bluuebunny/crossref_metadata_2025 huggingface dataset:
Rates of Attempted and Successful Trial of Labor After Cesarean Delivery by Race at a University Medical Center [A175]
Authors: Martin Angela , Leslie Dunmire , Wolff Sharon F. , Voth Cassandra , Mendez Rosa , DiTeresi Rachel
Published: June 2022

INTRODUCTION:

It is important that the counseling that patients receive regarding trial of labor after cesarean delivery (TOLAC) is data-driven and devoid of racial bias. Vaginal birth after cesarean delivery (VBAC) “calculators” are commonly used by providers, but many are based on older research studies and use race in their calculations, with patients of Hispanic and African American descent having lower rates of predicted success when controlling for other confounders.

METHODS:

This retrospective study included patients with a history of one or two prior cesarean deliveries and a current singleton, non-anomalous, term pregnancy. We compared rates of attempted TOLAC among various races. Among those who underwent a TOLAC, we compared rates of successful VBAC among patients of various races at the University of Kansas Medical Center (KUMC), a large tertiary-care center.

RESULTS:

A total of 791 patient charts were analyzed and showed no difference in attempted TOLAC rates among Black, Hispanic, Asian, and patients of “other” race compared to White patients after adjusting for BMI, number of previous cesarean deliveries, history of vaginal birth, and gestational age at delivery. Among patients who had a TOLAC, the likelihood of successful VBAC also did not show significant variation by race after adjusting for potential confounding variables.

CONCLUSION:

This data shows that there is no difference in rate of attempted or successful TOLAC based on race at a large tertiary-care center. These results further highlight the importance of eliminating racial bias in TOLAC counseling.
Characteristics That Influence the Success of External Cephalic Version in Nulliparous Women [A198]
Authors: Gude Jessica , Anasti James , Durgham Ryan A.
Published: June 2022

INTRODUCTION:

Studies identified that nulliparous women (NW) are at increased risk for failed external cephalic version (ECV). This study examined maternal characteristics and maternal/neonatal outcomes of NW with failed and successful ECVs.

METHODS:

Using the NBER Natality Database (2016–2018) ECV attempts in NW were identified. ECV success and cesarean delivery (CD) rates were calculated. Maternal demographics, comorbidities, and neonatal outcomes were compared between cohorts using bivariate analysis. Statistically significant (P<.001) differences were reported.

RESULTS:

The ECV success rate in 13,015 NW was 40.0%. Black NW had the highest success rate (54.5%), followed by Hispanic (49.1%), Asian/Pacific Islander (45.0%), White (37.8%), and American Indian/Alaskan Native (27.2%) NW. Self-pay NW had the highest ECV success rate (58.3%), followed by Medicaid (45.2%), and private insurance (26.8%). Successful ECV saw decreased neonatal ventilation (5.4% versus 6.8%) but increased NICU admission (9.9% versus 6.7%). NW with successful ECV had a 29.9% CD rate. Higher CD rates were found in NW with a history of hypertension (54.3% versus 29.4%), gestational diabetes mellitus (56.3% versus 28.9%), and gestational hypertension (38.3% versus 29.2%). There was no association between race or payer status and CD rate after successful ECV. Pertinent negatives for both cohorts include, age, BMI, history of diabetes, birth weight, gestational age at birth, Apgar scores, neonatal seizures, maternal ICU admission, transfusion, and unplanned hysterectomy.

CONCLUSION:

When counseling NW on ECV, it is important to fully account for several factors that affect the chance of ECV success or CD. The reasons for the impact of the factors found here will require further investigation.
A Review of Women’s Unanswered Questions Following Miscarriage on Different Social Media Platforms [A207]
Authors: Ong Emily , Davis Lauren , Sanchez Alyssa , Stohl Hindi E. , Nelson Anita L. , Robinson Nuriya
Published: June 2022

INTRODUCTION:

The purpose of this study was to investigate common questions asked and advice offered about miscarriage that women post on social media to identify any opportunities to improve care.

METHODS:

Institutional review board committee approval was waived for the study. English language, public social media posts between January 1, 2019, and June 30, 2021, were searched using the keywords of “miscarriage”, “early pregnancy loss”, “spontaneous abortion”, and “#IHadAMiscarriage”. The inclusion criteria varied by site: all posts in public Facebook miscarriage groups, YouTube videos with ≥1,000 views, Reddit r/Miscarriage with ≥175 upvotes, Instagram photos with ≥50 likes, and tweets with ≥1 interaction were analyzed for mentions of questions and advice. Each theme and each advice in a post was counted. Advice was classified into categories of “accurate” if it was supported by current guidelines from the American College of Obstetricians and Gynecologists, “insufficient evidence” if it was advice only supported by published reports, and “inaccurate” if any part was unsupported.

RESULTS:

A total of 103 posts were identified for common themes, including suffering from grief (20.4%), blame (19.4%), quality of post-miscarriage counseling in different care settings (14.6%), and inadequate medical counseling (13.6%). Most posts (82.9%) mentioned coping with loss. A total of 17.1% of posts offered medical advice eligible for evaluation, the most accurate platforms being YouTube (66.6%), Instagram (100%), and Reddit (100%). The least accurate platform was Facebook (33.3%). Twitter yielded insufficient results that did not meet the inclusion criteria.

