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New Research Uses Nanotechnology to Prevent Preterm Birth, March of Dimes honors abstract on prematurity at SMFM Annual Meeting

ATLANTA, FEB. 4, 2016 ­­– Using nanoparticles to engineer a special drug, a team of researchers has demonstrated in mice a new way to both reduce preterm birth and avoid the risks of medication in pregnancy to unborn babies. Jerrie S. Refuerzo, M.D., of the McGovern Medical School at The University of Texas Health Science More »

Study Develops New Equation for Estimating Gestational Age

ATLANTA (Feb. 1, 2016)—In a study to be presented on Feb. 6 at 8:45 a.m. EST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting™, in Atlanta, researchers will present findings from a study titled, The NICHD Fetal Growth Studies: Development of a contemporary formula for estimating gestational age from ultrasound fetal biometrics. More »

Study Shows Time of Hospital Rounds for Postpartum Women Impacts Patient Satisfaction

ATLANTA (Feb. 1, 2016)—In a study to be presented on Feb. 6 at 8:45 a.m. EST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting™, in Atlanta, researchers will present findings from a study titled, Routine versus delayed timing of morning hospital rounds for postpartum women on patient satisfaction: A randomized quality improvement More »

Effectiveness of Influenza Vaccine for Pregnant Women May Differ by Trimester

ATLANTA (Feb. 1, 2016)—In a study to be presented on Feb. 5 in an oral concurrent session at 1:15 p.m. EST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting™, in Atlanta, researchers will present findings from a study titled, T-follicular helper (Thf) cell expansion varies by trimester after influenza vaccination in pregnancy. More »

Study on Use of Umbilical Cord vs. Biocellulose Film for Antenatal Spina Bifida Repair, Regenerative patch may improve neurological outcomes

ATLANTA (Feb. 1, 2016)—In a study to be presented on Feb. 5 in an oral plenary session at 8 a.m. EST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting™, in Atlanta, researchers will present findings from a study titled, Cryopreserved Human Umbilical Cord (HUC) vs. Biocellulose Film (BCF) for Antenatal Spina Bifida More »

Study Shows Increased Risk of Early Mortality in Women with Hypertensive Disease During Pregnancy

ATLANTA (Feb. 1, 2016)—In a study to be presented on Feb. 5 at 8 a.m. EST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting™, in Atlanta, researchers will present findings from a study titled, Long-term mortality risk following hypertensive disease of pregnancy (HDP). It has long been recognized that pregnancy puts considerable More »

Study Finds Maternal Intake of High Fructose Leads to Fetal Programming of Adult Obesity, Hypertension and Metabolic Dysfunction Especially in Female Offspring

ATLANTA (Feb. 4, 2016)—In a study to be presented on Feb. 5 in the oral session at 1:15 p.m. EST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting™, in Atlanta, researchers will present findings on the effects of antenatal exposure to a high fructose diet on the offspring’s development of metabolic syndrome-like phenotype and cardiovascular disease later in life.

The study, titled High fructose diet in pregnancy leads to fetal programming of hypertension, insulin resistance and obesity in adult offspring, randomly allocated either a fructose solution or water as the only drinking fluid for pregnant mice from first day of pregnancy through delivery. Offspring were then started on regular chow and evaluated after one year of life.  Percent of visceral adipose tissue was measured along with liver fat infiltrates using computed tomography, and blood pressure using a non-invasive monitor. Glucose tolerance testing was also performed and serum concentrations of glucose, insulin, triglycerides, total cholesterol, leptin and adiponectin were measured.

Maternal weight, pup number and average weight at birth were similar between the two groups. Male and female offspring born to mothers who received the fructose solution group had higher peak glucose compared with controls. Female offspring from the fructose group were heavier and had a higher percent of visceral adipose tissue, liver fat infiltrates, fasting homeostatic model assessment scores, higher serum concentrations of leptin and lower concentrations of adiponectin.

No significant differences in these parameters were noted in male offspring. Serum concentrations of triglycerides and total cholesterol were not different between the two groups or either gender.

“While this study was done in a mouse model, it is an important indicator of the effect of the mothers’ diet during pregnancy on the health of their children later in life,” explained Antonio Saad, M.D. with UTMB Galveston and the lead researcher of the study. “Through this study, we know that consuming high fructose during pregnancy putts the child at future risk for a variety of health conditions including obesity and the many complications it causes.”

The study concluded that, while maternal intake of high fructose leads to fetal programming of adult obesity, hypertension, and metabolic dysfunction—all of which risk factors for cardiovascular disease; limiting high fructose enriched diets in pregnancy may have a significant impact on long term health.

