bluuebunny/crossref_metadata_2025 huggingface dataset:
Opioid Detoxification during Pregnancy: Systematic Review and Meta-Analysis of Maternal and Neonatal Outcomes [11R]
Authors: Wang Michelle , Kuper Spencer , Sims Brian , Paddock Cayce , Williams-Glass Terri , Harper Lorie
Published: April 2018

INTRODUCTION:

While maintenance therapy for opioid use disorders is the standard of care, the expanding opioid epidemic has renewed interest in maternal detoxification. We aim to assess the efficacy and safety of detoxification from opioids compared to maintenance with methadone or buprenorphine to treat opioid-dependent pregnant women.

METHODS:

We searched PubMed, Embase, the Cochrane Library and ClinicalTrials.gov from inception to June 2017. We included randomized controlled trials or cohort studies that compared detoxification with maintenance for treating opioid-dependent pregnant women. We sought to find any studies with outcomes data for maternal abstinence at time of delivery, neonatal abstinence syndrome (NAS), stillbirth, and preterm birth (PTB). Pooled relative risks (RRs) were calculated using a random-effects model. Heterogeneity was assessed using the chi-squared test for heterogeneity and the I2 test. Publication bias was assessed using funnel plots and Harbord test.

RESULTS:

Three cohort studies met inclusion criteria; these studies compared an inpatient taper to inpatient or outpatient maintenance therapy. These eligible studies included a total of 235 women with opioid use disorder in pregnancy. Maternal detoxification was associated with increased risk of relapse (RRs 1.91, 95% confidence interval (CI) = 1.14-3.21). However, no treatment differences were observed for rates of NAS (RRs=0.99, 95% CI = 0.38-2.53) or PTB (RRs = 0.39, 95% CI = 0.10-1.60).

CONCLUSION:

Our findings suggest there is an increased risk of relapse with detoxification compared with maintenance; however, we found detoxification does not increase the risk of PTB or NAS. Further studies should confirm our findings and explore mechanisms to fight the opioid epidemic.
The Experience of Pregnant Women With a History of Addiction at a High Risk Clinic [16R]
Authors: Williams Eva , Strong Abigail , Finch Lindsey , Curry Christine
Published: April 2018

INTRODUCTION:

5.0% of pregnant women use one or more addictive substances. Drug use during pregnancy significantly increases the risk of adverse maternal and fetal outcomes. The Prenatal Recovery Clinic (PRC) is a specialty clinic at Jackson Memorial Hospital that provides care for pregnant women with a history of addiction. The objective of our study is to gain a greater understanding of the patients, their drug habits, health care experiences, and health outcomes at the PRC.

METHODS:

Pregnant women 18-50 years old that used substance and were patients at the PRC between March 2016 and April 2017 were eligible to participate in the study. Surveys was administered at two different times; the first at a PRC prenatal visit and another postpartum. Birth outcome data was extracted from medical records manually.

RESULTS:

Twelve patients were enrolled in the study. Of these patients, 33% reported more than one drug as their drug of choice. Participants rated the PRC clinic experience overall more favorably than their experience at the hospital for delivery, although the two experiences were not found to be statistically significant. Averages of PRC patient birth outcomes, such as gestational age, birth weight, and APGAR scores fell within normal limits.

CONCLUSION:

Pregnant patients with addiction can benefit from specialized clinics like the PRC that provide specialized care and assistance for pregnant women with a history of substance use. The results from our study indicate a potential for establishing a model similar to the PRC, that can be replicated to other clinics to address addiction in pregnancy.
Severe Maternal Morbidity and Mortality in Women with Congenital Heart Disease [18R]
Authors: Platner Marissa , Lipkind Heather S. , Campbell Katherine
Published: April 2018

INTRODUCTION:

Studies have demonstrated an increase in adverse pregnancy outcomes in women with congenital heart disease. We sought to examine the association of maternal congenital heart disease (CHD) with the risk of severe maternal morbidity and mortality (SMM) compared to women without congenital heart disease.

METHODS:

This retrospective cross-sectional study used 2008 through 2012 New York City (NYC) birth certificates linked to hospital discharge data to identify delivery hospitalizations. Cases of SMM were identified using ICD-9 diagnosis and procedure codes based on the Center for Disease Control and Prevention criteria. Data were limited to singleton, live births. CHD included women with any vascular, septal, or valvular abnormality of the heart at birth. Multivariable logistic regression was used to evaluate SMM in women with CHD adjusting for maternal demographics, socioeconomic status, and medical comorbidities.

RESULTS:

From 2008 through 2012 there were 578,840 live singleton births in NYC, 347 of these births were to women with CHD (6/10,000). Acute renal failure, adult respiratory distress syndrome, thrombotic embolism, cardiac arrest/ventricular fibrillation, pulmonary edema/heart failure, conversion of cardiac rhythm, and transfusion were all independently associated with CHD. Women who had CHD had higher adjusted odds of SMM(aOR 2.43; 95% CI 1.60-3.70) compared to women without CHD after adjusting for maternal socioeconomic status, demographics and medical comorbidities. There was one maternal death.

