bluuebunny/crossref_metadata_2025 huggingface dataset:
Preoperative Counseling and Surgical Practice: Gynecologic Surgeons' Approach to Ovary-Sparing Hysterectomy [ID 2683432]
Authors: Nora Anne E. , Harris Kendra , Miller Megan , Green Isabel C. , Laughlin-Tommaso Shannon , Cohen Rassier Sarah L.
Published: May 2024

INTRODUCTION:

Since the early 20th century, surgical practices on prophylactic oophorectomy at the time of hysterectomy have fluctuated. This study aims to assess how current gynecologic surgeons are counseling patients on ovary-sparing benign hysterectomies and assess any gaps in provider knowledge.

METHODS:

Institutional review board exception was obtained. A survey was piloted and underwent several rounds of editing before being sent to members of American Association of Gynecologic Laparoscopists (AAGL) in April 2023. The questionnaire evaluated preoperative counseling on risks and benefits of ovary-sparing hysterectomy for benign indications and surgical practices for when to perform bilateral salpingectomy and oophorectomy. Descriptive statistics and regression analyses were performed.

RESULTS:

The survey was sent out by email to 6,622 AAGL members, 3,576 opened the email, and 520 completed surveys (14% response rate). Approximately one-half (58%) completed subspeciality training. Most counsel patients on the benefits of ovarian conservation including the prevention of osteoporosis (88%), early onset menopause (87%), cardiovascular disease (84%), and dementia (52%). Fifty percent recommend routine bilateral salpingo-oophorectomy at time of hysterectomy starting at age 61, whereas 38% recommend this be performed at age 51–55 years.

CONCLUSION:

Gynecologic surgeons are counseling patients on the risks and benefits of ovarian conservation. How frequently ovary-sparing hysterectomies are offered and the age at which bilateral salpingo-oophorectomy is recommended vary by provider. Additional high-quality studies are needed to further understand the optimal timing of oophorectomy at time of benign hysterectomy, and there is also a need for provider education to minimize discrepancy in practice patterns.
Same-Day Discharge in Minimally Invasive Gynecologic Surgery: A Care Partner Perspective [ID 2683597]
Authors: Micolucci Savannah , Van Deman John , Robinson Erica F.
Published: May 2024

INTRODUCTION:

Same-day hospital discharge after minimally invasive gynecologic surgery has gained popularity and become feasible with increased adherence to enhanced recovery after surgery protocols. Benefits include reduced hospital admissions, increased cost-effectiveness, and practicality of patient recovery at home—without any demonstrable increase in patient harm or readmissions. Although studies show patients perceive same-day discharge favorably, there are little data regarding care partner perception of this trend.

METHODS:

A REDCap survey was administered prospectively to care partners of patients undergoing minimally invasive hysterectomy (MIH) within a single tertiary-care department between November 2022 and September 2023. The 16-question survey included questions evaluating care-partner perspectives regarding same-day discharge and postoperative home care. Approximately 75 patients were targeted for recruitment. Responses were analyzed using descriptive statistics.

RESULTS:

Approximately 66.7% of care partners indicated they were “very comfortable” caring for the patient at home the night of surgery. When asked to rate the level of concern about the patient going home on the same day as surgery, 64% selected a 2 or below on a 5-point Likert scale, with 36.4% of these individuals indicating that they were “not concerned at all.” Moreover, 42.4% of the respondents reported that this was their experience with postoperative home care.

CONCLUSION:

This study demonstrates that despite having no prior experience, care partners are comfortable caring for MIH patients on postoperative day 0. This is additive to current literature on patient comfort in same-day discharge. Thus, not only is same-day discharge a reasonable option for many patients but also most care partners are comfortable supporting this plan.
Effect of Dobbs on the Obstetrics and Gynecology Workforce [ID 2683443]
Authors: Arora Kavita S. , Sabbath Erika L. , Buchbinder Mara , McKetchnie Samantha M.
Published: May 2024

INTRODUCTION:

After the Dobbs v. Jackson decision in June 2022, 17 U.S. states have functionally banned abortion. Little research has focused on consequences of these bans for obstetrician–gynecologists in affected states, for whom medically necessary care provision may now carry serious personal and professional consequences. The objective of the Study of Ob-Gyns in Post-Roe America (SOPRA) was to characterize how abortion bans affect obstetrician–gynecologists and identify institution-level practices to support obstetrician–gynecologists in abortion-restrictive policy climates.

METHODS:

This was a cross-sectional qualitative study of 54 obstetrician–gynecologists from 13 of 14 states that had banned abortion as of March 2023. Data included semistructured interviews conducted from March to August 2023, which were thematically coded and analyzed. Institutional review board approval was obtained.

RESULTS:

We identified three major domains in which laws affected obstetrician–gynecologists: 1) clinical effects (waiting to provide necessary care until patients became sicker or institutional permission to treat was obtained; inability to counsel on pregnancy options; inability to provide or refer for appropriate care; patient relationships); 2) professional effects (conflicts with colleagues; documentation; fears and perceived consequences of law violation; practicing below the standard of care; moral distress and moral injury; job satisfaction; intention to leave the state); and 3) personal effects (health and well-being). Institutional practices—both helpful and harmful—modified the laws' effects on physicians.

