bluuebunny/crossref_metadata_2025 huggingface dataset:
Perspectives on Pharmacy Access to Hormonal Contraception Among Rural New Mexican Women (PHARM) [10P]
Authors: Thaxton Lauren D. , Sible Alexandra , Clark Elizabeth , Sussman Andrew , Espey Eve
Published: May 2019

INTRODUCTION:

With the goal of expanding access to family planning, we interviewed rural New Mexican women to determine their perceptions of pharmacists' prescriptive authority and how it could impact contraceptive access in their communities.

METHODS:

Semi-structured telephone interviews were conducted with women recruited from four rural New Mexico communities. Researchers used interview guides to explain the new protocol; the guide covered topics including general attitudes, advantages, and disadvantages within their community.

RESULTS:

Between November 2017 and May 2018, 32 women were enrolled. Participants were young (56% between the ages of 18-29), gravid (52% with 3 or more prior pregnancies), employed (94%) and white (69%) Hispanic (84%). The majority used Medicaid as their primary insurer (57%). The majority of women were supportive of pharmacy access. Many expressed the desire for pharmacists to review side effects with them; most women did not think pharmacy access would reduce provider visits for preventive care. The main perceived benefit of pharmacy access was convenience: longer hours of operation, shorter wait times and no requirement for an appointment. Many did not support over the counter access to hormonal contraception due to concerns about side effects. Some concerns included lack of privacy, lack of individualized care and preference for a physician.

CONCLUSION:

Rural New Mexican women generally support pharmacy access to contraception. Operationalizing pharmacy access requires input from local community members to promote advantages and address concerns.
Tracking Obstetrical and Gynecological Experiences Using Mobile Devices [19P]
Authors: Jordan Sali , Marko Emily , McLeod Francine , Perez-Visona Sira
Published: May 2019

INTRODUCTION:

Tracking clinical experiences is important toward progression of entrustable professional activities required by medical schools. The purpose of this study was to determine the effectiveness of using an innovative real-time mobile device tracker for medical student clinical experiences compared with the traditional tracking using a passport log.

METHODS:

A prospective single cohort observational study was performed using third year medical students in obstetrics and gynecology rotations. Participants downloaded the obstetrics and gynecology (OBG) tracker and recorded their clinical experiences; procedures, number, and degree of involvement. Results were compared with data from the passport log. Outcomes included data comparison from both tracking methods and end of clerkship student surveys. Internal review board exemption was obtained. Paired t-tests were used for data analysis.

RESULTS:

Thirty-six students participated in the study over 6 months. The OBG tracker recorded 269 entries, the passport recorded 187. The OBG tracker recorded higher numbers of procedures compared to the passport (procedure type, 56 OBG tracker, 8 passport, p<0.001; degree of involvement, 30 OBG tracker, 0 passport, p<0.001). OBG tracker also tabulated student involvement in cases; 40.2% vaginal deliveries, 41.2% delivered placentas, 62.0% coached patients, 50.9% inserted catheters, 35.8% sutured, 33.3% pelvic exam, 23.3% breast exams. Student surveys rated OBG tracker more useful than the passport (OBG tracker 1.29, passport 4.06, p<0.001).

CONCLUSION:

The use of a mobile device tracker for clinical experiences allowed for more meaningful real-time data of learners than the traditional passport logs. Tracking detailed experiences and degree of involvement is important to entrustment decisions in medical education.
Does Antepartum Vitamin D3 Supplementation Prevent Chorioamnionitis? [24P]
Authors: Persad Malini D. , Staszewski Cara , Khan Farzana , Perseleni Tatyana , Herrera Kimberly , Garretto Diana
Published: May 2019

INTRODUCTION:

To determine the relationship between maternal Vitamin D status and the incidence of clinical chorioamnionitis and endometritis.

METHODS:

Nested case-control study performed 10/2016-5/2018 enrolled women from 12-16 weeks gestation. Women were excluded if taking Vitamin D3 supplements, had a malabsorption disorder, or carrying an anomalous fetus. Women were assigned to receive daily Vitamin D3 3000IU or no supplementation. Maternal demographics, baseline Vitamin D3 status, and pregnancy outcomes were collected. Clinical chorioamnionitis was defined as presence of elevated temperature of >39 C or 38 C occurring twice 30 minutes apart with fetal tachycardia, maternal tachycardia, purulent vaginal discharge or uterine tenderness. Endometritis was defined as elevated temperature and uterine tenderness in the postpartum period. Parametric and nonparametric statistics were performed. A p value of <0.05 was statistically significant.

RESULTS:

There were 210 women included, 103 in the Vitamin D3 supplementation group and 107 in the no supplementation group. There were no significant differences in baseline characteristics between the groups. The incidence of maternal infection was 4.8% (10/210). Women with Vitamin D deficiency had a significant higher risk for the development of chorioamnionitis (12.9 vs. 0%; OR 20.7; p=0.003). Women who were Vitamin D deficient, with or without supplementation, had an increased risk of chorioamnionitis (8.8 vs. 0%; OR 13.4; p=0.02). There was no association between Vitamin D3 status and endometritis.

CONCLUSION:

Women who are Vitamin D deficient, with or without antepartum Vitamin D supplementation, are at an increased risk for chorioamnionitis. Optimization of Vitamin D status may be considered in prevention of maternal infection.
Risk Factors of Subsequent Preeclampsia in Multiparous Women Among a Primarily African American Cohort [26P]
Authors: Rana Sarosh , Njoroge Scolastica , Minhas Ruby , Mueller Ariel
Published: May 2019

INTRODUCTION:

Women with a history of preeclampsia (preE) have a higher risk of developing preE in subsequent pregnancies. However, the role of the inter-pregnancy interval on this association is unclear.

