Nonsteroidal anti-inflammatory drug "allergy" labeling is associated with increased postpartum opioid utilization.

Background: Current guidelines recommend a stepwise approach to postpartum pain management, beginning with acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), with opioids added only if needed. Report of a prior NSAID-induced adverse drug reaction (ADR) may preclude use of first-line analgesics, despite evidence that many patients with this allergy label may safely tolerate NSAIDs.

Objective: We assessed the association between reported NSAID ADRs and postpartum opioid utilization.

Human Papillomavirus Inpatient Postpartum Vaccination: Clinical Guideline Implementation.

Objective: The nine-valent human papillomavirus (9vHPV) vaccine is highly effective at preventing cervical cancer, yet U.S. vaccination rates remain low.

Disparities in Maternal-Infant Drug Testing, Social Work Assessment, and Custody at 5 Hospitals.

Objective: To evaluate for disparities in peripartum toxicology testing among maternal-infant dyads across a hospital network and subsequent child protective services (CPS) involvement.

Methods: Retrospective chart review of 59,425 deliveries at 5 hospitals in Massachusetts between 2016 and 2020. We evaluated associations between maternal characteristics, toxicology testing, and child welfare involvement with disproportionality risk ratios and hierarchical logistical regression.

Informed consent is poorly documented when obtaining toxicology testing at delivery in a Massachusetts cohort.

Background: Positive toxicology testing at delivery can have enormous consequences for birthing persons and their families, including charges of child abuse or neglect and potential loss of custody for the birthing parent. Therefore state and national guidelines stipulate that, clinicians must obtain consent before toxicology testing at delivery.

Objective: This study aimed (1) to determine clinician documentation of patient consent for peripartum toxicology testing and (2) to characterize the extent to which patient and hospital characteristics were associated with documented consent.

Mode of Delivery and Unplanned Cesarean: Differences in Rates and Indication by Race, Ethnicity, and Sociodemographic Characteristics.

Objective: We aimed to examine the relationship of sociodemographic variables with racial/ethnic disparities in unplanned cesarean births in a large academic hospital system. Secondarily, we investigated the relationship of these variables with differences in cesarean delivery indication, cesarean delivery timing, length of second stage and operative delivery.

Study Design: We conducted a retrospective cohort study of births >34 weeks between 2017 and 2019.

Results of a Statewide Survey of Obstetric Clinician Depression Practices.

Perinatal depression affects upwards of one in seven women and is associated with significant negative maternal and child consequences. Despite this, it remains under-detected and under-treated. We sought to identify clinician practices, self-efficacy, and remaining barriers to comprehensively addressing perinatal depression care.

Toxicology Testing in a Newborn ICU: Does Social Profiling Play a Role?

Objective: A rising incidence in maternal drug use during pregnancy has led to a concomitant rise in neonatal opioid withdrawal syndrome. Despite evidence that drug use during pregnancy affects all demographic groups equally, authors of recent studies have suggested that minority women are tested for drug use more than their counterparts. In this study, we aimed to assess whether toxicology testing of neonates was associated with maternal characteristics.

Racial differences in indications for obstetrical toxicology testing and relationship of indications to test results.

Background: Despite illicit substance use in pregnancy occurring across all demographic groups, minority pregnant and delivering patients with a low income tend to undergo testing at a higher rate than their counterparts. National guidelines for indications do not exist and ordering of toxicology testing may be applied inequitably.

Objective: This study aimed to evaluate whether any documented indications in a large cohort of patients were associated with a positive toxicology test and whether indications for urine toxicology testing were applied consistently to different demographic groups.

Safety and Tolerability of Repetitive Transcranial Magnetic Stimulation During Pregnancy: A Case Report and Literature Review.

Patients with neuropsychiatric disease may benefit from repetitive transcranial magnetic stimulation as a nonpharmacologic alternative to relieve symptoms of major depression, obsessive compulsive disorder, and perhaps other syndromes such as epilepsy. We present a case of repetitive transcranial magnetic stimulation treatment as an adjunct therapy for a patient experiencing refractory epileptic seizures during the third trimester of pregnancy. Notably, the patient tolerated repetitive transcranial magnetic stimulation well, without adverse events, and delivered a healthy child.

Association of Antenatal Depression with Clinical Subtypes of Preterm Birth.

