bluuebunny/crossref_metadata_2025 huggingface dataset:
Elagolix With Add-Back Therapy Improves Hemoglobin Concentration in Women With Fibroid-Associated Heavy Menstrual Bleeding Across Subgroups: Post Hoc Analysis of Elaris UF-1 and UF-2 [ID: 1368060]
Authors: Schlaff William , Jewell Susan , Kho Andrea , Snabes Michael , Uribe Liz
Published: May 2023

INTRODUCTION:

Premenopausal patients with fibroid-associated heavy menstrual bleeding often experience anemia-related symptoms and reduced quality of life. Here, we report the effect of elagolix with estradiol/norethindrone acetate add-back therapy (ELA+AB) on hemoglobin (Hgb) concentration across subpopulations of patients at 6 months of treatment.

METHODS:

This post hoc analysis from duplicate, IRB-approved, randomized, double-blind, placebo-controlled, 6-month phase 3 Elaris UF-1/UF-2 studies (NCT02654054/NCT02691494) evaluated Hgb improvement from baseline to 6 months of therapy by change in Hgb concentration and proportion of patients who achieved greater than 1 and greater than 2 g/dL improvement by subgroups (race, age, primary International Federation of Gynecology and Obstetrics [FIGO] score, and baseline menstrual blood loss volume) in prespecified anemic subpopulations (baseline Hgb≤10.5 and 10.5 to ≤12 g/dL).

RESULTS:

Overall, baseline demographics and clinical characteristics were balanced between groups. Regardless of subgroup, patients with mean baseline Hgb less than 10.5 g/dL receiving ELA+AB experienced significant improvements in mean Hgb concentration at 6 months, compared with placebo (P<.001; no adjustment for multiple comparisons were made). These patients had a mean Hgb concentration of 11.6 g/dL at 6 months, with a range of 11.3–12.3 g/dL depending on subgroup. At 6 months, 47% of these patients had an increase of greater than 2 g/dL with a range of 41–59% depending on subgroup.

CONCLUSION:

ELA+AB was effective in improving Hgb concentration across subgroups of premenopausal women with uterine fibroids and anemia (Hgb <10.5 g/dL), regardless of baseline demographics or clinical characteristics, which may therefore alleviate symptoms and reduce complications of anemia.
Sarcopenia in Perimenopausal and Postmenopausal Women in a Tropical Country [ID: 1377057]
Authors: Agarwal Anjoo , Asnani Mona , Singh Renu , Sridhar Aparna
Published: May 2023

INTRODUCTION:

Improving health services worldwide has led to a gradually aging population. Sarcopenia has been identified as an important contributor to health costs in elderly women in developed countries. The lifestyle and access to medical services is vastly different in the developing countries like India. The present research was conducted to study the status of sarcopenia among perimenopausal and postmenopausal women of India.

METHODS:

Institutional review board approval for the study was obtained from institutional ethical committee. Women aged 40 years or more, having no complaints, and coming to hospital as companions were enrolled after taking consent. A detailed history was taken and activity levels were classified according to the ICATUS 2016 (International Classification for Time-Use Statistics). Muscle strength was evaluated by handgrip strength, gait speed, and appendicular skeletal mass measurement. Serum estradiol, vitamin D3, fasting plasma glucose, and fasting insulin levels were also assessed.

RESULTS:

A total of 50 women were enrolled. 80% (n=40) of women had a sedentary lifestyle while the remaining reported light activity. Sarcopenia was noted in 16% (n=8) and showed a significant association with increasing age (P<.001). None of the women less than 62 years of age had sarcopenia. All women with sarcopenia had a sedentary lifestyle. Women with low body mass index were more likely to have sarcopenia. Low serum estradiol and serum vitamin D3 levels were significantly correlated to sarcopenia (P<.001).

CONCLUSION:

Sarcopenia is an emerging problem. Counseling of women for good nutrition and an active lifestyle can help prevent or delay the onset of sarcopenia. Poor nutrition status of women in developing countries needs to be addressed to combat the problem.
Application of British Criteria for Evaluation of Pregnancies of Unknown Location [ID: 1381226]
Authors: Zhou Linlin
Published: May 2023

INTRODUCTION:

In the United States, it is recommended that pregnancies of unknown location (PUL) are evaluated with serial β-hCG levels until undetectable or location identified. In Britain, a declining β-hCG level of greater than 50% is considered low risk for ectopic pregnancy, and serial β-hCG measurements are stopped. We sought to investigate the effectiveness of British criteria in excluding ectopic gestation in the management of PUL in an urban U.S. population.

METHODS:

Retrospective study, collection, and statistical analysis of key data points in all patients seen at Jamaica Hospital Medical Center over a 3-year period between January 1, 2019 and December 31, 2021, with PUL were performed.

RESULTS:

Of 260 patients evaluated for PUL, 52 (20%) were ultimately diagnosed with ectopic pregnancies, 72% (28%) with intrauterine pregnancies, and 136 (52%) with spontaneous or missed abortions. A greater than 50% decrease in β-hCG was identified in 62 (24%) patients and was significantly associated with nonectopic gestation (P<.001). Of these patients, only one patient (1.6%) had an ectopic gestation. The β-hCG of the patient with ectopic declined from 649 to 240 in the first 48 hours, and then rose to 546 at 96 hours. A presumptive diagnosis of ectopic was made, for which methotrexate was administered.

