bluuebunny/crossref_metadata_2025 huggingface dataset:
Racial Disparities in Labor Induction Outcomes [36Q]
Authors: Teal Elizabeth Nicole , Lewkowitz Adam , Koser Sarah , Tran Carol , Gaw Stephanie
Published: May 2019

INTRODUCTION:

Maternal morbidity is disproportionately high for non-white women in the US. This study aims to determine whether non-white race is associated with increased risk of maternal morbidity in the setting of induction of labor (IOL).

METHODS:

This retrospective cohort study included nulliparous women with non-anomalous, singleton, cephalic pregnancies who underwent IOL with intact membranes at a tertiary-care academic hospital from January 2015 to April 2017. Patients with undisclosed race were excluded. Primary outcome was cesarean delivery rate. Secondary outcomes were postpartum hemorrhage, transfusion, peripartum infection, and NICU admission. The data were analyzed using the Kruskal-Wallis test and multivariable logistic regression analysis.

RESULTS:

Of 769 patients, 230 (30%) underwent CD. Black and Asian/Pacific Islander race were associated with significantly higher odds of CD despite controlling for confounders (adjusted odds ratio [aOR], 2.5, 95% confidence interval [CI] 1.2 - 5 and aOR 1.7, CI 1.1 - 2.5 respectively). Furthermore, these groups had increased odds of hemorrhage (aOR 2.7, CI 1.4 - 5.2 and aOR 2.0, CI 1.3 -2.9 respectively). Black, Latina, and multirace/other were associated with increased odds of transfusion (aOR 3.8, CI 1.5-9.8; aOR 4.4, CI 2.0-9.8; aOR 2.9 CI 1.2 - 7.0; respectively). Latina and Asian/Pacific Islander race was associated with increased odds of infection (aOR 2.56, CI 1.40-4.71 and aOR 2.41, CI 1.46 - 3.97 respectively). There were no differences in neonatal outcomes.

CONCLUSION:

In this cohort, non-white race was independently associated with increased odds of CD, hemorrhage, transfusion, and peripartum infection. Further research is needed to examine why these disparities exist.
17-Hydroxyprogesterone Caproate and the Prevention of Preeclampsia [14G]
Authors: Greenbaum Ryley Lawrence , Cottrell Constance , Bacak Stephen , Paul Sarah Alexis
Published: May 2019

INTRODUCTION:

Preeclampsia is a hypertensive disease caused by a dysfunction of the maternal and placental vasculature. Prior studies have shown that progesterone decreases inflammatory markers, mean arterial pressure and promotes vasodilation. Preeclampsia and preterm labor exhibit similar characteristics such as increased cytokines and inflammation. The goal of our study was to examine the association of 17-hydroxyprogesterone caproate and the development of preeclampsia.

METHODS:

We conducted a retrospective cohort study at a single high-risk obstetric center. All singleton pregnancies from January 1, 2016 through February 28, 2017 were identified. Patients with in multifetal gestations were excluded. Data were analyzed using Student t-test, chi-square test and logistic regression with significance set at P<.05.

RESULTS:

Our study included 1942 women, of which 96 women used 17-hydroxyprogesterone caproate. There was a significant difference in gravity (P<.001), parity (P .019) and gestational age at delivery (P<.001). There was no difference in the incidence of all forms of preeclampsia in patients exposed to 17-OH-P vs not exposed, P .640. No difference was found between preterm delivery secondary to preeclampsia with features and exposure to 17-OH-P, P .176.

CONCLUSION:

In our cohort, 17-hydroxyprogesterone caproate was not associated with a decrease in the incidence of preeclampsia or preterm delivery secondary to preeclampsia with features. Further studies are needed to determine if progesterone is a viable option for the prevention of preeclampsia.
Comparative Assessment of Serum Versus Menstrual Blood for Diagnostic Purposes [10C]
Authors: Naseri Sara , Lerma Klaira , Blumenthal Paul D.
Published: May 2019

INTRODUCTION:

Blood testing remains an essential component of diagnosis for a wide range of disorders or for preventive assessments. Phlebotomists, laboratory infrastructure, storage, collection, and transport are required for current methods of blood collection. Menstrual blood has many of the same characteristics as circulating blood, but has not previously been assessed as a potential diagnostic resource. We investigated whether biomarkers derived from menstrual blood correlated with systemic blood and assessed whether menstrual blood could become a convenient alternative vehicle for diagnostic and health monitoring purposes.

METHODS:

This was a prospective observational study of healthy reproductive-aged women. We chose a panel of 16 common biomarkers and compared them between systemic and menstrual blood. IRB approval was obtained.

RESULTS:

Overall, the correlation was high, particularly for 13 biomarkers with no statistically significant differences between the mean menstrual and serum values. These include cholesterol (p for differences in means=0.89, R2 for correlation=0.89), cortisol (p=0.490, R2=0.68), creatinine (p=0.32, R2=0.94), hsCRP (p=0.89, R2=0.99), LDL (p=0.21, R2=0.84), LH (p=0.32, R2=0.5), or triglycerides (p=0.45, R2=0.89), HbA1c (p=0.54, R2=0.80), HDL (p=0.33, R2=0.77), Iron (p=0.93, R2=0.34), Total T3 (p=0.12, R2=0.02), Vitamin A (p=0.66, R2=0.97) and Vitamin D (p=0.48, R2=0.20). For one biomarker, FSH (p<0.001, R2=0.97), which was less directly comparable to systemic blood, a linear relationship was recognized suggesting that the correlation could be mathematically derived, and therefore diagnostic utility could remain.

