bluuebunny/crossref_metadata_2025 huggingface dataset:
The Ob-Gyn and Women's Health Selective Pathway for Senior Medical Students [7O]
Authors: Castro Lony , Wong Shirley , Nausheen Fauzia , Al-Eyd Ghaith , Valenzuela Guillermo , Tenore Alfred
Published: May 2017

INTRODUCTION:

The content of year 4 of medical school and student to resident transition are the subject of debate. The AAMC has outlined “Entrustable Professional Activities” (EPAs) expected of all physicians on day 1 of residency. An added concern of residency directors is that graduating students may not be adequately prepared for their chosen specialty. To meet these challenges, CalMed-SOM, an LCME applicant school with an active learning curriculum, has designed a 4th year selective pathway.

METHODS:

Faculty in Ob-Gyn, Anatomy, Pathology, and Medical Education established goals for the knowledge, skills, and attitudes desired of a beginning Ob-Gyn resident and the content and pedagogies required for the pathway based on: 1) specialty specific requirements; 2) broader learning outcomes (e.g. AAMC EPA's and CalMed-SOM core competencies); 3) our collective experience educating residents. Formative and summative assessments were designed to determine students' proficiency levels in the desired competencies.

RESULTS:

A 4th year Ob-Gyn and Women's Health Selective Pathway was created with 4 clinically integrated experiences: 1) the Clinical Pelvic Anatomy Laboratory (4 weeks), with a surgical skills component using fresh cadavers; 2) Ob-Gyn Surgical Pathology (4 weeks); 3) Diagnostic Imaging (4 weeks); 4) the Ob-Gyn Sub-Internship (8 weeks). Curriculum mapping demonstrated content integration across the 4 years of the curriculum.

CONCLUSION:

A 4th year pathway in Ob-Gyn and Women's Health can be designed to meet the aspiring Ob-Gyn's need for a curriculum that fulfills general and specialty specific competencies. Assessment results as well as program director and resident surveys will guide further modifications of this pathway.
Genetic Testing Requests on Gamete Donors After Conception; Pre-Test Counseling Considerations for Patients [8O]
Authors: Callum Pamela
Published: May 2017

INTRODUCTION:

To document the requests for genetic testing on gamete donors after conception and outline counseling considerations for patients to be informed about prior to testing.

METHODS:

All requests for additional genetic testing on sperm donors from January 2013 through September 2016 were reviewed and sorted to identify requests received during ongoing pregnancies.

RESULTS:

Fifty-two requests for additional genetic testing on sperm donors were received. Most requests involved carrier screening for conditions for which patients were identified to be carriers. Some requests involved microarray findings in fetuses that required additional donor testing in order to help interpret fetal risks. Donors in our program are frequently available and willing to participate in additional testing but their availability is not guaranteed and testing can take several weeks or months. This can cause patient distress during pregnancy when the donor is unavailable or willing to have testing or if donor testing takes considerable time to accommodate.

CONCLUSION:

Requests for additional testing on gamete donors are frequently received to help define the risks to a fetus. Prior to testing, patients should be counseled about the potential limitations of testing on a donor should testing be warranted. This will aid in their decision-making process prior to performing testing and help to prepare them for the circumstances they could encounter following their own positive test results.
Is the New Terminology of “Triple I” For Chorioamnionitis Really Different? [10O]
Authors: Williams Nayo , Misra Neeti , Lin Yong
Published: May 2017

INTRODUCTION:

The proposed terminology of “Triple I” was developed to clarify the heterogeneity of manifestations associated with chorioamnionitis. This study aims to evaluate if those with a concordant (both histological and clinical) diagnosis of chorioamnionitis are different from those that do not meet the confirmed “Triple I” criteria.

METHODS:

Retrospective three-year analysis of term patients with chorioamnionitis classified as: 1) clinical (CCA)–via ICD-9 codes, 2) histological (HCA), 3) concordant. Variables evaluated: age, gravidity, white blood cell (WBC) count, gestational age, Group B Strep, rupture of membranes, epidural, highest temperature, fetal heart tracing prior to cesarean, Apgar score, infant sex, special care nursery (SCN) admission and presence of bandemia in infant. Analysis by multinomial logistic regression.

RESULTS:

In the CCA, HCA and concordant group there were 27, 51 and 23 subjects, respectively. When compared to the concordant group, three variables had statistical significance (P < 0.05). In CCA and HCA, for every one-unit increase in WBC they are 18.6% (95% CI 0.65-0.95) and 17.3% (95% CI 0.69-0.99) less likely to match with concordant group, respectively. The HCA group is 96.6% (95% CI 0.003-0.387) less likely to be a primigravida and are 12.3 times (95% CI 2.8-53.6) more likely not to have infant in SCN.

CONCLUSION:

Our analysis finds the concordant group (confirmed Triple-I) is similar to CCA and HCA group. In term patients, the terminology “Triple I” does not bring clarity to the diagnosis of chorioamnionitis. Therefore, additional research is needed to refine the diagnosis criteria. This will improve maternal and neonatal management by providers.
Availability of Zika Virus Testing Information on Local Health Department Websites in the State of Texas [14O]
Authors: Adesomo Adebayo , Page-Ramsey Sarah M. , Ireland Kayla , Sullivan Adriana , Rodriguez Emma , Ramsey Patrick S.
Published: May 2017

INTRODUCTION:

Zika virus infection is an emerging health threat. It is important that obstetric providers can easily access Zika virus testing information. Our objective was to evaluate the availability of information about Zika virus testing on county and regional health department websites in Texas.

