimia nervosa may be associated with inadequate pregnancy weight gain, nutritional deficiencies, and maternal stress. However, knowledge of maternal and newborn risks associated with bulimia nervosa during pregnancy remains limited. The objective of this study was to evaluate pregnancy outcomes among women with bulimia nervosa using a population database.

METHODS:
A retrospective cohort study was conducted using data from the Healthcare Cost and Utilization Project–Nationwide Inpatient Sample from 2004 to 2014. ICD-9 code 307.51 was used to identify deliveries among women with bulimia nervosa. Multivariate logistic regression analyses were performed, adjusting for confounding effects.

RESULTS:
Of the 9,096,788 pregnancies included in the cohort, 260 were among women with bulimia nervosa (2.86/100,000 pregnancies). Infants born to women with bulimia nervosa were more likely to be small for gestational age (SGA) compared to infants born to women without bulimia nervosa (aOR, 3.35; 95% CI, 1.85–6.09). There were no statistically significant differences in the risk of gestational hypertension, preeclampsia, gestational diabetes, or preterm delivery between groups.

CONCLUSION:
Contrary to previous smaller studies, we found an increased risk of SGA among pregnant women with bulimia nervosa. Therefore, we recommend increased surveillance for fetal growth restriction among women with eating disorders in pregnancy.
The Obstetric Response to the Opioid Epidemic [A218]
Authors: Tuller Molly , Miller Edward E. , Frazier La-Tisha , Engelbrecht Allison B. , De La Paz Melisa Noa 
Published: June 2022

INTRODUCTION:
Daily, 136 Americans die from an opioid overdose. One of the areas hardest hit by this epidemic is the Appalachian region. To combat this crisis, Congress and the American College of Obstetricians and Gynecologists recommend a multifaceted approach in identifying, monitoring, and managing patients. Medication-assisted treatment (MAT) with methadone or buprenorphine is a cornerstone of therapy. Despite the acceptance of MAT as standard of care, opioid related maternal and neonatal morbidity rates continue to rise.

METHODS:
A telephone survey of obstetric care professionals in highly affected counties (as determined by Centers for Disease Control and Prevention analysis) in West Virginia, Kentucky, Ohio, Tennessee, Indiana, and South Carolina was performed. Providers were asked if they: 1. Prescribe methadone or buprenorphine; 2. Manage patients who obtain the medications from other prescribers; 3. Had a preferred provider where they referred these patients. Additional variables included average distance to the referral center and average wait time on phone.

RESULTS:
Our data show that pregnant women experience limited access as well as significant barriers in obtaining MAT compared to nonpregnant patients. Data analysis will be displayed graphically as well as illustratively using state mapping data highlighting the limited options that pregnant women face when seeking MAT.

CONCLUSION:
Our data show a wide gap in both the quantity and the accessibility of obstetric providers willing to prescribe MAT to pregnant patients. The burden of management has fallen disproportionately on academic centers and non-obstetric providers which makes accessing this potentially life-saving treatment in a timely manner out of reach in this high-risk population.
The Utility of Rescue Antenatal Corticosteroids in Patients With Preterm Prelabor Rupture of Membranes [A222]
Authors: Gulersen Moti , Gyamfi-Bannerman Cynthia , Peralta Patricia , Li Xueying , Rochelson Burton , Bornstein Eran 
Published: June 2022

INTRODUCTION:
The benefit of rescue antenatal corticosteroids (ACS) in patients with preterm prelabor rupture of membranes (PPROM) is unknown. We investigated whether rescue ACS is associated with a lower rate of adverse neonatal outcomes in patients with PPROM.

METHODS:
Retrospective cohort of all patients admitted with PPROM within a university health system from October 2015 to May 2020. Patients with singleton gestations and PPROM between 23 0/7 and 32 6/7 weeks of gestation who remained undelivered seven days after admission, and thus were eligible for a second course of ACS, were included. Missing outcome data were excluded. Cases were stratified into two groups based on the number of ACS courses administered: one course (n=52) versus a second, rescue course (n=20). The primary outcome was the incidence of respiratory distress syndrome (RDS). Secondary outcomes included mechanical ventilation (MV), neonatal intensive care unit (NICU) length of stay, and composite neonatal morbidity. Statistical analysis included use of chi-square and Wilcoxon rank sum tests.

