bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perceived Maternal Discrimination and Adverse Perinatal Outcomes Among Black Women [A136]
Authors: Adeyeye Adeola , Ard Quantrilla , Da Cunha Godoy Lucas , Shields Andrea , Campbell Winston , Cooper Shontreal 
Published: June 2022

INTRODUCTION:
The purpose of this study is to determine if perceived maternal discrimination among Black women with varying levels of education impacts adverse perinatal outcomes such as preterm delivery and low birth weight.

METHODS:
We surveyed a cohort of 400 Black women between January and April 2019 who delivered an infant in the United States within the last 5 years after institutional review board approval. Participants were recruited through advertisements on social media. Inclusion criteria were participants who self-identified as a Black female, 18 years or older, and fluent in English. The validated Jackson, Hogue, Phillips Contextualized Stress Measure Survey was used. Scores were obtained from the sum of the responses. Scores were divided into tertiles to denote low, moderate, and high stress levels. Data was analyzed using Fisher’s exact test and pairwise comparison if the Fisher’s test was statistically significant. A P value <0.05 was considered statistically significant.

RESULTS:
From the 400 Black women surveyed, 107 completed surveys were returned and analyzed. The mean age of the respondents was 38 (26–49). The majority of respondents had either a college (42.9%) or professional degree (48.5%). Approximately 58% reported household incomes greater than $90,000. Of women with moderate to high levels of perceived racism, 13.51% and 15.79% had a preterm delivery, P=.02.

CONCLUSION:
Perceived racism and indicators of general stress were associated with preterm delivery and low birth weight. These findings provide further evidence that psychosocial factors may play an important role in birth outcome disparities among Black women.
The Association of Endometriosis and Placenta Previa During Pregnancy [A137]
Authors: Lee Misooja , Shibata Michiko , Matsuzaki Shinya , Matsuzaki Satoko , Sakaguchi Hitomi , Hisa Tsuyoshi , Kamiura Shoji 
Published: June 2022

INTRODUCTION:
Endometriosis is a common gynecological disease characterized by chronic inflammation, with an estimated prevalence of approximately 5% to 15%. The prevalence of endometriosis has been increasing in reproductive-aged women, but recent developments in assisted reproductive technologies have improved pregnancy rates among women with endometriosis.

METHODS:
This study aimed to assess the relationship between placenta previa and endometriosis. In compliance with the Preferred Reporting Items for Systematic Reviews guidelines, a systematic review of the literature was conducted through June 30, 2021, using PubMed, Scopus, and the Cochrane Library.

RESULTS:
Twenty-three studies in which 99,773 pregnancies with endometriosis and 7,184,426 pregnancies without endometriosis were systematically reviewed. Using an adjusted-pooled random effects analysis, we found that endometriosis was associated with an increased incidence of placenta previa (adjusted odds ratio [aOR], 3.17; 95% CI, 2.58–3.89) compared to those without endometriosis. We also performed an unadjusted analysis using a fixed effects model and found that severe endometriosis was associated with an increased prevalence of placenta previa (OR, 11.86; 95% CI, 4.32–32.57), whereas non-severe endometriosis was not (OR, 2.16; 95% CI, 0.95–4.89). Notably, one study showed that placenta previa with endometriosis was associated with increased intraoperative bleeding (1,515 mL versus 870 mL, P<.01) compared to those without endometriosis.

CONCLUSION:
There is a strong association between endometriosis and an increased rate of placenta previa, and endometriosis may be associated with adverse surgical outcomes during cesarean delivery. Therefore, the development of novel therapeutic agents or methods are warranted to prevent placenta previa in women with endometriosis.
Perinatal Outcomes of High-Risk Patients Delivered by Resident Versus Private Practice Physicians [A138]
Authors: Gould Alexander J. , Recabo Olivia , Has Phinnara , Ayala Nina , Savitz David A. , Lewkowitz Adam K. 
Published: June 2022

INTRODUCTION:
This study compared perinatal outcomes of deliveries performed by resident and private practice physicians.

METHODS:
This is a secondary analysis of a large institutional review board‒approved, National Institutes of Health–funded retrospective cohort study of pregnant patients with chronic hypertension, diabetes, and/or fetal growth restriction who delivered singletons at a tertiary-care maternity hospital from January 2002 to March 2013. Maternal and neonatal outcomes of deliveries by resident physicians were compared to those of private practice physicians. The primary outcome was mode of delivery.