METHODS:

We reviewed all Texas county, regional, and metropolitan health department websites for information on testing patients with suspected Zika virus infection. Information abstracted included education on appropriate patient selection for testing, where to have blood drawn, where to submit specimens, availability of testing forms, and contacts for additional testing information. In cases where information about Zika virus testing did not appear immediately on the main webpage, an internal search of the site using the terms “Zika” was performed.

RESULTS:

Information for providers about Zika virus testing was identified on 3.1% of 254 county health department websites, 9.1% of the 11 public health region websites, and 5.0% of the 39 metropolitan health department websites. Very few websites had access to testing guidelines and testing forms available for providers.

CONCLUSION:

Growing concerns about Zika virus warrant guidance for healthcare providers on testing. The Centers for Disease Control recommends patients contact healthcare providers for guidance on testing, and that providers seek guidance from local public health departments. Providers in Texas have poor access to local and regional information for testing through these online resources. Improved local efforts are needed to assist providers with guidance on Zika testing.
Interpregnancy Interval in Placenta Previa With Morbidly Adherent Placenta [15O]
Authors: Shamshirsaz Amir A. , Erfani Hadi , Salmanian Bahram , Fox Karin A. , Vidaeff Alex C.
Published: May 2017

INTRODUCTION:

To evaluate whether there is a difference in interpregnancy interval between women diagnosed with placenta previa and morbidly adherent placenta (MAP) and those with placenta previa without MAP.

METHODS:

Retrospective case-control study of women with previous cesarean delivery and index pregnancy complicated by placenta previa. Cases had pathology proven MAP (n=39). Controls (n=39) without MAP were matched by number of previous cesarean deliveries. Primary outcome was the interpregnancy interval. A number of secondary maternal and neonatal outcome were also recorded. Data were reported as mean ± SD, median (IQR) and rates. Comparisons and adjustments were made using t-test, Mann Whitney U test, chi square test, ANCOVA and multinomial logistic regression.

RESULTS:

Median interpregnancy interval was 42 (20, 60) months in the placenta previa with MAP group and 43 (24, 86) months in the placenta previa without MAP group (P = NS). Gestational age at delivery and birth weight were lower in the MAP group (P < 0.001) with a significant increase in RDS rate. As expected, gravidity and parity were higher in the MAP group (P < 0.001). In the same group, the median estimated blood loss and use of blood products at delivery were higher and the hospital stay longer.

CONCLUSION:

In contrast to similar previous publications, we placed special emphasis on the use of comparable populations as cases and controls. Another strength of our study is case ascertainment, limiting the cases to women who underwent hysterectomy. Our data do not suggest an association between interpregnancy interval and MAP in women with placenta previa.
A Systematic Review and Statistical Analysis of Prenatal Non-Invasive Diagnosis of Sickle Cell Disease [27O]
Authors: Beebeejaun Yusuf , Short Lauren , Oteng-Ntim Eugene
Published: May 2017

INTRODUCTION:

With over 2 million American affected by Sickle Cell Disease (SCD) and an estimated 17,000 women affected by the disease in the United Kingdom, pregnancies complicated by SCD can be very challenging with various maternal and fetal complications. Currently, for SCD to be tested prenatally, fetal DNA is extracted by amniocentesis, chorionic villus sampling or cordocentesis and then analyzed by polymerase chain reaction (PCR). However, these procedures increase the risk of fetal miscarriage by up to 1%. In this presentation, we explore the efficacy of testing for SCD, non-invasively, using cell-free fetal DNA (cffDNA), which is extracted from maternal blood plasma.

METHODS:

Using literature databases we systematically reviewed existing studies pertaining to the use of cffDNA for non-invasive prenatal testing or diagnosis for SCD. The data collected as statistically analyzed, with the aim of appraising the sensitivity and specificity of this method of prenatal testing.

RESULTS:

Our analysis an average of 87.20% accuracy of diagnosis when using cffDNA to test for SCD, with 7.51% of fetuses incorrectly diagnosed.

CONCLUSION:

SCD is associated with significant maternal fetal complications such as intra uterine growth restrictions and preeclampsia. CffDNA for non-invasive prenatal SCD diagnosis appears to have the potential to be an accurate technique for the testing of this genetic disease. Whilst there are currently very limited data on the use of this technique for the specific testing of SCD, there is great opportunity for further research into the standardization and clinical application of this procedure.
Timing and Indications for Delivery at Less Than 39 Weeks in Neonates With Complex Congenital Heart Disease [28O]
Authors: Belay Wubishet , Davis-Nelson Shareece , Gates Judy , Hopper Andrew , Goff Donna
Published: May 2017

INTRODUCTION:

To describe timing and indications for delivery at less than 39 weeks of gestation in neonates with complex congenital heart disease (CCHD).

METHODS:

All neonates with CCHD admitted to Loma Linda University Children's Hospital from 2011 to 2015 were included in this study. Review of medical records was performed to collect data regarding CCHD lesion, maternal medical or fetal conditions and indication for delivery at less than 39 weeks of gestation. Indications for delivery were summarized by categories based on gestational age. Descriptive statistics were used to compare the groups.