METHODS:

Data was collected from an ongoing study where women with hypertensive disorders of pregnancy (HDP) are enrolled and consented upon admission to the labor and delivery floor. From this dataset, we identified multigravid women with a prior diagnosis of preE and compared them to women with no prior history.

RESULTS:

The study included 375 women with HDP who were predominantly African American (74.4%). Of these, 245 were multigravida and 44 (18.0%) had a prior history of preE. Women with prior preE had earlier gestational age of delivery (36.1 vs 38.0 weeks), higher rates of preterm delivery (63.6% vs 31.8%), and a higher incidence of preE with severe features (sPE) (56.8% vs 29.8%) in the index pregnancy (p-values≤0.001) than those without. The median number of years between history of preE in previous pregnancy and current pregnancy was 6 years (range 1-19). Among patients with a prior history of PreE, preterm delivery in a prior pregnancy was identified as a risk factor in developing sPE in subsequent pregnancies (OR 9.00, 95% CI: 2.18-37.18, p=0.002); however, interpregnancy interval and number of previous pregnancies were not associated with severe preE (p-values>0.51).

CONCLUSION:

A number of factors were identified as risk factors for developing preeclampsia in subsequent pregnancy. These factors need to be considered as part of discussion when counselling these patients.
Risk of Readmission for Relapse Among Pregnant Women on Methadone With a Co-Occurring Psychiatric Diagnosis [27P]
Authors: Rosenthal Emily , Cruz Yury , Reyes Andres , Hand Dennis , Roman Amanda
Published: May 2019

INTRODUCTION:

At our institution, methadone initiation for pregnant women with opioid use disorder (OUD) occurs in the inpatient setting. We sought to determine whether those who have a co-occurring psychiatric diagnosis are more likely to be readmitted for relapse than those who do not.

METHODS:

This is a retrospective cohort study of pregnant women with OUD at our institution from 2012-2017. The primary outcome was readmission for relapse during pregnancy. Women with a co-occurring psychiatric diagnosis were compared to those without.

RESULTS:

Readmission for relapse occurred in 59 patients (16%). A co-occurring psychiatric diagnosis was documented for 269 patients (71%). Of these, 190 patients were on a psychiatric medication (71%), and 124 patients (46%) received an inpatient psychiatric consultation. There was no significant difference in readmission for relapse between groups with and without a co-occurring psychiatric diagnosis (OR 1.13, 95% CI 0.62-2.12). Within the group with a co-occurring psychiatric diagnosis, there was no significant difference in readmission for relapse between those who were on psychiatric medication vs. not (20% vs 16%, OR 1.45, 95% CI 0.70-2.96). Women with a co-occurring psychiatric diagnosis who received an inpatient psychiatric consultation were significantly more likely to be readmitted for relapse than those who did not (26% vs 13%, OR 2.86, 95% CI 1.42-5.74).

CONCLUSION:

Pregnant women with OUD on methadone with a co-occurring psychiatric diagnosis are not more likely to be readmitted for relapse than those without. However, a co-occurring psychiatric disorder necessitating inpatient psychiatric consultation was associated with two-fold increased odds of readmission for relapse.
Seasonal Variation in the Incidence of Preeclampsia and Eclampsia in Kigali, Rwanda [28P]
Authors: Mutabazi Leon , Bazzett-Matabele Lisa , Small Maria Jacqueline , Ntasumbumuyange Diomede , Rulisa Stephen , Magriples Urania
Published: May 2019

INTRODUCTION:

Hypertensive disorders complicate 5 to 10% of all pregnancies. The WHO estimates the incidence of preeclampsia (PEC) to be 7 times higher in developing countries (2.8%) than in developed countries. The aim of this study was to document the prevalence of preeclampsia (PEC) and eclampsia (EC) in Kigali, Rwanda and to determine whether seasonality at conception or delivery affects the rate

METHODS:

A combined retrospective and prospective study at 2 large teaching hospitals in Kigali, Rwanda was performed over a 2-year period. Data were collected through an admission questionnaire by trained midwives.

RESULTS:

Over a 2-year period, 19,746 deliveries were conducted and 454 cases of PEC/EC were identified for an overall prevalence of 2.3% (2.0% PEC; 0.3% EC). Most of the patients with PEC presented with severe features (62.3%). Half of the patients were admitted with blood pressure greater than 160/110 mmHg and 55.1% were admitted between 28 weeks to 36 weeks 6 days of gestation age. Women with PEC were more likely to have chronic hypertension than women with EC (10.9% vs 0%, p=0.05). Two thirds of patients presenting with PEC/EC were admitted during the rainy season (OR 1.36, p=0.002). Season at conception did not affect the prevalence of PEC/EC at admission. There was no difference in the severity of the disease based on seasonality.

CONCLUSION:

The overall prevalence of PEC/EC was 2.3%, with a higher prevalence in rainy season. Further studies need to examine whether this is affected by seasonal variation in other diseases such as malaria.
Super-Utilizers' of L&D Triage Do Not Have an Increased Postpartum EPDS [35P]
Authors: Cronin Sean , Style Michele , Goldberg Jay , Jaspan David
Published: May 2019

INTRODUCTION:

Non-pregnant patients overutilizing emergency room resources have been reported to have higher rates of depression. Obstetrical "Super-utilization" has been previously defined as > 4 acute/unscheduled medical visits during pregnancy. We wished to determine if being a pregnant “Super-utilizer” could be a marker for postpartum depression.

METHODS:

A hospital obstetrical database was searched to determine the number of acute/unscheduled L&D triage visits for patients delivering during a three month time period. Patients with > 4 acute/unscheduled labor and delivery triage visits were considered “Super-utilizers.” Demographic and outcomes data were collected. An Edinburgh Postnatal Depression Score (EDPS) of ≥11 was considered a positive screen. Data were summarized, and groups were compared using chi-squared test for independence and Fisher's exact test.