RESULTS:
Patient characteristics such as gestational ages at PPROM and delivery, time interval from PPROM to delivery, rate of chorioamnionitis, magnesium exposure prior to delivery, and mode of delivery were similar between the two groups. The incidence of RDS in neonates was similar between the two groups. Secondary outcomes were also similar between the two groups.

CONCLUSION:
Our data did not show improvement in respiratory morbidity in neonates exposed to rescue ACS following PPROM. This remains an understudied clinical scenario, and future studies with larger cohorts are needed before determining clinical guidelines regarding rescue ACS for this select population.
Impact of a Multidisciplinary Team Approach on the Diagnosis and Management of Placenta Accreta Spectrum Disorder [A228]
Authors: Yao Ruofan , Nguyen Hoang Yen , Hong Linda , Martin Courtney , Balli Kevin , Ioffe Yevgeniya 
Published: June 2022

INTRODUCTION:
Patients with suspected placental accreta spectrum (PAS) are recommended to be referred to specialized centers for antepartum management and cesarean hysterectomy. Previously, it was shown that multidisciplinary approach could improve outcomes, but evidence on referral volume and antenatal diagnostic accuracy were sparse. Our goal is to evaluate the impact of a multidisciplinary team on referral volume, diagnostic accuracy, and surgical outcomes.

METHODS:
This was a single-center retrospective cohort study, based in the only university-affiliated tertiary referral center within the region. Patients who underwent cesarean hysterectomy for suspected PAS from January 2014 to April 2021 were divided based on pre- and post-exposure of the multidisciplinary team in January 2019. The outcomes of interest were quantitative blood loss, blood transfusion, diagnostic accuracy, ICU admission, bladder injury, and postoperative length of stay. This study was approved by the institutional review board (#520052).

RESULTS:
A total of 114 patients were included in the cohort: 59 patients were from January 2014 to December 2018 and 55 patients were from January 2019 to April 2021. Since the establishment of the multidisciplinary center, there was a 1.4-fold increase in referral volume. Patients undergoing cesarean hysterectomy since the establishment of the multidisciplinary team had less quantitative blood loss (P=.005) and required less units of packed red blood cell transfusion (P<.001). In addition, the diagnostic accuracy improved from 35.6% to 83.6% (P<.001).

CONCLUSION:
Since the establishment of the multidisciplinary team, our center experienced an increase in referral volume, improvement in antenatal diagnostic accuracy, and surgical outcomes.
Loving Mothers’ Hearts: Screening for Undiagnosed Cardiomyopathy in Peripartum Women [A229]
Authors: Warkus Erica , Glaze Danielle , Castro Monica , Dowd Anne , Drafahl Bridget , Hill Washington C. 
Published: June 2022

INTRODUCTION:
Peripartum cardiomyopathy (PPCM) is a leading cause of pregnancy-related maternal mortality, but it is easily treated if diagnosed early. Better screening allows earlier treatment, which can decrease maternal mortality. Prognosis is closely linked to left ventricular ejection fraction (LVEF) at time of diagnosis and treatment. There are no consensus screening guidelines for PPCM.

METHODS:
To address this need, we have created a PPCM screening questionnaire (PSQ), which is used to calculate a PPCM Severity Index (PSI). The PSQ was distributed on social media to women with PPCM (N ∼4,900), preeclampsia (N ∼3,000), uncomplicated pregnancies, and participants enrolled from a cross-sectional sample of peripartum patients presenting to a single maternity center. Peripartum participants in this ongoing, Institutional review board‒approved study (n=1,500) are screened for PPCM using bedside echocardiography. The LVEF measurements are paired with PSI scores and N-terminal pro b-type natriuretic peptide (NT-proBNP) levels for analysis. Study participants are offered free serial echocardiographic assessments at 0–2 weeks, 4–6 weeks and 5–12 months postpartum.