CONCLUSION:

Retrospective application of British criteria for PUL successfully predicted greater than 98% of patients with low-risk gestation. Using this criterion would have resulted in 19% fewer visits and 19.9% fewer β-hCG levels drawn. However, one presumptive ectopic was missed. Public health guidelines must balance cost and safety criteria. Larger prospective studies with built-in safety mechanisms and strictly defined outcome criteria are needed to better characterize the safety profile and potential cost savings of the application of the British guidelines for PUL to a U.S. population.
Evaluation of Vaginal Microbiome to Estimate Vaginal Health in Gynecology Patients Presenting With Vaginitis [ID: 1381290]
Authors: Johnson Sarah , Carroll Lisa , Ivan Nicole , Ray Margaret
Published: May 2023

INTRODUCTION:

Approximately 50% of vaginitis cases are misdiagnosed because of human error with the current diagnostic method of light microscopy wet mount. Untreated vaginitis may lead to complications of increased risk of sexually transmitted infections or preterm birth. Use of artificial intelligence (AI) and immunofluorescence scanning microscopy can aid in determining the health of the vaginal microbiome.

METHODS:

Institutional review board approval was obtained for the study. Participants who fit the inclusion and exclusion criteria were consented for participation. Patient demographic information was de-identified and recorded. Three swabs from each patient were collected: one for traditional wet-mount diagnosis, and two for DayZ Vaginal Health Assessment Assay analysis. The targets of interest recorded were clue cells, yeast pseudohyphae, and trichomonads. The evaluation compared wet-mount findings to the automated AI algorithm results.

RESULTS:

In preliminary data analysis of 58 patient samples, AI had an accuracy of 95% in finding trichomonads, 91% in candida, and 90% in clue cells. The AI detected trichomonads on one sample that was missed by the expert reader, detected pseudohyphae on three samples that were undetected by the expert reader, and detected clue cells in 17 samples that were undetected by the expert reader. These data are preliminary as the sample collection and data analysis are ongoing.

CONCLUSION:

The assay has shown superior ability to diagnose wet-prep findings compared to standard wet-mount evaluation. This new technology could provide a reliable source to determine a quick and accurate diagnosis for patients with symptomatic or asymptomatic vaginitis.
Survival Outcomes of Kidney Transplantation Among Women of Reproductive Age in the United States [ID: 1373252]
Authors: Akinyemi Oluwasegun , Guoyang Luo , Lipscombe Christina , Ogundipe Temitayo , Weldeslase Terhas Asfiha
Published: May 2023

INTRODUCTION:

Adult kidney transplantation in the United States has steadily increased over the years. In 2018, there were 678 kidney recipients per million people, representing a 40% growth since 2008. Different studies have shown disparities in the rate and outcomes of kidney transplantation in the United States. However, few have explored how the social determinants of health influence the outcomes of kidney transplantation among women of reproductive age. This group needs to be studied separately as factors like sexuality, contraception, and pregnancy can complicate outcomes after transplantation.

METHODS:

We utilized data from the United Network for Organ Sharing (UNOS 1987–2022) database to explore outcomes of renal transplantation among women of the reproductive-aged group (15–49 years). The outcome measures include graft survival and overall patient survival. In addition, we compared outcomes among women and men across different age groups. In the multivariate analysis, we adjusted for the patient’s body mass index, donor’s age, sex, body mass index, preexisting comorbidities such as hypertension and diabetes, and ABO group.

RESULTS:

Among the 521,797 kidney transplant recipients in the United States kidney records in the study period, 282,253 were women. Among these female kidney recipients, 6,680 (3.2%) were aged less than 15 years, 101,908 (49.4%) were between 15 and 49 years, and the remaining 97,723 (47.4%) were above the age of 50 years. The 5- and 10-year survival according to age group was less than 15 years (78.5%, 60.4%), 15–49 years (74.7%, 55.5%), and 50 years or older (74.8%, 49.8%). Across the different age groups, outcomes were better in women than men. The table shows the influence of race and ethnicity, insurance type, and education level on graft and overall patient survival.

CONCLUSION:

Women kidney recipients have better outcomes compared to men. Increasing education level and race and ethnicity are significant drivers of outcomes among women renal transplant recipients in the reproductive-aged group.
Effect of Social Determinants of Health on Advanced Stage Type 2 Endometrial Cancer at Time of Diagnosis [ID: 1376689]
Authors: Blustein Pegah , Dillon Kayla , Pereira Elena , Villella Jeannine , Werner Sarah
Published: May 2023

INTRODUCTION:

Type 2 endometrial cancer (T2EC) accounts for 38.7% of all endometrial cancers but is responsible for 74.6% of endometrial cancer deaths. This is potentially due to advanced stage at time of diagnosis. We examine whether social determinants of health are predictors associated with T2EC diagnosed at an advanced stage.

METHODS:

Retrospective analysis of T2EC cases was performed from May 1, 2015, to March 31, 2022, at one academic site. The primary outcome was advanced stage at time of surgical diagnosis, defined as FIGO stages 3 or 4. Patient age, ethnicity, race (White versus non-White), obesity, and diabetes were evaluated. Multivariate logistic regression model was used to investigate predictors associated with increased risk of advanced-stage disease (ASD), with two-sided P value of <.05 considered significant.

RESULTS:

A total of 72 patients with T2EC were identified. Thirty-eight (52.7%) cases had early-stage disease and 34 (47.3%) cases had ASD at diagnosis. Ethnicity was the only predictor significantly associated with the primary outcome. Hispanic or Latina ethnicity was associated with 5 times higher odds (odds ratio 5.1, 95% CI 1.2–21.6, P=.028) of ASD at diagnosis, compared to non-Hispanic or Latina.