 

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A copy of the abstract is available at http://www.smfmnewsroom.org and below. For interviews please contact Vicki Bendure at Vicki@bendurepr.com 202-374-9259 (cell).

 

The Society for Maternal-Fetal Medicine (est. 1977) is the premiere membership organization for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine. The society is devoted to reducing high-risk pregnancy complications by sharing expertise through continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual meeting in which groundbreaking new ideas and research in the area of maternal-fetal medicine are shared and discussed.  For more information visit www.smfm.org.

 

Abstract 67    High Fructose Diet in Pregnancy Leads to Fetal Programming of Hypertension, Insulin Resistance and Obesity in Adult Offspring

 

Authors: Antonio Saad1, Joshua Disckerson1, Phyllis Gamble1, Huaizhi Yin1, Talar Kechichian1, Ashley Salazar1, Igor Patrikeev2, Massoud Motamedi2, George Saade1, Maged Costantine1

1UTMB Galveston, Galveston, TX, 2UTMB Center of Biomedical Engineering, Galveston, TX

 

Objective: Consumption of fructose rich diets in the U.S is on the rise and thought to be associated with obesity and cardio-metabolic diseases. Our objective was to determine the effects of antenatal exposure to high fructose diet on offspring’s development of metabolic syndrome-like phenotype and other cardiovascular disease (CVD) risk factors later in life.
Study Design: Pregnant C57BL/6J dams were randomly allocated to fructose solution (FRC, 10% W/V, n=10) as only drinking fluid or water (CTR, n=10) from day 1 of pregnancy until delivery. Pups were then started on regular chow, and evaluated at 1 year of life. We measured % visceral adipose tissue (VAT) and liver fat infiltrates using computed tomography (CT), and blood pressure using CODA/ non-invasive monitor. Intraperitoneal glucose tolerance testing (IPGTT), with corresponding insulin concentrations were obtained. Serum concentrations of glucose, insulin, triglycerides (TG), total cholesterol (TC), leptin, and adiponectin were measured in duplicate using standardized assays. Fasting homeostatic model assessment (HOMA- IR) was also calculated to assess insulin resistance.
Results: Maternal weight, pup number and average weight at birth were similar between the two groups. Male and female FRC offspring had higher peak glucose and area under the IPGTT curve, compared with CTR (Figures 1A&B), and higher mean arterial pressure compared to CTR (Figure 1C). Female FRC offspring were heavier and had higher % VAT (Figure 1D), liver fat infiltrates, HOMA-IR scores, insulin area under the IPGTT curve, serum concentrations of leptin, and lower concentrations of adiponectin compared to female CTR offspring (Table). No significant differences in these parameters were noted in male offspring. Serum concentrations of TG or TC were not different between the 2 groups for either gender.
Conclusion: Maternal intake of high fructose leads to fetal programming of adult obesity, hypertension and metabolic dysfunction, all risk factors for CVD. This fetal programming is more pronounced in female offspring. Limiting intake of high fructose enriched diets in pregnancy may have significant impact on long term health.

 

Abstract 67a

Abstract 67b

Study Shows Maternal Diet Alters the Breast Milk Microbiome and Microbial Gene Content

ATLANTA (Feb. 1, 2016)—In a study to be presented on Feb. 5 at 2:30 p.m. EST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting™, in Atlanta, researchers will present findings from a study titled, Maternal Diet Alters the Breast Milk Microbiome and Microbial Gene Content.

Breast milk contains a diverse microbiome that is presumed to colonize the infant gastrointestinal tract and contribute to the establishment of the infant gut microbiome. The composition of the breast milk microbiome varies over time and among individuals, though the factors driving the variation are largely unknown. Since maternal diet during gestation and lactation has been previously shown to independently alter the offspring microbiome and offspring disease susceptibility, researchers speculated that the breast milk microbiome may be a mediator of this dietary impact. Two groups of lactating women participated in highly-controlled single-blinded cross-over dietary intervention studies to evaluate if maternal diet plays a significant role in structuring the taxonomic and metagenomic composition of the breast milk microbiome.

“We saw considerable differences based on maternal diet,” explained Kristen Meyer, with the Baylor College of Medicine, one of the researchers of the study and the presenter at the SMFM annual meeting. “Based on this, we speculate that the maternal diet serves as a significant driver of the early infant microbiome, reinforcing the gestational dietary impact,” added Meyer.

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A copy of the abstract is available at http://www.smfmnewsroom.org and below. For interviews please contact Vicki Bendure at Vicki@bendurepr.com 202-374-9259 (cell).

