bluuebunny/crossref_metadata_2025 huggingface dataset:
Deriving a Clinical Prediction Tool to Measure the Success of Labour Induction [12OP]
Authors: Alavifard Sepand , Meier Kennedy , Shulman Yonatan , Tomlinson George , D'Souza Rohan
Published: April 2018

INTRODUCTION:

There is high-quality evidence supporting induction of labour (IOL) for a number of maternal and fetal indications. However, one fifth of inductions fail, requiring emergency cesarean deliveries. This has negative clinical, emotional and financial implications. Our objective was to derive and internally validate a clinical prediction tool to determine the success of IOL.

METHODS:

Data was extracted from electronic medical records of consecutive pregnant women who were induced between April 26, 2016 and December 31, 2016, at Mount Sinai Hospital (Toronto, Canada). A multivariable logistic regression model was developed using variables identified as predictors of successful IOL by literature review and expert opinion. Repeated K-fold cross-validation was used to internally validate the model.

RESULTS:

Of the 916 cases of IOL, 249 (27%) failed. The multivariable logistic regression model found maternal age, parity, pre-pregnancy weight, pre-pregnancy body mass index, weight at delivery and cervical dilation at time of induction as significant predictors of successful IOL. The prediction tool was well calibrated (Hosmer-Lemeshow χ2=6.42, P=.60) and demonstrated good discriminatory ability (area under the receiver-operating characteristic curve [AUROC], 0.79 [95% CI 0.76–0.82]). Internal validation of the model showed a similar discriminatory ability (AUROC, 0.77 [95% CI 0.68–0.85).

CONCLUSION:

We have derived and internally validated a clinical prediction tool for IOL in a large and diverse population. Once prospectively validated in other settings, this has potential for widespread use in clinical practice and research, as well as for enhancing patient experience and allocation of healthcare resources.
HIV Vertical Transmission Does Not Differ When Using Protein Inhibitor or Integrase Inhibitor Antiretrovirals [17OP]
Authors: Gomez Luis M. , Sublette Nina , Wang Jenny Q. , Samson Fernand , Tate Danielle L.
Published: April 2018

INTRODUCTION:

HIV vertical transmission is reduced from 25% (baseline) to <2% with combined-antiretroviral therapy (cART) when the viral load (VL) near delivery is <1,000 copies/mL. For many years, the standard cART in pregnancy included 2 nucleoside reverse transcriptase inhibitors and 1 protease inhibitor (PI). Recently, integrase strand transfer inhibitors (INSTI) have been approved for use in pregnancy as an alternative to PI. We sought to compare the rate of HIV vertical transmission in women receiving PI- to those receiving INSTI-based cART.

METHODS:

This was a prospective cohort study of pregnant HIV-infected women who received care in an obstetric infectious disease clinic during 2010–2016. Women were included if they had at least 2 VL (before and after intervention) obtained during pregnancy. Our primary outcome was the rate of vertical transmission. Secondary outcomes included the rate of VL<1,000 copies/mL and undetectable VL near delivery.

RESULTS:

156 women received PI-based cART and 98 INSTI-based cART. The rate of vertical transmission was 0.6% (1/156) in the PI-group and 3% (3/98) in the INSTI-group (P=.32). After adjusting for confounders, the rate of VL<1,000 copies/mL near delivery was similar among both groups: PI=77.6% (121/156), and INSTI=81.2% (80/98); P=.37. More women in the INSTI-group had undetectable VL near delivery, 75.5% (74/98) vs PI-group, 46.1% (72/156); P=.001.

CONCLUSION:

HIV-infected pregnant women treated with PI- or INSTI-based cART had statistically comparable rates of vertical transmission. Both treatment groups achieved similar rates of VL<1,000 copies/mL near delivery and appeared equivalently efficacious to treat HIV-infected women in pregnancy.
Outcomes of Women age 40 or More Undergoing Cesarean Delivery or Trial of Labor After Cesarean [19OP]
Authors: Ahmadzia Homa , Bathgate Susanne , Macri Charles , Denny Kate , Quinlan Scott , Gimovsky Alexis
Published: April 2018

INTRODUCTION:

The purpose of this study was to evaluate United States maternal and neonatal outcomes in women age 40 or more undergoing cesarean delivery or trial of labor after cesarean delivery.

METHODS:

We conducted a secondary analysis using the MFMU Cesarean Registry database comparing women age 40 years or more at the time of delivery with those age less than 40 (control group). We excluded multiple gestations. Maternal and neonatal outcomes were compared and Poisson regression was used to adjust for confounders including race and type of delivery.

RESULTS:

A total of 67,389 women met inclusion criteria, of which 2,436 were age >40 year old and 65,403 were <40 at delivery. The >40 group had higher rate of PRBC transfusion (aRR 1.75; 95% CI 1.20–2.56), maternal ICU admission (aRR 2.02; 1.41–2.89), bowel injury (aRR 3.65; 1.43–9.31), placenta accreta (aRR 1.92; 1.09–3.38) and classical uterine incision (aRR 1.59; 1.43–9.31) compared to the control group. Maternal death rates were the same in both groups (P=.30). NICU admission and length of stay (LOS) was significantly higher in the >40 group compared to the control group (aRR 1.17; 1.09–1.25, LOS P=.005). Birth weight was significantly smaller in size of neonates born to women >40 group compared to the control group (3165 grams versus 3214 grams, P=.002).

