bluuebunny/crossref_metadata_2025 huggingface dataset:
Strong Start for Mothers and Newborns: Impact on OB Triage Visits [20D]
Authors: Wolfenden Emily , Manriquez Maria , Santiago Ricardo , Kang Paul
Published: May 2019

INTRODUCTION:

The Strong Start for Mothers and Newborns Initiative was launched in 2012 as an effort to reduce preterm birth rates, improve birth outcomes, and reduce costs of medical care for those enrolled in Medicaid or CHIP1. The Strong Start program utilizes a maternity medical home model of care, which includes the services of an additional project manager, registered nurse care coordinator, and two community health workers, with the aim to provide enhanced prenatal and psychosocial services. Previous studies have shown that implementation of patient-centered medical home models of care among patients with chronic diseases have led to deceases in frequency of ED visits among these patients 2, 3. However, research is lacking regarding the effectiveness of implementation of a maternity medical home model of care on reduction of OB Triage visits.

METHODS:

IRB committee approval was obtained for this study. This retrospective chart review compared rates of OB Triage visits between two cohorts of women: Strong Start Maternity Medical Home participants (n=958) and non-Strong Start controls (n=1,223) within an urban county hospital network.

RESULTS:

Mean number of OB Triage visits among Strong Start participants was 0.78 (95% CI 0.70-0.86), compared to 0.58 (95% CI 0.52-0.64) among controls (P<0.001).

CONCLUSION:

Frequency of OB Triage visits was increased among Strong Start participants compared to controls. Further research is necessary to determine trends in OB Triage chief complaints, highlight modifiable factors that may allow a reduction in OB Triage visits, and determine the cost effectiveness of patient enrollment in a maternity medical home model of care.
The Efficacy of Intravenous Iron Sucrose in Treating Iron Deficiency Anemia of Pregnancy [23D]
Authors: Valdes Eduardo Ernesto , Gallo Danielle , Payero Elfy , Rezai Shadi , Henderson Cassandra
Published: May 2019

INTRODUCTION:

Women diagnosed with iron deficiency anemia (IDA) in pregnancy are routinely treated with oral iron supplements, although side effects often prompt non-adherence. Parenteral administration of iron sucrose is reported to be a useful tool in the management of IDA in pregnancy. Inadequate iron stores during the prenatal period is often managed with transfusion of packed red blood cells (PRBCs). We have previously reported in a small sample that antenatal use of iron sucrose was associated with lower rates of PRBCs transfused during pregnancy. Our aim was to evaluate iron sucrose as a tool to treat IDA during pregnancy.

METHODS:

Searched PubMed and Google scholar using terms: pregnancy, iron sucrose and anemia for articles published between January 2017 and August 2018.

RESULTS:

813 RCTs and observational studies were identified. After applying exclusion criteria, 11 articles were selected for review. Between 14 and 36 weeks of gestation 2420 women between 14 and 36 weeks of gestation were studied. Antenatal infusion of parenteral iron sucrose was universally associated with increased concentration of hemoglobin and ferritin. While infusion site erythema was common, anaphylaxis was rare.

CONCLUSION:

Intravenous iron sucrose is an effective method of treating IDA in pregnant women with minimal side effects. These results, as well as our previous report associating intravenous iron sucrose with decreased PRBC transfusion, demonstrate the potential of this therapy to treat IDA and decrease rates of allogenic blood transfusion. We recommend additional studies be conducted to show the correlation between iron sucrose treatment and incidence of blood transfusion in pregnant women.
Upstream Obstetrics: Assessing the Prevalence of Food Insecurity in a High-Risk Obstetrics Population [26D]
Authors: Raghavan Deepika , Haugsdal Michael L. , Syrop Craig H.
Published: May 2019

INTRODUCTION:

Food insecurity, a social determinant of health defined as limited availability of and access to adequate food, may heighten risks for poor pregnancy outcomes particularly if compounded by existing co-morbidities in high-risk pregnancies. The Upstream Obstetrical Clinic is a quality improvement project that seeks to address food insecurity in high-risk obstetrics patients. This study aims to identify the prevalence and impact of food insecurity among pregnant patients in the clinic population.

METHODS:

This project was deemed IRB-exempt by the HSRD. Validated survey questions regarding food insecurity were administered to high-risk obstetrics patients. Screen positive individuals were offered counseling by a team member to identify nutrition resources in the patient's residential area. Data collected were used to assess prevalence of social needs, correlation of social needs with co-morbidities, and effects on pregnancy outcomes.

RESULTS:

One hundred eighty-five women completed the survey, with 24% (44/185) screening positive. Diabetes was the most prevalent co-morbidity for screen positive patients (25/44, 57%). Twenty-two percent of screen positive, delivered patients were affected by diabetes (9/40). The prevalence of abnormal HgbA1C was 66% (6/9) among these patients. There was no difference in perinatal outcomes between patient subgroups.

CONCLUSION:

Twenty-four percent of all patients and 22% of diabetic patients identified as food insecure. Statistical differences could not be assessed due to limited sample size. Nevertheless, these results suggest that food insecurity may be associated with adverse health outcomes. As the Upstream Clinic population increases, the impact of food insecurity on obstetric and neonatal outcomes will continue to be assessed.
The Impact of Molecular Testing and Therapy for Gynecologic Cancers in Low Resource Environments [31D]
Authors: Berger Marisa C. , Sartor Rita A. , Le Anna H. , Mahlum Leigh S. , Robinson William R.
Published: May 2019

INTRODUCTION:

Targeted cancer therapies based on tumor molecular analysis have grown exponentially in the last 5 years. Multiple gynecologic tumors can express markers that predict response to specific treatments. However not all insurance covers costly testing for every tumor marker, which can prevent un- or under-insured women from receiving optimal treatment. We worked with independent laboratories to provide free or cost-reduced testing. This study's aim is to demonstrate the impact of a universal molecular-based therapeutic program for gynecologic cancers in a low-resource environment.

