Admission For Delivery Research Articles

The Association of the Coronavirus Disease-2019 Pandemic With Disparities in Maternal Outcomes.

In the United States, Black and Hispanic patients have substantially worse maternal outcomes than non-Hispanic White patients. The goals of this study were to evaluate the association between the coronavirus disease-2019 (COVID-19) pandemic and maternal outcomes, and whether Black and Hispanic patients were disproportionately affected by the pandemic compared to White patients. Multivariable logistic regression was used to examine in the United States the association between maternal outcomes (severe maternal morbidity, mortality, failure-to-rescue, and cesarean delivery) and the weekly hospital proportion of COVID-19 patients, and the interaction between race, ethnicity, payer status, and the hospital COVID-19 burden using US national data from the Vizient Clinical Database between 2017 and 2022. Among 2484,895 admissions for delivery, 457,992 (18.4%) were non-Hispanic Black (hereafter referred to as Black), 537,867 (21.7% were Hispanic), and 1489,036 (59.9%) were non-Hispanic White (hereafter referred to as White); mean (standard deviation [SD]) age, 29.9 (5.8). Mortality (adjusted odds ratio [AOR], 2.72; 95% confidence interval [CI], 1.28-5.8; P = .01) and failure-to-rescue (AOR, 2.89; 95% CI, 1.36-6.13, P = .01), increased during weeks with a COVID-19 burden of 10.1% to 20.0%, while rates of severe maternal morbidity and cesarean delivery were unchanged. Compared to White patients, Black and Hispanic patients had higher rates of severe maternal morbidity ([Black: OR, 1.97; 95% CI, 1.85-2.11, P < .001]; [Hispanic: OR, 1.37;95% CI, 1.28-1.48, P < .001]), mortality ([Black: OR, 1.92; 95% CI, 1.29-2.86, P < .001]; [Hispanic: OR, 1.51;95% CI, 1.01-2.24, P = .04]), and cesarean delivery ([Black: OR, 1.58; 95% CI, 1.54-1.63, P < .001]; [Hispanic: OR, 1.09;95% CI, 1.05-1.13, P < .001]), but not failure-to-rescue. Except for Black patients without insurance (1.3% of the patients), the pandemic was not associated with increases in maternal disparities. Odds of mortality (AOR, 1.96; 95% CI, 1.22-3.16, P = .01) and failure-to-rescue (AOR, 3.67; 95% CI, 1.67-8.07, P = .001) increased 2.0 and 3.7-fold, respectively, in Black patients without insurance compared to White patients with private insurance for each 10% increase in the weekly hospital COVID-19 burden. In this national study of 2.5 million deliveries in the United States, the COVID-19 pandemic was associated with increases in maternal mortality and failure-to-rescue but not in severe maternal morbidity or cesarean deliveries. While the pandemic did not exacerbate disparities for Black and Hispanic patients with private or Medicaid insurance, uninsured Black patients experienced greater increases in mortality and failure-to-rescue compared to insured White patients.

Oral Glucose-Lowering Agents vs Insulin for Gestational Diabetes

Metformin and glyburide monotherapy are used as alternatives to insulin in managing gestational diabetes. Whether a sequential strategy of these oral agents results in noninferior perinatal outcomes compared with insulin alone is unknown. To test whether a treatment strategy of oral glucose-lowering agents is noninferior to insulin for prevention of large-for-gestational-age infants. Randomized, open-label noninferiority trial conducted at 25 Dutch centers from June 2016 to November 2022 with follow-up completed in May 2023. The study enrolled 820 individuals with gestational diabetes and singleton pregnancies between 16 and 34 weeks of gestation who had insufficient glycemic control after 2 weeks of dietary changes (defined as fasting glucose >95 mg/dL [>5.3 mmol/L], 1-hour postprandial glucose >140 mg/dL [>7.8 mmol/L], or 2-hour postprandial glucose >120 mg/dL [>6.7 mmol/L], measured by capillary glucose self-testing). Participants were randomly assigned to receive metformin (initiated at a dose of 500 mg once daily and increased every 3 days to 1000 mg twice daily or highest level tolerated; n = 409) or insulin (prescribed according to local practice; n = 411). Glyburide was added to metformin, and then insulin substituted for glyburide, if needed, to achieve glucose targets. The primary outcome was the between-group difference in the percentage of infants born large for gestational age (birth weight >90th percentile based on gestational age and sex). Secondary outcomes included maternal hypoglycemia, cesarean delivery, pregnancy-induced hypertension, preeclampsia, maternal weight gain, preterm delivery, birth injury, neonatal hypoglycemia, neonatal hyperbilirubinemia, and neonatal intensive care unit admission. Among 820 participants, the mean age was 33.2 (SD, 4.7) years). In participants randomized to oral agents, 79% (n = 320) maintained glycemic control without insulin. With oral agents, 23.9% of infants (n = 97) were large for gestational age vs 19.9% (n = 79) with insulin (absolute risk difference, 4.0%; 95% CI, -1.7% to 9.8%; P = .09 for noninferiority), with the confidence interval of the risk difference exceeding the absolute noninferiority margin of 8%. Maternal hypoglycemia was reported in 20.9% with oral glucose-lowering agents and 10.9% with insulin (absolute risk difference, 10.0%; 95% CI, 3.7%-21.2%). All other secondary outcomes did not differ between groups. Treatment of gestational diabetes with metformin and additional glyburide, if needed, did not meet criteria for noninferiority compared with insulin with respect to the proportion of infants born large for gestational age. Netherlands Trial Registry Identifier: NTR6134.