CONCLUSION:

Women age 40 or more undergoing cesarean delivery or trial of labor after cesarean delivery are more likely to have maternal complications including intraoperative transfusion, maternal ICU admission, abnormal placentation and more complicated surgeries.
Postpartum Intrauterine Device Utilization Rate at an Academic Institution [12F]
Authors: Roche Michael , Kim Jin , Maines Jaimie
Published: April 2018

INTRODUCTION:

In the first year postpartum, 70% of pregnancies are unintended. Long acting reversible contraceptives, such as intrauterine devices (IUDs), are among the most effective forms of contraception and have been successful in reducing unintended pregnancy rates. Many institutions do not place IUDs until several weeks postpartum despite the American College of Obstetricians and Gynecologists’ recent Committee Opinion No. 670.

METHODS:

A retrospective cohort study was performed among women who delivered from 7/2014 through 6/2015 at our institution. Those who expressed desire to use an IUD as contraception prior to discharge from the hospital following delivery were included. Billing lists with ICD-10 codes for IUD insertion were used to cross reference inpatient lists from the postpartum hospital stays. Primary outcome measure was percentage of patients who had an IUD inserted by three months postpartum. Additional reasons for not receiving an IUD were examined.

RESULTS:

196 patients were identified who desired an IUD for postpartum contraception, and 86 (43.9%) received one. The most common reason for not receiving an IUD was loss to follow up (60%). Other reasons included choosing to use another form of contraception: hormonal (28.1%), barrier (9.1%), or abstinence (1.8%).

CONCLUSION:

More than half of our patients do not receive their desired method of postpartum contraception. As loss to follow up is the most common reason, institution of immediate postplacental IUD placement may allow for increased utilization and fewer unintended pregnancies. Further study is necessary to elucidate the barriers to immediate postpartum contraception.
Evaluating the Availability of Ulipristal Acetate in Eastern Long Island [15F]
Authors: Korotkaya Yelena , Schmidt Elizabeth
Published: April 2018

INTRODUCTION:

Ulipristal acetate (UPA) was approved by the FDA in 2010 as a form of emergency contraception (EC), which can be taken within 120 hours of unprotected sex. Evidence has shown that UPA is more effective than oral levonorgestrel emergency contraceptive pills (LNG-ECP) and more cost effective. UPA is more effective in patients with a BMI >30. No studies have looked at the availability of UPA in New York State. We specifically looked at Long Island due to its population density.

METHODS:

We conducted an observational population-based study utilizing a telephone-based secret shopper methodology. Researchers called 200 unique retail pharmacies in Long Island from May 2016-July 2017, representing themselves as patients and physicians.

RESULTS:

Only 9.5% of pharmacies had UPA immediately available, although 81% reported ability to order UPA. In contrast, 80% reported having LNG-ECP readily available. Only 47% of pharmacists who had UPA available could correctly identify its differences from LNG-ECP. 82% of pharmacists in the physician call group were unfamiliar with UPA. In addition, 0% of pharmacists mentioned BMI as an important difference in efficacy between UPA and LNG-ECP.

CONCLUSION:

Although UPA is the more effective EC than LNG-ECP, its availability is limited. Knowledge of UPA is lacking in pharmacists and clinicians alike. Increasing education of clinicians, pharmacists and patients regarding differences between EC pills may assist in increasing demand for UPA and could increase overall availability of UPA.
Prevalence, and Pattern of LARC Use in Immediate Postpartum Period at Jimma University Medical Center, Ethiopia [18F]
Authors: Arero Wariyo , Teka Woubishet , Jarso Habtamu
Published: April 2018

INTRODUCTION:

Postpartum family planning (PPFP) is defined as the prevention of unintended pregnancy and closely spaced pregnancies through the first twelve months following childbirth. Immediate postpartum period is particularly favorable time to provide LARC methods and postpartum provision of LARC is safe and effective. Despite the advantages of LARCs, they are infrequently used in Ethiopia.

METHODS:

A cross-sectional study was conducted on 393 women who gave birth at Jimma University Medical Centre (JUMC) from November 12, 2016 to January 21, 2017. Data were collected by face-to-face interview and record review using pre-tested questionnaire and analysed using SPSS 20. Logistic regression was used to identify associated factors for LARC method use.

RESULTS:

Prevalence of LARCs use among immediate postpartum mothers was 53.2% and more than three quarter (78.0%) of participants used Implanon. The most common reported reasons for not using LARC were preference of other method (25.5%). Having more than four alive kids (95% CI: 1.15-5.95), high monthly income (95% CI: 1.08-7.20), planning to delay next pregnancy by more than two years (95% CI: 1.60-9.28), previous experience of LARC use (95% CI: 1.30- 7.20), completed family size (95% CI:1.12- 3.15), and most importantly receiving counselling during antenatal care (ANC) follow up and before delivery (95% CI 1.01- 4.73) were associated with immediate postpartum LARC use.

CONCLUSION:

Utilisation of immediate postpartum LARC methods use among counselled mothers was high compared to other low income countries reviewed.

The need for providing counselling during ANC follow up and delivery to increase utilisation of immediate postpartum LARC use is emphasised.
Outcomes of Pulmonary Hypertension in Pregnancy in an Academic Hospital in Ethiopia [31F]
Authors: Whelan Anna , Yeman Awol , Briller Joan , Nixon Heather , Hailu Abraha , Goba Gelila
Published: April 2018

INTRODUCTION:

Pulmonary hypertension (PH) is a rare disease that is infrequently associated with pregnancy. However, when present in the parturient, it can be devastating. In the developed world, mortality from PH during pregnancy and postpartum decreased from 50% in the 1970s to 16% in 2014. Proper management requires a multidisciplinary team approach and close follow up. In the developing world, physicians face many challenges when caring for these complicated patients.