CONCLUSION:

Findings reveal pervasive effects of state abortion bans on obstetrician–gynecologists, with implications for workforce sustainability, physician health, and patient outcomes. Institutional practices to support and protect obstetrician–gynecologists in restrictive policy environments may help mitigate laws’ effects on attrition and physician well-being.
24-Hour Compared With 48-Hour β-hCG Follow-up for Patients With Pregnancy of Unknown Location [ID 2683407]
Authors: Watkins Jayla , Flynn Anne N. , Seng Panhaneath , Ponzini Matthew D.
Published: May 2024

INTRODUCTION:

Patients who are followed with a pregnancy of unknown location (PUL) are generally advised to return for repeat β-hCG level after 48 hours. This study compares the time to final diagnosis for patients who had repeat β-hCG levels 24 versus 48 hours after diagnosis of PUL.

METHODS:

This was a retrospective cohort study of patients diagnosed with PUL who were recommended to return at 24 versus 48 hours at a single site from 2021 to 2022. We reviewed charts for time to final diagnosis, demographic characteristics, pregnancy history, β-hCG levels, interventions, and whether the patient was lost to follow-up. We compared the time to final diagnosis using Kaplan–Meier curves and log-rank tests between the two cohorts.

RESULTS:

Over the two-year time period, 61 patients were eligible for inclusion, 18 of whom followed up at 24 hours and 43 of whom followed up at 48 hours. Most patients completed the recommended follow-up (94.4% 24-hour versus 83.7% 48-hour). The median time to final diagnosis was 2 days (interquartile range [IQR] 1–5 days) for the 24-hour cohort compared to 6 days (IQR 3–13) for the 48-hour cohort (P=.03). None of the 24-hour group was lost to follow-up compared to 11.6% (n=5) in the 48-hour group.

CONCLUSION:

We found the time to final diagnosis was shorter in the 24-hour group compared to the 48-hour group. Clinicians may consider 24-hour follow-up for patients at higher risk for ectopic pregnancy or to expedite the time to a final diagnosis.
“Disheartened and Powerless”: How Abortion Providers Discuss Moral Distress Under Dobbs [ID 2683590]
Authors: Wascher Jocelyn , Howard Dana , Tomu Taylor , Bornstein Marta , Norris Alison H. , Rivlin Katherine
Published: May 2024

INTRODUCTION:

Moral distress occurs when providers feel powerless to provide ethical health care. We analyzed how abortion providers discuss moral distress since the Dobbs decision.

METHODS:

In 2023, we distributed an IRB exempt survey measuring moral distress to U.S. abortion providers through professional listservs. Surveys included an optional open-ended section where participants reflected on their experience of moral distress. Using thematic analysis, we compared open-ended responses between providers practicing in states protective and restrictive to abortion. Open-ended responses were deidentified, so we categorized “protective” and “restrictive” based on the written description of practice environment.

RESULTS:

Of 253 practitioners who completed the survey, 57% practiced in “protective” states and 43% practiced in “restrictive” states (using Guttmacher's classifications). Of these, 164 (64%) completed the optional, deidentified, open-ended section. Providers who indicated practicing in restrictive environments experienced moral distress arising from being forced to turn patients away or provide substandard care, the instability and ambiguity of abortion laws, and feeling powerless to use the specialized skills central to their identities as providers. Providers who indicated practicing in protective environments experienced moral distress arising from witnessing burdens placed on patients seeking care and the substandard care out-of-state patients received, a lack of resources to accommodate increased clinical volume, and encountering restrictive institutional policies despite the protections afforded by permissive state policy.

CONCLUSION:

Restrictions on abortion care can harm providers through their experiences of moral distress. Moral distress can lead to provider burnout and attrition, which exponentiates provider shortages and can ultimately lead to poor patient outcomes.
Loss to Follow-up in Fertility-Sparing Management of Endometrial Cancer and Pre-cancer [ID 2683403]
Authors: Hartup Lindsay A. , Yauger Belinda , Schenken Claire M. , Kohler Kelsey R.
Published: May 2024

INTRODUCTION:

Follow-up is essential with conservatively managed endometrial cancer (EC) and endometrial intraepithelial neoplasia (EIN) due to high risk of recurrence. There are little published data regarding follow-up in this population. The purpose of this study was to assess possible factors associated with loss to follow-up.

METHODS:

This was an IRB-approved retrospective chart review (protocol HSC20220315EX). Patients aged 18–45 with a history of EIN or early EC who elected fertility-sparing management and achieved pathologic response were included. Demographic and clinical data were collected and compared across patients who followed up and did not follow up.

RESULTS:

Eighty-six patients met inclusion criteria, of which 40 were lost to follow-up. 52% of patients with EIN and 25% of patients with EC were lost to follow-up (P=.12). 43% of patients with private insurance were lost to follow-up, compared to 63% with Medicaid (P=.45) and 67% without insurance (P=.40). There was no difference in follow-up based on age (P=.24), race (P=.47), body mass index (P=.90), or parity (P>.99), nor was there a difference based on fertility consultation (P=.83), assisted reproductive technology utilization (P>.99), or achievement of pregnancy (P>.99).

CONCLUSION:

Although no statistical differences were found, trends towards difference in follow-up based on diagnosis and insurance warrant further investigation. Barriers to care also may be more individual than systemic in nature. A future survey study of patients lost to follow-up may provide additional insight.
Reducing Endometrial Cancer Disparities to Advance Health Equity (REACH Study) [ID 2683434]
Authors: Suh-Burgmann Betty , Nau Claudia , Finertie Holly , Eng Sarah
Published: May 2024

INTRODUCTION:

Racial disparities in endometrial cancer survival have been increasing over the past 10 years. While Black women are diagnosed more often with aggressive histologic subtypes, studies have found tumor characteristics only partially account for their lower rates of survival. The degree to which system factors such as insurance and access to subspecialty care contribute to disparate survival outcomes is unclear.

