bluuebunny/crossref_metadata_2025 huggingface dataset:
A Synthetic Cannabinoid Use in Pregnancy: A Brief Educational Intervention for Obstetric Providers and Patients [19I]
Authors: Sellers Jeffrey , Nunes Vanessa
Published: May 2017

INTRODUCTION:

Synthetic Cannabinoid (SC) use is on the rise with the Substance Abuse and Mental Health Services Administration reporting a doubling of visits to Emergency Departments between 2010 and 2011 and has continued to rise resulting in increased federal attention and regulation. An acute intoxication syndrome is characterized by sympathomimetic effects, psychosis, hallucinations, delirium, acute kidney injury and even death. This drug is not detected by routine urine drug testing and no rapid testing currently exists. There is no antidote and treatment is largely supportive. The Obstetric Provider should be familiar with the mechanism of action, presentation, workup and treatment of this drug and its particular obstetric sequelae.

METHODS:

A literature review was performed on the SC and Pregnancy on the PubMed database and found 0 studies on SC use in Pregnancy. One study was found regarding SC and potential reproductive outcomes. An extensive literature search was then performed on SC use in non-pregnant patients. This information was used to create two brief evidence-based educational pamphlet one for providers and one for patients.

RESULTS:

The synthetic cannabinoids should be avoided in pregnancy. There is a baseline danger of the acute intoxication syndrome with these substances that can put the maternal fetal unit in danger. Pregnancy specific concerns include the effects of cannabinoids on neuronal migration in early pregnancy and the impact of altered autonomic regulation on the fetoplacental unit.

CONCLUSION:

An evidence based intervention for Obstetric Providers and Patients may help provide information on this growing substance epidemic for both obstetric providers and patients.
Attitudes Regarding Transitions of Care of Obstetric and Gynecology Patients in a County Hospital Setting [20I]
Authors: Jackson Angalene , Marshall Hayley , Hoang Christine , Kremer Timothy
Published: May 2017

INTRODUCTION:

Handoffs and transitions of care have been a central part of patient safety goals at John Peter Smith Hospital. With twice daily shift changes for physician and nurses, the Department of Obstetrics and Gynecology introduced a new interdisciplinary team transition of care system. Initial anecdotal feedback suggested that the handoff process was suboptimal and communication efforts could be improved. The purpose of the study was to evaluate attitudes of faculty, residents, and nursing staff about a transition of care system and identify opportunities to improve the safety and quality of care involving antepartum, postpartum, and gynecology patients.

METHODS:

An anonymous online survey was administered to physicians and nurses participating in the new handoff system. The results were analyzed to identify opportunities for improvement.

RESULTS:

Responses were analyzed from 21 members of the interdisciplinary team. 47% of the respondents found the transition of care system helpful. 55% felt their goals for handoffs were accomplished. All respondents reported importance in addressing updates on patient plans of care and anticipated discharge dates. Content of handoffs should focus on the acute and critically ill patients. The attending physician, chief resident, and nursing team leaders should participate in the handoff process.

CONCLUSION:

Differences in goals and content focus between physicians and nurses contributed to suboptimal communication and handoffs. Identifying the deficits allows opportunities for improvement in transitioning care and ultimately the safety and quality of care provided to patients. Participation in the process should include faculty physicians, chief residents, and nursing leaders.
Incorporation of “One Health” Into Obstetrics and Gynecology [21I]
Authors: Jasani Sona , Fuchs Ashley , Jasani Sona , Bergmann Jonathan , Spencer Brint , Bachmann Gloria
Published: May 2017

INTRODUCTION:

It has been well established that there is high conservation between humans and animal organisms in their biology, genetics, and diseases. The “One Health” movement, which is an effort to have multiple health disciplines collaborate to improve the health of people, animals and the environment, is particularly suited to obstetrics and gynecology. Veterinarians are involved not only in the various obstetrical dystocias, pelvic floor prolapse and contraceptive issues of many mammals, including primates, but also in species conservation and breeding programs. An opportunity exists for OB/GYN programs to become more involved with zoos and wildlife parks in their locale.

METHODS:

The Rutgers OB/GYN department established a partnership with Turtle Back Zoo (a national AZA accredited site) such that physicians, fellows, residents and medical students interface with the professionals working there.

RESULTS:

This partnership has not only resulted in the exchange of education from a reproductive endocrinology, contraceptive, and obstetrical perspective, but also in providing needed equipment to the Zoo. It was noted that many of the items discarded after a surgical procedure (sutures, drapes, disposable instruments, etc) at our academic teaching hospital that cannot be used again for humans is suitable for veterinary use.

CONCLUSION:

Medical institutions and veterinary colleges have traditionally worked in isolated silos. There are few collaborations and comparative studies across the two disciplines. However, with diseases manifesting similarly in humans and animals, there is a wealth of information to be tapped into and we propose greater collaboration through the “One Health” initiative.
Obstetrics and Gynecology Fellowship Interview Preferences [22I]
Authors: Barnard Emily , Byrnes Jenifer , Occhino John A.
Published: May 2017

INTRODUCTION:

The number of applicants to Obstetrics and Gynecology subspecialty fellowships is projected to increase; however, it is known that the interview process is taxing for both applicants and the programs they attend. Concerns include excessive time away from work, cost, lack of coordination for regional travel, and overlapping interview dates. Little is known about applicant preferences for interviewing.

