bluuebunny/crossref_metadata_2025 huggingface dataset:
Association Between Mode of Delivery and Postpartum Assessment of High-Grade Cervical Dysplasia Diagnosed in Pregnancy [ID 2683564]
Authors: Mulder Isabelle , Nambiar Anjali , Holloway Steven Blaine , Pruszynski Jessica , Lea Jayanthi , Martin Robert B.
Published: May 2024

INTRODUCTION:

Approximately 5% of pregnancies are complicated by cervical dysplasia. It is hypothesized that cervical remodeling during vaginal delivery may confer higher rates of postpartum regression when compared to cesarean. We sought to evaluate the relationship between mode of delivery and postpartum dysplasia outcomes.

METHODS:

This is a retrospective cohort study of patients with biopsy-proven high-grade dysplasia diagnosed during pregnancy from January 2013 to December 2022. Demographics, obstetric outcomes, and antepartum and postpartum cervical pathology were collected and IRB approval obtained. Only immunocompetent patients with postpartum pathology obtained within 1 year of delivery were included. Definitions based on postpartum pathology were as follows: regression as low-grade or resolved dysplasia, persistence as high-grade dysplasia, and progression as cervical cancer. Rates were stratified by mode of delivery and data analyzed using the chi-squared test.

RESULTS:

Among our cohort (N=286), 101 (35%) were diagnosed with CIN2, 181 (63%) with CIN3/CIS, and 4 (1%) with HSIL (not otherwise specified) on antepartum cervical biopsy. 228 (80%) delivered via vaginal delivery and 58 (20%) delivered via cesarean. Rate of postpartum regression was similar in both delivery groups (37% versus 38%; P=.927), as was persistence (62% versus 60%; P=.786). Rate of apparent progression to invasive cancer was low in both groups (<1% versus 2%; P=.365).

CONCLUSION:

High rates of persistence and low rates of apparent progression were observed subsequent to both vaginal and cesarean deliveries. Our data indicate that the natural history of high-grade dysplasia diagnosed during pregnancy is not affected by route of delivery in a way that should influence postpartum management.
Intrinsic and Extrinsic Apoptotic Pathways May Dictate In Vitro Fertilization Outcomes in Women of Advanced Maternal Age [ID 2683425]
Authors: Archer Hannah C. , Nguyen Dieu Thao , Petyak Eleanor , Chosed Renee J. , Green Lisa , Chang T. Arthur
Published: May 2024

INTRODUCTION:

Women of advanced maternal age (AMA) (≥35 years) are at an increased risk for a decline in ovarian reserve and have a decreased rate of live birth after one cycle of in vitro fertilization (IVF). Current practice recommends preimplantation genetic testing for aneuploidy (PGT-A) to women of AMA to increase live birth outcomes. However, recent studies have found that conventional IVF was non-inferior to PGT-A. Identifying additional biomarkers may provide another metric for selecting the most viable embryo.

METHODS:

Blastocoel fluid-conditioned media was collected from day 5 IVF embryos that underwent PGT-A. RNA was purified from pooled blastocoel fluid samples from four groups based on implantation status and maternal age, and then cDNA was synthesized. RT-qPCR was used to assess expression of CASP3, CASP7, CASP8, and BCL2L12 levels in a total of 64 embryos.

RESULTS:

CASP3 and CASP7 expression were higher in the media from IVF embryos with positive implantation outcomes from patients aged less than 35 years. There was increased CASP8 expression in media from IVF embryos from AMA patients regardless of implantation status.

CONCLUSION:

Preliminary analysis suggests increased CASP8 expression is associated with successful implantation outcomes in AMA patients. This suggests that CASP8 could be activated in preimplantation embryos as an aging response as found in AMA media samples. One explanation is that CASP8 is associated with aneuploidy in the AMA samples. Further research will determine whether expression and activation of CASP8 are required for positive implantation outcomes and be used as an additional embryo selection tool for other AMA patients utilizing IVF.
Addiction-Centered Pregnancy Care: Bridging the Gap Between Addiction Treatment and Prenatal Care to Improve Outcomes for Pregnant People and Infants [ID 2683418]
Authors: Morgan Alexandra , Saunders Elizabeth , Goodman Daisy J.
Published: May 2024

INTRODUCTION:

Opioid use disorder (OUD) is a leading cause of maternal mortality. This study evaluated a new model of care for pregnant people with OUD, addiction-centered pregnancy care (ACPC), which provides assessment and support for the social, economic, and personal challenges linked to OUD within prenatal care. Unlike integrated models of care providing medication for OUD, ACPC is easier to implement and rapidly scalable. This study compared risk of preterm delivery and infant length of stay for patients receiving ACPC versus standard prenatal care.

METHODS:

In this retrospective cohort study approved by the Dartmouth Hitchcock IRB, data were abstracted from charts of patients with OUD who received ACPC (n=53) or standard prenatal care (n=41) and delivered at an academic medical center in the Northeast between 2018 and 2021. Risk of preterm delivery was examined using multivariate logistic regressions, and infant length of stay was assessed with negative binomial models.

RESULTS:

Women in the ACPC cohort had reduced odds of preterm delivery (n=3, 5.7%) compared to the standard prenatal cohort (n=11, 26.8%; odds ratio [OR] 0.40; 95% CI, 0.21, 0.80). Compared to standard prenatal care, infants of patients receiving ACPC stayed in the hospital fewer days after delivery (incidence risk ratio, 0.77; 95% CI, 0.61, 0.97).