METHODS:

This was a retrospective cohort study of individuals diagnosed with endometrial cancer from 2005 to 2021 within a large integrated health care system with high levels of access to gynecologic oncologists. Data were extracted from tumor registry and electronic databases. Multivariable logistic regression was used to evaluate associations between 1- and 5-year survival rates and race.

RESULTS:

Among 11,249 women, 61.9% identified as White, 15.1% Asian, 7.8% Black, 13.6% Hispanic, and 0.6% mixed or unknown race, with 46.5% having public insurance through Medicare or Medi-Cal. In preliminary analysis, Black women had lower survival compared to White women at 1 year (87.4% versus 92.3%) and 5 years (67% versus 78.7%) (OR 0.57; 95% CI, 0.46–0.71; P<.001). However, when adjusted for histology and stage, survival differences between Black and White women at both 1 year (OR 0.83; 95% CI, 0.65–1.07; P=.15) and 5 years (OR 0.92; 95% CI, 0.73–1.15; P=.45) were no longer significant.

CONCLUSION:

Among a diverse group of insured individuals receiving care within an integrated health care system, tumor characteristics largely accounted for racial disparities in survival. These findings suggest that disparities in survival not explained by tumor characteristics can be addressed by closing gaps in insurance coverage and access to care.
Age-Related Increase in Live-Birth Rates of First Frozen Thaw Embryo Compared With First Fresh Transfer in Initial Assisted Reproductive Technology Cycles Without Preimplantation Genetic Testing [ID 2683417]
Authors: Wang Sarah , Seifer David B.
Published: May 2024

INTRODUCTION:

Compare live-birth outcomes stratified by age between primary frozen (FET) and fresh transfers in initial autologous assisted reproductive technology (ART) cycles without preimplantation genetic testing (PGT).

METHODS:

This was a retrospective cohort study of autologous first ART cycles without PGT comparing success rates of primary embryo transfer (frozen thaw versus fresh) from the 2014–2020 SARTCORS database. We compared live-birth rate (LBR) stratified by age and cumulative live-birth rate (CLBR) for first FET versus first fresh cycles in first ART cycle. Primary transfer (FET or fresh) was the first transfer for an index retrieval. LBR was number of live births from first embryo transfer associated with first retrieval. CLBR was defined as at least one live birth from all linked embryo transfers within 1 year from initial retrieval. Multivariate logistic regression (MLR) determined association between live-birth outcomes and method of transfer.

RESULTS:

228,171 first ART cycles resulted in primary embryo transfer. 62,100 initial FETs and 166,071 fresh transfers were compared. LBR was 48.3% for initial FETs versus 39.8% for initial fresh transfers (P<.001). CLBR was 71.8% for initial FETs versus 59.2% for initial fresh transfers (P<.001). MLR demonstrated that initial FETs had a greater chance of live birth across all age groups, with adjusted odds ratio of live birth incrementally increasing with advancing age groups.

CONCLUSION:

Overall, LBR and CLBR were greater for first FET than fresh transfers with incremental increases in odds of live birth with advancing age, suggesting the presence of a more favorable age-related change in endometrial receptivity present in frozen–thawed cycles.
U.S. Gestational Carrier Embryo Transfer Trends, 2014–2020 [ID 2683526]
Authors: Traub Ariana M. , Shandley Lisa M. , Boulet Sheree L. , Hipp Heather S. , Kawwass Jennifer Fay
Published: May 2024

INTRODUCTION:

Multiple embryo transfers (METs) are common among gestational carriers (GCs) despite increased obstetric risks of multiple gestations and strong recommendations from American Society for Reproductive Medicine (ASRM) for single-embryo transfers. This study assessed GC embryo transfer trends from 2014–2020 to evaluate compliance with national guidelines.

METHODS:

This retrospective, population-based cohort study used data from the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System. All cycles from 2014 to 2020 involving an embryo transfer to a GC were analyzed. The number of GC embryo transfers, use of preimplantation genetic testing (PGT), and outcome (singleton versus multiple gestation) were assessed. Poisson and linear regression models evaluated trends in number and proportion of cycles over time. Institutional review board approval was obtained.

RESULTS:

Of the 40,177 GC transfer cycles from 2014 to 2020, 11,081 (27.6%) involved transfer of two or more embryos. Both the number (n=2,001 in 2014; n=814 in 2020) and proportion of METs (56.6% of all transfers in 2014; 11.8% in 2020) (P<.05 for both) decreased. The use of PGT among MET GC cycles increased from 23.9% in 2014 to 61.4% in 2020. Among live births, there was a 71.0% reduction in the proportion of multiple gestations from 2014 (25.5%) to 2020 (7.4%) (P<.05). Among double-embryo transfers, the majority were performed at the blastocyst stage with an increase from 2014 (76.7%) to 2020 (88.1%) (P<.05).

CONCLUSION:

With increased use of PGT and extended blastocyst culture, MET and subsequent multiple gestation pregnancies have decreased amongst U.S. GCs. These trends suggest increased compliance with ASRM national guidelines.
Evaluating the TRH Test: Prolactin Cutoff Level on the Prevalence of Reactive Hyperprolactinemia Among PCOS Women [ID 2683598]
Authors: Vargas Sofía B. , Ugarte Fernanda Villa , Ortuzar Antonia , Soto Hugo , Jose del Rio María , Vigil Pilar
Published: May 2024

INTRODUCTION:

The prolactin cutoff value is currently under discussion, although accepted values range between 15 and 25 ng/mL. The thyrotropin-releasing hormone (TRH) test is a validated methodology for the study of reactive hyperprolactinemia, but there is no consensus for which group of patients it should be used, especially in those women diagnosed with polycystic ovary syndrome (PCOS). The objective of this study was to classify the prolactin values obtained from the TRH test in women of reproductive age but previously diagnosed with PCOS, according to ranges: group A: PRL, less than 15 ng/mL; group B: PRL, 15–20 ng/mL; and group C: PRL, 20–25 ng/mL.