METHODS:

Women with new gynecologic cancers presenting to an inner-city academic facility were identified between 1/1/18 and 6/30/18. Pedigree analysis and molecular testing of tumor specimens were done in all subjects. Data collected includes: demographics (including insurance status), tumor type and stage, and initial treatments.

RESULTS:

45 women with gynecologic cancer were identified. (Cervix-18, Ovary-7, Uterus-10, Vulva/vagina-10). 5/18 cervix cancers showed Combined Predictive Score >1.0; 3/10 uterine cancers showed mismatch repair (MMR) deficiencies; 3/10 vulva/vagina showed MMR deficiencies; and 2/7 ovarian cancers showed somatic BRCA mutations. In this 6-month period, 13/45 (29%) of gynecologic malignancies diagnosed had molecular markers associated with targeted therapies, and 7/13 (53%) patients with predictive molecular markers accepted a targeted therapy.

CONCLUSION:

Molecular analysis of cancer with therapy based on molecular markers is the gold standard for gynecologic cancers. 29% of the subjects had molecular markers associated with targeted therapies. While molecular testing and targeted therapies may be expensive, many laboratories and pharmaceutical companies are willing to work with patients with limited resources.
A Survey Assessment of Maternal Understanding of the Midtrimester Anatomy Scan [32D]
Authors: Buennemeyer Devin E. , Morgan Danielle , Terplan Mishka , Springel Edward H.
Published: May 2019

INTRODUCTION:

Few studies have examined patients' understanding of prenatal ultrasounds (US). Our primary aim was to describe women's understanding of abnormalities detectable by midtrimester fetal anatomy scan. Our secondary aim was to determine if differences in the results varied with maternal demographics to identify subgroups who may benefit from additional counseling.

METHODS:

This was a cross-sectional survey of English-speaking patients presenting for a midtrimester fetal anatomy scan at a tertiary care teaching hospital. Patients were recruited prior to their US and if consent was obtained they completed a pre-US survey. The survey obtained demographic information and assessed knowledge of US detectable anatomic abnormalities by seven questions. Comparison between groups was performed by Wilcoxon rank sum test, Spearman rank correlation, and bivariate linear regression as appropriate.

RESULTS:

123 participants were recruited, 117 consented, and 116 completed surveys. A median of 43% [Interquartile Range 14-71%] of questions were answered correctly. Number of correct responses was found to correlate inversely with income <$50,000/year (P<0.0001), education less than Bachelor’s Degree (P<0.0001), age (P=0.001), and African American race (P<0.0001) in bivariate analyses.

CONCLUSION:

Patients with lower income, less education, younger age, and African American race have less knowledge about fetal anomalies detected via a midtrimester ultrasound. These data suggest that these women may benefit from additional counseling regarding the function of ultrasound as a medical test with the purpose of detecting fetal anomalies early in pregnancy.
Validation of Animal Model of Pelvic Radiation Induced Female Sexual Dysfunction and Cystitis [35D]
Authors: Burleson Lindsey K. , Powers Shelby A. , Odom Michael R. , Ellis Dillon A. , Jung Jae W. , Hannan Johanna L.
Published: May 2019

INTRODUCTION:

Women receiving radiation therapy (RT) for cervical and endometrial cancers experience injury and fibrosis to surrounding healthy tissues leading to genitourinary dysfunction, specifically vaginal atrophy, dyspareunia and radiation cystitis.

METHODS:

Adult female Sprague-Dawley rats were separated into three groups (n=7-8/group): control, 4-week RT, and 9-week RT. RT rats received a single 20Gy dose of cervical x-ray irradiation. In vivo, pelvic nerve electric field stimulated (EFS) increases in vaginal blood flow were measured using a laser Doppler probe. Ex vivo tissue bath experiments assessed vaginal adrenergic and cholinergic contractions. Bladder cholinergic contractions were measured in the presence or absence of muscarinic inhibition. Internal and external urethral sphincter contractions to cholinergic agonists and caffeine were measured. EFS neurogenic contractions were evaluated in all tissues. Experiments were conducted in accordance with the East Carolina University Institutional Animal Care and Use Committee.

RESULTS:

Pelvic RT caused a decrease in vaginal blood flow and less cholinergic vaginal contraction 4-weeks post-RT. Following 9-weeks RT, vaginal blood flow normalized; however, adrenergic-mediated vaginal contraction remained elevated. In both RT groups, EFS neurogenic-mediated bladder contractions were reduced. No changes were observed in internal urethral sphincter contractility. In contrast, external urethral sphincter contractions to EFS and caffeine were elevated at 4 and 9-weeks post-RT.

CONCLUSION:

This pelvic RT model demonstrated impaired sexual arousal and increased vaginal contractility. Similar to previous RT studies, the bladder developed decreased neurogenic contractions; a symptom of radiation cystitis. Using our female pelvic RT model, we can begin to understand the pathophysiology of RT-induced sexual dysfunction and cystitis.
The Effect of a Diagnosis of Interstitial Cystitis/Bladder Pain Syndrome: A Qualitative Approach [36D]
Authors: Komatsu Emi J. , Volpe Katherine , Pahwa Avita
Published: May 2019

INTRODUCTION:

Interstitial cystitis/bladder pain syndrome (IC/BPS) is an underdiagnosed chronic pain syndrome that often causes profound detrimental effects on quality of life. We sought to investigate whether obtaining a diagnosis of IC/BPS makes a significant impact on patients' symptom course and coping.

