bluuebunny/crossref_metadata_2025 huggingface dataset:
Genetic Predictors of Ondansetron Effectiveness and Recurrence Risk for Hyperemesis Gravidarum [A177]
Authors: Jin Emmy , Quan Courtney , Plummer Danielle R. , MacGibbon Kimber , Mullin Patrick , Fejzo Marlena
Published: June 2022

INTRODUCTION:

Most women experience nausea and vomiting of pregnancy, and 18% require medication. The most severe form, hyperemesis gravidarum (HG), is associated with weight loss, undernutrition, and adverse maternal and child outcomes. Antiemetic effectiveness and recurrence risk are major concerns. This study aimed to investigate the association of selected germline polymorphisms with 1) ondansetron response and 2) recurrence risk in HG patients.

METHODS:

HG patients provided DNA samples and reported treatments and effectiveness. Polymorphisms in pharmacogenetic modifiers of ondansetron (ABCB1, CYP2D6, HTR3C, HTR3B) and published HG risk locus PGR_TRPC6 were analyzed for association with ondansetron effectiveness and recurrence risk, respectively. Institutional review board approval was obtained.

RESULTS:

Of 426 HG patients, 58% (249) reported that ondansetron, used off-label, was effective and were significantly less likely to require enteral nutrition (P=.0009). No associations were found between the ABCB1, CYP2D6, HTR3C, and HTR3B variants tested and self-reported effectiveness of ondansetron. Of 151 participants with two pregnancies, 83% (125) had a recurrence of HG, and rs59743346 in TRPC6 was a significant predictor (OR, 9.1; 95% CI, 2.3–35.0; P=.001). Homozygosity for the minor allele was identified in only 3% of recurrences, compared to 23% of cases that did not recur.

CONCLUSION:

The strong association between those reporting ondansetron ineffectiveness and their treatment with enteral nutrition validates self-reporting of effectiveness. However, the variants tested did not predict ondansetron effectiveness. Our study found that rs59743346, in addition to previously identified GDF15 polymorphism rs16982345, may be useful in predicting recurrence risk. This work has implications for elucidating the biology of HG, counseling, diagnosis, and treatment.
Obstetrician Communication After Neonatal Hypoxic Ischemic Encephalopathy [A178]
Authors: Park Isabella S. , Frenn Recia
Published: June 2022

INTRODUCTION:

Our research investigates parent perception of communication between obstetricians and parents of newborns who have experienced hypoxic ischemic encephalopathy (HIE).

METHODS:

After institutional review board approval, an anonymous 7-item survey was shared with parents belonging to the Hope for HIE parent support group. After brief demographics, parents provided open-ended answers that described what went well, what did not go well, and what suggestions they had for improved communication with their obstetric care professional. A thematic analysis was then performed.

RESULTS:

A total of 111 respondents completed the survey and 102 reported their child being diagnosed with HIE (91.89%). Respondents represented all parts of the U.S., with the majority of survey respondents coming from the South (32.4%). The majority of respondents gave birth 1–5 years ago (45.9%), followed by <5 years ago (26.1%), then <6 months ago (17.2%), with the fewest delivering 6–12 months ago (9.5%). The themes identified of what went well included: (1) being comforting, being honest and upfront, (2) having a debrief, and (3) having frequent check-ins. Themes that covered communication that did not go well included: (1) not enough follow-up, (2) inadequate debrief/lack of explanation, and (3) being defensive. Lastly, themes suggested to improve communication included: (1) debriefing, 2) providing resources, (3) provider education on trauma-informed care, (4) empathy/compassion, and (5) long-term follow-up.

CONCLUSION:

The themes identified offer the groundwork to create a formative guide, which could include a robust debrief and education on trauma-informed care, to help improve communication between obstetricians and parents after neonatal HIE.
Motivations for Recovery Among Pregnant Individuals With Opioid Use Disorder [A184]
Authors: Hafen Kody L. , Smid Marcela , Garets Mitchell , Machado Annika , White Ashley H. , Cochran Gerald
Published: June 2022

INTRODUCTION:

Little is understood about pregnant individuals’ motivation to engage in opioid use disorder (OUD) treatment. Our objective was to explore motivations for treatment engagement among pregnant individuals with OUD enrolled in a patient navigator, comparative study (NCT03833245).

METHODS:

We performed a qualitative analysis of 16 baseline psychosocial treatment sessions with pregnant individuals with OUD, randomly selected from 103 total sessions. We used a two-cycle coding method: in cycle 1, themes and sub-themes related to treatment motivations were established, and in cycle 2, two researchers analyzed sessions using a coding schema. Inter-rater statistics (kappa [k] and rater percent agreement [A]), the proportion of sessions (S) that a sub-theme was mentioned, and total references (n) were calculated.

RESULTS:

Participants identified maximizing fetal/neonatal wellbeing, establishing independence, and improving emotional wellbeing as important motivating factors for OUD treatment engagement. Maximizing fetal/neonatal wellbeing was a strong motivator, specifically fetal health (S=63%, n=25, k=0.65, A=98.5%), stability for children (S=50%, n=22, k=0.73, A=98.4%) and maintaining custody (S=44%, n=20, k=0.86, A=98.7%). Establishing independence was an important motivator, specifically financial independence (S=56%, n=19, k=0.50, A=98.4%), freedom from opioid dependence (S=50%, n=10, k=0.51, A=98.7%), recognizing internal drive (S=50%, n=9, k=0.47, A=98.37%), and not burdening others (S=19%, n=7, k=0.83, A=99.22%). Finally, improving emotional wellbeing was significant, specifically processing emotions (S=63%, n=14, k=0.33, A=98.15%), improving hope (S=25%, n=11, k=0.76, A=98.7%), and being more genuine (S=13%, n=2, k=0.87, A=99.9%).

