Improving The Continuity Of Care For Opioid Use Disorder: Investigating Fentanyl Overdose Outcomes And Pharmacy-Level Buprenorphine Access, Lyn Yuen Choo

Graduate Theses, Dissertations, and Problem Reports (ETD)

Opioid overdose (OD) deaths remain a leading cause of injury-related death in the United States (US) and approximately 76,516 drug OD deaths were predicted in the past year prior to April 2025. While previous research has focused on fatal opioid ODs, less is known about outcomes following non-fatal opioid ODs (NFOO) involving fentanyl. Patients who experienced a fentanyl OD may develop significant morbidity and inpatient mortality due to fentanyl’s high potency, rapid onset of action, and decreased response to naloxone. Research efforts to improve continuity of care for opioid use disorder (OUD) are highly needed to ensure appropriate follow-up care …

Effects Of An Early-Onset Hfd On Hepatic Functioning In A 3xtg Model Of Ad, Matthias Hirst

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Approximately 1 billion people currently live with obesity. Driven by factors such as a high-fat diet (HFD), this pathology can have drastic effects throughout the body, with the liver in particular being a main target of its downstream consequences. Although it is capable of storing lipids, excess fat can conglomerate in the liver and contribute to various hepatic pathologies. A specific pattern of hepatic dysfunction seen in response to an HFD is increased acetylation of mitochondrial proteins. Further, expression and activity of insulin-degrading enzyme (IDE), involved in the degradation of Aβ, are altered in response to an HFD. Aβ …

Evaluation Of Finger-Tightening Torque Applied To Implant Healing Abutments By Dental Providers With Varying Experience And Physical Characteristics: An In-Vitro Study., Bayan Abuhalimeh

Graduate Theses, Dissertations, and Problem Reports (ETD)

Aim: The primary objective of this project is to measure the actual torque applied by dental providers when finger-tightening a healing abutment and assess the variability among individuals. A secondary objective is to analyze the correlation between applied torque and: provider experience level (residents, general dentist, specialist); gender; age; and, physical attributes (e.g., grip strength, hand size, and dominant hand used for tightening). The null hypothesis is that there is no difference in the mean finger-tightening among the three groups of dental providers, and there are no significant differences in torque values among practitioners based on demographic and professional variables. …

Effectiveness Of Occupational Therapy-Inspired Educational Sessions For Mothers Accessing Women, Infants, And Children (Wic) Services, Samantha Annette Merew

Graduate Theses, Dissertations, and Problem Reports (ETD)

This doctoral capstone project examined the effectiveness of occupational therapy (OT)-inspired group and one-on-one educational sessions designed to support the emotional, mental, and social well-being of pregnant and postpartum mothers accessing Women, Infants, and Children (WIC) services in Onslow County, North Carolina. Grounded in the Model of Human Occupation and Cognitive Behavioral Frame of Reference, the program aimed to address gaps in holistic maternal health support, particularly among low-income and at-risk populations. Eight structured group sessions and five one-on-one sessions were developed, implemented, and evaluated, focusing on topics such as stress management, emotional regulation, self-care, role transition, and self-advocacy. A …

Comparison Of Three Methods In Diagnosing Maxillary Transverse Discrepancy, Madison Hull Smith

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction

There are several different methods in determining the maxillary transverse discrepancy (MTD). In specific, MTD can be determined with the help of a cone beam computer tomography (CBCT), 3D scan and models, or simply a 2D occlusogram.  Do they provide the same MTD values for diagnosing transverse discrepancies? A patient may need a certain amount of skeletal and dental expansion based on a diagnosis of MTD, but this amount may vary depending on the diagnosis method used. There is a lack of knowledge in the literature comparing 2D and 3D methods in determining MTD. Currently, methods in measuring MTD …

A Prospective Analysis Of Success And Survival Of Haptic Robotically Driven Dental Implant Placement., Samuel Clarkman Smith

Graduate Theses, Dissertations, and Problem Reports (ETD)

Purpose: The aim of this prospective study was to assess survivability of dental implants placed using robotic computer aided implant surgery via Yomi® (Neocis, Inc. Miami, FL) after at least 1 year of functional loading. Secondary analysis included additional success and marginal bone loss outcomes after at least 1 year of functional loading of the same Straumann (Basel, Switzerland) titanium dental implants that were placed with the r-CAIS workflow. Materials and Methods: Since acquisition of the Yomi® robotic system, a comprehensive list of patients who underwent dental implant therapy via r-CAIS methodology at West Virginia University Department of Graduate Periodontics …

Comparative Evaluation Of Bending Resistance And Retentive Torque Stability Of Zest Locator® And Straumann Novaloc® Abutments: An In Vitro Study, Hammad Ul Haq

Graduate Theses, Dissertations, and Problem Reports (ETD)

Abstract

Comparative Evaluation of Bending Resistance and Retentive Torque Stability of Zest Locator® and Straumann Novaloc® Abutments: An In Vitro Study

Hammad Ul Haq B.D.S.