CONCLUSION:

This study indicates a need to improve the counseling that women receive post-miscarriage. Clinicians may direct grieving patients to social media to connect with others.
Determining the Impact of Socioeconomic Status and Distance to a Rural Tertiary-Care Center on Preterm Delivery [A219]
Authors: Darivemula Shilpa M. , Kouassi-Brou Marilyn , Pollack Catherine C. , Goodman Daisy J. , Fisher Timothy
Published: June 2022

INTRODUCTION:

Hospital-based labor and delivery units are closing at increasing rates in the rural U.S., with significant implications for maternal and newborn health. The goal of this analysis was to examine clinical, sociodemographic, and geographic risk factors for preterm delivery (PTD) at a single, rural, level III maternal obstetric care center.

METHODS:

This study was a retrospective electronic medical record review of singleton pregnancies delivering at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, U.S. between 2016 and 2018. The primary outcome was PTD (at less than 37 weeks of gestation), with secondary outcomes of low birth weight (LBW) and intensive care nursery (ICN) admission. The primary exposures included travel time and insurance carrier. Demographic and clinical covariates and ZIP code level socioeconomic data were incorporated into the multivariate models.

RESULTS:

Compared to patients traveling less than 30 minutes, patients traveling 1–1.5 hours had approximately twice the odds of PTD (odds ratio [OR,], 2.08; 95% CI, 1.32–3.29; P=.002), birth of a LBW neonate (OR, 2.15; 95% CI, 1.29–3.58; P=.005), and infant admission to the ICN (OR, 1.83; 95% CI, 1.22–2.76; P=.004). Marital status, prenatal visit count, history of PTD, primiparity, and tobacco exposure also increased risks for PTD, LBW, and ICN admission. Insurance carrier status was not associated with increased odds of PTD, LBW, or ICN admission.

CONCLUSION:

This study suggests that rurality and its impact on maternal health is not just about distance from hospitals or degree of socioeconomic deprivation, but about local resource access as well.
Cumulative Effect of Medical and Social Risk Factors on Routine Prenatal Care Screening [A231]
Authors: Pennathur Harini , Ghrayeb Leena , Debnath Dipra , Ganzi Stephanie , Cohn Amy , Peahl Alex F.
Published: June 2022

INTRODUCTION:

Social risk factors affect prenatal care attendance; however, little is known about how cumulative medical and social risk factors influence receipt of prenatal services. We describe the association between medical and social risk factors and the timing of a routine prenatal care screening: gestational diabetes (GDM).

METHODS:

We identified patients with a GDM diagnosis receiving prenatal care at a single institution from January 1 to December 31, 2018. We divided patients into four groups by medical and social risk factors in the electronic health record: completely low-risk, social risk only, medical risk only, and completely high-risk. We compared the timing of GDM diagnosis and time for all group members to receive the GDM diagnosis. The study was deemed exempt by the institutional review board.

RESULTS:

We identified 102 patients with GDM: 11 (10.8%) completely low-risk, 17 (16.7%) social risk only, 11 (10.8%) medical risk only, and 63 (61.8%) completely high-risk. The median gestational age of diagnosis for GDM was 28.6 weeks (IQR, 27.2–30.9) and was similar across groups: completely low-risk 28.8 (IQR, 27.4–30.9) weeks, social risk only 28.2 (IQR, 27.1–29.6) weeks, medical risk only 29.2 (IQR, 27.6–30.1) weeks, and completely high-risk 28.6 (IQR, 26.9–31.4) weeks. The time for all patients to be diagnosed was later for groups with social risk factors, regardless of medical risk factors: completely low-risk 32 weeks, social risk only 35 weeks, medical risk only 30 weeks, and completely high-risk 36 weeks.

CONCLUSION:

Many patients with social risk factors were diagnosed with GDM later in pregnancy. Attention to social risk factors can potentially improve timeliness of diagnosis of pregnancy complications and pregnancy outcomes.
Risk of Uterine Rupture and Dehiscence Among Women Attempting a Vaginal Birth After a Low Vertical Uterine Incision [A232]
Authors: Fermin Oriana , Ben Khallouq Bee , Desai Neeraj , Smid Marcela , Herrera Christina
Published: June 2022

INTRODUCTION:

The risk of uterine rupture after a prior low vertical (LVCS) is unknown. The objective of this study was to estimate the risk of uterine rupture in individuals attempting a trial of labor after cesarean delivery (TOLAC) with a prior LVCS.

METHODS:

This is a secondary analysis of the Maternal Fetal Medicine Units Network’s C-section Registry, a multicenter, prospective observational study. We included individuals with term singleton pregnancies undergoing TOLAC with a prior low transverse incision (LTCS) or LVCS and excluded those who received prostaglandins or had a history of myomectomy. Multivariate regression models were used to estimate the relative risk between uterine rupture with a prior LVCS compared to LTCS. After controlling for known confounders, our secondary outcome was uterine dehiscence.

RESULTS:

In this cohort, 14,773 individuals attempted TOLAC (14,665 prior LTCS; 108 prior LVCS). Uterine rupture occurred in 94 (0.7%) of women with prior LTCS and 1 (0.1%) woman with prior LVCS. Uterine dehiscence occurred in 101 (0.7%) of individuals with prior LTCS and 3 (2.9%) of individuals with prior LVCS. Compared to those with a prior LTCS, the risk of uterine rupture was not different (RR, 1.49; 95% CI, 0.21–10.58). However, the risk of uterine dehiscence was increased among those with prior LVCS (RR, 4.07; 95% CI, 1.31–12.63) compared to prior LTCS.