CONCLUSION:

Among a cohort of pregnant patients with OUD in the Northeast, receiving ACPC was associated with reduced risk for preterm delivery and shorter length of infant hospitalization compared to standard prenatal care. Future research should assess if these differences are due to this model’s focus on supporting psychosocial and socioeconomic challenges linked to OUD.
ChatGPT Compared With Google Bard: Which Large Language Model Responds Best to Commonly Asked Pregnancy Questions? [ID 2683501]
Authors: Khromchenko Keren , Shaikh Sameeha S. , Singh Meghana , Vurture Gregory , Rana Rima , Baum Jonathan
Published: May 2024

INTRODUCTION:

Large language models (LLMs) have proven themselves in a variety of settings and shown the ability to provide information on a variety of topics in obstetrics and gynecology. Which platform performs best in regard to its ability to respond to commonly asked pregnancy questions is unknown.

METHODS:

A qualitative analysis of ChatGPT and Google Bard was performed in August of 2023. We queried each LLM on 12 commonly asked pregnancy questions and asked for their references. Query responses were graded as “acceptable” or “not acceptable” based on correctness and completeness in comparison to American College of Obstetricians and Gynecologists (ACOG) publications, PubMed-indexed evidence, and clinical experience. References were classified as “verified,” “broken,” “irrelevant,” “non-existent,” and “no references.” Review and grading of the responses and references for both LLMs were performed by the co-authors individually and then as a group to formulate a consensus.

RESULTS:

A grade of acceptable was given to 58% of ChatGPT’s responses (7 out of 12) and 83% of Google Bard’s responses (10 out of 12). A grade of not acceptable was assigned to 42% of ChatGPT’s responses (2 were incomplete and 3 were incorrect) and 17% of Google Bard’s responses (2 incomplete). In regard to references, ChatGPT had reference issues in 100% of its references (12 out of 12). No references were provided for 10 answers, one answer had a non-existent reference, and another answer had two broken references and two verified references. Google Bard had discrepancies in 8.3% of its references (1 out of 12): 11 answers had verified references, and 1 answer had a broken reference.

CONCLUSION:

Google Bard has superior response performance regarding content and references when queried on commonly asked pregnancy questions. Both LLMs must be carefully evaluated and vetted prior to being accepted as accurate and reliable for this purpose.
Trimester-Specific SARS-CoV-2 Infection and the Association With Preeclampsia [ID 2683535]
Authors: Leftwich Heidi K. , Hillman Michelle , Khan Lyba , Patel Jenna , Dmello Monalisa , Chernick Rebecca
Published: May 2024

INTRODUCTION:

With COVID-19 becoming more endemic, trimester-specific infection risks are important to study. Here, we examine the effect of SARS-CoV-2 positivity by trimester on development of preeclampsia.

METHODS:

This was an IRB-approved, retrospective cohort study of patients receiving prenatal care and delivering at a single academic hospital from January 1, 2019, to December 30, 2022. Primary outcomes were rate and severity of preeclampsia. Secondary outcomes were characteristics of placental pathology.

RESULTS:

6,174 patients met inclusion criteria, 649 of whom were SARS-CoV-2-positive during pregnancy. Of SARS-CoV-2-positive patients, 19.4%, 40.8%, and 39.8% tested positive in the first, second, and third trimesters, respectively. Preeclampsia rates were higher in first (19.2%) and second (18.2%) but not third (11.2%) trimester compared to no infection (11.7%; P=.001). After adjusting for confounding factors, second-trimester SARS-CoV-2-positive patients were 48% more likely to develop preeclampsia than uninfected (95% CI, 1.04–2.11; P=.005). Severity was increased in all trimester infections versus no infection (P=.008), but adjusted analyses showed this difference remained only in first-trimester infections (odds ratio 6.55 [1.90–22.55]; P=.003). SARS-CoV-2 infection in the second trimester was also associated with 63% increase in meconium-stained placenta (95% CI, 1.01–2.61; P=.044), but no other studied placental pathology.

CONCLUSION:

Consistent with timing of pathogenesis of preeclampsia in late first/early second trimester, patients infected with SARS-CoV-2 in the first and second trimester had higher rates of preeclampsia and severity. This finding helps clarify conflicting studies versus the risk of preeclampsia with SARS-CoV-2 infection in that this risk may be trimester specific and can help aid in our counseling and proposed future research.
The Association of Second-Trimester Cervical Length and Gestational Age at Delivery [ID 2683538]
Authors: Pember Nicolette G. , Thayer Sydney M. , Zofkie Amanda C.
Published: May 2024

INTRODUCTION:

Second-trimester transvaginal cervical length (TVCL) under 2.5 cm is a well-established risk factor for preterm birth, although few studies have evaluated delivery outcomes in “normal” cervical length groups. We aimed to evaluate the association of normal TVCL (2.5 cm or greater) tertiles on gestational age (GA) at delivery.

METHODS:

This is a retrospective cohort study of patients eligible for vaginal birth with singleton term gestations and normal TVCL (at 16–24 weeks of gestation) delivering at a tertiary care center June 2022 to June 2023. Mean GA at delivery and rates of term deliveries were compared by TVCL tertiles (T1: 2.5–3.49 cm, T2: 3.5–4.49 cm, and T3: 4.5 cm or greater). Multivariable logistic regression was used to control for potential confounders. Institutional review board approval was obtained.

RESULTS:

Of 1,034 eligible deliveries, 984 (95.2%) were term (37 0/7 weeks or greater). Patients with TVCLs in T2 and T3 were significantly more likely to have a term delivery than patients with TVCL in T1 (T2 96.0% versus T1 90.9%, P=.007; T3 96.2%, P=.03). Compared to T1, those with TVCLs in T2 and T3 also had increased odds ratio (OR) of a term birth (OR 2.4 [CI, 1.2–4.8] and OR 2.55 [CI, 1.03–6.7], respectively). After adjusting for confounders, this relationship remained statistically significant (T2 adjusted OR 3.05 [CI, 1.4–6.6]; T3 3.91 [CI, 1.3–11.4]).