CONCLUSION:

SMM is increased in women with CHD, even after adjusting for co-morbid conditions. It is important that these women receive care from an identified multidisciplinary team from preconception to postpartum to optimize pregnancy outcomes.
Multidisciplinary Prenatal Care of the Patient with Opioid Use Disorder: A One Stop Shop [21R]
Authors: Peneva Ralitza , Holman Stacey , Heard Asha , Conrad Erich
Published: April 2018

INTRODUCTION:

Opioid use has increased dramatically over the past two decades and affects pregnant women across racial, ethnic, and socioeconomic groups. Rates of neonatal drug withdrawal have increased in accordance. Pregnancy provides a unique opportunity to identify and treat opioid use disorders to optimize maternal and fetal health. Most studies focus on targeting this chronic issue with pharmacotherapy, but few have examined the benefits of streamlining care for prenatal patients. We propose combining the evidence-based practice of “SBIRT” (Screening, Brief Intervention, Referral to Treatment) and treatment itself into a multidisciplinary clinical experience.

METHODS:

This is a descriptive study of a collaboration between the Louisiana State University Departments of Obstetrics and Gynecology and Psychiatry in New Orleans, LA. Prenatal patients with opioid use disorders are referred to addiction psychiatry clinic . Prenatal care is given within the same clinic space to allow for collaboration between services. Inpatient pregnant patients undergoing opioid initiation or treatment are also referred to this specialized clinic upon discharge from the hospital.

RESULTS:

Since initiating this joint effort in July 2014, the perinatal psychiatry clinic has had approximately 2.5 scheduled patient encounters per week. A review of delivered patients over the past 5 years shows 3-5 patients/month with opioid use disorders. Of our pregnant patients, this constitutes about 3% of the delivery population.

CONCLUSION:

This collaboration has improved access to care for pregnant patients with opioid use disorders. Future work includes looking at patient compliance with visits and neonatal outcomes. Multidisciplinary care for this patient population is essential to optimize maternal and fetal outcomes.
What are the Perinatal Outcomes Associated with Expectant Management of PPROM Cases in the Periviable Period? [23R]
Authors: Moni Saila , Comfort Lizelle , Tropper Pamela , Bernstein Peter
Published: April 2018

INTRODUCTION:

PPROM is estimated to complicate 3% of all births and is associated with up to 40% all preterm births. Recently ACOG has extended the appropriateness of the administration of latency antibiotics starting at 20 wks of gestation for patients who opt for expectant management in the periviable period. Our objective was to evaluate perinatal outcomes among PPROM patients in the periviable period (20-23+6 wks of gestation).

METHODS:

This is a case series of all cases of PPROM after 20 weeks of gestation delivered at our institution from January 2014-May 2017.

RESULTS:

We reviewed 14 cases of PPROM in the periviable period (20 wks and 2 days to 23 wks and 5 days) that were managed expectantly. 13 patients (93%) received latency antibiotics on admission, 9 patients (64%) received betamethasone at 23 wks or later in gestation, 6 patients (43%) received tocolytics and 6 patients (43%) received magnesium for neuroprotection. Seven7 patients (50%) delivered prior to reaching 24 wks of gestation and 11 patients (79%) delivered prior to reaching 25 wks of gestation. The furthest gestational age reached was 31wks and 2 days. The following maternal and fetal/neonatal morbidities were noted: 5 (36%) chorioamnionitis, 1 (7%) abruption, 1 (7%) cord prolapse, 6 (43%) IUFDs and 2 (14%) neonatal demises. 6 neonates (43%) survived to discharge from the hospital.

CONCLUSION:

Given the significant morbidity and mortality associated with expectant management of PPROM cases at less than 24 wks of gestation, appropriate and accurate counseling of maternal and neonatal outcomes is required.
Limiting Leftovers: Analysis of Usage and Storage Patterns of Opiate Medication after Cesarean Delivery [37R]
Authors: Grimes Meghan , Dangel Alissa , Iyer Vidya , Sadr Farnaz
Published: April 2018

INTRODUCTION:

Limiting excess opiate medication in the community should be a focus of all physicians including Ob-Gyns. Patient’s pain medication usage and home storage patterns following Cesarean delivery may provide insight into limiting accessibility to leftover medication.

METHODS:

A single site, prospective cohort study was initiated to survey postpartum women regarding their post Cesarean pain control, medication usage and storage patterns. Patients were eligible if they underwent cesarean section at Tufts Medical Center, were >18 years old and had a valid email address. The automated survey was sent via the RedCap database at 2 weeks postpartum.

RESULTS:

The initial 100 survey responses from 177 recruited subjects were reviewed, 98 of which had usable data (response rate of 55.4%). Of responders, 63.3% underwent a primary cesarean section. Most patients (75.5%) indicated they only took opiate medication for 7 days or less. Opiate storage information was available on 95% of respondents as follows; 25.5% bathroom, 40.8% bedroom, 22.4% kitchen and 9.2% other. Specific location indicated 34.7% storing their medication in a closed space (cabinet or drawer), of which only 39% used any form of lock. Medication disposal plans included the following: 8% flushing medication, 11.2% return to a designated facility, 10.2% planned on keeping them and 28.6% were unsure.

CONCLUSION:

There are a significant amount of leftover opiate pills associated with cesarean delivery being stored in unsecured locations. Patient education regarding safe storage and subsequent disposal of opiate medication should be initiated.
FOXO3 Expression in the Human Ovary [6OP]
Authors: Swenson Helen Paige , Beachy Dawn E. , Barilovits Sarah J. , Nick Harry S. , Rush Demaretta S. , Rhoton-Vlasak Alice
Published: April 2018

INTRODUCTION:

To assess FOXO3 gene expression levels and members of the KL-PI3K-AKT-FOXO3 pathway in pre- and postmenopausal human ovaries. To evaluate in a temporal manner protein localization of FOXO3 in pre- and postmenopausal human ovaries by immunohistochemistry (IHC).