CONCLUSION:

Pregnant individuals with OUD are motivated by fetal/neonatal wellbeing, independence, and emotional wellbeing. To promote engagement, interventions should be tailored to align with maternal motivators.
MHPAEA/ACA Policy Implementation and Severe Maternal Morbidity Among Commercially Insured Individuals, 2008–2019 [A192]
Authors: Admon Lindsay , Dalton Vanessa , Kolenic Giselle , Tilea Anca , Hall Stephanie V. , Zivin Kara
Published: June 2022

INTRODUCTION:

We aimed to identify rates and trends in severe maternal morbidity (SMM) in relationship to implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA) and Affordable Care Act (ACA).

METHODS:

We conducted a serial, cross-sectional analysis among individuals with continuous commercial coverage in the year preceding and following an inpatient livebirth using data from Optum Cliniformatics Data Mart. We identified hospital deliveries and cases of SMM using standard methods. We excluded cases of SMM in which blood transfusion represented the only indicator of SMM. We evaluated rates and trends in SMM in both the implementation (2008–2014) and post-implementation (2015–2019) periods using an interrupted time-series model fit with generalized estimating equations for the overall population and compared those with and without perinatal mood and anxiety disorders (PMAD). The University of Michigan Institutional Review Board deemed this study exempt from review.

RESULTS:

The sample included 681,616 births. SMM decreased by 53.2% from 195.8 (95% CI, 188.1–203.3) to 91.6 (95% CI, 85.7–97.6) per 10,000 hospitalizations for birth between 2008 and 2019. We identified decreasing SMM rates in both periods, with a larger decrease in the post-implementation period (implementation marginal effects [ME], −0.0012; post-implementation ME, −0.0015; P<.001). We observed decreasing SMM rates in both periods for those with and without PMAD, with the steepest decline among those with PMAD in the post-implementation period.

CONCLUSION:

These data suggest that implementation of the MHPAEA and ACA may have had a role in decreasing rates of SMM among childbearing individuals with commercial insurance.
Maternal Outcomes Based on Inpatient Length of Stay After Cesarean Delivery Using the NSQIP Database [A193]
Authors: Shrestha Kevin S. , Knupp Rubymel J. , Martin Kimberly D. , Battarbee Ashley N. , Subramaniam Akila
Published: June 2022

INTRODUCTION:

Cesarean deliveries (CD) are common surgeries performed in the U.S., yet a patient’s postpartum length of stay (LOS) is not standardized and is influenced by multiple factors. We sought to examine whether postpartum maternal outcomes differ based on post-cesarean LOS.

METHODS:

Retrospective cohort study of all CDs from 2019 in the National Surgical Quality Improvement Program database. Patients with a LOS >4 days postpartum were excluded. Patients were categorized based on postpartum LOS: 0–2, 3, and 4 days. Our primary outcome was a composite of maternal complications including hospital readmission, reoperation, and death, up to 30 days postpartum. Outcomes were compared between the LOS exposure groups and adjusted odds ratios calculated using 4 days as the reference.

RESULTS:

Of 9,959 patients, 6,288 (63%) had a LOS of 0–2 days, 2,901 (29%) 3 days, and 770 (8%) 4 days. At baseline, the LOS groups differed in terms of maternal age, race, tobacco use, diabetes, hypertension, and type of surgical case. Compared to a 4-day LOS, patients with LOS 0–2 days had significantly decreased odds of composite maternal complications (aOR, 0.5; 95% CI, 0.3–0.7), as well as readmissions (aOR, 0.6; 95% CI, 0.4–0.9) and reoperations (aOR, 0.3; 95% CI, 0.2–0.5). Patients with a 3-day LOS (versus 4 days) only had reduced reoperations (aOR, 0.5; 95% CI, 0.2–0.9).

CONCLUSION:

Discharge earlier than 4 days postpartum did not show an increased risk of maternal complications, readmissions, or reoperations. The selection of low-risk patients for early discharge does not appear to be harmful, and policies requiring prolonged hospitalization for all patients are likely unnecessary.
Health Care Utilization Patterns in Adolescent Pregnant Women: A Retrospective Analysis [A205]
Authors: Davitt Katlin , Gurram Padmalatha , White Samantha , Staudenmaier Emily , Denisova Elizabeth , Abruzzese Jessica
Published: June 2022

INTRODUCTION:

Adolescent mothers are at increased risk for adverse outcomes. Utilization of perinatal health care services across the continuum of care, antepartum, intrapartum, and postpartum is crucial to improve outcomes. We aimed to study utilization of perinatal health care services, including outpatient and inpatient resources by adolescent mothers.

METHODS:

Retrospective review of women who received prenatal care and delivered between February 2019 and February 2020. Subjects were divided into three cohorts based on age: adolescent (13–21), non-adolescent (22–34), and advanced maternal age (≥35, AMA). The adequacy of prenatal care was determined by Kessner index: Adequate (begins in first trimester or includes 9+ visits), Intermediate (begins in second trimester or includes 5–8 visits), and Inadequate (begins in third trimester or includes ≤4 visits). Utilization of inpatient services was determined by access ratio, calculated as inpatient services (emergency department + labor & delivery triages + antepartum admissions + postpartum ED visits) / ambulatory services (prenatal + postpartum + ultrasound visits). Institutional review board approval was obtained.