RESULTS:

Of 750 delivered patients during a three month period, 56 (7.5%) pregnant triage “Super-utilizers” were identified. 3 (5.4%) of the 56 of “Super-utilizers” had an EPDS ≥11. Obstetrical non-“Super-utilizers” had similar rates of positive EPDS.

CONCLUSION:

Pregnant triage “Super-utilizers” were not statistically more likely to have an Edinburgh Postnatal Depression Score (EDPS) ï‚³ 11 than non-“Super-utilizers.”
The Effect of Decreased Opioid Prescribing After Routine Vaginal Delivery on Post Discharge Patient Encounters [37P]
Authors: Olsen Nina , Eagan Alexandra , Udayakumar Anu , Romutis Kristin , Martin Caitlin Eileen , Terplan Mishka
Published: May 2019

INTRODUCTION:

In line with nationwide commitment to decrease opioid prescribing, our department instituted new guidelines to no longer routinely provide opioids at discharge following vaginal delivery. The purpose of this study was to measure the effect of this change on discharge opioid prescriptions and postpartum encounters.

METHODS:

This was a retrospective cohort study of patients who underwent vaginal delivery during two time periods: November 2016 to January 2017 before the guideline and November 2017 to January 2018 after its implementation. IRB approval was obtained. Exclusion criteria included substance use disorder history, age under 18 and having a contraindication for nonopioid analgesic use. The number of patients who were provided discharge opioid prescriptions or had an outpatient encounter related to pain within six weeks postpartum were compared using Student t-tests.

RESULTS:

A total of 1,188 patients delivered during the study periods, of those 810 met inclusion criteria. 405 patients delivered prior to the guideline and 405 after its implementation. The proportion of patients prescribed opioids decreased from 79.8% (n=323) to 7.2% (n=29) after the guideline (p<0.001). The number of patients who had a post-discharge outpatient encounter (either in the Emergency Department, clinic or via phone call) related to pain did not change (4% before and 6.7% after the guideline; p = 0.085). The majority of encounters were related to dysuria and pain around repaired lacerations.

CONCLUSION:

Substantially limiting opioid prescribing after vaginal delivery does not appear to increase the burden of outpatient patient encounters after discharge.
The Effect of Gestational Weight Gain on Neonatal Birth Weight in Obese Women With Type 2 Diabetes [38P]
Authors: Kabacka Julia , LaCoursiere D. Yvette , Laurent Louise , Ramos Gladys
Published: May 2019

INTRODUCTION:

The Institute of Medicine recommends gestational weight gain (GWG) between 11 and 20 lbs for women with BMI ≥30 kg m-2. It is unknown whether these new guidelines improve outcomes in obese women with type 2 diabetes (T2DM). Objective: To determine the impact of GWG on neonatal birth weight (NBW) in obese pregnant women with T2DM.

METHODS:

Retrospective cohort study of women with initial BMI ≥30 kgm-2 and T2DM treated at UCSD between 2011 and 2016, stratified by GWG category: inadequate, adequate or excessive. The primary outcome was neonatal birth weight. Secondary outcomes included rate of macrosomia, cesarean delivery (CD), SGA infants, low Apgar scores and presence of hypertensive disorders.

RESULTS:

A total of 217 participants were enrolled. The inadequate GWG category had a higher initial BMI than the other two groups (39.8±7.5 vs 37.6±6.2 and 36.0±5.3, P=.001). Mean NBW was not significantly different between the three groups (3516.26±468 g in inadequate vs 3598.42±518 g in adequate vs 3665.75±687 g in excessive GWG groups, P=.34). The rates of CD (69.3% vs 50% and 54.7%, P=.04) and macrosomia (12.3% vs 2% and 3.8%, P=.04) were higher in the excessive GWG group. There were no differences in the rate of low birth weight infants, hypertensive disorders or Apgar scores.

CONCLUSION:

Among women with T2DM with inadequate or excessive GWG, there is no difference in neonatal birth weight. Excessive GWG is associated with higher rates of CD and macrosomia. Inadequate GWG was not associated with SGA infants or low Apgar scores.
The Effect of Method of Induction on Delivery Outcomes in Fetal Growth Restriction [40P]
Authors: Gimovsky Alexis C. , Thomas Janelle , Carter Jene , Sparks Andrew , Ahmadzia Homa K.
Published: May 2019

INTRODUCTION:

To evaluate whether method of induction used for pregnancies complicated by fetal intrauterine growth restriction has an impact on perinatal outcomes.

METHODS:

Secondary analysis of the Consortium for Safe Labor database. Women were compared by induction method in 3 groups: 1- misoprostol, 2-dinoprostone or 3-mechanical dilation or oxytocin. Inclusion criteria: ≥37 weeks, cephalic presentation. Exclusion criteria: prior cesarean delivery (CD), stillbirth, major congenital anomaly or aneuploidy. Primary outcome was CD due to “non-reassuring” fetal heart rate. Perinatal outcomes were measured secondarily. This study was IRB approved.

RESULTS:

632 women met inclusion criteria: 72 women with misoprostol, 66 women with dinoprostone and 494 women with mechanical dilation/oxytocin. Demographics differed by parity, with higher parity in the mechanical/oxytocin group (p = 0.001). Incidence of CD for “non-reassuring” heart rate was 18.1% in the misoprostol group (13/72), 13.6% in the dinoprostone group (9/66) and 6.5% in the mechanical/oxytocin group (32/494), p = 0.001. Overall incidence of CD was 31.9% (23/72) with misoprostol, 18.2% (12/66) with dinoprostone and 11.1% (55/494) with mechanical/oxytocin induction (p < 0.001). Incidence of operative vaginal delivery did not differ between groups. Resuscitation occurred in 2.8%, 4.6%, and 0.8% of the misoprostol, dinoprostone, and mechanical/oxytocin groups, respectively (p = 0.03).

