bluuebunny/crossref_metadata_2025 huggingface dataset:
Differences in Metabolic Profiles Among Women of Differences Races With Diabetes in Pregnancy [8E]
Authors: Martingano Daniel , Patel Nishant Pravinchandra , Tse Jaqueline , Shah Tanay , Singh Shailini
Published: May 2019

INTRODUCTION:

The purpose of the study is to evaluate the racial differences in metabolic profiles among pregnant women with gestational (GDM) and pregestational (T2DM) diabetes and its impact on management.

METHODS:

We conducted a 3-year retrospective study on all pregnant women who were diagnosed as GDM or T2DM during the third trimester of pregnancy. Fasting C-peptide, fasting blood sugar (FBS), total cholesterol (TC), triglycerides (TG), and high density lipoprotein (HDL) were drawn prior to insulin use.

RESULTS:

This study included 200 patients, 68% GDM and 32% T2DM. Difference in fasting C-peptide values for Asian (A), Hispanic (H), African Black (AB), and Caribbean/Haitian Black (CHB) pregnant women and FBS were noted, p<0.01 and p=0.91, respectively. After adjusting for BMI respective to race, C-peptide values still differed significantly, p<0.01. Differences in insulin sensitivity by ISHOMA (C peptide) also demonstrated this effect, p<0.01. TG were higher on average for A and CHB versus H and AB p=<0.01. Differences in HDL and TC differ between race groups, p=0.05 and p=0.03, respectively. A and CHB required insulin therapy more often than H and AB, p=0.04.

CONCLUSION:

Pregnant A and CHB women likely have beta cell defects resulting in low fasting insulin levels as measured by fasting C-peptide but higher insulin sensitivity on ISHOMA (C peptide) and higher TC, HDL, TG, whereas women of AB race appear to have metabolic profiles more similar to H women.
Associations Between Racial Bias and Adverse Perinatal Outcomes [10E]
Authors: Johnson Jasmine D. , Vuletich Heidi A. , Stuebe Alison M.
Published: May 2019

INTRODUCTION:

Race disparities in health outcomes are pervasive. Using the Implicit Association Test (IAT) as a marker of structural racism, studies have shown that racial bias among White individuals is associated with negative outcomes for minorities; however, this dataset may not be representative. We investigated both the IAT and the rate of racially charged internet search terms by state - and their relationship to adverse perinatal outcomes. We hypothesized that states with greater racial bias would have worse perinatal outcomes among non-Hispanic Black (NHB) populations compared with non-Hispanic White (NHW) populations.

METHODS:

We performed a secondary analysis of state-level data quantifying racially charged internet search rates and IAT results. We modeled the association between these measures of racial bias and publicly available Vital Statistics data on the rates of preterm birth, low and very low birth weight, infant mortality, and breastfeeding initiation by race. Multivariate regression was used for statistical analyses.

RESULTS:

Data from all 50 states were included. Higher state rates of racially charged internet search terms were correlated with higher rates of adverse outcomes for both NHW and NHB populations. Anti-White bias among Black IAT participants was associated with worse perinatal outcomes for both NHB and NHW populations, with a greater disparity in outcomes between NHW and NHB (P=<.05) populations.

CONCLUSION:

Structural racism, whether indexed by racially-charged internet search terms or IAT results, was associated with worse perinatal outcomes. These results suggest that efforts to address racial bias have the potential both to reduce disparities and improve population health.
Postpartum Hemorrhage After Vaginal Delivery [12E]
Authors: Peleg David , Nofal Mais Abu , Ben Shachar Inbar
Published: May 2019

INTRODUCTION:

The incidence of postpartum hemorrhage (PPH) following vaginal delivery, an estimated blood loss of 500 mL or more, has been reported to occur in 1 to 5 percent of all vaginal deliveries. In our practice, blood loss after vaginal delivery is estimated using the bedpan technique. Our objective was to determine the incidence of PPH after vaginal delivery using the bedpan technique.

METHODS:

This was a retrospective study of 4510 women who gave birth vaginally between March 2015 and September 2016 at Ziv Medical Center, Zefat, Israel. Following delivery of the baby, the umbilical cord was clamped and cut, and a cardboard bedpan was placed under the buttocks of the woman. Blood was continually collected in the bedpan during delivery of the placenta and until the uterus was firmly contracted and bleeding was minimal. Uterotonics were routinely used during and after the third stage. The bedpan was then weighed without the placenta, and the net weight gain was recorded as blood loss.

RESULTS:

Although the mean blood loss using the bedpan technique was 305.64 ml±210.3 ml, 486 of the 4510 women had blood loss >500 ml, indicating the incidence of PPH was 10.3%. Also, 2.4% of women had blood loss >1000 ml.

CONCLUSION:

Compared to visual estimation, the bedpan technique appears to be a more accurate method for determining blood loss following vaginal delivery. The incidence of PPH using this method was twice as high as that reported in the literature.
Does Implementation of Universal Cervical Length Screening Increase Antepartum Resource Utilization? [15E]
Authors: Hogg James P. , Temming Lorene A. , Stephenson Courtney , Pollack Rebecca E.
Published: May 2019

INTRODUCTION:

Concern has been raised regarding “intention creep” and increased resource utilization with implementation of universal cervical length (CL) screening. We compared the incidence of antepartum interventions before and after implementation of screening.

METHODS:

Retrospective cohort study of singleton gestations who underwent anatomic ultrasound between 16w0d and 20w6d for two years pre and post implementation of screening. Excluded multiples, fetal anomalies, aneuploidy, and missing records. Interventions included ≥2 repeat CL measurements, vaginal progesterone, 17-OHP, cerclage, pessary, admission for preterm labor, betamethasone administration, and NICU consultation. Multivariable logistic regression was used.

