bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intrahepatic Cholestasis of Pregnancy: Is Cholecystectomy a Risk Factor? [A168]
Authors: Collins Ana M. , Davidov Adi , Fruhman Gary 
Published: June 2022

INTRODUCTION:
To evaluate the incidence of intrahepatic cholestasis of pregnancy (ICP) and determine if cholecystectomy is a risk factor for ICP.

METHODS:
We conducted a retrospective cohort study of women who delivered at SIUH from January 1, 2018, to December 31, 2020. During this timeframe, there were 8,025 deliveries. Exclusion criteria included intrauterine fetal demise (IUFD) and gestational age at delivery <24 weeks, maternal age <18 years, multiple gestations, and missing variables. After exclusion criteria, 7,146 deliveries were included in this study. We conducted analyses using Chi-square and t-tests, where P<.05 was considered statistically significant. The study was institutional review board‒approved.

RESULTS:
The overall incidence of ICP was 0.39%, which is consistent with the current estimated incidence in the U.S. The incidence of ICP in patients who had a prior cholecystectomy was 10.7%, compared with 0.17% in patients with no history of cholecystectomy (P<.001). The relative risk of developing ICP in patients with a prior cholecystectomy compared to those without cholecystectomy was 62.2 with a 95% CI of 29.9‒129.1 (P<.001). Patients with a prior cholecystectomy had higher bile acids and liver enzymes; however, only the difference in bile acids was statistically significant.

CONCLUSION:
There was an increased incidence and relative risk of developing ICP in patients with a prior cholecystectomy. As ICP can be associated with an increased risk of morbidity and stillbirth, providers should consider utilizing a lower threshold to screen for ICP in patients who have had a cholecystectomy. However, further studies are necessary to confirm these findings.
Factors Affecting Diagnostic Accuracy of Spot Protein/Creatinine Ratio for Evaluation of Proteinuria in Pregnancy [A171]
Authors: Khan Sameer A. , Burdeaux Shayna , Gurram Padmalatha , Polavarapu Satya , Sampino Anthony 
Published: June 2022

INTRODUCTION:
Spot urinary protein/creatinine ratio (SPCR) has been shown to be a reliable alternative to 24-hour urine protein collection (24hrUP). Several factors can affect urine protein excretion. We aimed to study factors affecting diagnostic accuracy of SPCR in evaluating proteinuria.

METHODS:
Retrospective study of women who had 24hrUP and SPCR from July 2019 to May 2021. Correlation between SPCR and 24hrUP, clinical characteristics, inpatient versus outpatient collection, time of day were studied to determine any impact on accuracy of SPCR. Institutional review board‒approval was obtained.

RESULTS:
A total of 121 patients were included. Correlation between SPCR and 24hrUP was high (r=0.80). When stratified based on SPCR of >0.3 versus <0.3, 24hrUP and SPCR values were in agreement in 92 patients and non-agreement in 29 patients. Of those 29, 19 patients had elevated 24hrUP and normal SPCR and 10 patients had elevated SPCR and normal 24hrUP. The optimal cutoff appears to be SPCR of 0.3, with a sensitivity of 72% and specificity of 82%. Maternal age <35 years and inpatient collection tend to have higher false positive rates (P>.05). Tests performed from 6 p.m. to 11.59 p.m. had the highest false negative rates (FNR, P=.09). Patients with antepartum complications tended to have higher FNR (P≥0.05).

CONCLUSION:
This study suggests that when SPCR is >0.3, 24hrUP is not needed, but when SPCR is <0.3, 24hrUP is warranted. In women with antepartum complications, a lower cutoff might improve the correlation; further studies are required.
Recent Trends in NICU Admission Among Women With Gestational Diabetes by Race and Ethnicity [A172]
Authors: Mester Nonda , Pawar Deepraj , Hersh Alyssa R. , Boniface Emily , Valent Amy 
Published: June 2022

INTRODUCTION:
To determine if NICU admission rates are increasing among neonates born to women with gestational diabetes and if there are disparities by race and ethnicity.

METHODS:
This was a retrospective cohort study of deliveries between 2014 and 2018 in the United States. Inclusion criteria were non-anomalous, singleton deliveries with gestational age ≥20 weeks and gestational diabetes. Analyses were stratified by maternal race/ethnicity, including the following categories: non-Hispanic (NH) White, NH Black, NH American Indian or Alaska Native (AI/AN), NH Asian or Native Hawaiian and Pacific Islander (NHOPI), NH multiracial and Hispanic. The confounders assessed included age, parity, cigarette use, educational attainment, gestational age at delivery, birth weight, and insurance type. We used multivariable logistic regression and calculated predicted probabilities (PP) to estimate the adjusted proportion of deliveries resulting in NICU admission. All analyses were conducted using STATA 17.