RESULTS:

There were a total of 330 neonates admitted with CCHD during the study period with 129/330 (39%) born at less than 39 weeks GA with spontaneous labor in 54/129 (42%). The majority, 81/129 (63%) were born at early term, 34/129 (26%) were late preterm births and 14/129 (11%) were born prior to 34 weeks of gestation. Pregestational and gestational diabetes complicated 34/129 (26%) of the pregnancies while hypertensive disorders of pregnancy and intrauterine growth retardation were present in 18/129 (14%) and 13/129 (10%) of pregnancies, respectively. Vaginal and cesarean section deliveries accounted for 53% and 47% of the cases, respectively. Repeat cesarean sections with and without labor (38%), non-reassuring fetal heart rate patterns (21%) and breech presentation (20%) were the main indications for cesarean delivery.

CONCLUSION:

Delivery at less than 39 weeks of gestation is common in neonates with CCHD and more likely reflective of preterm labor, maternal medical or fetal condition rather than elective delivery.
Tocometry Rule-In After Maternal Accident (TRAuMA): Does It Affect Neonatal Outcomes? [30O]
Authors: Rojas Kristin E. , Kreczko Alicja , Raker Christina , Matteson Kristen , Vrees Roxanne
Published: May 2017

INTRODUCTION:

Minor trauma patients with viable pregnancies with at least 6 contractions per hour in 4 hours “rule-in” for 24 hours of monitoring to detect early abruption. We sought to determine if women who “rule-in” are at greater risk for adverse neonatal outcomes than those who “rule out” for extended monitoring.

METHODS:

A retrospective chart review included women with viable pregnancies in the Emergency Department following minor trauma between 2008 and 2013. Minor trauma included low-speed motor vehicle accident, falls, and assault. The primary outcome was NICU admission or fetal demise.

RESULTS:

Six-hundred and three minor trauma patients with viable pregnancies were included. Age, substance abuse, race, pregnancy comorbidities, and mode of delivery were not significantly different between groups. Women who “ruled-in” had significantly greater gestational age at presentation (34.2 weeks vs. 30.2 weeks p < 0.0001), less days from trauma to delivery (34.8 vs. 63.4 p < 0.0001), more motor vehicle accidents (32.4% vs. 22.8% p=0.03), and were more likely to report contractions (34.2% vs. 14.6% p < 0.0001). The rate of abruption was not significantly different between groups (ruled-in: 2.3% vs. ruled-out: 1.4%, p=0.5). Ten percent of those who “ruled-in” and 11% of those who “ruled-out” experienced the primary outcome, but this was not significantly different (RR=0.86 95% CI 0.55-1.35).

CONCLUSION:

Patients who “ruled-in” for extended monitoring were not found to have a greater risk of fetal demise or NICU admission than those who “ruled-out”. The current risk assessment and management algorithm of obstetric minor trauma patients should be re-examined.
Emergency Cesarean Section – Benefit or Extra Maternal Harm? [34O]
Authors: Tuck Alexis X. , Kesavan Meera , Blood Danielle , Morgan Dorcas
Published: May 2017

INTRODUCTION:

To determine the outcomes including complications that occur when an emergency code, “Condition Pink” is used on labor and delivery for either maternal or fetal reasons.

METHODS:

Retrospective chart review was conducted on all patients who delivered at New York University – Lutheran Medical Center between January 2014 and December 2015. Fifty – eight patients had a “Condition Pink” called. Mode of delivery, neonatal Apgar scores and maternal complications such as infection, hemorrhage, and bladder injury were reported. Also reviewed were readmissions to the hospital. Because majority of these women had cesarean deliveries, they were compared to women who underwent cesarean deliveries during that same time period. Statistical significance was assessed using the chi-squared test.

RESULTS:

All 56 emergent cesarean deliveries and a random sample of 96 non-emergent cesarean deliveries were selected. Patients requiring an emergent cesarean delivery were found to have a 16% (9/56) chance of overall maternal complications while non-emergent cesarean deliveries had only a 5% (5/96) chance (P=0.039). Risk of individual maternal complications, including postpartum hemorrhage, bowel or bladder injury, and postoperative infection were also evaluated, but these individual outcomes were relatively rare and differences between groups were not statistically significant.

CONCLUSION:

Emergent Cesarean sections (where a maternal or fetal emergency warrants immediate delivery of the fetus) carry an increased risk of overall maternal complications.
Efficacy of Suture Material in Prophylactic and Rescue Transvaginal Cervical Cerclages: A Retrospective Analysis [35O]
Authors: Daigle Patrick , Savage Megan , Bergeron Michelle , Karlin Samantha , Hagan Joseph , Stafford Irene
Published: May 2017

INTRODUCTION:

Cervical cerclage has been used for cervical insufficiency to reduce the risks of premature birth. There is limited data on the efficacy of commonly used cerclage materials. This study was conducted to compare the efficacy of monofilament, braided, and 5mm tape suture in prophylactic and rescue cerclages.

METHODS:

A chart review of women who received a prophylactic or rescue cerclage between January 2011- December 2015 at Touro Infirmary, New Orleans was performed. The Wilcoxon rank sum test was used to compare gestational age at delivery achieved with different sutures. Fisher's exact test was used to compare gestational age at delivery (≥32, 34, and 37 weeks) between different sutures. SAS version 9.4 was used for data analysis. A 5% significance level was used for hypothesis tests.