RESULTS:

A total of 79 adolescents, 203 non-adolescents, and 59 AMA were studied. Mean gestational age at initial care visit was 15 weeks in adolescents. Compared to other cohorts, adolescents had fewer prenatal, ultrasound, and postpartum visits (P<.05). Adolescents were more likely to have intermediate (44.6%) and inadequate (18.9%) prenatal care (P=.04). Adolescents also had higher antepartum admissions (P=.006) and a higher access ratio (P=.01). Outcomes were similar except for higher rates of preterm contractions (P=.03).

CONCLUSION:

The pattern of resource utilization demonstrates an overall favoring of inpatient services among adolescent mothers with inadequate access to outpatient resources. Strategies to improve access to prenatal outpatient visits are essential.
Time from Insertion to Expulsion of Cervical Ripening Balloon in Preterm Versus Term Inductions of Labor [A206]
Authors: Roth Lindsey A. , Kreiger-Benson Elana , Friedman Steven , Gossett Dana R. , Shanahan Lisa
Published: June 2022

INTRODUCTION:

Preterm induction of labor can be necessary for maternal and fetal wellbeing. Duration of cervical ripening balloon (CRB) use has been studied only in term inductions. Our study investigated duration of time for CRB expulsion and vaginal delivery in preterm inductions of labor.

METHODS:

This was a single-institution retrospective cohort study of preterm (<37 weeks) and term (≥37 weeks) inductions with CRB between 2010 and 2021. Cesarean deliveries were excluded. Primary outcome was insertion to expulsion time (IET) of CRB. Secondary outcomes included induction to delivery time (IDT), cervical dilation after expulsion, and misoprostol and Pitocin use. Institutional review board approval was obtained prior to the study.

RESULTS:

A total of 98 patients with vaginal delivery after preterm CRB use were identified and matched 1:1 on baseline characteristics to patients with vaginal delivery after term CRB use. Mean IET was significantly shorter for term CRB than for preterm induction (mean 7.2±3.09 hours versus 8.5±3.38 hours; P=.004). Mean IDT was significantly shorter for term CRB than preterm CRB induction (18.4±7.6 hours versus 22.5±9.01 hours; P<.001). Increased use of misoprostol, Pitocin, and second CRB were noted among the preterm cohort compared to the term cohort. Among term patients, more CRB placement at start of induction and greater cervical dilation post-balloon were found in comparison to preterm patients.

CONCLUSION:

Among patients undergoing preterm induction, longer IET, longer IDT, and increased interventions should be expected. Different standards for labor management should be considered for achieving vaginal delivery in preterm inductions.
May-Thurner Syndrome in Pregnancy: A Case Report [A209]
Authors: Ajibade Olufemi , Malhotra Radhika , Tyler Lamarr , Kjos Siri L. , Howard David L.
Published: June 2022

CASE:

A 31-year-old gravida 1, para 0 at 28.6 weeks of gestation presented to the emergency room with a 2-month history of progressive lower left leg swelling since 21.2 weeks of gestation. The patient denied pain, loss of sensation, shortness of breath, and dyspnea on exertion. She had a history of domestic violence at 17 weeks. A physical exam of her lower extremities revealed 3+ pitting edema in the left lower extremity from ankle to groin. The left thigh measured 26 inches and the left calf measured 19 inches. No edema was noted on the right lower extremity. Venous Doppler ultrasounds of bilateral lower extremities yielded negative results for deep vein thrombosis (DVT) on three occasions. Magnetic resonance angiography of the pelvis without contrast revealed no evidence for DVT of the left pelvic veins and no evidence of pelvic mass compression. The overall finding was severe compression of the upper left common iliac vein and lower inferior vena cava by gravid uterus. Clinical suspicion became high for May-Thurner Syndrome (MTS). Few cases of MTS have been identified in pregnancy, and none of these cases present without DVT as a presenting symptom. MTS is extrinsic venous compression caused by the arterial system against bony structures in the ilio-caval territory, leading to formation of venous spurs. Symptomatic patients typically have left lower extremity swelling that often involves the entire limb. Risk factors associated with MTS include female sex, scoliosis, hypercoagulable disorders, and dehydration. There is more research to be done to elicit causes and improve diagnosis of MTS.
Qualitative Evaluations of Obstetric Transport Experiences During the COVID-19 Pandemic [A211]
Authors: Hu Connie , Hong Emily , Espino Luis , Garcia Eliana , Banwarth-Kuhn Brenna , Quiner Trevor
Published: June 2022

INTRODUCTION:

The COVID-19 pandemic drastically affected the emergency obstetric transport experience on a multidimensional level. The objective of this study is to understand how the pandemic has affected the physical and emotional health of these patients prior to, during, and after their transport to the University of New Mexico Hospital (UNMH).

METHODS:

Participants transported for emergency obstetric indications were recruited at UNMH. Patient informed consent, demographic questionnaires, interviews, and surveys were obtained and graded on a 5-point Likert scale. These were delivered in person, via telephone, or via Zoom software and securely recorded. English interviews were transcribed via Otter.ai, and interviews conducted in Spanish were manually translated. Institutional review board approval was obtained.

RESULTS:

Preliminary results consisted of 10 participants. A majority (90%) felt that they had a good experience with the transport service and 70% of the individuals felt that proper protocols were put in place to protect them from a COVID-19 exposure. However, 40% of respondents had concerns about their safety during the transport process and 50% had concerns about their baby’s safety. Additionally, 60% of participants felt that COVID-19 overall had a negative effect on their transport experience.