METHODS:

An e-mail link to a survey designed using web-based tool SurveyMonkey was sent to all residency directors for distribution to fourth year residents at ACGME-accredited Obstetrics and Gynecology programs in the United States.

RESULTS:

A total of 190 residents responded, 138 of whom applied to fellowship in 2016. Applicants were predominantly female (73.6%), Caucasian (78.3%), married (76.7%), and without children (74.4%). Most (81.3%) were from an academic program. Applicants attended a mean of 10.9 interviews; the most common reason to cancel was conflict with another interview (72.3%). Saturday was the most preferred interview day (46.7%). The majority of applicants preferred half-day interviews (93.2%), and 61.0% preferred an 0800 start to earlier or later times. A pre-interview dinner was favored (64.4%) with work restraints being the largest barrier to attendance. Personal days granted for interviews varied by program from zero (16.1%) to greater than 11 (25.0%). Vacation and unpaid leave were utilized by 56.5% and 9.0% respectively.

CONCLUSION:

Interviewing for fellowship is a burdensome process, but it could be improved by implementing regional coordination, shorter interview days and weekend interview dates. Gathering information from applicants and fellowship directors can help further streamline the process.
Correlation Between Perceived Versus Actual Proficiency in OBGYN Residency Training for Obstetric Ultrasounds [23I]
Authors: Sulmers Christine , Diaz-Sylvester Paula , Groesch Kathleen , Patterson Jacquelyn , Delfino Kristin , Taylor Funminiyi
Published: May 2017

INTRODUCTION:

Accreditation Council for Graduate Medical Education (ACGME) describes “the full range of commonly employed obstetrical diagnostic procedures, including ultrasonography” as one of the critical competencies required for graduation from an Obstetrics and Gynecology (Ob/Gyn) residency program. Although evidence suggests weaknesses in ultrasound curriculum, this is primarily based on perception and not proficiency. We explored the correlation between perceived knowledge, skill/performance and comfort teaching/supervising obstetric ultrasound and actual proficiency.

METHODS:

A needs assessment survey was disseminated to all ACGME-approved Ob/Gyn residency programs in the U.S.A. Questions evaluating proficiency were correlated with perceived knowledge, skill/performance and comfort teaching/supervising obstetric ultrasound.

RESULTS:

One-hundred-forty-four residents completed the survey. A positive correlation was noted between perceived knowledge and actual proficiency in: effect of frequency on image resolution, principle of as low as reasonably achievable (ALARA), fetal heart rate assessment, components of the anatomic survey; skill/performance in performing growth survey; comfort teaching/supervising growth ultrasound, identification of appropriate images for biparietal diameter and abdominal circumference assessments and recognizing gastroschisis. There was a negative correlation in perceived skill/performance in first trimester ultrasound and identifying the correct first trimester crown rump length image. Higher PGY-level respondents tended to answer the question of effect of resolution on image quality correctly, though they also tended to answer the question regarding first trimester crown rump length incorrectly.

CONCLUSION:

There appears to be a correlation between perceived knowledge, skill/performance and comfort teaching/supervising and actual proficiency. Results of this study may be utilized to integrate future interventions directed towards obstetric ultrasound education.
What Do Medical Students Interested in Obstetrics and Gynecology Value in Their Future Careers? [28I]
Authors: Nguyen My-Linh , Mei Jenny Y. , Mularz Amanda , Maykin Melanie
Published: May 2017

INTRODUCTION:

To identify the personal values and desired practice patterns held by medical students who have high interest in obstetrics and gynecology.

METHODS:

We recruited 2nd-year medical students to complete an institutional survey on early career interests, which was developed to assess specialty interests and characterize factors that may affect career choice (adapted from the AAMC 2015 Matriculating Student Questionnaire). Level of interest in OB/GYN was rated from 1 (no interest) to 5 (high interest). Level of importance of personal values and practice preferences was rated from 1 (not important) to 4 (essential). Spearman’s rank correlation coefficient was used to correlate variables, P < 0.05 as significant.

RESULTS:

160 students completed surveys. 44% (71) were male and 56% (89) female. Median age was 25 (range: 22-33) years. Medical student interest in OB/GYN positively correlated with a desire to work for social change (0.365, p < .001), expression of personal values (0.189, p=0.017), desire to work with patients of lower socioeconomic status (-0.208, p=0.008), longer patient continuity (0.265, p=0.001) and preference for younger patients (0.173, p=0.029). Higher interest in OB/GYN correlated with older age of the student (0.222, p=0.005). OB/GYN interest negatively correlated with desire for high income potential (-0.197, p=0.013).

CONCLUSION:

Interest in OB/GYN correlates with socially minded values such as working for social change, expression of personal values and working with the underserved. They preferred longer continuity of care, and working with younger patients. Larger studies are underway to determine the relative importance of these factors in students who eventually enter OB/GYN careers.
Impacts of Volunteer-Run Clinics on the Next Generation of Health Care Professionals and Their Career Preferences [30I]
Authors: O'Rourke Katherine , Kruse Carly , Landry Mary , Durand Madeline , Graziano Scott
Published: May 2017

INTRODUCTION:

Two medical schools partnered with community organizations to provide free gynecologic care to uninsured women. The clinics integrate community outreach, patient care, and a peer-teaching model. Both are volunteer-run with the mission to improve the health of underserved women in need of gynecologic care and enhance student education and career development.