CONCLUSION:

Patients with longer TVCL measured at anatomy ultrasound are significantly more likely to have a term delivery, even after adjusting for confounders. These results can be used to guide patient counseling and expectations for labor and delivery outcomes.
Stakeholder Perspectives of PATH (Plan for Appropriate Tailored Healthcare in Pregnancy) Telemedicine Recommendations [ID 2683565]
Authors: Rajpurkar Asavari , Zahn Christopher M. , Daniel Yannet , Lott Lauren , Ahmed Lamiya , Peahl Alex
Published: May 2024

INTRODUCTION:

The COVID-19 pandemic has propelled innovation in prenatal care delivery including use of telemedicine for routine prenatal visits. The Plan for Appropriate Tailored Healthcare in Pregnancy (PATH), a consensus-based prenatal care recommendation developed by a multidisciplinary panel of prenatal care experts, includes two recommendations regarding telemedicine: 1) telemedicine should be an option for all visits aside from four key in-person contacts requiring in-person visits; and 2) home monitoring is an appropriate option for most routine parameters during pregnancy. A national listening tour was conducted to elicit stakeholder feedback for incorporating telemedicine recommendations into practice.

METHODS:

We conducted nine, 120-minute virtual focus groups with more than 25 organizations including professional (8), patient advocacy (8), public health (5), and payer groups (4). Focus groups were transcribed, coded by recommendation. Data were next analyzed with matrix coding across positive attitudes, negative attitudes, and implementation considerations.

RESULTS:

Focus groups included 110 participants. Most participants supported telemedicine use as a care modality for routine prenatal care. Positive attitudes included the belief that telemedicine increased care flexibility, care access, and patients' health agency. Negative attitudes included concerns that poor digital literacy, insufficient access to devices, and high cost could perpetuate existing health disparities. Implementation considerations included the importance of relationship building with patients, technical support staff use, home monitoring device validation, and patient education on telehealth best practices. Participants also emphasized needed improvements to telehealth infrastructure and funding.

CONCLUSION:

Interprofessional stakeholders broadly support telemedicine use in routine prenatal care. Improvements in existing advocacy efforts, research, and infrastructure in underserved communities are needed to facilitate increased access to telemedicine.
Stakeholder Perspectives of the PATH (Plan for Appropriate Tailored Healthcare in Pregnancy) Targeted Visit Schedule Recommendation [ID 2683601]
Authors: Rajpurkar Asavari , Zahn Christopher M. , Daniel Yannet , Lott Lauren , Ahmed Lamiya , Peahl Alex
Published: May 2024

INTRODUCTION:

Traditional prenatal care delivery guidelines recommend 12–14 in-person visits for all patients, although care can be safely delivered to average-risk patients with 8–9 targeted visits. These additional visits may result in oversurveillance and unnecessary interventions. The Plan for Appropriate Tailored Healthcare in Pregnancy (PATH), a consensus-based prenatal care recommendation developed by a multidisciplinary team of prenatal care experts, recommends tailoring care delivery to patients' needs by using targeted visit schedules for average-risk patients. A national listening tour was conducted to obtain stakeholder feedback for incorporating this care delivery model into practice.

METHODS:

We conducted nine, 120-minute virtual focus groups with more than 25 organizations including professional (8), patient advocacy (8), public health (5), and payer groups (4). Focus groups were transcribed and coded by recommendation, and analyzed with matrix coding across positive attitudes, negative attitudes, and implementation considerations.

RESULTS:

Focus groups included 110 participants. Positive attitudes included the belief that targeted visit schedules would improve visit attendance, care flexibility, and resource equity. Negative attitudes included concerns for inappropriate targeted visit schedule application, inadequate safety net systems for missed services, and reduced payer reimbursement. Providers were also concerned about decreased opportunities for relationship building and counseling in targeted visit schedules. Implementation considerations included the importance of shared decision-making, serial needs assessments, and clear risk stratification guidelines. Participants emphasized the need for multidisciplinary safety net processes to ensure timely, adequate care.

CONCLUSION:

Participants were receptive to incorporating targeted visit schedules for average-risk individuals into routine prenatal care. Greater infrastructure investment is needed to implement more flexible care models successfully.
Starting Conversations About Gestational Weight Gain: How Weight and Weight Gain Communication Is Initiated in the First Prenatal Visit [ID 2683652]
Authors: Harinath Malini , Smith Alaina M. , Binstock Anna Berlyn. , Pollak Kathryn I. , Levine Michele D. , Chang Judy C.
Published: May 2024

INTRODUCTION:

The American College of Obstetricians and Gynecologists (ACOG) recommends that obstetric (OB) providers discuss appropriate weight gain and body mass index (BMI) with their patients at initial prenatal care visits. Few studies have examined how obstetric care providers initiate and discuss this topic. The aim of this study is to describe weight conversations during initial prenatal visits.

METHODS:

We analyzed data from an IRB-approved, larger prospective observational study. Patient–provider conversations at initial prenatal visits were audio-recorded with patient consent. Transcripts of 70 visits were coded for discussions of diet, exercise, and weight discussions, including who initiated weight conversations.