CONCLUSION:

Our results show that Hispanic or Latina ethnicity was significantly associated with advanced stage at diagnosis. Non-White race, obesity, diabetes, and age at surgery were not found to be predictors significantly associated with the primary outcome. This could be due to sample size limitations. To facilitate health equity, there is continued need for investigation into the effect of social determinants of health on ASD for T2EC.
Racial Disparities in Vaginal Hysterectomy Postoperative Outcomes: Trends Using the NSQIP Database [ID: 1377940]
Authors: Gragas Anna , Abella Maveric , Casil Paige , Cochrane Brooklyn , Collins Robert , Stafford Michelle
Published: May 2023

INTRODUCTION:

Vaginal hysterectomies (VHs) are associated with superior outcomes in operative time, postoperative complications (PCs), and recovery, and thus VH is often the preferred approach whenever feasible. Racial disparities have previously been described for abdominal and laparoscopic hysterectomies, but not for the vaginal approach. The purpose of this study was to disaggregate racial data and evaluate variation in VH surgical outcomes by race.

METHODS:

The National Surgical Quality Improvement Program was queried to identify all VHs from 2011 to 2020 in the National Surgical Quality Improvement Project (n=59,469). Multivariable regression models were used to investigate the effect of race on 30-day PCs and same-day discharge (SDD).

RESULTS:

Compared to non-Hispanic White patients and other minority groups, American Indians and Alaskan Natives (AI/AN) had 2.6% higher odds of PC (adjusted odds ratio [AOR] 1.026, 95% CI 1.002–1.050) and 6.2% lower odds of SDD (AOR 0.938, 95% CI 0.911–0.965). Non-Hispanic Black patients had 1.1% higher odds of PC (AOR 1.011, 95% CI 1.003–1.020). Paradoxically, Native Hawaiian and Pacific Islander (NH/PI), Asian, and Hispanic patients had 30.9%, 18.7%, and 3.3% higher odds of SDD, respectively, without statistically significant increased odds of PC.

CONCLUSION:

AI/AN and Black patients were more likely to have a PC, while NH/PI, Asian, and Hispanic patients were more likely to have SDD without significantly higher odds of PC. Given these findings, it may be reasonable to encourage the VH approach especially in the NH/PI, Asian, and Hispanic patient populations.
Association Between ACEs and Postoperative Pain After Gynecologic Surgery [ID: 1377683]
Authors: LaPorte Amanda , Gnade Colette , Owusu Raiven , Patanwala Insiyyah
Published: May 2023

INTRODUCTION:

Adverse childhood experiences (ACEs) are instances of abuse or household dysfunction that occur prior to 18 years of age. Numerous studies have demonstrated an increased risk of morbidity and mortality with increasing ACE scores. An association between ACEs and chronic pelvic pain has also been described; however, data for acute pain are lacking. This study evaluates the relationship between ACEs and acute postoperative pain after benign minimally invasive hysterectomies.

METHODS:

Institutional review board approval was obtained at a large academic health center. Consenting participants completed the ACEs survey prior to hysterectomy. Patient data were collected by retrospective chart review, including postoperative care unit pain scores. Descriptive statistics, Kruskal-Wallis tests, and Spearman’s correlation coefficients were utilized for analysis. Enrollment is ongoing with a recruitment goal of 112 participants.

RESULTS:

Preliminary analysis included 47 participants. Average patient age was 39.2±11.4 years. The average ACE score was 3.5±2.9 and 46.8% of participants had high ACE scores, defined as 4 or more. Although not statistically significant, patients with high ACE scores trended towards higher pain scores and morphine milligram equivalents (MME) usage. Maximum pain scores and required MME were 5.86 and 16.50 MME in the high-ACE group versus 4.88 and 7.50 MME in the low-ACE group, respectively (P=.41, P=.40).

CONCLUSION:

High ACE scores are greater than threefold more prevalent in our surgical study population compared to previously reported general population rates. Although preliminary data suggest ACE scores and postoperative pain are not associated, further data are needed.
Abortion on TikTok Versus YouTube: An Analysis of Abortion Stance and Purpose [ID: 1365895]
Authors: Bringley Johanna , Dobrowolski Ciara , Springer-Miller Ryan
Published: May 2023

INTRODUCTION:

Social media platforms are an accessible way for individuals to consume medical information. The topic of abortion is undergoing extensive discussion, and there is increasing need to understand the information available to the public. We aimed to assess whether the social media video platform affected abortion content stance and purpose.

METHODS:

We performed a cross-sectional study of abortion content on TikTok and YouTube. We searched the term “abortion” on each platform and reviewed the first 155 videos. Videos were categorized by purpose, abortion stance, and medical misinformation. We calculated descriptive statistics and used χ2 testing to compare between groups. The Albany Medical Center IRB determined this study was exempt.

RESULTS:

Of 310 videos, 280 were included for analysis with 137 YouTube videos and 143 TikTok videos. YouTube is more likely than TikTok to have anti-abortion content (19.71% versus 7.69%, P=.003) and strongly anti-abortion content (15.33% versus 4.20%, P=.002). YouTube is more likely than TikTok to have content categorized as news (33.58% versus 0.70%, P<.001) and less likely to have personal experience content (14.6% versus 41.26%, P<.001). The platforms were similar in their content containing medical misinformation (10.14% on YouTube versus 5.44% on TikTok, P=.137).