CONCLUSION:

Based on our results, menstrual blood can reliably estimate levels of several biomarkers and may be a promising option for non-invasive collection of blood for diagnosis and health monitoring.
Is Ultrasound Evaluation of the Cervical Stroma After Ultrasound-Indicated Cerclage Useful to Predict Outcomes? [33S]
Authors: Jackson Araba A. , Seif Karl E. , Awosika Olubukunola , Alawneh Maysarah , Khoury Alfred , Gomez Luis M.
Published: May 2019

INTRODUCTION:

We sought to assess if the evaluation of the cervical stroma before US-indicated cerclage placement contributes to the prediction of spontaneous preterm delivery (SPTD) <35 weeks.

METHODS:

Retrospective cohort study conducted at a single tertiary care institution. We collected information of women undergoing US-indicated cerclage from 2012 to 2017 who had transvaginal imaging of the cervix within 14 days before the procedure. We excluded cases of patients with other indications for cerclage, without cervical imaging before cerclage, Mullerian anomalies and multiple gestations. Measurement of the cervical length (CL) and stromal width of the posterior cervical lip were obtained. Our primary outcome was the rate of SPTD <35 weeks. Patients' consent and Institutional IRB approval were obtained.

RESULTS:

We analyzed outcomes of 110 patients who underwent US-indicated cerclage during the study period. The median gestational age at cerclage placement was 21 weeks. The median gestational age at delivery was 38 weeks. A total of 18/110 (19.8%) women delivered before 35 weeks. The median CL before cerclage for those who delivered <35 weeks was 13 mm compared to 17.4 mm for those delivering >35 weeks; P=0. 089. Meanwhile, the median cervical stroma in women delivering <35 weeks was 8.2 mm compared to 12.6 mm for those delivered >35 weeks; P=0.003 (after adjusting for confounders).

CONCLUSION:

Assessment of the cervical stroma is a useful predictor of SPTD <35 weeks in women who will undergo US-indicated cerclage. This technique is readily available and should be performed routinely in patients who will undergo US-indicated cerclage placement.
Saline-Air-HyCoSy Is Equivalent to the Modified HSG Following Hysteroscopic Sterilization [11M]
Authors: Wood Michelle , Luong Emerly , Yaklic Jerome , Maxwell Rose , Winter Thomas , Lindheim Steven
Published: May 2019

INTRODUCTION:

Transvaginal ultrasound (TVU) is FDA approved for coil location (CL) only following hysteroscopic sterilization. We compared saline-air-hysterosalpingo-contrast-sonography (SA-HyCoSy) to modified HSG (mHSG) for confirmation of both CL and tubal occlusion (TO).

METHODS:

19 women underwent SA-HyCoSy and mHSG after random assignment to one followed by the other. Percent agreement and predictive values of SA-HyCoSy for CL and TO compared to mHSG by two interpreters were calculated along with inter-rater reliability. Differences in procedural time and pain score using a Likert 11-point pain scale were recorded.

RESULTS:

In total, 38 fallopian tubes were evaluated. For each interpreter, satisfactory CL was noted with mHSG in 97.4% and 100% compared to satisfactory-optimal CL with TVU in 100% for a PPV of 97.4% and 100%, respectively. TO on mHSG was noted in 97.3% of tubes compared with SA-HyCoSy in 97.3% and 94.6% for a PPV of 100% and NPV of 50% and 33%, respectively. SA-HyCoSy agreed with mHSG for both interpreters in 97.4% and 95.7% (kappa=0.67, P<.01). SA-HyCoSy changed CL in 50% and 44.7% (P-NS), being down-graded from optimal to satisfactory in 42.9% (9/21) and 36% (9/25) and upgraded to optimal in 58.8% (10/17) and 61.5% (8/13) (P-NS) for each, respectively. Procedural time (7.5 vs 9.4 min) and pain scores (2.3 vs 3.1) were similar for mHSG and SA-HyCoSy.

CONCLUSION:

There is a high degree of accuracy for TO with SA-HyCoSy, though CL was changed in nearly half of cases. While procedural time and pain were higher, avoidance of radiation with SA-HyCoSy may outweigh any drawbacks.
Segesterone Acetate/Ethinyl Estradiol 1-Year Contraceptive Vaginal System Safety Evaluation [12M]
Authors: Thomas Michael , Gemzell-Danielsson Kristina , Creinin Mitchell D. , Barnhart Kurt , Miranda Maria-Jose , Sitruk-Ware Regine
Published: May 2019

INTRODUCTION:

A novel, 1-year contraceptive vaginal system (CVS) releasing a daily average of segesterone acetate (SA) 150 mcg and ethinyl estradiol (EE) 13 mcg has been developed. We evaluated clinical safety outcomes from nine studies conducted for product development.

METHODS:

We pooled data from four studies conducted with the final manufactured CVS, including a one-year, pharmacokinetic study; two 1-year duration, phase-3 trials; and a study extending treatment into a second year. The five other studies evaluated pilot SA/EE formulations. Safety was evaluated by adverse event (AE) reporting and three sub-studies of endometrial biopsies, vaginal microbiology, and liver proteins.

RESULTS:

The combined studies included 3052 women; 2308 (75.6%) women received the final manufactured CVS of whom, 999 (43.3%) completed 13 cycles. Treatment-related AEs most frequently reported included headache (n=601, 26%), nausea (n=420, 18%), vaginal discharge/vulvovaginal mycotic infection (n=242, 10%), and abdominal pain (n=225, 10%) However, <1.5% of women discontinued for each of these. Four (0.2%) women experienced venous thromboembolism (VTE), three of whom had other thrombosis risk factors (Factor V Leiden mutation [n=1]; BMI >29 kg/m2 [n=2]). Some participants (n=1107; 52.8%) reported at least 1 complete (24.5%) or partial (44.0%) expulsion during their use of the CVS; expulsions were most frequently reported in the initial cycle. Safety sub-studies revealed no unexpected safety signals.