RESULTS:

Thirty-four out of 70 visits (49%) included weight discussions. Out of these 34 visits, the OB provider brought up weight 71% of the time. Providers gave weight recommendations by generally speaking about how much weight gain can be expected (55%). In 12% of the visits, providers specifically cited organizational guidelines. There were no visits during which providers mentioned patients' BMI. Patients expressed concern over their weight at 29% of the visits. Providers reassured patients during weight discussions in 32% of the visits. Providers made potentially judgmental comments about their patients’ bodies regarding weight on 9% of visits (eg, “if anything you are a little twig of a woman”).

CONCLUSION:

Although providers usually initiated weight discussions, these discussions occurred in only half of initial prenatal visits; this does not meet ACOG recommendations. Providers mostly reassured patients but occasionally expressed comments that could be interpreted as judgmental or stigmatizing. Communication strategies to invite patients’ weight/weight gain concerns may be helpful to improve these conversations.
Association of Low Levels of Placental Growth Factor With Abnormal Fetal Doppler Assessment [ID 2683423]
Authors: Figueiro-Filho Ernesto A. , Versteeg Kathryn , Vinken Jamie , Orieux Alyx , Grzyb Karolina
Published: May 2024

INTRODUCTION:

Placental growth factor (PlGF) is involved in placental angiogenesis and maturation. Low maternal serum PlGF levels predict placental dysfunction and associated conditions, such as preeclampsia, and fetal growth restriction. These pregnancy complications can lead to abnormal fetal Doppler assessment, indicating progressive fetal deterioration prompting preterm delivery.

METHODS:

We collected retrospective data from laboratory results of PlGF levels and fetal Dopplers (umbilical artery [UA], middle cerebral artery [MCA], and ductus venosus [DV]) from patients who had clinical indication for PlGF testing. Over 100 patients were identified to have results of all assessments between 2021 and 2023. Levels of PlGF were stratified in five categories according to gestational age and compared with normal and abnormal doppler results. For comparisons, the values were aggregated in normal and low PlGF.

RESULTS:

There were statistically significant associations between PlGF levels and Dopplers. Patients with low PlGF (less than 5th percentile for gestational age) were more likely to have abnormal dopplers than patients with normal PlGF (UA, P<.001; MCA, P<.001; DV, P<.001). A normal PlGF had a high negative predictive value (NPV) for normal dopplers (UA, 88%; MCA, 94.3%; DV, 98.6%).

CONCLUSION:

The results show that normal PlGF is highly associated with normal Dopplers. Additional data will be required to account for confounding factors; however, our preliminary data suggest that PlGF could be a useful tool for patients in rural and remote locations, as normal PlGF has a statistically and clinically significant negative predictive value for normal Doppler assessment.
Autoimmune Condition Diagnosis After Recurrent Pregnancy Loss [ID 2683458]
Authors: Imbroane Marisa R. , LeMoine Felicia V. , Gibson Kelly S.
Published: May 2024

INTRODUCTION:

Research has suggested a link between recurrent pregnancy loss (RPL) and cell-mediated immunity dysregulation. We aim to determine whether a history of RPL is associated with development of cell-mediated autoimmune condition (AIC) diagnosis.

METHODS:

This was a retrospective cohort study using the TriNetX network database. The RPL group had greater than or equal to three spontaneous abortions (SABs), whereas controls had at least one pregnancy but did not have the diagnosis of RPL (ICD-10 N96). The rate of new AIC diagnosis was measured from diagnosis of the third SAB or first pregnancy for the RPL and control groups, respectively. Propensity score matching was used for age, race, and ethnicity. Logistic regression analyses investigated the relationship between RPL and AIC diagnoses.

RESULTS:

113,118 patients were included in each arm. Recurrent pregnancy loss was associated with an increased risk for systemic lupus erythematosus (relative risk [RR] 2.22; 95% CI, 1.88–2.63), rheumatoid arthritis (1.52 [1.30–1.78]), multiple sclerosis (1.57 [1.36–1.82]), Crohn’s disease (1.40 [1.12–1.74]), ulcerative colitis (1.42 [1.17–1.73]), Hashimoto’s thyroiditis (1.74 [1.57–1.91]), Graves’ disease (1.61 [1.37–1.90]), and Sjogren syndrome (1.81 [1.53–2.15]), but not psoriatic arthritis.

CONCLUSION:

Patients with a history of RPL are at nearly double the risk for development of AIC when compared to those without a history of RPL.
No-Show Rates in a Perinatal Practice: Telemedicine Compared With In-Person Visits [ID 2683494]
Authors: Ruma Michael S.
Published: May 2024

INTRODUCTION:

The objective of this study was to determine the effect of telemedicine on no-show rates in a perinatal practice before, during, and after the COVID-19 pandemic.

METHODS:

A retrospective study was conducted among pregnant patients receiving care at a private maternal–fetal medicine (MFM) practice in New Mexico from January 2020 to June 2023. The primary outcome was attendance for telemedicine versus in-person visit evaluated by visit type including MFM consultation, diabetes management, and mental health.

RESULTS:

Maternal–fetal medicine visits showed no difference in no-show rates between telemedicine versus in-person visits for 2020, 2022, and 2023. More no-show visits occurred in 2021 with 118/1,800 (6.56%) for telemedicine versus 632/15,608 (4.05%) for in-person visits (P<.0001) and for all years combined with 352/7,144 (4.93%) for telemedicine versus 1,952/49,363 (3.95%) for in-person visits (P=.0001). The odds ratio for no-show visits for all years was 1.26 (1.12, 1.41) for telemedicine versus in-person visits. Diabetes management visits showed higher no-show rates for telemedicine versus in-person visits each year and overall. For all years combined, more diabetes management no-show visits (1,454/12,232 [11.89%]) occurred for telemedicine versus 15/310 (4.84%) for in-person visits with an odds ratio for telemedicine no-show visits of 2.65 (1.57, 4.47) (P=.002). For all years combined, fewer mental health no-show visits (362/1,823 [19.86%]) occurred for telemedicine versus 76/224 (33.93%) for in-person visits with an odds ratio for telemedicine no-show visits of 0.48 [0.36, 0.65] (P<.001).