RESULTS:

There were 8309 patients- 4350 before (unexposed) vs. 3959 after (exposed). In the unexposed group 94 (0.87%) patients had a CL of ≤3 cm vs. 56 (1.41%) in the exposed group (p=0.02). There were no differences in demographics between groups. Of those with short cervix, the median CL was 2.4 cm (unexposed) vs. 2.5 cm (exposed). The exposed were less likely to undergo ≥1 antepartum intervention (58.9% vs. 80.0%, aRR 0.68, 95% CI 0.34, 0.99). There were no differences in the rates of individual interventions (cerclage placement, vaginal progesterone, 17-OHP, PTL admission, NICU consultation or administration of steroids). Chorioamnionitis was less frequent in the exposed (8.9 vs. 26.3%, p=0.02). There were no differences in neonatal outcomes or the rate of preterm birth.

CONCLUSION:

Implementation of universal CL screening identified more people with a short cervix with no difference in the rate of individual interventions. The exposed were less likely to undergo ≥one intervention. Universal CL screening does not unduly increase antepartum resource utilization.
Pregnancy Outcomes in Peri-Menarchal Adolescents [8F]
Authors: Bauer Alison Marie , Lappen Justin , Hackney David
Published: May 2019

INTRODUCTION:

The birth rate among adolescents has been declining, and is particularly low in peri-menarchal adolescents (age 10-14 years). At extremely young maternal ages that precede full adult stature, there is theoretical concern for an increased risk of cesarean delivery (CD) due to cephalopelvic disproportion. The aim of this study is to evaluate pregnancy outcomes in peri-menarchal adolescents.

METHODS:

A retrospective cohort study was performed using the National Inpatient Sample (NIS) in 2012. Adolescents with pregnancy and delivery International Classification of Diseases (ICD-9) codes were identified, and terminations were excluded. The risk of CD and composite outcome (postpartum hemorrhage, blood transfusion, hysterectomy, intrauterine growth restriction, preterm delivery, and pre-eclampsia) were compared for adolescents age 10-14 years and 14-18 years, using 18-22 years as a reference group. Univariable and multivariable analyses were performed with adjustment for confounding factors.

RESULTS:

839 adolescents age 10-14, and 35,453 adolescents age 14-18 were identified. In univariable analysis, peri-menarche was associated with decreased frequency of CD (p<0.001, aOR 0.57, 95% CI 0.47-0.69) and increased frequency of the composite outcome (p<0.001, aOR 1.42, 95% CI 1.20-1.67). In multivariable regression, adolescents had decreased odds of undergoing CD and increased odds of pre-eclampsia and the composite outcome.

CONCLUSION:

Pregnancy in the peri-menarche age group is associated with an increased risk of hypertensive disorders in pregnancy and the composite outcome, though is associated with a decreased risk of CD. Thus, peri-menarchal patients have a reduced risk of undergoing CD despite not yet having achieved full adult stature. Thus, peri-menarchal patients have a reduced risk of undergoing CD despite not yet having achieved full adult stature.
Contribution of Maternal Factors to Infant Mortality From Extreme Preterm Birth [25F]
Authors: AnneKelly Elizabeth , Plagge Thomas , McKinney David Nelson , Adcock Ryan , DeFranco Emily A.
Published: May 2019

INTRODUCTION:

Extreme preterm birth (EPB), defined as birth at ≤28 weeks gestation, is a primary driver of infant mortality. This study aims to quantify the impact of maternal characteristics on infant mortality due EPB using attributable risk percentage (ARP).

METHODS:

We performed a statewide population-based retrospective cohort study of all extreme preterm births (n=17,307) and infant deaths in this cohort (n=3,770) using linked Ohio birth and infant death records from January 2006 through December 2015. We excluded infants born with congenital malformations. Births were stratified by gestational age and the prevalence of maternal characteristics were compared between the infants that died and those that lived. The protocol for this study was approved by the human subjects Institutional Review Board of the Ohio Department of Health.

RESULTS:

Maternal factors associated with infant death due to EPB were inadequate prenatal care (ARP 51.5%, CI 45.8-56.7%), obese BMI (ARP 23.0%, CI 13.3-31.7%), not enrolled in WIC (ARP 38.0%, CI 30.4-44.7%), Gonorrhea infection during index pregnancy (ARP 51.8%, CI 22.4-70.0%), inadequate weight gain (ARP 54.7%, CI 49.2-59.6%), interpregnancy interval >60 months (ARP 33.6%, CI 25.2-41.1%), and prior infant mortality (ARP 57.3%, CI 45.8-65.3%).

CONCLUSION:

The maternal characteristics were associated with 403 infant deaths per year. The potentially modifiable factors of obesity, inadequate prenatal care, gonorrhea infection, inadequate weight gain, and not being enrolled in WIC were associated with 281 infant deaths per year. Understanding the contribution of maternal factors to infant mortality in a cohort of infants born before 28 weeks gestation is important in informing interventions and providing maternal counseling.
Pulmonary Hypertension in Pregnancy: Maternal and Neonatal Trends and Outcomes [01OP]
Authors: Shao Yi-Hong , Czuzoj-Shulman Nicholas , Spence Andrea , Abenhaim Haim Arie
Published: May 2019

INTRODUCTION:

Pulmonary hypertension (PH) is associated with significant maternal and fetal morbidity and mortality. With recent treatment advances, women with PH are electing to continue their pregnancy to term. Our study compared the demographics, comorbidities and clinical outcomes in parturients with PH and without PH.