CONCLUSION:

A significant portion of participants felt that the COVID-19 pandemic had a negative effect on their obstetric transport experience. Understanding the needs of these patients during the COVID-19 pandemic is important given the safety-restrictions that have been in place. This highlights the need for studies identifying barriers for patients during the transport process to improve the patient experience.
Urine Drug Screening for a History of Isolated Marijuana Use: Is Our Help Hurting? [A224]
Authors: Rubin Alexandra , Zhong Lydia , Nacke Lauren , Raghuraman Nandini , Carter Ebony B. , Kelly Jeannie
Published: June 2022

INTRODUCTION:

Despite being widely legalized, marijuana use commonly triggers urine drug screening (UDS) in obstetric practice, mainly to identify other substance exposures that could require intervention. We sought to identify frequency of concomitant nonprescribed substance use in patients who underwent UDS for isolated marijuana use (IMU) at delivery.

METHODS:

We performed a retrospective cohort study of all patients admitted for delivery from January 1 to July 31, 2020, at an urban academic center where UDS are sent based on specific criteria, including IMU. Demographic data were compared between those with IMU versus those not meeting UDS criteria. UDS results for patients with IMU are described.

RESULTS:

Of 2,045 deliveries, 484 (23.7%) had UDS performed. Reported IMU represented the most common reason for UDS (43.2%). Compared to patients who did not meet UDS criteria, those undergoing UDS for IMU were more likely Black (78.5% versus 43.1%, P<.001), younger (median age 25 versus 29 years, P<.001), and publicly insured (60.9% versus 37.0%, P<.001). Of 209 UDS sent for IMU, 4 (1.9%) were positive for nonprescribed substances other than marijuana. Of 125 UDS positive for marijuana only, 117 (93.6%) were mandatorily reported to the state Child Abuse/Neglect hotline. All 209 (100%) patients with IMU were discharged home with their infant.

CONCLUSION:

Over 40% of UDS were sent due to IMU on a labor unit, but ultimately identified a minority of other substance exposures. IMU as an indication for UDS disproportionately targets young, Black, publicly insured patients by triggering a downstream cascade of stigmatized legal consequences, and should be carefully examined for necessity.
Prevalence of Postpartum Depression Following the COVID-19 Pandemic at an Urban Academic Institution [A235]
Authors: Green Danetta , Southern Clayton , Sessions Kayle , Chen Judy , Ragonetti-Zebell Georgia , Green Lisa
Published: June 2022

INTRODUCTION:

Postpartum depression (PPD) is a complication of pregnancy commonly occurring within the first month of delivery. Numerous risk factors are associated with PPD, including financial stressors, inadequate emotional support, and perceived social isolation. This study evaluated the impact of the implemented social restrictions to mitigate the spread of the COVID-19 virus on the overall prevalence of PPD at an urban academic center.

METHODS:

Following institutional review board approval, a retrospective cohort study was performed of 1,097 subjects between 1 and 8 weeks postpartum. Group 1, the control group, included 420 women with routine PPD screening prior to the COVID-19 pandemic (April 1–December 31, 2019). Group 2, our case group, included 677 women with routine PPD screening during the pandemic (April 1–December 31, 2020). Both groups completed the Edinburgh Postnatal Depression Scale (EPDS), and the prevalence of PPD (defined as having an EPDS score greater than 11) was determined. Postpartum patients following fetal demise were excluded.

RESULTS:

The prevalence of PPD was higher in postpartum women before the COVID-19 pandemic (13.10%) when compared to postpartum women screened during the pandemic (10.78%). This increased prevalence, however, was not found to be statistically significant (P=.2474).

CONCLUSION:

Our study revealed no statistically significant difference in the prevalence of PPD before or during the COVID-19 pandemic. Nevertheless, the downward trend of PPD during the pandemic may be due to quarantine recommendations allowing families/spouses to work from home. The association of PPD and specific social support systems should be evaluated further.
“It Just Feels Useless”: Views of Economically Marginalized Women of Color on Prenatal Telehealth [A236]
Authors: Dickens Molly , Franck Linda , Scott Karen , Dy Eric
Published: June 2022

INTRODUCTION:

Virtual prenatal care has spiked during the COVID-19 pandemic, yet most research has neglected to consider care satisfaction from individuals at highest risk for poor health care experiences and outcomes.

METHODS:

We recruited economically marginalized, pregnant individuals of color to share their experiences with telehealth prenatal care for a survey- and text-message-based study. A pre-study survey assessed level of trust in providers (1–5 score) and overall care satisfaction (CSAT score; 1–10). After individual appointments, participants assigned appointment-based CSAT scores alongside narrative feedback. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using directed thematic analysis.

RESULTS:

A total of 13 participants engaged in the study from May to July 2020. Most participants identified as Black/African American, with reported household income below $50,000/year. Most participants rated trust in providers positively. For care satisfaction, telehealth delivery was generally viewed negatively within the scope of overall care. For individual appointments, CSAT scores for in-office visits were higher (median, 9; IQR, 1; n=35) than for telehealth visits (median, 6; IQR, 4; n=11). Participants’ narratives reflected three themes: relationship/trust with provider, information sharing/support, and maternal/fetal assessment. In-person appointment narratives contained more positive language, while telehealth narratives contained more negative language.

CONCLUSION:

Most participants report feeling negative and less satisfied with telehealth with dissatisfaction centered on level of information provided and inability to physically evaluate their health and their baby’s health. As remote prenatal care expands, there is an urgent need to engage patients as partners in the design and evaluation of its use and to augment telehealth with technology to objectively measure maternal and fetal health.
The Effect of the COVID-19 Pandemic on EPDS Scores and Maternal Quality of Life [A239]
Authors: Twichell Elizabeth , Zofkie Amanda , Mathisen Danielle , Lafferty Ashlyn , McIntire Donald D. , Morgan Jamie
Published: June 2022

INTRODUCTION:

The COVID-19 pandemic has impacted mental health. We evaluated the impact on pregnant women and compared the Edinburgh Postpartum Depression Scale (EPDS) and a Maternal Postpartum Quality of Life Questionnaire (mPQOL) before and during the pandemic to evaluate the effect of the pandemic on maternal mental health and quality of life.