CONCLUSION:

There are significant differences in abortion content available for public consumption on popular social media video platforms. Understanding these differences can help us recognize content biases outside the clinical setting, facilitate creation of medically accurate and patient friendly content, and spur future work on medical misinformation and changes in social media over time.
Does Proposed Anti-Abortion Legislation Affect Access to Abortion Care? A State-by-State Comparison [ID: 1371679]
Authors: Elwood Adam , Sauer Mark
Published: May 2023

INTRODUCTION:

Concerns over unhindered access to abortion have heightened because of newly proposed state legislation designed to restrict care in the United States. This study examines the effect of such measures on abortion access within each state prior to the 2022 Dobbs v Jackson ruling.

METHODS:

Proposed anti-abortion measures from 2015 to 2019 were collected from Guttmacher Institute databases, and sorted by state and legislative progress. Rates of abortions during that period were collected from Centers for Disease Control Vital Statistics reports, and similarly sorted by state. Basic statistical analyses were used to compare data.

RESULTS:

The average ratio of introduced to enacted anti-abortion legislation in the United States was 0.176, with North Dakota having the highest ratio of 1. Average overall abortion rates did not significantly change during this time (9.70 versus 9.44 per 1,000, P=.79). However, the correlation coefficient of state data comparing enacted legislation to overall abortion rates grew in magnitude from −0.189 in 2015 to −0.350 in 2019. The overall percent change in abortion rate per enacted legislation was −0.0089%, with Washington, DC, having the largest at −0.14%.

CONCLUSION:

Prior to the overturning of Roe v Wade, most state-introduced anti-abortion bills failed to be enacted into law. However, in states legislating restriction, women were disproportionately affected by lack of access to abortion locally. Patients and physicians alike should remain vigilant to the danger posed by anti-abortion legislation that would further hinder access to the reproductive health care of women.
Advanced Cervical Neoplasia Rates in Young Service Members: Implications of Primary HPV Screening for Military Readiness [ID: 1380248]
Authors: Crum Madison , Gregg Rebecca , Keyser Erin , Miller Caela , Watkin Rachel
Published: May 2023

INTRODUCTION:

The new American Cancer Society (ACS) cervical cancer screening guidelines dissuade cervical cancer screening in women younger than 25, and may become universal national screening guidelines. We queried the incidence of advanced cervical dysplasia and carcinoma in military service members to determine the readiness implications of these recommendations.

METHODS:

A retrospective cohort study using the Military Health System (MHS) Data Repository and Management Analysis and Reporting Tool (MDR/M2) was performed to identify active-duty patients aged 21–25 diagnosed with cervical dysplasia and cancer across all military treatment facilities (MTFs) from January 1, 2017 to December 31, 2021. Additionally, patient age, human papillomavirus (HPV) infection status, and treatment type were collected.

RESULTS:

Only active-duty patients treated in a MTF fulfilling the above criteria were captured. In the 5 years of data collection, there were 955 active-duty women who met the inclusion criteria. Moderate to severe cervical dysplasia accounted for 62.3%, while carcinoma in situ and cervical cancer accounted for 35.6%, and 2.1%, respectively. The majority of patients did not have HPV testing or vaccination status encoded; therefore, this endpoint was eliminated from analysis.

CONCLUSION:

There are a militarily significant number of cases of advanced cervical lesions among young service members. If the new ACS guidelines are adopted, service members with treatable precancerous conditions will evade or delay detection, resulting in cancers that compromise readiness, increase cost, and compromise the health of military women. Mandatory HPV vaccination should be considered if ACS guidelines are adopted.
Chance of Pregnancy Not Decreased With Increasing Time Duration Between Ultrasound and Trigger Shot in Insemination Cycles [ID: 1368364]
Authors: Ravipati Vaishnavi , Hurley Emily , Sax Megan , Starostanko Andrea
Published: May 2023

INTRODUCTION:

Follicle growth is often estimated during intrauterine insemination (IUI) ultrasounds in order to benefit the patient financially and decrease the number of appointments. There is a paucity of research evaluating the risks of increasing time duration between last ultrasound and ovulation induction. We sought to explore this research question further using clinical pregnancy rate as the primary outcome.

METHODS:

A retrospective cohort study was performed utilizing the UCHealth Center for Reproductive Health IUI database (November 2021 to June 2022). Patient population includes women with history of polycystic ovarian syndrome and infertility. The main variable evaluated was the interval time (day[s]) between the final ultrasound of the ovulation induction cycle and the date of trigger shot. Primary outcome measured is clinical pregnancy rate (CPR). Chi-square analysis was used to determine a significant relationship between the data sets.

RESULTS:

A total of 324 cycles were included. There was a statistical difference in CPR (12.77% versus 34%, P=.000) when comparing the interval of less than 3 days versus greater than 3 days, respectively. There was also a statistical difference in CPR (10.99% versus 23.31%, P=.003) when comparing the interval of less than 2 days versus greater than 2 days, respectively.

CONCLUSION:

Increasing time between the final ultrasound date and the date of trigger shot does not decrease the rate of clinical pregnancy. Further research should be done, incorporating a larger sample size and increasing population diversity.
Evaluation of Perioperative Factors Influencing Vaginal Cuff Dehiscence After Minimally Invasive Hysterectomy [ID: 1372339]
Authors: Brescia Sara , Davitt Katlin , Galaviz Veronica , Gibbs Jennifer , Khan Sameer , Paolillo Salvatore
Published: May 2023

INTRODUCTION:

Vaginal cuff dehiscence (VCD) is one of the few surgical complications identified more commonly in minimally invasive hysterectomies (MIHs) versus open hysterectomies. The objective of this study is to determine perioperative risk factors that contribute to the development of VCD in patients undergoing MIH.