CONCLUSION:

Individuals with a prior LVCS have an increased risk of uterine dehiscence, but not uterine rupture, compared to prior LTCS. These results may inform counseling for those individuals considering TOLAC after prior LVCS.
Maternal Morbid Obesity Is Associated With an Increased Risk of Severe Maternal Morbidity [A234]
Authors: Baranco Nicholas , Elkafrawi Deena , Wojtowycz Martha , Parker Pamela R. , Nosovitch John , Mastrogiannis Dimitrios
Published: June 2022

INTRODUCTION:

Prepregnancy obesity (body mass index [BMI]≥30) has been consistently associated with maternal morbidity. The rate of morbid obesity (BMI≥40) appears to be increasing. This study investigated whether morbid obesity was associated with severe maternal morbidity in a population cohort.

METHODS:

Internal review board exemption was obtained. We identified 197,822 patients using the birth-certificate-based New York Statewide Perinatal Data System from 2010 to 2020. Women were divided into two categories, those with prepregnancy BMI <40 and those with prepregnancy BMI ≥40 (morbid obesity). The risk of severe maternal morbidity (maternal transfusion, intensive care unit admission, unplanned hysterectomy, and unplanned reoperation) was compared. We also compared the risk of cesarean delivery, hypertensive disorders of pregnancy, and gestational diabetes. Chi-square and t tests were used to compare categorical and continuous variables respectively.

RESULTS:

We identified 197,822 deliveries, of which 13,120 (6.63%) were complicated by maternal morbid obesity. Morbidly obese women had a significantly higher risk of severe morbidity (RR, 1.16; 95% CI, 1.003–1.33). The risk of intensive care unit admission was significantly increased (RR, 1.84; 95% CI, 1.35–2.53), but blood transfusion, unplanned hysterectomy, and unplanned reoperation were unchanged.

CONCLUSION:

Morbid obesity was associated with increased severe maternal morbidity specifically due to maternal intensive care unit admission. This may indicate a higher risk of severe medical complications and likely represents a higher risk of maternal mortality.
Anteroposterior Diameter of the Upper Cervix: A Potential Marker for Cervical Insufficiency [A240]
Authors: Foster Todd L. , Frantskevich Katsiaryna , Sumners James
Published: June 2022

INTRODUCTION:

Having observed an apparent smaller cervical diameter on clinical examination in patients presenting for cerclage because of a history of cervical insufficiency in all prior pregnancies (congenital cervical insufficiency [CCI]), an observational study of upper cervical anteroposterior diameter (APD) was undertaken of this measurement in the second trimester of CCI patients (n=86, 28.4%), utilizing APD in a comparison group of patients from a general obstetric practice (normal, n=217, 71.6%) with prior obstetric histories devoid of preterm deliveries.

METHODS:

APD (expressed in millimeters) was measured in each group on images taken for clinical use in both groups between 14 completed weeks and 23+6 weeks gestation. Patients with cerclage in place, cervical surgical treatment or damage and multifetal pregnancies were excluded. Analysis of central tendency and variation were undertaken in each group.

RESULTS:

The APD (mean ± standard deviation) was 32.0±4.3 mm in the CCI group and 40.6±5.2 mm in the normal group. The gestational age of the measurement taken at the ultrasound was included as a covariate in a generalized linear model. There was a statistically significant difference in the size of the APD between the normal group and the CCI group (t=7.08, P<.001).

CONCLUSION:

This preliminary, exploratory study suggests that upper cervical diameter may be a marker to distinguish patients seen in their first pregnancy who are at risk for clinical manifestation of cervical insufficiency. A much larger prospective study of primigravid patients will be necessary to verify this relationship.
Adverse Neonatal Outcomes in the Setting of Inflammatory Bowel Disease [A241]
Authors: Chaiken Sarina , Ghafari-Saravi Afsoon , Packer Claire , Garg Bharti , Caughey Aaron
Published: June 2022

INTRODUCTION:

To examine neonatal outcomes among pregnant patients with inflammatory bowel disease (IBD).

METHODS:

A retrospective cohort study using linked vital statistics and hospital discharge data from California (2007–2011). We included singleton, non-anomalous pregnancies, using chi-square tests to compare demographics and outcomes of intrauterine fetal demise (IUFD), infant death, NICU admission >24 hours, Apgar score <7 at 5 minutes, and small for gestational age. Multivariate logistic regressions controlled for maternal age, race/ethnicity, education, and insurance.

RESULTS:

The cohort included 1,559 (0.06%) individuals with IBD. Compared to those without IBD, IBD patients were more likely to be White, older, highly educated, on private insurance, and with normal BMI. Pregnancies of patients with IBD were more likely to result in NICU admission (P<.001), small for gestational age neonates (P=.004), or congenital anomaly (P=.049), but not IUFD (P=.105), infant death (P=.753), Apgar score <7 (P=.261), macrosomia (P=.094), or birth injury (P=.262). On multivariate regression, IBD neonates were more likely to require NICU admission (aOR, 1.71; 95% CI, 1.48–1.98) or be small for gestational age (aOR, 1.55; 95% CI, 1.32–1.83), and less likely to have macrosomia (aOR, 0.75; 95% CI, 0.62–0.90).