METHODS:

Total RNA was isolated from human ovary collected from pre- and postmenopausal patients undergoing oophorectomy and used for real-time qPCR for members of the KL-PTEN-PI3K-FOXO3 pathway, as well as other genes. IHC was performed on archived paraffin embedded ovaries to visualize the presence and localization of FOXO3 in human ovaries ranging from fetal to menopausal.

RESULTS:

FOXO3 is expressed in premenopausal human ovary and to a significantly reduced level in postmenopausal ovary. Nine additional genes in the KL-PTEN-PI3K-FOXO3 pathway were also expressed in premenopausal ovaries but like FOXO3 displayed significantly decreased levels in the postmenopausal cohort. IHC analysis revealed strong nuclear FOXO3 staining in primordial follicles from pre-pubertal ovaries through menarche/post-pubertal. A dominant population of primordial follicles were identified in older post-pubertal ovaries and in the reproductive/premenopausal groups that displayed light to negative nuclear staining for FOXO3, with a second much less abundant population of primordial follicles retaining strong positive nuclear FOXO3 staining. Postmenopausal ovaries were devoid of follicles but had strong stromal FOXO3 staining.

CONCLUSION:

As predicted from mouse genetic models, FOXO3 mRNA and protein is present in premenopausal human ovary as are nine members of the KL- PI3K-AKT-FOXO3 pathway. FOXO3 localization in the human ovary undergoes an age-dependent transition from strongly positive nuclei in young ovaries to predominantly light to negative staining in reproductive/premenopausal. Given FOXO3's importance to genome stability, primordial follicles with high nuclear FOXO3 levels may define high quality oocytes lacking detrimental levels of DNA damage, so that the ratio of FOXO3 positive to negative oocytes may explain the consequences of decreasing ovarian reserve.
Expanding the Cervical Cancer Screening Guidelines in Resource Limited Settings [9OP]
Authors: Hari Anjali Y. , Brabender Danielle E. , Temko Jamie E. , Shen Aricia
Published: April 2018

INTRODUCTION:

The World Health Organization (WHO) guidelines for cervical cancer prevention in low resource countries recommend Visual Inspection with Acetic Acid (VIA) and cryotherapy to screen and treat women ages 30–50. Our study examined the clinical benefit of extending the screening to include patients aged 18 to 75.

METHODS:

841 women were screened at two sites during different campaigns in Tanzania. VIA+ women, regardless of age, were treated with cryotherapy. Women with cervical cancer were referred for gynecologic oncology consults.

RESULTS:

The combined VIA+ rate was 13.32% overall (112 out of 841), 14.94% for women under 30 (39 out of 261), and 7.32% for women over 50 (6 out of 82). 34.82% of VIA+ results were in women ages 18 to 29 (39 out of 112). Severe dysplasia and cervical cancer was detected in 15 patients overall, 6 of whom fall outside the 30–50 age limit.

CONCLUSION:

Despite WHO guidelines, we found a high rate of VIA+ results in patients under 30, consistent with studies assessing VIA+ prevalence in resource limited areas. VIA has established specificity and sensitivity (∼79% and 85%, respectively) in identifying CIN2+ lesions, which guidelines advise to treat in younger patients. Given the low rates of pelvic exams in this population and low cryotherapy complication rates, women over 50 should also be screened. We propose reassessing the WHO guidelines to reflect the need for screening and appropriate treatment for women aged 18–75, especially in resource-limited countries like Tanzania.
Assisted Reproductive Technology and Stillbirth Risk: Selected States, 2006–2011 [15OP]
Authors: Chang Jeani , Zhang Yujia , Boulet Sheree L. , Crawford Sara B. , Kissin Dmitry M.
Published: April 2018

INTRODUCTION:

To examine trends and characteristics of stillbirths among pregnancies (live births and stillbirths) following assisted reproductive technology (ART) and to evaluate the association between ART and risk of stillbirth using linked ART surveillance and vital records from Connecticut, Florida, Massachusetts, and Michigan.

METHODS:

We examined trends of stillbirth rate (number of stillbirths/1,000 live births and stillbirths) and estimated the adjusted risk ratios (aRR) for associations between ART and stillbirth (adjusting for maternal characteristics, pregnancy history, and pre-pregnancy medical conditions), stratified by plurality and gestational age (<28 and >28 weeks). We also used ICD-10 to examine causes of stillbirth.

RESULTS:

During 2006–2011, 282 ART stillbirths and 15,540 non-ART stillbirths were identified. ART stillbirth rates were lower than the non-ART stillbirth rates for both singleton (3.1 versus 6.0) and multifetal pregnancies (9.4 versus 18.3). At <28 weeks, the risk of stillbirth among ART-pregnancies was significantly lower than for non-ART pregnancies, aRR 0.38, 95% confidence interval (CI) 0.22–0.65 among singletons and aRR 0.63, 95% CI 0.42–0.94 among multiples. The leading causes of stillbirth were similar for both ART and non-ART pregnancies; maternal conditions (16.6%) (eg, hypertensive disorders, infections, respiratory diseases, periodontal diseases, incompetent cervix, etc), followed by placental abnormalities (9.8%), umbilical cord conditions (9.2%), chorioamnionitis (3.8%), and low birth weight (2.7%).