METHODS:

After institutional review board approval, EPDS screening exams and mPQOL surveys were collected postpartum on all pregnant women during six 12-week epochs prior to and during the pandemic (Epoch 1: December 16, 2019, to March 8, 2020; Epoch 2: March 9, 2020, to May 31, 2020; Epoch 3: June 1, 2020, to August 23, 2020; Epoch 4: August 24, 2020, to November 15, 2020; Epoch 5: November 16, 2020, to January 31, 2021; Epoch 6: February 1, 2021, to May 2, 2021). Scores were compared among the epochs. A score of 13 or higher indicated screening positive for depression. The mPQOL survey was evaluated by sub-categories: Psychological/Baby, Socioeconomic, Relational/Partner, Relationships/Family, and Health/Functioning. Satisfaction was ranked on a scale from 1 to 6 (1=very dissatisfied, 6=very satisfied). EPDS scores and mPQOL scores were compared among the epochs to determine contributors that impacted quality of life during the pandemic.

RESULTS:

Out of 2,011 women, an EPDS score of 13 or higher increased from 3% to 9% from Epoch 1 to Epoch 2 and peaked at 11% in Epoch 5 (P=0.007). mPQOL Socioeconomic and Relational/Partner sub-category scores decreased significantly from 5.8 to 5.5 (P=0.014) and 5.5 to 5.4 (P=0.041), respectively, from Epoch 2 to Epoch 3.

CONCLUSION:

There was a significant increase in positive EPDS screens in pregnant women during the COVID-19 pandemic. Sub-scores obtained from the mPQOL survey suggest that increasing socioeconomic concerns and relational partner issues may have driven these trends.
Neonatal Outcomes Among Patients Taking Medication for Opioid Use Disorder [A248]
Authors: Keer Emma , Irani Sanaya , Boggan Jordyn , Townsel Courtney
Published: June 2022

INTRODUCTION:

Our multidisciplinary “Partnering for the Future” (PFF) clinic cares for birthing people with a mood or substance use disorder, including patients receiving medications for opioid use disorder (MOUD). The purpose of this study was to summarize the neonatal outcomes among infants born to patients receiving MOUD.

METHODS:

We conducted a retrospective analysis of all patients receiving care in our PFF clinic from January 2019 to August 2021. We excluded patients who were not maintained on MOUD and those only seen for consultation. Neonatal characteristics were abstracted from the medical record. Descriptive statistics were computed in SPSS v27. This study was deemed exempt by the institutional review board

RESULTS:

A total of 92 maternal-infant pairs were identified, of whom 49 patients were taking MOUD, resulting in 51 (54.3%) opioid-exposed infants (two twin pregnancies). Methadone exposure occurred in 21 (43%) pregnancies and buprenorphine exposure in 28 (57%). Neonatal intensive care unit (NICU) admission occurred in 45% (23/51) of infants. Neonatal opioid withdrawal syndrome (NOWS) was diagnosed in 26 (51.0%) infants, with 69% (18/26) infants developing severe NOWS meeting criteria for treatment. Severe NOWS occurred in 57% (12/21) of methadone-exposed pregnancies and 21% (6/28) of buprenorphine-exposed pregnancies. Among the 18 neonates diagnosed with severe NOWS, the average time to initial NOWS diagnosis was 22.35 (±0.86) hours compared to 40.4 (±0.70) hours for neonates diagnosed with non-severe NOWS.

CONCLUSION:

Severe NOWS was more prevalent among infants exposed to methadone and diagnosed sooner than non-severe NOWS cases. Strategies are needed to reduce NICU admissions and identify infants at highest risk for severe NOWS.
The Economic Impact of Preconception Fibroid Treatment With Myomectomy on Neonatal Outcomes [A261]
Authors: Colson-Fearon Darien N. , Drabo Emmanuel F. , Coleman Jenell
Published: June 2022

INTRODUCTION:

Fibroids during pregnancy have been associated with premature birth. However, there is no recommendation to guide counseling. We aimed to assess the cost-effectiveness of treating prevalent fibroids prior to pregnancy and universal screening for fibroids with treatment of incident and prevalent cases.

METHODS:

A decision tree model was used to compare (1) preconception myomectomy for prevalent fibroids with no treatment and (2) universal ultrasound screening and subsequent myomectomy. Probabilities and costs from the U.S. health care sector’s perspective were derived from the literature. Effectiveness was measured in incident premature births, and a lifetime horizon following birth was used. Incremental cost-effectiveness ratio (ICER) was used and measured in incremental cost per premature birth averted. ICERs were compared to a societal willingness-to-pay threshold of USD $100,000 per premature birth. One-way sensitivity analyses were conducted to identify influential parameters.

RESULTS:

Treating known fibroids prior to pregnancy yielded an ICER of USD $25,678 per premature birth averted. Universal fibroid screening with treatment of incident and prevalent cases yielded an ICER of USD $307,173 per premature birth averted. Sensitivity analyses showed cost-effectiveness improved with decreased cost of myomectomy, increased proportion of prevalent cases, and increased proportion of incident cases detected. Additional analysis assessing cost-effectiveness of universal screening among Black women yielded an ICER of USD $87,944 per premature birth averted.