METHODS:

A case series of 20 patients with pulmonary hypertension who were treated at Mekelle University Hospital, Ethiopia.

RESULTS:

20 cases of severe PH from September 2015 to September 2017 were reviewed. Average systolic pulmonary arterial pressure measured by echocardiography was 104.1 mmHg (SD 11.4, range 83-134 mmHg). Etiology was attributed to chronic rheumatic valvular heart disease in 17 patients and congenital heart defects in 3 patients. Eight patients had disease classified NYHA functional class III or IV heart failure (40%). There were 5 confirmed deaths (25%). Eleven patients underwent cesarean deliveries, 4 underwent vaginal deliveries with assisted second stage. Three patients underwent termination of pregnancy and 2 died prior to delivery. Death was caused by pulmonary edema in 3 cases and pulmonary venous thromboembolism in 2 cases. Sixty-five percent of pregnancies resulted in live birth.

CONCLUSION:

Pulmonary hypertension complicating pregnancy continues to be a highly morbid disease worldwide. Increased mortality in this study may reflect differences in etiology as well as delays in diagnosis and reduced access to healthcare. Multidisciplinary teams including cardiology, anesthesia, and obstetrics, are important to improving maternal and fetal outcomes.
Small Bowel Obstruction in Pregnancy: A Systematic Review [32F]
Authors: Sagi Yair , Bussiere-Cote Sophie , Meier Kennedy , Bischoff Danielle , D'Souza Rohan
Published: April 2018

INTRODUCTION:

The objective of this study was to review pregnancy outcomes and management options in pregnant women presenting with small bowel obstruction (SBO).

METHODS:

We conducted a systematic review of all studies describing SBO in pregnant women from 2006. Four bibliographic databases were searched using appropriate MeSH terms and keywords. Two reviewers independently screened articles and extracted data from eligible studies. Outcomes were described as proportions.

RESULTS:

We identified 3656 studies and included 78 describing 92 pregnancies. Most presented in the third (60%) or second (37%) trimesters. The commonest risk-factor was previous abdominal surgery (49%), presenting symptoms were abdominal pain (88%) and vomiting (67%) and examination findings were tenderness (49%) and distension (28%). Abnormal laboratory parameters were seen only in 26%. Diagnosis was confirmed on ultrasound (49%), computerized tomography (39%), X-ray (15%) or magnetic resonance imaging (14%). Conservative management was only successful in 4%, and laparoscopic surgery was only performed in 7%. The commonest aetiologies were adhesions (30%), internal hernias (25%) and volvulus (24%) and the commonest site was the ileum (37%). Maternal complications included death (4%), bowel perforation (14%), hypovolemic shock (12%) and sepsis (8%), while perinatal complications included prematurity (45%), low birthweight (11), stillbirths (9%) and neonatal death (4%). Almost 50% of the deliveries were by caesarean, to facilitate simultaneous surgical intervention for SBO, 88% of which were performed preterm.

CONCLUSION:

SBO is associated with high rates of adverse pregnancy outcomes, caesarean deliveries and iatrogenic prematurity. An algorithm for prompt diagnosis and management is needed to improve maternal and perinatal outcomes.
Identifying Trends in GBS Prophylaxis Patterns Within an Underserved Patient Population [37F]
Authors: Mora Nelsi
Published: April 2018

INTRODUCTION:

GBS infections remain the most common cause of early onset neonatal sepsis in the United States. ACOG deems addressing perinatal GBS status and achieving adequate intrapartum prophylaxis the standard of care. Due to reported lapses in adequate intrapartum prophylaxis of GBS positive and unknown mothers at our institution, this study aims to identify trends in institutional GBS prophylaxis patterns following the standardization of admission notes.

METHODS:

This study was conducted in a single, University-based, urban teaching hospital with a historically disproportionate number of patients presenting in labor with insufficient to no prenatal care. An electronic medical record query was performed to enumerate the number of recorded institutional deliveries, the number of discharged infants born to mothers receiving insufficient to no prenatal care, and infants with inadequate intrapartum GBS prophylaxis at delivery.

RESULTS:

The monthly distribution of mothers and babies details that 7% of infants were born to mothers with insufficient prenatal care, and 92% of these infants had an unknown GBS status at delivery. An R-squared data plot model measured the data fitted to a regression line in relation to infants born with inadequate GBS prophylaxis, revealing: R2 = 0.29, 0.28; p values = 0.058, 0.07; infants totaling 0.4% receiving inadequate intrapartum GBS prophylaxis.

CONCLUSION:

This retrospective data review was performed to identify if changes in a system’s based practice affected trends in practice outcomes in an underserved urban population. The investigation and analysis of perinatal GBS prophylaxis patterns intrapartum may contribute to decreased institutional perinatal morbidity and mortality.
Cold Compress for Pain Associated With Intrauterine Device Insertion: A Randomized Controlled Trial [5G]
Authors: Hylton Jordan , Milton Sarah , Sima Adam
Published: April 2018

INTRODUCTION:

Pain with intrauterine device (IUD) insertion is identified as a barrier to compliance with this highly effective long acting reversible contraceptive. Several studies have assessed the efficacy of interventions to alleviate patient discomfort associated with IUD insertion, but no interventions have been clearly shown to improve procedural pain. The aim of this study was to determine if use of a cold compress on the abdomen during intrauterine device insertion improves pain.