CONCLUSION:

ART was associated with a decreased stillbirth risk prior to 28 weeks of gestation. Earlier detection and management of fetal and maternal conditions among ART-conceived pregnancies may explain the lower rates of early fetal death observed in this study.
Demographics and the Placebo Response in the REPLENISH TRIAL: A Study of Vasomotor Symptoms [16OP]
Authors: Constantine Ginger , Graham Shelli , Bernick Brian , Archer David
Published: April 2018

INTRODUCTION:

High placebo responses (up to 61%) are reported in studies evaluating therapeutic agents for vasomotor symptoms (VMS). Placebo response rates by subgroups from a recently completed positive trial of an investigational combination of 17β-estradiol and progesterone capsule (TX-001HR) are presented.

METHODS:

REPLENISH was a phase 3, randomized, double-blind, placebo-controlled trial that evaluated safety/efficacy of TX-001HR in postmenopausal women, who had ≥50 moderate to severe hot flushes at baseline. 767 women received one of four TX-001HR daily doses or placebo; frequency and severity of VMS at baseline and weeks 4 and 12 were recorded by diary. Secondary endpoints were responder analyses and menopause-specific quality of life (MENQOL) questionnaire. Subgroup analysis of efficacy was performed on demographics.

RESULTS:

The placebo response rate was high (55%). Significant differences were observed in the placebo response rates between White (51%) and African American (65%) women at 12 weeks (P=.049). Mean age was similar; more African American women had BMI≥30 kg/m2 (32.4%) vs White (18.7%). More African American women were current smokers than White (41.5% vs 17.6%). Significant differences in responders (≥50% and ≥75%) and the MENQOL Vasomotor Domain were observed for all groups compared to placebo in the White population; no differences noted in African Americans due to high placebo rate. Baseline estradiol levels and compliance rates for African American and White women were similar.

CONCLUSION:

Large placebo responses occurred and more frequently in African Americans. Understanding factors that contribute to placebo responses are important in designing and assessing the efficacy of medications in clinical trials.
Effect of First Trimester Bleeding on Retained Placenta Requiring Dilatation and Curettage [20OP]
Authors: Le Gallee Marissa , Lee Seohyuk , Czuzoj-Shulman Nicholas , Klam Stephanie , Abenhaim Haim Arie A.
Published: April 2018

INTRODUCTION:

It is hypothesized that development of early subchorionic hemorrhage may lead to disruption in the placental-uterine matrix resulting in an adherence of the placenta to the endometrium. We sought to evaluate the effect of a first trimester bleed on the need for a post-vaginal delivery D&C for removal of retained placenta.

METHODS:

We carried out a case-control study at a tertiary care centre in Montréal, Canada between 2012 and 2016. Women identified through medical records as having had a post vaginal delivery D&C for retained placenta were considered cases and matched 2:1 with women delivering vaginally the same day as the case who did not have a retained placenta requiring D&C. Logistic regression evaluated the adjusted effect of a first trimester bleed on the requirement for D&C for retained placenta.

RESULTS:

There were 68 cases of retained placenta requiring D&C for an estimated 3/1,000 deliveries. Women requiring a D&C for placental removal were slightly older than controls but otherwise comparable in baseline characteristics. First trimester bleeding was more common among women requiring a D&C for retained placenta 11.8% vs 1.5%, respectively. In adjusted analysis, first trimester bleeding was strongly associated with requiring a D&C for removal of retained placenta (OR 7.70, CI 1.37.5). As well, it was associated with a greater postpartum hemorrhage and requirement for blood transfusions.

CONCLUSION:

First trimester bleeding is associated with a greater risk of retained placenta requiring D&C and blood transfusions. Women with a first trimester bleed should be considered at increased risk of postpartum hemorrhage and retained placenta.
Increasing Access to Reproductive Health Care for Underserved Women: Lessons Learned from Student Advocates [4F]
Authors: Hellerstein Leah H. , Wong Adriana J. , Brosch Jessica , Mundy Lawren , Oldak Sean , Curry Christine
Published: April 2018

INTRODUCTION:

The American College of Obstetricians and Gynecologists supports access to comprehensive contraceptive methods for all women. The most effective reversible birth control method is long acting reversible contraception (LARC), which includes intrauterine devices (IUD) and the birth control implant. Although LARC is used by 7.2% of all women ages 15-44 in the United States, access is limited for underserved women. This study evaluates a patient advocacy program for women with barriers to accessing LARC and abortions.

METHODS:

Senior medical students designed an 8-hour training program to educate first-year Student Reproductive Health Advocates in contraception, counseling, pregnancy options, and legal-financial concerns. Patients were referred to advocates for connection to LARC or abortions. Advocates reported progress with patients biweekly and completed a survey. Three years of data were collected.

RESULTS:

Over three years, 48 students advocated for a total of 196 patients, and students reported outcomes for 174 patients. Out of the 71% of patients that students successfully contacted, 37% were lost to follow up after counseling. Advocates made appointments for the remaining 34% of patients, out of which 58% received the service they requested (LARC or abortion). Students cited insurance restrictions, patient loss of interest in LARC, and LARC availability as barriers in 36% of the patients. Patients who had any of these barriers were less likely to receive LARC (p < 0.05).

