bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characteristics and Outcomes Associated With COVID-19 Infection in Pregnancy [A189]
Authors: Sznajder Katharine , Jefferson Celeena R. , Kim Seohyun , Weinfield Nancy S. 
Published: June 2022

INTRODUCTION:
Data on COVID-19 in pregnancy are skewed toward infection at time of labor and delivery, and few studies have controlled for confounding variables. We aimed to explore the sociodemographic and health risk factors for COVID-19 at any point in pregnancy and its impact on maternal outcomes in a diverse cohort during the first year of the pandemic.

METHODS:
We conducted a retrospective cohort study using data abstracted from the electronic medical record within Kaiser Permanente Mid-Atlantic States, an integrated health care system, from March 15, 2020, to March 15, 2021. We included women at least 15 years old and pregnant during that timeframe, comparing those who tested positive for COVID-19 to those who did not. We used multivariable logistic regression to identify risk factors for COVID-19 infection during pregnancy. We then used propensity score matching to create a comparison group to explore associations between infection and key outcomes.

RESULTS:
Among 18,285 pregnant members, 1,036 (5.7%) tested positive for COVID-19 during pregnancy, with 26%, 31%, and 43%, respectively, diagnosed in each trimester of pregnancy. Patients with COVID-19 were more likely to be young, Latina, obese, and multiparous; being White or Asian was protective (P<.001). Patients with COVID-19 during pregnancy were more likely to be hospitalized apart from delivery (P=.029). There were no significant differences in fetal demise, cesarean delivery, preterm delivery, gestational diabetes, hypertensive disorders of pregnancy, venous thromboembolism, postpartum readmission, or maternal death between groups.

CONCLUSION:
Our study was consistent with previously identified disparities in COVID-19 infection. Outcome data were surprisingly reassuring.
Clinical Relevance of Ovarian Vein Thrombosis in Pregnancy and Postpartum [A197]
Authors: Greenman Michelle , Bustamante Bethany , Nizam Aaron , Yeisley Christopher , Grimaldi Gregory , Goldberg Gary L. 
Published: June 2022

INTRODUCTION:
Ovarian vein thrombosis (OVT) is a rare complication of pregnancy and can result in sepsis, extensive thrombosis and secondary venous thromboembolism (VTE). Treatments range from observation to anticoagulation and antibiotics. This study aims to identify the incidence of secondary VTE and factors that correlate with subsequent VTE.

METHODS:
After institutional review board approval, a cross-sectional study of patients diagnosed with OVT in the peripartum period from 2012 to 2020 at our institution was performed. The incidence of secondary VTE and their clinical management was reviewed. Descriptive statistics were performed to identify risk factors for secondary VTE. Numeric variables were compared using Mann-Whitney U test, and categorical variables were compared using chi-square or Fischer’s exact test.

RESULTS:
A total of 37 postpartum patients with OVT were included. The incidence of secondary VTE was 16.2% (6 patients). Patient characteristics including age, race, BMI, tobacco use, mode of delivery, cesarean hysterectomy, and chorioamnionitis were similar between patients with OVT alone and OVT with secondary VTE (P=.918, .911, 1, .115, 1, .62, .535, respectively). Radiographic measurement of OVT extension into the IVC or renal veins as both continuous or nominal variables did not confer increased risk of secondary VTE.

CONCLUSION:
Secondary VTE following OVT occurred in 16% of women in this select population. No clinical or demographic factors were found to be significant for a higher risk of developing VTE. Although OVT is rare, it is associated with significant maternal morbidity and mortality. Future studies are needed to identify high-risk patients for secondary outcomes of OVT and improve therapeutic guidelines.
Effect of Race in the Diagnosis of Fetal Growth Restriction in a Multicultural Urban Population [A202]
Authors: Chen Cindy , Kon Maria , Rathi Sourish , Vincent Sarah J. , Ram Kavitha T. 
Published: June 2022

INTRODUCTION:
Despite significant differences in fetal growth curves based on maternal race/ethnicity, fetal growth restriction (FGR) continues to be defined by the Hadlock formula generated from a study involving 392 predominantly White pregnancies. Accuracy in FGR diagnosis is crucial to prevent iatrogenic preterm delivery and unnecessary antenatal surveillance and intervention. We sought to compare the diagnostic accuracy of FGR in fetuses classified by Hadlock criteria versus Eunice Kennedy Shriver National Institute of Child Health and Human Development racial/ethnic-stratified criteria in a multicultural urban population.

