bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characteristics That Influence the Success of External Cephalic Version in Nulliparous Women [A198]
Authors: Gude Jessica , Anasti James , Durgham Ryan A. 
Published: June 2022

INTRODUCTION:
Studies identified that nulliparous women (NW) are at increased risk for failed external cephalic version (ECV). This study examined maternal characteristics and maternal/neonatal outcomes of NW with failed and successful ECVs.

METHODS:
Using the NBER Natality Database (2016–2018) ECV attempts in NW were identified. ECV success and cesarean delivery (CD) rates were calculated. Maternal demographics, comorbidities, and neonatal outcomes were compared between cohorts using bivariate analysis. Statistically significant (P<.001) differences were reported.

RESULTS:
The ECV success rate in 13,015 NW was 40.0%. Black NW had the highest success rate (54.5%), followed by Hispanic (49.1%), Asian/Pacific Islander (45.0%), White (37.8%), and American Indian/Alaskan Native (27.2%) NW. Self-pay NW had the highest ECV success rate (58.3%), followed by Medicaid (45.2%), and private insurance (26.8%). Successful ECV saw decreased neonatal ventilation (5.4% versus 6.8%) but increased NICU admission (9.9% versus 6.7%). NW with successful ECV had a 29.9% CD rate. Higher CD rates were found in NW with a history of hypertension (54.3% versus 29.4%), gestational diabetes mellitus (56.3% versus 28.9%), and gestational hypertension (38.3% versus 29.2%). There was no association between race or payer status and CD rate after successful ECV. Pertinent negatives for both cohorts include, age, BMI, history of diabetes, birth weight, gestational age at birth, Apgar scores, neonatal seizures, maternal ICU admission, transfusion, and unplanned hysterectomy.

CONCLUSION:
When counseling NW on ECV, it is important to fully account for several factors that affect the chance of ECV success or CD. The reasons for the impact of the factors found here will require further investigation.
A Review of Women’s Unanswered Questions Following Miscarriage on Different Social Media Platforms [A207]
Authors: Ong Emily , Davis Lauren , Sanchez Alyssa , Stohl Hindi E. , Nelson Anita L. , Robinson Nuriya 
Published: June 2022

INTRODUCTION:
The purpose of this study was to investigate common questions asked and advice offered about miscarriage that women post on social media to identify any opportunities to improve care.

METHODS:
Institutional review board committee approval was waived for the study. English language, public social media posts between January 1, 2019, and June 30, 2021, were searched using the keywords of “miscarriage”, “early pregnancy loss”, “spontaneous abortion”, and “#IHadAMiscarriage”. The inclusion criteria varied by site: all posts in public Facebook miscarriage groups, YouTube videos with ≥1,000 views, Reddit r/Miscarriage with ≥175 upvotes, Instagram photos with ≥50 likes, and tweets with ≥1 interaction were analyzed for mentions of questions and advice. Each theme and each advice in a post was counted. Advice was classified into categories of “accurate” if it was supported by current guidelines from the American College of Obstetricians and Gynecologists, “insufficient evidence” if it was advice only supported by published reports, and “inaccurate” if any part was unsupported.

RESULTS:
A total of 103 posts were identified for common themes, including suffering from grief (20.4%), blame (19.4%), quality of post-miscarriage counseling in different care settings (14.6%), and inadequate medical counseling (13.6%). Most posts (82.9%) mentioned coping with loss. A total of 17.1% of posts offered medical advice eligible for evaluation, the most accurate platforms being YouTube (66.6%), Instagram (100%), and Reddit (100%). The least accurate platform was Facebook (33.3%). Twitter yielded insufficient results that did not meet the inclusion criteria.

CONCLUSION:
This study indicates a need to improve the counseling that women receive post-miscarriage. Clinicians may direct grieving patients to social media to connect with others.
Determining the Impact of Socioeconomic Status and Distance to a Rural Tertiary-Care Center on Preterm Delivery [A219]
Authors: Darivemula Shilpa M. , Kouassi-Brou Marilyn , Pollack Catherine C. , Goodman Daisy J. , Fisher Timothy 
Published: June 2022

INTRODUCTION:
Hospital-based labor and delivery units are closing at increasing rates in the rural U.S., with significant implications for maternal and newborn health. The goal of this analysis was to examine clinical, sociodemographic, and geographic risk factors for preterm delivery (PTD) at a single, rural, level III maternal obstetric care center.