CONCLUSION:

The 1-year SA/EE CVS has an acceptable safety profile, in line with other combination hormonal contraceptives. Similar prescribing precautions for combined hormonal contraceptives will apply and studies are warranted in obese women who are at higher VTE risk.
Cool Therapy to Reduce Menopausal Symptoms [18M]
Authors: Scheller Tracy F. , Abramson David
Published: May 2019

INTRODUCTION:

Up to 80% of women going through menopause experience vasomotor symptoms. Some women are not medical candidates or personally choose not to start hormone replacement therapy. This study is a pilot study looking at a cooling bolero jacket as a non-hormonal option for hot flashes.

METHODS:

EHMC IRB Protocol E-16-661 with a patient informed consent. A study of 10 consecutive patients with significant menopausal symptoms wore a cooling bolero for one hour in the morning and one hour in the evening. The cooling bolero maintains a temperature of 15 degrees centigrade making it comfortable and easy for the patient to wear. Demographic data included BMI ranging from 20-32.9. Six patients spontaneously entered menopause while four had menopause either induced by surgery or other medical conditions. The patients tracked the number of hot flashes, menopausal symptoms, their severity and duration for six weeks. The first two weeks were used to create a baseline followed by four weeks of wearing the cooling bolero.

RESULTS:

The number of hot flashes decreased from 7.23/24 hours prior to wearing the bolero to 3.4/24 hours by week four. The number of symptoms decreased from 2.95 to 1.86 while the severity score decreased from 2.29 to 1.11. The duration of the hot flashes was significantly reduced.

CONCLUSION:

This study shows decreased hot flashes using cooling therapy targeting brown adipose tissue with a temperature controlled device.
Predictors of Frequency and Severity of Vasomotor Symptoms: Results from the REPLENISH Trial [19M]
Authors: Bitner Diana , Constantine Ginger , Graham Shelli , Bernick Brian , Mirkin Sebastian
Published: May 2019

INTRODUCTION:

The objective of this analysis was to determine whether baseline characteristics can predict the frequency and severity of hot flushes (HF) in postmenopausal women.

METHODS:

REPLENISH was a phase 3, randomized, double-blind, placebo-controlled trial that evaluated the safety and efficacy of TX-001HR (17β-estradiol/progesterone oral capsule) in 767 postmenopausal women, who had ≥50 moderate to severe HF/week at baseline. Post hoc associations of baseline characteristics (age, race, BMI, smoking, time since last menstrual period [LMP], age at LMP, tubal ligation, parity, estradiol levels, and menopause-specific quality of life [MENQOL] total and vasomotor domain scores) with frequency and severity of hot flushes were evaluated.

RESULTS:

Baseline predictors for having ≥50 moderate to severe HF/week were BMI (P=.0299), MENQOL total score (P<.0001), and MENQOL Vasomotor domain score (P<.0001). For every unit increase in BMI, the odds of having ≥50 moderate to severe HF decreased by 12.6% while a one-point increase in MENQOL total and vasomotor scores increased the odds by 20.9% and 110.9%, respectively. Baseline predictors for HF severity were current smoking (P=.0042), and MENQOL overall (P<.0001) and vasomotor (P<.0001) scores. Multiple regression analyses showed that the MENQOL vasomotor score was the best predictor of severity (R2=0.1876; P<.0001), followed by MENQOL total score + smoking (R2=0.0325; P<.0001). Other baseline characteristics evaluated were not predictors of HF frequency and/or severity.

CONCLUSION:

In REPLENISH, baseline BMI, smoking, and MENQOL total and vasomotor scores were predictors for moderate to severe HF frequency and/or severity. These characteristics could potentially be used to predict women's HF frequency and severity at menopause.
Assessment of HPV Vaccination Compliance Rates Among Gynecology Providers: An Institutional Study of 845 Patients [24M]
Authors: Schneiter Mali , Elsamadicy Emad A. , Mehta Sumit
Published: May 2019

INTRODUCTION:

Identifying the drivers of noncompliance is necessary to better overall patient care and utility of the HPV vaccine. The primary aim of this study is to assess the compliance rates with HPV vaccination rates amongst gynecological (GYN) providers and has it improved over time.

METHODS:

The medical records of 845 women patients who were administered the HPV vaccine series by a GYN provider were retrospectively reviewed from 2006-2010 and 2014-2015. Patients were grouped by date of vaccine initiation, whether “Earlier” (2006-2010) or “Later” (2014-2015) cohorts. Patient demographics, dates of vaccine administration, and practice where vaccines were administered were collected on each patient. Patients who received all 3 vaccines within 6 months were deemed compliant. The primary outcome was the compliant rates.

RESULTS:

845 patients were reviewed, (Earlier: n=399, Later: n=475). The mean ages at initiation were similar between the cohorts (Earlier: 22.0 years vs. Later: 22.3 years, P=.16). The Later-cohort trended to have a lower compliant rate than the Earlier-cohort (Earlier: 35.2% vs. 30.9%, P=.20). Amongst patients in the Later cohort, the ages at initiation were similar between the two cohorts (p=.61). There was a significant difference between the compliance rates among the different Races (P=.036), with African-American (18.9%) and Hispanic (20.00%) patient-populations having lowest compliance rates.