Objective: To compare the mechanical performance of Locator® (Zest Anchors) and Novaloc® (Straumann) implant overdenture attachment systems connected to Straumann Bone Level Conical (BLC) implants under standardized cyclic and static off-axis loading conditions.

Materials and Methods: Ten Straumann BLC implants were divided into two groups (n = 5): Group 1 received Locator® abutments and Group 2 received Novaloc® abutments. All abutments were tightened to 35 N·cm and retightened after 10 minutes. Baseline removal torque values …

Exploring The Role Of Occupational Therapy In A Pediatric Specialty Care Office, Sierra Leigh Hays

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: The role of OT in primary and specialty care clinics is a rising area of interest in the field. There are also many multidisciplinary clinics that OTs can be or are apart of. This study aims to evaluate the consulting role of OT in primary and specialty care clinics, as well as to evaluate data collected by an OT in a pediatric brachial plexus and peripheral nerve clinic. Methods: The first objective was focused on analyzing functional outcomes, using the Active Movement Scale (AMS), of children following neurosurgery or onabotulinum toxin A injections. This was a retrospective study with …

Caring For The Caregiver: Implementing An Occupational Therapy-Tailored Educational Program To Alleviate Caregiver Burden, Lura Elizabeth Simons

Graduate Theses, Dissertations, and Problem Reports (ETD)

Caregivers of traumatic brain injury (TBI) survivors experience caregiver burden, which is a prevalent issue. The most significant concern is for symptoms of burden affecting mental health and sleep quality. This doctoral capstone project addressed the knowledge gap regarding programs that alleviate these signs and symptoms through evidence-based interventions. The objective was to create an educational program with modules that demonstrated improvement in satisfaction and content understanding through in-person sessions and individualized interviews with staff members. This project aimed to reduce perceived burden by conducting in-person sessions to implement interventions through an occupational therapy (OT) lens and by using educational …

Impact Of Occupational Therapy Within The Rosenbaum Family House: How Program Development Supports Health And Well-Being For Caregivers And Care Recipients, Zaccardi P. Muniz

Graduate Theses, Dissertations, and Problem Reports (ETD)

Healthcare hospitality houses (HHH) are designed to accommodate patients and caregivers receiving medical treatment far from home. The Rosenbaum Family House (RFH) acts as the HHH adjacent to J.W. Ruby Memorial Hospital in Morgantown, West Virginia. The RFH offers amenities that meet the basic needs of guests; However, there is an opportunity for occupational therapy-based program development to help further assist caregivers and care recipients both inside and outside the RFH. During the doctoral capstone experience (DCE), a three-phase project was developed to support the health and well-being of guests and WVUMedicine clients through group programming, resource guide development, and …

Increasing Documentation Of Endotracheal Tube Cuff Pressures: A Quality Improvement Initiative For Flight Crew Providers, Matthew D. Noss

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

Background: There was a lack of documentation of endotracheal tube (ETT) cuff pressures (CPs) by flight crew providers at Base 1 of HealthNet Aeromedical Services. A three-month pre-intervention data collection showed 1.8% of patients had initial CPs documented. Inadequate documentation and monitoring of ETT CPs can lead to patient complications such as tracheal injury and aspiration making this an important area for quality improvement.

Purpose: To increase documentation of ETT CPs through education and evidence-based interventions.

Intervention: This project implemented an educational in-service on ETT cuff syringe manometry for flight crew providers. The educational intervention consisted of …

An Evidence-Based Practice Initiative To Promote Debriefing Within The Obstetrics Surgical Team, Rachel Lynn Runatz

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Operating room debriefing is an evidence-based strategy shown to improve communication, efficiency, patient safety, and safety culture; however, debriefing is inconsistently performed in obstetric operating rooms due to workflow, cultural, and time-related barriers.

Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to increase the frequency of debriefings in the Birthing Center operating rooms at WVU Medicine Children’s Hospital through implementation of a nurse-driven, evidence-based debriefing initiative.

Intervention: A nurse-driven debriefing protocol was implemented using the Iowa Implementation for Sustainability Framework. Interventions included staff education, accessible laminated debriefing documents, identification of nurse champions, leadership support, and …

The Effects Of Music Therapy On Anxiety And Sedation Requirements For Total Knee Arthroplasty Patients Undergoing Regional Anesthesia: An Evidence-Based Practice Pilot Initiative, Kyra Marie Savrese

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Excessive noise in the operating room negatively impacts patient comfort and outcomes, particularly in patients undergoing spinal anesthesia who have the potential for awareness.

Background: Research demonstrates that music therapy is a low-cost, low-risk intervention that reduces perioperative anxiety and sedative requirements. Literature supports the use of music as an adjunct to anesthesia care, especially in orthopedic populations.

Purpose: At J.W. Ruby Memorial Hospital, orthopedic procedures with regional anesthesia expose patients to high noise levels, often leading to increased anxiety, sedation use, and longer recovery times. Addressing this problem aligns with institution goals for safe, patient-centered care.

Methods: Using …

Resilience And Reactivity: The Relation Between John Henryism And Cardiovascular Responses To Laboratory Stressors In An Appalachian Sample, Emma Raycher Thompson

Graduate Theses, Dissertations, and Problem Reports (ETD)

John Henryism active coping (JHAC), named for folk hero John Henry, is defined as the perception that one can overcome stressors through hard work (James et al., 1983). This construct has been tied to numerous health outcomes, showing a negative influence on cardiovascular health (Bennett et al., 2004). Many researchers have examined the relation between JHAC and cardiovascular reactivity to stress, though findings are mixed. Further, despite the legend of John Henry occurring in Appalachia, and traits associated with John Henryism, such as resilience, being prominent within this region, no study has examined the relation between JHAC and reactivity in …

Improving Access To Care And Utilization Of Telehealth In Pediatric Inflammatory Bowel Disease Patients Through Scheduling Interventions: A Quality Improvement Project, Sarah R. Bergstrom

Graduate Theses, Dissertations, and Problem Reports (ETD)

Abstract

Improving Access to Care and Utilization of Telehealth in Pediatric Inflammatory Bowel Disease Patients Through Scheduling Interventions: A Quality Improvement Project

Sarah Bergstrom

Introduction/Background. Inflammatory bowel disease (IBD) tends to affect pediatric patients with a more severe, aggressive phenotype as compared to adults. Following closely with a pediatric gastroenterologist (GI) is best practice to manage pediatric IBD. However, pediatric subspecialty clinics are generally located within academic institutions in urban areas. Patients in rural areas often have limited access to pediatric GI care, and poor access to care is associated with increased risk of poor disease control. Telehealth subspecialty …

Improving Sedative Administration In Patients Receiving Paralytics During Intubation: A Quality Improvement Initiative Within A Large Academic Medical Center In West Virginia, David Bryon Underwood

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Awake paralysis (AWP) occurs when long-acting neuromuscular blockers outlast short-acting sedatives during intubation, leaving patients chemically paralyzed but conscious. This highlights the critical need for timely post-intubation sedation.

Background: A 2024 review in the Neurological Critical Care Unit (NCCU) revealed that 72% of patients who received rocuronium were not given a post-intubation sedative. The difference in duration of action of paralyzing agents versus sedatives can result in patients being conscious while paralyzed, potentially resulting in hemodynamic instability and psychological harm.

Purpose: The quality improvement initiative aimed to reduce the number of patients receiving neuromuscular blocking agents without post-intubation sedation. …

Empowered Choices: A Quality Improvement Women’S Health Initiative In Faith-Based Nursing For Women Recovering From Substance Use Disorder, Jennifer Mewshaw

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Women with substance use disorder (SUD) face higher rates of unplanned pregnancy, reproductive infections, and delayed prenatal care. Faith community nurses (FCNs) often already serve within this community and have a long history of promoting public health interventions. However, they lack the knowledge and confidence in sexual and reproductive health (SRH) education.