CONCLUSION:

Student-reported patient outcomes revealed aspects of success and areas of improvement for the program. Overall, student advocates have the potential to positively impact women’s access to reproductive healthcare.
Postpartum Contraception use in Somali Women: A Population-Based Study [5F]
Authors: Cope Adela , Mara Kristin , Weaver Amy , Casey Petra
Published: April 2018

INTRODUCTION:

Contraception is an important resource for Somali women as this population is at increased risk for adverse pregnancy outcomes. This study compares postpartum contraception use between Somali and non-Somali women.

METHODS:

A retrospective cohort study was performed utilizing the Rochester Epidemiology Project. All Somali women aged 18 and older who experienced liveborn, singleton births in Olmsted County, Minnesota, in 2009-2015 (n=317) and an age-matched non-Somali cohort (n=317) were identified. Postpartum contraception was defined as use of any method within 12 months after the first delivery in the time period of interest. Contraception use was compared using a chi-square test. Factors associated with contraception use were evaluated using multivariable logistic regression.

RESULTS:

Somali women were significantly less likely to use contraception than non-Somali women (62.1% versus 89.3%, p<0.001). Of those who used contraception, both Somali and non-Somali women reported comparable use of long-acting reversible contraception (LARC) (19.8% versus 23.7%, p=0.31) and non-LARC hormonal contraception (40.1% versus 45.2%, p=0.26). Somali women were more likely to use less reliable methods including natural family planning and barrier methods (57.3% versus 21.1%, p<0.001). Among Somali women, postpartum contraception use was less likely with older maternal age (OR 0.12 for oldest versus youngest quartile, 95% CI 0.04-0.37) and more likely with pre-pregnancy contraception use (OR 15.46, 95% CI 5.18-46.18).

CONCLUSION:

Our study represents the first assessment in the literature of contraception use in Somali women in the United States. Somali women are less likely to utilize postpartum contraception, highlighting an opportunity for improvement in counseling practices.
The Effect of Eliminating Cost Sharing on Adolescent IUD Utilization [6F]
Authors: Advani Raina , Kobernik Emily , Kolenic Giselle , Minadeo Leah , Heisel Erica , Dalton Vanessa K.
Published: April 2018

INTRODUCTION:

The Affordable Care Act (ACA) removed major cost barriers by expanding coverage to dependents and eliminating out of pocket costs (OOPC) for IUD placement. Our objective was to characterize the effect of eliminating OOPCs on IUD cost and placement among commercially-insured young women

METHODS:

This study used de-identified data from The Clinformatics™ Data Mart Database to examine changes in cost sharing and IUD placement among commercially-insured women ages 15-26 between 2009 and 2014. IUD placement was identified using ICD-9 and CPT-4 codes. Plans were categorized by cost sharing patterns: $0 OOPC, low OOPCs, and high OOPCs. Multilevel models were used to estimate the effect of cost sharing on IUD placement.

RESULTS:

We identified 604 unique plans that were utilized for IUD services in 2009 and 2014. The 75th percentile of OOPCs in 2009 was $241 and dropped to $0 in 2014. Average plan utilization rate increased significantly from 7.4% in 2009 to 10.3% in 2014 (p<.001). When grouped by cost sharing patterns, significant increases in IUD utilization were observed for all groups. However, differences in plan utilization between 2009 and 2014 were not found. IUD plan utilization rate did not differ between plans with high OOPCs in 2009 and $0 in 2014 compared to plans that always had $0 OOPC (difference in slopes=.0115, p=.574).

CONCLUSION:

The elimination of cost sharing did not cause adolescents to increase IUD utilization beyond the general trend. Adolescents may be continuing to go outside their plans to access contraception despite the elimination of cost sharing.
Analysis of Personal Preferences Influencing Contraceptive Decision Making Using a Digital Women’s Health Advisor [8F]
Authors: Sridhar Aparna , Yoast Felicity , Witte Carolyn
Published: April 2018

INTRODUCTION:

Tia is a mobile application that helps women make informed reproductive health decisions. A core feature of the app is a birth control recommendation algorithm that provides women personalized birth control recommendations. Users are able to select two preferences, indicating which is the most important preference. These include maximum effectiveness, non-daily method, acne reduction, amenorrhea, non-hormonal methods, avoiding a procedure, hidden method and having regular monthly cycles.

METHODS:

We analyzed anonymous data from 3,184 users who used Tia for contraception decision-making. The preferences were analyzed by age to identify the most and the least preferred personal preferences.

RESULTS:

The most common first preference was birth control effectiveness (33%) followed by non-daily method (13%) and acne reduction (12%). When segmented by age, the number one concern for users ages 14-25 remained birth control effectiveness (35%), however, for women over 25 the top preference shifted to a non-daily method. For young users the gap between the most common and the second most common top priority was 20 percentage points, for older women this variation was minimal. Hidden method (4% chose as their first preference, 6% as their second preference) was the least commonly desired benefit across all methods.

CONCLUSION:

Women hold differentiated preferences through their birth control choices. Women still view birth control effectiveness as a top priority, before being an option to help with secondary benefits. While younger women are less likely to have same preferences, older women have a wider array of preferences when choosing their contraceptive method.
Contraception Knowledge in Transgender Individuals: Are we Doing Enough? [9F]
Authors: Abern Lauren , Maguire Karla
Published: April 2018

INTRODUCTION:

Transgender individuals are often reluctant to seek reproductive health care and have under-addressed needs. Our objective is to determine use and awareness of contraceptive methods and views on abortion in this population.