CONCLUSION:

Our study found that there was no significant increase in HPV vaccination compliance rates among GYN patients over time. Additionally, our study suggests that race may have a role in vaccine compliance. Further studies are necessary to identify risk factors and independent predictors of non-compliance.
Does Remote Monitoring of Blood Glucose Levels During Pregnancy Expedite Time to Intervention? [25M]
Authors: Leggett Kelly , Hutchinson Mandy , Paddock Beverly , Rassette Kelly , Rider Cal
Published: May 2019

INTRODUCTION:

Patients with diabetes mellitus monitor blood glucose levels throughout their pregnancy to determine if intervention is required. Traditional paper recording only allows readings to be reviewed during visits. The aim of this study is to determine if remote monitoring of blood glucose levels through a mobile application increases the availability of data and allow providers to expedite intervention.

METHODS:

Women with gestational diabetes mellitus or pre-existing diabetes mellitus were invited to participate in the remote monitoring program. Patients received Babyscripts, a mobile application with a digital glucose log, and were asked to enter fasting and postprandial glucose levels. Physicians used a web portal to monitor patients' glucose logs. The physician's office was also contacted for triggers needing immediate attention. These thresholds were as follows: Fasting CBG < 60 mg/dl or >150 mg/dl or postprandial >250 mg/dl. Offices were also notified if 7 or more elevated readings occurred during alone week period (fasting >96 mg/dl, or postprandial >120 mg/dl).

RESULTS:

Eighteen pregnant women were offered the program and 17 agreed to be enrolled. A total of 1304 glucose levels were recorded by 17 patients. Providers were alerted 60 times to review abnormal values.

CONCLUSION:

Remote monitoring of blood glucose levels resulted in an increased availability of data for providers outside of the scheduled visit setting. Trigger protocols improved the provider's response times to both hypo- and hyperglycemia. Noncompliance was also quickly identified. Further research is needed to determine if the availability of blood glucose levels impacts maternal health and birth outcomes.
Use of a Targeted Lynch Syndrome Next Generation Sequencing Panel in Women at Risk for or With Endometrial Cancer [32M]
Authors: Padron Maria Mercedes M. , Camacho-Vanegas Olga , Pandya Deep , Camacho Sandra Catalina , Dottino Peter , Martignetti John A.
Published: May 2019

INTRODUCTION:

Women with endometrial cancer should be screened for Lynch syndrome (LS), a hereditary cancer syndrome caused by germline mutations in DNA mismatch repair (MMR) genes. This information directly affects immediate clinical management including future risk reducing/surveillance strategies for patients and at-risk family members. It is currently unclear how best to provide molecular screening. We investigated the use of a newly developed, targeted next generation sequencing panel (NGS), requiring only low input amounts of DNA, in a cohort of patients referred to a Gynecology Oncology clinic.

METHODS:

All patients included in this IRB-approved study were either being treated for endometrial cancer or being evaluated for risk. Germline/tumor DNA was isolated and 10ng DNA was used for targeted exon-level hotspot coverage of four genes, MLH1, MSH2, MSH6 and PMS2, using Swift's Accel-Amplicon Plus Lynch Syndrome Panel.

RESULTS:

Prior to patient sample analysis, the panel was shown to exhibit >90% on target and >90% coverage uniformity using 10 DNA control samples. The workflow allowed us to move from library preparation to data analysis within 2 days. All germline patient samples were found to possess either an insertion, deletion or single nucleotide variant predicted to inactivate either MSH2, MSH6 or MLH1. Paired tumor samples possessed the same MMR mutations. No inactivating PMS2 mutations were identified. All results were validated against commercially-available gene tests.

CONCLUSION:

A targeted NGS panel rapidly identified both germline and somatic Lynch syndrome pathogenic mutations. This panel provides an additional molecular tool for identifying women with this hereditary cancer syndrome.
Identifying Barriers to Postpartum Tubal Ligation: A Retrospective Chart Review [3N]
Authors: Ka Ng June Hoi , Esguerra Cybill Ruth , Ho Diana Yau , Patel Jharna M. , Amico Jennifer
Published: May 2019

INTRODUCTION:

Tubal ligation is the second most common method of contraception in the United States and is also one of the most effective, with a failure rate of 1.85% over 10 years. However, multiple barriers to postpartum bilateral tubal ligation (ppBTL) exist, including Medicaid paperwork, physician concern for regret, lack of facilities or staff, and cost. Some of these risk factors affect women of low socioeconomic status disproportionately.

METHODS:

To identify barriers to completion of ppBTL, we conducted a retrospective chart review over 18 months of all patients (n=645) who desired ppBTL on admission to labor and delivery at an academic institution in New Jersey.

RESULTS:

Overall ppBTL completion rate was 81.2%. Completion of ppBTL after vaginal delivery was 73.3% and completion rate after Cesarean delivery was 93.1%. The three most common reasons for non-completion of ppBTL were a patient changing her mind (44 patients, 36%), not documented (28 patients, 23%), and inability to access the Fallopian tubes (10 pts, 8.3%). Of the non-completed ppBTLs, 7 patients returned to our institution with a subsequent pregnancy (5.8%). While 41.5% of patients from our Federally Qualified Health Center that desired ppBTL did not receive it, only 7.3% of private patients that desired ppBTL did not receive it.

CONCLUSION:

Overall, completion rates of ppBTL at our institution are reassuring. However, we identified a disparity in completed tubal rates in our uninsured vs. insured population. Whether it is improving patient counseling antepartum or improving documentation postpartum, additional efforts are needed to improve these rates.
Reports of Sexual Violence Among Lesbian, Bisexual, and Heterosexual Women in Puerto Rico [13N]
Authors: García-Crescioni Keyla B. , Roura-Monllor Jaime A. , Frontera-Hernández Mariana , Romaguera Josefina
Published: May 2019

INTRODUCTION:

Sexual violence (SV) is a highly prevalent public health issue that affects a person's physical and emotional health. In the United States, approximately 36.3% of women report SV. A history of SV has been associated with increased mental disorders, substance abuse, criminal activity, and high-risk sexual practices. In Puerto Rico (PR), the Department of Health informed that SV was most commonly reported in girls aged 10 to 14 years.