Maternal Characteristics and Pregnancy Outcomes Associated with Delivery versus Expectant Management following Decreased Fetal Movement at Term.

This study aimed to compare maternal characteristics and pregnancy outcomes between term patients evaluated for decreased fetal movement (DFM) who were delivered versus expectantly managed. Retrospective cohort study of term patients delivering within a large hospital system from 2015 to 2023 who were evaluated for DFM. Patients were classified into three groups based on the time between evaluation for DFM and delivery admission: (1) <24 hours, (2) 24-48 hours, (3) >48 hours. Bivariate comparisons and multinomial logistic regression were performed to evaluate which maternal characteristics were associated with immediate delivery (<24 and 24-48 hours latency) as compared with expectant management (>48 hours latency) as well as to compare delivery and neonatal outcomes. Of 2,015 patients, significant sociodemographic and clinical variations were noted between groups. Following adjustment, noncommercial insurance, hypertension in pregnancy, and body mass index (BMI) ≥30 kg/m2 at delivery were associated with reduced odds of admission <24 and 24-48 hours as compared with >48 hours. There were no cases of stillbirth or neonatal demise and there were no differences in delivery or neonatal outcomes. Among patients with DFM at term, there are significant sociodemographic and clinical variations between those admitted for <24, 24-48, and >48 hours, though delivery and neonatal outcomes were similar. · Having noncommercial insurance, hypertension in pregnancy, and BMI ≥30 kg/m2 at delivery were associated with reduced odds of admission within <24 and 24-48 hours as compared with >48 hours after presenting with DFM at term.. · There were no cases of stillbirth or neonatal demise among this cohort of patients presenting with DFM at term.. · There were no differences in delivery or neonatal outcomes among this cohort of patients presenting with DFM at term as stratified by timing from presentation to admission for delivery..

Efficacy and safety of misoprostol compared with dinoprostone for labor induction at term: an updated systematic review and meta-analysis of randomized controlled trials

BackgroundLabor induction is a common obstetric intervention, increasingly performed worldwide, often using prostaglandins like misoprostol and dinoprostone.ObjectiveThis study aims to compare the effectiveness and safety of intravaginal misoprostol versus dinoprostone for inducing labor, examining their impact on various maternal and neonatal outcomes.MethodsA systematic review and meta-analysis were conducted using four databases—PubMed, Google Scholar, EBSCO, and the Cochrane Library—from January 2000 to April 2023. We included randomized controlled trials (RCTs) involving singleton pregnancies at term (37–42 weeks) with unfavorable cervices, where intravaginal misoprostol was compared to dinoprostone. Key outcomes evaluated for effectiveness included vaginal delivery within 24 h, overall vaginal delivery rate, and need for oxytocin augmentation. Safety outcomes assessed were tachysystole, uterine hyperstimulation, abnormal cardiotocography, NICU admissions, cesarean delivery, and APGAR scores. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects model in Review Manager (RevMan) version 5.4.1.ResultsEight RCTs with a total of 1,801 participants (937 in the misoprostol group and 864 in the dinoprostone group) met the inclusion criteria. Misoprostol required a significantly less oxytocin augmentation than dinoprostone [RR = 0.83; 95% CI (0.71, 0.97), p = 0.02]. Other outcomes, including rates of cesarean delivery, uterine tachysystole, hyperstimulation, and NICU admissions, showed no significant differences between the two groups, indicating comparable safety and efficacy profiles.ConclusionThis meta-analysis demonstrates that intravaginal misoprostol is an effective and safe alternative to dinoprostone for labor induction at term. Misoprostol achieved comparable efficacy and safety outcomes while requiring less oxytocin augmentation, supporting its potential as a practical induction agent in clinical settings.

A statewide analysis of uptake of highly effective contraception offered immediately postpartum in Massachusetts, 2017-2021.

To investigate provision of immediate postpartum (iPP) highly effective contraception in Massachusetts. We performed logistic regressions evaluating contraceptive implant, intrauterine device, and permanent contraception procedures occuring during delivery admissions between 2017 and 2021, analyzing outcomes by method reversibility and delivery type. Hispanic and privately-insured patients had higher odds of receiving any iPP method, whereas patients delivered at non-teaching hospitals had lower odds of receiving any method. Patients who were Hispanic, publicly-insured, or delivered atnon-teaching hospitals had lower odds of receiving reversible compared to permanent methods. Differential uptake of iPP contraception suggests programming opportunities to address unmet postpartum contraception needs.