CONCLUSION:

In term women with fetal growth restriction, induction of labor using misoprostol resulted in the highest incidence of CD for “non-reassuring” fetal heart rate with a 465% increase in comparison to mechanical methods. Newborn resuscitation was more common in the dinoprostone group compared to mechanical, but not increased over misoprostol.
The Impact of Current Smoking on Wound Complications, A Review of the ACS NSQIP Dataset [11Q]
Authors: Hammer Karissa , Fogg Louis , Maurice Joseph Michael
Published: May 2019

INTRODUCTION:

Smoking is a modifiable risk factor that is associated with cardiac, respiratory, and wound postoperative complications. We investigate the impact of smoking on postoperative wound complications.

METHODS:

The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) dataset was queried for patient who underwent hysterectomy by primary CPT code from 2011 to 2014. CPT codes used included laparoscopic hysterectomy (58570-58573), laparoscopic assisted vaginal hysterectomy (58550-58554), abdominal hysterectomy (58150), vaginal hysterectomy (58260, 58261, 58290, 58291). Smoking was defined by the ACS NSQIP as individuals who have smoked cigarettes within the previous twelve months leading up to surgery. Univariate analysis was used to assess 30 day postoperative wound complications. Wound complications included: superficial surgical site infection (SSI), deep SSI, organ space SSI and wound disruption.

RESULTS:

There were significant differences between number of wound complications and relative risk for smokers compared to non-smokers undergoing hysterectomy. The relative risk for superficial wound complication is 1.5 (p<0.05), deep surgical site infection is 1.89 (P<0.05), organ space infection is 1.59 (p<0.05), and wound disruption 1.61 (p <0.05) for smokers compared to non-smokers undergoing hysterectomy. The risk of a single complication increases by 1.56 (p<0.001) with smoking, risk of two complications increases by 2.12 (p<0.001), and the risk of having three complications increases by 4.88 (p<0.001).

CONCLUSION:

Smoking at the time of hysterectomy greatly increased the risk of wound complications. Future studies should investigate the amount of time from smoking cessation to surgery required to decrease the risk of wound complications.
Utilization and Outcomes of Ovarian Conservation at Hysterectomy for Benign Gynecologic Indications [15Q]
Authors: Mandelbaum Rachel S. , Chen Ling , Shoupe Donna , Roman Lynda D. , Wright Jason , Matsuo Koji
Published: May 2019

INTRODUCTION:

The long-term benefits of ovarian conservation (OC) in young women have been well-established, however short-term outcomes remain relatively understudied. We examined utilization and outcomes of OC at the time of hysterectomy for benign gynecologic disease.

METHODS:

A population-based retrospective analysis of the Nationwide Inpatient Sample between 2001-2015 was performed. Hospital discharge records for women <50 years undergoing hysterectomy for benign gynecologic disease, without ovarian pathology or malignancy, were extracted and weighted. Women were grouped as elective oophorectomy versus OC. Propensity score matching was performed, and length of hospitalization, total charges, and perioperative complications were compared.

RESULTS:

There were 1,432,046 women who underwent hysterectomy for benign gynecologic disease during the study period, and 1,084,703 (75.7%) women had OC. OC rates varied between 71.5% and 79.9% during the study period (P<0.05). OC was associated with younger age, Black/Hispanic race, non-obese habitus, fewer comorbidities, higher household income, Medicaid insurance, residence in the Northeast, urban-teaching hospital status, and minimally-invasive hysterectomy approach (all, P<0.05). After propensity score matching, the proportion of patients requiring hospital stays >2 days (27.8% vs. 30.9%, relative risk reduction 10.1%, P<0.001) and median total charges ($17,383 vs. $18,419, net difference -$1,036, P<0.001) were significantly lower for women who had OC compared to oophorectomy. Perioperative complication rates were clinically similar (9.0% vs. 9.2%, P=0.004). Similar findings were observed among women <45 and <40 years of age (all, P<0.05).

CONCLUSION:

Our study suggests that OC is associated with modestly decreased length of hospitalization and total charges in young women undergoing hysterectomy for benign gynecologic indications.
Incarceration in Women at Risk for HIV [17Q]
Authors: Knittel Andrea K. , Shook-Sa Bonnie , Rudolph Jacqueline , Edmonds Andrew , Ramirez Catalina , Adimora Adaora A.
Published: May 2019

INTRODUCTION:

Incarceration is associated with HIV risk behaviors including high-risk sexual behavior and injection drug use among women in the United States.

METHODS:

The Women's Interagency HIV Study is a geographically diverse multicenter cohort study of women, including 970 at risk for HIV. During semiannual study visits, participants were asked about incarceration of themselves (10/2007-09/2017) and of their sexual partners (10/2013-09/2017). We used descriptive statistics to characterize incarceration among the HIV-negative cohort, and multivariable logistic regression to identify baseline predictors of incident incarceration for 602 HIV-negative women followed forward from 10/2007.

RESULTS:

Nearly half (n=453, 46.7%) of HIV-negative women were incarcerated during or before the study, and the incarceration rate between 2007 and 2017 was 6.1 per 100 person-years. Women experienced a lifetime median of three incarcerations (IQR 1-6 episodes), and eight months of incarcerated time (IQR 2-26 months). One third of incarcerated women (n=86) reported that one or more male sexual partners were incarcerated during the project period. In the multivariable model, incident incarceration was associated with prior incarceration (OR 7.5, 95% CI 4.3-13.0), non-injection drug use (OR 2.2, 95% CI 1.4-3.6), and housing instability (OR 3.8, 95% CI 1.6-8.9).