CONCLUSION:

Telemedicine use expanded greatly during the COVID-19 pandemic in all areas of health care including maternal–fetal medicine. In this large private practice-based cohort, different outcomes were noted in areas unique to perinatal care. Patients undergoing MFM consultation with ultrasound had comparably low no-show rates for telemedicine versus in-person visits. Opposite effects were noted for diabetes management and mental health visits with higher no-show rates for telemedicine diabetes management visits and lower no-show rates for telemedicine mental health visits.
Implementation of a Perinatal Mental Health Program in a Private Maternal–Fetal Medicine Practice [ID 2683639]
Authors: Ruma Michael S.
Published: May 2024

INTRODUCTION:

The American College of Obstetricians and Gynecologists (ACOG) recommends that treatment for mental health disorders be equitably available and accessible to all pregnant women. We detail the implementation of a perinatal mental health program within a statewide maternal–fetal medicine (MFM) practice.

METHODS:

A retrospective quality improvement study was conducted among pregnant patients at a large, private MFM practice in New Mexico from October 2021 to September 2023. The primary outcome aimed to describe implementation of a perinatal mental health program and determine the demand for care of mood and anxiety disorders among pregnant patients being seen for antenatal high-risk obstetric care.

RESULTS:

In October 2021, an initial psychiatric mental health nurse practitioner (PMH-NP) employed by our MFM practice began providing care to pregnant patients. In June 2022, a second PMH-NP joined and a third was added in February 2023. No advertising of this new program was conducted to better serve existing patients. Patients are screened during each MFM visit with the Patient Health Questionnaire 9 (PHQ-9), a nine-item depression scale. Patients scoring higher than 4 were offered consultation with the PMH-NP and the patient elected to then schedule the visit. Additionally, patients with mood or anxiety disorders listed on their active problem list were queried by a clinician, offered consultation with the PMH-NP, and the patient elected to then schedule the visit. In 2021, 47 patients were seen with a total of 96 visits. In 2022, 284 patients were seen with a total of 1,046 visits. In 2023, 367 patients were seen with a total of 1,331 visits.

CONCLUSION:

Although ACOG recommends mental health treatment be available for all pregnant women, New Mexico lacks sufficient services. Implementation of a perinatal mental health program integrated within our MFM practice was successful with strong uptake by patients and year-over-year growth.
Polycystic Ovary Syndrome and Mental Health: Influence of Hyperandrogenism During Brain Plasticity Periods on Emotional Distress and Social Cognition [ID 2683671]
Authors: Del Río Juan Pablo , Dabed Francisca , Díaz Javiera P. , Ladrón de guevara Amanda , Crisosto Nicolás , Vigil Pilar
Published: May 2024

INTRODUCTION:

Polycystic ovary syndrome (PCOS) is the most prevalent cause of endocrine disorders in teenagers. Hyperandrogenism affects brain maturation, especially in high plasticity periods (intrauterine and adolescence), potentially modulating the social-emotional status of affected adolescents (aPCOS). This study characterizes the consequences of hyperandrogenism in social-emotional status and social cognition on aPCOS.

METHODS:

This was an analytical cross-sectional study that included aPCOS between 12 and 25 years. Each patient underwent a clinical evaluation and measurements of the following: intrauterine androgen exposure markers (2D:4D, AGD), hormonal parameters, psychological questionnaires (PANAS, SDQ, EQ/SQ, RET, CAM), and Eye-Tracking (Tobii). This study was approved by Universidad de Chile's ethics commitee.

RESULTS:

Ninety participants were included: 43 cases and 47 controls. aPCOS presented more intrauterine exposure to androgens ([15/18] AGD: 9.7 versus 7.8; P=.014) and hyperandrogenemia ([15/18] FAI: 7.5 versus 4.1; P=.004). They exhibited a predominance of negative affects ([43/47] PANAS: 8.0 versus 2.0; P=.049), more socio-emotional problems ([43/47] SDQ: 2.5 versus 1.5; P=.047), less self-reported empathy ((43/47) EQ: 19.0 versus 25.1; P=.001), and differences in gaze patterns, such as longer time to first fixation in areas of interest (s) ([7/3] AOI(s): 0.35 versus 0.28; P=.037), which was associated with a worse score in emotional recognition (CAM; aR2=−0,920; f=19,48; Pr>|t|=|t|=0.049).

CONCLUSION:

aPCOS presented with predominance of negative affects, more social-emotional difficulties, and lower score on emotional recognition, associated with exposure to hyperandrogenism during the most critical neuroplasticity periods. These findings suggest that mental health should be evaluated on every PCOS patient, especially adolescents.
Effect of Financial Penalties on Appointment Nonadherence in Academic Obstetrics and Gynecology Clinics [ID 2683433]
Authors: Forbes Lauren A. , Kawakita Tetsuya , Takacs Peter
Published: May 2024

INTRODUCTION:

The objective of this study was to examine the effect of patient financial penalties on appointment nonadherence within a single academic institution's obstetrics and gynecology outpatient clinics.

METHODS:

This retrospective policy effectiveness-implementation hybrid study included administrative data from all appointments at a single academic institution’s obstetrics and gynecology outpatient clinics from May 1, 2018, to April 30, 2022. Institutional review board approval was waived for this study. The department-wide patient financial penalty policy for appointment nonadherence was implemented on May 1, 2020. We conducted an interrupted time series analysis after stratifying by insurance (Medicaid versus all insurance). Poisson regression was used to calculate incidence risk ratios (IRRs) with 95% CIs.