METHODS:
This study was a retrospective electronic medical record review of singleton pregnancies delivering at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, U.S. between 2016 and 2018. The primary outcome was PTD (at less than 37 weeks of gestation), with secondary outcomes of low birth weight (LBW) and intensive care nursery (ICN) admission. The primary exposures included travel time and insurance carrier. Demographic and clinical covariates and ZIP code level socioeconomic data were incorporated into the multivariate models.

RESULTS:
Compared to patients traveling less than 30 minutes, patients traveling 1–1.5 hours had approximately twice the odds of PTD (odds ratio [OR,], 2.08; 95% CI, 1.32–3.29; P=.002), birth of a LBW neonate (OR, 2.15; 95% CI, 1.29–3.58; P=.005), and infant admission to the ICN (OR, 1.83; 95% CI, 1.22–2.76; P=.004). Marital status, prenatal visit count, history of PTD, primiparity, and tobacco exposure also increased risks for PTD, LBW, and ICN admission. Insurance carrier status was not associated with increased odds of PTD, LBW, or ICN admission.

CONCLUSION:
This study suggests that rurality and its impact on maternal health is not just about distance from hospitals or degree of socioeconomic deprivation, but about local resource access as well.
Cumulative Effect of Medical and Social Risk Factors on Routine Prenatal Care Screening [A231]
Authors: Pennathur Harini , Ghrayeb Leena , Debnath Dipra , Ganzi Stephanie , Cohn Amy , Peahl Alex F. 
Published: June 2022

INTRODUCTION:
Social risk factors affect prenatal care attendance; however, little is known about how cumulative medical and social risk factors influence receipt of prenatal services. We describe the association between medical and social risk factors and the timing of a routine prenatal care screening: gestational diabetes (GDM).

METHODS:
We identified patients with a GDM diagnosis receiving prenatal care at a single institution from January 1 to December 31, 2018. We divided patients into four groups by medical and social risk factors in the electronic health record: completely low-risk, social risk only, medical risk only, and completely high-risk. We compared the timing of GDM diagnosis and time for all group members to receive the GDM diagnosis. The study was deemed exempt by the institutional review board.

RESULTS:
We identified 102 patients with GDM: 11 (10.8%) completely low-risk, 17 (16.7%) social risk only, 11 (10.8%) medical risk only, and 63 (61.8%) completely high-risk. The median gestational age of diagnosis for GDM was 28.6 weeks (IQR, 27.2–30.9) and was similar across groups: completely low-risk 28.8 (IQR, 27.4–30.9) weeks, social risk only 28.2 (IQR, 27.1–29.6) weeks, medical risk only 29.2 (IQR, 27.6–30.1) weeks, and completely high-risk 28.6 (IQR, 26.9–31.4) weeks. The time for all patients to be diagnosed was later for groups with social risk factors, regardless of medical risk factors: completely low-risk 32 weeks, social risk only 35 weeks, medical risk only 30 weeks, and completely high-risk 36 weeks.

CONCLUSION:
Many patients with social risk factors were diagnosed with GDM later in pregnancy. Attention to social risk factors can potentially improve timeliness of diagnosis of pregnancy complications and pregnancy outcomes.
Risk of Uterine Rupture and Dehiscence Among Women Attempting a Vaginal Birth After a Low Vertical Uterine Incision [A232]
Authors: Fermin Oriana , Ben Khallouq Bee , Desai Neeraj , Smid Marcela , Herrera Christina 
Published: June 2022

INTRODUCTION:
The risk of uterine rupture after a prior low vertical (LVCS) is unknown. The objective of this study was to estimate the risk of uterine rupture in individuals attempting a trial of labor after cesarean delivery (TOLAC) with a prior LVCS.

METHODS:
This is a secondary analysis of the Maternal Fetal Medicine Units Network’s C-section Registry, a multicenter, prospective observational study. We included individuals with term singleton pregnancies undergoing TOLAC with a prior low transverse incision (LTCS) or LVCS and excluded those who received prostaglandins or had a history of myomectomy. Multivariate regression models were used to estimate the relative risk between uterine rupture with a prior LVCS compared to LTCS. After controlling for known confounders, our secondary outcome was uterine dehiscence.