RESULTS:
The cohort included 9,744 deliveries: 1,928 resident and 7,816 private. Compared to private patients, resident patients were younger; more likely to be non-White, multiparous, or cigarette-smoking; and more likely to have public or no insurance, low BMI, or chronic hypertension. Private practice patients were more likely to have fetal macrosomia and diabetes. After adjusting for these factors, resident patients had 18% lower risk of cesarean delivery (CD) overall (aRR, 0.82; 95% CI, 0.76–0.88), driven by a 45% reduction in elective CD (aRR, 0.55; 95% CI, 0.43–0.70). Resident patients also had lower rates of episiotomy (aRR, 0.71; 95% CI, 0.58–0.88), but higher rates of endometritis (aRR, 1.93; 95% CI, 1.49–2.49) and NICU admission (aRR, 1.19; 95% CI, 1.04–1.36).

CONCLUSION:
In this cohort of high-risk pregnant patients, delivery by resident physicians was associated with a reduction in CD, particularly elective CD, and episiotomy. A focus on understanding the choice of private practice patients to undergo elective cesarean delivery and their providers to perform elective cesarean delivery may help reduce preventable morbidity.
Initial Clinical Experience With Brexanolone for Postpartum Depression: Why Aren’t More Patients Using It? [A140]
Authors: Silver David F. , Sholley Kristy , Silver Nazanin E. , Getz Virginia L. 
Published: June 2022

INTRODUCTION:
Postpartum depression (PPD) occurs after 15% of live births. Brexanolone (BRX, Zulresso) demonstrated 60–70% rapid and durable response rates in randomized clinical trials (RCT) with 5% risk of excessive sedation or altered consciousness (LOC). We examined the outcomes of our first 20 patients treated with BRX for moderate-to-severe PPD.

METHODS:
PPD diagnosis and severity were based on 90-minute psychiatric evaluations (PE) and Hamilton Depression scores (HAM-D) greater than 20. Depressive episodes started in the third trimester or within 4 weeks postpartum (PP). Patients were consented and enrolled in the FDA Risk Evaluation Mitigation Strategy (REMS) and treated/monitored per REMS protocol. Edinburgh Postpartum Depression Scales (EPDS) and PE were obtained pre-infusion and daily until discharge. Follow-up included 2-week, 4-week, and 3-month post-treatment PE. EPDS, PE, and side effects were prospectively recorded.

RESULTS:
BRX was offered to 78 patients and provided to 20 (26%) patients from September 2019 through September 2021. All 20 remained on stable doses of pretreatment SSRI or SNRI. All 20 completed BRX without interruption or dose reduction. No patients had sedation or LOC. Overall response rate was 85% (17/20). Twelve of 17 patients responded by Day 3. The remaining five responded by Day 10. Sixteen of 17 responses were durable for 3 months of follow-up. One patient relapsed between 3 and 4 weeks post-treatment. She was subsequently diagnosed with bipolar 1 disorder requiring lithium. Of three nonresponders, two had migraines during treatment and one had preexisting untreated OCD. Eleven of 20 patients breastfed during treatment.

CONCLUSION:
Of 20 patients, 60% responded to BRX on Day 3, consistent with RCTs. A further 25% responded between Days 3 and 10 (total response=85%).
Accuracy of Blood Loss Assessments During Cesarean Deliveries [A144]
Authors: Zermeno Yuri , Kram Jessica J. , Dickson Elizabeth , Salvo Nicole 
Published: June 2022

INTRODUCTION:
Traditionally, during deliveries blood loss was estimated visually (Estimated Blood Loss; EBL). More recently, Quantitative Blood Loss (QBL) has been implemented to increase blood loss assessment accuracy. Our quality improvement study aimed to identify if QBL is superior to EBL in quantifying blood loss in comparison to Calculated Blood Loss (CBL).

METHODS:
We retrospectively reviewed all women with a cesarean delivery in one urban hospital between December 1, 2018, and December 1, 2019, who had EBL and QBL recorded. CBL, our gold standard for identifying postpartum hemorrhage, was calculated using maternal height, weight, pre- and post-delivery hematocrit. Hemorrhage was defined as blood loss ≥1,000 mL. Basic descriptive and inferential statistics were conducted.