METHODS:

This study is a prospective, randomized controlled trial comparing cold compression to no intervention during IUD device insertion. Study participants were women who desired IUD placement at Virginia Commonwealth University OB/GYN clinics. Subjects were randomized to control (n=40) versus cold compress (n=47) and they completed a pre- and post-procedural visual acuity scale for pain. Additional data was collected regarding gravidity, parity, history of cervical procedures and socioeconomic status as well as history related to chronic pain.

RESULTS:

There was no difference in pre and post-insertional pain in those who received a cold compress versus the control during insertion of intrauterine device (3.6 versus 2.8, P=0.223). The insertional pain was rated at 4.5 and 4.7 for patients who received the cold compress and the control group, respectively (P=0.724).

CONCLUSION:

While a cold compress is a simple, inexpensive and safe method of pain control this study shows no improvement in insertional pain for intrauterine device placement.
Timing of LARC Insertion in Resident Physicians vs. Nurse Practitioners at an Urban Teaching Facility [11G]
Authors: Cortez Sarah , Runyan Aliye , Roberts LeAnne , Recanati Maurice , Dai Jing
Published: April 2018

INTRODUCTION:

To examine the time interval between request and placement of long-acting reversible contraceptives (LARC) by residents vs. nurse practitioners at an urban teaching facility.

METHODS:

Retrospective electronic health record review of all patients who received LARC devices in 2016 at the University Health Center Ob/Gyn staff clinic in Detroit, MI. Data was analyzed using descriptive statistics and student’s t-test for comparison of means.

RESULTS:

Between January 1 and December 31, 2016, 311 patients received intrauterine devices (IUD) or subdermal implants (SDI). Of patients desiring LARC, 24% did not receive their contraceptive device same-day. Average interval between IUD request and placement, for those not receiving same-day contraception, was similar in nurse practitioner (1.2 months) vs. resident clinic (1.0 months). Average interval between SDI request and placement in nurse practitioner (1.3 months) vs. resident clinic (0.5 months) was statistically significant (95% CI, 0.4 to 1.2, p=0.0002). The only cited reason for interval delay of SDI placement was “no available trained provider”.

CONCLUSION:

The majority of patients at University Health Center did receive same-day LARC placement, however, many patients required multiple visits between expressed interest of LARC and placement of the contraceptive device. Interval timing, for IUD placement, did not differ in resident vs. nurse practitioner clinic; however interval timing of SDI placement was affected by a reduced number of available trained providers in the nurse practitioner group. ACOG recommends same-day LARC placement, therefore increasing SDI placement training or increasing the availability of SDI trained providers is an identified area of improvement for our clinics.
A Multi-Dimensional View of Contraception and Teen Pregnancy in Flint, MI [15G]
Authors: Drolet Anne , Smith Lauren , Sadler Richard
Published: April 2018

INTRODUCTION:

USA has the highest rates of adolescent pregnancy of any industrialized country. These rates are disproportionally higher in both minority and low-income communities, as in Flint, MI, where the pregnancy rate (42.8 births per 1000 teens) is higher than the state average (31.6). This rate nearly doubles when examining African American teens (71.7). We aim to gain a better understanding of what factors may influence teen pregnancy. Examining the data geographically, we can also better understand spatial differences in this phenomenon.

METHODS:

We used CPT and ICD-9 codes to identify teen contraceptive use and pregnancy counseling, and linked this data with the patient’s ZIP code to model spatial variations in these behaviors. We also distributed a survey to Flint-area schools about their sex education. We then used geospatial analysis to determine which areas have higher risk for teen pregnancy, and compare this to the usage of contraception, sex education availability, amount of physician counseling, proximity to medical services, and other demographic spatial covariates

RESULTS:

We expect teen pregnancy to vary spatially with other socioeconomic factors, and are producing maps of the area showing co-occurrence of other factors (such as location of medical services and type of sex education available by school). From this data, we are computing statistical evidence to suggest which factors have the strongest links to teen pregnancy.

CONCLUSION:

Our results can be used as a model to help physicians understand what influences pregnancy rates for their teen patients and deliver spatially targeted interventions which best reflect local conditions and experiences.
Impact of Long-Acting Reversible Contraceptive Counseling on Postpartum Contraceptive Choice [17G]
Authors: Torre Bryna , Nokovic Jessica , Shelton James , Tsai Pai-Jong
Published: April 2018

INTRODUCTION:

Approximately half of pregnancies occurring in the United States annually are unintended. Long-acting reversible contraceptives (LARCs) could help reduce unintended pregnancy, yet they are used by less than 3% of women in the United States. The objective of this study is to determine if prenatal contraceptive counseling for high-risk pregnant women will impact LARC choice postpartum.

METHODS:

A prospective cohort study was performed at the Perinatal Center of Women and Children’s Hospital of Buffalo. Patients who presented between ages 18 and 45 and within 34 weeks of gestation were recruited to participate in the study. Our intervention included two prenatal contraceptive counseling sessions. The patient’s choice of a LARC postpartum was compared to both their pre-counseling choice as well as to the choice of a control group who received standard prenatal counseling in the year prior to our intervention. Descriptive data and bivariate analysis were performed using SPSS. P-values less than or equal to .05 were considered significant.

