associated with delivery via cesarean section in bivariate analysis and RESULTS: In both resident (n518) and nursing
t (n518) and nursing (n547) domains, new
remained a predictor. Mothers of neonates with extremes of birth
weights (, 2500, .4000 g) had higher odds of having a cesarean
delivery, compared to neonates with normal birth weight (OR 4.7
95%CI 2.3 9.4 and OR 4.6 95% CI 1.1 19.4).
CONCLUSION: Among adolescent nulliparous patients, birth
weight of the neonate was found to be a risk factor that places the
gravid teen at increased risk for cesarean delivery. Further research
with a greater sample size over a 10-year period is under way.
Financial Disclosure: The authors did not report any potential conflicts of
interest.
Etiologies and Risk Factors of Placental Abruption
and Neonatal Mortality: A Retrospective Study [6K]
Sarah Araji, MD
St. Josephs Regional Medical Center, Paterson, NJ
Aldo Khoury, MD, Deena Elkafrawi, and Jacob Miller
INTRODUCTION: Placental abruption is defined as bleeding at the
decidual-placental border leading to placental separation prior to
delivery of the fetus. Placental abruption is a significant cause of
maternal and perinatal mortality. In this retrospective study, we aim to
evaluate the correlation between various causes and risk factors of
placental abruption and neonatal mortality.
METHODS: A retrospective chart review of placental abruption
patients at SJRMC between 1986-1996 was conducted. Preeclampsia,
eclampsia, HELLP, CHTN, preterm labor and placenta previa were
recorded. Smoking, alcohol and cocaine use were assessed. Perinatal
morbidity was based on length of NICU stay; neonatal mortality was
defined as stillbirth or death.
RESULTS: Our sample size was 271 pregnant women with placental
abruption. Sixteen of 271 had HELLP (5.90%), 76 of 271 had
preeclampsia (28.0%), and 22 of 271 had CHTN (8.11%). Forty of
271 used cocaine (14.7%), 104 of 271 smoked (38.4%) and 45 of 271
used alcohol (16.6%). Nine of 271 pregnant women with placental
abruption had placental previa (3.32%). 37 of 271 infants were stillborn
(13.6%) and 44 of 271 were dead on discharge (16.2%). HELLP
syndrome was directly proportional to infant death (P50.026; 95% CI,
0.26 to 4.03). Preeclampsia was proportional to neonatal mortality
(P50.000); CHTN was statistically significant for neonatal mortality
(P50.0010). Cocaine and alcohol correlated with increased neonatal
mortality (P50.0057; P50.0220).
CONCLUSION: CHTN, HELLP, preeclampsia, and placenta previa
as causes of placental abruptions were found to be statistically
significant predictors of neonatal mortality. Smoking, cocaine and
alcohol use were directly proportional to neonatal mortality.
Financial Disclosure: The authors did not report any potential conflicts of
interest.
Evaluating Effect of New Secure Smartphone Texting
Tool in Obstetrics [7K]
Jacqueline Feinberg, MD
Yale School of Medicine, Yale-New Haven Hospital, New Haven, CT
Sara Shaw, RN, Nitu Kashyap, MD, Katherine Campbell, MD, MPH,
and Christian Pettker, MD
INTRODUCTION: As hospitals consider adopting HIPAA-
compliant smartphone-based messaging, it is necessary to determine
impact. Small studies found texting reliable and efficient, but insecure
for patient information. Literature is sparse on new HIPAA-compliant
texting, with no relevant studies in obstetrics. We evaluated a new
HIPAA-compliant texting system (MH-Cure by Mobile Heartbeat)
implemented in obstetrics at Yale-New Haven Hospital in 2016 for
perceived effect on care and workflow.
METHODS: Before implementation, surveyed residents and nurses
on effects of current communication system (pagers with text receiving,
service mobile phones, personal cellphones) on clinical workflow and
patient care. Following roll-out (1-month), teams were again surveyed
with same questions. Surveys used both 5-point Likert scale and open-
ended questions. Results compared using Student t-tests.