RESULTS:
Preliminary data show that PSI scores are correlated with degree of LV dysfunction and can differentiate between women with PPCM (n=178), healthy pregnant controls (n=32), and women with preeclampsia (n=43). Postpartum PSI scores were more specific for PPCM than pregnant PSI scores. The most frequent symptoms reported by PPCM patients are dyspnea (94%), orthopnea (84%), and fatigue (79%).

CONCLUSION:
The PSQ is an effective screening tool for PPCM and, if used in conjunction with BNP testing and echocardiography, may significantly reduce pregnancy-related maternal mortality.
Should Women With Diabetes Be Counseled Differently If Nephropathy Was Detected? [A242]
Authors: Baghlaf Haitham , Aldhaheri Sarah , Badeghiesh Ahmad , Dahan Michael H. 
Published: June 2022

INTRODUCTION:
The prevalence of diabetes mellitus (DM) has increased tremendously in the last two decades mainly due to the pandemic of obesity. Diabetes is a well-known cause of complications during pregnancy. Diabetic nephropathy (DN) is a marker of severe diabetes and resultant organ damage. Despite that, only small studies have evaluated the implications of DN on pregnancy complications. The objective of this study was to explore the effect of nephropathy on obstetric and perinatal outcomes among women with DM using a population database.

METHODS:
This was a retrospective cohort study utilizing data from the Healthcare Cost and Utilization Project–Nationwide Inpatient Sample including women who delivered between 2004 and 2014. Multivariate logistic regression was used to control for confounding effects.

RESULTS:
Among 86,615 pregnancies that were complicated by DM, 1,241 (1.4%) had DN. Women with DN were more likely to smoke during pregnancy; have chronic hypertension, neuropathy, retinopathy, peripheral circulatory disorders, and thyroid diseases; and experience diabetic ketoacidosis compared to diabetic patients without nephropathy (all P<0.05). After adjusting for confounding factors, DN was associated with preeclampsia (aOR, 2.26; 95% CI, 1.90–2.68), superimposed preeclampsia or eclampsia (aOR, 4.21; 95% CI, 3.53–5.01), preterm birth (aOR, 1.83; 95% CI, 1.59–2.1), and blood transfusion (aOR, 3.55; 95% CI, 2.82–4.46).

CONCLUSION:
DN is associated with increased obstetric and perinatal morbidity than DM alone. These patients may benefit from vigilant antenatal surveillance, rigorous screening and prevention methods for hypertensive disorders and delivery in a tertiary-care center.
Outcomes in Adolescent Pregnant Patients Infected With SARS-CoV-2 [A249]
Authors: Murrin Ellen M. , Nguyen Anh Q. , Hitchings Laura , Nasrallah Sebastian , Wang Jenny , Gomez Luis M. 
Published: June 2022

INTRODUCTION:
Pregnancy carries increased risk factors for severe COVID-19 and adverse obstetric outcomes. Yet, it has not been evaluated whether increased risk during pregnancy varies with age. We sought to evaluate the risk of severity and adverse obstetric outcomes in SARS-CoV-2 positive adolescent patients compared to both non-infected adolescent and infected non-adolescent subjects.

METHODS:
Retrospective study across four Inova Health System Hospitals between March 2020 and January 2021. Patients were grouped by age and SARS-CoV-2 status: (i) adolescents (aged 14–19 years) SARS-CoV-2-positive, (ii) adolescents SARS-CoV-2-negative, and (iii) adults (age >20 years) SARS-CoV-2-positive. Statistical pairwise and regression analyses evaluated differences in disease distribution, severity, rates of prematurity, and cesarean delivery (CD) between group (i) and groups (ii) and (iii).

RESULTS:
Compared to SARS-CoV-2-negative adolescents (n=394), SARS-CoV-2-positive adolescents (n=48) were more likely to be Hispanic (91.7% versus 12.2%; adjusted P<.001), be uninsured (50% versus 7.9%; adjusted P<.001), require CD (25% versus 11.9%; adjusted P=.03), and deliver at greater gestational age (39 1/7 versus 38 4/7 weeks; adjusted P=.002). Compared to adult SARS-CoV-2-positive patients (n=695), adolescent SARS-CoV-2-positive patients were more likely to be Hispanic (91.7% versus 74.5%; adjusted P=.006), asymptomatic (79.2% versus 60.7%; adjusted P=.03), and to deliver at greater gestational age (39 1/7 versus 37 6/7 weeks; adjusted P=.004). We found no significant difference in the rates of prematurity, fetal growth restriction, NICU admission, and stillbirth.