RESULTS:

There were 414,006 obstetrics and gynecology outpatient clinic appointments (pre-implementation [pre]: 208,696; post-implementation [post]: 205,410). Of these, 58,473 (14.1%; pre: 29,533 [14.2%]; post: 28,940 [14.1%]) appointments were not attended. Compared to the all insurance group, Medicaid patients had a higher rate of appointment nonadherence (36,872/188,343 [19.6%]; pre: 18,070 [19.6%]; post: 18,802 [19.6%]). In the all insurance group, the implementation of financial penalties resulted in a 4% increase in nonadherence (IRR 1.04 [95% CI, 0.99–1.09]). In the Medicaid group, the implementation of financial penalties did not change nonadherence (IRR 1.00 [95% CI, 0.98–1.02]). There was no significant difference in the coefficient between Medicaid and all insurance groups (P>.05).

CONCLUSION:

Institutional implementation of patient financial penalties for appointment nonadherence did not change appointment nonadherence rates in obstetrics and gynecology outpatient clinics. The lack of change persisted after stratifying by insurance despite the inability to charge Medicaid patients a financial penalty for appointment nonadherence.
The Association Between Food Insecurity and Census Tract-Based Indexes in an Urban Academic Reproductive Clinic: Can Residence Predict Food Insecurity in Reproductive Patients? [ID 2683613]
Authors: Deshmukh Sanyukta , Pagano Rose , Lee Jessica K.
Published: May 2024

INTRODUCTION:

Identifying food-insecure patients remains a priority in reproductive clinics given nutrition’s effect on maternal health. We sought to determine the association between self-reported food insecurity with census tract-based indexes including the Childhood Opportunity Index (COI), Social Vulnerability Index (SVI), and the U.S. Department of Agriculture (USDA) low-income and low-food access areas (LILAs), to identify which indexes can help identify at-risk patients.

METHODS:

This is a cross-sectional survey study (UMBHP-00099693) of patients presenting for reproductive care at one urban academic center. Food insecurity was scored as greater than 0 on the 6-Item USDA Food Security Module, and living within a LILA was collected from the 2019 USDA database. We categorized social vulnerability as moderate/low/very low vulnerability or high/very high vulnerability using the SVI. We categorized childhood opportunity using the COI as very low/low and moderate/high/very high.

RESULTS:

Of the 179 participants in the study, 84 (47%) reported food insecurity. The following proportions lived in a: LILA 96 (54%); high/very high vulnerability tract 138 (77%); and low/very low childhood opportunity (CO) tract 144 (86%). Living within a LILA was associated with an increased odds of experiencing food insecurity (odds ratio [OR] 1.8 [1.0, 3.4]). Living within a high/very high vulnerability tract was not significantly associated with food insecurity (OR 1.2 [0.6, 2.4]), nor was living within a low/very low CO tract (OR 1.6 [0.8, 3.5]).

CONCLUSION:

Residence within a LILA could be associated with food insecurity in patients seeking reproductive care, which can inform the development of future clinical and geographic interventions. As one in two patients were food insecure, we recommend universal screening of all patients at reproductive appointments.
Risks of Infections With Contraceptive Vaginal Rings Compared to No Hormone Use [ID 2683646]
Authors: Karam Kathleen , Arceneaux Amy , Vincent Kathleen L. , Pyles Richard
Published: May 2024

INTRODUCTION:

Alterations in the vaginal microbiome by hormones, foreign bodies, intercourse, etc., can affect the body’s susceptibility to infection. The effect of combined contraceptive vaginal rings (CCVRs) on the vaginal microbiome needs more study. We aim to explore the outcomes of CCVRs on vaginal health and infection risk when compared to women without hormone use to better understand the effect of these devices.

METHODS:

De-identified data were collected from TriNetX. Using ICD-10 and RXNorm codes, populations were selected for women receiving etonogestrel and ethinyl estradiol CCVR without segesterone use, versus sexually active women of reproductive age on no hormonal contraceptives. Cohorts were matched for age at index, race, and ethnicity. Statistical analysis within 1 year of CCVR placement using risk ratios (RRs); P<.05 was considered significant.

RESULTS:

Cohort sizes were 274,743 each. Combined contraceptive vaginal ring usage showed an increased risk of gonorrhea (RR 1.221; P=.012), HSV-2 (RR 1.229; P<.0005), acute vaginitis (RR 1.314; P<.0005), subacute/chronic vaginitis (RR 1.708; P<.0005), acute vulvitis (RR 1.708; P<.0005), subacute/chronic vulvitis (RR 1.722; P<.0005), pelvic inflammatory disease (RR 1.184; P<.0005), anogenital warts (RR 1.314; P<.0005), and candidiasis (RR 1.402; P<.0005) when compared to women receiving no hormonal contraception. Combined contraceptive vaginal ring showed significant decreased risk of chlamydia (RR 0.786; P<.0005), syphilis (RR 0.493; P<.0005), and HIV (RR 0.434; P<.0005). Trichomoniasis was statistically insignificant.

CONCLUSION:

Women on etonogestrel and ethinyl estradiol CCVRs have an increased risk of gonorrhea, HSV-2, vaginitis, vulvitis, PID, anogenital warts, and candidiasis, with a decreased risk of chlamydia, syphilis, and HIV when compared to women receiving no hormonal contraception. Further investigation could be useful in developing multipurpose prevention technologies.
Pain Management in Outpatient Gynecologic Procedures: An Exploration of #Colposcopy on TikTok [ID 2683582]
Authors: Fulton Jessica , Chalif Julia , Morton Molly , Chambers Laura
Published: May 2024

INTRODUCTION:

TikTok, a rapidly expanding social platform, features content on painful outpatient gynecologic procedures like colposcopy. Although pain management strategies have been studied, mainstream perceptions of this procedure remain underresearched. This study aims to describe #colposcopy content on TikTok.