METHODS:

Student volunteers completed an 18-item, open-ended survey evaluating motives for volunteering and the impact on education. Surveys were sent electronically to volunteers (n=137) with a response rate of 51%. Results were thematically coded and analyzed by two separate individuals.

RESULTS:

Students reported their motives for volunteering were to: gain experience in gynecology or women’s health (65%), learn about and contribute to underserved medicine (55%), and increase clinical experiences (36%). All students reported achieving their self-identified goals. Peer teaching provided a positive experience for 98%, with students valuing learning from upperclassmen and teaching underclassmen. Volunteering sparked, increased, or confirmed an interest in a career in obstetrics and gynecology (48%) and women’s health (11%). Volunteering also sparked, increased, or confirmed interest in a career in underserved medicine (79%) and academic medicine (41%).

CONCLUSION:

Volunteer-run clinics provide opportunities for the growth of our next generation of physicians. Through this model, medical students participate in a unique space to set and achieve career goals while simultaneously improving upon clinical skills. At Share the Health, career goals that developed or were reinforced included gynecology, women’s health, and underserved medicine. Further studies might explore if current OB/Gyn physicians had similar experiences to inform career choices.
Description of Medium- and Long-Term Complications After PCN Placement for Malignant Urinary Obstruction [1J]
Authors: Acosta-Torres Stefany , McDevitt Joseph , Zhang Ning , Xi Yin , Pillai Anil , Miller David S.
Published: May 2017

INTRODUCTION:

There is little data on medium- and long-term complications after placement of percutaneous nephrostomy tubes (PCNs) placed for malignant urinary obstruction due to gynecologic cancers and no evidence-based recommendations to guide time to PCN exchange. We sought to define the frequency and time distribution of these complications.

METHODS:

Patients with malignant urinary obstruction due to a gynecologic malignancy that underwent placement and at least one exchange of a PCN between 2011 and 2013 were reviewed. Exchanges were classified as routine (not due to a complication), or due to one of three complication types: mechanical (tube dislodgement), obstruction, or infection (i.e. pyelonephritis).

RESULTS:

Thirty-three patients with 59 exchange encounters were included. Twenty-six (79%) patients had cervical cancer. Twenty-one (36%) of exchange encounters were routine, occurring at a median of 96 days (interquartile range: 91-101 days), while 15 (25%) were due to tube obstruction, occurring at a median of 48 days (IQR: 15-59 days). Seventeen (29%) were due to infection, occurring at a median of 66 days (IQR: 38-93 days), and 6 (10%) were due to mechanical dislodgement, occurring at a median of 66 days (IQR: 52-82 days).

CONCLUSION:

Medium- and long-term complications were frequent after PCN placement for obstruction due to gynecologic malignancies, as nearly two-thirds of exchanges were due to a complication. Additionally, the median time for each complication type is nearly one month before the currently recommended scheduled routine exchange time. Further work can quantify the excess cost due to these complications and determine the most cost-effective time for routine scheduled exchanges.
Antegrade (AG) Versus Retrograde (RG) Stents for Ureteral Obstruction (UO) In Locally Advanced Cervical Cancer (CC) [3J]
Authors: Talati Asha , Sheyn David , Zakem Sarah , Zanotti Kristine
Published: May 2017

INTRODUCTION:

UO is common in patients with newly diagnosed CC. Management of UO commonly occurs with stent or nephrostomy placement (NT). The success rates for AG and RG stents amongst this group have not been reported. We sought to document performance of these procedures to inform comparative effectiveness studies.

METHODS:

Medical records of patients with locally advanced CC and UO treated at our institution between 2000 - 2009 were reviewed. Failure of a procedure was defined as worsening hydronephrosis on imaging, rising creatinine, or need for an alternate method of management.

RESULTS:

55 patients with stage IIIA-IVA CC were identified. Stages at presentation were 13% (IIIA), 60% (IIIB), and 27% (IVA). Fifty-one percent of patients presented with UO and 93% of these underwent a procedure. Fifty-four percent had attempted AG stent placement while 46% had attempt at RG stent. Thirty-eight percent of patients failed initial stent attempt: 50% failed via AG approach and 20% via RG. Amongst successful placement, mean number of follow up procedures secondary to stent failure was 3. Median stent survival was 120 days. Thirty percent of patients required long term management of UO with NT placement. Failure of UO management following NT placement was 0%.

CONCLUSION:

High short and long-term failure rates were seen with both AG and RG approaches and required multiple follow up procedures to manage UO. NT was most successful for long term management of UO. Given this, NT may be a reasonable initial management strategy for advanced stage CC with UO.
Association of Obesity With Transtheoretical Stage of Change and Self-Efficacy in Women With Endometrial Cancer [5J]
Authors: Chiu Kimberley , Nevadunsky Nicole , Van Arsdale Anne
Published: May 2017

INTRODUCTION:

Exercise and lifestyle interventions may improve health metrics and quality of life in survivors of endometrial cancer. The purpose of this study was to evaluate the association between patient characteristics and self-efficacy as well as transtheoretical stage of change for diet or exercise in an ethnic/racially diverse population of women with endometrial cancer.

METHODS:

After IRB approval, 100 survivors of endometrial cancer completed a questionnaire including demographics, disease factors and co-morbidities. Transtheoretical Stage of Change and Self-Efficacy for Diet and Exercise were assessed using the Stages of Change Measure and Five Item Self Efficacy Measure. Associations were evaluated using Krusal Wallis and ANOVA testing, performed with Stata version 13.0.