Prospective Survey of Discrimination in Pregnant Persons and Correlation with Unplanned Healthcare Utilization.

To determine the association between lifetime exposure to discrimination and unplanned healthcare utilization in pregnant persons. This was a prospective cohort study of pregnant persons receiving care from 2021 to 2022. Primary data was collected from participants on sociodemographic factors and on Perceived Ethnic Discrimination Questionnaire (PED-Q), a validated 17-item scale measuring perceived lifetime interpersonal racial and ethnic discrimination in four domains: work/school, social exclusion, stigmatization, and threat. The primary outcome was unplanned healthcare utilization, defined as unplanned labor and delivery admissions, triage, Emergency Department, or urgent care visits. Bivariate and multivariate analyses were done to examine the association between lifetime exposure to discrimination and unplanned healthcare utilization. A total of 289 completed the PED-Q and were included in the analysis. Of these, 123 (42.6%) had unplanned healthcare utilization. Mean (SD) of lifetime racial and ethnic discrimination was significantly higher in people with unplanned healthcare utilization compared to those with planned healthcare utilization [1.67 (0.63) vs 1.48 (0.45), p = 0.003]. Univariate analysis showed that lifetime racial and ethnic discrimination was significantly associated with unplanned healthcare utilization (OR1.96, 95% CI 0.23-3.11). Significant associations were found between unplanned healthcare utilization and maternal age (p = 0.04), insurance type (p = 0.01), married status (p < 0.001), education (p = 0.013), household income (p = 0.001), and chronic hypertension (p = 0.004). After controlling for potential confounding factors, self-reported lifetime racial and ethnic discrimination remained significantly associated with higher odds of unplanned healthcare utilization (aOR 1.78, CI 95% 1.01-3.11). We found that a higher level of self-reported lifetime racial and ethnic discrimination was associated with increased unplanned healthcare utilization during pregnancy.

Immediate postplacental intrauterine device placement: retrospective cohort study of expulsion and associated risk factors

BackgroundPostpartum contraception is typically provided during postpartum visits. When desired and accessible, the immediate postpartum period provides an additional opportunity to increase utilization of more effective contraceptive methods to potentially reduce subsequent unintended pregnancy and improve pregnancy outcomes. In New York State, recent policy changes expanded Medicaid coverage to include immediate postplacental IUD insertion. ObjectiveWe investigated clinically documented IUD expulsion within 12 months of placement in patients who depend on state-funded health insurance. Study designThis retrospective cohort study included Medicaid patients with an immediate postplacental intrauterine device placed after third trimester delivery, who delivered between 3/2/17 and 9/2/19. Current Procedural Terminology code billing data was used to identify 238 patients who underwent intrauterine device placement during their delivery admission. Electronic medical record data was analyzed using chi-squared tests, t-tests, and multivariable logistic regression. ResultsThere were 17.6% (42/238) documented intrauterine device expulsions within the first year after placement. After vaginal deliveries, 22.1% (29/131) of intrauterine devices placed had a documented expulsion, while patients who had cesarean deliveries expelled 12.2% (13/107) of their intrauterine devices (p=0.04). Controlling for body mass index, parity, intrauterine device type, and gestational age, patients who delivered vaginally were more likely to experience intrauterine device expulsion within one year compared to cesarean delivery (Adjusted Odds Ratio 2.71, 95% Confidence Interval: 1.27-5.80). Patients with a documented intrauterine device expulsion within one year were more likely to have a subsequent pregnancy prior to October 2020: 35.7% (15/42) as compared to 15.3% (30/196) in the no expulsion group (p=0.002). ConclusionsThe overall percentage of documented intrauterine device expulsion within one year following immediate postplacental placement was 17.6% with a greater percentage of expulsion in patients who underwent vaginal delivery. Patients with a documented intrauterine device expulsion within one year of placement were significantly more likely to experience a subsequent pregnancy.

Development and Validation of a Predictive Model for Maternal Cardiovascular Morbidity Events in Patients With Hypertensive Disorders of Pregnancy.