Objective: To estimate the association between antenatal depression and spontaneous preterm birth (SPTB) relative to medically indicated preterm birth (MPTB).

Study Design: This was a secondary analysis of a nested case-control study of preterm birth (PTB). The exposure was a clinical diagnosis of antenatal depression.

Is There an Association between Body Mass Index and Cervical Length? Implications for Obesity and Cervical Length Management in Pregnancy.

 Obesity and cervical insufficiency are leading causes of morbidity in pregnancy. We assess the relationship between maternal body mass index (BMI) and second-trimester cervical length.  A secondary analysis of a nested case-control study of women with singleton gestations enrolled from 2006 to 2008.

Utilizing Longitudinal Measures of Fetal Growth to Create a Standard Method to Assess the Impacts of Maternal Disease and Environmental Exposure.

Impaired or suboptimal fetal growth is associated with an increased risk of perinatal morbidity and mortality. By utilizing readily available clinical data on the relative size of the fetus at multiple points in pregnancy, including delivery, future epidemiological research can improve our understanding of the impacts of maternal, fetal, and environmental factors on fetal growth at different windows during pregnancy. This study presents mean and standard deviation ultrasound measurements from a clinically representative US population that can be utilized for creating Z-scores to this end.

Evaluation of the sealing capability of implants to titanium and zirconia abutments against Porphyromonas gingivalis, Prevotella intermedia, and Fusobacterium nucleatum under different screw torque values.

Statement Of Problem: When evaluating long-term implant success, clinicians have always been concerned with the gap at the implant-abutment junction, where bacteria can accumulate and cause marginal bone loss. However, little information regarding bacterial leakage at the implant-abutment junction, or microgap, is available.

Purpose: The purpose of this study was to evaluate sealing at 2 different implant-abutment interfaces under different screw torque values.

Estimated fetal weight by ultrasound: a modifiable risk factor for cesarean delivery?

Objective: The purpose of this study was to investigate whether knowledge of ultrasound-obtained estimated fetal weight (US-EFW) is a risk factor for cesarean delivery (CD).

Study Design: Retrospective cohort from a single center in 2009-2010 of singleton, term live births. CD rates were compared for women with and without US-EFW within 1 month of delivery and adjusted for potential confounders.

Fetal bisphenol A exposure: concentration of conjugated and unconjugated bisphenol A in amniotic fluid in the second and third trimesters.

Bisphenol A (BPA) is an estrogenic compound widely used in polycarbonate plastics. The placental enzyme β-glucuronidase may deconjugate BPA into its "free" active form. We sought to quantify levels of conjugated and free BPA in second and third trimester amniotic fluid.

Determination of bisphenol-A levels in human amniotic fluid samples by liquid chromatography coupled with mass spectrometry.

Bisphenol A (BPA) is one of the environmental endocrine-disrupting chemicals used widely in common consumer products. There is an increasing concern about human exposure to BPA, particularly in fetuses, due to the potential adverse effects related to the estrogenic activity of BPA. In assessing environmental exposure to BPA, it is essential to have a sensitive, accurate, and specific analytical method, particularly for low BPA levels in complex sample matrices.

Hematologic disease in pregnancy: the obstetrician's perspective.

Pregnancy can be a time of significantly increased morbidity and mortality in women with hematologic disease. With careful planning and preparation, most women can be cared for safely, resulting in a healthy mother and child. Management concerns in each trimester are reviewed, with a particular focus on labor and delivery planning and common obstetric complications.

Protein:creatinine ratio in uncomplicated twin pregnancy.

Objective: Women with twin pregnancies may have higher rates of isolated proteinuria than do those with singletons. We compared protein-to-creatinine (P:C) ratios longitudinally through gestation in uncomplicated twin and singleton pregnancies.

Study Design: P:C ratios were compared at 3 times points in 102 (51 twins, 51 singletons) healthy gravid patients who did not have preeclampsia develop, using linear and logistic regression techniques.

Contemporary management of monochorionic diamniotic twins: outcomes and delivery recommendations revisited.

Objective: We sought to investigate outcomes of contemporaneously managed monochorionic diamniotic (MCDA) twins, stratified by pregnancy complication.

Study Design: Four hundred eighteen MCDA pregnancies from 2001 through 2008 were retrospectively reviewed.

Results: There were 236 ongoing pregnancies at 24 weeks' gestation.