 

The Society for Maternal-Fetal Medicine (est. 1977) is the premiere membership organization for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine. The society is devoted to reducing high-risk pregnancy complications by sharing expertise through continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual meeting in which groundbreaking new ideas and research in the area of maternal-fetal medicine are shared and discussed.  For more information visit www.smfm.org.

 

abstract 66

New Research Uses Nanotechnology to Prevent Preterm Birth, March of Dimes honors abstract on prematurity at SMFM Annual Meeting

ATLANTA, FEB. 4, 2016 ­­– Using nanoparticles to engineer a special drug, a team of researchers has demonstrated in mice a new way to both reduce preterm birth and avoid the risks of medication in pregnancy to unborn babies.

Jerrie S. Refuerzo, M.D., of the McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) was frustrated with the limitations of existing tocolytic (anti-contraction or labor-repressant) medications such as indomethacin in treating women experiencing preterm labor. These drugs can cross the placental barrier and cause a heart defect or other problems in the fetus. Dr. Refuerzo and Monica Longo, M.D., Ph.D. (UT Health), in collaboration with colleagues from Houston Methodist Research Institute, Biana Godin, PharmD, Ph.D., bioengineered an innovative microscopic nanoparticle of indomethacin aimed at reaching the pregnant uterus but not crossing the placenta to the fetus. This targeted liposomal indomethacin, called LIPINDORA, was coated with an oxytocin receptor antagonist to make it bind to uterine tissue.

LIPINDORA was given to near-term pregnant mice and the researchers found that the treated mice were significantly less likely than controls to have preterm uterine contractions or to deliver prematurely.

“These findings are exciting because we don’t currently have any medication that can reliably stop contractions or prevent preterm birth without also crossing the mom’s placenta and causing risks to babies,” explained Edward R. B. McCabe, M.D., Ph.D,, senior vice president and chief medical officer of the March of Dimes.

Preterm birth (birth before 37 weeks of pregnancy) is the number one killer of babies in the United States.

About 380,000 babies are born too soon each year in this country, and those who survive an early birth often face an increased risk of a lifetime of health challenges, such as breathing problems, cerebral palsy, intellectual disabilities and others. Even babies born just a few weeks early have higher rates of hospitalization and illness than full-term infants.

Dr. McCabe said nanoparticles are a leading-edge technology also being studied for delivery of drugs for other conditions, such as cancer, heart disease, and bacterial infections, in order to target specific cells to reduce toxicity and side effects of those medications and to make them more effective. Nanoparticles range 100-200 nanometers in diameter and a nanometer is one billionth of a meter. To demonstrate scale: a nanometer is to a tennis ball as a tennis ball is to the earth.

Dr. Refuerzo and her team, F. Leonard, A. E. Ontiveros, N. Buleyeva, Biana Godin, and Monica Longo, are being honored by the March of Dimes at the annual Society for Maternal-Fetal Medicine. Joe Leigh Simpson, M.D., senior vice president for Research and Global Programs, will present Dr. Refuerzo with the March of Dimes award for Best Abstract in Prematurity at the SMFM’s Annual Meeting. 2016 marks the 13th year that the March of Dimes award has been presented.

Dr. Refuerzo said the team currently is conducting tests of LIPINDORA’s effectiveness in human uterine tissue donated from C-sections. They’re looking for biomarkers to indicate that the tissue has an anti-contraction response to the drug. If successful, they hope to begin a Phase I human clinical trial of the drug within the next few years.

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The Society for Maternal-Fetal Medicine (est. 1977) is the premiere membership organization for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine. The society is devoted to reducing high-risk pregnancy complications by sharing expertise through continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual meeting in which groundbreaking new ideas and research in the area of maternal-fetal medicine are shared and discussed. For more information visit www.smfm.org.

The March of Dimes is the leading nonprofit organization for pregnancy and baby health. For more than 75 years, moms and babies have benefited from March of Dimes research, education, vaccines, and breakthroughs. Find out how you can help prevent premature birth and birth defects by joining March for Babies at marchforbabies.org. For the latest resources and information, visit marchofdimes.org or nacersano.org. Find us on Facebook and Twitter.

Study Develops New Equation for Estimating Gestational Age

ATLANTA (Feb. 1, 2016)—In a study to be presented on Feb. 6 at 8:45 a.m. EST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting™, in Atlanta, researchers will present findings from a study titled, The NICHD Fetal Growth Studies: Development of a contemporary formula for estimating gestational age from ultrasound fetal biometrics.

