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5. Contemporary Test Performance of the Random Urine Protein-to-creatinine Ratio.

Author

Champion, Macie L., Becker, David A., McIlwraith, Claire, Blanchard, Christina T., Szychowski, Jeff M., Kim, Dhong-Jin, Jauk, Victoria C., Harper, Lorie M., Casey, Brian M., and Tita, Alan T.

Subjects
PROTEINURIA diagnosis, PROTEINS, PREDICTIVE tests, PEARSON correlation (Statistics), CREATININE, RECEIVER operating characteristic curves, RETROSPECTIVE studies, LONGITUDINAL method, HYPERTENSION in pregnancy, PREGNANCY complications, URINE collection & preservation, CONFIDENCE intervals, REGRESSION analysis, SENSITIVITY & specificity (Statistics), PREGNANCY
Abstract

Objective The random urine protein-to-creatinine ratio (UPCR) is a screening test used for predicting clinically significant proteinuria (urine protein ≥ 300 mg) during pregnancy. No consensus exists on the optimal random UPCR cutoff for performing follow-up 24 hour urine (24H) total protein collection. We aim to evaluate the test performance of random UPCR in predicting proteinuria in a contemporary cohort. Study Design This was a retrospective cohort study of pregnant patients at our institution from 2014 to 2018 with a random UPCR and follow-up 24H protein collection. The primary analysis estimated the test characteristics (sensitivity, specificity, positive and negative predictive values) of using random UPCR for the detection of proteinuria defined as urine protein ≥300 mg on 24H protein collection. UPCR cutoffs from 0.10 to 0.30 mg/dL were evaluated, receiver operator characteristic (ROC) curve was constructed, and area under the curve (AUC) was determined. A secondary analysis examined the correlation between UPCR and 24H protein using least squares regression and Pearson correlation. Results Paired UPCR and 24H collection results were available for 1,120 patients. Mean gestational age at time of UPCR was 31.1 ± 5.1 weeks and 687 (61.3%) of patients had a 24H ≥300 mg. UPCR <0.10 mg/dL effectively excluded proteinuria ≥300 mg on 24H collection, while UPCR ≥0.18 mg/dL correctly classifies proteinuria with 91% sensitivity, 57% specificity, 77% positive predictive value, and 79% negative predictive value. UPCR ≥1.07 mg/dL had 100% specificity for 24 hour proteinuria. The area under ROC curve was 0.86. UPCR and 24H collection were highly correlated with a Pearson correlation coefficient of 0.85. After our institution lowered the threshold to obtain a 24H from UPCR ≥0.20 mg/dL to ≥0.10 mg/dL in May 2017, the percentage of patients meeting criteria for 24H collection increased from 57.8 to 84.4%. Conclusion The AUC and Pearson correlation suggest random UPCR is a high performance test for the prediction of proteinuria on 24H. Optimal test performance is dependent upon clinical consideration and upon the implications of the disease or condition. A random UPCR screen positive threshold of 0.18 mg/dL maximizes sensitivity to identify clinically significant proteinuria. Key Points Random urine protein to creatinine ratio is a high performance test for proteinuria. A random UPCR threshold of 0.18 mg/dL maximizes sensitivity to identify proteinuria. Optimal test performance is dependent on the disease or clinical condition. [ABSTRACT FROM AUTHOR]

Published
2024
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12. Outcomes in low-risk patients before and after an institutional policy offering 39-week elective induction of labor

Author

Cozzi-Glaser, Gabriella D., primary, Blanchard, Christina T., additional, Stanford, Jenna N., additional, Oben, Ayamo G., additional, Jauk, Victoria C., additional, Szychowski, Jeff M., additional, Subramaniam, Akila, additional, Battarbee, Ashley N., additional, Casey, Brian M., additional, Tita, Alan T., additional, and Sinkey, Rachel G., additional

Published
2023
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13. Predicting peripartum infection in laboring patients at high risk in Cameroon, Africa

Author

Cozzi, Gabriella D, primary, Ye, Yuanfan, additional, Mbah, Rahel, additional, Mbunwe, Doreen M, additional, Pekwarake, Seraphine, additional, Yui Bunwi, Edwan, additional, Fondzeyuf, Anthony, additional, Ngong, Mary G, additional, Dionne, Jodie A, additional, Harper, Lorie M, additional, Jauk, Victoria C, additional, Carlo, Waldemar A, additional, HALLE-EKANE, Gregory, additional, TIH, Pius M, additional, SZYCHOWSKI, Jeff M, additional, TITA, Alan T, additional, and SUBRAMANIAM, Akila, additional

Published
2023
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14. Single Dose of Oral Azithromycin With or Without Amoxicillin to Prevent Peripartum Infection in Laboring, High-Risk Women in Cameroon: A Randomized Controlled Trial

Author

Subramaniam, Akila, Ye, Yuanfan, Mbah, Rahel, Mbunwe, Doreen M., Pekwarake, Seraphine, Bunwi, Edwan Yui, Fondzeyuf, Anthony, Ngong, Mary G., Dionne-Odom, Jodie, Harper, Lorie M., Jauk, Victoria C., Carlo, Waldemar A., Halle-Ekane, Gregory, Szychowski, Jeff M., Tih, Pius, and Tita, Alan T.