RESULTS:

A total of 55 pregnant women were recruited. All women had co-morbid conditions, including chronic hypertension, diabetes, and venous thrombo-embolism. Counseling increased the intent for LARC from 27% pre-counseling to 42% post-counseling (P=.011). The intervention group also had higher postpartum LARC intent (42%) compared to control group who received standard counseling (20%) with P=.003.

CONCLUSION:

Our study suggests that instituting a prenatal contraceptive education program can improve LARC rates in high-risk pregnant women.
Contraception for Transgender Men: A Call to Action [18G]
Authors: Bonnington Adam , Obedin-Maliver Juno
Published: April 2018

INTRODUCTION:

Contraceptive counseling is a cornerstone of most OBGYNs' practices and should extend to transgender patients. There are several reports of transgender men who become pregnant even when amenorrheic on testosterone, but discussing contraception with this population can be challenging given the lack of guidance available. Unmet contraceptive need can result in unplanned pregnancies and poorer pregnancy outcomes among cisgender women, but there are potential additional risks for transgender men. Given the paucity of contraceptive data for transgender men, providers find themselves needing guidance.

METHODS:

We conducted a review of available literature on contraception, pregnancy intention, and pregnancy capability for transgender men. We reviewed clinical medicine, psychology, social science, basic science, and public health literature. Using the Centers for Disease Control contraceptive efficacy model, we highlight key contraceptive considerations by method from provider and patient perspectives.

RESULTS:

Overall, we don’t anticipate that the risks associated with the various contraception methods differ significantly for transgender men, though more study is necessary. However, considerations of context and administration reflect transgender men’s unique needs. Bothersome side effects, need for frequent office visits, and role of pelvic exams, are just a few examples of factors that may differentially effect this population.

CONCLUSION:

Transgender individuals face pervasive discrimination, violence, and barriers to medical care. As OBGYNs, we are uniquely poised to care for this underserved population and provide solace and comprehensive care. By providing a safe and accepting space, we can use our knowledge to ensure intentional family planning and access to appropriate reproductive healthcare for these patients.
Use of Cycle Length Alone to Predict Ovulation, as Predicted by Apps, is Highly Inaccurate [19G]
Authors: Johnson Sarah , Marriott Lorrae , Zinaman Michael
Published: April 2018

INTRODUCTION:

Women trying to conceive will often use methods to time intercourse. There are a plethora of free Apps available, claiming to be able to predict ovulation based on cycle length alone. This study sought to determine whether they could predict accurately.

METHODS:

This was an observational study of women >18 years old who were seeking to conceive (n=850). Volunteers collected daily urine samples for quantitative measurement of LH (AutoDELFIA), with day of ovulation determined as the day following LH surge. App determination of ovulation day for each cycle length was generated. Calendar based methods (rhythm, alternative rhythm, standard days and simple calendar method) were applied to determine accuracy.

RESULTS:

For each cycle length there was a wide spread of possible days of ovulation. For a 28 day cycle, day 16 was most common (21%), range 11-20. The most accurate calendar method was the rhythm method which gave 89% accuracy, providing an average fertile window of 11 days, whereas the simple calendar method provided a 2 day window, but only achieved 22% accuracy.

CONCLUSION:

The only way cycle length alone can be used to predict ovulation is by providing a very wide window of potential days, which is no better than the advice of frequent intercourse. Therefore Apps using cycle length alone are providing either inaccurate or imprecise information. If women wish to time intercourse to enhance their chance of pregnancy, they should use a true prospective method such as home ovulation tests.
Effect of Contraception Decisional Aid on Postpartum Contraceptive Choice: A Replicated Time Series Study [20G]
Authors: Sridhar Aparna , Kuperman Julie , Hulugalle Avanthi
Published: April 2018

INTRODUCTION:

Contraception after birth is essential to the wellbeing of mothers as well as the health of their future children. The WHO recommends a two to three year inter-pregnancy interval. Decisional aids have helped to assist women with contraceptive decision-making. Our goal was to develop and test an electronic decisional aid to inform pregnant women about options for postpartum contraception.

METHODS:

We conducted a replicated interrupted time series study. A decisional aid was developed using attributes from Health Belief Model’s behavioral theory. It included detailed and interactive information about reversible and permanent contraceptives. We enrolled a total of 200 pregnant women between 24 to 36 weeks into either the intervention group (received decisional aid) or control group. The primary outcome was to compare contraceptive choice between two groups. The secondary outcome was to assess whether the patient received their contraceptive choice post delivery.

RESULTS:

Women did not differ in their demographics or contraceptive choice prior to delivery. Of the 200 participants, 56 decided to obtain very effective contraceptives such as intrauterine device and implant postpartum. This was similar across control and intervention groups (p= .697). Post-delivery, the majority of participants received birth control that was of similar or higher efficacy. Women in the intervention group however had less decisional conflict compared to those in control group (p < 0.05).

CONCLUSION:

The postpartum contraception decisional aid was successful in reducing decisional conflict. There was no significant difference in contraceptive choice or uptake between the intervention and control group.
Uptake of Immediate Postpartum LARC in Women at Risk of Loss to Follow Up [21G]
Authors: Bayer Chelsea , Paul Rachel , Braun Emma , Mullen Mary , Frisse Ann , Robbins Camaryn Chrisman
Published: April 2018

INTRODUCTION:

Unintended pregnancies are associated with maternal depression, limited access to prenatal care, financial burden and in the case of short interval unintended pregnancies, increased risk of preterm delivery. Medicaid reimbursement for immediate postpartum LARC placement (immediate post-placental IUD insertion and implant insertion before discharge) lowers the risk of being lost to follow-up using no contraceptive method. The objective of this study was to investigate the uptake of immediate postpartum LARC among women lost to follow-up who are consequently at high risk for unintended pregnancy.