METHODS:

Three hundred seventy-eight women between 12 and 40 years old, previously diagnosed with PCOS according to Rotterdam criteria, and without a diagnosis of hyperprolactinemia or use of antipsychotics were considered. An initial prolactin measurement was performed, the TRH test was performed after 15 and 30 minutes, and the resulting values were classified in groups A, B, and C, respectively.

RESULTS:

The number of patients obtained was 266. Group A (n=199) had 34.17% (68) of patients with an altered TRH test, whereas in group B (n=42) 47.62% (20) had an abnormality in the test. Finally, in group C (n=25), 28.00% (7) showed an altered TRH test.

CONCLUSION:

Group B is the one with the highest prevalence of reactive hyperprolactinemia compared to groups A and C. It is concluded that the application of the TRH test is suggested in those patients with PCOS with prolactin ranges between 15 and 20 ng/mL.
The Effect of Body Mass Index on the Risk of Postoperative Complications After Myomectomy [ID 2683654]
Authors: Meyer Raanan , Hamilton Kacey M. , Schneyer Rebecca , Truong Mireille , Wright Kelly , Siedhoff Matthew T.
Published: May 2024

INTRODUCTION:

We aimed to evaluate the association of body mass index (BMI) and short-term postoperative complications after myomectomy.

METHODS:

Using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, we analyzed major and minor complications according to BMI for patients who underwent myomectomy between 2012 and 2020.

RESULTS:

A total of 29,305 cases were included. Postoperative complications occurred in 11.5% of cases (n=3,374), ranging from 10.2% among underweight patients to 15.9% among patients with obesity class 3 (P<.001). In multivariable regression analysis, overweight patients experienced fewer postoperative complications (adjusted odds ratio [aOR] 95% CI, 0.89 [0.80–0.99]), both minor (aOR 95% CI, 0.89 [0.80–0.99]), and major (aOR 95% CI, 0.75 [0.58–0.98]), compared to patients with normal BMI. Patients with obesity class 1 also experienced fewer major complications compared to normal weight (aOR 95% CI, 0.61 [0.45–0.84]). Patients with obesity class 3 experienced more complications (aOR 95% CI, 1.21 [1.05–1.38]), both minor (aOR 95% CI, 1.17 [1.02–1.34]) and major (aOR 95% CI, 1.17 [1.02–1.35]), compared to the other BMI classes combined. When examining abdominal myomectomies only, compared to normal weight, overweight patients experienced fewer minor complications, and obesity class 1 patients had fewer major complications. Complications did not differ based on BMI when restricting the cohort to minimally invasive or vaginal myomectomies only.

CONCLUSION:

Class 3 obese patients are at increased odds for experiencing complications after myomectomy, whereas being overweight or slightly obese appears to be protective. These differences based on BMI are largely driven by complications experienced following abdominal, rather than minimally invasive, myomectomy.
Risk Factors and Racial Disparities of Maternal and Neonatal Morbidity at Premier Health Maternity Facilities [ID 2683422]
Authors: Whitehead Katie , McKenna David
Published: May 2024

INTRODUCTION:

Nationally, racial disparities in obstetrical outcomes have proven to be contributing to the high maternal morbidity and mortality rates in the United States when compared to other developed nations. To best approach the inequalities in our community, we sought to determine whether and where obstetrical outcomes were being disproportionately affected by the race of the patient.

METHODS:

We conducted a retrospective chart review of patients delivering singleton pregnancies at 37 weeks of gestation or greater from January 2019 to July 2021. Using the patient’s self-identified race, regression modeling was used to identify disparities in obstetrical outcomes. A composite of maternal outcomes consisting of third/fourth-degree lacerations, blood transfusion, febrile morbidity, and ICU admission was used to compare morbidities. Neonatal composite morbidity consisted of respiratory distress, sepsis, need for resuscitation, and neonatal intensive care unit (NICU) admission. This study was approved by the Wright State University IRB (protocol number: 07272).

RESULTS:

There were 13,689 births during the study period. Significantly more non-Caucasian patients experienced cesarean sections than Caucasian patients (30.3% versus 28.5%; P <.01) and on average had a higher maternal composite score (0.5 versus 0.03; P <.01). Black or African American babies were more likely to qualify as small for gestational age, be admitted to the NICU, and have a higher composite score than Caucasian babies (P<.01).

CONCLUSION:

Within our community, obstetrical and neonatal outcomes were experienced at significantly different rates by different race groups. Next steps include creating standardized protocols to decrease the opportunity for implicit bias to adversely affect patient care.
External Validation of the fullPIERS Risk Prediction Model in a U.S. Cohort of Women With Preeclampsia [ID 2683408]
Authors: Long Danielle , Flicker Kari , Vishnia Maya , Wright Madeleine , Francis Matilda , Kawakita Tetsuya
Published: May 2024

INTRODUCTION:

Hypertensive disorders of pregnancy are a leading cause of maternal morbidity and adverse pregnancy outcomes. The fullPIERS model was developed to predict severe adverse maternal outcomes within 48 hours of admission in patients with preeclampsia. This model has not been validated in the U.S. cohort. We sought to examine whether the fullPIERS model was predictive in the U.S. cohort.