RESULTS:

Mean age of 99 responders was 69 years and BMI was 34.1 kg/m2. There was a difference in BMI between stages of transtheoretical stage of change for exercise, maintenance vs contemplation (29.2 vs 38.0, p less than 0.01) and between stage of change for diet (38.6 vs 31.4, p=0.04) . Obesity (BMI greater than 30) was associated with the action stage of change when evaluated as a categorical variable (p less than 0.01). Self-efficacy for exercise as compared to transtheoretical stage of change was of borderline significance (p=0.08), however it was not significant for diet.

CONCLUSION:

In survivors of endometrial cancer, BMI was the only clinical/pathological factor associated with transtheoretical stage of change for exercise. Patient centered diet and exercise lifestyle intervention programs may consider patient BMI, and education as well as transtheoretical stage of change and self-efficacy to improve recruitment and retention.
Adequacy of Surgical Staging for Stage I Ovarian Carcinoma in a Military Tertiary Care Facility [7J]
Authors: Sawtelle Ashley L. , Miller Caela R. , Leath Charles A. , Dengler Katherine
Published: May 2017

INTRODUCTION:

Ovarian cancer has a lifetime risk of 1 in 70 with 14,000 deaths in the United States in 2015. Surgical staging is the mainstay of ovarian cancer treatment with five-year survival for stage I ovarian cancer at 92.1% if completely staged. Our goal was to evaluate the adequacy of surgical staging in our low volume military treatment facility (MTF) to determine the need to centralize oncologic care.

METHODS:

We performed a retrospective chart review of all patients with stage I ovarian and fallopian tube cancer who received surgery at our MTF. Surgery had to include pelvic washings, lymph node sampling, peritoneal biopsy and omentectomy to be considered adequately staged. Complications, patient demographics and recurrence rates were also analyzed using chi-square analysis.

RESULTS:

Sixty two percent of patients were adequately staged. Of those that were inadequately staged, the majority had a clear reason; 31.2% were due to body habitus, 25% had borderline tumors and 12.5% had severe pelvic adhesive disease. Adequate staging increased surgery time by 50 minutes (P = .028), and had a statistically insignificant increased risk of complications. Interestingly, recurrence was more likely in those that were adequately staged (P = .02) and no patients that were inadequately staged had recurrence. Five year survival was 98%.

CONCLUSION:

Our five year survival rates are similar to other large referral centers nationwide. We postulate that our resource availability compensates for our low patient volumes, though more analysis is needed to determine exact causation.
Ovarian Cancer Risk Associated With Benign Gynecologic Conditions in African American Women [13J]
Authors: Park Hyo K. , Schildkraut Joellen M. , Cote Michele L.
Published: May 2017

INTRODUCTION:

The association between common benign gynecologic conditions and ovarian cancer remains under-studied in African Americans (AA). Therefore, we examined the association between self-reported history of benign gynecologic conditions and epithelial ovarian cancer risk in AA women.

METHODS:

Data from a large population-based, multi-center case-control study of epithelial ovarian cancer in AA women were analyzed to estimate the association between self-reported history of endometriosis, fibroid, pelvic inflammatory disease (PID), and ovarian cyst with epithelial ovarian cancer. Logistic regression models were used to calculate odds ratios (OR) and 95% confidence intervals (CI) for the associations between individual and composite gynecologic conditions and ovarian cancer.

RESULTS:

628 cases and 752 controls enrolled in the African American Cancer Epidemiology Study between December 1, 2010 and December 31, 2015 were included in the analysis. After adjusting for potential confounders, a history of endometriosis was associated with ovarian cancer (OR 1.73; 95% CI 1.06-2.81). A modest association was observed with PID (OR 1.57; 95% CI 0.98-2.51), while no association was observed in women with a history of fibroid or ovarian cyst. A positive trend was observed for an increasing number of reported gynecologic conditions (p=0.002) with consistency across histologic subtypes and among both oral contraceptive users and non-users.

CONCLUSION:

A self-reported history of endometriosis among AA women was associated with increased risk of ovarian cancer. Having multiple benign gynecologic conditions had a cumulative effect on ovarian cancer risk.
Surgical Staging of Borderline Ovarian Tumors With and Without Lymphadenectomies: A Multi-Institutional Study [14J]
Authors: Padhy Radha R.
Published: May 2017

INTRODUCTION:

In 2013, NCCN guidelines added the recommendation of lymphadenectomy on a case-by-case basis during comprehensive surgical staging of borderline ovarian tumors. In 2016, NCCN deleted comprehensive surgical staging for borderline tumors altogether. The objective of this study was to examine the recurrence rate between completely surgically staged borderline ovarian tumors with and without lymphadenectomies, and compare them to patients who were incompletely staged.

METHODS:

From 1998 to 2015, 128 borderline ovarian cancers were identified with concurrent frozen analysis and final pathologies. Fifty-nine cases (46%) underwent complete surgical staging: bilateral or unilateral salpingo-oophorectomy, omentectomy, resection of macroscopic implants, peritoneal biopsies/washings, and lymphadenectomy. Thirty-nine cases (30%) underwent complete surgical staging with all of the above performed except lymphadenectomy. The remaining 30 cases (23%) were incompletely staged. Recurrence was recorded following repeat surgical staging.