METHODS:

Women receiving Medicaid were prospectively recruited from a postpartum service of a large, urban hospital after immediate postpartum reimbursement took effect. Women completed a survey regarding their contraceptive choices, and additional information was gathered from the medical record. Lost to postpartum follow-up was defined as missing postpartum appointments or being unreachable via phone.

RESULTS:

65 women were classified as lost to postpartum follow-up. Of these, 24 were discharged with LARC in place, 23 without any form of contraception and 18 with a non-LARC contraceptive. 96% of women who had immediate postpartum LARC had been informed about the availability of immediate postpartum LARC during prenatal care or during labor compared to 56% of women who chose an alternate method.

CONCLUSION:

Immediate postpartum LARC ensures that women who are lost to follow-up after discharge may receive reliable, long acting contraception. Educating women during prenatal appointments and throughout the course of their labor about this option is associated with increased use of immediate postpartum LARC.
Endometrial Biopsies with Insufficient Tissue: Descriptive Analysis and Cancer Outcomes in Women aged 50 and Above [26G]
Authors: Chopra Vini , Sangha Roopina , Gadde Ramya , Alkhoory Wamidh
Published: April 2018

INTRODUCTION:

Dilatation and curettage has remained the gold standard for evaluating postmenopausal bleeding. Office endometrial biopsy (EMB) is most times the first step in the investigation. Occasionally, however, the EMB results with insufficient tissue samples, which leads to additional interventions. We correlated EMB results with endometrial thickness and available follow up data to further investigate the presence of cancer.

METHODS:

We took a look at EMB done at our institution over a 12-month span that returned with insufficient tissue sample or scant tissue. For these patients, we also stratified a history of DM or HTN, BMI, and what subsequent procedure they had done afterward.

RESULTS:

We looked at 103 individuals who were 50+ years old with EMB that had insufficient tissue or scant tissue. We then looked at their follow up, specifically at following groups: no further invention, ultrasound, D&C or other surgical procedure. We found that 46 individuals (45%) had no further intervention, 9 women (9%) had a repeat biopsy within 3 months, 58 women (56%) had an ultrasound, 8 individuals (8%) underwent D&C, and 3 (3%) individuals opted for a hysterectomy. Out of these individuals, 1 individual who had a D&C done was diagnosed with endometrial adenocarcinoma. We found that the 58 individuals who had ultrasounds done, 43% of these individuals had an endometrial stripe that was >4mm. Of these 43% of individuals with an endometrial stripe over 4mm, only 4% had a diagnosis of cancer on after a hysteroscopy, D&C was done. This concludes that insufficient tissue samples on EMB rarely lead to serious endometrial pathology and despite endometrial thickness of >4mm on ultrasound done after this type of EMB, most individuals do not have any serious endometrial pathologies.

CONCLUSION:

Insufficient tissue samples on EMB rarely lead to serious endometrial pathology despite the comorbidities that increase the risk of endometrial carcinoma. Despite endometrial thickness of >4mm, most individuals did not have any serious endometrial pathologies.
Targeted Didactic Education to Increase Knowledge and Rate of Postpartum Placement of IUDs by Resident Physicians [3H]
Authors: Lagneaux Alex , Isley Michelle , Mclaughlin Eric , Hade Erinn
Published: April 2018

INTRODUCTION:

The purpose of the study was to evaluate the effect of targeted didactic education on postpartum placement of intrauterine devices (IUDs) by resident physicians. We hypothesized that removal of barriers to immediate postpartum IUD placement through a targeted didactic education would increase knowledge and the rate of postpartum placement of IUDs by resident physicians.

METHODS:

A targeted didactic session on the proper placement, risks, and benefits of immediate postpartum IUDs was conducted at The Ohio State University for ObGyn residents. Residents completed surveys to assess changes in knowledge, confidence, and perception. The number of IUDs placed was collected 6 months before and after the didactic session. Scores were compared by the Wilcoxon rank sum test. Poisson regression models estimated the change in the rate of IUD placement.

RESULTS:

Twenty-eight residents completed the surveys. Significant increases in knowledge scores were found (0.93 points increase on average, P<.0001). 25% correctly answered all 6 questions before the session compared to 82% after. Significant increases in resident confidence were observed after the session (93% reporting being very or moderately confident after versus 72% prior, P=.0195). One hundred IUDs (5.2% of deliveries) were placed before the session with 108 (6.2%) placed after, suggesting limited evidence of an increase in the number of IUDs inserted after the didactic session (Rate ratio: 1.2, 95% CI 0.9-1.6).

CONCLUSION:

The study demonstrates targeted didactic education improves resident knowledge and confidence in postpartum placement of IUDs. As barriers are lifted through education, further research is needed to monitor an increase in placement rates.
Updating Fetal Foot Length to Gestational Age Reference Ranges: A Chart Review of Abortion Cases from 2012 to 2014 [4H]
Authors: Stevens Katelyn , Elia Jennifer L. , Kaneshiro Bliss , Salcedo Jennifer , Soon Reni , Tschann Mary
Published: April 2018

INTRODUCTION:

Pathologists routinely use fetal foot length (FFL) to estimate the gestational ages (GA) of aborted fetuses. However, there is no standard formula. We aimed to develop an updated FFL-to-GA reference range from patient reported last menstrual period (LMP), ultrasound estimate, and best estimate for GA based on American College of Obstetricians and Gynecologists’ criteria in our patient population. After determining a reference range, we compared our measurements to those of previously published, commonly referenced FFL tables, which may not represent the ethnic diversity, or increasing BMI of current patient populations.