METHODS:

This was a retrospective study of patients with preeclampsia who delivered at 23 weeks or greater from January 1, 2010, to December 31, 2020. Our primary outcome was a composite of maternal mortality or other serious complications of preeclampsia that occurred within 48 hours of admission. Using the prediction model that considers gestational age at admission, chest pain or dyspnea, serum creatinine, platelet, aspartate transaminase, and oxygen saturation, we calculated the probability of the composite outcome. We assessed performance using the area under the curve (AUC) of the receiver operating characteristic curve. Hosmer–Lemeshow test was used to assess the goodness-of-fit.

RESULTS:

Of 1,552 patients with preeclampsia, 77 (5.0%) had the composite outcome within 48 hours. The fullPIERS model had an AUC of 0.73 (95% CI, 0.66–0.80). However, the Hosmer–Lemeshow test showed poor calibration with a value of P<.001. The calibration plot showed the model underestimated when the predicted probability was less than 10% and overestimated when the predicted probability was over 28%.

CONCLUSION:

The fullPIERS model had good AUC in the U.S. cohort of patients with preeclampsia but poor calibration. The fullPIERS model may not be clinically useful in the United States.
Maternal and Neonatal Characteristics Associated With Failed Induction of Labor in Diabetic Mothers [ID 2683497]
Authors: Alhousseini Ali , Abdel-Gadir Deena , Hashmi Nabiha , Diab Maya , Ramseyer Abigail
Published: May 2024

INTRODUCTION:

Uncontrolled diabetes is a risk factor for cesarean delivery. Identifying and stratifying associated risk factors for failed induction of labor (IOL) may improve counseling and intrapartum care. This study aims at determining maternal and fetal factors that would predict the occurrence of failed IOL in diabetic mothers.

METHODS:

This is a retrospective study of 2,172 diabetic mothers who underwent IOL at a single university medical center between January 2013 and December 2021. Maternal and neonatal characteristics were obtained. Among the studied maternal characteristics were ethnicity, age, gestational age, medical comorbidities (including preeclampsia and essential hypertension), insulin administration, parity, and health insurance type (public versus private). Statistical analysis was performed using univariate and multivariate logistic regression. A value of P<.05 was considered statistically significant.

RESULTS:

Our preliminary analysis showed that 567 out of 2,172 (26.1%) diabetic mothers failed IOL and delivered via cesarean pathway. Failed IOL was associated with nulliparity (P=.0001), preexisting diabetes (compared to gestational diabetes) (P=.001), control of diabetes by insulin (P=.001), maternal essential hypertension (P=.001), preeclampsia (P=.001), polyhydramnios (P=.001), prenatal diagnosis of fetal growth restriction (P=.008), and placental abnormalities (P=.027). Neonatal weight, large for gestational age, head circumference, and height were not statistically associated with failed induction of labor (all values of P>.05). Failed IOL was associated with admission to neonatal intensive care unit (P=.001), hyperbilirubinemia (P=.001), lower APGAR score at 1 minute (P=.033), longer stay in the hospital (0.001). Failed IOL was not associated with lower APGAR score at 5 minutes, lower umbilical cord pH value, neonatal readmission or maternal ethnicity (all values of P>.05).

CONCLUSION:

Failed IOL among diabetic mothers is associated with significant maternal and neonatal adverse outcomes. Our continued data analysis aims at assessing the role of optimal glucose control and other maternal factors in improving maternal and neonatal outcomes.
Does Longer Second-Trimester Cervical Length Increase Likelihood of Labor Induction? [ID 2683543]
Authors: Pember Nicolette G. , Thayer Sydney M. , Zofkie Amanda C.
Published: May 2024

INTRODUCTION:

Second-trimester transvaginal cervical length (TVCL) under 2.5 cm is associated with increased rates of spontaneous preterm birth; however, little is known about the effect of increasing TVCLs on spontaneous labor rates. We aimed to determine if longer TVCL is associated with increased risk of induction of labor (IOL).

METHODS:

This is a retrospective cohort study of patients eligible for vaginal birth with singleton term gestations and normal TVCL (at 16–24 weeks of gestation) delivering at a tertiary care center June 2022 to June 2023. Rates of IOL were compared by TVCL tertiles (T1: 2.5–3.49 cm; T2: 3.5–4.49 cm; and T3: 4.5 cm or greater). Multivariable logistic regression controlled for potential confounders. Institutional review board approval was obtained.

RESULTS:

Of 1,027 eligible deliveries, 594 (58%) underwent IOL. Patients with TVCLs in T2 and T3 were significantly more likely to undergo IOL than patients with TVCL in T1 (T2 59.6% versus T1 49.4%, P=.02; T3 56.5%, P=.04). Patients in T2 had increased odds of IOL compared to those in T1 (OR 1.5 [CI, 1.1–2.1]). This relationship did not remain significant after adjusting for potential confounders including term delivery, delivery mode, race/ethnicity, age, and body mass index. The odds of IOL with TVCL in T3 were not significantly different than for those in T1, before and after adjusting for confounders.

CONCLUSION:

Within a cohort of patients with normal mid-trimester TVCL, increasing TVCLs were not associated with higher rates of IOL after adjusting for confounding variables. These results can be used to guide patient counseling surrounding birth plans and expectations for labor and delivery.
Relationship Between Vaginal and Gut Microbiome on Stress and Depression in Pregnancy [ID 2683607]
Authors: Worly Brett Lawrence , Gur Tamar L. , Rajasekera Therese
Published: May 2024

INTRODUCTION:

Pregnancy is a period of significant stress and weight gain; however, the effect of the vaginal and gut microbiome on pregnancy, depression, stress, and the neonate is not completely understood.