CONCLUSION:

Preconception myomectomy to prevent preterm birth is cost-effective, but treating prevalent cases plus ultrasound screening followed by myomectomy for incident cases in all populations is not a cost-effective strategy. However, evidence supports universal screening intervention for African American women, in whom fibroid prevalence and diagnosis is higher than national averages.
Too Much of a Good Thing? The Impact of Initial Prescription Size in Post-Cesarean-Delivery Pain Management [A265]
Authors: Goodrich Robyn N. , Nunziato James Jaclyn D. , Hagerdorn Meghan K. , Spivey Cara N. , Tegge Allison , Locklear Tonja M.
Published: June 2022

INTRODUCTION:

Abuse of prescription opioids has reached epidemic proportions, and research demonstrates that prescription opioids used in post-cesarean-delivery pain management contribute significantly to this epidemic. Research in other surgical specialties demonstrated that patients consume about half of their initial prescription dose; however, this theory has yet to be applied to the field of obstetrics and gynecology. The objective of this research is to determine if initial prescription size influences patient consumption of opioids for post-cesarean-delivery pain management.

METHODS:

This randomized controlled trial involves 170 opioid-naive women ages 19–40 years undergoing scheduled cesarean deliveries at Carilion Roanoke Memorial Hospital. Patients were randomized to receive either 10 or 20 tabs of oxycodone 5 mg as an initial postoperative prescription in a double-blinded, parallel trial design. Outcome metrics regarding opioid consumption patterns and pain control were collected at three different time points postoperatively: 2–3 days, 10–14 days, and 6 weeks.

RESULTS:

Preliminary data (n=62) demonstrates that an average of 5 (±3.73) opioid tablets were consumed postoperatively in the 10-tablet group, compared to 8.4 (±8.87) tablets in the 20-tablet group (P=.05). Moreover, no participant requested additional refills of opioids.

CONCLUSION:

We observed that the average number of opioids consumed for adequate postoperative pain management was about half of the initial prescription size in both groups. Preliminary data supports the idea that initial prescription size influences patient opioid consumption. This study has direct implications to support a standard reduction of opioid prescriptions for post-cesarean pain management and the potential to directly impact millions of women every year.
Contraceptive Efficacy and Safety of 52 mg Levonorgestrel-Releasing Intrauterine Systems During Years 6–8 of Use: Data From the Mirena Extension Trial [A13]
Authors: Jensen Jeffrey T. , Lukkari-Lax Eeva , Schulze Andrea , Baisden Kristie W. , Serrani Marco , Kroll Robin
Published: June 2022

INTRODUCTION:

The Mirena Extension Trial (MET) evaluated efficacy and safety of 52 mg levonorgestrel-releasing intrauterine systems (LNG-IUS, Mirena) during extended use.

METHODS:

MET was a multicenter, single-arm US study enrolling women aged 18–35 years who were current users of 52 mg LNG-IUS for 4.5–5 years. Institutional review board approval was obtained for all centers. Contraceptive efficacy (Pearl Index, PI) of 52 mg LNG-IUS beyond 5 years up to 8 years of use was assessed.

RESULTS:

Of 362 participants starting year 6, 243 entered year 8, with 346 included in the year 8 primary analysis set (PAS, all participants aged 36 years or less at end of year 8). Mean (standard deviation) age for the year 8 PAS was 29.2 (±2.9) years and 50.9% were parous. Two pregnancies occurred (both with device in situ): one of undetermined location that spontaneously resolved in year 6 and one ectopic in year 7. For years 6–8, the 3-year PI (95% confidence interval) was 0.28 (0.03–1.00), with an estimated pregnancy probability of 0.68% (0.17–2.71). PIs for years 6, 7, and 8 were 0.34 (0.01–1.88), 0.40 (0.01–2.25), and 0.00 (0.00–1.90), respectively. Treatment-emergent adverse events were reported in 249/362 participants (68.8%) and were related to 52 mg LNG-IUS in 65 (18.0%). The discontinuation rate was 38.4% (139/362), most commonly due to wish for pregnancy (12.2%, 44/362). At end of year 8, 220/223 (98.7%) were satisfied with 52 mg LNG-IUS.

CONCLUSION:

52 mg LNG-IUS, initially approved for 5 years, maintains high contraceptive efficacy, user satisfaction, and a favorable safety profile through 8 years of use.
Medication Abortion Experiences Before and During the COVID-19 Pandemic: A Content Analysis of Online Reddit Posts [A19]
Authors: Reissner Hana , Ponzio Madeline R. , Nagatani-Short Lindsay , Hurtado Alondra , Nguyen Brian
Published: June 2022

INTRODUCTION:

The COVID-19 pandemic impacted abortion access, prompting initiatives to improve medication abortion access. We examined self-reported experiences and inquiries about medication abortion before and during the pandemic, using the anonymous platform Reddit.

METHODS:

We identified medication abortion-related Reddit posts across seven subreddits (e.g., r/Askwomen, r/abortion) using keywords linked to medication abortion (e.g., “abortion pill,” “misoprostol”). We restricted our search to pre-pandemic (September-November 2019) and during pandemic (April-June 2020) and filtered posts for experiences with or questions about medication abortion. We analyzed posts via inductive and iterative coding to characterize salient themes. We examined the prevalence of themes before and during the pandemic using chi-square tests. Institutional review board approval was obtained.