METHODS:

Retrospective chart review of 628 dilation and evacuation (D&E) clinical records and procedure pathology reports from October 2012 to December 2014 in Honolulu, HI.

RESULTS:

A linear relationship exists between FFL and GA in our population. Linear regression analysis of three pregnancy dating methods demonstrated that ultrasound derived dating provided the best-fit regression formula: FFL (mm) =496*(GA in days)-34.53 with an R2 value of .916. Patient race/ethnicity and BMI did not affect these equations in regression analysis. Our mean FFL differed from historically referenced ranges by .36-3.92mm, dependent on GA. Our FFL by GA was similar to ranges more recently endorsed by the National Abortion Federation despite differences in population racial and ethnic backgrounds.

CONCLUSION:

If post-abortion FFL measurement is utilized for GA estimation, then updated, modern ranges should be referenced to better reflect the diversity of abortion patients nationwide.
Utilization Patterns in Family-centered Cesarean Deliveries: A National Survey of Providers [16H]
Authors: Albert Arian L. , Spicer Alexandra B. , Greer Danielle M. , Kram Jessica J. F. , Forgie Marie M.
Published: April 2018

INTRODUCTION:

Mothers undergoing cesarean delivery may experience later skin-to-skin contact, greater difficulty breastfeeding, and decreased satisfaction than mothers delivering vaginally. Mimicking a vaginal delivery, the family-centered cesarean section (FCS) allows a mother to watch the birth through a lowered or clear surgical drape and receive her baby immediately after delivery. We sought to document previously-unknown FCS utilization patterns through a nationwide survey.

METHODS:

Our survey targeted providers who deliver in US hospitals. Using a publicly-available sampling frame of 1,031 hospitals and a regionally-stratified two-stage random sampling design, we post-mailed invitations containing the web address of our anonymous 19-item online questionnaire to 2,324 providers at 250 hospitals. Patterns in awareness and use of FCS across provider, patient-population, and healthcare-setting characteristics were examined.

RESULTS:

Survey respondents (n=130) were geographically distributed and suggested broadly-dispersed awareness/use of FCS, with 87% (105/121) reporting awareness, 58% (65/121) reporting facility use, and 55% (64/116) reporting personal observation/performance. Overall, 81% (94/116) of providers recommended future use, 65% (34/52) in those who had not experienced FCS and 94% (60/64) in those who previously performed/observed FCS. In facilities having performed FCS, 60% (38/63) of providers reported that ≤20% of all cesarean sections were FCSs. In facilities without prior FCS use, 27% (15/56) of providers reported facility consideration of future use. Awareness and use of FCS also differed regionally and showed strong associations with provider demographics and credentials, patient socioeconomic characteristics, and facility size.

CONCLUSION:

Despite reporting moderate use of FCS, providers nationally suggest high levels of awareness and strong desire for future use.
Reproductive Outcomes After Laser Surgery for Twin-Twin Transfusion Syndrome [28H]
Authors: French Ashley , DeFranco Emily , Habli Mounira , Lim Foong-Yen , McKinney David , Tabbah Sammy
Published: April 2018

INTRODUCTION:

There is a paucity of evidence describing future reproductive outcomes in women who have had selective fetoscopic laser photocoagulation (SFLP) for twin-twin transfusion syndrome (TTTS). Our study aims to compare these outcomes following exposure to SFLP to outcomes following a monochorionic multiple gestation with no SFLP.

METHODS:

This is a retrospective cohort study which analyzed records of patients who were evaluated at the Cincinnati Fetal Center (2007-2014) for monochorionic multiple gestations. A questionnaire regarding reproductive and gynecologic outcomes following the index pregnancy was administered to participants by electronic distribution or by mail. Subsequent pregnancy and gynecologic outcome data was compared between pregnancies with prior SFLP vs no prior SFLP.

RESULTS:

There was a higher response rate in the SFLP group (150/355, 42.3%) vs the referent group (60/187, 32.1%). Approximately 38% of women in both groups attempted conception after the index pregnancy with a greater than 90% pregnancy success rate. Use of ART was highly prevalent in both the index and subsequent pregnancies with no significant difference between groups. The median interpregnancy interval for the entire cohort was between 1-2 years. Over 60% of women in each group did not attempt future pregnancy. Roughly 1 in 3 women cited the outcome of the index pregnancy as the primary reason for not pursuing future conception. There were no significant differences in selected maternal-fetal complications and new onset gynecologic problems.

CONCLUSION:

SFLP for TTTS does not appear to be associated with adverse reproductive outcomes. Our data will help facilitate evidence-based counseling for this patient population.
Predicting Postpartum Hypertension: A Study of High Risk Women Discharged Without Antihypertensive Therapy [37H]
Authors: Wiese Sarah , Leftwich Heidi , Chung Charles , Birchall Courtney , Yu Camilla , Leung Katherine
Published: April 2018

INTRODUCTION:

Hypertensive disease of pregnancy is a leading cause of maternal mortality. The primary objective of our study was to identify associations between demographics and persistent postpartum hypertension, and secondary outcome to identify postpartum blood pressures predicting persistent hypertension.