METHODS:

From 2016 to 2022, a multicenter retrospective analysis of patients undergoing MIH was conducted. Patient characteristics, preexisting conditions, surgical history, intraoperative factors, and type of MIH were evaluated to determine factors contributing to the development of VCD.

RESULTS:

One thousand one hundred eighty-nine patients underwent MIH. Only 10 (0.8%) patients developed VCD. There was no significant difference in mean body mass index, postoperative length of stay, or estimated blood loss between those with VCD versus those without. Incidence of VCD was highest in total laparoscopic hysterectomy versus all other MIH modalities (P=.002). There were no cases of VCD in laparoscopic-assisted vaginal hysterectomy. No patients with endometriosis experienced VCD, and there was no difference in the incidence in patients with cancer versus benign conditions (1.3% versus 0.8%, P=.488, odds ratio [OR] 1.29, 95% CI 0.68–8.23). Personal history of diabetes, hypertension, cesarean delivery, prior laparoscopy, prior laparotomy, or smoking did not affect the incidence of VCD (P>.05) as well as insurance status and race (P=.728 and P=.775, respectively). Patients who developed deep surgical site infections (SSIs) had significant increase in VCD (10.0% versus 2.3%, P=.006, OR 4.79, 95% CI 0.587–33.22).

CONCLUSION:

We observed that mode of MIH and SSI were perioperative risk factors that contribute to the development of VCD. What is notable is that demographics and medical comorbidities did not affect the incidence of VCD.
Evaluation of Perioperative Factors Contributing to Organ Space Surgical Site Infection After Minimally Invasive Hysterectomy [ID: 1374862]
Authors: Davitt Katlin , Brescia Sara , Gibbs Jennifer , Khan Sameer , Krickellas Joan , Paolillo Salvatore
Published: May 2023

INTRODUCTION:

Postoperative organ space surgical site infection (oSSI), commonly referred to as pelvic abscess, is a clinically impactful complication after hysterectomy. Although more common in open hysterectomies, oSSIs occur in minimally invasive hysterectomy (MIH), contributing to morbidity. In the current study, we evaluate perioperative factors contributing to development of oSSIs in patients undergoing MIH.

METHODS:

From 2016 to 2022, a multicenter retrospective analysis of patients undergoing MIH was conducted. Patient characteristics, preexisting conditions, surgical history, intraoperative factors, and type of MIH were evaluated to determine factors contributing to the development of oSSI.

RESULTS:

One thousand one hundred eighty-nine patients underwent MIH. 28 patient (2.4%) developed oSSI. There was no difference in age or body mass index between groups (P>.05) and no difference in the incidence of oSSI based on type of MIH (P=.832). Patients with endometriosis were more likely to develop oSSI (4.9% versus 2.0%, P=.045, odds ratio [OR] 2.49, 95% CI 1.98–6.25). A diagnosis of cancer did not affect oSSI (3.9% versus 2.1%, P=.162, OR 1.90, 95% CI 0.76–4.78). History of diabetes, hypertension, cesarean delivery, prior laparoscopy, prior laparotomy, smoking, or obesity did not affect the incidence of oSSI (P<.05). Patients developing oSSI had a greater mean intraoperative estimated blood loss (EBL) (233.55 cc versus 94.3 cc, P<.001), greater mean length of stay (LOS) (2.4 versus 0.9 days, P<.001), higher incidence of post-operative ileus (15.8% versus 0.7%, P<.001) and blood transfusion (34.6% versus 1.0%, P<.001).

CONCLUSION:

Development of oSSI is associated with preexisting endometriosis and greater intraoperative EBL. Development of oSSI was associated with greater LOS, postoperative ileus, and blood transfusions. Attention to hemostasis may reduce rates of oSSI.
In-Person Versus Virtual Instruction and Simulation for Unplanned Out-of-Hospital Births [ID: 1371433]
Authors: Stansbury Nicholas , Page-Ramsey Sarah , Schenken Claire , Schenken Robert
Published: May 2023

INTRODUCTION:

Unplanned out-of-hospital births are uncommon and associated with serious complications. Most emergency medical services (EMS) personnel receive little or no instruction on emergent vaginal delivery. Our in-person (IP) lecture and simulation training on emergent vaginal delivery for EMS personnel previously demonstrated improvement in knowledge and confidence. With COVID-19 we adapted the same curriculum into a virtual training session (VTS). In-person simulation increases confidence and knowledge, but less is known about virtual simulation training. The purpose of this study was to assess EMS personnel’s knowledge and confidence after IP versus VTS in emergent vaginal delivery.

METHODS:

The IP and VTS participants received the same lecture on emergent delivery either in-person or virtually. The IP group received in-person simulation training using a birth simulator. The VTS group received simulation training via virtual demonstration on the same model. Participants completed pretraining and posttraining surveys to assess knowledge and confidence. Responses were analyzed and compared using Student’s t test.

RESULTS:

Ninety-eight participants (59 IP, 39 VTS) participated with 100% survey completion. Pretraining knowledge scores were similar (IP 45% versus VTS 37%, P=.22). Although both groups showed improvement, the IP group had significantly higher posttraining knowledge scores (IP 99% versus VTS 75%, P<.01). More IP participants reported confidence in performing emergent delivery after training (IP 100% versus VTS 51%, P<.01).