Evidence Review: A literature review identified barriers to SRH care for women with SUD and the role of FCNs in community and public health interventions. Evidence supports providing FCNs with the knowledge and skills to deliver SRH education and support for women with SUD using trauma-informed and …

Electronic Cigarettes Increase Blood-Brain And Blood-Tumor Barrier Drug Efflux In A Preclinical Lung Cancer Model Of Brain Metastasis, Cullen Parker Wolford

Graduate Theses, Dissertations, and Problem Reports (ETD)

This dissertation (a) provided a comprehensive review of the known therapeutic challenges in nicotine delivery system users with lung cancer and (b) investigated the impact of electronic cigarettes on blood-brain/blood-tumor barrier function and efficacy of small molecule KRAS inhibitors in a syngeneic lung cancer brain metastasis model. The blood-brain barrier is a physiochemical barrier that limits systemic delivery of therapeutics into brain. When tumors invade the central nervous system, the blood-brain barrier is disrupted and subsequently forms a blood-tumor barrier. Despite the inherent leakiness and variable permeability of the blood-tumor barrier, it continues to restrict anti-cancer drugs from accumulating at …

A Mixed Methods Study Of The Transition To Adult Health Care For Sexual Minority Young Adults With Chronic Pain: Understanding The Impact Of Stigma, Cecily Newel Conour

Graduate Theses, Dissertations, and Problem Reports (ETD)

Sexual minorities with chronic pain are likely to experience stigma stemming from their sexual identity and chronic pain. Pain stigma and sexual minority stigma are associated with increased health disparities and differences in health care utilization, particularly for adults. The transition to the adult health care system appears to be a critical point to understand the impact of stigma on health care utilization to then improve outcomes. With a sample of 48 sexual minority young adults with chronic pain, the current study investigated transition experiences using an explanatory, sequential mixed-methods design that was both observational and cross-sectional. Participants completed quantitative …

Acute Correction Of Acquired Genu Valgum Secondary To Post-Traumatic Growth Arrest At The Time Of Distal Femur Fracture., Josiah Wolf, Nicholas Pelz, Adam Mansour, Christopher Iobst, Allen Kadado

Surgery Articles

A 14-year-old male patient sustained a distal femur fracture after a ground-level fall. His history was notable for severe acquired genu valgum secondary to a childhood lawnmower accident, which had required multiple limb salvage procedures including a Syme amputation and soft-tissue skin grafting. Acute correction of the limb deformity was performed concurrently with fracture fixation using a retrograde intramedullary nail and poller blocking screws. Retrograde intramedullary nailing represents a viable treatment option for simultaneous acute correction of acquired genu valgum and stabilization of distal femur fractures.

Derivation Of An Intrinsic Brain Activity Biomarker For The Earliest Prediction Of Cognitive Decline, Leslie S. Prichep, Syed N. Zaidi, Kara Brink, Saloni Kanakia, Bo Liang, Yang Jiang, Ruben Armañanzas

Behavioral Science Faculty Publications

Early identification of cognitive decline in the elderly is essential for timely and effective intervention. Current neuroimaging and clinical biomarkers have largely focused on patients with mild cognitive impairment (MCI) and dementias, and though effective, have not been demonstrated to be sensitive to the earliest signs of functional abnormalities. The electroencephalogram (EEG), with a millisecond time base, allows a precise exploration of synaptic dysfunction even at the initial stages of the damage. This study introduces a novel non-invasive EEG-based biomarker to predict cognitive decline of participants showing only subjective cognitive impairment (SCI). Baseline EEG recordings from 88 SCI participants who …

The Interaction Of Tobacco Retailer Density And Rurality With Tobacco Use Prevalence In Kentucky, Shyanika W. Rose, W. Jay Christian, Judy Van De Venne, Delvon T. Mattingly, Bethany Shorey Fennell, Saber Feizy, Mary Kay Rayens

Behavioral Science Faculty Publications

Purpose: Tobacco retailer density is a key correlate of tobacco use prevalence in the United States, but this relationship has typically been examined in urban areas. We examined the relationship between retailer density and tobacco use across Kentucky counties, a state with high smoking rates and a substantial rural population.