RESULTS:

Of the 59 cases that underwent complete surgical staging with lymphadenectomies (p < 0.001), 8 cases were upstaged due to positive lymph nodes. There were 5 recurrences (8.5%) in this group with only one involving positive lymph nodes. Of the 39 cases that underwent complete staging without lymphadenectomy, there was one recurrence (2.6%). The recurrence rate in the group of incompletely staged patients was higher (13.3%) with 4 recurrences.

CONCLUSION:

There was no statistically significant difference in recurrence rates whether lymphadenectomy was performed or not during the complete surgical staging procedure for borderline ovarian cancers. With lymphadenectomy now being discretionary within acceptable staging guidelines for borderline ovarian cancers, gynecologic generalists can consider complete surgical staging for such tumors when diagnosed on frozen analysis.
Evaluation of the Predictive Value of Myometrial to Endometrial Ratio in Type II Endometrial Cancer: A Case Series [16J]
Authors: Ahmed Rimsha , Estes Stephanie , Paroder Viktoriya , Frimer Marina , Kesterson Joshua , Phaeton Rebecca
Published: May 2017

INTRODUCTION:

Endometrial cancer is the most common gynecologic malignancy in the U.S., classified by two histologic subtypes. Type II endometrial cancers are known to be non-estrogen dependent, poorly-differentiated, and with worse prognosis. Diagnostic imaging includes the use of transvaginal ultrasound (TVUS). Current guidelines don’t require further endometrial sampling if ultrasonography depicts an endometrial thickness of less than 4 mm. However, ultrasound alone could miss 4% of cancer diagnoses, since it often doesn’t correlate with histologic subtypes. This study aims to assess the ratio of myometrial to endometrial thickness obtained via TVUS in Type II endometrial cancer.

METHODS:

A chart review was performed at two academic centers, to identify all cases of Type II endometrial cancer from January 2009 to December 2014. Using pre-operative TVUS images, four distinct myometrial measurements were made in the longitudinal axis. The measurements were averaged and compared to thickness of the endometrium. Patients were excluded if myometrial or intracavitary lesions were noted.

RESULTS:

Out of a total of 103 cases of Type II endometrial cancer, 30 met inclusion criteria. Mean myometrial thickness ranged from 7.75 mm to 21.25 mm and endometrial thickness ranged from 2.4 mm to 37 mm. Thickness ratio of myometrium to endometrium ranged from 0.35 to 7.21, with an average ratio of 1.45.

CONCLUSION:

Type II histologic subtype of endometrial cancer presents with varying thicknesses of the uterine layers noted on TVUS. Significant variations in sonographic characteristics may result in delayed diagnoses compared to Type I endometrial cancers. Further research will be focused on directly comparing both histologic subtypes of endometrial cancer.
Provider Follow-up of Sexual Function in a Cohort of Pelvic Cancer Patients Treated With Radiation [20J]
Authors: Dutta Sonia , Garcia Bobby , Serna-Gallegos Tasha , Lane Felicia
Published: May 2017

INTRODUCTION:

Survivorship and survival rates amongst women with pelvic cancers continues to improve. While enteritis and cystitis are known side effects of radiation, there is a lack of information regarding its effect on sexual dysfunction.

METHODS:

This was an IRB-approved study of females with a pelvic cancer who underwent radiation treatment between 2010-2015. Demographic and clinical variables, as well as radiation treatment specifics, vaginal dilator counseling and sexual function assessment, were collected through electronic medical record review. Logistic regressions were performed using SPSS Statistics software.

RESULTS:

In this convenience sample, records of 87 pelvic cancer patients were extensively reviewed (71 with gynecologic malignancy and 16 with colorectal cancer). The mean age of the cohort was 55.4 years, with mean parity of 2.6 and average BMI 27.79. Eighty five percent (74/87) of the cohort received external beam radiation and 41/87 (47%) had vaginal brachytherapy. Mean cumulative radiation dose was 63.5 gray. In this cohort, 38/87 (43.6%) had documentation of vaginal dilator counseling following treatment. This counseling was significantly associated with a prior urogynecologic diagnosis, vaginal brachytherapy and dosage of radiation. Sexual function was assessed in 20/87 patients (22.9%). Patient age, menopausal status, history of voiding complaints, use of vaginal dilators as well as post-radiation urogynecologic evaluation and vaginal estrogen use were significantly associated with sexual function evaluation by providers.

CONCLUSION:

Prevention of vaginal stenosis and assessment of sexual dysfunction following pelvic radiation is low. Increased counseling and treatment may improve our survivors’ quality of life.
The Impact of the Affordable Care Act on U.S. Maternal Mortality [21J]
Authors: Hope Shelley-Ann , Nunes Vanessa , Lambert Calvin , Miller Edward
Published: May 2017

INTRODUCTION:

Between 2013-2014 the Maternal Mortality Rate in the United States was 21-22 per 100,000 - the worst among high-income countries. The World Health Organization attributes this in part to inadequate prenatal supervision. The Affordable Care Act (ACA) was fully implemented in 2014 and has provisions to increase access to health insurance and thus prenatal care. This study aims to determine any relationship between the 2014 implementation of the ACA on prenatal care attendance and maternal mortality.

METHODS:

State-level data from the Census Bureau and CDC was used to perform a multivariate logistic regression (ANOVA) on Percentage of Mothers Receiving Prenatal Care in First Trimester and Percentage of Uninsured Patients and their relationship to maternal mortality (MM) before and after the full implementation of the ACA nationwide.