CONCLUSION:

Live in-person instruction and simulation training of emergent vaginal delivery among EMS personnel results in higher knowledge scores and confidence when compared to virtual instruction and simulation training. Further evaluation is needed to determine generalizability to other learner groups.
No Transfer of Merotocin (FE 202767) to Breast Milk in Postpartum Women: A Novel Short-Acting Oxytocin Receptor Agonist for the Induction and Support of Lactation [ID: 1370662]
Authors: Hale Thomas , Bagger Yu , Baker Teresa , Holmqvist Carina , Jonker Daniel , Urban Lorien
Published: May 2023

INTRODUCTION:

Establishing lactation after preterm birth is challenging, and there are no approved therapies. Merotocin (FE 202767) is a potent, short-acting, selective oxytocin-receptor agonist in clinical development for induction and support of lactation. This phase 1, open-label, parallel-group study of early postpartum women and women with established lactation investigated possible transfer of merotocin from plasma to breast milk.

METHODS:

Merotocin was administered as a single 90-minute intravenous (IV) infusion mimicking the intranasal pharmacokinetic profile. In part A, 12 early postpartum women received doses of 5 micrograms (n=6) or 20 micrograms (n=6) merotocin within 4 days of delivery. In part B, 6 women with established lactation received 20 micrograms of merotocin. The total amount of merotocin excreted in breast milk was determined, as well as the presence of metabolites of merotocin in breast milk, and adverse events. The IV route was chosen to minimize the variability in bioavailability often observed with nasal sprays. Institutional review board approval was obtained for the study.

RESULTS:

In all women (mean age, 26.3 years; 83.3% Caucasian) and at all time points, merotocin in breast milk was below the limit of quantification (25 pg/mL). Merotocin metabolites were not detected in any milk samples. Sixteen treatment-emergent adverse events occurred in early postpartum women only: including seven uterine spasms, and three breast engorgements. All events were mild except one moderate.

CONCLUSION:

Merotocin is not transferred into breast milk at quantifiable amounts, and is well tolerated. This study supports the evaluation of merotocin in an ongoing phase 2 study in women with preterm delivery (NCT02545127).
Daily Versus Twice-Daily Dosing of Nifedipine for Blood Pressure Control in Pregnancy and Postpartum [ID: 1375881]
Authors: Band Isabelle , Bianco Angela , Peterson Jessica , Wang Kelly
Published: May 2023

INTRODUCTION:

Hypertensive disorders of pregnancy (HDP) may be managed with oral antihypertensives; however, pregnancy-induced changes in the hormonal milieu and volume of distribution make it difficult to determine optimal dosing regimens. Nifedipine is a first-line therapy for treatment of HDP. The purpose of this study is to compare 60 mg daily (QD) of extended released (XR) nifedipine to 30 mg twice daily (BID) for blood pressure (BP) control antepartum and postpartum.

METHODS:

This was a retrospective chart review conducted in Mount Sinai Health System. Patients admitted from January 1, 2015 to April 30, 2021, who were diagnosed with a HDP and received nifedipine XR 30 mg BID or 60 mg QD for intrapartum or postpartum BP control were included. The primary outcome was need for dose adjustment of nifedipine or addition of another antihypertensive agent. Patients were excluded if they had preexisting renal disease or were already taking oral antihypertensives.

RESULTS:

Two hundred thirty-seven patients were included, 139 (59%) received 30 mg BID and 98 (41%) 60 mg QD. There was no statistically significant difference in the need for increase in nifedipine dose or addition of another oral antihypertensive between those receiving 30 mg BID versus 60 mg QD (33.8% versus 35.7%, adjusted odds ratio [95% CI], 0.90 [0.50, 1.60]; P=.71). Additionally, there was no difference in need for emergency hypertensive treatment after reaching study dose (P=.19) or readmission for BP control between the two groups (P>.99).

CONCLUSION:

These findings suggest that BID versus QD dosing of nifedipine XR does not improve blood pressure control in the antepartum or postpartum periods; thus, daily dosing is reasonable and may be preferable for patient convenience and compliance.
Does the Decision to Perform Cesarean Delivery for Nonreassuring Fetal Status Vary by Time of Day? [ID: 1376814]
Authors: Huysman Bridget , Carter Ebony , Dickison Shelby , Kelly Jeannie , Raghuraman Nandini , Woolfolk Candice
Published: May 2023

INTRODUCTION:

Nonreassuring fetal status (NRFS) is a diagnosis lacking standardized definitions, making the diagnosis susceptible to bias and systemic factors. We assessed whether the decision to proceed with intrapartum cesarean delivery (CD) was associated with time of the day and whether this relationship was influenced by the presence of in-house obstetricians.

METHODS:

This was a retrospective cohort study of term pregnancies admitted in spontaneous labor or for induction between January 2019 and June 2021. The primary outcome was decision to perform intrapartum CD for NRFS. Generalized additive models with smoothing splines were used to explore nonlinear associations between time of day and CD rates. Results were then stratified by whether the attending obstetrician was in-house or remote.

RESULTS:

Of 5,526 deliveries, 6.0% were intrapartum CD for NRFS. In the overall cohort, CD for NRFS was consistent throughout the day (P=.056). For patients with in-house obstetricians, the decision for CD for NRFS was not influenced by time of day (P=.072). For patients without in-house obstetricians, the decision to perform CD for NRFS was influenced by the time of day (P=.028), with a decreasing frequency from midnight to afternoon with nadir at 15:00 (2.5%), and a subsequent increasing frequency that peaked at 23:00 (10.3%).