RESULTS:

Medication abortion-related posts increased by 134% during the pandemic (70 prior vs. 164 during). Frequent themes included sharing anxieties (34%), geographic barriers (22%), privacy/secrecy surrounding abortion (21%), post-abortion relief (19%), concerns about pain/bleeding (18%), and medication seeking (12%). For posts during the pandemic, 56 (24%) mentioned COVID-19 as a barrier; more posts expressed concerns about efficacy during than prior to COVID-19 (17% vs. 3%, P<.05). We did not detect a statistically significant change in posts specifying self-managed abortion (23% vs. 27%), teleabortion (9% vs. 16%), or clinic abortion (46% vs. 32%) before versus during COVID-19. Nine posts (7%) specified interest in medication abortion above 11 weeks.

CONCLUSION:

Individuals share abortion experiences and seek support and advice on Reddit. Nearly a quarter of posts reported COVID-19 being a barrier to abortion access. However, concerns about abortion access, emotions surrounding abortion, and advice-seeking were prevalent across time periods.
Giving a Voice to the Unheard: Latinx Attitudes, Decision-Making, and Experiences With Abortion [A25]
Authors: Urbina Josephine , Rivas Mercedes Posadas , Kerns Jennifer , Steinauer Jody
Published: June 2022

INTRODUCTION:

While Latinas make up 25% of abortion patients in the US, they are poorly represented in abortion studies. This gap in information has contributed to an inadequate understanding of Latinx pregnancy-related decision making. The goal of this ethnically and language-concordant study was to qualitatively examine how Latinx women feel about abortion and their decision-making path in order to provide the community with equitable and quality care, outcomes, and experiences.

METHODS:

We recruited English- and Spanish-speaking Latinx women from the five US cities with the largest Latinx populations. After screening participants online, we invited a diverse pool to participate in one-on-one interviews to examine their attitudes, decision-making, and experiences with abortion. We utilized a community advisory board of Latinx women to provide insight into the development of the interview guide. Using thematic analysis, we analyzed transcripts iteratively, identifying themes from interviews; we stopped recruitment when we reached thematic saturation.

RESULTS:

We conducted 30 interviews, and participants described mixed experiences. Three overarching themes from the qualitative interviews were: shame and/or stigma, cultural humility, and access to abortion. Most participants described providers not understanding their culture as a larger barrier than providers not speaking their language. In addition, participants identified family and culture as the most influential factors on their beliefs about abortion. Religion was mentioned less frequently.

CONCLUSION:

Latinx attitudes and decision-making surrounding abortion is not monolithic. Abortion care delivery should be individualized and efforts should continue to assess the cultural and linguistic relevance of how services are delivered to the Latinx community.
Continuation Rates of the Etonogestrel Implant and Factors Associated With Early Discontinuation [A32]
Authors: Hines Genesis V. , Quinones Joanne N. , Walker Treasure N. , Waxman Andrea
Published: June 2022

INTRODUCTION:

The etonogestrel implant is a highly effective, 3-year, long acting reversible contraceptive (LARC) device. Studies report a 1-year continuation rate of 80%, with 10% of patients reporting abnormal uterine bleeding (AUB) leading to discontinuation. Our primary objective was to describe the continuation rates of the implant in our population. Secondarily, we aimed to identify factors associated with early discontinuation.

METHODS:

Single center retrospective cohort study of women with placement of the etonogestrel implant at Lehigh Valley Health Network Obstetrics and Gynecology department between January 1, 2015 and December 31, 2017. Institutional review board (IRB) approval was obtained. A sample size calculation was performed to guide a subanalysis of the implant side effect profile.

RESULTS:

From 2015-2017, 774 women had the etonogestrel implant inserted. The 1-year continuation rate was significantly less than the literature reported value (62% vs 80%, P<.001). A subanalysis of 216 women revealed that 82% reported side effects (n=177) and 73% discontinued use due to side effects. Side effects were more common in women who discontinued use at 1 year compared to women who continued use (93% vs 71%, P<.001). The most common side effect, AUB (n=115), was not associated with early discontinuation. Neurologic and psychiatric complaints were reported by 16.7% of patients (n=18), and associated with early discontinuation (P=.02).

CONCLUSION:

The 1-year continuation rate of the etonogestrel implant may be significantly lower than that reported in the literature. Side effects are common, and patients with psychiatric or neurologic side effects are more likely to discontinue. Future studies should examine this relationship.
Reasons for Early Removal of the Etonogestrel Subdermal Implant in Obese Women [A35]
Authors: Hatch Cherise , Brouse Brynne , Young Amanda , Gray Celia M. , Paglia Michael J. , Howard Denise
Published: June 2022

INTRODUCTION:

To evaluate women's reasons for electing early removal of the etonogestrel subdermal implant (EI) across body mass index (BMI) classes.

METHODS:

This is a retrospective chart review between January 2010 and December 2019 in a large health system which evaluated women’s reasons for early removal of the EI. Early removal was defined as removal less than 2.5 years after insertion. The reasons for removal as documented by providers were manually abstracted from the electronic health record. Listed reasons included abnormal uterine bleeding (AUB), desire to conceive (DTC), perceived weight gain, and implant complications. The subjects were grouped by BMI class and a test of trend analysis was performed for each of the reasons for removal.

RESULTS:

The cohort included 1,433 women, of whom 36% were normal/underweight, 25% were overweight, and 39% were obese. The trend for early removal secondary to AUB decreased with increasing BMI class: 64.0% in the normal/underweight group, 60.6% in overweight, 45.9% in class I obese, 41.7% in class II obese, and 40.5% in class III obese group (P<.0001). The trend for early removal secondary to perceived weight gain, desire to conceive, and implant complications increased with increasing BMI.