Hypertensive disorders of pregnancy (HDP) are a major contributor to maternal morbidity, mortality, and accelerated cardiovascular (CV) disease. Comorbid conditions are likely important predictors of CV risk in pregnant people. Currently, there is no way to predict which people with HDP are at risk of acute CV complications. We developed and validated a predictive model for all CV events and for heart failure, renal failure, and cerebrovascular events specifically after HDP. Models were created using the Premier Healthcare Database. The inclusion criteria for the model dataset were delivery with an HDP with discharge from October 1, 2015 to December 31, 2020. Machine learning methods were used to derive predictive models of CV events occurring during delivery hospitalization (Index Model) or during readmission (Readmission Model) using a training set (60%) to estimate model parameters, a validation set (20%) to tune model hyperparameters and select a final model, and a test set (20%) to evaluate final model performance. The total model cohort consisted of 553,658 deliveries with an HDP. A CV event occurred in 6501 (1.2%) of the delivery hospitalizations. Multilabel neural networks were selected for the Index Model and Readmission Model due to favorable performance compared to alternatives. This approach is designed for prediction of multiple events that share risk factors and may cooccur. The Index Model predicted all CV events with area under the receiver operating curve (AUROC) 0.878 and average precision (AP) 0.239 (cerebrovascular events: AUROC 0.941, heart failure: AUROC 0.898, and renal failure: AUROC 0.885). With a positivity threshold set to achieve ≥90% sensitivity, model specificity was 65.0%, 83.5%, 68.6%, and 65.6% for predicting all CV events, cerebrovascular events, heart failure, and renal failure, respectively. CV events within 1 year of delivery occurred in 3018 (0.6%) individuals. The Readmission Model predicted all CV events with AUROC 0.717 and AP 0.022 (renal failure: AUROC 0.748, heart failure: AUROC 0.734, and cerebrovascular events AUROC 0.698). Feature importance analysis indicated that the presence of chronic renal disease, cardiac disease, pulmonary hypertension, and preeclampsia with severe features had the greatest effect on the prediction of CV events. Among individuals with HDP, our multilabel neural network model predicted CV events at delivery admission with good classification and events within 1 year of delivery with fair classification.

Obstetric and neonatal outcomes of immune thrombocytopenic purpura in pregnancy and the role of delta hemoglobin index: A case-control study from a tertiary center.

To evaluate the effect of idiopathic thrombocytopenic purpura (ITP) on pregnancies and the role of the delta hemoglobin indices in the evaluation of treatment effectiveness. This case-control study was conducted with 23 ITP and 115 low-risk pregnancies. Obstetric outcomes (fetal growth retardation (FGR), preterm delivery) and neonatal outcomes (weights, APGAR scores, NICU admissions, thrombocytopenia) were recorded. ITP group was subgrouped based on the platelet ratio at the admission for delivery and evaluated the impact of platelet ratios on blood loss amounts at delivery by using delta hemoglobin indices. Eleven patients received treatment during pregnancy. The gestational age at birth and fetal APGAR scores were lower, and the preterm delivery and FGR rates were higher in the ITP group. Four newborns (17.4%) had thrombocytopenia. There were two postpartum hemorrhages. Newborn platelet counts did not correlate with maternal platelet counts. The study showed no difference in delta hemoglobin counts between the ITP and control groups. ITP is associated with an increased risk of maternal and fetal complications. The presented study showed by using the delta hemoglobin indices that, hemorrhagic complications could be prevented with appropriate management. Neonatal thrombocytopenia should be considered for all ITP patients.

Trends in severe maternal morbidity following an institutional team goal strategy for disparity reduction

BackgroundRacial disparities in maternal pregnancy outcomes, specifically in morbidity and mortality, are persistent in the U.S., and a multifaceted approach to mitigating these disparate outcomes is critical. In 2020, our health system committed to reducing severe maternal morbidity (SMM) in Black patients, employing multiple strategic interventions including implicit bias training, regular reporting of a composite SMM metric stratified by race and ethnicity, standardization of best practices, focused efforts for hemorrhage risk reduction, and system-wide team building. ObjectiveThe goal of this study is to investigate trends in SMM by race across this period of concentrated interventions to improve maternal outcomes overall, and specifically for Black patients. Study DesignThis is a retrospective cohort study evaluating all delivery admissions at an academic, urban, tertiary-care hospital in Philadelphia—one site of a health system encompassing five delivery hospitals—over a 3-year period from 2019 to 2021. Data including patient demographics, clinical features, and outcomes were extracted from the electronic medical record (EMR). Self-reported race was categorized as Black vs non-Black as documented in the EMR. SMM was defined according to established CDC indicators as well as additional codes identified by Vizient for common sources of SMM including hemorrhage, infection, and embolism. Data were analyzed by year with a multivariable logistic regression model including insurance type and obstetric comorbidity index (OB-CMI), a weighted scoring system accounting for numerous chronic medical conditions and antepartum pregnancy complications. ResultsIn total, 12,339 deliveries were included, 64.6% (N=8012) of which were to Black patients. Median OB-CMI score was higher for Black patients at 3 (interquartile range [IQR] 1–5) compared to 2 (IQR 1–4) for non-Black patients, P<.01. There was a significant decrease in SMM for the entire cohort over the study period (8.5% in 2019 to 6.5% in 2021, P=.001), driven by a decreased rate specifically among Black patients (8.9% in 2019 to 6.6% in 2021, P=.005) with a nonsignificant decrease for non-Black patients (7.8% in 2019 to 6.3% in 2021, P=.21). The adjusted model similarly demonstrated decreased risk of SMM over time for Black patients (2020 vs 2019 adjusted odds ratio [aOR] = 0.81, 95% confidence interval [CI] 0.69–0.96; 2021 vs 2019 aOR 0.73, 95% CI 0.62–0.86). ConclusionDedicated efforts to improve equity in maternal outcomes over a 2-year period (2020–2021) in this hospital serving a Black patient majority were associated with a significant decline in SMM, especially among Black patients. This finding demonstrates the success of a high-level, coordinated, and systematic approach in reducing SMM and associated disparities, and is highly consequential in light of the ongoing major epidemic of racial disparities in obstetric outcomes.