METHODS:

We conducted a population-based retrospective cohort study using Nationwide Inpatient Sample (NIS) of Healthcare Costs and Utilization Project (HCUP) database from 2000 to 2014. We used an unconditional logistic regression analyses to estimate the associated risks of maternal and neonatal outcomes.

RESULTS:

We identified 2,087 cases of PH in pregnancy. Compared to non-PH pregnant women, PH in pregnancy was associated with an increase in hypertensive disorders (23.24% vs. 4.99%, P<0.0001), including pre-eclampsia (13.61% vs. 3.47%, P<0.0001) and eclampsia (0.38% vs. 0.08%, P<0.0001). A 1.9-fold increase in cesarean section rate was observed. The most common maternal post-partum complication was cardiomyopathy (5.70% vs. 0.02%, P<0.0001). The maternal mortality rate was 2.64% compared to 0.01% in controls (P<0.001). Mortality rate trends have remained stable, while hospital delivery admission rates have risen significantly (P=0.028). Neonatal outcomes were worse among PH patients, notably higher rates of intra-uterine growth restriction and death, preterm birth and congenital anomalies.

CONCLUSION:

PH in pregnancy is rare and associated with increased risk of adverse pregnancy, maternal and neonatal outcomes. However, our study found a significantly lower maternal mortality rate compared to those previously quoted in the literature. Given significantly higher risk of thromboembolic events, careful consideration should be given to thromboprophylaxis.
In Vitro Activity of Ibrexafungerp (SCY-078) Against Candida spp. (Including Fluconazole-Resistant Isolates) [14OP]
Authors: Borroto-Esoda Katyna , Barat Stephen , Angulo David , Sobel Ryan
Published: May 2019

INTRODUCTION:

Vulvovaginal candidiasis (VVC) is a common fungal infection caused by Candida spp., with only one oral treatment, fluconazole, currently approved in the U.S. Another oral option is desirable, particularly with azole resistance on the rise among some Candida spp. Ibrexafungerp (IBX, formerly SCY-078) is a first-in-class, broad-spectrum, intravenous and oral, triterpenoid antifungal, a novel class of glucan synthase inhibitors, currently in phase 3 development for the treatment of VVC. The purpose of this study was to evaluate the activity of IBX against Candida spp., including fluconazole-resistant isolates.

METHODS:

In vitro MIC data for IBX against multiple Candida spp. were compiled from 7 independent studies. The combined studies included 242 isolates with fluconazole resistance (FLU-R) and 532 wild-type (WT) isolates of C. albicans, C. glabrata, C. tropicalis and C. parapsilosis. In vitro susceptibility was determined by broth micro-dilution using CLSI methods. Isolates with IBX MIC values >2-fold dilutions as compared to WT MIC50 values were considered resistant. FLU-R was defined for Candida spp. per CLSI M27-S4.

RESULTS:

MIC50 values for IBX against the WT isolates ranged from 0.008 to 0.5 ug/mL. Similar results were obtained against FLU-R strains, for which IBX MIC50 values ranged from 0.06 to 0.5 ug/mL. Overall, IBX was active (MIC within 2 dilutions of WT) against 240/242 (99%) of the FLU-R isolates tested in these studies.

CONCLUSION:

IBX exhibited in vitro activity against FLU-R Candida spp. These results suggest that IBX is a highly-promising, orally bioavailable antifungal agent for the treatment of patients with FLU-R VVC.
DONALD F. RICHARDSON PRIZE PAPEREvaluating the Use of Handheld Point-Of-Care Ultrasound Testing for Gynecologic Pathology: A Pilot Study for Use in Low Resource Settings [07OP]
Authors: Toscano Marika , Szlachetka Kam , Whaley Natalie , Thornburg Loralei Lacina
Published: May 2019

INTRODUCTION:

Point of care ultrasound (POC-US) is clinician-performed ultrasound at the bedside with direct interpretation. POC-US allows increased access in low resource settings (LRS). We investigated whether POC-US can identify and triage gynecologic (GYN) pathology in a LRS.

METHODS:

Validation of POCUS for GYN pathology performed in high resource setting as a prospective, blinded, cross-over study of 60 subjects. 20 subjects underwent POC-US with 3 test units (GE Vscan (US-V), Sonosite Iviz (US-I), Philips Lumify (US-L)) followed by reference diagnostic ultrasound (DxUS). Images scored blindly by two sonographers for quality and correlation; quantitative measurements compared. 40 subjects underwent POC-US with highest scoring device and reference DxUS. Concordance assessed by Cohen’s kappa and accuracy by Pearson’s and Bland-Altman plot. In a LRS, 20 subjects with GYN complaints underwent POC-US at a mobile clinic in North Haiti with intent to triage for referral.

RESULTS:

US-V was inferior in image quality and correlation. US-L and US-I were equivalent; US-L selected for further validation. No statistically significant differences in US-L measurements of endometrium, uterus, ovaries, adnexal pathology, or leiomyomata (P<0.02 for all) with excellent concordance (Kappa >0.7 for pathology). Sensitivity/specificity of detecting pathology 80-100%. In a LRS, POC-US was acceptable to providers/patients and utilized successfully to visualize GYN structures. No subjects were triaged for referral based on POC-US.