RESULTS:

Thirty four pregnant patients received a cerclage. Sixteen received braided sutures, 12 received monofilament sutures, and 6 received 5 mm tape. The gestational age at delivery was higher for those who received monofilament sutures compared to braided (p= 0.010). The gestational age at delivery for patients who received tape fell between monofilament and braided, but was not significantly different from either (p= 0.367 and 0.782 respectively). A higher proportion of patients who received monofilament sutures delivered at greater than 32 (p= 0.016), 34 (p= 0.024), and 37 (p= 0.017) weeks compared to patients who received braided sutures.

CONCLUSION:

Our study confirmed that monofilament sutures are superior to braided sutures in achieving greater gestational age at time of delivery, demonstrating that suture material does have an effect on cerclage efficacy.
Value of Mandatory Statewide Collection of Demographic Data About Obstetrician-Gynecologists [4E]
Authors: Moffett Maurice , Rayburn William F. , Pearson Amy Farnbach , Larson Richard
Published: May 2017

INTRODUCTION:

The New Mexico Workforce Data Collection, Analysis, and Policy Act of 2011 requires that all providers respond to a mandatory survey when obtaining or renewing (every 3 years) a medical license. This study highlights the value of continuously collecting a breadth of data about the entire obstetrician-gynecologist (ob-gyn) workforce for health policy initiatives.

METHODS:

All medical doctors licensed in New Mexico in 2015 with board certification in ob-gyn or gynecology only were included. License renewal survey data were collected between 2010 to 2015.

RESULTS:

In 2015, there were 316 licensed ob-gyn physicians in New Mexico, yet 213 (67.4%) practiced at a New Mexico address (54.9% female, 45.1% male). The proportion who practiced ob-gyn (83.0%) versus gynecology only (17.0%) remained constant. By age, 71.6% of the males and 33.9% of females were 55 or older. Nearly one-fourth (22.8%) worked part-time, regardless of gender. The 28.8% of all ob-gyns who practiced in rural counties (18.4% of females; 41.5% of males) saw more outpatients. Only 23.5% were owner/operators of independent practices, while 31.9% were employed as organizationally-affiliated providers. Net migration was positive between 2010 and 2015 (n = 70) with most practicing in metropolitan counties after migrating from another state.

CONCLUSION:

As demonstrated in New Mexico, mandatory collection of physician demographic and practice data at the time of licensure or relicensure provides a rich source of information to evaluate snapshots and trends of the ob-gyn workforce at a state level.
Residency Satisfaction in Ambulatory Clinics: Improvement Is Possible [9E]
Authors: Kole Martha , Friedman M. Alexandra , Eger Renee
Published: May 2017

INTRODUCTION:

Low provider satisfaction has been documented in trainee ambulatory clinics across specialties despite the importance of ambulatory care and patient management in residency training. An OB-GYN resident ambulatory clinic based in a large academic center led an initiative to improve clinic flow and overall provider satisfaction through the addition of scheduling changes, improved clinic logistics, dedicated didactic time for clinic coordination, and increased continuity through resident and nurse practitioner teams.

METHODS:

A 360 degree survey was created and piloted as part of the quality improvement process. Surveys were distributed to resident physicians for a baseline measure, and one year following clinic changes. Surveys were ten minutes in length, and were completed during resident didactic time.

RESULTS:

Of the 32 residents invited to participate 26 completed the pre-survey (81%) and 25 completed the post-survey (78%). Of residents surveyed, 23% of those who completed the pre-test, and 24% of those who completed the post-test were interns. Following improvement initiatives in the clinic, residents reported increased overall satisfaction (PRE, POST p=0.014). Most specifically residents noted increased satisfaction with the waiting room experience (PRE, POST p < 0.001), visit experience (PRE, POST p=0.02), continuity (PRE, POST p=0.05), and checkout process (PRE, POST p=0.02). Additionally, residents were more likely to refer a friend to the ambulatory clinic following these changes (p=0.014).

CONCLUSION:

Residents historically report low satisfaction in the ambulatory clinics setting. With increased time and resources dedicated to improving infrastructure, education and continuity, residents can have a more positive outpatient experience.
Group Prenatal Care and Its Effects on Triage Visits [12E]
Authors: Gullatt Erin , White Anna
Published: May 2017

INTRODUCTION:

Group prenatal care has a positive impact on patients and their pregnancy. We investigated effects of group prenatal care on number of patient initiated triage visits, gestational age at delivery, breastfeeding initiation rates, and attendance at postpartum visit.

METHODS:

Pregnant women receiving traditional prenatal care at a private obstetric clinic, traditional prenatal care at a resident clinic, and group prenatal care were compared through single-site, retrospective chart review. Multiple gestations, prenatal care beginning after 20 weeks gestation, and patients without documented delivery were excluded. The number of triage visits, gestational age at delivery, breastfeeding initiation, and postpartum visit attendance was collected through chart review. We used Zero-inflated Poisson regression to analyze triage visits and Chi-square analysis to analyze gestational age at delivery, feeding methods, and postpartum appointment attendance.

RESULTS:

Group prenatal care patients had increased patient initiated triage visits (p=0.0187). There was no difference between private patients compared to group prenatal care patients or when comparing private patients to resident patients. Group care patients had higher breastfeeding initiation (70%) than private (63%) and resident patients (57%), (P=0.3777). Postpartum visit attendance was higher in group care (95%) than in private (84%) and resident patients (81%) (P=0.1240). There were no differences in gestational age at delivery (P=0.122).