METHODS:

Participants with self-reported IC/BPS completed publicly available online surveys from October 2017-January 2018. Surveys included demographic information, validated questionnaires and free-text response on the utility of obtaining a diagnosis. Researchers coded and analyzed the comments using Dedoose Version 7.0.23 and Grounded Theory methodology.

RESULTS:

1052 participants completed the survey and 673 answered the free-text response. The median age was 53 (interquartile range [IQR] 41, 64) with an average of 7 years (IQR 3, 14) since IC/BPS diagnosis. Two categories were identified in the participants' responses:1) effects of the diagnosis on daily life and 2) effects of the diagnosis on medical care. Within each category, both positive and negative experiences were noted. Effects on daily life included emotional response to diagnosis (hope vs. desperation) and impacts on everyday activities (social support vs. financial burden of treatment). Effects on medical care included IC/BPS-specific treatment (appropriate referrals vs. no improvement despite different treatments) and changes to provider interactions (validation vs. stigmatization). The majority of participants noted emotional benefit and improved treatment with diagnosis. However, some participants reported detrimental effects.

CONCLUSION:

IC/BPS diagnosis has a significant physical and emotional effect on patients' experiences of their symptoms. Validating patients' experiences may help to minimize possible negative effects of diagnosis.
Differences in Body Composition Between Appropriate for Gestational Age and Large for Gestational Age Term Neonates [6E]
Authors: Weatherborn Megan M. , Stark Sydney , Landau Daphne
Published: May 2019

INTRODUCTION:

At birth, neonates are classified as small, large, or appropriate for gestational age based on birth weight. However, birth weight does not account for differences in body composition. The goal of this study is to investigate the differences in body composition among appropriate for gestational age (AGA) and large for gestational age (LGA) term neonates.

METHODS:

On admission, all term infants in our nursery undergo assessment of body composition and percent body fat (%BF) by a validated anthropometric model. Neonates were grouped by sex then categorized by completed gestational age. Subjects with incomplete data were excluded. Definitions for AGA and LGA were based upon WHO criteria by sex. Data were examined for equal variance and then analyzed using the appropriate Student t test. Data were expressed as mean ± SD. P<.05 was considered significant.

RESULTS:

Our cohort included 1,175 neonates, 636 male and 539 female. For males, mean birth weight in the AGA group (N=601) was 3.35kg (±0.31), and LGA (N=35) 4.26kg (±0.25). For females, mean birth weight in the AGA group (N=500) was 3.18kg (±0.30), and LGA (N=39) 4.04kg (±0.27). We identified a significant difference in mean %BF between the AGA and LGA neonates, for both males (13.12% vs 18.08%, P<.05) and females (13.02% vs 17.98%, P<.05).

CONCLUSION:

We identified a significant difference in body composition between AGA and LGA term neonates, with higher %BF in the LGA group. Evaluating patterns of neonatal fat mass at birth may be useful in understanding patterns of excessive fetal growth and nutrient acquisition in utero.
Differences in Body Composition Between Appropriate Gestational Age and Small Gestational Age Infants at Term [7E]
Authors: Landau Daphne , Stark Sydney , Weatherborn Megan
Published: May 2019

INTRODUCTION:

Small for Gestational Age (SGA) infants are defined as <10 percentile birthweight. Birthweight centiles provide limited information on neonatal nutritional status. Body composition measures percent body fat (%BF) and may be a useful adjunct to assess undernutrition. We sought to investigate the differences in body composition between Appropriate for Gestational Age (AGA) and SGA infants at term.

METHODS:

On admission, all term infants in our nursery undergo assessment of %BF by a validated Anthropometric Model. For this analysis, infants were grouped by sex then categorized by completed gestational age (GA). Subjects with incomplete data were excluded. Definitions for AGA and SGA were based upon WHO criteria by sex. Data was examined for equal variance and then analyzed using the appropriate Student t test. Data was expressed as mean ± SD. P<.05 was considered significant.

RESULTS:

Our cohort included 1,262 infants, 680 male and 582 female. For males, mean birthweight for AGA infants (N=601) was 3.35 kg (±0.31) and SGA (N=79) 2.53 kg (±0.21). For females, mean birthweight for AGA infants (N=500) was 3.18 kg (±0.30) and SGA (N=82) 2.45 kg (±0.22). There was a significant difference in mean %BF between the AGA and SGA infants for both males (13.12 vs 7.77, P<.05) and females (13.02 vs 8.25, P<.05).

CONCLUSION:

We identified a difference in %BF between AGA and SGA infants for both males and females. Future studies should investigate whether infants with low %BF are at higher risk for adverse perinatal outcomes and if %BF at birth can provide a better estimate of likely neonatal morbidity.
Does Excessive Gestational Weight Gain Increase the Risk of Cesarean Delivery? [13E]
Authors: Wells Matthew , John Nicole , Vahanian Sevan , Kinzler Wendy Lyn , Sicuranza Genevieve B. , Vintzileos Anthony M.
Published: May 2019

INTRODUCTION:

To determine whether excessive gestational weight gain (GWG), as defined by the Institute of Medicine (IOM) guidelines, increases the risk of cesarean delivery (CD) in term singleton gestations.

METHODS:

This was a retrospective cohort study of singleton gestations at term (>37 weeks gestation), admitted for intended vaginal delivery from January to December 2015. Patients with prior CD, multiple gestation, malpresentation, or missing data were excluded. Demographics, obstetrical and neonatal characteristics, first office visit weight/BMI, and admission weight/BMI were collected from prenatal and hospital records. Women were divided into 2 groups: those with excessive GWG, and those with weight gain at or below IOM guidelines. Baseline characteristics and CD rates were compared between the 2 groups using parametric and non-parametric tests as appropriate with a P<0.05 considered statistically significant and relative risks were calculated.