CONCLUSION:

Compared with less than one incarceration per 100 person-years in the general population, incarceration is more common for women at risk for HIV. Incarceration is associated with drug use and unstable housing. HIV prevention interventions targeting incarcerated women have the potential to reach a large proportion of women at risk of HIV infection in the US.
Hepatitis C Viral Infection Among Pregnant Women in Utah, 2009–2016 [18Q]
Authors: Smid Marcela Carolina , Maeda Jewel , Stone Nicole , Shakib Julie , Baksh Laurie
Published: May 2019

INTRODUCTION:

Little is known about women with hepatitis C virus (HCV) infection in pregnancy in Utah. Our objectives were to 1) describe the demographics of women with HCV in pregnancy and 2) assess the trends in HCV infection among pregnant women in Utah.

METHODS:

Population-based retrospective cohort of all livebirths >= 20 weeks gestation in Utah from 2009-2016. We describe demographics of women with HCV compared to women with no infections. We assessed change in prevalence of HCV, HIV, hepatitis B and syphilis from 2009-2016 using linear test of trend.

RESULTS:

From 2009-2013, 411,936 women had a delivery >= 20 weeks in Utah: 595 (0.14%) had HCV, 543 (0.13%) HBV, 103 (0.03%) HIV, and 83 (0.02%) syphilis. Compared to women with no infection, women with HCV were more likely to have less than a high school education (10.7 vs 25.7%), have Medicaid insurance (26.0 vs 64.7%), no prenatal care (0.5 vs 5.1%), smoke in the third trimester (3.0 vs 33.1%) and use illicit drugs during pregnancy (0.8 vs 39%), (all p<0.001). From 2009-2016, the proportion of pregnant women with HCV increased significantly (p=<0.001). There was no significant change in the proportion of pregnant women diagnosed with HBV (p=0.20), HIV (p=0.74) or syphilis (p=0.11).

CONCLUSION:

In contrast to other infection, HCV among pregnant women in Utah is increasing. While there are no current perinatal interventions for HCV, referral and treatment of women with HCV in the postpartum period is in line with recent guidelines encouraging providers to use the “fourth trimester” to improve maternal health.
Depression Risk is Associated With Higher Viral Loads in Women Infected With Human Immunodeficiency Virus [21Q]
Authors: Doehrman Pooja Deb , Willey Alicia S. , Casper Katie , Egbe Thomas Obinchemti , Marcelin Ngowe , Sab Sab Melvin
Published: May 2019

INTRODUCTION:

Human Immunodeficiency Virus (HIV)-positive patients in Cameroon have a three-fold increased risk of depression compared to non-infected patients. This study identifies the relationship between psychological, social, and economic factors that affect disease progression in this population.

METHODS:

Patient Health Questionnaire (PHQ-9) depression risk assessments, viral load, marriage, religion, occupation, and income data was collected from 237 women in a cross-sectional study, from the Buea and Limbe municipalities of Cameroon. An independent T-test was performed to compare viral loads in patients with high and low-risk depression assessments, as defined as a PHQ-9 score above or below 10. Two-way ANOVA was performed to evaluate the interaction of several social factors and depression risk on viral load.

RESULTS:

A statistically significant difference exists between mean HIV viral load in individuals with low-risk (<10) versus high-risk depression screening (>9) (7,281 vs 206,433, P <.001). Married women high-risk for depression had the highest viral load 465,014, with a statistically significant interaction between marriage and depression on viral load (P<.001).

CONCLUSION:

Women at high risk for depression were more negatively affected by the social construct of marriage, with higher mean viral loads. Mental health and social factors seem to influence immunologic resilience and subsequent disease progression in certain at risk populations of HIV- positive women. Strategies to improve treatment outcomes may be more effective with consideration of these psycho-social factors.
Effect of Duration from Diagnosis of Clinical Chorioamnionitis to Delivery on Short Term Neonatal Outcomes [22Q]
Authors: Patel Krunal P. , Rana Rima , Williams Shauna F. , Gittens Lisa Nadine , Apuzzio Joseph
Published: May 2019

INTRODUCTION:

Clinical chorioamnionitis (CC) is associated with poor neonatal outcomes. It is not well known if the duration from diagnosis of CC to delivery has an impact on neonatal outcome. Our hypothesis is that the duration from diagnosis of CC to delivery at term does not affect the short term neonatal outcome.

METHODS:

This is a retrospective cohort study of patients >37 weeks gestation diagnosed with CC at a single tertiary care hospital from Jan 1, 2015 to December 31, 2017. Medical records were reviewed for maternal demographics and neonatal records were reviewed for length of NICU stay, total hospital stay, 5 minute APGAR score and presence of bacteremia. Patients were grouped by duration of diagnosis of CC to delivery <4 hours and> 4 hours. Mann Whitney test, Fisher's exact test and t-test were performed when appropriate.

RESULTS:

131 patients met inclusion criteria. 94 women delivered within 4 hours of diagnosis of CC and 37 women delivered after 4 hours of diagnosis. There was no difference in length of NICU stay, length of hospital stay, 5 minute APGAR score or neonatal bacteremia. When comparing time of diagnosis to delivery at time points of 1 and 6 hours, there was no difference in neonatal length of hospital stay.

CONCLUSION:

Time to delivery after diagnosis of chorioamnionitis at term does not appear to affect short term neonatal outcomes.
Obstetric Hemorrhage Policies and Practices Among New York State Obstetric Hemorrhage Project Hospitals [23Q]
Authors: Goffman Dena , Roy Amanda , Atallah Fouad , Lawless Kristen , Ghazaryan Lusine , Kacica Marilyn
Published: May 2019

INTRODUCTION:

The New York State (NYS) Obstetric Hemorrhage Project (NYSOHP) aims to reduce maternal morbidity and mortality by improving management of obstetric hemorrhage. In order to develop a strategy for intervention, a survey of current policies and practices was conducted.