RESULTS:
There were 1,104,082 deliveries included in this analysis. The predicted probability of NICU admission was higher in 2018 than in 2014 for NH White, NH Black, and Hispanic women, but the results were not statistically significant. The predicted probability was lower in 2018 than in 2014 for NH AI/AN, NH Asian/NHOPI, and NH multiracial women, but the results were not statistically significant. The predicted probability of NICU admission was highest among women who were NH Black at 12.42%, and lowest among women who were NH AI/AN at 9.7%.

CONCLUSION:
NICU admissions may be increasing among some neonates of pregnant women with gestational diabetes, and there are disparities in admission rates when accounting for race and ethnicity.
Genetic Predictors of Ondansetron Effectiveness and Recurrence Risk for Hyperemesis Gravidarum [A177]
Authors: Jin Emmy , Quan Courtney , Plummer Danielle R. , MacGibbon Kimber , Mullin Patrick , Fejzo Marlena 
Published: June 2022

INTRODUCTION:
Most women experience nausea and vomiting of pregnancy, and 18% require medication. The most severe form, hyperemesis gravidarum (HG), is associated with weight loss, undernutrition, and adverse maternal and child outcomes. Antiemetic effectiveness and recurrence risk are major concerns. This study aimed to investigate the association of selected germline polymorphisms with 1) ondansetron response and 2) recurrence risk in HG patients.

METHODS:
HG patients provided DNA samples and reported treatments and effectiveness. Polymorphisms in pharmacogenetic modifiers of ondansetron (ABCB1, CYP2D6, HTR3C, HTR3B) and published HG risk locus PGR_TRPC6 were analyzed for association with ondansetron effectiveness and recurrence risk, respectively. Institutional review board approval was obtained.

RESULTS:
Of 426 HG patients, 58% (249) reported that ondansetron, used off-label, was effective and were significantly less likely to require enteral nutrition (P=.0009). No associations were found between the ABCB1, CYP2D6, HTR3C, and HTR3B variants tested and self-reported effectiveness of ondansetron. Of 151 participants with two pregnancies, 83% (125) had a recurrence of HG, and rs59743346 in TRPC6 was a significant predictor (OR, 9.1; 95% CI, 2.3–35.0; P=.001). Homozygosity for the minor allele was identified in only 3% of recurrences, compared to 23% of cases that did not recur.

CONCLUSION:
The strong association between those reporting ondansetron ineffectiveness and their treatment with enteral nutrition validates self-reporting of effectiveness. However, the variants tested did not predict ondansetron effectiveness. Our study found that rs59743346, in addition to previously identified GDF15 polymorphism rs16982345, may be useful in predicting recurrence risk. This work has implications for elucidating the biology of HG, counseling, diagnosis, and treatment.
Obstetrician Communication After Neonatal Hypoxic Ischemic Encephalopathy [A178]
Authors: Park Isabella S. , Frenn Recia 
Published: June 2022

INTRODUCTION:
Our research investigates parent perception of communication between obstetricians and parents of newborns who have experienced hypoxic ischemic encephalopathy (HIE).

METHODS:
After institutional review board approval, an anonymous 7-item survey was shared with parents belonging to the Hope for HIE parent support group. After brief demographics, parents provided open-ended answers that described what went well, what did not go well, and what suggestions they had for improved communication with their obstetric care professional. A thematic analysis was then performed.

RESULTS:
A total of 111 respondents completed the survey and 102 reported their child being diagnosed with HIE (91.89%). Respondents represented all parts of the U.S., with the majority of survey respondents coming from the South (32.4%). The majority of respondents gave birth 1–5 years ago (45.9%), followed by <5 years ago (26.1%), then <6 months ago (17.2%), with the fewest delivering 6–12 months ago (9.5%). The themes identified of what went well included: (1) being comforting, being honest and upfront, (2) having a debrief, and (3) having frequent check-ins. Themes that covered communication that did not go well included: (1) not enough follow-up, (2) inadequate debrief/lack of explanation, and (3) being defensive. Lastly, themes suggested to improve communication included: (1) debriefing, 2) providing resources, (3) provider education on trauma-informed care, (4) empathy/compassion, and (5) long-term follow-up.

