bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Assisted Reproductive Technology on the Occurrence of Birth Defects: A Population-Based Study [25P]
Authors: Maor Gil Shechter , Czuzoj-Shulman Nicholas , Spence Andrea , Abenhaim Haim Arie
Published: May 2017

INTRODUCTION:

Studies have shown that births conceived with Assisted Reproductive Technology (ART) may be associated with a greater risk of birth defects compared with non-ART births. The purpose of our study is to evaluate the association between ART and births defects using a large population-based database set in the United States.

METHODS:

We used the Centers for Disease Control and Prevention's Period linked birth-infant death data files and fetal death database for 2011 to 2013 to conduct a retrospective cohort study consisting of live births during that period. Multivariate logistic regression was used to determine the adjusted effect of ART on birth defects, both overall and by specific defects.

RESULTS:

Between 2011 and 2013 there were 11,862,780 live births, of which 11,791,730 were spontaneous pregnancies and 71,050 were conceived by ART, with an increasing trend in incidence of ART during this 3-year period and an overall increasing trend of birth defects during the study period. Overall, infants conceived by ART had a greater risk of having birth defects compared with infants conceived spontaneously (77/10,000 vs 24/10,000, respectively, OR 2.20, 95% CI 2.00-2.42). The most malformation most commonly associated with ART was cyanotic heart defects (OR 2.74, 95% CI 2.42-3.09) while other malformations included cleft lip and/or palate and hypospadias.

CONCLUSION:

There is an increased risk of birth defects, overall and of specific types, in the ART population. Appropriate counseling and specialized ultrasound evaluations should be considered in pregnancies conceived by ART
Does Oral Contraceptive Use Lessen the Impact of Concussions in Adult Female Athletes? [28P]
Authors: Chace Kathleen , Bachmann Gloria , Simonds Adrienne , Dettwiler Annegret
Published: May 2017

INTRODUCTION:

Sports-related concussion (SRC) is classified as a mild traumatic brain injury (mTBI) and occurs over 2 million times annually. Female athletes acquire SRCs at higher rates and experience poorer outcomes and increased cognitive impairment compared to males. Progesterone has been utilized as intervention for TBI because of its neuroprotective effects. Applicability of this research to female athletes is limited because of predominantly male subject populations, failure to measure endogenous progesterone levels, menstrual cycle phase at time of injury, and oral contraceptive pill (OCP) use. The purpose of this research was to explore the role of oral contraceptive use on SRC outcomes in women.

METHODS:

A search of the literature was conducted from June to September 2016 using PubMed and OVID databases. Search terms used included: “concussion”; “brain injury”; “menstrual cycle”; “progesterone” “oral contraception”; and “females.”

RESULTS:

76 articles were identified with 5 remaining after applying exclusion criteria. Women on OCPs or in the follicular phase at the time of injury performed significantly better on quality of life and somatic symptom measures. Athletes on OCPs reported fewer concussion symptoms with less symptom severity than eumenorrheic athletes.

CONCLUSION:

Menstrual cycle phase and OCP use at the time of concussion may influence concussion outcomes. OCP use was associated with better outcomes in adult female athletes with SRC. Gender-specific research efforts are necessary to improve outcomes after SRC, including prospective analysis of SRC outcomes and OCP use in female athletes.
PPROM Following Open Fetal Myelomeningocele Repair [2Q]
Authors: Said Heather M. , Vricella Laura K. , Miller Collin , Elbabaa Samer , Vlastos Emanuel
Published: May 2017

INTRODUCTION:

The objective is to characterize the risk of PPROM following open fetal MMC repair.

METHODS:

This retrospective cohort of 51 patients who underwent open fetal MMC repair was analyzed in two groups based on PPROM. Primary outcome was occurrence of PPROM. Secondary outcomes included latency from repair to delivery and gestational age at delivery. Intraoperative factors, obstetric complications and delivery outcomes were also evaluated.

RESULTS:

Demographics were similar between groups. PPROM occurred in 22 patients (43%) at a mean gestational age of 31w1d. Mean latency from surgery to PPROM was 50 days. Patients with PPROM had a lower gestational age at repair (24.7 + 0.7 weeks without PPROM; 23.9 + 1.2 weeks with PPROM; p < 0.007), latency from MMC repair to delivery (78.3 + 17.3 days without PPROM; 61.4 + 25.8 days with PPROM; p = 0.008) and gestational age at delivery (35.9 + 2.6 weeks without PPROM; 32.7 + 3.4 weeks with PPROM; p < 0.005). Patients with PPROM had lower infant birth weights (2614 g without PPROM; 1990 g with PPROM; p=0.001) and one-minute Apgars (7.2 without PPROM; 5.5 with PPROM; p=0.016) but similar five-minute Apgars. In multivariate analysis, greater gestational age at repair was protective against PPROM (RR 0.286; 95% CI 0.095-0.861; p=0.026), as was multiparity (RR 0.122; 95% CI 1.064-62.792; p = 0.043).

CONCLUSION:

PPROM occurred frequently among patients undergoing open fetal MMC repair and was associated with preterm delivery, earlier gestational age at repair and lower one-minute Apgar but not the occurrence of preterm labor, abruption or chorioamnionitis.
Utility of Intrapartum Fetal Heart Rate Monitoring in a Contemporary Labor and Delivery Unit [4Q]
Authors: Taylor Rachel , Burk Camden , Sugiyama Nathaniel , Friedman Perry , Ogunyemi Dotun
Published: May 2017

INTRODUCTION:

To evaluate the use of intrapartum electronic fetal heart rate monitoring (EFM) as a screening tool for adverse neonatal outcomes.