CONCLUSION:

IBD neonates were more likely to require NICU admission and be small for gestational age, but less likely to have macrosomia. When adjusting for characteristics of IBD patients, IUFD, infant death, poor Apgar scores, congenital anomaly, and birth injury were not more likely. This study is limited by the small incidence of some outcomes. Further work should elucidate how IBD is related to these adverse neonatal outcomes.
Screening in Vein: Hemoglobin Electrophoresis Misses Most Alpha Thalassemia Carriers [A243]
Authors: Aldrich Stacey , German Ryan J. , Peacock Jacqueline , Fecteau Heather , Carlson Robert
Published: June 2022

INTRODUCTION:

Carrier screening for alpha thalassemia is universally recommended in the U.S., regardless of a patient’s ancestry. While hemoglobin electrophoresis is traditionally recommended as the first-line test for alpha thalassemia carrier screening, newer genetic testing technology shows promise to improve the detection of alpha thalassemia carriers.

METHODS:

A retrospective chart review was conducted of 515 participants who received both hemoglobin electrophoresis and genetic testing for alpha thalassemia carrier screening at a U.S. commercial laboratory between March 2019 and October 2020.

RESULTS:

In this panethnic U.S. population, 8% of participants (42/515) were identified to be carriers of alpha thalassemia via genetic testing, and hemoglobin electrophoresis was abnormal for 12% (5/42) and normal for 88% (37/42). Among the 38 “silent” alpha thalassemia carriers identified via genetic testing, 13% (5/38) had an abnormal hemoglobin electrophoresis and 87% (33/38) had a normal hemoglobin electrophoresis. Among the four alpha thalassemia “trait” carriers identified via genetic testing, 0% (0/4) had an abnormal hemoglobin electrophoresis and 100% (4/4) had a normal hemoglobin electrophoresis.

CONCLUSION:

Hemoglobin electrophoresis is an older screening technology that failed to detect the majority (88%) of alpha thalassemia carriers identified by genetic testing in our study. Previous studies also found that genetic testing outperforms hemoglobin electrophoresis in alpha thalassemia carrier detection. Genetic testing should be considered as a first-line screening option for alpha thalassemia carrier detection to help providers identify more at-risk couples.
Effect of Guideline Change on Gestational Age at Delivery for Intrahepatic Cholestasis of Pregnancy [A254]
Authors: Berra Alexandra L.
Published: June 2022

INTRODUCTION:

The optimal gestational age to deliver women with intrahepatic cholestasis of pregnancy (ICP) is unknown. Traditionally, delivery has been recommended at 37 0/7 weeks of gestation or greater when diagnosed. In 2019, the American College of Obstetricians and Gynecologists (ACOG) updated guidelines for induction to occur at 36 0/7 weeks, or at diagnosis if later. Our objective was to estimate the effect this guideline change had on the gestational age at delivery.

METHODS:

Retrospective chart review of women undergoing induction of labor for ICP one year before compared with one year after ACOG guideline change in 2019. To detect a one-week-earlier delivery (from 37 to 36 weeks of gestation), with a standard deviation of two weeks at P<.05 with a 90% power, would require 85 women in each group.

RESULTS:

During the one year prior to the guideline change, 159 women underwent an induction of labor for ICP, versus 134 in the one year post guideline change. No difference was noted in the gestational age at delivery, median 37.1 (range, 28.7–40.3) weeks versus 37.1 (range, 33.4–40.3) weeks (P=.65). No difference was noted in the gestational age at diagnosis of ICP, median 34.4 (range, 13.0–40.1) weeks versus 34.1 (range, 17.0–40.3) weeks (P=.62). Similar levels of bile acid were used at diagnosis, median 14 (range, 10–225) micromoles/L versus 15 (range, 10–264) micromoles/L (P=.36).

CONCLUSION:

Current change to ACOG guidance for delivering women with ICP has not resulted in earlier delivery.
Mode of Delivery in Patients With Fetal Central Nervous System Anomalies [A259]
Authors: Fennimore Nicole , Prewitt Kristin , Hersh Alyssa R. , Bridges Alexis , Pilliod Rachel
Published: June 2022

INTRODUCTION:

Balancing maternal risk with fetal prognosis in counseling regarding mode of delivery can be challenging. This study investigates mode of delivery for patients with pregnancies complicated by fetal anencephaly and myelomeningocele.

METHODS:

We conducted a retrospective cohort study using National Vital Statistics Live Birth Data between 2014 and 2018. Inclusion criteria were patients without a history of cesarean delivery carrying singleton, cephalic fetuses that were at least 23 weeks of gestation. We compared mode of delivery among patients with pregnancies complicated by each central nervous system (CNS) anomaly to those without the anomaly. Chi-square and multivariable logistic regression were performed for statistical analyses using STATA version 17.

RESULTS:

A total of 15,032,798 patients met the inclusion criteria; 0.011% had fetal myelomeningocele and 0.008% had fetal anencephaly. Among women with fetal myelomeningocele, 63.1% underwent cesarean delivery compared to 17.7% for those without myelomeningocele (P<.01). In patients with fetal anencephaly, 22.0% underwent cesarean delivery compared to 17.7% for those without anencephaly (P<.01). After adjusting for confounders, the odds of cesarean delivery among patients with pregnancies complicated by myelomeningocele and anencephaly were 8.6 (95% CI, 7.7–9.5) and 0.88 (95% CI, 0.75–1.02), respectively.