CONCLUSION:

Clinician-performed POC-US has high diagnostic accuracy, sensitivity/specificity for basic GYN anatomy and pathology. POC-US was an acceptable and feasible instrument in LRS, but future studies are needed to prove that POC-US improves GYN outcomes in LRS.
Evaluation of a Community-Based Intervention on Postpartum Contraceptive Utilization in Rural Nepal [12OP]
Authors: Wu Wan-Ju , Maru Sheela
Published: May 2019

INTRODUCTION:

Unmet need for postpartum contraception in rural Nepal remains high. Strategies that integrate contraceptive counseling along the continuum of reproductive health care are more effective than isolated counseling sessions. One program is utilizing a system of Community Health Workers (CHWs) to provide integrated reproductive, maternal, newborn, and child health care. Structured contraceptive counseling is delivered at antenatal and postnatal home visits and data collected via a mobile phone application.

METHODS:

A mixed methods approach was used to evaluate the effect of the intervention on postpartum contraceptive uptake. We compared the odds of modern contraceptive uptake among recently postpartum women in the pre-intervention and intervention groups using multivariate logistic regression. Eleven individual interviews were conducted with staff and participants to understand the implementation process and mechanisms of behavior change.

RESULTS:

There were 445 postpartum women in the pre-intervention group and 510 in the intervention group. Modern contraceptive use increased from 29.4% pre-intervention to 46.1% in the intervention group. Women in the intervention group had twice the odds of using a modern contraceptive method as compared to the pre-intervention group (OR=2.05, P<.0001). Salient themes noted in the interviews include overall positive perceptions of the intervention and emphasis on the need to involve family members as they play a critical role in women's contraceptive decision-making.

CONCLUSION:

An integrated community-based structured contraceptive counseling intervention delivered by professionalized CHWs in the home in rural Nepal appears to be effective in increasing use of modern contraceptive methods. The intervention is being to scaled to other similar settings in Nepal.
Prevalence and Determinants of Maternal and Perinatal Outcome of Preeclampsia at a Teaching Hospital in Ethiopia [3T]
Authors: Yeman Awol , Zelelow Yibrah Berhe , Ahmed Sumeya , Teka Hale , Goba Gelila
Published: May 2019

INTRODUCTION:

Preeclampsia is a common pregnancy disorder with potential adverse maternal and neonatal outcome. Ayder Referral Hospital (ARH), a tertiary hospital in northern Ethiopia where most preeclamptic patients are treated. This study aimed to assess the prevalence and determinants of maternal and perinatal outcome of preeclampsia at ARH.

METHODS:

Our study was a retrospective chart review of preeclamptic patients treated at ARH between September 1, 2016 and September 30, 2018. This study was approved by IRB.

RESULTS:

Over the study period, the total number of deliveries recorded was 8,502. There were 362 patients with preeclampsia. Most (77.3%) patients had preeclampsia with severity features. Poor maternal outcome was present in 40% of cases while 25% of cases had poor perinatal outcome. The top three poor maternal outcomes reported in this study were, eclampsia (6.6%), maternal death (2.8%), and renal failure (1.1%). Headache (AOR 32.26 95% CI 0.003-0.326 P=.004) and low hemoglobin value (AOR 3.44 95% CI 1.772-6.761 P=.005) were associated with poor maternal outcome. The poor perinatal outcomes were low APGAR score (18.8%), still births (5.8%), and early neonatal deaths (1.1%). Earlier gestational age at diagnosis (AOR 3.19 95% CI 1.762-5.766 P=.0001) was associated with poor perinatal outcome.

CONCLUSION:

Preeclampsia is a significant problem in Ethiopia. In a resource limited setting where tools are scarce, clinical profile should be taken into consideration for prediction of poor outcome. Owing to the association found in between maternal outcome and hemoglobin, further prospective research is required to identify if anemia was the cause or effect of preeclampsia.
Interpersonal Trauma: An Under-Recognized Risk Factor for Urinary Tract Dysfunction in Midlife and Older Women [16T]
Authors: Boyd Brittni , Gibson Carolyn , Van Den Eeden Stephen , McCaw Brigid , Subak Leslee , Huang Alison
Published: May 2019

INTRODUCTION:

Interpersonal trauma has the potential to contribute to genitourinary dysfunction in women, but few studies have examined whether emotional, physical, or sexual abuse are associated with urinary tract symptoms.

METHODS:

We analyzed data from a multiethnic cohort of women aged 40-80 years enrolled in a large integrated healthcare system in California. Lifetime history of traumatic exposures, current post-traumatic stress disorder (PTSD) symptoms, and current urinary tract symptoms were assessed using structured-item questionnaires. Multivariable-adjusted logistic regression models examined associations between interpersonal trauma exposures and PTSD with: 1) any weekly incontinence, 2) weekly stress-type incontinence, 3) weekly urgency-type incontinence, and 4) nocturia ≥-2 times/night.

RESULTS:

Of the 1999 participants analyzed, 36% were Caucasian, 22% Black, 23% Latina, and 20% Asian. Twenty-seven percent reported at least one lifetime interpersonal trauma exposure and 22.5% reported clinically significant PTSD (PTSD Checklist-Civilian Version score ≥30). Overall, 45% reported any weekly incontinence, 23% weekly stress-type incontinence, 23% weekly urgency-type incontinence, and 35% nocturia. Women with a history of emotional abuse were more likely to report any weekly incontinence (OR=1.3, CI=1.0-1.7) and nocturia (OR=1.73, CI=1.36-2.19). Physical abuse was associated with nocturia (OR=1.35, CI=1.04-1.77) but not incontinence. PTSD was associated with any weekly incontinence (OR=1.46, CI=1.15-1.85), stress-type incontinence (OR=1.7, CI=1.3-2.2), urgency-type incontinence (OR=1.6, CI=1.2-2.1), and nocturia (OR=2.0, CI-1.6-2.5).