METHODS:

Transgender patients ages 18-65 participated in an online survey about reproductive history, contraceptive use and knowledge, and abortion views.

RESULTS:

100 transgender men and 20 transgender women completed the survey. The mean age of transgender men and women was 22.9 (SD 5.6) and 25.9 (SD 9.5) respectively. The majority was white (85%). 76/101 (75%) were at risk of unintended pregnancy. 30/97 (31%) transgender men and 12/18 (67%) transgender women believed or were unsure if testosterone or estrogen therapy prevents pregnancy. 1/18 (6%) transgender women and 9/93 (9%) transgender men indicated that a provider stated gender affirming hormones prevented pregnancy. Over 70% had knowledge of condoms, oral contraceptive pills, and sterilization. 70% of transgender men were also aware of the contraceptive ring and implant. However, only 18/89 (20%) transgender men and 4/11 (36%) transgender women used contraception. 8/17 (47%) transgender women and 44/87 (51%) transgender men stated a provider did not discuss contraception after initiating hormone therapy. There were no unplanned pregnancies (0/16, 0%) in partners of transgender women. 3/93 (3%) transgender men had unplanned pregnancies. 2/3 chose abortion. The vast majority (95%) identify as pro-choice.

CONCLUSION:

Although many transgender individuals in our cohort were at potential risk of pregnancy, contraceptive use was limited. This highlights need for educational interventions for patients and providers and increased access to contraceptive and reproductive services.
First Bluetooth Connected Ovulation Test with App to Predict and Track Cycles [10F]
Authors: Thomas Michael A. , Johnson Sarah , Grace Bola , Marriott Lorrae , Zinaman Michael
Published: April 2018

INTRODUCTION:

Fertility Apps offer the convenience of cycle tracking and storage of data over multiple cycles. However, accuracy of ovulation prediction by most Apps is very poor. Therefore an App that uploads accurate ovulation test data would be of benefit to women seeking to conceive. This study examined women’s usage and experience of the new Clearblue Connected Ovulation Test System.

METHODS:

This home based study required volunteers to pair the Bluetooth connected ovulation test to their mobile phone using the associated App, then use the App and ovulation tests for 1 cycle. The tests measure both estrogen and luteinizing hormone to identify the wider fertile window and pinpoint ovulation. Test results are uploaded using the App enabling easy tracking of fertility data. Volunteers completed usability questionnaires when pairing App with holder and after 4 weeks usage. Qualitative feedback from volunteers and Cloud data usage was analysed.

RESULTS:

Of 164 Android users, 98% found the test and 93% found the App easy to use. For iOS users (n=23), 100% found the test and 95% found the App easy to use. Cloud data showed women conducted tests on the right days and chose to add additional data e.g. intercourse and menses. Volunteers also successfully uploaded their test results to the App, providing a central, concise record of data. Qualitative data indicated women found this very beneficial.

CONCLUSION:

Conclusions: This Clearblue Connected Ovulation Test System combines the convenience of an App with the accuracy and benefit of a home ovulation test.
Reproductive Coercion in the Perinatal Context [11F]
Authors: Fay Kathryn , Gomez Helen , Yee Lynn
Published: April 2018

INTRODUCTION:

Reproductive coercion (RC), or behavior that interferes with contraception use and/or pregnancy autonomy, has been poorly assessed in the perinatal context. Our objective was to determine patient factors associated with RC and to explore associations between RC and pregnancy engagement.

METHODS:

This was a cross-sectional study utilizing an anonymous, self-administered, Spanish or English survey among women with at least one prior pregnancy. The RC questionnaire queried participants’ experience of birth control sabotage and/or pressure to become pregnant by a partner at the time of their most recent pregnancy. Surveys were distributed at a tertiary care center during routine outpatient visits. Descriptive and bivariable analyses were performed.

RESULTS:

In this sample of 93 women, 6.5% screened positive for RC. In the overall cohort, the mean age was 36.8 years, 79.6% were racial or ethnic minorities, and 41.9% were college graduates. Women reporting RC were younger (27.6vs.37.4 years, p=0.036) and reported more limited prenatal care (66.7%vs.25.3% with late/no prenatal care, p=0.049). There were trends demonstrating greater work insecurity, younger age at first pregnancy, poorer self-perception of health, and increased frequency of intimate partner violence (p<0.075). Race/ethnicity and education did not differ by experience of RC. Women were significantly more likely to have had an undesired pregnancy or pregnancy ambivalence if they had experienced RC (p=0.004).

CONCLUSION:

In this unselected population, RC was present in a distinct minority of women without discrimination along racial, ethnic, education and economic lines. These data suggest that RC experience is associated with pregnancy ambivalence/unintendedness and poorer engagement in perinatal care.
The Impact of Rural or Urban Location on Clinical Availability of the Copper IUD: A Mystery Caller Study [14F]
Authors: Lilja Kristen , Infante Sofia , Micks Elizabeth
Published: April 2018

INTRODUCTION:

The copper IUD is the only highly effective non-hormonal method of contraception. It is also the most effective form of emergency contraception (EC), when placed within 5 days of unprotected intercourse, and is the only method of EC that provides ongoing contraception. For these reasons, local availability of the copper IUD to women is essential.