Published
2021
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22. Outpatient Foley Catheter for Induction of Labor in Obese Nulliparous Patients: A Secondary Analysis of OFFSITE II Randomized Controlled Trial

Author

Seasely, Angela R., additional, Xue, Yumo, additional, Ausbeck, Elizabeth B., additional, Jauk, Victoria C., additional, Blanchard, Christina T., additional, Files, Pamela, additional, Kuper, Spencer C., additional, Casey, Brian M., additional, Szychowski, Jeff M., additional, Harper, Lorie M., additional, Tita, Alan T., additional, and Subramaniam, Akila, additional

Published
2022
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24. In Reply

Author

Kuper, Spencer G., Jauk, Victoria C., Edwards, Rodney K., and Harper, Lorie M.

Published
2018
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27. Outpatient Foley Catheter for Induction of Labor in Obese Nulliparous Patients: A Secondary Analysis of OFFSITE II Randomized Controlled Trial.

Author

Seasely, Angela R., Xue, Yumo, Ausbeck, Elizabeth B., Jauk, Victoria C., Blanchard, Christina T., Files, Pamela, Kuper, Spencer C., Casey, Brian M., Szychowski, Jeff M., Harper, Lorie M., Tita, Alan T., and Subramaniam, Akila

Subjects
OBESITY, LENGTH of stay in hospitals, RESEARCH, INDUCED labor (Obstetrics), RETROSPECTIVE studies, URINARY catheters, DESCRIPTIVE statistics, BODY mass index, SECONDARY analysis
Abstract

Objective In the OFFSITE II randomized controlled trial, outpatient cervical ripening with a Foley catheter (CF) in nulliparous patients undergoing elective induction of labor (eIOL) shortened the time from admission to delivery. Given that patients with obesity have protracted labor and higher rates of failed IOL, we sought to determine if outpatient ripening with a CF may be even more beneficial for this high-risk group. Study Design We performed a secondary analysis of the OFFSITE II randomized controlled trial. For this analysis, all patients from the primary trial were classified by their intervention assignment (inpatient vs. outpatient) and also by their admission body mass index (BMI) class (BMI ≥ 30 and BMI < 30 kg/m 2). The primary outcome was time from labor and delivery (L&D) admission to delivery. Secondary outcomes included cesarean delivery, time from admission to hospital discharge, and rates of clinically diagnosed chorioamnionitis and endometritis. Results In patients with BMI ≥ 30, the primary outcome, time from admission to delivery, (18.0 [13.5–20.9] vs. 20.4 [16.6–31.3] hours, p = 0.01), as well as total hospitalization length (3.2 [2.5–3.3] vs. 3.4 [3.1–4.3] days, p = 0.02) were shorter in the outpatient group. There were no differences in rates of chorioamnionitis or endometritis in outpatient compared with inpatient CF. Furthermore, in those with a BMI ≥ 30, the cesarean rate was significantly lower with outpatient CF (19.4% vs. 44.7%, p = 0.03); it was not statistically different in patients with BMI < 30. Conclusion In this exploratory retrospective secondary analysis of the OFFSITE II randomized control trial, we found that in patients with BMI ≥ 30 undergoing eIOL, outpatient CF was associated with a lower time from L&D admission until delivery. This was also associated with a shorter time of total hospital duration and decreased the rate of cesarean, a benefit not detected in the overall analysis presented in the primary study. In nulliparas undergoing induction of labor, ripening with outpatient cervical Foley may even more significantly reduce labor duration, total hospital duration, and the rate of cesarean in patients with obesity. Key Points Outpatient CF was associated with a lower time from L&D admission until delivery in obese nulliparas. Outpatient CF was associated with a shorter time of total hospital duration in obese nulliparas. Outpatient CF was associated with a decreased rate of cesarean birth in obese nulliparas. [ABSTRACT FROM AUTHOR]

Published
2023
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29. Timing of Maternal Discharge after Cesarean Delivery and Risk of Maternal Readmission

Author

Oben, Ayamo, additional, Perez, William, additional, Jauk, Victoria C., additional, Boggess, Kim, additional, Clark, Erin, additional, Saade, George, additional, Esplin, M Sean, additional, Longo, Sherri, additional, Cleary, Kirsten L., additional, Wapner, Ronald, additional, Blackwell, Sean C., additional, Owens, Michelle Y., additional, Ambalavanan, Namasivayam, additional, Szychowski, Jeff M., additional, and Tita, Alan, additional