METHODS:

This is a retrospective study of 16,980 term, singleton deliveries at a single hospital from 2013-2014. Cases of adverse neonatal outcomes were compared to unaffected controls by the following predictor variables: late, variable, early, and prolonged decelerations; accelerations; tachycardia; bradycardia; and minimal variability. The primary outcome was a composite adverse outcome comprised of five-minute Apgar score less than 4, umbilical arterial pH less than 7.0, sepsis, seizures, encephalopathy, and respiratory failure. Secondary outcomes were neonatal intensive care unit (NICU) admission, hypoxia, hypoglycemia, pH less than 7.0, seizures, and abstinence syndrome. Independent associations were ascertained using logistic regression. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for significant parameters.

RESULTS:

For the composite adverse outcome, prolonged decelerations were positively (OR 2.19) and accelerations were negatively (OR 0.044) associated. For NICU admission, associations included prolonged (OR 1.24) and late (OR 1.39) decelerations, minimal variability (OR 1.17), and tachycardia (OR 1.81). Neonatal hypoxia (OR 0.076), hypoglycemia (OR 0.21) and seizures (OR 0.005) were all negatively associated with accelerations. Low five-minute Apgar score was positively associated with prolonged decelerations (OR 8.69). For the composite adverse outcome, prolonged decelerations had sensitivity, specificity, PPV, and NPV of 0.372, 0.657, 0.00606, and 0.995, while for absence of accelerations were 0.0185, 0.998, 0.0357, and 0.996, respectively.

CONCLUSION:

Standard EFM parameters have excellent NPV but poor PPV when used intrapartum to screen for adverse neonatal outcomes.
The Use of Hemoglobin and Hematocrit Values to Estimate Intrapartum Blood Loss: A Systematic Review [9Q]
Authors: Komorowski Adam S. , Zaffar Nusrat , Shah Prakesh , Murphy Kellie , D'Souza Rohan
Published: May 2017

INTRODUCTION:

The purpose of this study was to systematically review formulae using hemoglobin (Hb) or hematocrit (Hct) that have been derived, validated or used to objectively estimate intrapartum blood loss and determine their diagnostic accuracy.

METHODS:

MEDLINE, EMBASE, and Web of Science were searched from inception until 29 July 2016 for studies describing the use of Hb or Hct to estimate intrapartum blood loss in pregnant women. Studies were limited to humans, with no other search restrictions. Citation tracking and grey literature searches were performed. Two independent investigators screened titles and abstracts; performed data extraction; and completed risk of bias assessments using a revised tool for quality assessment of diagnostic accuracy studies (QUADAS-2). Disagreement was resolved through discussion or adjudication with a third reviewer. The study protocol was registered with the PROSPERO International Prospective Register of Systematic Reviews (CRD42016043505).

RESULTS:

Of the 6463 identified titles, 63 full-texts were retrieved and 13 studies included in qualitative synthesis. The risk of bias was deemed to be low in five and unclear in eight studies. A total of 12 unique formulae were identified that used Hb or Hct as variables (in addition to height and bodyweight) to estimate peripartum blood loss, of which two were derived and seven were validated. Meta-analysis was not possible due to clinical and methodological heterogeneity between studies.

CONCLUSION:

This systematic review identified 12 formulae that could provide an objective method for estimating intrapartum blood loss. These formulae need to be validated by adequately powered, prospective studies.
The Risk of Preterm Birth in Pregnancies With Fetal Anomalies [11Q]
Authors: Berger Victoria , Moghadassi Michelle , Gosnell Kristin , Sparks Teresa , Velez Juan Gonzalez , Norton Mary
Published: May 2017

INTRODUCTION:

To examine the relationship between congenital fetal anomalies and rates of preterm birth (PTB).

METHODS:

Retrospective study of singleton pregnancies with fetal anomalies, delivered at greater than or equal to 24 weeks at our institution between 2007 and 2015. Our primary outcomes were any PTB and spontaneous PTB (both less than 37 weeks). Anomalies were classified as: cardiac, congenital diagrammatic hernia (CDH), gastrointestinal (GI, including abdominal wall defects), genitourinary (GU), central nervous system (CNS), sacrococcygeal teratoma (SCT), musculoskeletal (MSK), neck mass, and multiple. Chi square and Fisher's exact tests were used to compare proportions, and multivariate logistic regression adjusted for potential confounders.

RESULTS:

Among 728 pregnancies, the mean gestational age at delivery was 36.8 ± 3.3 weeks. Twenty-nine percent were delivered preterm, and 15.0% were delivered after spontaneous preterm birth (sPTB) specifically. GI anomaly was associated with a 2.62 fold increased odds of sPTB (95% CI 1.52-4.53), while SCT anomaly was associated with 4.50 fold increased odds of the same (95% CI 1.26-16.05). Considering any PTB, there was a 4.81 fold increased odds (95% CI 2.86-8.09) with GI anomaly, and a 3.66 fold increased odds (95% CI 1.06-12.64) with neck mass, adjusting for maternal age, race, BMI, tobacco and substance use.

CONCLUSION:

Nearly one third of pregnancies with fetal anomalies do not reach term, and the risk of preterm birth varies by anomaly. Increased odds of sPTB were seen with GI anomalies and SCT, and increased odds of any PTB were seen with GI anomalies and neck masses.
The Giving Voice to Mothers Study: Measuring Respectful Maternity Care in the United States [18Q]
Authors: Vedam Saraswathi , Declercq Eugene R. , Monroe Shafia M. , Joseph Jennie , Rubashkin Nicholas
Published: May 2017

INTRODUCTION:

Adverse perinatal outcomes among immigrants, refugees, and women of colors in the US are well-documented and persist even when socio-economic background is considered.