RESULTS:
In this cohort, 14,773 individuals attempted TOLAC (14,665 prior LTCS; 108 prior LVCS). Uterine rupture occurred in 94 (0.7%) of women with prior LTCS and 1 (0.1%) woman with prior LVCS. Uterine dehiscence occurred in 101 (0.7%) of individuals with prior LTCS and 3 (2.9%) of individuals with prior LVCS. Compared to those with a prior LTCS, the risk of uterine rupture was not different (RR, 1.49; 95% CI, 0.21–10.58). However, the risk of uterine dehiscence was increased among those with prior LVCS (RR, 4.07; 95% CI, 1.31–12.63) compared to prior LTCS.

CONCLUSION:
Individuals with a prior LVCS have an increased risk of uterine dehiscence, but not uterine rupture, compared to prior LTCS. These results may inform counseling for those individuals considering TOLAC after prior LVCS.
Maternal Morbid Obesity Is Associated With an Increased Risk of Severe Maternal Morbidity [A234]
Authors: Baranco Nicholas , Elkafrawi Deena , Wojtowycz Martha , Parker Pamela R. , Nosovitch John , Mastrogiannis Dimitrios 
Published: June 2022

INTRODUCTION:
Prepregnancy obesity (body mass index [BMI]≥30) has been consistently associated with maternal morbidity. The rate of morbid obesity (BMI≥40) appears to be increasing. This study investigated whether morbid obesity was associated with severe maternal morbidity in a population cohort.

METHODS:
Internal review board exemption was obtained. We identified 197,822 patients using the birth-certificate-based New York Statewide Perinatal Data System from 2010 to 2020. Women were divided into two categories, those with prepregnancy BMI <40 and those with prepregnancy BMI ≥40 (morbid obesity). The risk of severe maternal morbidity (maternal transfusion, intensive care unit admission, unplanned hysterectomy, and unplanned reoperation) was compared. We also compared the risk of cesarean delivery, hypertensive disorders of pregnancy, and gestational diabetes. Chi-square and t tests were used to compare categorical and continuous variables respectively.

RESULTS:
We identified 197,822 deliveries, of which 13,120 (6.63%) were complicated by maternal morbid obesity. Morbidly obese women had a significantly higher risk of severe morbidity (RR, 1.16; 95% CI, 1.003–1.33). The risk of intensive care unit admission was significantly increased (RR, 1.84; 95% CI, 1.35–2.53), but blood transfusion, unplanned hysterectomy, and unplanned reoperation were unchanged.

CONCLUSION:
Morbid obesity was associated with increased severe maternal morbidity specifically due to maternal intensive care unit admission. This may indicate a higher risk of severe medical complications and likely represents a higher risk of maternal mortality.
Anteroposterior Diameter of the Upper Cervix: A Potential Marker for Cervical Insufficiency [A240]
Authors: Foster Todd L. , Frantskevich Katsiaryna , Sumners James 
Published: June 2022

INTRODUCTION:
Having observed an apparent smaller cervical diameter on clinical examination in patients presenting for cerclage because of a history of cervical insufficiency in all prior pregnancies (congenital cervical insufficiency [CCI]), an observational study of upper cervical anteroposterior diameter (APD) was undertaken of this measurement in the second trimester of CCI patients (n=86, 28.4%), utilizing APD in a comparison group of patients from a general obstetric practice (normal, n=217, 71.6%) with prior obstetric histories devoid of preterm deliveries.

METHODS:
APD (expressed in millimeters) was measured in each group on images taken for clinical use in both groups between 14 completed weeks and 23+6 weeks gestation. Patients with cerclage in place, cervical surgical treatment or damage and multifetal pregnancies were excluded. Analysis of central tendency and variation were undertaken in each group.

RESULTS:
The APD (mean ± standard deviation) was 32.0±4.3 mm in the CCI group and 40.6±5.2 mm in the normal group. The gestational age of the measurement taken at the ultrasound was included as a covariate in a generalized linear model. There was a statistically significant difference in the size of the APD between the normal group and the CCI group (t=7.08, P<.001).

CONCLUSION:
This preliminary, exploratory study suggests that upper cervical diameter may be a marker to distinguish patients seen in their first pregnancy who are at risk for clinical manifestation of cervical insufficiency. A much larger prospective study of primigravid patients will be necessary to verify this relationship.
Adverse Neonatal Outcomes in the Setting of Inflammatory Bowel Disease [A241]
Authors: Chaiken Sarina , Ghafari-Saravi Afsoon , Packer Claire , Garg Bharti , Caughey Aaron 
Published: June 2022

INTRODUCTION:
To examine neonatal outcomes among pregnant patients with inflammatory bowel disease (IBD).