METHODS:

A mystery caller model was employed with a single caller making inquiries to urban and rural clinics in Washington state over a two-month period regarding availability of copper IUDs using a standardized script. Clinic types included OB/GYN, primary care, family planning and multispecialty. Clinics were identified using the HRSA 340B database, with allocation as urban vs rural based on the Office of Management and Budget county designations. The primary outcome was the reported availability of the copper IUD. Secondary outcomes included ability to schedule an appointment for copper IUD placement within 5 days.

RESULTS:

A total of 97 urban and 97 rural clinics were included in the analysis. A greater proportion of urban clinics reported availability of copper IUDs than rural clinics (78 vs 50%; p <0.001). Only 19 urban clinics and 10 rural clinics were able to schedule an appointment for copper IUD placement within the 5 day window needed for EC use (19 vs 10%, p = 0.07).

CONCLUSION:

Rural clinics are less likely to have copper IUDs available, even when clinic type is taken into account. Efforts are needed to increase availability of this method, particularly in rural areas.
Women’s Intentions for Pregnancy and Breastfeeding Impact Breastfeeding Outcomes, Implications & Opportunities [16F]
Authors: Stalcup Alane M.
Published: April 2018

INTRODUCTION:

Breastfeeding is the optimal form of infant feeding with short and long term advantages for baby and mother. The aim of this study was to assess whether pregnancy wantedness as defined by the WHO and intention to breastfeed are associated with breastfeeding outcomes.

METHODS:

A cross-sectional study of mother-infant dyads in North Carolina was randomly drawn from birth certificates. Mothers were contacted for a one-time telephone interview. 'Wantedness' of the pregnancy, as defined by the WHO, and pre-birth breastfeeding intention were analyzed in relation to breastfeeding duration taking into account confounding social, demographic, and support factors.

RESULTS:

Wantedness of the pregnancy was predictive of breastfeeding duration. Women with mistimed or unwanted pregnancies had higher odds of breastfeeding cessation than women with timely, wanted pregnancies.

Intention to breastfeed was strongly associated with breastfeeding initiation and duration, but doesn’t appear to be absolutely necessary for initiation or to guarantee initiation. A notable group of women who had not intended to breastfeed did initiate (15.9%), and a smaller group who had planned to breastfeed never initiated (5.5%).

CONCLUSION:

Timely, wanted pregnancies are more likely to lead to breastfeeding initiation and to longer duration. This highlights the importance of a woman’s ability to access effective and attractive contraception not only for the mother’s health outcomes, but also for those of her child and for society as a whole.

Intention to breastfeed was strongly associated with breastfeeding initiation and duration. Efforts to influence a woman’s pre-conception and/or prenatal breastfeeding intention may be a high-yield opportunity for improving breastfeeding outcomes.
Acceptability of Postpartum No-Cost LARC Among Women Using Emergency Medicaid for Labor and Delivery [19F]
Authors: Dempsey Angela , Billings Debbie , Mattison Amy , Burgis Judith , Tyson Adam
Published: April 2018

INTRODUCTION:

In 2012, South Carolina (SC) instituted a Medicaid policy allowing full reimbursement for inpatient post-partum long acting reversible contraceptives (LARC) and related services; however, the policy does not apply when delivery costs are covered by Emergency Medicaid. This study evaluated the acceptability of inpatient postpartum no-cost LARC for women with Emergency Medicaid coverage.

METHODS:

This cross-sectional study enrolled participants following delivery in three teaching hospitals in SC between November 2016 and May 2017. Eligible women were at least 18 years old and qualified for Emergency Medicaid coverage. Data were collected through patient interviews and chart abstraction. Each site provided LARC at no cost regardless of study enrollment.

RESULTS:

Among the 220 women enrolled, 89 women (40%) left with either the implant (n=57) or an IUD (n=32). Among those women, 79% were “very satisfied” with the insertion. When comparing pre-delivery documented contraception plans with method recorded at discharge, we found an increase in those choosing implant (pre= 18%, postpartum=26%) and a decrease in no method (pre= 26%, postpartum=15%) and IUD (pre=17%, postpartum= 15%,). Contraceptive counseling was recorded in most inpatient records (81%) and prenatal records (76%). Few participants reported receiving the information they needed about the IUD (36%) or implant (38%). Though 89% of participants planned to breastfeed, only 70% and 6% received information about breastfeeding while using implants and IUDs, respectively.

CONCLUSION:

LARC methods were commonly selected postpartum among this population. Despite counseling documented by providers, patients receive insufficient information about specific LARC methods and their use while also breastfeeding.
Sexual Violence Screening Practices Among Obstetricians and Gynecologists [21F]
Authors: Hicks-Courant Katherine , Baer Samantha , Lee Eung-Mi , Evans Megan L.
Published: April 2018

INTRODUCTION:

In the United States, almost 1 in 5 women are affected by sexual assault and may face particular challenges when it comes to obstetric and gynecologic care. This study examines providers’ knowledge, comfort level, and barriers to screening patients for a history of sexual violence.

METHODS:

We conducted an anonymous computer-based survey which was sent to all physicians (n=46) in an Obstetrics and Gynecology department at a tertiary academic medical center.

RESULTS:

Our sample included 18 faculty members and 18 resident physicians for a response rate of 78%. The majority agree that it is important (97%) and that it is part of their role (81%) to screen patients for a history of sexual violence. While the majority agree that they feel comfortable screening patients for a history of sexual violence (69%), only 44% screen at least half of the time. The majority report feeling comfortable modifying their physical exam techniques to meet the needs of a patient with a history of sexual violence (61%), but do not know how to connect patients with timely, accurate resources (75%) and have not received formal training in screening patients (67%), responding to a disclosure of violence (67%), or modifying physical exam techniques (75%).