METHODS:

We performed a retrospective electronic chart review of women with hypertensive disorders of pregnancy, delivered from 7/1/09-7/1/16. Exclusion criteria were anti-hypertensive medication upon discharge and no recorded blood pressure within 12 weeks postpartum. Study variables included maternal demographics, the three highest systolic and diastolic values <24 and 24-72 hours postpartum, and postpartum outpatient values. Chi-square and student’s T-test were used for analysis of patient demographics. A receiver operating characteristic analysis was performed to identify blood pressure values which would predict persistent hypertension.

RESULTS:

591 women met study criteria. Women with persistent hypertension were significantly more likely to be multiparous (p= 0.008) and obese (p=0.016) with a trend towards increased maternal age (p=0.05). Systolic and diastolic pressures 24-72 hours after delivery were significantly associated with continued postpartum hypertension (p<0.001). No specific systolic or diastolic value within 72 hours postpartum could reliably predict persistent hypertension.

CONCLUSION:

Persistent postpartum hypertensive disease is more likely in multiparous, obese women, with a trend towards increasing age. Although elevated blood pressures 24 to 72 hours postpartum are significantly associated with persistent hypertension, there is no specific systolic or diastolic value above which persistence can be accurately predicted from our study. This stresses the importance of close follow up for women with hypertensive disorders of pregnancy.
Assessing Documentation of Procedure Prerequisites in Women Undergoing Vacuum-Assisted Vaginal Delivery (VAVD) [3I]
Authors: Doulaveris Georgios , Moni Saila , Stone Joanne , Frieden Faith , Atallah Fouad , Bernstein Peter
Published: April 2018

INTRODUCTION:

There are specific prerequisites that need to be met prior to VAVD and documented afterwards to demonstrate standard of care was met. Our objective was to examine the presence of adequate documentation in patients undergoing VAVD.

METHODS:

This was a retrospective cohort analysis of patients undergoing VAVD in seven academic NY hospitals over two years derived from a quality improvement database. Singletons in cephalic presentation beyond 34 weeks of gestation were included. Data was reviewed for documentation of fetal station and position, cervical dilation, pelvic adequacy, fetal heart tracing, estimated fetal weight, empty bladder, and indication. Standard univariate analyses were performed.

RESULTS:

698 VAVDs were reviewed. 654 (93.7%) patients had a successful VAVD and 44 (6.3%) had a failed VAVD. In 246 cases (35.2%) at least one component was not documented; cervical dilation was most commonly omitted (74 cases, 10.6%) and indication least commonly (12 cases, 1.7%). Failed procedures had a significantly higher percentage of missing documentation for indication (6.8% vs. 1.4%, p=0.03), number of pop-offs (22.7 vs. 6.6%, p=0.0009), fetal station (27.3% vs. 3.8%, p<0.0001) and head position (36.4 vs. 4%, p<0.0001) compared to successful VAVD. Only 50% of patients with failed VAVD had adequate documentation compared to 68.5% after successful VAVD (p=0.01).

CONCLUSION:

VAVD is an operative procedure with significant risks. Failed procedures that require urgent cesarean present additional risk and require accurate and complete documentation. We observed that documentation was often suboptimal, particularly in unsuccessful procedures. Consideration should be given to utilizing functionality in electronic medical records to improve documentation.
Concordance Between Maternal Recollection Versus Documented Date of Vaccinations in Pregnancy [11I]
Authors: Gelvin Brady J. , Morrow Ardythe L. , Staat Mary A. , DeFranco Emily
Published: April 2018

INTRODUCTION:

To assess the concordance between patient reporting time and documented date of vaccine administration of influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) immunizations in pregnant women.

METHODS:

Pregnant women >34 weeks were offered enrollment in a prospective cohort study, Pediatric Respiratory & Enteric Virus Acquisition and Immunogenesis Longitudinal Cohort (PREVAIL, www.cdc.gov/surveillance/nvsn/prevail.html). The difference between maternal report and medical record documented date of vaccine receipt were calculated (vaccine recall error, VRE). Multivariate logistic regression estimated the association between a large VRE (≥30 days) and maternal characteristics.

RESULTS:

Of 58 enrolled mothers, 38 (65.5%) reported influenza and 44 (75.9%) reported Tdap vaccine receipt during pregnancy. Medical record confirmed administration for 31 (81.6%) for influenza and 41 (93.2%) for those self-reporting Tdap vaccine. The mean VRE was 34.7 (±31.7, range 0-127 days) and 21.4 (±30.6, range 0-170 days) days for influenza and Tdap vaccinations, respectively, p-value = 0.0653. No factors were significantly associated with a high VRE of ≥30 days, which may be influenced by small sample size. For influenza vaccine, multiparity adjusted RR 2.09 (95% CI 0.22-19.53), public insurance 3.61 (0.18-71.40), black race 1.72 (0.08-34.93), and income <$25,000 2.41 (0.31-18.52). Factors associated with a high VRE for Tdap were no college education 7.37 (0.56-97.12), public insurance 6.31 (0.19-207.71), black race 0.80 (0.04-14.90), income <$25,000 1.12 (0.09-14.09), and smoking 1.00 (0.09-11.30).

CONCLUSION:

Our preliminary analysis has demonstrated that reporting times for recommended maternal vaccinations varies greatly and this time difference needs to be taken into consideration in future research utilizing survey data.