RESULTS:
Overall, 486 patients had EBL, QBL, and CBL values. The median values for EBL (600.0; IQR, 500.0–800.0) and QBL (547.5; IQR, 347.0–808.0), were significantly lower (both P<.001) than CBL (896.2; IQR, 512.4–1,323.4). When compared to CBL, EBL had low sensitivity (12.0%; 95% CI, 7.7–16.3%) and high specificity (89.7%; 95% CI, 78.6–100.0%). QBL also demonstrated low sensitivity (22.6%; 95% CI, 17.0–28.1%) and high specificity (94.4%; 95% CI, 91.7–97.2%). The negative predictive value for EBL (58.2%; 95% CI, 53.7–62.7%) and QBL (60.2%; 95% CI, 55.5–64.9%) was low. The positive predictive value for EBL (89.7%; 95% CI, 78.6–100.0%) was greater than QBL (76.6%; 95% CI, 66.2–87.0%). Ultimately, only six additional hemorrhages were detected by QBL (35 versus 29 for EBL); on the other hand, CBL detected 153.

CONCLUSION:
Given the time and resources necessary to calculate QBL, this study questions its utilization and/or superiority to EBL in the detection of postpartum hemorrhage.
Implementation of Nursing Protocol to Decrease Admission-to-Induction Timeline [A154]
Authors: Livergood M Christine , Kessel Johanna , Uner Ismet Joan , Ford Jordanne , Tsaih Shirng-Wern , Peterson Erika 
Published: June 2022

INTRODUCTION:
A quality initiative of nurse training in ultrasound and vaginal misoprostol placement was performed. The study objective was to determine if that initiative decreased admission to induction times for term inductions of labor.

METHODS:
Retrospective pre-intervention data was collected for 6 months. Following the intervention, there was a wash-out period and then 6 months of data was collected. Inclusion criteria were planned term inductions of labor. Clinical characteristics were collected. Univariable and graphical analyses were performed.

RESULTS:
A total of 368 pre-intervention and 430 post-intervention inductions were analyzed. The inductions did not differ in multiparity, gestational age, starting cervical dilation, induction medication, or cesarean delivery rate. The average time from admission to administration of induction medication did not differ from pre-intervention to post-intervention (90.8 min versus 87.3 min, P=.37). The post-intervention group had a nearly significant decreased time to delivery compared to pre-intervention (21.5 hours versus 22.7 hours, P=.07). The post-intervention group had fewer inductions that took>60 mins to start (67.2% versus 73.9%, P=.04). On graphical analysis, there appeared to be a trend toward decreased time from admission to induction as the months progressed after the intervention.

CONCLUSION:
While the intervention did not decrease the time from admission to induction, there was a trend toward decreasing times. There was a decrease in number of inductions that took greater than 60 minutes to begin. We believe the intervention to be a viable quality initiative; however, further work needs to be done on optimizing induction and admission processes.
The Effect of Co-Existing Maternal Obesity and Chronic Hypertension on Neonatal Birth Weight [A156]
Authors: Pinkerton Elizabeth , Siff Lauren 
Published: June 2022

INTRODUCTION:
While the individual effects of maternal obesity and chronic hypertension on neonatal birth weight are well known, there is little data when these factors are co-existing. The goal of this study was to investigate the effect of these co-existing factors on neonatal birth weight.

METHODS:
This retrospective cohort study utilized the 2018 Natality Database from the Centers for Disease Control and Prevention. Institutional review board approval was obtained. Live birth records at 37, 38, and 39 weeks with recorded birth weight and maternal BMI greater than 18.4 were isolated. Exclusion criteria included maternal pregestational or gestational diabetes, gestational hypertension, preeclampsia, eclampsia, maternal tobacco use, multi-gestational pregnancies, suspected or confirmed chromosome disorder, or fetal anomaly.

RESULTS:
Univariate analysis of the primary objective revealed that neonates born from mothers with obesity and chronic hypertension weighed more than mothers without by 17 g, 28 g, and 18 g at 37, 38, and 39 weeks respectively. The secondary objective compared birth weights at varying obesity levels. At the same maternal BMI, neonates born from mothers with hypertension weighed less than those without. Compared to normotensive, normal-BMI mothers, neonates born from mothers with hypertension weighed less when maternal BMI was less than 30; weighed most similar at BMI 30–34.9; and weighed more as BMI increased over 35.

CONCLUSION:
While statistically significant differences in birth weight were noted between neonates from normotensive, normal-BMI mothers and those with chronic hypertension and obesity, these differences of less than 50 g are unlikely to be clinically significant. The opposing weight effects of obesity and hypertension balanced at BMI 30–34.9. Neonatal outcomes from mothers with co-existing risk factors should be investigated.
Effect of Postoperative Intravenous Ketorolac Administration on Postoperative Urine Output After Cesarean Delivery [A169]
Authors: Collins Ana M. , Moncada Kea , Ali Munira , Spierer Gary , LaPorta Christopher , Fruhman Gary 
Published: June 2022

INTRODUCTION:
To determine if intravenous ketorolac administration has an effect on the postoperative urine output after cesarean delivery.