CONCLUSION:

Fetal CNS anomalies are associated with higher rates of cesarean delivery. Variable prognosis exists with myelomeningocele, and additional data is needed to determine the optimal mode of delivery. Anencephaly, on the other hand, is considered a lethal diagnosis. While cesarean rates were lower in this cohort, our findings suggest that palliative birth availability and mode of delivery requires additional study for this condition.
Immediate vs Routine Postpartum Intrauterine Device Placement After Teen Pregnancy: A Cost-Effectiveness Analysis [A02]
Authors: Andrus Shelby , Frank Zoe , Willey Alicia S. , Brady R. Michael
Published: June 2022

INTRODUCTION:

The time surrounding a teen’s first pregnancy represents an ideal period to counsel on effective contraception and prevent additional unplanned pregnancies. It has yet to be examined if post placental intrauterine device (IUD) placement is cost effective in teenage patients relative to routine placement in the office.

METHODS:

A decision analytic model was built using TreeAge software to compare outcomes and costs among teenagers receiving either post placental or routine IUD placement. Outcomes, associated health care costs, and maternal quality-adjusted life years (QALY) were compared. All probabilities, utilities, and costs were derived from the literature. Costs were in 2021 US dollars with a cost-effectiveness threshold of $100,000/QALY. Sensitivity analyses were performed to assess how variation in baseline assumptions impacted model outputs.

RESULTS:

In a theoretical cohort of 300,000 teen births, post placental IUD placement yielded 35,620 more QALYs but cost $32 million more than routine placement. Post placental placement prevented 9,740 additional unplanned births—including 1585 preterm births—and 5595 abortions. Post placental placement was no longer cost effective when the likelihood of IUD removal within the next year rose from our baseline estimate of 0.14 to 0.46 or when the rate of subsequent unplanned teen pregnancy without an IUD fell to 0.007.

CONCLUSION:

Post placental IUD placement is cost effective for teenage patients from the maternal perspective. The cost effectiveness of the strategy is contingent on the likelihood of removal within the next year and of unplanned pregnancy without an IUD in place.
Providing Mifepristone and Misoprostol in Emergency Departments During the COVID-19 Pandemic [A08]
Authors: Bleck Roselle R. , Gurney Elizabeth P.
Published: June 2022

INTRODUCTION:

Compared to misoprostol alone, medical management of early pregnancy loss (EPL) with mifepristone and misoprostol has a 25% higher success rate, reduces subsequent uterine aspiration, and is cost-effective. During the COVID-19 pandemic, we began providing mifepristone and misoprostol for EPL in our urban emergency departments (EDs), aiming to increase access to essential services and to minimize repeated health care visits. We sought to describe the safety and efficacy of this novel practice.

METHODS:

With institutional review board approval, we retrospectively reviewed the charts of all patients receiving mifepristone and misoprostol for first trimester pregnancy management in our EDs between April 2020 and March 2021 (n=33). Effective treatment was defined as pregnancy resolution after a single treatment with mifepristone and misoprostol. Safety outcomes included need for additional management, emergent surgical interventions, and blood transfusion. Descriptive statistics and univariate analysis were performed.

RESULTS:

The prevalence of effective treatment was 70% (n=23). Among the 10 subjects (30%) requiring additional management, interventions were: one additional dose of misoprostol (n=4), uterine aspiration (n=4), methotrexate (n=1), and uterine artery embolization (n=1). Three interventions (30%) were emergent, and two of these patients also required transfusion. Demographic characteristics were not associated with effective treatment nor with safety outcomes. Twenty-eight subjects (84%) participated in follow-up, 17 via telemedicine and 11 in person.

CONCLUSION:

Providing mifepristone and misoprostol for EPL in the ED may be an effective method to increase health care access. Further research is needed to determine whether this population is truly at increased risk for serious complications.
The Impact of the COVID-19 Pandemic on Postpartum LARC: A Retrospective Cohort Study [A20]
Authors: Jensen Rachel , Habib Alyssar , Lenus Sasha , Lee Jessica K.
Published: June 2022

INTRODUCTION:

At the onset of the COVID-19 pandemic, providers were encouraged to counsel patients interested in long-acting reversible contraception (LARC) about immediate postpartum placement to decrease in-person postpartum visits. We assessed the impact of this COVID-related hospital policy on postpartum LARC uptake.

METHODS:

In this retrospective cohort study, we compared patients who delivered a live born infant(s) during two periods, one immediately prior to the COVID pandemic (“pre-COVID cohort” (December 16, 2019 to March 1, 2020)), and one at the onset of the pandemic (“COVID cohort” (March 16-May 31, 2020)). We collected electronic medical record data, including sociodemographic characteristics and contraception choices, in the antenatal and postpartum periods for 649 patients. Odds ratios were adjusted for age and race.

RESULTS:

We found an increase in immediate postpartum LARC use during COVID (13% vs. 9%, P=.12, aOR 1.44, CI 0.87-2.39). The etonogestrel implant was the most placed form of immediate postpartum LARC in both cohorts (67% and 71% in pre- and during COVID cohorts, respectively). In general, contraceptive choices at discharge differed between the cohorts (P=.01), with fewer patients desiring LARC placement at the postpartum visit during COVID (13% vs. 6% in pre- and during COVID cohorts). There was no difference between the average number of postpartum visits attended in each cohort (OR 0.93, CI 0.68-1.28).