Association between psychopharmacotherapy and postpartum hemorrhage

BackgroundPrior studies evaluating the relationship between psychopharmacotherapy (PPT), and postpartum hemorrhage (PPH) have yielded inconsistent findings. Clarifying this potential relationship is important for effective counseling and risk stratification. ObjectivesOur primary objective was to evaluate the association between prenatal exposure to PPT (any drug class) and the occurrence of PPH requiring transfusion of packed red blood cells (PPH+pRBC) after systematically adjusting for known hemorrhage risk factors at the time of admission for delivery. Secondary objectives were to evaluate the association between individual PPT drug classes and PPH+pRBC, and the association between treatment intensity of mental health condition and PPH+pRBC. Finally, we evaluated the association between PPT and a broader definition of PPH that included deliveries requiring multiple uterotonic drugs. Study designThis is a retrospective cross-sectional study of all pregnancies delivered at 23 weeks of gestational age or greater at seven hospitals within a large academic health system in New York between January 2019 and December 2022. There were no exclusion criteria, as postpartum hemorrhage risk assessment is necessary for all patients admitted for delivery. We assessed exposure to prenatal PPT, including selective serotonin reuptake inhibitors (SSRIs: escitalopram, fluoxetine, sertraline), serotonin-norepinephrine reuptake inhibitors (SNRIs: duloxetine, venlafaxine), dopamine-norepinephrine reuptake inhibitors (DNRIs: buproprion), benzodiazepines (alprazolam, diazepam, lorazepam), and others (buspirone, trazodone, zolpidem). Multivariable logistic regression was performed to evaluate the relationship between PPT and PPH+pRBC, while systematically adjusting for known hemorrhage risk factors at the time of hospital admission. Similar regression analyses were performed to address the secondary objectives. ResultsA total of 107,425 deliveries were included. Non-Hispanic White patients constituted the largest race and ethnicity group (43.4%), followed by Hispanic patients (18.7%), Asian or Pacific Islander patients (13.2%), and non-Hispanic Black patients (12.3%). Prenatal exposure to PPT occurred in 3.6% of pregnancies (n=3,834). The overall rate of PPH+pRBC was 2.9% (n=3,162). PPH+pRBC occurred more frequently in pregnancies exposed to PPT than in pregnancies which were not exposed (5.5% vs. 2.8%, respectively; aOR 2.10, 95% CI: 1.79–2.44). SSRIs and benzodiazepine monotherapy were each associated with higher odds of PPH+pRBC than nonexposure. Compared to patients without a mental health condition, monotherapy was associated with nearly 2-fold increased odds and combination PPT was associated with nearly 4-fold greater odds of PPH+pRBC after adjustment for confounding variables (monotherapy: aOR 1.94, 95% CI: 1.64–2.28; combination PPT: aOR 3.96, 95% CI: 2.61–5.79). Patients with untreated mental health conditions (no PTT) had no increased odds of PPH+pRBC compared to those without mental health conditions. Finally, after adjusting for covariates, a positive association was found between PPT and PPH requiring pRBC transfusion and/or the use of two additional uterotonic agents beyond routine postpartum oxytocin (aOR 1.53, 95% CI: 1.35–1.73). ConclusionsPrenatal PPT exposure is associated with increased odds of clinically significant PPH+pRBC after adjusting for other hemorrhage risk factors. Combination PPT was associated with greater odds of PPH+pRBC than monotherapy.

Assessment of vitamin B12 and homocysteine levels in pregnant women admitted for delivery and cord blood samples of their newborn babies: a multicenter study.

Vitamin B12, an indispensable micronutrient, is pivotal in numerous physiological processes, with particular significance during pregnancy and fetal development. The increasing adoption of vegetarian diets and the economic challenges associated with accessing animal-based food sources contribute to the prevalence of vitamin B12 deficiency. This study aims to examine the levels of vitamin B12 and homocysteine in pregnant women upon admission for delivery and to analyze corresponding cord blood samples from their newborn infants in a substantial sample within the Istanbul metropolitan area. This cross-sectional multicenter study included women aged ≥16 years admitted for delivery and their newborns ≥34 weeks. The demographic data and the results of complete blood counts within the previous 24 hours before birth were recorded. Vitamin B12 and homocysteine levels were measured in maternal and cord blood samples. The study parameters were compared between the groups based on the mothers' and babies' homocysteine and vitamin B12 levels. The study included 832 pregnant women and 832 neonates. Anemia affected 36% of pregnant women, with a higher frequency in mothers with vitamin B12 deficiency. Seventy-eight mothers and 48.9% of neonates showed Vitamin B12 levels below 200 pg/mL, while elevated homocysteine levels were observed in 30% of mothers and 26% of neonates. Maternal vitamin B12 deficiency was significantly correlated with cord blood B12 deficiency and elevated homocysteine. The median cord blood vitamin B12 level was inversely correlated with the number of previous pregnancies. Vitamin B12 deficiency is extremely common in pregnant women before delivery, significantly correlating to cord blood homocysteine and vitamin B12 levels. However, homocysteine alone is not a reliable marker for maternal vitamin B12 status. Implementing strategies to detect vitamin B12 deficiency and supplying adequate vitamin B12 supplementation during pregnancy holds the potential to enhance maternal and neonatal health in Türkiye.