METHODS:

The NYSOHP Current Practices Survey was disseminated to all NYS birthing hospitals. Participating hospitals were asked to complete the survey upon joining the project beginning October 2017. One survey was completed per hospital. Results were analyzed in aggregate and by hospital level.

RESULTS:

84 of 123 NYS birthing hospitals are participating in NYSOHP. 100% of project participants completed the survey. 98% of hospitals have an obstetric hemorrhage protocol. The top three elements addressed in protocols were: obstetric hemorrhage definition (89%), massive transfusion protocol (85%) and hemorrhage risk assessment (83%), while advisement on huddles/debriefs (57%), outcomes monitoring (43%), and information for patients (28%) were identified as areas for improvement. In practice, risk assessments were conducted: 88% on admission, 47% intrapartum, and 28% postpartum. Quantification of blood loss was used exclusively in 23% of hospitals, 20% used visual estimation and 57% used a combination. 86% conduct hemorrhage drills with variable frequency, only 37% are at least quarterly. 88% conduct reviews after serious hemorrhages.

CONCLUSION:

The majority of NYS birthing hospitals fulfill many elements of readiness for obstetric hemorrhage. However, significant variation remains. Better understanding of opportunities for improvement allowed for the development of a State-wide QI intervention launched in November 2017. Further data collection and analysis will allow assessment of impact on outcomes.
Outcome Reporting in Studies on Pregnant Women With Cardiac Disease: A Systematic Review [30Q]
Authors: Hall Chelsea , Shishkina Anna , Pal Ankita , D'Souza Rohan D.
Published: May 2019

INTRODUCTION:

To systematically review the literature for reported outcomes is studies on pregnant women with cardiac disease.

METHODS:

A search strategy was designed for Medline, Embase, Web of Science and Cochrane Central databases from 1980 to 2015 to identify all experimental and observational studies in pregnant women with cardiac disease. The search was limited to studies describing five patients or more, studies in the English language and excluded conference abstracts. As the intent was to describe reported outcomes, authors were not contacted for clarifications, the grey literature was not searched and no risk of bias assessment was performed.

RESULTS:

3118 titles and abstracts were reviewed and 327 studies were included in this review, stratified under valvular heart disease (78), all cardiac disease (75), cardiomyopathies (68), complex congenital heart disease (49), cardiac interventions in pregnancy (35) and others including aortopathies and arrhythmias (22). There was large variation in the number and nature of reported outcomes. The most commonly reported maternal outcomes included: maternal mortality (n=169), thrombo-embolism (n=118), and mode of delivery (n=190). The most commonly reported fetal/neonatal outcomes included: preterm birth (n=143), miscarriage/abortion (n=119) and neonatal death (n=100). Proportions of studies that provided definitions for outcomes varied, and definitions were highly inconsistent between studies.

CONCLUSION:

Meta-analysis of studies involving pregnant women with cardiac disease requires consistency in the reporting and defining of outcomes for meaningful clinical conclusions to be drawn. To address this issue, a core outcome set, a standardized set of outcomes obtained through consensus between relevant stakeholders, is urgently required.
Parity and Starting Effacement as Predictors of Successful Induction of Labor With Foley Balloon [33C]
Authors: Coghlan Martha K. , Hurvitz Julie , Atkins Kristin L. , Crimmins Sarah D.
Published: May 2019

INTRODUCTION:

We sought to determine if parity and starting effacement predict successful induction of labor (IOL), defined as achievement of complete cervical dilation (ACD), when utilizing Foley Balloon (FB) for IOL.

METHODS:

A retrospective study with IRB approval was conducted of all singleton pregnancies undergoing IOL between 2013 and 2016 at a single institution. Stillbirths and prior cesarean delivery (CD) were excluded. Primary outcome was ACD. Secondary outcomes were CD, postpartum hemorrhage, chorioamnionitis, and NICU admission. Starting effacement was stratified into quartiles: 0-25%, 26-50%, 51-75%, and 76-100%, and parity divided into nulliparous and multiparous groups. Multivariate logistic regression were performed to assess the effect of parity and starting effacement on the rate of ACD.

RESULTS:

Of the 1,260 patients that met inclusion criteria, 615 had starting effacement between 0-25% with a mean parity of 1.0. In nulliparous women with starting effacement 0-25% receiving FB for IOL, 50.4% (68) ACD, compared to 69.0% (116) in the same group not receiving FB (P<0.001, OR 0.45; 95th CI: 0.28-0.73). The CD rate was also higher in nulliparous women receiving FB (54.8% v 34.9%, P<0.001, OR: 2.3; 95th CI: 1.4-3.6) compared to nulliparous women not receiving FB. In multiparous women with starting effacement 0-25% receiving FB for IOL, 84.8% (56) ACD, compared to 86.2% (219) in the same group not receiving FB (P=0.69, OR 0.86; 95th CI: 0.4-1.8). There were no statistically significant differences in the secondary outcomes.

CONCLUSION:

Nulliparous patients with low starting effacement may benefit from additional medications, rather than placement of FB for IOL.
Prediction Models for Determining the Success of Labor Induction: A Systematic Review [35C]
Authors: Meier Kennedy , Parrish Jacqueline , D'Souza Rohan D.
Published: May 2019

INTRODUCTION:

The purpose of this study was to systematically identify all derived and/or validated clinical prediction models for labor induction containing universally accessible factors and compare their performance to inform the development of a model that could be recommended for clinical practice.