Published
2022
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32. Predicting Postpartum Hemorrhage in Laboring Patients in Cameroon, Africa

Author

Dunk, Sarah A., primary, Ye, Yuanfan, additional, Cozzi, Gabriella D., additional, Mbah, Rahel, additional, Mbunwe, Doreen M., additional, Pekwarake, Seraphine, additional, Bunwi, Edwan, additional, Fondezeyuf, Anthony, additional, Ngong, Mary G., additional, Dionne-Odom, Jodie, additional, Harper, Lorie M., additional, Jauk, Victoria C., additional, Carlo, Waldemar A., additional, Halle-Ekane, Gregory, additional, Tih, Pius M., additional, Szychowski, Jeff M., additional, Tita, Alan T., additional, and Subramaniam, Akila, additional

Published
2022
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33. Predicting peripartum infection in laboring patients at high risk in Cameroon, Africa

Author

Cozzi, Gabriella D., primary, Ye, Yuanfan, additional, Mbah, Rahel, additional, Mbunwe, Doreen M., additional, Pekwarake, Seraphine, additional, Bunwi, Edwan, additional, Fondzeyuf, Anthony, additional, Ngong, Mary G., additional, Dionne-Odom, Jodie, additional, Harper, Lorie M., additional, Jauk, Victoria C., additional, Carlo, Waldemar A., additional, Halle-Ekane, Gregory, additional, Tih, Pius M., additional, Szychowski, Jeff M., additional, Tita, Alan T., additional, and Subramaniam, Akila, additional

Published
2022
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43. Skin preparation type and post-cesarean infection with use of adjunctive azithromycin prophylaxis.

Author

Ausbeck, Elizabeth B., Jauk, Victoria C., Boggess, Kim A., Saade, George, Longo, Sherri, Esplin, Sean, Cleary, Kirsten, Wapner, Ronald, Letson, Kellett, Owens, Michelle, Blackwell, Sean, Ambalavanan, Namasivayam, Szychowski, Jeff M., Andrews, William, and Tita, Alan T. N.

Abstract

To compare the frequency of postoperative surgical site infection (SSI) by type of skin preparation used for unscheduled cesarean in the setting of adjunctive azithromycin prophylaxis. Secondary analysis of a multi-center randomized controlled trial of adjunctive azithromycin (500 mg intravenous) versus placebo in women who were ≥24 weeks gestation and undergoing unscheduled cesarean (i.e. during labor or ≥4 h after membrane rupture). Type of skin preparation used was identified based on the protocol at the hospital at the time of delivery: iodine-alcohol, chlorhexidine, chlorhexidine-alcohol, or the combination of chlorhexidine-alcohol and iodine. The primary outcome of this analysis was incidence of post-operative SSI, as defined by CDC criteria. Multivariable logistic regression was applied for adjustments. All 2013 women in the primary trial were included in this analysis. Women were grouped according to type of skin preparation received: iodine-alcohol (n = 193), chlorhexidine (n = 733), chlorhexidine-alcohol (n = 656), and chlorhexidine-alcohol and iodine combined sequentially (n = 431). The unadjusted rates of wound infection ranged from 2.9% to 5.7%. Using iodine-alcohol as the referent, the adjusted odds ratios for wound SSI were 0.71 (95% CI 0.30–1.66) for chlorhexidine, 0.97 (95% CI 0.41–2.28) for chlorhexidine-alcohol, and 0.88 (95% CI 0.36–2.20) for chlorhexidine-alcohol with iodine combination. In women undergoing unscheduled cesarean delivery in a trial of adjunctive azithromycin, the type of skin preparation used did not appear to be associated with the frequency of wound SSI. [ABSTRACT FROM AUTHOR]

Published
2022
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44. 341 Outpatient cervical ripening with foley catheter for elective induction of labor (eIOL) in obese nulliparas

Author

Seasely, Angela R., primary, Xue, Yumo, additional, Ausbeck, Elizabeth B., additional, Jauk, Victoria C., additional, Blanchard, Christina T., additional, Files, Pamela, additional, Kuper, Spencer, additional, Casey, Brian M., additional, Szychowski, Jeff M., additional, Harper, Lorie M., additional, Tita, Alan, additional, and Subramaniam, Akila, additional

Published
2021
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47. Patient Satisfaction with Outpatient Cervical Ripening in Parous Women

Author

Wang, Michelle J., additional, Jauk, Victoria C., additional, George, David M., additional, Kuper, Spencer G., additional, Edwards, Rodney K., additional, Szychowski, Jeff M., additional, Mazzoni, Sara E., additional, Files, Pamela, additional, Tita, Alan T., additional, Subramaniam, Akila, additional, and Harper, Lorie M., additional

Published
2020
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