CONCLUSION:

Changes in contraceptive counseling during COVID were accompanied by differences in postpartum contraceptive choices at discharge. Targeted contraceptive counseling can influence patient choices in the setting of expected barriers to routine postpartum care.
Secret Shopper Study Evaluating Long Acting Reversible Contraception Access Barriers in Rural Michigan [A22]
Authors: Lozier Ann , Ling Vivian , Keer Emma , Dalton Vanessa , Owens Lauren , Moniz Michelle
Published: June 2022

INTRODUCTION:

Rural communities are disproportionately affected by unintended pregnancy and access barriers to long-acting reversible contraception (LARC). It is unknown whether differences in patient payer type affect LARC access in rural communities. We evaluated rural access to LARC and same-day insertion, using the Upper Peninsula of Michigan (UP) as a case study for rural access.

METHODS:

Using a secret shopper study design, we administered a screening telephone survey to UP women’s health clinics, excluding those not accepting new patients or not offering LARC. Between September 15 and October 29, 2021, we re-contacted eligible clinics using a telephone script simulating an adult patient with either commercial or Medicaid insurance seeking LARC insertion. Key outcomes were differences in access to LARC and same-day insertion by payer type and LARC access by county, ascertained by merging LARC access findings with 2010 census data.

RESULTS:

Of 19 eligible clinics, 16 (84.2%) offered LARC to simulated patients, with all 16 offering LARC to both commercial insurance and Medicaid enrollees. Same-day LARC insertion was available at 7 of 19 clinics (36.8%) for commercially insured enrollees and 4 of 19 clinics (21.1%) for Medicaid enrollees. Of 15 counties in the UP, five have zero clinics that currently offer LARC insertion to new patients, representing 12,677 women of childbearing age (24.9% of this population in the UP).

CONCLUSION:

LARC access is limited in Michigan’s UP and may be particularly challenging for Medicaid patients given less opportunity for same-day LARC placement.
Impact of Immediate Postpartum Long Acting Reversible Contraception on Short Interval Pregnancy Rates [A27]
Authors: Hess Amanda K. , Quiñones Joanne N. , Flicker Amanda B.
Published: June 2022

INTRODUCTION:

To evaluate the impact of immediate postpartum long acting reversible contraception (LARC) at our institution, we compared short interval pregnancy (SIP) rates between women who received immediate postpartum LARC with those who did not.

METHODS:

Institutional review board (IRB) approval was obtained for a single center retrospective cohort study of women >/= 18 years old with government insurance who delivered between 7/1/2019-3/31/2020. SIP was defined as <12 months from live birth to conception of a subsequent pregnancy. Women who underwent cesarean hysterectomy or postpartum sterilization were excluded from analysis.

RESULTS:

A total of 1,220 women were identified. Of these, 150 (12.3%) received LARC prior to discharge: 56 received a levonorgestrel intrauterine device (IUD) (37.3%), 20 received a copper IUD (13.3%), 74 received an etonogestrel implant (49.3%). A higher proportion of women who received a LARC were ages 18-21 (26.7%), compared with the non-LARC group (14.1%, P<.001). SIP rate in the LARC group was 4.0% (n=6) vs. 14.5% (n=155) in the non-LARC group (P<.001). Excluding women who declined or deferred contraception until the postpartum visit, women choosing contraceptive methods other than immediate postpartum LARC also had a higher rate of SIP (12.6%) when compared with the LARC group (4.0%, P=0.003). After adjustment for potential confounders including nulliparity, young maternal age, and married status, SIP was lower with immediate postpartum LARC [AOR 0.27 (95% CI 0.18, 0.64), P=.003] and higher by married status [AOR 1.89 (95% CI 1.26, 2.84), P=.002].

CONCLUSION:

Implementation of an immediate postpartum LARC program decreased SIP rates. Improved counseling about the impact of immediate LARC placement for family planning is encouraged.
Contraceptive Use After Removal or Expulsion of Malpositioned and Nonmalpositioned Intrauterine Devices [A37]
Authors: Frisse Ann , Louik Jay , Kachwala Isha , Vorawandthanachai Thammatat , Avila Karina , Benfield Nerys
Published: June 2022

INTRODUCTION:

The effect of intrauterine device (IUD) malposition on subsequent contraceptive choice is not well characterized. We aimed to evaluate contraceptive choice after removal or expulsion of IUDs identified as malpositioned or non-malpositioned on ultrasound imaging.

METHODS:

We performed a retrospective cohort study of IUD users with ultrasounds performed between July 2014 to July 2017 within a large, urban, academic medical system. Data was collected via medical record review. Descriptive statistics were reported for contraceptive choice after removal or expulsion of malpositioned and non-malpositioned IUDs. Institutional review board (IRB) approval was obtained for this study.

RESULTS:

Of 1,759 ultrasound reports with an IUD present, 436 described malpositioned IUDs. Baseline characteristics between participants with malpositioned and non-malpositioned IUDs did not differ aside from age (30.7 and 31.9 years old respectively, P=.02). Contraceptive use after IUD expulsion or removal was available for 677 participants. Of the participants who had their non-malpositioned IUDs removed or expulsed, 29.4% used no contraceptive method compared to 19.4% of participants with malpositioned IUDs. The contraceptive implant or another IUD was used by 2.7% and 22.2% of participants after removal or expulsion of a non-malpositioned IUD, whereas these methods were used by 5.2% and 25.9% of participants who initially had a malpositioned IUD.