METHODS:
A retrospective recalculation of estimated fetal weight (EFW) and abdominal circumference (AC) in fetuses diagnosed with FGR over a 5-year period using NICHD race-specific fetal growth criteria was performed. FGR was defined as EFW or AC less than 10th percentile. Chi-square analysis was performed to evaluate the differential effects of recalculation across racial groups.

RESULTS:
A total of 384 pregnancies with FGR were identified in 147 (38.3%) Asian, 114 (29.67%) Hispanic, 111 (28.9%) Black, and 12 (3.3%) White mothers. Recalculation normalized growth in 64 (16.7%) pregnancies and was disproportionate, with the greatest effect in pregnancies of Black mothers (29, 26.1%), followed by Hispanic mothers (17, 14.9%) and Asian mothers (18, 12.2%) (P=.01).

CONCLUSION:
Application of NICHD race-specific criteria reversed the diagnosis of a substantial number of FGR pregnancies, with the greatest reversal seen in pregnancies of Black mothers. More research is needed to evaluate the neonatal and long-term outcomes of fetuses misdiagnosed as FGR based on the old growth standards, as iatrogenic preterm delivery and steroid administration carry potential morbidity later in life.
Increased Risk of Cesarean Delivery in Severely Obese Patients Who Are Induced Electively or For Obese Status Alone [A212]
Authors: Myers Brittany A. , Root Emily A. , Mukherjee Anish , Gaskins Jeremy , Pierson Rebecca C. , Kline Jessica 
Published: June 2022

INTRODUCTION:
Prepregnancy obesity is reaching epidemic proportions in the United States. Maternal obesity alone is not an indication for induction of labor (IOL). Recent studies have shown that elective IOL >39 weeks does not increase cesarean delivery (CD) rates; however, patients with severe obesity (BMI >40) are not represented in many of these trials, creating a gap in our ability to provide patient-centered care.

METHODS:
A retrospective chart review of patients with BMI >40 between May 2016 and December 2020 at a single institution was conducted. Exclusion criteria included: scheduled CD, vaginal birth after cesarean delivery, repeat CD, multiple-gestation pregnancies, delivery <20 weeks, or intrauterine fetal demise. Demographic and other clinical features were analyzed using ANOVA and Fisher tests. The primary outcome was analyzed using linear and logistical regression models.

RESULTS:
There were 1,010 deliveries, of which 545 met study criteria. The median BMI was 43.9 (IQR, 41.8–48.5; range, 40.0–92.9). The groups by BMI classification were matched for age, gravida/para, and race. A total of 72.5% of patients were induced during this study period. Of patients who underwent IOL for obesity alone (n=99), 27% delivered via CD, versus 12% for patients who presented in spontaneous labor. Regression models showed significant association between increasing BMI and CD from BMI >40 to BMI 60.

CONCLUSION:
In patients with BMI >40 who undergo elective induction of labor, there is a significant increase in cesarean delivery rate as opposed to those who present in spontaneous labor.
Maternal and Neonatal Outcomes in Recipients of Solid Organ Transplantation [A213]
Authors: Nguyen Hoang Yen , Yao Ruofan 
Published: June 2022

INTRODUCTION:
Pregnant patients who have received solid organ transplantations face high morbidity and mortality. Risks of preeclampsia and preterm delivery were previously observed, but data on gestational diabetes, maternal and neonatal ICU admissions were sparse. Most data regarding maternal and neonatal outcomes have been derived from the transplantation registry and single-center retrospective studies.