CONCLUSION:

Most providers agree that screening for a history of sexual violence is important and is part of their role as obstetricians or gynecologists. However, less than half screen patients regularly. Additional training and education could improve this discrepancy and improve care for patients with a history of sexual violence.
Childhood Abuse Increases Risk of Adverse Perinatal Outcomes [22F]
Authors: Johnson Quinetta , Bush Heather , Coker Ann
Published: April 2018

INTRODUCTION:

Intimate partner violence (IPV) has been associated with numerous adverse perinatal outcomes. Little is known, however, regarding the impact of childhood abuse on subsequent adverse pregnancy outcomes among women never experiencing IPV.

METHODS:

Data from the University of Kentucky’s Women’s Health & You cohort were used to assess the association between women who experienced childhood sexual (CSA) and/or physical (CPA) abuse and the self-reported history of third trimester bleeding, postpartum depression, preterm labor, preeclampsia, and gestational diabetes. Multivariate logistic regression modeling was used to determine rate ratios (RR) for women who had never experienced IPV. Childhood abuse was categorized as experiencing both sexual and physical abuse, sexual abuse ‘alone’, and physical abuse ‘alone’; the comparison group were women never experiencing abuse.

RESULTS:

Among the 12,507 ever pregnant participants, 21% reported postpartum depression, 7.0% reported bleeding in their 3rd trimester, 12.3% disclosed preeclampsia, 16.0% reported preterm labor, and 8.2% had gestational diabetes. CSA and CPA alone were both statistically significantly (P<.05) associated with an increased risk of 3rd trimester bleeding, preterm labor, and postpartum depression. Those experiencing both CSA and CPA were at an increased risk of all five outcomes with the highest RR of 2.05 (95% CI 1.30-3.23) for 3rd trimester bleeding and 1.95 (95% CI 1.54-2.43) for postpartum depression.

CONCLUSION:

Childhood sexual and/or physical abuse were both associated with multiple adverse perinatal outcomes. Because both forms of abuse have adverse perinatal impact, screening for such abuse and tailoring a woman’s prenatal care may improve maternal and neonatal outcomes.
Association Between Timing of Epidural Placement and Obstetric Outcome with Reference to the Start of Active Labor [26F]
Authors: Braverman Alexis , Alban Juan , Dillard Morgan , Ghelani Seema , Hajnas Natalia , Haar Charlotte ter
Published: April 2018

INTRODUCTION:

Previous research suggests that there is no association between timing of epidural placement and mode of delivery. However, with active labor now defined as beginning at six centimeters cervical dilation, we explored if timing of epidural placement before active labor was associated with higher rates of Cesarean section. Secondary outcomes included rate of operative vaginal delivery and length of the second stage.

METHODS:

We conducted a retrospective chart review of patients who delivered at an urban, academic hospital between June 2015 and May 2016. Primiparous women delivering live-born, singleton, full-term infants were included.

RESULTS:

Of 433 women, 284 (66%) had epidurals placed prior to six centimeters cervical dilation, while the remaining 149 (34%) women had epidurals placed after six centimeters. There was no difference in the rate of Cesarean section between those who had epidurals placed prior to (15.8%, N=45) and after (13.4% N=20) six centimeters, as well as no difference in the rate of operative vaginal delivery (4.2% vs. 3.3%, respectively), [Χ2(2, N=433) = 0.701 P=0.704]. Finally, there was no difference in the mean length of the second stage of labor (mean of 88 minutes vs 80 minutes), [F(1, 356) = 0.929, P=0.336].

CONCLUSION:

Placement of epidural prior to or after the onset of active labor did not differentiate mode of delivery or length of the second stage. With further study, providers may counsel patients to make decisions on timing of epidural based on maternal comfort without fear of increased risk of primary Cesarean section.
Distractions in the Obstetric Operating Room [27F]
Authors: Curcio Erin , Baum Jonathan , Sommer Brenna , Ricciardi Camille
Published: April 2018

INTRODUCTION:

Distractions in the operating room are common. The frequency and impact of distractions during obstetric surgery is unknown. According to JACHO and HRO, distractions are an important cause of mistakes in medicine. Persoon et al reported distractions occurred at a rate of one event every 1.8 minutes during endo urological procedures at a teaching hospital in the Netherlands. Our goal was characterize the type and frequency of distractions in obstetric surgery at our institution.

METHODS:

Obstetric surgeries were observed at a community teaching hospital in suburban New Jersey. A researcher recorded all observed distractions during cesarean sections using a study design validated by Persoon et al. Distractions were categorized by severity, based on how distracting they were to the surgeons.

RESULTS:

23 operations were observed. Mean operating time was 47 ±16minutes (range 32-78 minutes). Average distractions per case was 57±16 (range 21-85). Potentially distracting events occurred every 54 ± 23 seconds (range 29-113). There were 3 distracting events that caused one of the surgeons to stop what they were doing to engage entirely with the distracting stimuli — twice for phone calls, and once for conversation related to another patient.

CONCLUSION:

Distractions appear to be twice as common in obstetric surgery versus the rate reported during endo urologic procedures. While no obvious adverse events were observed in this small study, the frequency, characterization and impact of distractions in obstetric surgery warrant further study.