VOL. 129, NO. 5 (SUPPLEMENT), MAY 2017 Copyright by The American College of Obstetricians
and Gynecologists. Published by Wolters Kluwer Health, Inc.
Unauthorized reproduction of this article is prohibited.
communication tool was perceived to improve efficiency (improving
from no effect to moderately effective (Residents: p , .001, Nurses:
p , .001)) and enhance patient care (improving from minor negative
impact to minor positive impact (Residents: p , .001, Nurses: p ,
.001)). Qualitative results strongly favor two-way messaging (60% of
respondents mentioned) and indicate quick adoption (89% of respond-
ents using) with concerns regarding new systems impact and connec-
tivity during emergencies (35% of respondents mentioned).
CONCLUSION: New text-based communication tool does not
demonstrate subjective workflow interruptions, and may improve
efficiency and care. Despite significant shortcomings, even in first
month of implementation a system can demonstrate impactful benefits.
We recommend teams implementing new technologies for communi-
cation plan, test, and communicate strategies to avoid implementation
flaws during emergencies.
Financial Disclosure: The authors did not report any potential conflicts of
interest.
Evaluating Ethnic Differences in the Labor Curve in
Arabic Women: A Retrospective Cohort Study [8K]
Dorcas C. Morgan, MD
NYU Lutheran-Brooklyn Campus, Brooklyn, NY
Asmaa Al-Kadhi, MD
INTRODUCTION: Studies have described normal labor curves in
nulliparous and multiparous women. Few studies have attempted to
analyze data in regards to ethnicity. In this study we present the stages of
labor of Arabic women in a community hospital labor and delivery unit.
METHODS: We conducted a retrospective cohort study of term,
singleton, vertex, laboring Arabic women from 9/2014-7/2016.
Exclusion criteria: chorioamnionitis, multiple gestations, induction of
labor, non-identifiable ethnicity, previous cesarean desired TOL,
chromosomal abnormalities, IUFD and uterine surgery. Cervical
dilatation was recorded from admission to delivery.
RESULTS: 354 patients were included. 34.5% were nulliparous with
mean age 26.16 4.7 years and neonatal birth weight of 3195.96367.9 g.
38% had oxytocin. Mean cervical dilatation on admission was 4.2 6
1.8 cm; the median time from 6-10 cm was 5.5 hours. The median length
of second stage was 4.0 hours. 64.6% were multiparous with mean age
29.7 6 5.1 years and neonatal birth weight of 3344.5 6 406.3 g. 18.8%
had oxytocin. The mean cervical dilatation was 4.7 6 1.8 cm upon
admission, and the median time from 6-10 cm was 3.7 hours. The
median length of second stage was 2.1 hours.
CONCLUSION: In historical comparison to Friedmans nulliparous,
our nulliparous had a longer second stage and took our patient 5.8 h to
dilate from 4-10 cm compare to 4 h and 5.3 h in Friedmans and
Zhengs nulliparous respectively. Preliminary findings suggest standard
management of labor may not apply in this population. Ethnic specific
labor progression should be explored further.
Financial Disclosure: The authors did not report any potential conflicts of
interest.
Evaluating Severity of Postpartum Hemorrhage
Retrospectively Based on Risk Factors [9K]
Stephanie Amaya
University of Arizona COM-Phoenix, Phoenix, AZ
John Mattox, MD, Christina Tussey, MSN, CNS, RNCOB, RNC-MNN,
and Paul Kang, MPH
INTRODUCTION: Postpartum hemorrhage (PPH) is the leading
cause of maternal death worldwide. Currently, all patients receive
oxytocin in the third stage of labor to prevent PPH. Several studies
have identified risk factors for PPH secondary to uterine atony, but
with little evidence to support additional prophylaxis for patients with
these risk factors. Therefore, the objective of this study is to compare
risk factors to determine which cause a more severe PPH.
METHODS: Blood loss amount and risk factors were obtained
from medical records of patients diagnosed with PPH between
December 2011-to-December 2014 from Banner University Medical
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