METHODS:

Community members and researchers designed a survey to capture patient-oriented data on maternity care experiences among communities of color. Items included previously validated instruments including the Mothers Autonomy in Decision Making (MADM) scale, the Mothers on Respect index (MORi); and the Perceptions of Racism (PR) scale. The final instrument was content validated, piloted, and distributed across the US. Descriptive statistics describe access, experience, and outcomes; and regression analyses link MADM and MORi scale scores to respectful care and autonomy (adjusting for differences in sociodemographics, risk profile, type of provider, and place of birth).

RESULTS:

Of the total sample (N=2260), 37.3% were women of color (Black, Hispanic, Native, other), and 18% Medicaid recipients. Women of color had significantly lower MADM scores, and 20.5% were not satisfied with their role in decision making. Women with low MORi scores reported pressure by health professionals to accept interventions [(6.8%) epidurals, (15.8%) inductions, (11.1%) cesarean]. Reported discrimination due to a difference in opinion with providers was more common (17%) among women of color. MADM, MORi, and PR scores varied significantly by place of birth and type of provider.

CONCLUSION:

Persons of color in the US report receiving less respectful maternity care, and reduced access to options for physiologic birth care. Data suggest that type of provider or place of birth modulates outcomes, and institutional racism may be a contributing factor.
The Effects of Continuous Local Anesthetic After Cesarean Delivery on Pain and Narcotic Use [22Q]
Authors: Yaklic Jerome , Maxwell Rose , Urschel Kiera , Lindheim Steven , Griffiths Kara
Published: May 2017

INTRODUCTION:

Studies of the effectiveness of continuous local anesthetic administration for pain reduction after Cesarean delivery have provided inconsistent results. This study evaluated the effectiveness of this mode of administration on post-surgical pain and narcotic use.

METHODS:

Fifty women who had a Cesarean delivery were enrolled into a randomized double-blind, placebo controlled trial. The On-Q continuous abdominal wall and intraperitoneal wound irrigation system for local anesthetic administration was placed at the time of closure. Total post-operative narcotic use and patient reported pain scale scores were used to evaluate efficacy of treatment at 6, 12, 24 and 48 hours postoperatively.

RESULTS:

Forty patients completed the study. Repeated measures ANOVA revealed no significant difference in narcotic use or reported pain scores between the control group and those receiving local anesthetic for all time points. There was a trend towards reduced pain and narcotic use in the study group at the 6, 12, and 48-hour time points (group*time interaction p < 0.09). Regardless of group assignment, women who had a prior Cesarean section, versus primigravid women, had an increased total narcotic use (58.06 mg vs. 38.28 mg, respectively; p < 0.03).

CONCLUSION:

Dual catheter placement and infusion of bupivacaine has potential to decrease the use of narcotics and pain following Cesarean delivery; however, given the small sample size of the study, a significant difference between groups could not be delineated. Further study is indicated to investigate catheter placement and effects on pain control, narcotic use and other potential benefits such as shorter length of stay.
A Widening Gap: The Obstetric Response to the Opioid Epidemic [25Q]
Authors: Miller Edward , McDonald Vanessa , Lambert Calvin , Wongk Ashley , Nunes Vanessa
Published: May 2017

INTRODUCTION:

78 Americans die daily from an opioid overdose. One of the areas hardest hit by this epidemic is the Appalachian region. To combat this crisis, Congress and the American College of Obstetricians and Gynecologists recommend a multifaceted approach in identifying, monitoring, and managing patients. Medication assisted treatment (MAT) with methadone or buprenorphine is a cornerstone of this therapy. Despite the acceptance of MAT as standard of care, opioid related maternal and neonatal morbidity rates continue to rise.

METHODS:

A survey of all obstetric providers in highly affected counties (as determined by CDC analysis) in West Virginia, Kentucky, Ohio, Tennessee, Indiana, and South Carolina was performed. Providers were asked if they: 1. Prescribe Methadone or buprenorphine. 2. Manage patients who obtain the medications from other prescribers 3. Where did they refer their patients for treatment.

RESULTS:

In West Virginia, 47 practices comprising 208 physicians were surveyed. 6.3% of practices (2 Academic, 1 Community) prescribed methadone/buprenorphine. At one academic institution, a sole provider prescribed methadone/buprenorphine. 2.45% of obstetric providers in West Virginia prescribe methadone/buprenorphine. 77% of community practices referred to academic centers for management. 10% were unsure where to refer their patients. Final data is pending for the remaining states and will be displayed numerically and graphically by county.

CONCLUSION:

Our data shows a wide gap both in the quantity and the accessibility of obstetric providers prescribing MAT. The burden of management has fallen disproportionately on academic centers creating a log jam which makes accessing this potentially life-saving treatment in a timely manner out of reach in this high risk population.
The Collaborative Laborist and Midwife Model at Sanford Health: An Accepted and Sustainable Model [31Q]
Authors: Landeen Laurie , Krolikowski Keely , Watson Trevor
Published: May 2017

INTRODUCTION:

To examine the effects of a Collaborative Laborist and Certified Nurse Midwife (CNM) Model on the rates of induction, primary and repeat cesarean sections, vaginal birth after cesarean (VBAC), and nursing staff satisfaction with this model of care.

METHODS:

This was a prospective cohort study at the largest birthing center in South Dakota between 2008-2016. Rates of induction, primary and repeat cesarean section, VBAC, and nursing staff satisfaction were compared over three 2 year time periods: before and after Laborist Model initiated and with the addition of CNM to the model. Linear regression and two-way ANOVA were used to compare trends of primary cesarean, repeat cesarean, VBAC, and induction. A two-tailed t-test compared values of nursing satisfaction.