METHODS:

Four databases were searched from inception to November, 2017 for studies that derived and/or validated clinical prediction models containing antenatal history and cervical examination. Risk-of-bias of included studies was assessed using the Prediction Study Risk of Bias Assessment Tool. In view of anticipated heterogeneity between studies, only descriptive analysis was possible.

RESULTS:

We identified 16 studies describing 14 prediction models derived between 1966 and 2018. Models varied with regard to participant inclusion, sample size, considered and included variables, endpoint definitions, study design and performance. Of the derived models, six were validated internally and three externally. Performance was most commonly measured using the area under the receiver operator characteristic curve, which ranged from 0.68 to 0.79, 0.67 to 0.77 and 0.61 to 0.73 for derived, internally validated and externally validated models, respectively. Studies' risk-of-bias ranged between studies fulfilling 36% to 86% of eligible items.

CONCLUSION:

No published model to determine the success of vaginal birth after labor induction can be currently recommended for clinical use. In order to improve performance and uptake, researchers should incorporate attitudes of women and care providers, assess clinical and resource implications and adhere to recommendations made by this systematic review before deriving and validating prediction models for determining the success of labor induction.
Management and Outcomes of Peptic Ulcer Disease in Pregnancy [37C]
Authors: Rosen Charlotte , Abenhaim Haim Arie , Mishkin Daniel , Czuzoj-Shulman Nicholas
Published: May 2019

INTRODUCTION:

Given the altered physiology of pregnancy, gastroenterologists are often reluctant to perform endoscopic procedures in pregnant women. The purpose of our study was to compare management practices and outcomes among pregnant and non-pregnant women admitted to the hospital for peptic ulcer disease (PUD).

METHODS:

A retrospective matched cohort study was carried out using the Healthcare Cost and Utilization Project—National Inpatient Sample. All births that took place from 1999 to 2015 were identified and women were classified as having PUD on the basis of ICD-9 coding. Logistic regression analysis was used to evaluate the adjusted effect of PUD on variables and outcomes of interest.

RESULTS:

PUD was diagnosed in 2,535 pregnant women and 12,675 age-matched non-pregnant women during the 16-year study period. Compared with non-pregnant women, pregnant women were more likely to be Hispanic, less likely to be Caucasian and less likely to be smokers. As compared to non-pregnant women, pregnant women with PUD were less likely to undergo diagnostic or therapeutic esophagogastroduodenoscopies for this indication. Outcomes including fever, infection, sepsis, shock, transfusion and death were less likely to occur in pregnant women as compared to non-pregnant women and pregnant women also experienced shorter hospital stays.

CONCLUSION:

Pregnant women with PUD are less likely to undergo interventional diagnostic and therapeutic procedures than non-pregnant women with PUD. The reluctance to intervene in pregnancy does not appear to result in more adverse PUD-associated outcomes.
Patients Presenting After Sexual Assault: Population Characteristics and Rates of Follow up [1D]
Authors: Choi Jennie ES , Bechtel Kirsten , Pathy Shefali
Published: May 2019

INTRODUCTION:

Survivors of sexual assault (SA) experience a range of physical and mental health consequences. Despite universal agreement that utilization of longitudinal follow-up decreases morbidity and mortality of survivors, studies demonstrate that only one-third of victims receive follow-up care directly related to their assault. This study aims to describe the patient population presenting after SA, characteristics of their acute care, and rates of follow-up within one year in an urban hospital setting.

METHODS:

A retrospective medical record review was conducted of patients presenting to emergency departments and primary care and women's outpatient clinics across two campuses of the Yale New Haven Health Systems from 01/2014-02/2017. Inclusion criteria were patients older than 12 years old with one of eleven ICD-10 codes associated with SA/abuse.

RESULTS:

There were 285 patients whose encounters met inclusion criteria. Mean patient age was 25.85 years (SD=11.98 y); 95% were female; 46% were White and 35% were Black. The overall rate of follow-up within one year after discharge was 34%, consistent with the reported national average. However, when analyzed by age, follow up rate for patients older than 18 years (42/197; 21%) was significantly lower than the rate for patients 13-18 years old (57/93; 61%) (Ï‡2=44.89; p<0.05).

CONCLUSION:

The rate of follow-up within one year after SA in patients is overall low, especially in women older than 18 years old. We suggest follow-up may be improved with implementation of a discharge protocol and consistent resources for patients seen in the ED for SA.
Early Discontinuation of Postpartum Long-Acting Reversible Contraception Among Women Living With HIV (WLWH) [7D]
Authors: Francis Elizabeth , Rucker Lindsay , Brzozowski Nicole Christine , Dempsey Angela , Lazenby Gweneth B.
Published: May 2019

INTRODUCTION:

The objective of this study was to determine if WLWH were more likely than HIV negative women to remove postpartum (pp) LARC <12 months of placement (ED).

METHODS:

This is an IRB-approved, retrospective cohort study of women who had a LARC device (IUD or implant) placed <90 days pp and documentation of removal during the study period (1/1/09-2/14/18). Key variables were delivery date, LARC device, dates of placement and removal, age, parity, race/ethnicity, pregnancy characteristics and outcomes. Outcomes were compared using bivariate analysis. Logistic regression was used to evaluate factors associated with ED.

RESULTS:

794 women who had a LARC device placed <90 days pp were eligible for analysis: 50 WLWH and 744 HIV negative women. Most women selected IUDs (85%). Median time to insertion was 42 days (IQR 35-51 days). WLWH were more likely to use implants (52% vs 87%, P<0.0001) and were more likely to receive LARC <4 days pp (76% vs 17%, P<0.0001). WLWH were not more likely to have ED (38% vs 36%, P=.9). Placement of LARC <4 days pp was associated with ED [aOR 2.6, (95% CI 1.8-3.9)]. Women who bottle fed were less likely to have ED [aOR 0.6, (CI 0.4-0.8)].