CONCLUSION:

Group prenatal care patients present more often to triage for evaluation than those receiving routine prenatal care, possibly due to increased education and symptom awareness in this patient group. Although not statistically significant, group prenatal care patients have slightly higher breastfeeding initiation rates, and postpartum appointment attendance.
Analysis of Cytology and Histopathology Results in an Immunocompromised Population [13E]
Authors: Downer Kimberley , Gabbur Nagaraj
Published: May 2017

INTRODUCTION:

HIV and Renal Transplant patients are in general at higher risk for cervical dysplasia and cancer due to their immunocompromised status. However, the literature is not clear if these patients are at equal risk. The objective of the study is to compare PAP smear results as well has histopathology findings in these two populations.

METHODS:

A retrospective chart review of colposcopy patients seen at SUNY Downstate Medical Center with a history of HIV or Renal Transplant was performed. Each patient’s index PAP and colposcopy results were reviewed.

RESULTS:

A total of 61 HIV patients and 11 Renal Transplant patients were included. 29.5% (18/61) of HIV patients had an initial PAP result of ASCUS and 33% (6/18) of these patients had biopsies positive for precancerous lesions ranging from CIN 1 - 3. 54% (33/61) of HIV patients had an initial PAP of LSIL and 42% (14/33) of these patients had positive biopsy results. 10% (6/61) had an initial PAP of HSIL or ASC-H and 100% of these patients had precancerous lesions (CIN 1-3) or cervical cancer (1/6). Of the 11 Renal Transplant patients, 5/11 presented with ASCUS and 6/11 had LSIL. Only 3/11 had histopathology and all had CIN 1.

CONCLUSION:

An analysis of PAP smear results in these two populations reveals that HIV patients tend to have PAP smears of a higher grade with a higher incidence of dysplasia as compared to Renal Transplant patients. The reason for this is unclear but may be due to the underlying reasons for the immunocompromised state.
Assessment of Lifestyle Counseling Offered During Pregnancy [18E]
Authors: Schneider Jason , Spiryda Lisa Beth
Published: May 2017

INTRODUCTION:

Mild to moderate exercise, proper diet, and appropriate weight gain during pregnancy are linked to numerous maternal health benefits and improved fetal outcomes. This study was done to assess discrepancies in current patient counseling offered by outpatient clinicians, with a future goal of creating standardized patient education programs.

METHODS:

IRB exempt status was obtained. Surveys were administered before obstetric office visits. Information gathered included age, race/ethnicity, insurance type, body mass index, education level, pregnancy history, and counseling/knowledge about diet, exercise, and weight management. Statistical analysis was performed with JMP and GraphPad statistical software.

RESULTS:

73 surveys were completed with 69 subsequently analyzed. Average age of participants was 30.25 years, gestational age ranged from 7-40 weeks with a mean of 25.2, and 29.4% were primigravid. Only 48.5% of patients received exercise counseling, 64.2% diet counseling, and 58.2% weight gain counseling. White and Black women were counseled more about diet than Asian women (p=0.045 and p=0.0067); Black women received more than Hispanic women (p=00192). Obese women received more exercise and diet counseling than normal-weight women (p=0.016 and p=0.0294). Underweight women also received more diet counseling than normal-weight women (p=0.0168). There were no differences in counseling about weight gain during pregnancy according to BMI class or race.

CONCLUSION:

The number of women receiving counseling on diet, exercise, and weight management during pregnancy is suboptimal. Of the patients receiving counseling, there is a discrepancy between races and weight. Future implementation of a standardized program is recommended to adequately educate all patients.
Impact of Telephone Reminder on Attrition Rate for Reading of Tuberculin Skin Test in Prenatal Visits [19E]
Authors: Chaudhuri Aparajita , Dad Nimra , Spilsbury Alexa , Sylvestre Georges
Published: May 2017

INTRODUCTION:

Tuberculin skin test (TST) is widely used in detection of latent tuberculosis in pregnancy. Despite being economic and easily readable, a major limitation in its use is high attrition rate and therefore, missed reading. The aim of our study was to examine the change in attrition rate associated with a telephone reminder on the day prior to reading of TST.

METHODS:

This was a case-control study involving new patients who underwent the TST at the antenatal clinic of Flushing Hospital Medical Center between June, 2016 and September, 2016 were included in the study. Women who had TST in prior visits or known positive PPD status were excluded. A reminder telephone call was made to the patient 24 hours prior to the reading date. Data on age, parity, ethnicity, insurance status and English Language Proficiency (ELP) were collected and analyzed using Microsoft Excel. P < 0.05 was defined as statistically significant.

RESULTS:

Patients (N=100) were divided in two study arms: Group A (n=100, no telephone reminder) and Group B (n=100, received telephone reminders), which were comparable in terms of demography, parity and ELP. Attrition rate was 35% in Group A and 16% in Group B. Influence of parity, age, ethnicity, ELP and insurance status was also studied.

CONCLUSION:

A telephone call as a reminder to return is shown to be associated with reduced attrition rate for TST reading during prenatal care. Further studies should be directed at the cost analysis of this simple intervention.
Comparison of Breastfeeding and Exclusive Formula Feeding Rates 2-3 and 6-8 Weeks After Delivery Amongst Primiparas [21E]
Authors: Batig Alison , Carty Jenava
Published: May 2017

INTRODUCTION:

Our study’s objective was to compare breastfeeding and exclusive formula feeding rates amongst primiparous women with an expressed intent to breastfeed during their admission for childbirth when randomized to either a 2-3 or 6-8 week follow up interval.