METHODS:

An IRB-approved prospective cohort study was performed for pregnant individuals and their neonates. The Perceived Stress Scale (PSS) and Center for Epidemiologic Studies Depression Scale (CES-D) surveys were administered in the antepartum and postpartum patient, vaginal and fecal microbiome samples were collected, and neonate umbilical cord blood and fecal specimens were also collected. Using full-length 16S rRNA sequencing, fecal and vaginal community composition was characterized. Additionally, possible covariates such as body mass index, cohabitation status, educational attainment, dietary intake, public/private insurance status, chronic health conditions, and pregnancy complications were captured.

RESULTS:

The study sample consisted of 35 pregnant individuals, average age 30 years, and half primiparous. Increased early pregnancy stress (PSS greater than or equal to 14) was associated with increased abundance of fecal taxa, and increased stress from late pregnancy through postpartum was associated with increased abundance of fecal microbial pathogens. Depressed participants (CES-D greater than or equal to 16) experienced steeper decreases in prenatal vaginal microbiome diversity. In late pregnancy, maternal stress and depression scores were associated with elevated maternal inflammatory markers (CCL2). At delivery, neonatal umbilical CCL2 concentration was negatively correlated with relative abundance of maternal fecal lactobacilli.

CONCLUSION:

These findings highlight the relationship between stress and depression in pregnancy, the microbiome of the pregnant patient, and inflammatory markers in the pregnant patient and the neonate.
Is Preeclampsia With Low Sodium Levels Associated With Increased Need for Antihypertensives? [ID 2683464]
Authors: Band Isabelle C. , Goldberger Cody , Wang Kelly Z. , Cohen Rebecca M. , Zachem Alexis L. , DeBolt Chelsea A.
Published: May 2024

INTRODUCTION:

Preeclampsia (PEC) complicates 5–10% of pregnancies. Preeclampsia and low sodium (PALS) has been reported, but risks of low sodium are not well understood. We hypothesize that PALS is associated with increased need for antihypertensives.

METHODS:

This was an IRB-approved retrospective cohort study of 521 PEC patients with a documented sodium level during delivery or postpartum admission at Mount Sinai Hospital (2013–2021). Primary outcomes were need for emergency antihypertensives during admission and long-acting antihypertensives at discharge. Secondary outcomes were maternal length of stay (LOS), ICU admission, and readmission for PEC.

RESULTS:

Patients with PALS (sodium <135 mmol/L; n=111) were more likely to be nulliparous (P=.004), have lower body mass index (P=.03), and have a history of PEC (P=.047). In a multivariable logistic regression adjusting for history of PEC, chronic hypertension, aspirin use in pregnancy, multiple gestations, and PEC subtypes, patients with PALS were more likely to require long-acting antihypertensives at discharge (adjusted odds ratio [aOR] 1.79; 95% CI [1.13, 2.83]; P=.01) compared to PEC with normal sodium. Need for emergency antihypertensives, rates of maternal ICU admission and maternal readmission did not differ between groups. However, the distribution of maternal LOS differed between groups (median [interquartile range (IQR)]: 4.0 [3.0, 5.0] for normal sodium, 4.0 [4.0, 6.0] for low sodium; P<.0001).

CONCLUSION:

Preeclampsia and low sodium is associated with increased need for long-acting antihypertensives at discharge. Preeclampsia and low sodium may represent a more severe PEC presentation, warranting closer attention to sodium levels in the management of PEC patients. Future studies with larger sample sizes are needed to assess the effects of lower sodium levels.
Prevalence of Large for Gestational Age and Polyhydramnios on Late Third-Trimester Ultrasound and Associated Adverse Pregnancy Outcomes [ID 2683531]
Authors: Moss Heather , Riley William L. , Mastronardi Alicia , Brechtel Leanne E. , Patel Mithil D. , Reeder Callie
Published: May 2024

INTRODUCTION:

The objective of this study was to evaluate the prevalence of large for gestational age (LGA) and polyhydramnios found on ultrasound performed between 34 and 38 weeks of gestation and investigate the prevalence of gestational diabetes and delivery outcomes in this population.

METHODS:

A retrospective cross-sectional study (IRB #4869) was performed including chart review of late third-trimester ultrasounds performed on singleton pregnancies between 34 and 38 weeks of gestation from April 2020 to April 2022 at a hospital-owned private practice. Patients were grouped as no LGA (estimated fetal weight >90%) or polyhydramnios (amniotic fluid index ≥25 or maximum vertical pocket ≥8) or LGA and/or polyhydramnios. Differences in cesarean delivery (CD), gestational diabetes diagnosis, and macrosomia between groups were assessed via χ2 and Fisher's exact tests.

RESULTS:

Of 1,510 pregnancies, 15.0% (227/1,510) were diagnosed with LGA and/or polyhydramnios on late third-trimester ultrasound. The overall prevalence of CD in the group without LGA and/or polyhydramnios was 25.5%, whereas the rate of CD in patients having LGA and/or polyhydramnios was 44.1% (P<.001). The overall prevalence of macrosomia in the group without LGA and/or polyhydramnios was 8.8%, whereas the rate of macrosomia in patients having LGA and/or polyhydramnios was 17.2% (P<.001). The prevalence of diabetes in pregnancy was not significantly different between groups (without LGA and/or polyhydramnios 12.2% versus having LGA and/or polyhydramnios 16.7%; P=.081).