CONCLUSION:
The themes identified offer the groundwork to create a formative guide, which could include a robust debrief and education on trauma-informed care, to help improve communication between obstetricians and parents after neonatal HIE.
Motivations for Recovery Among Pregnant Individuals With Opioid Use Disorder [A184]
Authors: Hafen Kody L. , Smid Marcela , Garets Mitchell , Machado Annika , White Ashley H. , Cochran Gerald 
Published: June 2022

INTRODUCTION:
Little is understood about pregnant individuals’ motivation to engage in opioid use disorder (OUD) treatment. Our objective was to explore motivations for treatment engagement among pregnant individuals with OUD enrolled in a patient navigator, comparative study (NCT03833245).

METHODS:
We performed a qualitative analysis of 16 baseline psychosocial treatment sessions with pregnant individuals with OUD, randomly selected from 103 total sessions. We used a two-cycle coding method: in cycle 1, themes and sub-themes related to treatment motivations were established, and in cycle 2, two researchers analyzed sessions using a coding schema. Inter-rater statistics (kappa [k] and rater percent agreement [A]), the proportion of sessions (S) that a sub-theme was mentioned, and total references (n) were calculated.

RESULTS:
Participants identified maximizing fetal/neonatal wellbeing, establishing independence, and improving emotional wellbeing as important motivating factors for OUD treatment engagement. Maximizing fetal/neonatal wellbeing was a strong motivator, specifically fetal health (S=63%, n=25, k=0.65, A=98.5%), stability for children (S=50%, n=22, k=0.73, A=98.4%) and maintaining custody (S=44%, n=20, k=0.86, A=98.7%). Establishing independence was an important motivator, specifically financial independence (S=56%, n=19, k=0.50, A=98.4%), freedom from opioid dependence (S=50%, n=10, k=0.51, A=98.7%), recognizing internal drive (S=50%, n=9, k=0.47, A=98.37%), and not burdening others (S=19%, n=7, k=0.83, A=99.22%). Finally, improving emotional wellbeing was significant, specifically processing emotions (S=63%, n=14, k=0.33, A=98.15%), improving hope (S=25%, n=11, k=0.76, A=98.7%), and being more genuine (S=13%, n=2, k=0.87, A=99.9%).

CONCLUSION:
Pregnant individuals with OUD are motivated by fetal/neonatal wellbeing, independence, and emotional wellbeing. To promote engagement, interventions should be tailored to align with maternal motivators.
MHPAEA/ACA Policy Implementation and Severe Maternal Morbidity Among Commercially Insured Individuals, 2008–2019 [A192]
Authors: Admon Lindsay , Dalton Vanessa , Kolenic Giselle , Tilea Anca , Hall Stephanie V. , Zivin Kara 
Published: June 2022

INTRODUCTION:
We aimed to identify rates and trends in severe maternal morbidity (SMM) in relationship to implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA) and Affordable Care Act (ACA).

METHODS:
We conducted a serial, cross-sectional analysis among individuals with continuous commercial coverage in the year preceding and following an inpatient livebirth using data from Optum Cliniformatics Data Mart. We identified hospital deliveries and cases of SMM using standard methods. We excluded cases of SMM in which blood transfusion represented the only indicator of SMM. We evaluated rates and trends in SMM in both the implementation (2008–2014) and post-implementation (2015–2019) periods using an interrupted time-series model fit with generalized estimating equations for the overall population and compared those with and without perinatal mood and anxiety disorders (PMAD). The University of Michigan Institutional Review Board deemed this study exempt from review.

RESULTS:
The sample included 681,616 births. SMM decreased by 53.2% from 195.8 (95% CI, 188.1–203.3) to 91.6 (95% CI, 85.7–97.6) per 10,000 hospitalizations for birth between 2008 and 2019. We identified decreasing SMM rates in both periods, with a larger decrease in the post-implementation period (implementation marginal effects [ME], −0.0012; post-implementation ME, −0.0015; P<.001). We observed decreasing SMM rates in both periods for those with and without PMAD, with the steepest decline among those with PMAD in the post-implementation period.

CONCLUSION:
These data suggest that implementation of the MHPAEA and ACA may have had a role in decreasing rates of SMM among childbearing individuals with commercial insurance.
Maternal Outcomes Based on Inpatient Length of Stay After Cesarean Delivery Using the NSQIP Database [A193]
Authors: Shrestha Kevin S. , Knupp Rubymel J. , Martin Kimberly D. , Battarbee Ashley N. , Subramaniam Akila 
Published: June 2022

INTRODUCTION:
Cesarean deliveries (CD) are common surgeries performed in the U.S., yet a patient’s postpartum length of stay (LOS) is not standardized and is influenced by multiple factors. We sought to examine whether postpartum maternal outcomes differ based on post-cesarean LOS.