METHODS:

The data for this study was obtained as part of a randomized controlled trial that recruited term, primiparous women with an expressed intent to breastfeed to postpartum appointment intervals of either 2-3 or 6-8 weeks following childbirth. At the time of their postpartum encounter, their infant feeding method was categorized and compared using an odds ration with 95% CI.

RESULTS:

Of the 340 women enrolled in the study, 307 returned for a postpartum appointment where their infant feeding could be assessed. For 4 women in each group, infant feeding status was not denoted in their encounter record. Women randomized to the 2-3 week follow up interval were less likely to report exclusive formula feeding (OR 0.16, 95% CI 0.05-0.46, p < 0.01) and more likely to report breastfeeding of any degree (OR 6.41, 95% CI 2.15-19.11, p < 0.01).

CONCLUSION:

Amongst primiparous women with an expressed intent to breastfeed during their inpatient postpartum stay, our study demonstrated that women seen for earlier postpartum follow up were more likely to report breastfeeding to any degree and less likely to report exclusive formula feeding. Our findings suggest significant breastfeeding attrition may occur between 2-3 and 6-8 weeks after delivery. Understanding the timing for breastfeeding attrition may help us to target interventions to promote breastfeeding success and continuation.
Safety of Cosmetic Procedures During Pregnancy and Lactation: A Review [24E]
Authors: Trivedi Megha , Inouye Takeshi , Murase Jenny
Published: May 2017

INTRODUCTION:

The safety of cosmetic procedures in pregnant and lactating patients is a complex clinical question surrounded by uncertainty. Our objective is to consolidate data on the safety of commonly requested cosmetic procedures in the pregnant and lactating population after systematic review of the current literature so as to guide evidence-based care in the future.

METHODS:

A systematic search of the PubMed database was conducted for articles pertaining to cosmetic procedures in pregnancy and lactation. Prior review literature was also referenced.

RESULTS:

Due to a lack of controlled trials, individual cases were also considered. Minor procedures that involve shave, punch, snip, or electrocautery or considered safe. With respect to chemical peels, glycolic and lactic acid peels are deemed safe; However, TCA and salicylic acid peels should be avoided or used with caution. Although safety data on botulinum toxin A is insufficient, is may be safe since systemic absorption and placental transfer are insignificant. Sclerotherapy can be safe in pregnancy but must be avoided in the 1st trimester and after the 36th week. Laser and light therapy have been considered generally safe for granulomatous conditions and condylomata. Epilation should be limited to waxing, shaving, and topicals instead of permanent procedures. In lactation, most therapies discussed above are safe but fat transfer, sclerotherapy, and tumescent liposuction are not recommended.

CONCLUSION:

More controlled trials are needed to make concrete recommendations on safety of cosmetic therapy during pregnancy and lactation, but preliminary evidence suggests excellent safety profiles for many commonly requested cosmetic procedures.
A Review of Laser and Light Therapy in Melasma [25E]
Authors: Trivedi Megha , Murase Jenny , Inouye Takeshi
Published: May 2017

INTRODUCTION:

Melasma is a condition of facial hyperpigmentation and is commonly associated with pregnancy. Current treatments are unsatisfactory due to high rates of recurrence and adverse events. Laser and light therapy are often times the treatment of choice for refractory melasma. Our objective is to comment on both the efficacy and safety of the most commonly used laser and light therapies for melasma as published in the current literature.

METHODS:

A systematic literature search was done using the PubMed database. Key words included, “melasma” and “laser” in the title. A total of 442 results were obtained. Exclusion criteria were applied to the 442 search results. This systematic approach yielded 55 relevant prospective studies which were selected for review.

RESULTS:

Several types of laser and light therapy have been studied in the treatment of melasma. Of the Q-switched lasers, Qs Nd:YAG lasers have been the most effective especially with the use of sub-photothermolytic fluencies to reduce side effects. Intense pulsed light in combination with Qs Nd:YAG lasers and topical creams have shown to be effective in darker-skinned patients. Non-ablative lasers are often superior in safety to ablative lasers. However, non-ablative lasers are shown to be generally inferior to Qs Nd:YAG and should be used with caution in darker-skinned patients.

CONCLUSION:

Laser and light therapy, especially in combination with traditional therapies for melasma seem to be promising therapeutic modalities. More studies with longer term follow-up and varied patient populations are needed to further guide clinical practice.
A Survey of Obstetricians and Gynecologists Responses to Practices That Violate Female's Reproductive Rights [27E]
Authors: Shamshirsaz Alireza A. , Moaddab Amirhossein , Schulkin Jay , Stark Lauren , Raine Susan , McCullough Laurence
Published: May 2017

INTRODUCTION:

In most Western countries there are no exact estimates of extent of health care professionals’ involvement in honor-related practices such as virginity testing, virginity restoration, and female genital mutilation/cutting (FGM). We aimed to conduct an exploratory, descriptive investigation of the experiences and attitudes of practicing OBGYNs in the U.S toward requests for these practices.

METHODS:

From June to August 2016, an anonymous online survey contained questions on physicians’ demographic and practice characteristics were sent to 1,000 fellows and junior fellows of the American College of Obstetricians and Gynecologists.