RESULTS:

A total of 743 women met inclusion criteria with an average pre-pregnancy BMI of 25.5+/-5.6 kg/m2. The CD rate for the cohort was 19.2% (n=143). After adjusting for age, pre-pregnancy BMI, parity, and race, women with excessive GWG were 50% more likely to have a CD compared to those with lower GWG [relative risk 1.51 (1.07-2.05)]. This increased risk was greatest in nulliparous women. A trend toward increased rate of labor dystocia as an indication for CD was noted in the excessive GWG group.

CONCLUSION:

Women who gain more than recommended weight by the IOM guidelines, particularly if nulliparous, are at increased risk of having a CD compared to those who have appropriate weight gain.
Does Fetal Testing Decrease Fetal Demise in Pregnancies Complicated by Obesity? [14E]
Authors: Valle Eduardo , Kirsten Herr , Vragovic Olivera , Abbott Jodi , Markenson Glenn R.
Published: May 2019

INTRODUCTION:

Maternal obesity complicates over 30% of pregnancies, and is a risk factor for fetal demise (FD). Some have advocated increased fetal surveillance in pregnancies complicated by maternal obesity. The objective of this study is to determine if a protocol for fetal testing in obese women decreases the risk of FD.

METHODS:

This was a retrospective cohort study of women who delivered at Boston Medical Center, from 2006-2018, and deemed exempt by th IRB. FD rates in obese women (BMI≥30) with no other pregnancy complications, were compared to low risk pregnancies. Obese patients were scheduled for growth ultrasounds every 4 weeks and weekly fetal testing starting at 36 weeks.

RESULTS:

There were 3,037 women in the obese group, and 13,980 women in the uncomplicated group. There was no significant difference in FD between the two groups. The obese group had a fetal death rate of 3/1000 (n=10) after 24 weeks gestation, and 1/1000 after 36 weeks gestation (n=2) compared to a FD rate in the normal group of 5/1000 (n=66) after 24 weeks gestation and 2/1000 (n=31) after 36 weeks gestation. The obese group had an increased median number of fetal tests (4 vs 2, P<0.01), and cesarean deliveries (35% vs 24%, p<0.01).

CONCLUSION:

Despite a known increased incidence of FD in pregnancies complicated by obesity, a protocol of intensive antepartum fetal testing resulted in a FD incidence similar to a low risk population. This suggests that increased fetal testing should be offered for all pregnancies complicated by obesity.
Evaluating Driver's Safety During Pregnancy: A Prospective Observational Study [19E]
Authors: Zaragoza Jorge E. , Franco Andrea , Colina Andreina , Bremer Pamela , Villanueva Mariana , Gei Alfredo F.
Published: May 2019

INTRODUCTION:

To evaluate seatbelt use, driving positioning and steering wheel clearance to abdomen and chest in pregnant women drivers.

METHODS:

Prospective study including pregnant women attending prenatal care in two private practices serving a multi ethnic population in Houston, TX. Observations of seat belt (SB) use, patient's position and clearance to the steering-wheel (SW) were recorded in the patient's vehicles. All patients were counseled on proper SB placement. Pregnancy outcomes were not obtained. Chi square, Fisher's exact test and ANOVA used as appropriate (significance <.05).

RESULTS:

125 pregnant women were included. The average patient was 31.6+/-5.7 years (mean+/-S/D); gravida 2 (range: 1-6); 25.5 (+/-9.3 weeks) had a BMI of 31.6+/-7.2. 64.8% of patients had a previous MVA. Though 74.4% of women felt comfortable with the SB placement, 47.2% of them had an incorrect placement. A clearance <25 cm between lower SW rim and abdomen was seen in 94.4%. Gestational age (GA) and BMI had an adverse impact in the clearance between the SW and maternal trunk (p<0.001).

CONCLUSION:

A high proportion of driving pregnant women had been previously involved in a MVA. According to NTHSA guidelines a large proportion of driving pregnant women have an inappropriate placement of the SB. The majority of patients have an inadequate distance between the uterus and the steering wheel for safe deployment of an air bag. Gestational age and BMI have a negative impact in the ergonomics of pregnant drivers.
Perceptions and Comfort of Obstetricians and Gynecologists of Cesarean Hysterectomy [20E]
Authors: Menzies Anya V. , Pearl Michael Loran , Gossner Gabrielle , Burke William M.
Published: May 2019

INTRODUCTION:

Within obstetrics and gynecology, many physicians sub-specialize. As a result, surgical experience differs among providers. On labor and delivery, postpartum hemorrhage is a rare event that occasionally leads to cesarean hysterectomy. If this occurs, some providers may find themselves performing a technically challenging procedure that they perform infrequently.

METHODS:

As part of our departmental QA assessment, a survey was distributed to attending physicians who oversee the care of patients on labor and delivery. The purpose of this survey was to better understand frequency of hysterectomy and comfort with emergent cesarean hysterectomy among these physicians.

RESULTS:

There were 27 (93%) respondents, which included 17 (62.9%) generalists, 7 (25.9%) MFM, and 3 (11.1%) MIS/Urogyn sub-specialists. Regarding total hysterectomies performed per year, 7 (25.93%) surgeons reported completing greater than 15, while the majority, 12 (44.4%), reported completing 1-5 hysterectomies per year by any method. For abdominal hysterectomies, 5 (18.52%) surgeons reported none, 17 (62.97%) surgeons reported 1-5 per year, one reported 11-15, and none reported greater 15. When describing their comfort with performing an emergent cesarean hysterectomy, 23 (85.25%) surgeons reported feeling either very comfortable or moderately comfortable. Of the surgeons who perform five or fewer abdominal hysterectomies per year, 15.8% describe feeling uncomfortable performing an emergent cesarean hysterectomy.