METHODS:
Retrospective cohort study of all CDs from 2019 in the National Surgical Quality Improvement Program database. Patients with a LOS >4 days postpartum were excluded. Patients were categorized based on postpartum LOS: 0–2, 3, and 4 days. Our primary outcome was a composite of maternal complications including hospital readmission, reoperation, and death, up to 30 days postpartum. Outcomes were compared between the LOS exposure groups and adjusted odds ratios calculated using 4 days as the reference.

RESULTS:
Of 9,959 patients, 6,288 (63%) had a LOS of 0–2 days, 2,901 (29%) 3 days, and 770 (8%) 4 days. At baseline, the LOS groups differed in terms of maternal age, race, tobacco use, diabetes, hypertension, and type of surgical case. Compared to a 4-day LOS, patients with LOS 0–2 days had significantly decreased odds of composite maternal complications (aOR, 0.5; 95% CI, 0.3–0.7), as well as readmissions (aOR, 0.6; 95% CI, 0.4–0.9) and reoperations (aOR, 0.3; 95% CI, 0.2–0.5). Patients with a 3-day LOS (versus 4 days) only had reduced reoperations (aOR, 0.5; 95% CI, 0.2–0.9).

CONCLUSION:
Discharge earlier than 4 days postpartum did not show an increased risk of maternal complications, readmissions, or reoperations. The selection of low-risk patients for early discharge does not appear to be harmful, and policies requiring prolonged hospitalization for all patients are likely unnecessary.
Health Care Utilization Patterns in Adolescent Pregnant Women: A Retrospective Analysis [A205]
Authors: Davitt Katlin , Gurram Padmalatha , White Samantha , Staudenmaier Emily , Denisova Elizabeth , Abruzzese Jessica 
Published: June 2022

INTRODUCTION:
Adolescent mothers are at increased risk for adverse outcomes. Utilization of perinatal health care services across the continuum of care, antepartum, intrapartum, and postpartum is crucial to improve outcomes. We aimed to study utilization of perinatal health care services, including outpatient and inpatient resources by adolescent mothers.

METHODS:
Retrospective review of women who received prenatal care and delivered between February 2019 and February 2020. Subjects were divided into three cohorts based on age: adolescent (13–21), non-adolescent (22–34), and advanced maternal age (≥35, AMA). The adequacy of prenatal care was determined by Kessner index: Adequate (begins in first trimester or includes 9+ visits), Intermediate (begins in second trimester or includes 5–8 visits), and Inadequate (begins in third trimester or includes ≤4 visits). Utilization of inpatient services was determined by access ratio, calculated as inpatient services (emergency department + labor & delivery triages + antepartum admissions + postpartum ED visits) / ambulatory services (prenatal + postpartum + ultrasound visits). Institutional review board approval was obtained.

RESULTS:
A total of 79 adolescents, 203 non-adolescents, and 59 AMA were studied. Mean gestational age at initial care visit was 15 weeks in adolescents. Compared to other cohorts, adolescents had fewer prenatal, ultrasound, and postpartum visits (P<.05). Adolescents were more likely to have intermediate (44.6%) and inadequate (18.9%) prenatal care (P=.04). Adolescents also had higher antepartum admissions (P=.006) and a higher access ratio (P=.01). Outcomes were similar except for higher rates of preterm contractions (P=.03).

CONCLUSION:
The pattern of resource utilization demonstrates an overall favoring of inpatient services among adolescent mothers with inadequate access to outpatient resources. Strategies to improve access to prenatal outpatient visits are essential.
Time from Insertion to Expulsion of Cervical Ripening Balloon in Preterm Versus Term Inductions of Labor [A206]
Authors: Roth Lindsey A. , Kreiger-Benson Elana , Friedman Steven , Gossett Dana R. , Shanahan Lisa 
Published: June 2022

INTRODUCTION:
Preterm induction of labor can be necessary for maternal and fetal wellbeing. Duration of cervical ripening balloon (CRB) use has been studied only in term inductions. Our study investigated duration of time for CRB expulsion and vaginal delivery in preterm inductions of labor.