CONCLUSION:

Individuals with malpositioned IUDs had higher contraceptive use and higher use of long-acting reversible contraceptive methods after IUD removal or expulsion compared to those with non-malpositioned IUDs. This difference could be due to a difference in pregnancy desires which was not captured with this study design.
Effect of Intrauterine Device Malposition on Pregnancy Occurrence [A38]
Authors: Frisse Ann , Louik Jay , Kachwala Isha , Felix Nicole , Avila Karina , Benfield Nerys
Published: June 2022

INTRODUCTION:

We aimed to compare pregnancy occurrence within 12 months of ultrasound evaluation of intrauterine device (IUD) position.

METHODS:

We performed a retrospective cohort study of IUD users with ultrasounds performed between July 2014 to July 2017 within a large, urban, academic medical system. Data was collected through medical record review. The Fisher exact test was used to compare groups. Institutional review board (IRB) approval was obtained.

RESULTS:

Of 1,759 ultrasound reports with an IUD present, 436 described malpositioned IUDs. Baseline characteristics between participants with malpositioned and non-malpositioned IUDs did not differ aside from age (30.7 and 31.9, P=.02). Pregnancy status was available for 323 participants with malpositioned IUDs and 1007 participants with non-malpositioned IUDs. Compared to participants with non-malpositioned IUDS, those with malpositioned IUDs were more likely to be pregnant within 12 months of their initial ultrasound (10% and 5%, P=.002). Of the participants whose initial ultrasound showed a malpositioned IUD, 33 experienced a pregnancy: three with IUD in situ, 26 after IUD removal, and three after IUD expulsion. Of participants whose initial ultrasound showed a non-malpositioned IUD, 51 experienced a pregnancy: five with IUD in situ, 35 after IUD removal, and four after IUD expulsion. No significant difference was seen in pregnancy occurrence between groups for those with IUD in situ, after IUD expulsion, or after IUD removal.

CONCLUSION:

Participants with malpositioned IUDs were more likely to experience pregnancy within 12 months of initial ultrasound. However, this was not due to increased risk of pregnancy with an IUD in situ.
Exploring Contraception Attitudes, Beliefs, and Practices Among Refugee Women [A41]
Authors: Pfeil Sarah , Crouthamel Bonnie , Chalmiers Morgen A. , Ghebrendrias Selemawit , Kully Gennifer , Mody Sheila
Published: June 2022

INTRODUCTION:

In order to improve patient care and education efforts, there is a need to have more insight into the attitudes, beliefs, and practices regarding contraception among refugee women.

METHODS:

We conducted a qualitative study among refugee women in California. All participants provided informed consent. The focus groups included questions about general women’s health, prior experiences with health care professionals in the United States, and attitudes towards, as well as experience with, birth spacing and contraception. In addition, we asked refugee women to evaluate the appropriateness of MyPATH, a web-based reproductive goals decision-support tool.

RESULTS:

Sixty-two refugee participated in focus groups. Participants ranged from 20-50 years and came from Congo, Somalia, Sudan, Eritrea, Ethiopia, Kenya, Uganda, Iraq, and Syria. Limiting family size while in the United States was more important than in participants’ home countries given economic burdens and lack of family support. Side effects, misconceptions that contraception contributes to cancer and infertility, and impact on menses were major concerns with utilizing contraception. Many participants desired in-person female interpreters for reproductive health visits. Participants were receptive to the web-based reproductive goals decision support tool MyPATH, but preferred being able to ask questions in person during low technology reproductive-health education sessions at community centers.

CONCLUSION:

The refugee women in this study were interested in using contraceptives to limit family size due to economic strain. Participants reported concerns about side effects that impacted their current contraception use. The women preferred contraceptive education in their community centers.
The Effect of an Educational Intervention on Obstetrics and Gynecology Residents’ Postpartum Depression Knowledge [A45]
Authors: Haslam Melissa D. , Cruz Amy , Baweja Ritika
Published: June 2022

INTRODUCTION:

Up to 15% of women experience postpartum depression (PPD), and maternal suicide is a leading cause of maternal mortality. Obstetrician-gynecologists (ob-gyns) are intimately involved in postpartum care of women and are in a position to help diagnose and manage PPD. Council on Resident Education in Obstetrics and Gynecology (CREOG) learning objectives include goals for residents to diagnose and perform initial management of postpartum complications such as PPD. The objective of this study was to assess if a psychiatry educational intervention (pre-recorded didactic lecture and facilitated discussion) would improve ob-gyn residents’ knowledge and comfort level in diagnosing and managing PPD.

METHODS:

We performed an educational intervention study including ob-gyn residents at an academic training program. A pre-lecture survey/test was sent to residents. A prerecorded psychiatric didactic session was sent to residents. Participants were instructed to complete the post-lecture survey/test. A facilitated discussion via Zoom at which time presubmitted questions were reviewed and discussed with a psychiatrist was performed. A postdiscussion survey was then sent out.

RESULTS:

Before the intervention, 32% of residents agreed/strongly agreed that they felt comfortable diagnosing PPD; after the intervention, this increased to 81% of residents. Before the intervention, 25% of residents agreed/strongly agreed that they felt comfortable treating PPD; after the lecture/discussion this increased to 69% of residents. The difference in pre and post test scores was significantly improved (POST-PRE difference of 2.6 with a 95% CI of 1.8-3.5, P<.0001).