METHODS:

On August 30, 2023, the first 200 videos under #colposcopy on TikTok were collected for cross-sectional content analysis. Data were collected for author demographics, intent, tones, timing, and content themes. Educational videos were rated for quality and reliability utilizing the modified DISCERN scale.

RESULTS:

As of August 2023, #colposcopy on TikTok had 65.3 million views. 183 of the first 200 posts were eligible for inclusion. On average, each video received 21,754 likes, 623 comments, and 752 shares. The majority of creators (n=133; 72.7%) were White, 14 (7.7%) were Black, 6 (3.3%) were Asian, 6 (3.3%) were Hispanic/Latino, and 24 (13.1%) were unable to determine. 109 (59.6%) of the creators were patients sharing their experiences, and 26 (14.2%) were physicians or APPs intending to educate. 33 (18.0%) TikToks were educational, with a median DISCERN score of 2. Among 13 content categories, the category most observed was “pain and pain management” (n=117; 63.9%), with 81 (75.7%) creators describing the procedure as painful and 26 (25.5%) describing it as painless. Significant differences in content were also analyzed by author demographics, intent, tone, and timing.

CONCLUSION:

Colposcopy-related content on TikTok centers on patients’ pain experiences. Specifically, users of #colposcopy discussed the providers’ lack of pain management options. Opportunities exist to improve pain expectations and management strategies with patients.
Size Matters: In-Office Hysteroscopy and Successful Removal of Endometrial Polyp [ID 2683670]
Authors: Marquez Kyara M. , Marbin Staci J. , Mouhanna Joelle N. , Rodriguez Suset , Carugno Jose
Published: May 2024

INTRODUCTION:

Hysteroscopy serves as the gold standard for investigating intrauterine pathologies. Previous studies suggest successful in-office hysteroscopic polypectomy in younger, lower body mass index, premenopausal patients with smaller polyps and painless examinations. We share our in-office hysteroscopic polypectomy experience and aim to determine the threshold for estimated polyp size on ultrasound imaging most associated with successful in-office removal.

METHODS:

We conducted a retrospective study at a single urban hospital, including all patients who underwent in-office hysteroscopy (IOH) between December 2018 and April 2023. Using standardized protocols, we employed vaginoscopy no-touch techniques with a 5-mm diagnostic hysteroscope (30-degree optic) using normal saline for distension without anesthesia. Polyps were removed using hysteroscopic instruments. Preoperative ultrasound reports provided initial polyp diameter, which was subsequently correlated with intraoperative hysteroscopic impression and postoperative pathology reports.

RESULTS:

One hundred forty patients underwent IOH. Among them, 53 (38%) were referred for suspected endometrial polyps identified on ultrasound. 10 patients were excluded from the study: 6 lacked available imaging, 2 showed no polyps on imaging, and 2 had unsuccessful entry due to cervical stenosis. Successful entry into the endometrial cavity was achieved in 95.3% of cases, with cervical stenosis and pain as limiting factors. 13.9% (6 patients) experienced failed in-office polypectomy due to large polyp size (mean estimated diameter: 2.23 cm).

CONCLUSION:

In-office hysteroscopy using the vaginoscopy no-touch technique is a highly advantageous therapeutic modality for managing patients with endometrial polyps. Polyps larger than 2 cm pose challenges, often leading to unsuccessful in-office removal.
Correlation of Medical Specialty With Malpositioned Intrauterine Devices [ID 2683518]
Authors: Hewell Kerrilyn , Wilson Teresa S. , Groesch Kathleen , Delfino Kristin , Nguyen Lynn , Zeino Mhd Yahia
Published: May 2024

INTRODUCTION:

Intrauterine devices (IUDs) are an effective method of long-acting reversible contraception (LARC) and essential for preventing unintended pregnancies, as well as controlling abnormal uterine bleeding (AUB). Intrauterine devices are placed by both obstetrician−gynecologists and primary care providers. As an academic institution, our objective was to determine if training specialty of inserting provider correlated with the rate of malpositioned IUDs.

METHODS:

All ultrasounds from 2017 to 2020 in which an IUD was documented at SIU School of Medicine Department of Obstetrics and Gynecology, an American Institute of Ultrasound Medicine-certified center, were reviewed (IRB# 21-834). Association between specialty of inserting provider and malposition rate was assessed using chi-squared test.

RESULTS:

A total of 602 ultrasound reports documenting an IUD were reviewed; 109 malpositioned IUDs were identified (18.1%). Body mass index, age, and gravidity/parity were not significantly different in participants with malpositioned IUDs from those with a properly placed IUD. Indications for ultrasound included pelvic pain, bleeding, and lost strings. Intrauterine devices placed by primary care providers were malpositioned at a significantly higher rate than those placed by obstetrician−gynecologists, 30.0% versus 17.3%, respectively (P=.043). Obstetrician−gynecologists placed 1,961 IUDs and primary care providers placed 276 IUDs between 2017 and 2020.