METHODS:
This was a retrospective study using the California Office of Statewide Health Planning and Development Linked Birth File. Exposure was defined as a history of heart, lung, liver, or kidney transplantation using maternal ICD-9 codes. Primary outcomes included risks of preeclampsia, preterm delivery, cesarean delivery, maternal and neonatal ICU admissions. Secondary outcomes included blood transfusion, hysterectomy, unplanned cesarean delivery, low Apgar score, neonatal intubation, stillbirth, and neonatal death.

RESULTS:
This study included 3,186,249 patients in the control group and 263 patients in the exposure group. The most commonly transplanted organs are kidneys, followed by liver, heart, and lungs. When compared to controls, patients with heart, liver, or kidney transplant had significantly increased risk of preeclampsia, preterm delivery, cesarean delivery, and maternal and neonatal ICU admissions. Risks of hysterectomy, unplanned cesarean delivery, neonatal intubation, and stillbirth in the exposure group were similar to the control group. Patients with kidney transplantation presented with the highest rates of the aforementioned complications, with further increased risks of maternal blood transfusion, low Apgar score, and neonatal death.

CONCLUSION:
Pregnancies of recipients of solid organ transplantation are associated with higher morbidity and mortality for both patients and neonates compared to the general population.
Postpartum Depression in Women With Hypertensive Disorders of Pregnancy [A220]
Authors: Otto Abigail M. , Kistner Margaret , Schultz Elyse , Tjaden Anne , Yang Linda , Prock Paula White 
Published: June 2022

INTRODUCTION:
Depression affects 10–15% of women during and after pregnancy. Studies have shown that increasing stressors increase rates of depression. Preeclampsia, a hypertensive disorder of pregnancy, often results in stressful sequelae at various points in pregnancy, including preterm birth and prolonged hospitalization. We hypothesize that women with hypertensive disorders of pregnancy are at an increased risk for peripartum depression.

METHODS:
We conducted a retrospective study and examined women who delivered at Loyola University Medical Center between January 1, 2014, and December 31, 2019. Our cohort included 6,270 women and 7,125 pregnancies. We collected information including Edinburgh Postnatal Depression Scale (EPDS) scores, hypertensive status, demographics, and clinical characteristics.

RESULTS:
In our cohort, 79.51% of mothers had no hypertensive disorders, 10.22% had chronic or gestational hypertension, and 10.22% had preeclampsia. Predicted population average EPDS scores were higher for preeclamptic women than for all other women at all time points (P<.05). At 28 weeks of gestation, immediately postpartum, and 2–6 weeks postpartum, odds of peripartum depression for preeclamptic women were 1.72 times (P=.01), 1.45 times (P=.02), and 1.40 times (P=.03) those for normotensive women, respectively.

CONCLUSION:
Maternal mental health is an emerging focus within obstetrics with the larger goal of reducing maternal morbidity and mortality. In our study, women with hypertensive disorders had higher EPDS scores and higher odds of having depression. Those with preeclampsia specifically had the highest risk at all points in pregnancy. Understanding hypertensive disorders as a risk factor for depression may help us better support at-risk mothers.
Assessing Risk Factors for Obstetric Anal Sphincter Injury in the United States [A223]
Authors: Propst Katie A. , Bruckman David , Hickman Lisa C. 
Published: June 2022

INTRODUCTION:
Due to the infrequency of obstetric anal sphincter injury (OASI), a clear understanding of risk factors beyond operative vaginal delivery and episiotomy is lacking. Given the significant short- and long-term impacts of OASI, a better understanding of risk factors is essential for prevention and accurate laceration identification.

METHODS:
The aim of this study is to evaluate risk factors for OASI at the time of vaginal birth. We utilized the Healthcare Cost and Utilization Project–National Inpatient Survey datasets of 2008–2017 to identify women undergoing singleton vaginal births aged 18–49 years. Multivariable logistic regression, survey weight-adjusted, was applied to determine factors associated with the primary outcome of OASI. Risk factors were defined as odds ratios.