Methods: We obtained a list of tobacco retailers from the 2021 Kentucky Synar program, used for minor’s access inspections. We merged these data with county-level prevalence estimates for cigarette and smokeless tobacco use for each county in Kentucky, calculated using pooled 3-year estimates (2017-2019) of Kentucky Behavioral Risk Factor Surveillance …

Severe Maternal Morbidity According To Sickle Cell Disease Genotype, Tetsuya Kawakita, Natsume Furukawa, Sora A. Jones, Salimah Navaz Gangji

Department of Obstetrics & Gynecology Faculty Publications

Background

Sickle cell disease (SCD) is a genetic hemoglobinopathy that disproportionately affects individuals of African descent and is associated with elevated risks of maternal complications. However, the contribution of specific SCD genotypes to severe maternal morbidity (SMM) and postpartum readmission remains poorly characterized at the population level.

Objective

We sought to examine the association between SCD genotypes-hemoglobin SS (HbSS) disease, hemoglobin SC (HbSC) disease, sickle thalassemia, and sickle cell trait-and SMM, hospital readmission, and related adverse maternal outcomes.

Study design

This was a retrospective cohort study using the Nationwide Readmissions Database from 2016 through 2022, representing over 20 million weighted …

Risk Of Gestational Diabetes By Aerobic And Resistance Exercise During The First And Second Trimesters, Takaki Tanamoto, George Saade, Leryn J. Reynolds, Tetsuya Kawakita

Department of Obstetrics & Gynecology Faculty Publications

Objective

While some studies have shown that exercise reduces the incidence of gestational diabetes mellitus (GDM), there is limited evidence on whether aerobic or resistance exercise is more beneficial. This study aimed to examine the rate of GDM according to the type of exercise during early pregnancy.

Study design

We analyzed data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b), a prospective cohort of individuals enrolled during the first and second trimesters. We excluded participants with pregestational diabetes or delivery < 20 weeks. The primary exposure was either aerobic or resistance exercises in the first or second trimester. For each trimester, the metabolic equivalent of task hours per week (MET-h/week) was calculated for each exercise. Participants were grouped as follows: "Aerobic exercise" (≥7.5 MET-h/week from aerobic exercises), "Resistance exercise" (≥2 times/week from resistance exercises), "Both types of exercise" (≥7.5 MET-h/week from aerobic exercise and ≥2 times/week from resistance exercises), and "Insufficient exercise" (≤7.5 MET-h/week from aerobic exercise and ≤2 times/week from resistance exercises). Our primary outcome was GDM. Adjusted relative risks (aRRs) with 95% confidence intervals (95% CIs) were calculated using modified Poisson regression, adjusting for potential confounders.

Results

In both the first and second trimesters, analyses included 9049 individuals. In the first trimester, individuals who performed …

The Taper Sign: Sonographic Representation Of Uterine Dehiscence In Severe Cases Of Placenta Accreta Spectrum, Uma Deshmukh, Anna M. Modest, Alfred Abuhamad, Alireza A. Shamshirsaz, Jonathan L. Hecht, Scott A. Shainker

Department of Obstetrics & Gynecology Faculty Publications

Introduction: Prenatal diagnosis of placenta accreta spectrum (PAS) depends on reliable ultrasound markers and skilled image interpretation. Existing PAS markers emphasize placental features suggestive of abnormal adherence and require advanced image optimization. However, emerging hypotheses suggest that uterine dehiscence—not placental invasion—is the central mechanism underlying PAS, particularly in severe (Grade 3) disease. Despite this, few established ultrasound markers address this uterine dehiscence. We describe a novel ultrasound marker, the taper sign, which uniquely represents the uterine dehiscence in severe PAS with anterior placenta previa, and outline a standardized technique for image acquisition and interpretation.

Methods: This descriptive report details the …

Racial Differences In Adverse Pregnancy Outcomes And Incident Hypertension: A Mediation Analysis, Lucia C. Petito, Xiaoning Huang, C. Noel Bairey, Natalie Bello, Janet Catov, Ernesto Licon, Abbi Lane, David M. Haas, Lisa D. Levine, Rebecca B. Mcneil, Eliza Miller, Uma M. Reddy, Bethany Barone Gibbs, George Saade, Lauren Theilen, Laura E. Wiener, Brian M. Mercer, Hyagriv N. Simhan, Lynn M. Yee, Philip Greenland, William A. Grobman, Sadiya S. Khan

Department of Obstetrics & Gynecology Faculty Publications

Background

Adverse pregnancy outcomes (APOs) are associated with increased hypertension risk. Black women experience higher rates of APOs and hypertension compared with White women, but whether APOs contribute to Black-White hypertension disparities remains unknown.