CONCLUSION:

WLWH were more likely to receive LARC <4 days pp, but they were not more likely to have ED. WLWH were found to have a significantly lower pp IUD use compared to controls. Further investigation is needed to elucidate disparities in pp IUD use among WLWH.
Predictive Value of Fetal Abdominal Circumference in Diagnosing Large for Gestational Age Infants [9D]
Authors: Kopparam Rohini , Matthews Kathy , Khan Rana , Grossman Tracy B. , Gelber Shari Ellen
Published: May 2019

INTRODUCTION:

Macrosomia is associated with adverse perinatal outcomes and has implications for mode of delivery. Research increasingly supports the use of fetal abdominal circumference (AC) as an additional measure to capture large for gestational age (LGA) infants. We evaluated the predictive value of sonographic fetal abdominal circumference (AC) measurement from 25-36 weeks' gestation for detection of LGA infants.

METHODS:

Retrospective chart review following IRB approval. LGA was defined as a newborn birth weight >90th percentile on the Fenton Growth Curve. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) at various gestational age ranges (25-28, 29-32 and 33-36 weeks' gestation) for a Z-score >+1.88, corresponding to the 97th percentile, were calculated. Area under receiver operating characteristic curve (AUROCC) of AC Z-scores ranging from -3.00 to +3.00 was calculated.

RESULTS:

Ultrasounds of 4801 women with 5799 pregnancies were reviewed. Our study population had an LGA infant prevalence of 5.8%. An AC Z-score of +1.88 had a maximal sensitivity of 34.3%, specificity of 98.2%, and NPV of 96.2% for detecting LGA births at 29-32 weeks' gestation. The AUROCC at this time point was 0.88.

CONCLUSION:

Fetal AC <97th percentile in the third trimester has a very high specificity and negative predictive value in ruling out LGA newborns. These measures indicate that this modality can identify pregnancies that are not at high risk for fetal macrosomia and would not benefit from unnecessary cesarean delivery. High AUROCC demonstrates independent predictive potential of AC and supports its adjunct use with more traditional measurements.
Risk Factors for Neonatal Hypoglycemia Following Exposure to Antenatal Corticosteroids [14D]
Authors: Nickel Mara , Fixler Joseph S. , DeFranco Emily A.
Published: May 2019

INTRODUCTION:

To quantify the influence of maternal and neonate characteristics on risk of neonatal hypoglycemia in pregnancies exposed to antenatal steroids (ANCS).

METHODS:

We performed a retrospective cohort study utilizing a 2013-2017 dataset created from electronic medical records (EPIC) of all mothers who delivered early (<34) and late preterm (34 to <37 weeks) at the University of Cincinnati, linked to neonatal data through 1 week postdelivery. Maternal and neonatal characteristics were compared between preterm neonates exposed to ANCS experiencing hypoglycemia and those with normal glycemic levels. Multivariate logistic regression estimated the relative risk of these factors on the risk of neonatal hypoglycemia following preterm ANCS.

RESULTS:

1,210 mother-neonate pairs were included. Hypoglycemia, defined as neonatal BG of <40 mg/dL in the first week of life, was present in 24.0% of early preterm births (PTBs) and 24.4% of late PTBs exposed to ANCS. The factor most strongly associated with neonatal hypoglycemia was maternal hyperglycemia (BG ≥180mg/dL) on the day of or day prior to delivery. This association was stronger in late PTBs (adjusted relative risk [adjRR] 4.49; 95% CI 1.50, 13.40) than early PTBs (adjRR 1.91; 95% CI 1.07, 3.41).

CONCLUSION:

The presence of maternal hyperglycemia proximate to time of delivery (0-1 days prior to birth) is the most predictive factor for neonatal hypoglycemia, with magnitude of risk higher in late preterm compared to early preterm neonates This information demonstrates the importance of maternal glycemic control near the time of delivery after exposure to ANCS.
Risk of Primary Cesarean Delivery: Role of Language Preference and Language-Concordant Labor Support [17D]
Authors: Schaefer Kimberly , Modest Anna M. , Chie Lucy , Connor Yamicia , Golen Toni , Molina Rose L.
Published: May 2019

INTRODUCTION:

Increasing rates of cesarean deliveries (CD) in the US over recent decades have been associated with social factors such as race and migration status. This study aims to assess the effects of English language proficiency and language-concordant labor support on risk of primary CD at Beth Israel Deaconess Medical Center (BIDMC). Such labor support is offered uniquely at BIDMC-associated South Cove Community Health Center (SCCHC), which has a primarily Asian immigrant population with limited English proficiency (LEP).

METHODS:

We conducted a retrospective cohort study using BIDMC records of nulliparous, term, singleton, vertex (NTSV) deliveries from 2011-2016 with women over 18 years old. We used modified Poisson regression models with robust error variance to assess risk ratios for CD between English-speaking, LEP SCCHC, and LEP non-SCCHC groups, adjusting for age, education, race, insurance, and delivery year. This study received BIDMC IRB approval.

RESULTS:

Of the 11,599 women included, 89.8% (n=10,411) were English-speaking, 5.6% (n=654) were LEP at SCCHC, and 4.6% (n=534) were LEP at a non-SCCHC practice. Proportions of CD were 24.4% (n=2,537), 17.1% (n=112), and 22.1% (n=118), respectively. LEP women at SCCHC had 0.75 (95% CI 0.61-0.93) times the risk of CD compared with English-speaking women; the risk for CD was not significantly different between non-SCCHC LEP and English-speaking women (RR 0.89, 95% CI 0.75-1.05).

CONCLUSION:

Prenatal care provision at SCCHC for women with LEP was associated with a 25% decreased risk of CD, suggesting that language-concordant labor support can play a key role in limiting rates of NTSV cesarean deliveries.