Improving Amniotic Fluid Index with L-Arginine Supplementation

Background: Oligohydramnios, characterized by a low Amniotic Fluid Index (AFI), is associated with adverse pregnancy outcomes, including fetal growth restriction, preterm labor, and low birth weight. Effective interventions for improving AFI are critical, particularly in resource-limited settings. L-Arginine, a nitric oxide precursor, has shown promise in enhancing uteroplacental circulation and increasing AFI. This study aimed to evaluate the efficacy of L-Arginine supplementation in improving AFI and associated maternal and neonatal outcomes in pregnant women with oligohydramnios in Bangladesh. Methods: This study was conducted at Islami Bank Hospital over one year (July 2023 to June 2024), involving 90 pregnant women diagnosed with oligohydramnios. Participants received daily L-Arginine supplementation, and AFI was measured before and after the intervention. Maternal and neonatal outcomes, including gestational age at delivery, birth weight, and neonatal intensive care unit (NICU) admissions, were recorded. Statistical analysis was performed using paired t-tests, with p &lt; 0.05 considered statistically significant. Results: The mean AFI increased significantly from 5.4 cm (SD ±1.7) before the intervention to 8.6 cm (SD ±2.1) after supplementation, with a mean difference of 3.2 cm (p &lt; 0.001). Low birth weight was observed in 20% of the neonates, while 17.78% required NICU admission. There was a notable improvement in neonatal outcomes with L-Arginine supplementation. Conclusion: L-Arginine supplementation significantly improved AFI and neonatal outcomes, making it a viable intervention for managing oligohydramnios in pregnant women. Further research is recommended to confirm these findings in larger populations.

Tennessee Medicaid patient immediate postpartum long-acting reversible contraception utilization

ObjectivesTo understand immediate postpartum long-acting reversible contraception (IPP LARC) desire and utilization trends among publicly insured patients delivering at one academic hospital in a state with health care barriers and high short-interval birth rates. Study designWe conducted a retrospective cohort study of electronic delivery records between March 2018 and June 2023 for publicly insured patients. Patient demographics, IPP LARC desire and utilization trends were compared using χ2 or Fisher exact tests. Binary logistic regression explored the relationship between IPP LARC utilization and demographics. Multivariable logistic regression was performed on all statistically significant variables. ResultsAnalysis included 10,472 delivery encounters; 2459 (23.5%) requested IPP LARC on admission and 464 (4.4%) changed contraception to IPP LARC after admission. Among those obtaining IPP LARC (n = 2523, 24.1%), 1224 (48.5%) selected arm implants and 1299 selected intrauterine devices (IUDs). Patients who self-reported as non-Hispanic Black and non-Hispanic Other or multiple races utilized IPP LARC less (adjusted Odds Ratio (aOR)=0.84, 95% CI: 0.72–0.98, aOR=0.68, CI 95%: 0.48–0.97, respectively). Patients with cesarean delivery (aOR=1.45, 95% CI: 1.31–1.61) or inadequate prenatal care (aOR=1.54, CI 95%: 1.35–1.75) were more likely to utilize IPP LARC. Maternal age and years of education were inversely associated with utilization. Primiparous patients were less likely to utilize IPP LARC. ConclusionsLong-acting reversible contraception (LARC) utilization was 24.1% during the immediate postpartum period; higher than the 11% nationally reported interval LARC use among publicly insured patients. Understanding the demographics of those desiring IPP LARC could highlight accessibility gaps. The impact of IPP LARC utilization on rates of short-interval birth is being evaluated. ImplicationsUnderstanding the demographics of IPP LARC utilizers may contribute to understanding accessibility gaps and facilitate discernment of factors impacting patient initiation. Evidence suggests that comprehensive contraception access during delivery admission is feasible, patient-desired, and essential.