METHODS:

This was a secondary data analysis of an anonymous web-based questionnaire given to 476 women in PR. The study variables were history of SV and age of first sexual experience. The data was grouped by sexual orientation and analyzed using chi-square testing. A P-value < .05 was considered significant.

RESULTS:

Sociodemographic characteristics were similar between groups except for age. The most common age of first sexual experience was between 7 and 12 years and was not significantly different between groups. The SV question was answered by 392 (82.4%) of participants. Of these, 18.1% heterosexual, 12.2% lesbian, and 34.7% bisexual women reported SV. Bisexual participants were significantly more likely to disclose a history of SV (P = .007). Overall 19.1% of participants reported SV.

CONCLUSION:

In this study a majority of women stated having a sexual experience at a young age. Significant amounts reported SV at least once in their lifetime with bisexual women being the most likely. Screening for sexual violence must be routinely performed by health professionals in order to provide counseling to its victims.
Knowledge, Attitudes and Perceptions About Medicolegal Education: A Survey of OB/GYN Residents [17N]
Authors: Mathew Shilpa , Ramm Olga , Cooksey Christie , Samant Navendu D.
Published: May 2019

INTRODUCTION:

The practice of obstetrics and gynecology (OB/GYN) is inextricably linked to tort liability in the United States (US). Nationally, 40-50% of OB/GYN physicians have altered their practice due to professional liability insurance demands or fear of litigation. Despite the pervasiveness of medicolegal concerns, formal instruction on these topics has not been widely adopted in residency training and many residents may lack pertinent knowledge to prepare them for practice.

METHODS:

All US OB/GYN residents during the 2017-2018 academic year were invited by email or in person to complete an anonymous survey on their demographics, medicolegal knowledge, medicolegal education within their respective residency programs, and the impact potential litigation has on their practice plans. This study was deemed exempt by the institution's IRB.

RESULTS:

Of the 5,152 OB/GYN residents invited to complete the survey, 17% (n=865) responded. Of these, 44% (n=378) reported receiving no medicolegal education during residency, 21% (n=181) were unsure, and 34% (n=293) reported receiving some formal education. Sixty-five percent (n=549) reported receiving medicolegal education by "word of mouth" or by "observing colleagues." Sixty percent (n=500) could not identify malpractice as a form of tort liability. In describing their exposure to medicolegal topics, 67% (n=571) did not feel they had adequate exposure and 19% (n=163) were unsure. Ninety-two percent (n=782) of residents reported concerns of being sued and 67% (n=571) believed that formal instruction during residency training may prevent lawsuits.

CONCLUSION:

OB/GYN residents report inadequate exposure to medicolegal topics and desire more formal instruction during residency.
Maternal Risk Factors Associated With Persistent Placenta Previa [27N]
Authors: King Luke , Nordberg Cara , Mackeen Awathif D. , Paglia Michael J.
Published: May 2019

INTRODUCTION:

The purpose of our study is to identify maternal characteristics that are associated with increased likelihood of placenta previa persisting to delivery.

METHODS:

We performed a retrospective, cohort study of 695 women diagnosed with placenta previa between 17 and 24 weeks gestation, who delivered at a Geisinger Health System facility from 2002 to 2016. Variables of interest included age, BMI, race, smoking status, substance abuse, parity, multigravida status, history of cesarean section, history of dilation and curettage, and history of placenta previa in prior a pregnancy. Logistic regression techniques were used for statistical analysis, P-values <0.05 considered significant.

RESULTS:

Of the 695 cases of placenta previa reviewed, a total of 368 cases were deemed complete placenta previa and the remaining cases were low-lying placentas. A total 63 (17.1%) women with complete placenta previa in the second trimester persisted to 36 weeks 0/7 days gestation requiring cesarean section. In the women diagnosed initially with complete placenta previa, a history of cesarean section (P<.001), history of dilation and curettage (P=.004), and multigravida (P<.001) were statistically significant, univariately. Other variables of interest were found not to be statistically significant. In a multivariate regression model, history of cesarean section and history of dilation and curettage remained significant with odds of persistent placenta previa (PPP) 7.0 (95% CI 3.72-13.07) and 2.5 (95% CI 1.27-5.01), respectively.

CONCLUSION:

Women diagnosed with complete placenta previa in the second trimester with a history of cesarean section and dilation and curettage are significantly more likely to have PPP.
Maternal Weight Gain and Risk of Cesarean Delivery in Women With Class III Obesity [28N]
Authors: Reiff Emily S. , Tucker Ann Robin , Brown Haywood L. , Gatta Luke , Adkins Lamani , Dotters-Katz Sarah Kathleen
Published: May 2019

INTRODUCTION:

Class III obesity is an independent risk factor for cesarean delivery (CD). Current Institute of Medicine (IOM) guidelines recommend 11-20lbs of gestational weight gain (GWG) in women with obesity. We evaluated the association between GWG and mode of delivery in women with Class III obesity.

METHODS:

Retrospective cohort study of women who delivered a liveborn neonate at term at a single institution from 7/2013-12/2017 with a baseline BMI ≥40 in the first trimester. Pregnancies complicated by prior CD, multiple gestation, or fetal anomalies were excluded. Primary outcome was CD. Demographics, pregnancy & delivery characteristics of women who gained more than 20lbs (mIOM) were compared to women who gained ≤20lbs (lIOM) using bivariate statistics. Multivariable analysis using stepwise backward-elimination approach and planned sub-analysis of multiparous women was performed.