RESULTS:

The primary cesarean delivery and induction rate decreased from 15.9% to 13.5% (P < .005 95% CI 0.67–0.22) and 49.38% to 30.75% (P < .006 95% CI 7.24–1.23) respectively. VBAC success rates increased from 1.55% to 2.21% (P < .017 95% CI .07-.23) of all deliveries. There was a significant increase in respect between physician and staff (P < .01 8.9% difference), NICU communication (p < .001 16.2% difference), and provider involvement in triage (P < .001 27.9%) This difference was shown following addition of CNM's.

CONCLUSION:

The rates of primary cesarean section and induction are significantly decreasing at the same time as the rate of VBAC is increasing. These results represent an overall positive outcome of employing the Laborist and CNM Collaboration Model.
Male Fetal Sex: A Risk Factor for Gestational Diabetes Mellitus in Chinese Ethnicity [1R]
Authors: Rebolos Mark , Faris Basma , Schubert Finn
Published: May 2017

INTRODUCTION:

About 6-7% of pregnancies are complicated by Gestational Diabetes Mellitus (GDM); these pregnancies are at a higher risk for gestational hypertension, preeclampsia, cesarean section and other potential comorbidities. This study's objective is to determine whether Chinese mothers carrying male fetuses are at a higher risk of GDM compared with Chinese mothers carrying female fetuses.

METHODS:

We conducted a retrospective review of women of Chinese ethnicity who were admitted to NYU Lutheran for a delivery during calendar year 2015. This work in progress report covers all data for women with GDM and data for women without GDM from November 22, 2015 through the end of the year. Patients were excluded if they had late prenatal care initiation (>28 weeks), or missing data on key variable. Data collected included: Age, BMI, delivery type, birth weight, gestational age, fetal sex, and glucose values. We used the chi-squared test to compare the proportion of mothers with GDM among those with male versus female babies.

RESULTS:

We analyzed data for 141 women with GDM and 110 women without GDM. Diabetic women were significantly older than non-diabetic women (mean 28.8 vs 31.0, p < .001). Seventy-nine women with GDM (56%) had a male baby, while 56 (51%) non-diabetic women had a male baby, the difference was not statistically significant.

CONCLUSION:

This study did not show a difference between diabetic and non-diabetic women in terms of fetal sex, however, it was not adequately powered and a larger study may show a different result.
Modified B-Lynch Suture Technique for Prevention of Postpartum Hemorrhage [16R]
Authors: Hall Evelyn , Djordjevic Miroslav , Mazzullo Lisa
Published: May 2017

INTRODUCTION:

In 1997 B-Lynch described a technique using a continuous suture to mechanically compress the uterus in cases of failed medical management of uterine atony. Subsequently several have described modifications to the procedure in order to make it more simple and effective.

METHODS:

In this surgical case series, we describe a technique where 3 side-by-side B-lynch sutures are placed during postpartum hemorrhage at cesarean. Using a modified B-lynch technique, an initial suture is placed and secured in the middle third of the uterus. Two additional B-lynch sutures are placed lateral to the middle suture. The increased compression of these sutures will cause the initial suture to loosen. To avoid bowel complications such as strangulation, the first suture is retied under tension to either one of the B-lynch ties or an additionally placed stitch. Finally, the uterus is measured to ensure it is not expanding. The purpose of the technique is to provide greater amount of compression to the uterus than a solitary B-lynch suture.

RESULTS:

From 2008-2016, we used this technique in over 150 women with postpartum hemorrhages at cesarean that did not respond to conservative treatment. Over this period, there were 2 failures resulting in hysterectomy. No cases of uterine necrosis were noted.

CONCLUSION:

The use of multiple B-lynch sutures is an effective, easy, safe and fertility preserving technique for treating uncontrollable postpartum hemorrhage.
Obesity Effect on Induction of Labor Duration [25R]
Authors: Fitzgerald Garrett , Crimmins Sarah , Kopelman Jerome , Harman Chris , Turan Ozhan
Published: May 2017

INTRODUCTION:

Obesity and associated morbidity significantly impacts obstetric management, including increased indication for induction of labor (IOL). Retrospective studies report obesity prolonging labor course. We aim to investigate duration of IOL stratified by body mass index (BMI). We hypothesize obesity prolongs IOL.

METHODS:

Prospective cohort study of singletons undergoing IOL. Obstetric management was per provider's discretion (vaginal misoprostol, cervical balloon, intravenous oxytocin). The primary outcome was interval from starting IOL to latent labor. Secondary outcomes include duration to active labor and delivery. Labor was considered prolonged if greater than 24 h to latent labor, and greater than 36 h to active labor. Patients were analyzed by BMI category (under 30, between 30 and 39.9, over 40 kg/m2). Cesarean delivery outcomes were excluded. Non-parametric and chi-square test were used for analysis.

RESULTS:

Total of 99 enrolled, 23 were delivered by cesarean, leaving 76 analyzed. The median BMI was 36 kg/m2 (19-75); 17 BMI under 30, 37 BMI between 30 and 39.9, 22 BMI over 40. The parity and Bishop's score were not significantly different. The BMI group median duration to latent labor (10.6 v 9.6 v 12.7 h, P=.5), to active labor (14.1 v 15.0 v 19.2 h, P=.5), and to delivery (18.5 v 17.8 v 20.6 h, P=.5) were not significantly different. The time to achieve active labor trended longer with increasing BMI (P=.049).

CONCLUSION:

Prospectively analyzed induced labor curves were not significantly different between normal weight, obese, and severely obese women. This provides evidence that, regardless of BMI, IOL is a viable management option.
Early Onset Severe IUGR: Waiting to Deliver Does Not Appear to Improve Outcome and May Be Harmful [35R]
Authors: Fore Matthew S. , Quinn Kristen H. , Street Linda M. , Nitsche Joshua F. , Denney Jeffrey M.
Published: May 2017

INTRODUCTION:

Preterm delivery of IUGR fetuses prior to 32 wks is rarely indicated, occurring in < 1.9% of all pregnancies. We sought to determine if delaying delivery until non-reassuring fetal heart tracing (NRFT) increases adverse outcomes.