Pregnancy Outcome of SARS-Cov-2 Infection on Newborns and Infants – A Systematic Review and Meta-Analysis

Abstract Background The impact of coronavirus disease (COVID -19) on maternal and newborn health is unclear so there is a great need to understand the effects of maternal COVID-19 infection on birth outcomes. Aim of the Work This study aimed to provide evidence using a systematic review and meta-analysis on the impact COVID-19 during pregnancy on neonates and infants. Patients and Methods The study included published case-control studies, case report studies, and retrospective case follow-up evaluating the COVID-19 infection in pregnancy and its effect on newborns and infants. A total of 429 studies were evaluated and only 61 met the eligibility criteria for data extraction and data analysis. Of these, 30 studies were used in meta-analysis and underwent quality assessment and bias evaluation. Results Fourteen studies were included detecting preterm labor event among cases with and without COVID-19 and showed significantly higher preterm labour among pregnant women with COVID-19 than without with p-value at &amp;lt; 0.0001. Eleven studies were included detecting NICU admission event among cases with and without COVID-19 which showed significantly higher NICU admission among pregnant women with COVID-19 than without with p-value at &amp;lt; 0.0001 while 4 studies were included detecting stillbirth admission event among cases with and without COVID-19 which showed insignificant differences of still births between the two groups with p-value at 0.6786, and 8 studies were included detecting Intrauterine growth retardation (IUGR)\ low birth weight admission event among cases with and without COVID-19 that showed insignificant differences of IUGR/ low birth weight between the two groups at p-value 0.1822. Conclusion COVID-19 infection in pregnant women has an impact on several neonatal outcomes, such as, preterm delivery, oxygen therapy, intubation, and NICU admission, but it does not significantly affect low birth weight, neonatal mortality, IUFD and stillbirth.

Adolescent Childbirth at Gao Hospital in Mali

The aim was to assess the prevalence and maternal and perinatal prognosis of adolescent childbirth at the Gao Hospital. Materials and methods: This was a prospective and cross-sectional study from January 1, 2020 to December 31, 2020. Results: we recorded 655 cases out of 3010 deliveries, i.e. a prevalence of around 21.7% with an average age of 17.39 years. The majority of them were married (92.5%), and the pregnancy was not followed in 33.3% of cases. On admission for delivery, they had anaemia (19%), high blood pressure (2.6%), pre-eclampsia (1.2%) and even eclampsia (4.5%). Prematurity accounted for 10.1%. Deliveries were conducted vaginally (84%). The main indications for caesarean sections were immature pelvis (32.3%) and eclampsia (26.6%). Complications were soft tissue tears (5%), postpartum hemorrhage (2.74%). The maternal mortality rate was two cases out of a total of 655 and the stillbirth rate was 5.6%.

Association between late pregnancy prehypertension and adverse outcomes among newborns of women delivered at a tertiary hospital in Eastern Uganda: a prospective cohort study

BackgroundPrehypertension during pregnancy is currently not considered as a high-risk pregnancy state in existing guidelines despite recent research correlating it with higher rates of morbidity and mortality in both the mother and the fetus. Studies on prehypertension have not been conducted in Africa despite high rates of poor neonatal outcomes.AimsThe study aimed to determine the association between late pregnancy prehypertension and adverse outcomes in newborns of women with late pregnancy prehypertension at Jinja Regional Referral Hospital.Methods and materialsBetween September 2022 and January 2023, a hospital-based prospective cohort study including 300 pregnant women was conducted. Participants were divided according to third-trimester blood pressure, as determined by the JNC-8 criteria. Following hospital admission for labor and delivery, 150 normotensive women and 150 prehypertensive women were identified and followed until delivery, and their neonates were followed until death or hospital discharge. A p value of ≤ 0.05 was the threshold for statistical significance when comparing the groups using the relative risk, X2, and Mantel-Haenszel adjustment.ResultsComposite adverse neonatal outcomes were more common in prehypertensive women compared to normotensive women (48.67% versus 32.67%), particularly Small-for-Gestation Age (SGA), stillbirth, and composite adverse neonatal outcomes had significantly higher likelihood, with aRRs of 1.63 (95% CI 1.10–2.42, p = 0.037), 9.0 (95% CI 1.15–70.16, p = 0.010), and 1.55 (95% CI 1.16–2.08, p < 0.001), respectively. By a linear model, birthweight decreased by 45.1 g for every 10 mmHg rise in systolic blood pressure (p = 0.041, Pearson correlation of -0.118).Conclusion and recommendationsPrehypertension in late pregnancy increased risks for adverse neonatal outcomes, thus a need to potentially lower pregnancy hypertension cut-off levels possibly through adopting the ACC/AHA blood pressure definitions for pregnant women.