Accurate assessment of gestational age is an important variable affecting perinatal morbidity and mortality. The most commonly used formula for estimating gestational age has been Hadlock’s formula which uses biparietal diameter, head circumference, femur length and abdominal circumference. If gestational age is not accurately estimated, induction of labor may be performed inappropriately. A smaller premature fetus may be thought to have fetal growth restriction and undergo induction of labor, which can produce prematurity. A fetus wrongly thought to be post term may also undergo induction of labor, which is an unnecessary intervention. It is important to accurately estimate gestational age.

Researchers used fetal biometric data from the National Institute of Child Health and Human Development Fetal Growth Studies. They sought to develop and validate a new gestational age estimation equation and compare its accuracy to Hadlock formula created in 1984.

Healthy women from four racial/ethnic groups comprised of 614 (26%) non-Hispanic whites, 611 (26%) non-Hispanic blacks, 649 (28%) Hispanics and 460 (20%) Asians. All were low-risk for altered fetal growth and reported a sure last menstrual period, underwent serial ultrasound every four weeks starting at an average of 19.7 weeks.

Biparietal diameter (BPD) which is one of the basic biometric parameters to assess fetal size, abdominal circumference (AC), femur length (FL) and head circumference (HC) were used to develop a formula for estimating gestational age.  The formula was validated using 50% training and test set paradigm; a 50% random sample was used to develop the predictor and the remaining 50% was used to evaluate predictive accuracy. This procedure was run one thousand times and the predictive accuracy measures averaged. Comparative formula accuracies were assessed using the standard deviation of prediction derived from the predicted versus actual population gestational ages.

Daniel W. Skupski, M.D., one of the researchers of the study who is with New York Presbyterian Queens in Flushing, N.Y. and will present the findings said, “We have developed and validated a new equation for estimating gestational age from fetal biometrics measured between 14 and 22 weeks gestational age using a multi-racial/ethnic population, certified sonographers and modern ultrasound units.”  The study shows a slight improvement in this newly developed formula over the traditional Hadlock with accuracy of less than nine days versus less than 10 days for Hadlock.  It also validates the establishment of this new formula in a large, high-quality multi-center study.

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A copy of the abstract is available at http://www.smfmnewsroom.org and below.  For interviews please contact Vicki Bendure at Vicki@bendurepr.com 202-374-9259 (cell).

The Society for Maternal-Fetal Medicine (est. 1977) is the premiere membership organization for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine.  The society is devoted to reducing high-risk pregnancy complications by sharing expertise through continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual meeting in which groundbreaking new ideas and research in the area of maternal-fetal medicine are shared and discussed.  For more information visit www.smfm.org.

Abstract 105  The NICHD Fetal Growth Studies: Development of a contemporary formula for estimating gestational age from ultrasound fetal biometrics

Authors: Daniel W. Skupski1, John Owen2, Sungduk Kim3, Paul Albert3, Katherine Laughon Grantz3

1New York Presbyterian Queens, Flushing, NY, 2University of Alabama at Birmingham, Birmingham, AL, 3Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD

Objective: Using fetal biometric data from the NICHD Fetal Growth Studies, we sought to develop and validate a new gestational age (GA) estimation equation and compare its accuracy to a commonly used formula (Hadlock 1984).

Study Design: Healthy women from 4 racial/ethnic groups who were low-risk for altered fetal growth and reported a sure LMP confirmed by CRL at <14+0 weeks, underwent serial ultrasound every 4 weeks, starting at an average of 19.7 weeks, using study-certified sonographers. Project EDC was based on the LMP date+280 days. Linear regression with BPD, AC, FL and HC and product terms were used to develop a formula for estimating GA. The formula was validated using 50% training and test set paradigm; a 50% random sample was used to develop the predictor and the remaining 50% was used to evaluate predictive accuracy. This procedure was run 1,000 times and the predictive accuracy measures averaged. Comparative formula accuracies were assessed using the standard deviation (SD) of prediction derived from the predicted versus actual population GA’s.

Results: The study population comprised: 614 (26%) non-Hispanic Whites, 611 (26%) non-Hispanic Blacks, 649 (28%) Hispanics, and 460 (20%) Asians. The best-fit formula was: GA=7.85-0.127*BPD+0.07304*HC+0.00638*AC+0.122*FL+0.000685*BPD*AC-0.00015*HC*AC; validation confirmed a SD of 4.57 days (2SDs=9.14 days). The SD of the Hadlock 1984 formula was 5.06 days (2 SDs=10.12 days). Figure 1 shows the observed versus the predicted GA for the best-fit formula.