METHODS:
We conducted a retrospective cohort study of women who delivered at Staten Island University Hospital from January 1 to June 30, 2021. During this timeframe, there were 236 cesarean deliveries. Exclusion criteria included intrauterine fetal demise (IUFD) and gestational age at delivery. Operative records and PACU records were utilized to determine intraoperative urine output, intraoperative estimated blood loss (EBL), intraoperative intravenous fluid (IVF) administration, postoperative urine output, and whether or not ketorolac was administered (dependent on surgeon preference). All patients received IVF postoperatively at 125 mL/hour. Urine output was measured for the first three hours postoperatively and was considered adequate if >0.5 mL/kg/hour. We conducted analyses using multiple linear regressions and chi-square tests, where P<.05 was considered statistically significant. The study was institutional review board‒-approved.

RESULTS:
After controlling for potential cofounders (operative EBL, amount of Pitocin, and intraoperative IVF), a linear regression showed the effect of IV ketorolac was significant (P<.001), with a mean decreased postoperative urine output of 53 mL/hour compared to patients who did not receive ketorolac.

CONCLUSION:
As postoperative ketorolac administration after cesarean delivery is associated with clinically significant decreased urine output and is contraindicated in patients who are at high risk of bleeding, alternative modalities for postoperative pain management should be considered.
Periviable Delivery Management and Outcomes in a Largely Native Hawaiian, Pacific Islander, and Asian Population [A170]
Authors: Maykin Melanie , Mercer Elizabeth , George Kandie , Yamasato Kelly 
Published: June 2022

INTRODUCTION:
Racial disparities among Native Hawaiian, Pacific Islanders, and select Asian subgroups have been reported in obstetric outcomes. We describe periviable delivery management and outcomes by maternal race at the highest-volume labor and delivery unit in Hawai‘i.

METHODS:
This was a retrospective cohort study of births from 2017 to 2019 between 22 and 24 weeks of gestation at our institution. Maternal and neonatal outcomes were stratified by self-reported race and analyzed with Fisher’s exact tests. A P value <.05 was considered significant.

RESULTS:
A total of 74 neonates were born of 63 gravidas (53 singleton, nine twins, one triplets). Of these, 13 were born at 22 weeks, 22 at 23 weeks, and 32 at 24 weeks. In all, 65 neonates received some form of resuscitation. Native Hawaiians comprised 38% of periviable births, followed by Asians (19%) and White individuals (15%). The racial composition of periviable deliveries was similar to that of the overall State of Hawai‘i live birth rate. Among maternal outcomes, the cesarean delivery rate was 54%, of which 90% were classical hysterotomies. Neonatal survival among those who received resuscitation was 14% at 22 weeks, 41% at 23 weeks, and 63% at 24 weeks. Survival at 22 and 23 weeks did not vary by race, but at 24 weeks this trended toward significance (P=.056).

CONCLUSION:
Survival rates between 22 and 24 weeks of gestation at our institution were comparable to other published cohorts, without obvious racial disparities. Neonatal resuscitation and cesarean delivery were common among all racial groups. These data provide background for future studies examining periviable outcomes in this uniquely diverse and understudied population.
The Cost of Loss: A Secret-Shopper Survey of Mortuary Disposition of Fetal Remains [A182]
Authors: Burns Roshan , Henkel Andrea , Cahill Erica 
Published: June 2022

INTRODUCTION:
While only a minority of patients facing a pregnancy termination or loss seek burial or cremation of fetal remains, there is little information or awareness around the cost of these services. With an increasing number of states introducing mandatory fetal cremation/burial laws, we investigated the availability and cost of these services.

METHODS:
This was a cross-sectional “secret shopper” telephone survey of all mortuaries in five Northern California counties identified by the California Cemetery and Funeral Bureau. Two “secret shoppers” presented as clinicians assessing the availability and cost of cremating and/or burying fetal remains for loss in the second trimester.

RESULTS:
Of the 60 funeral homes contacted, 21% did not accept fetal remains. No mortuaries that accepted fetal remains had policies excluding remains from abortion procedures. The total cost of cremation ranged from USD $0 to $1,800, with a mean of $596.98. This was significantly less than the cost of burial services, mean $853.67 (P=.01), which were also often accompanied by additional cemetery fees and plot expenses up to $3,000.