RESULTS:

Of 298 women, 113 (37.9%) gained mIOM. Women in the mIOM group were more likely to be nulliparous, have a lower initial and higher delivery BMI, and higher birthweight. The CD rate was 40.7% in the mIOM group and 27.5% in the lIOM group (p=0.02, OR=1.80, 95% CI 1.10, 2.96). When adjusted for multiparity, birthweight and BMI at delivery, the aOR for CD was 1.00 (95% CI 0.56, 1.76). In subanalysis of multiparous women, the OR for CD in the mIOM group was 2.54 (95% CI 1.07, 6.07). When adjusted for BMI at delivery, the aOR for CD was 0.71 (95% CI 0.16, 3.10.

CONCLUSION:

An association between excess GWG and CD in women with Class III obesity may exist, though influenced by additional risk factors.
Measuring Meconium Aspiration Syndrome With Discharge Data [31N]
Authors: Thornton Patrick D. , Campbell Richard , Mogos Mulubrhan
Published: May 2019

INTRODUCTION:

Discharge data (International Classification of Diseases ICD codes) have not been used to estimate population level incidence of meconium aspiration syndrome (MAS) in the U.S. Existing population estimates are at least 15 years old and based on vital statistics data which are no longer collected. Estimates from other nations have used combined and disparate ICD codes (“with” and “without” respiratory symptoms).

METHODS:

We compared MAS diagnoses “with” and “without” respiratory symptoms using nationally representative newborn hospital discharges 2010-2012 (Nationwide Inpatient Sample-KIDS data). We compared incidence and outcomes of each MAS diagnosis controlling for demographic and hospital characteristics.

RESULTS:

Incidence of MAS with symptoms was 2.49/1000; 1.15/1000 without symptoms. Almost 1/3 (32%) of MAS cases identified by ICD codes were “without respiratory symptoms.” Odds ratio of MAS with symptoms was 1.54 (95% C-I 1.39-1.73) for African American newborns compared to whites. Length of stay was nearly twice as long (6.68 versus 3.65 days) and total charges were nearly 3 times higher ($44,000 versus $15,461) for newborns with symptoms than those without. Crude and adjusted OR's for hypoxic ischemic encephalopathy, pulmonary hypertension of the newborn, facility transfers and mortality are attenuated when disparate ICD codes are combined compared to cases “with symptoms” alone.

CONCLUSION:

ICD codes for MAS represent very different diseases or disease severity. Discharge data is useful in providing population estimates of MAS incidence, but diagnosis severity should be clearly distinguished by researchers. Combining disparate MAS diagnoses misrepresents incidence and disease severity, complicating population level comparisons and prevention strategies.
Missed Postpartum Venous Thromboembolism: A National Analysis of Different Hospital Readmission [33N]
Authors: Kedar Wenche , Parreco Joshua , Coll Alison Simone , Curry Christine Lynette , Rattan Rishi
Published: May 2019

INTRODUCTION:

Venous thromboembolism (VTE) causes morbidity and mortality after delivery and is a quality indicator. Prior studies have found that readmission to a different hospital can be significant and hidden, with unique risk factors. The national rate of postpartum different hospital readmission for VTE is unknown. The purpose of this study was to calculate the rate of missed postpartum VTE.

METHODS:

The 2014 Nationwide Readmissions Database was queried for patients >14 years with a delivery hospitalization. Outcomes included: 30-, 60-, and 90-day readmission with VTE to index and different hospitals. Multivariate logistic regression identified risk factors.

RESULTS:

Of the 3,718,711 patients queried, VTE readmission rate was 0.046% (n=1,729), 0.053% (n=1,972), and 0.055% (n=2,047) at 30-, 60-, and 90-days, respectively. Patients were readmitted to different hospitals 27.13%, 29.01%, and 29.70% of the time at 30-, 60-, and 90-days, respectively. Risk factors for different hospital readmission for VTE at 60-days were unique compared to index hospital VTE readmission risk factors and included initial admission to a for-profit hospital (OR 1.80 [1.33-2.42], p<0.01) and Medicaid (OR 1.33 [1.06-1.66], p=0.01). Initial admission to a public hospital decreased the likelihood of different hospital readmission for VTE (OR 0.69 [0.49-0.97], p=0.04).

CONCLUSION:

Nearly one in three postpartum VTEs are missed by current quality metrics, with significant implications for outcomes and quality. For-profit hospitals have more VTE readmissions hidden, falsely lowering their readmission rates relative to public hospitals. Women who are publicly insured are at higher risk for disruption of their continuity of care.
Obesity in Pregnancy Patient-Reported Outcomes: A Qualitative Meta-Synthesis [40N]
Authors: Dadouch Rachel , Hall Chelsea , D'Souzoa Rohan D.
Published: May 2019

INTRODUCTION:

Patient-reported outcomes are infrequently reported in obesity (BMI>30 kg/m2) in pregnancy trials, compromising patient-centered care. Our primary objective was to meta-synthesize qualitative results, to determine outcomes reported by these women that may inform research and clinical practice.

METHODS:

MEDLINE, Embase, CINAHL, PubMed and grey literature were searched from inception to June 2018, identifying English-language qualitative studies of women with obesity in pregnancy. Results were screened and reference lists of included studies were searched. Study characteristics were extracted, followed by a thematic synthesis, in which patient-reported outcomes were identified according to the Core Outcome Measures in Effectiveness Trials' definition. Outcomes were categorized into the taxonomy of outcomes in medical research (Dodd et al.).