CONCLUSION:

The decision to perform CD for NRFS is influenced by the time of day when the obstetrician is not in-house. This decision is not affected by time of day when the obstetrician is in-house. Systemic factors such as immediate obstetrician availability affect the diagnosis of NRFS.
Effect of Neonatal Drug Screen on Monitoring and Management of Neonatal Opiate Withdrawal Syndrome [ID: 1376913]
Authors: Witcher Kristina , Huddleson Amy , Mark Katrina , Soltanian Ayda
Published: May 2023

INTRODUCTION:

Neonates exposed to opiates in utero are at risk for developing neonatal opiate withdrawal syndrome (NOWS), which may require pharmacologic therapy if severe. Neonatal drug screening has been proposed to identify at-risk neonates that require extended monitoring for NOWS. We hypothesized that documented maternal history of opiate use would be prevalent and better predict the need for monitoring at our institution.

METHODS:

Retrospective chart review was conducted for 342 neonates with documented NOWS scores at the University of Maryland Medical Center in Baltimore, Maryland, from January 1, 2017 to January 1, 2022. Institutional review board approval was obtained prior to initiation of the study. Maternal medical history was reviewed in addition to neonatal drug screen, NOWS scores, and need for pharmacologic treatment. The primary objective was to determine the proportion of neonates for which neonatal drug screening was the only indicator that the neonate required monitoring for NOWS.

RESULTS:

There was a maternal indication for NOWS monitoring present at time of delivery for 85.4% of neonates. Of the remaining 50 (14.6%), 13 tested positive for opiates; however, only 3 of these neonates required pharmacologic treatment for NOWS. Seven neonates required treatment after negative opiate screening. Overall, the sensitivity of neonatal drug testing for NOWS requiring pharmacologic therapy was 76.3% with a positive predictive value of 55.8%.

CONCLUSION:

Maternal history of opiate use is present for most neonates monitored for NOWS, and neonatal drug screening incompletely predicted severe NOWS. Universal neonatal drug screening may not identify additional neonates at risk of NOWS with possible unforeseen risks including unnecessary monitoring or social services involvement.
Perinatal Mental Illness in Canada: Canadian Health Care Providers Do Not Feel Competent [ID: 1377412]
Authors: Cook Jocelynn
Published: May 2023

INTRODUCTION:

Consequences of untreated perinatal mental illness (PMI) can be severe and have negative implications for mothers and children across generations. Canadian data report 33% of new mothers are concerned about PMI, which is likely a very conservative estimate. Health care providers (HCPs) play a critical role in identification, screening, and treatment of PMI, yet we regularly receive requests for practice guidance. The purpose of this study was to explore practices, needs, and perceived competencies of HCPs related to PMI.

METHODS:

An online survey was administered to perinatal HCPs. Multiple choice questions and open text responses focused on needs, screening, treatment, referrals, and barriers. Descriptive statistics were used to report findings by profession, and text comments analyzed using content analysis.

RESULTS:

Respondents (N=290) frequently encounter patients with anxiety (84%), mood disorders (63%), and psychological aspects of transition to parenthood (60%). They occasionally encounter patients with eating (74%), personality (74%), or substance use (66%) disorders. Greater than 90% wanted more information about all disorders in the prenatal period; resources were most frequently requested; information about diagnosis was least requested. Family practitioners felt very confident screening for PMI (69%), but fewer were confident counselling (54%) or treating (27%) PMI. Few obstetricians (8%), nurses (15%), and midwives (16%) felt very confident providing counseling or treatment (1–4%). Barriers included a lack of awareness of supports and resources.

CONCLUSION:

Canadian HCPs do not feel competent to manage patients with PMI and need more guidance and resources. Results will inform development of targeted education and resource initiatives, including Clinical Practice Guidelines.
A Rare Case of Biparental Placental Mesenchymal Dysplasia: A Case Report and Literature Review [ID: 1336615]
Authors: Portilla Francisco Ruiloba , Wolff Megan Barragan , Cuevas Montserrat , Chaidez Salvador Jiménez , Vázquez Yolotzin Valdespino , Alexandra van Tienhoven Ximena
Published: May 2023

INTRODUCTION:

Placental mesenchymal dysplasia (PMD) is a rare placental anomaly associated with high perinatal mortality; it is predominantly seen in female fetuses and very few cases have been reported. The evaluation of first- and second-trimester products of conception is of the utmost importance when assessing molar pathologies such as complete hydatidiform moles, partial hydatidiform moles, and nonmolar samples.

METHODS:

We report a monochorionic 46XX,69XXY pregnancy with placental mesenchymal dysplasia (PMD) with possible androgenetic biparental mosaicism etiology (Instituto Nacional de Perinatología Isidro Espinosa de los Reyes approval number P-270-18).

RESULTS:

The patient is a 28-year-old gravida 2, para 1, female with no notable past medical history. She had a previous pregnancy resulting in an uncomplicated abdominal delivery at 39 weeks of gestation 5 years prior. The patient was transferred to our health center at 24.2 weeks of gestation with a molar component because of USG data consistent with a probable hepatic tumor, perimembranous ventricular septal defect, and probable PMD. Ultrasound at 24.3 weeks of gestation demonstrated a single intrauterine pregnancy with one-third of the placenta appearing normal, the second third showing irregular cystic masses, and the remaining third with larger cysts. Placental mesenchymal dysplasia was diagnosed retrospectively based on data from the gross, histologic, and genetic components.