CONCLUSION:

Patients with LGA and/or polyhydramnios on late third-trimester ultrasound had significantly higher rates of CD and macrosomia. They were not more likely to have a diagnosis of diabetes during pregnancy. Late third-trimester ultrasound findings of LGA and/or polyhydramnios could be useful in detecting undiagnosed and/or missed diabetes. Future work will evaluate the timing of gestational diabetes screening and subsequent testing for diabetes if findings suggest LGA and/or polyhydramnios.
Obstetric Outcomes After Chemotherapy in Pregnancy [ID 2683556]
Authors: Nambiar Anjali , Mulder Isabelle , Rodriguez Aldeboran N. , Duryea Elaine L. , Lea Jayanthi , Spong Catherine Y.
Published: May 2024

INTRODUCTION:

Cancer affects approximately 1 in 1,000 pregnancies; limited data exist to guide clinical decision making and counseling regarding chemotherapy. We investigated the obstetric outcomes of patients who received chemotherapy for cancer in pregnancy at a large county hospital.

METHODS:

In this retrospective IRB-approved study, patients diagnosed with cancer prior to or during pregnancy from May 2009 to May 2023 were identified. Those who received chemotherapy in pregnancy were included. Type of cancer, chemotherapeutic agents, and obstetric outcomes were obtained from the electronic medical record.

RESULTS:

Of 22 patients who initiated or continued chemotherapy, seven had a cancer diagnosis prior to pregnancy. Fifteen were diagnosed in pregnancy, at an average gestational age of 15.5 weeks. Average maternal age was 30.5 years. Hematologic (36%) and breast (32%) cancers were most common. Four terminated pregnancy and 18 continued pregnancy. Chemotherapy initiation occurred at an average of 21.2 weeks. Most patients received alkylating agents or antitumor antibiotics, and only one required antepartum admission for chemotherapy-related complications. Patients delivered at an average of 35.6±3.0 (29–41) weeks and 9/18 (50%) patients delivered prior to 37 weeks. Severe fetal growth restriction (less than third percentile) occurred in 6/18 (33%) patients; one had a history of fetal growth restriction in a prior pregnancy. There were no neonatal deaths or congenital malformations.

CONCLUSION:

While high rates of fetal growth restriction and preterm birth were observed, chemotherapy was well tolerated in pregnancy and all non-terminated pregnancies delivered viable infants in the third trimester. Chemotherapy can be administered in pregnancy with counseling regarding neonatal risks.
Cardiovascular Risk Assessment in Pregnancy: Findings From a Large Urban Academic Medical Center [ID 2683572]
Authors: Flatley Kevin , Hameed Afshan , Wolfe Diana S. , Thiel de Bocanegra Heike
Published: May 2024

INTRODUCTION:

The goal of this study is to describe patients who screened positive and had true cardiovascular disease (CVD) identified using a risk assessment tool in pregnancy or postpartum.

METHODS:

This is a prospective validation study of the CVD screening algorithm proposed by the California Maternal Quality Care Collaborative (CMQCC). The CVD risk assessment tool was embedded in the electronic medical record for use by all prenatal care providers with a goal of at least one CVD risk assessment during pregnancy and/or postpartum period. Patients identified with increased risk of CVD received an echocardiogram, electrocardiogram, and cardiology consultation. We describe the assessment tool responses, timing of assessment, cardiac findings, and subsequent interventions. This study was approved by the IRB at Albert Einstein College of Medicine.

RESULTS:

A total of 1,877 patients were screened as of September 1, 2023, with 148 screening positive for at risk of CVD. Thirty-two patients were found to be true positives including 2 (6.25%) with systolic and/or diastolic dysfunction, 10 (31.3%) with ventricular dilation or hypertrophy, and 23 (71.9%) with a valvular abnormality.

CONCLUSION:

All 32 true-positive cases were seen by a multidisciplinary cardio-obstetrics team at least once. Ten patients had multiple visits with the cardio-obstetrics team. Three patients were deemed to be of higher risk for decompensation during labor by modified World Health Organization classification and required detailed plans for intrapartum and postpartum management. Seven patients were started on cardiovascular medications. The cardiovascular risk assessment tool proved valuable for identifying and providing individualized care for cardio-obstetric patients.
Preeclampsia Risk in Pregnant Patients With Preexisting Ischemic Heart Disease [ID 2683588]
Authors: Azar Michelle , Bailey Beth A.
Published: May 2024

INTRODUCTION:

Preeclampsia (PreE) affects 1 in 25 U.S. pregnancies. Recognized risk factors include obesity, chronic hypertension, and diabetes, and PreE may elevate risk of cardiovascular disease (CVD) later in life. Despite shared vascular integrity concerns with known risk factors, there is no clear link between preexisting CVD, particularly ischemic heart disease (IHD), and increased risk of PreE during pregnancy. This study investigates whether preexisting IHD heightens risk of PreE in pregnant patients, and if this relationship can be explained by elevated rates of hypertension, diabetes, and obesity.

METHODS:

Data were obtained from the Healthcare Cost and Utilization Project (HCUP) national database, containing comprehensive de-identified patient data on U.S. hospital encounters. ICD-10 codes for IHD, chronic hypertension, gestational and preexisting diabetes, obesity, and PreE were used to identify relevant cases among delivery admissions. Data were analyzed using logistic regression, controlling for confounders.

RESULTS:

The sample included 1,670,527 patients who delivered between 2016 and 2019. Although no differences by race were observed, patients with IHD were significantly older and more likely to qualify for Medicaid. After controlling for age and insurance status, pregnant patients with IHD were nearly three times more likely to develop PreE than those without IHD (OR 2.75 [1.93–3.39]). With adjustment for possible mediators including chronic hypertension, preexisting and gestational diabetes, and obesity, IHD was still associated with a twofold increased risk of PreE (OR 2.07 [1.44–2.99]).