RESULTS:

Of 101 results, 27 studies were included. The following themes emerged: Perceived Barriers and Benefits of Interventions, Emotions, Fears or Concerns, Social Support, Healthcare Provider Support, Size-Related Experiences (Psychosocial and/or Obstetrical), and Concerns Regarding Medical Care, Equipment and/or Environment. No study specifically aimed to determine outcomes, thus only nine outcomes were explicitly identified and the rest were synthesized from findings. Emotional Functioning/Well-being and Delivery of Care were the most frequent categories in the outcome taxonomy, while outcomes in Mortality/Survival and Physiological/Clinical and Resource Use were least highlighted.

CONCLUSION:

Identified outcomes may inform future research and clinical practice, as they vary from outcomes currently reported in clinical trials. Furthermore, the limited number of measurable outcomes in qualitative studies highlights the need for future qualitative research that specifically aims to elicit patient-reported outcomes that can be measured in clinical trials.
Knowledge and Use of Contraception Among a Population of Female Survivors of Torture [1A]
Authors: Rajeev Pournami , Bach Sonya Chemouni , Chessky Anna , Goddard Brian , Torresan Mirella , Ades Veronica
Published: May 2019

INTRODUCTION:

Bellevue Hospital's Program For Survivors of Torture (PSOT) sees patients applying for asylum from developing countries with limited access to contraception. The objective of this study is to examine contraceptive knowledge and use among a population of asylum candidates, in order to better understand their contraceptive educational needs.

METHODS:

An observational study was conducted using a cross-sectional structured interview questionnaire. IRB approval and patient informed consent were obtained. Data were collected from 55 participants as part of a larger research study to assess histories, perceptions, and gynecological needs of immigrant female survivors of torture. Data analysis was conducted via REDCap.

RESULTS:

Sixty-three percent of participants did not want to get pregnant within the next year, but only 32% of them were using any form of effective contraception. The only effective method of contraception that a majority (53%) of participants had been taught to use were oral contraceptive pills (OCPs) and only 36% had knowledge about long-acting reversible contraceptives (LARCs). Comparatively, 75% knew how to use the rhythm method. Prior use of LARCs, OCPs, and non-effective methods were 9%, 31%, and 63%, respectively.

CONCLUSION:

A majority of the immigrant women in this study did not want to get pregnant in the next year, but a minority had knowledge about effective contraceptive options outside of OCPs, and an even fewer had knowledge about LARCs. The discrepancy of usage between non-effective methods of contraception and effective methods suggests providers who see patients entering the American healthcare system should provide education on effective contraceptive options.
The Intersection of Race and Class and the Use of Long Acting Reversible Contraception (LARC) a Quantitative Analysis [3A]
Authors: Alfred Kywanna , Holmes Katherine M.
Published: May 2019

INTRODUCTION:

Long-acting reversible contraceptive agents (LARC), including IUD and implants are the most effective forms of reversible contraception. As such, they have gained attention from clinicians and public health organizations with their ability to decrease the rates of unintended pregnancy, abortion and teen births. Simultaneously, in the United States there has been a long history of reproductive coercion of marginalized groups. This study attempts to answer the key question: does the legacy of classism and racism affect patients' decisions to use LARC?

METHODS:

IRB Approval was obtained through the IRB at Wilson Hospital. Study population was a cross sectional group of women aged 18-50 registered at the UHS Wilson Primary Care Clinic as well as WIC participants in Broome County, Binghamton, NY. After informed consent was obtained, a structured qualitative interview was conducted with participants until theme saturation was reached. Questions included forms of birth control used, familiarity with and concerns about LARC. Demographic information, income levels and race were self-identified by study participants.

RESULTS:

Women of color and low-income women had the greatest number of concerns that use of a LARC contraceptive agent would harm them. The top two concerns were that the LARC would migrate or cause infertility. Patients would like their physician to talk to them about their fears.

CONCLUSION:

Counseling about birth control options should include an elicitation of patient fears: fear of harm and decreased reproductive autonomy are common and seem to be affecting decisions about LARC use.
Exploring How Targeted Regulations of Abortion Providers Affect Training and Practice Location [4A]
Authors: Gowda Tejasvi , O'Connor-Terry Carly , Lance Audrey , Chang Judy
Published: May 2019

INTRODUCTION:

Targeted Regulations of Abortion Providers (TRAP laws) create variable abortion accessibility by state. We explored how TRAP laws affect where physicians choose to receive family planning training and practice.

METHODS:

We conducted semi-structured telephone interviews with 25 physicians who provide abortion care across the United States and asked them about their experiences providing care in the recent political climate. Using an iterative qualitative coding process, we detected themes around how political climate and state laws around abortion affected personal preference in location of family planning training and practice.

RESULTS:

State laws surrounding abortion provision often influenced where providers chose to receive family planning training and practice. Reasons for choosing to train in liberal areas with few TRAP laws include a higher patient load and more opportunity to gain procedural skills. Some providers chose to train in restrictive areas for experience in navigating state laws that limit abortion access. When choosing location of practice, those that chose a hostile environment cited a greater need for abortion providers in restrictive areas. Those who practice in liberal areas often had personal reasons, including safety concern for themselves and their families as well as a desire to work in an environment where state laws do not force providers into practicing substandard care.

CONCLUSION:

Understanding how state TRAP laws affect location of training and practice of abortion providers creates an opportunity to further analyze what training, supports, and resources can be provided to encourage physicians to practice in underserved areas with restrictive abortion policies.
Incidence and Risk Factors for Venous Thromboembolism During Cesarean Delivery Hospitalization [9A]
Authors: Mardock Alexandra L. , Sanaiha Yas , Rudasill Sarah E. , Rao Rashmi , Benharash Peyman , Cohen Joshua G.
Published: May 2019

INTRODUCTION:

This study aimed to identify risk factors for venous thromboembolism (VTE) in women undergoing cesarean delivery in the United States.