Conclusion: We have developed and validated a new equation for estimating GA from fetal biometrics measured between 14 and 22 weeks’ gestational age using a multi-racial/ethnic population, certified sonographers and modern ultrasound units. Sonography confirms the best GA with accuracy of ≤ 9 days. Our study shows a slight improvement in our newly developed formula over the traditional Hadlock formula (accuracy ≤ 10 days) and validates this established formula in a large high-quality multi-center study.

Abstract 105

Study Shows Time of Hospital Rounds for Postpartum Women Impacts Patient Satisfaction

ATLANTA (Feb. 1, 2016)—In a study to be presented on Feb. 6 at 8:45 a.m. EST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting™, in Atlanta, researchers will present findings from a study titled, Routine versus delayed timing of morning hospital rounds for postpartum women on patient satisfaction: A randomized quality improvement trial.

While it is convenient for physicians to have early morning hospital rounds so that they can handle other clinical duties including seeing patients in-office, it is not always convenient for postpartum hospital patients who often face sleep disruption and inadequate communication.

The study looked at 152 women with similar maternal demographics and clinical characteristics, except that delivery mode differed. More women had cesarean delivery in the routine.  The women were all under the care of a university-based obstetrics/gynecology faculty practice and delivered at a tertiary care medical center. They were randomly allocated to either routine rounding (4-7 a.m.) or delayed physician rounding (after 8 a.m.) from postpartum day one until discharge. Women with medical conditions or delivery complications that precluded the ability to delay rounding were excluded. On day of discharge, research staff blinded to rounding group distributed a standardized survey that included questions regarding physician communication and hospital experience.

The result was that postpartum women who received delayed physician rounding were more satisfied with physician communication and overall hospital experience without prolonging their hospital stay or time of discharge.

“This simple study indicates that physicians should be more cognizant of the hours they perform their rounds with healthy postpartum patients,” stated Robyn P. Roberts, M.D.  Roberts, with the University of Texas Medical School at Houston was researcher on the study and will present the study this week at the SMFM annual meeting.  “By just moving rounds later in the morning, patient satisfaction can be significantly improved,” added Roberts.

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A copy of the abstract is available at http://www.smfmnewsroom.org and below.  For interviews please contact Vicki Bendure at Vicki@bendurepr.com 202-374-9259 (cell).

The Society for Maternal-Fetal Medicine (est. 1977) is the premiere membership organization for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine.  The society is devoted to reducing high-risk pregnancy complications by sharing expertise through continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual meeting in which groundbreaking new ideas and research in the area of maternal-fetal medicine are shared and discussed.  For more information visit www.smfm.org.

Abstract 84:   Routine versus delayed timing of morning hospital rounds for postpartum women on patient satisfaction: A randomized quality improvement trial

Authors: Robyn P. Roberts1, Sean C. Blackwell1, Kelly M. Brown1, Baha M. Sibai1, Jon E. Tyson1

1UT Health-University of Texas Medical School at Houston, Houston, TX

Objective: Early morning physician rounding is a part of traditional hospital culture. Benefits include early patient discharge as well as physician convenience to begin other clinical duties. Potential disadvantages include inadequate communication and sleep disruption. The objective of this study was to determine whether timing of physician rounding of postpartum women impacts patient satisfaction.

Study Design: Women under the care of a university-based OB/GYN faculty practice who delivered at a tertiary care medical center were randomly allocated to either routine rounding (4 – 7am) or delayed physician rounding (after 8 am) from postpartum day 1 until discharge. Women with medical conditions or delivery complications that precluded the ability to delay rounding were excluded. On day of discharge, research staff blinded to rounding group distributed a standardized survey that included questions regarding physician communication and hospital experience. Based on delivery volumes, we planned to conduct the study over a pre-defined two month period. We estimated that the study would require 74 total subjects (N=37 per group) to detect a 20% difference in overall rating of the hospital (0-10 score) between groups (assumption P=0.05 and power 90%).

Results: 152 women participated in the study (N= 76 routine rounding; N= 76 delayed rounding). Maternal demographics and clinical characteristics were similar between groups except for delivery mode. More women had cesarean delivery in the routine compared to delayed rounding group (47.4% vs. 22.4%). Patient satisfaction scores were improved not only for quality of physician communication, but also for hospital experience and overall hospital rating (see Table). Adjustment for delivery mode with linear regression did not alter the findings (p < 0.001). There were no differences between groups in timing of maternal discharge occurring after 10 am (25% routine vs. 30.3% delayed; p=0.47) or timing of neonatal discharge after 10 am, 94.7% vs. 90.8% (p=0.35).

Conclusion: Postpartum women who received delayed physician rounding were more satisfied with physician communication and overall hospital experience without prolonging their hospital stay or time of discharge.

 Abstract 84

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