CONCLUSION:

There was no correlation between self-reported number of hysterectomies performed and comfort level of obstetricians and gynecologists managing emergent cesarean hysterectomies. Given recent literature suggesting increased complication rates with low- volume surgeons, a more rigorous approach to credentialing for and completion of cesarean hysterectomy may be appropriate.
Piloting a Breastfeeding-Friendly Provider's Office Protocol at a Private Obstetrical Clinic [24E]
Authors: Haring Anna , Duong Jennifer , Woods Nikki Keene , DeAllie Addia , Grainger David A. , Robbins Ashley
Published: May 2019

INTRODUCTION:

Extended breastfeeding rates among all demographics remain lower than national recommendations. The overall objective of this study was to pilot a “Breastfeeding-Friendly Provider's Office Protocol” at a private obstetrical clinic, and to examine breastfeeding outcomes.

METHODS:

Components of the Academy of Breastfeeding Medicine (ABM) Breastfeeding-Friendly Provider's Office Protocol were implemented at a single clinic, which included: adopting a breastfeeding-friendly office policy, displaying positive images of breastfeeding and signs of support, standardizing breastfeeding education, and providing a breast pump prescription. Breastfeeding rates prior to and after protocol implementation were assessed via hospital data. Patients were invited to complete electronic surveys regarding breastfeeding support after attending the six week postpartum visit. IRB committee approval was obtained for this study.

RESULTS:

Maternal preference for exclusive breastfeeding increased from 71.9% to 86% (N=128). Breastfeeding at hospital discharge increased from 74.7% to 84.8%, and at the six week postpartum visit increased from 88.2% to 100%. During the intervention, most patients received education packets (82.8%, 106/128) and breastfeeding pump prescriptions (84.4%, 107/128). Sixty-four patients completed the survey, of which 34% (22/64) were first-time mothers, and average infant age was 9.6 weeks. Breastfeeding initiation was self-reported at 98% (63/64). At the time of postpartum survey, 90% (56/58) reported continued breastfeeding. Five patients (7.8%) reported the need for more breastfeeding information.

CONCLUSION:

Implementing a Breastfeeding-Friendly Provider's Office Protocol at a private obstetrical clinic improved maternal preference for exclusive breastfeeding, breastfeeding at hospital discharge and six weeks postpartum. There continues to be a desire for more breastfeeding information during the postpartum period.
A Team-Based Approach for Improving Postpartum Glucose Screening in Gestational Diabetes Patients [28E]
Authors: Bounds Faye L. , Giwa Erica P. , Armstrong Faunda N. , Miao Di , Hollier Lisa M. , Ratan Bani
Published: May 2019

INTRODUCTION:

Postpartum testing of gestational diabetes (GDM) patients with an oral 2-hour glucose tolerance test (OGTT) is suboptimal, with national rates ranging from 18-57%. The purpose of this study was to investigate if a standardized workflow supplemented with educational sessions could improve the OGTT screening rate.

METHODS:

A multi-disciplinary workflow was implemented in two Medicaid clinics in January 2018. Pre-intervention subjects were GDM patients in the 4-12 week postpartum period between March-June 2017, while post-intervention subjects were between January-April 2018. Immediately prior and during the post-intervention time period, the obstetrical team received small-group education sessions on the American College of Obstetricians and Gynecologists (ACOG) GDM guidelines, with re-enforcement of workflow. A pretest and posttest were performed to assess effectiveness. Paired t-test was used to compare the pretest and posttest scores, and chi-square testing was used to compare compliance with screening. IRB approval was obtained for this study.

RESULTS:

Nineteen out of thirty members (63%) of the obstetric team completed the educational session. Mean pretest score for the team was 57.4%; the mean posttest score was 99.2% (p<0.01). Eighteen patients were in the pre-intervention group, while 26 patients were in the post-intervention group. Postpartum screening of GDM patients improved from 39% to 77% after workflow implementation (p=0.01).

CONCLUSION:

Educational sessions and standardized workflow interventions utilizing a multi-disciplinary team were associated with improvement in both understanding of the ACOG guidelines and patient compliance with postpartum glucose screening. This team-based approach may be useful in other quality improvement initiatives.
Music and Its Impact on Pain and Anxiety During Office Hysteroscopy: A Randomized Controlled Trial [31E]
Authors: Yuan Valerie
Published: May 2019

INTRODUCTION:

Office hysteroscopy is an important diagnostic and therapeutic procedure for many intrauterine diseases. Excessive pain is a limiting factor in patient compliance and is associated with reduced levels of satisfaction. We investigate the impact of music on patients' pain and anxiety levels during office hysteroscopy.

METHODS:

From March to September 2017, patients undergoing diagnostic office hysteroscopy at Harbor-UCLA Medical Center were computer-generated, block randomized into two groups: Music group (Toradol 30 mg intra-muscular and patient's choice of background music) and Non-Music Group (Toradol 30mg intra-muscular only). IRB approval was obtained. Hysteroscopy was performed by rotating residents supervised by the same attending physician. Using Visual Analog Scales and abbreviated State-Trait Anxiety Inventory questionnaires, we assessed pain and anxiety levels before and after hysteroscopy.