METHODS:

In a cohort of IUGR < 32 wks, two groups were compared: those delivered for abnormal UAD studies and those delivered for NRFT. Fetuses with persistent absent (AEDF) or reversed end diastolic flow (REDF) were placed on continuous monitoring until delivery. Pregnancies were excluded when delivered for maternal deterioration. T-test and Chi-square were performed where appropriate.

RESULTS:

43 singletons with IUGR < 32 weeks gestation and abnormal UAD from 2012-2015. Mean GA at diagnosis 24.7 +/-3.1 wks (range 18-30.3 wks). 30 delivered for abnormal UAD and 13 for NRFT. Pregnancy characteristics were similar between groups. Women progressing to urgent delivery due to NRFT were more likely to undergo cesarean (CD) than SVD (p=0.01). 83.9% of both groups were delivered via CD and were significantly smaller compared to those able to be born via SVD (p=0.026). Women with HTN, preeclampsia or GHTN were also more likely to undergo CD than SVD (p=0.04). Expectant management until NRFT of abnormal UAD did not decrease requirement for CPR at delivery or incidence of IVH, RDS, or death. Length of stay was 50.9 days in those delivered for Doppler while 61.2 days in the group delivered emergently (p=0.23).

CONCLUSION:

Waiting to deliver until there was NRFT does not appear to decrease neonatal morbidity/mortality, increases risk for emergency CD, and may increase length of stay in NICU.
Patient Quality Scoring and Its Utility as a Predictor of Pregnancy Outcomes Amongst Gestational Diabetic Patients [36R]
Authors: Ake-Uzoigwe Rukeme , Arora Anubha , Salafia Carolyn , Zhang Dongping , Akinnawonu Kolawole , Fuks Aleksandr
Published: May 2017

INTRODUCTION:

To assign a quality score to patients based on the quality of care they received and determine if the quality of care a patient received determined pregnancy outcomes.

METHODS:

A retrospective cohort study of gestational diabetic patients', who delivered from January 2013 to December 2015. Patients were given a quality score based on predefined quality of care parameters. Patients were then categorized as having received high or low quality care. High Quality score (HQS) was defined as a score greater than 19/27, while Low quality score (LQS) was defined as less than or equal to 19/27. The association between quality group and pregnancy outcomes was explored using logistic regression.

RESULTS:

Of the 514 patients in the study. 468 (91%) patients were categorized as receiving high quality care based on HQS; 46 (9%) had low quality care based on LQS. Analysis demonstrated the following: Shoulder dystocia: HQS (1%) vs. LQS (7%) (OR 0.18, p = 0.02); Any complication (ie, Neonatal Hypoglycemia, Jaundice, Macrosomia, shoulder dystocia) HQS (47%) vs. LQS (66%) (OR 0.46, p=0.02); Induction of labor: HQS (53%) vs. LQS (37%) (OR 1.99, p = 0.03); Postpartum OGTT compliance: HQS (38%) vs. LQS (16%) (OR 3.87, p= 0.003).

CONCLUSION:

Assigning quality scores to patients allowed us to categorize prenatal care received by GDM patients. Patients with high quality care, had fewer adverse pregnancy outcomes compared to patients with low quality care. Low quality group patients were less likely to be compliant with postpartum OGTT.
Expulsion of Immediate Postplacental Copper IUDs at Six Weeks: A Prospective Cohort Study [5A]
Authors: Gurney Elizabeth , Sonalkar Sarita , McAllister Arden , McClusky Jessica , Frarey Alhambra , Schreiber Courtney
Published: May 2017

INTRODUCTION:

Postplacental intrauterine device (IUD) placement could improve contraceptive access and child spacing. We sought to report a precise point estimate of the proportion of TCu380A IUDs expelled 6 weeks after immediate postplacental placement, and to assess risk factors for expulsion.

METHODS:

We enrolled women who received a TCu380A IUD after vaginal delivery beyond 33 weeks gestation from April 2015-August 2016. A sample size of 195 enabled us to detect a 15% expulsion proportion with a 95% confidence interval of ±6%. Follow-up to determine IUD status occurred 6 weeks postpartum.

RESULTS:

195 women enrolled. Six weeks postpartum, 155 of 171 (90.6%) telephone survey respondents believed their IUD was in place, and 136 (79.5%) reported high satisfaction. Of the 147 women who completed a pelvic exam, 104 had a correctly positioned IUD and continued its use (70.7% [95% CI 63.4-78.1%]). Mechanical IUD complications included: 10 complete expulsions (6.8%), 14 partial expulsions (IUD in cervix; 9.5%), 5 devices in the lower uterine segment (3.4%), and 8 rotated in the uterus (5.4%). IUD strings were visible on exam for 112 subjects (76.2%); of these, 90 (80.4%) had correctly positioned devices. There were no statistically significant associations between clinical covariates assessed and IUD continuation.

CONCLUSION:

In our cohort, continuation of a correctly positioned IUD was 71% at 6 weeks postpartum. Mechanical complications occurred in 25%, and visualization of IUD strings did not assure fundal placement. The significance of malpositioned IUDs requires further investigation. Participants were satisfied with postplacental IUD access.
Factors Affecting Abortion Provision Among Obstetrics and Gynecology Residents: A National Survey [6A]
Authors: Hammoud Nadine , Marko Emily , Nieves Kelsey
Published: May 2017

INTRODUCTION:

Elective abortion is a widely performed procedure in the United States. The number of physicians who perform abortions however has decreased due to diminishing availability of training. The purpose of this study is to identify the factors associated with residents’ attitudes about providing elective abortion and whether personal beliefs influence residents’ willingness to be trained and perform these procedures.