RESULTS:

Two-hundred and eighty eight OBGYNs responded to the survey for a response rate of 31.7%. During the last 12 months, 10.1%, 5.6%, and 58.6% of physicians provided care to at least one patient who requested for virginity testing, virginity restoration, or underwent FGM, respectively. Among all, 34.4% and 18.6% perform virginity testing and restoration, respectively upon requests which were not limited to the foreign nationals or immigrant generations. Only 10 (3.5%) of OBGYNs were aware of any institutional policies regarding receiving such requests. Surprisingly, three OBGYNs reported visiting patients who underwent FGM in the U.S. Only 34% of OBGYNs were aware that federal laws prohibit FGM.

CONCLUSION:

Although these practices are not ethically permissible, a significant number of OBGYNs perform the practices and are not aware of any available guideline/law in managing these patients. There is an urgent need for all obstetrician-gynecologists to act on their professional responsibility in the care of these patients.
Combined Hormone Pills: Physician Practice Patterns in Two Catholic Affiliated Community Hospitals [30E]
Authors: Pereira Stacey
Published: May 2017

INTRODUCTION:

Our objective is to explore primary healthcare physicians prescribing patterns of oral combined hormone pills (CHP) in a community health setting specifically associated with a catholic hospital. CHP refers to any oral medication that contains both an estrogen and a progesterone.

METHODS:

Primary care physicians associated with two catholic affiliated community hospitals in Chicago, IL were identified. Physicians received an online survey via email which was resulted anonymously.

RESULTS:

A total of 45 respondents; 49% Internal Medicine, 27% OB/GYN, and 24% Family Practice. 64% had prescribed CHPs within the last year. Correct identification of contraindications to therapy as recommended per CDC was on average 73.47%. 68% of respondents routinely document discussion of VTE risk. Most commonly prescribed concentration of ethinyl estradiol is 20-25 mcg (60%) n=25. Only 54% of respondents prescribe < 7 refills. 58% of respondents continue to prescribe bi or triphasic pills. 33% of respondents require a pelvic exam for refill, 50% require an in-person appointment for refills. When prescribing for pregnancy prevention (n=23) 39% of respondents counsel a Sunday start.

CONCLUSION:

Catholic affiliated hospital physicians do prescribe CHPs. Important knowledge gaps exist within community physicians with regards to eligibility criteria for CHPs. There has been slow adaptation of recommended standards of practice with respect to CHPs such as number of refills given, physical exam requirements and other recommendations set forth by current population based research. Patient education by community physicians is lacking with regards to benefits of CHPs.
Determination of Optimal Routine Exchange Frequency After PCN Placement for Malignant Urinary Obstruction [35E]
Authors: Acosta-Torres Stefany , McDevitt Joseph , Zhang Ning , Xi Yin , Pillai Anil , Miller David S.
Published: May 2017

INTRODUCTION:

To determine the optimal time for routine exchange of indwelling percutaneous nephrostomies (PCNs) in patients with malignant urinary obstruction.

METHODS:

Patients with urinary obstruction due to gynecologic malignancies who underwent placement of PCN that required at least one exchange from 2011-2013 were reviewed. Exchanges were classified as routine or due to one of three complication types: mechanical (tube dislodgement), obstruction, or infection. Charges for each complication type were defined as the median value from representative cases. The distribution of exchange types under different routine exchange frequencies was estimated with an Accelerated Failure Time Model and average yearly PCN-related hospital charges were estimated with a Markov Chain Monte Carlo model.

RESULTS:

33 patients with 57 exchange encounters were included. Median representative hospital charges were $3.4k for routine exchanges, $36.5k for infection, $10.5k for obstruction, and $8.3k for mechanical. The model predicted that with a 90-day routine exchange and 50% adherence, 25% of exchanges would be routine and 35% would be due to infection, which would improve to 47% and 20%, respectively, with a 60-day routine exchange and 75% adherence. Estimated yearly PCN-related hospital charges were $160.0k without mandated routine exchanges, and were lowest when routine exchange was performed at 60 days (savings of $22.9k ± $2.0k with 75% adherence). Projected savings increased as patient adherence improved, as projected savings with 60-day exchange were reduced to $7.6k ± $0.7k if adherence fell to 25%.

CONCLUSION:

Scheduled routine PCN exchanges every 2 months is the least costly strategy for patients with malignant ureteral obstruction.
Oral Contraceptive Preference and Prescription Patterns Among Primary Care Residents in an Academic Medical Center [1F]
Authors: Zhang Shiliang , Sridhar Aparna
Published: May 2017

INTRODUCTION:

Oral contraceptive pills (OCPs) are the most widely-used form of reversible contraception in the United States. There are a variety of formulations available with little evidence in the literature on which to recommend over another. This study analyzes OCP prescription patterns among primary care residents within the University of California Los Angeles (UCLA) Health System.

METHODS:

An IRB-approved cross-sectional survey was administered electronically to residents in three primary care specialties (family medicine, internal medicine, obstetrics and gynecology). The survey contained questions analyzing frequency of OCP prescription, as well as attitudes and practices regarding prescription of OCP formulations. Data analysis was performed using univariate statistics.

RESULTS:

Survey response rate is 34% with 52 completed surveys. 52% of respondents reported prescribing up to 5 OCPs per week. A majority of residents (85%) demonstrated understanding of the pharmacological and clinical equivalences between generic and branded OCPs. However only 35% of residents felt comfortable helping patients choose an appropriate OCP or counseling patients on choices between generic versus branded pills. More than half of the respondents (62%) did not feel comfortable managing breakthrough bleeding with the use of OCPs. When asked to choose a “preferred” formulation, residents tended to choose a monophasic (72%), combined hormonal (92%), generic (72%) oral contraceptive pill.