RESULTS:

Of 72 eligible patients, 58 patients were included in the final analysis: 28 Music Group (MG) patients and 30 Non-Music Group (NMG) patients. MG patients had a significant greater anxiety level decrease compared to NMG patients (-9.66 vs -2.94, P=.01). Although not reaching statistical significance, MG patients had trends toward greater decrease in heart rate (-4.95 vs -2.52), less increase in systolic blood pressure (2.73 vs 5.12), and smaller pain score change (19.08 vs 24.29) compared to NMG patients. 27 of 28 MG patients enjoyed the music played during the procedure.

CONCLUSION:

We show that music can be used as an inexpensive and feasible adjunct to pain medications to decrease a patient's perception of anxiety during office hysteroscopy. Future studies can investigate the potential benefits of music during other gynecological procedures.
Patient Preferences for Obstetrician and Gynecologists on the US-Mexico Border [32E]
Authors: Domina Michael Glenn. , Sanchez Sheralyn , Mallawaarachchi Indika , Mendez Melissa Dawn
Published: May 2019

INTRODUCTION:

The field of OBGYN is predominantly made up of female physicians. Physician communication, patient perception, and intimate examinations may influence a patient's preference for female providers. No studies on physician preference have been performed along the United States-Mexico border. We performed a cross-sectional study to evaluate which factors play the greatest role in shaping a patient's OBGYN preference.

METHODS:

Patients presenting for their first OB or GYN care visit, age 18 years or older, completed an anonymous self-administered survey. Odds ratios (OR) for dichotomous outcomes were calculated using logistic regression.

RESULTS:

Of 233 patients, 48.9% preferred having a female OB/GYN physician while 40.2% preferred female physicians when receiving prenatal care. Women who were born in Mexico were significantly less likely than women born elsewhere to have a gender preference when choosing an OB/GYN: adjusted OR=0.45, 95% confidence interval (CI): 0.24-0.85, P=0.013. Subjects who replied that the personality of the doctor is an important quality when choosing an OB/GYN were less likely to have a gender preference when choosing an OB/GYN. Respondents whose annual household income was $40,000 or greater were more than twice as likely as those with an income of <$40,000 to answer “male” or “female” versus “no preference” when asked which gender of doctors have more sympathy: adjusted OR=2.60, 95% CI: 1.08-6.25, P=0.032).

CONCLUSION:

Women who were born in Mexico and those who considered the provider's personality when selecting an OB/GYN were less likely to have a gender preference when choosing an OB/GYN.
Characteristics of Ovarian Cancer Patients on Neoadjuvant Chemotherapy Unable to Have Debulking After 3 Cycles [35E]
Authors: Dunn Timothy , Norton Sara E. , Smith Haller J. , Leath Charles Alexander
Published: May 2019

INTRODUCTION:

To report on characteristics of patients undergoing neoadjuvant chemotherapy (NACT) for advanced ovarian, fallopian tube, or primary peritoneal carcinoma who did not undergo interval debulking-surgery after three cycles.

METHODS:

An IRB retrospective cohort study was performed on women undergoing NACT following diagnosis. Abstracted data included demographics, clinicopathologic features, treatment and toxicities.

RESULTS:

Of 96 identified patients, 30 (31.3%) patients did not undergo surgery after 3 cycles of NACT. Median age was 66.5 (range: 46-85) with median BMI 30.0 (21.2-47.8). Median Charlson Comorbidity Index was 6 (2-11). Median CA-125 was 1240.4 (23.6-11,820). Median baseline albumin was 2 (1.9-4.1). Average neutrophil to lymphocyte ratio was 5.80 (0.9-21.5). Adenocarcinoma was the most common histology (83.3%). 70% of cases were diagnosed with laparoscopy and 20% by cytology. 20% of patients required treatment delays and 33% of patients required hospitalization during treatment. 55% of cases specified residual disease or CA125 elevation for continued treatment as opposed to debulking after 3 cycles. 10.3% of patients required continued therapy due to regimen changes during treatment.

CONCLUSION:

Patients receiving NACT who did not undergo debulking had a median albumin of <3 along with a significant median comorbidity index. Patients who did not undergo surgery after 3 cycles had significant rates of treatment delay and hospitalization during their treatment course, and the most common cited reason for continued therapy was persistent disease or persistent CA125 elevations.
Alabama Early Detection Program Reveals High Rates of Cervical Dysplasia and Cancer in Young Women [37E]
Authors: Lee Tinker Nicholas , Grette Katherine Virginia , Huh Warner K. , Seetala Kumari , Norris Katherine , Pierce Jennifer Young
Published: May 2019

INTRODUCTION:

The Alabama Breast and Cervical Cancer Early Detection Program (ABCCEDP) recently expanded to include coverage for women age 30-39 in an effort to decrease disparities related to cervical cancer. We sought to better understand the impact of inclusion of younger women on overall incidence of cervical intraepithelial neoplasia III or cancer (CIN3+).

METHODS:

A descriptive analysis of the database of women undergoing screening through the ABCCEDP was undertaken. We analyzed data from 2012 to 2016. Any Pap with atypical cells of undetermined significance (ASCUS) or positive for high-risk human papillomavirus (HRHPV) was considered abnormal. Incidence of CIN3+ was compared between the two groups (30-39 and 40-64).

RESULTS:

During a five-year period, a total of 24,530 pap tests and 1050 procedures were performed. Of these, 14.1% were performed on women in the younger cohort. An abnormal test was found in 15% of these and in 8% of women aged 40-64. Overall, 1 in 130 women were ultimately diagnosed with CIN3+, with a significantly higher incidence in younger women (1:57 vs 1:166, p<0.0001). Of the women who returned for follow-up, final diagnosis was CIN3+ in 1 of 6 women aged 30-39 and 1 of 8 women aged 40-64. In total, 32.5% of CIN3+ were diagnosed in the younger cohort of women despite only making up 14% of the total population of women screened.