METHODS:

Anonymous surveys were sent out to all obstetrics and gynecology residents. The survey included demographic information and rated factors influencing their decision to perform abortion using a Likert scale. Multivariable logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI). The factors associated with abortion provision were compared using chi square analysis.

RESULTS:

Of the 201 respondents (67% response rate), 83% planned to perform elective abortion. In a multivariable analysis; religion, age, gender, ethnicity and marital status were found to be not statistically significantly associated with plans to provide terminations. Residents’ attitude regarding providing abortion was dependent on the reasons for abortion with the most influential being “pregnancy has potential medical risks on the mother” (OR 8.2; 95% CI 6-14.3) followed by “fetus with congenital anomalies” (OR 6.7; 95% CI 3.7-11.6) and “gestational age” (OR 2.3; 95% CI 1.6-7.9). “Recent laws regarding abortion” and “maternal age” were the least influential factors.

CONCLUSION:

Providing elective abortions is an important element of women’s healthcare. In order to optimize integration of abortion training into residency programs it is important to identify resident attitudes and obstacles to providing elective abortions.
Factors Influencing Contraception Use in Rural Haiti Women: A Mixed-Methods Pilot Study [8A]
Authors: Reyes Jasmin , Tukiainen Erica , Partovi Susan , Sridhar Aparna
Published: May 2017

INTRODUCTION:

Haiti has the highest maternal mortality rate in the western hemisphere, which can be potentially reduced via family planning utilization. However only 31% of married women are using modern methods of contraception. We conducted a mixed-methods pilot study in rural Mussotte to understand the factors influencing contraception use.

METHODS:

20 women were given a structured questionnaire followed by a semi-structured interview. The study was approved by local hospital administration. The data was transcribed with interpreters, audio recorded, exported into excel, and analyzed using grounded theory technique.

RESULTS:

Majority of the participants were married (85%). Median gravidity was 3 pregnancies. 90% were not planning to get pregnant in the next year. However, only half of them were currently using modern contraceptive method. All women had heard of at least one type of modern contraceptive method, the most common being condoms and Depo-Provera. 90% of participants obtained contraceptive knowledge from a healthcare provider. More than half of the participants believed that family planning use was not good for their health. 74% participants believed that family planning would harm future offspring. Analysis of qualitative responses generated three main themes: 1) Menstruation changes influencing contraception use; 2) Concern for negative effects (miscarriage, stillborn, poor development) on future offspring/pregnancy; and 3) Shared decision-making between partners without concealed contraceptive use.

CONCLUSION:

Healthcare providers must consider counseling women to dispel myths about negative effects on future pregnancies. Setting realistic expectations about menstruation changes and other side effects may change the contraception uptake and discontinuation rates.
The Availability of Long-Acting Reversible Contraception Through Los Angeles County FamilyPACT Clinics [14A]
Authors: Natavio Melissa Faith , Brown Niquelle , Blotky Elizabeth , Van Horn Christine , Waters Caitlin , Nelson Anita
Published: May 2017

INTRODUCTION:

Family Planning, Access, Care and Treatment (FamilyPACT) is a Medicaid waiver program in California that provides all methods of contraception without charge to uninsured women and men with family incomes below 200% of the federal poverty level. The program requires that FamilyPACT clinics provide all methods on site or by referral. Extensive efforts with training and education have been made to encourage use of long-acting reversible contraception (LARC), but only 13% of women use an implant or IUD. This study was designed to assess the availability of LARC methods in Los Angeles County FamilyPACT clinics.

METHODS:

A list of all 855 Los Angeles County FamilyPACT clinics was obtained through the program’s website, from which a random sample of 400 clinics was generated. Young female researchers posing as potential patients called each clinic to ask a scripted series of questions about LARC availability in that practice.

RESULTS:

Of the 400 clinics selected, 340 responded to callers’ questions; 284 accepted FamilyPACT. Of these clinics, 61% did not offer any LARC method; 15% offered all currently available LARC; and 6% offered same-day LARC placement.

CONCLUSION:

The majority of FamilyPACT clinics surveyed did not offer any LARC and very few offered same-day LARC placement, despite FamilyPACT Program’s efforts to increase LARC use.
Spousal Concordance in Knowledge of Contraceptive Methods Among Married Couples in Rural Maharashtra, India [17A]
Authors: Mody Sheila , Saggurti Niranjan , Silverman Jay , Donta Balaiah , Raj Anita
Published: May 2017

INTRODUCTION:

This study investigates spousal concordance in knowledge of contraceptive methods among married couples in rural Maharashtra, India.

METHODS:

Current analyses used baseline data from N=1081 young married couples (aged 18-30 years) who participated in a family planning evaluation trial (CHARM) conducted in Maharashtra, India. Baseline surveys conducted separately with husbands and wives assessed demographics, contraceptive knowledge and use. Cohen’s Kappas (K) were used to assess concordance in knowledge of contraceptive methods for husbands and wives; Kappa correlation coefficients were defined as Poor < 0.00, Slight 0.00-0.20, Fair 0.21-0.40, Moderate 0.41-0.60, Substantial 0.61-0.80, and Almost Perfect 0.81-1.00 for the total sample, and stratified by modern contraceptive users and non-users.