CONCLUSION:

Over 20% of women in this multiethnic, community-based cohort reported a history of interpersonal trauma and/or PTSD, which was associated with symptomatic urinary tract dysfunction. Findings highlight the need for trauma-informed care of midlife and older women with urinary symptoms.
The Effect of Video Education on Skin-to-Skin at the Time of Delivery [18T]
Authors: Caponero Catherine M. , Moussa Hind N. , Heh Victor
Published: May 2019

INTRODUCTION:

Skin-to-skin contact (SSC) is significantly associated with breastfeeding which continues to be below national goals. With a lack of research on how to overcome barriers to SSC, this trial examined the effect of video education upon admission for delivery on intent to, and actual participation in SSC.

METHODS:

Randomized control trial (June 2017-October 2017) of educational intervention in women (N=240) 18 or older admitted in anticipation of normal spontaneous term delivery. Alternate patients were randomized at the time of admission into video (N=120) and no video (N=120) groups. Both groups received a brief survey about SSC. The video group watched a patient education DVD and completed a post survey about SSC. IRB approval and patient informed consent were obtained.

RESULTS:

During the pre-intervention survey, 89.2% (107/120) of those in the video group compared to 83.3% (100/120) of those in the no video group indicated that they planned to use SSC (p=0.396). After the video, 98.3% (118/120) planned to do SSC after delivery (p<0.001). However, only 59.8% (55/92) started SSC within 5 minutes of delivery in the video group and only 49.4% (42/85) started SSC within 5 minutes of delivery in the no video group (p=0.17).

CONCLUSION:

Video education at the time of admission prior to delivery alters the intention of patients and trends towards preforming SSC within five minutes of delivery. Despite the plans for SSC there was no significant difference in rates of utilization between the two groups. These findings support that obstacles, other than prenatal education, may affect early SSC.
The Glitz and Glamour Trial: Effects of Nail Polish Use on Post-Cesarean Wound Infections [20T]
Authors: van Staalduinen Brittany , Tricorico Gabrielle , Petrucci Samantha , Moretti Michael L. , Lakhi Nisha
Published: May 2019

INTRODUCTION:

To determine the effect of fingernail polish on the rate of post-operative wound infection following Cesarean delivery.

METHODS:

This is a block-randomized trial where surgeons were assigned to wear or not wear nail polish for two week block-intervals. After each non-emergent Cesarean delivery nail characteristics were logged on a case-coded sheet. The primary outcome was wound site infection (superficial or deep) occurring within 6 weeks of cesarean delivery. A t-test and chi-squared or Fisher's exact were used with p < 0.05 considered significant.

RESULTS:

From August 1, 2017 - October 1, 2018, 632 cases met the inclusion criteria: 297 (47%) were randomized to the nail polish and 335 (53%) to the nail polish free arm. Mean age, 31.8 (15 - 52) vs. 31.7 years (16 - 47), p = 0.830 and gestational age at delivery, 38.6 (23.2 - 41.5) vs. 38.4 weeks (25.6 - 41.5), p = 0.125 were similar for the nail polish and nail polish free arms respectively. BMI was greater in the nail polish group, 29.3 (16.1 - 64.1) vs. 27.9 (16.5 - 49.4), p = 0.015, and more patients were obese 38.5% vs. 30.3%, p = 0.031. Other demographics including race and insurance status were similar. The rate of wound infection was lower in the nail polish group, although this difference was not significant (1.7% vs. 3.9%, p = 0.077).

CONCLUSION:

The rate of postoperative wound infection is not affected by the use of fingernail polish.
The Role of Surgical Attire in the Prevention of Postoperative Infections: A Before and After Study [24T]
Authors: Wajid Naji Abdul , Staudenmaier Emily K. , Kim-Vaghela Jessica Juhee , Sampino Anthony F. , Gurram Padmalatha
Published: May 2019

INTRODUCTION:

Rates of postoperative infection (PI) related to cesarean delivery (CD) range from 2 to 7 percent. Traditional operating room attire consists of surgical cap, mask, and shoe cover. In August 2015, our institution adopted policy based on Association for Perioperative Registered Nurses (AORN) guidelines. Policy dictates use of surgical hood, laundered scrubs, beard cover, and disposable jacket before scrubbing. The objective of the study is to investigate the rate of PI in women undergoing CD before (Group 1) and after (Group 2) policy implementation.

METHODS:

A retrospective chart review was performed of women with term pregnancies who underwent elective CD for two years before (Group 1) and after (Group 2) new policy. Institutional Review Board approval was obtained. Inclusion criteria are as follows: hospital readmission, fever, positive wound culture, antibiotic treatment, cellulitis, endometritis, intra-abdominal abscess. Exclusion criteria included labor, ruptured membranes, intrapartum infection, and cerclage.

RESULTS:

The primary outcome measure was the rate of PI between the two groups. Group 1 consisted of 131 and Group 2 159 patients. Maternal characteristics and antepartum complications were similar between groups (p < 0.05). Mean gestational age at delivery was 38.96 weeks (Group 1) and 38.89 weeks (Group 2). Both groups had similar incidences of primary versus repeat CD. Rate of infection in group 1 was 4.5 percent vs 2.5 percent in group 2 (p > 0.05).

CONCLUSION:

The addition of surgical hood and jacket did not lead to a statistically significant decrease in postoperative infection. Further investigation may determine if the additional cost yields benefits.
Use of 17-Hydroxyprogesterone Caproate in Twin Gestations With a Prior Singleton Spontaneous Preterm Birth [30T]
Authors: Ward Andrew R. , Greenberg Victoria Rachel , Valcarcel Breanna , Al-Kouatly Huda Bachir , Berghella Vincenzo
Published: May 2019

INTRODUCTION:

The purpose was to determine if weekly 17-hydroxyprogesterone caproate injections prevent preterm birth in women with a twin pregnancy and a history of a singleton spontaneous preterm birth.