RESULTS:

2014 data demonstrates a statistically significant relationship between MM and the percentage of uninsured patients with the ACA (r= 0.33, p=0.017) not found prior to the ACA implementation (2012: r=0.33, p=0.120) and (2013: r=0.17, p=.0214). A negative correlation between prenatal care in the first trimester with MM was statistically significant in 2012 (r=-0.402, p=0.011) and 2013 (r=-0.395, p=0.009) but this was increased in 2014 with ACA(r =-0.523, p = 0.0001).

CONCLUSION:

Preliminary analysis found a negative correlation between maternal mortality and percentage of prenatal care in the first trimester, this became increasingly statistically significant in 2014 with the ACA implementation. Similarly, a positive correlation was found between maternal mortality and percentage of uninsured patients by state that became statistically significant only after 2014 with the ACA implementation.
Hematologic Malignancy Recurrence in Female Reproductive Tract Seen on Routine Gynecologic Screening [25J]
Authors: Vyas Nina , Boitano Teresa , Battiwalla Minoo , Barrett John , Stratton Pamela
Published: May 2017

INTRODUCTION:

Patients who undergo hematopoietic stem cell transplantation to treat hematologic malignancy are at risk of recurrent disease including myeloid sarcoma, an extramedullary collection of leukemic cells. Isolated extramedullary relapse after transplant in the form of a myeloid sarcoma is rare (< 1%). In women, the reproductive tract is often overlooked as a potential site of hematologic malignancy recurrence.

METHODS:

At our center, we assess women for symptoms of genital chronic graft-versus-host disease and conduct visual inspection of the lower reproductive tract, cervical cytology and human papillomavirus screening as part of post-transplant gynecology care. We present two cases of myeloid sarcoma occurring post-transplant isolated to the female reproductive tract and breast identified during routine gynecologic examination.

RESULTS:

The first case is a recurrence of mastocytosis manifesting as vaginal bleeding and cervical mass. The second is recurrent acute myeloid leukemia found in a large pelvic and bilateral breast granulocytic sarcoma.

CONCLUSION:

The sole manifestation of relapse of hematologic malignancy post-transplant may be a myeloid sarcoma in the reproductive tract or breast. Autopsies of women with acute myeloid leukemia show 36% and 40% involvement of the ovary and uterus, respectively — suggesting involvement of the female reproductive tract is more common than clinically suggested. Routine gynecologic care not only detects common post-transplant complications of human papillomavirus disease and genital graft-versus-host disease, but also is important to identify recurrent malignancy, potentially enabling earlier diagnosis and treatment.
Maternal Weight Retention Two Years After Delivery of a Baby: 2012 Los Angeles Mommy and Baby (LAMB) Follow Up Project [27J]
Authors: Sun Stacy , Chao Shin
Published: May 2017

INTRODUCTION:

Postpartum weight retention can predict future weight gain and long-term obesity. This study identifies factors associated with weight retention two years after pregnancy.

METHODS:

We analyzed data from the 2012 LAMB Follow Up project. LAMB surveys Los Angeles mothers after a live birth. LAMB Follow Up re-interviews these same mothers shortly after the baby’s second birthday. A total of 3,488 mothers completed the 2012 Follow Up (63% response rate). Women with a subsequent pregnancy after the index baby were excluded leaving a final sample size of 2,049. Weight retention was defined as any weight gain between pre-pregnancy and 2 years postpartum. Logistic regression analyses were performed to identify differences in postpartum weight retention.

RESULTS:

Two-years after delivering a baby, women weighed an average of 7 pounds more than before pregnancy. After controlling for potential confounders, Latino mothers were 1.4 times more likely to have gained weight than whites (aOR=1.4, 95% CI=1.1-1.9); teens (< 20 years old) were 2.1 times more likely to have gained weight than non-teens (aOR=2.1, 95% CI=1.4-3.1); women who did not excise in the past month were 1.7 times more likely to have gained weight than those mothers who exercised 5 or more days/per week (aOR=1.74, 95% CI=1.19-2.6). There were no associations between weight gain and breastfeeding practice or perceived accessibility of healthy food.

CONCLUSION:

Postpartum weight retention was experienced differently among subgroups. Teens and Latino women had difficulty in returning to their pre-pregnancy weight compared to their older, non-Latino counterparts. Increased physical exercise was associated with improved weight loss.
Evaluating Transfer of Certolizumab Pegol and Polyethylene Glycol into Breast Milk [28J]
Authors: Thorp John , Clowse Megan , Förger Frauke , Hwang Caroline , Dolhain Radboud J.E.M. , Hale Thomas W.
Published: May 2017

INTRODUCTION:

Breastfeeding women receiving anti-TNFs for chronic inflammatory disease face concerns surrounding their potential transfer into breast milk. CRADLE was the first sponsored study to evaluate certolizumab pegol (CZP) concentrations in breast milk and estimate CZP Average Daily Infant Dose.

METHODS:

CRADLE (NCT02154425) studied lactating mothers (≥6 weeks postpartum) receiving CZP. After ≥3 CZP doses, breast milk samples were collected across 1 dosing period (14 days for 200 mg Q2W; 28 days for 400 mg Q4W). Optimal analytical methods were developed to determine CZP and total polyethylene glycol (PEG) levels in breast milk.