RESULTS:

For males and females, respectively, the most commonly recognized contraceptives (reported by >60%) were female sterilization (90% and 82%), pills (90% and 85%), and male condom (96% and 61%), with males having greater knowledge than females. Concordance in knowledge was slight for all contraceptive methods except male sterilization (kappa=.21) and IUD (kappa=.27). Concordance analyses stratified by contraceptive use found fair concordance in knowledge of male sterilization (kappa=.29), IUD (kappa=.28), and injectables (kappa=.21) among contraceptive users, but slight concordance in knowledge across all contraceptive methods for non-users.

CONCLUSION:

There is low concordance in contraceptive method knowledge among couples in this study, but concordance is stronger for contraceptive users suggesting that couples’ shared contraceptive knowledge may support better use.
Zika: Preconception & Perinatal Opportunities in Los Angeles County (LAC) [21A]
Authors: Ramos Adriana , Ramos Diana E.
Published: May 2017

INTRODUCTION:

In Los Angeles County, there are over 3.8 million men and women of reproductive age. Forty-seven percent of pregnancies in LAC are unintended, and rates are disproportionately higher among African American (67%) and Hispanic (56%) women. Because the Zika virus can pass from a pregnant woman to her fetus and cause potential harm, awareness and prevention of the virus is an urgent public health priority. The CDC recommends that health departments increase “access to and use of effective contraception” as part of preparedness for areas with Aedes species mosquitoes. Our aim here is to review the use of the most effective contraceptive methods used in LAC women who have already had at least one child.

METHODS:

3,500 women with at least one child completed a self-administered questionnaire focusing on their preconception and perinatal experience.

RESULTS:

28% are not using any contraceptive method. Of those using a method (2,400): 38.1% used condoms, 15.6% used pills, 14.8% used withdrawal method, 15% used permanent sterilization (10% with tubal ligation and 5.0% with vasectomy), 14.5% used intrauterine devices (IUD), 6.8% used rhythm method, 6.1% used Depo-Provera, and 1.7% used vaginal rings.

CONCLUSION:

With almost half of LAC births being unplanned and over 59% using less effective contraceptive methods, educating providers to place the most effective methods (LARC- IUD and implant) and informing the public on the most effective contraceptive methods can decrease neonatal Zika complications by preventing unplanned pregnancies. LAC is undertaking these activities to decrease the number of neonatal Zika cases.
Hormonal Contraception and Therapy Use in Breast Cancer Survivors: Do Recurrence or Mortality Risks Increase? [23A]
Authors: O'Meara Sara M. , Greer Danielle M. , Kram Jessica J.F. , Tjoe Judy A. , Dorton Benjamin
Published: May 2017

INTRODUCTION:

Breast cancer survivors are advised to avoid hormone use for contraception or peri-menopausal or post-menopausal symptoms. This study assessed the recurrence and mortality risks of contraceptive and non-contraceptive hormone use in breast cancer survivors.

METHODS:

We retrospectively studied women aged 18-55 years who were diagnosed with stage I-III breast cancer during 2006-2015 and entered remission. Multivariable extended proportional hazards models, supporting adjusted hazard ratio (HR), overall survival (OS), and locoregional and distant recurrence probability estimation, were used to examine the time-dependent effects of hormonal contraception (pill, patch, ring, subcutaneous device, injection, intrauterine device) and non-contraceptive hormonal therapies (e.g., menopausal symptoms), while adjusting for time-invariant patient, tumor, and treatment effects.

RESULTS:

Following diagnosis, 3,134 (91.2%) patients used no hormones, 171 (4.98%) used hormonal contraceptives, 129 (3.75%) used non-contraceptive hormones, and 3 (0.09%) used both. Models incorporating patients who used hormonal contraceptives versus no hormones revealed recurrence risk did not differ between groups (HR: 0.78, 95% confidence interval [CI]: 0.34-1.80). Mortality risk also did not differ (HR: 0.52, 95% CI: 0.13-2.15), with 5-year OS rates of 0.97 (95% CI: 0.90-0.99) and 0.95 (95% CI: 0.94-0.96), respectively. In models incorporating patients who used non-contraceptive hormones versus no hormones, recurrence risk was similar (HR: 1.52, 95% CI: 0.77-2.99) but hormone users incurred greater risk of death (HR: 2.95, 95% CI: 1.70-5.09).

CONCLUSION:

Breast cancer survivors who use hormonal contraceptives are not at increased risk of recurrence or mortality relative to women who do not use hormones. However, those who use non-contraceptive hormones demonstrate greater mortality risk.
Public Interest in Essure Tubal Occlusion [29A]
Authors: Schertz Katherine E. , Balica Adrian , Stadler Christian , Bachmann Gloria
Published: May 2017

INTRODUCTION:

In 2015 the FDA conducted a review on Essure after a significant number of patient complaints were reported. Multiple sources were used to gather information on adverse reports including social media through “social listening” [1]. We aim to quantify the number of web searches related to Essure and to correlate these findings with FDA complaints.

METHODS:

We used Bing Adwords, a web search tool to quantify the monthly number of searches for 2015 until July 2016. Search terms included: Essure, Essure procedure, tubal occlusion, tubal ligation. We also quantified the number of FDA complaints during the same time.

RESULTS:

The average number of monthly searches on Essure or Essure procedure was 5,849 in 2015 and 4,824 in 2016 (18% decrease). In September 2015 and March of 2016 the number of searches increased to 7,760 and 7,260 searches, respectively. Similarly, the number of FDA reports decreased from an average of 500 per month in 2015 to 380 per month in 2016 (24% decrease) [2]. Tubal occlusion and tubal ligation searches remained in the same range for 2015-2016.