METHODS:
A retrospective cohort study using linked vital statistics and hospital discharge data from California (2007–2011). We included singleton, non-anomalous pregnancies, using chi-square tests to compare demographics and outcomes of intrauterine fetal demise (IUFD), infant death, NICU admission >24 hours, Apgar score <7 at 5 minutes, and small for gestational age. Multivariate logistic regressions controlled for maternal age, race/ethnicity, education, and insurance.

RESULTS:
The cohort included 1,559 (0.06%) individuals with IBD. Compared to those without IBD, IBD patients were more likely to be White, older, highly educated, on private insurance, and with normal BMI. Pregnancies of patients with IBD were more likely to result in NICU admission (P<.001), small for gestational age neonates (P=.004), or congenital anomaly (P=.049), but not IUFD (P=.105), infant death (P=.753), Apgar score <7 (P=.261), macrosomia (P=.094), or birth injury (P=.262). On multivariate regression, IBD neonates were more likely to require NICU admission (aOR, 1.71; 95% CI, 1.48–1.98) or be small for gestational age (aOR, 1.55; 95% CI, 1.32–1.83), and less likely to have macrosomia (aOR, 0.75; 95% CI, 0.62–0.90).

CONCLUSION:
IBD neonates were more likely to require NICU admission and be small for gestational age, but less likely to have macrosomia. When adjusting for characteristics of IBD patients, IUFD, infant death, poor Apgar scores, congenital anomaly, and birth injury were not more likely. This study is limited by the small incidence of some outcomes. Further work should elucidate how IBD is related to these adverse neonatal outcomes.
Screening in Vein: Hemoglobin Electrophoresis Misses Most Alpha Thalassemia Carriers [A243]
Authors: Aldrich Stacey , German Ryan J. , Peacock Jacqueline , Fecteau Heather , Carlson Robert 
Published: June 2022

INTRODUCTION:
Carrier screening for alpha thalassemia is universally recommended in the U.S., regardless of a patient’s ancestry. While hemoglobin electrophoresis is traditionally recommended as the first-line test for alpha thalassemia carrier screening, newer genetic testing technology shows promise to improve the detection of alpha thalassemia carriers.

METHODS:
A retrospective chart review was conducted of 515 participants who received both hemoglobin electrophoresis and genetic testing for alpha thalassemia carrier screening at a U.S. commercial laboratory between March 2019 and October 2020.

RESULTS:
In this panethnic U.S. population, 8% of participants (42/515) were identified to be carriers of alpha thalassemia via genetic testing, and hemoglobin electrophoresis was abnormal for 12% (5/42) and normal for 88% (37/42). Among the 38 “silent” alpha thalassemia carriers identified via genetic testing, 13% (5/38) had an abnormal hemoglobin electrophoresis and 87% (33/38) had a normal hemoglobin electrophoresis. Among the four alpha thalassemia “trait” carriers identified via genetic testing, 0% (0/4) had an abnormal hemoglobin electrophoresis and 100% (4/4) had a normal hemoglobin electrophoresis.

CONCLUSION:
Hemoglobin electrophoresis is an older screening technology that failed to detect the majority (88%) of alpha thalassemia carriers identified by genetic testing in our study. Previous studies also found that genetic testing outperforms hemoglobin electrophoresis in alpha thalassemia carrier detection. Genetic testing should be considered as a first-line screening option for alpha thalassemia carrier detection to help providers identify more at-risk couples.
Effect of Guideline Change on Gestational Age at Delivery for Intrahepatic Cholestasis of Pregnancy [A254]
Authors: Berra Alexandra L. 
Published: June 2022

INTRODUCTION:
The optimal gestational age to deliver women with intrahepatic cholestasis of pregnancy (ICP) is unknown. Traditionally, delivery has been recommended at 37 0/7 weeks of gestation or greater when diagnosed. In 2019, the American College of Obstetricians and Gynecologists (ACOG) updated guidelines for induction to occur at 36 0/7 weeks, or at diagnosis if later. Our objective was to estimate the effect this guideline change had on the gestational age at delivery.

METHODS:
Retrospective chart review of women undergoing induction of labor for ICP one year before compared with one year after ACOG guideline change in 2019. To detect a one-week-earlier delivery (from 37 to 36 weeks of gestation), with a standard deviation of two weeks at P<.05 with a 90% power, would require 85 women in each group.