RESULTS:
A total of 22,345,397 vaginal deliveries were identified. The rate of OASI significantly decreased from 3.37% in 2008 to 2.36% in 2017 (P<.001). The following risk factors were noted to be associated with OASI: maternal exhaustion (odds ratio [OR], 6.01; 95% CI, 5.84–6.18), fetopelvic disproportion (OR, 5.13; 95% CI, 4.02–6.56), long labor (OR, 4.80; 95% CI, 4.36–4.97), occiput posterior position (OR, 4.60; 95% CI, 4.34–4.88), operative vaginal delivery (OR, 4.33; 95% CI, 4.17–4.50), chorioamnionitis (OR, 2.31; 95% CI, 2.22–2.40), heart rate abnormalities (OR, 2.16; 95% CI, 2.12–2.21), fetal distress (OR, 2.01; 95% CI, 1.98–2.04), shoulder dystocia (OR, 1.64; 95% CI, 1.55–1.72), postterm pregnancy (OR, 1.64; 95% CI, 1.61–1.66), and induction of labor (OR, 1.43; 95% CI, 1.09–1.88). The following factors were protective against OASI: precipitous labor (OR, 0.43; 95% CI, 0.41–0.47) and obesity (OR, 0.62; 95% CI, 0.60–0.64).

CONCLUSION:
We recommend increased awareness of the identified risk factors for OASI. For women with these risk factors, we encourage the use of techniques to reduce OASI and thorough post-delivery perineal exams for proper laceration classification.
Improving the On-Time Administration of Antibiotics for Cesarean Delivery in African American and Latina Women [A233]
Authors: Mele Michele M. , Le Kyle , Hewlett Guy , Perry Robin 
Published: June 2022

INTRODUCTION:
In 2020, we observed a spike in cesarean delivery (CD) postoperative infections. All aspects of our CD care were examined via chart review. The overall rate of on-time antibiotic administration (OTAA) was 89.2%; with a rate of 86.6% in African American women, 86.0% in Latina women, and 92.1% in White women. We established a combined departmental diversity, equity, and inclusivity quality goal for 2021 to improve the OTAA of antibiotic prophylaxis for CDs in African American and Latina women.

METHODS:
A multidisciplinary collaboration among obstetrics and gynecology, anesthesia, nursing, pharmacy, and information technology strategized to remove all obstacles to OTAA, defined as antibiotic administration within 60 minutes of incision. Emergent cases were excluded. Our action plan included: 1. adding antibiotic discussions in pre-CD huddle and labor and delivery morning report; 2. working with pharmacy to ensure all antibiotics are immediately available; 3. emphasizing antibiotic administration in pre-induction anesthesia time-out; and 4. ensuring best performance with ongoing team education. We performed a biweekly review of CD antibiotic reports to identify missed opportunities and remediate causes.

RESULTS:
From January 1 to September 30, 2021, there were 329 non-emergent CDs. After interventions, the overall OTAA rate increased from 89.2% to 92.7%. All subgroups also improved, African American from 86.6% to 89.9% (10 of 99), Latina from 86.0% to 94.8% (5 of 97), and White from 92.1% to 92.9% (7 of 98).

CONCLUSION:
Our structured multidisciplinary approach to improving OTAA both improved overall performance in antibiotic administration and mitigated the racial disparity originally seen.
Characteristics of Individuals Who Underwent Cesarean Delivery After Prolonged Labor [A245]
Authors: Chaiken Sarina , Phillips Jillian , Packer Claire , Garg Bharti , Caughey Aaron 
Published: June 2022

INTRODUCTION:
We sought to determine factors associated with cesarean delivery among those with prolonged labor.

METHODS:
We utilized linked vital statistics-patient discharge data from California (2007–2011) and included singleton non-anomalous pregnancies with a diagnosis of prolonged labor. We examined the prevalence of CD in women with prolonged labor for varying subgroups and performed multivariable logistic regression to determine factors associated with CD in those with prolonged labor.