CONCLUSION:
SARS-CoV-2 unequally affects Hispanic and uninsured adolescent pregnant patients. Infected adolescents are at high risk for CD compared to their non-infected adolescent counterparts. Infected pregnant adolescents tend to present with fewer COVID-19 symptoms compared to infected pregnant adults. Other obstetric outcomes were comparable among groups.
Effect of Guideline Change on Preconception Counseling for Heart Disease in Pregnancy [A250]
Authors: Berra Alexandra L. , Turrentine Mark A. , Ramirez Mildred A. 
Published: June 2022

INTRODUCTION:
There is limited evidence that implementation of guidelines in preconception counseling improves pregnancy outcomes. In 2019, the American College of Obstetricians and Gynecologists’ Pregnancy and Heart Disease Task Force developed a risk assessment score for cardiovascular disease based on symptoms, vital signs, risks factors, and physical examination. Women with a combined score of ≥4 are to be referred to maternal–fetal medicine (MFM) or primary care or cardiology (PCP) plus obtaining an electrocardiogram (EKG) with brain natriuretic peptide (BNP). Our objective was to estimate the effect of guideline changes on risk screening for cardiovascular disease during preconception counseling.

METHODS:
Retrospective chart review of women undergoing preconception counseling 6 months before versus 6 months after guidelines changed. We identified women with a combined score of ≥4 to evaluate if recommendations were followed.

RESULTS:
During the six months pre-publication, 174 women underwent preconception counseling, compared with 187 in the six months post-publication. Most women were screened by a reproductive endocrinology infertility (REI) physician (95% versus 83% in the pre versus post periods). Similar rates of women had a score of ≥4 in the two periods (5% versus 3%, P=.59). Referral to MFM or a PCP physician was high (88% versus 100%, P=.78), but there was no improvement for obtaining an EKG (88% versus 33%, P=.09) or BNP (0% versus 0%).

CONCLUSION:
Women with preconception counseling are being screened primarily by REI and are being referred to MFM/PCP, but are not consistently receiving recommended cardiovascular screening.
The ARRIVE Effect: What Do the Real-World Data Show? [A251]
Authors: Wood Rachel , Clapp Mark A. , Little Sarah 
Published: June 2022

INTRODUCTION:
Published in August 2018, the ARRIVE trial found that induction of labor (IOL) of low-risk, nulliparous patients at a gestational age (GA) of 39 weeks decreased the risk of cesarean delivery (CD). We assessed the rate of elective IOL and CD rates post-ARRIVE in the U.S.

METHODS:
The 2018–2020 U.S. Vital Statistics birth certificate database was used. Nulliparous, singleton, low-risk pregnancies at 39 weeks of gestation or greater were included. Data was analyzed by county and quarter, including counties with more than 100 births in all quarters. Comparisons were made between April and June 2018, the quarter just prior to ARRIVE publication, and October and December 2020, the latest available quarter.

RESULTS:
A total of 297 counties were included, representing over 120,000 births per quarter. The rate of all IOL ≥39 weeks GA increased significantly, from 35% (±9%) to 41% (±11%) (paired t test, P<.001), as did the rate of IOL specifically in the 39th week, from 13% (±6%) to 18% (±8%) (paired t test, P<.001). An interrupted time series analysis showed that the rate of IOLs in the 39th week was rising pre-ARRIVE, but the rate of change was significantly greater post-ARRIVE (0.3% increase per quarter in 39-week IOL post-ARRIVE versus 0.19% increase pre-ARRIVE, P<.001). There was no change, however, in the CD rate: 25.1% (±5%) to 24.7% (±5%) (paired t test, P=.054).

CONCLUSION:
Since the publication of the ARRIVE trial, nulliparous, singleton, low-risk ≥39-week inductions have significantly increased across the U.S. at a greater rate than prior to ARRIVE. There has been no change in the rate of CD.