CONCLUSION:

Women with obesity were less likely to have the EI removed early due to AUB, but they were more likely to have it removed early because of the desire to conceive, perceived weight gain, and implant complications. This information will be helpful in counseling women with obesity regarding the use of the EI for long-acting reversible contraception.
Increasing Student-Perceived Readiness for Obstetrics and Gynecology Clerkship Using a Student-Created Curriculum [A56]
Authors: Nelms Laurel M. , Gupta Sonul , Ross-Shelton Brenda
Published: June 2022

INTRODUCTION:

Among third-year medical students at a community-based medical school, students report feeling less prepared at the start of an obstetrics and gynecology clerkship compared to other clerkships. We sought to determine if a student-led curriculum is an effective resource for third-year clerkship preparation and how this curriculum affects student interest in obstetrics and gynecology, perceptions of the obstetrician-gynecologist attending lifestyle, comfort with obtaining a specialty-specific history and physical (H&P), and obstetric ultrasound techniques.

METHODS:

Fourth-year medical students pursuing obstetrics and gynecology designed clerkship-specific curricula and administered a lecture to third-year medical students via Zoom. This lecture focused on obtaining obstetrics and gynecology-specific H&P, interpreting tests of fetal well-being, labor and delivery (L&D) triage cases, and obstetric ultrasound techniques. An eight-question pre and postlecture survey using a Likert scale was distributed to all attendees.

RESULTS:

The pre and post lecture survey had 26 and 22 respondents, respectively. Attendees reported increased comfort with obstetrics and gynecology-specific patient presentations (P<.001), taking obstetric and gynecologic histories (P<0.001, P<.001), performing a pelvic exam (P<.001), and performing obstetric ultrasound (P<.001) after attending the lecture. Respondents overall felt more prepared for the obstetrics and gynecology clerkship relative to Family Medicine (P<.001). In terms of career guidance, students believed obstetrics and gynecology to be less demanding post-lecture (P<.03); however, student interest in the specialty did not significantly change.

CONCLUSION:

This study suggests that a single, remotely conducted, upperclassmen-led lecture centered on applied clinical knowledge in obstetrics and gynecology significantly improves third-year medical student comfort with performing specialty-specific history and physical exams, obstetric ultrasound techniques, and perception of attending lifestyle. It also confirms that student-led curriculum is an effective resource for third-year clerkship preparation.
In the Eye of the Beholder: Perspectives of Fellowship Applicants on Virtual Interviews [A66]
Authors: Tran Ann D. , Heisler Christine , Botros-Brey Sylvia , Gaigbe-Togbe Bertille , Leegant Ava , Hardart Anne
Published: June 2022

INTRODUCTION:

The COVID-19 pandemic shifted many in-person activities to virtual settings. Given nationwide travel restrictions and recommendations from the Association of American Medical Colleges, subspecialty program directors for obstetrics and gynecology conducted interviews using a virtual platform for 2020. The impact of virtual interviews (VI) on a candidates’ ability to effectively create a rank list is unknown. The primary objective was to evaluate obstetrics and gynecology subspecialty fellowship applicants’ perspectives regarding the effectiveness of VI for creating a rank list. Secondary outcomes included perceived advantages and disadvantages of the process, including preference of interview type, cost, and time savings.

METHODS:

This was a cross-sectional electronic survey administered to a convenience sample of obstetrics and gynecology subspecialty applicants. This institutional review board-exempt survey was administered via REDCap. Descriptive statistics were used.

RESULTS:

Response rate was 158 of 330 (48%). Nearly all (99%) applicants cited cost savings as a distinct advantage of VI. Overall, 82% percent of respondents felt confident in making their rank list based on the VI, and 92% were “very satisfied” or “somewhat satisfied” with the process. Most respondents (91%) preferred Zoom to other virtual platforms. Of those who expressed an interview style preference (in-person versus VI), 44% of respondents preferred VI; 33% had no preference or were not sure.

CONCLUSION:

The majority of applicants to obstetrics and gynecology subspecialty fellowships felt confident to create a rank list based on VI. This study indicates that the virtual format is suitable for fellowship interviews and can be utilized beyond the pandemic to improve equity and diversity in the applicant pool.
Effects of COVID-19 on Cervical Cancer Screening [A74]
Authors: Patterson Taylor , Palmer Kathryn , Robinson William R.
Published: June 2022

INTRODUCTION:

In the United States, cancer screening rates declined in spring 2020 due to the COVID-19 pandemic. Stay-at-home orders and social distancing mandates created a new barrier to health care while further exposing the pre-pandemic health care disparities.

METHODS:

Using fully de-identified electronic health record data from the University of Mississippi Medical Center’s (UMMC) Patient Cohort Explorer, we assessed changes in cervical cancer screening before and during the COVID-19 pandemic. The number of women screened with cervical cytology and human papillomavirus (HPV) testing in the pre-COVID months of September 2019 and January 2020 were compared with the same months of the following year during the pandemic (September 2020; January 2021).

RESULTS:

Data showed a pre-pandemic baseline of 319 and 340 women screened via cervical cytology during September 2019 and January 2020, respectively. Compared to pre-pandemic baseline, cervical cytology screening remained consistent throughout the pandemic with 302 and 311 women screened in September 2020 and January 2021, respectively. Similarly, HPV testing in the pre-COVID months resulted in 229 and 226 women screened as compared to 211 and 170 women screened during the pandemic.

CONCLUSION:

Cervical cancer screening did not significantly decline during the COVID-19 pandemic in Mississippi as compared to the 80% decline in cervical screening noted in California. The lack of change could be attributed to the low number of women screened both before and during the pandemic. Low cancer screening in women demonstrates various health care disparities affecting the UMMC patient population and the need to increase patient awareness and education regarding the importance of routine cancer screening.