RESULTS:
Among those with a diagnosis of prolonged labor (N=41,130), 28.72% (11,811) underwent cesarean delivery. Compared with non-Hispanic White individuals, non-Hispanic Black patients had significantly lower odds of CD (aOR, 0.88; 95% CI, 0.78–0.99), while Hispanic (aOR, 1.29; 95% CI, 1.22–1.37) or Asian persons (aOR, 1.14; 95% CI, 1.07–1.23) had higher odds of CD. As compared to those with normal BMI, being underweight (BMI<18.5) had lower odds of CD (aOR, 0.81; 95% CI, 0.72–0.91), while overweight (BMI 25–29.9; aOR, 1.33; 95% CI, 1.26–1.41) or obese (BMI ≥30; aOR, 1.87; 95% CI, 1.76–2.00) patients had higher odds of CD. Those aged ≥35 years had higher odds of CD (aOR, 1.28; 95% CI, 1.20–1.35), and patients on public insurance had lower odds of CD (aOR, 0.91; 95% CI, 0.86–0.96).

CONCLUSION:
Our results indicate that sociodemographic factors, including race, BMI, and age, impact odds of CD among those with prolonged labor. It is known that bias can impact decision-making in the context of labor and delivery, further attention should be placed to understand and remedy the structural causes of bias that impact who undergoes CD with prolonged labor.
Thrombotic Thrombocytopenic Purpura and Pregnancy Outcomes: A Cohort Study [A258]
Authors: Tzur-Tseva Ayellet , Czuzoj-Shulman Nicholas , Abenhaim Haim A. 
Published: June 2022

INTRODUCTION:
Thrombotic thrombocytopenic purpura (TTP) is a rare microangiopathy. Little is known of its impact on pregnancy. The aim was to evaluate the association between maternal TTP and pregnancy and neonatal outcomes.

METHODS:
A retrospective cohort study was conducted using the U.S. Healthcare Cost and Utilization Project–Nationwide Inpatient Sample. A cohort of women who delivered between 1999 and 2015 was created. Then ICD-9 code 446.6 was used to identify women with a diagnosis of TTP, with the remaining women without a TTP diagnosis being the comparison group. Multivariate logistic regression estimated the effect of TTP on maternal and neonatal outcomes, while adjusting for maternal baseline variables.

RESULTS:
A total of 13,792,544 women delivered between 1999 and 2015, of whom 280 had a TTP diagnosis (2/100,000). Women with a TTP diagnosis, compared to those without, had more preexisting health conditions (diabetes, hypertension, and obesity). TTP was associated with several adverse outcomes: maternal death (odds ratio [OR], 215.50; 95% CI, 121.19–383.22), preeclampsia (OR, 18.63, 14.57–23.82), eclampsia (OR, 27.80; 95% CI, 13.08–59.11), placental abruption (OR, 5.20; 95% CI, 3.18–8.50), disseminated intravascular coagulation (OR, 139.11; 95% CI, 81.97–236.09), venous thromboembolism (OR, 10.69; 95% CI, 5.25–21.73), sepsis (OR, 118.42; 95% CI, 63.62–220.42), myocardial infarction (OR, 268.60; 95% CI, 84.30–855.81), postpartum hemorrhage (OR, 15.00; 95% CI, 11.66–19.29), requiring a blood transfusion (OR, 59.77; 95% CI, 46.54–76.76), and cesarean delivery (OR, 3.52; 95% CI, 2.74–4.53). Neonates born to women with a TTP diagnosis were at increased risk for preterm birth (OR, 3.40; 95% CI, 2.58–4.49), intrauterine growth restriction (OR, 2.73; 95% CI, 1.68–4.41), and stillbirth (OR, 9.41; 95% CI, 5.95–14.88).