METHODS:

Retrospective cohort study of women with twin gestation and prior singleton spontaneous PTB at two institutions between 2005 and 2016. Study group included women receiving 17P while the control group did not. Primary outcome was twin spontaneous PTB <34 weeks. Secondary outcome was composite neonatal morbidity: respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), neonatal intensive care nursery admission, and fetal or infant death prior to discharge. IRB approval was obtained.

RESULTS:

79 patients were included. 27 women received weekly 17P and 52 did not. There were no significant differences in maternal demographics (Table 1) or preterm birth (Table 2) aside from maternal age. Spontaneous PTB <34 weeks occurred in 16 study patients (59%) versus 24 (46%) controls (OR 1.69, 95% CI 0.68-4.54). There was no difference in the rate of spontaneous PTB <32 weeks (33% vs 31% [OR 1.12; 95% CI 0.42-3.06]), <28 weeks (18% vs 19% [OR 0.95, 95% CI 0.32-3.18]), and <24 weeks (11% vs 13% [OR 0.8, 95% CI 0.21-3.42]) between the study group and control group, respectively. Composite neonatal morbidity occurred in 20 pregnancies (74%) in the study group and 41 pregnancies (79%) in the control group (OR 0.76, 95% CI 0.27-2.12).

CONCLUSION:

Weekly 17P injections do not appear to prevent spontaneous preterm birth or neonatal complications in twin gestations with prior singleton spontaneous preterm birth.
Improving Nutrition and Exercise Counseling in the Outpatient Setting by Obstetrics and Gynecology Residents [33T]
Authors: Warehime Jenna , Dhanraj Dave
Published: May 2019

INTRODUCTION:

Nutrition and exercise are large contributors to a patient's overall health. With the obesity epidemic in the United States, many of our patients have a body mass index above normal and could benefit from counseling in nutrition and exercise, potentially reducing their risks for many diseases over the course of their life. The purpose of this study is to determine if the availability of a food and exercise diary handout increases the frequency and comfort levels with which Obstetrics and Gynecology resident physicians counsel patients on nutrition and exercise.

METHODS:

This is an institutional review board approved prospective survey study. Residents were surveyed before and 6 months after a food and exercise diary handout was made available as a resource in the outpatient clinic, and the responses were analyzed.

RESULTS:

While our results did not show a statistically significant difference before and following the implication of the food/exercise diary handout, anecdotally there was an increase in frequency of comfort level for resident's counseling patients in both nutrition and exercise. On average three to four residents increased the frequency they counsel on these topics from rarely or occasionally to most of the time. The same increase was seen in the comfort level that residents had for discussing these topics with patients.

CONCLUSION:

Our results suggest that while a food and exercise diary handout may be helpful in increasing the frequency or comfort with which residents counsel patients, the availability of the resource alone is not sufficient to change residents' practice.
Association of Fetal Middle Cerebral Artery Doppler Indices in Different Positions and Adverse Perinatal Outcomes [40T]
Authors: McLaren Rodney Anthony , Kalgi Bharati , Ndubizu Chima , Haberman Shoshana
Published: May 2019

INTRODUCTION:

Evidence has shown that “brain sparing” phenomenon can be replicated using maternal position as a physiological stress. Our study's objective is to ascertain if changes in Middle Cerebral Artery (MCA) Doppler pulsatility indices (PI) due to physiological stress caused by maternal position correlates with adverse perinatal outcomes in low risk and in high risk patients.

METHODS:

A prospective cohort study of singleton, nonanomalous pregnancies with chronic hypertension or pregestational diabetes, and low risk pregnancies between 18 and 36 weeks gestation. Pregnancies with Rh isoimmunizations, fetal growth restriction, maternal cardiac disease, smoking or drug use history were excluded. Fetal doppler velocimetry indices were obtained from the fetal MCA in maternal supine and left lateral decubitus position. ANOVA was used to compare demographics between cohorts and composite of adverse perinatal outcomes, which included fetal growth restriction, oligohydramnios and preeclampsia.

RESULTS:

The delta of MCA Doppler PI between the two maternal positions did not correlate with adverse perinatal outcome (p= 0.409). 89 patients were included. There were 34 (38.2%) women with adverse outcomes; 22 (64.7%) patients were from the low risk group and 12 (35.3%) patients were from the high risk group.

CONCLUSION:

Our preliminary study did not demonstrate correlation between delta fetal MCA Doppler indices and composite outcome. The limitation of this study was that it was not powered for the finding of high composite adverse outcome in the “low risk” group, which might suggest underlying unknown risks. More data is needed in order to address the significance of fetal MCA Doppler indices changes.
Why Women With Access to Health Care Undergo Elective Second Trimester Abortions: Identifying Risk Factors [8S]
Authors: Rounds Kacie , Silvestre Isabella , Wei Julia , Weintraub Miranda Ritterman , Goldsmith Crystal Marie
Published: May 2019

INTRODUCTION:

Twelve percent of elective abortions are performed during the second trimester despite increased cost and morbidity. As health insurance is a major factor affecting abortion access nationally, we assessed risk factors associated with elective second trimester abortion among a well-insured population of women.

METHODS:

This IRB approved retrospective cohort study of women who obtained second trimester abortions at Kaiser Permanente Northern California (KPNC) between 2015 and 2016 used electronic medical records to identify the cohort and elective vs non-elective abortion indication, early (<16 weeks) vs late (≥16 weeks) second trimester abortion status, and demographic and clinical characteristics. Data were analyzed using descriptive and bivariate analyses.