CONCLUSION:

This study helps show the importance of interdisciplinary didactics and interactive learning sessions which can help improve ob-gyn residents’ knowledge and comfort level in diagnosing/managing PPD in patients.
Effect of Pelvic Floor Education and Physical Therapy Referral on Postpartum Patient Satisfaction [A46]
Authors: Wallace Erika , Griffin Alexis , Redhunt Allyson M. , Heiden Erica , Sokol Nicole , Liff Ingrid
Published: June 2022

INTRODUCTION:

Postpartum pelvic floor dysfunction (PFD) is associated with reduced quality of life; however, patient education regarding PFD is limited. The purpose of this study was to evaluate impact of PFD education and pelvic floor physical therapy (PFPT) referral on patient satisfaction with postpartum care.

METHODS:

This randomized controlled trial included 160 postpartum patients recruited during their delivery admission between November 2020 and June 2021. Patients were randomized to receive postpartum PFD education materials and PFPT referral (n=80) or to receive standard postpartum teaching (n=80). The Client Satisfaction Questionnaire (CSQ-8) was used to assess patient satisfaction at 12 weeks postpartum.

RESULTS:

In total, 131 (81.87%) participants completed the questionnaire. The groups were well matched in terms of demographics, comorbidities, and delivery type. In total, 60 of 131 (45.8%) reported PFD symptoms. Overall satisfaction did not differ between groups (27.43 vs. 28.31 out of 32, P=.28). Significantly more patients in the intervention group felt that they received enough PFD education and support (47.1% vs. 27.0%, P=.017). Of those who read the educational materials (48 of 68, 70.6%), 89.6% found them helpful, and 100% thought all patients should receive PFD education. Most common obstacles to attending PFPT included lack of interest, time commitment, and childcare.

CONCLUSION:

Our study demonstrates that while providing PFD education and PFPT referral does not lead to increased patient satisfaction, patients do find these resources helpful. Postpartum PFD is prevalent; however, few patients attend PFPT despite referrals. We identify specific barriers to attending PFPT which are targets for future studies on patient satisfaction.
A Validated Needs Assessment to Inform a Simulation-Based Maternal Cardiac Arrest Resuscitation Curriculum [A47]
Authors: Kavanagh Laurie D. , Shields Andrea , Battistelli Jacqueline , Thomson Brook , Nielsen Peter
Published: June 2022

INTRODUCTION:

Maternal cardiac arrest (MCA) is a clinically challenging event, yet there are currently no standardized training courses to train providers to prevent, identify, and treat MCA. We conducted a needs assessment of the target learner populations to inform a simulation-based curriculum.

METHODS:

The authors sent a modified, validated personnel, infrastructure, procedures, equipment, and supplies (PIPES) tool to target learners of a proposed simulation-based curriculum in MCA resuscitation. The tool assessed the target learners’ clinical and procedural confidence with cardiopulmonary resuscitation (CPR) skills during an MCA.

RESULTS:

A total of 191 in-hospital and 124 pre-hospital practitioners completed the survey. Most respondents had 20+ years of experience and were diverse in geographic and specialty representation. Most respondents were familiar with the 2015 American Heart Association (AHA) resuscitation guidelines for cardiac arrest in pregnancy and had performed CPR on a pregnant or postpartum patient. Less than half of respondents were comfortable leading a maternal code. Of 21 clinical scenarios, in-hospital respondents were least confident managing amniotic fluid embolism, anesthetic complication, drug overdose, pneumothorax, post-arrest care, and ventricular tachycardia. Of 16 procedural skills assessed, prehospital providers reported the least confidence in performing left uterine displacement. Participants in both populations lacked the most confidence in placing a chest tube and a central line during pregnancy.

CONCLUSION:

Despite an awareness of existing guidelines and personal experience responding to MCA, respondents lacked confidence in many clinical and procedural skills used during a maternal code. This needs assessment will help inform the learning objectives of a standardized simulation-based curriculum on MCA.
A National Survey of Obstetrics and Gynecology Emergency Training and Deficits in Office Emergency Preparation [A53]
Authors: Maciejko Laura , Cope Adela , Mara Kristin , Bell Shannon L. , Green Isabel
Published: June 2022

INTRODUCTION:

While rare, emergencies encountered during office procedures have the potential for significant morbidity if the team is caught unprepared. The aim of this study was to evaluate current availability of and needs for training in office emergencies in residency programs in the United States.

METHODS:

This was a cross-sectional survey of residents from accredited obstetrics and gynecology residency programs. Identified programs were those with representation in the American College of Obstetricians and Gynecologists Simulation Working Group (ACOG SWG). A multi-item instrument was developed, designed, and edited by representatives of the ACOG SWG for accuracy and content validity. Participants were asked to rate their level of agreement with statements on importance of training in the recognition and management of obstetrics and gynecology emergencies and their confidence in management of those emergencies. Specific emergencies encountered in the office, gynecologic surgery, and obstetrics were queried.

RESULTS:

Six programs participated for a total of 116 residents and a response rate of 62% (116/188). Most residents agreed office emergency (97.5%) and obstetric emergency training (94.8%) were important in residency training. While 65.5% were confident in managing a vasovagal episode in the office, 0.9% were confident in managing lidocaine toxicity. In contrast, the majority of residents felt confident in obstetric emergency management across all listed emergencies (hemorrhage, cord prolapse, shoulder dystocia, eclampsia).

CONCLUSION:

While rated as important to residency training, significant gaps exist within resident preparation for identification and management of office-based emergencies, providing an opportunity for curriculum development and education.