Methods

The nuMoM2b-HHS (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be-Heart Health Study) prospectively recruited nulliparous pregnant people at 8 US centers (2010-2013) with follow-up 2 to 7 years postpartum (2014-2017). Race, which represents a social construct, was self-identified. The primary outcome was incident hypertension at follow-up. APOs included hypertensive disorders of pregnancy, preterm birth, and small-for-gestational age birth. Potential confounders (psychological health, social factors, and health behaviors) …

Vaginal Pra1 Identifies Clinically Relevant Candida Albicans Vaginitis And Excludes Asymptomatic Colonization: An Exploratory Study, Elena Roselletti, Barbara Kozma, David Ratonyi, Alexandra Kunkli, Bence Kozma, Peter Takacs, Duncan Wilson

Department of Obstetrics & Gynecology Faculty Publications

Background

Accurate interpretation of Candida detection in women with vulvovaginal symptoms remains difficult, because organism recovery may reflect either clinically relevant infection or nonpathogenic colonization. We have recently demonstrated that the secreted fungal zinc-binding protein, Pra1 is responsible for driving the inflammatory immunopathology of VVC. We therefore reasoned that PRA1 expression by Candida albicans in the vagina may act as a diagnostic tool to discriminate between commensal colonisation and active disease.

Methods

We conducted a 12-week prospective, single-center exploratory biomarker analysis nested within a registered parent clinical trial. Nine women with vulvovaginal symptoms provided cervicovaginal lavage samples and clinical data …

Trends In Glp-1 Based Therapy Use Before And After Pregnancy, Nansi S. Boghossain, Lauren Mcabee, Antonio F. Saad, Maged M. Costantine, Marwan Ma'ayeh, Joseph A. Ewing

Department of Obstetrics & Gynecology Faculty Publications

[Introduction] Glucagon-like peptide-1 (GLP-1)-based therapies are increasingly prescribed for the treatment of type 2 diabetes and obesity, with rapid uptake of newer agents such as semaglutide and tirzepatide [1, 2]. These medications improve glycemic control and promote weight loss and are now widely used among reproductive-aged individuals [2, 3]. However, GLP-1-based therapies are typically discontinued prior to pregnancy because of limited safety data and potential fetal risks, and current guidance recommends avoiding use during pregnancy [3]. As prescribing expands, a growing number of individuals entering pregnancy may have recent exposure to GLP-1-based …

Low-Lying Placenta Is Associated With Increased Risk Of Hemorrhage And Severe Maternal Morbidity: A Nationwide Analysis, May Abiad, Giulia Bonanni, Nikan Zargarzadeh, Ali Javinani, Scott A. Shainker, Anna M. Modest, George R. Saade, Kjersti Aagaard, Alireza A. Shamshirsaz

Department of Obstetrics & Gynecology Faculty Publications

Background

Placenta previa (PP) is a well-recognized obstetric complication with established maternal risks, particularly hemorrhage, that contribute significantly to maternal morbidity. In contrast, low-lying placenta (LLP) has historically been grouped with previa in both coding and clinical practice, limiting our ability to study its imparted associated outcomes as a distinct entity. However, in 2017, coding revisions allowed for a parsed diagnosis of LLP and PP and enabled the current study of differentiated associated outcomes.

Objectives

To describe and compare the independent rates of hemorrhage and severe maternal morbidity (SMM) associated with LLP and PP relative to normal placentation.

Methods

We …

Hospital Cesarean Delivery Rankings By Overall, Low-Risk, And Reliability-Adjusted Metrics, Tetsuya Kawakita, Regan N. Theiler, George Saade

Department of Obstetrics & Gynecology Faculty Publications

Importance: The Society for Maternal-Fetal Medicine (SMFM) low-risk cesarean delivery metric aims to improve comparability, but the extent to which additional patient-level adjustment and reliability profiling alter hospital rankings is not well characterized.

Objectives: To evaluate how hospital cesarean delivery rankings differ across overall, SMFM-defined low-risk, and reliability-adjusted low-risk approaches, and to identify hospital characteristics associated with reliability-adjusted low-risk rates.

Design, Setting, and Participants: This cross-sectional study used data from the 2022 National Inpatient Sample, a nationally representative all-payer database, on individuals aged 11 to 55 years who were hospitalized for childbirth. Data were analyzed from October 2025 through June …