CONCLUSION:

There was a similar decreasing trend for both the number of Essure searches and the number of FDA reports in 2016, suggesting that public interest in Essure began to decline after 2015. Web searches spiked during the FDA review and update in September 2015 and March 2016. This trend was not observed for tubal occlusion searches, perhaps because the general population does not use this term. This method could be useful for population health interest research.
Prenatal Video-Based Contraceptive Counseling and Postpartum LARC Uptake: A Randomized Controlled Trial [32A]
Authors: Staley Allison , Slough Laurel , Charm Samantha , Rowe Carleen , Zerden Matthew , Morse Jessica E.
Published: May 2017

INTRODUCTION:

Increasing access to long-acting reversible contraception (LARC) in the postpartum period can improve inter-pregnancy intervals and possibly prevent some of the associated infant and maternal morbidities. Videos are understudied as a tool to improve postpartum LARC use. Our primary goal is to evaluate if a validated, evidence-based, free counseling video during prenatal care increases postpartum LARC use.

METHODS:

We randomized women receiving prenatal care at an academic obstetric clinic to receive LARC FIRST video contraceptive counseling or routine prenatal care. All participants received information on free LARC methods in the postpartum period. The primary outcome was LARC placement by 12 weeks postpartum, with a secondary outcome of overall contraception use at 12 weeks postpartum. The primary outcome was analyzed using chi-square testing and logistic regression.

RESULTS:

Eighty-four participants were enrolled. To date, 80 have reached the 12 week postpartum period, of which 63 (78.75%) have completed all follow-up. Thirty were randomized to view the LARC FIRST video; 33 to routine prenatal care. LARC placement by 12 weeks postpartum was 14/30 (46.66%) versus 10/33 (30.30%), respectively. Any contraceptive method use at 12 weeks postpartum was reported by 28/30 (93.33%) and 25/33 (76.76%) participants in the LARC FIRST video versus routine prenatal care groups. We anticipate completing data collection on remaining participants by 10/17/2016.

CONCLUSION:

Video-based contraception counseling improved postpartum LARC rates with high levels of satisfaction. Widespread use of the LARC FIRST video has the potential to improve prenatal contraceptive counseling and reduce rapid, repeat unintended pregnancy.
Preliminary Baseline Findings of the CALM (Comfort, Assurance, Language Model) Approach [37A]
Authors: Ginde Savita , Stempinski-Metoyer Kelly , Bridge Rebecca , Abraham Angel , Patel Ashlesha
Published: May 2017

INTRODUCTION:

Concerns about pain during IUC insertion are common among women and limit acceptability of IUCs. This study evaluates pain associated with IUC insertion prior to CALM intervention implementation (presence of a support person dedicated to patient comfort, enhanced assurance, scripted gentle language).

METHODS:

Women ages 18-53 seeking IUC insertion were recruited for participation at two clinic sites. There are 110 women in the control group receiving standard of care procedures. We calculated mean VAS Pain Scores from a Pain Sensitivity Questionnaire, 2 pre-insertion scales, 5 time points during the procedure and overall, and 2 post-procedure scales. We calculated t-tests for binary variables, ANOVA for categorical variables, and linear regression for continuous variables.

RESULTS:

Participants received 77 Mirena and 32 Paragard IUCs. VAS scores were M= 32.2mm for pain sensitivity, M= 48.0mm for pain expected, M=49.7mm for post procedure pain, M= 51.7mm for entire procedure pain, and M= 53.8mm for IUC insertion pain. There was a moderately significant difference in post procedure pain means between parous and nulliparous women (p-val = 0.05) and provider reported procedure difficulty (p-val=0.07). Pain sensitivity mean and pain level during period significantly predicted post procedure pain (p-val < 0.0001).

CONCLUSION:

Nulliparous women had a greater mean VAS pain score than parous women, and more difficult provider experience had a greater mean VAS pain score. There is a linear relationship between both period pain and pain sensitivity with post procedure pain. This may allow us to identify those most at risk for painful IUC insertion.
Are Baseline Elevations in Reactive Non-Stress Testing of Diabetic Mothers an Indicator of Fetal Compromise? [4B]
Authors: Alekseyeva Farzana , Gimovsky Martin , Nazir Munir , Koscica Karen
Published: May 2017

INTRODUCTION:

To determine if baseline fetal tachycardia in reactive non-stress test (NST) is an indicator of fetal compromise in diabetic pregnancies.

METHODS:

Retrospective analysis of 145 diabetic mothers including gestational and pregestational diabetics from 2013-2016. Demographics included age, BMI, race, and gestational age. We reviewed the NST of patients >34 weeks of gestation and within 7 days of delivery. Baseline fetal heart rate (FHR) and the presence of 15x15mm accelerations were noted. Outcome measures included mode and indications for delivery.

RESULTS:

Of 145 diabetic patients, 55 patients had a baseline >150bpm. 47 of them had reactive tracings. Of those 47 patients, 35 underwent cesarean deliveries (C/S) (74.4%). Two patients with baseline tachycardia were diagnosed with IUFD on subsequent testing. 17 of 47 C/S performed were for non-reassuring tracing (36.17%). In comparison, 92 of 145 diabetic patients had baseline FHR < 150 bpm. 68 of 92 patients had reactive tracings. Of these 68 patients, 40 underwent C/S (58.82%), 8 were for non-reassuring fetal heart tracing (11.76%). The C/S rate for non-reassuring fetal heart tracing was significantly higher in the diabetics with elevated baseline FHR and reactive tracings in comparison to those with baseline FHR < 150bpm and reactive tracings, P < 0.05.

CONCLUSION:

The C/S rate secondary to non-reassuring fetal heart tracings was significantly higher in diabetics with elevated baseline FHR than those with baseline FHR < 150bpm even in the setting of a reactive tracing. This may be clinically relevant in antenatal testing of diabetic mothers as it implies that elevation in baseline heart rate may indicate fetal jeopardy.