CONCLUSION:

There is extensive redundancy of OCP formulations on the market. Improving knowledge of OCP prescription preferences is essential to clarifying common practices among physicians. Curriculum for primary care residents should elucidate the differences between formulations of OCPs, types of progestins, and relative side effects.
Postpartum LARC Use in Low-Risk Women in Centering Pregnancy® Versus Traditional Nurse Midwifery Prenatal Care [5F]
Authors: Hoff Tara , Hahn Petra , Huntly Jaimie , Sharma Deepti , Stockdale Colleen , Hardy-Fairbanks Abbey
Published: May 2017

INTRODUCTION:

Despite the low failure rates of long-acting reversible contraceptive devices (LARC) of 0.05-0.8%, women typically choose less effective forms of contraception. This is of particular interest in the postpartum patient population with regards to prevention of short interval pregnancies, which have increased morbidity. This study investigates rates of LARC use in women who attend Centering Pregnancy® (CP), a standardized group care, versus traditional prenatal (TP) care with Certified Nurse Midwifes (CNM).

METHODS:

IRB approved, retrospective chart analysis was conducted for all women who participated in (1) GP care between March 2012 and May 2016 and (2) TP care during the same time period. Contraception status was recorded at discharge and at a scheduled 6-8 week postpartum visit.

RESULTS:

126 women participated in GP care and 847 women attended TP care. GP patients were more likely to be admitted to the antepartum service (33.6% vs 13.4%, P < .0001), deliver before 37 weeks (9.5% vs 3.8%, P=.004) and have a higher average of prenatal visits (14 vs 11, P < .0001). LARC use rates at discharge were similar between the two groups (27.8% vs 34.4%, P=.144). More women attended their postpartum visit in the GP group (94.4% vs 83.2%, P=0.001) and LARC use rates at the postpartum visit were not statistically different (31.9% vs 33.3%, P=0.764).

CONCLUSION:

Despite a greater number of prenatal visits among women who attended group prenatal care at our institution, there was no significant difference in LARC use rates at discharge after delivery or at the postpartum visit.
Postpartum Contraception Education: Contraceptive Choice and Use of Long-Acting Reversible Contraception (LARC) [6F]
Authors: Vaglio Meghan E. , Satterwhite Catherine , Wieneke Carrie , Fitzgerald Sharon
Published: May 2017

INTRODUCTION:

Comprehensive contraception counseling provided in the postpartum period has the potential to increase LARC use.

METHODS:

A prospective observational study evaluating the impact of the Bedsider.org website contraception selection among consenting patients during the immediate postpartum period was conducted. After a baseline survey assessing their intended postpartum contraception method, participants were invited to use Bedsider to explore contraception methods. A follow-up survey was administered to determine participants’ contraception choice after having an opportunity to use Bedsider. The final contraception choice at the six-week postpartum visit was captured by chart review.

RESULTS:

Of the 103 participants enrolled, 65 participants completed both surveys (63.1%). The most common contraception method selected at baseline was oral contraceptives and Depo Provera (43.1%), with 16.9% indicating planned LARC use. A total of 8 participants changed their baseline method after visiting Bedsider; 5 reported intended LARC use. Among women attending a post-partum follow up visit (41/65), 24% received a LARC method at their visit. When compared to the intended method documented in the follow-up survey, one third of participants selected a different final contraception method at their postpartum follow-up visit (31.7%).

CONCLUSION:

Most patients were not influenced by the Bedsider tool. LARC education may be more effective if delivered in the prenatal period or at the postpartum visit.
Policies Restricting Medicaid Coverage for Pregnancy Termination in Women With Moderate Chronic Kidney Disease [8F]
Authors: Scrivner Karen , Clennon Emily , Savitsky Leah , Caughey Aaron B.
Published: May 2017

INTRODUCTION:

Recent policies have attempted to restrict which reproductive health services Medicaid can cover. Under these policies, a woman seeking an abortion with renal disease requiring dialysis treatment, but not a woman with moderate (Stage 3) chronic kidney disease (CKD) can undergo a termination covered by Medicaid. Our objective was to analyze the costs and outcomes associated with a policy that does not cover a pregnancy termination in a woman with moderate CKD.

METHODS:

A decision-analytic model was constructed using TreeAge 2016 software, and all probabilities were derived from the literature. We calculated our costs and outcomes using a hypothetical cohort of 5,000 women with CKD who experience an unintended pregnancy and would be covered by Medicaid. Primary outcomes included the cost associated with this policy restriction and the cost per quality adjusted life year (QALY). A cost-effectiveness threshold was set at $100,000 per QALY.

RESULTS:

In our cohort of 5,000 women, restricting funding for abortion in cases of Stage 3 CKD results in an additional societal cost of $5 million. Our cohort also experienced a decrease of 20 QALYs, 3 more cases of progression to Stage 4 CKD and 1 to dialysis, the same number of neonatal deaths, 6 more cases of intrauterine growth restriction, 11 more preterm deliveries and 7 more instances of preeclampsia.

CONCLUSION:

Restricting Medicaid coverage for abortion results in an increased economic burden and worse maternal and neonatal outcomes. These policy bans should consider both the health care and economic impact to women when deciding to enact these policies.