RESULTS:
During the one year prior to the guideline change, 159 women underwent an induction of labor for ICP, versus 134 in the one year post guideline change. No difference was noted in the gestational age at delivery, median 37.1 (range, 28.7–40.3) weeks versus 37.1 (range, 33.4–40.3) weeks (P=.65). No difference was noted in the gestational age at diagnosis of ICP, median 34.4 (range, 13.0–40.1) weeks versus 34.1 (range, 17.0–40.3) weeks (P=.62). Similar levels of bile acid were used at diagnosis, median 14 (range, 10–225) micromoles/L versus 15 (range, 10–264) micromoles/L (P=.36).

CONCLUSION:
Current change to ACOG guidance for delivering women with ICP has not resulted in earlier delivery.
Mode of Delivery in Patients With Fetal Central Nervous System Anomalies [A259]
Authors: Fennimore Nicole , Prewitt Kristin , Hersh Alyssa R. , Bridges Alexis , Pilliod Rachel 
Published: June 2022

INTRODUCTION:
Balancing maternal risk with fetal prognosis in counseling regarding mode of delivery can be challenging. This study investigates mode of delivery for patients with pregnancies complicated by fetal anencephaly and myelomeningocele.

METHODS:
We conducted a retrospective cohort study using National Vital Statistics Live Birth Data between 2014 and 2018. Inclusion criteria were patients without a history of cesarean delivery carrying singleton, cephalic fetuses that were at least 23 weeks of gestation. We compared mode of delivery among patients with pregnancies complicated by each central nervous system (CNS) anomaly to those without the anomaly. Chi-square and multivariable logistic regression were performed for statistical analyses using STATA version 17.

RESULTS:
A total of 15,032,798 patients met the inclusion criteria; 0.011% had fetal myelomeningocele and 0.008% had fetal anencephaly. Among women with fetal myelomeningocele, 63.1% underwent cesarean delivery compared to 17.7% for those without myelomeningocele (P<.01). In patients with fetal anencephaly, 22.0% underwent cesarean delivery compared to 17.7% for those without anencephaly (P<.01). After adjusting for confounders, the odds of cesarean delivery among patients with pregnancies complicated by myelomeningocele and anencephaly were 8.6 (95% CI, 7.7–9.5) and 0.88 (95% CI, 0.75–1.02), respectively.

CONCLUSION:
Fetal CNS anomalies are associated with higher rates of cesarean delivery. Variable prognosis exists with myelomeningocele, and additional data is needed to determine the optimal mode of delivery. Anencephaly, on the other hand, is considered a lethal diagnosis. While cesarean rates were lower in this cohort, our findings suggest that palliative birth availability and mode of delivery requires additional study for this condition.
Immediate vs Routine Postpartum Intrauterine Device Placement After Teen Pregnancy: A Cost-Effectiveness Analysis [A02]
Authors: Andrus Shelby , Frank Zoe , Willey Alicia S. , Brady R. Michael 
Published: June 2022

INTRODUCTION:
The time surrounding a teen’s first pregnancy represents an ideal period to counsel on effective contraception and prevent additional unplanned pregnancies. It has yet to be examined if post placental intrauterine device (IUD) placement is cost effective in teenage patients relative to routine placement in the office.

METHODS:
A decision analytic model was built using TreeAge software to compare outcomes and costs among teenagers receiving either post placental or routine IUD placement. Outcomes, associated health care costs, and maternal quality-adjusted life years (QALY) were compared. All probabilities, utilities, and costs were derived from the literature. Costs were in 2021 US dollars with a cost-effectiveness threshold of $100,000/QALY. Sensitivity analyses were performed to assess how variation in baseline assumptions impacted model outputs.

RESULTS:
In a theoretical cohort of 300,000 teen births, post placental IUD placement yielded 35,620 more QALYs but cost $32 million more than routine placement. Post placental placement prevented 9,740 additional unplanned births—including 1585 preterm births—and 5595 abortions. Post placental placement was no longer cost effective when the likelihood of IUD removal within the next year rose from our baseline estimate of 0.14 to 0.46 or when the rate of subsequent unplanned teen pregnancy without an IUD fell to 0.007.

CONCLUSION:
Post placental IUD placement is cost effective for teenage patients from the maternal perspective. The cost effectiveness of the strategy is contingent on the likelihood of removal within the next year and of unplanned pregnancy without an IUD in place.