CONCLUSION:

All states currently screening women under the National Breast and Cervical Cancer Early Detection Program should expand screening to a younger cohort of women.
PARP Inhibition Shows Anticancer Activity in Small Cell Carcinoma of the Ovary Hypercalcemic Type (SCCOHT) [40E]
Authors: Guo Ting , Li Bin , Xu Congjian
Published: May 2019

INTRODUCTION:

Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is a rare, aggressive ovarian cancer characterized by germline and somatic inactivation of SMARCA4. There is urgent need for effective targeted therapy for SCCOHT.

METHODS:

In silico screening of the Genomics of Drug Sensitivity in Cancer (GDSC) database that included drug sensitivity data of 265 compounds in 1,074 cancer cells were conducted. Drug sensitivity in ovarian cancer cells with SMARCA4 mutation was analyzed, and further in vitro and in vivo studies were performed using the compound. Animal use was approved by local institutional review board.

RESULTS:

Two PARP inhibitors (PARPi) and 1 AR inhibitor showed significant selectivity for the 3 ovarian cancer cell lines with SMARCA4 mutation and 2 of which were confirmed SCCOHT cell lines (OVK-18 and TOV-112D). BRCA1/2 or ATM status did not affect selectivity. We validated findings in another two SCCOHT cell lines (BIN-67 and COV434) showing significant inhibition of proliferation with PARPi whereas only trend for inhibition for AR blockade in contrast with OVCAR3 and SK-OV-3 ovarian cancer cell lines that did not harbor SMARCA4 mutation. AR blockade however enhanced effect of PARPi in SCCOHT cell lines. Similar effects of PARPi+/-AR blockade were also observed in apoptosis, epithelial-to-mesenchymal transition, migration and colony formation assays. PARPi and AR blockade inhibited BIN-67 xenograft tumor growth with no remarkable toxicity.

CONCLUSION:

PARPi plus AR blockade holds promise for SMARCA4-mutant SCCOHT in both in vitro and in vivo preclinical models. Further investigation for clinical translation is warranted.
Referrals to Abortion Care by Student Health Centers in Pennsylvania: A “Secret Caller” Study [1F]
Authors: Anand Priyanka , McAllister Arden , Schreiber Courtney A. , Sonalkar Sarita
Published: May 2019

INTRODUCTION:

One in ten women between 20 and 24 years has an unintended pregnancy. For college students, student health centers play a vital role in providing reproductive health services, but their role in abortion referrals is unknown.

METHODS:

We conducted a “secret caller” study at 4-year colleges in Pennsylvania between June 2017 and April 2018. A female researcher posing as a student seeking abortion referral contacted student health centers using a structured script, once as a minor (under 18 years), and once as an adult (over 18). Calls were transcribed in real time. The primary outcome was “direct referral,” defined as a referral to an abortion provider; secondary outcomes were “no referral,” “indirect referral” (non-specific provider), and “inappropriate referral” (non-abortion provider). The study was approved by the University of Pennsylvania IRB.

RESULTS:

One hundred and fifteen institutions were contacted, resulting in 202 successful contacts. One hundred contacts (49.5%) resulted in a direct referral, which did not differ by caller age (P=0.48). Religious institutions were less likely than non-religious institutions to provide a direct referral to both minors (26.3% vs 59.4% P=0.001) and adults (36.6% vs 62.7% P=0.01). For adult callers, larger institutions (1,000+ students) as compared to smaller institutions were more likely to offer direct referral (63.0% vs. 20.0% P=0.003). Inappropriate referrals was the next most common outcome, in 68 (33.7%) contacts.

CONCLUSION:

Half of college health centers in Pennsylvania do not provide direct abortion referrals, and many provide inappropriate referrals. Religious institutions are less likely to provide direct abortion referrals, particularly for minors.
Narcotic Use in Endometriosis: A Nationwide Case-Control Study [6F]
Authors: Swailes Alexa , Cho Yonghee Kristina , Schaefer Eric , Deimling Timothy Allen
Published: May 2019

INTRODUCTION:

Endometriosis affects up to 10% of reproductive-age women and is highly co-morbid with other chronic pain conditions. Clinical suspicion is high that narcotics may be used as a mainstay of treatment for many women with endometriosis or chronic pelvic pain. Very few data are available regarding rates of narcotic use in this population.

METHODS:

Data were obtained from a commercial insurance claims database from employee-sponsored health plans. 706,863 patients with endometriosis/chronic pelvic pain were identified as cases. 706,863 patients without endometriosis/CPP were identified as age- and state-matched controls. Rates of narcotic use were compared in the year prior to diagnosis and the two years subsequent to diagnosis. Use subsequent to diagnosis was further analyzed by stratification by use prior to diagnosis.

RESULTS:

Narcotic use was higher prior to diagnosis (31.3 vs 21.3%), subsequent to diagnosis (56.3 vs 34.5%), and at higher morphine-equivalent dosages in cases vs. controls. Patient with narcotic use prior to diagnosis were more prone to use after diagnosis (74.2 vs 57.1%). All p-values <0.001.

CONCLUSION:

In patients with endometriosis or chronic pelvic pain, the rates of narcotic use are high both before and after diagnosis. Rates increase substantially following diagnosis. Narcotics are associated with decreased functional status and quality of life. Alternative therapies should be exhausted prior to use of narcotics as a primary mode of analgesia in these patients.
Membrane Separation After Laser Treatment for Twin-Twin Transfusion Syndrome and Perinatal Outcomes [9F]
Authors: De Zoysa Madushka Y. , Chon Andrew H. , Korst Lisa , Llanes Arlyn , Chmait Ramen H.
Published: May 2019

INTRODUCTION:

Postoperative membrane separation is a complication of selective laser photocoagulation of communicating vessels (SLPCV) for treatment of twin-twin transfusion syndrome (TTTS). This study aims to determine its association with preterm premature rupture of membranes (PPROM) and preterm delivery (PTD).