Abstract P402: The Impact of Preeclampsia Education in Rural Communities

Preeclampsia (PE) and other hypertensive disorders of pregnancy are the leading cause of maternal and perinatal morbidity and mortality. There are 4,000 PE cases/year in IA. Rural counties are at a significantly higher risk of pregnancy-related mortality. A lack of PE education regarding signs and symptoms may contribute to this risk. PE complications and mortality may be preventable with early implementation of patient education on preeclampsia during pregnancy. Our objective was to determine if implementing a magnet as an intervention increases patients' knowledge of the signs and symptoms of PE. A magnet that includes common signs and symptoms of PE was designed to serve as an educational visual aid for patients. Pregnant patients ≥18 years old from two hospitals in Northwest IA were recruited. A pre-survey was given at a prenatal appointment prior to receiving the magnet. The post-magnet survey was administered during admission for delivery. The control group did not receive the magnet. Pre- and post-surveys asked about preeclampsia and current understanding, if they received a magnet, if it was referenced, number of healthcare visits, questions during visits about PE, and if they were diagnosed with PE. Between 8/23-5/24, 62 pre- and 83 post-magnet surveys were collected. Statistical analyses were performed using a 95% confidence interval with p&lt;0.05 considered significant. Ages ranged from 18-42 years old, with majority Caucasian patients (69% in pre-survey and 58% in post-survey). Levels of highest education obtained ranged from 4 th grade to doctoral degree, with the majority completing high school as the highest level of education (29%).The magnet group rated their level of understanding of PE as good to excellent which was higher than both pre-intervention and control groups. Both control and magnet groups identified more symptoms and complications of PE on the post-survey compared to the pre-survey. Both control and magnet groups were noted to have increased discussions about preeclampsia with their physician. Lastly, both groups had increased knowledge on what to do if they developed symptoms on the post-survey compared to pre-survey responses. Of the magnet group, 71% thought receiving a magnet was helpful to increase awareness of PE. Implementation of a magnet increased patient literacy regarding the signs, symptoms, and complications of PE, discussions with physicians, and knowledge of what to do if patients develop symptoms of PE.

Abstract 67: Cardiac Biomarkers in Pregnancies with and without Hypertension – a Case Control Study

Background: There is ongoing debate about hypertension (HTN) management during pregnancy with a range of recommended targets. Whether HTN is related to subclinical cardiac injury during pregnancy is unclear. Objective: To determine the relationship between HTN with subclinical cardiac injury during and immediately after pregnancy, measured via high sensitivity troponin I (hs-cTnI). Methods: In a prospective, 1:1 case-control design, we enrolled pregnant women with and without HTN between 24-32 weeks gestation (2019-2022). HTN cases were defined by a clinician diagnosis at &lt;20 weeks gestation or a baseline blood pressure (BP) ≥140/90 mm Hg. The control group (no HTN) had a systolic BP &lt;120 mm Hg. Hs-cTnI was collected at baseline, the delivery admission, and postpartum day 1. We used mixed effects tobit models to compare the groups on log-transformed hs-cTnI, adjusted for age and BMI. Results: The mean age of the HTN group (N=38) was 33.6 (SD 5.4) vs. 30.3 (5.8) years for the no HTN group (N=38). Mean (SD) baseline BP was 131.1 (14.7)/88.2 (13.5) for the HTN group and 110.1 (7.2)/70.9 (8.2) mm Hg for no HTN. At baseline, hs-cTnI was 1.3 (0.2) in the HTN group and 0.6 (0.1) ng/L in the no HTN group ( Figure ). Compared to baseline, hs-cTnI increased 89.1% (95% CI: 27.3-180.8%) and 322% (192-511%) for the HTN group, and 101.6% (41.0-188.3%) and 165.2% (88.6-272.9%) for no HTN at delivery and postpartum, respectively. Across all time points, the HTN group had a higher hs-cTnI of 1.05 (0.07-2.03) ng/L compared to the control group. Discussion: HTN was associated with subclinical cardiac injury during and immediately postpartum. These findings support recommendations to control HTN throughout pregnancy to reduce cardiac injury.

Study of Ultrasonographic Changes of the Adrenal Gland in Growth Restricted Fetus

Background: Fetuses with Fetal Growth Restriction (FGR) are at increased risk of chronic intra-uterine hypoxia, due to increased secretion of corticosterone from the fetal adrenal glands. This plays a major role in the cardiovascular and circulatory adaptation of FGR fetuses. These modifications are untimely identified by sonographic imaging. Objective: To study the association between ultrasound features of the adrenal gland and growth restriction in the fetus. Methods: A total of 104 pregnant women (52 FGR pregnancies and 52 controls) were evaluated between 28 and 36 weeks of gestation. All the study participants underwent transabdominal ultrasonography to measure bilateral fetal adrenal gland volume and fetal zone volume, corrected for gestational age. They were followed up until delivery. The two groups were compared to analyze the perinatal outcome in relation to ultrasonographic changes in the adrenal gland. Results: The adrenal gland measurements were significantly larger in fetuses with FGR as compared to the control group. FGR group had a larger corrected adrenal gland volume(cAGV) and fetal zone and adrenal gland (FZ/AG)ratio A statistically significant correlation was found between the two groups regarding gestational age at delivery, birth weight, APGAR score, and NICU admissions. Perinatal morbidity was found to be higher among women diagnosed with FGR, i.e., 14 (53.84%). Conclusion: Fetal adrenal gland size measurement is important to identify FGR fetuses that are vulnerable to hypoxia. It helps the obstetrician prepare for effective in-utero management to reduce perinatal morbidity and mortality.