CONCLUSION:

To our knowledge, this is the first reported case of PMD with a 46XX,69XXY karyotype. A radical and cautious approach to PMD cases is needed because of the lack of sufficient data and reports.
Effect of Telehealth Adaptation on the Diagnosis of Hypertensive Disorders of Pregnancy [ID: 1358276]
Authors: Abelman Sarah , Boelig Rupsa , Felder Laura , Svetec Sarah
Published: May 2023

INTRODUCTION:

COVID-19 caused a rapid integration of telehealth into prenatal care. This study aims to assess the effect of telehealth adaptation on timing and severity of the diagnosis of hypertensive disorders of pregnancy (HDP).

METHODS:

This is an IRB-approved retrospective cohort study of patients with HDP who delivered from April to October of 2019 (pre-pandemic) and 2020 (pandemic) at one urban tertiary care center. The primary outcome was mean gestational age at diagnosis of HDP. Secondary outcomes included initial and final severity of diagnosis before delivery. Results were adjusted for baseline characteristics different at P<.10, using multivariable logistic regression and ANCOVA as appropriate.

RESULTS:

Four hundred ninety-eight patients were included, with 231 from 2019 and 267 from 2020. 17.1% had preeclampsia with severe features initially, and 29.3% met these criteria by delivery. In 2020, 80.5% of patients used telehealth (versus 0.9% in 2019), doing so for a mean of 29% of prenatal appointments. Unadjusted and adjusted analyses showed no significant difference in gestational age at diagnosis or diagnosis severity between cohorts. In the adjusted analysis, Black race was significantly associated with initial diagnosis severity (odds ratio [OR] 1.7 [1.0–2.8], P=.046); telehealth use as represented by cohort year was not (0.9 [0.5–1.3], P=.54). Black race (OR 2.6 [1.6–4.3], P<.001), non-Hispanic ethnicity (OR 0.4 [0.2–0.8], P=.04), and body mass index (OR 1.04 [1.0–1.1], P=.005) were significantly associated with final diagnosis severity; telehealth use was not (OR 1.0 [0.6–1.4], P=.87).

CONCLUSION:

The adaptation of telehealth is not associated with a change in timing or severity of diagnosis of HDP.
Regional Differences in COVID-19 Vaccination and Breakthrough Infection Rates by U.S. Census Region Using Cerner Real-World Data [ID: 1363147]
Authors: Vircks Julie , Casubhoy Imaima , Maulik Devika , Mohamed Yahia , O’Brien Devon , Sahil Suman
Published: May 2023

INTRODUCTION:

The rate of COVID-19 infection varies across different regions in the United States. However, there are limited data evaluating the vaccination rates and subsequent infection among the pregnant population with regard to geographical location. The primary aim of the study was to determine the COVID-19 vaccination rate and subsequent infection rate among pregnant people in each U.S. census region.

METHODS:

A retrospective data collection of pregnant people from January 2020 to March 2022 was performed using the Cerner Real-World Data from 106 centers. The four census regions were defined by the U.S. Census Bureau. Breakthrough infection was defined as a positive COVID-19 test during or after pregnancy among immunized mothers. Because the database was fully de-identified, IRB approval was not required.

RESULTS:

The study included 389,764 pregnant persons, of which 44,846 were vaccinated. The rate of vaccination against COVID-19 was 14.57%, 11.80%, 11.71%, and 5.24% in the South, West, Northeast, and Midwest census regions, respectively. The COVID-19 infection rate after vaccination was 1.70%, 1.31%, 0.36%, and 0.06% in the Northeast, South, Midwest, and West census regions, respectively.

CONCLUSION:

The reported 11% vaccination rate suggests low utilization among pregnant people; that said, breakthrough infections rates appeared extremely low, suggesting robust protection. The study is limited in that it queried hospital-based vaccinations and breakthrough infections and is unable to capture larger community-based data. Further studies may compare vaccination and infection trends with nonpregnant patient populations.
Factors Associated With Surgical Intervention in Patients With Renal Colic During Pregnancy [ID: 1366267]
Authors: Abruzzese Jessica , Gurram Padmalatha , Khan Sameer , Tassone Lauren , Trivedi Kiran , White Samantha
Published: May 2023

INTRODUCTION:

We studied clinical characteristics of patients whose renal colic and nephrolithiasis are managed surgically in pregnancy compared to patients who were managed expectantly.

METHODS:

This is a retrospective study of patients presenting with renal colic from June 2013 to May 2022. Clinical characteristics, number of admissions and length of stay, and pregnancy outcomes (preterm labor/preterm delivery or preeclampsia) of patients requiring surgical intervention (SI) were compared to patients that were managed expectantly (EM). Surgical interventions were matched to EM 1:1 based on year of SI. Patients that underwent other nonobstetric surgeries and obstetric surgeries (cerclage) within 30 days of SI were excluded. Institutional review board approval was obtained.

RESULTS:

One thousand one patients were admitted with renal colic and 40 received SI. Ureteral stents is the commonest procedure (35 patients), followed by percutaneous nephrostomy. Maternal characteristics were similar except for Black race (P=.38). Mean gestational age of presentation is 24.5 weeks in both groups (P>.05). Common indications documented for SI are intractable pain (80%) and obstructing stone with sepsis (40%). The mean pain score was 5.2 in SI versus 1.6 in EM (P=.00). Fever was seen in 15.5% of SI versus 2.5% in EM (P=.04). Computed tomography scan performed in 22.5% of SI versus 2.5% in EM. Number of admissions were 1.75 versus 1.08 in EM (P=.03). Length of stay was 5.34 versus 1.38 days in EM (P=.00). Pregnancy outcomes were similar (P>.05).

CONCLUSION:

Black race, pain score greater than 5, and fever are more likely to have SI. Surgical intervention can be safely performed in pregnancy without increase in adverse outcomes.