RESULTS:

18 CZP-treated mothers were screened, and 17 entered the sampling period: 16 on 200 mg Q2W and 1 on 400 mg Q4W. 77/137 (56%) samples had no measurable CZP in breast milk. For 4/17 mothers, all samples were below LLQ. Estimated Average Daily Infant Dose was 0‒0.0104 mg/kg/day; median relative infant dose (RID): 0.125%. PEG was undetectable in 134/137 samples (3 had indeterminate results upon retesting). Infants of CZP-exposed mothers had a safety profile consisting of events occurring in unexposed infants of similar age.

CONCLUSION:

CZP was undetectable in 56% of breast milk samples. When detectable, CZP concentrations were < 3xLLQ (< 1% plasma concentration observed with therapeutic dose), indicating no/minimal CZP transfer from plasma to breast milk. RID was below 0.5% of maternal dose < 10% is considered unlikely to be of clinical concern. No transfer of PEG was observed. CZP absorption by infants via breast milk is unlikely, due to its low oral bioavailability and Fc-free structure. These findings are reassuring and support continuation of CZP treatment during breastfeeding.
Care-by-Parent as a Tool for Reduction in Neonatal Opioid Withdrawal Syndrome [37H]
Authors: Lawlor Megan , McQuerry Kristen , Chavan Niraj , Shook Lori , Critchfield Agatha
Published: May 2017

INTRODUCTION:

Neonatal Opioid Withdrawal Syndrome (NOWS) is a significant public health problem. Care-By-Parent (CBP) is a model for mothers to room-in with their opioid-exposed infants during inpatient observation for postnatal development of NOWS. The purpose of this study is to determine if CBP is associated with a reduction in treatment-requiring NOWS.

METHODS:

We performed a retrospective, case control study of pregnant women enrolled in a combined prenatal and medication assisted treatment (MAT) program for opioid-dependent patients. Patients stable on MAT (as indicated by appropriate urine drug screen at Labor & Delivery admission) who participated in CBP were matched by gestational age, smoking and breastfeeding status with controls also stable in the combined prenatal/MAT program. Fisher Exact Test, ANOVA and logistic regression were performed. Primary outcome was diagnosis of treatment-requiring NOWS in neonates.

RESULTS:

Forty women met inclusion criteria (20 cases, 20 controls). There were no differences in age, gravidity, parity, birth weight, Apgar scores, or buprenorphine dose (P>.05). For the primary outcome, there was a statistically significant reduction in the rate of treatment requiring NOWS among cases vs controls (OR 0.08 95% CI 0.01-0.71). Significant difference was noted in patient time in program (cases vs controls, 19 vs 14 weeks, P=0.02) however, logistic regression demonstrated that the time in program did not affect the rate of NOWS (OR 0.99 95% CI 0.88-1.12).

CONCLUSION:

CBP significantly reduces the rate of treatment requiring NOWS. This approach decreases NICU admissions, increases maternal-child bonding and has the potential for alleviating maternal substance abuse patterns.
Epidemiological Surveillance of Teen Birth Rates in the United States 2006-2012 [19A]
Authors: Amin Raid , DeCesare Julie , Roussos-Ross Dikea
Published: May 2017

INTRODUCTION:

To investigate the geographical variation in the average teen birth rates by county between 2006 and 2012 in the contiguous US.

METHODS:

SaTScan™, a software for disease surveillance and spatial cluster analysis was used to evaluate the spatial variation in teen birth rates and identify clusters with elevated relative risk. The analyses were first completed using unadjusted teen birth data. The data was then adjusted for percent poverty and percent high school diploma.

RESULTS:

The southern half of the US harbored most of the teen birth clusters in the unadjusted data set, and represented seven of the top ten cluster areas. When adjusting for poverty and high school diploma rate, the south still was the most represented geographical area, harboring four of the top ten clusters.

CONCLUSION:

Despite an overall national decline in the teen birth rate, clusters of elevated teen birth rates remain. These clusters are not random, and remain higher than expected when adjusted for poverty and education. This data set will provide a framework to focus targeted intervention implementation in order to reduce teen birth rates in this high risk population.
Can the Acting Intern Elective for 4th Year Students Teach and Assess APGO/CREOG Obstetric Competencies? [40C]
Authors: Garrison Etoi , Ruth Charles , Fambrough Jada , Mason Leilani , New Melinda , Goldberg Mack , Dewey Charlene M.
Published: May 2017

INTRODUCTION:

The acting internship (AI) in Obstetrics provides 4th year medical students with progressive independence. Student learning is often self-directed and can be influenced by faculty teaching and patient volume. The purpose of this study is to determine if the AI elective enables students to manage an intern-level patient census and if the course is successful at teaching and assessing milestone level l APGO/CREOG preparation for residency competencies.

METHODS:

One AI student/month was enrolled during 4 consecutive months in the 2015-2016 academic year. The hospital database was retrospectively reviewed to identify all OB patient notes electronically linked to the AI students (n=4) and interns during the study period. All student notes (n=245) and formal assessments by faculty were reviewed.

RESULTS:

1485 patients were admitted during the 4 month study period. There were no statistically significant differences in the number of progress notes and vaginal deliveries attended by the AIs and interns (P>0.05). The AI students entered fewer discharge summaries, H&Ps, and patient care orders compared to the interns (P<0.05). Students were exposed to 6 of 10 APGO/CREOG procedural objectives and 8 of 12 APGO/CREOG knowledge objectives in OB. Limited objective information however, regarding student knowledge and procedural skills, could be obtained to support entry level mastery of these competencies.