CONCLUSION:

Pregnant women with preexisting IHD face significantly higher risk of developing PreE, even when considering comorbidities including obesity, diabetes, and hypertension. Preeclampsia is a leading cause of maternal morbidity and mortality worldwide. As the incidence of IHD rises, understanding the potential interactions between these conditions becomes crucial. Further research is needed to clarify connections between IHD and PreE, especially in identifying IHD and its risk factors to improve PreE prophylaxis and management.
Inflammatory Bowel Disease and Associated Placental Histopathology [ID 2683599]
Authors: Schneider Emily , Kantorowska Agata , Akerman Meredith , Khullar Poonam , Kinzler Wendy L. , Rekawek Patricia
Published: May 2024

INTRODUCTION:

Inflammatory bowel disease (IBD) has been associated with adverse obstetric outcomes, but its effect on placental histopathology is not well studied. We sought to determine the placental histopathology findings associated with maternal IBD.

METHODS:

This is an IRB-approved retrospective cohort study of patients with IBD who delivered singleton live births at a single institution from October 2019 to April 2023 and had placental pathology available. Participants were identified using an ultrasound query for “Crohn’s” or “ulcerative colitis” (UC). Cases with fetal aneuploidy or major anomalies were excluded. Controls were matched 2:1 for maternal age, gestational age at delivery, and medical comorbidities. Demographics, pregnancy outcomes, and pathology findings were obtained from the electronic medical record. Mann–Whitney and Fisher's exact tests were used with significance set at P<.05.

RESULTS:

Placental pathology was compared between 18 IBD participants (11 Crohn's, seven UC) and 36 controls. Of 18 IBD participants, three were treated with sulfasalazine, seven with TNF-α inhibitors, and eight used no medication. Baseline demographics and cesarean delivery rates were similar between groups. Five participants per group had histologic evidence of acute chorioamnionitis and/or funisitis (27.8% versus 13.9%; P=.27). Three IBD participants demonstrated maternal vascular malperfusion (MVM) versus 15 controls (16.7% versus 41.7%; P=.07). There were no differences in placental weight, meconium, or fetal vascular malperfusion.

CONCLUSION:

Inflammatory bowel disease was not associated with adverse placental histopathology. Decreased incidence of MVM may result from IBD medications reducing systemic inflammation. Larger studies are warranted to further evaluate the effect of IBD on placental pathology.
Questioning the Value of Urine Protein for the Diagnosis of Hypertensive Disorders of Pregnancy [ID 2683605]
Authors: Hopman Clarice , Class Quetzal A. , Wheatley Catherine N. , Thiyagarajan Dhanalakshmi
Published: May 2024

INTRODUCTION:

Preeclampsia with severe features (PreE w/SF) is often preceded with a diagnosis of gestational hypertension (gHTN) or preeclampsia without severe features (PreE w/o SF). These diagnoses remain differentiated via a 24-hour urine protein (24 UP) or a urine–protein creatinine ratio (PCR). We examine the utility of the 24 UP/PCR in differentiating the progression of gHTN or PreE w/o SF to PreE w/SF.

METHODS:

We created a retrospective cohort study of 1,687 patients who delivered a live-born neonate at our urban, academic hospital between September 2011 and September 2021. All patients had an initial diagnosis of either gHTN or PreE w/o SF. Patients with chronic hypertension or an initial diagnosis of PreE w/SF were excluded. We performed descriptive and inferential statistics including chi-square.

RESULTS:

We identified 910 (54%) patients initially diagnosed with gHTN and 777 (46%) PreE w/o SF. A total of 972 (57.7%) reported to be Black and 518 (30.1%) Hispanic. The rate of progression to PreE w/SF did not differ across those with an initial diagnosis of gHTN (n=147 [16%]) or PreE w/o SF (n=153 [19%]; X2 (1)=3.55, P>.05). Timing of initial diagnosis being antenatal or postnatal was not predictive of disease progression.

CONCLUSION:

We found no clinical significance of a 24 UP/PCR in predicting progression to PreE w/SF from gHTN or PreE w/o SF. Performing a 24 UP or PCR takes health care dollars and patients' time, which has economic and social effects. Although further investigation is needed, our findings support eliminating 24 UP/PCR as a diagnostic criterion.
How Patients Seeking Abortion in a Surge State Use Their Stories to Support Each Other [ID 2683411]
Authors: Banwarth-Kuhn Brenna , McQuade Miriam M. , Truehart Amber , Trujillo Victoria
Published: May 2024

INTRODUCTION:

A changing legal landscape after Texas Senate Bill 8 and the Dobbs decision resulted in a surge of out-of-state patients accessing abortion care in New Mexico. In one health center, patients undergoing procedural abortion can write entries in a recovery room journal titled, “Tell your story; it may help someone else.” Journals were not developed for research but with the goal of invoking community. Patients can read and anonymously share their abortion experience. We analyzed the themes from journal entries to understand how patients share their experiences to foster community during a time of increasing restrictions.

METHODS:

We reviewed 74 anonymous narrative journal entries from a single health center in Albuquerque, New Mexico, from 2020 to 2023, identifying overarching themes using inductive content.

RESULTS:

Journal entries described complex decisions and emotions. Themes included solidarity, autonomy, gratitude, and difficulty of accessing care. People invoked comradeship with words of encouragement and reassured others that restrictive abortion laws should not define their decisions or interfere with their autonomy.

CONCLUSION:

This study highlights the importance of patient storytelling in improving health outcomes. Developed with the goal of invoking community and shared experience for normalization of abortion care, these stories can help us understand how patients frame the context of their decision to help others. The challenges they present and real-time emotional processing help frame the complexity of this decision and the accessibility of abortion care during the time period of increasing restrictions on abortion care.