CONCLUSION:

Intrauterine devices are a safe and reliable choice for LARC to prevent unwanted pregnancies and to control AUB. Training providers on proper techniques for IUD insertion is imperative for good clinical practice and patient satisfaction. Primary care providers are often seen for contraception management; therefore, the significantly higher malpositioned rate indicates the need to implement an enhanced simulation/education curriculum for IUD insertion.
Short-Term Telehealth Follow-up in Complex Gynecologic Conditions [ID 2683660]
Authors: Phillips Nancy , Rocktashel Maria
Published: May 2024

INTRODUCTION:

Studies show up to 50% of patients leave health care appointments not understanding or remembering important information, instructions, or correct use of medications. The Rutgers Center for Vulvovaginal Health treats women referred for complex vulvovaginal or pain disorders and sexual dysfunctions. Despite receiving written instructions and diagrams at initial visit, many returned without having started or having discontinued treatment. We initiated a nurse practitioner telehealth visit 2–3 weeks after initial encounter to evaluate acceptance and benefit in this population.

METHODS:

This was a retrospective chart review of 50 telehealth visits for new patients seen at the center. Outcome measures were determined from questions presented to all women regarding understanding of condition, and adherence to medication and treatment plan.

RESULTS:

Overall, 98% of women found the telehealth visit helpful, and 46% had questions related to their first visit. Of the 43 prescribed medications, 37 initiated treatment (86%) and only 2 (4.7%) had not attempted to fill the prescription. Medication was changed in 10%, mostly because of side effects. Pelvic floor physical therapy and imaging studies were initiated in 75% and 67%, respectively.

CONCLUSION:

Women with complicated gynecologic problems viewed a short-term follow-up telehealth visit positively. This communication presents an opportunity for another point of contact that can be incorporated into a busy practitioner schedule without the requirement of an in-person visit, and allow convenience and reinforcement for women, as well as necessary treatment alterations. Further studies are needed to see if this short-term follow-up enhances long-term compliance or outcomes.
Assessing the Performance of ChatGPT in Correctly Evaluating Preventive Screening Clinical Vignettes Commonly Seen in Obstetrics and Gynecology Practice [ID 2683617]
Authors: Daram Naveena
Published: May 2024

INTRODUCTION:

Preventive screening is vital in obstetrics and gynecology practice, where the accurate assessment of clinical vignettes is pivotal for delivering optimal care. This research delves into ChatGPT’s performance, an advanced language model, in evaluating common obstetrics and gynecology preventive screening scenarios.

METHODS:

We compiled a diverse dataset of obstetrics and gynecology clinical vignettes, covering areas like cervical and breast cancer screening, sexually transmitted infection testing, and prenatal care. Using 20 vignettes initially generated by ChatGPT and enriched with specific details, we rigorously assessed ChatGPT’s responses for clinical accuracy and relevance. Our evaluation was guided by quantitative metrics, aligning ChatGPT’s performance with recognized guidelines such as United States Preventive Services Task Force, American Society for Colposcopy and Cervical Pathology, American College of Obstetricians and Gynecologists, and more.

RESULTS:

ChatGPT displayed promise in comprehending obstetrics and gynecology clinical information. Out of 20 vignettes, only 2 (10%) fell short of evaluating the clinical vignette adequately. Among the remaining 18 vignettes, an impressive 15 (83%) adhered to the latest clinical guidelines, whereas 3 (17%) evaluations proved inaccurate. Notably, in 19 out of 20 vignettes (95%), ChatGPT deferred to the provider’s clinical judgment.

CONCLUSION:

This study underscores ChatGPT’s potential to assist obstetrics and gynecology practitioners in preventive screening decision-making. While promising, ChatGPT should complement, not replace, human expertise. Limitations include a focus on quantitative metrics; future research should delve into qualitative aspects of ChatGPT’s performance. Integrating ChatGPT into obstetrics and gynecology practice could enhance preventive screening quality and efficiency, potentially improving women’s health care outcomes. This research contributes to the broader discourse on AI integration in health care, particularly in women’s preventive health care, paving the way for further AI-driven solutions.
#Infertility: Evaluation of Quality and Accuracy of TikTok Videos [ID 2683621]
Authors: Brogan Cailey , Dillon Kayla , Hare Maia , Peyser Alexandra
Published: May 2024

INTRODUCTION:

The objective of this study was to determine the quality and accuracy of infertility content on TikTok using the validated DISCERN scoring system.

METHODS:

The top 100 TikTok videos tagged “#Infertility” were assessed across 15 DISCERN categories by three reviewers. Videos were classified by type (educational, lifestyle, entertainment) and creator (patient, obstetrician–gynecologist, non-physician health care professionals, non-health care professionals, unknown). Multiple linear regression explored the creator-DISCERN score correlation, adjusting for video type, with significance at P<.05.

RESULTS:

One hundred videos were assessed: 59 lifestyle, 24 entertainment, and 17 educational, with a mean DISCERN score of 23.64±0.636. The majority of videos scored less than 39, indicating “poor”/“very poor” quality, while five scored “fair” with 39+. Most videos were patient-created (68%), followed by obstetrician–gynecologist-created (14%). There was significant association between creator and DISCERN score with patient-created videos (mean, 21.71±0.545) scoring lower than obstetrician–gynecologist-created videos (mean, 29.41±2.142; P<.001). Chi-squared independence test showed significance in video type distribution among creators with 82% of patient videos falling in the lifestyle category and 71% of obstetrician–gynecologist videos falling in the educational category (X2=67.537; df=8; P<.001). After adjusting for video type, linear regression showed no significant difference among scores of patient and obstetrician–gynecologist videos (P=.184).

CONCLUSION:

Fertility-related TikTok videos created by patients had lower DISCERN scores than those created by obstetrician–gynecologists. These results demonstrate that TikTok does not provide appropriate knowledge to educate patients. There is an increased need for unbiased fertility-related content on TikTok.