METHODS:

The 2005-2015 Nationwide Inpatient Sample database was used to analyze VTE incidence during cesarean delivery hospitalization of women aged 12-55. Incidence, resource utilization, and risk factors were assessed using chi-square and logistic regression analyses.

RESULTS:

Of 14,071,941 cesarean delivery hospitalizations, 9,663 (0.07%) had VTE. Women experiencing VTE were more likely of Black race (19.6 vs 12.7%, P<.001) or insured by Medicaid (43.5 vs 40.8%, P=.018). Risk factors associated with VTE included puerperal infection (OR 7.88 [6.54-9.49], P<.001), thrombophilia (OR 6.93 [4.83-9.93], P<.001), cancer (OR 4.37 [1.75-10.95], P<.001), history of VTE (OR 3.63 [2.27-5.83], P <.001), disseminated intravascular coagulation (DIC) (OR 3.42 [2.33-5.02], P<.001), congestive heart failure (OR 3.33 [2.05-5.41], P<.001), need for blood transfusion (OR 3.21 [2.56-4.01], P<.001), and sickle cell disease (OR 3.05 [1.79-5.19], P<.001), among others. With multivariable analysis, Black race (OR 1.17 [0.98-1.38], P=.076) and Medicaid insurance (OR 1.04 [0.92-1.18], P=0.556) were not independently associated with VTE. VTE hospitalizations were associated with greater mortality (1.4 vs .01%, P<.001), adjusted cost ($25,706 vs $6,985, P<.001), and mean length of stay (10.2 vs 3.5 days, P<.001).

CONCLUSION:

Demographic disparities in VTE incidence exist among patients undergoing cesarean delivery. The strongest independent risk factors for VTE included infection, thrombophilia, cancer, history of VTE, DIC, and congestive heart failure, among others. Strategies to improve risk stratification and prophylactic anticoagulation decisions in at-risk populations are warranted.
BNP Levels as a Predictive Marker for Preterm Birth in Women With Hypertensive Disorders in Pregnancy [10A]
Authors: Duhon Ashley , Lai Monica , Heard Asha J. , Grant Joshua , Hagan Joseph , Stafford Irene A.
Published: May 2019

INTRODUCTION:

Few tests are able to determine the risk of preterm birth (PTB) in women with hypertensive disorders in pregnancy. B-type natriuretic peptide (BNP) is a sensitive marker discerning early cardiac dysfunction and volume expansion in these women. The primary purpose of this study is to evaluate BNP levels in pregnant women with hypertensive disorders as a predictor of medically indicated PTB.

METHODS:

Pregnant women who presented at Touro Infirmary, New Orleans, LA, between April 2015 and May 2017 for hypertension evaluation were eligible for enrollment. BNP values were collected prior to and at delivery. A BNP level of >100 was considered elevated. All obstetrical and neonatal outcomes were recorded. Fisher's test was used to compare the proportion of patients with elevated BNP levels for women with versus without indicated PTB and for women with versus without newborn requiring neonatal intensive care unit (NICU) stay. Neonatal weight and Apgar scores were compared using the Wilcoxon rank sum test.

RESULTS:

Of 52 women with hypertensive disorders as an indication for PTB, 34.6% had an elevated BNP, as compared to 12.5% of those with hypertensive disorders that delivered at term (p=0.004). Of 41 women whose newborn required NICU stay, 34.2% had an elevated BNP, as compared to 15.4% of those whose newborn did not require NICU stay (p=0.021). Neonatal weight and Apgar scores were not different (p>0.05) for those with elevated maternal BNP levels.

CONCLUSION:

BNP measurement may be helpful in determining which women with hypertensive disorders are at higher risk for medically indicated PTB.
Impact of an On-site Perinatal Mood Disorders Clinic in the Diagnosis and Management of Perinatal Depression [15A]
Authors: Roberson Dana , Roussos-Ross Dikea , Goodin Amie
Published: May 2019

INTRODUCTION:

Perinatal mood disorders are a widespread complication of pregnancy and the postpartum period, with negative effects for mother and child if left untreated. This study assessed health outcomes of women seen in an onsite Perinatal Mood Disorder Clinic (PMDC) intended to improve access to timely evaluation and treatment.

METHODS:

A retrospective chart review was performed of 120 patients seen at the PMDC between March 1, 2017 and June 1, 2018. The primary outcome was participants' Edinburgh Postnatal Depression Scale (EPDS) score at final visit, where score >12 indicated postpartum depression. Two-tailed t-tests compared initial and final EPDS scores. A multivariable linear regression model with robust standard errors estimated the relationship between patient characteristics and final EPDS score for patients with greater than one score, controlling for initial score, mood disorder history, treatment type, and demographics.

RESULTS:

Mean final EPDS score (11.04) was lower than mean initial score (16.54; P<.001), among n=57 with greater than one score. There was a significant decrease between initial and final score for those receiving pharmacotherapy (P<.001) and those receiving combination pharmacotherapy/counseling (P<.01), but not those receiving counseling only (P=.137). Initial to final EPDS score decreased significantly for those in ongoing treatment at study period end (P<.01) and those referred back to primary physicians (P<.001), but not for those referred to psychiatry (P=.256) or lost to follow-up (P=.540).

CONCLUSION:

Women treated at the PMDC showed improved EPDS scores. Therefore, the PMDC may be filling a gap in access to timely care for perinatal mood disorders.