METHODS:
This was a single-institution retrospective cohort study of preterm (<37 weeks) and term (≥37 weeks) inductions with CRB between 2010 and 2021. Cesarean deliveries were excluded. Primary outcome was insertion to expulsion time (IET) of CRB. Secondary outcomes included induction to delivery time (IDT), cervical dilation after expulsion, and misoprostol and Pitocin use. Institutional review board approval was obtained prior to the study.

RESULTS:
A total of 98 patients with vaginal delivery after preterm CRB use were identified and matched 1:1 on baseline characteristics to patients with vaginal delivery after term CRB use. Mean IET was significantly shorter for term CRB than for preterm induction (mean 7.2±3.09 hours versus 8.5±3.38 hours; P=.004). Mean IDT was significantly shorter for term CRB than preterm CRB induction (18.4±7.6 hours versus 22.5±9.01 hours; P<.001). Increased use of misoprostol, Pitocin, and second CRB were noted among the preterm cohort compared to the term cohort. Among term patients, more CRB placement at start of induction and greater cervical dilation post-balloon were found in comparison to preterm patients.

CONCLUSION:
Among patients undergoing preterm induction, longer IET, longer IDT, and increased interventions should be expected. Different standards for labor management should be considered for achieving vaginal delivery in preterm inductions.
May-Thurner Syndrome in Pregnancy: A Case Report [A209]
Authors: Ajibade Olufemi , Malhotra Radhika , Tyler Lamarr , Kjos Siri L. , Howard David L. 
Published: June 2022

CASE:
A 31-year-old gravida 1, para 0 at 28.6 weeks of gestation presented to the emergency room with a 2-month history of progressive lower left leg swelling since 21.2 weeks of gestation. The patient denied pain, loss of sensation, shortness of breath, and dyspnea on exertion. She had a history of domestic violence at 17 weeks. A physical exam of her lower extremities revealed 3+ pitting edema in the left lower extremity from ankle to groin. The left thigh measured 26 inches and the left calf measured 19 inches. No edema was noted on the right lower extremity. Venous Doppler ultrasounds of bilateral lower extremities yielded negative results for deep vein thrombosis (DVT) on three occasions. Magnetic resonance angiography of the pelvis without contrast revealed no evidence for DVT of the left pelvic veins and no evidence of pelvic mass compression. The overall finding was severe compression of the upper left common iliac vein and lower inferior vena cava by gravid uterus. Clinical suspicion became high for May-Thurner Syndrome (MTS). Few cases of MTS have been identified in pregnancy, and none of these cases present without DVT as a presenting symptom. MTS is extrinsic venous compression caused by the arterial system against bony structures in the ilio-caval territory, leading to formation of venous spurs. Symptomatic patients typically have left lower extremity swelling that often involves the entire limb. Risk factors associated with MTS include female sex, scoliosis, hypercoagulable disorders, and dehydration. There is more research to be done to elicit causes and improve diagnosis of MTS.
Qualitative Evaluations of Obstetric Transport Experiences During the COVID-19 Pandemic [A211]
Authors: Hu Connie , Hong Emily , Espino Luis , Garcia Eliana , Banwarth-Kuhn Brenna , Quiner Trevor 
Published: June 2022

INTRODUCTION:
The COVID-19 pandemic drastically affected the emergency obstetric transport experience on a multidimensional level. The objective of this study is to understand how the pandemic has affected the physical and emotional health of these patients prior to, during, and after their transport to the University of New Mexico Hospital (UNMH).

METHODS:
Participants transported for emergency obstetric indications were recruited at UNMH. Patient informed consent, demographic questionnaires, interviews, and surveys were obtained and graded on a 5-point Likert scale. These were delivered in person, via telephone, or via Zoom software and securely recorded. English interviews were transcribed via Otter.ai, and interviews conducted in Spanish were manually translated. Institutional review board approval was obtained.

RESULTS:
Preliminary results consisted of 10 participants. A majority (90%) felt that they had a good experience with the transport service and 70% of the individuals felt that proper protocols were put in place to protect them from a COVID-19 exposure. However, 40% of respondents had concerns about their safety during the transport process and 50% had concerns about their baby’s safety. Additionally, 60% of participants felt that COVID-19 overall had a negative effect on their transport experience.

CONCLUSION:
A significant portion of participants felt that the COVID-19 pandemic had a negative effect on their obstetric transport experience. Understanding the needs of these patients during the COVID-19 pandemic is important given the safety-restrictions that have been in place. This highlights the need for studies identifying barriers for patients during the transport process to improve the patient experience.