RESULTS:

Of the 400 procedures randomly reviewed, 197 (49%) were performed in the second trimester, and of these, 95 (48%) were elective. Elective procedures were more likely to occur earlier in the second trimester (P<.0446). The mean age (standard deviation) of women undergoing an elective procedure was significantly younger at 26.5 (7.0) vs 33.5 years (5.7) (P<.0001). Women with a prior abortion were more likely to undergo an elective procedure (P<.0136). There were variations in elective status according to race/ethnicity (P<.0001); Black women were more likely to have an elective abortion. There were no differences in elective status according to gravidity, parity, history of irregular menses, or body mass index.

CONCLUSION:

Women who had a prior abortion, were younger, or Black were more likely to undergo elective termination. Further analyses are needed to identify factors independently linked to second trimester elective abortion in an insured population.
Using Quality Improvement to Increase the Awareness of Obesity Among Endometrial Cancer Patients [38R]
Authors: Shafa Anousheh , Torres Diogo , Bird Megan , Mundi Manpreet , Langstraat Carrie , Kumar Amanika
Published: May 2019

INTRODUCTION:

Obesity is associated with endometrial cancer (EC); however, most patients are unaware of this association and the long-term consequences of their elevated body mass index (BMI). Our objectives were to increase both patient awareness of this association and referral rates to our weight loss clinic using quality improvement (QI) methodology.

METHODS:

A multidisciplinary team used QI methods to create a multi-pronged toolkit to improve obesity education in patients < 80 years old with a BMI ≥30 mg/kg2 and diagnosis of grade 1-2, stage I EC. Gynecologic oncology and bariatric surgery providers, endocrinologists, nutritionists, and psychologists collaboratively implemented the toolkit comprised of provider communication workshops, patient education resources, and dictation templates. A historic cohort from (July through December 2015) was compared to a post-intervention cohort (July through December 2017). Clinical characteristics, documented conversations, and referrals to the weight loss clinic were abstracted. Data for the two cohorts were compared using Chi-squared test, Fisher exact test, and Student t-test.

RESULTS:

The historic cohort had 54 patients and the post-intervention cohort had 53 patients. Clinical characteristics were balanced between groups. Conversations about obesity increased from 11.1% (6/54) to 79.2% (42/53) after toolkit implementation (P<.001). Referral rates to the weight loss clinic also increased from 3.7% (2/54) to 25.9% (14/53) (P<.005). No clinical characteristics, including age, BMI, or pre-operative diagnosis, were associated with documented conversations or referrals (P=1.0).

CONCLUSION:

A multidisciplinary quality improvement project can be used to increase discussion about obesity and referral to a weight loss clinic in patients with low-risk EC.
Predictors of Receiving an Opioid Prescription Refill After Vaginal Delivery [25R]
Authors: Sheng Jessica S. , Wernimont Sarah A. , Eyck Patrick Ten , Moreira Nina
Published: May 2019

INTRODUCTION:

Opioids are not routinely prescribed at our institution for postpartum care after vaginal deliveries (VD). We sought to determine a model to predict need for opioid prescription refill after a VD.

METHODS:

This is an IRB-approved secondary analysis retrospective cohort study of all VD at a single tertiary care center from Dec 2014 to May 2015 and Dec 2015 to May 2016. Medical records were queried for demographic and clinical data. Multivariable logistic regression modeling was performed to determine the most relevant predictors for receiving an opioid prescription refill within 30 days of discharge. The performance of the prediction model was assessed by using the Akaike information criterion (AIC).

RESULTS:

Of the total 1100 VD patients included, 24 (2.2%) received an opioid prescription refill within 30 days of discharge. Factors included in the top model according to AIC were last pain score (OR 1.267, CI 1.01-1.60, P=.045) and age (OR 1.10, CI 1.00-1.21, P=.044). Predictors that were not included in the top model according to AIC were BMI, race, postpartum tubal ligation, gravidity, gestational age, tobacco use, psychiatric diagnoses and insurance.

CONCLUSION:

Last pain score is a significant modifiable predictor for patients requiring a refill for opioid pain medications after a VD. Better control of pain prior to discharge may help decrease the need for opioid refills within 30 days of discharge after a VD.
Treatment Practices of Pelvic Inflammatory Disease at Selected STD Clinics: STD Surveillance Network, 2015–2017 [16R]
Authors: LLata Eloisa , Braxton Jim , Trivedi Shivika , Pathela Preeti , Torrone Lizzi
Published: May 2019

INTRODUCTION:

CDC recommends broad-spectrum antimicrobial therapy (ceftriaxone 250 mg and doxycycline 100 mg BID for 14 days) for women with mild to moderate acute pelvic inflammatory disease (PID). The addition of metronidazole, commonly used to treat bacterial vaginosis (BV) and trichomoniasis, can be considered. We assessed PID treatment practices in STD clinic settings.

METHODS:

We conducted a cross-sectional analysis of women diagnosed with PID from 2015-2017 in 26 U.S. STD clinics. For each PID episode, we reviewed treatment information within 14 days of the visit where PID was diagnosed, stratified by concomitant diagnosis of BV and/or trichomoniasis.

RESULTS:

A total of 1,032 PID episodes were identified over 3 years. Treatment was documented in 941 (91.2%) episodes. Of these 941 episodes, concomitant BV and/or trichomoniasis was identified in 40.0% (377/941) of episodes (31.9% BV only, 5.2% trichomoniasis only, and 3.0% both BV and trichomoniasis). CDC recommended therapy was documented for 66.7% of all PID episodes; an additional 25.7% received ceftriaxone with dosing for doxycycline <14 days. Metronidazole, in combination with PID treatment, was documented in 52.5% of episodes. Metronidazole was more frequently included in episodes associated with BV and/or trichomoniasis (72% [271/377]) compared to those without these diagnoses (39% [220/564]).