METHODS:

TTTS patients who underwent SLPCV from 2006 to 2017 were retrospectively studied. Patients with membrane separation documented on ultrasound on postoperative day (POD) 1 were stratified into greatest width of separation <1 cm (Group A) or ≥1 cm (Group B) and compared to patients without separation by the following outcomes: PPROM ≤21 postoperative days, PTD <28 gestational weeks, and PTD <32 gestational weeks.

RESULTS:

Of 651 patients with intact membranes on POD 1, 120 (18.4%) had membrane separation: Group A (N=91) and Group B (N=29). Bivariate analysis demonstrated a difference in the occurrence of PPROM â‰¤21 days: 4.9% in those without separation, 9.9% in Group A, and 31.0% in Group B (P<.0001). Multiple logistic regression analysis controlling for potential covariates of PPROM yielded associations with PPROM for Group B (OR 8.60, 95% CI 3.38-21.90, P<.0001) and Group A (OR 2.82, 95% CI 1.31-6.08, P=.0369) compared to those without membrane separation. In similar models, neither Group A nor B were associated with PTD <28 weeks, but Group B was associated with PTD <32 weeks (OR 2.37, 95% CI 1.09-5.19, P=0.0304).

CONCLUSION:

Postoperative membrane separation was associated with an increased risk of PPROM within 21 days. If membrane separation was ≥1 cm, there was also a higher risk of PTD <32 gestational weeks.
Electronic Medical Record Intervention to Improve Adherence to Prenatal Vaccination Recommendation [12F]
Authors: Greenfield Isabel , Wu Danny , Anderson Meredith , Postlethwaite Debbie , Zerbo Ousseny , Klein Nicola
Published: May 2019

INTRODUCTION:

In 2013, the Advisory Committee on Immunization Practices (ACIP) changed its recommendation to administer prenatal Tetanus, Diphtheria, and acellular Pertussis (Tdap) vaccine to between 27 and 37 weeks gestation for optimal placental antibody transmission. In 2014, Kaiser Permanente Northern California (KPNC) instituted a “Best Practice Advisory” (BPA) within the Electronic Medical Record (EMR) to alert clinicians to give prenatal Tdap in this optimal window. We examined whether the BPA was associated with an increase in optimally-timed prenatal Tdap.

METHODS:

An IRB-approved retrospective cohort study of pregnancies resulting in live births after 20 weeks gestation at KPNC between 6/1/2011 and 5/31/2017 was conducted. We compared the proportions of Tdap received during pregnancy and during the optimal window: before the ACIP recommendation, after the recommendation but before the BPA, and after instituting the BPA. We evaluated demographic and clinical characteristics associated with receiving prenatal and optimally-timed Tdap using multivariable logistic regression models.

RESULTS:

166,705 pregnancies in 143,306 women were included. Throughout the study period, there was an increasing trend in receiving prenatal Tdap (31% to 89%, P<.0001). Receipt of optimally-timed Tdap increased from 91% before to 96% after the BPA (P<.0001). Younger, lower income, African American, and parous women were less likely to receive prenatal Tdap. After the BPA, women who were over age 40, African American, and lower income were less likely to receive optimally-timed Tdap.

CONCLUSION:

An EMR-based intervention targeting prenatal Tdap vaccination was associated with improved adherence to ACIP recommendations.
Blood Loss Measurement Technique That Predicts Decrease in Hemoglobin After Cesarean Delivery [17F]
Authors: Coviello Elizabeth Michelle , Chornock Rebecca Lynn , Fries Melissa H. , Cheney Megan Clair , Iqbal Sara Naeem
Published: May 2019

INTRODUCTION:

To identify the blood loss technique that best predicts a decrease in hemoglobin (Hgb) >3 g/dL 24 hours after cesarean delivery (CD).

METHODS:

This was an IRB approved, retrospective review of women with singleton pregnancies who underwent cesarean delivery at >=34 weeks' gestation between July 1, 2017 and June 30, 2018. Women had blood loss measured by visually estimation (EBL), gravimetric estimation (QBL), Gauss Surgical's Triton (TBL) and a 24-hour postoperative complete blood count. The primary outcome was the optimal threshold for decrease in Hgb >3 g/dL by the area under the receiver-operating characteristic (ROC) curve (AUC) using blood loss estimation technique.

RESULTS:

Of the 446 women meeting inclusion criteria, 65 (15%) had a decrease in Hgb >3 g/dL. Women who had a decrease in Hgb >3 g/dL compared to women without a decreased in Hgb >3 g/dL were more likely to have increased gestational age, postoperative tachycardia (heart rate >100 beats per minute) at 12 and 24 hours post CD, postpartum hemorrhage by QBL and TBL and require blood product transfusion, (all P<0.05). None of the blood loss measurement techniques had a high AUC for predicting women with decrease in Hgb >3 g/dL (EBL 0.64 [95% CI 0.56-0.71], QBL 0.67 [95% CI 0.60-0.74] and TBL 0.70 [95% CI 0.63-0.77], P=0.13. All techniques had low sensitivity and high specificity for women with PPH and decrease in Hgb >3 g/dL.

CONCLUSION:

Blood loss at time of cesarean, measured by EBL, QBL or TBL, is a poor predictor for a decrease in Hgb by >3 g/dL.