CONCLUSION:

The traditional AI offered students sufficient procedural volume however documentation of OB knowledge and procedural competency was limited. Future studies will determine if the addition of formal curricula to teach APGO/CREOG entry level competencies improve knowledge and procedural skill.
Contraception Use in Reproductive-Age Women Taking Warfarin: A Retrospective Chart Review [40L]
Authors: Webster Carolyn , Morse Jessica E. , Bhatti Khadijah
Published: May 2017

INTRODUCTION:

Reproductive-age women using oral anticoagulation have unique contraceptive and gynecologic needs due to teratogenic and bleeding risks.

METHODS:

This is a retrospective chart review of reproductive-age women taking warfarin in a university outpatient setting. Electronic medical record (EMR) query identified 18-44 year-old women who were prescribed warfarin and seen in a University of North Carolina primary care clinic during the 18-month study period. Outcome data were obtained by EMR query and chart review. The primary outcome was documented contraceptive method; secondary outcomes were gynecologic referral and method provision, adverse bleeding events, and unintended pregnancies. Primary analysis was descriptive; chi-square was employed for secondary analysis.

RESULTS:

Fifty-six women met inclusion criteria, yielding 65 separate patient-courses of warfarin. Contraceptive method was documented in 83%; the most common being intrauterine devices (30%) and abstinence (24%). Contraceptive method was documented in only 19% of initial primary care visits after warfarin initiation. For those without active gynecologic care, 38% (23/61) were referred to an obstetrician/gynecologist; 74% attended these consultations. Fourteen additional patients self-referred. Among women who attended general gynecologic consultation, 52% left with Tier 1 methods. Gynecologic consultation was associated with greater use of more effective contraception (p=0.002). Three adverse bleeding events and one unintended pregnancy were encountered.

CONCLUSION:

Many reproductive-age women taking warfarin are not using effective contraception, leaving them susceptible to complicated pregnancies. Gynecologic consultation is associated with greater use of effective contraception in this population. Providers should be cognizant of these unmet needs, and systems established to supply necessary contraceptive counseling and provision.
Outcome Comparison Between Obese and Nonobese Patients With Singleton Gestations Following Cerclage Placement [38F]
Authors: Rodriguez Phillip Andres , Patwardhan Sanjay , Ebeling Myla , Sullivan Scott , Vessa Blake
Published: May 2017

INTRODUCTION:

Cervical cerclage is an established treatment in preventing preterm birth, however, there are little data regarding the effect of obesity on cerclage efficacy. The primary purpose of this study was to identify the effect of obesity on preterm birth prevention in patients undergoing cerclage placement.

METHODS:

A retrospective cohort study was performed at a single teaching institute and included all singleton pregnancies that underwent McDonald cerclage placement between 2006 and 2014. The study group consisted of patients with a body mass index (BMI) greater than or equal to 30 kg/m2 and was stratified into obesity classes based on World Health Organization (WHO) criteria. The control group consisted of patients with a BMI less than 30 kg/m2. Additional variables included maternal demographics, progesterone use, cerclage indication, and maternal co-morbidities (hypertension, smoking, history of preterm birth and diabetes).

RESULTS:

326 deliveries were included. There was a statistically significant latency between non-obese and class III obesity in reaching 30 weeks gestation (70% vs 55%, P = .0477). There was no difference in delivery less than 37 weeks and no difference in neonatal outcomes (Apgar scores, intubation, ICU admission, interventricular hemorrhage). There was a significant increase of chorioamnionitis in class III obesity (47% vs 14%, P < .005). A non-significant increase in the rate of preterm premature rupture of membranes (PPROM) with increasing BMI class was observed.

CONCLUSION:

In patient’s undergoing cerclage placement, class III obesity appears to increase the risk of earlier preterm birth as well as antenatal maternal complications (PPROM and chorioamnionitis) however this had no impact on neonatal outcomes.
A Targeted Postpartum CBC Protocol for Uncomplicated Vaginal Deliveries [40H]
Authors: Ton Jessica , Waitner Matthew , Sheth Sheetal
Published: May 2017

INTRODUCTION:

Prior to our study, a complete blood count (CBC) was collected on all delivered patients on postpartum day one, regardless of risk factor or mode of delivery. While a routine CBC may detect asymptomatic anemia, this practice is costly and inconvenient to patients without significant benefit. We established a targeted postpartum CBC protocol, which exempts patients with uncomplicated vaginal deliveries from a routine CBC.

METHODS:

The protocol was instituted for 30 days. Patients who had uncomplicated vaginal deliveries had only a CBC collected on admission. Patients who met the following criteria had a routine CBC drawn on postpartum day one: cesarean delivery; operative vaginal delivery; postpartum hemorrhage (estimated blood loss. 500 mL for vaginal delivery); admission hematocrit, 35 g/dL; chorioamnionitis; and preeclampsia; signs or symptoms of anemia.

RESULTS:

In 30 days, our institution had 226 deliveries. Using the aforementioned criteria, 113 patients were exempt from a routine postpartum CBC, demonstrating a 50% reduction in postpartum blood draws. Those with a hematocrit between 30 and 35 on admission were started on iron empirically. Of patients who were exempt from a postpartum CBC, none experienced signs or symptoms requiring a CBC, and none required blood transfusion or iron therapy. At our institution a CBC costs $117. Estimated cost savings per month is approximately $13,000/month, or almost $160,000/year.

CONCLUSION:

A targeted postpartum CBC protocol is an effective quality improvement measure that benefits patients and significantly lowers cost without proven additional risk.