CONCLUSION:

Over 90% of patients diagnosed with PID in selected STD clinics were treated with the recommended ceftriaxone; however, over a quarter did not receive the recommended dose of doxycycline. Metronidazole was provided in about half of PID episodes and was more likely to be included with concurrent BV and/or trichomoniasis.
Effect of Needle Exchange Programs on Maternal HCV Prevalence [11R]
Authors: Brady Matthew , Rossi Robert M. , Warshak Carri
Published: May 2019

INTRODUCTION:

To quantify the prevalence of maternal hepatitis C virus (HCV) before and after implementation of the needle exchange program (NEP) in Scioto county, Ohio.

METHODS:

Population-based retrospective cohort study of live births in Ohio (2006-2015). Rate of increase for maternal HCV was compared before (2006-2011) and after (2012-2015) implementation of an NEP (2011) in Portsmouth, Ohio (Scioto county). Trends in maternal HCV prevalence in neighboring counties both physically adjacent and regional (not physically adjacent) to Scioto were evaluated. Obstetric and neonatal outcomes were compared between Scioto post-NEP implementation (2012-2015) and regional counties. Multivariate regression estimated the association of obstetric and neonatal outcomes according to NEP status (Scioto vs regional counties).

RESULTS:

During the 10-year study period, there were 7,069 reported cases of maternal HCV at delivery among 1,463,506 (0.5%) live births in Ohio. The rate of maternal HCV increased 1017% (95% CI, 728 -1391) in Scioto between 2006-2011. After NEP implementation, the rate of increase from 2012-2015 was 12% (95% CI, -24 - 48%). Rate of increase in maternal HCV declined precipitously in bordering counties while regional, nonadjacent counties experienced substantial increases. After adjusting for confounders, delivery in Scioto (post-NEP implementation) was associated with decreased composite neonatal adverse events (NICU admission, low 5-min Apgar (<7), death, assisted ventilation, surfactant, and antibiotic administration), aRR 0.3 (95% CI 0.2-0.3) and maternal adverse events (ICU admission, transfusion, unplanned operation, hysterectomy, chorioamnionitis), aRR0.1 (95% CI 0.1-0.2) compared to regional counties.

CONCLUSION:

Our findings highlight a dramatic change in maternal HCV infection trajectory after NEP implementation in Scioto county, Ohio.
Resolution of Dermatitis After Laparoscopic Essure Coil Removal [7R]
Authors: Garneau Audrey , Hoffman Mark
Published: May 2019

INTRODUCTION:

Systemic contact dermatitis due to nickel component of Essure is a rare complication.

METHODS:

We present a case of a 31 year old who developed a rash after Essure placement that resolved with complete removal of the coils. The patient had a history significant for Crohn's disease and multiple abdominal surgeries. To avoid another surgery, she elected for surgical sterilization with Essure. Approximately two months after placement of Essure, she developed diffuse itching and blistering with scarring. Over the course of two years, she was seen by numerous subspecialists for evaluation of the rash. Allergen testing by dermatology revealed a nickel allergy. The patient was then referred to gynecologic surgeons to discuss management. On exam, she was found to have ill-defined, erythematous patches, studded with red/brown crusted papules and superficial excoriation. The patient was counseled on her options and she preferred Essure removal. She underwent a hysteroscopy and laparoscopic bilateral salpingectomy with complete removal of the Essure coils. Complete removal was confirmed by identifying the gold tag at the proximal end of the coil after removal. Her skin lesions and itching began to improve immediately, and the lesions had almost completely resolved six weeks after surgery.

CONCLUSION:

Allergic contact dermatitis that resolves with Essure removal has been reported. This is the fifth case report of such a reaction. With allergic reactions like this, complete removal of the coils is essential, as leaving even a small piece of the coil could result in persistent symptoms.
Racial/Ethnic Variations in Trial of Labor After Cesarean in an Understudied Population [37Q]
Authors: Wong Jennifer W.H. , Pacheco Misty , Kaneakua-Pia Iolana , Chang Ann L.
Published: May 2019

INTRODUCTION:

Increasing the vaginal birth after cesarean (VBAC) rate for appropriate candidates would help to decrease the high cesarean delivery rate in the United States. The purpose of this study is to examine racial/ethnic differences in trial of labor after cesarean (TOLAC) and VBAC rates in a largely Asian and Pacific Islander population.

METHODS:

Retrospective chart review was performed on all women with a term, singleton, live, cephalic fetus and with a history of 1 or 2 prior cesarean deliveries who delivered at a single institution in Honolulu, Hawaii between the years 2010 and 2016. Multiple logistic regression was performed to examine the likelihood of a successful VBAC for twelve different races/ethnicities.

RESULTS:

A total of 4,517 women met study criteria. Of the 37.8% that tried labor, 80.1% had a successful VBAC resulting in an overall 30.3% VBAC rate for the population studied. Native Hawaiians and other Pacific Islander (PI) groups (Marshallese, Micronesian, Other PI) (n=1,814) had the highest TOLAC rates (37.6-78.5%). Adjusted odds of successful VBAC was similar to White women in all groups except for Marshallese and Micronesian women (aOR 4.24, 95% CI 2.02-8.90 and aOR, 3.51, 95% CI 1.83-6.76).

CONCLUSION:

The high VBAC rate in the population studied was largely due to a high TOLAC rate. One's race/ethnicity should not deter a patient from attempting VBAC. Further research should be performed to see if these findings can be replicated.