CONCLUSION:
TTP increases the risk of adverse maternal and neonatal outcomes, including maternal and fetal death. Women with TTP in the past or present should be followed closely by a multidisciplinary team.
Progesterone for Prevention of Miscarriage and Preterm Birth in Women With First-Trimester Bleeding: PREEMPT Trial [A260]
Authors: Abenhaim Haim A. , Audibert Francois , Gagnon Robert , Girard Isabelle , Kellow Zina , Klam Stephanie 
Published: June 2022

INTRODUCTION:
First-trimester bleeding is associated with miscarriage and preterm birth, for which progesterone has been suggested to improve outcomes. Our study objective was to evaluate the effect of progesterone treatment throughout pregnancy on preventing miscarriage and preterm birth in pregnancies with first trimester bleeding.

METHODS:
This was a multicenter, double-blind, placebo-controlled, randomized trial comparing 200 mg micronized progesterone, vaginally administered nightly from presentation to 34 weeks of gestation, with an identically appearing placebo. Subjects with vaginal bleeding and live intrauterine pregnancy <14 weeks of gestation were eligible. Multifetal gestations, cervical insufficiency, recurrent pregnancy loss, or bleeding unrelated to placentation were excluded. Primary outcome was occurrence of live term pregnancy. Secondary outcomes included adverse maternal/newborn events and time to miscarriage or birth. Chi-square analyses compared proportions and Mann-Whitney tests compared time-to-event outcomes.

RESULTS:
A total of 549 patients were randomized, of whom 16 withdrew or were lost to follow-up, leaving 264 patients in the progesterone group and 269 patients in the placebo group. Baseline characteristics were comparable in both groups. The number of patients having a live term birth among those in the progesterone group was 197 (74.6%), compared with 190 (70.6%) in the placebo group (P=.30). Compared to the placebo group, those in the progesterone group had comparable risks of abortion <20 weeks (38 (14.4%) versus 43 (16.0%), P=.94), preterm birth (27 [10.2%] versus 33 [12.3%], P=.46), and stillbirth (2 [0.9%] versus 3 [1.3%], P=.65). There were no differences in adverse maternal or newborn outcomes, or in time-to-event for miscarriage or birth between the groups.

CONCLUSION:
Progesterone prescribed throughout pregnancy is not effective in preventing miscarriage or prematurity in subjects presenting with first-trimester vaginal bleeding in context of a live intrauterine pregnancy.
COVID-19 Vaccine Acceptance in Pregnancy [A262]
Authors: Odedokun Temitope , Marquez Rafael , Thakkar Meera , Dinglas Cheryl , El Kady Dina 
Published: June 2022

INTRODUCTION:
The purpose of the study is to evaluate the acceptance rate of the COVID-19 vaccine among pregnant women at our institution and determine whether there are factors including health disparities associated with acceptance or hesitance.

METHODS:
This is an IRB-exempt descriptive study. Anonymous surveys were administered and completed by 701 pregnant patients at Mount Sinai South Nassau’s affiliated Maternal Fetal Medicine office from February to May 2021. Descriptive statistics were calculated for the overall sample, as well as separately by group (acceptance versus declining/undecided about getting the COVID-19 vaccine). A result was considered statistically significant at the P<.05 level of significance.

RESULTS:
Of the 701 pregnant women who completed the survey, 96 patients accepted the vaccine. Pregnant women willing to get the flu vaccine and/or the Tdap vaccine in pregnancy were also more likely to obtain the COVID-19 vaccine (P=.0037 and P<.0001, respectively). Pregnant patients who had household members willing to receive the COVID-19 vaccine also more likely to obtain the vaccine for themselves (P<.0001). Interestingly, pregnant women who had an underlying respiratory illness in the pregnancy were less likely to accept the COVID-19 vaccine than those who had either other or no medical problems (P=.0279).

CONCLUSION:
There is a low rate of COVID-19 vaccine acceptance among pregnant women at only 13.69%. Efforts should be made to encourage the vaccine in this vulnerable population in order to protect them from the health risks of COVID-19 infection.