CONCLUSION:
Private disposition of fetal remains after an abortion or pregnancy loss is expensive and not available in all mortuary settings. When discussing options for disposition of remains with families, providers must be mindful of the associated costs as a limitation for many families. Legislation requiring private or clinic disposition of fetal remains would add significant cost and financial burden to those seeking or providing abortion care.
Hypertensive and Diabetic Disorders of Pregnancy in Women in Same-Sex Versus Different-Sex Marriages [A188]
Authors: Rubin Elizabeth , Snowden Jonathan , Sandström Anna , Paula Amato , Jae Downing 
Published: June 2022

INTRODUCTION:
Sexual-minority women may have higher rates of adverse perinatal outcomes; however, population level maternal morbidity has not been studied in this group.

METHODS:
We conducted a cross-sectional study of birth certificates from Massachusetts (2012–2018) and Ohio (2016–2018). Within each state, women giving birth in same-sex marriages were compared to those in different-sex marriages. Outcomes included gestational hypertension or preeclampsia (GHTN/PEC), chronic hypertension, pregestational diabetes, and gestational diabetes. Chi-square tests were used for comparisons. Multivariable logistic regression was performed to control for age, parity, race, and socioeconomic status.

RESULTS:
Of the 315,432 and 323,841 birth records from married individuals in Massachusetts and Ohio, respectively, 1,997 (0.6%) and 1,677 (0.2%) were from those in same-sex marriages. In both states, women giving birth in same-sex marriages had higher rates of nulliparity, age over 35, obesity, and tobacco use. In Ohio they were more likely to be of Black race, lower education level, and utilizing WIC, but in Massachusetts they were more likely to be of White race, higher educational level, and not utilizing WIC. In both states, this population had higher rates of GHTN (3.5% versus 2.3%), PEC (11.8% versus 8.8%), and, in Massachusetts, chronic hypertension (3% versus 1.7%) (all P<.001). In the multivariable logistic regression models, the adjusted odds ratios of GHTN/PEC, chronic hypertension, pregestational diabetes, or gestational diabetes were similar between women in same-sex and different-sex marriages.

CONCLUSION:
In two large populations, women in same-sex marriages were significantly more likely to have GHTN/SPEC, but not after controlling for known risk factors, all of which were higher in this population.
The Effect of Changes in Treatment Recommendations for Gestational Diabetes on Perinatal Morbidity [A191]
Authors: White Samantha , Gurram Padmalatha , Danhauser Sara , Tassone Lauren , Ngyuen Anh , Mover Kelly 
Published: June 2022

INTRODUCTION:
Evidence about the lack of efficacy of glyburide prompted the American College of Obstetricians and Gynecologists (ACOG) to recommend insulin as first-line treatment and metformin as an alternative for treatment of gestational diabetes (GDMA2) in February 2018. This study compared the treatments and perinatal outcomes in women before and after the ACOG recommendations.

METHODS:
This was a retrospective study of patients treated for GDMA2. Patients were divided into two groups (group 1: February 2016 to January 2018; group 2: February 2018 to January 2020). The primary outcome was comparison of perinatal outcomes between the groups during those two periods. The secondary outcome was comparison of the effect of glyburide, metformin, and insulin on perinatal outcomes regardless of the time frame. Outcomes were also compared between insulin glargine and insulin NPH. Maternal outcomes included rates of primary cesarean delivery, preeclampsia, and ICU admission. Neonatal outcomes included large for gestational age, shoulder dystocia, NICU admission, hypoglycemia, hyperbilirubinemia, and stillbirth. Institutional review board approval was obtained.

RESULTS:
A total of 160 patients received medications. Baseline characteristics were similar. Insulin was the most common medication used in both groups (58%). In group 1, 21 patients received glyburide versus seven in group 2 (P=.01). There was no difference regarding insulin or metformin use between groups (P>.05). Perinatal outcomes were similar in both groups (P>.05). Regardless of time frame, NICU admissions (P=.01) and shoulder dystocia (P=.04) were higher with glyburide. Preeclampsia rates were lower in women receiving insulin NPH (P=.03).

CONCLUSION:
Glyburide use decreased after ACOG recommendations. Decline in use of glyburide is not accompanied by significant improvements in perinatal morbidity. Regardless of time frame, glyburide is associated with higher neonatal adverse outcomes and NPH with decrease in maternal adverse outcomes.